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Clarke EN, Norman P, Thompson AR. Online compassion-based self-help for depression in people with skin conditions: a feasibility study. Pilot Feasibility Stud 2024; 10:63. [PMID: 38627850 PMCID: PMC11020170 DOI: 10.1186/s40814-024-01486-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND There is a need to develop psychological interventions for depression in people with skin conditions. This study aimed to investigate the acceptability, feasibility, and effects of an online compassion-based self-help intervention for depression in people with skin conditions. METHODS Adult participants (n = 34) with skin conditions and mild-moderate depressive symptoms were invited to undertake a six-week, compassion-based online intervention for depression with email support. Engagement with the intervention was monitored, along with time spent facilitating the intervention, and participant feedback was collected each week and post-intervention. Pre-post changes in depression, self-compassion and dermatological quality of life were also assessed. RESULTS The intervention was started by 25 participants and completed by 13. Feedback scores indicated that the website was evaluated positively and that the sessions had positive impacts on participants. Participants appreciated the skin-specific aspects of the intervention but varied as to which of the compassion-based exercises they found helpful. The online intervention was feasible to provide and facilitate, and treatment completers showed improvements in depression, quality of life and self-compassion. CONCLUSIONS The online compassion-based intervention holds promise as a treatment for depression in people with skin conditions. Recommendations are made for future research and further development of the intervention. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov on 21 October 2019, NCT04132973.
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Affiliation(s)
- Elaine N Clarke
- Department of Psychology, Sociology & Politics, Sheffield Hallam University, Heart of the Campus, Collegiate Crescent, Sheffield, S10 2BP, UK.
- Department of Psychology, University of Sheffield, Sheffield, UK.
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew R Thompson
- Department of Psychology, University of Sheffield, Sheffield, UK
- School of Psychology, Cardiff University, Cardiff, UK
- Cardiff and Vale University Health Board, Cardiff, UK
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Ahmadzadeh B, Patey C, Hurley O, Knight J, Norman P, Farrell A, Czarnuch S, Asghari S. Applications of Artificial Intelligence in Emergency Departments to Improve Wait Times: Protocol for an Integrative Living Review. JMIR Res Protoc 2024; 13:e52612. [PMID: 38607662 DOI: 10.2196/52612] [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: 09/13/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Long wait times in the emergency department (ED) are a major issue for health care systems all over the world. The application of artificial intelligence (AI) is a novel strategy to reduce ED wait times when compared to the interventions included in previous research endeavors. To date, comprehensive systematic reviews that include studies involving AI applications in the context of EDs have covered a wide range of AI implementation issues. However, the lack of an iterative update strategy limits the use of these reviews. Since the subject of AI development is cutting edge and is continuously changing, reviews in this area must be frequently updated to remain relevant. OBJECTIVE This study aims to provide a summary of the evidence that is currently available regarding how AI can affect ED wait times; discuss the applications of AI in improving wait times; and periodically assess the depth, breadth, and quality of the evidence supporting the application of AI in reducing ED wait times. METHODS We plan to conduct a living systematic review (LSR). Our strategy involves conducting continuous monitoring of evidence, with biannual search updates and annual review updates. Upon completing the initial round of the review, we will refine the search strategy and establish clear schedules for updating the LSR. An interpretive synthesis using Whittemore and Knafl's framework will be performed to compile and summarize the findings. The review will be carried out using an integrated knowledge translation strategy, and knowledge users will be involved at all stages of the review to guarantee applicability, usability, and clarity of purpose. RESULTS The literature search was completed by September 22, 2023, and identified 17,569 articles. The title and abstract screening were completed by December 9, 2023. In total, 70 papers were eligible. The full-text screening is in progress. CONCLUSIONS The review will summarize AI applications that improve ED wait time. The LSR enables researchers to maintain high methodological rigor while enhancing the timeliness, applicability, and value of the review. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52612.
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Affiliation(s)
- Bahareh Ahmadzadeh
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christopher Patey
- Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Oliver Hurley
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - John Knight
- Data and Information Services, Digital Health, NL Health Services, St. John's, NL, Canada
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Paul Norman
- Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Stephen Czarnuch
- Department of Electrical and Computer Engineering, Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, NL, Canada
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Hines SA, Morin AJS, Norman P, Read JP, O'Connor RM. Development and validation of the perceived approval of Risky Drinking Inventory in undergraduate students. Psychol Addict Behav 2024:2024-48815-001. [PMID: 38300536 DOI: 10.1037/adb0000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Undergraduates frequently engage in risky drinking (i.e., drinking alcohol in ways that may result in problems). The reasoned action approach identifies injunctive norms (i.e., perceptions that others approve of risky drinking) as central in predicting engagement in risky drinking. However, research linking injunctive norms and risky drinking is equivocal, possibly because of extensive variability in the operationalization of injunctive norms across studies. This study describes the development and validation of the Perceived Approval of Risky Drinking Inventory (PARDI), designed according to best practice guidelines in questionnaire development. METHOD Undergraduate students (N = 1,313) participated in one of the three phases of data collection, including focus group interviews for item generation (n = 31), self-report questionnaires for scale refinement (n = 407), and self-report questionnaires for scale validation (n = 875). RESULTS Exploratory and confirmatory factor analyses supported a 20-item four-factor solution (Heavy Drinking, Drinking-Related Problems, Coping-Related Drinking, and Sexual-Risk Taking) across the three assessed referent groups (friends, parents, and typical students), all of which present satisfactory estimates of scale score and composite reliability. The results also provided preliminary support for the convergent validity of scores obtained on the PARDI, as demonstrated through correlations with other measures of perceived norms, alcohol use, alcohol-related problems, and coping-motivated drinking. Finally, the results supported the generalizability of the PARDI factor structure by demonstrating its measurement invariance across gender and drinking status (i.e., alcohol use and problems). CONCLUSIONS The PARDI represents a reliable, valid, yet nuanced measure of injunctive norms that can be used to support further theory development and intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | - Paul Norman
- Department of Psychology, University of Sheffield
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Conner M, Wilding S, Norman P. Does Intention Strength Moderate the Intention-Health Behavior Relationship for Covid-19 Protection Behaviors? Ann Behav Med 2024; 58:92-99. [PMID: 37874734 PMCID: PMC10831218 DOI: 10.1093/abm/kaad062] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The present research tests whether intention strength moderates intention-health behavior relations and the extent to which this is accounted for by the moderating effects of intention stability, goal priority, and goal conflict. METHODS In a prospective multi-behavior study, a representative sample of UK adults (N = 503) completed measures of past behavior, intention, intention strength, goal priority, and goal conflict in relation to eight Covid-19 protection behaviors at time 1. Intention and self-reported behavior were assessed at time 2 (2 months later). Intention stability was assessed over 2 months. RESULTS Intention strength was a significant moderator of the intention-behavior relationship (controlling for past behavior). Controlling for the moderating effects of intention stability attenuated the moderating effect of intention strength, while also controlling for the moderating effects of goal priority and goal conflict reduced the moderating effects of intention strength to nonsignificance. CONCLUSIONS The present findings indicate that intention strength is a significant moderator of the intention-health behavior relationship. They also suggest that the moderating effect of intention strength is explained by effects on intention stability, goal priority, and goal conflict. Tests of interventions to manipulate intention strength as a means to strengthen intention stability and intention-behavior relations are warranted.
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Affiliation(s)
- Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
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St Quinton T, Morris B, Lithopoulos A, Norman P, Conner M, Rhodes RE. Self-efficacy and alcohol consumption: Are efficacy measures confounded with motivation? Cogent Psychology 2023. [DOI: 10.1080/23311908.2023.2180872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Tom St Quinton
- School of Psychology & Therapeutic Studies, Leeds Trinity University, Leeds, UK
| | - Ben Morris
- School of Psychology & Therapeutic Studies, Leeds Trinity University, Leeds, UK
| | - Alexander Lithopoulos
- School of Exercise Science, Physical & Health Education, University of Victoria, BC, Canada
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Ryan E. Rhodes
- School of Exercise Science, Physical & Health Education, University of Victoria, BC, Canada
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Vogt KS, Stephenson J, Norman P. Comparing self-affirmation manipulations to reduce alcohol consumption in university students. J Am Coll Health 2023; 71:2380-2389. [PMID: 34731076 DOI: 10.1080/07448481.2021.1968409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/26/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
Objective: Self-affirmation theory proposes that defensive processing prevents people from accepting health-risk messages, which may explain university students' dismissal of risk-information about binge drinking. SA-interventions may encourage non-biased processing of such information through impacting on interpersonal feelings and self-esteem. This study compared two self-affirmation manipulations on interpersonal feelings, self-esteem, message processing, message acceptance and subsequent alcohol consumption.Participants: UK university students (N = 454).Methods: Participants were randomly allocated to one of three conditions (Self-affirmation Implementation Intention, Kindness Questionnaire, Control) before reading health-risk information about binge drinking. This was followed by measures of interpersonal feelings, self-esteem, message processing, acceptance and behavioral intentions. Alcohol consumption was assessed one week later.Results: The self-affirmation manipulations had non-significant effects on all outcome variables.Conclusion: Consistent with previous research, the results indicate that self-affirmation interventions are not effective for reducing alcohol consumption in university students.
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Affiliation(s)
- Katharina Sophie Vogt
- School of Health and Health Sciences, University of Huddersfield, Huddersfield, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
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7
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Heapy C, Norman P, Cockayne S, Thompson AR. The effectiveness of mindfulness-based cognitive therapy for social anxiety symptoms in people living with alopecia areata: a single-group case-series design. Behav Cogn Psychother 2023; 51:381-395. [PMID: 37550306 DOI: 10.1017/s1352465823000292] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an immunological disorder characterised by hair loss. Individuals with AA report high levels of social anxiety. One intervention that holds potential for reducing social anxiety in individuals with AA is mindfulness-based cognitive therapy (MBCT). AIMS Our key aim was to investigate whether MBCT reduces social anxiety in individuals with AA. The study also investigated whether MBCT reduces depression, general anxiety, and increases quality of life and increases trait mindfulness in individuals with AA. METHOD Five participants with AA took part in an 8-session in-person MBCT intervention. A multiple-baseline single-group case series design was adopted. Idiographic measures of social anxiety were measured each day from baseline, through intervention, to follow-up. Standardised questionnaires of trait mindfulness, social anxiety, depression, anxiety, and quality of life were completed at baseline, post-intervention, and at 4-week follow-up. RESULTS All participants completed the MBCT course, but one participant was excluded from the idiographic analysis due to a high amount of missing data. The remaining four participants demonstrated reductions in idiographic measures of social anxiety from baseline to follow-up. These effects were larger between baseline and follow-up, than between baseline and post-intervention. Two participants demonstrated significant improvement in standardised measures of wellbeing from baseline to follow-up - they also practised mindfulness most regularly at home between sessions. CONCLUSION MBCT may be effective in reducing social anxiety and improving wellbeing in individuals with AA, although this might be dependent on the extent to which participants regularly practise mindfulness exercises.
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Affiliation(s)
- Connor Heapy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Sarah Cockayne
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Andrew R Thompson
- Department of Psychology, University of Sheffield, Sheffield, UK
- South Wales Clinical Psychology Training Programme, Cardiff University and Cardiff and Vale University Health Board, School of Psychology, Tower Building, Park Place, Cardiff, UK
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Sturley C, Norman P, Morris M, Downing A. Contrasting socio-economic influences on colorectal cancer incidence and survival in England and Wales. Soc Sci Med 2023; 333:116138. [PMID: 37579558 DOI: 10.1016/j.socscimed.2023.116138] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the world and second most common cause of cancer death. The relationship between socio-economic deprivation and CRC incidence is unclear and previous findings have been inconsistent. There is stronger evidence of an association between area-level deprivation and CRC survival; however, few studies have investigated the association between individual-level socio-economic status (SES) and CRC survival. Data from the Office for National Statistics Longitudinal Study (LS) in England and Wales was used. LS members aged 50+ were stratified by individual-level educational attainment, social class, housing tenure and area deprivation quintile, measured at the 2001 Census. Time-to-event analysis examined associations between indicators of SES and CRC incidence and survival (all-cause and CRC death), over a 15-year follow-up period. Among 178116 LS members, incidence of CRC was lower among those with a degree, compared to those with no degree and higher among those employed in manual occupations compared to non-manual occupations. No clear relationship was observed between CRC incidence and the area-based measure of deprivation. Disparities were greater for survival. Among 5016 patients diagnosed with CRC aged 50+, probability of death from all-causes was lower among those with a degree, compared to no degree and higher among those employed in manual occupations, compared to non-manual occupations and among those living in social-rented housing, compared to owner-occupiers. Individual indicators of SES were also associated with probability of death from CRC. Those living in the most deprived areas had a higher probability of death (from all-causes and CRC) compared to those in the least deprived areas. Both individual and area-based indicators of SES were associated with CRC survival, and the relationships were stronger than those observed for CRC incidence. These findings could help inform more effective targeting of public health interventions for CRC.
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Affiliation(s)
- Charlotte Sturley
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Michelle Morris
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Amy Downing
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Munyombwe T, Dondo TB, Hall M, Nadarajah R, Hurdus B, Aktaa S, Haris M, Keeley A, West R, Hall A, Soloveva A, Norman P, Gale CP. Cohort profile: Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) Longitudinal Cohort. Eur Heart J Qual Care Clin Outcomes 2023; 9:442-446. [PMID: 37451698 PMCID: PMC10405135 DOI: 10.1093/ehjqcco/qcad040] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
AIMS The Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) longitudinal cohort study aims to investigate health trajectories of individuals following hospitalization for myocardial infarction (MI). METHODS AND RESULTS EMMACE is a linked multicentre prospective cohort study of 14 899 patients with MI admitted to 77 hospitals in England who participated in the EMMACE-3 and -4 studies between 1st November 2011 and 24th June 2015. Long-term follow-up of the EMMACE cohorts was conducted through the EMMACE-XL (27th September 2020 to 31st March 2022) and EMMACE-XXL (1st July 2021 to 1st July 2023) studies. EMMACE collected individual participant data for health-related quality of life (HRQoL) measured by three-level EuroQol five-dimension and visual analogy scale at admission, 1 month, 6 months, 12 months, and 10 years follow-up, as well as medications, medication adherence, beliefs about medicines, Satisfaction with Information about Medicines Scale, and illness perceptions. Participant data were deterministically linked to the Myocardial Infarction National Audit Project (MINAP) for information on baseline treatments and comorbidities, Hospital Episode Statistics Admitted Patient Care (for cause-specific hospitalization data), and the Office for National Statistics (for mortality data) up to 2020. CONCLUSION EMMACE is a nationwide prospective cohort that will provide unique insights into fatal and non-fatal outcomes, medication adherence, and HRQoL following MI.Trial registration: ClinicalTrials.gov NCT01808027 and NCT01819103.
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Affiliation(s)
- Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Tatendashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Ramesh Nadarajah
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Ben Hurdus
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Mohammad Haris
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Adam Keeley
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT Leeds, UK
| | - Alistair Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, 2 Akkuratova street, Saint Petersburg 197341, Russian
| | - Paul Norman
- School of Geography, University of Leeds, LS2 9JT Leeds, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Coates E, Zarotti N, Williams I, White S, Halliday V, Beever D, Hackney G, Stavroulakis T, White D, Norman P, McDermott C. Patient, carer and healthcare professional perspectives on increasing calorie intake in Amyotrophic Lateral Sclerosis. Chronic Illn 2023; 19:368-382. [PMID: 34935521 PMCID: PMC9999280 DOI: 10.1177/17423953211069090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Research suggests that higher Body Mass Index is associated with improved survival in people with Amyotrophic Lateral Sclerosis (pwALS). Yet, understanding of the barriers and enablers to increasing calorie intake is limited. This study sought to explore these issues from the perspective of pwALS, informal carers, and healthcare professionals. METHODS Interviews with 18 pwALS and 16 informal carers, and focus groups with 51 healthcare professionals. Data were analysed using template analysis and mapped to the COM-B model and Theoretical Domains Framework (TDF). RESULTS All three COM-B components (Capability, Opportunity and Motivation) are important to achieving high calorie diets in pwALS. Eleven TDF domains were identified: Physical skills (ALS symptoms); Knowledge (about high calorie diets and healthy eating); Memory, attention, and decision processes (reflecting cognitive difficulties); Environmental context/resources (availability of informal and formal carers); Social influences (social aspects of eating); Beliefs about consequences (healthy eating vs. high calorie diets); Identity (interest in health lifestyles); Goals (sense of control); Reinforcement (eating habits); and Optimism and Emotion (low mood, poor appetite). DISCUSSION To promote high calorie diets for pwALS, greater clarity around the rationale and content of recommended diets is needed. Interventions should be tailored to patient symptoms, preferences, motivations, and opportunities.
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Affiliation(s)
- Elizabeth Coates
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
- Elizabeth Coates, Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Nicolò Zarotti
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Isobel Williams
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Sean White
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Vanessa Halliday
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
| | - Gemma Hackney
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
| | - Theocharis Stavroulakis
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
- Elizabeth Coates, Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
- Elizabeth Coates, Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
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Conner M, Norman P. Health behaviour: sexually transmitted infection prevention behaviour, sun protection behaviour, medication non-adherence, and health professional behaviour. Psychol Health 2023; 38:667-674. [PMID: 37132656 DOI: 10.1080/08870446.2023.2167076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Mark Conner
- School of Psychology, University of Leeds, LS2 9JTLeedsUnited Kingdom of Great Britain and Northern Ireland
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
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Furlong KR, O'Donnell K, Farrell A, Mercer S, Norman P, Parsons M, Patey C. Older Adults, the "Social Admission," and Nonspecific Complaints in the Emergency Department: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e38246. [PMID: 36920467 PMCID: PMC10132007 DOI: 10.2196/38246] [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: 05/05/2022] [Revised: 11/09/2022] [Accepted: 12/21/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older adults have a higher visit rate and poorer health outcomes in the emergency department (ED) compared to their younger counterparts. Older adults are more likely to require additional resources and hospital admission. The nonspecific, atypical, and complex nature of disease presentation in older adults challenges current ED triage systems. Acute illness in older adults is often missed or commonly disguised in the ED as a social or functional issue. If diagnostic clarity is lacking or safe discharge from the ED is not feasible, then older adults may be labelled a "social admission" (or another synonymous term), often leading to negative health consequences. OBJECTIVE This scoping review aims to describe and synthesize the available evidence on patient characteristics, adverse events, and health outcomes for older adults labelled as "social admission" (and other synonymously used terms), as well as those with nonacute or nonspecific complaints in the ED or hospital setting. METHODS A literature search of MEDLINE, Embase, Scopus, PsycINFO, and CINAHL was completed. Relevant reference lists were screened. Data have been managed using EndNote software and the Covidence web application. Original data have been included if patients are aged ≥65 years and are considered a "social admission" (or other synonymously used term) or if they present to the ED with a nonacute or nonspecific complaint. Two review team members have reviewed titles and abstracts and will review full-text articles. Disagreements are resolved by consensus or in discussion with a third reviewer. This review does not require research ethics approval. RESULTS As of January 2023, we have completed the title and abstract screening and have started the full-text screening. Some remaining full-text articles are being retrieved and/or translated. We are extracting data from included studies. Data will be presented in a narrative and descriptive manner, summarizing key concepts, patient characteristics, and health outcomes of patients labelled as a "social admission" (and other synonymously used terms) and of those with nonacute and nonspecific complaints. We expect the first results for publication in Spring 2023. CONCLUSIONS Acute illness in the older adult is not always easily identified. We hope to better understand patient characteristics, adverse events, and health outcomes of older adults labelled as a "social admission," as well as those with nonacute or nonspecific complaints. We aim to identify priorities for future research and identify knowledge gaps that may inform health care providers caring for these vulnerable patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38246.
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Affiliation(s)
- Kayla Rose Furlong
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
| | - Kathleen O'Donnell
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University Libraries, Memorial University, St John's, NL, Canada
| | - Susan Mercer
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Paul Norman
- Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
| | - Michael Parsons
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
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13
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Almulhim AN, Hartley H, Norman P, Caton SJ, Doğru OC, Goyder E. Behavioural Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis. BMC Public Health 2023; 23:95. [PMID: 36639632 PMCID: PMC9837922 DOI: 10.1186/s12889-022-14874-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Given the high rates globally of Type 2 Diabetes Mellitus (T2DM), there is a clear need to target health behaviours through person-centred interventions. Health coaching is one strategy that has been widely recognised as a tool to foster positive behaviour change. However, it has been used inconsistently and has produced mixed results. This systematic review sought to explore the use of behaviour change techniques (BCTs) in health coaching interventions and identify which BCTs are linked with increased effectiveness in relation to HbA1C reductions. METHODS In line with the PICO framework, the review focused on people with T2DM, who received health coaching and were compared with a usual care or active control group on HbA1c levels. Studies were systematically identified through different databases including Medline, Web of science, and PsycINFO searches for relevant randomised controlled trials (RCTs) in papers published between January 1950 and April 2022. The Cochrane collaboration tool was used to evaluate the quality of the studies. Included papers were screened on the reported use of BCTs based on the BCT taxonomy. The effect sizes obtained in included interventions were assessed by using Cohen's d and meta-analysis was used to estimate sample-weighted average effect sizes (Hedges' g). RESULTS Twenty RCTs with a total sample size of 3222 were identified. Random effects meta-analysis estimated a small-sized statistically significant effect of health coaching interventions on HbA1c reduction (g+ = 0.29, 95% CI: 0.18 to 0.40). A clinically significant HbA1c decrease of ≥5 mmol/mol was seen in eight studies. Twenty-three unique BCTs were identified in the reported interventions, with a mean of 4.5 (SD = 2.4) BCTs used in each study. Of these, Goal setting (behaviour) and Problem solving were the most frequently identified BCTs. The number of BCTs used was not related to intervention effectiveness. In addition, there was little evidence to link the use of specific BCTs to larger reductions in HbA1c across the studies included in the review; instead, the use of Credible source and Social reward in interventions were associated with smaller reductions in HbA1c. CONCLUSION A relatively small number of BCTs have been used in RCTs of health coaching interventions for T2DM. Inadequate, imprecise descriptions of interventions and the lack of theory were the main limitations of the studies included in this review. Moreover, other possible BCTs directly related to the theoretical underpinnings of health coaching were absent. It is recommended that key BCTs are identified at an early stage of intervention development, although further research is needed to examine the most effective BCTs to use in health coaching interventions. TRIAL REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228567 .
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Affiliation(s)
- Abdullah N. Almulhim
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA UK ,grid.449598.d0000 0004 4659 9645Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, 13316 Saudi Arabia
| | - Hannah Hartley
- grid.418447.a0000 0004 0391 9047Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, BD9 6RJ UK
| | - Paul Norman
- grid.11835.3e0000 0004 1936 9262Department of Psychology, The University of Sheffield, Cathedral Court, The University of Sheffield, Vicar Ln, Sheffield, S1 2LT UK
| | - Samantha J. Caton
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA UK
| | - Onur Cem Doğru
- grid.411108.d0000 0001 0740 4815Department of Psychology, Afyon Kocatepe University, Gazlıgöl St, 03200 Afyonkarahisar, Turkey
| | - Elizabeth Goyder
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA UK
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14
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Taylor H, Dawes P, Kapadia D, Shryane N, Norman P. Investigating ethnic inequalities in hearing aid use in England and Wales: a cross-sectional study. Int J Audiol 2023; 62:1-11. [PMID: 34908513 DOI: 10.1080/14992027.2021.2009131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To establish whether ethnic inequalities exist in levels of self-reported hearing difficulty and hearing aid use among middle-aged adults. DESIGN Cross-sectional data from the UK Biobank resource. STUDY SAMPLE 164,460 participants aged 40-69 who answered hearing questions at an assessment centre in England or Wales. RESULTS After taking into account objectively assessed hearing performance and a corresponding correction for bias in non-native English speakers, as well as a range of correlates including demographic, socioeconomic, and health factors, there were lower levels of hearing aid use for people from Black African (OR 0.36, 95% CI 0.17-0.77), Black Caribbean (OR 0.38, 95% CI 0.22-0.65) and Indian (OR 0.60, 95% CI 0.41-0.86) ethnic groups, compared to the White British or Irish group. Men from most ethnic minority groups and women from Black African, Black Caribbean and Indian groups were less likely to report hearing difficulty than their White British or Irish counterparts. CONCLUSIONS For equivalent levels of hearing loss, the use of hearing aids is lower among ethnic minority groups. Inequalities are partly due to lower levels of self-reported hearing difficulty among minority groups. However, even when self-reported hearing difficulty is considered, hearing aid use remains lower among many ethnic minority groups.
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Affiliation(s)
- Harry Taylor
- Social Statistics, The University of Manchester School of Social Sciences, Manchester, UK.,School of Social Sciences, The University of Manchester Cathie Marsh Institute for Social Research, Manchester, UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, The University of Manchester School of Health Sciences, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Dharmi Kapadia
- School of Social Sciences, The University of Manchester Cathie Marsh Institute for Social Research, Manchester, UK.,Sociology, The University of Manchester School of Social Sciences, Manchester, UK
| | - Nick Shryane
- Social Statistics, The University of Manchester School of Social Sciences, Manchester, UK.,School of Social Sciences, The University of Manchester Cathie Marsh Institute for Social Research, Manchester, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
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15
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Cooke R, McEwan H, Norman P. The effect of forming implementation intentions on alcohol consumption: A systematic review and meta-analysis. Drug Alcohol Rev 2023; 42:68-80. [PMID: 36173203 PMCID: PMC10087331 DOI: 10.1111/dar.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/15/2021] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Meta-analysis was used to estimate the effect of forming implementation intentions (i.e., if-then plans) on weekly alcohol consumption and heavy episodic drinking (HED). Sample type, mode of delivery, intervention format and timeframe were tested as moderator variables. APPROACH Cochrane, EThOS, Google Scholar, PsychArticles, PubMed and Web of Science were searched for relevant publications to 31 March 2021. Random-effects meta-analysis was used to estimate the effect size difference (d) between individuals forming versus not forming implementation intentions on weekly consumption and HED. KEY FINDINGS Sixteen studies were included in meta-analyses. The effect size difference for forming implementation intentions on weekly alcohol consumption was d+ = -0.14 confidence interval (CI) [-0.24; -0.03]. Moderator analyses highlighted stronger effects for: (i) community (d+ = -0.38, CI [-0.58; -0.18]) versus university (d+ = -0.04, CI [-0.13; 0.05]) samples; (ii) paper (d+ = -0.26, CI [-0.43; -0.09]) versus online (d+ = -0.04, CI [-0.14; 0.06]) mode of delivery; and (iii) volitional help sheet (d+ = -0.34, CI [-0.60; -0.07]) versus implementation intention format (d+ = -0.07, CI [-0.16; 0.02]). In addition, effects diminished over time (B = 0.02, SE = 0.01, CI [0.03; 0.01]). Forming implementation intentions had a null effect on HED, d+ = -0.01 CI [-0.10; 0.08]. IMPLICATIONS Forming implementation intentions reduces weekly consumption but has no effect on HED. CONCLUSION This review identifies boundary conditions on the effectiveness of implementation intentions to reduce alcohol consumption. Future research should focus on increasing the effectiveness of online-delivered interventions and integrating implementation intention and motivational interventions.
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Affiliation(s)
- Richard Cooke
- School of Health, Wellbeing and Science, Staffordshire University, Stoke on Trent, UK
| | - Helen McEwan
- School of Psychology, University of Worcester, Worcester, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
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16
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Musson LS, Baxter SK, Norman P, O'Brien D, Elliott M, Bianchi S, Kaltsakas G, McDermott CJ, Stavroulakis T, Hobson EV. Delivery of non-invasive ventilation to people living with motor neuron disease in the UK. ERJ Open Res 2022; 9:00388-2022. [PMID: 37009026 PMCID: PMC10052642 DOI: 10.1183/23120541.00388-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveNon-invasive ventilation (NIV) improves survival and quality of life in motor neuron disease (MND), but many patients fail to receive effective ventilation. This study aimed to map the respiratory clinical care for MND patients at a service and individual healthcare professional (HCP) level to understand where attention may be needed to ensure all patients receive optimal care.MethodsTwo online surveys of HCPs working with MND patients in the UK were conducted. Survey 1 targeted HCPs providing specialist MND care. Survey 2 targeted HCPs working in respiratory/ventilation services and community teams. Data were analysed using descriptive and inferential statistics.ResultsResponses from 55 HCPs providing specialist MND care who worked at 21 MND care centres and networks and 13 Scotland Health Boards were analysed from Survey 1. Responses from 85 HCPs from respiratory/ventilation services and 73 HCPs from community teams, representing 97 services were analysed from Survey 2.Significant differences in practice were identified at each stage of the respiratory care pathway as well as evidence of the need for improvement. This included when patients were referred to respiratory services, the time taken waiting to commence NIV, the availability of sufficient NIV equipment and provision of services, particularly out of hours.ConclusionWe have highlighted significant disparity in MND respiratory care practices. Increased awareness of the factors that influence NIV success and the performance of individuals and services is important for optimal practice.
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17
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Murray ET, Head J, Shelton N, Beach B, Norman P. Does it matter how we measure the health of older people in places for associations with labour market outcomes? A cross-sectional study. BMC Public Health 2022; 22:2252. [PMID: 36460979 PMCID: PMC9719185 DOI: 10.1186/s12889-022-14661-0] [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: 06/17/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Inequalities between different areas in the United Kingdom (UK) according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population. METHODS We used the Office for National Statistics (ONS) Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Seven health indicators from local-authority census and vital records data were chosen to represent the older working age population (self-rated health 50-74y, long-term illness 50-74y, Age-specific mortality rate 50-74y, avoidable mortality, life expectancy at birth and 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50 years). An additional two health indicators (life expectancy at birth and infant mortality rate) were included as test indicators to determine if associations were limited to the health of older people in a place. These nine health indicators were then linked with the LS sample aged 16-74y with data on employment outcomes and pertinent demographic and individual health information. Interactions by gender and age category (16-49y vs. 50-74y) were also tested. FINDINGS For all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the 'unhealthiest' older population, had higher odds of not being in paid work, including all four types of economic inactivity. The strongest associations were seen for the health-in-a-place measures that were self-reported, long-term illness (Odds Ratio 1.60 [95% Confidence Intervals 1.52, 1.67]) and self-rated health (1.60 [1.52, 1.68]). Within each measure, associations were slightly stronger for men than women and for the 16-49y versus 50-74y LS sample. In models adjusted for individual self-rated health and gender and age category interactions, health-in-a-place gradients were apparent across all economic inactivity's. However, these same gradients were only apparent for women in part-time work and men in full-time work. CONCLUSION Improving health of older populations may lead to wider economic benefits for all.
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Affiliation(s)
- Emily T. Murray
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Jenny Head
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Nicola Shelton
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Brian Beach
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Paul Norman
- grid.9909.90000 0004 1936 8403School of Geography, University of Leeds, 10.11 Irene Manton, 6 Clarendon Way, Woodhouse, Leeds, LS2 9NL UK
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18
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Doğru OC, Webb TL, Norman P. Can behavior change techniques be delivered via short text messages? Transl Behav Med 2022; 12:979-986. [PMID: 36190350 DOI: 10.1093/tbm/ibac058] [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] [Indexed: 01/20/2023] Open
Abstract
Despite significant advancements in behavioral science it is unclear whether behavior change techniques (or BCTs) can be delivered to large numbers of people in a cost-effective and reliable way. The current study investigated whether it is possible to reliably deliver BCTs using short text messages. Short text messages were designed to deliver each of the 93 BCTs specified in the BCT taxonomy v1. Following initial coding and refinement by the team, a Delphi study with a panel of 15 experts coded which BCT each short text message was designed to deliver and also rated whether they were likely to be understood by recipients and easily converted to target different behaviors. After two iterations, the experts correctly assigned 66 of the 93 messages to the BCT that they were designed to deliver and indicated that these messages were likely to be easy to apply to a range of behaviors and understood by recipients. Experts were not able to identify which BCT 27 of the messages were designed to deliver and it was notable that some clusters of BCTs (e.g., "Goals and planning") were easier to deliver via short text messages than other clusters (e.g., "Scheduled consequences"). The findings suggest that short text messages can be a reliable way to deliver many, but not all, BCTs. The implications of the current study are discussed with respect to the delivery of specific BCTs and clusters of the taxonomy, as well as the need to test the acceptability of interventions delivered via short messages and the impact of messages on behavior.
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Affiliation(s)
- Onur Cem Doğru
- Department of Psychology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Sheffield, UK
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19
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Clarke EN, Norman P, Thompson AR. How does self-compassion help people adjust to chronic skin conditions? A template analysis study. Front Med (Lausanne) 2022; 9:974816. [PMID: 36313995 PMCID: PMC9606614 DOI: 10.3389/fmed.2022.974816] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/23/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives Skin conditions can greatly impact people's lives, but greater understanding of the processes involved in positive adjustment is required. Self-compassion has strong links to wellbeing and adaptive functioning and therefore may play an important role in adjustment to skin conditions. Design Template analysis was used to explore how self-compassion operates in people living with skin conditions, with reference to existing theories of self-compassion. Methods Semi-structured interviews were conducted with highly self-compassionate people with chronic skin conditions (N = 10). Theoretical models of self-compassion were used in the development of the initial template and interview schedule. Participants were purposively selected on the basis of having high scores on a measure of self-compassion. Results Participants reported a variety of ongoing skin-related difficulties and their ways of managing these. Sensitivity to distress and care for wellbeing were identified as foundation themes: necessary components of a compassionate response to distress. Eleven types of difficulty-management strategies built upon these foundation themes: empathy, non-judgement, distress tolerance, self-kindness, mindful attention, perspective-taking, self-talk, self-care, using social support, concealment, and idiosyncratic coping strategies. Conclusions Components of self-compassion helped people adjust to chronic skin conditions in a wide variety of ways, indicating that psychological adjustment is not a simple, linear process. Sometimes compassionate responses occurred automatically and sometimes with deliberate effort. Further research on compassion-based interventions for people with skin conditions is warranted.
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Affiliation(s)
- Elaine N. Clarke
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, United Kingdom,Department of Psychology, University of Sheffield, Sheffield, United Kingdom,*Correspondence: Elaine N. Clarke
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Andrew R. Thompson
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom,School of Psychology, Cardiff University, Cardiff, United Kingdom,Cardiff and Vale University Health Board, Cardiff, United Kingdom
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20
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Abstract
This manuscript overviews recent research on the intention-behavior gap, focusing on moderators of the intention-behavior relationship. The manuscript draws on the concept of intention strength to make two important points. First, strong intentions provide better predictions of behavior, thereby reducing the intention-behavior gap. However, strong intentions have the additional features of being more stable over time, less pliable in the face of interventions to change them, and more likely to bias information processing about engaging in the behavior. These four features of intention strength are not independent. For example, stable intentions are likely to provide better predictions of behavior. Second, various predictors of strength (e.g., importance, certainty, extremity) may also constitute important, but little studied, moderators of the intention-behavior relationship. Moreover, the effects of these moderators of the intention-behavior relationship may be mediated through intention stability (and perhaps other features of intention strength). Future research on the intention-behavior gap would benefit from a more systematic consideration of a broad range of moderators of the intention-behavior relationship both individually and in combination. In addition, future research could usefully explore how these moderating effects might be explained. Such a systematic approach may further our understanding of the intention-behavior gap in relation to physical activity and other behaviors.
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Affiliation(s)
- Mark Conner
- School of Psychology, University of Leeds, Leeds, United Kingdom
- *Correspondence: Mark Conner,
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Abstract
Background Preventive behaviors continue to play an important role in reducing the spread of the SARS-CoV-2 virus. Purpose This study aimed to apply the reasoned action approach (RAA) to predict Covid-19 preventive intentions and behavior and to test whether temporal stability moderates relations between RAA constructs and behavior. Methods A representative sample of UK adults (N = 603) completed measures of RAA variables (i.e., experiential attitudes, instrumental attitudes, injunctive norms, descriptive norms, capacity, autonomy and intention) in relation to six Covid-19 preventive behaviors (i.e., wearing face coverings, social distancing, hand sanitizing, avoiding the three Cs [closed spaces, crowded places, and close contacts], cleaning surfaces, and coughing/sneezing etiquette) at baseline (December 2020) and after 1 month. Self-reported behavior was assessed at baseline and after 1 and 2 months. Results The RAA was predictive of Covid-19 preventive intentions at time 1 and time 2; instrumental attitudes, descriptive norms, and capability were the strongest predictors at each time point. The RAA also predicted subsequent behavior across time points with intention, descriptive norms, and capability the strongest/most consistent predictors. Temporal stability moderated a number of RAA–behavior relationships including those for intention, descriptive norms, and capability. In each case, the relationships became stronger as temporal stability increased. Conclusions Health cognitions as outlined in the RAA provide appropriate targets for interventions to promote Covid-19 preventive intentions and behavior. Moreover, given that continued performance of Covid-19 preventive behaviors is crucial for reducing transmission of the SARS-CoV-2 virus, the results highlight the need for consistent messaging from governments and public health organizations to promote positive intentions and maintain preventive behavior.
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Affiliation(s)
- Paul Norman
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, UK
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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Norman P, Exeter D, Shelton N, Head J, Murray E. (Un-) healthy ageing: Geographic inequalities in disability-free life expectancy in England and Wales. Health Place 2022; 76:102820. [PMID: 35690019 DOI: 10.1016/j.healthplace.2022.102820] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
Health expectancies are an indicator of healthy ageing that reflect quantity and quality of life. Using limiting long term illness and mortality prevalence, we calculate disability-free life expectancy for small areas in England and Wales between 1991 and 2011 for males and females aged 50-74, the life stage when people may be changing their occupation from main career to retirement or alternative work activities. We find that inequalities in disability-free life expectancy are deeply entrenched, including former coalfield and ex-industrial areas and that areas of persistent (dis-) advantage, worsening or improving deprivation have health change in line with deprivation change. A mixed health picture for rural and coastal areas requires further investigation as do the demographic processes which underpin these area level health differences.
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Affiliation(s)
- Paul Norman
- School of Geography, University of Leeds, UK.
| | - Dan Exeter
- School of Population Health, University of Auckland, New Zealand
| | - Nicola Shelton
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Jenny Head
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Emily Murray
- Research Department of Epidemiology and Public Health, University College London, UK
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23
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Vahabli E, Mann J, Heidari BS, Lawrence‐Brown M, Norman P, Jansen S, Pardo EDJ, Doyle B. The Technological Advancement to Engineer Next-Generation Stent-Grafts: Design, Material, and Fabrication Techniques. Adv Healthc Mater 2022; 11:e2200271. [PMID: 35481675 DOI: 10.1002/adhm.202200271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/03/2022] [Revised: 04/04/2022] [Indexed: 12/12/2022]
Abstract
Endovascular treatment of aortic disorders has gained wide acceptance due to reduced physiological burden to the patient compared to open surgery, and ongoing stent-graft evolution has made aortic repair an option for patients with more complex anatomies. To date, commercial stent-grafts are typically developed from established production techniques with simple design structures and limited material ranges. Despite the numerous updated versions of stent-grafts by manufacturers, the reoccurrence of device-related complications raises questions about whether the current manfacturing methods are technically able to eliminate these problems. The technology trend to produce efficient medical devices, including stent-grafts and all similar implants, should eventually change direction to advanced manufacturing techniques. It is expected that through recent advancements, especially the emergence of 4D-printing and smart materials, unprecedented features can be defined for cardiovascular medical implants, like shape change and remote battery-free self-monitoring. 4D-printing technology promises adaptive functionality, a highly desirable feature enabling printed cardiovascular implants to physically transform with time to perform a programmed task. This review provides a thorough assessment of the established technologies for existing stent-grafts and provides technical commentaries on known failure modes. They then discuss the future of advanced technologies and the efforts needed to produce next-generation endovascular implants.
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Affiliation(s)
- Ebrahim Vahabli
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - James Mann
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - Behzad Shiroud Heidari
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
| | | | - Paul Norman
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- Medical School The University of Western Australia Perth 6009 Australia
| | - Shirley Jansen
- Curtin Medical School Curtin University Perth WA 6102 Australia
- Department of Vascular and Endovascular Surgery Sir Charles Gairdner Hospital Perth WA 6009 Australia
- Heart and Vascular Research Institute Harry Perkins Medical Research Institute Perth WA 6009 Australia
| | - Elena de Juan Pardo
- School of Engineering The University of Western Australia Perth 6009 Australia
- School of Mechanical Medical and Process Engineering Queensland University of Technology Brisbane Queensland 4059 Australia
- T3mPLATE Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth WA 6009 Australia
| | - Barry Doyle
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
- British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh Edinburgh EH16 4TJ UK
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Griffin B, Conner M, Norman P. Applying an extended protection motivation theory to predict Covid-19 vaccination intentions and uptake in 50-64 year olds in the UK. Soc Sci Med 2022; 298:114819. [PMID: 35245755 PMCID: PMC8867961 DOI: 10.1016/j.socscimed.2022.114819] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 11/09/2022]
Abstract
Objectives To examine the correlates of Covid-19 vaccination intentions and subsequent uptake as outlined in an extended version of protection motivation theory (PMT). Design A two-wave online survey conducted at the start of the vaccination rollout to 50–64 year olds in the UK and three months later. Measures Unvaccinated UK adults (N = 438) aged 50–64 completed baseline measures from PMT (perceived vulnerability, perceived severity, maladaptive response rewards, response efficacy, self-efficacy, response costs, intention) as well as measures of injunctive and descriptive norms, demographics, Covid-19 experiences, and past influenza vaccine uptake. Self-reported uptake of a Covid-19 vaccination was assessed three months later (n = 420). Results The extended PMT explained 59% of the variance in Covid-19 vaccination intentions, after controlling for demographics, Covid-19 experiences, and past influenza vaccine uptake. All extended PMT variables, with the exception of perceived severity and descriptive norms, were significant independent predictors of intention. In line with national figures, 94% of the sample reported having received a Covid-19 vaccination at follow-up with intention found to be the key predictor of uptake. Conclusions Interventions to increase Covid-19 vaccination uptake need to increase intentions to be vaccinated by emphasizing the benefits of vaccination (e.g., in terms of reducing risk) and likely approval from others while also addressing the concerns (e.g., safety issues) and common misperceptions (e.g., natural immunity versus vaccines) that people might have about Covid-19 vaccines. Future research is needed in countries, and on groups, with lower uptake rates.
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Mariathas HH, Hurley O, Anaraki NR, Young C, Patey C, Norman P, Aubrey-Bassler K, Wang PP, Gadag V, Nguyen HV, Etchegary H, McCrate F, Knight JC, Asghari S. A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial. JMIR Res Protoc 2022; 11:e30454. [PMID: 35323121 PMCID: PMC8990381 DOI: 10.2196/30454] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient's perspective, this challenge has been described as "patients wait in pain or discomfort for hours before being seen at EDs." To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. OBJECTIVE The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician's initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon's effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. METHODS The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. RESULTS Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon's eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. CONCLUSIONS By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. TRIAL REGISTRATION ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30454.
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Affiliation(s)
- Hensley H Mariathas
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Oliver Hurley
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nahid Rahimipour Anaraki
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christina Young
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christopher Patey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, Canada
| | - Paul Norman
- Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, Canada
| | - Kris Aubrey-Bassler
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Peizhong Peter Wang
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Veeresh Gadag
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Holly Etchegary
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Farah McCrate
- Department of Research and Innovation, Eastern Health, St. John's, NL, Canada
| | - John C Knight
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Anaraki NR, Jewer J, Hurley O, Mariathas HH, Young C, Norman P, Patey C, Wilson B, Etchegary H, Senior D, Asghari S. Implementation of an ED surge management platform: a study protocol. Implement Sci Commun 2022; 3:21. [PMID: 35236510 PMCID: PMC8889380 DOI: 10.1186/s43058-021-00247-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency departments (EDs) around the world are struggling with long wait times and overcrowding. To address these issues, a quality improvement program called SurgeCon was created to improve ED efficiency and patient satisfaction. This paper presents a framework for managing and evaluating the implementation of an ED surge management platform. Our framework builds on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to structure our approach and the Consolidated Framework for Implementation Research (CFIR) to guide our choice of outcome variables and scalability. METHODS Four hospital EDs will receive the SurgeCon quality improvement intervention. Using a stepped wedge cluster design, each ED will be randomized to one of four start dates. Data will be collected before, during, and after the implementation of the intervention. RE-AIM will be used to guide the assessment of SurgeCon, and guided by CFIR, we will measure ED key performance indicators (KPI), patient-reported outcomes, and implementation outcomes related to SurgeCon's scalability, adaptability, sustainability, and overall costs. Participants in this study consist of patients who visit any of the four selected EDs during the study period, providers/staff, and health system managers. A mixed-methods approach will be utilized to evaluate implementation outcomes. DISCUSSION This study will provide important insight into the implementation and evaluation techniques to enhance uptake and benefits associated with an ED surge-management platform. The proposed framework bridges research and practice by involving researchers, practitioners, and patients in the implementation and evaluation process, to produce an actionable framework that others can follow. We anticipate that the implementation approach would be generalizable to program implementations in other EDs. TRIAL REGISTRATION • Name of the registry: ClinicalTrials.gov • Trial registration number: NCT04789902 • Date of registration: 03/10/2021.
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Affiliation(s)
- Nahid Rahimipour Anaraki
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Jennifer Jewer
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Oliver Hurley
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Hensley H Mariathas
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Christina Young
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Paul Norman
- Eastern Health, Carbonear Institute for Rural Research and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, A1Y 1A4, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Brenda Wilson
- Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Holly Etchegary
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Dorothy Senior
- Patient Advisory Council, NLSUPPORT, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
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Campbell CS, Patey C, Dubrowski A, Norman P, Bartellas M. Casting Into The Future: Effectiveness of a 3D-Printed Fishhook Removal Task Trainer. Cureus 2022; 14:e22609. [PMID: 35371625 PMCID: PMC8958115 DOI: 10.7759/cureus.22609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
While participation in both recreational and commercial fisheries is common, it is not risk-free. Puncture wounds caused by fishhooks are commonly incurred by people who fish recreationally and commercially. Despite literature that details the challenges of treating fishhook injuries and specific techniques for fishhook removal, only a single publication focuses on teaching fishhook removal techniques to medical trainees and staff physicians. The aim of this technical report is to investigate the efficacy of using a 3D-printed task trainer for simulating and teaching fishhook removal techniques. To facilitate this, the 3D-printed Fishhook Emergency Removal Simulator (FISH-ER 3D) was designed by the Memorial University of Newfoundland (MUN) MED 3D Network and satellite research partner, Carbonear Institute for Rural Reach and Innovation by the Sea (CIRRIS). A sample of 22 medical residents and staff physicians were asked to evaluate the task trainer by way of a practical session, which was then followed by an evaluation survey. The overall realism of the 3D-printed task trainer components was ranked as “realistic” or “very realistic” by 86% of the evaluators. The majority of evaluators rated acquiring and performing various fishhook removal techniques using the simulator as “easy” or “somewhat easy”. Most evaluators found that using the task trainer increased user competence and confidence with fishhook removal techniques, and 100% of the evaluators rated the task trainer as a “very valuable” or “valuable” training tool. The results of this report demonstrate support for the FISH-ER 3D as an efficacious simulator for building competence in fishhook removal techniques.
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Parker L, Reutersberg B, Syed M, Munshi B, Richards S, Sakalihasan N, Eckstein HH, Norman P, Doyle B. False Lumen Thrombosis and Pressure Predicts Outcome in Patients with Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Young C, Patey C, Norman P, Chan T, Hurley O, Swab M, Asghari S. Identifying relevant topics and training methods for emergency department flow training. CAN J EMERG MED 2022; 24:837-843. [PMID: 36242732 PMCID: PMC9763133 DOI: 10.1007/s43678-022-00390-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Despite the importance of patient flow to emergency department (ED) management, there is a need to strengthen and expand training in flow strategies for practicing ED staff. To date, there has been limited academic inquiry into the skills and training that ED staff require to improve patient flow. As part of a quality improvement initiative, our team aimed to identify the topics and training methods that should be included in flow training for ED staff. METHODS We conducted an integrative review and modified Delphi. For the integrative review, we sought to identify appropriate skills, training strategies, and training modalities to include in a curriculum for ED staff. The findings from the review were compiled and distributed to Canadian experts in ED efficiency through a modified Delphi, including physicians, nurses, and nurse practitioners. RESULTS Our literature search retrieved 8359 articles, of which 46 were included in the review. We identified 19 skills, 9 training strategies, and 12 training modalities used to improve ED efficiency in the literature. For the modified Delphi, we received responses from 39 participants in round one and 28 in round two, with response rates of 57% and 41%, respectively. The topics chosen by the most respondents were: "flow decisions," "teamwork," "backlog and surge management," "leadership," and "situational awareness." CONCLUSION Our findings suggest that flow training should teach ED staff how to make decisions that improve flow, work more effectively as a team, manage patient backlog and surge, improve leadership skills, and develop situational awareness. These findings add to a gap in the academic literature regarding the training ED staff require to improve patient flow.
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Affiliation(s)
- Christina Young
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Christopher Patey
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada ,Carbonear General Hospital, Carbonear, NL Canada
| | - Paul Norman
- Carbonear General Hospital, Carbonear, NL Canada
| | - Teresa Chan
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Oliver Hurley
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL Canada
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Murray ET, Shelton N, Norman P, Head J. Measuring the health of people in places: A scoping review of OECD member countries. Health Place 2021; 73:102731. [PMID: 34929525 DOI: 10.1016/j.healthplace.2021.102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/10/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022]
Abstract
A scoping review was performed to identify how Organisation for Economic Co-operation and Development (OECD) countries measure overall health for sub-national geographies within each country. Sixty publications were selected from MEDLINE, Scopus and Google Scholar, plus information extracted from 37 of 38 OECD countries statistical agency and/or public health institute websites that were available in English. Data sources varied by categorisation into national statistical agency mortality (n = 7) or population-level survey morbidity (n = 5) health indicators. Region was the most common geographic scale (e.g., eight indicators for 26 countries), slightly fewer indicators for urban areas (max countries per most frequent indicator = 24), followed by municipality (range of 1-14 countries per indicator). Other geographies, particularly those at smaller granularity, were infrequently available across health indicators and countries. Wider availability of health indicators at smaller, and non-administrative, geographies is needed to explore the best way to measure comparative population health in local areas.
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Affiliation(s)
- Emily T Murray
- University College London, Research Department of Epidemiology and Public Health, London, UK.
| | - Nicola Shelton
- University College London, Research Department of Epidemiology and Public Health, London, UK
| | - Paul Norman
- University of Leeds, School of Geography, Leeds, UK
| | - Jenny Head
- University College London, Research Department of Epidemiology and Public Health, London, UK
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Murray ET, Shelton N, Norman P, Head J. Health of older people in places and work-related outcomes: are all health indicators equal? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Health has been posited as an explanation for why older people who live in more disadvantaged areas have worse work-related outcomes. The policy implication being that if a higher proportion of older persons in a place had better health, those labour markets would be better for everyone. No literature exists on this topic.
Methods
Data was used from 428,646 members of the Office for National Statistics Longitudinal Study (LS) who were 16-74y at the 2011 census and had information on employment status, economic activity and occupational socioeconomic classification. Generalised Structural Equation Modelling was used to examine whether each of the three work-related outcomes were equally related to nine 2011 local authority district (LAD)-level older adult health indicators.
Results
In age-adjusted analysis, all nine LAD-level health indicators (modelled in terciles) were associated with all three work outcomes. However, strengths of association varied both across and within each outcome. For example, the strongest associations were for being ‘sick or disabled' versus ‘In employment'. If an LS member lived in the ‘unhealthiest' versus ‘healthiest' third of LADs, associations varied between a high of 2.74 higher odds (95% CI: 2.53,2.95) for long-term illness and a low of 2.10 higher odds (1.89,2.32) for disease-free life expectancy at age 50y. The weakest associations were for part-time versus full-time employment: ranging from life expectancy at birth at 1.29 (1.21,1.38) to healthy-life expectancy at age 50y: 1.18 (1.10,1.27). Adjustment for individual health reduced, but did not eliminate, associations. Sensitivity analysis showed robustness to area health indicators being assessed for sub-groups of older people (ages 50-64 & 65-74), genders and a reduced sample of older persons (50-74y) only.
Conclusions
Health of older people in places is associated with work outcomes of people in those places; both the older people themselves and the wider community.
Key messages
At a place level, health and work outcomes are linked. Strengths of association between place-level health and work outcomes will depend on the health measure used.
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Affiliation(s)
- ET Murray
- Epidemiology and Public Health, University College London, London, UK
| | - N Shelton
- Epidemiology and Public Health, University College London, London, UK
| | - P Norman
- School of Geography, University of Leeds, Leeds, UK
| | - J Head
- Epidemiology and Public Health, University College London, London, UK
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Hassan S, Stambulic T, King M, Norman P, Payne D, Derry K, El Diasty M. POST-OPERATIVE PAIN AND ANALGESIC USE FOR CARDIAC SURGERY WITH MEDIAN STERNOTOMY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
BACKGROUND Previous studies showed increasing number of children with a life-limiting or life-threatening condition who may benefit from input from pediatric palliative care services. AIM To estimate the current prevalence of children with a life-limiting condition and to model future prevalence of this population. DESIGN Observational study using national inpatient hospital data. A population-based approach utilizing ethnic specific population projections was used to estimate future prevalence. SETTING/PARTICIPANTS All children aged 0-19 years with a life-limiting condition diagnostic code recorded in Hospital Episodes Statistics data in England from 2000/01 to 2017/18. RESULTS Data on 4,543,386 hospital episodes for 359,634 individuals were included. The prevalence of children with a life-limiting condition rose from 26.7 per 10,000 (95%CI 26.5-27.0) in 2001/02 to 66.4 per 10,000 (95% CI: 66.0-66.8) in 2017/18. Using a more restricted definition of a life-limiting condition reduced the prevalence from 66.4 to 61.1 per 10,000 (95%CI 60.7-61.5) in 2017/18. Highest prevalence was in the under 1-year age group at 226.5 per 10,000 and children with a congenital abnormality had the highest prevalence (27.2 per 10,000 (95%CI: 26.9-27.5)).The prevalence was highest among the most deprived group and in children of Pakistani origin.Predicted future prevalence of life-limiting conditions ranged from 67.0 (95%CI 67.7-66.3) to 84.22 (95%CI 78.66-90.17) per 10,000 by 2030. CONCLUSIONS The prevalence of children with a life-limiting or life-threatening condition in England has risen over the last 17 years and is predicted to increase. Future data collections must include the data required to assess the complex health and social care needs of these children.
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Affiliation(s)
- Lorna K Fraser
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
| | - Deborah Gibson-Smith
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
| | - Stuart Jarvis
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Roger C Parslow
- Leeds Institute of Cardiovascular and Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK
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Schüz B, Conner M, Wilding S, Alhawtan R, Prestwich A, Norman P. Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours? Soc Sci Med 2021; 285:114261. [PMID: 34332252 PMCID: PMC8299154 DOI: 10.1016/j.socscimed.2021.114261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/11/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors. METHODS Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation). RESULTS Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups. CONCLUSION Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.
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Affiliation(s)
| | | | | | - Rana Alhawtan
- University of Leeds, UK; Princess Nourah bint Abdulrahman University, Saudi Arabia
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Mackenzie K, Such E, Norman P, Goyder E. Using Co-Production to Develop "Sit Less at Work" Interventions in a Range of Organisations. Int J Environ Res Public Health 2021; 18:ijerph18157751. [PMID: 34360045 PMCID: PMC8345370 DOI: 10.3390/ijerph18157751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 12/22/2022]
Abstract
Prolonged periods of sitting are associated with negative health outcomes, so the increase in sedentary jobs is a public health concern. Evaluation of interventions to reduce workplace sitting have suggested that participatory approaches may be more effective. This paper describes the use of co-production in four diverse organisations. Workshops with staff in each organisation were conducted to develop an organisation-specific strategy. The first workshop involved creative activities to encourage participants to develop innovative suggestions. The second workshop then developed a feasible and acceptable action plan. An ecological approach was used to consider behaviour change determinants at a range of different levels including intrapersonal, interpersonal, organisational, and environmental-level factors. 41 staff volunteered for workshops (seven in a small business, 16 in a charity, 15 in a local authority, and three in a large corporation). Of those, 27 were able to attend the first workshops and 16 were able to attend the second. Whilst there were some similarities across organisations, the smaller organisations developed a more tailored and innovative strategy than large organisations where there were more barriers to change and a more diverse workforce. Co-production resulted in bespoke interventions, tailored for different organisational contexts, maximising their potential feasibility and acceptability.
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Affiliation(s)
- Kelly Mackenzie
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK; (E.S.); (E.G.)
- Correspondence:
| | - Elizabeth Such
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK; (E.S.); (E.G.)
| | - Paul Norman
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, UK;
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK; (E.S.); (E.G.)
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Mackenzie K, Such E, Norman P, Goyder E. Understanding the Implementation of "Sit Less at Work" Interventions in Three Organisations: A Mixed Methods Process Evaluation. Int J Environ Res Public Health 2021; 18:7361. [PMID: 34299816 PMCID: PMC8304152 DOI: 10.3390/ijerph18147361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022]
Abstract
Long periods of workplace sitting are associated with poor health outcomes. Interventions to reduce workplace sitting time have had variable impacts, the reasons for which require further investigation. In this paper, we report on a process evaluation aiming to determine the intervention fidelity of three "sit less at work" interventions and to explore barriers and enablers to implementation, using a mixed methods "before and after" intervention study design. Convenience samples of staff were recruited from three diverse organisations to participate in pre- and post-intervention online questionnaires, objective measures of sitting time (using activPAL3™ devices) and post-intervention focus groups. Intervention implementers and key personnel were also recruited to participate in post-intervention focus groups and interviews. The process evaluation found that none of the interventions were implemented as intended, with no consistent reductions in sitting time. Contextual and organisational cultural barriers included workload pressures and the social norms of sitting, competing priorities, lack of management buy-in, and perceptions of where the responsibility for behaviour change should come from. To ensure effective implementation of future initiatives, deeper organisational-level change, requiring buy-in from all levels of management and staff, may be needed to shift organisational culture and associated social norms.
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Affiliation(s)
- Kelly Mackenzie
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK; (E.S.); (E.G.)
| | - Elizabeth Such
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK; (E.S.); (E.G.)
| | - Paul Norman
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, UK;
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK; (E.S.); (E.G.)
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Jivraj S, Murray ET, Norman P, Nicholas O. The impact of life course exposures to neighbourhood deprivation on health and well-being: a review of the long-term neighbourhood effects literature. Eur J Public Health 2021; 30:922-928. [PMID: 31576400 PMCID: PMC8489013 DOI: 10.1093/eurpub/ckz153] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background In this review article, we detail a small but growing literature in the field of health
geography that uses longitudinal data to determine a life course component to the
neighbourhood effects thesis. For too long, there has been reliance on cross-sectional
data to test the hypothesis that where you live has an effect on your health and
well-being over and above your individual circumstances. Methods We identified 53 articles that demonstrate how neighbourhood deprivation measured at
least 15 years prior affects health and well-being later in life using the databases
Scopus and Web of Science. Results We find a bias towards US studies, the most common being the Panel Study of Income
Dynamics. Definition of neighbourhood and operationalization of neighbourhood
deprivation across most of the included articles relied on data availability rather than
a priori hypothesis. Conclusions To further progress neighbourhood effects research, we suggest that more data linkage
to longitudinal datasets is required beyond the narrow list identified in this review.
The limited literature published to date suggests an accumulation of exposure to
neighbourhood deprivation over the life course is damaging to later life health, which
indicates improving neighbourhoods as early in life as possible would have the greatest
public health improvement.
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Affiliation(s)
- Stephen Jivraj
- UCL Institute of Epidemiology and Health Care, London, UK
| | - Emily T Murray
- UCL Institute of Epidemiology and Health Care, London, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
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Conner M, van Harreveld F, Norman P. Attitude stability as a moderator of the relationships between cognitive and affective attitudes and behaviour. Br J Soc Psychol 2021; 61:121-142. [PMID: 34117794 DOI: 10.1111/bjso.12473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/19/2021] [Revised: 04/29/2021] [Indexed: 11/27/2022]
Abstract
Temporal stability is assumed to be an important basis for attitudes being strong predictors of behaviour, but this notion has been little tested. The current research reports tests of temporal stability in moderating the attitude-behaviour relationship, specifically in relation to cognitive attitude (i.e., evaluation implied by cognitions about an attitude object) and affective attitude (i.e., evaluation implied by feelings about the attitude object). In three prospective studies (Study 1: physical activity, N = 909; Study 2: multiple health behaviours, N = 281; Study 3: smoking initiation, N = 3,371), temporal stability is shown to moderate the cognitive and affective attitudes to subsequent behaviour relationship in two-, three-, and four-wave designs utilizing between- (Studies 1 and 3) and within-participants (Study 2) analyses and controlling for past behaviour. Effects were more consistent for affective attitudes (when affective and cognitive attitudes were considered simultaneously and past behaviour controlled). Moderation effects were attenuated, but remained significant, in three- and four-wave compared with two-wave designs. The findings underline the role of temporal stability as an indicator of strength and confirm the relative importance of affective over cognitive (components of) attitudes for predicting behaviour.
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Harrison GF, Deng Z, Zhen J, Zhang G, Chen R, Sun G, Yu Q, Nemat-Gorgani N, Guethlein LA, He L, Tang M, Gao X, Cai S, Palmer W, Shortt J, Gignoux C, Carrington M, Zhou H, Parham P, Hong W, Norman P. Genetically Determined Strength of Natural Killer Cells is Enhanced by Adaptive Admixture of HLA class I Allotypes in East <a>Asians</a>. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.111.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Human natural killer (NK) cells are essential for controlling infection, cancer and fetal development. NK cell functions are modulated by interactions between polymorphic inhibitory killer cell immunoglobulin-like receptors (KIR) and polymorphic HLA-A, -B and -C ligands expressed on tissue cells. All HLA-C alleles encode a KIR ligand and contribute to reproduction and immunity. In contrast, only some HLA-A and -B alleles encode KIR ligands and they focus on immunity. By high-resolution analysis of KIR and HLA-A, -B and -C genes, we show that the Chinese Southern Han are significantly enriched for interactions between inhibitory KIR and HLA-A and -B. This enrichment has had substantial input through population admixture with neighboring populations, who contributed HLA class I haplotypes expressing the KIR ligands B*46:01 and B*58:01, which subsequently rose to high frequency by natural selection. Consequently, over 80% of Southern Han HLA haplotypes encode more than one KIR ligand. Complementing the high number of KIR ligands, the Chinese Southern Han KIR locus combines a high frequency of genes expressing potent inhibitory KIR, with a low frequency of those expressing activating KIR. The Southern Han centromeric KIR region encodes strong, conserved, inhibitory HLA-C specific receptors, and the telomeric region provides a high number and diversity of inhibitory HLA-A and -B specific receptors. In all these characteristics, the Southern Han represent other East Asians, whose NK cell repertoires are thus enhanced in quantity, diversity and effector strength, likely through natural selection for resistance to endemic viral infections.
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Affiliation(s)
| | | | | | | | | | - Ge Sun
- 2Shenzhen Blood Center, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Norman
- 1University of Colorado Anschutz Medical Campus
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Abstract
Background A greater understanding of the mechanisms of action of weight-management interventions is needed to inform the design of effective interventions. Purpose To investigate whether dietary restraint, habit strength, or diet self-regulation mediated the impact of a behavioral weight-management intervention on weight loss and weight loss maintenance. Methods Latent growth curve analysis (LGCA) was conducted on trial data in which adults (N = 1,267) with a body mass index (BMI) ≥28 kg/m2 were randomized to either a brief intervention (booklet on losing weight), a 12 week weight-management program or the same program for 52 weeks. LGCA estimated the trajectory of the variables over four time points (baseline and 3, 12 and 24 months) to assess whether potential mechanisms of action mediated the impact of the weight-management program on BMI. Results Participants randomized to the 12 and 52 week programs had a significantly greater decrease in BMI than the brief intervention. This direct effect became nonsignificant when dietary restraint, habit strength, and autonomous diet self-regulation were controlled for. The total indirect effect was significant for both the 12 (estimate = −1.33, standard error [SE] = 0.41, p = .001) and 52 week (estimate = −2.13, SE = 0.52, p < .001) program. Only the individual indirect effect for dietary restraint was significant for the 12 week intervention, whereas all three indirect effects were significant for the 52 week intervention. Conclusions Behavior change techniques that target dietary restraint, habit strength, and autonomous diet self-regulation should be considered when designing weight loss and weight loss maintenance interventions. Longer interventions may need to target both deliberative and automatic control processes to support successful weight management.
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Affiliation(s)
- Sarah Bates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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White S, Zarotti N, Beever D, Bradburn M, Norman P, Coates E, Stavroulakis T, White D, McGeachan A, Williams I, Hackney G, Halliday V, McDermott C. The nutritional management of people living with amyotrophic lateral sclerosis: A national survey of dietitians. J Hum Nutr Diet 2021; 34:1064-1071. [PMID: 33786908 DOI: 10.1111/jhn.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/26/2020] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND People living with amyotrophic lateral sclerosis (ALS) face many challenges with respect to taking adequate nutrition. Growing evidence links weight loss with negative prognostic outcomes. We aimed to explore the practice of dietitians in the UK with regard to the nutritional management of ALS. METHODS A national online survey was disseminated via professional groups, social media and newsletters to UK healthcare professionals between September and November 2018. The survey examined the nutritional management of ALS. Dietitian responses are reported in the present study. RESULTS In total, 130 dietitians responded to the survey. Two-thirds reported that ALS comprised less than 20% of their total patient caseload. Forty-two percent reported that nutritional screening took place in their organisation. One-half of dietitians reported that patients were referred for dietetic assessment at 'about the right time', although 44% reported referrals were made too late. The majority (83%) of dietitians used resting energy expenditure predictive equations not validated in ALS. When setting weight goals, dietitians reported most frequently recommending weight maintenance if the patient's body mass index was 18.5-25 kg m-2 (72%), 25-30 kg m-2 (98%), and > 30 kg m-2 (79%). In addition, 43% reported that people with ALS were not weighed sufficiently frequently. CONCLUSIONS Although the importance of early nutritional assessment is recognised, the timeliness of dietetic input and on-going monitoring of nutritional status in ALS care might not currently be ideal. Dietitians report using energy requirement predictive equations and setting weight goals that may not promote positive outcomes. Further research is required to understand the optimal nutritional management of ALS.
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Affiliation(s)
- Sean White
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicolò Zarotti
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Daniel Beever
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Elizabeth Coates
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Theocharis Stavroulakis
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - David White
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Alexander McGeachan
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Isobel Williams
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Gemma Hackney
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Vanessa Halliday
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
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Vander Hoorn S, Murray K, Nedkoff L, Hankey GJ, Flicker L, Yeap BB, Almeida OP, Norman P, Brunekreef B, Nieuwenhuijsen M, Heyworth J. Long-term exposure to outdoor air pollution and risk factors for cardiovascular disease within a cohort of older men in Perth. PLoS One 2021; 16:e0248931. [PMID: 33780497 PMCID: PMC8006998 DOI: 10.1371/journal.pone.0248931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/14/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
While there is clear evidence that high levels of pollution are associated with increased all-cause mortality and cardiovascular mortality and morbidity, the biological mechanisms that would explain this association are less understood. We examined the association between long-term exposure to air pollutants and risk factors associated with cardiovascular disease. Air pollutant concentrations were estimated at place of residence for cohort members in the Western Australian Centre for Health and Ageing Health in Men Study. Blood samples and blood pressure measures were taken for a cohort of 4249 men aged 70 years and above between 2001 and 2004. We examined the association between 1-year average pollutant concentrations with blood pressure, cholesterol, triglycerides, C-reactive protein, and total homocysteine. Linear regression analyses were carried out, with adjustment for confounding, as well as an assessment of potential effect modification. The four pollutants examined were fine particulate matter, black carbon (BC), nitrogen dioxide, and nitrogen oxides. We found that a 2.25 μg/m3 higher exposure to fine particulate matter was associated with a 1.1 percent lower high-density cholesterol (95% confidence interval: -2.4 to 0.1) and 4.0 percent higher serum triglycerides (95% confidence interval: 1.5 to 6.6). Effect modification of these associations by diabetes history was apparent. We found no evidence of an association between any of the remaining risk factors or biomarkers with measures of outdoor air pollution. These findings indicate that long-term PM2.5 exposure is associated with elevated serum triglycerides and decreased HDL cholesterol. This requires further investigation to determine the reasons for this association.
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Affiliation(s)
- Stephen Vander Hoorn
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Centre for Air Pollution, Energy and Health Research, Glebe, New South Wales, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Graeme J. Hankey
- Medical School, The University of Western Australia, Crawley, Australia
| | - Leon Flicker
- Medical School, The University of Western Australia, Crawley, Australia
- WA Centre for Health & Ageing, The University of Western Australia, Crawley, Australia
| | - Bu B. Yeap
- Medical School, The University of Western Australia, Crawley, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Osvaldo P. Almeida
- Medical School, The University of Western Australia, Crawley, Australia
- WA Centre for Health & Ageing, The University of Western Australia, Crawley, Australia
| | - Paul Norman
- Medical School, The University of Western Australia, Crawley, Australia
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Jane Heyworth
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Centre for Air Pollution, Energy and Health Research, Glebe, New South Wales, Australia
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Jones G, Norman P. Predicting exercise after university: an application of the reasoned action approach across a significant life transition. PSYCHOL HEALTH MED 2021; 27:1495-1506. [PMID: 33622096 DOI: 10.1080/13548506.2021.1890160] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study applied an extended version of the reasoned action approach (RAA) to explain students' post-university exercise intentions and behaviour. Students (N = 136) completed measures of RAA variables, past behaviour, habit strength and self-identity before leaving university, and exercise behaviour six months later (n = 84). The RAA explained 67% of the variance in exercise intentions (experiential attitude, instrumental attitude and autonomy were significant predictors), and 20% of the variance in behaviour (experiential attitude and intention were significant predictors). Past behaviour explained additional variance in exercise intentions and behaviour, but its effects were mediated by self-identity. The RAA provides a useful framework for understanding students' exercise intentions and behaviour as they transition out of university. Self-identity may be particularly important for maintaining exercise levels across significant life transitions.
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Affiliation(s)
- Gareth Jones
- Academy for Sport and Physical Activity, Health and Wellbeing Department, Sheffield Hallam University, Sheffield, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Sheffield, UK
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Halliday V, Zarotti N, Coates E, McGeachan A, Williams I, White S, Beever D, Norman P, Gonzalez S, Hackney G, Ezaydi N, Stavroulakis T, Bradburn M, McDermott C. Delivery of nutritional management services to people with amyotrophic lateral sclerosis (ALS). Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:350-359. [PMID: 33507093 PMCID: PMC8312499 DOI: 10.1080/21678421.2021.1874991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate how nutritional management services for people with Amyotrophic Lateral Sclerosis (pwALS) are structured in the UK, in order to gain insight into current practice and identify key barriers and enablers to delivering and providing services. Methods: A three-part, sequential mixed-methods study was conducted that comprised (i) a thematic analysis of data from five focus groups (with 47 ALS health professionals from 41 UK organizations and four service user representatives), (ii) a nationwide cross-sectional survey (281 ALS healthcare professionals) and (iii) a freedom of information request (251 organizations). Results: UK nutritional management services for pwALS are coordinated from specialist (n = 22) and non-specialist care centers (n = 89), with national variability in the organization and delivery of services. Multidisciplinary working was highlighted to facilitate the coordination of nutritional care. However, the need to provide evidence-based continuing education for HCPs was evident. Overall, the lack of clear guidelines on the nutritional management of people with ALS was identified as a key barrier to the delivery of effective nutritional care, as was the lack of transparency and consistency in the commissioning of nutritional services. Further concerns over the timeliness of the dietetic intervention and equity of access and provision were raised. Conclusions: Our findings suggest that development of guidelines for nutritional management, particularly at diagnosis and pre-gastrostomy, could drive standardization of high quality nutritional care for pwALS. Such guidance has the potential to reduce inequalities in geographical provision by providing clarity for those commissioning specialist nutrition services.
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Affiliation(s)
- Vanessa Halliday
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Nicolò Zarotti
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Elizabeth Coates
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Alexander McGeachan
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Isobel Williams
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Sean White
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Daniel Beever
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Sarah Gonzalez
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Gemma Hackney
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Naseeb Ezaydi
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Theocharis Stavroulakis
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
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Shwageraus E, Norman P, Blaise P, Farnan I, Margulis M, Baker U, Cosgrove P, DeHart M, Boyle J, Armstrong C. PHYSOR2020: TRANSITION TO A SCALABLE NUCLEAR FUTURE. EPJ Web Conf 2021. [DOI: 10.1051/epjconf/202124700001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Engelbrecht R, Patey C, Dubrowski A, Norman P. Development and Evaluation of a 3D-Printed Adult Proximal Tibia Model for Simulation Training in Intraosseous Access. Cureus 2020; 12:e12180. [PMID: 33489591 PMCID: PMC7815301 DOI: 10.7759/cureus.12180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intraosseous infusion remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients and those presenting to the emergency department. There is a scarcity of cost-effective, anatomically correct trainers to improve physician confidence and competency in this skill. The purpose of this report is to describe the development and evaluation of a three-dimensional (3D) printed Adult Proximal Intraosseous (IO) Tibia task trainer for simulation-based medical education. The proposed trainer was designed by combining open-source models of a human skeleton and a lower leg surface scan in Blender (Blender Foundation - www.blender.org) and manipulating them further using a JavaScript program. Polylactic acid was used to simulate bone while cured silicone moulds were used to replicate skin and soft tissue. Two trainers were produced and tested by 15 rural family medicine residents, six rural emergency medicine physicians, and six registered nurses. Participants evaluated the realism of the trainer and its efficacy as a training tool through a structured survey. The trainer received overall positive feedback from all participants, and most participants felt that no improvements were required to use the trainer for medical education. Notable suggestions for improvement included adding an infusion component, increasing the size of the tibial tubercle for better landmarking, and creating a variety of sizes for different patient body types. Residents and emergency medicine physicians practising in rural Newfoundland and Labrador found the 3D-printed trainer to be a practical tool for practising intraosseous technique. The outcome of this report supports the use of this cost-effective trainer for simulation-based medical education.
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Affiliation(s)
| | - Chris Patey
- Emergency Medicine, Carbonear General Hospital, Carbonear, CAN
| | | | - Paul Norman
- Emergency Medicine, Carbonear General Hospital, Carbonear, CAN
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Taylor H, Shryane N, Kapadia D, Dawes P, Norman P. Understanding ethnic inequalities in hearing health in the UK: a cross-sectional study of the link between language proficiency and performance on the Digit Triplet Test. BMJ Open 2020; 10:e042571. [PMID: 33293400 PMCID: PMC7725084 DOI: 10.1136/bmjopen-2020-042571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 07/22/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Research using the UK Biobank data has shown ethnic inequalities in hearing health; however, the hearing test used may exhibit a disadvantage for non-native language speakers. OBJECTIVES To validate the results of the UK Biobank hearing test (Digit Triplet Test, DTT) against self-reported measures of hearing in the dataset and create classifications of hearing health. To observe if language proficiency and migration age have the same effect on hearing health classification as on the DTT in isolation. Our hypothesis is that language proficiency acts differently on the DTT, demonstrating that the DTT is biased for non-native speakers of English. DESIGN Latent classes representing profiles of hearing health were identified from the available hearing measures. Factors associated with class membership were tested using multinomial logistic regression models. Ethnicity was defined as (1) White, native English-speaking, (2) ethnic minority, arrived in the UK aged <12 or (3) ethnic minority, arrived aged >12. PARTICIPANTS The UK Biobank participants with valid hearing test results and associated covariates (N=151 268). OUTCOME MEASURES DTT score, self-reported hearing difficulty, self-reported hearing difficulty in noise and hearing aid use. RESULTS Three classes of hearing health were found: 'normal', 'generally poor' and 'only subjectively poor'. In a model adjusting for known confounders of hearing loss, a poor or insufficient hearing test result was less likely for those with better language (OR 0.69, 95% CI 0.65 to 0.74) or numerical ability (OR 0.71, 95% CI 0.67 to 0.75) but more likely for those having migrated aged >12 (OR 3.85, 95% CI 3.64 to 4.07). CONCLUSIONS The DTT showed evidence of bias, having greater dependence on language ability and migration age than other hearing indicators. Designers of future surveys and hearing screening applications may wish to consider the limitations of speech-in-noise tests in evaluating hearing acuity for populations that include non-native speakers.
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Affiliation(s)
- Harry Taylor
- Social Statistics, The University of Manchester School of Social Sciences, Manchester, UK
- School of Social Sciences, The University of Manchester Cathie Marsh Institute for Social Research, Manchester, UK
| | - Nick Shryane
- Social Statistics, The University of Manchester School of Social Sciences, Manchester, UK
- School of Social Sciences, The University of Manchester Cathie Marsh Institute for Social Research, Manchester, UK
| | - Dharmi Kapadia
- School of Social Sciences, The University of Manchester Cathie Marsh Institute for Social Research, Manchester, UK
- Sociology, The University of Manchester School of Social Sciences, Manchester, UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, The University of Manchester School of Health Sciences, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
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Rand M, Norman P, Goyder E. A systematic review of interventions to increase attendance at health and fitness venues: identifying key behaviour change techniques. BMC Public Health 2020; 20:1874. [PMID: 33287788 PMCID: PMC7720513 DOI: 10.1186/s12889-020-09898-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background Members’ attendance at health and fitness venues typically declines over the course of their membership, with a likely negative impact on physical activity and health outcomes. This systematic review sought to examine the effectiveness of interventions to increase attendance at health and fitness venues and identify the behaviour change techniques (BCTs) included in effective interventions. Methods A systematic search of seven databases was conducted. The Behaviour Change Technique Taxonomy was used to code the interventions. Cohen’s d was used to assess the effectiveness of the interventions. Results Fourteen papers reporting 20 interventions were included in the review. Most interventions were found to have trivial or small effects on attendance, although one had a medium effect (d = 0.60) and three had a large effect (ds = 1.00, 1.37, 1.45). The interventions used a limited range of BCTs, with “Prompts/Cues” being the most frequently used. Of the interventions with large effect sizes, two used “Problem solving” and “Pros and cons” and one used “Goal setting (behaviour)” and “Review behaviour goals”. Conclusions Only a small number of studies have tested interventions to increase attendance at health and fitness venues, with predominantly trivial or small effects. With the possible exception of problem solving alongside decisional balance and goal setting alongside reviewing behaviour goals, there is little evidence for the effectiveness of specific BCTs. Further research is required to identify the key components of effective interventions to increase attendance at health and fitness venues.
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Affiliation(s)
- Matthew Rand
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Cathedral Court, The University of Sheffield, 1 Vicar Ln, Sheffield, S1 2LT, UK
| | - Elizabeth Goyder
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
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Patey C, Asghari S, Norman P, Hurley O. Restructuration d’un service des urgences en milieu rural en préparation à la pandémie de COVID-19. CMAJ 2020; 192:E1343-E1346. [DOI: 10.1503/cmaj.200509-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
OBJECTIVES There are few tests of the ability of cognitive and affective attitudes to predict long-term performance of health behaviours. We assessed relationships between cognitive and affective attitudes and healthy eating behaviour over periods of 4, 6 and 10 years. Design: A prospective survey measuring cognitive and affective attitudes at baseline (T1) and 6 years (T2), and self-report healthy eating behaviour at baseline (T1), 6 (T2) and 10 (T3) years later in a sample of UK adults recruited through General Practice (N = 285). Results: When considered simultaneously, affective attitude (T1 and T2) predicted healthy eating behaviour cross-sectionally (at T1 and T2) and prospectively (over 4 [T2-T3], 6 [T1-T2] and 10 [T1-T3] years) whereas cognitive attitude did not. Stability of affective attitude (T1-T2) moderated the affective attitude-behaviour relationship in some (T1-T2, T1-T3), but not all (T2-T3), prospective analyses. Change in affective attitude, but not cognitive attitude (T1-T2), predicted change in behaviour over 6 (T1-T2) and 10 (T1-T3) years. Conclusions: The findings indicate that affective attitudes can be significant predictors of healthy eating behaviour over prolonged time periods suggesting they may be useful targets for interventions designed to produce long-term change in eating behaviour.
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Affiliation(s)
- Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Paul Norman
- Psychology, University of Sheffield, Sheffield, UK
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