A randomised controlled trial of a telephone administered brief HIV risk reduction intervention amongst men who have sex with men prescribed post-exposure prophylaxis for HIV after sexual exposure in the UK: Project PEPSE.

BACKGROUND: In western countries, men who have sex with men (MSM) are most affected by HIV and increasingly likely to engage in risky sexual behaviour. MSM who experience a potential sexual exposure to HIV (PEPSE) and receive a preventative regimen of anti-HIV treatment are at particularly high risk of acquiring HIV and could potentially benefit from targeted risk reduction behavioural interventions such as motivational interviewing (MI). PURPOSE: The aim of this trial was to examine the impact of augmented MI (MI plus information provision and behavioural skills building), over and above routine care, on reducing risky sexual behaviour in MSM prescribed PEPSE. Secondary aims of the research were to examine whether the intervention reduced sexually transmitted infections (STI) and further requests for PEP. METHODS: A parallel-group pragmatic randomised controlled trial was conducted with 175 MSM recruited from five sexual health (SH) clinics in the south east of England. The intervention was two fixed-duration sessions of telephone administered augmented MI. A manual guided the selection of individualised persuasive communication strategies based on underlying change mechanisms specified by the Information, Motivation and Behavioural Skills (IMB) model. Primary outcomes were the number of receptive and active anal intercourse (AI) partners, the use of condoms every time during receptive and active AI and the use of condoms sometimes during receptive and active AI. RESULTS: There were no significant impacts on sexual risk behaviour or any of the psychological measures, and no discernible reduction in requests for repeat PEP or rates of STIs within a year. CONCLUSION: Our behavioural intervention of augmented MI did not affect risky sexual behaviour, rates of further PEP and STIs, and psychological factors, in MSM prescribed PEPSE. TRIAL REGISTRATION NUMBERS: UKCRN ID:11436; ISRCTN00746242.

Illness and treatment beliefs in head and neck cancer: is Leventhal's common sense model a useful framework for determining changes in outcomes over time?

OBJECTIVE: The main aim of this prospective study was to examine the utility of Leventhal's common sense model in predicting longitudinal judgement-based outcomes in patients with head and neck cancer (HNC). The study is of potential importance as it focuses on the relations between personality factors, coping styles, informational needs, illness representations, and outcomes using a longitudinal study design. This has particular value as the trend in similar research is to focus on concurrent relations between variables. In addition, the prediction of numerous outcomes from illness perceptions has received relatively scant attention in the field of HNC. METHODS: Fifty patients completed the following measures prior to treatment, 1 month and 6-8 months after treatment: IPQ-R, BMQ, Brief COPE, LOT-R, SCIP, EORTC QLQ-C30, SF-12, Patient Generated Index (PGI), and HADS. RESULTS: Baseline illness and treatment beliefs were not predictive of HR-QoL, individualized QoL, or anxiety 6-8 months after treatment; however, beliefs about the chronicity of the disease (timeline beliefs) were predictive of depression after treatment. Coping strategies employed and levels of satisfaction with information before treatment were significant predictors of several outcomes. CONCLUSIONS: Our findings suggest that a common sense model may be a useful framework for eliciting and understanding patients' beliefs regarding HNC; however, there are concerns regarding the use of a 'dynamic' model to predict longitudinal outcomes from baseline factors that may change over the course of an illness.

The impact of stomatological disease on oral health-related quality of life.

The clinical diagnosis of stomatological disease may indicate its cause and prognosis; however, it says little about the resulting level of impairment from the patient's perspective. The primary objective of this study was to test whether patients attending an outpatient oral medicine clinic would have worse oral health related quality of life (OHR-QoL) compared with the general population. In addition, we aimed to assess whether anxiety or depression could be predicted by OHR-QoL and to explore the relationship between clinical diagnoses, OHR-QoL and anxiety/depression. Data were collected from patients (n = 97) through face-to-face interviews using the Oral Health Impact Profile Short form (OHIP-14) to measure OHR-QoL, the Hospital Anxiety and Depression Scale (HADS) for psychiatric morbidity, and a visual analogue scale for self-rated general health. Age- and sex-matched controls (n = 388) were provided from a normative data set collected in a UK national survey in 1998. Participants had significantly lower OHR-QoL scores than the general population on all domains and overall OHR-QoL scores. Of the variance in anxiety, 55% was predicted by general health ratings and OHR-QoL domains of 'psychological discomfort' and 'psychological disability'. Of the variance in depression, 54% was predicted by general health ratings and OHR-QoL domains of 'functional limitation' and 'social disability'. Patient centred, routine assessment of OHR-QoL provides an additional dimension that may help to improve awareness of the impact of disease on the individual's life and enhance the clinical decision-making process.