Conectar
Adolescents and young adults (AYAs) in low- and middle-income countries (LMICs) are at high risk of harmful sexual and reproductive health (SRH) practices due to limited knowledge, low availability or acceptability of modern contraceptives, gender inequality and cultural practices like child marriage. Preventive and educational interventions by lay health workers or through technological means are a cost-effective and scalable solution. Unfortunately, too little is currently known about the scope, content and conditions of the effectiveness and sustainability of these approaches and synthetic evidence on this topic is scarce. To help fill this knowledge gap and to identify where further research is needed, we will conduct a scoping review of technology-based or lay health-worker delivered preventive and educational SRH interventions targeting AYAs in LMICs. This information is valuable to both policymakers and researchers as it provides a synthesis of existing interventions, highlights best practices for their implementation and identifies potential avenues for future research.
This review will include studies on SRH preventive and educational interventions targeting AYAs aged 10–24 years in LMICs. It encompasses interventions delivered by lay health workers or via technological means, assessing various outcomes including but not limited to SRH literacy, sexual risk behaviours, pregnancies, sexually transmitted infections and gender-based violence. Key databases, including PubMed via MEDLINE and Embase, will be searched from 1 January 2000 up to 23 January 2024, using a comprehensive search strategy. Screening will be conducted using Covidence software. Data extraction will cover study details, methods, intervention strategies, outcomes and findings. A narrative synthesis will be conducted following synthesis without meta-analysis guidelines.
The scope of this scoping review is limited to publicly accessible databases that do not require prior ethical approval for access. The findings will be disseminated through peer-reviewed journal publications, as well as presentations at national and international conferences and stakeholder meetings in LMICs.
The final protocol is prospectively registered with the Open Science Framework on 7 May 2024 (osf.io/vna2z).
To explore the perspectives and experiences of maternity care providers regarding obstetric violence across low-, middle-, and high-income countries.
An integrative review of the literature.
A systematic literature search in CINAHL, Medline (via Ovid), SCOPUS, and the Cochrane Library was conducted from 2014 to 2024. Further papers were identified through a review of the reference lists of identified studies and through email alerts from searched databases. Articles were appraised using the applicable Joanna Briggs Institute qualitative or cross-sectional critical appraisal tool.
Title and abstract screen were undertaken on 2748 records. Fifty-four studies using qualitative, quantitative, and mixed-methods designs were included. Maternity providers across all socio-economic levels described witnessing, and/or involvement in both respectful care and incidents of obstetric violence. The most common forms of obstetric violence were verbal and physical abuse, coercion, unconsented and unnecessary interventions, and violations of privacy and autonomy. Women who were socially marginalised, impoverished, and illiterate were vulnerable to obstetric violence. Differences were noted between low- and high-income countries, with detention of women for non-payment, privacy violations due to building design and lack of space, mistreatment due to HIV status, and women who were considered non-compliant being more vulnerable to obstetric violence in low-and low-middle-income countries. Obstetric violence was justified and normalised in the name of saving the baby, with less focus on the psychological health of the mother.
Our findings demonstrate that obstetric violence is a gender-based violence enabled through patriarchal structures and power imbalances. Maternity providers are witnessing or enacting obstetric violence across low-, middle- and high-income countries, with significant impacts on women and maternity care providers alike. This review highlights opportunities for further research and action to develop health and legal frameworks to prevent instances of obstetric violence and improve outcomes for women and maternity care providers.
A woman-centred approach underpinned by respectful maternity care has benefits for pregnant and birthing women. Obstetric violence, including verbal and physical abuse, coercion, and overmedicalisation, is prevalent in maternity services globally. This integrative review explored the perspectives and experiences of maternity care providers regarding obstetric violence across low-, middle-, and high-income countries. This review highlights the similarities and differences of witnessed, enacted, and perceived obstetric violence from the experience of maternity care providers. This review identifies the covert and overt nature of obstetric violence across low-, middle- and high-income countries. Gaining insight into provider perspectives across low-, middle-, and high-income countries may inform policy and practice reforms to eliminate obstetric violence and advance the provision of respectful maternity care.
This integrative review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
No patient or public contribution.
Diagnosis in the early stages of dementia can lead to successful delay in associated cognitive decline. However, up to 76% of Australians diagnosed with dementia have already advanced beyond the early stage of disease. BrainTrack is an evidence-based mobile application (app) designed in Australia to promote brain health self-awareness, self-determination to promote help-seeking and, ultimately, a timelier dementia diagnosis. We will evaluate user experience, implementation and social return-on-investment outcomes of BrainTrack and will report dementia-related concerns, dementia literacy, knowledge, stigma and motivation for behaviour change and explore their associations with demographic characteristics.
A multimethods, concurrent, two-study observational design will be used. Study 1 will evaluate BrainTrack user experience and implementation outcomes, changes in users’ dementia literacy, dementia knowledge, perceptions of dementia-related stigma and help-seeking at five time points (baseline, 1, 3, 6 and 12 months). People residing in all states and territories of Australia will be recruited to the study via the BrainTrack app. Data collection will occur online and through teleconferencing. Approximately 1000 participants will complete all five surveys. Google Analytics data will measure adoption. App usage data will identify app use patterns. A sample of continuing app users (~n=80) and those who cease app use within 6 months (~n=20) will be interviewed to obtain in-depth information about their app use and help-seeking experience. Dementia Australia Helpline data will quantify help-seeking calls triggered by BrainTrack use. In Study 1, longitudinal outcomes will be analysed using mixed models. The economic and social value of BrainTrack will be assessed using social return on investment analysis. In Study 2, general practitioners (~n=20) currently practising in Australia will participate in semi-structured interviews conducted via online teleconferencing. Interviews will elicit perceptions of the usefulness of BrainTrack for initiating and facilitating discussions with patients about cognition and dementia. Qualitative data will be analysed thematically, followed by deductive analysis guided by the Theoretical Domains Framework.
This study has received Human Research Ethics Committee approval from Deakin University Human Research Ethics Committee (Study 1: HREC Reference Number 2022–220) and Deakin University Human Ethics Advisory Group, Faculty of Health (Study 2: Reference Number 202_2022). Informed consent will be obtained prior to participation, either verbally for interviews or online for surveys. Study findings will be published in peer-reviewed journals and communicated to key stakeholders.
Haematological cancers are common in the UK, with a variety of morphologies. Stem cell transplants and chimeric antigen receptor (CAR) T-cell therapies provide significant options for hard to treat haematological cancers, although with difficult to predict outcomes. Research into the determinates of treatment efficacy, and access to treatments, is key to ensuring equal benefit across patients and patient safety. With this, there are concerns about the small representation of minority groups in related research. We aim to report on the current knowledge to guide future research.
A variety of databases will be searched for literature on UK minority ethnic populations receiving haematopoietic stem cell transplant or CAR T-cell therapy. Searches will be restricted to the year 2011 or later. Many outcomes will be analysed, covering the patient care pathway for those of the target population, although with a focus on follow-up after therapy. Plans have been made to conduct narrative synthesis, with meta-analysis where applicable.
Ethical approval is not required for this study. Outputs will be published in an appropriate journal and discussed with the wider National Institute for Health and Care Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics (BTRU) group. Discussions will also be undertaken with the BTRU patient partners group.
To estimate the prevalence of dementia and mild cognitive impairment (MCI) in the older prisoner population in England and Wales and to establish risk of harm to self and others, activity of daily living needs and social networks of prisoners with likely MCI and dementia.
We screened 869 older prisoners (aged 50 years and older) using the Montreal Cognitive Assessment (MoCA). Participants testing positive on the MoCA (≤23) were interviewed using the Addenbrooke’s Cognitive Examination, Third Revision (ACE-III) and a range of standardised assessments were used to assess risks of externalised violence and of self-harm; activities of daily living needs; mental health needs; history and symptoms of brain injury (if applicable) and social networks.
The sample was drawn randomly from women’s prisons (n=10) and a representative range of adult men’s prisons (n=11) across England and Wales.
Participants were aged 50 or over and resident in one of the participating prison establishments on the study’s census day.
ACE-III.
We recruited 596 men and 273 women prisoners. Across the whole sample of older prisoners, the prevalence of dementia was 7.0% (95% CI 5.5%, 8.9%) (when weighted for sex and age), with the highest prevalence found among prisoners aged 70 years and older at 11.8% (95% CI 8.0%, 17.1%). The prevalence of dementia for men was 7.0% (95% CI 5.2%, 9.4%) and for women was 6.0% (95% CI 3.8%, 9.5%). Only two individuals (3%) who screened positively on the MoCA had a diagnosis of dementia in their prison healthcare notes, suggesting current under-recognition. The prevalence of MCI was 0.8% (95% CI 0.4% to 1.7%, weighted by age). Of those who screened positively on the MoCA, 32 (46%) participants had a high or very high risk of harm to self or others, and 70 (35%) had no friends with whom they could talk to about private matters or to call on for help (n=35, 50%).
Approximately 1020 older adults living in prison have symptoms of likely dementia, and service provision for this group is inadequate.
by Patrice Whitehorne-Smith, Kunal Lalwani, Robyn Martin, Gabrielle Mitchell, Ben Milbourn, Wendel Abel, Sharyn Burns
Chronic physical illnesses (CPI) are highly prevalent among people with serious mental illnesses (PWSMI) yet people in this population experience significant challenges accessing healthcare. This study utilised a constructivist grounded theory approach to collect and analyse data related to the enablers and barriers to public healthcare access for PWSMI & CPI. Data were collected through semi-structured interviews conducted with fifty-seven participants comprising PWSMI &CPI and their caregivers, health policymakers, primary care physicians, psychiatrists, and mental health nurses. Enablers and barriers to healthcare access were represented using a socio-ecological model consisting of five levels: wider society, health system, clinician, family and community, and individual. Jamaica’s free public healthcare system was the most pronounced enabler of healthcare access, while poverty, stigma, and discrimination were the most pronounced barriers. Factors such as social support, time, clinician beliefs, attitudes and training, and individual characteristics were identified as consisting of dimensions that were both enablers and barriers to healthcare access. These findings indicated that factors that influenced healthcare access for PWSMI & CPI were aligned with the social determinants of health. Improved healthcare access for PWSMI & CPI necessitates strategies that incorporate a multi-sectoral approach to address social and environmental factors influencing healthcare access across all levels of the socio-ecological model.
FreshRSS 