Effects of Brief Mood-Improving Interventions on Immunity: A Systematic Review and Meta-Analysis

Objectives: Positive mood has been associated with enhanced immune function. Interventions that improve mood could, therefore, provide a mechanism for optimising immune related health outcomes. Brief interventions that improve mood, also known as mood inductions, potentially offer a pragmatic approach to enhancing immune function for finite periods where this would be beneficial to health (e.g., in advance of vaccination or surgery). This review sought to systematically examine the evidence regarding the effects of brief, single-session positive mood interventions on immunity.Methods: Systematic searches of electronic databases were performed from earliest records to 25th July 2018. We identified 42 interventions suitable for inclusion, six of which were tested in multiple sub-populations. Random effects meta-analyses were performed for pre-post experimental group immune outcomes measured in at least 5 intervention studies. Results: While interventions were heterogeneous, 81% resulted in a statistically significant change in at least one immune parameter following the positive mood intervention for one or more of the sub-populations examined. However, studies were, in general, of low-to-moderate quality with small sample sizes (median n=32) and did not examine the persistence, or clinical relevance of the immune changes observed. Random effects meta-analyses showed a significant medium-sized effect of interventions on increasing secretory IgA concentration (g=0.65), a small but statistically significant effect for increased IL-6 production (g=0.12) and non-significant effects on NK cell activity (g=0.15).Conclusions: The current literature provides modest evidence that improvements in mood resulting from brief interventions can influence some immune parameters in ways indicative of enhanced immune function. However, there is a need for higher quality research in this area that focuses on clinically relevant immune outcomes and mechanisms

Mood and influenza vaccination in older adults: A randomized controlled trial.

Objective: Positive mood on the day of vaccination has been associated with subsequent antibody responses to the influenza vaccine in older adults. The primary aim of this trial was to examine whether a brief intervention was able to enhance positive mood at the time of vaccination in a clinical context. Secondary aims included exploratory analyses of the effects of the intervention on nonspecific and influenza-specific immunity. Method: One hundred three older adults (65–85 years) participated in a 2-arm, parallel, single-blind, randomized controlled trial. Participants viewed either a 15-min video package designed to induce positive mood or a matched neutral control video, immediately prior to receiving a standard dose quadrivalent influenza vaccination. State affect and secretory immunoglobulin A levels were assessed immediately prior to, and following, the interventions. Antigen-specific immunoglobulin G responses to the vaccination were assessed at 4 and 16 weeks postvaccination. Results: The positive mood intervention resulted in significant improvements in state positive affect, compared with the neutral control. Secretory immunoglobulin A levels significantly increased across both groups. Antigen-specific immunoglobulin G responses to influenza vaccination were not statistically significantly different between groups, although point estimates of effect size favored participants who viewed the positive mood intervention for most strains at both 4 and 16 weeks postvaccination. Conclusions: A 15-min intervention can improve positive mood in older adults prior to vaccination. Future trials should examine whether enhancing mood at the time of vaccination could enhance the effectiveness of influenza vaccination on patients and benefit health services

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

Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement:a systematic review

Objectives: To assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR).Design: The systematic review protocol was registered on the International Prospective Register of Systematic reviews (CRD42018095100). MEDLINE, EMBASE, and PsycINFO were searched from inception to up to 9th May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short and long-term post-operative pain after TKR were included. Screening, data extraction and assessment of methodological quality was performed in duplicate by two reviewers. The primary effectiveness outcome was post-operative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological wellbeing. Reporting standards were assessed using the TIDieR checklist for intervention reporting. Results: 12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study) progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive behavioural therapy (two studies), and a post-operative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR. Conclusion: Further evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute post-operative pain and chronic post-operative pain would be of benefit

Factors influencing the decision to attend screening for cancer in the UK: a meta-ethnography of qualitative research

Background: This review aimed to better understand experiences of being invited to cancer screening and associated decision-making. Methods: Qualitative evidence explaining UK cancer screening attendance decisions was systematically identified. Data were extracted and meta-ethnography used to identify shared themes, synthesise findings and generate higher level interpretations. Results: Thirty four studies met inclusion criteria. They related to uptake of breast, cervical, colorectal, prostate, ovarian and lung cancer screening. Three primary themes emerged from the synthesis. Relationships with the health service shaped decisions, influenced by trust, compliance with power, resistance to control or surveillance, and perceived failures to meet cultural, religious and language needs. Fear of cancer screening was both a motivator and barrier in different ways and to varying degrees. Strategies to negotiate moderate fear levels were evident. Experiences of risk included the creation of alternative personal risk discourses and the use of screening as a coping strategy, influenced by disease beliefs and feelings of health and wellness. Conclusions: The findings highlight the importance of the provider-patient relationship in screening uptake and enrich our understanding of how fear and risk are experienced and negotiated. This knowledge can help promote uptake and improve the effectiveness of cancer screening

Stress, illness perceptions, behaviours and healing in venous leg ulcers: findings from a prospective observational study

Objective: To investigate the impact of stress, illness perceptions and behaviours on healing of venous leg ulcers. Methods: A prospective observational study of 63 individuals for 24 weeks investigated possible psychosocial predictors of healing. There were two indices of healing: rate of change in ulcer area and number of weeks to heal. Psychological variables were assessed at baseline using self-report measures (Perceived Stress Scale, Hospital Anxiety and Depression Scale, Revised Illness Perception Questionnaire, adapted Summary of Diabetes Self-Care Activities, Adherence Questionnaire and Short-Form Health Survey). Results: Controlling for socio-demographic and clinical variables, over the 24 weeks a slower rate of change in ulcer area was predicted by greater stress (standardised beta =-0.61, p=0.008); depression (standardised beta =-0.51, p=0.039); holding negative perceptions or beliefs about the ulcer (standardised beta =-1.4, p=0.045). By 24 weeks 69% of ulcers had closed. A more negative emotional response to the ulcer at baseline, (i.e., emotional representation of the ulcer), was associated with a greater number of weeks to heal [Hazard Ratio (HR) = 0.63, 95% CI 0.41 - 0.95, p=0.028]. Higher educational attainment (HR= 3.22, 95% CI 1.37 - 7.55, p=0.007) and better adherence to compression bandaging (HR= 1.41 95% CI 1.06 - 1.88, p=0.019) were associated with fewer weeks to heal. No other psychosocial variable (stress; perceptions about the ulcer; health behaviours) predicted weeks to heal. Conclusions: Alongside ulcer-related predictors, psychological and sociodemographic factors were associated with healing. Future research should explore mediating mechanisms underlying these associations and develop interventions to target these variables

Mental health in the UK during the COVID-19 pandemic: cross-sectional analyses from a community cohort study

Objectives: Previous pandemics have resulted in significant consequences for mental health. Here, we report the mental health sequelae of the COVID-19 pandemic in a UK cohort and examine modifiable and non-modifiable explanatory factors associated with mental health outcomes. We focus on the first wave of data collection, which examined short-term consequences for mental health, as reported during the first 4–6 weeks of social distancing measures being introduced.Design: Cross-sectional online survey.Setting: Community cohort study.Participants: N=3097 adults aged ≥18 years were recruited through a mainstream and social media campaign between 3 April 2020 and 30 April 2020. The cohort was predominantly female (n=2618); mean age 44 years; 10% (n=296) from minority ethnic groups; 50% (n=1559) described themselves as key workers and 20% (n=649) identified as having clinical risk factors putting them at increased risk of COVID-19.Main outcome measures: Depression, anxiety and stress scores.Results: Mean scores for depression (Embedded Image =7.69, SD=6.0), stress (Embedded Image =6.48, SD=3.3) and anxiety (Embedded Image = 6.48, SD=3.3) significantly exceeded population norms (all p < 0.0001). Analysis of non-modifiable factors hypothesised to be associated with mental health outcomes indicated that being younger, female and in a recognised COVID-19 risk group were associated with increased stress, anxiety and depression, with the final multivariable models accounting for 7%–14% of variance. When adding modifiable factors, significant independent effects emerged for positive mood, perceived loneliness and worry about getting COVID-19 for all outcomes, with the final multivariable models accounting for 54%–57% of total variance.Conclusions: Increased psychological morbidity was evident in this UK sample and found to be more common in younger people, women and in individuals who identified as being in recognised COVID-19 risk groups. Public health and mental health interventions able to ameliorate perceptions of risk of COVID-19, worry about COVID-19 loneliness and boost positive mood may be effective

Native Apps versus Web Apps: which is best for healthcare applications?

Smartphone applications (Apps) provide a new way to deliver healthcare, illustrated by the fact that healthcare Apps are estimated to make up over 30% of new Apps currently being developed; with this number seemingly set to increase as the benefits become more apparent. In this paper, using the development of an In Vitro Fertilisation (IVF) treatment stress study App as the exemplar, the alternatives of Native App and Web App design and implementa-tion are considered across several factors that include: user interface, ease of development, capabilities, performance, cost, and potential problems. Development for iOS and Android platforms and a Web App using JavaScript and HTML5 are discussed

OP36 Decisions about smoking in patients screened with the early cdt-lung test for the early detection of lung cancer: a qualitative study

Background: Routine screening for lung cancer in high risk groups (characterised by age and smoking history) is recommended in the USA and may be implemented elsewhere. It is unclear whether being screened for lung cancer promotes smoking cessation or conversely provides false reassurance and a ‘license to smoke’. This study aimed to understand how experiences of lung cancer screening influence individual decision making about smoking. Methods: Thirty one people in Scotland, aged 51–74, took part in semi-structured interviews. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test–Lung Cancer Scotland (ECLS) Study and were long-term smokers when screened. Verbatim transcripts were analysed using thematic analysis. Results: Interpretations of test results was a key theme, but were often inaccurate, for example a negative result interpreted as an ‘all-clear’ from lung cancer and a positive result as meaning lung cancer will definitely develop. There was no clear pattern in decisions made about smoking in response to positive or negative test results. Emotional response to those interpretations was an overarching theme in decisions about smoking. Emotions included fear, shock, upset, worry, anxiety, guilt, relief, reassurance and indifference. Other themes included changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking, interpersonal family influences and avoidance of thoughts about smoking. Of those who had stopped smoking, some cited screening experiences as the sole reason and some cited screening along with other coinciding factors. Cues to change were experienced at different stages of the screening process and not always immediately following a test result. Some participants indicated they underwent screening in order to try and stop smoking. Others expressed little or no desire to stop. In general, lung cancer screening was experienced as a unique opportunity, which sometimes prompted successful or unsuccessful attempts to stop smoking. Conclusion: Lung cancer screening can be a ‘teachable moment’ for smoking behaviour change. Emotional responses to test results, which can be misinterpreted, were an important theme but behavioural responses varied according to the individual. Findings should be considered within the context of a group of predominantly life-long smokers undergoing a novel blood screening test, who might already have increased motivation to stop smoking. Lung cancer screening presents an opportunity to engage high risk smokers in cessation support but our findings suggest such support may need to be available flexibly to be most effective. In collaboration with the ECLS study team

A 10-year (2000-2010) systematic review of interventions to improve quality of care in hospitals.

ABSTRACT: BACKGROUND: Against a backdrop of rising healthcare costs, variability in care provision and an increased emphasis on patient satisfaction, the need for effective interventions to improve quality of care has come to the fore. This is the first ten year (2000--2010) systematic review of interventions which sought to improve quality of care in a hospital setting. This review moves beyond a broad assessment of outcome significance levels and makes recommendations for future effective and accessible interventions. METHODS: Two researchers independently screened a total of 13,195 English language articles from the databases PsychInfo, Medline, PubMed, EmBase and CinNahl. There were 120 potentially relevant full text articles examined and 20 of those articles met the inclusion criteria. RESULTS: Included studies were heterogeneous in terms of approach and scientific rigour and varied in scope from small scale improvements for specific patient groups to large scale quality improvement programmes across multiple settings. Interventions were broadly categorised as either technical (n = 11) or interpersonal (n = 9). Technical interventions were in the main implemented by physicians and concentrated on improving care for patients with heart disease or pneumonia. Interpersonal interventions focused on patient satisfaction and tended to be implemented by nursing staff. Technical interventions had a tendency to achieve more substantial improvements in quality of care. CONCLUSIONS: The rigorous application of inclusion criteria to studies established that despite the very large volume of literature on quality of care improvements, there is a paucity of hospital interventions with a theoretically based design or implementation. The screening process established that intervention studies to date have largely failed to identify their position along the quality of care spectrum. It is suggested that this lack of theoretical grounding may partly explain the minimal transfer of health research to date into policy. It is recommended that future interventions are established within a theoretical framework and that selected quality of care outcomes are assessed using this framework. Future interventions to improve quality of care will be most effective when they use a collaborative approach, involve multidisciplinary teams, utilise available resources, involve physicians and recognise the unique requirements of each patient group