Modelling patterns of polydrug use in the population of Great Britain:A latent class approach

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The effect of question order on outcomes in the ORBITAL core outcome set for alcohol brief interventions among online help-seekers (QOBCOS): findings from a randomised factorial trial

OBJECTIVE: A core outcome set (COS) has been developed in alcohol brief intervention (ABI) research through international consensus. This study aimed to estimate order effects among questions in the COS. METHODS: Individuals aged 18 or older who searched online for alcohol-related help were invited to complete the COS. The order of questions was randomised following a factorial design. Primary outcomes were order effects among the COS items and patterns of attrition. RESULTS: Between 21/10/2020 and 26/11/2020, we randomised 7334 participants, of which 5256 responded to at least one question and were available for analyses. Current non-drinkers were excluded. We found evidence of higher self-reported average consumption and odds of harmful and hazardous drinking was found among those who first answered questions on recent consumption and impact of alcohol use. Lower self-reported recent consumption was found among those first asked about average consumption. Quality of life (QoL) was reported lower among those who first responded to when questions on impact of alcohol use were asked first, which in turn was lower among those who first answered question on when average consumption and QoL were asked first. Attrition was lowest when average consumption was asked first, and highest when QoL or impact of alcohol use was asked first. Median completion time for the COS was 4.3 min. CONCLUSIONS: Question order affects outcomes and attrition. If the aim is to minimize attrition, consumption measures should be asked before QoL and impact of alcohol use; however, this order impacts self-reported alcohol consumption and so researchers should be guided by study priorities. At a minimum, all participants should be asked the same questions in the same order. TRIAL REGISTRATION: The trial was prospectively registered (ISRCTN17954645)

Can physical activity support young people after the death of a parent? The BABYSTEPS Project

Background: Annually, 41,000 UK children and young people are parentally bereaved. Grief is an individual process and must be supported properly. Many mental health aspects that cross over with grief outcomes (i.e. anxiety and depression) can be improved through physical activity. Yet there is limited research investigating whether physical activity can support bereaved individuals with their grief and what services are currently available. Methods: A systematic review of the literature (10 databases) and service provision (5 search engines) was performed. Empirical studies (qualitative and quantitative) had to explore physical activity (of any type) to help individuals (of any age) who had experienced a bereavement (of any human, other than national loss). Organisations which provide bereavement support to young people were contacted (via questionnaire and telephone) to record details about their service and if they offer physical activity support. Results: From 564 studies screened, 20 met the inclusion criteria, with 5 reporting using physical activity to support parental bereavement. Running and martial arts were noted as types of beneficial activity. Of the 373 organisations identified, 26 provided physical activity support (i.e. residential retreats, football) for bereaved young people. Conclusion: There is evidence that physical activity can support the wellbeing of young people who have been parentally bereaved. However, this evidence is limited, with just a small number of organisations offering physical activity. There is a clear need for more research and services to understand and increase the use of physical activity to support young people following the death of their parent.Peer reviewe

How do naloxone-based interventions work to reduce overdose deaths: a realist review

BACKGROUND: Naloxone-based interventions as part of health systems can reverse an opioid overdose. Previous systematic reviews have identified the effectiveness of naloxone; however, the role of context and mechanisms for its use has not been explored. This realist systematic review aims to identify a theory of how naloxone works based on the contexts and mechanisms that contribute to the success of the intervention for improved outcomes. METHODS: Pre-registered at PROSPERO, this realist review followed RAMESES standards of reporting. Keywords included 'naloxone' and ' opioid overdose'. All study designs were included. Data extraction using 55 relevant outputs based on realist logic produced evidence of two middle-range theories: Naloxone Bystander Intervention Theory and Skills Transfer Theory. RESULTS: Harm reduction and/or low threshold contexts provide a non-judgemental approach which support in-group norms of helping and empower the social identity of the trained and untrained bystander. This context also creates the conditions necessary for skills transfer and diffusion of the intervention into social networks. Stigma and negative attitudes held by first responders and stakeholders involved in the implementation process, such as police or GPs, can prohibit the bystander response by inducing fear in responding. This interferes with skills transfer, naloxone use and carriage of naloxone kits. CONCLUSIONS: The findings provide theoretically informed guidance regarding the harm reduction contexts that are essential for the successful implementation of naloxone-based interventions. Peer-to-peer models of training are helpful as it reinforces social identity and successful skills transfer between bystanders. Health systems may want to assess the prevalence of, and take steps to reduce opioid-related stigma with key stakeholders in contexts using a low threshold training approach to build an environment  to support positive naloxone outcomes. TRIAL REGISTRATION: PROSPERO 2019 CRD42019141003. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12954-022-00599-4

Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus

BACKGROUND: People with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience. METHODS: The CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from ‘not a problem’ to ‘a very big problem’. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA. RESULTS: The best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus ‘not a problem’, and ‘a small problem’ or ‘a moderate problem.’ CONCLUSION: This study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12955-016-0524-5) contains supplementary material, which is available to authorized users

Can physical activity support grief outcomes in individuals who have been bereaved? A systematic review

© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Background: In 2018, there were 616,014 registered deaths in the United Kingdom (UK). Grief is a natural consequence. Many mental health concerns, which can be identified as grief outcomes (e.g. anxiety and depression) in those who have experienced a bereavement, can be improved through physical activity. The objective of this review was to identify from the existing literature if physical activity can benefit grief outcomes in individuals who have been bereaved. Methods: A systematic review of nine databases was performed. Included studies (qualitative and quantitative) explored physical activity to help individuals (of any age) who had experienced a human bereavement (excluding national loss). Results: From 1299 studies screened, 25 met the inclusion criteria, detailing eight types of bereavement (parental (n = 5), spousal (n = 6), patient (n = 4), pre-natal (n = 3), later life (n = 1), caregiver (n = 1), multiple (n = 4) and non-defined (n = 1). Activities including yoga, running, walking and martial arts were noted as beneficial. Physical activity allowed a sense of freedom, to express emotions, provided a distraction and an escape from grief, whilst enhancing social support. Conclusion: There is some evidence that physical activity may provide benefit for the physical health and psychological wellbeing of those who have been bereaved, including when the loss has happened at a young age. This review is timely, given the wide-scale national loss of life due to COVID-19 and extends knowledge in this area. More research is needed to explore the benefits of physical activity for those who have been bereaved. In particular, there is a need for well-designed interventions which are tailored to specific activities, populations and grief outcomes.Peer reviewe