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Living with cough and secretion issues: the experiences of people with amyotrophic lateral sclerosis and their caregivers
Get PDFPurpose: To explore the experiences of people living with amyotrophic lateral sclerosis (ALS) and their caregivers managing cough and secretion problems. Methods: A qualitative study was completed with 15 individuals participating in 10 interviews; 10 people living with ALS and five informal caregivers. Interview methods were adapted to ensure inclusivity of participants who had physical, respiratory and communication impairments. Data was analysed inductively using reflexive thematic analysis. Results: Our analysis identified the challenges of living day to day with cough and secretion problems. Care coordination and the presence of informal caregivers were important in ensuring that cough and secretion interventions could be implemented successfully. Participants felt access to cough and secretion knowledge and skills specific to ALS was key to supporting care and supported them to acquire information which influenced decision-making around their care. Conclusion: Cough and secretion care in ALS is multifaceted and multifactorial. Future development of clinical interventions in this area are needed to support the complex web of professionals, treatments and knowledge to optimise care
The psychometric performance of the EQ-HWB-9 for measuring health and wellbeing in a general population sample from Australia and New Zealand
Get PDFPurpose
The EuroQol Health and Wellbeing Short (EQ-HWB-9) is a new, generic 9-item instrument, suitable for evaluating interventions in health and social-care settings for patients and caregivers. The instrument now requires validation across general and caregiver populations. Informal caregiving can be time-intensive and impact caregiver’s physical and mental well-being. However, caregiver outcomes are often overlooked in healthcare decisions, which can lead to inefficient resource allocation. We aimed to examine the psychometric performance of the EQ-HWB-9 in a general population dataset, including caregivers of persons with disability/chronic illness.
Methods
Using general population samples, stratified by age, gender, region, ancestry, and income for Australia and New Zealand, we investigated EQ-HWB-9 item distribution and known-group validity (t-tests; Cohen’s d for effect size, with sub-group analysis by country, gender and age) across sum-scores and UK pilot preference-weighted scores. Item scores were compared across caregiver groups. Convergent validity was assessed between the EQ-HWB-9 and the Kessler-6 using Spearman’s Rho.
Results
The sample included 2542 participants, 2018 from Australia and 524 from New Zealand. Item distribution was similar to previous studies. Known-group validity results aligned to a priori hypotheses for caregiver, mental health, physical health and disability and sleep issues variables. Caregivers had significantly higher scores across each item than their counterparts. Convergent validity conformed to a priori expectations.
Conclusion
The EQ-HWB-9 appears valid in this general population setting. This study helps to build the evidence for the use of the instrument across diverse settings. Australian- and New Zealand-specific value-sets would be a good future addition
Applying a Risk-Risk Tradeoff Economics Approach to the Occupational Health of Nurses: Economic and Microbial Risk Analysis
No full textPublic health challenges are increasingly complex, and interventions reducing the risk of one health outcome may increase the risk of another. We focus on the increased risk of occupational asthma (OA) for nurses and the decreased risk of occupational infections from contaminated surfaces from intensifying cleaning and disinfection protocols (i.e., during the COVID-19 pandemic). A risk–risk trade-off approach allows for the calculation of tolerable risks. We then determine, through a quantitative microbial risk assessment, critical concentrations of SARS-CoV-2 hygiene standards for surfaces that would achieve those tolerance levels. We find that, on average, in three out of our four scenarios, nurses prefer contracting a respiratory viral illness over OA around 80% of the time. Knowing another person who has contracted a respiratory viral infection (RVI) is negatively related to increasing respiratory viral infection risk. Critical concentrations were <0.01 viral particles/cm2, implying frequent monitoring of viral concentrations on surfaces is needed to ensure risk targets are achieved. When applied to occupational health trade-offs for nurses engaging in cleaning and disinfection, we show that high environmental hygiene standards are needed
Model Health and Resource Consequences of Reducing the Faecal Immunochemical Test (FIT) Screening Threshold for Colonoscopy in the NHS Bowel Cancer Screening Programme (BCSP)
Get PDFWorkshops as a qualitative research method in health research
Get PDFAIM: Researchers are increasingly using workshops within health research, particularly in the context of developing complex interventions. The status of workshops within health research is not clear. Are workshops a research method or a form of stakeholder involvement akin to patient and public involvement? Do they require ethics approval? How are data collected and analysed? How should the results be published - if at all?
METHODS: Reflection on the methodological literature.
REFLECTIONS: Researchers can frame workshops as a qualitative research method if they aim to generate new knowledge that is useful to stakeholders external to their research project and therefore aim to publish the findings of the workshops. In that context, ethics approval is required, with written informed consent taken from participants. Data collection can occur using a range of approaches including post-it notes, handwritten notes or audio or video recordings of discussions. Data can be analysed using a range of approaches including thematic or content analysis. Like any qualitative research, results can be published in a research article. A list of issues to consider and report when undertaking workshops as a research method is offered, based on methodological literature from a range of research fields. Alternatively, researchers can frame workshops as 'stakeholder involvement in research' if they aim to identify knowledge for use within their research project only. The product of these workshops might be characterised as a set of actions for the research team to take. Formal analysis will not be necessary-merely identification of actions-and reporting within publications may be similar to the reporting of patient and public involvement activity with a research project. Researchers may face grey areas when deciding which route to adopt. Team reflection and documenting the justification for the decision made may help to formulate appropriate decisions
Unlocking Policy for Nature Based Solutions: Stage 1 - Research Synthesis Report
Get PDFiCASP was awarded funding from the University of Leeds - Research England Policy Fund to develop an evidence base to unlock policy to support implementation of Nature Based Solutions (NBS) in England.
The project seeks to identify policy barriers in England to facilitate more widespread use of well evidenced NBS. This final report presents key challenges identified from four main activities:
1. Survey of practitioners which received 128 responses
2. Systematic literature review (SLR) of evidence of impacts from NBS activities – over 120 documents were reviewed.
3. Three themed stakeholder workshops on:
1) Green Finance: Unlocking Green Finance Opportunities;
2) Nature Based Solutions: Identifying key priorities and solutions;
3) Natural Flood Management Monitoring and Evaluation. There were approximately 150 participants across these three workshops.
4. Review of draft report with recommendations by an expert panel of 13 representatives from different regions of England, different types of NBS and mix of organisations and community groups.
Using the information gathered from the above activities, this report recommends improvements in policy to support evidence-based implementation of NBS
Happy citizens trust their rulers
Get PDFUsing Chinese panel data, we examine whether citizen well-being impacts the formation of political trust, which is key to regime stability. Through a quasi-experimental method, we demonstrate how an improvement in subjective well-being directly leads to increased political trust. In a supplementary analysis, we also demonstrate how low political trust is predictive of actions that undermine regime stability. These findings suggest that any government, even an authoritarian one, has an incentive to foster the happiness of its citizens
Effect of physical activity on cardiorespiratory fitness and markers of cardiovascular disease risk during menopause:A systematic review and meta-analysis of randomised-controlled trials
No full textLess continuity with more complaints:a repeated cross-sectional study of the association between relational continuity of care and patient complaints in English general practice
Get PDFOBJECTIVE: Relational continuity of care is associated with better patient experience and health outcomes. In England, relational continuity of primary care has been declining over a decade, coinciding with an increase in patient complaints. This study investigates the relationship between relational continuity of care and patient complaints. METHODS: Cross-sectional analysis of linked practice-level data in the English National Health Service (NHS) (2016/2017-2022/2023) obtained from NHS Digital and General Practice Patient Survey (GPPS). A negative binomial model was used to investigate the association between the proportion of patients never or almost never seeing their preferred general practitioner (GP) and new written complaints per 10 000 patients, with adjustment for patient demographics, socioeconomic status, care experiences, practice care capacity and care quality. Mediation analysis was further conducted to examine patients' lost trust and unmet clinical needs as potential mechanisms. RESULTS: A 10 percentage point increase in the proportion of patients reporting low continuity was associated with 1.34 more new complaints per 10 000 patients (95% CI 1.23 to 1.46). The association may be stronger after than before the pandemic, among general practices with historically better continuity, and in more deprived areas. The findings were robust in using different measures of relational continuity, adjusting for primary case demand-supply mismatches, implementing a Poisson model with practice fixed effects and excluding ethnicity from the model specification. Mediation analysis showed that neither lost trust nor unmet care needs were important mediators of the effects of low continuity. CONCLUSION: Self-reported low continuity of primary care is associated with more patient complaints in England. Future research should explore potential underlying mechanisms and establish whether the same relationship exists between objectively measured relational continuity and patient complaints
Reliable solution to dynamic optimization problems using integrated residual regularized direct collocation
Get PDFDirect collocation (DC) is a widely used method for solving dynamic optimization problems (DOPs), but its implementation simplicity and computational efficiency are limited for challenging problems. For DOPs involving singular arcs, DC solutions often exhibit significant fluctuations along the singular arc, accompanied by large residual errors between collocation points, where the dynamic constraints are enforced as equality constraints. In this paper, we introduce the direct transcription method of integrated residual regularized direct collocation (IRRDC). This approach enforces dynamic constraints using a combination of point-wise residual constraints (expressed as either equalities or inequalities) and a penalty term on the integrated residual error, which helps reduce errors between collocation points. IRRDC retains the implementation simplicity of DC while improving both solution accuracy and efficiency, particularly for challenging problem types. Through the examples, we demonstrate that for problems where traditional DC results in excessive fluctuations, IRRDC effectively suppresses fluctuations and yields solutions with greater accuracy — at least two orders of magnitude lower in various error measures in relation to the dynamic and path constraints
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