NIHRDataInsights/HRCSData huggingface dataset:
Title: Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: Some estimates suggest that as many as 75% of cancer survivors experience cognitive impairment and as a consequence of receiving treatment for their cancer (Argyriou et al. 2011). There is a strong association between receipt of chemotherapeutic agents to treat cancer and impaired cognitive functioning, sometimes referred to as ‘chemo brain’, ‘chemo fog’ or chemotherapy-induced cognitive impairment. Experiences impairment encompasses dysfunction across a range of cognitive processes including memory, learning, attention and general though processes. Cognitive impairment following cancer can be long lasting and have a negative impact on the quality of life of cancer survivors (O’Shaughnessy 2003; Bowers 2008). Interventions have been developed to ameliorate the debilitating cognitive effects following treatment among this population. However, as yet there have been no reviews conducted in this area to collate and synthesise the evidence and it is important to understand which interventions have the best effects to improve cognitive functioning among cancer survivors. This review aims to assess the effects of interventions for cognitive dysfunction among individuals (over 18 years of age) who have completed treatment for cancer. Patients with brain cancer or brain metastases will not be included as cognitive functioning may be impaired already due to the direct impact of cancer on the brain (Vardy et al. 2007); also, patients with non-melanoma skin cancer will be excluded as the epidemiology and treatment differs largely from other cancers. Both single and multi-factorial interventions which have been designed to improve cognitive functioning in patients after cancer treatment will be included. Included studies will be limited to randomised controlled trials only; primary outcomes will include measures of cognitive functioning including assessments of memory, attention, executive functioning and language. Secondary outcomes will include measures of wellbeing, quality of life and everyday functioning. All outcomes must be measured using a validated, standardised test.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH;CANCER AND NEOPLASMS
Title: 2009 Doctoral Fellowships: Promoting a Sense of Coherence and Wellbeing in Teenagers and Young Adults with Cancer Receiving Hospital Care
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: Young people who develop cancer during their teenage or young adult years are at risk of developing psychosocial problems during the cancer treatment trajectory, and for those who survive the disease, for many years after treatment finishes. Recent policy developments have led to a new interest in health and social care provision for this under-researched population in Northern Ireland. By examining the perspectives of teenagers and young adults (TYAs) with cancer, carers and professionals, through a theoretical framework of sense of coherence (SOC), this study will explore TYAs' experiences within the hospital context, and examine how hospital care and multi-disciplinary practice can be enhanced to effectively promote their sense of coherence and wellbeing throughout the treatment trajectory.The study adopts a multi-method, participatory research approach: including interviews with primary carers and professional staff; and four in-depth, semi-structured individual interviews with each TYA over a two-year period to explore their experiences of hospital care and coping with the challenges of cancer as they progress through treatment. SOC and wellbeing will be measured by the Orientation to Life Questionnaire, and delivered twice with each TYA during research fieldwork. Narrative methods will also be used, including video and audio diaries, to creatively capture the voice of TYAs with cancer. Research findings will be disseminated to TYAs and carers, and to relevant professional bodies to inform policy and practice.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;CANCER AND NEOPLASMS
Title: Exploring the utility of the metacognitive model in predicting and preventing emotional distress after cancer.
Funder: Medical Research Council

Abstract: Aims To explore the utility of the metacognitive model in predicting emotional distress after cancer and in identifying causal factors that can be manipulated in an intervention to prevent persistent or recurrent distress. Objectives Specific objectives are to: (A) Test a theory of the role of the ‘cognitive-attentional syndrome‘ (CAS) in causing or maintaining emotional distress after cancer (B) Test the clinical utility of the CAS in predicting which individuals will develop clinically significant distress (C) Model an intervention to implement the findings and evaluate its acceptability to patients. Design The research spans the pre-clinical phase and phase 1 of the MRC framework for developing complex interventions. A mixed method approach will link (i) a prospective quantitative study to identify causal factors in the development of long-term emotional distress after cancer diagnosis with (ii) qualitative and quantitative methods to translate these finding into a preventative self-help intervention and to evaluate its feasibility and acceptability. Methods Study 1. In a prospective cohort study, 240 patients will be assessed psychologically 3 and 12 months after diagnosis of breast or prostate cancer to identify components of the CAS at 3 months that predict depression, anxiety or post-traumatic stress disorder at 12 months. Study 2. About six patient focus groups (n=8) will be conducted in 3 phases to explore how findings from study 1 can be translated into a practicable and acceptable intervention. Group discussion and thematic analysis will focus on implementing variables implicated in Study 1, avoiding barriers to effectiveness. Study 3. A randomised design will evaluate the feasibility and acceptability of the intervention. 80 patients identified through screening as ‘at risk‘ 3 months after diagnosis will be randomised to receive the intervention or care as usual. Patients will complete a questionnaire supplemented by a telephone interview after 1-2 weeks and again at 3 months to compare the groups on satisfaction with care as a whole and to analyse consumer evaluation of, and adherence with, the intervention in the group receiving it. Scientific and Medical Opportunities Identification of causal factors in long-term emotional distress after diagnosis of cancer will allow vulnerable patients to be identified as ‘at risk‘ early after diagnosis. The intervention will educate ‘at risk‘ patients about their own cognitive processes - what to look out for, and how to manage them - so that distress may be prevented or minimised before reaching levels requiring professional intervention.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH;CANCER AND NEOPLASMS
Title: The cognitive neuroscience of over-eating: normative and clinical studies of goal-driven and stimulus-driven responses
Funder: Wellcome Trust

Abstract: There is a pressing need to understand the phenotypic variations of obesity in order to elucidate the diverse pathways and mechanisms by which it arises and, ultimately, to offer suitably tailored interventions. My proposed work aims to provide insights into the cognitive neuroscience of health-harming over-consumption. Its ultimate goals are to characterise cognitive mechanisms underlying eating behaviours, exploring how these are selected and deployed in ways that are shaped by both internal and environmental signals. The work is based on the view that obesity is ultimately driven by a complex integration of environmental and bodily signals and that a comprehensive approach must characterise this integration in order to determine how it may be altered in over-eating. My proposal has the following goals: 1. To understand how stimulus-driven (automatic) and goal-directed (reflective) reward behaviours are balanced in relation to eating choices and to explore how this balance may differ across hungry and sated, lean and obese people. 2. To relate these underlying processes to hormonal/metabolic signals as well and to real-world eating choices. 3. To characterise the effects of three specific perturbations to this integrated system: (i) elective gastrectomy, (ii) single gene mutations affecting hypothalamic circuitry and (iii) psychopharmacological manipulations

Lay abstract: Obesity is a serious global problem with profound implications for physical and mental health. It is clearly driven by our environment but there is a strong inherited component too. The genetic studies strongly suggest that vulnerability to obesity resides in the brain, how it processes the environment, how it responds to reward stimuli such as foods and how it leads us to choose actions and options that we know are not healthy. Understanding brain processes requires that we take into account external signals (such as the sight of food), as well as bodily signals of hunger together with existing, learned valuations of factors such as health and taste. For example, changes in gut hormone levels can make even very bland foods seem appetising while some foods are so attractive that we over-ride powerful signals telling us that we are not hungry. I want to understand this complex brain-body-environment relationship, because we cannot understand over-eating and obesity until we do so. I propose a complementary series of studies in healthy people and in patients with unique and specific disturbances to brain circuits and to gastro-intestinal signalling. By elucidating variation in the underlying mechanisms, this work will provide new insights into over-eating.

Research activity codes: 1.2 PSYCHOLOGICAL AND SOCIOECONOMIC PROCESSES
Health categories: MENTAL HEALTH;CANCER AND NEOPLASMS;NEUROLOGICAL
Title: Cardiff Translational Drug Discovery Centre (CTDDC)
Funder: Welsh Government Office for Science

Abstract: Our aim is to translate advances in the understanding of disease mechanism biology, largely driven by genetic studies of patient populations such as those led by Cardiff University scientists, into novel drugs for treating unmet medical need. In the first instance, our focus will be neuroscience, working with colleagues within, for example, the Neuroscience and Mental Health Research Institute and the UK Dementia Research Institute to identify and validate novel pathways and molecular targets and then developing small molecules that can modify these drug targets, whether they be ion channels, G-protein coupled receptors or enzymes. Novel drugs can then be evaluated in clinical studies in collaboration with Cardiff University Brain Research Imaging Centre (CUBRIC) in a unique, bench-to-bedside drug discovery platform.. Our drug discovery skills and technical capabilities (assay development, X-ray crystallography, cellular models for proof-of-mechanism studies, medicinal chemistry) are transferable across a number of therapeutic areas and so we are always willing and able to collaborate with scientists across Wales (as well as the UK and internationally) that have novel insights into disease mechanisms irrespective of the therapeutic area. Hence, in the medium to long term, we plan to extend our focus beyond neuroscience into areas such as cancer, immunology and other disease areas and are continually on the lookout for potential collaborators.


Research activity codes: 5.1 PHARMACEUTICALS;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;1.1 NORMAL BIOLOGICAL DEVELOPMENT AND FUNCTIONING
Health categories: MENTAL HEALTH;CANCER AND NEOPLASMS;NEUROLOGICAL;GENERIC HEALTH RELEVANCE
Title: Exploring the potential role of allostatic load bio-markers in risk assessment of patients presenting with depressive symptoms Allostatic load use in
Funder: Chief Scientist Office (Scotland)

Abstract: Objective I wish to test the hypothesis that a combination of allostatic (stress) bio-markers will form a predictive algorithm in defining clinically meaningful outcomes in a population of patients with depression complicated by co-morbidity in the area of vascular and metabolic disease. Study Design I will use data from two different populations. 1) DepChron, a large routinely collected dataset of more than 150000 patients which has information mainly on secondary markers of allostatic load (AL). The results will guide more elaborate testing in 2) pSoBid dataset of 666 patients, which will facilitate calculation of a composite allostatic index (AI) score, comprising both primary and secondary allostatic bio-markers. Techniques I will calculate the AI score for patients in both datasets by applying a statistical algorithm to the available bio-markers value, at the time of patient recruitment. A set of adverse outcomes (hospitalizations, incidence of Myocardial Infarction/Stroke, mortality) will be studied using data linkage with Information Services Division (ISD), at 5 years of follow-up from recruitment. I will examine the utility of an AI score in prediction of adverse clinical outcomes, adjusting for covariates such as age, gender and deprivation status. I will formulate an AI score which best balances prediction accuracy and required number of AL measures, to ensure cost effectiveness. Outcome Completion of hypothesis testing that if positive, will have produced a predictive measure of AI score using an algorithm of AL markers, which will help in identifying patients with depression, who are at higher risk of adverse clinical outcomes.


Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.5 RESEARCH DESIGN AND METHODOLOGIES (AETIOLOGY)
Health categories: MENTAL HEALTH;CARDIOVASCULAR
Title: Developing an intervention to increase exercise in schizophrenia.
Funder: Chief Scientist Office (Scotland)

Abstract: Schizophrenia is associated with considerable suffering and substantial costs. In addition to psychotic symptoms, people with schizophrenia also have elevated rates of obesity, diabetes, hypertension, coronary heart disease and stroke. Their average life expectancy is 10-25 years less than the general population, primarily due to unhealthy lifestyles as most people with schizophrenia are overweight, sedentary, and levels of dietary fat intake, smoking and alcohol consumption are high. Cardiovascular disease is the leading cause of mortality in people with schizophrenia. Physical inactivity significantly contributes to this. Regular exercise can reduce many of the modifiable risk factors as well as improve well-being. However, the physical health of people with schizophrenia is largely neglected by psychiatric services and most risk reduction programmes specifically exclude people with major psychiatric disorders. There is insufficient evidence of what works to increase physical activity in people with schizophrenia to inform clinical service developments. This project aims to develop a complex behavioural change intervention to increase physical activity in people with schizophrenia that is acceptable and could be implemented in everyday NHS practice. By reviewing the literature, conducting qualitative work with local patients to identify barriers and motivators to physical activity, and collaborating with NHS staff and leisure services, I will develop and pilot a novel intervention based on this evidence-base. Using the specialised training received during this fellowship, I will then go on to further develop the intervention, testing its effectiveness in a randomised controlled trial, and, if effective, seek to implement it nationally.


Research activity codes: 5.7 PHYSICAL;5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH;CARDIOVASCULAR
Title: Equity of access to cardiac and mental health services in England
Funder: Department of Health (England)

Abstract: The project focuses on the ecological analysis of quantitative data drawn from a variety of sources including crucially small area estimation data derived from the modelling of the clinical needs of organisationally- and geographically-defined populations. The analysis will cover the whole of England and the primary units of analysis will be the General Practice and the Middle Layer Output Area (MSOA). Following an initial period of systematic review and synthesis of clinical guideline and health care literature – resulting in the formalisation of our ‘pathways to care’ conceptual framework and the definition of detailed modelling and analytical objectives – the project comprises two substantive phases of research. The first focuses on the production of condition-specific estimates of clinical need for all practices and MSOAs in England. This rests on a) the use of data drawn from major epidemiological surveys (principally the Health Survey for England and recent Psychiatric Morbidity Surveys) to construct using a Bayesian approach multilevel models which describe the risk that different types of person living in different areas will experience particular cardiac or metal health conditions and b) the application of the resulting model parameters to microsimulated estimates of the socio-demographic characteristics all individuals in practice and MSOA populations in order to derive local probabilistic estimates of the burden of health care needs in those populations. Having generated need estimates which capture both expressed and unexpressed need at practice and MSOA level the second substantive phase of research concerns relating those estimates to the subsequent utilisation of health services by those populations. This will draw in particular on Quality Outcome Framework (QOF) data on primary care activity Hospital Episode Statistics (HES) data on Inpatient and Outpatient activity and ‘prescribing analyses and cost’ (PACT) data on prescribing activity. Additional mental health data will be drawn from the Mental Health Minimum Dataset (MHMDS) and ‘Improving Access to Psychological Therapies’ (IAPT) data with respect to the treatment of people suffering from depression and anxiety disorders. The goal here is to establish a sound evidential basis upon which to test whether the various use:need ratios vary significantly at practice PCT MSOA or LA level and if so to model the extent to which inequalities in the uptake of service can be explained with reference to systematic demand- or supply-side factors.Dissemination plans include the a) delivery of estimate toolkits & the underlying methodology via the Public Health Observatory website b) journal & conference papers to academic and practitioner audiences and c) a proactive exploration in the south west of how local estimates of cardiac and mental illness can be used to inform local public health and commissioning processes.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;CARDIOVASCULAR
Title: Randomised trial of Blood pressure Rapid Intensive Lowering And Normal Treatment for Mood and Cognition in Persistent Depression (BRILiANT Mood Study)
Funder: Medical Research Council

Abstract: Currently even with optimum treatment a large proportion of people with major depression do not attain remission. There is therefore a pressing need to examine alternative approaches by identifying subgroups with shared features. One such subgroup is middle-aged and older adults with poorly controlled hypertension, about a quarter of this age-group. Persistent mood and cognitive symptoms are strongly related to cerebrovascular disease due to hypertension. Mechanistically, poorly treated hypertension has adverse effects on cerebral autoregulation, making the brain more vulnerable to inadequate perfusion. Previous work showed lowering blood pressure (BP) can correct these changes and improve cerebral perfusion. We propose to test the novel hypothesis that intensive BP lowering improves mood and cognitive symptoms in this subgroup and does so by improving cerebral bloodflow. We will recruit 60 subjects with persistent symptoms (Hamilton depression rating (HAM-D) >10) after treatment of major depression who also have inadequately treated hypertension. We will use a PROBE (prospective randomised open blinded end-point) design, with subjects randomised to standard BP treatment (NICE recommended) or protocolised intensive BP lowering. We have demonstrated this produces a 10mm Hg group difference with cerebral bloodflow improvements in the intensive group by 6 weeks. Outcome measures, assessed blind to treatment at 12 weeks: mood change with HAM-D; neuropsychological functioning (memory and executive function); cerebral blood flow using MRI arterial spin labelling. Due to the inherent problem in trials utilising executive functioning as an outcome (i.e. how to deal with the complexity of this neuropsychological domain in terms of its multiple processes) we will explore deriving a small number of composite measures that reflect executive functions and memory. We will use the data from this study to adequately power a further study which we will submit to the MRC DCS scheme.


Research activity codes: 6.1 PHARMACEUTICALS
Health categories: MENTAL HEALTH;CARDIOVASCULAR
Title: The Colombo Twin and Singleton Study (CoTaSS) follow up.
Funder: Wellcome Trust

Abstract: Twin studies allow researchers to determine whether susceptibility to a disorder in a population can be explained by genetic or environmental factors, or by interactions between the two. They do this by seeing whether the chance of one twin having a disorder is increased if the other twin has it (concordance). By looking at differences in concordance rates between identical and non-identical twins, it is possible to establish the extent of genetic and environmental contributions. We will u se an existing twin study to explore the way in which psychiatric disorder and risk factors for heart disease and diabetes may overlap. We will ask twins to have various blood tests and physical measurements (e.g. height and weight). The twins will be interviewed to detect and explore risk factors for depression. We will increase the sample of twins, to identify some with more severe depression, as we want to see if severe depression is more heritable than milder depression. We will use a range of statistical tools to determine whether the overlap between risk factors for heart disease and depression is greater than expected by chance, and whether any such overlap can be explained by genes.


Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: MENTAL HEALTH;CARDIOVASCULAR