17837 research outputs found
Sort by
A systematic review to explore patients’ MS knowledge and MS risk knowledge
Get PDFLiving with a chronic illness poses particular challenges, including maintaining current disease knowledge to optimiseself-management and interaction with health professionals. People with Multiple Sclerosis (MS) are increasingly encouragedto participate in shared decision making. Making informed decisions is likely to rely on adequate knowledge aboutthe condition and its associated risks. The aim of this systematic review is to explore patients’ existing MS knowledge andMS risk knowledge, and how these relate to demographic and disease variables. A literature search was conducted usingPsycINFO, PubMed and Cochrane Library. Eligible studies were published peer-reviewed reporting quantitative measuresof MS knowledge and MS risk knowledge in adult MS patients. Eighteen studies met inclusion criteria comprising a totalsample of 4,420 patients. A narrative synthesis was undertaken because studies employed various measures. Suboptimallevels of MS knowledge and MS risk knowledge were generally identified across studies. Greater self-reported adherence anda willingness to take medication were related to higher MS knowledge, while educational level was a significant predictorof both MS knowledge and MS risk knowledge. Associations with other demographic and disease-related variables weremixed for both knowledge domains. Direct comparison of results across studies were limited by methodological, samplingand contextual heterogeneity. The review’s findings and implications for future research and clinical practice are consideredfrom this perspective
Prevalence, treatment and correlates of depression in multiple sclerosis
Get PDFBackgroundThe prevalence of depression in Multiple Sclerosis (MS) is often assessed by administering patient reported outcome measures (PROMs) examining depressive symptomatology to population cohorts; a recent review summarised 12 such studies, eight of which used the Hospital Anxiety and Depression Scale-Depression (HADS-D). In clinical practice, depression is diagnosed by an individual structured clinical interview; diagnosis often leads to treatment options including antidepressant medication. It follows that an MS population will include those whose current depressive symptoms meet threshold for depression diagnosis, plus those who previously met diagnostic criteria for depression and have been treated such that depressive symptoms have improved below that threshold. We examined a large MS population to establish a multi-attribute estimate of depression, taking into account probable depression on HADS-D, as well as anti-depressant medication use and co-morbidity data reporting current treatment for depression. We then studied associations with demographic and health status measures and the trajectories of depressive symptoms over time.MethodsParticipants were recruited into the UK-wide Trajectories of Outcome in Neurological Conditions-MS (TONiC-MS) study, with demographic and disease data from clinical records, PROMs collected at intervals of at least 9 months, as well as co-morbidities and medication. Interval level conversions of PROM data followed Rasch analysis. Logistic regression examined associations of demographic characteristics and symptoms with depression. Finally, a group-based trajectory model was applied to those with depression.ResultsBaseline data in 5633 participants showed the prevalence of depression to be 25.3% (CI: 24.2-26.5). There were significant differences in prevalence by MS subtype: relapsing 23.2% (CI: 21.8- 24.5), primary progressive 25.8% (CI: 22.5-29.3), secondary progressive 31.5% (CI: 29.0-34.0); disability: EDSS 0-4 19.2% (CI: 17.8-20.6), EDSS ≥4.5 31.9% (CI: 30.2-33.6); and age: 42-57 years 27.7% (CI: 26.0-29.3), above or below this range 23.1% (CI: 21.6-24.7). Fatigue, disability, self-efficacy and self esteem correlated with depression with a large effect size (>.8) whereas sleep, spasticity pain, vision and bladder had an effect size >.5. The logistic regression model (N=4938) correctly classified 80% with 93% specificity: risk of depression was increased with disability, fatigue, anxiety, more comorbidities or current smoking. Higher self-efficacy or self esteem and marriage reduced depression. Trajectory analysis of depressive symptoms over 40 months in those with depression (N=1096) showed three groups: 19.1% with low symptoms, 49.2% with greater symptoms between the threshold of possible and probable depression, and 31.7% with high depressive symptoms. 29.9% (CI: 27.6-32.3) of depressed subjects were untreated, conversely of those treated, 26.1% still had a symptom level consistent with a probable case (CI: 23.5-28.9).ConclusionA multi-attribute estimate of depression in MS is essential because using only screening questionnaires, diagnoses or antidepressant medication all under-estimate the true prevalence. Depression affects 25.3% of those with MS, almost half of those with depression were either untreated or still had symptoms indicating probable depression despite treatment. Services for depression in MS must be pro-active and flexible, recognising the heterogeneity of outcomes and reaching out to those with ongoing symptoms
Large igneous province control on ocean anoxia and eutrophication in the North Sea at the Paleocene-Eocene Thermal Maximum
Get PDF
Autoinsecurity: mobility futures in the age of autonomous vehicles
Get PDFThis PhD thesis complicates the familiar-yet-simplistic industry imaginations of future autonomous mobility technologies, using a critical security lens and narrative methods to explore alternative, everyday futures. It does this in three parts. First, it identifies possible future trajectories for autonomous mobilities that go beyond limited industry imaginaries, through a round of stakeholder interviews. Second, it translates this research into a narrative-story form with the aim of enabling a type of ‘ethnographic access’ to complex and intangible futures. Third, it uses this narrative to animate discussions with participants from civil society organisations to upset the passive acceptance that appears necessary for industry imaginaries, and to explore the mess and complexity of the everyday insecurities and freedoms associated with autonomous mobility futures. The thesis thus complicates a dominant techno-solutionist framing within industry, government, and some parts of academia, arguing that a potential realignment of groups and their values to better align with industry-desired futures risks security conflicts arising, given a range of specific insecurities that combine to inform a broad response to several possible trajectories for autonomous mobilities, centred on concerns around agency and political insecurity. It further offers insight into the use of a short story as a tool for feeding research findings through a project’s stages, illustrating its ability to engage participants in reflecting upon sociotechnical futures, in complicating assumptions of dominant futures, and in providing a form of access to uncertain futures. The thesis also demonstrates the value of positive security as a critical lens in thinking through futures and responses to futures, and in exploring human-scale impacts. It consequently demonstrates a need for diverse, everyday perspectives to be heard and to shape futures, technologies, and applications, incorporating a greater range of values into decision calculi through an enablement-oriented, human-centric, longer-term approach to planning, designing, and developing technological futures
Filter Bubbles, Echo Chambers, and Epistemic Bubbles in English Young People
Get PDFParticularly since the shock popularity and victories of Brexit and Donald Trump, there has been increased concern that citizens exist in democratically dysfunctional ideological bubbles, where they only hear likeminded perspectives. Researchers examined the extent of these bubbles - particularly through analysis of digital platforms such as search engines and social media. Our understanding of this ‘embubblement’ and its implications for democracy is hindered by the relative lack of qualitative research on filter bubbles and young people, and the overly simple way media exposure is often measured, which fails to consider the context (and assumes, for example, that all cross-cutting exposure is ‘good’). The study explores embubblement in this marginal, perhaps high-risk group, who get more news online and are considered more impressionable. This mixed-methods digital ethnography contains a 10-wave cohort study, diary study hybrid. One day a month for 10 months, English participants aged 16-18 (n=20) captured any political communication they encountered across all mediums - online and in-person. Descriptive statistics using regression analysis suggest strength of partisanship positively correlates with embubblement, though no participants were strongly embubbled (even strong partisans). No statistically significant correlations emerged between embubblement and increased embubblement over time or political polarisation. However, embubblement positively correlated with degree of political engagement. Ethnography explored what causes embubblement. Embubblement occurred rarely, influenced by structural factors: ‘socialising agents’, including family, peers, education, media, and events. This thesis makes a new contribution, a typology of factors shaping embubblement, incorporating an agent-centred approach. Main factors were agreeable news sites, apps and hyperpartisan social media communities. The research addresses questions of agency – for example, a user making a new TikTok account, to reset personalisation algorithms after realising the existing ones were radicalising her. Implications for schools and policy-makers are addressed through recommendations on how to encourage political engagement without embubbling citizens
Data sources:
Access Repository Dashboard
Do you manage Royal Holloway - Pure? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!