710 research outputs found
The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids:answers from the English Longitudinal Study of Ageing (ELSA)
No full textPURPOSE: The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive symptoms over time.METHODS: We examined the longitudinal relationship between HL and depressive symptoms (CES-D) applying dynamic cross-lagged mediation path models. We used the full dataset of participants aged 50-89 years (74,908 person-years), from all eight Waves of the English Longitudinal Study of Ageing (ELSA). Their quality of life (CASP-19) and their wealth were examined as the mediator and moderator of this relationship, respectively. Subgroup analyses investigated differences among those with hearing aids within different models of subjectively and objectively identified HL. All models were adjusted for age, sex, retirement status and social engagement.RESULTS: Socioeconomic position (SEP) influenced the strength of the relationship between HL and depression, which was stronger in the lowest versus the highest wealth quintiles. The use of hearing aids was beneficial for alleviating depressive symptoms. Those in the lowest wealth quintiles experienced a lower risk for depression after the use of hearing aids compared to those in the highest wealth quintiles.CONCLUSION: HL poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities. The early detection of HL and provision of hearing aids may not only promote better-hearing health but could also enhance the psychosocial wellbeing of older adults, particularly those in a lower SEP.</p
Regional patterns and trends of hearing loss in England: evidence from the English longitudinal study of ageing (ELSA) and implications for health policy
No full textBackground: hearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England. The aim of this research was to explore the regional patterns and trends of HL in a representative longitudinal prospective cohort study of the English population aged 50 and over.Methods: we used the full dataset (74,699 person-years) of self-reported hearing data from all eight Waves of the English Longitudinal Study of Ageing (ELSA) (2002–2017). We examined the geographical identifiers of the participants at the Government Office Region (GOR) level and the geographically based Index of Multiple Deprivation (IMD). The primary outcome measure was self-reported HL; it consisted of a merged category of people who rated their hearing as fair or poor on a five-point Likert scale (excellent, very good, good, fair or poor) or responded positively when asked whether they find it difficult to follow a conversation if there is background noise (e.g. noise from a TV, a radio or children playing).Results: a marked elevation in HL prevalence (10.2%) independent of the age of the participants was observed in England in 2002–2017. The mean HL prevalence increased from 38.50 (95%CI 37.37–39.14) in Wave 1 to 48.66 (95%CI 47.11–49.54) in Wave 8. We identified three critical patterns of findings concerning regional trends: the highest HL prevalence among samples with equal means of age was observed in GORs with the highest prevalence of participants in the most deprived (IMD) quintile, in routine or manual occupations and misusing alcohol. The adjusted HL predictions at the means (APMs) showed marked regional variability and hearing health inequalities between Northern and Southern England that were previously unknown.Conclusions: a sociospatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities. The Clinical Commissioning Groups (CCGs) currently responsible for the NHS audiology services in England should not consider HL an inevitable accompaniment of older age; instead, they should incorporate socio-economic factors and modifiable lifestyle behaviours for HL within their spatial patterning in England
Conceptual model of hearing health inequalities (HHI model): a critical interpretive synthesis
No full textHearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and preventthe adverse consequences of hearing loss on people’s health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual’s life span; tackling socioeconomic inequalities throughout the life-course could improve the population’s health, maximizing the opportunity for healthy aging
Our safety blind-spots when using digital health interventions
No full textProblemHearing loss (HL) constitutes a major public health challenge, affecting over 12 million people in the UK. The help-seeking behaviour for HL starts with the self-diagnosis and the initiation of contact with a health provider in primary care. However, little is known about the patterns of diagnosis of HL in primary care and referral to secondary care. Also, the consequences of HL in older adults’ mental health are relatively unknown. We aimed to examine: (a) the accuracy of self-reported measures of hearing difficulty in comparison to objective hearing data, and (b) the relationship between HL and depressive symptoms in later life.ApproachWe used data from the English Longitudinal Study of Ageing (ELSA), which is a large population-based prospective cohort study. We examined cross-sectionally 8,529 individuals that had an assessment in their hearing by both self-reported measures and consented for assessment via a handheld audiometric screening device (HearCheck™ Screener). Multiple logistic regression models examined the validity of self-reported measures of hearing and their potential drivers across different population subgroups. Also, we applied a novel structural equation modelling (SEM) approach to examine the longitudinal association between the HL and clinically significant depressive symptoms of participants (CES Depression Scale), across the 8 Waves of ELSA Dataset.FindingsA large percentage (30.2%) of individuals with HL were not detected by the self-report measure. Statistically significant predictors of misreporting hearing difficulties (while they had objectively measured HL >35dBHL at 3.0kHz, in the better-hearing ear) were: female gender (OR 1.97, 95%CI 1.18-3.28), no educational qualifications (OR 1.37, 95%CI 1.26-2.55), routine/manual occupation (OR 1.43, 95%CI 1.28-2.61), tobacco consumption (OR 1.14, 95%CI 1.08-1.90), harmful use of alcohol (OR 1.13, 95%CI 1.11-2.34), and lack of moderate physical activity (OR 1.25, 95%CI 1.03-1.42). The relative risk for depressive symptoms was higher for those who had reported HL than for those who had not reported HL, ranging from 1.40 (Wave 1) to 1.58 (Wave 8).ConsequencesUp to one-third of adults with HL in England may remain undiagnosed and therefore not referred to ear specialists or given access to hearing aids. People belonging in high-risk groups for HL, such as older and less educated people that face socioeconomic inequalities and adopt an unhealthy lifestyle, are the least likely to be accurately identified. These findings provide novel insights into clinical practice and reinforce the importance of an effective and sustainable HL screening strategy in primary care, for the early detection and intervention for HL in older adults. Importantly, as our findings are consistent with the hypothesis that the early detection of HL could largely prevent or delay the onset of depression, a Primary Health Care approach for hearing health is crucial in maximising wellbeing for people across their life course.Funding acknowledgement: This research was funded by the NIHR Manchester Biomedical Research Centre (PhD Studentship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health
The influence of personal communities on the self-management of medication taking: a wider exploration of medicine work
No full textObjectives There is a lack of focus on the broader social context, networks and influences on medicine-taking as part of illness work. This work adopts a social network approach and seeks to explicate the nature of medicine-taking work that people with multiple long-term conditions (LTCs) and their social network members (SNMs) do in attempting to take their medications on a daily basis, the division of labour amongst these members and when and why SNMs become involved in that work. Methods Semi-structured interviews were conducted with 20 people who had multiple LTCs. Medication networks were constructed and the division of labour in relation to medication-work was explored. Results Four types of medication-work emerged: medication articulation, surveillance, emotional and informational. Involvement of SNMs in medication-work was selective, performed primarily by family members, within the home. Involvement reflected network composition and/or an individual’s conceptualisation/presentation of self. Discussion Our findings support and extend the conceptualisation of routine medicine-taking as a type of work. Furthermore, we illustrate the involvement of SNMs in aspects of medicine-work. Health professionals should explore and support the role of SNMs in medicine-taking where possible. Future research should explore the implications of network types and compositions on medicine-taking and associated work. <br/
The world's longest known parallel temperature dataset: A comparison between daily Glaisher and Stevenson screen temperature data at Adelaide, Australia, 1887–1947
No full textWeather observing stations are subject to changes in instrumentation, location and surrounding environment over time. Parallel observations between old and new conditions are therefore vital to ensure that a reliable dataset can be built and used for long-term climate analysis. Here, we examine the world's longest known sets of parallel temperature observations: daily data for Adelaide, South Australia, recorded using two different thermometer screens for 60 years from 1887 to 1947. These data are globally significant for their length and completeness, but the daily observations in the Glaisher stand have only recently been digitized for analysis. We find maximum temperatures recorded in the Glaisher stand are warmer than the Stevenson screen observations, with the difference increasing with absolute temperature, while minimum temperatures recorded in the Glaisher stand are consistently slightly cooler. These differences are similar to those identified using monthly means, as well as other studies of shorter datasets. However, the daily resolution enabled us to identify periods of inconsistent relationships due to changes in observations times (particularly from 1938 onwards), and quantify the differences during extreme events. In particular, percentile analysis revealed that the differences for extremely high temperatures are only slightly greater than the average difference during the warmer months. The data provide an opportunity to attempt the development of 160-year continuous daily temperature record for one of the oldest colonial cities in the Southern Hemisphere. As expected, we find temperatures in recent decades to be the highest since 1859, although the Glaisher stand maximum temperature data in the 1860s are notably warm, likely due to dry conditions and persistent inhomogeneities. While the relationships we have identified cannot be applied to other 19th century Glaisher stand observations without careful metadata examination, they provide a possible tool for analysis and re-examination of historical midlatitude temperature observations elsewhere around the world.Linden Ashcroft, Blair Trewin, Mac Benoy, Darren Ray, Catherine Courtne
Daily temperature data at Adelaide, Australia taken in a Glaisher thermometer stand (1856–1952) and a homogenised daily temperature dataset for Adelaide (1856–2019)
No full text23000_Adelaide_Glaisherstand_Tx_data.tsv and 23000_Adelaide_Glaisherstand_Tn_data.tsv: Daily maximum and minimum temperature observations for Adelaide,South Australia, taken in a Glaisher thermometer stand from November 1856 to July 1947. Data are given in Station Exchange Format (SEF, https://github.com/C3S-Data-Rescue-Lot1-WP3/SEF/wiki).
23000_combined_homogenised_data.tsv: A homogenised daily temperature dataset for Adelaide, South Australia, from January 1859 to December 2019. Data are provided in the format Year, Month, Day, Maximum temperature (degrees Celcius), Minimum temperature (degrees Celcius).
Images of the data source for File 1 are available from the Australian Meteorological Association at https://www.met-acre.net/MERIT/AMETA.html.
The data are shared under Attribution-NonCommercial 4.0 International licence (CC BY-NC 4.0)Full details of the dataset development are provided in Ashcroft, L., Trewin, B., Benoy, M., Ray, D., and Courtney, C. The world's longest known parallel temperature dataset: A comparison between daily Glaisher and Stevenson screen temperature data at Adelaide, Australia, 1887–1947, International Journal of Climatology, 2021, DOI: 10.1002/joc.7385
Correction: Three Early Formal Approaches to the Verification of Concurrent Programs
No full text\ua9 The Author(s) 2025.In the paragraph beginning ‘Manna and Ashcroft concede that…’ under section ‘Ashcroft and Manna (Stanford 1969/1970)’ in this article, the formula ‘(m + n)!/(m! + n!)’ should have read ‘(m + n)!/(m! * n!)’. The original article has been corrected
Recognizing the complexities of co-prescriptions and life-stylefactors in opioid agonist treatment: A response from EleniDomzaridou, Matthew J. Carr, Tim Millar, Roger T. Webb and Darren M. Ashcroft
No full textApplying quantitative methods in the assessment of outcomes of pharmacotherapy of psoriasis
No full textHealthcare providers and policy makers are faced with an ever-increasing number of medical publications. Searching for relevant information and keeping up to date with new research findings remains a constant challenge. It has been widely acknowledged that narrative reviews of the literature are susceptible to several types of bias and a systematic approach may protect against these biases. The aim of this thesis was to apply quantitative methods in the assessment of outcomes of topical therapies for psoriasis. In particular, to systematically examine the comparative efficacy, tolerability and cost-effectiveness of topical calcipotriol in the treatment of mild-to-moderate psoriasis. Over the years, a wide range of techniques have been used to evaluate the severity of psoriasis and the outcomes from treatment. This lack of standardisation complicates the direct comparison of results and ultimately the pooling of outcomes from different clinical trials. There is a clear requirement for more comprehensive tools for measuring drug efficacy and disease severity in psoriasis. Ideally, the outcome measures need to be simple, relevant, practical, and widely applicable, and the instruments should be reliable, valid and responsive. The results of the meta-analysis reported herein show that calcipotriol is an effective antipsoriatic agent. In the short-tenn, the pooled data found calcipotriol to be more effective than calcitriol, tacalcitol, coal tar and short-contact dithranol. Only potent corticosteroids appeared to have comparable efficacy, with less short-term side-effects. Potent corticosteroids also added to the antipsoriatic effect of calcipotriol, and appeared to suppress the occurrence of calcipotriol-induced irritation. There was insufficient evidence to support any large effects in favour of improvements in efficacy when calcipotriol is used in combination with systemic therapies in patients with severe psoriasis. However, there was a total absence of long-term morbidity data on the effectiveness of any of the interventions studied. Decision analysis showed that, from the perspective of the NHS as payer, the relatively small differences in efficacy between calcipotriol and short-contact dithranol lead to large differences in the direct cost of treating patients with mildto-moderate plaque psoriasis. Further research is needed to examine the clinical and economic issues affecting patients under treatment for psoriasis in the UK. In particular, the maintenance value and cost/benefit ratio for the various treatment strategies, and the assessment of patient's preferences has not yet been adequately addressed for this chronic recurring disease
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