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Todd A, Waldron C, McGeagh L, Norris R, Bolnykh I, Stewart SJ, Slodkowska‐Barabasz J, Moon Z, Cahir C, Thompson S, Harmer V, Wells M, Watson E, Sharp L. Identifying determinants of adherence to adjuvant endocrine therapy following breast cancer: A systematic review of reviews. Cancer Med 2024; 13:e6937. [PMID: 38240343 PMCID: PMC10905548 DOI: 10.1002/cam4.6937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/01/2023] [Accepted: 12/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In oestrogen-receptor positive breast cancer, daily oral adjuvant endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer-specific mortality. However, many women are poorly adherent to ET. Development of effective adherence support requires comprehensive understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence. METHODS We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization's dimensions of adherence. Reviews were quality appraised and overlap assessed. RESULTS Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non-adherence: The most consistently identified non-adherence determinants were patient-related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET 'cons' vs. 'pros'). Healthcare system/healthcare professional-related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio-economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication-related and condition-related factors, but several may be relevant (e.g. experiencing side-effects, cost). Potentially modifiable factors are more influential than non-modifiable/fixed factors (e.g. patient characteristics). CONCLUSIONS The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
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Affiliation(s)
- Adam Todd
- Newcastle UniversityNewcastle upon TyneUK
| | | | | | | | - Iakov Bolnykh
- Newcastle UniversityNewcastle upon TyneUK
- The Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | | | - Zoe Moon
- University College LondonLondonUK
| | | | | | | | - Mary Wells
- Imperial College Healthcare NHS TrustLondonUK
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Woof VG, McWilliams L, Howell A, Evans DG, French DP. How do women at increased risk of breast cancer make sense of their risk? An interpretative phenomenological analysis. Br J Health Psychol 2023; 28:1169-1184. [PMID: 37395149 PMCID: PMC10947456 DOI: 10.1111/bjhp.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Offering breast cancer risk prediction for all women of screening age is being considered globally. For women who have received a clinically derived estimate, risk appraisals are often inaccurate. This study aimed to gain an in-depth understanding of women's lived experiences of receiving an increased breast cancer risk. DESIGN One-to-one semi-structured telephone interviews. METHODS Eight women informed that they were at a 10-year above-average (moderate) or high risk in a breast cancer risk study (BC-Predict) were interviewed about their views on breast cancer, personal breast cancer risk and risk prevention. Interviews lasted between 40 and 70 min. Data were analysed using Interpretative Phenomenological Analysis. RESULTS Four themes were generated: (i) encounters with breast cancer and perceived personal significance, where the nature of women's lived experiences of others with breast cancer impacted their views on the significance of the disease, (ii) 'It's random really': difficulty in seeking causal attributions, where women encountered contradictions and confusion in attributing causes to breast cancer, (iii) believing versus identifying with a clinically-derived breast cancer risk, where personal risk appraisals and expectations influenced women's ability to internalize their clinically derived risk and pursue preventative action and (iv) perceived utility of breast cancer risk notification, where women reflected on the usefulness of knowing their risk. CONCLUSIONS Providing (numerical) risk estimates appear to have little impact on stable yet internally contradictory beliefs about breast cancer risk. Given this, discussions with healthcare professionals are needed to help women form more accurate appraisals and make informed decisions.
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Affiliation(s)
| | | | - Anthony Howell
- University of ManchesterManchesterUK
- The Nightingale Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - D. Gareth Evans
- University of ManchesterManchesterUK
- The Nightingale Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
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Hipolito G, Pagnamenta E, Stacey H, Wright E, Joffe V, Murayama K, Creswell C. A systematic review and meta-analysis of nonpharmacological interventions for children and adolescents with selective mutism. JCPP Adv 2023; 3:e12166. [PMID: 37720585 PMCID: PMC10501694 DOI: 10.1002/jcv2.12166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/28/2023] [Indexed: 09/19/2023] Open
Abstract
Background Selective mutism (SM) is an anxiety disorder that often starts in early years with serious and lasting consequences. Nonpharmacological interventions are commonly seen as the preferred first treatment. This systematic review identifies outcome measures used and outcomes achieved for nonpharmacological interventions for children and adolescents with SM. Methods Systematic searches were conducted using 13 electronic databases and hand searches, including peer-reviewed and grey literature since 1992. Results Twenty-five studies were identified. While specific measures varied, all studies reported an outcome measure for speaking behaviour and 18 used a measure of anxiety. Few studies reported measures of SM remission (k = 6), well-being (k = 6), academic impact (k = 2), or quality of life (k = 1). Within subject outcomes for nonpharmacological interventions were variable for improvements in speaking behaviours (very small to large positive effects) and reduction in anxiety symptoms (very small negative to large positive effects). Only five randomised controlled trials (RCTs) were included in the meta-analysis. Three studies compared a combined systems/behavioural approach with waitlist controls indicating a significant and large effect (Hedges g = 1.06, p < .0001, 95% CI: 0.57-1.56) on improved speaking behaviour. Two of these RCTs showed a large effect for SM remission favouring the intervention (Risk Ratio = 4.25, p = .1774, 95% CI: 0.52-34.84) but this did not reach statistical significance. Non-significant outcomes for two RCTs with active controls (Hedges g = 0.55, p < .2885, 95% CI: -0.47 to 1.57) showed considerable heterogeneity in approach and outcomes, one with large and one with negligible effects. Conclusion Despite the considerable impairment caused by SM, there has been little systematic evaluation of non-pharmacological interventions. Although combined systems/behavioural interventions are promising, further systematic evaluations are urgently needed to inform treatment approaches. Cross-study measurement harmonisation is required to promote learning from all studies, including wider clinical and economic outcomes. Clinical Trial Registration Not applicable.
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Affiliation(s)
- Gino Hipolito
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
- Paediatric Speech and Language Therapy DepartmentSt George's University Hospitals NHS Foundation TrustLondonUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Emma Pagnamenta
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Helen Stacey
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Emily Wright
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Victoria Joffe
- School of Health and Social CareUniversity of EssexColchesterUK
| | - Kou Murayama
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
- Hector Research Institute of Education Sciences and PsychologyUniversity of TübingenTübingenGermany
| | - Cathy Creswell
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
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Pollard J, Reardon T, Williams C, Creswell C, Ford T, Gray A, Roberts N, Stallard P, Ukoumunne OC, Violato M. The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis. JCPP Adv 2023; 3:e12149. [PMID: 37720587 PMCID: PMC10501703 DOI: 10.1002/jcv2.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs. Methods A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, 'effect direction' was used as a common metric, with random effects meta-analysis undertaken where possible. Results Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. 'Effect direction' was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP). Conclusions Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.
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Affiliation(s)
- Jack Pollard
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Tessa Reardon
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Chloe Williams
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Cathy Creswell
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation TrustCambridgeUK
| | - Alastair Gray
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Nia Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | | | - Obioha C. Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Mara Violato
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Shaw S, Barrett M, Shand C, Cooper C, Crozier S, Smith D, Barker M, Vogel C. Influences of the community and consumer nutrition environment on the food purchases and dietary behaviors of adolescents: A systematic review. Obes Rev 2023; 24:e13569. [PMID: 37081719 PMCID: PMC10909420 DOI: 10.1111/obr.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
Adolescence is a period of increased autonomy over decision-making, including food choices, and increased exposure to influences outside the home, including the food environment. This review aims to synthesize the evidence for the influence of community nutrition environments, spatial access to food outlets, and consumer nutrition environments, environments inside food outlets, on adolescent food purchasing and dietary behaviors in high-income countries. Six databases were searched for articles published before January 2023. Results were synthesized using a vote-counting technique and effect direction plots that record the direction of the effect in relation to the anticipated relationship with health. Thirty-four observational and two intervention studies met the inclusion criteria. In the 13 studies assessing adolescent exposure to healthy community nutrition environments, results did not show clear associations with dietary and purchasing outcomes. Thirty studies assessed adolescents' exposure to unhealthy community nutrition environments with the majority (n = 17/30, 57%) reporting results showing that greater exposure to food outlets classified as unhealthy was associated with less healthy food purchases and dietary intakes. Inconsistent results were observed across the seven studies investigating associations with the consumer environment. Further research in these areas, including more high-quality intervention studies, may help to develop policy strategies to improve adolescents' dietary behaviors.
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Affiliation(s)
- Sarah Shaw
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
| | - Millie Barrett
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- Centre for Food Policy, CityUniversity of LondonNorthampton SquareLondonEC1V0HBUK
| | - Calum Shand
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre2 Venture Road, ChilworthSouthamptonSO16 7NPUK
| | - Dianna Smith
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre2 Venture Road, ChilworthSouthamptonSO16 7NPUK
- Geography and Environmental ScienceUniversity of SouthamptonSouthamptonSO17 1BJUK
| | - Mary Barker
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- School of Health SciencesFaculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonSO17 1BJUK
| | - Christina Vogel
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- Centre for Food Policy, CityUniversity of LondonNorthampton SquareLondonEC1V0HBUK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre2 Venture Road, ChilworthSouthamptonSO16 7NPUK
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Mehta H, Tasin I, Hackstein CP, Willberg C, Klenerman P. Prostaglandins differentially modulate mucosal-associated invariant T-cell activation and function according to stimulus. Immunol Cell Biol 2023; 101:262-272. [PMID: 36541521 PMCID: PMC10152717 DOI: 10.1111/imcb.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/29/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Mucosal-associated invariant T (MAIT) cells are an innate-like T-cell type conserved in many mammals and especially abundant in humans. Their semi-invariant T-cell receptor (TCR) recognizes the major histocompatibility complex-like molecule MR1 presenting riboflavin intermediates associated with microbial metabolism. Full MAIT cell triggering requires costimulation via cytokines, and the cells can also be effectively triggered in a TCR-independent manner by cytokines [e.g. interleukin (IL)-12 and IL-18 in combination]. Thus, triggering of MAIT cells is highly sensitive to local soluble mediators. Suppression of MAIT cell activation has not been well explored and could be very relevant to their roles in infection, inflammation and cancer. Prostaglandins (PG) are major local mediators of these microenvironments which can have regulatory roles for T cells. Here, we explored whether prostaglandins suppressed MAIT cell activation in response to TCR-dependent and TCR-independent signals. We found that protaglandin E2 (PGE2 ) and to a lesser extent protaglandin D2 (PGD2 ), but not leukotrienes, suppressed MAIT cell responses to Escherichia coli or TCR triggers. However, there was no impact on cytokine-induced triggering. The inhibition was blocked by targeting the signaling mediated via PG receptor 2 (PTGER2) and 4 (PTGER4) receptors in combination. These data indicate that prostaglandins can potentially modulate local MAIT cell functions in vivo and indicate distinct regulation of the TCR-dependent and TCR-independent pathways of MAIT cell activation.
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Affiliation(s)
- Hema Mehta
- The Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
| | - Irene Tasin
- The Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
| | | | - Christian Willberg
- The Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
| | - Paul Klenerman
- The Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
- NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
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Morris AC, Ibrahim Z, Heslin M, Moghraby OS, Stringaris A, Grant IM, Zalewski L, Pritchard M, Stewart R, Hotopf M, Pickles A, Dobson RJB, Simonoff E, Downs J. Assessing the feasibility of a web-based outcome measurement system in child and adolescent mental health services - myHealthE a randomised controlled feasibility pilot study. Child Adolesc Ment Health 2023; 28:128-147. [PMID: 35684987 PMCID: PMC10083915 DOI: 10.1111/camh.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Interest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinical information and track their child's progress. This study aimed to assess whether MHE improves the completion of the Strengths and Difficulties Questionnaire (SDQ) compared with paper collection. Secondary objectives were to explore caregiver satisfaction and application acceptability. METHODS A 12-week single-blinded randomised controlled feasibility pilot trial of MHE was conducted with 196 families accessing neurodevelopmental services in south London to examine whether electronic questionnaires are completed more readily than paper-based questionnaires over a 3-month period. Follow up process evaluation phone calls with a subset (n = 8) of caregivers explored system satisfaction and usability. RESULTS MHE group assignment was significantly associated with an increased probability of completing an SDQ-P in the study period (adjusted hazard ratio (HR) 12.1, 95% CI 4.7-31.0; p = <.001). Of those caregivers' who received the MHE invitation (n = 68) 69.1% completed an SDQ using the platform compared to 8.8% in the control group (n = 68). The system was well received by caregivers, who cited numerous benefits of using MHE, for example, real-time feedback and ease of completion. CONCLUSIONS MHE holds promise for improving PROM completion rates. Research is needed to refine MHE, evaluate large-scale MHE implementation, cost effectiveness and explore factors associated with differences in electronic questionnaire uptake.
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Affiliation(s)
- Anna C. Morris
- South London and Maudsley NHS Foundation TrustLondonUK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Zina Ibrahim
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Emotion & Development Branch, National Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Ian M. Grant
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Lukasz Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Megan Pritchard
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Robert Stewart
- South London and Maudsley NHS Foundation TrustLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Matthew Hotopf
- South London and Maudsley NHS Foundation TrustLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Richard J. B. Dobson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation TrustLondonUK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Johnny Downs
- South London and Maudsley NHS Foundation TrustLondonUK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
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Zaitcev A, Eissa MR, Hui Z, Good T, Elliott J, Benaissa M. Automatic inference of hypoglycemia causes in type 1 diabetes: a feasibility study. Front Clin Diabetes Healthc 2023; 4:1095859. [PMID: 37138580 PMCID: PMC10150960 DOI: 10.3389/fcdhc.2023.1095859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/16/2023] [Indexed: 05/05/2023]
Abstract
Background Hypoglycemia is the most common adverse consequence of treating diabetes, and is often due to suboptimal patient self-care. Behavioral interventions by health professionals and self-care education helps avoid recurrent hypoglycemic episodes by targeting problematic patient behaviors. This relies on time-consuming investigation of reasons behind the observed episodes, which involves manual interpretation of personal diabetes diaries and communication with patients. Therefore, there is a clear motivation to automate this process using a supervised machine learning paradigm. This manuscript presents a feasibility study of automatic identification of hypoglycemia causes. Methods Reasons for 1885 hypoglycemia events were labeled by 54 participants with type 1 diabetes over a 21 months period. A broad range of possible predictors were extracted describing a hypoglycemic episode and the subject's general self-care from participants' routinely collected data on the Glucollector, their diabetes management platform. Thereafter, the possible hypoglycemia reasons were categorized for two major analysis sections - statistical analysis of relationships between the data features of self-care and hypoglycemia reasons, and classification analysis investigating the design of an automated system to determine the reason for hypoglycemia. Results Physical activity contributed to 45% of hypoglycemia reasons on the real world collected data. The statistical analysis provided a number of interpretable predictors of different hypoglycemia reasons based on self-care behaviors. The classification analysis showed the performance of a reasoning system in practical settings with different objectives under F1-score, recall and precision metrics. Conclusion The data acquisition characterized the incidence distribution of the various hypoglycemia reasons. The analyses highlighted many interpretable predictors of the various hypoglycemia types. Also, the feasibility study presented a number of concerns valuable in the design of the decision support system for automatic hypoglycemia reason classification. Therefore, automating the identification of the causes of hypoglycemia may help objectively to target behavioral and therapeutic changes in patients' care.
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Affiliation(s)
- Aleksandr Zaitcev
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Mohammad R. Eissa
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Mohammad R. Eissa,
| | - Zheng Hui
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Tim Good
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Jackie Elliott
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS FT, Sheffield, United Kingdom
| | - Mohammed Benaissa
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
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