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Health literacy in relation to web-based measurement of cognitive function in the home: UK Women’s Cohort Study
Get PDFOBJECTIVE
Older adults may require additional support to comprehend written information due to inadequate health literacy, which involves components of cognitive function including reaction time. This study tested the acceptability of web-based reaction time testing in the UK Women’s Cohort Study and possible sources of bias. Additionally, it assessed the association between health literacy and reaction time.
DESIGN
A cross-sectional analysis was conducted using data from the UK Women’s Cohort Study, a prospective cohort study.
PARTICIPANTS
The study involved women aged 48 to 85 without cancer registration who participated in the 2010/11 follow-up (n = 768)..
SETTING
Postal questionnaires and web-based cognitive function tests were administered in participants’ homes.
METHODS AND ANALYSIS
Logistic regression identified predictors of volunteering for reaction time testing, used to calculate inverse probability weights for the primary analysis. Associations between health literacy and reaction time were estimated with linear regression models, adjusting for volunteer effects. Poisson regression models assessed associations between health literacy and choice reaction time errors.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was acceptability of web-based testing (response rate, task distress, task difficulty). Secondary outcomes were sources of volunteer bias, and the association between health literacy and reaction time.
RESULTS
Web-based testing of cognitive function was attempted by 67% of women (maximum age 80), with little distress or difficulty reported. There was substantive volunteer bias. Women providing data on cognitive function were younger, had higher health literacy, higher educational attainment and were higher in self-rated intelligence. Inadequate health literacy was associated with making fewer choice reaction time errors among those providing valid data, but was also associated with not providing valid data. Health literacy was not associated with other aspects of reaction time (speed, variability). Additionally, selection bias may have restricted range on study variables, given that 2010/11 volunteers were younger and more educated compared to those at recruitment in 1995/98.
CONCLUSION
Brief web-based measures of cognitive function in the home are acceptable to women aged 48 to 80, but there are substantive selection effects and volunteer biases. Additionally, there are potentially vulnerable subgroups who provide poorer quality data
Transforming Organisations Through AI: Emerging Strategies for Navigating the Future of Business
Get PDFThe rise of artificial intelligence (AI), particularly generative AI (GenAI), presents both significant opportunities and challenges for business leaders. This paper explores how AI can reshape business models, operations, and the nature of work, drawing lessons from past technological revolutions and emerging insights from leading global organisations. It argues that AI's true potential lies not just in automating tasks but in fundamentally rethinking organisational processes and business models. The paper offers practical strategies for senior leaders to navigate this evolving landscape and successfully steer their organisations through an AI-driven future
Interventions for myopia control in children: a living systematic review and network meta-analysis
Get PDFRationale
The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia‐related ocular morbidity. Interventions to slow its progression are needed in childhood, when myopia progression is most rapid. This is a review update, conducted as part of a living systematic review.
Objectives
To assess the comparative efficacy and safety of interventions for slowing myopia progression in children using network meta‐analysis (NMA). To generate a relative ranking of interventions according to their efficacy. To produce a brief economic commentary, summarising economic evaluations.
Search methods
We searched CENTRAL, MEDLINE, Embase, and three trial registers. The latest search date was 19 February 2024.
Eligibility criteria
We included randomised controlled trials (RCTs) of optical, pharmacological, light therapy and behavioural interventions for slowing myopia progression in children, up to 18 years old.
Outcomes
Critical outcomes were progression of myopia (mean difference (MD) in the change in spherical equivalent refraction (SER, dioptres (D)), and axial length (AL, mm) in the intervention and control groups at one year or longer), and difference in the change in SER and AL following cessation of treatment (rebound).
Risk of bias
We assessed the risk of bias (RoB) for SER and AL using the Cochrane RoB 2 tool.
Synthesis methods
We followed standard Cochrane methods. We rated the certainty of evidence using the GRADE approach for change in SER and AL at one and two years. We used the surface under the cumulative ranking curve (SUCRA) to rank the interventions for all available outcomes.
Included studies
We included 104 studies (40 new for this update) that randomised 17,509 children, aged 4 years to 18 years. Most studies were conducted in China or other Asian countries (66.3%), and North America (14.4%). Eighty‐four studies (80.8%) compared myopia control interventions against inactive controls. Study durations ranged from 12 months to 48 months.
Synthesis of results
Since most of the networks in the NMA were poorly connected, our estimates are based on direct (pairwise) comparisons, unless stated otherwise.
The median change in SER for controls was −0.65 D (55 studies, 4888 participants; one‐year follow‐up). These interventions may reduce SER progression compared to controls: repeated low intensity red light (RLRL: MD 0.80 D, 95% confidence interval (CI) 0.71 to 0.89; SUCRA = 93.8%; very low‐certainty evidence); high‐dose atropine (HDA (≥ 0.5%): MD 0.90 D, 95% CI 0.62 to 1.18; SUCRA = 93.3%; moderate‐certainty evidence); medium‐dose atropine (MDA (0.1% to < 0.5%): MD 0.55 D, 95% CI 0.17 to 0.93; NMA estimate SUCRA = 75.5%; low‐certainty evidence); low dose atropine (LDA (< 0.1%): MD 0.25 D, 95% CI 0.16 to 0.35; SUCRA = 53.2%; very low‐certainty evidence); peripheral plus spectacle lenses (PPSL: MD 0.45 D, 95% CI 0.16 to 0.74; SUCRA = 50.2%; very low‐certainty evidence); multifocal soft contact lenses (MFSCL: MD 0.27 D, 95% CI 0.18 to 0.35; SUCRA = 49.9%; very low‐certainty evidence); and multifocal spectacle lenses (MFSL: MD 0.14 D, 95% CI 0.08 to 0.21; SUCRA = 30.8%; low‐certainty evidence).
The median change in AL for controls was 0.33 mm (58 studies, 9085 participants; one‐year follow‐up). These interventions may reduce axial elongation compared to controls: RLRL (MD –0.33 mm, 95% CI –0.37 to –0.29; SUCRA = 98.6%; very low‐certainty evidence); HDA (MD −0.33 mm, 95% CI −0.35 to −0.30; SUCRA = 88.4%; moderate‐certainty evidence); MDA (MD −0.24 mm, 95% CI −0.34 to −0.15; NMA estimate SUCRA = 75.8%; low‐certainty evidence); LDA (MD −0.10 mm, 95% CI −0.13 to −0.07; SUCRA = 36.1%; very low‐certainty evidence); orthokeratology (ortho‐K: MD −0.18 mm, 95% CI −0.21 to −0.14; SUCRA = 79%; moderate‐certainty evidence); PPSL (MD −0.13 mm, 95% CI −0.21 to −0.05; SUCRA = 52.6%; very low‐certainty evidence); MFSCL (MD −0.11 mm, 95% CI −0.13 to −0.09; SUCRA = 45.6%; low‐certainty evidence); and MFSL (MD −0.06 mm, 95% CI −0.09 to −0.04; SUCRA = 26.3%; low‐certainty evidence). Ortho‐K plus LDA probably reduces axial elongation more than ortho‐K monotherapy (MD –0.12 mm, 95% CI –0.15 to –0.09; SUCRA = 81.8%; moderate‐certainty evidence).
At two‐year follow‐up, change in SER was reported in 34 studies (3556 participants). The median change in SER for controls was −1.01 D. The ranking of interventions to reduce SER progression was close to that observed at one year; there were insufficient data to draw conclusions on cumulative effects. The highest‐ranking interventions were: HAD (SUCRA = 97%); MDA (NMA estimate SUCRA = 69.8%); and PPSL (SUCRA = 69.1%).
At two‐year follow‐up, change in AL was reported in 33 studies (3334 participants). The median change in AL for controls was 0.56 mm. The ranking of interventions to reduce axial elongation was similar to that observed at one year; there were insufficient data to draw conclusions on cumulative effects. The highest‐ranking interventions were: ortho‐K plus LDA (SUCRA = 94.2%); HAD (SUCRA = 96.8%); and MDA (NMA estimate SUCRA = 88.4%).
There was limited evidence on whether cessation of myopia control therapy increases progression beyond the expected rate of progression with age. Adverse events and treatment adherence were not consistently reported. Two studies reported quality of life, showing little to no difference between intervention and control groups.
We were unable to draw firm conclusions regarding the relative costs or efficiency of different myopia control strategies in children.
Authors' conclusions
Most studies compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. These interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. Less evidence is available for two years and beyond; uncertainty remains about the sustained effect of these interventions.
Longer term and better quality studies comparing myopia control interventions alone or in combination are needed, with improved methods for monitoring and reporting adverse effects.
Funding
Cochrane Eyes and Vision US Project is supported by grant UG1EY020522, National Eye Institute, National Institutes of Health.
Registration
The previous version of this living systematic review is available at doi: 10.1002/14651858.CD014758.pub2
EU and UK Competition Law in the Video Games Industry: Past, Present, and Potential Future
Get PDFEpic’s battles against app store terms and Microsoft’s $68.7 billion acquisition of Activision Blizzard have created significant interest in how competition law applies to the video games industry. Research into this topic is limited and often focuses on narrow issues. This paper addresses the gap in the literature by offering a broad analysis of the past, present, and potential future application of EU and UK competition law to video games companies. It covers enforcement of the law on anticompetitive agreements, merger control, and abuse of dominance, plus complementary regimes regulating the digital economy. It offers an accessible overview for those without prior knowledge of competition law. For those more familiar with the law, the also paper highlights peculiarities of investigations into the gaming sector vis-à-vis other areas of activity. These include an exclusive focus on agreements that restrict cross-border sales between EU Member States, greater concern for the non-horizontal effects of acquisitions over direct loss of competition between developers, and ambivalence on market definition. Furthermore, the paper identifies several practices by video games companies which have not yet been subject to scrutiny, but could be. In particular, it explores the implications for gaming of the EU Digital Markets Act and UK Digital Markets, Competition and Consumers Act. While cloud streaming services and mobile gaming are significant beneficiaries of these new regulatory regimes aimed at the gatekeepers of the digital economy, the giants of the gaming industry should be very wary of comparable obligations being placed on their own digital stores
Characteristics of children with a psychiatric disorder in 1999, 2004 and 2017: an analysis of the national child mental health surveys of England
Get PDFBackground
While research has described the profile of children with poor mental health, little is known about whether this profile and their needs have changed over time. Our aim was to investigate whether levels of difficulties and functional impact faced by children with a psychiatric disorder have changed over time, and whether sociodemographic and family correlates have changed.
Methods
Samples were three national probability surveys undertaken in England in 1999, 2004 and 2017 including children aged 5–15 years. Psychiatric disorders were assessed using the Development and Well‐Being Assessment (DAWBA), a standardised multi‐informant diagnostic tool based on the tenth International Classification of Diseases (ICD‐10). The impact and difficulties of having a disorder (emotional, behavioural or hyperkinetic) were compared over time using total difficulty and impact scores from the Strengths and Difficulties Questionnaire (SDQ). Analyses explored the impact of having any disorder, as well as for each disorder separately. Regression analyses compared associations between disorders and sociodemographic factors over time.
Results
Parent‐ and adolescent‐reported total SDQ difficulty and impact scores increased between 1999 and 2017 for children and adolescents with disorders. No differences were noted when using teacher ratings. No differences in total SDQ difficulty score were found for children without a disorder. Comparison of sociodemographic correlates across the surveys over time revealed that ethnic minority status, living in rented accommodation and being in the lowest income quintile had a weaker association with disorder in 2017 compared to 1999.
Conclusions
Our study reveals a concerning trend; children with a disorder in 2017 experienced more severe difficulties and greater impact on functioning at school, home and in their daily lives, compared to children with a disorder in earlier decades. Research is needed to identify and understand factors that may explain the changing nature and level of need among children with a disorder
Policy over Protest: Experimental Evidence on the Drivers of Support for Movement Parties
Get PDFAcross the world, political parties are incorporating social movement strategies and frames. In this study, we pivot from the dominant focus on party characteristics to analyze drivers of support for movement parties in six European countries. We report results from a choice-based conjoint survey experiment showing that contrary to previous research, movement party voters favor neither candidates who are institutional outsiders nor those who actively partici-pate in protests. Candidate policy positions are the most important driver of the vote for movement parties. Movement party voters, additionally, prefer candidates who either display anti-elitist sentiments or who want to ensure the smooth running of the current political sys-tem. These insights invite renewed attention to movement parties as an electoral vehicle whose voters prioritize decisive policy change
Unveiling the Online Dynamics Influencing the Success and Virality of TikTok Social Movements: A Case Study on Pro and Anti Hijab Feminist Activism
Get PDFWhen TikTok started as a youth-oriented platform, it was mostly used for light entertainment, including music, songs, and dance clips. Today, however, it is often relied upon as a hub for social and political activism. Hashtags are an important affordance to create visibility and attract attention. Using a qualitative multimodal thematic analysis, this study examines the shifting patterns in TikTok's nature as a social media platform and investigates its various affordances in the realm of activism, in general, and feminist activism, in particular. Adopting a comprehensive approach, which takes into account various dynamics including the overall political and social context, the various actors, and the deployed tools and tactics, this study investigates why and how some feminist TikTok campaigns, such as #MahsaAmini which erupted in Iran to resist the imposition of the Hijab, following the murder of Mahsa Amini, are more likely to go viral and gain more international visibility than other TikTok feminist campaigns, such as #HandsOffMyHijab which erupted in France to resist the Hijab and Niqab ban. Findings revealed how various factors contributed to increasing the virality and international visibility of the Iranian Mahsa Amini’s #WomanLifeFreedom campaign, including the used online tactics, the support of media and political actors, the power of celebrities and social media influencers, and the online and offline support by male figures. The undertaken thematic analysis identified different dominant themes and representations of Hijab in the two online social movements, reflecting varying expressions of feminisms, activisms, and resistance. In so doing, the study offers a conceptual model for understanding of these online dynamics within the appropriate socio-political and cultural contexts
Actual, potential, and non-participants: Advancing the differential analysis of protest participation
Get PDFIn this article, we contribute to the analysis of protest participation on a gradient from non- to actual participation. Using survey data from six European countries, we take the analysis beyond a binary differentiation between participants and non-participants. We evidence a participation gradient underpinned by a combination of social and political variables and separate patterns that allow for distinctions between non-, potential, and actual protesters. We establish that some factors have a gradual, linear, relation to protest participation, increasing the likelihood of moving from non-participation to potential participation and from potential to actual participation. Second, we find evidence of a punctuated rather than a linear participation gradient in as far as a range of variables distinguish protesters and potential protesters from non-participants but do not differentiate them from each other. Our findings provide practical insights into mobilization pathways while also inviting further research into intervening factors influencing protest behavior
Assessment and treatment of gesture in neurogenic communication disorders: An international survey of practice
Get PDFBackground
Gesture and speech collaborate in conveying meaning, and gesture is often leveraged by people with neurogenic communication disorders, such as aphasia, cognitive‐communicative impairments and primary progressive aphasia, when words fail them. Because gesture is imagistic, transitory and holistic, there are inherent challenges when assessing and treating it.
Aims
The survey had three primary research questions: (1) what gesture assessment practices, and (2) what gesture treatment practices, are employed by speech and language therapists (SLTs) internationally; and (3) what are the factors that influence these practices?
Methods and Procedures
An online survey of practice using Qualtrics was piloted and then disseminated to practising SLTs working with people with neurogenic communication disorders. In addition to descriptive statistics summarising across the three research questions, statistical comparisons were made for two independent groups: primary work setting (research versus clinical), and primary work setting considering years of experience specific to neurogenic communication disorders (research, high; research, low; clinical, high; and clinical, low).
Outcomes and Results
A total of 130 international SLTs completed the first two parts of the survey. A total of 107 completed all four sections of the survey. Fifty percent of respondents reported assessing gesture sometimes/for some clients, with only 5% reporting that they never assessed gesture. Nearly 70% of respondents reported never using a published test to evaluate gesture, with qualitative results suggesting a lack of formal assessments. This was further highlighted by the most prominent barrier being a lack of published tests (50% of respondents said this). The primary reason for evaluating gesture was to assess nonverbal communication. There was no significant difference in gesture assessment practices across comparison groups. The research group, and those within the research group with most years of experience, tended to target gestures during treatment and write treatment goals containing gesture more than other respondents. The most common facilitator to assessing or treating gesture was that the family or individual prioritised gesture for enhancing communication (53.1% of respondents). No group differences were identified for barriers/facilitators.
Conclusions and Implications
Findings indicate that whilst gesture is a critical nonverbal communicative behaviour, there is an unmet need for empirical and standardised methods for assessing gesture in speech and language clinical practice and there is a lack of gesture‐specific treatment resources. SLTs working in research settings may feel more able, or have more resources, to include gesture during treatment. Essential next steps include creating empirical and standardised methods for assessing gesture in speech and language clinical practice.
WHAT THIS PAPER ADDS
What is already known on the subject
Gesture is a complex and crucial aspect of communication. It is a key part of the role of speech and language therapists (SLTs), as described in clinical guidelines, to assess people with aphasia's use of gesture and consider whether it could be enhanced through treatment.
What this study adds to existing knowledge
This is the first international survey of practice focusing on gesture assessment and treatment. It highlights the variety of methods used by SLTs to assess and treat gesture, the importance they attach to this area and the need for standardised assessment tools and treatment resources.
What are the clinical implications of this work?
This study provides a comprehensive overview of practices for assessing and treating gesture in neurogenic communication disorders, as well as a list of gesture resources being actively used by clinicians and researchers. These may be useful for clinicians looking to expand their understanding of approaches and resources for assessment and treatment in this domain. The study also reports on the reasons clinicians assess gesture and the barriers and facilitators they encounter which may inform clinical practice in this area
Gender and family-role portrayals of autism in British newspapers: An intersectional corpus-based study
Get PDFA recent large-scale study on the portrayal of autism in British newspapers revealed a deficit-based coverage, which concentrated on children and boys in particular, typically represented from the mothers’ perspective. This follow-up study refines these representations, considering how they differ by gender and family role. We analysed 2998 text samples, which discussed autism in the context of four combinations of gender and family roles, namely, BOY, GIRL, FATHER and MOTHER. These samples included sources with different publication dates, reporting style and political orientation. Autism representations remained negative regardless of gender and family role. Over time, stories about autistic girls started to emerge, identifying them as a distinct group explicitly compared to autistic boys. Newspapers, especially broadsheets, associated girls with diagnostic difficulties, camouflaging and sometimes gender dysphoria − discussed particularly for those assigned female at birth. The child’s autism was more often attributed to maternal than paternal behaviours or lifestyle. Autistic mothers were mentioned more often than fathers and were portrayed negatively. We conclude that newspapers portray female autism as less significant than male autism and, in addition, place mothers under more ethical scrutiny than fathers. These disparities reflect both historical biases in autism research and gender and family-role stereotypes
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