110 research outputs found
'Barriers' to participation in higher education? Depends who you ask and how
No full textIn this article, we draw on evidence from a large-scale research project to explore the metaphorical concept of "barriers" to participation in higher education (HE) and to show how our data challenge the idea that non-participation by under-represented groups can be attributed to individuals experiencing a range of readily identifiable barriers. First, we briefly outline the perspectives of policy and practice stakeholders in widening participation (WP) in HE which suggest that the discourse of barriers is central to their understanding of "non-participation" and how to reduce it. Second, we introduce findings from two case studies. Each case study consists of interviews with an individual aged over 21 who has the qualifications (level 3) to enter HE but who has not (yet) done so, as well as members of his or her self-nominated "networks of intimacy" (Heath and Cleaver, 2003) consisting of friends and family. These interviewees do not tend to talk in terms of barriers in their accounts of their educational, employment and personal histories and the influences on their participation decisions. This evidence suggests that patterns of participation and non-participation in HE are strongly embedded in and explained by people's interwoven social, historical and biographical circumstances and experience. This article contributes to the debate about the utility of the barriers metaphor and challenges the policy assumption that individual non-participation can be "solved" solely by the removal of predefined obstacles. We conclude by arguing that the opportunity to collect multiple accounts with members of social networks indicates the value of looking at participation in and decision-making about education across the life course and as a socially embedded practice
LSHTM - April 2013 Podcast - Malaria Centre, bowel cancer survival, and zombie outbreak
No full textThe April 2013 podcast from the London School of Hygiene & Tropical Medicine.
Includes Dr Chris Drakeley from the School's Malaria Centre, Camille Maringe on her recent research into bowel cancer survival, and research student Conall Watson discussing the science of zombies.
Look out for extended video interviews on the School website
Contrasting effects of comorbidities on emergency colon cancer diagnosis: A longitudinal data-linkage study in England
No full textBackground: One in three colon cancers are diagnosed as an emergency, which is associated with worse cancer outcomes. Chronic conditions (comorbidities) affect large proportions of adults and they might influence the risk of emergency presentations (EP). Methods: We aimed to evaluate the effect of specific pre-existing comorbidities on the risk of colon cancer being diagnosed following an EP rather than through non-emergency routes. The cohort study included 5745 colon cancer patients diagnosed in England 2005-2010, with individually-linked cancer registry, primary and secondary care data. In addition to multivariable analyses we also used potential-outcomes methods. Results: Colon cancer patients with comorbidities consulted their GP more frequently with cancer symptoms during the pre-diagnostic year, compared with non-comorbid cancer patients. EP occurred more frequently in patients with 'serious' or complex comorbidities (diabetes, cardiac and respiratory diseases) diagnosed/treated in hospital during the years pre-cancer diagnosis (43% EP in comorbid versus 27% in non-comorbid individuals; multivariable analysis Odds Ratio (OR), controlling for socio-demographic factors and symptoms: men OR = 2.40; 95% CI 2.0-2.9 and women OR = 1.98; 95% CI 1.6-2.4. Among women younger than 60, gynaecological (OR = 3.41; 95% CI 1.2-9.9) or recent onset gastro-intestinal conditions (OR = 2.84; 95% CI 1.1-7.7) increased the risk of EP. In contrast, primary care visits for hypertension monitoring decreased EPs for both genders. Conclusions: Patients with comorbidities have a greater risk of being diagnosed with cancer as an emergency, although they consult more frequently with cancer symptoms during the year pre-cancer diagnosis. This suggests that comorbidities may interfere with diagnostic reasoning or investigations due to 'competing demands' or because they provide 'alternative explanations'. In contrast, the management of chronic risk factors such as hypertension may offer opportunities for earlier diagnosis. Interventions are needed to support the diagnostic process in comorbid patients. Appropriate guidelines and diagnostic services to support the evaluation of new or changing symptoms in comorbid patients may be useful
The influence of the school on the decision to participate in learning post 16
No full textThe paper reports on work in progress for a Department for Education and Skills (DfES) funded research project on “The Influence of the School in the Decision to Participate in Learning Post-16”. The primary aim of the project is to identify the nature and influence of school-based factors in the choices of young people about their post-16 education, training and career pathways. Twenty-four schools were selected to represent schools with rising attainment. The sampling frame included schools both with and without sixth forms, in nine Metropolitan, Urban Unitary, and Shire County Local Education Authorities (LEAs)in Engaland. A profile of schools whose ‘catchment’ areas represented different social and economic status was created using data on the number of pupils receiving free schools meals. Schools with and schools without rising levels of participation post-16 were also included in the sample. Pupils from Year 11 and Year 10 were interviewed in single sex focus groups providing a total of 48 pupils in each school. Each pupil interviewed completed a questionnaire. Year 11 pupils will also take part in follow up interviews planned for Autumn 2003 when they have left compulsory education. Semi-structured interviews were also carried out with head teachers, senior careers teachers and Year 11 tutors, LEA and local Connexions service representatives. The study also analysed secondary data relating to each school to build a profile for the schools in terms of its social and economic context, ethos and organisation. The secondary data included; inspection reports, DfeS and LEA published data for each school as well as school produced promotional material. The study identified the attitudes and preferences of the pupils, their teachers and advisors towards post-16 education and training. The factors that influenced the pupils’, the teachers’ and advisors’ attitudes and preferences were identified and compared to those factors considered in previous research. The DfES commissioned the study to look specifically at the influence of the school rather than factors beyond the school, and aimed at contributing an understanding of the impact of schooling, thereby informing the policy development for widening participation post-16. In addition to the investigation of school based factors that influence the choices young people make about post- 16 learning the study had two other aims:
To identify implications for the development of careers education and guidance and decision making awareness amongst pupils in schools.
To enhance further the modelling of pupil decision-making in education and training markets, and in the labour markets. This paper considers some of the preliminary findings of the research, carried out in 2003
Deriving stage at diagnosis from multiple population-based sources: Colorectal and lung cancer in England
No full textBackground: Stage at diagnosis is a strong predictor of cancer survival. Differences in stage distributions and stage-specific management help explain geographic differences in cancer outcomes. Stage information is thus essential to improve policies for cancer control. Despite recent progress, stage information is often incomplete. Data collection methods and definition of stage categories are rarely reported. These inconsistencies may result in assigning conflicting stage for single tumours and confound the interpretation of international comparisons and temporal trends of stage-specific cancer outcomes. We propose an algorithm that uses multiple routine, population-based data sources to obtain the most complete and reliable stage information possible. Methods: Our hierarchical approach derives a single stage category per tumour prioritising information deemed of best quality from multiple data sets and various individual components of tumour stage. It incorporates rules from the Union for International Cancer Control TNM classification of malignant tumours. The algorithm is illustrated for colorectal and lung cancer in England. We linked the cancer-specific Clinical Audit data (collected from clinical multi-disciplinary teams) to national cancer registry data. We prioritise stage variables from the Clinical Audit and added information from the registry when needed. We compared stage distribution and stage-specific net survival using two sets of definitions of summary stage with contrasting levels of assumptions for dealing with missing individual TNM components. This exercise extends a previous algorithm we developed for international comparisons of stage-specific survival. Results: Between 2008 and 2012, 163 915 primary colorectal cancer cases and 168 158 primary lung cancer cases were diagnosed in adults in England. Using the most restrictive definition of summary stage (valid information on all individual TNM components), colorectal cancer stage completeness was 56.6% (from 33.8% in 2008 to 85.2% in 2012). Lung cancer stage completeness was 76.6% (from 57.3% in 2008 to 91.4% in 2012). Stage distribution differed between strategies to define summary stage. Stage-specific survival was consistent with published reports. Conclusions: We offer a robust strategy to harmonise the derivation of stage that can be adapted for other cancers and data sources in different countries. The general approach of prioritising good-quality information, reporting sources of individual TNM variables, and reporting of assumptions for dealing with missing data is applicable to any population-based cancer research using stage. Moreover, our research highlights the need for further transparency in the way stage categories are defined and reported, acknowledging the limitations, and potential discrepancies of using readily available stage variables
On the prediction and projection of cancer survival
No full textCancer survival is a key metric for monitoring improvement in awareness, early diagnosis and access to effective treatments for cancer patients. For the majority of cancers, survival has been increasing for a number of decades, as a result of successful health policies and the availability of more effective treatment. Nevertheless, there is an unavoidable delay between policy implementation and impact. In parallel, the measure of survival requires follow-up information, adding to the delay in quantifying health benefits. Predictions of cancer survival for cohorts of patients most recently diagnosed could help fill the gap in our knowledge of the likely effects of cancer policies. In this thesis, I modelled the excess hazard of death as a function of predictors available in linked cancer registry data in the UK. These include age, stage and year of diagnosis, levels of deprivation, type of diagnosis, and access to curative treatment. In such contexts, selecting the form of the model, the predictors, the shape of their effects, and potential interactive effects is challenging. Several model selection strategies are compared and their performance assessed in simulations. I provide practical guidelines for the modelling of the excess hazard of death, in particular in relation to cancer lethality, model complexity and impact of model mis-specification. Besides, these multi-variable regression models offer opportunities for predicting cancer-related death rate, for cohorts of patients most recently diagnosed, and for whom follow-up is not yet available. Along with model selection algorithms, I explore strategies based on information criteria and model averaging. Inference is therefore conditional on a pool of models of equivalent support, rather than a uniquely selected model. Advantages include absence of multiple testing, and allowance for model selection uncertainty in inference. Finally, a measure of explained variation, RE, is extended to the relative survival data setting. It is part of the model validation toolkit, and can provide estimates of how much variation in excess mortality due to cancer is explained by the models, and the variables that compose them. There are several methodological assets from the work presented here. First, excess hazard model selection is well formalised. Furthermore, the way RE is adapted to the relative survival data setting will most certainly nurture ideas for the adaptation of other validation tools, commonly used in prognosis research. Lastly, multi-model inference using model averaging is paving the way for the utilisation of ensemble learning in the prediction of excess hazard of death due to cancer. Scenario modelling is a public health application that naturally follows the work done in this PhD thesis. With well-crafted set of predictive models, simulated scenarios can be designed to identify areas for improvement in policy, prevention or treatment. Those generating largest increase in survival can lead to actual recommendations. Methodological advances and public health go hand in hand here. This work emphasises the importance of developing, assessing, and validating excess hazard models. It offers a toolkit so that accurate survival predictions help design effective policies
Summarizing and communicating on survival data according to the audience: a tutorial on different measures illustrated with population-based cancer registry data
No full textAurélien Belot, Aminata Ndiaye, Miguel-Angel Luque-Fernandez, Dimitra-Kleio Kipourou, Camille Maringe, Francisco Javier Rubio, Bernard Rachet Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Abstract: Survival data analysis results are usually communicated through the overall survival probability. Alternative measures provide additional insights and may help in communicating the results to a wider audience. We describe these alternative measures in two data settings, the overall survival setting and the relative survival setting, the latter corresponding to the particular competing risk setting in which the cause of death is unavailable or unreliable. In the overall survival setting, we describe the overall survival probability, the conditional survival probability and the restricted mean survival time (restricted to a prespecified time window). In the relative survival setting, we describe the net survival probability, the conditional net survival probability, the restricted mean net survival time, the crude probability of death due to each cause and the number of life years lost due to each cause over a prespecified time window. These measures describe survival data either on a probability scale or on a timescale. The clinical or population health purpose of each measure is detailed, and their advantages and drawbacks are discussed. We then illustrate their use analyzing England population-based registry data of men 15–80 years old diagnosed with colon cancer in 2001–2003, aiming to describe the deprivation disparities in survival. We believe that both the provision of a detailed example of the interpretation of each measure and the software implementation will help in generalizing their use. Keywords: survival, competing risks, relative survival setting, conditional survival, restricted mean survival time, net survival, crude probability of death, number of life years los
Breast Cancer Screening and Impact on Cancer Outcomes in Kuwait
No full textThe Kuwait National Mammography Screening Programme (KNMSP) was launched in 2014 to address the increasing burden of breast cancer (BC) among women. Screening uptake seems however to remain low. The overarching aim of this thesis is to provide a comprehensive picture of the BC screening situation in Kuwait to improve screening strategies, reduce advanced BC stages, and improve BC outcomes for women in Kuwait.
To achieve that, population-based cancer registry data were linked to KNMSP screening data and other mammography data from governmental hospital services. Other data sources were used to provide information on socio-demographic characteristics and vital status of women. The first specific aim was to estimate the BC screening uptake, overall and according to associated factors, using a generalised linear model with a negative binomial distribution. In the second specific aim, a multinomial logistic regression was applied to estimate the impact of screening engagement on stage at diagnosis among Kuwaiti and non-Kuwaiti women. The complete-case analyses were complemented with multiple imputation and sensitivity analyses. Finally, net survival by BC screening engagement was estimated using the consistent non-parametric Pohar-Perme estimator.
The first study highlights persistently low BC screening uptakes among both Kuwaiti and non-Kuwaiti women. Even though uptake varies according to socio-demographic and geographic factors, the overall screening uptakes are too low to have any significant impact at population level.
The second study finds a strong association between engagement in screening and lower odds of advanced-stage BC diagnosis in both Kuwaiti and non-Kuwaiti women.
The third study shows the association of higher screening engagement with improved survival outcomes among BC patients, even after correcting for potential lead-time bias.
Major changes to the KNMSP are urgently needed if it is to have a significant impact on BC survival. Targeted awareness campaigns and invited screenings are key to improving participation in the BC screening programm
Using Discrete Choice Modelling in the Marketing of Higher Education in the North East of England
No full textSince 1952 students at English universities have received grants towards covering the cost of their university education. Nevertheless, in September 1998, students for the first time were expected to contribute towards the cost of their undergraduate education in the form of tuition fees. More recently, the student contribution has increased to the point where in 2012 students will be paying a major contribution to their undergraduate tuition fees and by many people may be considered as ‘customers’ of education.
The aim of this marketing thesis is to investigate how ‘Discrete Choice Experiments’ provide an alternative approach within consumer behaviour theory to estimating course level decision making in English Higher Education. To do this, it introduces the marketisation of the English Higher Education sector, and explores the consumer behaviour literature in the areas of student choice and consumer reservation price. Whilst the attributes that influence student choice of university have been explored, explicit research has failed to use discrete choice theory to examine the attributes that influence choice of course. Furthermore, despite the practical importance of knowing how much prospective students would pay for their undergraduate course, there remains limited research into estimating consumer reservation price in the marketing field.
This thesis establishes a preliminary model which provides a greater insight into the attributes and levels that have a significant influence on student choice of course. This model is then used to underpin the primary research conducted within this thesis using a discrete choice experiment. The sample population was Years 12 and 13 students based at two North-east secondary schools. Although the study was restricted to only focusing on the North east of England, findings reveal students are willing to pay more for degree course that have better access to good quality student accommodation and have a higher number of teaching hours. This suggests that universities that offer newly refurbished accommodation and offer greater levels of contact time could justify charging higher fees. Based on the findings of the discrete choice experiment the contributions to theory and methodology of this thesis are the development of a checklist containing the factors to consider when constructing a discrete choice experiment along with the application of a discrete choice experiment contextualised for the English Higher Education sector. Moreover this provides a basis for future discrete choice experiment research in the marketing field
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