76 research outputs found
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National or population level interventions addressing the social determinants of mental health – an umbrella review
Background
Social circumstances in which people live and work impact the population’s mental health. We aimed to synthesise evidence identifying effective interventions and policies that influence the social determinants of mental health at national or scaled population level. We searched five databases (Cochrane Library, Global Health, MEDLINE, EMBASE and PsycINFO) between Jan 1st 2000 and July 23rd 2019 to identify systematic reviews of population-level interventions or policies addressing a recognised social determinant of mental health and collected mental health outcomes. There were no restrictions on country, sub-population or age. A narrative overview of results is provided. Quality assessment was conducted using Assessment of Multiple Systematic Reviews (AMSTAR 2). This study was registered on PROSPERO (CRD42019140198).
Results
We identified 20 reviews for inclusion. Most reviews were of low or critically low quality. Primary studies were mostly observational and from higher income settings. Higher quality evidence indicates more generous welfare benefits may reduce socioeconomic inequalities in mental health outcomes. Lower quality evidence suggests unemployment insurance, warm housing interventions, neighbourhood renewal, paid parental leave, gender equality policies, community-based parenting programmes, and less restrictive migration policies are associated with improved mental health outcomes. Low quality evidence suggests restriction of access to lethal means and multi-component suicide prevention programmes are associated with reduced suicide risk.
Conclusion
This umbrella review has identified a small and overall low-quality evidence base for population level interventions addressing the social determinants of mental health. There are significant gaps in the evidence base for key policy areas, which limit ability of national policymakers to understand how to effectively improve population mental health
Redesign and commissioning of sexual health services in England – a qualitative study
Objectives
Responsibility for the commissioning of sexual and reproductive health (SRH) services transferred from the National Health Service to local authorities in England in 2013. This transfer prompted many local authorities to undertake new procurements of these SRH services. This study was undertaken to capture some of the lessons learnt in order to inform future commissioning and system redesign.
Study design
A qualitative study was carried out involving semi-structured interviews.
Methods
Interviews were conducted with 13 local authority sexual health commissioners in Yorkshire and the Humber from 11 interviews. Thematic analysis was used to identify themes from transcripts of the interviews with the 13 participants.
Results
Key themes identified were as follows: the challenge and complexity to those new to clinical commissioning; the prerequisites of robust infrastructural inputs to undertake the process, including technical expertise, a dependable project team, with clarity over the timescales and the budget; the requirement for good governance, stakeholder engagement and successful management of relationships with the latter; and the need to focus on the outcomes, aiming for value for money and improved system performance.
Conclusions
Several key issues emerged from our study that significantly influenced the outcome of the redesign and commissioning process for sexual health services. An adapted model of the Donabedian evaluation framework was developed to provide a tool to inform future system redesign. Our model helps identify the key determinants for successful redesign in this context which is essential to both mitigate potential risks and maximize the likelihood of successful outcomes. Our model may have wider applications
Materials for hydrogen-based energy storage - past, recent progress and future outlook
Globally, the accelerating use of renewable energy sources, enabled by increased efficiencies and reduced
costs, and driven by the need to mitigate the effects of climate change, has significantly increased
research in the areas of renewable energy production, storage, distribution and end-use. Central to this
discussion is the use of hydrogen, as a clean, efficient energy vector for energy storage. This review, by
experts of Task 32, “Hydrogen-based Energy Storage” of the International Energy Agency, Hydrogen TCP,
reports on the development over the last 6 years of hydrogen storage materials, methods and techniques,
including electrochemical and thermal storage systems. An overview is given on the background to the
various methods, the current state of development and the future prospects. The following areas are
covered; porous materials, liquid hydrogen carriers, complex hydrides, intermetallic hydrides, electrochemical storage of energy, thermal energy storage, hydrogen energy systems and an outlook is presented for future prospects and research on hydrogen-based energy storage
Impact of sub-optimal HIV viral control on activated T-cells : an earnest sub study
Objective: HIV viral load (VL) monitoring is generally conducted 6–12 monthly in
low- and middle-income countries, risking relatively prolonged periods of poor viral
control. We explored the effects of different levels of loss of viral control on immune
reconstitution and activation.
Design: Two hundred and eight participants starting protease inhibitor (PI)-based
second-line therapy in the EARNEST trial (ISRCTN37737787) in Uganda and Zimbabwe
were enrolled and CD38Ăľ/HLA-DRĂľ immunophenotyping performed (CD8-FITC/
CD38-PE/CD3-PerCP/HLA-DR-APC; centrally gated) in real-time at 0, 12, 48, 96
and 144 weeks from randomization.
Methods: VL was assayed retrospectively on samples collected every 12–16 weeks and
classified as continuous suppression (<40 copies/ml throughout); suppression with
transient blips; low-level rebound (two or more consecutive VL >40, <5000 copies/
ml); high-level rebound/nonresponse (two or more consecutive VL >5000 copies/ml).
Results: Immunophenotype reconstitution varied between that defined by numbers of
cells and that defined by cell percentages. Furthermore, VL dynamics were associated
with substantial differences in expression of CD4Ăľ and CD8Ăľ cell activation markers, with
only individuals with high-level rebound/nonresponse (>5000 copies/ml) experiencing
significantly greater activation and impaired reconstitution. There was little difference
between participants who suppressed consistently and who exhibited transient blips or
even low-level rebound by 144 weeks (P > 0.2 vs. suppressed consistently).
Conclusion: Detectable viral load below the threshold at which WHO guidelines
recommend that treatment can be maintained without switching (1000 copies/ml)
appear to have at most, small effects on reconstitution and activation, for patients
taking a PI-based second-line regime
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