Influencing side-effects to medicinal treatments : a systematic review of brief psychological interventions

Background: Nocebo effects contribute to a large proportion of the non-specific side-effects attributed to medications and are mainly generated through negative expectations. Previous reviews show that interventions designed to change participants' expectations have a small effect on pain experience. They are also effective in reducing side-effects caused by exposure to sham medications. To date, there has been no review of the influence of such interventions on symptoms attributed to real medicinal treatments. Objective: To review studies using a randomized controlled design testing the effect of brief psychological interventions compared to usual practice on the side-effect experience to medicinal treatments in healthy volunteers and patients. Methods: We searched Web of Science, Scopus, Medline, PsycINFO, PsycARTICLES, and Cochrane CENTRAL using search terms for randomized controlled trials along with “nocebo,” “placebo effect,” “medication,” “side-effects,” and associated terms. Studies were eligible if they studied a human population, used an active medicine, delivered a brief psychological intervention intended to influence side-effect reporting compared to usual care or no intervention, and used a randomized controlled design. Because of the heterogeneity of the literature we used a narrative synthesis and assessed evidence quality using the GRADE approach. Results: Our database search and supplementary search of the reference sections of included studies retrieved 50,140 citations. After screening, full text review and manual reference searches, 27 studies were included. The quality of the studies and evidence was judged to be low. The strongest and most consistent effect came from omitting side-effect information, although surprisingly de-emphasizing side-effects did not affect side-effect reporting. Other techniques, including priming, distraction, and altering the perception of branding, produced mixed results. Conclusion: Brief psychological interventions can influence side-effect reporting to active medications. Research is currently investigating new ways to de-emphasize side-effects whilst still upholding informed consent, but larger confirmatory trials with suitable control groups are needed. The literature in this area would be improved by more detailed reporting of studies

Effective responder communication improves efficiency and psychological outcomes in a mass decontamination field experiment: implications for public behaviour in the event of a chemical incident

The risk of incidents involving mass decontamination in response to a chemical, biological, radiological, or nuclear release has increased in recent years, due to technological advances, and the willingness of terrorists to use unconventional weapons. Planning for such incidents has focused on the technical issues involved, rather than on psychosocial concerns. This paper presents a novel experimental study, examining the effect of three different responder communication strategies on public experiences and behaviour during a mass decontamination field experiment. Specifically, the research examined the impact of social identity processes on the relationship between effective responder communication, and relevant outcome variables (e.g. public compliance, public anxiety, and co-operative public behaviour). All participants (N = 111) were asked to visualise that they had been involved in an incident involving mass decontamination, before undergoing the decontamination process, and receiving one of three different communication strategies: 1) Health-focused explanations about decontamination, and sufficient practical information; 2) No health-focused explanations about decontamination, sufficient practical information; 3) No health-focused explanations about decontamination, insufficient practical information. Four types of data were collected: timings of the decontamination process; observational data; and quantitative and qualitative self-report data. The communication strategy which resulted in the most efficient progression of participants through the decontamination process, as well as the fewest observations of non-compliance and confusion, was that which included both health-focused explanations about decontamination and sufficient practical information. Further, this strategy resulted in increased perceptions of responder legitimacy and increased identification with responders, which in turn resulted in higher levels of expected compliance during a real incident, and increased willingness to help other members of the public. This study shows that an understanding of the social identity approach facilitates the development of effective responder communication strategies for incidents involving mass decontamination

O processo de filtragem de políticas: Entendendo as respostas distintas do National College Completion Agenda en los Estados Unidos

The United States has faced stagnant postsecondary education degree completion rates for over a decade. When coupled with improved educational outcomes in other nations, the one-time world leader in higher education attainment has precipitously declined in standing internationally. Coupling this reality with the need for a more educated workforce domestically led President Barack Obama to proclaim improving higher education completion rates a national imperative in 2009. Despite input from the federal government, due to the decentralized nature of American postsecondary education, individual states maintain primary responsibility for governance and policy decisions. Consequently, there has been a range of state responses to improving college completion. Through a comparative case analysis, this study considers a putatively homogenous region to investigate state-level factors that “filtered” the national college completion agenda to distinct responses in Georgia, South Carolina, and Texas.Estados Unidos se ha enfrentado a tasas de finalización de estudios de educación postsecundaria estancadas durante más de una década. Cuando se combina con mejores resultados educativos en otras naciones, el líder mundial en el logro de la educación superior ha disminuido precipitadamente en su posición internacional. Al combinar esta realidad con la necesidad de una fuerza de trabajo más educada, el presidente Barack Obama proclamó que mejorar las tasas de finalización de la educación superior era un imperativo nacional en 2009. A pesar del aporte del gobierno federal, debido a la naturaleza descentralizada de la educación postsecundaria estadounidense, responsabilidad por la gobernanza y las decisiones de política. En consecuencia, ha habido una variedad de respuestas estatales para mejorar la finalización de la universidad. A través de un análisis comparativo de casos, este estudio considera una región putativamente homogénea para investigar los factores a nivel estatal que "filtraron" la agenda de finalización de la universidad nacional a respuestas distintas en Georgia, Carolina del Sur y Texas.Os Estados Unidos foram submetidos a uma série de finalizações de estudos de educação pós-graduados durante mais de uma década. A combinação de todos os resultados educativos em outras nações, o mundo em curso no domínio da educação superior tem sido precipitadamente na sua posição internacional. Al preliminar this realidad to necesidad de una fuerza de trabajo más educada, el presidente Barack Obama proclamou que as melhores tarefas de finalização da educação superior era um imperativo nacional em 2009. A pesar delporte do governo federal, debito a naturaleza descentralizada de la educación postsecundaria estadounidense, responsabilidad por la gobernanza y las decisiones de political. En consecuencia, ha habito una variedad de respuestas estatales for mejorar la finalización de la universidad. A case to un analogis comparative case, this study is a region was applied in port homogénea for investigating the factors a level estatal that "filtraron" the agenda of finalisation of the universidad nationals and conditions in Georgia, Carolina del Sur and Texas

Recognising and understanding collective resilience in crowds of survivors

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What Factors Influence Symptom Reporting and Access to Healthcare During an Emerging Infectious Disease Outbreak? A Rapid Review of the Evidence

During any emerging infectious disease outbreak, people with symptoms of the illness are asked to report to a health service immediately to facilitate contact tracing. Several factors may influence a person's willingness to report symptoms and their ability to access healthcare services. Understanding these factors has become urgent during the COVID-19 pandemic. To determine which factors influence symptom reporting during an emerging infectious disease outbreak, we conducted a rapid review of the evidence. Studies included in the review were based on primary research, published in a peer-reviewed journal, written in English, included factors associated with symptom reporting or accessing healthcare, and were related to a major public health incident involving an infectious disease outbreak. Five themes were identified as facilitators of symptom reporting or accessing healthcare: accurate and informative communication about the disease and the need to seek help, symptom severity, concern about disease exposure, ease of access to healthcare facilities, and relationship with the healthcare provider. Seven themes were identified as barriers to symptom reporting or accessing healthcare: lack of knowledge of the disease and its treatment, fear of the disease and fear of subsequent treatments or requirements, stigmatization attached to having a disease, invasion of privacy, low concern about symptoms, economic consequences of disease diagnosis, and challenges related to attending a healthcare facility. For contract tracing services to be effective, members of the public need to have the capability, opportunity, and motivation to use them. The themes identified should be used to evaluate information provided to the public to ensure as many people as possible with relevant symptoms report them to a healthcare provider

Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey

Objective To assess whether perceptions of the swine flu outbreak predicted changes in behaviour among members of the public in England, Scotland, and Wales

The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022

BACKGROUND: Understanding the dynamics of an infectious disease outbreak linked to sexual activity requires valid expectations of likely counts of unique sex partners during the infectious period. Typically, age is the key demographic trait linked to expected partner count, with many transmission models removing adults from the sexually active pool abruptly at a pre-specified age threshold. Modelling the rate of decline in partner counts with age would benefit from a better description of empirical evidence. MEETHODS: During the 2022 mpox epidemic in the UK, we asked individuals about their partner counts in the preceding three weeks, which is about the same as usual infectious period for persons with active mpox. We used negative binomial regression (all responses) and Weibull regression (non-zero responses) to analyse the relationship between age and partner counts, adjusted for other demographic data (such as education level and occupation), sub-dividing by three types of respondent: men who have sex with men (MSM), men who have sex with women, and women who have sex with men. RESULTS: Most respondents had zero or one recent partner, all distributions were skewed. There was a relatively linear declining relationship between age and partner counts for heterosexual partnership groups, but a peak in partner counts and concurrency for MSMs in middle age years (age 35–54), especially for MSM who seemed to be in a highly sexually active subgroup. CONCLUSION: Useful data were collected that can be used to describe sex partner counts during the British mpox epidemic and that show distinctive partner count relationships with age, dependent on partnership type

Worry and behaviour at the start of the COVID-19 outbreak: results from three UK surveys (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study)

We aimed to describe worry and uptake of behaviours that prevent the spread of infection (respiratory and hand hygiene, distancing) in the UK at the start of the COVID-19 outbreak (January and February 2020) and to investigate factors associated with worry and adopting protective behaviours. Three cross-sectional online surveys of UK adults (28 to 30 January, n=2016; 3 to 6 February, n=2002; 10 to 13 February 2020, n=2006) were conducted. We used logistic regressions to investigate associations between outcome measures (worry, respiratory and hand hygiene behaviour, distancing behaviour) and explanatory variables. 19.8% of participants (95% CI 18.8% to 20.8%) were very or extremely worried about COVID-19. People from minoritized ethnic groups were particularly likely to feel worried. 39.9% of participants (95% CI 37.7% to 42.0%) had completed one or more hand or respiratory hygiene behaviours more than usual in the last seven days. Uptake was associated with greater worry, perceived effectiveness of individual behaviours, self-efficacy for engaging in them, and having received more information. 13.7% (95% CI 12.2% to 15.2%) had reduced the number of people they had met. This was associated with greater worry, perceived effectiveness, and self-efficacy. At the start of novel infectious disease outbreaks, communications should emphasise perceived effectiveness of behaviours and ease with which they can be carried out

'Immunity Passports' for SARS-CoV-2: an online experimental study of the impact of antibody test terminology on perceived risk and behaviour.

OBJECTIVE: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours. DESIGN: 2×3 experimental design. SETTING: Online. PARTICIPANTS: 1204 adults from a UK research panel. INTERVENTION: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). MAIN OUTCOME MEASURES: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing. RESULTS: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)). CONCLUSIONS: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/tjwz8/files/