This systematic review and meta-analysis assessed the effectiveness of smoking cessation interventions among women smokers in low socio-economic status (SES) groups or women living in disadvantaged ...areas who are historically underserved by smoking cessation services.
A systematic literature search was conducted using MEDLINE (OVID), EMBASE, Cochrane, CINAHL, PsychINFO and Web of Science databases. Eligibility criteria included randomised controlled trials of any smoking cessation intervention among women in low SES groups or living in socio-economically disadvantaged areas. A random effects meta-analysis assessed effectiveness of interventions on smoking cessation. Risk of bias was assessed with the Cochrane Risk of Bias tool. The GRADE approach established certainty of evidence.
A total of 396 studies were screened for eligibility and 11 (6153 female participants) were included. Seven studies targeted women-only. 5/11 tested a form of face-to-face support. A pooled effect size was estimated in 10/11 studies. At end of treatment, two-thirds more low SES women who received a smoking cessation intervention were more likely to stop smoking than women in control groups (risk ratio (RR) 1.68, 95% CI 1.36-2.08, I
= 34%). The effect was reduced but remained significant when longest available follow-up periods were pooled (RR 1.23, 95% CI 1.04-1.48, I
= 0%). There was moderate-to-high risk of bias in most studies. Certainty of evidence was low.
Behavioural and behavioural + pharmacotherapy interventions for smoking cessation targeting women in low SES groups or women living in areas of disadvantage were effective in the short term. However, longer follow-up periods indicated reduced effectiveness. Future studies to explore ways to prevent smoking relapse in this population are needed.
PROSPERO: CRD42019130160.
The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, ...motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks.
A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience.
Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks.
This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.
IntroductionWomen who inherit a pathogenic mutation in Breast Cancer Susceptibility Genes 1 or 2 (BRCA1 or BRCA2) are at substantially higher risk of developing breast and ovarian cancer than the ...average woman. Several cancer risk management strategies exist to address this increased risk. Decisions about which risk management strategies to choose are complex, personal and multifactorial for these women. This scoping review will map evidence relevant to cancer risk management decision making in BRCA mutation carriers without a personal history of cancer. The objective is to identify and describe the features of patient decision aids that have been developed for BRCA mutation carriers. This information may be beneficial for designing new decision aids or adapting existing decision aids to support decision making in this population.Methods and analysisThis scoping review will be conducted according to the Joanna Briggs Institute’s scoping review methodological framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used for guidance. Studies on decision aids for women with a BRCA mutation who are unaffected by breast or ovarian cancer will be considered for inclusion. Five electronic databases will be searched (MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science) with no restrictions applied for language or publication date. Studies for inclusion will be selected independently by two review authors. Data will be extracted using a predefined data extraction form. Findings will be presented in tabular form. A narrative description of the evidence will complement the tabulated results.Ethics and disseminationEthical approval for conducting this scoping review is not required as this study will involve secondary analysis of existing literature. Findings will be published in a peer-reviewed journal and presented at relevant conferences.
Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning ...as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making.
To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting.
A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development.
This protocol has been submitted for registration on PROSPERO, registration number CRD42020189568 and is awaiting review.
Background:
Achieving adequate amounts of physical activity (PA) confers important physical and mental health benefits. Despite this, people with mental health conditions often do not meet ...recommended levels of PA. eHealth, the delivery of health information through internet and mobile technologies, is an emerging concept in healthcare which presents opportunities to improve PA. The aim of this systematic review is to describe the use of eHealth to increase or monitor PA levels in people with mental health conditions.
Methods:
Databases searched included OVID Medline, EMBASE, PsychInfo and Web of Science using a combination of key-words and medical subject headings. Articles were included if they described an eHealth technology designed to improve or monitor PA in people with mental health conditions. Two reviewers screened articles. Articles included in the qualitative synthesis were screened for risk of bias using the Cochrane Risk of Bias Tool for experimental studies and Downs and Black Checklist for non-experimental studies.
Results:
Seven studies met the eligibility criteria. A variety of eHealth platforms designed to promote or monitor PA were described in these studies; web-based (n=4), web and mobile application (n=3) and e-mail-based (n=1), one study used both a web-based and mobile application. Three studies reported eHealth interventions significantly increased PA levels, however it is unclear if eHealth interventions are superior at promoting PA compared to conventional interventions. Four studies reported that higher levels of PA, measured using eHealth, were associated with better mental health profiles.
Conclusion:
eHealth interventions may be an innovative low-cost method to increase PA levels which may have knock-on effects on mental health outcomes. Although some of the included studies in this review demonstrated promising results, methodological restrictions and potential biases from using subjective measures of PA limit the interpretability of these results. Future research should evaluate this promising technology using well-designed trials.
Background:
Achieving adequate amounts of physical activity (PA) confers important physical and mental health benefits. Despite this, people with mental health conditions often do not meet ...recommended levels of PA. eHealth, the delivery of health information through internet and mobile technologies, is an emerging concept in healthcare which presents opportunities to improve PA. The aim of this systematic review is to describe the use of eHealth to increase or monitor PA levels in people with mental health conditions.
Methods:
Databases searched included OVID Medline, EMBASE, PsychInfo and Web of Science using a combination of key-words and medical subject headings. Articles were included if they described an eHealth technology designed to improve or monitor PA in people with mental health conditions. Two reviewers screened articles. Articles included in the qualitative synthesis were screened for risk of bias using the Cochrane Risk of Bias Tool for experimental studies and Downs and Black Checklist for non-experimental studies.
Results:
Seven studies met the eligibility criteria. A variety of eHealth platforms designed to promote or monitor PA were described in these studies; web-based (n=4), web and mobile application (n=3) and e-mail-based (n=1), one study used both a web-based and mobile application. Three studies reported eHealth interventions significantly increased PA levels, however it is unclear if eHealth interventions are superior at promoting PA compared to conventional interventions. Four studies reported that higher levels of PA, measured using eHealth, were associated with better mental health profiles.
Conclusion:
eHealth interventions may be an innovative low-cost method to increase PA levels which may have knock-on effects on mental health outcomes. Although some of the included studies in this review demonstrated promising results, methodological restrictions and potential biases from using subjective measures of PA limit the interpretability of these results. Future research should evaluate this promising technology using well-designed trials.
Purpose
To determine the effect of resistance training during adjuvant chemotherapy and radiation therapy in cancer patients on measures of lean mass and muscle strength. Secondary aims were to ...analyse the prescription and tolerability of supervised resistance training in this population.
Methods
EMBASE, Medline, CINAHL, Cochrane Library and Web of Science were searched from inception until 29 March 2021. Eligible randomised controlled trials (RCTs) examining supervised resistance training > 6 weeks duration during adjuvant chemotherapy and/or radiation therapy in cancer patients with objective measurement of muscle strength and/or lean mass were included. The meta-analysis was performed using Revman 5.4.
Results
A total of 1910 participants from 20 articles were included (mean age: 54 years, SD = 10) and the majority were female (76.5%). Resistance training was associated with a significant increase in upper body strength (standardised mean difference (SMD) = 0.57, 95% CI 0.36 to 0.79,
I
2 = 64%,
P
< 0.0001), lower body strength (SMD = 0.58, 95% CI 0.18 to 0.98,
I
2 = 91%,
P
= 0.005), grip strength (mean difference (MD) = 1.32, 95% CI 0.37 to 2.27,
I
2 = 0%,
P
< 0.01) and lean mass (SMD = 0.23, 95% CI 0.03 to 0.42,
I
2 = 0%,
P
= 0.02). A
P
value of < 0.05 was considered statistically significant. The quality of the studies included was moderate to high with low risk of bias as per the PEDro scale.
Conclusion
Resistance training is an effective adjunct therapy to improve muscle strength and lean mass in cancer patients undergoing chemotherapy and/or radiation therapy.
PROSPERO Registration Number
CRD42020180643
Exercise has been shown to play an important role in managing chemotherapy-related side effects, preserving skeletal muscle mass, and attenuating decline in cardiorespiratory fitness associated with ...chemotherapy treatment, however, the feasibility of how these exercise programs are being delivered has yet to be synthesized. The objective of this review was to measure the rates of recruitment, adherence, and retention to exercise programs delivered for cancer patients during chemotherapy.
Relevant studies were identified through a search of MEDLINE, Cochrane, EMBASE and CINAHL databases from January 2002 to July 2022 using keywords relating to exercise interventions during chemotherapy. Title and abstract screening, full text review, data extraction, and quality assessment were all performed independently by two reviewers.
A total of 36 studies were included in the review. The mean recruitment rate for the included studies was 62.39% (SD = 19.40; range 25.7–95%). Travel was the most common reason for declining recruitment in these trials. Adherence rates ranged from 17–109%, however the definition of adherence varied greatly between studies. Mean retention rates for the exercise groups was 84.1% (SD = 12.7; range 50–100%), with chemotherapy side effects being the most common reason why participants dropped out of these trials.
Multiple challenges exist for cancer patients during chemotherapy and careful consideration needs to be given when designing an exercise program for this population. Future research should include public and patient involvement to ensure exercise programs are pragmatic and patient centred.
Display omitted
•Home-based exercise has higher recruitment rates compared to supervised interventions.•Travel was the most common reason for declining recruitment to exercise interventions.•Aerobic exercise has better adherence rates compared to resistance exercise.•In-person exercise has higher retention rates compared to home-based exercise.
Summary
To date, there has been no systematic analysis of the literature regarding health‐related quality of life in narcolepsy. This systematic review aimed to examine the impact of narcolepsy on ...health‐related quality of life, measured through standardised health‐related quality of life questionnaires such as the Short Form 36 and Functional Outcome of Sleep Questionnaire. The following databases: Medline, Embase, Cinahl, and Web of Science were searched for studies that investigated health‐related quality of life in adults with narcolepsy. Studies were reviewed independently by two reviewers, and a random‐effects meta‐analysis was performed. A total of 30 studies were eligible for inclusion in the review. Additionally, meta‐analyses were conducted for the Short Form 36 and the EQ5D. The Short Form 36 meta‐analysis identified that the pooled mean scores for the Physical Component Summary (45.91) were less affected than the Mental Component Summary (42.98). People with narcolepsy experience substantially lower health‐related quality of life when compared with the general population norms of the USA, UK, France and Norway, as well as compared with people with chronic diseases such as multiple sclerosis, diabetes, hypertension and epilepsy. Further research is warranted to identify the longitudinal effects of narcolepsy on health‐related quality of life, and to develop a narcolepsy‐specific health‐related quality of life tool.
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