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Fatigue has a profound impact on health-related quality of life (HRQOL). The aim of this study was to describe the clinical characteristics and HRQOL of head and neck cancer patients who raised the issue of fatigue on the Patient Concerns Inventory (PCI) at their review consultation. Eight consultants were randomized to use the PCI as part of a cluster-controlled trial. Patients also completed the University of Washington Quality of Life version 4 (UWQOL), EQ-5D-5L (EuroQol Group), and Distress Thermometer questionnaires. The study included 140 patients who attended clinics at a median of 108 (interquartile range 70-165) days after the end of treatment. The PCI item 'fatigue' was the sixth most commonly selected, by 29% (n=40). Those with advanced tumours were more likely to have selected the item (30/84, 36% vs 10/56, 18%; P=0.02), as were those treated with radiotherapy±chemotherapy (34/87, 39% vs 6/53, 11%; P

We thank the China Medical Board, which financially supported our study. Objective To investigate if a Family-Clinician Shared Decision-Making (FCSDM) intervention benefits patients, families and intensive care units (ICUs) clinicians. Methods Six ICUs in China were allocated to intervention or usual care. 548 patients with critical illness, 548 family members and 387 ICU clinicians were included into the study. Structured FCSDM family meetings were held in the intervention group. Scales of SSDM, HADS, QoL2 and CSACD were used to assess families’ satisfaction and distress, patients’ quality of life, and clinicians’ collaboration respectively. Results Comparing the intervention group with the control group at post-intervention, there were significant differences in the families’ satisfaction (P =0.0001), depression level (P =0.005), and patients’ quality of life (P =0.0007). The clinicians’ mean CSCAD score was more positive in the intervention group than controls (P < 0.05). There was no significant between-group differences on ICU daily medical cost, but the intervention group demonstrated shorter number of days’ stay in ICU (P=0.0004). Conclusion The FCSDM intervention improved families’ satisfaction and depression, shortened patients’ duration of ICU stay, and enhanced ICU clinicians’ collaboration. Practice implications Further improvement and promotion of the FCSDM model are needed to provide more evidence to this field in China. Publisher PDF

This work was supported by the China Medical Board, CMB 14-200. Objective To investigate physicians’ responses to negative emotions in high-risk preoperative conversations; and to explore the influencing factors of these responses. Methods One hundred and sixty-two audio recordings were coded using the Chinese Verona Coding Definition of Emotional Sequences (VR-CoDES). Big Five Personality Inventory Brief Version and Emotional Intelligence Scale were administered to explore the influencing factors of physicians’ responses. SPSS 24.0 and R 3.6.3 LME4 Package were used for data analysis. Results Reduce Space (83%), referring to physicians’ responses reducing the opportunities of patients to disclose emotions, was physicians’ most frequent response to patients or families’ emotions. The main responses were Information-advice (ERIa) and Ignoring (NRIa). Younger age, female, Agreeableness and Openness were factors positively associated with Explicit Provide Space (EP); Neuroticism was negatively correlated with EP. Extroversion was negatively correlated with Explicit Reduce Space (ER); Conscientiousness was negatively correlated with both EP and ER responses. Emotional intelligence had no significant influence on physicians’ responses. Conclusion The majority of physicians were inclined to reduce space by providing information advice or ignoring. Physicians’ responses were correlated with their gender, age and personality traits. Practice Implications The trainees’ gender, age and personality should be considered when conducting doctor-patient communication skills training. Publisher PDF

Purpose The main aim of this paper is to present baseline demographic and clinical characteristics and HRQOL in the two groups of the Patient Concerns Inventory (PCI) trial. The baseline PCI data will also be described. Methods This is a pragmatic cluster preference randomised control trial with 15 consultant clusters from two sites either ‘using' (n = 8) or ‘not using’ (n = 7) the PCI at a clinic for all of their trial patients. The PCI is a 56-item prompt list that helps patients raise concerns that otherwise might be missed. Eligibility was head and neck cancer patients treated with curative intent (all sites, stage of disease, treatments). Results From 511 patients first identified as eligible when screening for the multi-disciplinary tumour board meetings, 288 attended a first routine outpatient baseline study clinic after completion of their treatment, median (IQR) of 103 (71–162) days. At baseline, the two trial groups were similar in demographic and clinical characteristics as well as in HRQOL measures apart from differences in tumour location, tumour staging and mode of treatment. These exceptions were cluster (consultant) related to Maxillofacial and ENT consultants seeing different types of cases. Consultation times were similar, with PCI group times taking about 1 min longer on average (95% CL for the difference between means was from − 0.7 to + 2.2 min). Conclusion Using the PCI in routine post-treatment head and neck cancer clinics do not elongate consultations. Recruitment has finished but 12-month follow-up is still ongoing.

Background: Fear of cancer recurrence (FCR) is recognized as a common concern for patients with head and neck cancer (HNC). The aim of this study is to describe in greater detail the demographic and clinical characteristics of HCN patients who indicate a high level of FCR in their review consultation.Methods: A pragmatic cluster-controlled trial was conducted between January 2017 and December 2018 at two UK HNC centers (Leeds and Liverpool) to test the efficacy of a prompt tool called the Patient Concerns Inventory (PCI). Patients completed the PCI and the UW-QOLv4 which included a single 5 category rating of FCR. Secondary statistical analyses focused on variables associated with high FCR.Results: Two hundred and eighty-eight trial patients were recruited in this trial. At a median of 194 days after diagnosis and 103 days after the end of treatment 8% stated (n = 24) “I get a lot of fears of recurrence and these can really preoccupy my thoughts” and 3% (n = 8) “I am fearful all the time that my cancer might return, and I struggle with this.” Thus, 11% (n = 32) responded in the worst two categories, 95% Confidence interval 7.7–15.3% for high FCR. Stepwise logistic regression resulted in female gender (p < 0.001), age (p = 0.007), and receiving financial benefits (p = 0.01) as independent predictors.Conclusions: Around one in ten HNC patients attending routine outpatient follow-up consultations report high FCR, however for female patients under the age of 55 the rate was one in three. This group requires specialist attention and could be the focus of a multicenter intervention trial.

Objective: Patients will experience a plethora of issues when faced with a recurrence of their cancer. It is unclear if cancer type is a significant factor in how recurrence is experienced by an individual. The aim of the current review is to explore the evidence base and summarise the experiences of patients specifically with a recurrence of breast or prostate cancer (the most common for women and men, respectively) and then provide a comparison of these experiences. These experiences include the physical, psychological and psychosocial issues that arise at this time.Methods: A systematic search was conducted of studies published between January 1994 and April 2019. Due to the mix of research designs used previously in the literature, this review was conducted in an integrative manner; allowing for inclusion of diverse research designs. Results were synthesised narratively, with data categorised according to physical, psychological, and psychosocial indices of quality of life. The review protocol was registered in the international database of prospective systematic reviews in health and social care- (CRD42019137381).Results: Fifteen breast cancer and six prostate cancer articles were identified, each reporting one relevant study. Patients reported several negative issues at the time of a breast or prostate cancer recurrence. Similarities were found between cancer types, with physical problems such as fatigue, psychological issues including anxiety and depressive symptoms, and psychosocial concerns such as issues with healthcare professionals common in both cancers. Certain findings were inconsistent across studies, with some experiences differing between studies rather than due to cancer type.Conclusions: Differences in the experience of recurrent cancer appear to be more heavily influenced by individual factors, rather than cancer type. Findings are confounded by gender; and should be considered preliminary. Effects of recurrence should be studied in samples where cancer type and gender are not confounded. Concerns are raised about available study quality and differing outcome measures in this interpretation. Care and support of the individual at the time of a cancer recurrence is a key focus. Future research suggestions with implications for clinical practise are included.Systematic Review Registration: PROSPERO 2019 CRD42019137381.

We would like to acknowledge the funding from the Scottish Government for the Childsmile Programme. Background : The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team. Aim : To apply PaeD‐TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child participation within an oral health promotion session. Method : A video observational study was applied. The sample consisted of a dental nurse and 22 children aged 2‐5 years in a general dental practice in Scotland. Behaviours were catalogued with time stamps using PaeD‐TrICS. Analysis of behavioural sequences with child participation as the dependent variable was conducted using multilevel modelling. Results : Children varied significantly in their participation rate. The statistical model explained 28% of the variance. The older the child and longer consultations significantly increased child participation. Both nurse and parental behaviour had immediate influence on child participation. Parental facilitation had a strong moderating effect on the influence of the nurse on child participation. Conclusions : Child participation was dependent on nurse and parent encouragement signalling an important triadic communication process. The coding scheme and analysis illustrates an important tool to investigate these advisory sessions designed for delivering tailored messages to young children and parents. Patient or Public Contribution : The dental staff, child patients and their parents were involved closely in the conduct and procedures of the present study. Publisher PDF

Previous work (FORECAST) has shown that concerns of breast cancer patients after finishing radiotherapy are responsive to conversations with radiographers during the treatment period. This study seeks to further understand radiographer and patient experiences, determine shared priorities for improvement in clinical interaction and develop communication guidelines and training to help radiographers support patients.Methods: Using the principles of Experience-Based Co-Design, semi-structured interviews were held with N = 4 patients (videoed) and N = 4 radiographers, followed by feedback events (N = 7) to validate findings. Patients and radiographers exchanged experiences in a joint co-design session, agreed with shared priorities and generated ideas for further support. A survey was conducted for process evaluation. To scale up findings, UK-wide representatives from patient networks (N = 8) and radiographers and managerial staff (N = 16) provided consultative input utilizing an iterative, adaptive procedure.Results: Radiographers expressed a need for support with “difficult conversations,” especially those on Fear of Cancer Recurrence, and their appropriate management. Important pointers for reassuring communication were identified, including: being treated like a person, knowing what to expect, and space to ask questions. The co-design process was rated positively by both staff and patients. Thematic collation of findings and mapping these on literature evidence resulted in the “KEW” communication guidelines for radiographers: Know (Confidence; Expectations; Person), Encourage (Emotions; Space; Follow-up), Warmth (Start; Normalize; Ending). National stakeholder consultations validated and helped fine-tune the training model. The resulting training package, included: trigger videos (n = 6), a simulated patient scenario and interactive handouts on fears of cancer recurrence and the patient pathway.Conclusions: The co-design process captured good practice to help standardize quality in empathic communication in the radiotherapy service. The resulting KEW: Know, Encourage, Warmth guidelines, and training package are user-centered as well as evidence-based. Supplementing single-site co-design with national consultative feedback allows for the development of interventions that are relevant to the clinical practice, even in detail, and helps to generate appropriate buy-in for roll out on a wider scale after evaluation.Trial Registration:www.ClinicalTrials.gov ID: NCT03468881

Purpose The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). Methods A pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. Results Consultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. Conclusion This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.

BackgroundFidelity of implementation (FOI) reflects whether an intervention was implemented in clinical practice according to the originally developed manual and is a key aspect in understanding intervention effectiveness. To illustrate this process of developing a fidelity measure, this study uses the Mini-AFTERc, a brief psychological intervention aimed at managing breast cancer patients’ fear of cancer recurrence, as an example.ObjectivesTo illustrate the development of an FOI measure through (1) applying this process to the Mini-AFTERc intervention, by including the design of a scoring system and rating criteria; (2) content validating the FOI measure using thematic framework analysis as a qualitative approach; (3) testing consistency of the FOI measure using interrater reliability.MethodsThe FOI measure was developed, its scoring system modified and the rating criteria defined. Thematic framework analysis was conducted to content validate the FOI measure using nine intervention discussions between four specialist cancer nurses and four breast cancer patients, and one simulated breast cancer patient. Intraclass-correlation was conducted to assess interrater reliability.ResultsThe qualitative findings suggested that the Mini-AFTERc FOI measure has content validity as it was able to measure all five components of the Mini-AFTERc intervention. The interrater reliability suggested a moderate to excellent degree of reliability among three raters, rICC = 0.84, 95% CI [0.51, 0.96].ConclusionThe study has illustrated the steps that an FOI measure can be developed through a systematic approach applied to the Mini-AFTERc intervention. The FOI measure was found to have content validity and was consistently applied, independently, by three researchers familiar with the Mini-AFTERc intervention. Future studies should determine whether similar levels of interrater reliability can be obtained by distributing written and/or video instructions to researchers who are unfamiliar with the FOI measure, using a larger sample. Employing developed and validated FOI measures such as the one presented for the Mini-AFTERc would facilitate implementation of interventions in the FCR field in clinical practice as intended.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03763825.

Head and neck oncology post-treatment consultations form a critical component of care in terms of support and surveillance. They occur frequently in the first few years and can place substantial demands on healthcare resources. However, they provide useful opportunities for patients to raise issues and receive tailored information and support. The aim of this paper was to assess whether completion of a 56-item patient prompt list (PCI - the Patient Concerns Inventory) immediately prior to the consultation significantly increased its duration. This was a pragmatic cluster preference randomised controlled trial of 288 patients with 15 consultant clusters from two sites “using” (n = 8) or “not using” (n = 7) the PCI. Consultation times were known for 283 patients (136 PCI, 147 non-PCI) who attended their first post-treatment trial consultation a median (IQR) of 103 (70-160) days after the end of treatment. Consultations lasted a median (IQR) of 10 (7-13) minutes (mean 11) in non-PCI patients and a median (IQR) of 11 (8-15) minutes (mean 12) in PCI patients (p = 0.07). After adjustment for patient clustering and significant case mix, the 95% confidence interval for the mean difference was between 1.45 minutes shorter with the PCI and 2.98 minutes longer (p = 0.50). There was significant variation in duration by consultant, tumour stage, treatment mode, overall quality of life (QoL), and distress (all p

Background: This is a protocol for a systematic review of the motivations and expectations of adult patients who seek orthodontic treatment. With the continuous improvement of orthodontic technique and rapid innovation of orthodontic appliances, more adults begin to consider orthodontic treatment. Appropriate motivations and realistic expectations play an important role towards a desired goal that are thought to increase patients’ cooperation and achieve satisfaction with treatment outcome. This review aims to assess the motivations and expectations of adult patients who seek orthodontic treatment and investigate how their motivations and expectations affect their satisfaction with treatment outcomes.Methods: A systematic search will be undertaken to map and screen the literature on adult patients’ motivations and expectations of orthodontic treatment and their effects on satisfaction of treatment outcome. Papers written in English or Chinese with no study design restrictions will be included. The study of adolescent patients or patients’ parents, patients with craniofacial hypoplasia and orthodontic treatment combined with orthognathic surgery will be excluded. If quantitative synthesis is possible, a meta-analysis will be conducted. Discussion: This systematic review will identify and gather evidence on adult patients’ motivations and expectations of orthodontic treatment. The method orthodontists obtain and assess adult patients’ motivations and expectations will be discussed. Accurate obtaining and appropriate managing adult patients’ motivations and expectations may increase the cooperation during treatment and satisfaction of the treatment outcome.Systematic review registration: PROSPERO CRD42020185022

The treatment of head and neck cancer (HNC) is often radical and the patient's journey challenging, especially for individuals who are struggling with pre-existing mental health problems and who lack social support. Patients frequently suffer from high levels of emotional distress at some point before, during, or after treatment, and their risk of suicide is markedly elevated. This structured review aimed to identify the extent of the problem, appropriate interventions, and areas for future research. We found that the incidence of suicide among HNC patients was significantly elevated above that of the demographically matched general population. Furthermore, the risk was frequently higher in patients with HNC than in those with cancers in other sites. Despite the clear burden of suicide in patients with HNC, there is an absence of evidence on interventions used to reduce suicidal ideation and the risk of suicide. Recommendations for practice are made, drawing from the wider literature on the prevention of suicide.

Funding: Academy of Finland and Signe and Ane Gyllenberg Foundation. Objectives The aim was to confirm the factor structure of Modified Dental Anxiety Scale (MDAS) and to investigate whether the association of these factors with general anxiety and depression varied across gender. Methods The FinnBrain Birth Cohort Study (www.finnbrain.fi) data from the first collection point at gestational week 14 were used. Of the invited participants (n = 5790), 3808 (66%) expectant mothers and 2623 fathers or other partners of the mother agreed to participate, and 3095 (81.3%) mothers and 2011 (76.7%) fathers returned the self‐report questionnaire. Dental anxiety was measured with the MDAS, general anxiety symptoms with Symptom Checklist‐90 (anxiety subscale) and depressive symptoms with the Edinburgh Postnatal Depression Scale. Multiple group confirmatory factor analysis (MGCFA) was conducted to test the equivalence of the factor structure and multiple group SEM (MGSEM) to test the configural invariance (unconstrained model) and metric invariance (structural weights model), across genders. Results Of those consenting, 3022 (98%) women and 1935 (96%) men answered the MDAS. The MGCFA indicated good convergent validity for the two‐factor model for MDAS, but somewhat low discriminant validity (factors demonstrated 72% shared variance). The MDAS items loaded clearly higher for the assigned factor than to the other factor (differences in loadings >0.2), indicating that the 2‐factor model has merit. According to the final MGSEM model, anxiety symptoms were directly related to anticipatory dental anxiety, but not to treatment‐related dental anxiety. Conclusions When assessing dental anxiety with MDAS, considering also its two factors may help clinicians in understanding the nature of patient's dental anxiety. Postprint

This trial is funded by the RfPB on behalf of the NIHR (PB-PG-0215-36047). Background: The consequences of treatment for Head and Neck cancer (HNC) patients has profound detrimental impacts such as impaired QOL, emotional distress, delayed recovery and frequent use of healthcare. The aim of this trial is to determine if the routine use of the Patients Concerns Inventory (PCI) package in review clinics during the first year following treatment can improve overall quality of life, reduce the social-emotional impact of cancer and reduce levels of distress. Furthermore, we aim to describe the economic costs and benefits of using the PCI. Methods: This will be a cluster preference randomised control trial with consultants either ‘using’ or ‘not using’ the PCI package at clinic. It will involve two centres Leeds and Liverpool. 416 eligible patients from at least 10 consultant clusters are required to show a clinically meaningful difference in the primary outcome. The primary outcome is the percentage of participants with less than good overall quality of life at the final one-year clinic as measured by the University of Washington QOL questionnaire version 4 (UWQOLv4). Secondary outcomes at one-year are the mean social-emotional subscale (UWQOLv4) score, Distress Thermometer (DT) score ≥ 4, and key health economic measures (QALY-EQ-5D-5 L; CSRI). Discussion: This trial will provide knowledge on the effectiveness of a consultation intervention package based around the PCI used at routine follow-up clinics following treatment of head and neck cancer with curative intent. If this intervention is (cost) effective for patients, the next step will be to promote wider use of this approach as standard care in clinical practice. Trial registration: 32,382. Clinical Trials Identifier, NCT03086629. Protocol: Version 3.0, 1st July 2017. Publisher PDF

Funding: Scottish Government - Childsmile Programme. Aim To explore the time taken and the types of communication strategies used by dental health professionals (DHPs) when interacting with and providing fluoride varnish and oral health advice to children with their parents. Methods A video observational study was conducted to explore the types of communication strategies used by DHPs when interacting with child patients and their parents during preventive oral healthcare appointments. Three dentists and two extended duty dental nurses (EDDNs) from four general dental practices were recruited in East of Scotland. Forty-four child-parent dyads participated in the study. Verbal and non-verbal behaviours were coded with Observer XT 10.5 using the PaeD-TrICS coding scheme. Frequencies of communication behaviours were compared using Mann-Whitney U-tests. Results The communication during the preventive care appointment ranged in time from 130 seconds to 1,756 seconds with an average of 736 seconds. The total number of communication strategies (verbal and non-verbal behaviours) based on 44 video observations was 7,299. DHPs used different communication strategies when providing fluoride varnish application (FVA) and oral health advice. Dentists used more direct communication strategies to elicit child patients' cooperation in FVA. EDDNs used communication behaviours to maintain a balanced relationship with children. Consequently, children exhibited different responses to the two different dental professional groups. Conclusions Differences in the style of communication strategies existed between the participating DHPs when interacting with children during preventive dental appointments. Further work is required to confirm these initial findings. Postprint

Background Fear of cancer recurrence (FCR) is common in people affected by breast cancer. FCR is associated with increased health service and medication use, anxiety, depression and reduced quality of life. Existing interventions for FCR are time and resource intensive, making implementation in a National Health Service (NHS) setting challenging. To effectively manage FCR in current clinical practice, less intensive FCR interventions are required. Mini-AFTERc is a structured 30-min counselling intervention delivered over the telephone and is designed to normalise moderate FCR levels by targeting unhelpful behaviours and misconceptions about cancer recurrence. This multi-centre non-randomised controlled pilot trial will investigate the feasibility of delivering the Mini-AFTERc intervention, its acceptability and usefulness, in relation to specialist breast cancer nurses (SBCNs) and patients. This protocol describes the rationale, methods and analysis plan for this pilot trial of the Mini-AFTERc intervention in everyday practice. Methods This study will run in four breast cancer centres in NHS Scotland, two intervention and two control centres. SBCNs at intervention centres will be trained to deliver the Mini-AFTERc intervention. Female patients who have completed primary breast cancer treatment in the previous 6 months will be screened for moderate FCR (FCR4 score: 10‑14). Participants at intervention centres will receive the Mini-AFTERc intervention within 2 weeks of recruitment. SBCNs will audio record the intervention telephone discussions with participants. Fidelity of intervention implementation will be assessed from audio recordings. All participants will complete three separate follow-up questionnaires assessing changes in FCR, anxiety, depression and quality of life over 3 months. Normalisation process theory (NPT) will form the framework for semi-structured interviews with 20% of patients and all SBCNs. Interviews will explore participants’ experience of the study, acceptability and usefulness of the intervention and factors influencing implementation within clinical practice. The ADePT process will be adopted to systematically problem solve and refine the trial design. Discussion Findings will provide evidence for the potential effectiveness, fidelity, acceptability and practicality of the Mini-AFTERc intervention, and will inform the design and development of a large randomised controlled trial (RCT). Trial registration ClinicalTrials.gov: NCT0376382. Registered 4th December 2018, https://clinicaltrials.gov/ct2/show/NCT03763825

Objective: Without an agreed‐upon set of characteristics that differentiate clinical from non‐clinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR. Method: A three‐round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty‐five experts in FCR (researchers, psychologists, physicians, nurses, allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM‐5 and proposed ICD‐11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symptom Disorder) to clinical FCR. Results: Participants’ ratings suggested that the following 4 features are key characteristics of clinical FCR: 1) high levels of preoccupation; 2) high levels of worry; 3) that are persistent; and 4) hypervigilance to bodily symptoms. Of participants whose professional role allowed them to diagnose mental disorders 84% indicated it would be helpful to diagnose clinical FCR, but the use of established diagnostic criteria related to health anxiety or somatic‐related disorders to clinical FCR was not supported. This suggests that participants consider clinical FCR as a presentation that is specific to cancer survivors. Conclusion: Clinical FCR was conceptualized as a multi‐dimensional construct. Further research is needed to empirically validate the proposed defining features. Postprint

Introduction Fear of cancer recurrence (FCR) in people with breast cancer affects treatment recovery, quality of life, service utilisation and relationships. Our aim was to investigate how specialist breast cancer nurses (SBCN) respond to their patients’ fears of cancer recurrence and analyse SBCN’s views about embedding a new psychological intervention, the Mini-AFTERc, into their consultations. Method A mixed methods sequential design was used, informed by normalisation process theory. Phase 1: UK SBCNs were emailed a web-based survey to investigate how breast cancer survivors’ FCR is currently identified and managed, and their willingness to utilise the Mini-AFTERc. Phase 2: a purposive sample of respondents (n = 20) were interviewed to augment phase 1 responses, and explore views on the importance of addressing FCR, interest in the Mini-AFTERc intervention, its content, skills required and challenges to delivering the intervention. Results Ninety nurses responded to the survey. When SBCN’s were asked to identify the proportion of patients experiencing FCR in their caseload, there was no consensus on the size of the problem or unmet need. They estimated that 20–100% people experience moderate FCR and 10–70% severe FCR. The interviews identified that clinical conversations are focused primarily on giving information about signs and symptoms of recurrence rather than addressing the psychological aspects of fear. Conclusion Findings indicate wide variability in how FCR was identified, assessed and supported by a sample of UK SBCNs. The introduction of a structured intervention into practice was viewed favourably and has implications for nursing and health professional ways of working in all cancer services. Electronic supplementary material The online version of this article (10.1007/s00520-019-04762-9) contains supplementary material, which is available to authorized users.

Distress is a complex condition which affects a significant percentage of cancer patients and may lead to depression, anxiety, sadness, suicide and other forms of psychological morbidity. Compelling evidence supports screening for distress as a means of facilitating early intervention and subsequent improvements in psychological well-being and overall quality of life. Nevertheless, despite the existence of evidence based and easily administered screening tools, for example, the Distress Thermometer, routine screening for distress is yet to achieve widespread implementation. Efforts are intensifying to utilise innovative, cost effective methods now available through emerging technologies in the informatics and computational arenas., Comment: Accepted in European Journal of Cancer Care

AIM To test the psychometric properties of an Arabic version of the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) a using confirmatory factor analysis. METHODS Two convenience samples were obtained: Sample [1]: 600 boys (33%) and girls attending 4 public schools in Onizah and Sample [2] 800 girls attending 8 public schools in Buridah. The questionnaire asked the participant's age, gender, and completion of the CFSS-DS. The data were subjected to exploratory factor analysis (EFA), parallel factor analysis, Cronbach's alpha, confirmatory factor analysis (CFA), and goodness of fit statistics. RESULTS A total of 513 children in Sample [1] and 503 children in Sample [2] participated giving a valid response rate of 86% and 67%, respectively. From the EFA, 3 factors were identified and confirmed statistically using parallel factor analysis. The internal consistency of the 3 factors, Dental Fear Subscale (0.86), Hospital Fear Subscale (0.77), and Stranger Fear Subscale (0.71), was good. The CFA showed that the current EFA model was an equivalent fit to the El Housseiny et al (BMC Oral Health 2016;16:49). model; however, the solution using El Housseiny et al's structure was distorted. CONCLUSIONS A 3-factor structure with acceptable reliability exists for this Arabic version of the CFSS-DS, confirmed by a CFA using an additional data set.

Background A key element in the interaction between clinicians and patients with cancer is reassurance giving. Learning about the stochastic nature of reassurances as well as making inferential statements about the influence of covariates such as patient response and time spent on previous reassurances are of particular importance. Methods We fit Hidden Markov Models (HMMs) to reassurance type from multiple time series of clinicians’ reassurances, decoded from audio files of review consultations between patients with breast cancer and their therapeutic radiographer. Assuming a latent state process driving the observations process, HMMs naturally accommodate serial dependence in the data. Extensions to the baseline model such as including covariates as well as allowing for fixed effects for the different clinicians are straightforward to implement. Results We found that clinicians undergo different states, in which they are more or less inclined to provide a particular type of reassurance. The states are very persistent, however switches occasionally occur. The lengthier the previous reassurance, the more likely the clinician is to stay in the current state. Conclusions HMMs prove to be a valuable tool and provide important insights for practitioners. Trial registration Trial Registration number: ClinicalTrials.gov: NCT02599506. Prospectively registered on 11th March 2015. Electronic supplementary material The online version of this article (10.1186/s12874-018-0629-0) contains supplementary material, which is available to authorized users.

Based on our ongoing work, this work in progress project aims to develop an automated system to detect distress in people to enable early referral for interventions to target anxiety and depression, to mitigate suicidal ideation and to improve adherence to treatment. The project will utilize either use existing voice data to assess people into various scales of distress, or will collect voice data as per existing standards of distress measurement, to develop basic computing algorithms required to detect various attributes associated with distress, detected through a person's voice in a telephone call to a helpline. This will be then matched with the already available psychological assessment instruments such as the Distress Thermometer for these persons. In order to trigger interventions, organizational contexts are essential as interventions rely on the type of distress. Therefore, the model will be tested on various organizational settings such as the Police, Emergency and Health along with the Distress detection instruments normally used in a psychological assessment for accuracy and validation. The outcome of the project will culminate in a fully automated integrated system, and will save significant resources to organizations. The translation of the project will be realized in step-change improvements to quality of life within the gamut of public policy.

Objective: The study aimed to design and evaluate a health behaviour change intervention for looked after young people, targeting sexual health, smoking, exercise, healthy eating and non-dependent alcohol and drug use. Design: A pre–post intervention evaluation was undertaken exploring health behaviours and wellbeing. Methodology: The one-to-one intervention was individually tailored to each person. Young people eligible for the intervention were aged 11 years and over and were ‘looked after’, meaning they were under a supervision order with a local authority in Scotland, or were a care leaver. A total of 144 young people referred to the intervention service between March 2009 and January 2014 were eligible for the evaluation. Evaluation data were analysed using standard statistical tests on SPSS. Results: Behaviour change techniques, including goal setting, action planning, barrier identification/problem solving and motivational interviewing contributed to improvements in all areas. Difficulties with consent and follow-up were highlighted as barriers to effective evaluation. Conclusion: Improving the current health of looked after young people with a view to prevent future ill health using a tailored intervention with behaviour change techniques enables this group to improve health behaviours, despite numerous challenges in working with these vulnerable clients.

Despite a rapidly growing research interest in fear of cancer recurrence, lack of consensus on definition and measurement including clinical fear of cancer recurrence, sparse model development and testing, and limited available clinical interventions have impeded knowledge transfer into patient services. To move forward, a 2-day colloquium was held in Ottawa, Canada in August 2015 to progress knowledge and identify future research directions. A comprehensive research program was proposed, including development of a clinical definition, an updated review of screening measures, and a review of existing interventions. A new special interest group was created with the International Psychosocial Oncology Society to facilitate the implementation of this research program and future international collaborations. Copyright © 2016 John Wiley & Sons, Ltd.

Item does not contain fulltext PURPOSE: Research to date on fear of cancer recurrence (FCR) shows that moderate to high FCR affects 22-87 % of cancer survivors and is associated with higher psychological morbidity (Simard et al J Cancer Surviv 7:300-322, 2013). Despite growing research interest in FCR, the lack of consensus on its definition and characteristics when it reaches a clinical level has impeded knowledge transfer into patient services. METHODS: In order to address these gaps, expert researchers, policy makers, trainees, and patient advocates attended a 2-day colloquium at the University of Ottawa in August 2015. A Delphi method was used to identify the most relevant definition of FCR, and the attendees generated possible diagnostic characteristics of clinical FCR. RESULTS: After three rounds of discussion and voting, the attendees reached consensus on a new definition of FCR: "Fear, worry, or concern relating to the possibility that cancer will come back or progress." Regarding clinical FCR, five possible characteristics were proposed: (1) high levels of preoccupation, worry, rumination, or intrusive thoughts; (2) maladaptive coping; (3) functional impairments; (4) excessive distress; and (5) difficulties making plans for the future. CONCLUSIONS: The new proposed definition of FCR reflects the broad spectrum in which patients experience FCR. A consensual definition of FCR and the identification of the essential characteristics of clinical FCR are necessary to accurately and consistently measure FCR severity and to develop effective interventions to treat FCR. We hope this broad definition can encourage further research and the development of inclusive policies for all cancer patients and survivors who are struggling with this issue.

FORECAST study supported generously by Breast Cancer Now (Reg. No. SP529). Fears of cancer recurrence (FCR) in patients with breast cancer may develop during radiotherapy. Radiographer communication with their patients may influence early survivorship FCR level. Aim To investigate the management of emotional talk in patients with breast cancer attending their initial review appointments during radiotherapy and predict FCR at 6–8 weeks follow-up. Methods A mixed-methods observational study was conducted. Patients (consecutive sample, n = 60) with breast cancer, attending a major Scottish cancer centre, had their first two review appointments with their therapeutic radiographer (TR) audio-recorded. In addition, FCR was assessed (FCR7) at baseline and at 6–8 weeks following their final radiotherapy visit. Two TRs participated. Audio files were coded by the VR-CoDES system to identify emotional cues and therapeutic radiographer (TR) responses. Linear regression models were tested for fit and to identify factors associated with follow-up FCR, i.e. patient cues, responses by TR. Results Follow-up FCR was predicted negatively (robust estimator, p = .01) by level of patient emotional talk at the second review session. The provision of space by the TR, at the second session, to enable patients to expand their emotional utterances was also associated, but negatively (p = .01), with follow-up FCR. These effects were maintained after inclusion of covariates: age, treatment received and living conditions. Conclusions Patient’s emotional expression and TR responses at the second review meeting predicted follow-up FCR. The study shows the effect of communication processes on this specific distress component of the patient’s survivorship experience. Trial registration NCT02599506 Postprint

Background: Fear of recurrence (FoR) is the most frequent concern patients wish to discuss in head and neck review clinics. Aim: To design a simple screening question on fear of recurrence to be incorporated into the University of Washington Quality of Life Questionnaire (UW-QOLv4), for use in clinical practice. Methods: A cross-sectional survey comprising 528 patients. Results: 11% selected the two most severe FoR categories. FoR responses correlated strongly (Spearman rs=-0.82) with the mean score of the 7 items of the Fear of Recurrence Questionnaire. There was also a strong association with anxiety and mood dysfunction as measured from the UW-QOL, and with overall QOL. Patients more affected by FoR tended to be younger and post radiotherapy or chemotherapy. Conclusion: The FoR screening question should be bolted on to the UW-QOLv4 in order to help identify patients with significant FoR might benefit from further intervention. Postprint

Objectives: Paan chewing is a recognized risk factor for oral cancer in the Asian population. However, there is currently little evidence about the intergenerational psychosocial transmission of paan chewing in South Indian families. We investigated the association between parental and participant's paan chewing in a South Indian population. Methods: A subset of data was drawn from a hospital-based case-control study on oral cancer, the HeNCe Life study, conducted at Government Dental and Medical Colleges of Kozhikode, South India. Analyses were based on 371 noncancer control participants having diseases unrelated to known risk factors for oral cancer. Demographics, behavioral habits (e.g., paan chewing, smoking), and indicators of socioeconomic position (SEP) of both participants and their parents were collected with the use of a questionnaire-based interview and a life grid technique. Unconditional logistic regression assessed odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between parental and participant's paan chewing, adjusted for confounders. Results: Over half of the participants were males (55.2%), and the mean age of participants was 59 (SD=12) years. After adjusting for age, religion, parents' SEP, parents' education, smoking and alcohol consumption, and perceived parenting behavior, we observed that maternal paan chewing and paternal paan chewing were significantly associated with the participant's paan chewing ([OR=2.40, 95% CI=1.11-5.21] and [OR=3.05, 95% CI=1.48-6.27], respectively). Conclusions: Intergenerational psychosocial transmission of the habit of paan chewing could occur through shared sociocultural or environmental factors.

Funding: British Association of Head and Neck Oncologists Fear of cancer recurrence (FCR) is common among individuals treated for cancer. Explorations of how this fear is expressed within an oncology setting and responded to are currently lacking. The aim was to investigate how head and neck cancer survivors in follow-up consultations express FCR, investigate how a healthcare professional addresses recurrence fears, and examine how survivors experience this interaction. We recorded the follow-up consultations of those participants who have reported FCR as a concern on the Patient Concerns Inventory. We also conducted a follow-up phone interview with the participants. We analysed the transcripts using thematic analysis. Five men and six women were recruited, aged 55–87 (mean age = 64). Follow-up consultation analyses revealed that the consultant used “normalising FCR,” “reassurance,” and “offer of referral to a counsellor.” Interviews revealed themes around how they coped with FCR, relevance of personal history on FCR, and the impact of feeling gratitude towards the consultant on expression of FCR. Analyses indicate that patients may feel reluctant to raise their FCR with their clinician for fear of appearing “ungrateful” or of damaging a relationship that is held in high esteem. Findings indicate the initiation of FCR with patients can be beneficial for patient support. Postprint

This study has been funded by the breast cancer research charity Breast Cancer Now (Ref: 2015NovSP679). Background: Fear of recurrence (FoR) is a major concern for patients following treatment for primary breast cancer, affecting 60–99% of breast cancer survivors. Mini-AFTER is a brief intervention developed to address this fear, that breast care nurses are ideally placed to deliver. However, their interest in delivering such an intervention is unknown and crucial to its introduction. This study aims to assess the perceived feasibility of the Mini-AFTER telephone intervention for implementation by breast care nurses to manage moderate levels of fear of recurrence among breast cancer survivors. Methods: A sequential explanatory mixed-methods design will be used, informed by normalisation process theory (NPT). The design will be guided by the stages of NPT. Specifically, understanding and evaluating the process (implementation) that would enable an intervention, such as the Mini-AFTER, not only to be operationalised and normalised into everyday work (embedded) but also sustained in practice (integration). Phase 1: all members on the UK Breast Cancer Care Nursing Network database (n = 905) will be emailed a link to a web-based survey, designed to investigate how breast cancer survivors’ FoR is identified and managed within current services and their willingness to deliver the Mini-AFTER. Phase 2: a purposive sample of respondents (n = 20) will be interviewed to build upon the responses in phase 1 and explore breast care nurses’ individual views on the importance of addressing fear of recurrence in their clinical consultations, interest in the Mini-AFTER intervention, the content, skills required and challenges to deliver the intervention. Discussion: This study will provide information about the willingness of breast care nurses (BCNs) to provide a structured intervention to manage fear of recurrence. It will identify barriers and facilitators for effective delivery and inform the future design of a larger trial of the Mini-AFTER intervention. Publisher PDF

While increasingly appreciated for its importance,the interaction between health care professionals (HCP) and patients is notoriously difficult to study, with both methodological and practical challenges. The former has been addressed by the so-called Verona coding definitions of emotional sequences (VRCoDES)– a system for identifying and coding patient emotions and the corresponding HCP responses – shown to be reliable and informative in a number of independent studies in different health care delivery contexts. In the present work we focus on the practical challenge of the scalability of this coding system,namely on making it easily usable more widely and on applying it on larger patient cohorts. In particular, VR-CoDES is inherently complex and training is required to ensure consistent annotation of audio recordings or textual transcripts of consultations.Following up on our previous pilot investigation, in the present paper we describe the first automatic, computer based algorithm capable of providing coarse level coding of textual transcripts. We investigate different representations of patient utterances and classification methodologies, and label each utterance as either containing an explicit expression of emotional distress (a ‘concern’), an implicit one (a ‘cue’),or neither. Using a data corpus comprising 200 consultations between radiotherapists and adult female breast cancer patients we demonstrate excellent labelling performance. Postprint

Increasing awareness of, and information about, overdose risk is an appropriate approach in risk reduction. e-Health technology in substance use disorders is an opportunity to support behavioral changes related to public health concerns. The present study aimed to evaluate the short-term impact of an innovative e-health psychoeducational software, the Overdose RIsk InfOrmatioN (ORION) tool. The ORION programme provided relevant information to opioid-dependent individuals about the risk of suffering a drug overdose as a result of high risky and dysfunctional behaviors. Seven aggregate risk factors were identified through a systematic review and their outputs included in a risk estimation model. We recruited 194 opioid-dependent treatment-seeking individuals from the United Kingdom, Germany, Italy, and Denmark. All participants were given at study entry, and after their use of the software, the General Self-Efficacy (GSE) Scale. We found comparable pre- and post-ORION administration mean GSE scores (SD), 28.49 (5.50) and 28.32 (5.90), respectively (p = 0.297). However, there was an inverse correlation between the number of risk factors and reported levels of self-efficacy (p

Objective To discuss the theoretical and empirical framework of VR-CoDES and potential future direction in research based on the coding system. Methods The paper is based on selective review of papers relevant to the construction and application of VR-CoDES. Results VR-CoDES system is rooted in patient-centered and biopsychosocial model of healthcare consultations and on a functional approach to emotion theory. According to the VR-CoDES, emotional interaction is studied in terms of sequences consisting of an eliciting event, an emotional expression by the patient and the immediate response by the clinician. The rationale for the emphasis on sequences, on detailed classification of cues and concerns, and on the choices of explicit vs. non-explicit responses and providing vs. reducing room for further disclosure, as basic categories of the clinician responses, is described. Conclusions Results from research on VR-CoDES may help raise awareness of emotional sequences. Future directions in applying VR-CoDES in research may include studies on predicting patient and clinician behavior within the consultation, qualitative analyses of longer sequences including several VR-CoDES triads, and studies of effects of emotional communication on health outcomes. Practice implications VR-CoDES may be applied to develop interventions to promote good handling of patients’ emotions in healthcare encounters.

Dental anxiety of patients is a common feature of the everyday experience of dental practice. This article advocates the use of regular assessment of this psychological construct to assist in patient management. Various tools, such as the Modified Dental Anxiety Scale (MDAS), are available to monitor dental anxiety that are quick to complete and easy to interpret. Patient burden is low. A new mobile phone assessment system (DENTANX) is being developed for distribution. This application and other psychological interventions are being investigated to assist patients to receive dental care routinely. CPD/Clinical Relevance: This article provides evidence and expert opinion on the worth of regular dental anxiety assessment in dental practice using structured tools, such as the Modified Dental Anxiety Scale, and consideration of psychological intervention development.

Objective: To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health–related quality of life (COHRQoL). Setting: Primary schools, high social deprivation, Ireland/Northern Ireland. Design: Cluster randomised controlled trial. Method: A total of 383, 7- to 8-year-old children were invited to participate and randomly allocated into intervention and control conditions. Baseline and 12-month follow-up assessments of COHRQoL, self-esteem, toothbrushing–fluoride toothpaste knowledge and unstimulated saliva samples were made. An 18-hour post-brushing, saliva fluoride concentration was used to assess toothbrushing with fluoride toothpaste (behaviour). The data were entered onto SPSSv22. Structural equation modelling was applied using AMOSv22 to test for the role of health-learning capacity (baseline self-esteem and COHRQoL) and simultaneous effects of Winning Smiles upon knowledge, behaviour and COHRQoL (at follow-up). Results: A total of 238 children participated at baseline and follow-up. A partial latent hybrid model fitted the data reasonably well (χ2 = 65.6, df = 50, p = .07) as shown in addition by a Comparative Fit Index of .97 and a Root Mean Square Error of Approximation (RMSEA) value of .042 (90% confidence interval [CI]: .00, .06). The intervention had a significant effect on toothbrushing–fluoride toothpaste knowledge ( p Conclusion: The model of health-learning capacity assisted in explaining the effect of a school-based intervention upon knowledge, toothbrushing behaviour and tentatively on COHRQoL.

We would like to acknowledge the funding from the Public Dental Services, NHS Highland. Aim: To examine how quality standards of dental undergraduate education, postgraduate training and qualifications together with confidence and barriers could be utilised to predict intention to provide inhalation sedation. Methods: All 202 dentists working within primary dental care in NHS Highland were invited to participate. The measures in the questionnaire survey included demographic information, undergraduate education and postgraduate qualifications, current provision and access to sedation service, attitudes towards confidence, barriers and intention to provide inhalation sedation. A path analytical approach was employed to investigate the fit of collected data to the proposed mediational model. Results: One hundred and nine dentists who completed the entire questionnaire participated (response rate of 54%). Seventy-six per cent of dentists reported receiving lectures in conscious sedation during their undergraduate education. Statistically significantly more Public Dental Service dentists compared with General Dental Service (GDS) dentists had postgraduate qualification and Continuing Professional Development training experience in conscious sedation. Only twenty-four per cent of the participants stated that they provided inhalation sedation to their patients. The findings indicated that PDS dentists had higher attitudinal scores towards inhalation sedation than GDS practitioners. The proposed model showed an excellent level of fit. A multigroup comparison test confirmed that the level of association between confidence in providing inhalation sedation and intention varied by group (GDS vs. PDS respondents). Public Dental Service respondents who showed extensive postgraduate training experience in inhalation sedation were more confident and likely to provide this service. Conclusion: The quality standards of dental undergraduate education, postgraduate qualifications and training together with improved confidence predicted primary care dentists’ intention to provide inhalation sedation. Postprint

Hayden C, Bowler JO, Chambers S, Freeman R, Humphris G, Richards D, CecilJE. Obesity and dental caries in children: a systematic review and meta-analysis. Community Dent Oral Epidemiol 2012. © 2012JohnWiley&SonsA/SAbstract – Objectives: Obesity and dental caries have become increasinglyprevalent challenges to public health. Research results into the relationshipbetween obesity and dental caries in children have been mixed andinconclusive. The aim of this review and meta-analysis was to provide evidenceto quantify the relationship between obesity and dental caries in children usinga systematic approach. Methods: A systematic search for papers between 1980and 2010 addressing childhood obesity and dental caries was conducted and arandom effects model meta-analysis applied. Results: Fourteen papers met theselection criteria. Overall, a significant relationship between childhood obesityand dental caries (effect size = 0.104, P=0.049) was found. When analysed bydentition type (primary versus permanent), there was a nonsignificantassociation of obesity and dental caries in permanent and primary dentitions,yet on accounting only for standardized definitions for assessment of childobesity using body mass index, a strong significant relationship was evident inchildren with permanent dentitions. Moderating for study country of origin(newly ‘industrialized’ versus industrialized) showed a significant relationshipbetween obesity and dental caries in children from industrialized but not newlyindustrialized countries. Cofactors such as age and socioeconomic class weresignificant moderators. Conclusions: Future analysis should investigate theseconfounding variables, helping shape the future of obesity managementprogrammes and oral health interventions, through determining common riskfactors.

Objective: Smoking continues to be a major global cause of mortality and morbidity. Countries have increasingly adopted the use of images as warnings on cigarette packs. We aimed to investigate the likely differential impact of varied images and messages on sub-groups of the United Kingdom (UK) smoking population. Methods: Forty two images developed and approved by the European Union (EU) were viewed by participants in an online survey. Respondents indicated which images they felt would most effectively reduce rates of smoking. Socio-demographic data was sought from participating adults including age, sex, occupation, ethnicity and current smoking behaviour. There were 19,810 participants in the survey. Results: Three images, with graphic content, were found to consistently stand out as the most popular across all sub-groups. Smokers (as opposed to ex- and non-smokers) and men were found to vote for significantly fewer images, potentially indicating greater scepticism regarding the efficacy of images. Significant socio-demographic variations across a number of images were found suggesting that particular images and messages may have a differential impact on particular sub-groups. Conclusion: Images may vary significantly in their impact on different social sub-groups. Careful consideration is required when selecting which images to use. Attaching images targeting a sub-group to tobacco brands with that socio-demographic market may enhance the effectiveness of such warnings.

Objective Emotions, are in part conveyed by varying levels of fundamental frequency of voice pitch (f0). This study tests the hypothesis that patients display heightened levels of emotional arousal (f0) during Verona Coding Definitions of Emotional Sequences (VR-CoDES) cues and concerns versus during neutral statements. Methods The audio recordings of sixteen head and neck cancer survivors’ follow-up consultations were coded for patients’ emotional distress. Pitch (f0) of coded cues and concerns, including neutral statements was extracted. These were compared using a hierarchical linear model, nested for patient and pitch range, controlling for statement speech length. Utterance content was also explored. Results Clustering by patient explained 30% of the variance in utterances f0. Cues and concerns were on average 13.07 Hz higher than neutral statements (p = 0.02). Cues and concerns in these consultations contained content with a high proportion of recurrence fears. Conclusion The present study highlights the benefits and challenges of adding f0 and potential other prosodic features to the toolkit of coding emotional distress in the health communication setting. Practice implications The assessment of f0 during clinical conversations can provide additional information for research into emotional expression.

Aims: To compare the prevalence of high dental anxiety across a variety of past distressing experiences with a previously reported Dutch sample. Method: University students from the UK (N=1024) completed an online survey containing; the Modified Dental Anxiety Scale, and the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ). Adjusted odds ratios (OR) were calculated to assess the association of self-reported distressing experiences and dental anxiety. Results: The percentage of respondents with high dental anxiety (HDA) (total MDAS score ≥19) was 11.2%. Significant prevalence of HDA across several distressing experiences was shown in both UK and Dutch samples notably: extreme helplessness during dental treatment, lack of understanding of the dentist and extreme embarrassment during dental treatment. There were little or no effects of non dental trauma, with the exception of sexual abuse in the UK sample. Conclusions: Trauma from various past experiences may be implicated in an increased risk of high dental anxiety. Postprint

International Journal of Paediatric Dentistry 2010; 20: 374–381 Objective. To investigate camera awareness of female dental nurses and nursery school children as the frequency of camera-related behaviours observed during fluoride varnish applications in a community based health programme. Methods. Fifty-one nurse–child interactions (three nurse pairs and 51 children) were video recorded when Childsmile nurses were applying fluoride varnish onto the teeth of children in nursery school settings. Using a pre-developed coding scheme, nurse and child verbal and nonverbal behaviours were coded for camera-related behaviours. Results. On 15 of 51 interactions (29.4%), a total of 31 camera-related behaviours were observed for dental nurses (14 instances over nine interactions) and children (17 instances over six interactions). Camera-related behaviours occurred infrequently, occupied 0.3% of the total interaction time and displayed at all stages of the dental procedure, though tended to peak at initial stages. Conclusions. Certain camera-related behaviours of female dental nurses and nursery school children were observed in their interactions when introducing a dental health preventive intervention. Since the frequency of camera-related behaviours are so few they are of little consequence when video-recording adults and children undertaking dental procedures.

Background Looked after young people (LAYP) have poorer sexual health outcomes than their peers. However, research seldom examines the health needs of, or intervenes with, this group. The aim of the current study was to identify LAYP’s perceived sexual health needs and explore sources of sexual health information, knowledge levels, concerns and service preferences. Methods Looked after young people within Fife, Scotland, were recruited through their workers and carers to participate in qualitative semistructured interviews. Those aged 12‐19 years were targeted for recruitment. National Health Services ethics approval was granted. Thematic analysis was conducted using NVivo. Results Interviews were conducted with 10 LAYP. Key themes included gaps in knowledge, and gaps between knowledge and behaviour. Being ‘looked after’ may have negative consequences on knowledge, sources of support and safer sex. A flexible, one-to-one service, aimed at several lifestyle issues, not solely sexual health, was preferred by respondents. Conclusion Looked after young people require support to bridge the gap between knowledge and behaviour and several theories relevant to the findings have been identified. Participants desired more support around a range of health issues, which may come from school, workers and carers, as well as health professionals. Further research examining effective interventions with this group is crucial to improve outcomes.

Background Socially disadvantaged men are at a substantially higher risk of developing alcohol-related problems. The frequency of heavy drinking in a single session is high among disadvantaged men. Brief alcohol interventions were developed for, and are usually delivered in, healthcare settings. The group who binge drink most frequently, young to middle-aged disadvantaged men, have less contact with health services and there is a need for an alternative method of intervention delivery. Text messaging has been used successfully to modify other adverse health behaviours. This study will test whether text messages can reduce the frequency of binge drinking by disadvantaged men. Methods/design Disadvantaged men aged 25 to 44 years who drank >8 units of alcohol at least twice in the preceding month will be recruited from the community. Two recruitment strategies will be used: contacting men listed in primary care registers, and a community outreach method (time-space sampling). The intended sample of 798 men will be randomised to intervention or control, stratifying by recruitment method. The intervention group will receive a series of text messages designed to reduce the frequency of binge drinking through the formation of specific action plans. The control group will receive behaviourally neutral text messages intended to promote retention in the study. The primary outcome measure is the proportion of men consuming >8 units on at least three occasions in the previous 30 days. Secondary outcomes include total alcohol consumption and the frequency of consuming more than 16 units of alcohol in one session in the previous month. Process measures, developed during a previous feasibility study, will monitor engagement with the key behaviour change components of the intervention. The study will incorporate an economic evaluation comparing the costs of recruitment and intervention delivery with the benefits of reduced alcohol-related harm. Discussion This study will assess the effectiveness of a brief intervention, delivered by text messages, aimed at reducing the frequency of binge drinking in disadvantaged men. The process measures will identify components of the intervention which contribute to effectiveness. The study will also determine whether any benefit of the intervention is justified by the costs of intervening. Trial registration ISRCTN07695192. Date assigned: 14 August 2013.