Scottish Regions Research Articles

Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.

There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance. To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics. Population-based analyses using administrative data. 148 care-homes in two Scottish regions, with 6633 residents registered with 139 general practices. Prescriptions for any antibiotic and for broad-spectrum antibiotics between 1 April 2016 and 31 March 2017 were analysed using cross-classified multilevel negative binomial regression. For any antibiotics, the mean prescription rate was 6.61 (SD 3.06) per 1000 resident bed-days (RBD). In multivariate analysis, prescribing was associated with resident age [incidence rate ratio (IRR) 1.30 [95% confidence interval 1.19 to 1.41] for 90+ versus <80years old] and comorbidity (1.88 [1.71 to 2.06] for Charlson Comorbidity Index 3+ versus 0), and the care-home's sampling rate for microbiological culture (1.53 [1.28 to 1.84] for >7 versus <3.5 samples per 1000 RBD), with residual unexplained variation between care-homes (median IRR 1.29 [1.23 to 1.36]) and general practices (1.11 [1.05 to 1.18]). For broad-spectrum antibiotics, the mean rate was 0.98 (0.92) per 1000 RBD. Broad-spectrum prescribing was also associated with resident age, sex, comorbidity and sampling rate, with larger residual unexplained variation between care-homes (1.56 [1.36 to 1.77]) and general practices (1.51 [1.31 to 1.72]). Variation in prescribing was influenced by resident case-mix, but there is significant unexplained variation between care-homes and between general practices, indicating a need for antibiotic stewardship to target both.

Seasonal Early Warning of Impacts of Harmful Algal Blooms on Farmed Shellfish in Coastal Waters of Scotland

AbstractHarmful Algal Blooms (HABs) can produce phycotoxins that accumulate in shellfish and subsequently poison aquatic predators and human consumers, potentially causing significant economic impacts to the shellfish aquaculture industry. HAB events are challenging to foresee as they are driven by complex inter‐annual and seasonal changes in physical, chemical and biological factors. Accounting for these environmental drivers and their interactions in statistical models allows for the development of HAB early warning systems. Typically, these have a forecasting horizon of 1–2 weeks, allowing shellfish businesses and regulators to increase monitoring intensity and take evasive action, including harvesting suspensions to protect consumer health. However, there is critical need for longer‐term predictions of risk, to enable more proactive mitigation, business planning, harvest scheduling and supply chain management. We present a statistical framework for providing seasonal‐scale early warnings of the occurrence and impacts of Dinophysis spp. HABs on shellfish aquaculture in Scotland, UK. We use penalized smooth functions of winter‐spring daily sea surface temperature to predict the severity and impact of ensuing summer blooms, including the percentage of toxicity measurements exceeding the harvesting closure threshold, as well as the anticipated start, end, and overall duration of closures. We illustrate the application of this framework to two Scottish aquaculture regions: One with a high spatial concentration of harvesting sites (Shetland) and one with more dispersed sites (West Scotland and the Hebrides). Through a comprehensive yearly prediction experiment, we demonstrate considerable skill in predicting the impact of unseen HAB seasons at a regional level.

The Characteristics and Variation of the Golden Eagle Aquila chrysaetos Home Range

Satellite tracking allows for novel investigations into golden eagle home range characteristics. Understanding home range characteristics is important for conservation and for assessing the potential impact of landscape changes from forest planting, wind farms, etc. Small sample sizes, inconsistent definitions and methods restricted several previous studies. Our study involved 69 resident tagged eagles with over one year of data across five Scottish regions. Home range size was estimated from 95% isopleth contours extracted from Utilisation Distributions. Above a small threshold, estimated range size was not affected by the number of records but at least one year of data is required, largely because of the breeding and non-breeding seasonal differences. There were no significant range size differences between birds tagged as range holders and those previously tagged as nestlings. Across four regions, with considerable intra-regional variation, planar 95% isopleths did not differ (medians, km2): Argyll 58.9, Northwest Highlands 61.7, Northeast Highlands 89.3, South of Scotland 91.9. Ranges in the isolated Outer Hebrides region were exceptionally small, at 24.0 km2. Estimated range area was usually reduced to 70–80% of the planar area when restricted to usable habitat, as estimated by the Golden Eagle Topography (GET) model. Applying measures of known unsuitable habitat (closed-canopy commercial forest and wind turbines) further reduced usable open land. Loss of otherwise suitable habitat was substantially due to commercial forest. Larger ranges had larger extents of suitable habitat (according to GET), with no apparent optimum of preferred GET habitat. Range size was not different across a year between the sexes. Breeding ranges were smaller, and females’ breeding ranges were much smaller than those of males, but larger than males’ ranges in the non-breeding season. Breeding attempt duration was probably also influential. Our study provides novel insights into golden eagle home range characteristics and can guide further research and practical applications.

Assessing the economic feasibility of voluntary carbon markets in land use management scenarios for Scottish saltmarshes

Saltmarshes have been valued for their multiple ecosystem services, including agriculture, recreation, habitats for fish and birds, coastal protection and carbon sequestration and long-term storage. However, because of the many threats faced, including rising sea levels, limited sediment supplies and anthropogenic impacts, saltmarshes require careful restoration and protection management to continue providing these benefits. In this study, we examined the feasibility of land abandonment caused by reinstated tidal flow in Scottish saltmarshes, based on the differential gains in soil carbon stock between natural saltmarshes and those manged for agricultural uses, and suggested considerations for a voluntary carbon market plan. The study's results showed that the proportion of Scottish saltmarshes used for agricultural activities was not very large (2.56 %, equivalent to 179.73 ha). The average net benefit (i.e., after removing the opportunity cost of land) of the new land use is GBP £ 5368.71/ha after a 67-year post-abandonment management program, showing that this model is economically viable to implement a carbon market mechanism. A voluntary carbon market scheme may be easier to implement than a compliance scheme, although the price of carbon credits under the voluntary carbon market is not high to fully compensate for the opportunity costs of land in all the Scottish regions. In effect, the carbon price at the break-even point (e.g., that balances the opportunity cost of land) in the Scottish regions varied widely (range £ 1.06–59.83/tC), which means that for regions with higher opportunity costs there is a need to consider compensating farmers through a blended private-public mechanism. Despite these difficulties, implementing saltmarshes management models for carbon market initiatives can benefit society in a broader sense, not just mitigate climate change.

Single and combined use of fall-risk-increasing drugs and fracture risk: a population-based case-control study.

while many drug groups are associated with falls in older people, less is known about absolute increases in risk and how these risks vary across different groups of drugs or individuals. we conducted a population based nested case-control study among people aged ≥65years in the Scottish regions of Tayside and Fife. Cases were individuals hospitalised with a fracture between 2010 and 2020, to whom we matched up to 10 controls. We examined relative and absolute risks of drug groups known as 'Fall-Risk-Increasing Drugs' (FRIDs), alone and in combination, and among younger and older (≥75years) adults. Adjusting for previous hospitalisations, drug use and laboratory data, we used conditional logistic regression to quantify associations between drug exposures and outcomes. We conducted four sensitivity analyses to test the robustness of our findings. the cohort comprised 246,535 people aged ≥65years, of whom 18,456 suffered an incident fracture. Fracture risks were significantly increased for most FRIDs examined. Absolute risks were much larger among older vs younger people and both relative and absolute risks increased with the number of FRIDs combined. Overall, the highest absolute increase in risk were found in people aged ≥75years for selective serotonin reuptake inhibitors (number needed to harm 53), tricyclic antidepressants (NNH 81), antipsychotics (NNH 75) and use of three or more FRIDs (NNH ≤66). patients aged ≥75years prescribed antidepressants or antipsychotics or taking three or more drugs that increase risk of falls may benefit most from deprescribing interventions.

Exploring the Determinants of the Relationships between the Land-Based Sectors with the Wider Rural Business Base in Scotland: An Empirical Analysis

Over the past two decades, the relative socio-economic importance of land-based sectors has declined in comparison to non-land-based businesses such as tourism, food and beverage activities. However, policy implementation and research have primarily focused on the economic contributions of land-based businesses, leaving businesses outside these sectors and in rural areas, referred to as non-land-based businesses, largely overlooked. Therefore, this study aims to examine the importance of non-land-based businesses and the key determinants of the relationships between non-land-based businesses and land-based (farming, forestry and landed estate) sectors in rural Scotland. Through a survey of 1500 businesses whose primary focus is not agriculture, forestry or landed rural estates in four Scottish regions, the key findings of the logit model reveal that businesses located in rural areas are more likely to have relationships, both direct (supplying or purchasing goods/services) and indirect, with farming, forestry and landed estate sectors than their urban counterparts. Focusing on rural businesses, the results show that business size, sectors, business age, exporting, importing and business constraints related to cash flow, digital connectivity and government financial support significantly influence their relationships with land-based sectors. The results of crosstab analysis also reveal differences in business performance, business challenges related to Brexit and future plans between non-land-based rural businesses having relationships with land-based sectors in different rural classifications: accessible/remote small towns, accessible rural areas and remote rural areas. The paper concludes with policy recommendations to support rural businesses and future land-based and non-land-based sectors in rural Scotland.

Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care: A nominal group technique approach.

The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures. To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology. A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered. Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures. The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology.

Bus franchising in English and Scottish regions – Viable solution or unfeasible instrument?

Much research surrounds the move from publicly owned and operated bus markets to publicly controlled and privately operated markets, or in the case of Great Britain, a fully deregulated market. Little research however exists concerning the counter move and the issues that this may raise. Such a step would be consistent with Gwilliam's regulatory cycle, which suggests that a combination of self seeking behaviour of suppliers and unrealistic aspirations of politicians leads to instability in the regulatory arrangements for the provision of bus services. Consequently, the associated structural and institutional arrangements go through a cycle of private/public ownership and competitive/regulated markets.The paper discusses some of the practicalities at the regional level of introducing the measures provided by the Bus Services Act 2017 in England and the Transport Act 2019 in Scotland, both of which offer the option of a partial or full economic reregulation of bus services. Theories of radical policy change are examined and applied in the context of the issue through interviews with key informants in regional authorities in Scotland and England. The overriding conclusion from this analysis is that whilst deregulating the market does not actually break Gwilliam's regulatory cycle, it makes it very difficult to ‘re-connect’, and thus a further long term consequence of bus deregulation in Britain in the mid 1980s is that future policy options may have been severely restricted in the very long term.

The Use of Sheep Movement Data to Inform Design and Interpretation of Slaughterhouse-Based Surveillance Activities.

The design of surveillance strategies is often a compromise between science, feasibility, and available resources, especially when sampling is based at fixed locations, such as slaughter-houses. Advances in animal identification, movement recording and traceability should provide data that can facilitate the development, design and interpretation of surveillance activities. Here, for the first time since the introduction of electronic identification of sheep, the utility of a statutory sheep movement database to inform the design and interpretation of slaughter-house based surveillance activities has been investigated. Scottish sheep movement records for 2015–2018 were analyzed in combination with several other data sources. Patterns of off-farm movements of Scottish sheep to slaughter were described and the spatial distribution of several distinct slaughter populations, throughputs and catchment areas for Scottish slaughterhouses were determined. These were used to evaluate the coverage of a convenience-sample slaughter-house based survey for antimicrobial resistance (AMR). In addition, non-slaughter sheep movements within and between Scottish regions were described and inter-and intra-regional movement matrices were produced. There is potential at a number of levels for bias in spatially-associated factors for ovine surveillance activities based at Scottish slaughterhouses. The first is intrinsic because the slaughtered in Scotland population differs from the overall Scottish sheep slaughter population. Other levels will be survey-dependent and occur when the catchment area differs from the slaughtered in Scotland population and when the sampled sheep differ from the catchment area. These are both observed in the AMR survey. Furthermore, the Scottish non-slaughter sheep population is dynamic. Inter-regional movements vary seasonally, driven by the sheep calendar year, structure of the Scottish sheep industry and management practices. These sheep movement data provide a valuable resource for surveillance purposes, despite a number of challenges and limitations that were encountered. They can be used to identify and characterize the spatial origin of relevant populations and so inform the interpretation of existing slaughterhouse-based surveillance activities. They can be used to improve future design by exploring the feasibility and cost:benefit of alternative sampling strategies. Further development could also contribute to other surveillance activities, such as situational awareness and resource allocation, for the benefit of stakeholders.

Estimating a regional budget of marine plastic litter in order to advise on marine management measures

Using simple models, coupled with parameters extracted from published studies, the annual inputs of macro and micro plastics to the Scottish Atlantic Coast and the Scottish North Sea Coast regions are estimated. Two estimates of land-based sources are used, scaled by catchment area population size. The oceanic supply of floating plastic is estimated for wind-driven and general circulation sources. Minimum, typical and maximum values are computed to examine the magnitude of uncertainties. Direct inputs from fishing and the flux of macroplastic onto the seabed are also included. The modelled estimates reveal the importance of local litter sources to Scottish coastal regions, and hence local management actions can be effective. Estimates provide a scale against which removal efforts may be compared, and provide input data for future more complex modelling. Recommendations for research to improve the preliminary estimates are provided. Methods presented here may be useful elsewhere.

A checklist of marine bryozoan taxa in Scottish sea regions.

Contemporary and historical bryozoan records were compiled to provide a comprehensive checklist of species in Scottish waters. The checklist comprises 218 species in 58 families, with representatives from each of the extant bryozoan orders. The fauna was relatively sparse compared to other regions for which bryozoan checklists were available e.g. New Zealand and Australia. Six non-indigenous bryozoan species from the Scottish seas region were included in the checklist. Baseline information on species distributions, such as that presented in this checklist, can be used to monitor and manage the impact of human activities on the marine environment, and ultimately preserve marine biodiversity.

Public health significance of Campylobacter spp. colonisation of wild game pheasants (Phasianus colchicus) in Scotland

Campylobacter is the most common cause of bacterial food-borne diarrhoeal disease worldwide. Chicken meat is considered the main source of human infection; however, C. jejuni and C. coli have also been reported in a range of livestock and wildlife species, including pheasants. Wild pheasant meat reaches the consumer's table because of hunting but there is a lack of information concerning the risk of Campylobacter infection in humans. This study aimed to determine the prevalence of Campylobacter in wild game pheasants in Scotland, to identify the main sequence types (STs) present and to evaluate their impact on public health. A total of 287 caecal samples from five Scottish regions were collected during the hunting season 2013/2014. Campylobacter was detected and enumerated using standard culture methods. PCR and High Throughput Multi Locus Sequence Typing (HiMLST) were used for species identification and sequence typing. In total, 36.6% of 287 caecal samples (n = 105; 95% CI: 14–59.2) were Campylobacter positive. Using PCR, 62.6% of samples (n = 99) were identified as C. coli and 37.4% as C. jejuni. HiMLST (n = 80) identified 19 different STs. ST-828 (n = 19) was the most common, followed by ST-827 (n = 12) and ST19 (n = 7). Sixteen of the 19 STs isolated are present in humans and eight are C. coli STs that account for 6.96% of human infections, although the overall risk to public health from pheasant meat is still considered to be low.

Status of the Hen Harrier Circus cyaneus in the UK and Isle of Man in 2016

ABSTRACTCapsule: The fifth UK and the Isle of Man survey of Hen Harrier in 2016 showed varying trends by country and region.Aim: To estimate the size of the breeding Hen Harrier population (with associated 95% confidence intervals) in the UK and Isle of Man, constituent countries and Scottish regions, in 2016 and calculate population change over the five surveys to date.Methods: Complete surveys were made of all 10-km squares likely to be occupied by breeding Hen Harriers in England, Wales, Northern Ireland and the Isle of Man, using standard methods developed for previous national surveys. In Scotland, self-selected 10-km squares were surveyed by volunteers and a stratified random selection of the remaining 10-km squares within the known breeding range was surveyed.Results: The UK and Isle of Man Hen Harrier population was estimated at 575 territorial pairs (95% confidence limits, 477–694), a non-significant decline of 13% since 2010 but a significant decline of 24% since 2004. Scotland held the majority (80%) of the population with 460 (359–573) territorial pairs. Elsewhere, 46 territorial pairs were recorded in Northern Ireland, 35 in Wales, 30 in the Isle of Man and four in England. Significant decreases were recorded in the number of pairs in Scotland using grouse moor (−57%) and young forest (−54%).Conclusion: The combined breeding population of Hen Harriers in the UK and Isle of Man has shown a non-significant decline between 2010 and 2016. There were notable decreases in England, Northern Ireland and Wales since 2010.

Decision Support for Diabetes in Scotland: Implementation and Evaluation of a Clinical Decision Support System.

Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users' reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014. Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year. The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (-2.3 mmol/mol [-0.2%] versus -1.1 [-0.1%], P = .003). The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications.

Data linkage of Psychiatric and Maternity data to investigate the pregnancy outcomes of women with Non-affective Psychosis in Scotland

ABSTRACTObjectiveWomen with a diagnosis of non-affective psychosis have a lower fertility rate than the general population. However, perinatal outcomes in mothers with non-affective psychosis are under-researched. What is the general fertility rate (GFR) of women with a lifetime diagnosis of non-affective psychosis in Scotland? Does such a diagnosis affect the outcome of pregnancy?&#x0D; ApproachAn ‘exposed’ cohort with non-affective psychosis and at least one pregnancy was established using a combined dataset derived via data linkage in local safe havens of routine psychiatric and maternity data from two Scottish regions:•NHS Grampian (NHSGr): Aberdeen Maternity and Neonatal Databank (AMND); psychiatric casenotes•NHS Greater Glasgow and Clyde (NHSGG&amp;C): SMR02; PsyCIS bespoke psychiatric databaseExposed women were matched to women without a diagnosis of non-affective psychosis, by maternal age (NHSGG&amp;C only), year of first birth, parity and deprivation, sourced from AMND/SMR02 in a 3:1 unexposed:exposed ratio.&#x0D; Demographics and pregnancy outcomes of exposed versus unexposed women were analysed to describe effect of psychosis on pregnancy.&#x0D; ResultsMany challenges were encountered in terms of having legal agreements in place between institutions and safe havens, constructing cohorts and datasets within each study site and joining the data to analyse the overall cohort. Challenges with the data itself included discrepancies between the variables measured in datasets in different sites and missing information within patient records, particularly in earlier years. Preliminary results for the NHSGG&amp;C region show that the average GFR for exposed women aged 15-44 from 2005 to 2014 was 14.38 compared to the general population rate of 55.26. The number of women ever having a miscarriage was significantly higher in the exposed group (23.4% vs 9.9%; p-value &lt;0.001). However during the study period (1996 to 2014), more unexposed women had miscarriages (0.5% vs 4.7%; p-value = 0.002). There were no significant differences in pregnancy complications for the study period. The mean birthweight of babies was lower (3.23kg vs 3.35kg; p-value = 0.029) and more babies were admitted to neonatal units (17.5% vs 9.8%; p-value = 0.004) in the exposed group. Results for the NHSGr region and the combined dataset will also be reported.&#x0D; ConclusionThis work highlights that there remain hurdles to linking data across sites, despite availability of rich datasets within Scotland. Women with non-affective psychosis within NHSGG&amp;C region had a lower fertility rate on average than the general population and some poorer outcomes, such as birthweight and rate of admission to neonatal units.

The Sea Kings of the North: Scandinavian Scotland in Nineteenth Century Literature

Scotland’s relationship with the sea is partly defined by links with seafaring Nordic neighbours. Scandinavia is an appealing example of modernity today, but the influence of Viking invasions on Scottish coastal regions has remained a source of intrigue in the popular imagination since the Viking Revival. Scottish writers contributed to this Victorian trend, with Laing’s translation of Heimskringla, and Ballantyne’s novel Erling the Bold. British writers noted similarities between Scotland and the Scandinavian countries, including features like landscape, character and language. This link also appears in Scandinavian writing, such as HC Andersen’s depiction of a Scottish seascape, and Bjørnson’s Maria Stuart i Skottland. This paper will examine the construction of a shared Scottish and Scandinavian landscape mythology through literature and cultural commentary.

Mental health in carers with cardiovascular disease

Background: Little is known about the mental health of carers who have physical health conditions. This study aimed to investigate the prevalence and characteristics of adult carers with and without cardiovascular disease and their mental health status in Scotland's population using an independent dataset. Methods: Data from the Scottish Health Surveys for 2012 and 2013 were analysed. Information on demographics, lifestyle, regular care provided and mental health was obtained. Chi-square tests, t-tests and survey-weighted logistic and multinomial regression modelling were performed to test the associations among the study variables, between the exposure and the outcome accordingly. Results: The percentage of people providing care in the entire study sample (n=1721; 17.7%) is similar to those with cardiovascular disease (n=662; 18.0%) and those without (n=1059; 17.5%). The Scottish regions with the highest proportion of adult carers are Borders, Orkney and Lanarkshire. Carers with cardiovascular disease were more likely to lose sleep over anxiety and feel constantly under strain than patients who do not provide care. Mental health appeared to be worse in Scottish carers without cardiovascular disease than in those with such conditions. Conclusion: A longitudinal study could monitor the changes in both mental health and cardiovascular disease status and how they are associated. Continuous support in the community for all Scottish carers with and without any long-term conditions should be considered.

PReventing early unplanned hOspital readmission aFter critical ILlnEss (PROFILE): protocol and analysis framework for a mixed methods study

IntroductionSurvivors of critical illness experience multidimensional disabilities that reduce quality of life, and 25–30% require unplanned hospital readmission within 3 months following index hospitalisation. We aim to understand factors associated...

Coeliac screening in a Scottish cohort of children with type 1 diabetes mellitus: is DQ typing the way forward?

BackgroundChildren with type 1 diabetes mellitus (T1DM) are at increased risk of coeliac disease (CD). Recent guidelines indicate coeliac screening should include HLA typing for CD predisposing (DQ2/DQ8) alleles and...

Predictors of quality of life in head and neck cancer survivors up to 5years after end of treatment: a cross-sectional survey.

This study aimed to assess quality of life (QoL) in head and neck cancer (HNC) survivors and determine factors predictive of poor QoL in the first 5years after the end of treatment. A cross-sectional survey, including the Quality of Life in Adult Cancer Survivors (QLACS) measure, was sent to HNC survivors in three Scottish health regions, with responses linked to routinely collected clinical data. Independent sample t tests, ANOVAs, Pearson correlations and multiple hierarchical regressions were used to explore associations between and to determine the contribution made by demographic, lifestyle and clinical factors to predicting 'generic' and 'cancer-specific' quality of life. Two hundred eighty patients (65%) returned questionnaires. After adjustment, multivariate analysis showed that younger age, lower socio-economic status, unemployment and self-reported comorbidity independently contributed to poorer generic and cancer-specific quality of life. In addition to these factors, having had a feeding tube or a diagnosis of oral cavity cancer were independently predictive of poorer cancer-specific quality of life. Socio-economic factors and comorbidity are important predictors of QoL in HNC survivors. These factors and the detrimental long-term effects of feeding tubes need further attention in research and practice.