11237 research outputs found
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Development and psychometric validation of tinnitus qualities and impact questionnaire
No full textBackground: To develop and validate the Tinnitus Qualities and Impact Questionnaire (TQIQ), a new tool for evaluating the perceived qualities of tinnitus sound. Method: The study was part of two clinical trials on internet-based tinnitus interventions, using cross-sectional (n = 380) and pretest–posttest data (n = 280). Participants completed various questionnaires online, including the newly developed TQIQ and measures of tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder 7; GAD-7), depression (Patient Health Questionnaire 9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). The psychometric properties of the TQIQ were assessed, including construct validity, internal consistency reliability, floor and ceiling effects, interpretability, and responsiveness to treatment. Results: Exploratory factor analysis resulted in two factors that accounted for 57% of the variance—internal and external tinnitus qualities. Overall, 92% convergent validity predictions were confirmed; TQIQ total scores strongly (≥0.6) or moderately (0.30 to 0.59) correlated with the TFI, GAD-7, PHQ-9, and ISI. The known-groups validity prediction was confirmed as individuals with an overall TFI score > 50 (severe) obtained significantly higher TQIQ scores. All internal consistency reliability statistics were within the required range (Cronbach’s α > 0.8). Floor and ceiling effects were negligible. ROC established clinically important cut-off scores, enhancing the interpretability of tinnitus severity classification. Finally, 89% convergent validity predictions were confirmed; TQIQ and TFI change scores were moderately correlated, indicating good responsiveness of the former to treatment. Conclusions: The TQIQ has adequate psychometric properties, providing a standardized measure for the assessment of characteristics of tinnitus sound in clinical practice.</p
Investigating the effect of reducing the signs and symptoms of lid wiper epitheliopathy in dry eye subjects with perfluorohexyloctane
No full textBackground: Perfluorohexyloctane (PFHO) acts to prevent the evaporation of the tear film. It has the potential to limit friction related issues between the eye lid margin and the ocular surface. Prior to the present work, this had not yet been evaluated.Objective: To examine the potential of using perfluorohexyloctane for reducing the signs and symptoms of lid wiper epitheliopathy (LWE).Methods: Data were collected at 4 visits spanning 2 months. Patients who had symptomatic dry eye and a LWE score of ≥1.0 on the Korb LWE scale were recruited. Participants were randomized to PFHO 4 times a day or no treatment. Lid wiper epitheliopathy was graded at each visit with the Korb and photographic LWE (PLWE) scales. Symptoms were assessed using the Standard Patient Evaluation of Eye Dryness questionnaire and visual analog scales (0–100).Results: A total of 52 participants were enrolled (mean ± SD age, 49.7 ± 15.7 years; 79% female). Right eyes in the treatment group were significantly more likely to show an improvement of ≥0.5-units in PLWE scores at 2 months than the no treatment group (P = 0.04), but no left eye differences were noted. Korb and PLWE scores were significantly better in the treatment group compared with the no treatment group starting at 2 weeks and remained so for the duration of the study (all P Conclusions: Perfluorohexyloctane significantly reduced LWE and improved dry eye symptoms compared with no treatment, suggesting that PFHO may enhance ocular lubrication and reduce friction-related damage. Masked, randomized, trials are still needed to compare PFHO to other treatments in participants with LWE to support generalizability of results. ClinicalTrials.gov study NCT06671041.</p
The romantic vegetable eaters: the politics and poetics of an active diet
No full textThis thesis examines the relationship between the vegetable diet and change in the Romantic period. Romantic vegetable eaters believed that by reforming their diets they could reform the world, creating change that would benefit all. Through a boycott of the consumption of animal flesh, animals would lose their property status and have their rights recognised. Individuals in society would also become healthier as they ate a natural diet, and there would be a greater quantity of food to feed the growing population. Society would become more equitable as a result, and the natural world would flourish. Spearheaded by Percy Shelley, the romantic vegetable eaters passionately and ardently attempted to persuade their readers with this active and driven rhetoric. They wanted the world to change, as they themselves had changed. Percy Shelley, of all the vegetable eaters, was most idealistic as in his poetry he created a vision of the future based on these principles. These dreams of reform, however, were tempered by the reservations of Mary Shelley’s literary representations that highlighted the difficulties of creating change in the real world. This thesis examines the relationship between the vegetable diet and reform, highlighting its potential to create change. It also establishes how pertinent these arguments are today, and how they reflect contemporary versions of the same points of view. The thesis, however, concludes with the recognition that although these arguments have a strong legacy, they ultimately remain a Romantic ideal, yet to be achieved, as people have not universally adopted the regimen. As the creature in Mary Shelley’s Frankenstein is denied a mate and is unable to make a society in his ecologically driven image that unifies the human and animal worlds, the vegetable eaters did not create the degree of change they wished for. However, their legacy and ambition live on.</p
Large language models in genomics—a perspective on personalized medicine
No full textIntegrating artificial intelligence (AI), particularly large language models (LLMs), into the healthcare industry is revolutionizing the field of medicine. LLMs possess the capability to analyze the scientific literature and genomic data by comprehending and producing human-like text. This enhances the accuracy, precision, and efficiency of extensive genomic analyses through contextualization. LLMs have made significant advancements in their ability to understand complex genetic terminology and accurately predict medical outcomes. These capabilities allow for a more thorough understanding of genetic influences on health issues and the creation of more effective therapies. This review emphasizes LLMs’ significant impact on healthcare, evaluates their triumphs and limitations in genomic data processing, and makes recommendations for addressing these limitations in order to enhance the healthcare system. It explores the latest advancements in LLMs for genomic analysis, focusing on enhancing disease diagnosis and treatment accuracy by taking into account an individual’s genetic composition. It also anticipates a future in which AI-driven genomic analysis is commonplace in clinical practice, suggesting potential research areas. To effectively leverage LLMs’ potential in personalized medicine, it is vital to actively support innovation across multiple sectors, ensuring that AI developments directly contribute to healthcare solutions tailored to individual patients.</p
Solving the diet problem: meals as food choice heuristics for behaviour change
No full textThe diet problem is the challenge of choosing a healthy and affordable combination of foods to eat. This problem is complex, involving many possible foods, food attributes, contexts, and potential combinations. The current thesis is that people solve the diet problem by using meals as food choice heuristics: quick and efficient solutions to the computationally elaborate diet problem faced daily. The planning and preparation of meals represent a food choice behaviour that is specific, shared with others and context dependent. Meals are a part of cuisine, which itself follows a set of rules or grammar that reflect what is essential, normal or taboo in a diet for an individual. These rules likely reflect culture, geography, history and social status. The parallels between meals and heuristics from behaviour research are discussed, including recent evidence that support the proposal that food choices are made using heuristics. The potential value of focusing on meals for dietary change interventions is also discussed. The current thesis is that interventions that target meals to promote positive dietary behaviour for the individual, society or planet could be more impactful than those that target single nutrients, food groups or holistic diets.</p
The hidden clock: how chronotype is related to depression, anxiety, and stress in adolescents – insights from the EHDLA study
No full textBackground: Depression, anxiety, and stress symptoms are common among adolescents; however, studies exploring their relationship with chronotype in European youth populations is scarce. This study aimed to evaluate the association between chronotype status and depression, anxiety, and stress symptoms in adolescents.Methods: A secondary analysis of the Eating Healthy and Daily Life Activities (EHDLA) cross-sectional study was performed in 703 adolescents (56.3% girls) between 12 and 17 years from the Valle de Ricote, Spain. Chronotype preference was assessed using the Morningness/Eveningness Scale in Children (MESC), while symptoms were evaluated using the Depression, Anxiety, and Stress Scale (DASS-21). A robust generalized linear regression model was used to evaluate the associations between chronotype preferences and symptoms of depression, anxiety and stress in adolescents.Results: After adjusting for potential covariates (sex, age, socioeconomic status, body mass index, sleep duration, physical activity, sedentary behavior, and energy intake), the highest probability of having depression, anxiety, and stress was identified in those with an eveningness chronotype preference (depression: 27.4%, 95% confidence interval [CI] 17.5–40.1%; anxiety: 28.5%, 95% CI 18.6–41.0%; stress: 47.6%, 95% CI 34.1–61.5%). Conversely, the lowest probability was observed in adolescents with a morningness chronotype preference (depression: 11.9%, 95% CI 8.3–16.8%; anxiety: 15.4%, 95% CI 11.2–28.9%; stress: 19.5%, 95% CI 14.7–25.5%). Significant differences were found when comparing participants with the eveningness chronotype to those with a morningness or intermediate chronotype preference (p Conclusions: Depression, anxiety, and stress symptoms were more likely in adolescents with an eveningness chronotype preference than in those with morningness or intermediate chronotypes. Chronotype preferences should be taken into account for developing interventions that promote better mental health and healthy sleep habits in adolescents.</p
Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival: a post hoc analysis of the TTM2 trial
No full textPurpose: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA).Methods: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature Results: Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p Conclusions: Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.</p
A qualitative analysis of the experience of gambling harm and accessing support among United Kingdom Armed Forces personnel
No full textBackground: Military personnel (both currently serving and veterans) are vulnerable to harm from gambling, yet many are reluctant to seek help. The aims of this study were to explore the lived experience of gambling and gambling harm in currently serving members of the UK Armed Forces and to seek to improve military-specific gambling harm information and support. Methods: Semi-structured interviews were undertaken with self-selected currently serving personnel from the UK Armed Forces. Interview questions focus on lived experience of gambling harm, motivators and triggers around gambling, and awareness of gambling information and support. Results: Thematic analysis identified four main themes: (1) sociocultural pathways to gambling harm; (2) influencing factors unique to military life; (3) obstacles to early intervention and support; and (4) facilitators of help and support. Conclusions: Findings showed that the nature and extent of gambling harm within the UK Armed Forces may not be fully acknowledged, and that currently serving personnel face barriers accessing safer gambling information and support. Specifically, there was a lack of education around the nature of gambling harm, identifying it, how to go about seeking help, and from whom. The normalisation of potentially harmful behaviour, stigmatising attitudes, and concerns around anonymity serve as further barriers to help-seeking. There is a need to raise awareness, reduce stigma, and enhance support for gambling harm within the UK Armed Forces.</p
Recruiting and retaining doctors—a wicked problem needing complex solutions
No full textAbstract
Recruiting and retaining healthcare professionals, particularly doctors, remains a critical challenge for the National Health Service (NHS), exacerbated by an ageing population, geographical disparities, and persistent workforce shortages. Traditional linear solutions fail to address the complexity of these interconnected issues, necessitating a multidimensional approach rooted in complexity science. This article frames the recruitment and retention of doctors as a wicked problem, characterized by interdependencies, dynamic interactions, and context-specific nuances.
Using the Anglia Ruskin University School of Medicine in Essex as a case study, we explore a locally contextualized strategy within the national ‘train, retain, reform’ framework. Initiatives include the innovative Medical Degree Doctor Apprenticeship, targeted outreach programmes, and collaboration with NHS England to prioritize local foundation training posts for graduates. These strategies are designed to address workforce disparities in socioeconomically disadvantaged regions whilst fostering local retention.
Our findings highlight the need for adaptive, non-linear solutions that integrate national policies with local innovations to address workforce inequalities effectively. We argue that sustainable improvements require distributed control, interdependent systemic interventions, and stakeholder collaboration. This approach not only addresses local recruitment challenges but also contributes to reducing health inequalities, emphasizing the importance of local agency within a national framework.</p
“Falling between the cracks”: investigating the competing challenges experienced by professionals working with people who hoard
No full textHoarding disorder is characterised by both the distress associated with discarding and the resulting accumulation of possessions that clutter the home environment, and represents a substantial public health and social problem, requiring an effective multi-agency response. Although a recognised psychiatric condition since 2013, hoarding disorder is under-recognised within mental health treatment provision, and evidence-based treatment pathways are lacking. This study aimed to explore multi-agency working in practice and similarities and differences in how hoarding support is perceived across a broad range of front-line professionals. 35 semi-structured interviews representing a wide range of services from health, social care, housing, and the voluntary sector were conducted and analysed thematically. Three overarching themes are reported: Unique challenges of supporting people who hoard, Conflicting needs of client vs. needs of the organisation, Managing role boundaries and psychological tensions. Findings consistently highlight the challenges specific to these cases. However, they also point to a lack of consensus between professional groups in terms of perceived problems and risks to be addressed. Collaborating effectively with others to meet the psychological needs of clients while ensuring risk mitigation and addressing broader organisational, environmental, and community concerns was found to be a key challenge and associated with often going beyond designated role boundaries to support the person. Our findings point to a need for greater support and training of a diverse set of professionals in psychological models of people who hoard to enhance knowledge, awareness, and confidence of the psychological dimensions of hoarding disorder, and to support them in feeling more emotionally and practically prepared. The results indicate a need for greater integration of mental health measures in the assessment of hoarding cases, and to ensure adequate care pathways with dedicated psychological support along with assignment of case workers/coordination.</p
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