Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative.

BACKGROUND: Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. METHODS: A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. RESULTS: Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached 'strong agreement' (n = 25, 2, 0 for each round, respectively), a single statement achieved 'agreement' only (round 3), and 'no agreement' could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. CONCLUSIONS: The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.

Body shape and stable employment opportunity analysis of China's nonagricultural labor market.

Based on the integrated data of the China General Social Survey (CGSS) from 2010 to 2017, this study observes that body shape - being overweight or underweight - is important for labor market outcomes. Body shape significantly affects the employment opportunities of Chinese individuals, and this effect differs by gender and across the occupational hierarchy. Women face both slim premium and obesity penalty effects. Slim women, those with normal and lower but not excessively lower body weight, are more likely to gain long-term employment contracts in the labor market, while the opposite is observed for overweight individuals. The relationship between women's body shape and employment opportunities also varies by occupation. The obesity penalty is more pronounced in occupations with a higher International Socio-Economic Index (ISEI), while the slim premium is more evident in occupations with a low ISEI. The results suggest that the Chinese labor market is highly demanding regarding women's figures, while it is relatively tolerant of men's figures. By mechanism analysis, health capital is found to be the leading cause of the body shape effect. In addition, socialization is also a possible pathway of action. This paper has extended implications for the study of stature and employment stability, enriching the empirical research on labor market discrimination.

Does Time Fly When You Are Having Fun? A Day Reconstruction Method Analysis.

Duration-based measures of happiness from retrospectively constructed daily diaries are gaining in popularity in population-based studies of the hedonic experience. Yet experimental evidence suggests that perceptions of duration - how long an event lasts - are influenced by individuals' emotional experiences during the event. An important remaining question is whether observational measures of duration outside the laboratory setting, where the events under study are engaged in voluntarily, may be similarly affected, and if so, for which emotions are duration biases a potential concern. This study assesses how duration and emotions co-vary using retrospective, 24-hour diaries from a national sample of older couples. Data are from the Disability and Use of Time (DUST) supplement to the nationally representative U.S. Panel Study of Income Dynamics. We find that experienced wellbeing (positive, negative emotion) and activity duration are inversely associated. Specific positive emotions (happy, calm) are not associated with duration, but all measures of negative wellbeing considered here (frustrated, worried, sad, tired, and pain) have positive correlations (ranging from 0.04 to 0.08; p<.05). However, only frustration remains correlated with duration after controlling for respondent, activity and day-related characteristics (0.06, p<.01). The correlation translates into a potentially upward biased estimate of duration of up to 10 minutes (20%) for very frustrating activities. We conclude that estimates of time spent feeling happy yesterday generated from diary data are unlikely to be biased but more research is needed on the link between duration estimation and feelings of frustration.

Measuring Time Use of Older Couples: Lessons from the Panel Study of Income Dynamics.

Time diaries are a well established method for providing population estimates of the amount of time and types of activities respondents carry out over the course of a full day. This paper focuses on a computer assisted telephone application developed to collect multiple, same-day 24-hour diaries from older couples who participated in the 2009 Panel Study of Income Dynamics (PSID). We present selected findings from developmental and field activities, highlighting methods for three diary enhancements: 1) implementation of a multiple, same-day diary design; 2) minimizing erroneous reporting of sequential activities as simultaneous; and 3) tailoring activity descriptors (or "follow-up" questions) that depend on a pre-coded activity value. A final section discusses limitations and implications for future time diary efforts.

Disability, participation, and subjective wellbeing among older couples.

This paper investigates the link between disability and subjective wellbeing, using data from the 2009 Disability and Use of Time supplement to the Panel Study of Income Dynamics, the longest running national panel study in the United States. Disability is construed broadly to include both the presence of any physical, cognitive, or sensory impairment or activity limitation and also the severity of underlying impairments. Subjective wellbeing is measured using two distinct approaches: reports of life satisfaction and of moment-to-moment wellbeing-both positive and negative-on the previous day. The latter, collected through 24-h time diaries, also offers for the first time the ability to explore the role of participation in particular kinds of activities linking disability to subjective wellbeing. The analytic sample included married persons ages 60 and older and their spouses (n = 751 married individuals) who completed 1498 diaries. Several new findings emerged: no matter what the measure of wellbeing, older married adults with disability report worse subjective wellbeing than those without, and neither different demographic and socioeconomic profiles nor differences in participation fully account for these disparities. Influences of disability on global life satisfaction and episodic reports of happiness were relatively small and of comparable size. However, notably sizeable differences were identified in the cumulative number of pleasant minutes experienced yesterday by disability status - on the order of 71 fewer minutes on average for those with a disability of average severity. Differences appear to be more strongly linked to somatic symptoms of pain and feeling tired than to differential intensity of experiencing happiness, sadness, frustration, or worry. We also found limited support for the notion that participation partially mediates the relationship between disability and global, but not episodic, subjective wellbeing.

Shaping Health Behavior across Generations: Evidence from Time Use data in the Panel Study of Income Dynamics and its Supplements.

This paper examines ways that families use time to shape their children's health behaviors. Specifically, it explores ways that parents can prepare children to make health-enhancing choices as adults. It also analyzes ways that offspring manage their time during young adulthood, when they are old enough to make independent decisions about whether they will spend their time producing health, as the Grossman model argues that individuals can do (Grossman 2000). The empirical research uses time diary data from the Child Development Supplement CDS), data from the Panel Study of Income Dynamics (PSID) core and the PSID's Transition to Adulthood (TA) module. By examining the intergenerational transmission of healthy behaviors, it is possible to better understand decisions individuals make in adulthood.

Assessing Time Diary Quality for Older Couples: An Analysis of the Panel Study of Income Dynamics' Disability and Use of Time (DUST) Supplement.

Using same-day diaries from 394 older couples in the Panel Study of Income Dynamics (PSID), this paper develops and explores several new measures of diary quality. Two overarching questions are explored: 1) How do diary quality measures reflecting the data collection process enhance understanding of time use in later life? and 2) How well do same-day diaries from couples match up in terms of husbands' and wives' reports of time spent (actively engaged) together? We found a summary measure of diary quality indicated only 13.8% of diaries were lower quality. Lower quality diaries were more likely to be obtained from older adults (ages 70+ vs. 50-69) and first (vs. second) interviews. Joint activities from diaries of lower quality were less likely than those from higher quality diaries to be matched to an activity on a spouse's same-day diary. However, such a measure did not predict time spent in common activities nor did its inclusion have any effect on predictors of time use. We also found that among activities described as joint by at least one respondent, up to 76% had a matching record in the spouse's diary. The quality of matches appeared to be quite good, with the majority of matched activities having overlapping times reported by spouses and being described as joint by both spouses. Very similar estimates of joint time were reported by husbands and wives (about 5-5½ hours). Implications of findings for future methodological and substantive investigations are discussed.

Estimating Intergenerational Persistence of Lifetime Earnings with Life Course Matching: Evidence from PSID.

Why do estimates of the intergenerational persistence in earnings vary so much for the United States? Recent research suggests that life-cycle bias may be a major factor (Haider and Solon 2006; Grawe 2006). In this paper we estimate the intergenerational correlation in lifetime earnings by using sons' and fathers' earnings at similar ages in order to account for lifecycle bias. Our estimate based on earnings measured at 35-44 for both fathers and sons is similar to that for the age range 45-54.

Pension Participation: Do Parents Transmit Time Preference?

A wide range of economic and health behaviors are influenced by individuals' attitudes toward the future - including investments in human capital, health capital and financial capital. Intergenerational correlations in such behaviors suggest an important role the family may play in transmitting time preferences to children. This article presents a model of parental investment in future-oriented capital, where parents shape their children's time preference rates. The research identifies a dual role for a parent's time preference rate in the process of shaping the offspring's attitude toward the future, and discusses paths through which parents may socialize children to be patient. The model's implications are studied by investigating the parent-child correlation in pension participation using data from the Panel Study of Income Dynamics.

The Wage Effects of Personal Smoking History.

Why do we observe a wage differential between smokers and non-smokers? Pooling reports of current and prior smoking activity across 15 years from the Panel Study of Income Dynamics (PSID) allows the reconstruction of individual smoking histories. Dividing the sample into smoking history groups, the four largest of which are: persistent smokers, never smokers, former smokers, and future quitters reveals that there is no observed wage gap between former smokers and those who have never smoked. There is, however, a wage gap between those smokers who will continue smoking and three other groups of individuals: (1) those smokers who will quit smoking in the future, (2) those smokers who have quit smoking already, and (3) those who never smoked. The wage gap between smokers and non-smokers, observed in the 1986 cross-section, is largely driven by those who persist as smokers, 1986-2001. These results support the hypothesis that the cross-sectional wage differential is not driven by smoking per se, but may be driven by a non-causal explanation. One plausible interpretation is that a common factor such as myopia, leads to reduced investment in both health capital or firm-specific or other human capital.

Grandparental and parental obesity influences on childhood overweight: implications for primary care practice.

BACKGROUND: Community-based studies have suggested a multigenerational pattern of obesity affecting children's risk of overweight, but no national data have substantiated such a pattern. Our objective was to examine the prevalence of overweight [body mass index (BMI) >or=95th percentile for age and sex] among children aged 5 to 19 in a national sample, stratified by the obesity status of their parents and grandparents. METHODS: We used a secondary analysis of the Panel Study of Income Dynamics, Child Development Supplement, a multigenerational, genealogical, prospective cohort study of the US population. Self-report height and weight data from adults and measured height and weight data for children were used to calculate BMI. The prevalence of child overweight was calculated for different possible combinations of parental and grandparental BMI status, including missing status. RESULTS: The sample included 2,591 children aged 5 to 19 years, for whom parental BMI data were available for 94% and grandparental BMI data were available for 61%. Prevalence of childhood overweight (18.6%) in the sample was comparable with contemporaneous measured national data from other sources. Among children with normal-weight parents and normal-weight grandparents, 7.9% were overweight. In contrast, among children with overweight parents (BMI 25-29.9) and normal-weight grandparents, 17.9% were overweight, and among children with obese parents (BMI >or=30) and normal-weight grandparents, 31.9% were overweight (P < .0001). Importantly, when parents were normal weight, if grandparents were obese, then the prevalence of child overweight was 17.4% (P < .0001). The prevalence of child overweight was similarly elevated (16.4%) when parents were normal weight and grandparental BMI was missing. CONCLUSIONS: This is the first national study to find an association of child weight status with grandparental obesity, distinct from parental obesity. Primary care physicians may find it helpful to consider grandparents' weight status in judging risk of childhood overweight for their patients, especially when parents' weight is normal.

Laser debulking in malignant upper airway obstruction.

BACKGROUND: The conventional treatment for patients with upper airway obstruction secondary to malignancy is a tracheostomy. Although this effectively resolves the problem, a tracheostomy can be associated with complications and is irreversible in most patients. An alternative is to debulk part of the tumor causing airway obstruction to maintain the airway until the definitive procedure. METHODS: The clinical course of 43 patients who underwent laser debulking for airway obstruction caused by laryngeal or hypopharyngeal malignancies was retrospectively studied. We present our technique of laser debulking and the efficacy of the procedure in avoiding a tracheostomy. RESULTS: Fourteen patients who underwent this procedure received palliative treatment only. The number of debulking procedures per patient ranged from one to six, with a mean of 1.9 episodes. Although these patients had a higher comorbid burden, none were thought unsuitable for the procedure. A tracheostomy was avoided in 91% of patients. No laser-related complications were encountered. CONCLUSIONS: Laser debulking is a viable alternative to tracheostomy in patients with malignant upper airway obstruction.

Current indications and complications of tracheoesophageal puncture for voice restoration after laryngectomy.

Surgical voice restoration by valved tracheoesophageal fistula is undoubtedly the most successful method of voice restoration for laryngectomy patients, is one of the most important developments in head and neck surgery, and has resulted in a greatly enhanced quality of life for most patients who have undergone this debilitating procedure. In developed countries, it is now unacceptable to perform laryngectomy without giving patients the opportunity to undergo surgical voice restoration. Successful voice acquisition should be achievable in approximately 80% of patients. Success rates will be highest and problems most effectively dealt with under the auspices of a properly organized surgical voice restoration program within a specialist head and neck cancer unit with a well structured specialist multidisciplinary team. This article reviews recent publications addressing indications for surgical voice restoration by tracheoesophageal puncture, expected success rates, and reasons for failure and complications and ways to manage them in the context of the author's own experience.