What psychosocial interventions work to reduce hospital admissions in people with diabetes and elevated HbA1c : a systematic review of the evidence.

BACKGROUND: Diabetes is a chronic condition that can lead to devastating complications if not managed effectively. Individuals with elevated HbA1c are at higher risk of developing complications resulting in diabetes-related hospital admissions, an additional pressure and expense for healthcare systems. AIM: To systematically review evidence of the effectiveness of psychosocial interventions among individuals with elevated HbA1c , as indicated by hospital admissions. METHODS: Electronic databases (MEDLINE, PsychINFO, CINAHL, AMED, Embase and Scopus) were used to identify studies systematically. Studies were screened against eligibility criteria and included if they evaluated the effectiveness of a psychosocial intervention on diabetes-related hospital admissions in individuals with elevated HbA1c . Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, and a narrative synthesis was conducted. RESULTS: Of 15 362 studies, five were included in the review. Psychosocial interventions were found to significantly reduce diabetes-related hospital admissions in four of these studies and interventions involving psychotherapy in particular were found to reduce admissions. The methodological quality of studies ranged from weak to moderate, due to lack of blinding, weak study design and issues with withdrawals and drop-outs. CONCLUSIONS: Psychosocial interventions may reduce diabetes-related hospital admissions in individuals with elevated HbA1c ; however, due to variability in methodological rigour, the conclusion remains tentative. Further research targeting this group, particularly within the adult population, is recommended. (PROSPERO registration number: CRD42019133456).

Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review.

BACKGROUND: Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors. AIM: To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults. METHODS: Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading. FINDINGS: Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ2 = 254). A third study reported fewer UTIs per patient week (risk ratio = 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias. CONCLUSION: The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.

The effectiveness of physical activity interventions in improving well-being across office-based workplace settings: a systematic review.

OBJECTIVES: Although the benefits of regular physical activity (PA) are widely accepted, most of the population fails to meet the recommended levels of activity. Public health bodies such as the World Health Organisation emphasise promoting PA within workplaces as a key intervention setting to reach the health and well-being of the working population. Given the importance of well-being in workplace settings, it seems worthwhile to explore the evidence of effectiveness in the literature. This systematic review aims to assess the effectiveness of PA interventions for improving psychological well-being in working adults. It provides a review of current evidence, assesses the quality of the research into this topic area and identifies issues and recommendations for future research. STUDY DESIGN: A systematic review guided by the Cochrane Handbook was conducted. METHODS: PsycINFO, PubMed, ScienceDirect, Web of Science, Embase, MEDLINE and Cochrane Library literature searches were conducted from 2007 to April 2017. Using the keywords 'Physical Activity'; 'Exercise'; 'Wellbeing'; 'Employee' and 'Workplace', five articles were obtained that fit the inclusion criteria. Inclusion criteria were a workplace setting, an intervention including a PA intervention and an outcome measure including well-being. Extraction of articles and quality assessment of the articles were performed independently by two authors using the Cochrane's data extraction form and the Cochrane's risk of bias. Owing to heterogeneity in population characteristics, intervention components, outcome measures and the durations of interventions, a narrative synthesis was conducted. RESULTS: The review identified five office-based workplace PA interventions in promoting psychological well-being in 1326 participants. The included studies varied substantially in sample size characteristics, methodological quality, duration of follow-up, types of interventions and assessed outcomes. Three of the five included studies were of high quality. The types of PA intervention included yoga, exercise and three studies focussing on walking interventions. The findings evidenced that exercise, yoga and walking interventions improve well-being as measured across workplace settings compared with no intervention. Some studies did not include a placebo control group and therefore, a form of PA intervention regardless of the type may be better than no intervention at all. CONCLUSION: This review found mixed evidence that PA interventions can be effective in improving well-being across office settings. Although, the findings are promising, because of methodological failings, there is no conclusive evidence. Current evidence indicates that employees can improve their psychological well-being by participating in any form of PA interventions in an office setting.

Repeat use of contraceptive crisis services among adolescent women.

"They don't get pregnant twice unless they are hopeless." This was one Doctor's reported assessment of women who had more than one abortion. There is some evidence that the repeated use of pregnancy testing 'scares', emergency contraception and abortion is increasing across all women. However, there may also be an interaction between this general trend and the difficulties faced by particularly vulnerable groups of teenagers who also have higher rates of teenage parenthood. This paper aims to provide an overview of the research and international statistics in this sparsely researched area. It will draw on the author's own qualitative work with 'high risking' teenage girls, and that of other researchers, in order to attempt to reach an understanding of the mechanisms behind this increasingly common phenomenon. The indications from this work refutes the notion that these women form a special or 'hopeless' group, but point towards general problems with contraception and services common to all women that may become compounded through structural vulnerability such as deprivation.

To test or not to test, could you repeat the question?

We aimed to investigate clinical practice in the offering of HIV tests and subsequent uptake in a central London genitourinary medicine (GUM) clinic. A random sample (n = 330) of attenders at 3 inner-London GUM departments was surveyed. Reasons for and rates of offering of HIV tests were recorded and analysed in relation to demographic, risk group information and uptake. The results were integrated with the latest unlinked, anonymous seroprevalence data for the clinic. After exclusion of patients known to be HIV-positive or to have recently undergone HIV testing, HIV tests were offered to 96% of homo/bisexual men, 55% of heterosexual men and 60% of heterosexual women. Comparison with anonymous HIV seroprevalence data showed an inverse relationship between seroprevalence rates for heterosexual men/women (2.5% vs 1%) and rates of HIV test offering. A lack of research into the policy of offering HIV tests may have resulted in inconsistencies in practice. An evidence based policy should offer HIV tests in line with seroprevalence.