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Ferentinos P, Snape D, Koivula F, Faustini S, Nicholson-Little A, Stacey M, Gifford R, Parsons I, Lamb L, Greeves J, O'Hara J, Cunningham AF, Woods D, Richter A, O'Shea MK. Validation of dried blood spot sampling for detecting SARS-CoV-2 antibodies and total immunoglobulins in a large cohort of asymptomatic young adults. J Immunol Methods 2023; 518:113492. [PMID: 37201783 DOI: 10.1016/j.jim.2023.113492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Detecting antibody responses following infection with SARS-CoV-2 is necessary for sero-epidemiological studies and assessing the role of specific antibodies in disease, but serum or plasma sampling is not always viable due to logistical challenges. Dried blood spot sampling (DBS) is a cheaper, simpler alternative and samples can be self-collected and returned by post, reducing risk for SARS-CoV-2 exposure from direct patient contact. The value of large-scale DBS sampling for the assessment of serological responses to SARS-CoV-2 has not been assessed in depth and provides a model for examining the logistics of using this approach to other infectious diseases. The ability to measure specific antigens is attractive for remote outbreak situations where testing may be limited or for patients who require sampling after remote consultation. METHODS We compared the performance of SARS-CoV-2 anti-spike and anti-nucleocapsid antibody detection from DBS samples with matched serum collected by venepuncture in a large population of asymptomatic young adults (N = 1070) living and working in congregate settings (military recruits, N = 625); university students, N = 445). We also compared the effect of self-sampling (ssDBS) with investigator-collected samples (labDBS) on assay performance, and the quantitative measurement of total IgA, IgG and IgM between DBS eluates and serum. RESULTS Baseline seropositivity for anti-Spike IgGAM antibody was significantly higher among university students than military recruits. Strong correlations were observed between matched DBS and serum samples in both university students and recruits for the anti-spike IgGAM assay. Minimal differences were found in results by ssDBS and labDBS and serum by Bland Altman and Cohen kappa analyses. LabDBS achieved 82.0% sensitivity and 98.2% specificity and ssDBS samples 86.1% sensitivity and 96.7% specificity for detecting anti-Spike IgGAM antibodies relative to serum samples. For anti-SARS-CoV-2 nucleocapsid IgG there was qualitatively 100% agreement between serum and DBS samples and weak correlation in ratio measurements. Strong correlations were observed between serum and DBS-derived total IgG, IgA, and IgM. CONCLUSIONS This is the largest validation of DBS against paired serum for SARS-CoV-2 specific antibody measurement and we have shown that DBS retains performance from prior smaller studies. There were no significant differences regarding DBS collection methods, suggesting that self-collected samples are a viable sampling collection method. These data offer confidence that DBS can be employed more widely as an alternative to classical serology.
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Affiliation(s)
- P Ferentinos
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - D Snape
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - F Koivula
- Department of Army Health and Performance Research, Andover, Hampshire, UK
| | - S Faustini
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - A Nicholson-Little
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - M Stacey
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - R Gifford
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - I Parsons
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - L Lamb
- Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Greeves
- Department of Army Health and Performance Research, Andover, Hampshire, UK
| | - J O'Hara
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - A F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - D Woods
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Richter
- Clinical Immunology Service, University of Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - M K O'Shea
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
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Noble AJ, Snape D, Nevitt S, Holmes EA, Morgan M, Tudur-Smith C, Hughes DA, Buchanan M, McVicar J, MacCallum E, Goodacre S, Ridsdale L, Marson AG. Seizure First Aid Training For people with Epilepsy (SAFE) frequently attending emergency departments and their significant others: results of a UK multi-centre randomised controlled pilot trial. BMJ Open 2020; 10:e035516. [PMID: 32303515 PMCID: PMC7201300 DOI: 10.1136/bmjopen-2019-035516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE). DESIGN Pilot RCT with embedded microcosting. SETTING Three English hospital emergency departments (EDs). PARTICIPANTS Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs). INTERVENTIONS Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course. MAIN OUTCOME MEASURES Two criteria evaluated a definitive RCT's feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE's effect and intervention cost. RESULTS Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months. CONCLUSIONS In satisfying only one predetermined 'stop/go' criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial's finding's external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population. TRIAL REGISTRATION NUMBER ISRCTN13871327.
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Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Dee Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Mark Buchanan
- Emergency Department, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Jane McVicar
- MacKinnon Memorial Hospital / Broadford Hospital, NHS Highland, Broadford, Isle of Skye, UK
| | - Elizabeth MacCallum
- Emergency Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Gradinger F, Britten N, Wyatt K, Froggatt K, Gibson A, Jacoby A, Lobban F, Mayes D, Snape D, Rawcliffe T, Popay J. Values associated with public involvement in health and social care research: a narrative review. Health Expect 2015; 18:661-75. [PMID: 24325553 PMCID: PMC5060838 DOI: 10.1111/hex.12158] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Much has been written about public involvement (PI) in health and social care research, but underpinning values are rarely made explicit despite the potential for these to have significant influence on the practice and assessment of PI. OBJECTIVE The narrative review reported here is part of a larger MRC-funded study which is producing a framework and related guidance on assessing the impact of PI in health and social care research. The review aimed to identify and characterize the range of values associated with PI that are central elements of the framework. METHODS We undertook a review and narrative synthesis of diverse literatures of PI in health and social care research, including twenty existing reviews and twenty-four chapters in sixteen textbooks. RESULTS Three overarching value systems were identified, each containing five value clusters. (i) A system concerned with ethical and/or political issues including value clusters associated with empowerment; change/action; accountability/transparency; rights; and ethics (normative values). (ii). A system concerned with the consequences of public involvement in research including value clusters associated with effectiveness; quality/relevance; validity/reliability; representativeness/objectivity/generalizability; and evidence (substantive values). (iii) A system concerned with the conduct of public involvement in including value clusters associated with Partnership/equality; respect/trust; openness and honesty; independence; and clarity (process values). CONCLUSION Our review identified three systems associated with PI in health and social care research focused on normative, substantive and process values. The findings suggest that research teams should consider and make explicit the values they attach to PI in research and discuss ways in which potential tensions may be managed in order to maximize the benefits of PI for researchers, lay experts and the research.
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Affiliation(s)
| | - Nicky Britten
- Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | - Katrina Wyatt
- Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | - Katherine Froggatt
- Division of Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Andy Gibson
- Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | - Ann Jacoby
- Public Health and PolicyInstitute of Psychology, Health & SocietyUniversity of LiverpoolLiverpoolUK
| | - Fiona Lobban
- Division of Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Debbie Mayes
- Division of Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - Dee Snape
- Public Health and PolicyInstitute of Psychology, Health & SocietyUniversity of LiverpoolLiverpoolUK
| | - Tim Rawcliffe
- Lancashire Care NHS Foundation TrustMental Health Research NetworkNorth West HubPrestonUK
| | - Jennie Popay
- Division of Health ResearchFaculty of Health and MedicineLancaster UniversityLancasterUK
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Jacoby A, Snape D, Lane S, Baker GA. Self-reported anxiety and sleep problems in people with epilepsy and their association with quality of life. Epilepsy Behav 2015; 43:149-58. [PMID: 25599986 DOI: 10.1016/j.yebeh.2014.09.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/28/2022]
Abstract
Comorbidities are common in epilepsy, and their role in quality of life (QOL) is receiving increasing scrutiny. Considerable attention has been focused on the role of depression, the most common comorbidity, with rather less attention paid to its frequent concomitant, anxiety, and other conditions known to be at increased prevalence among people with epilepsy (PWE) when compared to the general population. In this paper, we report findings from a UK-based survey in which we examined self-reporting of two common comorbidities, anxiety and sleep problems, factors associated with them, and their role in QOL in people with and without epilepsy. Data were obtained via mailed questionnaires, supplemented by an internet survey, from PWE and age- and gender-matched controls. Based on self-reported symptoms, PWE were at higher risk of anxiety and sleep problems. Contributory factors for anxiety included poorer general health, worry about seizures, and self-reported antiepileptic drug (AED) side effects. Good social support emerged as protective for anxiety in PWE. Nighttime sleep problems were very common even in controls but were further elevated in PWE. Antiepileptic drug adverse events emerged as an important contributory factor for sleep problems. Trait anxiety emerged as significant for defining overall QOL, and its importance over state anxiety supports the notion of anxiety in PWE as a primarily premorbid condition. In contrast, sleep quality was not consistently predictive of QOL. Our study has important implications for clinical management, emphasizing the need for a holistic approach to address wider patient-reported problems as well as any epilepsy-specific ones.
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Affiliation(s)
- Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, UK.
| | - Dee Snape
- Department of Public Health and Policy, University of Liverpool, UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, UK
| | - Gus A Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
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Snape D, Kirkham J, Britten N, Froggatt K, Gradinger F, Lobban F, Popay J, Wyatt K, Jacoby A. Exploring perceived barriers, drivers, impacts and the need for evaluation of public involvement in health and social care research: a modified Delphi study. BMJ Open 2014; 4:e004943. [PMID: 24939808 PMCID: PMC4067891 DOI: 10.1136/bmjopen-2014-004943] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore areas of consensus and conflict in relation to perceived public involvement (PI) barriers and drivers, perceived impacts of PI and ways of evaluating PI approaches in health and social care research. BACKGROUND Internationally and within the UK the recognition of potential benefits of PI in health and social care research is gathering momentum and PI is increasingly identified by organisations as a prerequisite for funding. However, there is relatively little examination of the impacts of PI and how those impacts might be measured. DESIGN Mixed method, three-phase, modified Delphi technique, conducted as part of a larger MRC multiphase project. SAMPLE Clinical and non-clinical academics, members of the public, research managers, commissioners and funders. FINDINGS This study found high levels of consensus about the most important barriers and drivers to PI. There was acknowledgement that tokenism was common in relation to PI; and strong support for the view that demonstrating the impacts and value of PI was made more difficult by tokenistic practice. PI was seen as having intrinsic value; nonetheless, there was clear support for the importance of evaluating its impact. Research team cohesion and appropriate resources were considered essential to effective PI implementation. Panellists agreed that PI can be challenging, but can be facilitated by clear guidance, together with models of good practice and measurable standards. CONCLUSIONS This study is the first to present empirical evidence of the opinions voiced by key stakeholders on areas of consensus and conflict in relation to perceived PI barriers and drivers, perceived impacts of PI and the need to evaluate PI. As such it further contributes to debate around best practice in PI, the potential for tokenism and how best to evaluate the impacts of PI. These findings have been used in the development of the Public Involvement Impact Assessment Framework (PiiAF), an online resource which offers guidance to researchers and members of the public involved in the PI process.
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Affiliation(s)
- D Snape
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - J Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - N Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - K Froggatt
- Division of Health Research, Lancaster University, Lancaster, UK
| | - F Gradinger
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - F Lobban
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, UK
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Snape D, Kirkham J, Preston J, Popay J, Britten N, Collins M, Froggatt K, Gibson A, Lobban F, Wyatt K, Jacoby A. Exploring areas of consensus and conflict around values underpinning public involvement in health and social care research: a modified Delphi study. BMJ Open 2014; 4:e004217. [PMID: 24413356 PMCID: PMC3902382 DOI: 10.1136/bmjopen-2013-004217] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE There is growing interest in the potential benefits of public involvement (PI) in health and social care research. However, there has been little examination of values underpinning PI or how these values might differ for different groups with an interest in PI in the research process. We aimed to explore areas of consensus and conflict around normative, substantive and process-related values underpinning PI. DESIGN Mixed method, three-phase, modified Delphi study, conducted as part of a larger multiphase project. SETTING The UK health and social care research community. PARTICIPANTS Stakeholders in PI in research, defined as: clinical and non-clinical academics, members of the public, research managers, commissioners and funders; identified via research networks, online searches and a literature review. RESULTS We identified high levels of consensus for many normative, substantive and process-related issues. However, there were also areas of conflict in relation to issues of bias and representativeness, and around whether the purpose of PI in health and social care research is to bring about service change or generate new knowledge. There were large differences by group in the percentages endorsing the ethical justification for PI and the argument that PI equalises power imbalances. With regard to practical implementation of PI, research support infrastructures were reported as lacking. Participants reported shortcomings in the uptake and practice of PI. Embedding PI practice and evaluation in research study designs was seen as fundamental to strengthening the evidence base. CONCLUSIONS Our findings highlight the extent to which PI is already embedded in research. However, they also highlight a need for 'best practice' standards to assist research teams to understand, implement and evaluate PI. These findings have been used in developing a Public Involvement Impact Assessment Framework (PiiAF), which offers guidance to researchers and members of the public involved in the PI process.
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Affiliation(s)
- D Snape
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Guo W, Wu J, Wang W, Guan B, Snape D, Baker GA, Jacoby A. The stigma of people with epilepsy is demonstrated at the internalized, interpersonal and institutional levels in a specific sociocultural context: findings from an ethnographic study in rural China. Epilepsy Behav 2012; 25:282-8. [PMID: 23059066 PMCID: PMC3508429 DOI: 10.1016/j.yebeh.2012.08.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 11/24/2022]
Abstract
Epilepsy is a common chronic neurological disease. One of its characteristics is that it can bring severe stigma for patients. At the same time as controlling the epileptic seizures, taking appropriate measures to reduce the stigma of epilepsy is an important aspect of any comprehensive intervention strategy. We examined the views of 106 participants of different target groups, including patients with epilepsy (PWE), their family members, neighbors, teachers, employers, community administrators, doctors and nurses, using one-to-one in-depth interviews and group discussions. The discussions covered the following aspects related to epilepsy: the participants' understanding of epilepsy, the patients' own perception of epilepsy, attitudes of the surrounding people, the social and cultural environment, social support available to them, and government regulations and policies. We found that the stigma of epilepsy is a very negative self-feeling from the patients' perspective. Many complex and diverse factors determine its formation and severity. The stigma of epilepsy, in a particular social and cultural context, can be demonstrated at the internalized, interpersonal and institutional levels. Hence, we suggest that effective measures to alleviate stigma should be based on ways of eliminating factors that cause institutional stigma. Additionally, depending on the specific circumstances of PWE, a personalized approach to eliminate factors that cause internalized and interpersonal stigma needs to be adopted. Only by addressing impacting factors at each of these three levels can the stigma of PWE in China be alleviated or even eliminated.
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Affiliation(s)
- Wencui Guo
- Beijing Taintan Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Jianzhong Wu
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Biyan Guan
- Beijing Taintan Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Dee Snape
- Department of Public Health & Policy University of Liverpool, Liverpool, UK
| | - Gus A Baker
- Division of Neurosciences University of Liverpool, Liverpool, UK
| | - Ann Jacoby
- Department of Public Health & Policy University of Liverpool, Liverpool, UK,Corresponding author. Address: Division of Public Health & Policy, University Of Liverpool, Whelan Building, 3rd Floor, The Quadrangle, Brownlow Hill, Liverpool, UK L69 3GB. Fax:+44 151 794 5588. (A. Jacoby)
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Gamble C, Nadel S, Snape D, McKay A, Hickey H, Williamson P, Glennie L, Snowdon C, Young B. What parents of children who have received emergency care think about deferring consent in randomised trials of emergency treatments: postal survey. PLoS One 2012; 7:e35982. [PMID: 22586456 PMCID: PMC3346812 DOI: 10.1371/journal.pone.0035982] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 03/28/2012] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate parents’ views about deferred consent to inform management of trial disclosure after a child’s death. Methods A postal questionnaire survey was sent to members of the Meningitis Research Foundation UK charity, whose child had suffered from bacterial meningitis or meningococcal septicaemia within the previous 5 years. Main outcome measures were acceptability of deferred consent; timing of requesting consent; and the management of disclosure of the trial after a child’s death. Results 220 families were sent questionnaires of whom 63 (29%) were bereaved. 68 families responded (31%), of whom 19 (28%) were bereaved. The majority (67%) was willing for their child to be involved in the trial without the trial being explained to them beforehand; 70% wanted to be informed about the trial as soon as their child’s condition had stabilised. In the event of a child’s death before the trial could be discussed the majority of bereaved parents (66% 12/18) anticipated wanting to be told about the trial at some time. This compared with 37% (18/49) of non-bereaved families (p = 0.06). Parents’ free text responses indicated that the word ‘trial’ held strongly negative connotations. A few parents regarded gaps in the evidence base about emergency treatments as indicating staff lacked expertise to care for a critically ill child. Bereaved parents’ free text responses indicated the importance of individualised management of disclosure about a trial following a child’s death. Discussion Deferred consent is acceptable to the majority of respondents. Parents whose children had recovered differed in their views compared to bereaved parents. Most bereaved parents would want to be informed about the trial in the aftermath of a child’s death, although a minority strongly opposed such disclosure. Distinction should be drawn between the views of bereaved and non-bereaved parents when considering the acceptability of different consent processes.
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Affiliation(s)
- Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, United Kingdom.
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Mulhern B, Rowen D, Jacoby A, Marson T, Snape D, Hughes D, Latimer N, Baker GA, Brazier JE. The development of a QALY measure for epilepsy: NEWQOL-6D. Epilepsy Behav 2012; 24:36-43. [PMID: 22503427 DOI: 10.1016/j.yebeh.2012.02.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/24/2012] [Accepted: 02/26/2012] [Indexed: 10/28/2022]
Abstract
Cost-utility analysis is used to inform the allocation of healthcare resources, using the quality-adjusted life year (QALY) as the outcome measure. We report the development of an epilepsy-specific QALY measure (NEWQOL-6D) derived from the NEWQOL measure of health-related quality of life. Firstly, psychometric and Rasch analyses established the dimension structure of NEWQOL and generated a reduced health state classification system including one item per dimension. Secondly, health states generated by the classification system were valued using Time Trade Off, and the results were modeled to generate a utility score for every health state. A classification system with 6 dimensions (worry about attacks; depression; memory; concentration; stigma; control) was produced, and generalized least squares regression was used to generate utility scores for every health state. This study is the first attempt to derive an epilepsy-specific QALY measure, and the utility values can be used in the economic evaluation of emerging technologies for epilepsy.
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Affiliation(s)
- Brendan Mulhern
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Yang R, Wang W, Snape D, Chen G, Zhang L, Wu J, Baker GA, Zheng X, Jacoby A. Stigma of people with epilepsy in China: views of health professionals, teachers, employers, and community leaders. Epilepsy Behav 2011; 21:261-6. [PMID: 21606005 PMCID: PMC3127044 DOI: 10.1016/j.yebeh.2011.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 11/24/2022]
Abstract
To identify possible sources of stigma of epilepsy in key informant groups, "mini-ethnographic" studies were conducted in rural and urban locations in China. Data collected from 45 semistructured interviews and 8 focus group discussions (6 persons each) were analyzed to investigate the world experienced by people with epilepsy. Underpinned by a social constructionist approach to data analysis, emerging themes were identified with the use of computer-assisted data analysis (NVivo 8). A hierarchical model was then constructed, to include practical level issues (attitudes toward risk, attitudes toward costs of epilepsy) and cultural level issues (contrast between rurality and tradition and urbanization and modernity in the Chinese context). The analysis enriches current research on factors and sources of stigma of epilepsy and highlights issues for future practice.
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Affiliation(s)
- Rongrong Yang
- Institute of Population Research, Peking University, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Dee Snape
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Gong Chen
- Institute of Population Research, Peking University, China
| | - Lei Zhang
- Institute of Population Research, Peking University, China
| | | | - Gus A Baker
- Division of Neurosciences, University of Liverpool, UK
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, China,Corresponding Authors, Xiaoying Zheng, PhD, MD, Institute of Population Research/WHO Collaborating Centre, Peking University, Beijing 100871, China, , Telephone: 0086 10 62759185, Facsimile: 0086 10 62751974, Ann Jacoby, PhD, Department of Health Inequalities and the Social Determinants of Health, Institute of Psychology, Health and Society, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, UK, L69 3GB, , Telephone: 0044 151 794 5602/5943, Facsimile: 0044 151 794 5588
| | - Ann Jacoby
- Institute of Psychology, Health and Society, University of Liverpool, UK,Corresponding Authors, Xiaoying Zheng, PhD, MD, Institute of Population Research/WHO Collaborating Centre, Peking University, Beijing 100871, China, , Telephone: 0086 10 62759185, Facsimile: 0086 10 62751974, Ann Jacoby, PhD, Department of Health Inequalities and the Social Determinants of Health, Institute of Psychology, Health and Society, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, UK, L69 3GB, , Telephone: 0044 151 794 5602/5943, Facsimile: 0044 151 794 5588
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Aydemir N, Trung DV, Snape D, Baker GA, Jacoby A. Multiple impacts of epilepsy and contributing factors: findings from an ethnographic study in Vietnam. Epilepsy Behav 2009; 16:512-20. [PMID: 19800851 PMCID: PMC2811872 DOI: 10.1016/j.yebeh.2009.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/04/2009] [Accepted: 09/06/2009] [Indexed: 11/19/2022]
Abstract
We investigated issues related to treatment, impact of epilepsy, attitudes toward epilepsy, and disclosure in Vietnam through in-depth interviews with people with epilepsy (PWE) and their family members. We found that although participants prefer Western to traditional treatment, they experience problems in accessing different kinds of antiepileptic drugs and higher-level treatment facilities and with respect to treatment expenses. The impact of epilepsy can be observed in a wide range of daily living activities which include working, education, marriage, and family formation. Although both families and society at large do not hold negative attitudes toward epilepsy, most PWE reported a sense of burden to others. Both PWE and family members generally prefer disclosing epilepsy rather than concealing it from others. Our findings strongly suggest a need in Vietnam for different types of antiepileptic drugs and epilepsy support information for PWE, family members, and the general public.
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Affiliation(s)
- Nuran Aydemir
- Department of Psychology, Izmir University of Economics, Turkey
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Snape D, Wang W, Wu J, Jacoby A, Baker GA. Knowledge gaps and uncertainties about epilepsy: findings from an ethnographic study in China. Epilepsy Behav 2009; 14:172-8. [PMID: 18952003 DOI: 10.1016/j.yebeh.2008.09.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/23/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022]
Abstract
Epilepsy represents one of the major brain disorders worldwide. In China, research into how much people with epilepsy know about their condition appears limited. Drawing on data collected as part of a large ethnographic study, we present the experiences and views of Chinese people with epilepsy and their family members, to identify knowledge gaps and uncertainties about epilepsy within selected urban and rural communities. We also examine how respondents' demographic characteristics influence their knowledge, understanding, and beliefs about epilepsy. We found knowledge and understanding of epilepsy to be uneven and context specific. Hereditary factors were most frequently cited as a potential cause, although their impact remained unclear. Western medicalization of epilepsy appears less evident in the reports of rural informants, where traditional beliefs continue to shape definitions and treatment. Societal differences within these communities set boundaries on knowledge acquisition. Plotted against these differences, we suggest strategies for proposed educational/psychosocial intervention programs.
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Affiliation(s)
- D Snape
- University Department of Public Health, Liverpool, UK
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Abstract
Health promotion is an important part of the work of a wide range of healthcare professionals. The United Kingdom Central Council (UKCC 1983) states that education is a statutory responsibility and one of the most important and challenging aspects of the nurse's role. The nurse has a professional as well as a moral responsibility to educate for health as well as to care for the sick (UKCC 1994).
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Ritchie E, Snape D, Taylor WC. Chemical Studies of the Myrtaceae. III. Triterpenoids from the Wood of Tristania conferta R.Br. Aust J Chem 1961. [DOI: 10.1071/ch9610471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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