Factors influencing contraception choice and use globally: a synthesis of systematic reviews

Background: Unintended pregnancy has a huge adverse impact on maternal, child and family health and wealth. There is an unmet need for contraception globally, with an estimated 40% of pregnancies unintended worldwide. Methods: We systematically searched PubMed and specialist databases for systematic reviews addressing contraceptive choice, uptake or use, published in English between 2000 and 2019. Two reviewers independently selected and appraised reports and synthesised quantitative and qualitative review findings. We mapped emergent themes to a social determinants of health framework to develop our understanding of the complexities of contraceptive choice and use. Findings: We found 24 systematic reviews of mostly moderate or high quality. Factors affecting contraception use are remarkably similar among women in very different cultures and settings globally. Use of contraception is influenced by the perceived likelihood and appeal of pregnancy, and relationship status. It is influenced by women’s knowledge, beliefs, and perceptions of side effects and health risks. Male partners have a strong influence, as do peers’ views and experiences, and families’ expectations. Lack of education and poverty is linked with low contraception use, and social and cultural norms influence contraception and expectations of family size and timing. Contraception use also depends upon their availability, the accessibility, confidentiality and costs of health services, and attitudes, behaviour and skills of health practitioners. Interpretation: Contraception has remarkably far-reaching benefits and is highly cost-effective. However, women worldwide lack sufficient knowledge, capability and opportunity to make reproductive choices, and health care systems often fail to provide access and informed choice

Resources For Evidence-Based Health Care: Accessibility And Availability

Evidence – Based Practice (EBP) is a problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well-designed studies,  clinician’s expertise, and patient values and preferences (Melnyk & Fineout-Overholt, 2005; Sackett, Straus, Richardson, Rosenberg, &Haynes, 2000). It is important to see clinical expertise as the ability to integrate research evidence and patients' circumstances and preferences to help patients arrive at optimal decisions (Guyatt, Cook,& Haynes, 2004). Research has shown that patient outcomes are 28% better when clinical care is based upon evidence, versus clinical practice steeped in tradition (Heater, Becker, & Olsen, 1998).   The process of EBP minimizes the translation time needed for incorporating research findings into practice and clarifies the differences between ritualistic practice, habitual approaches, personal preferences, anecdotal experiences, empirical data, and statistical significance to support nursing practice (Alspach, 2006). The availability of evidence based practice tools and methods helps in faster identification of the best available evidence to provide care at the point it matters most.   Implementing EBP in health care is complex and challenging. One of the main components of EBP is retrieving evidence from different sources. Information explosion with thousands of health literature and research papers published every year has created a need to expand the knowledge base for providing evidence based health care worldwide. Retrieval of evidence from various sources may be difficult due to several reasons. It may be difficult for health professionals to find the best available evidence due to time constraints (Ervin, 2002) or lack of knowledge among health professionals to effectively search for evidence (Sitzia, 2002). It is even difficult to find authentic sources of evidence

The impact of mental health and psychosocial support programmes on children and young people’s mental health in the context of humanitarian emergencies in low- and middle-income countries: A systematic review and meta-analysis

Humanitarian emergencies pose a significant global health challenge for children and young people’s mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low- and middle-income countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments

Role of surgical thoracic sympathetic interruption in treatment of facial blushing: a systematic review

<p><b>Objectives</b>: This paper aims to review the evidence to support the effectiveness of sympathectomy as a treatment for facial blushing in terms of relief of facial blushing, patient satisfaction, recurrence of blushing, patients regretting treatment and its associated complications.</p> <p><b>Methods</b>: A systematic search strategy was performed in Ovid-Medline, Embase, Cochrane library and NICE. Studies reporting outcomes of sympathetic interruption in the treatment of facial blushing were retrieved.</p> <p><b>Results</b>: Nine studies met the inclusion criteria with 1369 patients included in the final analysis. The age range of patients was 8 to 74 years (from 7 studies) with 56% females. Mean follow up was 21 months in 8 studies (range 6 to 30 months). The pooled proportion of patients who had good relief of facial blushing was 78.30% (95% C.I. 58.20% – 98.39%). Complete satisfaction was reported in 84.02% (95% C.I. 71.71% – 96.33%). Compensatory sweating and gustatory sweating were the commonest complications occurring in 74.18% (95% C.I. 58.10% – 90.26%) and 24.42% (95% C.I. 12.22% – 36.61%) respectively. The estimated proportion of patients regretting surgery was 6.79% (C.I 2.08% 11.50%).</p> <p><b>Conclusion</b>: Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective treatment for facial blushing. However, lack of randomized trials comparing sympathetic interruption with non-surgical methods of treatment and heterogeneity of included studies with respect to assessment of outcome measures preclude strong evidence and definitive recommendations.</p