79 research outputs found
Understanding the attitudes and acceptability of extra-genital Chlamydia testing in young women:Evaluation of a feasibility study
Get PDFBackgroundChlamydia trachomatis (C. trachomatis) is the most common bacterial sexually transmitted infection in the UK. Recent studies suggest that in addition to the genital tract, C. trachomatis is found in the throat and rectum, suggesting the number of infections is under-reported. There is an urgent need to study the impact of extending diagnosis to include extra-genital samples; however, there is a lack of evidence on the acceptability of asking young women to provide these samples.MethodA mixed methods single group feasibility study explored the acceptability of combined genital and extra-genital testing in young women aged 16â25âyears consecutively attending a sexual health centre in Edinburgh, Scotland. Young women were asked to complete a self- administered anonymous questionnaire whether they would be willing to give self-taken throat and ano-rectal samples. Interviews with women (nâ=â20) willing to self-sample were conducted before and after self-sampling, and these explored the underlying reasons behind their decision, and feelings about the tests.ResultsOf 500 women recruited to the study, 422 (84.4%) women provided sufficient data for analysis. From completed questionnaires, 86.3% of respondents reported willingness to self-sample from the throat. Willingness of ano-rectal self-sampling was lower (59.1%), particularly in women under 20 ( < 20âyears: 44.4%; â„20âyears, 68.2%). Willingness of ano-rectal self-sampling was higher in women who had more sexual partners in the last 6âmonths (0 partners, 48.3%, nâ=â14, 3 or more partners, 67.4%, nâ=â60) and in those who have previous experience of a positive test for a sexually transmitted infection (STI) (positive: 64.5%; negative: 57%). Interviewed women suggested that a lack of knowledge of STIs, embarrassment and lack of confidence in the ability to carry out the sampling were barriers towards acceptability.ConclusionsIn this study, self-sampling of throat samples is largely acceptable; however, the acceptability of taking an ano-rectal sample for C. trachomatis testing in young women was lower in younger women. The study suggests further research to investigate the acceptability of extra-genital testing as an addition to routine C. trachomatis testing, and whether this increases detection and prevents infective sequelae for women
âDoing the right thingâ: factors influencing GP prescribing of antidepressants and prescribed doses
Get PDFBackground: Antidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPsâ use of antidepressants and their doses to treat depression.Methods: Semi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim.Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts,with data collection being interspersed with analysis by three researchers. The thematic framework was thensystematically applied to the data and conceptualised into an overarching explanatory model.Results: Depression treatment involved ethical and professional imperatives of âdoing the right thingâ for individuals by striving to achieve the âright care fitâ. This involved medicalised and non-medicalised patient-centred approaches.Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, andethically and professionally appropriate.Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2 weeks,preferring to wait 8-12 weeks before increasing or switching. Ongoing pressures to maintain prescribing (e.g. fear of depression recurrence), few perceived continuation problems (e.g. lack of safety concerns) and lack of proactive medication review (e.g. patients only present in crisis), all combine to further drive antidepressant prescribing growth over time.Conclusions: GPs strive to âdo the right thingâ to help people. Antidepressants are only a single facet of depression treatment. However, increased awareness of drug limitations and regular proactive reviews may help optimise care
Co-creation of five key research priorities across Law Enforcement and Public Health: A methodological example
Get PDFIntroductionLaw enforcement professions now assume more responsibility for tackling mental health issues alongside public health colleagues than ever before. The term âvulnerabilityâ is frequently used within Law Enforcement and Public Health (LEPH) to identify those requiring emergency mental health care. However, there are ongoing challenges within LEPH to determine whose responsibility this is.AimTo co-create the most important priorities for LEPH research in Scotland.MethodThe paper describes a collaborative workshop which brought together an Expert Advisory Group (EAG) of 26 senior stakeholders, from academia, policing, mental health nursing, psychiatry, paramedics, emergency medicine, people with lived experience, policy makers, and third sector.ResultsThe five key priorities included: vulnerability; mental health crisis; decision making around assessment and triage across professional groups and professional roles; peer support and organisational well-being; and information and data sharing.DiscussionThe paper discusses the EAG group event as a co-production process, focusing on how key LEPH research priorities were derived.Implications for PracticeThis paper demonstrates the inextricable link between co-production and co-creation of value via EAG group consensus on LEPH research priorities. Shared vision and professional will is not enough to ensure progress: there must also be shared policy, knowledge, and access
Health Inequalities in British Nurses using Census derived databases linked to an adjusted UK Index of Multiple Deprivation
Get PDFIntroduction
Scottish health outcomes are worse than in England and Wales. This variation remains after controlling for deprivation, which explains less excess mortality now than previously. Alternative cross-national deprivation measures have limitations which may explain some of this trend. Recent policy interventions to reduce inequalities have not been effective.
Objectives and Approach
This study aims to test a recently developed measure of area deprivation, the UK adjusted Index of Multiple Deprivation which has been linked to National Census derived Longitudinal Studies in England, Wales and Scotland. This adjusted measure is consistent across UK countries and addresses some limitations of previously utilised area measures of deprivation.
This study also aims to test whether characteristics of Nurses are protective against inequalities in health. This study will test whether Nurses are more socio-economically homogenous and whether higher health literacy is protective against the social gradient in health outcomes.
Results
(1) Comparing Nurses to Non-Nurses in Scotland we found that they have systematically different demographic characteristics. Nurses are; older on average, more likely to be female, more likely to own their home, more likely to live in less deprived areas and they report better self-rated health. (1a) Correlation tests will examine the strength of relationship between health and Deprivation quintile for these groups.
(2) Comparing Self-Rated Health of Scottish Nurses with English and Welsh Nurses will determine whether any âexcessâ in worse health outcomes exists and (2a) if an excess does exist, whether the UK consistent deprivation measure can account for this.
Analysis is currently ongoing and will be completed, with full results cleared for dissemination through disclosure control, prior to conference.
Conclusion/Implications
This study implements methods which provide a basis for cross-national comparison of inequalities using individual-level data and a consistent measure of area deprivation.
Results from this study may also permit recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in health
Health Inequalities in the British Nursing Workforce
Get PDFBackground
Average health in the UK is improving, yet geographical inequalities in health persist. The relative difference between the least and most deprived is also growing. Recent policy interventions to reduce these inequalities have not been effective.
Methods
This work compares Self-Rated Health using the ONS LS and SLS linked to an adjusted UK-consistent small-area Deprivation measure.
This study aims to compare Nurses to the general population to assess whether they also exhibit a social gradient in health. Using a single occupational group adjusts for potential confounders and tests whether characteristics of Nurses, such a good health literacy, degree education and above average income, are protective against inequalities.
Results
In Scotland, Nurses are more likely to be older, female, homeowners who live in less deprived areas with better Self-Rated Health than Non-Nurses. We will test whether the social gradient in health is observed for this occupational group.
Forthcoming results from cross-national analysis will be presented at conference following disclosure checks.
Conclusion
The relationship between area deprivation and health may remain even in relatively privileged groups.
Results from this study may inform recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in healt
A process evaluation of the implementation of ASSIST in Scotland. Research findings, 138/2017
Get PDFA Process Evaluation of the Implementation of ASSIST in Scotland: Final Report
Get PDFNo abstract available
A network meta-analysis of psychological interventions for schizophrenia and psychosis:Impact on symptoms
Get PDFBackground: Evidence for the effectiveness of psychological interventions for schizophrenia/psychosis is growing, however there is no consensus on the psychological intervention most likely to reduce symptoms. Methods: A network meta-analysis was conducted to identify all randomised controlled trials (RCTs) of psychological interventions for adults with schizophrenia/psychosis. A systematic review of the literature using MEDLINE, PsycINFO, EMBASE and CENTRAL led to an analysis of 90 RCTs with 8,440 randomised participants across 24 psychological intervention, and control groups. Psychological interventions were categorised and rated for treatment fidelity and risk of bias. Data for total symptoms were extracted and network meta-analysis, using a frequentist approach, was undertaken using Stata SE v15 to compare the direct and indirect evidence for the effectiveness of each psychological intervention. Findings: Psychological interventions were more likely to reduce symptoms than control groups, and one intervention, mindfulness-based psychoeducation, was consistently ranked as most likely to reduce total symptoms. Subgroup analyses identified differential effectiveness in different settings and for different subgroups.Interpretation: Mindfulness-based psychoeducation was consistently ranked as most likely to reduce symptoms; however all studies were based in China. More RCTs in a variety of cultural contexts would help to elucidate whether these findings generalise internationally. A number of psychological interventions could potentially be more effective than interventions recommended by NICE guidelines, such as CBT and family therapy, and additional RCTs and meta-analyses are needed to generate more conclusive evidence in this regard. Cognitive remediation and social skills training were differentially effective in different subgroup analyses
A feasibility study of a cross-diagnostic, CBT-based psychological intervention for acute mental health inpatients: Results, challenges and methodological implications
Get PDFObjectivesAcute psychiatric inpatient wards are characterised by minimal provision of therapeutic activities and high readmission rates. Implementation of a comprehensive inpatient psychological intervention service has been recommended to overcome these problems, however whether this is feasible or effective remains unclear.MethodsThis non-randomised parallel cluster feasibility trial examined the feasibility of delivering and evaluating cross-diagnostic psychologically informed acute psychiatric care (the E-Acute Psychological Inpatient Therapy Service; EDAPTS), and gathered preliminary clinical outcome data. Patients able to consent and complete questionnaires were recruited from two adult acute wards (i.e. clusters) and received either EDAPTS plus TAU or TAU.ResultsBetween October 2015 and 2016, 96 inpatients were recruited. Findings suggested there were good data completion rates for several clinical outcomes, that several EDAPTS components were successfully delivered and that some initial effects appeared to favour the intervention, depending on outcome. However difficulties relating to the recruitment process were also identified, as well as problems relating to adequate delivery of group therapies, participant engagement in some intervention components, and data-completion at follow-up.ConclusionThese issues, and the feasibility of randomisation and rater-blinding, have important implications for the design of future trials. Overall, this study provides an important insight into the challenges and complexities of developing and evaluating a comprehensive psychological intervention service in an acute psychiatric setting
Defining and assessing vulnerability within law enforcement and public health organisations: a scoping review
Get PDFBackground Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (that may arise because of mental health related problems and learning disabilities) alongside Public Health departments. While Law Enforcement has become a âlast line of supportâ and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations. Results Vulnerability is context-specific from a Law Enforcement perspective, and person-specific from a Public Health perspective. Definitions of vulnerability are at best fragmented, while models for assessing vulnerability lack uniformity across LEPH. The implications are two-fold. For âvulnerable groupsâ, the lack of an evidence-based definition and assessment model could prevent access to relevant LEPH services, exacerbating issues of multiple vulnerabilities, co-morbidity, and/or dual diagnosis. All could inadvertently enable social exclusion of vulnerable groups from political discourse and policy interventions. The lack of consistency regarding vulnerability may result in reactive crisis responses as opposed to proactive preventative measures. Conclusions This scoping review exposes the complexities associated with defining and assessing vulnerability from a LEPH perspective, which are perceived and prioritised differently across the organizations. Future research must bridge this gap. Building on the establishment of a definition of vulnerability within the empirical literature, researchers ought to engage with service users, LEPH staff, and those engaged in policy making to craft effective vulnerability definitions and assessment models. Only through evidence based, co-produced definitions and assessment models for vulnerability can we ensure that best-practice, but also meaningful and feasible practice, in vulnerability assessment can be achieved
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