Helen Stokes-Lampard

Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies

BACKGROUND Use of illicit drugs, particularly cannabis, by young people is widespread and is associated with several types of psychological and social harm. These relations might not be causal. Causal relations would suggest that recreational drug use is a substantial public health problem. Non-causal relations would suggest that harm-reduction policy based on prevention of drug use is unlikely to produce improvements in public health. Cross-sectional evidence cannot clarify questions of causality; longitudinal or interventional evidence is needed. Past reviews have generally been non-systematic, have often included cross-sectional data, and have underappreciated the extent of methodological problems associated with interpretation. METHODS We did a systematic review of general population longitudinal studies reporting associations between illicit drug use by young people and psychosocial harm. FINDINGS We identified 48 relevant studies, of which 16 were of higher quality and provided the most robust evidence. Fairly consistent associations were noted between cannabis use and both lower educational attainment and increased reported use of other illicit drugs. Less consistent associations were noted between cannabis use and both psychological health problems and problematic behaviour. All these associations seemed to be explicable in terms of non-causal mechanisms. INTERPRETATION Available evidence does not strongly support an important causal relation between cannabis use by young people and psychosocial harm, but cannot exclude the possibility that such a relation exists. The lack of evidence of robust causal relations prevents the attribution of public health detriments to illicit drug use. In view of the extent of illicit drug use, better evidence is needed.

What is it about intrauterine devices that women find unacceptable? Factors that make women non-users: a qualitative study

Introduction There is a lack of published research into the perceptions of ‘non-users’ of copper intrauterine contraceptive devices (IUDs). Despite this being one of the most commonly used methods of contraception in other countries, only 5% of contraceptive users in Great Britain aged 16–49 years currently use an IUD. This study explores how womens lay beliefs and perceptions about IUDs lead to rejection of this contraceptive choice. Methods One-to-one semi-structured interviews were conducted with 10 women of varying ages and parity recruited from an urban general practice. None of the women had ever used IUDs but all had used contraception in the previous 6 months. Data were subjected to qualitative analysis. Results Five analytical themes were identified: lack of objective information about IUDs, reported side effects of IUDs, anxieties about the process of fitting an IUD, IUDs as an infection risk and lack of personal control of an IUD, once fitted. Conclusions Some of the themes identified mirrored those found in studies of user attitudes to and experiences of IUDs. Others, particularly the prominent worries about mess and embarrassment during fitting and the association between the hidden nature of the fitted device and unreliability, are new and need wider exploration.

Exercise to reduce vasomotor and other menopausal symptoms: A review

Many women are reluctant to consider HRT as a therapeutic option for menopausal symptoms and are keen to use non-pharmacological treatments. Evidence from randomised controlled trials (RCTs) concerning the effects of aerobic exercise on vasomotor and other menopausal symptoms is limited but what evidence we do have suggests that aerobic exercise can improve psychological health and quality of life in vasomotor symptomatic women. In addition, several RCTs of middle-aged/menopausal-aged women have found that aerobic exercise can invoke significant improvements in several common menopause-related symptoms (e.g. mood, health-related QoL and insomnia), relative to non-exercise comparison groups. There is some evidence that alternative forms of low intensity exercise such as yoga are beneficial in reducing vasomotor symptoms and improving psychological well-being in menopausal women. Collectively, these RCTs highlight the broader potential that exercise could have for women during the menopause transition. Whilst both the Royal College of Obstetricians and Gynaecologists in the UK and the North American Menopause Society have recommended that women be advised to consider aerobic exercise as a treatment for vasomotor menopausal symptoms, to make any evidence-based conclusions regarding the effectiveness of exercise in managing these symptoms, more high quality research is needed.

Identifying symptoms of ovarian cancer: a qualitative and quantitative study

Introduction  Symptoms of ovarian cancer are often vague and consequently a high proportion of women with ovarian cancer are not referred to the appropriate clinic.

Factors associated with the use of complementary medicine and non-pharmacological interventions in symptomatic menopausal women

Background Hormone replacement therapy is now thought to have serious adverse effects; consequently, many menopausal women are seeking to use complementary and alternative medicine (CAM), including non-pharmacological interventions (NPI), to alleviate symptoms. The prevalence and perceived effectiveness of CAM and NPI for ameliorating menopausal symptoms are not widely known and factors likely to predict CAM and NPI utilization for menopausal symptom management have not been comprehensively documented. Objectives The objectives of this study were to (1) determine the prevalence of using CAM and NPI for menopausal symptoms; (2) describe the perceived effectiveness of CAM and NPI for symptom management; and (3) investigate lifestyle and demographic factors associated with CAM/NPI use among menopausal women with vasomotor symptoms. Methods Women aged 46–55 years were recruited via six socioeconomically diverse general practices. Participants completed a postal questionnaire that contained items relating to demographics, lifestyle factors, weight, height, exercise behavior, menopausal status, vasomotor symptoms and utilization and perceived effectiveness of a range of CAM/NPI for symptom management. Results Of 1206 women who responded, 563 (47%) were symptomatic. The most commonly used CAM/NPI for symptom management were diet/nutrition (44.3%), exercise/yoga (41.5%), relaxation/stress management (27.4%) and homeopathic/naturopathic remedies (25.4%). Of women who used these interventions, large proportions reported them to be helpful. The characteristics that were independently associated with use of CAM/NPI were White ethnicity, being physically active, and not smoking. Conclusions Many menopausal symptomatic women are using a wide range of CAM/NPI and report these to be effective, particularly those who are white, physically active and do not smoke.

Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature.

Background  Vaginal vault smears are used to detect persisting neoplasia of the lower genital tract after hysterectomy. Recent data suggest both widespread use and uncertain evidence of their effectiveness.

The effectiveness of exercise as treatment for vasomotor menopausal symptoms: randomised controlled trial

To investigate the effectiveness of exercise as treatment for vasomotor menopausal symptoms.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial

BACKGROUND Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members. METHODS We recruited individuals sharing a household by mailed invitation through general practices in England. After consent, participants were randomised online by an automated computer-generated random number programme to receive either no access or access to a bespoke automated web-based intervention that maximised handwashing intention, monitored handwashing behaviour, provided tailored feedback, reinforced helpful attitudes and norms, and addressed negative beliefs. We enrolled participants into an additional cohort (randomised to receive intervention or no intervention) to assess whether the baseline questionnaire on handwashing would affect handwashing behaviour. Participants were not masked to intervention allocation, but statistical analysis commands were constructed masked to group. The primary outcome was number of episodes of RTIs in index participants in a modified intention-to-treat population of randomly assigned participants who completed follow-up at 16 weeks. This trial is registered with the ISRCTN registry, number ISRCTN75058295. FINDINGS Across three winters between Jan 17, 2011, and March 31, 2013, we enrolled 20,066 participants and randomly assigned them to receive intervention (n=10,040) or no intervention (n=10,026). 16,908 (84%) participants were followed up with the 16 week questionnaire (8241 index participants in intervention group and 8667 in control group). After 16 weeks, 4242 individuals (51%) in the intervention group reported one or more episodes of RTI compared with 5135 (59%) in the control group (multivariate risk ratio 0·86, 95% CI 0·83-0·89; p<0·0001). The intervention reduced transmission of RTIs (reported within 1 week of another household member) both to and from the index person. We noted a slight increase in minor self-reported skin irritation (231 [4%] of 5429 in intervention group vs 79 [1%] of 6087 in control group) and no reported serious adverse events. INTERPRETATION In non-pandemic years, an effective internet intervention designed to increase handwashing could have an important effect in reduction of infection transmission. In view of the heightened concern during a pandemic and the likely role of the internet in access to advice, the intervention also has potential for effective implementation during a pandemic. FUNDING Medical Research Council.

What women want? Exercise preferences of menopausal women

BACKGROUND Many menopausal women are keen to find alternatives to HRT; exercise might be useful in this regard but more trial evidence is required. Before we conduct such trials however, it is important to understand the exercise preference of these women so that appropriate exercise interventions can be developed for inclusion in such trials. AIM To investigate the exercise preferences of menopausal women and to examine the association between exercise levels, BMI, and hot flushes/night sweats in this population. METHOD Participants were women aged 46-55 years from eight diverse general practices in Birmingham. A postal questionnaire containing items about demographics, lifestyle behaviours, weight, height, menopausal status, frequency of hot flushes/night sweats and preferences for exercise was sent to all eligible women. RESULTS 1693/2776 (61.0%) of women replied. The majority (75.9%) of respondents stated that exercise was an acceptable intervention. The most commonly chosen option for delivery of exercise interventions was by one-to-one consultations with a fitness advisor, followed by DVD sent by post. Telephone based interventions and e-Health interventions (i.e. Internet and mobile phone text messages) were the interventions least chosen. There was also an overwhelming choice for walking as a mode of exercise. A series of two factor analyses of covariance indicated exercise participation and BMI were not significantly related to frequency of hot flushes/night sweats in symptomatic menopausal women. CONCLUSION Menopausal women have strong preferences to receive exercise interventions that involve one-to-one contact with a fitness advisor or by exercise DVD. The use of more recent technology to deliver exercise interventions was highly unpopular. These findings should be considered in future studies when planning exercise interventions with this population.

How Strong Is the Evidence that Illicit Drug Use by Young People Is an Important Cause of Psychological or Social Harm? Methodological and Policy Implications of a Systematic Review of Longitudinal, General Population Studies.

Recreational use of illicit drugs (i.e. use not associated with a diagnosed drug problem) may cause psychological and social harm. A recent systematic review found that evidence for this was equivocal. Extensive evidence was only available in relation to cannabis use. This was relatively consistently associated with lower educational attainment and greater use of other drugs. However whether this association was causal was not clear. Cannabis use was less consistently associated with mental illness and antisocial behaviour. Causal relations between cannabis use and psychosocial harm could plausibly be mediated through either neurophysiological effects of cannabis or through social mechanisms related to use of an illegal substance. These different mechanisms might have different implications for harm-reduction policy. Alternatively associations may arise through non-causal pathways such as reverse causation, bias and confounding. In this latter situation, even effective reduction of cannabis use would be unlikely to be an effective harm-reduction policy in relation to psychosocial outcomes. Research strategies that could clarify these questions are discussed, as are the implications of these considerations for harm-reduction policy.