Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review.

BACKGROUND: Despite a broad consensus that communities should be actively involved in improving their own health, evidence for the effect of community participation on specific health outcomes is limited. We examine the effectiveness of community participation interventions in maternal and newborn health, asking: did participation improve outcomes? We also look at how the impact of community participation has been assessed, particularly through randomised controlled trials, and make recommendations for future research. We highlight the importance of qualitative investigation, suggesting key areas for qualitative data reporting alongside quantitative work. METHODS AND FINDINGS: Systematic review of published and 'grey' literature from 1990. We searched 11 databases, and followed up secondary references. Main outcome measures were the use of skilled care before/during/after birth and maternal/newborn mortality/morbidity. We included qualitative and quantitative studies from any country, and used a community participation theoretical framework to analyse the data. We found 10 interventions. Community participation had largely positive impacts on maternal/newborn health as part of a package of interventions, although not necessarily on uptake of skilled care. Interventions improving mortality or use of skilled care raised awareness, encouraged dialogue and involved communities in designing solutions-but so did those showing no effect. DISCUSSION: There are few high-quality, quantitative studies. We also lack information about why participation interventions do/do not succeed - an area of obvious interest for programme designers. Qualitative investigation can help fill this information gap and should be at the heart of future quantitative research examining participation interventions - in maternal/newborn health, and more widely. This review illustrates the need for qualitative investigation alongside RCTs and other quantitative studies to understand complex interventions in context, describe predicted and unforeseen impacts, assess potential for generalisability, and capture the less easily measurable social/political effects of encouraging participation

Injuries related to consumer products in Canada--a systematic literature review.

OBJECTIVES: To conduct a systematic literature review of injury related to certain consumer products. METHODS: Forty-six empirical research reports along with 32 surveillance reports from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were examined to determine the approximate number of injuries associated with a given product per year and any trends in frequency. Percentages of injuries that: (1) resulted in hospitalization, (2) appeared to result from the product itself and (3) were associated with risky or inappropriate use and/or non-use of a helmet were also extracted from the reports. RESULTS: Outdoor play and sports equipment appear to be associated with the greatest numbers of injuries. A relatively high proportion of injuries appear to result from inappropriate or risky use of a product and/or inadequate safety precautions. CONCLUSION: This review identified the following areas of concern regarding consumer products and injuries: lack of helmet use by people using in-line skates, sleds, snowboards, downhill skis and personal-powered watercraft; operation of all-terrain vehicles (ATVs) and snowmobiles by alcohol-impaired people; operation of snowmobiles at excessive speeds; poor design of playground equipment; and unsafe storage and use of matches

Frustration of purpose: public health and the future of death investigation in England & Wales

Coroners have existed since the 12th century when they were created to support itinerant judges and, thus, facilitate the levying of fines on people living in England and (following the Edwardian Conquest) those in Wales. Over the centuries, the medieval coroner lost this function and his descendants have, in spite of a long-standing lack of central guidance, been forced to reinvent the coronial identity and to discover a modern purpose. The coroner operates in the space between law and medicine. Consequently, the coroner has been forced to adapt to the development of medical science, the normalisation and codification of human rights, and the development of the theory and practice of public health. Recent scandals - most notably the inquiry into the crimes of Harold Shipman - have highlighted the shortcomings of the office and have resulted in calls for reform. Though there is clearly a case for change, and many have made specific suggestions as to how the office should be modernised, few have considered that what underlies many of the problems of the coroner system/office, and its anachronistic and atavistic nature is a fundamental lack of a responsible and logical purpose. The study attempts to describe the problems encountered by the coroner in recent years, to provide a background to outline the coroner’s evolution from the 12th century, and to pose the question: what, ultimately, is the purpose of the coroner? This study is based on a) qualitative interviews with coroners in England and Wales, b) qualitative interviews with professionals who encounter coroners through their work, c) observation of coroners during inquests, and d) a written submission to coroners requesting inquest data. Coroners were asked to state and describe their purpose - there was no consensus. Coroners described their purpose in one of six ways: to ‘give families closure’, to protect public health and safety, to discover homicide, to enforce Article 2 of the European Convention on Human Rights, to provide public reassurance, and to investigate the military. One coroner believed the question of purpose not to be germane. This study considers each response and attempts to come to an evidence-based, normative conclusion as to the purpose of the coroner. Some have suggested that the coroner’s role is both complex and multifarious and should necessarily include several distinct purposes; however, in practice, these purposes often undermine and contradict each other. This study argues for a single, overriding purpose for the coroner. In addition, the work considers changes which might render the office capable of pursing the normative purpose in a contemporary context in which our understanding of public health is more developed

The Acceptability of Online Consent in a Self-Test Serosurvey of Responders to the 2014–2016 West African Ebola Outbreak

Online participation in research is used increasingly to recruit geographically dispersed populations. Obtaining online consent is convenient, yet we know little about the acceptability of this practice. We carried out a serostudy among personnel returning to the UK/Ireland following deployment to West Africa during the 2014–2016 Ebola epidemic. We used an online procedure for consenting returnees and designed a small descriptive study to understand: how much of the consent material they read, how informed they felt and if they preferred online to traditional face-to-face consent. Of 261 returnees, 111 (43 per cent) completed the consent survey. Participants indicated a high level of engagement with the consent materials, with 67 per cent reporting having read all and 20 per cent having read ‘most’ of the materials. All participants indicated feeling completely (78 per cent) or mostly (22 per cent) informed about the purpose, methods and intended uses of the research, as well as what participation was required and what risks were involved. Only three participants indicated a preference for face-to-face consent. Free-text comments suggested that online consent may be an acceptable modality for uncomplicated and low-risk studies. The study sample was largely composed of health professionals, suggesting acceptability of online consent within this population

High prevalence of albuminuria amongst people who inject drugs: A cross-sectional study.

Albuminuria is a key biomarker for cardiovascular disease and chronic kidney disease. Our study aimed to describe the prevalence of albuminuria amongst people who inject drugs in London and to test any potential associations with demographic characteristics, past diagnoses, and drug preparation and administration practices. We carried out a cross-sectional survey amongst people who use drugs in London. The main outcome measure was any albuminuria including both microalbuminuria and macroalbuminuria. Three-hundred and sixteen samples were tested by local laboratory services. Our study initially employed point-of-care testing methods but this resulted in a high number of false positives. Our findings suggest the prevalence of albuminuria amongst PWID is twice that of the general population at 19% (95%CI 15.3-24.0%). Risk factors associated with albuminuria were HIV (aOR 4.11 [95% CI 1.37-12.38]); followed by overuse of acidifier for dissolving brown heroin prior to injection (aOR 2.10 [95% CI 1.04-4.22]). Albuminuria is high amongst people who inject drugs compared to the general population suggesting the presence of increased cardiovascular and renal pathologies. This is the first study to demonstrate an association with acidifier overuse. Dehydration may be common amongst this population and may affect the diagnostic accuracy of point-of-care testing for albuminuria

COVID-19 vaccination decisions among Gypsy, Roma, and Traveller communities: A qualitative study moving beyond “vaccine hesitancy”

Data availability: The data that has been used is confidential.Copyright © 2023 The Authors. Background Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. Methods We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. Findings Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of “vaccine hesitancy”. Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others’ health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. Interpretation A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage.National Institute for Health Research (NIHR) Policy Research Programme

Necropolitics and Necroresistance: A Qualitative Research with Gypsy, Traveller and Roma Communities during the COVID-19 Pandemic

In this article based on participatory research, we demonstrate how members of the Gypsy, Traveller, and Roma communities experienced the pandemic during a period of increasing criminalisation. Our investigation of responses to the COVID-19 pandemic among community members was enriched by having a criminologist from a Gypsy/Traveller background as part of the research team. The rich data gleaned during interviews provided insight into the broader context of the lives of Gypsy, Traveller, and Roma communities during the pandemic. Using Mbembe's theory of necropolitics to consider how these marginalised communities were experiencing the pandemic, we illustrate necroresistance, small acts of resistance to the pandemic and Governmental responses by communities and individuals. This article explores how individuals took responsibility for their families and broader networks' survival during the pandemic in conditions exacerbated by escalating systemic hostility.This paper is independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm's length bodies, and other Government departments

Community-led responses to COVID-19 within Gypsy and Traveller communities in England: A participatory qualitative research study

Copyright © 2023 The Authors. Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions. In future emergencies, communities must be given better material, political and technical support to help them to design and implement effective community-led solutions, particularly where government institutions are untrusted or untrustworthy.National Institute for Health Research (NIHR) Policy Research Programme

Avoiding obscure topics and generalising findings produces higher impact research

Much academic research is never cited and may be rarely read, indicating wasted effort from the authors, referees and publishers. One reason that an article could be ignored is that its topic is, or appears to be, too obscure to be of wide interest, even if excellent scholarship produced it. This paper reports a word frequency analysis of 874,411 English article titles from 18 different Scopus natural, formal, life and health sciences categories 2009-2015 to assess the likelihood that research on obscure (rarely researched) topics is less cited. In all categories examined, unusual words in article titles associate with below average citation impact research. Thus, researchers considering obscure topics may wish to reconsider, generalise their study, or to choose a title that reflects the wider lessons that can be drawn. Authors should also consider including multiple concepts and purposes within their titles in order to attract a wider audience