Factors relating to the uptake of interventions for smoking cessation amongst pregnant women: a systematic review and qualitative synthesis

Introduction The review had the aim of investigating factors enabling or discouraging the uptake of smoking cessation services by pregnant women smokers. Methods The literature was searched for papers relating to the delivery of services to pregnant or recently pregnant women who smoke. No restrictions were placed on study design. A qualitative synthesis strategy was adopted to analyse the included papers. Results Analysis and synthesis of the 23 included papers suggested ten aspects of service delivery that may have an influence on the uptake of interventions. These were: whether or not the subject of smoking is broached by a health professional; the content of advice and information provided; the manner of communication; having service protocols; follow-up discussion; staff confidence in their skills; the impact of time and resource constraints; staff perceptions of ineffectiveness; differences between professionals; and obstacles to accessing interventions. Discussion The findings suggest variation in practice between services and different professional groups, in particular regarding the recommendation of quitting smoking versus cutting down, but also in regard to procedural aspects such as recording status and repeat advice giving. These differences offer the potential for a pregnant woman to receive contradicting advice. The review suggests a need for greater training in this area and the greater use of protocols, with evidence of a perception of ineffectiveness/pessimism towards intervention amongst some service providers

Association Between Transfusion Status and Overall Survival in Patients With Myelodysplastic Syndromes: A Systematic Literature Review and Meta-Analysis

Introduction: Multiple studies show transfusion independence (TI) in myelodysplastic syndrome (MDS) has a positive impact on overall survival (OS). To assess this, a systematic review and meta-analysis of the association between TI and OS in patients with MDS was conducted (PROSPERO ID: CRD42014007264). Methods: Comprehensive searches of five key bibliographic databases were conducted and supplemented with additional search techniques. Included studies recruited adults aged >18 years with MDS and examined the impact of transfusion status on OS. Results: 55 studies (89 citations) were included. The vast majority reported a statistically significant HR for OS in favour of TI patients, or patients who acquired TI after treatment. A random effects meta-analysis was conducted. Patients classed as TI at baseline showed a 59% decrease in the risk of death compared with transfusion dependent (TD) patients (HR 0.41; 95% credible interval (CrI): 0.29, 0.56), and this effect did not appear to interact significantly with illness severity (interaction coefficient HR 1.3895% CrI: 0.62, 3.41). Meta-analysis of studies where patients acquired TI was not possible, but consistently reported a survival benefit for those who acquired TI. Conclusion: The findings revealed a 59% pooled reduction in mortality among TI patients when compared with TD patients

Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: a mixed methods systematic review

Objective: Low socioeconomic status (SES) is a risk factor for type 2 diabetes and changes in diet and physical activity can prevent diabetes. We assessed the effectiveness and acceptability of community-based dietary and physical activity interventions among low-SES groups in the UK. Method: We searched relevant databases and web resources from 1990 to November 2009 to identify relevant published and grey literature using an iterative approach, focusing on UK studies. Results: Thirty-five relevant papers (nine quantitative, 23 qualitative and three mixed methods studies) were data extracted, quality assessed and synthesised using narrative synthesis and thematic analysis. The relationship between interventions and barriers and facilitators was also examined. Dietary/nutritional, food retail, physical activity and multi-component interventions demonstrated mixed effectiveness. Qualitative studies indicated a range of barriers and facilitators, which spanned pragmatic, social and psychological issues. The more effective interventions used a range of techniques to address some surface-level psychological and pragmatic concerns, however many deeper-level social, psychological and pragmatic concerns were not addressed. Conclusion: Evidence on the effectiveness of community-based dietary and physical activity interventions is inconclusive. A range of barriers and facilitators exist, some of which were addressed by interventions but some of which require consideration in future research