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1.
Health Technol Assess ; 28(53): 1-152, 2024 09.
Artículo en Inglés | MEDLINE | ID: mdl-39259017

RESUMEN

Background: Older adults with multimorbidity experience impaired health-related quality of life and treatment burden. Yoga has the potential to improve several aspects of health and well-being. The British Wheel of Yoga's Gentle Years Yoga© programme was developed specifically for older adults, including those with chronic conditions. A pilot trial demonstrated feasibility of using Gentle Years Yoga in this population, but there was limited evidence of its effectiveness and cost-effectiveness. Objective: To determine the effectiveness and cost-effectiveness of the Gentle Years Yoga programme in addition to usual care versus usual care alone in older adults with multimorbidity. Design: Pragmatic, multisite, individually randomised controlled trial with embedded economic and process evaluations. Setting: Participants were recruited from 15 general practices in England and Wales from July 2019 with final follow-up in October 2022. Participants: Community-dwelling adults aged 65 years and over with multimorbidity, defined as two or more chronic health conditions from a predefined list. Interventions: All participants continued with any usual care provided by primary, secondary, community and social services. The intervention group was offered a 12-week programme of Gentle Years Yoga. Main outcome measures: The primary outcome and end point were health-related quality of life measured using the EuroQol-5 Dimensions, five-level version utility index score over 12 months. Secondary outcomes were health-related quality of life, depression, anxiety, loneliness, incidence of falls, adverse events and healthcare resource use. Results: The mean age of the 454 randomised participants was 73.5 years; 60.6% were female, and participants had a median of three chronic conditions. The primary analysis included 422 participants (intervention, n = 227 of 240, 94.6%; usual care, n = 195 of 214, 91.1%). There was no statistically or clinically significant difference in the EuroQol-5 Dimensions, five-level version utility index score over 12 months: the predicted mean score for the intervention group was 0.729 (95% confidence interval 0.712 to 0.747) and for usual care it was 0.710 [95% confidence interval (CI) 0.691 to 0.729], with an adjusted mean difference of 0.020 favouring intervention (95% CI -0.006 to 0.045, p = 0.14). No statistically significant differences were observed in secondary outcomes, except for the pain items of the Patient-Reported Outcomes Measurement Information System-29. No serious, related adverse events were reported. The intervention cost £80.85 more per participant (95% CI £76.73 to £84.97) than usual care, generated an additional 0.0178 quality-adjusted life-years per participant (95% CI 0.0175 to 0.0180) and had a 79% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. The intervention was acceptable to participants, with seven courses delivered face to face and 12 online. Limitations: Self-reported outcome data raise the potential for bias in an unblinded trial. The COVID-19 pandemic affected recruitment, follow-up and the mode of intervention delivery. Conclusions: Although the Gentle Years Yoga programme was not associated with any statistically significant benefits in terms of health-related quality of life, mental health, loneliness or falls, the intervention was safe, acceptable to most participants and highly valued by some. The economic evaluation suggests that the intervention could be cost-effective. Future work: Longer-term cost-effectiveness modelling and identifying subgroups of people who are most likely to benefit from this type of intervention. Trial registration: This trial is registered as ISRCTN13567538. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/94/36) and is published in full in Health Technology Assessment; Vol. 28, No. 53. See the NIHR Funding and Awards website for further award information.


It is common for older adults to have two or more long-term health conditions. These conditions affect quality of life differently, with some people feeling well and others needing healthcare support. The Gentle Years Yoga programme was developed to improve quality of life for older adults, including those with long-term health conditions. We wanted to see how well the programme worked and if it offered good value for money for the NHS. We tested whether offering a 12-week course of Gentle Years Yoga improved the quality of life and reduced anxiety, depression, loneliness and falls for people aged 65 years and over who had two or more long-term health conditions. We recruited 454 people through general practices across England and Wales, with 240 people selected at random to be invited to take part in the Gentle Years Yoga programme and the other 214 to continue with their usual care and not be offered Gentle Years Yoga. The average age of participants was 74 years, nearly two-thirds were female and the number of long-term health conditions participants had ranged from two to nine (average was three). They completed four questionnaires over a 12-month period. We also interviewed some of the participants and the yoga teachers to find out how the approach worked in practice. The yoga was delivered either face to face or online. We did not find any significant benefits in terms of quality of life, anxiety, depression, loneliness or falls. At interview, some yoga participants noted no or a modest impact on their health or lifestyle, while others described Gentle Years Yoga as transformative, having substantial impacts and improvements on their physical health and emotional well-being. Because running the yoga classes was relatively inexpensive and some insignificant benefits were seen, the Gentle Years Yoga programme may be good value for money.


Asunto(s)
Análisis Costo-Beneficio , Multimorbilidad , Calidad de Vida , Yoga , Humanos , Anciano , Femenino , Masculino , Inglaterra , Anciano de 80 o más Años , Gales , Evaluación de la Tecnología Biomédica , Enfermedad Crónica , Años de Vida Ajustados por Calidad de Vida
2.
Public Health Res (Southampt) ; 12(7): 1-111, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39268592

RESUMEN

Background: Young adults represent a third of the United Kingdom prison population and are at risk of poor health outcomes, including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of criminal sanctions and address the root causes of offending. However, evidence of their effectiveness has not yet been established. The Gateway programme, issued as a conditional caution, aimed to improve the life chances of young adults committing low-level offences. Participants agreed not to reoffend during the 16-week caution and, following a needs assessment, received individual support from a Gateway navigator and attended two workshops encouraging analysis of own behaviour and its consequences. Objective: To evaluate the effectiveness and cost-effectiveness of Gateway in relation to health and well-being of participants compared to usual process (court summons or a different conditional caution). Design, setting and participants: Pragmatic, multisite, parallel-group, superiority randomised controlled trial with two 6-month internal pilots and a target sample size of 334. Randomisation between Gateway and usual process was on a 1 : 1 basis. Four Hampshire Constabulary sites recruited 18- to 24-year-old residents of Hampshire and Isle of Wight who were questioned for an eligible low-level offence. Semistructured interviews were also held with a sample of Gateway programme participants, staff and police study recruiters. Main outcome measures: Primary outcome was the Warwick-Edinburgh Mental Wellbeing Scale score at 12 months. Secondary outcomes included health status, alcohol and drug use, recidivism and resource use. Results: Recruitment commenced in October 2019 and the trial stopped in April 2021. A total of 191 participants were recruited, with 109 randomised to Gateway and 82 to usual process. Due to an initial overestimation of potentially eligible young people and low retention rates, recruitment targets were adjusted, and a range of mitigating measures introduced. Although recruitment broadly met study progression criteria [35/50 (70%) Pilot 1: 64/74 (86%) Pilot 2], retention was low throughout (overall: data collected at week 4 was 50%: at week 16 it was 50%: 1-year 37%). Low retention was multifactorial, with one of the main barriers being difficulties contacting participants. It was therefore not possible to complete the randomised controlled trial or the health economics analyses. Qualitative interviews held with 58 individuals yielded rare insights into the benefits and limitations of this type of intervention, as well as barriers and facilitators in relation to recruitment in this setting. Limitations: Despite close collaboration with the police to address recruitment and consent issues, expansion of the inclusion criteria and recruitment area and introducing other measures, the researchers were unable to collect sufficient data within an acceptable timeframe. Conclusions: The Gateway study was a unique endeavour to gather evidence for a potentially life-changing intervention for an underserved population. The experience gained indicates that randomised controlled trials of interventions, with a health-related outcome, are possible in this setting but point towards the need for conservative recruitment and retention estimates in this target population. Other study designs should be considered. The qualitative evaluation provided a range of valuable lessons for those seeking to design similar interventions or conduct research in similar settings. Study registration: This study is registered as ISRCTN11888938. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/122/20) and is published in full in Public Health Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.


Young adults who commit low-level offences often have many health and social needs, making them vulnerable to physical and mental health problems. The Gateway programme was a conditional caution developed to address the underlying causes of low-level offending in young people aged 18­24 years and hence improve their life chances. In Gateway, a mentor assessed the young person's needs and supported them, signposting to healthcare, housing or other services as required. The young people also participated in two workshops, analysing the causes and consequences of their behaviour. To find out if Gateway improved health and reoffending rates, a group of those who received a Gateway conditional caution were compared with a group of those receiving a court summons or a different conditional caution. Of the 191 participants recruited to the study, 109 were randomised to Gateway and 82 to the usual process. However, the researchers had significant difficulties getting hold of the study participants on the phone and they were unable to collect enough information from them to be able to say whether Gateway worked. The researchers introduced various changes to overcome this, but in the end had to stop the study early. As part of the study, the researchers interviewed 28 Gateway programme participants, 17 Gateway project staff and 13 police officers and staff who had been recruiting into the study. From the interviews the study discovered the perceived benefits of Gateway, how programmes like this could be improved and which factors helped or got in the way of doing research in the police setting. The Gateway study aimed to provide evidence for a potentially life-changing intervention for vulnerable young adults. Although it proved impossible to complete the study, the lessons learnt from running it should help colleagues design similar programmes or plan research studies with similar populations or in similar settings.


Asunto(s)
Análisis Costo-Beneficio , Criminales , Humanos , Masculino , Adulto Joven , Femenino , Adolescente , Reino Unido , Criminales/psicología , Salud Mental , Estado de Salud , Evaluación de Programas y Proyectos de Salud
3.
NIHR Open Res ; 4: 18, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39145106

RESUMEN

Background: There is strong evidence that those recruited into studies are not always representative of the population for whom the research is most relevant. Development of the study design and funding decisions are points in the research process where considerations about inclusion of under-served populations may usefully be made. Current practical guidance focuses on designing and modifying participant recruitment and retention approaches but an area that has not been addressed is recruitment site selection. Methods: We present case studies of three NIHR funded trials to demonstrate how publicly available UK population datasets can be used to facilitate the identification of under-served communities for inclusion in trials. The trials have different designs, address different needs and demonstrate recruitment planning across Trauma centres, NHS Trusts and special educational settings.We describe our use of national freely available datasets, such as those provided by NHS Digital and the Office for National Statistics, to identify potential recruitment sites with consideration of health status, socio-economic status and ethnicity as well as clinical and risk factors to support inclusivity.For all three studies, we produced lists of potential recruitment sites in excess of the number anticipated as necessary to meet the recruitment targets. Discussion: We reflect on the challenges to our approach and some potential future developments. The datasets used are all free to use but each has their limitations. Agreeing search parameters, acceptable proxies and identifying the appropriate datasets, then cross referencing between datasets takes considerable time and particular expertise. The case studies are trials, but the methods are generalisable for various other study types. Conclusion: Through these exemplars, we aim to build on the NIHR INCLUDE project, by providing trialists with a much needed practical approach to embedding EDI into trial design at the grant application stage.

4.
Clin Genitourin Cancer ; 22(3): 102081, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38641444

RESUMEN

BACKGROUND AND OBJECTIVE: Considering the rapidly evolving treatment landscape of renal cell carcinoma (RCC), recent descriptions of the RCC population in the UK are lacking, as are real-world data on treatment and patient outcomes. To analyse the demographic and clinical characteristics, treatment patterns, and overall survival of patients with RCC using national data sets in England. PATIENTS AND METHODS: This was a retrospective cohort study of patients diagnosed with RCC (all stages) between 2014-2018 using demographic, clinical, cancer registration, and treatment data. Patients were followed until death or study end (December 31, 2020). Treatments administered in each line were described to understand treatment sequencing. Kaplan-Meier methods were used for time-to-event analyses. Factors associated with discontinuation and survival were identified using Cox proportional hazard models. RESULTS AND LIMITATIONS: Among 32,577 included patients, the median age at diagnosis was 66 years, 63.4% were male, and 6,786 (20.8%) had metastatic RCC at diagnosis. Tyrosine kinase inhibitor (TKI) monotherapy was the most common treatment class across lines. Over three quarters of patients (78.5% [95% CI: 78.0-78.9]) were alive one year after diagnosis (93.2% in the non-metastatic at diagnosis subgroup and 37.1% among patients with metastases at diagnosis). At three years post initial diagnosis, 18.0% patients were alive in the metastatic at diagnosis subgroup. Rapid evolution of the treatment landscape limits the results regarding lines of therapy. CONCLUSION: This large-scale study provides insight on characteristics of patients with RCC, and it highlights the need for better treatment options to improve survival.


Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/terapia , Masculino , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/mortalidad , Neoplasias Renales/terapia , Neoplasias Renales/patología , Femenino , Estudios Retrospectivos , Anciano , Inglaterra/epidemiología , Persona de Mediana Edad , Resultado del Tratamiento , Inhibidores de Proteínas Quinasas/uso terapéutico , Adulto , Anciano de 80 o más Años , Estimación de Kaplan-Meier , Tasa de Supervivencia
5.
BMJ Open ; 14(4): e081179, 2024 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-38670611

RESUMEN

BACKGROUND: Young adults who commit low-level offences commonly have a range of health and social needs and are significantly over-represented in the criminal justice system. These young adults may need to attend court and potentially receive penalties including imprisonment. Alternative routes exist, which can help address the underlying causes of offending. Some feel more should be done to help young adults entering the criminal justice system. The Gateway programme was a type of out-of-court disposal developed by Hampshire Constabulary, which aimed to address the complex needs of young adults who commit low-level crimes. This study aimed to evaluate the effectiveness and cost-effectiveness of the Gateway programme, issued as a conditional caution, compared with usual process. METHODS: The Gateway study was a pragmatic, parallel-group, superiority randomised controlled trial that recruited young adults who had committed a low-level offence from four sites covering Hampshire and Isle of Wight. The primary outcome was mental health and well-being measured using the Warwick-Edinburgh Mental Well-being Scale. Secondary outcomes were quality of life, alcohol and drug use, and recidivism. Outcomes were measured at 4, 16 and 52 weeks postrandomisation. RESULTS: Due to issues with retention of participants and low data collection rates, recruitment ended early, with 191 eligible participants randomised (Gateway 109; usual process 82). The primary outcome was obtained for 93 (48.7%) participants at 4 weeks, 93 (48.7%) at 16 weeks and 43 (22.5%) at 1 year. The high attrition rates meant that effectiveness could not be assessed as planned. CONCLUSIONS: Gateway is the first trial in a UK police setting to have a health-related primary outcome requiring individual data collection, rather than focusing solely on recidivism. We demonstrated that it is possible to recruit and randomise from the study population, however follow-up rates were low. Further work is needed to identify ways to facilitate engagement between researchers and vulnerable populations to collect data. TRIAL REGISTRATION NUMBER: ISRCTN11888938.


Asunto(s)
Salud Mental , Calidad de Vida , Humanos , Masculino , Adulto Joven , Femenino , Adulto , Análisis Costo-Beneficio , Adolescente , Crimen , Trastornos Relacionados con Sustancias , Reincidencia/prevención & control , Criminales/psicología
6.
Public Health Nutr ; 27(1): e65, 2024 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-38311338

RESUMEN

OBJECTIVE: To explore what Australian primary school parents want to learn about food and nutrition to improve their children's eating behaviours, as well as the associations between parents' personal and demographic characteristics and their views regarding their food and nutrition knowledge needs. DESIGN: An online nationwide cross-sectional survey was conducted in 2021 using a mixed-methods approach. Logistic regression analysis was utilised to examine the relationship between parents' demographics, personal values and their views. Content analysis was performed using Leximancer. SETTING: Australia. PARTICIPANTS: Seven hundred and eighty-seven parents. RESULTS: Fifty-one per cent wanted to learn more about food and nutrition to improve their children's healthy eating habits, and 77% of those preferred schools to provide that information. Online/printed newsletters and YouTube were the most preferred methods for receiving food and nutrition related information. Higher universalism-concern value (concern for the welfare of those in the larger society and world) scores were positively associated parents' preference for schools to provide food and nutrition-related information. Parents with non-English-speaking backgrounds and younger parents were more likely to want to learn about food and nutrition. Parents wanted to learn more about encouraging healthy eating, ideas for the lunchbox, food labels and age-specific portion sizes and recommendations. CONCLUSIONS: Findings can inform public health educators and assist them in designing future food and nutrition education programmes and resources targeting primary school parents.


Asunto(s)
Alimentos , Padres , Niño , Humanos , Australia , Estudios Transversales , Conducta Alimentaria , Instituciones Académicas
7.
Artículo en Inglés | MEDLINE | ID: mdl-38238984

RESUMEN

ISSUE ADDRESSED: This paper aims to explore Victoria parents' perceptions of their current practices and barriers in providing school lunches for their primary school children. METHODS: Respondents were asked via an online survey about their lunch provision practices, perceptions of the healthiness of school lunches, and barriers to providing healthy school lunches. Data were analysed using different statistical techniques: Chi-square test, Spearman correlation analysis, Mann-Whitney U test, and Kruskal-Wallis test. RESULTS: In total, 359 respondents completed the survey. Most respondents (84%) reported their child takes a home-packed lunch to school every day. Most respondents provided fruits (94%), vegetables (57%), and sandwiches (54%) every day for school lunches, whilst other core food items such as milk, meats, and legumes were provided less frequently. A substantial proportion of respondents provided some discretionary food items frequently (e.g., the proportion of respondents providing selected discretionary food items daily or 3-4 times/week: salty crackers-50%, sweet cookies/biscuits-40%, chips-20%). Respondents strongly agreed or agreed with several barriers; examples include not packing certain foods due to food spoilage concerns (50%) (school-related), the allocated time at their child's school is not enough to eat and enjoy school lunch (48%) (school-related), need more meal ideas (61%) (parent-related), healthy foods take more time to prepare (51%) (parent-related), and children request easy-to-eat food for school lunches (50%) (child-related). Core food score (an indicator of frequency of preparing/packing core food) was negatively correlated with parent-related and child-related barrier scores, whilst discretionary food score (an indicator of frequency of preparing/packing discretionary food) was positively correlated with these barrier scores. CONCLUSIONS: Overall, home-packed lunches remain the main option in primary schools in Victoria, and parents face several challenges in providing healthy lunches for their primary school children. SO WHAT?: The findings suggest the need for strategies from school leaders, education authorities, and policymakers to improve the quality of lunch content and address the barriers faced by parents.

8.
Appetite ; 193: 107122, 2024 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-37972657

RESUMEN

The lockdowns and restrictions due to COVID-19 caused changes in both food accessibility and availability for people around the globe resulting in changes in food habits and behaviours. To enable a better public health response to the next pandemic, lessons must be learnt from this most recent emergency. This study aimed to examine self-reported changes in food habits and behaviours, of Australian adults during COVID-19 restrictions in 2020. A cross-sectional, convenience, Australia-wide survey, with open-ended and closed-ended questions was conducted online. Respondents were asked to report their demographic characteristics, positive food habit development, worst food-related experiences, changes in food habits and behaviours and cooking and food preparation practices during the COVID-19 restriction period. Adult Australian residents, recruited through social media advertising of the survey. Respondents (n = 764) were mostly female (86%), over 55 years of age (57%, mean age (SD) 53.4 (18.1) years), and half (51%) were not in paid employment. Nearly two-thirds (63%) developed positive food habits, including trying new recipes (54%), eating less take-away (53%) and cooking from scratch (46%) during the COVID-19 restrictions. Furthermore, respondents reported including family members in food preparation and eating together as a family. Negative experiences included being unable to buy certain foods (due to lack of stock and store limits), cooking at home, and being unable to access some food outlets. Australians experienced both positive and negative food experiences during the COVID-19 pandemic and associated lockdown periods, with most experiencing positive changes such as cooking at home from scratch and trying new recipes and relying on less take-away. Females and those who experienced a change in employment status were more likely to develop positive new food habits.


Asunto(s)
COVID-19 , Culinaria , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Australia/epidemiología , Control de Enfermedades Transmisibles , COVID-19/epidemiología , Estudios Transversales , Pandemias , Anciano
9.
Public Health Nutr ; 26(12): 3320-3330, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37881855

RESUMEN

OBJECTIVE: (1) To explore the feasibility of such programmes in Australia, this study examined parents' views on free school lunch provision. (2) To examine the associations between parents' demographic and personal characteristics and their support for free universal school lunches. DESIGN: An online cross-sectional survey of parents. SETTING: Australia, April 2021. PARTICIPANTS: Seven hundred and eighty-seven parents took the survey. They had a mean age of 40. The respondents were predominantly female (95 %) and had a university degree (72 %). RESULTS: Fifty-three percentage of the respondents agreed that all students should have access to healthy and well-balanced, free school lunches. Parents were concerned about healthiness, catering, allergies and cost of school-provided school lunches. Ethnic background, universalism values and education levels were significantly associated with support for free school lunch provision. Non-native English-speaking parents were almost three times more likely to support free universal lunches in primary schools than their native English-speaking counterparts. Parents with higher universalism-concern values were more likely to endorse free lunches in primary school. However, the level of education was negatively associated with parents' support for free school lunches. CONCLUSIONS: The survey results highlight the complexity of parental views on free school lunch provision. Parents' concerns regarding lunches should be considered in developing school lunch programmes that meet the needs and preferences of diverse communities. These findings can be used to guide future primary school lunch provision initiatives.


Asunto(s)
Servicios de Alimentación , Almuerzo , Humanos , Femenino , Adulto , Masculino , Estudios Transversales , Australia , Instituciones Académicas , Padres
10.
JMIR Cancer ; 9: e45707, 2023 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-37436789

RESUMEN

BACKGROUND: The treatment of non-small cell lung cancer (NSCLC) has evolved dramatically with the approval of immuno-oncology (IO) and targeted therapies (TTs). Insights on the patient experience with these therapies and their impacts are lacking. Health-related social media has been increasingly used by patients to share their disease and treatment experiences, thus representing a valuable source of real-world data to understand the patient's voice and uncover potential unmet needs. OBJECTIVE: This study aimed to describe the experiences of patients with NSCLC as reported in discussions posted on lung cancer-specific social media with respect to their disease symptoms and associated impacts. METHODS: Publicly available posts (2010-2019) were extracted from selected lung cancer- or NSCLC-specific websites. Social media users (patients and caregivers posting on these websites) were stratified by metastatic- and adjuvant-eligible subgroups and treatment received using natural language processing (NLP) and machine learning methods. Automated identification of symptoms was conducted using NLP. Qualitative data analysis (QDA) was conducted on random samples of posts mentioning pain-related, fatigue-related, respiratory-related, or infection-related symptoms to capture the patient experience with these and associated impacts. RESULTS: Overall, 1724 users (50,390 posts) and 574 users (4531 posts) were included in the metastatic group and adjuvant group, respectively. Among users in the metastatic group, pain, discomfort, and fatigue were the most commonly mentioned symptoms (49.7% and 39.6%, respectively), and in the QDA (258 posts from 134 users), the most frequent impacts related to physical impairments, sleep, and eating habits. Among users in the adjuvant group, pain, discomfort, and respiratory symptoms were the most commonly mentioned (44.8% and 23.9%, respectively), and impacts identified in the QDA (154 posts from 92 users) were mostly related to physical functioning. CONCLUSIONS: Findings from this exploratory observational analysis of social media among patients and caregivers informed the lived experience of NSCLC in the era of novel therapies, shedding light on most reported symptoms and their impacts. These findings can be used to inform future research on NSCLC treatment development and patient management.

12.
NIHR Open Res ; 3: 52, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-39301167

RESUMEN

Background: People with multiple long-term conditions are more likely to have poorer health-related quality of life (HRQOL). Yoga has the potential to improve HRQOL. Gentle Years Yoga© (GYY) is a chair-based yoga programme for older adults. We investigated the effectiveness and cost-effectiveness of the GYY programme in older adults with multiple long-term conditions. Methods: In this pragmatic, multi-site, open, randomised controlled trial, we recruited adults aged ≥65 years with ≥2 long-term conditions from 15 primary care practices in England and Wales. Participants were randomly assigned to usual care control or a 12-week, group-based, GYY programme delivered face-to-face or online by qualified yoga teachers. The primary outcome was HRQOL (EQ-5D-5L) over 12 months. Secondary outcomes included anxiety, depression, falls, loneliness, healthcare resource use, and adverse events. Results: Between October 2019 and October 2021, 454 participants were randomised between the intervention (n=240) and control (n=214) groups. Seven GYY courses were delivered face-to-face and 12 courses were delivered online. The mean number of classes attended among all intervention participants was nine (SD 4, median 10). In our intention-to-treat analysis (n=422), there was no statistically significant difference between trial groups in the primary outcome of HRQOL (adjusted difference in mean EQ-5D-5L = 0.020 [favouring intervention]; 95% CI -0.006 to 0.045, p=0.14). There were also no statistically significant differences in key secondary outcomes. No serious, related adverse events were reported. The incremental cost-effectiveness ratio was £4,546 per quality-adjusted life-year (QALY) and the intervention had a 79% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY. The intervention was acceptable to most participants and perceived as useful by some. Conclusions: The offer of a 12-week chair-based yoga programme in addition to usual care did not improve HRQOL in older adults with multiple long-term conditions. However, the intervention was safe, acceptable, and probably cost-effective.

13.
JMIR Cancer ; 8(2): e34073, 2022 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-35559986

RESUMEN

BACKGROUND: Immunotherapy and targeted therapy treatments are novel treatments available for patients with metastatic and adjuvant melanoma. As recently approved treatments, information surrounding the patients' and caregivers' experience with these therapies, perceptions of treatments, and the effect the treatments have on their day-to-day life are lacking. Such insights would be valuable for any future decision-making with regard to treatment options. OBJECTIVE: This study aims to use health-related social media data to understand the experience of patients with adjuvant and metastatic melanoma who are receiving either immunotherapy or targeted therapies. This study also included caregivers' perspectives. METHODS: Publicly available social media forum posts by patients with self-reported adjuvant or metastatic melanoma (and their caregivers) between January 2014 to October 2019 were programmatically extracted, deidentified, cleaned, and analyzed using a combination of natural language processing and qualitative data analyses. This study identified spontaneously reported symptoms and their impacts, symptom duration, and the impact of treatment for both treatment groups. RESULTS: Overall, 1037 users (9023 posts) and 114 users (442 posts) were included in the metastatic group and adjuvant group, respectively. The most identified symptoms in both groups were fatigue, pain, or exanthema (identified in 5%-43% of patients dependent on the treatment group). Symptom impacts reported by both groups were physical impacts, impacts on family, and impacts on work. Positive treatment impacts were reported in both groups and covered the areas of work, social and family life, and general health and quality of life. CONCLUSIONS: This study explored health-related social media to better understand the experience and perspectives of patients with melanoma receiving immunotherapy or targeted therapy treatments as well as the experience of their caregivers. This exploratory work uncovered the most discussed concerns among patients and caregivers on the forums including symptoms and their impacts, thus contributing to a deeper understanding of the patient/caregiver experience.

14.
Appetite ; 175: 106060, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-35472622

RESUMEN

Young Australian adults exhibit poor food behaviour however, there is limited research as to why young adults choose to eat healthy or unhealthy foods. This study aimed to explore how young adults' (18-30 years) in Australia classify foods as healthy and unhealthy. Through a social-constructivist approach, 38 young adults (76% females and 21% males; mean age = 24.1 years) were interviewed Australia-wide. Data were thematically analysed. Participants were classified into three groups based on their living arrangements namely, parental, shared and independent households. Four themes emerged, food preparation; food groups; nutrient composition and perceived impact. Food classification criteria based on nutrients were the most frequently used criterion to classify foods as unhealthy. A strong emphasis was placed on avoiding less healthy nutrients and there were limited discussions about beneficial nutrients. Participants belonging to the different household groups defined 'moderation' in several ways to justify their consumption of unhealthy foods. Reading food labels was a key criterion for evaluating healthiness amongst the participants of the parental and independent household groups, not among the shared household group. Findings reveal how living arrangements influenced young adults' perceptions of healthiness. Future public health policy could incorporate the language of young adults identified in this study in the transfer of nutritional knowledge to young adults.


Asunto(s)
Preferencias Alimentarias , Alimentos , Masculino , Femenino , Humanos , Adulto Joven , Adulto , Australia , Industria de Alimentos , Valor Nutritivo
15.
Front Nutr ; 9: 811103, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35369053

RESUMEN

Understanding factors that promote student engagement with online learning environments is important for benchmarking and improving the quality of teaching in a digital era. This study aimed to describe the online interactive content created for delivery of an undergraduate nutrition course and to evaluate student engagement with the online interactive content. We collected online questionnaire data in 2018 and 2019 from two cohorts of students enrolled in a Deakin University undergraduate nutrition unit. Two-sample unpaired t-tests were used to examine differences in participant engagement with online topic guides between static text-based and interactive content. A total of 89 participants (19-56 years) were included. Sixty four of students reported always/usually reading static text-based topic guides most weeks and 64% perceived them as moderately/highly effective. While 60% of participants reported reading the online interactive topic guides most weeks and 93% perceived them as moderate/highly effective. Most participants indicated the interactive topic guides were more effective than static text-based topic guides they experienced in other courses (76%). Hours dedicated to the online interactive topic guide were higher (6.4 SD 2.9 vs. 1.7 SD 1.7 h; P < 0.001) as was the rating of how engaging the topic guides were (7.2 SD 1.6 vs. 6.7 SD 2.5; P = 0.008). These findings suggest that interactive content is more engaging. However, this content may not be accessible to all students, and so familiarization and training prior to engaging in an interactive online unit may be needed.

16.
Children (Basel) ; 9(4)2022 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-35455554

RESUMEN

Parents and teachers have a major influence in the formation of primary school children's eating behaviours. Although the cooperation of parents and teachers has frequently been recommended in the promotion of healthy eating habits among primary school children, little is known about the communication between these two groups regarding food- and nutrition-related issues. This paper reports findings from semi-structured interviews with primary school parents (n = 19) and primary teachers (n = 17), as well as findings from a survey of 787 parents in Australia. Audio-recorded interviews were analysed using NVivo and descriptive statistics were calculated for the survey questions. The results indicated that their communications involved various topics, including allergies, lunchbox content, and supervision requests, through diverse communication channels. The risk of offending each other and time scarcity were reported as communication barriers. Parents mainly expected teachers to ensure that their children were given enough time to eat their lunch, teach healthy eating, and be good role models of healthy eating. This study highlights the need to overcome communication barriers between parents and teachers and support teachers in their multifaceted professional roles.

17.
Curr Dev Nutr ; 6(3): nzac009, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35310618

RESUMEN

Background: Young Australian adults exhibit poor food behaviors. These include increased consumption of Energy-Dense, Nutrient-Poor (EDNP) foods, sugar-sweetened beverages, and low consumption of fruit and vegetables. However, little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected young Australian adults' pre-existing adverse food behaviors. Objectives: The present study aimed to understand the impact of the COVID-19 pandemic on food practices by exploring views of young adults living in Australia. Methods: Through qualitative descriptive methods, data gathered through individual interviews were thematically analyzed. Participants included 38 young adults aged 18-30 y with a mean age of 24.1 y (76% female). Results: Five themes emerged: 1) disruption of routines, 2) increased flexibility, 3) changes in food practices, 4) heightened psychological distress, and 5) impact on future behaviors. Disruption of routines and increased flexibility associated with working/learning from home resulted in both positive and negative changes in food practices. Negative changes included increased consumption of EDNP foods, increased consumption of foods prepared outside of home, decreased purchases and consumption of fresh foods, meal skipping, and a lack of meal planning. Positive changes included an increase in home cooking; consistent weekly eating patterns; decreased consumption of EDNP foods; smaller, more frequent meals; and decreased consumption of foods prepared outside of home. Conclusions: Young Australian adults reported more negative and fewer positive changes in food practices. The observed negative changes in food practices are likely to have accentuated young Australian adults' previously known poor food behaviors. This study adds to the international literature by reporting ways that young adults implemented positive changes during the pandemic and future directions of their food practices.

18.
Implement Sci ; 17(1): 22, 2022 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-35279171

RESUMEN

BACKGROUND: The aim of this trial was to assess the effectiveness of quality improvement collaboratives to implement large-scale change in the National Health Service (NHS) in the UK, specifically for improving outcomes in patients undergoing primary, elective total hip or knee replacement. METHODS: We undertook a two-arm, cluster randomised controlled trial comparing the roll-out of two preoperative pathways: methicillin-sensitive Staphylococcus aureus (MSSA) decolonisation (infection arm) and anaemia screening and treatment (anaemia arm). NHS Trusts are public sector organisations that provide healthcare within a geographical area. NHS Trusts (n = 41) in England providing primary, elective total hip and knee replacements, but that did not have a preoperative anaemia screening or MSSA decolonisation pathway in place, were randomised to one of the two parallel collaboratives. Collaboratives took place from May 2018 to November 2019. Twenty-seven Trusts completed the trial (11 anaemia, 16 infection). Outcome data were collected for procedures performed between November 2018 and November 2019. Co-primary outcomes were perioperative blood transfusion (within 7 days of surgery) and deep surgical site infection (SSI) caused by MSSA (within 90 days post-surgery) for the anaemia and infection trial arms, respectively. Secondary outcomes were deep and superficial SSIs (any organism), length of hospital stay, critical care admissions and unplanned readmissions. Process measures included the proportion of eligible patients receiving each preoperative initiative. RESULTS: There were 19,254 procedures from 27 NHS Trusts included in the results (6324 from 11 Trusts in the anaemia arm, 12,930 from 16 Trusts in the infection arm). There were no improvements observed for blood transfusion (anaemia arm 183 (2.9%); infection arm 302 (2.3%) transfusions; adjusted odds ratio 1.20, 95% CI 0.52-2.75, p = 0.67) or MSSA deep SSI (anaemia arm 8 (0.13%); infection arm 18 (0.14%); adjusted odds ratio 1.01, 95% CI 0.42-2.46, p = 0.98). There were no significant improvements in any secondary outcome. This is despite process measures showing the preoperative pathways were implemented for 73.7% and 61.1% of eligible procedures in the infection and anaemia arms, respectively. CONCLUSIONS: Quality improvement collaboratives did not result in improved patient outcomes in this trial; however, there was some evidence they may support successful implementation of new preoperative pathways in the NHS. TRIAL REGISTRATION: Prospectively registered on 15 February 2018, ISRCTN11085475.


Asunto(s)
Anemia , Artroplastia de Reemplazo de Rodilla , Infecciones Estafilocócicas , Anemia/complicaciones , Anemia/diagnóstico , Anemia/terapia , Humanos , Mejoramiento de la Calidad , Infecciones Estafilocócicas/prevención & control , Medicina Estatal , Infección de la Herida Quirúrgica/prevención & control
19.
Nutrients ; 14(4)2022 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-35215462

RESUMEN

Young Australian adults' exhibit high consumption of Energy Dense and Nutrient Poor (EDNP) foods; however, there is limited research concerning the factors influencing their consumption. This study aimed to explore socio-psychological factors associated with young Australian adults' (18-30 years) consumption of EDNP foods with consideration of the Food Related Lifestyle Model (FRLM) as a potential framework. Through qualitative descriptive research methodology, 38 young adults were interviewed. Data were thematically analyzed. Participants were classified into three groups based on their living arrangements namely, parental, shared and independent households. Five themes emerged, (1) psychological factors (2) intrinsic qualities of EDNP foods, (3) social factors, (4) accessibility and affordability and (5) health related beliefs. The FRLM takes into consideration some of the factors reported in this study as influencers of EDNP food intakes. However, the FRLM omits important psychological factors (motivation, restraint, cravings, coping strategies and habits) identified by participants as influencers over their EDNP food intakes. The FRLM may need to be extended in its application to EDNP food intakes of young Australian adults. Social marketing campaigns highlighting health risks, addressing social and environmental factors are suggested. The social desirability of healthier alternatives in social gatherings of young adults could be increased.


Asunto(s)
Alimentos , Nutrientes , Australia , Dieta/psicología , Humanos , Padres , Características de la Residencia , Adulto Joven
20.
BMJ Support Palliat Care ; 12(e5): e623-e631, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582385

RESUMEN

OBJECTIVES: This systematic review aims to assess the effectiveness of bereavement support interventions (BSIs) for parents of an infant or a child who has died from a medical condition or in unforeseen circumstances. METHODS: A systematic search of MEDLINE, PsycINFO, Embase and CINAHL (1980 to January 2018) was performed to identify studies investigating BSIs for the parents of children who died between the ages of 24 weeks gestation and 30 years. Due to significant clinical and methodological heterogeneity between studies, a narrative synthesis was performed. RESULTS: The database searches returned 24 550 records, with a further 6 identified through other sources. Of these, eight studies, reported in nine papers, met the inclusion criteria. Most studies were conducted in the USA (n=5) and in perinatal/neonatal deaths (n=6). Five of the included studies were randomised controlled trials and three were non-randomised comparative studies. Interventions were delivered to groups, individuals or families. Outcomes of interest were grief, mental health, physical health and 'others'. There were major concerns over the quality of study methods and reporting. Only three of the nine studies reported a significant difference between experimental and control arm participants in any outcomes, despite a total of 23 outcomes being measured. CONCLUSIONS: Poor methodology and reporting of the few studies which have assessed BSIs for parents limit any conclusions on their effectiveness. Agreement on core outcomes and more robust study methodology are required in this neglected area of research.


Asunto(s)
Aflicción , Cuidado Terminal , Niño , Lactante , Recién Nacido , Embarazo , Femenino , Humanos , Padres , Muerte
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