Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys.

BACKGROUND: Lesbian, gay and bisexual adults are more likely than heterosexual adults to experience worse health outcomes. Despite increasing public health interest in the importance of maintaining a healthy body weight, no study has considered sexual orientation identity (SOI) and unhealthy BMI categories among adults in the UK population. METHODS: Individual participant data meta-analysis using pooled data from population health surveys reporting on 93 429 adults with data on SOI, BMI and study covariates. RESULTS: Adjusting for covariates and allowing for between-study variation, women identifying as lesbian (OR = 1.41, 95% CI: 1.16, 1.72) or bisexual (OR = 1.24, 95% CI: 1.03, 1.48) were at increased risk of overweight/obesity compared to heterosexual women, but men identifying as gay were at decreased risk (OR = 0.72, 95% CI: 0.61, 0.85) compared to heterosexual men. Increased risk of being underweight was seen for women identifying as 'other' (OR = 1.95, 95% CI: 1.07, 3.56), and men identifying as gay (OR = 3.12, 95% CI: 1.83, 5.38), bisexual (OR = 2.30, 95% CI: 1.17, 4.52), 'other' (OR = 3.95, 95% CI: 1.85, 8.42). CONCLUSIONS: The emerging picture of health disparities in this population, along with well documented discrimination, indicate that sexual orientation should be considered as a social determinant of health.

The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey.

Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (1) a lack of patient-centred care and involvement in decision-making, (2) a need for health professional training and revision of information resources to negate the effects of heteronormativity and (3) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.

On the difference in scattering behavior of cyclic and linear polymers in bulk.

It has been suggested that, due to topological constraints, rings in the melt may assume a more compact shape than Gaussian chains. In this paper, we exploit the availability of narrow fractions of perdeuterated linear and cyclic polydimethylsiloxane (PDMS) and, through the analysis of the small angle neutron scattering (SANS) profiles, demonstrate the difference in scattering properties of linear and cyclic PDMS molecules. As expected for Gaussian chains, for the H/D linear PDMS samples, log-log plots of the scattered intensity versus scattering vector Q display a Q((-2)) dependence. However, for H/D cyclic blends, the scaling exponent is higher than 2, as predicted by computer simulations reported in the literature. We show that cyclic molecules in bulk display the characteristic maximum in plots of scattered intensity versus Q((-2)) that is expected on the basis of Monte Carlo calculations and from the Casassa equation [E. F. Casassa, J. Polym. Sci. A 3, 605 (1965)]. It is also shown that, for rings, the Debye equation [P. Debye, J. Appl. Phys. 15, 338 (1944)] is no longer appropriate to describe the SANS profiles of H/D cyclic blends, at least up to M(w) approximately 10 000. For these samples, the Casassa form factor gives a better representation of the SANS data and we show that this function which was developed for monodisperse cyclics is still adequate to describe our slightly polydisperse samples. Deviations from all above observations are noted for M(w)>11 000 and are attributed to partial contamination of cyclic samples with linear chains. The failure of both the Debye and the Casassa form factors could be due to contamination of the cyclic fractions by linear polymers or to a real conformational change.

Spasticity in multiple sclerosis.

The objective of this article is to establish the prevalence of spasticity in a random selection of people with multiple sclerosis (MS) in the city of Newcastle upon Tyne in the Northeast of England. A secondary aim was to assess the adequacy of current pharmacological intervention for spasticity and assess the relationship between spasticity and overall disability. The study design was a simple comparison that examined differences in functional independence in 2 random groups of people with MS subdivided by the presence of clinically significant spasticity. A total of 68 adults with a diagnosis of clinically definite MS were included in the study. Their level of functional independence was assessed using the Newcastle Independence Assessment Form (NIAF), the Functional Independence Measure (FIM), and the Kurtzke Extended Disability Status Scale (EDSS). Spasticity was assessed using the Modified Ashworth Scale. A subjective analysis was made of the appropriateness of oral antispastic medication by a rehabilitation physician. Thirty-two people (47%) had clinically significant spasticity (Modified Ashworth Score of 2, 3, or 4). Seventy-eight percent of the population were receiving some oral antispastic medication, but 50% were deemed to require some drug adjustment or additional treatment. Individuals with spasticity were found to have significantly higher levels of disability than those who had no spasticity or clinically insignificant spasticity. This study has confirmed that spasticity is highly prevalent in the MS population and is significantly associated with a reduced level of functional independence. Treatment of spasticity is suboptimal in a large proportion of the population, and the need for further information and education to health professionals and to people with MS is highlighted.

Botulinum toxin for people with dystonia treated by an outreach nurse practitioner: a comparative study between a home and a clinic treatment service.

OBJECTIVE: To study whether a trained outreach nurse practitioner could provide a service that is as good as, or better than, that provided at a hospital outpatient clinic for people who had been diagnosed with dystonia and required treatment with botulinum toxin. DESIGN: Randomized trial. SETTING: An outpatient department of a regional neurorehabilitation center and patients' homes in northern England. PATIENTS: Eighty-nine patients with a clinical diagnosis of spasmodic torticollis, blepharospasm, or hemifacial spasm who had ongoing treatment of dystonia with botulinum injections. INTERVENTIONS: Individuals were randomly allocated either to receive ongoing botulinum injections at home by the nurse practitioner or to continue attending the hospital outpatient clinic and be injected by medical staff. MAIN OUTCOME MEASURES: The following measures were recorded at each visit: demographic descriptors, dosage of botulinum toxin, treatment interval, side-effect profile, external referrals, and a questionnaire to determine qualitative opinion. RESULTS: Efficacy and duration of the botulinum was similar in both groups. Botulinum dosage and side-effect profiles were similar in both groups except for significantly less dysphagia (p < .018) in the home group (7 vs 24 occasions). Subjective opinion by the patients indicated statistically significant preference for home injections. Economic analysis indicated that the overall cost of the treatment was less in the home injection group (total cost per visit $36.90 [ pound 23.36] vs $79.00 [ pound 50.01]), but this difference was not statistically significant. CONCLUSION: A trained outreach nurse practitioner provided a service that was as good as, and in certain aspects better than, that provided by a hospital outpatient clinic. The nurse practitioner provided a more flexible, much appreciated, safe, and cost-effective service for this client group. Wider use of outreach nurse practitioners for dystonia should be encouraged.

Traumatic brain injury: efficacy of multidisciplinary rehabilitation.

OBJECTIVE: To establish efficacy of a coordinated multidisciplinary rehabilitation service for severe head injury, provided at Hunters Moor Regional Rehabilitation Centre. DESIGN: A quasi-experimental design to compare treatment effects between two groups. The first group received a coordinated, multidisciplinary regional rehabilitation service; the other, a single discipline approach provided by local, district hospitals. Follow-up was for 2 years postinjury. PATIENTS OR OTHER PARTICIPANTS: Fifty-six consecutive severe head injury admissions, with an identified main caregiver, referred for rehabilitation within 4 weeks of their injury. MAIN OUTCOME MEASURES: The Barthel index, the Functional Independence Measure (FIM), and the Newcastle Independence Assessment Form (NIAF), a newly developed, real-life, comprehensive measure. In addition, caregivers completed the General Health Questionnaire. RESULTS: The group that received coordinated multidisciplinary rehabilitation not only demonstrated significant gains throughout the study period but also maintained treatment effect after input ended. Furthermore, caregivers of this group had significantly reduced levels of distress. The comparison group, despite initial lower injury severity and shorter hospital stay, did not demonstrate equivalent gains or any posttreatment effect. CONCLUSIONS: The results show the efficacy of a comprehensive, specialist multidisciplinary regional service. There are significant implications for service provision for people with severe traumatic head injury.

The further validation and precision of the NIAF-R.

It is essential that any tool which is measuring outcome following head injury is sensitive to change over time. The Newcastle Independence Assessment Form-Research (NIAF-R) has been developed to be appropriate and applicable both in the acute situation and in the long-term. This paper illustrates the NIAF-R's level of sensitivity to change over time from eight weeks through to one year post-injury. There were no ceiling effects demonstrated at follow-up. Such effects can be a problem with other comparable measures. In addition, the results of further concurrent validation with the Barthel index, are reported. The NIAF-R scoring is refined through the development of an Adjusted Severity Indicator for more stringent analysis of level of independence. Scoring can now provide data in 55 individual areas of function for each subject or alternatively give an overall measure of severity of functional independence. Finally, this paper demonstrates the ability of the NIAF-R to predict outcome at follow-up.