1
|
Newton D, Stephenson J, Azevedo L, Sah RK, Poudel AN, Richardson O. The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis. Public Health 2024; 231:198-203. [PMID: 38703494 DOI: 10.1016/j.puhe.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.
Collapse
Affiliation(s)
- D Newton
- University of Huddersfield, Huddersfield, United Kingdom.
| | - J Stephenson
- University of Huddersfield, Huddersfield, United Kingdom
| | - L Azevedo
- University of Huddersfield, Huddersfield, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - R K Sah
- University of Huddersfield, Huddersfield, United Kingdom
| | - A N Poudel
- University of Huddersfield, Huddersfield, United Kingdom
| | - O Richardson
- University of Huddersfield, Huddersfield, United Kingdom
| |
Collapse
|
2
|
Murphy D, Stephenson J, Bouhbib Y, Graby J, Khavandi A, Lyen S, Hudson B, Rodrigues JCL. Investigating the impact of non-gated thoracic CT prior to CTCA to reduce layered testing. Clin Radiol 2023; 78:947-954. [PMID: 37718182 DOI: 10.1016/j.crad.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
AIM To determine the proportion of computed tomography (CT) coronary angiography (CTCA) referrals with coronary artery calcification (CAC) evident on previous non-cardiac CT imaging and how this impacted the diagnostic yield for CTCA, the requirement for additional diagnostic testing, and the associated costs to confirm or refute obstructive coronary artery disease (CAD). MATERIALS AND METHODS A retrospective review of CTCA examinations was undertaken between 01/05/2018 and 31/05/2020 in which the examinations were cross referenced for previous non-gated thoracic CT at Royal United Hospitals Bath. Major epicardial vessel CAC on baseline CT was re-evaluated by published semi-quantitative methods, giving a per-patient CAC score (mild = 1-3, moderate = 4-6, severe >6). Subsequent incomplete CTCA diagnostic yield, further testing, and cost implications were examined. RESULTS Of the 2140 CTCA examinations identified, 13% (280/2140) had a preceding non-gated thoracic CT (53% female, age 63 ± 11 years). The incomplete diagnostic rate increased with CAC grade, mild 32%, (RR 12; 95% CI 4-40), moderate 64% (RR 25; 95% CI 8-80), severe 75%, (RR 29; 95% CI 9-94). Additional diagnostic testing occurred in 4% for the mild CAC category, and 14% and 42% for moderate and severe, respectively. When severe CAC was identified on a non-gated thoracic CT a cost saving of £171/patient (dobutamine stress echo [DSE]) and £61/patient (myocardial perfusion scintigraphy [MPS]) was established with a direct to functional testing pathway. CONCLUSIONS In patients referred for CTCA where severe CAC was identified on a preceding non-gated thoracic CT a direct to functional testing altered management in 42% of cases and was cost-effective.
Collapse
Affiliation(s)
- D Murphy
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK; Department for Health, University of Bath, Bath, UK
| | - J Stephenson
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK
| | - Y Bouhbib
- Department of Radiology, Royal United Hospitals Bath, Bath, UK
| | - J Graby
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK; Department for Health, University of Bath, Bath, UK
| | - A Khavandi
- Department of Cardiology, Royal United Hospitals Bath, Bath, UK
| | - S Lyen
- Department of Radiology, Royal United Hospitals Bath, Bath, UK
| | - B Hudson
- Department of Radiology, Royal United Hospitals Bath, Bath, UK
| | - J C L Rodrigues
- Department for Health, University of Bath, Bath, UK; Department of Radiology, Royal United Hospitals Bath, Bath, UK.
| |
Collapse
|
3
|
Tosh C, Kavanagh K, Flynn AC, Stephenson J, White SL, Catalao R, Wilson CA. The physical-mental health interface in the preconception period: Analysis of 131,182 women planning pregnancy in the UK. BJOG 2023. [PMID: 36883460 DOI: 10.1111/1471-0528.17447] [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: 08/19/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE physical and mental health of women prior to conception can have a significant impact on pregnancy and child outcomes. Given the rising burden of non-communicable diseases, the aim was to explore the relationship between mental health, physical health and health behaviour in women planning a pregnancy. METHODS cross-sectional analysis of responses from 131,182 women to a preconception health digital education tool, providing data on physical and mental health and health behaviour. Logistic regression was used to explore associations between mental health and physical health variables. RESULTS physical health conditions were reported by 13.1% and mental health conditions by 17.8%. There was evidence for an association between self-reported physical and mental health conditions (OR 2.22; 95% CI 2.14 to 2.3). Those with a mental health condition were less likely to engage with healthy behaviour at preconception such as folate supplementation (OR 0.89; 95% CI 0.86 to 0.92) and consumption of the recommended amount of fruit and vegetables (OR 0.77; 95% CI 0.74 to 0.79). They were more likely to be physically inactive (OR 1.14; 95% CI 1.11 to 1.18), smoke tobacco (OR 1.72; 95% CI 1.66 to 1.78) and use illicit substances (OR 2.4; 95% CI 2.25 to 2.55). CONCLUSIONS greater recognition of mental and physical co-morbidities is needed and closer integration of physical and mental healthcare in the preconception period, which could support people to optimise their health during this time and improve long term outcomes.
Collapse
Affiliation(s)
- C Tosh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - A C Flynn
- Department of Women and Children's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, London, UK
| | - J Stephenson
- Institute for Women's Health, University College London, 1st floor Maple House, 149 Tottenham Court Road, London, UK
| | - S L White
- Department of Women and Children's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, London, UK
| | - R Catalao
- Section of Women's Mental Health, PO31 King's College London, SE5 8AF and South London and Maudsley NHS Foundation Trust, UK
| | - C A Wilson
- NIHR Academic Clinical Lecturer, Section of Women's Mental Health, PO31 King's College London, SE5 8AF and South London and Maudsley NHS Foundation Trust, UK
| |
Collapse
|
4
|
Grace B, Shawe J, Stephenson J. A mixed methods study investigating sources of fertility and reproductive health information in the UK. Sex Reprod Healthc 2023; 36:100826. [PMID: 36842189 DOI: 10.1016/j.srhc.2023.100826] [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: 08/14/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES This study aimed to assess the different sources used by individuals when seeking fertility information in order to understand what's working, what isn't, and opportunities for improvement. METHODS A mixed-method study was conducted via UK-wide cross-sectional survey and semi-structured interviews. 1082 survey-participants were recruited nationwide via online-newspaper and social-media adverts. Of those who agreed to follow-up interview, 35 were purposively sampled to reflect the diversity of gender, age-range, ethnicity and education. Tableau software was used for surveys and NVIVO for interviews. Interview data was transcribed and analysed via thematic framework analysis. RESULTS Sources of information identified included: school-education; healthcare-professionals; internet, social-media, smartphone-apps, online-forums and blogs; family, friends, and communities; books, magazines, newspapers; fertility-products; workplace, communities and sexual-health clinics/centres, charities, and third-party organisations. Participants reported varying levels of access, reliability, and trust, in relation to these sources. Interview themes around veracity showed that healthcare-professionals were highly trusted but not easily accessible. The internet was very popular due to accessibility and perceived anonymity but untrusted, and "the plethora of information can be overwhelming." There were recurring themes around discomfort. A respondent recalled that her first discussion of sex with her mother was on her wedding night stating, "…Mum, I'm 28! And you're just discussing this with me now?" CONCLUSIONS School education remains a consistent but sometimes inadequate source of fertility information. In addition to online-platforms and products based on robust scientific evidence, opportunities for improvement include using underexploited sources, such as workplace and community settings, with training for providers.
Collapse
Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK; Department of Development & Regeneration, University of Leuven, Belgium
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| |
Collapse
|
5
|
Shawe J, Grace B, Stephenson J. P-489 The ABC of fertility intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.126] [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
Study question
What are the intentions of men and women of reproductive age in the UK regarding fertility and family building?
Summary answer
We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom fertility-education strategies should be tailored differently to suit intentions.
What is known already
Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policy makers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore the different family building intentions in order to aid tailoring of information to help individuals and couples achieve their family building intentions.
Study design, size, duration
Mixed method research was conducted via a UK-wide cross-sectional survey and semi-structed interviews. Results were obtained from 1,082 survey respondents and in-depth interviews with 15 men and 20 women. Interviewees were purposively sampled to include men and women from the reproductive age range (18-45 years) and of varying ethnic and educational backgrounds.
Participants/materials, setting, methods
Survey participants were recruited nationwide via online newspaper and social media adverts and of those who agreed to a follow-up interview, 35 were included this study. Interviews lasted an hour on average. Data was transcribed and analysed via thematic framework analysis. Favourable ethical opinion was given by University College London Research Ethics Committee.
Main results and the role of chance
From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of fertility intentions: Avoiders describe respondents who have no children and do not want to have children in the future; Betweeners describe those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describe those who have child(ren) but do not want more; Desirers describe those who are actively trying to conceive; Expectants describe those who were pregnant at the time of the study and Flexers describe those who may or may not already have and are unsure but open to having child(ren) in the future. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future - whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making.
Limitations, reasons for caution
Due to the online recruitment method, there may be a bias toward more educated respondents.
Wider implications of the findings
We developed a user-friendly, alphabetical categorisation of fertility intentions, which can be used by individuals, healthcare professionals, educators, special interest groups, charities, and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family.
Trial registration number
not applicable
Collapse
Affiliation(s)
- J Shawe
- University of Plymouth, Faculty of Health , Plymouth, United Kingdom
| | - B Grace
- University College London, Institute of Women's Health , London, United Kingdom
| | - J Stephenson
- University College London, Institute of Women's Health , London, United Kingdom
| |
Collapse
|
6
|
Grace B, Shawe J, Stephenson J. P-496 “The plethora of information can be overwhelming…”: A mixed methods study exploring the sources of fertility information. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.118] [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: 11/14/2022] Open
Abstract
Abstract
Study question
What sources are used when seeking fertility information and how informed do individuals feel about these sources?
Summary answer
Sources discussed with varying levels of access, reliability, and trust included: school education; healthcare-professionals; websites (general/government/medical); social-media/online-forums; family/friends; smartphone-apps; books/magazines/newspapers; fertility-products; sexual-health clinics/centres and charities.
What is known already
As the average age of first-time parents continues to rise, health policies have highlighted the importance of optimising reproductive health through better knowledge. There has also been a concerted effort by various reproductive health groups to improve fertility awareness. Understanding the different sources of information used by the target audience is important for disseminating and improving fertility knowledge. This mixed-methods study therefore aimed to assess the different sources used by individuals when seeking fertility information and the perceived accessibility and reliability of these sources in order to understand what’s working, what isn’t, and opportunities for improvement.
Study design, size, duration
Mixed method research was conducted via a UK-wide cross-sectional survey and semi-structed interviews. Results were obtained from 1,082 survey respondents and in-depth interviews with 15 men and 20 women. Interviewees were purposively sampled to include men and women from the reproductive age range (18-45 years) and of varying ethnic and educational backgrounds.
Participants/materials, setting, methods
Survey participants were recruited nationwide via online newspaper and social media adverts and of those who agreed to a follow-up interview, 35 were included this study. Interviews lasted an hour on average. Data was transcribed and analysed via thematic framework analysis. Favourable ethical opinion was given by University College London Research Ethics Committee.
Main results and the role of chance
When asked about knowledge from school education, 89.3% of survey respondents selected ‘good’/’some knowledge’ on the biology of reproduction and pregnancy-prevention, contrasting with 76.4% who reported having ‘no knowledge’/’do not recall’ of factors affecting fertility or protection of fertility.
While healthcare-professionals were ranked the most trusted but not easily accessible source, the internet was the most used, due to accessibility and perceived anonymity. However, many internet sources weren’t trusted, with a respondent citing “the plethora of information can be overwhelming, you don’t know what you can trust.” Male, 27, White.
Interviews highlighted family and friends as important sources, but with recurring themes around awkwardness and embarrassment discussing the topic. For example, one respondent recalled that her first discussion of sex with her mother was on her wedding night stating, “…Mum, I'm 28! And you’re just discussing this with me now?” Female, 36, Asian.
Social media was seen as a useful tool for wider reach of different population groups. Mobile apps (e.g. cycle-trackers) were cited but with concerns over information reliability; while others discussed using fertility products like sperm and ovulation kits to better understand their fertility. Other sources discussed include health centres, sexual health clinics, charities and other third-party organisations.
Limitations, reasons for caution
A key methodological limitation of this study is that the interviewees were self-selected, which has implications for generalisability. The results necessarily reflect the views of those who were willing to participate. Additionally, the online recruitment method could result in potential bias towards respondents of higher socioeconomic status.
Wider implications of the findings
School education remains a consistent but sometimes inadequate source of fertility information. Ensuring better fertility information during school education may offset the impact of unreliable sources. In addition to websites, apps and products based on robust scientific evidence, there remains an important need for additional training for primary healthcare-professionals.
Trial registration number
N/A
Collapse
Affiliation(s)
- B Grace
- University College London, Institute for Women’s Health , London, United Kingdom
| | - J Shawe
- University of Plymouth, Faculty of Health , Devon, United Kingdom
| | - J Stephenson
- University College London, Institute for Women’s Health , London, United Kingdom
| |
Collapse
|
7
|
Thwaites A, Hall J, Barrett G, Stephenson J. P-734 How common is spontaneous pregnancy after In vitro Fertilisation (IVF) Livebirth? Systematic review and meta-analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.680] [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
Study question
How common is spontaneous pregnancy after IVF resulting in livebirth? How can this evidence inform future pregnancy planning by women who have successful IVF?
Summary answer
Current evidence suggests that spontaneous pregnancy occurs in at least one in five women in the first three years after having a baby via IVF.
What is known already
It is known that some women having IVF go on to conceive naturally. This reproductive history is of media interest often described as “miracle” pregnancies (1). Women with this experience also identify themselves as a rarity, and their subsequent pregnancies include rapid-repeat, unplanned and unwelcomed pregnancies (2).
Study design, size, duration
An initial scoping review revealed few, heterogeneous studies reporting rates of spontaneous pregnancy or livebirth after successful IVF. These studies suggested that this event is not rare, prompting this first systematic review and meta-analysis. This aims to identify, appraise and synthesise the current evidence on the rate of spontaneous pregnancy after successful IVF.
Participants/materials, setting, methods
Ovid Medline, Embase and PsycINFO were searched on 24/09/2021 using a strategy containing thesaurus and free text terms for the concepts of spontaneous pregnancy, assisted reproduction and livebirth. The search was limited to English language, human studies and publications from 1980. Results were de-duplicated and managed in EndNote, screened by title/abstract and then full text. Random-effects meta-analyses were used to produce a pooled effect estimate of the incidence of spontaneous pregnancy after IVF livebirth.
Main results and the role of chance
1108 distinct references were identified, reducing to 54 when screened by title and abstract. On evaluation of full text, 11 studies were included in this review. Rates of spontaneous pregnancy after IVF livebirth ranged from 10-33% of women. However, studies varied widely according to methodology, population, cause of subfertility, type and outcome of fertility treatment and length of follow-up. Different covariates were investigated and inconsistently found to be associated with spontaneous conception after IVF including younger age, shorter duration of subfertility, fewer number of treatment cycles prior to first delivery and specific causes of subfertility (unexplained, no male factor). The pooled estimate for the rate of spontaneous pregnancy after IVF livebirth was 19% (95% CI, 16%-22%). The pooled estimate was robust when stratifying by IVF/intracytoplasmic sperm injection (ICSI), outcome measure and follow up period. It is a likely underestimate as some studies reported on livebirths (i.e. excluding adverse pregnancy outcomes) and did not include spontaneous births that occurred outside of the study region. Moreover, no studies gave due consideration to contraception, plannedness of pregnancies, change in partner, nor serial spontaneous pregnancies in the same woman.
Limitations, reasons for caution
The current evidence is relatively scarce and diverse. Sample sizes are typically small with only two studies of over a thousand women. Better evidence, in the form of national, data-linked studies, is needed to provide more accurate estimates of this rate, analysis of associated factors and trends over time.
Wider implications of the findings
These findings refute a widely held misconception that spontaneous pregnancy after IVF livebirth is a rare phenomenon. They should be used to counsel women having babies via IVF and inform their decision-making regarding the timing and mode of conception of future pregnancies and contraception use.
Trial registration number
N/A
Collapse
Affiliation(s)
- A Thwaites
- University College London, Institute for Women's Health , London, United Kingdom
| | - J Hall
- University College London, Institute for Women's Health , London, United Kingdom
| | - G Barrett
- University College London, Institute for Women's Health , London, United Kingdom
| | - J Stephenson
- University College London, Institute for Women's Health , London, United Kingdom
| |
Collapse
|
8
|
Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. Hum Reprod 2022. [PMID: 35238351 DOI: 10.1093/humrep/deac036/6541644] [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] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people's reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one 'other' group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as 'Desirers' or 'Flexers' for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK.,SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| |
Collapse
|
9
|
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
- Correspondence address. UCL EGA Institute for Women’s Health, Faculty of Population Health Sciences, Room 236 Medical School Building, University College London, 74 Huntley Street, London WC1E 6AU, UK. E-mail:
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK
- SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
| |
Collapse
|
10
|
Stephenson J, Smith CM, Kearns B, Haywood A, Bissell P. The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study. BMC Public Health 2021; 21:1990. [PMID: 34732156 PMCID: PMC8567540 DOI: 10.1186/s12889-021-12009-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/21/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight. METHODS Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term conditions were tested as both covariates and mediating factors on the causal pathway between obesity and HRQoL. RESULTS Increasing levels of obesity are associated with reduced HRQoL, although this difference is negligible between those of normal weight and those who are overweight. Individuals with obesity and morbid obesity score 4.9 and 11.3 percentage points less on the EQ-5D summary scale respectively than those of normal weight. Concurrent physical, and particularly mental health-related long-term conditions are substantively related to HRQoL: those with 3 or more reported mental or physical health conditions score 29.8 and 14.6 percentage points less on the EQ-5D summary scale respectively than those with fewer conditions. Long-term conditions can be conceptualised as lying on the causal path between obesity and HRQoL, but there is weak evidence for a partial mediating relationship only. CONCLUSIONS To conclude, in agreement with the established literature we have found a clear inverse relationship between increasing weight status and decreasing HRQoL and confirmed the mediating role of long-term conditions in the reduction of HRQoL in people with obesity. Nevertheless, a high BMI remains independently related to HRQoL, suggesting that 'healthy people with obesity' may be in transition to an unhealthy future.
Collapse
Affiliation(s)
- J Stephenson
- School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
| | - C M Smith
- School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - B Kearns
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Haywood
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Bissell
- School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| |
Collapse
|
11
|
Hall JA, Silverio SA, Barrett G, Memtsa M, Goodhart V, Bender-Atik R, Stephenson J, Jurkovic D. Women's experiences of early pregnancy assessment unit services: a qualitative investigation. BJOG 2021; 128:2116-2125. [PMID: 34407281 PMCID: PMC9292489 DOI: 10.1111/1471-0528.16866] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the experiences of women who had used an Early Pregnancy Assessment Unit (EPAU) service in the UK and make recommendations for their improvement. DESIGN Qualitative interview study. SETTING Early Pregnancy Assessment Units in the UK. SAMPLE A maximum variation sample of women who had consented to be interviewed having attended one of 26 EPAUs involved in the VESPA study in 2018. METHODS In-depth telephone interviews with 38 women. A thematic framework analysis was conducted, with a focus on how experiences varied according to EPAU service configuration and clinical pathway. MAIN OUTCOME MEASURES Women's experiences of EPAU services. RESULTS We found that EPAUs are highly valued, and women's experiences were generally positive. However, women reported a range of issues that negatively affected their experience. These included difficulties accessing the service, insensitive management of the investigation and treatment options of pregnancy loss, poor communication, insufficient information and a lack of support for their psychological health. These issues were not strongly associated with EPAU configuration or clinical pathway. CONCLUSIONS Recommendations to improve women's experiences include the separation of EPAUs from general maternity services, and we make suggestions on how to remove barriers to access by reviewing opening hours, how to provide sensitive patient management, such as automatically cancelling appointments and scans following pregnancy loss, and how to improve communication, both with women and their partners as well as with other parts of the health service.
Collapse
Affiliation(s)
- J A Hall
- Faculty of Population Health Sciences, Elizabeth Garrett Anderson Institute for Women's Health, School of Life and Medical Sciences, University College London, London, UK
| | - S A Silverio
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, UK
| | - G Barrett
- Faculty of Population Health Sciences, Elizabeth Garrett Anderson Institute for Women's Health, School of Life and Medical Sciences, University College London, London, UK
| | - M Memtsa
- Faculty of Population Health Sciences, Elizabeth Garrett Anderson Institute for Women's Health, School of Life and Medical Sciences, University College London, London, UK.,Women's Health Services, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Goodhart
- Faculty of Population Health Sciences, Elizabeth Garrett Anderson Institute for Women's Health, School of Life and Medical Sciences, University College London, London, UK.,Women's Health Services, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - J Stephenson
- Faculty of Population Health Sciences, Elizabeth Garrett Anderson Institute for Women's Health, School of Life and Medical Sciences, University College London, London, UK
| | - D Jurkovic
- Faculty of Population Health Sciences, Elizabeth Garrett Anderson Institute for Women's Health, School of Life and Medical Sciences, University College London, London, UK.,Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Grace B, Shawe J, Stephenson J. P–483 “It’s a bigger deal for her”: Understanding differences in partner involvement in reproductive health decision-making. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.482] [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: 11/14/2022] Open
Abstract
Abstract
Study question
What is the level of partners involvement in family-building and reproductive health decisions?
Summary answer
Level of Involvement ranges from active decision-makers and equal-partnerships to indifferent or no partners. Fertility education needs to be tailored according to level of involvement.
What is known already
Partner involvement is very important in alleviating stress associated with fertility and reproductive health decisions. Recent global health policies have recognised the importance of improving knowledge and awareness of fertility and reproductive health among couples, additionally there has been a concerted effort among reproductive health groups, to improve fertility awareness. Understanding the role partners play in decision-making is therefore important in order to ensure that men and women achieve their family building intentions. In this study, we interviewed men and women, to understand partners involvement in decision-making.
Study design, size, duration
The study was a qualitative component of a wider mixed methods study. We carried out 35 in-depth interviews with 15 men and 20 women. Interviewees were purposively sampled to include men and women from the reproductive age range (18–45 years) and of varying ethnic and educational backgrounds.
Participants/materials, setting, methods
Interviewees were sampled from a UK cross-sectional survey on Fertility Awareness. Survey participants were recruited nationwide via online newspaper and social media adverts and of those who agreed to a follow-up interview, 35 were included this study. Interviews lasted an hour on average. Data was transcribed and analysed via framework analysis. Favourable ethical opinion was given by University College London Research Ethics Committee.
Main results and the role of chance
We identified four kinds of partner involvement and impact, as follows:
Drivers: These are active decision-makers who play a bigger role. The decision is usually clear and directive and are typically women. Quotes describing drives include: “Her body her rights”, “I just went with her [views]”, MP5 - Male, Age 38. “She carries the pregnancy, and it’s a bigger deal for her so it’s important for her to choose.” MP1 - Male, Age 45.
Sharers: In these equal partnerships, joint decisions are important. Being similarly minded and aligned is key to achieving desired family building decisions. . “It was very mutual because he’d actually been talking about it for a long time… so we were both completely ready.” Female, Age 31.
Neutrals: general indifference to family-building decision-making and are not as proactive as the drivers.
Solo: includes individuals with no partners or those who haven’t met a suitable partner at the right time or until later in life, or those for whom singleness by choice is key to their decision-making. “If I did meet the right person yeah, I would love one more child, because I’ve always wanted two” Female, Age 36.
Limitations, reasons for caution
One of the main methodological limitations of this study is that the interviewees were self-selected, which has implications for generalisability. The results necessarily reflect the views of those who were willing to participate. Online recruitment method could result in potential bias towards respondents of higher socioeconomic status.
Wider implications of the findings: To improve fertility awareness, current initiatives need to further explore the impact of partners in family-building decision-making in order to have effective campaigns which can help men and women achieve their desired fertility intentions.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- B Grace
- University College London, Institute for Women’s Health, London, United Kingdom
| | - J Shawe
- The University of Plymouth, Institute of Health and Community, Plymouth, United Kingdom
| | - J Stephenson
- University College London, Institute for Women’s Health, London, United Kingdom
| |
Collapse
|
13
|
Thwaites A, Hall J, Geraldine B, Stephenson J. P–743 The fertility paradox: the need for contraception after in vitro fertilisation. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.742] [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: 11/14/2022] Open
Abstract
Abstract
Study question
What are a woman’s contraceptive needs after successful in vitro fertilisation (IVF) pregnancy? and how should services respond to help prevent unintended pregnancies?
Summary answer
Women who have IVF pregnancies require tailored, postnatal contraception counselling. Services must provide evidence-based information about the risks of spontaneous conception to engage them effectively.
What is known already
Women undergoing IVF are an increasingly heterogeneous group with a wide range of causative subfertility factors. Furthermore, increasingly, women are accessing treatment primarily for reasons other than subfertility. The evidence relating to rates of spontaneous conception post assisted conception varies widely according to population, cause of subfertility, type and outcome of fertility treatment and length of follow-up. A recent large retrospective UK cohort study estimated the treatment-independent live birth rate after IVF live birth over 5 year follow up as 15% [https://doi.org/10.1093/humrep/dez099]. We aim to explore the experiences and views about contraception among this diverse group of women.
Study design, size, duration
A qualitative study of the views of women who have had spontaneous pregnancies after successful IVF was conducted in September/October 2020. A qualitative approach of in-depth interviews was chosen to allow exploration of individual experiences in an area not much studied previously. The sample consisted of twenty interviewees from around the UK.
Participants/materials, setting, methods
Purposive and snowballing sampling methods were used with eligible participants recruited from a range of sources including social media and peer networks. The sample included a wide range of spontaneous pregnancy outcomes after successful IVF, including single and multiple livebirths, miscarriage, ectopic pregnancy and termination of pregnancy. The framework method was used for analysis using NVivo12 software.
Main results and the role of chance
Contraceptive choices were subject to a complex and dynamic interaction of influencing factors including i) beliefs regarding their own subfertility, ii) desire for more children and iii) their views on contraception. After IVF pregnancy, the majority of women (n = 15) used no contraception or ineffective methods (inconsistent condom use or withdrawal) before their next pregnancy with only two women using hormonal methods (progesterone-only pill). Spontaneous pregnancy was not universally welcomed in this group and the inter-pregnancy intervals were often short (n = 15, less than 18 months) or very short (n = 6, less than 12 months). After subsequent spontaneous pregnancy, use of contraception and the most effective (long-acting reversible) methods remained low. Women held persistent beliefs regarding their subfertility despite subsequent spontaneous pregnancy (or pregnancies). Women associated aspects of the IVF process (e.g. need for multiple cycles, low numbers of eggs collected etc.) with a sense of personal failure, despite an ultimately “successful” outcome resulting in livebirth. This may contribute to or reinforce their self-belief in subfertility. Other specific barriers to contraception use, in women having IVF, included lack of knowledge of the likelihood of spontaneous pregnancy, lack of contraceptive experience and inherent incentives towards shorter inter-pregnancy intervals.
Limitations, reasons for caution
There is potential recall bias with some women recalling experiences associated with IVF treatment more than ten years ago. However our sample included women who were currently pregnant as well as women who were further towards the end of their reproductive life to capture a range of experiences.
Wider implications of the findings: The contraceptive needs of women having IVF pregnancies are being overlooked. Fertility services should take responsibility for providing accurate information on the risks of subsequent spontaneous pregnancy in this population. Maternity and community healthcare professionals must address women’s perceptions of their fertility in order to engage them in contraception counselling.
Trial registration number
N/A
Collapse
Affiliation(s)
- A Thwaites
- University College London, Institute for Women’s Health, London, United Kingdom
| | - J Hall
- University College London, Institute for Women’s Health, London, United Kingdom
| | - B Geraldine
- University College London, Institute for Women’s Health, London, United Kingdom
| | - J Stephenson
- University College London, Institute for Women’s Health, London, United Kingdom
| |
Collapse
|
14
|
Song SH, McMurray C, Thomas C, Kavanagh S, Stephenson J. Improving pre-pregnancy care for women with diabetes: a community-focused strategy. Diabet Med 2020; 37:2171-2172. [PMID: 32617999 DOI: 10.1111/dme.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 12/01/2022]
Affiliation(s)
- S H Song
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - C McMurray
- Sheffield Clinical Commissioning Group, Sheffield, UK
| | - C Thomas
- Sheffield Local Pharmaceutical Committee, Sheffield, UK
| | - S Kavanagh
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - J Stephenson
- Sheffield Clinical Commissioning Group, Sheffield, UK
| |
Collapse
|
15
|
Gianni C, Al-Ahmad A, Knight B, Tzou W, Santangeli P, Edzards M, Tarzia K, Lee J, Sharma A, Stephenson J, Bailey S, Horton R, Kessler D, Natale A. A novel cardiac signal processing system for electrophysiology procedures: early insights from the pure ep 2.0 study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0390] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Intracardiac electrogram data remain one of the primary diagnostic inputs guiding complex ablation procedures. However, the technology to collect, process, and display intracardiac signals has remained relatively unchanged for the past two decades.
Purpose
We test a new platform, the PURE EP™ 2.0 system (PEP; BioSig Technologies) for signal processing and display.
Methods
Identical electrocardiographic and intracardiac signal data were recorded during 15 AF ablation procedures from the PEP system, the signal recording system, and the 3D mapping system (Figure). The collected signals underwent blinded, controlled evaluation by three independent electrophysiologist reviewers to determine whether the PEP signals are a viable alternative to conventional sources and if it provides additional or clearer diagnostic information. Reviewers were asked to record the quality of each signal sample on a scale of 1–10 and select a rationale for their rating in a dropdown menu. Each paired signal rating was collected and unblinded for the analysis. If the reviewer rated the samples in the set within 1 point of each other, the PEP sample was deemed equivalent to the control. Using a 2+1 statistical method, the ratings from the three reviewers were then compared looking for at least two positive reviews for each PEP sample.
Results
Based on the ratings for each pair of signals, a cumulative total of 29 PEP signals out of 34 (85.3%) were rated as statistically equivalent or better for this dataset. In 35.5% of samples, the reviewers selected PEP because “more signal components were visible”.
Conclusion
The PURE EP 2.0 system is able to produce reliable and high-quality signals when compared to available standard of care systems. Further studies with larger dataset across multiple sites are needed to validate these results.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): BioSig Technologies
Collapse
Affiliation(s)
- C Gianni
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - A Al-Ahmad
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - B Knight
- Northwestern University, Cardiac Electrophysiology, Chicago, United States of America
| | - W Tzou
- University of Colorado, Cardiac Electrophysiology, Aurora, United States of America
| | - P Santangeli
- University of Pennsylvania, Cardiac Electrophysiology, Philadelphia, United States of America
| | - M Edzards
- BioSig Technologies, Westport, United States of America
| | - K Tarzia
- BioSig Technologies, Westport, United States of America
| | - J Lee
- BioSig Technologies, Westport, United States of America
| | - A Sharma
- BioSig Technologies, Westport, United States of America
| | - J Stephenson
- BioSig Technologies, Westport, United States of America
| | - S Bailey
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - R Horton
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - D Kessler
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - A Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| |
Collapse
|
16
|
Astin F, Stephenson J, Probyn J, Holt J, Marshall K, Conway D. 2201Coronary angioplasty patients' preferences for information about treatment risks: a survey study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0105] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Percutaneous Coronary Intervention (PCI) is the commonest invasive procedure in cardiology. Before treatment consent must be given. As part of this communication process patients receive information about the risks and benefits of PCI and alternative treatments. Published studies tell us that the amount and quality of the information received by patients undergoing PCI is variable; benefits are often overestimated, risks forgotten and alternative treatments not always considered. Very little is known about patients' preferences for PCI risk information. Aim: To describe patients' preferences for formation about PCI treatment risk as part of the informed consent process Methods: A cross-sectional survey was distributed to 350 participants treated with PCI across 10 PCI centres in England.
Results
Three hundred and twenty six participants completed the survey. Thirty percent of the sample reported needing help to understand written medical information. Fifty-one percent were treated with elective PCI, 75% were male, average age of 66.5 years. Recall and comprehension of PCI information given during the consent process was generally limited; 47% and 61% agreed that patients do not usually understand, or remember, the information given to them respectively. Eighty-eight percent of urgent PCI patients wanted to know about all possible risks compared to 90% of elective cases. Most participants (88% urgent and 94% elective) believed that PCI would reduce their risk of a future heart attack.
Conclusion
A significant proportion of PCI patients find it difficult to recall or understand information about treatment risks. It is recommended that patients are given health-related information designed to accommodate different health literacy levels in advance of their treatment.
Acknowledgement/Funding
National Institute for Health Research Research for Patient Benefit Programme Grant Reference Number PB-PG-0712-28089
Collapse
Affiliation(s)
- F Astin
- University of Huddersfield & Calderdale & Huddersfield NHS Trust, Huddersfield, United Kingdom
| | - J Stephenson
- University of Huddersfield, School of Human and Health Sciences, Huddersfield, United Kingdom
| | - J Probyn
- University of Salford, School of Health and Society, Allerton Building, Salford, United Kingdom
| | - J Holt
- University of Leeds, School of Healthcare, Leeds, United Kingdom
| | - K Marshall
- University of Huddersfield, School of Human and Health Sciences, Huddersfield, United Kingdom
| | - D Conway
- Pinderfields General Hospital, Cardiology, Wakefield, United Kingdom
| |
Collapse
|
17
|
Hall JA, Stephenson J, Barrett G. On the Stability of Reported Pregnancy Intentions from Pregnancy to 1 Year Postnatally: Impact of Choice of Measure, Timing of Assessment, Women's Characteristics and Outcome of Pregnancy. Matern Child Health J 2019; 23:1177-1186. [PMID: 31218607 PMCID: PMC6658581 DOI: 10.1007/s10995-019-02748-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Retrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention. METHODS We compared the test-retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher's exact tests, and calculated odds ratios to estimate effect size. RESULTS The DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51-0.66); the DHS had moderate reliability (0.56-0.58). The LMUP's stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p = 0.033), number of children (p = 0.048) and postnatal depression (p < 0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy. CONCLUSIONS FOR PRACTICE The LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.
Collapse
Affiliation(s)
- J A Hall
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, London, UK.
| | - J Stephenson
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, London, UK
| | - G Barrett
- Research Department of Reproductive Health, UCL EGA Institute for Women's Health, London, UK
| |
Collapse
|
18
|
Coyer F, Clark M, Slattery P, Thomas P, McNamara G, Edwards C, Ingleman J, Stephenson J, Ousey K. Exploring pressures, tissue reperfusion and body positioning: a pilot evaluation. J Wound Care 2019; 26:583-592. [PMID: 28976827 DOI: 10.12968/jowc.2017.26.10.583] [Citation(s) in RCA: 5] [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: 11/11/2022]
Abstract
OBJECTIVE To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR. METHODS This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. RESULTS We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091). CONCLUSIONS Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.
Collapse
Affiliation(s)
- F Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Herston, Queensland, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - M Clark
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - P Slattery
- Director, Department of Rehabilitation Engineering, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - P Thomas
- Consultant Physiotherapist, Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - G McNamara
- Clinical Nurse, Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - C Edwards
- Senior Lecturer and Course Coordinator (Graduate Diploma) Medical Ultrasound, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - J Ingleman
- MAdvPracticeCritCare, Research Assistant, School of Nursing, Faculty of Health, Queensland University of Technology, Herston, Queensland, Australia
| | - J Stephenson
- Senior Lecturer Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, UK
| | - K Ousey
- Professor and Director/Adjunct Associate Professor, School of Nursing, Faculty of Health, Queensland University of Technology, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| |
Collapse
|
19
|
Grace B, Shawe J, Johnson S, Stephenson J. You did not turn up… I did not realise I was invited…: understanding male attitudes towards engagement in fertility and reproductive health discussions. Hum Reprod Open 2019; 2019:hoz014. [PMID: 31218265 PMCID: PMC6573469 DOI: 10.1093/hropen/hoz014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/14/2019] [Revised: 04/15/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION What are the underlying reasons for low male engagement in fertility and reproductive health discussions and decision-making? SUMMARY ANSWER The perception of women's primacy in fertility and reproductive health limits the extent to which men believe their engagement is important. WHAT IS KNOWN ALREADY Active participation of men in the process of informed decision-making regarding childbearing is beneficial for mother, father, and child. However, in research studies in these areas, little attention has been given to men. Additionally, there is poor engagement by men, as well as a dearth of information from, and on, the male perspective. STUDY DESIGN SIZE DURATION In total, 35 semi-structured telephone and face-to-face interviews were conducted in an office setting with three groups: 13 lay women, 13 lay men, and 9 (2 male and 7 female) healthcare professionals. Interviews took place between October 2016 and February 2017. PARTICIPANTS/MATERIALS SETTING METHODS Participants were men and women of reproductive age from the general population and healthcare professionals who had completed an online fertility awareness survey and agreed to follow-up interviews. Interviews were audio recorded and lasted ~1 hour, during which participants were asked to provide their views on childbearing decision-making, and male and female representation in fertility and reproductive health. Data was transcribed verbatim and analysed qualitatively via framework analysis. MAIN RESULTS AND THE ROLE OF CHANCE Both men and women saw fertility as a woman's issue, but from different viewpoints. Women saw it from the perspective of societal stereotypes regarding male and female roles, whereas men tended to defer to the woman's primacy in reproductive decisions. Men generally wanted to be involved in childbearing discussions and improve their fertility knowledge. However, they felt they did not have a voice on the topic because discussions have traditionally focused on women. The notion that men are not expected to be interested and engaged thus becomes a self-fulfilling prophecy. Healthcare professionals agreed that fertility was perceived as the woman's domain, but also highlighted that poor male involvement is typically observed across healthcare needs and is not necessarily unique to fertility and reproductive health. LIMITATIONS REASONS FOR CAUTION Due to the online recruitment method, there is a potential bias towards respondents of higher, rather than lower, socioeconomic status within the general population. WIDER IMPLICATIONS OF THE FINDINGS Fertility tends to be seen as a private topic. Additional concerted effort by reproductive health researchers, charity organisations, educators, healthcare service providers, and policy makers is needed to proactively encourage male involvement in reproductive decision-making. This can be achieved through normalising and breaking taboos around the topic, male-friendly research study design approaches, male-inclusive reproductive healthcare services, implementation of health policies that recognise the needs of men, encouraging male research staff representation, and age-appropriate educational programmes on sexual and reproductive health, which include boys and adolescents from a young age. STUDY FUNDING/COMPETING INTERESTS Research funding was received from SPD Development Co. Ltd. B.G. and S.J. are employed by SPD Development Co. Ltd. None of the other authors have any conflict of interest related to the discussed topic. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- B Grace
- Research Department of Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.,SPD Development Company Limited, Bedford, UK
| | - J Shawe
- The Institute of Health and Community, Faculty of Health & Human Sciences, the University of Plymouth, Plymouth, UK
| | - S Johnson
- SPD Development Company Limited, Bedford, UK
| | - J Stephenson
- Research Department of Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| |
Collapse
|
20
|
Cashman P, Moberley S, Chee K, Stephenson J, Chaverot S, Martinelli J, Gadsden T, Bateman-Steel C, Redwood L, Howard Z, Ferson M, Durrheim D. Participant centred safety surveillance of health care workers receiving influenza vaccination. Vaccine 2019; 37:2427-2429. [DOI: 10.1016/j.vaccine.2019.02.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
|
21
|
Gorter RP, Stephenson J, Nutma E, Anink J, de Jonge JC, Baron W, Jahreiβ MC, Belien JAM, van Noort JM, Mijnsbergen C, Aronica E, Amor S. Rapidly progressive amyotrophic lateral sclerosis is associated with microglial reactivity and small heat shock protein expression in reactive astrocytes. Neuropathol Appl Neurobiol 2018; 45:459-475. [PMID: 30346063 PMCID: PMC7379307 DOI: 10.1111/nan.12525] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 05/06/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
AIMS Amyotrophic lateral sclerosis (ALS) is a chronic neurodegenerative disease characterized by progressive loss of motor neurons, muscle weakness, spasticity, paralysis and death usually within 2-5 years of onset. Neuroinflammation is a hallmark of ALS pathology characterized by activation of glial cells, which respond by upregulating small heat shock proteins (HSPBs), but the exact underlying pathological mechanisms are still largely unknown. Here, we investigated the association between ALS disease duration, lower motor neuron loss, TARDNA-binding protein 43 (TDP-43) pathology, neuroinflammation and HSPB expression. METHODS With immunohistochemistry, we examined HSPB1, HSPB5, HSPB6, HSPB8 and HSP16.2 expression in cervical, thoracic and sacral spinal cord regions in 12 ALS cases, seven with short disease duration (SDD), five with moderate disease duration (MDD), and ten age-matched controls. Expression was quantified using ImageJ to examine HSP expression, motor neuron numbers, microglial and astrocyte density and phosphorylated TDP-43 (pTDP-43+) inclusions. RESULTS SDD was associated with elevated HSPB5 and 8 expression in lateral tract astrocytes, while HSP16.2 expression was increased in astrocytes in MDD cases. SDD cases had higher numbers of motor neurons and microglial activation than MDD cases, but similar levels of motor neurons with pTDP-43+ inclusions. CONCLUSIONS Increased expression of several HSPBs in lateral column astrocytes suggests that astrocytes play a role in the pathogenesis of ALS. SDD is associated with increased microgliosis, HSPB5 and 8 expression in astrocytes, and only minor changes in motor neuron loss. This suggests that the interaction between motor neurons, microglia and astrocytes determines neuronal fate and functional decline in ALS.
Collapse
Affiliation(s)
- R P Gorter
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - J Stephenson
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - E Nutma
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - J Anink
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J C de Jonge
- Section Molecular Neurobiology, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Deltacrystallon, Leiden, The Netherlands
| | - W Baron
- Section Molecular Neurobiology, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Deltacrystallon, Leiden, The Netherlands
| | - M-C Jahreiβ
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - J A M Belien
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - C Mijnsbergen
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E Aronica
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Amor
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
22
|
Brackenridge L, Finer N, Batterham RL, Pedram K, Ding T, Stephenson J, Barry J, Hardiman P. Pre-pregnancy weight loss in women with obesity requesting removal of their intra-uterine contraceptive device in order to conceive: a pilot study of full meal replacement. Clin Obes 2018; 8:244-249. [PMID: 29892993 DOI: 10.1111/cob.12252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 12/17/2022]
Abstract
Obesity during pregnancy is associated with increased risks of thromboembolism, gestational diabetes, pre-eclampsia, miscarriage, congenital anomaly, macrosomia and stillbirth. The current practice, directed at reducing gestational weight gain, is largely ineffective. The present pilot study was designed to assess the acceptability of a 24-week intensive weight management programme (IWMP; full meal replacement followed by partial meal replacement and weight stabilization) to achieve weight loss for women with obesity requesting removal of their intra-uterine contraceptive device in order to conceive. Twenty six (65%) of eligible participants consented to the IWMP; three received this as routine National Health Service care in the University College Hospital clinic and 14 participated in the study. The commonest reasons for not participating were dislike of milk, anxiety and lack of support from family and friends. Omitting one woman who dropped out because of problems unrelated to the intervention, the completion rate was 46.2%. Including all women who started the programme, mean body mass index decreased significantly (P = 0.005) from 37.8 to 35.3 kg/m2 . The median percentage decrease was significantly (P = 0.007) greater for women who completed the study (14.2) compared to those who dropped out (1.2). These results suggest an impressive level of weight loss in about one third of all women offered the IWMP who had to defer what they were seeking (pregnancy) while following a challenging programme that they were not seeking. However, studies of other interventions, such as partial meal replacement or commercial products, which may have higher rates of completion are still required.
Collapse
Affiliation(s)
- L Brackenridge
- Institute for Women's Health, University College London, London, UK
| | - N Finer
- Institute of Cardiovascular Science, University College London, London, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK
| | - K Pedram
- Institute for Women's Health, University College London, London, UK
| | - T Ding
- Department of Statistical Science, University College London, London, UK
| | - J Stephenson
- Institute for Women's Health, University College London, London, UK
| | - J Barry
- Institute for Women's Health, University College London, London, UK
| | - P Hardiman
- Institute for Women's Health, University College London, London, UK
| |
Collapse
|
23
|
Stephenson J, Sinha R, Price S. A systematic review of cognitive functional outcomes reported in patients with glioblastoma multiforme treated with surgical resection. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.354] [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: 10/28/2022]
|
24
|
Dingley J, Stephenson J, Allender V, Dawson S, Williams D. Changes in hardness and resilience of i-gelTM
cuffs with temperature: a benchtop study. Anaesthesia 2018; 73:856-862. [DOI: 10.1111/anae.14300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Dingley
- Swansea University College of Medicine; Swansea UK
| | | | - V. Allender
- Food Science and Technology; Department of Healthcare and Food; Cardiff School of Sport and Health Sciences; Cardiff Metropolitan University; Cardiff UK
| | - S. Dawson
- Food Science and Technology; Department of Healthcare and Food; Cardiff School of Sport and Health Sciences; Cardiff Metropolitan University; Cardiff UK
| | - D. Williams
- Welsh Centre for Burns; ABM University Health Board; Swansea UK
| |
Collapse
|
25
|
Armstrong A, Grabner M, Stephenson J, Zhao R, Mallya U, Bieszk N, Miao R, Gadkari A, Chao J. 239 Physician experiences and perceptions of systemic therapies for atopic dermatitis in the United States. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.245] [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: 11/15/2022]
|
26
|
Ousey K, Edward KL, Lui S, Stephenson J, Walker K, Duff J, Leaper D. Perioperative, local and systemic warming in surgical site infection: a systematic review and meta-analysis. J Wound Care 2017; 26:614-624. [DOI: 10.12968/jowc.2017.26.11.614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Ousey
- Professor, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - K-L. Edward
- Professor of Nursing and Practice-based Research, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - S. Lui
- Senior Lecturer, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - J. Stephenson
- Senior Lecturer Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - K. Walker
- Professor, School of Health Sciences, University of Tasmania, Darlinghurst, Australia
| | - J. Duff
- Associate Professor, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - D. Leaper
- Emeritus Professor, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| |
Collapse
|
27
|
Ke X, Kavati A, Wertz D, Huang Q, Wang L, Willey V, Stephenson J, Ortiz B, Panettieri R, Corren J. P211 A real-world assessment of asthma exacerbations in asthma patients newly treated with omalizumab. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.249] [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: 10/18/2022]
|
28
|
Huang Q, Kavati A, Ke X, Wertz D, Wang L, Willey V, Stephenson J, Ortiz B, Panettieri R, Corren J. P210 Real-world comparisons of clinical characteristics and medication utilization pre- and post-omalizumab initiation in asthma patients. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.248] [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: 11/30/2022]
|
29
|
Ke X, Kavati A, Wertz D, Huang Q, Wang L, Willey V, Stephenson J, Ortiz B, Panettieri R, Corren J. P212 A real-world assessment of omalizumab treatment patterns in asthma patients newly treated with omalizumab. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.250] [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: 11/15/2022]
|
30
|
Harrison SJ, Messner J, Leeder DJ, Stephenson J, Sidhom SA. Are Albumin Levels a Good Predictor of Mortality in Elderly Patients with Neck of Femur Fractures? J Nutr Health Aging 2017; 21:699-703. [PMID: 28537335 DOI: 10.1007/s12603-016-0799-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
BACKGROUND Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (<35g/dl) has been highlighted as being a good biochemical predictor of short-term mortality (<12 months). Our aims were to assess whether there was an association between low albumin levels and mortality and whether the severity adversely affects outcomes. MATERIALS AND METHODS Patients admitted to our large district hospital between January 2011 and December 2012 who had sustained a NOF fracture, were over 65 years old and had a pre-operative albumin level were included. This retrospective, longitudinal, observational study concluded in July 2014. Demographic and pre-operative function and albumin data was collated retrospectively. An association with mortality was made. RESULTS 471 patients had usable data. Mean pre-operative albumin level was 29.5g/dl (SD 6.22g/dl) in patients who died and 32.8g/dl (SD 6.43g/dl) in patients who survived during the study period. Pre-operative albumin level was significantly associated with survival (hazard ratio 0.957: 95% CI (0.937, 0.978); p<0.001). Thus, a reduction of 1g/dl in pre-operative albumin is associated with an increased hazard of death of 4.3%. CONCLUSIONS Early identification of patients with hypoalbuminaemia on admission with a venous blood sample and timely input from orthogeriatrians could optimise these patients pre- and post-operatively. This may enable rates of morbidity and mortality to fall. Hypoalbuminaemia may be a reasonable predictor of shorter-term mortality in this patient subgroup. However, this may reflect existing co-morbidities rather than an isolated cause. This study supports an association between hypoalbuminaemia and poorer outcome for patients with NOF fractures.
Collapse
Affiliation(s)
- S J Harrison
- Simon J Harrison, Huddersfield Royal Infirmary, Acre Street, Huddersfield, HD3 3EA, United Kingdom, , Tel: +44 07967 759035
| | | | | | | | | |
Collapse
|
31
|
Kirshbaum MN, Dent J, Stephenson J, Topping AE, Allinson V, McCoy M, Brayford S. Open access follow-up care for early breast cancer: a randomised controlled quality of life analysis. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27717057 PMCID: PMC5516199 DOI: 10.1111/ecc.12577] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Accepted: 08/12/2016] [Indexed: 12/11/2022]
Abstract
This study evaluated the acceptability of a supportive model of follow‐up. One hundred and twelve women recovering from breast cancer were randomised to receive standard breast clinic aftercare (Control n = 56) or on demand by open access aftercare by breast care nurses (Intervention n = 56). Participants attended a support‐based psycho‐educational programme delivered in four half‐day group sessions. Three quality of life questionnaires (EORTC QLQ‐C30, QLQ‐BR23, HADS) were administered at baseline and 6‐monthly intervals for 2 years. Multilevel linear regression modelling methods were used for evaluation. Age was found to be a statistically significant predictor of quality of life in several sub‐scales. Increasing age was negatively associated with sexual functioning, systematic therapy side effects and physical functioning, and positively associated with future perspective. Aftercare assignment was not found to be a statistically significant predictor. Women treated for early breast cancer were not disadvantaged by allocation to the open access supportive care model in terms of quality of life experienced. The model for follow‐up was demonstrated to be a feasible alternative to routinised hospital‐based follow‐up and adds to the evidence for stratified follow‐up for low‐risk cancer patients, incorporating self‐management education. Stratified follow‐up pathways are viewed as a preferable approach.
Collapse
Affiliation(s)
- M N Kirshbaum
- School of Health, Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
| | - J Dent
- The Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | | | | | - V Allinson
- The Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - M McCoy
- Breast Cancer Care, Sheffield, UK
| | | |
Collapse
|
32
|
Atkinson R, Davies B, Jones A, van Popta D, Ousey K, Stephenson J. Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site infection. J Hosp Infect 2016; 94:80-5. [DOI: 10.1016/j.jhin.2016.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/13/2016] [Indexed: 01/28/2023]
|
33
|
Atkinson R, Stephenson J, Jones A, Ousey K. An assessment of key risk factors for surgical site infection in patients undergoing surgery for spinal metastases. J Wound Care 2016; 25 Suppl 9:S30-4. [DOI: 10.12968/jowc.2016.25.sup9.s30] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R.A. Atkinson
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
- Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - J. Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - A. Jones
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - K.J. Ousey
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
34
|
Abstract
OBJECTIVE To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes. METHOD Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. RESULTS Staff observed an average of 2.72 PUs in their workplaces over the previous 12 months, judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer PUs to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received before residents returned from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; reliance was placed on advice of district nurses or tissue viability specialists. CONCLUSION Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the health-care costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly necessary, as levels of the older population who may require assisted living continue to rise.
Collapse
Affiliation(s)
- K Ousey
- Director Institute of Skin Integrity and Infection Prevention.,School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
| | - V Kaye
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
| | - K McCormick
- NHS Heywood, Middleton and Rochdale Clinical Commissioning Group
| | - J Stephenson
- Director Institute of Skin Integrity and Infection Prevention.,School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
| |
Collapse
|
35
|
Grant A, Bolton W, Stephenson J, Hale A, Ben-Or S. V-066ROBOTIC-ASSISTED THORACOSCOPIC BRONCHOPLASTY: A NOVEL TECHNIQUE. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.66] [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: 11/13/2022] Open
|
36
|
Coignard-Biehler H, Isakov A, Stephenson J. Pre-hospital transportation in Western countries for Ebola patients, comparison of guidelines. Intensive Care Med 2015; 41:1472-6. [PMID: 25800581 PMCID: PMC4502292 DOI: 10.1007/s00134-015-3734-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/24/2015] [Indexed: 01/23/2023]
Affiliation(s)
- H Coignard-Biehler
- SPILF COREB Emergences (Coordination Opérationnelle du Risque Epidemique et Biologique), COREB AP-HP, LabEx IBEID Institut Pasteur, Service des Maladies Infectieuses et Tropicales, SAMU 75, Hôpital Necker-Enfants Malades, Paris, France,
| | | | | |
Collapse
|
37
|
Borad MJ, Reddy S, Uronis H, Sigal DS, Cohn AL, Schelman WR, Stephenson J, Chiorean EG, Rosen PJ, Ulrich B, Dragovich T, Prete SD, Rarick M, Eng C, Kroll S, Ryan D. Abstract LB-121: Randomized phase II study of the efficacy and safety of gemcitabine + TH-302 (G+T) vs gemcitabine (G) alone in previously untreated patients with advanced pancreatic cancer. Clin Trials 2014. [DOI: 10.1158/1538-7445.am2012-lb-121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
38
|
Whitehouse S, Stephenson J, Sinclair V, Gregory J, Tambe A, Verma R, Siddique I, Saeed M. A validation of the Oswestry Spinal Risk Index. Eur Spine J 2014; 25:247-251. [PMID: 25391625 DOI: 10.1007/s00586-014-3665-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). METHODS We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. RESULTS Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). CONCLUSIONS Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.
Collapse
Affiliation(s)
- S Whitehouse
- ST7 Orthopaedics, North West Deanery, Manchester, UK.
| | - J Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - V Sinclair
- ST7 Orthopaedics, North West Deanery, Manchester, UK
| | - J Gregory
- University of Manchester, Manchester, UK
| | - A Tambe
- Salford Royal Foundation Trust, Salford, UK
| | - R Verma
- Salford Royal Foundation Trust, Salford, UK
| | | | | |
Collapse
|
39
|
Evers J, Farley T, Gemzell-Danielsson K, Glasier A, Hannaford P, La Vecchia C, Moreau C, Stephenson J, Baird D, Crosignani P, Gianaroli L, Glasier A, Crosignani P. Simultaneous prevention of unintended pregnancy and STIs: a challenging compromise. Hum Reprod Update 2014; 20:952-63. [DOI: 10.1093/humupd/dmu030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
40
|
Pratt R, Stephenson J, Mann S. What influences contraceptive behaviour in women who experience unintended pregnancy? A systematic review of qualitative research. J OBSTET GYNAECOL 2014; 34:693-9. [DOI: 10.3109/01443615.2014.920783] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
41
|
Rahman R, Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients. Eye (Lond) 2014; 28:410-4. [PMID: 24406414 DOI: 10.1038/eye.2013.305] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/20/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To establish whether early vitrectomy for epiretinal membrane (ERM) is preferable to delayed surgery. METHODS We carried out a retrospective study of 120 eyes from 120 patients with pre-operative visual acuity (VA) of 6/60 or better. Pre-operative logMAR score was considered to act as an appropriate proxy measure for time of surgical procedure, with scores of 0.3 or less considered to represent early surgery, scores of 0.4 or 0.5 considered to represent medium surgery, and scores of 0.6 or more considered to represent late surgery for ERM. Patients were either pseudophakic at the time of vitrectomy or underwent combined phaco-vitrectomy for symptomatic ERM. RESULTS Evaluation of parameter coefficients indicated that controlling for other factors, a delay of the surgical procedure from a state of early to medium corresponded to an increase (ie, disbenefit) of 0.074 units in post-operative logMAR score (95% confidence interval -0.001-0.15). A delay of the surgical procedure from a state of early to late corresponded to an increase (ie, disbenefit) of 0.21 units in post-operative logMAR score (95% confidence interval 0.13-0.29). Mean post-operative VA for early surgery was 0.16, out of which 36.2% of patients had a LogMAR score of 0.1 or better. This is in comparison to 17.2% in late ERM (those with a pre-operative logMAR score of 0.6 or more). CONCLUSION We conclude that early surgery is associated with a lower (ie, better) post-operative logMAR score. Vitrectomy for early symptomatic ERM, in carefully selected patients, is beneficial in preserving excellent vision and allows quicker visual rehabilitation.
Collapse
Affiliation(s)
- R Rahman
- Calderdale Royal Hospital, Halifax, UK
| | - J Stephenson
- School of Human and Health Sciences, University of Huddersfield, Queensgate, UK
| |
Collapse
|
42
|
Ali M, Stephenson J, Naylor A. Delay Prior to Expedited Carotid Endarterectomy: A Prospective Audit of Practice. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.08.023] [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: 11/16/2022]
|
43
|
Al-Leswas D, Eltweri A, Hall T, Stephenson J, Pollard C, Garcea G, Metcalfe M, Dennison A. PP075-SUN SAFETY AND TOLERABILITY OF TWO PARENTERAL LIPID EMULSIONS IN PATIENTS WITH SEVERE ACUTE PANCREATITIS AS MEASURED BY SERUM TRIGLYCERIDE AND CHOLESTEROL LEVELS: A RANDOMISED CONTROLLED TRIAL. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60120-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Al-Leswas D, Chung WY, Eltweri A, Stephenson J, Arshad A, Pollard C, Garcea G, Metcalfe M, Dennison A. OP004 EVALUATION OF THE CYTOKINES RESPONSE TO OMEGA-3 FATTY ACIDS IN PATIENTS WITH SEVERE ACUTE PANCREATITIS: A RANDOMISED CONTROLLED TRIAL. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60006-0] [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: 10/26/2022]
|
45
|
Dave S, Svenstrup H, Carder C, Grant P, Morris-Jones S, Kidd I, Stephenson J. P3.062 Mycoplasma Genitalium Prevalence and Risk Factors Among Young Sexually Active Women in the General Population and Attending Sexually Transmitted Infection Clinics in London, UK. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0522] [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: 11/04/2022]
|
46
|
Graham CA, Panicker S, Shawe J, Stephenson J. Women's experiences with tailored use of a combined oral contraceptive: a qualitative study. Hum Reprod 2013; 28:1620-5. [DOI: 10.1093/humrep/det078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
47
|
Petrylak D, Kantoff P, Mega A, Stephenson J, Vogelzang N, Fleming M, Blattman S, Stambler N, D'Ambrosio P, Israel R. 244 Prostate Specific Membrane Antigen Antibody Drug Conjugate (PSMA ADC): a Phase 1 Trial in Castration-Resistant Metastatic Prostate Cancer (mCRPC). Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72042-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
48
|
Borad M, Reddy S, Bahary N, Uronis H, Sigal D, Cohn A, Schelman W, Stephenson J, Eng C, Ryan D. TH-302 + Gemcitabine (G + T) vs Gemcitabine (G) in Patients with Previously Untreated advanced Pancreatic Cancer (PAC). Ann Oncol 2012. [DOI: 10.1093/annonc/mds398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Caddick J, Green L, Stephenson J, Spyrou G. The psycho-social impact of facial skin cancers. J Plast Reconstr Aesthet Surg 2012; 65:e257-9. [DOI: 10.1016/j.bjps.2012.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/23/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
|
50
|
|