Trust in cervical screening and attribution of blame following a scandal
In 2018, the Irish Health Service Executive disclosed that some women diagnosed with invasive cervical cancer were not told that their earlier smear tests had been reviewed, post-diagnosis and found to be false negatives.
In this study, Poluektova et al (2024) investigated levels of trust and attribution of blame related to a cervical screening programme following this controversy – related to the programme's audit – by devising an experimental test of the effectiveness of new information materials. The researchers compared responses in Ireland (N = 872) to equivalent responses in Scotland (N = 400), which was unaffected by the controversy. Participants in Ireland were randomly assigned to either a treatment group that received the information materials or a control group that did not. Participants then responded to questions about their trust in cervical screening and how they would attribute blame in different scenarios describing women diagnosed with cervical cancer between screening rounds.
The study found that the control group in Ireland had lower trust and attributed higher blame to screening services than participants in Scotland. However, the provision of information materials to the treatment group improved trust and reduced blame. The authors conclude ‘that public controversies influence perceptions of screening programmes and underscore the importance of transparent, choice-based communication in mitigating these effects.’
The mental health and traumatic experiences of mothers of children with 22q11DS
22q11.2 Deletion Syndrome (22q11DS) is caused by a chromosomal microdeletion on the long arm of chromosome 22, and is the commonest microdeletion syndrome in humans, with an estimated prevalence of 1 in 2,000–3,000 live births. In this study, Finless et al (2024) aimed to
- Determine if caregivers of children diagnosed with 22q11DS experience symptoms of depression, anxiety and/or post-traumatic stress disorder (PTSD);
- Characterise the caregivers' traumatic experiences related to complications associated with their child's condition; and
- Compare the trauma experiences of caregivers of children with 22q11DS to those of caregivers of children with other neurodevelopmental disorders (NDDs). Seventy-one mothers of children diagnosed with 22q11DS completed an online survey about their mental health symptoms and traumatic experiences. Clinically significant mental health symptoms experienced included depression (39%), anxiety (25%), and PTSD symptoms (30%). The traumatic events experienced by mothers of children with 22q11DS differed from those of mothers whose children had other NDDs due to them being more likely to see their child undergoing a medical procedure, a lifethreatening surgery, or being in intensive care.
The authors conclude that 22q11DS caregivers are likely to require specific mental health support and care ‘tailored to the specific needs of this population as they experience different kinds of traumatic events compared to caregivers of children with other NDDS.’
What do guidelines say about deprescribing?
In the UK, around 10% of the 1.1 billion annually dispensed medications are described as potentially inappropriate medicines (PIMs). PIMs contribute to unwelcome outcomes like drugdrug interactions, adverse drug reactions, non-adherence, and mortality. International rates of PIM use are high, with one-third to a half of older adults taking one or more PIMs. Integration of deprescribing recommendations into clinical practice guidelines is a possible way to minimise PIM and reduce medicine-related harm. In this scoping review, Langford et al (2024) aimed to identify guidelines containing deprescribing recommendations; explored the content and format of deprescribing recommendations.
The authors evaluated 80 guidelines containing 316 deprescribing recommendations. Deprescribing recommendations varied substantially in their format and terminology, with most guidelines containing recommendations in relation to who (75%, n=60), what (99%, n=89) and when or why (91%, n=73) to deprescribe. But fewer guidelines (58%, n=46), however, contained detailed guidance on how to deprescribe. The authors conclude that while deprescribing recommendations are being increasingly incorporated into guidelines, ‘many guidelines do not contain clear and actionable recommendations on how to deprescribe which may limit effective implementation in clinical practice.’
Association between insulin resistance and multiple sclerosis
Multiple sclerosis (MS) is an autoimmune disease that is mainly found to occur in young adults, and which affects more than 2.3 million people worldwide. Previous studies have shown that the prevalence of type 2 diabetes is significantly higher in MS patients compared to the general population. In this systematic review, Sepidarkish et al (2024) undertook a systematic review and meta-analysis of observational studies to explore the association between insulin resistance, insulin concentrations and MS.
A total of 18 datasets from 2012 to 2022 were included in this meta-analysis, and the results showed a significant association between IR and MS. Further, the authors found that MS patients had higher insulin concentrations than healthy individuals. Insulin has two critical roles within the central nervous system (CNS): the control of appetite and the modulation of cognitive functions. The authors also note that aberrations in insulin signalling within the brain may contribute to the pathogenesis of certain neurodegenerative disorders such as MS.
The authors conclude that further studies are needed to determine how metabolic disturbance affects the immune system and CNS function: ‘Emphasizing the causal relationship between insulin alterations and MS could provide insights for developing effective disease control methods in the future.’