Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients' experiences

BACKGROUND: Routine screening is key to sexually transmitted infection (STI) prevention and control. Previous studies suggest that clinic-based screening programmes capture only a small proportion of people with STIs. Self-sampling using non- or minimally invasive techniques may be beneficial for those reluctant to actively engage with conventional sampling methods. We systematically reviewed studies of patients' experiences of obtaining self-samples to diagnose curable STIs. METHODS: We conducted an electronic search of MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, and Cochrane Database of Systematic Reviews to identify relevant articles published in English between January 1980 and March 2014. Studies were included if participants self-sampled for the diagnosis of a curable STI and had specifically sought participants' opinions of their experience, acceptability, preferences, or willingness to self-sample. RESULTS: The initial search yielded 558 references. Of these, 45 studies met the inclusion criteria. Thirty-six studies assessed patients' acceptability and experiences of self-sampling. Pooled results from these studies shows that self-sampling is a highly acceptable method with 85% of patients reporting the method to be well received and acceptable. Twenty-eight studies reported on ease of self-sampling; the majority of patients (88%) in these studies found self-sampling an "easy" procedure. Self-sampling was favoured compared to clinician sampling, and home sampling was preferred to clinic-based sampling. Females and older participants were more accepting of self-sampling. Only a small minority of participants (13%) reported pain during self-sampling. Participants were willing to undergo self-sampling and recommend others. Privacy and safety were the most common concerns. CONCLUSION: Self-sampling for diagnostic testing is well accepted with the majority having a positive experience and willingness to use again. Standardization of self-sampling procedures and rigorous validation of outcome measurement will lead to better comparability across studies. Future studies need to conduct rigorous economic evaluations of self-sampling to inform policy development for the management of STI

The usefulness of health education materials in GP waiting rooms: cross-sectional study

Background: More than half of patients in the UK wait between 5 and 15 minutes before seeing the GP, and this time in the waiting room (WR) provides an ideal opportunity for patient education. Aim: To assess patients’ perceptions of the usefulness, noticeability and attractiveness of health education materials (HEMs); and the variety, number, topics, design and accessibility of these HEMs. Method: An anonymous questionnaire was distributed to patients in the WR to assess their use of health information and perceptions of HEMs. A survey measured the availability of HEMs in the WR and evaluated their quality against 16 accessibility and design criteria. Results: A total of 556 questionnaires were completed (response rate 97.9%). On average, WRs contained 72 posters covering 23 topics, and 53 leaflets covering 24 topics. Multivariate analysis showed that patients’ perception of usefulness was significantly associated with reading in the WR, using written HEMs, and not having a university degree; whilst noticeability was associated with reading in the WR, and being female. Attractiveness was associated with not having a university degree and shorter waiting time. Conclusion: This study suggests that a wide variety of HEMs are available, and that many patients find them useful and noticeable, however, fewer find them well-designed and attractive. Future research should focus on the effectiveness of generally available HEMs at changing knowledge, attitudes, intentions, and behaviours; and utilising technology to deliver innovative means of providing patient health information

Protocol: Which variables are useful for phenotyping dementia in primary care records? A meta-analysis

Dementia is usually identified in primary care by general practitioners (GPs) and most identified patients are referred on to memory assessment clinics for formal diagnosis. However, epidemiological studies suggest only 50% of dementia cases are recorded in general practice. The UK government and the NHS have made increasing diagnosis rates a strategic priority. A range of indicators in the primary care record are likely to be predictive of patients at high risk of dementia and could be combined in a predictive model to help increase diagnosis rates. As part of the Wellcome Trust funded ASTRODEM study, we aim to conduct a systematic review and meta-analysis to identify conditions and medications previously found to be associated with dementia in primary care records

[Study Protocol] Health and wellbeing issues of Nepalese migrant workers in Gulf Countries and Malaysia: a systematic review

Nepal is a low-income country going through a demographic transition with an aging population and attendant chronic diseases. Approximately 3.8 million Nepalese (14% of the total population) work abroad (excluding India). Remittance contributes 27% of nation's Gross Domestic Product (GDP). Malaysia and the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE) have been the most attractive destinations for migration, contributing to 85% of labour migration. Working migrants send home £6 billion every year, one third of the national income, but at great cost to migrants, their families and to the nation. Many Nepalese die abroad every year, and more return home with debilitating injuries, mental and physical illness and often silent risks of transmitting sexual or other infectious diseases at home. As part of the Global Challenge Research Fund (GCRF) study, we aim to conduct a systematic review to summarise the evidence on health and wellbeing of Nepalese migrant workers in GCC countries and Malaysia

Respiratory symptoms and cross-shift lung function in relation to cotton dust and endotoxin exposure in textile workers in Nepal: a cross-sectional study

Objectives: Inhalation of a cotton-based particulates has previously been associated with respiratory symptoms and impaired lung function. This study investigates the respiratory health of Nepalese textile workers in relation to dust and endotoxin exposure. Methods: A total of 938 individuals from four sectors (garment, carpet, weaving and recycling) of the textile industry in Kathmandu, Nepal completed a health questionnaire and performed spirometry. A subset (n=384) performed cross-shift spirometry. Personal exposure to inhalable dust and airborne endotoxin was measured during a full shift for 114 workers. Results: The overall prevalence of persistent cough, persistent phlegm, wheeze ever, breathlessness ever and chest tightness ever was 8.5%, 12.5%, 3.2%, 6.5% and 12.3%, respectively. Symptoms were most common among recyclers and least common among garment workers. Exposure to inhalable dust significantly predicted persistent cough and chest tightness. Exposure to endotoxin did not have any independent predictive effect. Significant cross-shift reduction in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were found (p<0.001 for both) being largest for FEV1 in the recyclers (−143 mL), and least in the garment workers (−38 mL; p=0.012). Exposure to inhalable dust predicted a cross-shift reduction in FEV1. Conclusions: This study is the first to investigate the respiratory health of Nepalese cotton workers. The measured association between inhalable dust exposure and reporting of respiratory symptoms and across-shift decrement in FEV1 and FVC indicates that improved dust control measures should be instituted, particularly in the recycling and carpet sectors. The possible role of other biologically active agents of cotton dust beyond endotoxin should be further explored

Meditation for asthma: systematic review and meta-analysis

Objective: To conduct a comprehensive review and meta-analysis of the effectiveness of meditation on a variety of asthma outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO and AMED in June 2016 to identify randomised controlled trials (RCTs) investigating the effectiveness of meditation in adults with asthma. No restriction was put on language or year of publication. Study quality was assessed using The Cochrane Risk of Bias Assessment Tool. Meta-analysis was carried out using RevMan 5.3. Results: Four RCTS involving 201 patients met the inclusion criteria. Quality of studies was inconsistent with only one study reporting adequate allocation concealment. Disease-specific quality of life was assessed in two trials; a pooled result involving 62 intervention and 65 control participants indicated a significant improvement in quality of life in the meditation group compared to the control group (SMD 0.40, 95% CI 0.05 to 0.76). A pooled result from all four studies indicated the uncertain effect of meditation in forced expiratory volume in one second (FEV1) (SMD −0.67, 95% CI −2.17 to 0.82). Results from the individual trials suggest that meditation may be helpful in reducing perceived stress and the use of short-term rescue medication. Conclusion: Our review suggests that there is some evidence that meditation is beneficial in improving quality of life in asthma patients. As two out of four studies in our review were of poor quality, further trials with better methodological quality are needed to support or refute this finding

Readability, presentation and quality of allergy-related patient information leaflets: a cross sectional and longitudinal study

Objective: Patient information leaflets (PILs) are widely used to reinforce or illustrate health information and to complement verbal consultation. The objectives of the study were to assess the readability and presentation of PILs published by Allergy UK, and to conduct a longitudinal assessment to evaluate the impact of leaflet amendment and revision on readability. Methods: Readability of Allergy UK leaflets available in 2013 was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch-Kincaid Reading Grade Formula. Leaflet presentation was evaluated using the Clear Print Guidelines of the Royal National Institute of Blind People (RNIB) and the Patient Information Appraisal System developed by the British Medical Association (BMA). Changes in the leaflets’ readability scores over five years were investigated. Results: 108 leaflets, covering a wide range of allergic conditions and treatment options, were assessed. The leaflets had average SMOG and Flesch-Kincaid scores of 13.9 (range 11-18, SD 1.2) and 10.9 (range 5-17, SD 2.1) respectively. All leaflets met the RNIB Clear Print guidelines, with the exception of font size which was universally inadequate. The leaflets scored on average 10 (median 10, range 7-15) out of a maximum of 27 on the BMA checklist. The overall average SMOG score of 31 leaflets available in both 2008 and 2013 had not changed significantly. The process of leaflet revision resulted in 1% change in readability scores overall, with a predominantly upward trend with six leaflets increasing their readability score by >10% and only three decreasing by >10%. Conclusion: Allergy-related patient information leaflets are well presented but have readability levels that are higher than those recommended for health information. Involving service users in the process of leaflet design, together with systematic pre-publication screening of readability would enhance the accessibility and comprehensibility of written information for people with allergy and their careers

Qualitative study on mental health and well-being of Syrian refugees and their coping mechanisms towards integration in the UK

Objective This study aimed to explore the mental well-being of Syrian refugees and identify their coping mechanisms and pathways towards integration into new communities. Design Qualitative study using in-depth semi-structured interviews. Setting and participants Adult Syrian refugees (>18 years old) currently residing in South East of England. Results 12 participants (3 women and 9 men) took part in the study, all were born in Syria and the majority (n=9) were over 45 years of age. Our findings show that Syrian refugees face constant challenges as they try to integrate into a new society. Loss of and separation from loved ones as well as the nostalgia for the homeland were often cited as a source of psychological distress that created an overwhelming sense of sadness. Participants reported that they struggled for connectedness due to cultural difference and the problematic nature of rapidly formed migrant communities in their new setting. They believed in ‘being their own doctor’ and turning to faith, ritual and nature for healing and comfort. Taboo and stigma around mental health and language barriers were cited as barriers to accessing mental healthcare services. Conclusion Past experiences and present challenges frame Syrian refugees’ sense of well-being, impact use of healthcare and risk future mental health problems. It is hoped that this study will act as a catalyst for further research on this vulnerable group to promote integration, community support and culturally sensitive mental health services

A systematic review and meta-analysis of complementary and alternative medicine in asthma

Asthma is a chronic, inflammatory lung disease affecting around 235 million people worldwide. Conventional medications in asthma are not curative and patients have significant concerns regarding their side effects. Consequently, many asthma patients turn to Complementary and Alternative Medicine (CAM) for a more holistic approach to care. We systematically reviewed the available evidence on the effectiveness of CAM in the management of asthma in adults. We searched MEDLINE, EMBASE, CINAHL, AMED and Cochrane Databases for randomised controlled trials published in English between 1990 to 2016 investigating the effectiveness of oral or topical CAM in asthmatic adults. Quality of the studies was assessed using The Cochrane Risk of Bias Assessment Tool. RevMan 5.3 was used for meta-analysis. In all, 24 eligible trials were identified covering 19 different CAMs. Overall, there was limited evidence on the effectiveness of CAM in adult asthma as most CAMs were assessed in a single trial only. CAMs with multiple trials provided null or inconsistent results. Many of the trials were rated as having high risk of bias. The existing evidence is insufficient to recommend any of the oral and topical CAMs in the management of asthma in adults

Health and well-being issues of Nepalese migrant workers in the Gulf Cooperation Council countries and Malaysia: a systematic review

Objective To summarise the evidence on health and well-being of Nepalese migrant workers in the Gulf Cooperation Council (GCC) countries and Malaysia. Design Systematic review. Data sources EMBASE, MEDLINE, Scopus and Global Health databases. Eligibility criteria Studies were eligible if they: (1) included Nepalese migrant workers aged 18 or older working in the GCC countries or Malaysia or returnee migrant workers from these countries; (2) were primary studies that investigated health and well-being status/issues; and (3) were published in English language before 8 May 2020. Study appraisal All included studies were critically appraised using Joanna Briggs Institute study specific tools. Results A total of 33 studies were eligible for inclusion; 12 studies were conducted in Qatar, 8 in Malaysia, 9 in Nepal, 2 in Saudi Arabia and 1 each in UAE and Kuwait. In majority of the studies, there was a lack of disaggregated data on demographic characteristics of Nepalese migrant workers. Nearly half of the studies (n=16) scored as ‘high’ quality and the rest (n=17) as ‘moderate’ quality. Five key health and well-being related issues were identified in this population: (1) occupational hazards; (2) sexual health; (3) mental health; (4) healthcare access and (5) infectious diseases. Conclusion To our knowledge, this is the most comprehensive review of the health and well-being of Nepalese migrant workers in the GCC countries and Malaysia. This review highlights an urgent need to identify and implement policies and practices across Nepal and destination countries to protect the health and well-being of migrant workers