The epidemiology of infectious mononucleosis in Northern Scotland : a decreasing incidence and winter peak

Peer reviewedPublisher PD

Reforming the Canadian Refugee Determination System

If Canadian refugee policy is to serve interests of Canadians as well as those of genuine refugees in an effective manner, far more radical changes will be needed than have been attempted to date. They must include the introduction of robust safe third country designations, a review of the 1985 Singh decision of the Supreme Court of Canada, and possible withdrawal by Canada of its accession to the 1951 UN Refugee Convention. Other measures should also be considered such as placing an annual limit on the intake of refugees from overseas combined with that of successful in-country asylum seekers as well as establishing provision for temporary refugee status in Canada in addition to permanent resettlement. Measures should be taken to return Canada to its role primarily as a resettlement country for refugees selected abroad and not one that accommodates large numbers of asylum seekers making claims on our territory. With strong public backing for major changes, political parties that oppose such reforms will do so at the risk of losing electoral support.Si la politique envers les réfugiés au Canada doit servir les intérêts des Canadiens ainsi que ceux des réfugiés de bonne foi d’une manière effi cace, des changements bien plus radicaux seront nécessaires que ceux qui ont été tentés jusqu’ici. Ces changements doivent comprendre l’introduction de désignations robustes de pays tiers sûrs, un examen de la décision Singh de la Cour suprême du Canada de 1985 et le retrait éventuel par le Canada de son adhésion à la Convention du 28 juillet 1951 relative au statut des réfugiés de l’ONU. D’autres mesures devraient également être considérées comme la mise en place d’un plafond annuel à l’accueil des réfugiés d’outre-mer combiné à l’acceptation de demandes d’asile sur le territoire ainsi que l’ établissement de dispositions pour le statut de réfugié temporaire au Canada et la réinstallation permanente. Des mesures devraient être prises pour permettre au Canada de retrouver son rôle comme pays avant tout de réinstallation pour les réfugiés sélectionnés à l’étranger et non pas comme pays accueillant un grand nombre de demandeurs d’asile faisant des réclamations sur son territoire. Compte tenu de l’appui soutenu du public pour des changements majeurs, les partis politiques qui s’opposent à ces réformes le font au risque de perdre leur soutien électoral

Developing a whole campus approach to learning for sustainability: Challenges and opportunities for embedding and sustaining change

Learning for Sustainability (LfS) is a key component of Scottish Education. However, policy interpretation and enactment is a complicated process and there can often be a difference between policy intentions and implementation. The following research explores how one campus (for pupils aged 2-18) in Scotland undertook a year-long all staff career long professional learning programme (CLPL) to develop a whole campus approach to Learning for Sustainability. The aim of this research project was to better understand the implications (opportunities and challenges) at a whole school / campus and teacher level when developing a whole school / campus approach to Learning for Sustainability. Three semi-structured interviews were carried out, with focus groups made up of a small group of teaching staff, members of the senior management team, as well as a follow up interview with the head teacher. A theoretical thematic analysis was used to identify themes from the data and applied to further explore the emergence of these elements from the CLPL discussion forums including contributions from all participating staff members. The three main themes identified were: collaboration and collegiality; processes of change; and attitudes to learning and to change. The study revealed a tension between the need for both teachers and management to have an identified person ‘leading’ the agenda, and the need for that agenda to develop in a culture of collegiately and shared responsibility. There was also an interesting contrast between deep and shallow learning for both teachers and managers. The study also provided useful learning for other organisations leading the agenda for change, which can be summarised into three key recommendations: (1) Organisational leaders should engage with suitable learning prior to developing a leadership of change model for their organisation, which includes a distributed model of leadership. (2) Methods of professional learning for all practitioners should include an engagement with reflective activities, which enables them to access deeper and more transformational learning. (3) Large organisations should work with community-led groups and be sensitive to local contexts to establish a vision, which clearly articulates the imperative is the responsibility of all

The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities

The prevalence, and incidence, of mental ill-health in adults with intellectual disabilities and autism were compared with the whole population with intellectual disabilities, and with controls, matched individually for age, gender, ability-level, and Down syndrome. Although the adults with autism had a higher point prevalence of problem behaviours compared with the whole adult population with intellectual disabilities, compared with individually matched controls there was no difference in prevalence, or incidence of either problem behaviours or other mental ill-health. Adults with autism who had problem behaviours were less likely to recover over a two-year period than were their matched controls. Apparent differences in rates of mental ill-health are accounted for by factors other than autism, including Down syndrome and ability level

Correction to: A Systematic and Critical Review of Discrete Choice Experiments in Asthma and Chronic Obstructive Pulmonary Disease (Jul, 10.1007/s40271-.021-.00536-w, 2021)

The article “A Systematic and Critical Review of Discrete Choice Experiments in Asthma and Chronic Obstructive Pulmonary Disease”, written by Hannah Collacott, Dian Zhang, Sebastian Heidenreich and Tommi Tervonen1 was originally published electronically on the publisher’s internet portal on 12 July 2021 without open access.</p

A Systematic and Critical Review of Discrete Choice Experiments in Asthma and Chronic Obstructive Pulmonary Disease

BACKGROUND: Regulators have called for greater emphasis on the role of the patient voice to inform medical product development and decision making, and expert guidelines and reports for asthma and chronic obstructive pulmonary disease (COPD) both explicitly recommend the consideration of patient preferences in the management of these diseases. Discrete choice experiments (DCEs) are commonly used to quantify stakeholders’ treatment preferences and estimate the trade-offs they are willing to make between outcomes such as treatment benefits and risks. OBJECTIVE: The aim of this systematic literature review is to provide an up-to-date and critical review of DCEs published in asthma and COPD; specifically, we aim to evaluate the subject of preference studies conducted in asthma and COPD, what attributes have been included, stakeholders’ preferences, and the consistency in reporting of instrument development, testing and reporting of results. METHODS: A systematic review of published DCEs on asthma and COPD treatments was conducted using Embase, Medline and the Cochrane Database of Systematic Reviews. Studies were included if they included a DCE conducted in a relevant population (e.g. patients with asthma or COPD or their caregivers, asthma or COPD-treating clinicians, or the general population), and reported quantitative outcomes on participants’ preferences. Study characteristics were summarised descriptively, and descriptive analyses of attribute categories, consistency in reporting on key criteria, and stakeholder preferences were undertaken. RESULTS: A total of 33 eligible studies were identified, including 28 unique DCEs. The majority (n = 20; 71%) of studies were conducted in a patient sample. Studies focused on inhaler treatments, and included attributes in five key categories: symptoms and treatment benefits (n = 23; 82%), treatment convenience (n = 19; 68%), treatment cost (n = 17; 61%), treatment risks (n = 13; 46%), and other (n = 10; 36%). Symptoms and treatment benefits were the attributes most frequently ranked as important to patients (n = 26, 72%), followed by treatment risks (n = 7, 39%). Several studies (n = 9, 32%) did not qualitatively pre-test their DCE, and a majority did not report the uncertainty in estimated outcomes (n = 18; 64%). CONCLUSIONS: DCEs in asthma and COPD have focused on treatment benefits and convenience, with less evidence generated on participants’ risk tolerance. Quality criteria and reporting standards are needed to promote study quality and ensure consistency in reporting between studies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40271-021-00536-w

Patient Perceptions Regarding Multiple Myeloma and Its Treatment:Qualitative Evidence from Interviews with Patients in the United Kingdom, France, and Germany

BACKGROUND: The current standard of care for multiple myeloma requires several regimens of treatment, with patients experiencing high symptom burden and side effects, which negatively impact health-related quality of life (HRQoL). Thus, it is crucial to understand patient perceptions of multiple myeloma and how patients value different treatment options. OBJECTIVE: The purpose of this study was to conduct an exploratory investigation into concepts that could form attributes that influence treatment choices for patients with multiple myeloma and to identify trade-offs that patients are willing to make between treatment attributes. METHODS: In total, 30 patients with newly diagnosed or relapsed/refractory multiple myeloma from the UK, France, and Germany participated in semistructured interviews talking about their disease experience and symptoms, treatment benefits, treatment burden, perceived side effects, and benefit/risk trade-offs in treatment. The interview audio recordings were transcribed and analyzed using content analysis to identify treatment and disease aspects relevant to patients. RESULTS: Symptoms of fatigue and bone pain and treatment side effects of peripheral neuropathy, diarrhea, and constipation were cited by patients as the most disruptive to their HRQoL. Treatment duration was reported most frequently as a major treatment burden, and patients emphasized the importance of increased life expectancy as a treatment benefit. All patients showed good understanding of benefit/risk trade-offs in treatment, and some patients expressed a preference for more convenient modes of treatment administration. CONCLUSIONS: Qualitative interviews identified key aspects of multiple myeloma treatment that are most important to patients. These findings will inform a wider patient-preferences study, which could improve treatment choice and HRQoL for patients with multiple myeloma. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40271-021-00501-7