Predicting vaccine effectiveness for mpox.

The Modified Vaccinia Ankara vaccine developed by Bavarian Nordic (MVA-BN) was widely deployed to prevent mpox during the 2022 global outbreak. This vaccine was initially approved for mpox based on its reported immunogenicity (from phase I/II trials) and effectiveness in animal models, rather than evidence of clinical efficacy. However, no validated correlate of protection after vaccination has been identified. Here we performed a systematic search and meta-analysis of the available data to test whether vaccinia-binding ELISA endpoint titer is predictive of vaccine effectiveness against mpox. We observe a significant correlation between vaccine effectiveness and vaccinia-binding antibody titers, consistent with the existing assumption that antibody levels may be a correlate of protection. Combining this data with analysis of antibody kinetics after vaccination, we predict the durability of protection after vaccination and the impact of dose spacing. We find that delaying the second dose of MVA-BN vaccination will provide more durable protection and may be optimal in an outbreak with limited vaccine stock. Although further work is required to validate this correlate, this study provides a quantitative evidence-based approach for using antibody measurements to predict the effectiveness of mpox vaccination.

Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis.

BACKGROUND: Surrogates of antiviral efficacy are needed for COVID-19. We aimed to investigate the relationship between the virological effect of treatment and clinical efficacy as measured by progression to severe disease in outpatients treated for mild-to-moderate COVID-19. METHODS: In this systematic review and meta-analysis, we searched PubMed, Scopus, and medRxiv from database inception to Aug 16, 2023, for randomised placebo-controlled trials that tested virus-directed treatments (ie, any monoclonal antibodies, convalescent plasma, or antivirals) in non-hospitalised individuals with COVID-19. We only included studies that reported both clinical outcomes (ie, rate of disease progression to hospitalisation or death) and virological outcomes (ie, viral load within the first 7 days of treatment). We extracted summary data from eligible reports, with discrepancies resolved through discussion. We used an established meta-regression model with random effects to assess the association between clinical efficacy and virological treatment effect, and calculated I2 to quantify residual study heterogeneity. FINDINGS: We identified 1718 unique studies, of which 22 (with a total of 16 684 participants) met the inclusion criteria, and were in primarily unvaccinated individuals. Risk of bias was assessed as low in 19 of 22 studies for clinical outcomes, whereas for virological outcomes, a high risk of bias was assessed in 11 studies, some risk in ten studies, and a low risk in one study. The unadjusted relative risk of disease progression for each extra log10 copies per mL reduction in viral load in treated compared with placebo groups was 0·12 (95% CI 0·04-0·34; p<0·0001) on day 3, 0·20 (0·08-0·50; p=0·0006) on day 5, and 0·53 (0·30-0·94; p=0·030) on day 7. The residual heterogeneity in our meta-regression was estimated as low (I2=0% [0-53] on day 3, 0% [0-71] on day 5, and 0% [0-43] on day 7). INTERPRETATION: Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5 days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy. FUNDING: Australian Government Department of Health, Medical Research Future Fund, and Australian National Health and Medical Research Council.

Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis.

BACKGROUND: Randomised controlled trials of passive antibodies as treatment and prophylaxis for COVID-19 have reported variable efficacy. However, the determinants of efficacy have not been identified. We aimed to assess how the dose and timing of administration affect treatment outcome. METHODS: In this systematic review and meta-analysis, we extracted data from published studies of passive antibody treatment from Jan 1, 2019, to Jan 31, 2023, that were identified by searching multiple databases, including MEDLINE, PubMed, and ClinicalTrials.gov. We included only randomised controlled trials of passive antibody administration for the prevention or treatment of COVID-19. To compare administered antibody dose between different treatments, we used data on in-vitro neutralisation titres to normalise dose by antibody potency. We used mixed-effects regression and model fitting to analyse the relationship between timing, dose and efficacy. FINDINGS: We found 58 randomised controlled trials that investigated passive antibody therapies for the treatment or prevention of COVID-19. Earlier clinical stage at treatment initiation was highly predictive of the efficacy of both monoclonal antibodies (p<0·0001) and convalescent plasma therapy (p=0·030) in preventing progression to subsequent stages, with either prophylaxis or treatment in outpatients showing the greatest effects. For the treatment of outpatients with COVID-19, we found a significant association between the dose administered and efficacy in preventing hospitalisation (relative risk 0·77; p<0·0001). Using this relationship, we predicted that no approved monoclonal antibody was expected to provide more than 30% efficacy against some omicron (B.1.1.529) subvariants, such as BQ.1.1. INTERPRETATION: Early administration before hospitalisation and sufficient doses of passive antibody therapy are crucial to achieving high efficacy in preventing clinical progression. The relationship between dose and efficacy provides a framework for the rational assessment of future passive antibody prophylaxis and treatment strategies for COVID-19. FUNDING: The Australian Government Department of Health, Medical Research Future Fund, National Health and Medical Research Council, the University of New South Wales, Monash University, Haematology Society of Australia and New Zealand, Leukaemia Foundation, and the Victorian Government.

Monoclonal antibody levels and protection from COVID-19.

Multiple monoclonal antibodies have been shown to be effective for both prophylaxis and therapy for SARS-CoV-2 infection. Here we aggregate data from randomized controlled trials assessing the use of monoclonal antibodies (mAb) in preventing symptomatic SARS-CoV-2 infection. We use data on the in vivo concentration of mAb and the associated protection from COVID-19 over time to model the dose-response relationship of mAb for prophylaxis. We estimate that 50% protection from COVID-19 is achieved with a mAb concentration of 96-fold of the in vitro IC50 (95% CI: 32-285). This relationship provides a tool for predicting the prophylactic efficacy of new mAb and against SARS-CoV-2 variants. Finally, we compare the relationship between neutralization titer and protection from COVID-19 after either mAb treatment or vaccination. We find no significant difference between the 50% protective titer for mAb and vaccination, although sample sizes limited the power to detect a difference.

Predicting vaccine effectiveness against severe COVID-19 over time and against variants: a meta-analysis.

Vaccine protection from symptomatic SARS-CoV-2 infection has been shown to be strongly correlated with neutralising antibody titres; however, this has not yet been demonstrated for severe COVID-19. To explore whether this relationship also holds for severe COVID-19, we performed a systematic search for studies reporting on protection against different SARS-CoV-2 clinical endpoints and extracted data from 15 studies. Since matched neutralising antibody titres were not available, we used the vaccine regimen, time since vaccination and variant of concern to predict corresponding neutralising antibody titres. We then compared the observed vaccine effectiveness reported in these studies to the protection predicted by a previously published model of the relationship between neutralising antibody titre and vaccine effectiveness against severe COVID-19. We find that predicted neutralising antibody titres are strongly correlated with observed vaccine effectiveness against symptomatic (Spearman [Formula: see text] = 0.95, p < 0.001) and severe (Spearman [Formula: see text] = 0.72, p < 0.001 for both) COVID-19 and that the loss of neutralising antibodies over time and to new variants are strongly predictive of observed vaccine protection against severe COVID-19.

Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries.

AIMS: Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents. METHODS: Data were from 380,446 adolescents (aged 11-15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5). RESULTS: Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21-1.32) and 52% higher odds for girls (1.52; 1.46-1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36-1.48) and 69% higher in girls (1.69, 1.61-1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37-1.49) and girls (1.71, 1.65-1.77). CONCLUSIONS: Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content.

Association between Lifestyle Behaviours and Mental Health of Adolescents: Evidence from the Canadian HBSC Surveys, 2002-2014.

Physical activity (PA) and screen time (ST) are associated with mental health in adolescents, though little is known about their inter-relationships. This study examined the associations of PA and ST with psychosomatic complaints in adolescents. Data from four cycles of the Canadian Health Behaviour in School-aged Children (HBSC) surveys, collected between 2002 and 2014, were analysed. Eight psychosomatic health complaints were assessed and dichotomised as frequent (≥2 complaints/week) vs. infrequent. PA was assessed by number of days/week participants were physically active for ≥60 min. Discretionary ST was assessed by adding three screen uses: television, electronic games, and computer. Of the 37,829 adolescents (age 13.74 (SD 1.51) years; 52% girls), 25% boys and 39% girls reported frequent psychosomatic complaints. Multilevel logistic analyses showed that ST levels were positively associated while PA levels were negatively associated with reporting frequent psychosomatic complaints in a dose-dependent manner. Compared with ST ≤ 2 hrs/d, ST ≥ 4 hrs/d in girls and ST ≥ 6 hrs/d in boys showed higher odds of reporting psychosomatic complaints. Participating in PA ≥ 60 min every day compared to no PA showed lower odds of reporting psychosomatic complaints by 44% in girls and 57% in boys. Prospective research is needed to understand the causal pathway of these dose-dependent relationships.

Dose-dependent and joint associations between screen time, physical activity, and mental wellbeing in adolescents: an international observational study.

BACKGROUND: Mental wellbeing in adolescents has declined considerably during past decades, making the identification of modifiable risk factors important. Prolonged screen time and insufficient physical activity appear to operate independently and synergistically to increase the risk of poor mental wellbeing in school-aged children. We aimed to examine the gender-stratified dose-dependent and joint associations of screen time and physical activity with mental wellbeing in adolescents. METHODS: We used data from three rounds of Health Behaviour in School-aged Children cross-sectional surveys (2006, 2010, and 2014) from 42 European and North American countries. Survey participants, aged 11 years, 13 years, and 15 years, provided self-reported information by completing an anonymous questionnaire that included items on health indicators and related behaviours. We used the self-reported variables of life satisfaction and psychosomatic complaints as indicators of adolescents' mental wellbeing, combining these with the self-reported discretionary use of screens and engagement in physical activity. We used generalised additive models and multilevel regression modelling to examine the gender-stratified relationships between mental wellbeing and screen time and physical activity. FINDINGS: Our sample included 577 475 adolescents (mean age 13·60 years, SD 1·64), with 296 542 (51·35%) girls and 280 933 (48·64%) boys. The mean reported life satisfaction score (on a scale of 0-10) was 7·70 (95% CI 7·69-7·71) in boys and 7·48 (7·46-7·50) in girls. Psychosomatic complaints were more common among girls (mean 9·26, 95% CI 9·23-9·28) than boys (6·89, 6·87-6·91). Generalised additive model analyses showed slightly non-linear associations of screen time and physical activity with life satisfaction and psychosomatic complaints for girls and boys. Detrimental associations between screen time and mental wellbeing started when screen time exceeded 1 h per day, whereas increases in physical activity levels were beneficially and monotonically associated with wellbeing. Multilevel modelling showed that screen time levels were negatively associated with life satisfaction and positively associated with psychosomatic complaints in a dose-dependent manner. Physical activity levels were positively associated with life satisfaction and negatively associated with psychosomatic complaints in a dose-dependent manner. Joint associations of screen time-physical activity with mental wellbeing showed that, compared with the least active participants with more than 8 h per day of screen time and no physical activity, most of the other screen time-physical activity groups had considerably higher life satisfaction and lower psychosomatic complaints. INTERPRETATION: Higher levels of screen time and lower levels of physical activity were associated with lower life satisfaction and higher psychosomatic complaints among adolescents from high-income countries. Public health strategies to promote adolescents' mental wellbeing should aim to decrease screen time and increase physical activity simultaneously. FUNDING: None.

Association of carbonated soft drink and fast food intake with stress-related sleep disturbance among adolescents: A global perspective from 64 countries.

BACKGROUND: Poor quality sleep adversely impacts on adolescent wellbeing. More multinational research is needed to understand modifiable risk factors, such as dietary behaviours. This study aimed to examine the association of carbonated soft drink and fast food intake with stress-related sleep disturbance among adolescents across 64 countries. METHODS: We analysed the Global School-based Student Health Survey data from 175,261 adolescents (mean age 13.8 [0.98]; 48.5% females). Adolescents reported frequency of stress-related sleep disturbance and consumption of carbonated soft drinks and fast foods. Country-level estimates were obtained by using multivariable logistic regression and meta-analysis to obtain pooled estimates. FINDINGS: Overall, 7.5% of adolescents reported sleep disturbance during the past 12 months (males: 6.6%; females: 8.4%). Meta-analysis showed that adolescents having carbonated soft drinks ≥3 times/day had over 50% higher odds of reporting sleep disturbance than

Parental and Peer Support are Associated with Physical Activity in Adolescents: Evidence from 74 Countries.

Although parental and peer support can influence adolescents' physical activity (PA), these associations have not been fully examined through a global assessment. This study examined the associations of parental and peer support with PA among adolescents from 74 countries. The Global School-based Student Health Survey data from 250,317 adolescents aged 11-17 years (48.8% girls), collected between 2007 and 2016, were analysed. Adolescents were asked how many days/week they were physically active and about their parental and peer support. Meta-analysis showed that adolescents who had high parental or peer support had higher odds of attaining sufficient PA (odds ratio (OR): 1.40, 95% confidence interval (CI): 1.34-1.46; OR: 1.57, 95% CI: 1.49-1.65, respectively). Pooled estimates of association were significant across all World Health Organization (WHO) regions and country-income categories with the highest estimate from the low-income countries. The Western Pacific region showed the highest association between parental support and adolescents' PA (OR: 1.49, 95% CI: 1.41-1.59), while South-East Asia exhibited the highest association between peer support and adolescents' PA (OR: 1.80, 95% CI: 1.59-2.04). Country-level estimates of associations are presented. Future studies should use robust assessment of PA and PA-specific parental and peer support with emphasis on qualitative investigation to understand the complexity of the relationships.

Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study.

BACKGROUND: Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy-the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision-is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries. OBJECTIVE: The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non-health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake. METHODS: Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant. RESULTS: In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants. CONCLUSIONS: University students in non-health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries.

Assessment of knowledge, attitudes and practice towards Vitamin D among university students in Pakistan.

BACKGROUND: Pakistan has one of the highest reported incidence of vitamin D deficiency in studies conducted worldwide. However, there has been very limited exploration of vitamin D related knowledge, attitudes and practices among healthy youth in Pakistan. METHODS: A cross-sectional survey was conducted among youth (aged > 16 years) from two engineering universities in Pakistan. Participants were asked questions on their concern about vitamin D levels, testing, and supplementation practices. Knowledge was examined using questions about food sources, health benefits and factors affecting vitamin D production within the human body. Of the 900 eligible students invited to participate, 505 (56%) completed the questionnaire and were included in the analysis. RESULTS: Only 9% participants were able to identify the correct food sources of vitamin D, 33% were aware of the bone health benefits (bone health and calcium absorption) of vitamin D and 36% identified sunlight exposure as a factor influencing vitamin D production. Knowledge about food sources and health benefits of vitamin D was not associated with gender and individuals concern about their levels. Those tested and taking supplements were more likely to identify bone related health benefits and factors affecting vitamin D production. Forty percent male and 52% female students expressed concern that their vitamin D levels were too low. However, 72% participants reported that they had never been tested for vitamin D levels. Use of supplements was significantly higher among female students (F = 52% vs M = 37%; P = 0.003). Those who had been tested for vitamin D deficiency were more likely to take supplements. CONCLUSION: Despite being identified as a high-risk population, knowledge about vitamin D was limited among university students. Interventions are needed to increase awareness about the importance of vitamin D for health, including the need for exposure to sunlight and adequate dietary intake of vitamin D. Our study provides much needed baseline evidence for making health-policy recommendations for this vulnerable population group.

Low physical activity and high sedentary behaviour are associated with adolescents' suicidal vulnerability: Evidence from 52 low- and middle-income countries.

AIM: To examine the relationships of physical activity (PA) and sedentary behaviour (SB) with suicidal thoughts and behaviour among adolescents in low- and middle-income countries (LMICs). METHODS: Global School-based Student Health Survey data from 206 357 students (14.6 ± 1.18 years; 51% female) in 52 LMICs were used. Students reported on suicidal ideation, suicide planning, suicide attempts, PA, leisure-time SB and socio-demographic characteristics. Multilevel mixed-effects generalised linear modelling was used to examine the associations. RESULTS: High leisure-time SB (≥3 hours/day) was independently associated with higher odds of suicidal ideation, suicide planning and suicide attempts for both male and female adolescents. Insufficient PA (<60 mins/day) was not associated with higher odds of ideation for either sex; however, it was associated with planning and attempts for male adolescents. The combination of insufficient PA and high SB, compared with sufficient PA and low SB, was associated with higher odds of suicidal ideation and suicide planning for both male and female adolescents, and suicide attempts for male adolescents. CONCLUSION: High SB may be an indicator of suicidal vulnerability among adolescents in LMICs. Low PA may be a more important risk for suicidal thoughts and behaviours among male, than female, adolescents. Promoting active lifestyle should be integrated into suicide prevention programmes in resource-poor settings.

Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective.

The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of their related lifestyle risk factors. To address this deficit, we estimated the prevalence and clustering of six major NCD-risk factors in adolescents around the world. Data from the Global School-based Student Health Survey, collected between 2007 and 2016, were analysed in 304,779 adolescents aged 11-17 years (52.2% females) from 89 countries. We compared the observed (O) to expected (E) prevalence ratios of 64 possible combinations of six risk factors to determine their clustering patterns. Overall, 82.4% (95% CI 82.1-82.7) of adolescents had ≥2 risk factors, while 34.9% (34.6-35.3) had ≥3. Adolescents aged 16-17 years, compared to those aged 11-13 years, had higher odds (OR 1.33; 95% CI 1.31-1.36) of reporting ≥3 risk factors. Risk factors clustered in multiple combinations and differed by sex. The clustering of physical inactivity and low fruit and vegetable intake was evident in both males (O/E 1.10; 95% CI 1.07-1.12) and females (1.08; 1.06-1.10). The co-occurrence of cigarette smoking, alcohol drinking, physical inactivity, and low fruit and vegetable intake was 165% greater in females (2.65; 2.28-3.07) and 110% greater in males (2.10; 1.90-2.32) than expected. Globally, adolescents exhibit multiple modifiable risk factors for future development of NCDs. Early gender-specific prevention strategies targeting clusters of lifestyle risk factors should be prioritised to help mitigate future burden of NCDs globally. Periodical collection of behavioural risk factor data should be encouraged to facilitate a sustainable global surveillance.

Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study.

BACKGROUND: Suicide is a major global health challenge and a leading cause of death among adolescents, but research related to suicide has concentrated on high-income countries. We aimed to estimate the prevalence of suicidal ideation, suicide planning, and suicide attempts in adolescents from 59 low-income and middle-income countries. METHODS: In this population-based study, we used data from the Global School-based Student Health Survey of schoolchildren aged 13-17 years between 2003 and 2015, in 59 low-income and middle-income countries across six WHO regions. Using a meta-analysis with random effects, we computed the sex-based and age-based estimates of regional and overall prevalence of suicidal ideation, suicide planning, and suicide attempts. FINDINGS: Our sample consisted of 229 129 adolescents (mean age 14·6 [SD 1·18] years; 111 082 [48%] boys and 118 047 [52%] girls). The overall prevalence of suicidal ideation was 16·9% (95% CI 15·0-18·8), suicide planning was 17·0% (14·8-19·2), and suicide attempts was 17·0% (14·7-19·3) in the 12 months preceding survey completion. The African region had the highest prevalence of suicidal ideation (20·4%, 17·3-23·6) and suicide planning (23·7%, 19·1-28·3), and the western Pacific region had the highest prevalence of suicide attempts (20·5%, 14·3-26·7). Southeast Asia had the lowest prevalence of ideation (8·0%, 4·5-11·5), planning (9·9%, 5·0-14·8), and attempts (9·2%, 5·1-13·3). Girls had higher prevalence than boys for suicidal ideation (18·5%, 16·4-20·6 vs 15·1%, 13·4-16·7), suicide planning (18·2%, 15·8-20·6 vs 15·6%, 13·7-17·6), and suicide attempts (17·4%, 15·0-19·8 vs 16·3%, 14·0-18·6). Adolescents aged 15-17 years had higher prevalence than those aged 13-14 years of suicidal ideation (17·8%, 15·8-19·8 vs 15·9%, 14·1-17·6), suicide planning (17·8%, 15·7-20·0 vs 16·3%, 14·7-17·9), and suicide attempts (17·6%, 15·2-20·0 vs 16·2%, 13·8-18·5). INTERPRETATION: Suicidal thoughts and behaviours are prevalent among adolescents in low-income and middle-income countries, particularly in the African and the western Pacific regions, and particularly among girls and adolescents aged 15-17 years. Targeted suicide prevention initiatives are needed and should take into account the diverse range of cultural and socioeconomic backgrounds of the countries. FUNDING: None.

Assessment of the use of the Internet and social media among people with bladder cancer and their carers, and the quality of available patient-centric online resources: a systematic review.

OBJECTIVE: To conduct a systematic synthesis of the literature evaluating the use of the Internet and social media by people with bladder cancer (BCa) and their carers, and to synthesize the evidence on the quality of available online resources for patients with BCa. METHODS: We selected studies published between January 2000 and September 2018, written in the English language and meeting the inclusion criteria. Data sources included PubMed, PsycINFO, EMBASE, Web of Science and Scopus. RESULTS: A total of 15 studies were included in the review. Four studies explored patterns of Internet use among patients with BCa, five studies investigated social media use related to BCa and six studies evaluated the quality of online resources available for patients with BCa. Evidence in all these three dimensions was limited in its ability to establish rigorously if use of the Internet, social media and online resources for BCa is effective in improving the care outcomes for patients with BCa. CONCLUSION: Our review emphasizes the forgotten status of BCa by establishing that, despite its high global incidence, it remains underrepresented in the building of evidence on patient information needs and the possible role of online spaces. Our synthesis establishes that further research is needed to examine the full impact of online information and social media use on the health management of people with BCa.

Effect of solar ultraviolet radiation exposure on serum 25(OH)D concentration: a pilot randomised controlled trial.

Sunlight generates vitamin D, but there are scant human data from randomised trials on which to base health policy advice about how much sun exposure is necessary to change 25(OH)D concentrations. The purpose of the study was to evaluate the feasibility of using solar ultraviolet (UV) radiation exposure to generate a change in 25(OH)D concentration in a randomised controlled trial (RCT). The intervention tested in this RCT was supervised exposure to one standard erythemal dose (SED; 100 J m-2) of solar UV radiation three days per week for three weeks with approximately 35% of the body surface area not covered by clothing. Thirty-six fair-skinned (skin type II and III) indoor workers from Brisbane, Australia were randomised into either the intervention group (n = 16) or the control group (n = 20); the latter did not receive any supervised sun exposure. We asked both groups to use sunscreen and to minimise time outdoors during the study period. We collected blood samples at baseline, once per week during the three week intervention period, and four weeks after the intervention finished. The cumulative UV radiation exposure over the intervention period measured using polysulphone badges was higher in the intervention group than in the control group (median 8 vs. 4 SEDs, p = 0.14). After three weeks, the mean serum 25(OH)D concentration increased from 60 to 65 nmol l-1 in the intervention group and from 55 to 57 nmol l-1 in the control group. After adjustment for baseline 25(OH)D, the mean change per week during the intervention phase was non-significantly higher in the intervention than in the control group (0.7 vs. 0.3; p = 0.35). This difference was not sustained during the follow-up period. Large field trials are needed to inform policy about how much natural sun exposure is required to raise 25(OH)D concentrations. This pilot identified key issues that need to be considered in the design of such a trial.

Work engagement in cancer care: The power of co-worker and supervisor support.

PURPOSE: Co-worker and supervisor support can provide knowledge, advice and expertise which may improve motivation, confidence and skills. This exploratory study aimed to examine the association of co-worker and supervisor support, and other socio-demographic and practice variables with work engagement for cancer workers. METHODS: The study surveyed 573 cancer workers in Queensland (response rate 56%). Study participants completed surveys containing demographics and psychosocial questionnaires measuring work engagement, co-worker and supervisor support. Of these respondents, a total of 553 responded to the items measuring work engagement and this forms the basis for the present analyses. Oncology nurses represented the largest professional group (37%) followed by radiation therapists (22%). About 54% of the workforce was aged >35 years and 81% were female. Multiple regression analysis was performed to identify explanatory variables independently associated with work engagement for cancer workers. RESULTS: After adjusting for the effects of other factors, co-worker and supervisor support were both significantly associated with work engagement. Having 16 years or more experience, being directly involved in patient care, having children and not being a shift worker were positively associated with work engagement. Annual absenteeism of six days or more was associated with low work engagement. The fitted model explained 23% of the total variability in work engagement. CONCLUSIONS: This study emphasises that health care managers need to promote co-worker and supervisor support in order to optimise work engagement with special attention to those who are not directly involved in patient care.

Recovery experience and burnout in cancer workers in Queensland.

PURPOSE: Two key recovery experiences mediating the relationship between work demands and well-being are psychological detachment and relaxation over leisure time. The process of recovery from work-related stress plays an important role in maintaining well-being, but is poorly understood in cancer workers. The aim of this exploratory study was to examine the relationships of burnout, psychological well-being and work engagement with the recovery experiences of psychological detachment and relaxation in oncology staff. METHODS: A cross sectional survey of 573 cancer workers in Queensland was conducted (response rate 56%). Oncology nurses (n = 211) represented the largest professional group. Staff completed surveys containing demographics and psychosocial questionnaires measuring burnout, psychological distress, work engagement and recovery experience. Multiple regression analyses were performed to identify explanatory variables which were independently associated with Recovery Experience Score (RES). RESULTS: There was a negative association between the RES and burnout (p = 0.002) as well as psychological distress (p < 0.0001), but not work engagement. Age >25 years was negatively correlated with RES as was having a post graduate qualification, being married or divorced, having carer commitments. Participating in strenuous exercise was associated with high recovery (p = 0.015). CONCLUSIONS: The two recovery experiences of psychological detachment and relaxation had a strong negative association to burnout and psychological well-being, but not work engagement. Further research needs to be undertaken to better understand if improving recovery experience reduces burnout and improves the well-being of cancer workers.