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Comparing the treatment of endometriosis‐related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study
No full textAbstractObjectiveTo compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis‐related symptoms.DesignMulticentre prospective cohort.SettingEighty‐six specialist endometriosis centres.PopulationWomen undergoing rectovaginal endometriosis surgery between 2009 and 2021.MethodsWe performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow‐up.Main Outcome MeasuresPain scores, bowel symptoms and quality‐of‐life measures.ResultsCompared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non‐cyclical pain (MD: 1.41/10, 95% CI: 1.03–1.78, p </p
N-of-1 Trial of Angina Verification Before Percutaneous Coronary Intervention
No full textBackground: In stable coronary artery disease, 30% to 60% of patients remain symptomatic despite successful revascularization. Perhaps not all symptoms reported by a patient with myocardial ischemia are, in fact, angina. Objectives: This study sought to determine whether independent symptom verification using a placebo-controlled ischemic stimulus could distinguish which patients achieve greatest symptom relief from percutaneous coronary intervention (PCI). Methods: ORBITA-STAR was a multicenter, n-of-1, placebo-controlled study in patients undergoing single-vessel PCI for stable symptoms. Participants underwent 4 episodes (60 seconds each) of low-pressure balloon occlusion across their coronary stenosis, randomly paired with 4 episodes of placebo inflation. Following each episode, patients reported the similarity of the induced symptom in comparison with their usual symptom. The similarity score ranged from −10 (placebo replicated the symptom more than balloon occlusion) to +10 (balloon occlusion exactly replicated the symptom). The primary endpoint was the ability of the similarity score to predict symptom relief with PCI. Results: Fifty-one patients were recruited, aged 62.9 ± 8.6 years. The median fractional flow reserve was 0.68 (Q1-Q3: 0.57-0.79), and the instantaneous wave-free ratio was 0.80 (Q1-Q3: 0.48-0.89). The median similarity score was 3 (Q1-Q3: 0.875-5.25). The similarity score was a strong predictor of symptom improvement following PCI: a patient with an upper quartile similarity score of 5.25 was significantly more likely to have lower angina frequency at follow-up (OR: 8.01; 95% credible interval: 2.39-15.86) than a patient with a lower quartile similarity score of 0.875 (OR: 1.31; 95% credible interval: 0.71-1.99), Pr(difference) >99.9%. Conclusions: Similarity score powerfully predicted symptom improvement from PCI. These data lay the foundation for independent symptom mapping to target PCI to those patients most likely to benefit. (Systematic Trial of Angina Assessment Before Revascularization [ORBITA-STAR]; NCT04280575
Perception of Type 2 Diabetes Mellitus (T2DM) patients on diabetes self-care management in Fiji
No full textIntroduction
The prevalence of diabetes has increased globally where Type 2 Diabetes Mellitus (T2DM) is more common than any other type of diabetes. Self- care management education of diabetes provides skills and information for diabetic patients to effectively perform their own self diabetic self-care for optimum glycemic index control. As T2DM is a growing health issue in Fiji, promoting diabetes self manages among patients is a need, however there is lack of evidence in this regard. Therefore, the aim of this study is to explore the perception of T2DM patients on diabetic self-care management.
Method
This study used a qualitative method among T2DM patients regarding diabetic self-care management in Central Division, Fiji in 2022. This study was conducted in SOPD (Special Out Patient Department) clinics in the three chosen governmental health centers in the central division of Fiji. The study sample inclusion criteria were only T2DM patients, and no other types of diabetes, patients who are 18years and above, patients who are attending clinic at least for more than 6 months, self-identified as Fijian participants of any ethnicity or gender. The study settings were also purposively selected but the study sample was selected using purposive sampling. In depth interview using semi-structured open-ended questionnaires was used to collect data. Thematic analysis was done, followed by reviewing themes, defining and naming them.
Results
Thirty patients participated in this study. Five major themes emerged from the in-depth interview including; patient factors that affect diabetes self-care management, behavior and attitude towards T2DM self-care management, health services delivery, challenges and barriers faced by patients to perform diabetes self-care management, and recommendations to improve patient self-care management. Patients in this study have good knowledge about T2DM and the self-care management they have to perform. It is the patients’ attitude and behavior towards T2DM self-care management that affects patients to perform self-care management. The study also showed patients have gained good knowledge from Health Care Workers (HCW). Socio-economic and psychological status also played a vital part in patients’ self-care management. Apart from challenges, there were opportunities to learn the difficulties patients face in order to perform self-care management.
Conclusion
The results of this study revealed a combination of individual, cultural, and health systematic related factors as the mots influencer of diabetes self-management among patients in Fiji. Patients have to take ownership of their own health in order to improve their blood sugar reading and reduce complication of diabetes. Tailored interventions that consider patients’ belief and address potential challenges would be useful. A lot is needed in terms of upgrading facilities for the comfort of patients and need to collaborate more with other multidisciplinary team and stakeholders.</p
Psychosocial alterations during the COVID-19 pandemic and the global burden of anxiety and major depressive disorders in adolescents, 1990–2021: challenges in mental health amidst socioeconomic disparities
No full textBackground
The coronavirus disease 2019 (COVID-19) pandemic, a global health crisis, profoundly impacted all aspects of daily life. Adolescence, a pivotal stage of psychological and social development, is heavily infuenced by the psychosocial and socio-cultural context. Hence, it is imperative to thoroughly understand the psychosocial changes adolescents experienced during the pandemic and implement efective management initiatives.
Data sources
We examined the incidence rates of depressive and anxiety disorders among adolescents aged 10–19 years globally and regionally. We utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to compare pre-pandemic (2018–2019) and pandemic (2020–2021) periods. Our investigation covered 204 countries and territories across the six World Health Organization regions. We conducted a comprehensive literature search using databases including PubMed/MEDLINE, Scopus, and Google Scholar, employing search terms such as “psychosocial”, “adolescent”, “youth”, “risk factors”, “COVID-19 pandemic”, “prevention”, and “intervention”.
Results
During the pandemic, the mental health outcomes of adolescents deteriorated, particularly in terms of depressive and anxiety disorders. According to GBD 2021, the incidence rate of anxiety disorders increased from 720.26 [95% uncertainty intervals (UI)=548.90–929.19] before the COVID-19 pandemic (2018–2019) to 880.87 per 100,000 people (95% UI=670.43–1132.58) during the COVID-19 pandemic (2020–2021). Similarly, the incidence rate of major depressive disorder increased from 2333.91 (95% UI=1626.92–3138.55) before the COVID-19 pandemic to 3030.49 per 100,000 people (95% UI=2096.73–4077.73) during the COVID-19 pandemic. This worsening was notably pronounced in high-income countries (HICs). Rapid environmental changes, including heightened social anxiety, school closures, economic crises, and exacerbated racism, have been shown to adversely afect the mental well-being of adolescents.
Conclusions
The abrupt shift to remote learning and the absence of in-person social interactions heightened feelings of loneliness, anxiety, sadness, and stress among adolescents. This change magnifed existing socioeconomic disparities, posing additional challenges. These complexities profoundly impact adolescents’ well-being, especially vulnerable groups like those from HICs, females, and minorities. Acknowledging the underreporting bias in low- to middle-income countries highlights the importance of addressing these mental health alterations in assessments and interventions within these regions as well. Urgent interventions are crucial as the pandemic-induced mental stress may have lasting efects on adolescents’ mental health. </p
UK female veterans’ physical health: perceived impact of military service and experiences of accessing healthcare. Findings of a qualitative study
No full textIntroduction
Women make up almost 14% of the UK’s veteran population; however, little is known about female veterans’ physical health and experiences of accessing healthcare after military service. As part of a qualitative study to understand female veterans’ experiences of statutory and charitable support, participants were asked if they felt anything about their military service had impacted their physical health as civilians. They were also asked about their experiences with accessing healthcare and any associated challenges. The aim of this paper is to outline participants’ responses to inform the development of further research.
Methods
85 women who had served in the British Armed Forces took part in semistructured interviews conducted via Microsoft Teams between June and December 2022. Reflexive thematic analysis of interview transcripts was conducted to identify, analyse and report repeated patterns in responses to questions.
Results
Participants reported a range of physical health consequences that they attributed to military service. These included injuries sustained during training and deployment, ‘wear and tear’ through training and the impact of sometimes unsuitable clothing. They reported chronic pain, tendonitis, arthritis, slipped discs, broken bones and hearing loss. Some described their lives as severely restricted as a result. Challenges to accessing healthcare included perceived stigma associated with help-seeking, inconsistency around the transfer of medical records and a widespread lack of veteran awareness among civilian healthcare professionals.
Conclusions
There is a distinct lack of research in the UK against which to compare these findings; thus, further research is required in all areas of female veterans’ physical health and experiences of accessing healthcare. Research should begin by establishing the nature and prevalence of health conditions among female and male veterans to identify the unique needs of both and tailor support accordingly.</p
The Effect of Public Tolerance towards Corruptive Behaviour on Healthcare Efficiency and Equity – The Case of the UK’s COVID-19 Vaccination Programme
No full textOver the past four years, the COVID-19 pandemic has caused significant uncertainty, suffering, and economic disruption worldwide. Consequently, governments have faced pressure to ensure fair vaccine access while achieving vaccination targets quickly. Such challenging circumstances can create opportunities for nepotism and bribery, increasing attention to corruption risks associated with the pandemic response. This study investigates the relationship between public attitudes towards corruptive behaviour and the efficiency and equity of the UK's COVID-19 vaccination programme. It combines primary data on public tolerance towards corruptive behaviour with secondary data on the efficiency of the vaccination program at the local authority level in England and Scottland. We employ a survival analysis approach, estimating Cox Proportional Hazards Models, which examine the time taken to reach vaccination targets. Our findings suggest moderate tolerance towards nepotism/favouritism and bribery among the British public, with 28% of survey participants considering monetary bribery and 34% considering nepotism/favouritism as acceptable means to secure early vaccination access. Moreover, while public tolerance towards corruptive behaviour generally had a negative impact on the efficiency of the vaccination programme, it appears to have expedited the vaccination rollout in politically aligned local authorities governed by the Conservative and Unionist Party. However, this positive effect on efficiency appears to have come at the expense of reduced equity in vaccine distribution. These findings underscore the trade-off between efficiency and equity in vaccine distribution during public health crises, emphasising the need for health policies that balance efficiency with equity to ensure fair and effective distribution of vaccines in the future.</p
Using Literature Reviews to Research Marginalized Groups: The Case of Research on Carers in Higher Education
No full textIn this case study we reflect on a review we conducted of the English-language research literature on carers in academia. For the purpose of this study, we define a carer as an individual who self-identifies as having caring responsibilities, including, but not limited to, individuals looking after children, parents, grandparents, other relatives, and friends. This emerging field is expanding quickly, possibly because the COVID-19 pandemic has generated new interest in the ways care work intersects with other work. Researching care is a matter of social justice because care work has culturally been associated with women and marginalized groups and undervalued. Academic cultures have been described as “care?less” through their misrecognition of care. Similar in this to higher education itself, research on higher education turns care into an absent presence. Consistent with the feminist poststructuralist theories informing our work, we call for critical literature reviews that reflect on who and what gets to be repre?sented and how in research texts, taking carers in academia as an example. In addition to describing the tools and techniques we used to identify and categorize the research texts, we discuss the repre?sentations of various categories of carers in the literature. Drawing on an analysis of 158 texts that met the inclusion criteria, we contend that the literature tends to consolidate a number of cultural norms, including a representation of care work as “women’s work” and a model of the family that fails to cap?ture the diversity of family norms. We point out the need for reflexivity to appreciate how processes of knowledge production can contribute to the reproduction, or challenge, of social injustices.</p
“I Am Actually Scared of Everyone”: Older Adults’ Experiences of Social Isolation during COVID-19: A Qualitative Systematic Review
No full textThe emergence of the coronavirus COVID-19 in December 2019 in Wuhan, China, affected all facets of people’s lives worldwide. As a result of the severity of the pandemic, governments worldwide adopted several policies and containment measures, such as social isolation, especially for vulnerable populations, including older adults. This study aimed to explore these older adults’ experiences of social isolation during COVID-19. A systematic review method based on the PRISMA protocol was used, and five databases (EMBASE, PsycINFO, PsycEXTRA, CINAHL, and Medline) were comprehensively searched. Studies were limited to those published between 2020 and 2023. Thirteen qualitative studies met the inclusion criteria and were analysed thematically. A thematic analysis identified the following five major themes: intense feeling of loneliness due to social isolation; use of social media as a coping mechanism during social isolation; anxiety during social isolation; fear during social isolation; and financial security during social isolation. This review provides useful information on how to mitigate the effects of social isolation on the elderly population during future public health crises.</p
Extending the job demands–resources model to understand the effect of the interactions between home and work domains on work engagement
No full textScholars have extensively used the job demands–resources model to explain the dynamics underlying work engagement and proposed several versions of the model. However, in theoretical terms, nonwork elements have not been incorporated into the model. This study investigated the roles of home demands and resources in the model by testing the boost/buffer hypotheses for work engagement from the perspective of the work–home interface. We demonstrated that (1) the demands of a domain boost the positive impact of resources drawn from another domain on work engagement, (2) the resources of a domain buffer the negative impact of demands derived from another domain on work engagement; and (3) the buffering and boosting effects of home demands and resources impact work engagement. We conducted a diary study on a group of coffee shop employees in Ireland. The results partially supported the proposed hypotheses but nevertheless indicated support for the cross‐domain boost/buffer hypotheses with regard to work engagement. The proposed model may serve as a theoretical foundation for research on issues related to the impact of work and nonwork domains on work engagement. </p
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