Evaluating the Effects of Symptom Monitoring on Menopausal Health Outcomes: A Systematic Review and Meta-Analysis

Evidence suggests that monitoring and appraising symptoms can result in increased engagement in medical help-seeking, improved patient-doctor communication, and reductions in symptom prevalence and severity. To date, no systematic reviews have investigated whether symptom monitoring could be a useful intervention for menopausal women. This review explored whether symptom monitoring could improve menopausal symptoms and facilitate health-related behaviours. Results suggested that symptom monitoring was related to improvements in menopausal symptoms, patient-doctor communication and medical decision-making, heightened health awareness, and stronger engagement in setting treatment goals. Meta-analyses indicated large effects for the prolonged use of symptom diaries on hot flush frequencies. Between April 2019 and April 2021, PsychInfo, EMBASE, MEDLINE, CINAHL, Cochrane, ProQuest, PsychArticles, Scopus, and Web of Science were searched. Eighteen studies met the eligibility criteria and contributed data from 1,718 participants. Included studies quantitatively or qualitatively measured the impact of symptom monitoring on menopausal populations and symptoms. Research was narratively synthesised using thematic methods, 3 studies were examined via meta-analysis. Key themes suggest that symptom monitoring is related to improvements in menopausal symptoms, improved patient-doctor communication and medical decision-making, increased health awareness, and stronger engagement in goal-setting behaviours. Meta-analysis results indicated large effects for the prolonged use of symptom diaries on hot flush frequency: 0.73 [0.57, 0.90]. This review is limited due to the low number of studies eligible for inclusion, many of which lacked methodological quality. These results indicate that symptom monitoring has potential as an effective health intervention for women with menopausal symptoms. This intervention may be beneficial within healthcare settings, in order to improve patient-doctor relations and adherence to treatment regimes. However, findings are preliminary and quality assessments suggest high risk of bias. Thus, further research is needed to support these promising outcomes. Systematic Review Registration Number: https://www.crd.york.ac.uk/prospero/display_record.php?, PROSPERO, identifier: CRD42019146270

Models of health behaviour predict intention to use long-acting reversible contraception

The aim of this study was to investigate women’s intention to use long-acting reversible contraception using two established models of health behaviour: the theory of planned behaviour and the health belief model. A questionnaire was completed by a convenience sample of 128 women attending a community sexual health clinic. The independent variables were constructs of theory of planned behaviour (attitude, subjective norm and perceived behavioural control) and health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, health motivation and cues to action). The dependent variable was intention to use long-acting reversible contraception. The theory of planned behaviour and the health belief model accounted for 75% of the variance in intention to use. Perceived behavioural control, perceived barriers and health motivation predict the use of long-acting reversible contraception. Public health information for women considering using long-acting reversible contraception should be based around addressing the perceived barriers and promoting long-acting reversible contraception as a reliable contraceptive method

The Paradox of the Frontal Lobe Paradox. A Scoping Review

The “frontal lobe paradox” highlights a phenomenon in which a subset of patients who possess frontal lobe damage and exhibit marked impairments in everyday life are still able to able to verbally describe a logical course of action relating to a task and perform well in interview and test settings. Such cases pose a challenge with regard to the assessment of mental capacity within clinical settings. Recent position articles state that the frontal lobe paradox is a well-known phenomenon within the field of neuropsychology, anecdotal reports from clinicians in the UK suggest this is not the case. Consequently, we conducted a scoping review to examine the breadth and depth of literature relating to the frontal lobe paradox. Searches were conducted using electronic databases and search engines, which were supplemented with a snowball search of the references used within relevant literature. We identified and reviewed 28 documents specifically related to the frontal lobe paradox. Nearly 50% of all identified academic texts published since 2000 were position articles that cited a handful of case studies published between 1936 and 1986 as evidence for the phenomenon. We also observed instances of articles citing position articles as evidence of the frontal lobe paradox. Overall, our findings indicate a lack of readily accessible research specific to the frontal lobe paradox. In particular, there is a lack of contemporary research specific to the subject and an absence of clarification as to which syndromes and disorders are included within the term

Applicability of the ACE-III and RBANS cognitive tests for the detection of Alcohol-Related Brain Damage

Background and aims: Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose. Methods: Comparing 28 participants with ARBD (11 with Korsakoff’s Syndrome and 17 with the umbrella “ARBD” diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests. Results: High levels of screening accuracy were found for the total scores of both the ACE-III (AUC = .823, 95% CIs [.714, .932], SE = .056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (AUC = .846, 95% CIs [.746, .947], SE = .052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (AUC = .915, 95% CIs [.831, .999], SE = .043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III’s accuracy were observed (AUC = .854, 95% CIs [.744, .963], SE = .056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%). Conclusions: Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions

Does the Fast Alcohol Screening Test Accurately Distinguish Between Harmful and Severely Dependent Tiers of Alcohol Misuse?

AIMS: Primary aim: to determine the efficacy of FAST (the Fast Alcohol Screening Test) for detecting harmful and dependent levels of alcohol use. Secondary aim: to compare the performance of the FAST to two short forms of the Alcohol Use Disorder Identification Test (AUDIT): the AUDIT-C and AUDIT-3. METHODS: Data from 3336 individuals in South Wales, compiled from full AUDIT datasets, were examined. AUROC analysis, alongside measures of sensitivity and specificity of the FAST, AUDIT-C and AUDIT-3 were utilized for the identification of harmful and dependent alcohol use. RESULTS: The FAST demonstrated efficacy in the identification of harmful and dependent levels of alcohol use, with superior performance to both the AUDIT-C and AUDIT-3. CONCLUSION: The present paper demonstrates the potential of the FAST as a cost- and time-effective method for appropriate screening and signposting in the stepped care model utilized by many health care and treatment services. Further studies are needed to ensure validity, both within the general population and for specific services and populations

Alcohol-related brain damage: A mixed-method evaluation of an online awareness-raising programme for frontline care and support practitioners

INTRODUCTION: Alcohol-related brain damage (ARBD) is an umbrella term referring to the neurocognitive impairments caused by excessive and prolonged alcohol use and the associated nutritional deficiencies. This study evaluated the outcomes of an online research-informed training program for ARBD which aimed to improve client outcomes by promoting support staff's awareness and confidence in working with clients who may have (or who are at risk of developing) the condition. METHODS: Staff working within a large non-governmental non-profit housing organisation (n = 883) enrolled in the training program. Questionnaires were used pre- and post-training to collect self-reported awareness of ARBD and confidence in supporting individuals with the condition. Semi-structured interviews were conducted with 27 staff members approximately 10 weeks post-completion of the program. Interviews were audio-recorded, transcribed verbatim and analysed by employing qualitative content analysis. RESULTS: Findings from the questionnaires indicated a significant increase in all measures after completing the training program. Three main themes were developed based on the interview data: changes to awareness and understanding; professional practice; and training-specific characteristics. Participants reported changes in their ability to identify potential service users with ARBD and confidence in doing so. DISCUSSION AND CONCLUSION: Our findings demonstrate that online training programs can be effective in improving support staff's ability to identify ARBD, potentially leading an increase in signposting service users to relevant services. The research-informed nature of the training demonstrates that translating research findings directly to frontline workers can have a substantial impact and may improve outcomes for this client group