Psychological and psychophysical aspects of spatial orientation.

These studies were undertaken to investigate the psychological and psychophysical factors that mediate spatial orientation/disorientation in both healthy and patient populations. PERCEPTION OF ANGULAR VELOCITY: Using a new method of examining perception of rotation this study found a similarity between the sensation and ocular responses following velocity step stimuli. Both decayed exponentially with a time constant of circa 15 seconds following rotation in yaw; circa 7 seconds following rotation in roll. Both the ocular and sensation responses were significantly reduced following repeated vestibular and optokinetic stimulation. The test was conducted with patients suffering from congenital nystagmus, ophthalmoplegia or cerebellar lesions, all of whom had markedly reduced post-rotational sensation responses of approximately 7 to 9 seconds. ADAPTATION TO OSCILLOPSIA: Labyrinthine defective subjects were found to prefer less self- motion when viewing a moving video-image than either ophthalmoplegia subjects or normal controls. The results suggest that adaptation to oscillopsia may be related to an active approach to recovery (i.e. high external locus of control) and also to increased tolerance to retinal slip. This serves to illustrate the coactive role of psychological and psychophysical mechanisms in adaptation to vestibular disorders. INVESTIGATION OF PSYCHOLOGICAL AND PSYCHOSOCIAL FACTORS: This questionnaire- based study aimed to examine adjustment to illness in patients with balance disorders and with congenital nystagmus. The study identified a greater use of emotion-focused coping strategies than problem-focused strategies. It highlighted the prevaience of anxiety and depression among these patients and pointed towards several psychosocial variables (locus of control, self-esteem and social support) that play a significant role in the coping behaviour of these patients. MENSTRUATION, MIGRAINE AND MOTION SICKNESS: The relationship between hormonal cycles and migraine and motion sickness is poorly understood. The study demonstrated that motion sickness and headache occurred independently although exposure to rough seas could be a specific migraine trigger in certain individuals who did not otherwise suffer attacks. Female subjects were more prone to motion sickness around the period of menstruation and less so around ovulation

A randomised controlled trial of a brief cognitive behavioural intervention for men who have hot flushes following prostate cancer treatment (MANCAN)

OBJECTIVE: Hot flushes and night sweats (HFNS) are experienced by up to 80% of prostate cancer patients undergoing androgen deprivation therapy (ADT). This study evaluates the effects of a guided self-help cognitive behavioural therapy (CBT) intervention on HFNS problem-rating (primary outcome), HFNS frequency, mood and health-related quality of life (secondary outcomes) in patients undergoing ADT. METHODS: Patients reporting treatment-induced HFNS were randomly assigned to CBT (n = 33) or treatment as usual (TAU) (n = 35), stratified for cancer type. The CBT intervention included a booklet, CD plus telephone contact during a 4-week period. Validated self-report questionnaires were completed at baseline, 6 weeks and 32 weeks after randomisation. The primary outcome was HFNS problem rating (perceived burden of HFNS) at 6 weeks after randomisation. Potential moderators and mediators were examined. Data analysis was conducted on a modified intention-to-treat basis. RESULTS: Compared with TAU, CBT significantly reduced HFNS problem rating (adjusted mean difference: -1.33, 95% CI -2.07 to -0.58; p = 0.001) and HFNS frequency (-12.12, 95% CI -22.39 to -1.84; p = 0.02) at 6 weeks. Improvements were maintained at 32 weeks, but group differences did not reach significance. There were significant reductions in negative HFNS Beliefs and Behaviours following CBT, but not in mood or quality of life. CONCLUSIONS: Guided self-help CBT appears to be a safe and effective brief treatment for men who have problematic HFNS following prostate cancer treatments. Further research might test the efficacy of the intervention in a multicentre trial

A systematic review of acculturation, obesity and health behaviours among migrants to high-income countries

Objective: There is extensive evidence for weight gain among people migrating from low/middle-income to high-income countries, which may be due, in part, to acculturation factors. This review aimed to identify associations between acculturation and body weight among immigrants to high-income countries and identify if studies accounted for the role played by health behaviours Methods: A systematic literature search using keywords was performed with three databases (Medline, PsychINFO and EMBASE). The thirty-five studies were included that utilised quantitative methodology and presented empirical findings focussed on acculturation and body weight among adult immigrants. Findings: There was evidence presented across multiple studies for an association between acculturation (measured with standard measures or as duration of stay) and obesity. Most studies were cross sectional, which did not allow the exploration of drivers of change in health behaviours and weight gain. Conclusion: This is the first review to examine associations between acculturation and body weight among migrants utilising both acculturation scales and proxy measures of acculturation and to examine the role of health behaviours. Evidence from this review suggests that health interventions should target first generation migrants to promote retention of their original healthy behaviours. Recent migrant groups report healthier behaviours than comparative host country populations, and therefore interventions should be promoted at the initial stages following migration to avoid uptake of unhealthy behaviours

Understanding variation in men’s help-seeking for cancer symptoms: a semi-structured interview study

Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later stage at diagnosis and poorer health outcomes. Limited research has investigated variation in men’s experiences of and responses to cancer symptoms. This study examined the psychosocial aspects of men’s help-seeking for cancer symptoms, as well as potential variation across men residing in urban and rural Australia. Semi-structured interviews were conducted with men recently diagnosed with cancer (n=13). Participants’ partners (n=8) were recruited to enable data triangulation. Interview schedules addressed participants’ pathway to cancer treatment, cancer knowledge, masculinity, and rural living. A theoretical thematic analysis approach was used. Medical help-seeking behaviour was similar for participants residing in urban and rural areas. Five key themes and one sub-theme were identified, including: symptom factors, traditional masculine norms (sub-theme: women’s health-related responsibilities), level of concern, conflicting responsibilities and access, and trust in medical professionals. Participants from rural Australia experienced greater access difficulties and noted optimism regarding symptoms. Results highlight important within-gender differences in the psychosocial barriers to help-seeking for cancer symptoms. Future research should further explore variation between men and test the predictive strength of factors

The relationship between anticipated response and subsequent experience of cancer treatment-related side effects: a meta-analysis comparing effects before and after treatment exposure

Objective: To review the evidence for a systematic relationship between cancer patients’ pre-treatment expectations (anticipated side effects) and subsequent experience of treatment-related side effects, and to compare this relationship in patients with no prior treatment experience (cognitive expectations) and with some prior treatment experience (conditioned response). Methods: A total of 12,952 citations were identified through a comprehensive search of the literature published on or before November 2016 and screened against inclusion criteria. Studies were eligible if they included participants undergoing curative treatment for cancer, measured a treatment side effect, examined the relationship between anticipation and experience of side effects, and reported quantitative data. Results: Thirty-one studies were included in the review and meta-analysis (total N = 5,069). The side effects examined were nausea (anticipatory and post-treatment), vomiting, fatigue, pain, problems with concentration, and skin reactions. Meta-analyses indicated significant and positive associations between anticipation and subsequent experience for all included side effects in patients with no prior treatment exposure (r = 0.153 – 0.431). Stronger associations were found for all included conditioned side effects in patients with previous treatment experience (r = 0.211 – 0.476). No significant differences were found when overall effect sizes for patients with and without prior treatment exposure were compared for each side effect, except for anticipatory nausea (p = 0.012). Conclusion: These results may have implications for future interventions that target patients’ expectations of cancer treatment-related side effects. Future research could explore patient reports of messages received about likely treatment effects both before and during treatment

Interventions for raising breast cancer awareness in women

Background: Breast cancer continues to be the most commonly diagnosed cancer in women globally. Early detection, diagnosis and treatment of breast cancer are key to better outcomes. Since many women will discover a breast cancer symptom themselves, it is important that they are breast cancer aware i.e. have the knowledge, skills and confidence to detect breast changes and present promptly to a healthcare professional.Objectives: To assess the effectiveness of interventions for raising breast cancer awareness in women.Search methods: We searched the Cochrane Breast Cancer Group's Specialised Register (searched 25 January 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 27 January 2016), MEDLINE OvidSP (2008 to 27 January 2016), Embase (Embase.com, 2008 to 27 January 2016), the World Health Organization’s International Clinical Trials Registry Platform (ICTRP) search portal and ClinicalTrials.gov (searched 27 Feburary 2016). We also searched the reference lists of identified articles and reviews and the grey literature for conference proceedings and published abstracts. No language restriction was applied.Selection criteriaRandomised controlled trials (RCTs) focusing on interventions for raising women’s breast cancer awareness i.e. knowledge of potential breast cancer symptoms/changes and the confidence to look at and feel their breasts, using any means of delivery, i.e. one-to-one/group/mass media campaign(s).Data collection and analysis: Two authors selected studies, independently extracted data and assessed risk of bias. We reported the odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous outcomes and mean difference (MD) and standard deviation (SD) for continuous outcomes. Since it was not possible to combine data from included studies due to their heterogeneity, we present a narrative synthesis. We assessed the quality of evidence using GRADE methods.Main results: We included two RCTs involving 997 women: one RCT (867 women) randomised women to receive either a written booklet and usual care (intervention group 1), a written booklet and usual care plus a verbal interaction with a radiographer or research psychologist (intervention group 2) or usual care (control group); and the second RCT (130 women) randomised women to either an educational programme (three sessions of 60 to 90 minutes) or no intervention (control group).Knowledge of breast cancer symptoms: In the first study, knowledge of non-lump symptoms increased in intervention group 1 compared to the control group at two years postintervention, but not significantly (OR 1.1, 95% CI 0.7 to 1.6; P = 0.66; 449 women; moderate-quality evidence). Similarly, at two years postintervention, knowledge of symptoms increased in the intervention group 2 compared to the control group but not significantly (OR 1.4, 95% CI 0.9 to 2.1; P = 0.11; 434 women; moderate-quality evidence). In the second study, women’s awareness of breast cancer symptoms had increased one month post intervention in the educational group (MD 3.45, SD 5.11; 65 women; low-quality evidence) compared to the control group (MD −0.68, SD 5.93; 65 women; P < 0.001), where there was a decrease in awareness.Knowledge of age-related risk: In the first study, women’s knowledge of age-related risk of breast cancer increased, but not significantly, in intervention group 1 compared to control at two years postintervention (OR 1.8; 95% CI 0.9 to 3.5; P < 0.08; 447 women; moderate-quality evidence). Women's knowledge of risk increased significantly in intervention group 2 compared to control at two years postintervention (OR 4.8, 95% CI 2.6 to 9.0; P < 0.001; 431 women; moderate-quality evidence). In the second study, women’s perceived susceptibility (how at risk they considered themselves) to breast cancer had increased significantly one month post intervention in the educational group (MD 1.31, SD 3.57; 65 women; low-quality evidence) compared to the control group (MD −0.55, SD 3.31; 65 women; P = 0.005), where a decrease in perceived susceptibility was noted.Frequency of Breast Checking: In the first study, no significant change was noted for intervention group 1 compared to control at two years postintervention (OR 1.1, 95% CI 0.8 to 1.6; P = 0.54; 457 women; moderate-quality evidence). Monthly breast checking increased, but not significantly, in intervention group 2 compared to control at two years postintervention (OR 1.3, 95% CI 0.9 to 1.9; P = 0.14; 445 women; moderate-quality evidence). In the second study, women’s breast cancer preventive behaviours increased significantly one month post intervention in the educational group (MD 1.21, SD 2.54; 65 women; low-quality evidence) compared to the control group (MD 0.15, SD 2.94; 65 women; P < 0.045).Breast Cancer Awareness: Women’s overall breast cancer awareness did not change in intervention group 1 compared to control at two years postintervention (OR 1.8, 95% CI 0.6 to 5.30; P = 0.32; 435 women; moderate-quality evidence) while overall awareness increased in the intervention group 2 compared to control at two years postintervention (OR 8.1, 95% CI 2.7 to 25.0; P < 0.001; 420 women; moderate-quality evidence). In the second study, there was a significant increase in scores on the Health Belief Model (that included the constructs of awareness and perceived susceptibility) at one month postintervention in the educational group (mean 1.21, SD 2.54; 65 women) compared to the control group (mean 0.15, SD 2.94; 65 women; P = 0.045).Neither study reported outcomes relating to motivation to check their breasts, confidence to seek help, time from breast symptom discovery to presentation to a healthcare professional, intentions to seek help, quality of life, adverse effects of the interventions, stages of breast cancer, survival estimates or breast cancer mortality rates.Authors' conclusions: Based on the results of two RCTs, a brief intervention has the potential to increase women’s breast cancer awareness. However, findings of this review should be interpreted with caution, as GRADE assessment identified moderate-quality evidence in only one of the two studies reviewed. In addition, the included trials were heterogeneous in terms of the interventions, population studied and outcomes measured. Therefore, current evidence cannot be generalised to the wider context. Further studies including larger samples, validated outcome measures and longitudinal approaches are warranted

Evaluation of an intervention to increase clinician knowledge and confidence to support breastfeeding, kangaroo care and positive touch within neonatal units

Breastfeeding and kangaroo care rates in neonatal units across the United Kingdom vary despite evidence for the clinical benefits. Clinicians have reported a need for evidence-based training to support parents with these practices. The aim of this study was to evaluate the Small Wonders Change Programme (SWCP), an intervention that aims to increase clinician knowledge and confidence to support parents in neonatal units to undertake breastfeeding and kangaroo care. Two neonatal intensive care units participated and 47 clinicians completed the Neonatal Unit Assessment Tool (NUCAT) pre and post-intervention. 18 of these clinicians also participated in a semi-structured interview to further explore the impact of the intervention on clinician’s practice. Both clinician knowledge (t(46)=4.61, p<=0.000) and confidence (pre t(46)=4.82, p<.000) significantly increased following the intervention. Analysis of the interviews revealed that clinicians directly attributed subsequent individual and unit-wide change in practice to an increase in knowledge and confidence as a result of the intervention. This study suggests that a clinician focussed intervention can lead to positive changes in clinician confidence, knowledge and practice in supporting parents to undertake breastfeeding and kangaroo care in neonatal units

Benefits of adaptive cognitive training on cognitive abilities in women treated for primary breast cancer: findings from a one-year randomised control trial intervention

Objective: Evidence shows that adaptive cognitive training is beneficial for women with a breast cancer diagnosis. However, transfer effects of training benefits on perceived and objective measures of cognition are not substantiated. We investigated the transfer effects of online adaptive cognitive training (dual n-back training) on subjective and objective cognitive markers in a longitudinal design. Methods: Women with a primary diagnosis of breast cancer completed 12 sessions of adaptive cognitive training or active control training over two weeks. Objective assessments of working memory capacity, as well as performance on a response inhibition task, were taken while electrophysiological measures were recorded. Self-reported measures of cognitive and emotional health were collected pre-training, post-training, 6-months, and at 1-year follow-up times. Results: Adaptive cognitive training resulted in greater working memory capacity on the Change Detection Task and improved cognitive efficiency on the Flanker task together with improvements in perceived cognitive ability at 1-year post-training. Conclusions: Adaptive cognitive training can improve cognitive abilities with implications for long-term cognitive health in survivorship

Predicting men’s intentions to seek help for cancer symptoms: a comparison of the Theory of Planned Behaviour and the Health Belief Model

Objective: Targeted behavioural interventions are needed to address psychosocial factors leading to slower help-seeking for cancer symptoms among men. This study compared the variance in men’s help-seeking intentions explained by the Theory of Planned Behaviour and Health Belief Model. Method: A cross-sectional survey of 127 men was conducted, testing symptom knowledge and theory-derived constructs from the Theory of Planned Behaviour (attitudes, perceived norms, perceived behavioural control) and Health Belief Model (susceptibility, severity, benefits, barriers). The outcome variable was intention to seek help for cancer symptoms. Separate and combined hierarchical regressions tested the relative predictive power of the two models, potential overlap in variance explained, and the most salient constructs within the models. Results: Separate regressions (controlling for age and symptom knowledge) showed each model explained 10–12% variance in men’s help-seeking intentions over and above the adjusted variables. The combined regression indicated symptom knowledge, perceived benefits, and perceived behavioural control were significant predictors of men’s intentions (35% total variance explained). Conclusions: The Theory of Planned Behaviour and Health Belief Model may not be optimal models for explaining men’s help-seeking intentions for cancer symptoms, however, select constructs are important correlates. Future interventions may usefully target symptom knowledge, health beliefs, and control beliefs

Benefits of adaptive cognitive training on cognitive abilities in women treated for primary breast cancer: findings from a 1‐year randomised control trial intervention

Objective: While adaptive cognitive training is beneficial for women with a breast cancer diagnosis, transfer effects of training benefits on perceived and objective measures of cognition are not substantiated. We investigated the transfer effects of online adaptive cognitive training (dual n-back training) on subjective and objective cognitive markers in a longitudinal design. Methods: Women with a primary diagnosis of breast cancer completed 12 sessions of adaptive cognitive training or active control training over 2 weeks. Objective assessments of working memory capacity (WMC), as well as performance on a response inhibition task, were taken while electrophysiological measures were recorded. Self-reported measures of cognitive and emotional health were collected pre-training, post-training, 6-month, and at 1-year follow-up times. Results: Adaptive cognitive training resulted in greater WMC on the Change Detection Task and improved cognitive efficiency on the Flanker task together with improvements in perceived cognitive ability and depression at 1-year post-training. Conclusions: Adaptive cognitive training can improve cognitive abilities with implications for long-term cognitive health in survivorship