Rabeea’h Aslam

Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review.

Background Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services. Aims To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services. Method Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the ‘grey’ literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations. Results Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18–0.75) than for moderate- or lower-quality studies (range of d 0.18–4.3). The review found only two studies offering weak economic evidence. Conclusions Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices.

Parity of Esteem as a guiding principle for commissioning, service provision and laws related to health care: what do we know

The distinction between mind and body has a long history of philosophical debate has had a significant impact on generations of researchers and practitioners. This distinction is still found in current health care; policy and legislation disregards evidence showing that mental illness and physical illnesses share causation and coexistence (Thornicroft et al. 2008). Not only does this create fertile ground for a failure of illness-management in patient care, this duality points to the poverty in the level of discourse surrounding the understanding of mental illness, associated stigma and discrimination (Corrigan et al. 2004, Corrigan 2005,). Consequently, there is a lack of informed deliberation about the long-term costs of sustaining the current approach. Research has shown that people with serious mental illnesses have higher rates of physical illness and die on average 17 24 years earlier than the general population (Thornicroft et al. 2008). This premature mortality is largely from treatable conditions associated with modifiable risk factors such as smoking, obesity, substance abuse and inadequate medical care (Thornicroft et al. 2008). This results in increasing not only long-term treatment costs, but also societal costs that include economic productivity, employment and financial stability, making people with mental ill health more vulnerable to social exclusion, poverty, unemployment and multiple social and family difficulties (Knapp et al. 2011). Epidemiologic surveys indicate that one in four people in the UK have a psychiatric illness. Many studies show that of the 280 million consultations with a general practitioner in the UK, 30% are related to mental health (Royal College of General Practitioners 2006). Between 12% and 18% of all NHS expenditure on longterm conditions is linked to poor mental health and well-being between £8 and £13 billion in England each year (Naylor et al. 2012). The Royal College of Psychiatrists public health position statement summarises the evidence and economic arguments. It states that the total cost of mental illness is estimated to be £105 billion in the UK. This suggests that integration of physical and mental health care makes sense, and that mental illness should no longer be neglected if better patient outcomes are to be pursued within a sound public health economy. An approach that is gaining popularity is ‘Parity of Esteem’ as a guiding value and principle for all health care; this approach offers a partial solution to the disparities found between physical and mental health-related mortality and morbidity. The core principle is that behavioural health should be treated equally with physical illnesses. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) in the United States (The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) 2008) has brought forward concrete evidence of the benefits by legislating for parity of mental health (Barry et al. 2010). The law in the USA was Ethnicity & Health Vol. 17, Nos. 1 2, February April 2012, 13 15

Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances

BackgroundPrevious research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence.MethodsA multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives.ResultsThe searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers’ triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence.ConclusionsPregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence.Trial RegistrationPROSPERO CRD42012003168

An embedded realist review of what works, for whom, how, and in what circumstances to reduce repeat pregnancies in adolescence: a systematic mixed-methods review

Abstract Background The UK has one of the highest rates of pregnancies in adolescence in western Europe; a large number of them are repeat pregnancies. Previous research has demonstrated substantial emotional, psychological, and educational harm to young mothers after unintended conceptions. We aimed to synthesise evidence about how to reduce repeat pregnancies in adolescence. Methods A multistreamed, mixed-methods systematic review was conducted. Between May 8 and May 27, 2013, we searched the major electronic databases for articles published from 1995 onwards, and updated the search between June 11 and June 16, 2014 (see appendix for list of databases and search terms used). No language restrictions were imposed during the searches; however, grey literature searches were restricted to English and a UK context, to enhance applicability of results to UK public health agencies. Data extraction was conducted independently by two reviewers, and disagreements resolved by a third reviewer if necessary. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how, and in what context. Included literature was quality appraised with realist principles of relevance and rigor. Initial theory areas were developed through scoping the evidence, group discussion by the authors, and stakeholder engagement. Stakeholders included representatives from public health, primary care, sexual health, obstetrics, midwifery, and adolescent mothers. Theory areas were further refined and populated with evidence that either confirmed or contradicted the theory. A deliberative synthesis process resulted in the surfacing of an emerging story that included several key contexts and mechanisms, which resulted in a number of outcomes (context+mechanism=outcome configurations). Findings The searches identified 8664 documents initially, and 816 in repeat searches, filtering to 12 randomised controlled trials (RCTs), four quasi RCTs, ten qualitative studies, and 53 other quantitative studies published from 1995 to 2013. Four documents found in searches of the grey literature were also included in the realist synthesis. Contexts included experiences of young mothers, their knowledge and understanding, and their community or psychological perspective. Mechanisms included tailoring, motivations, and taking control. Potential outcomes resulting from the context+mechanism=outcome configurations included managing expectations, accessing services, and engagement with the issue of pregnancy in adolescence. Interpretation Pregnancy in adolescence is a complex issue, with many factors to consider. The key contexts and mechanisms highlighted can help guide policy makers and professionals towards areas that need to be attended to concerning the issue of repeat pregnancy in adolescence. These findings provide a conceptual platform on which proposed interventions might be built to enhance their potential to work. Funding This work was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) project number 11/141/05.

A systematic review of the diagnostic accuracy of automated tests for cognitive impairment

The aim of this review is to determine whether automated computerised tests accurately identify patients with progressive cognitive impairment and, if so, to investigate their role in monitoring disease progression and/or response to treatment.

Follow-up strategies for women with endometrial cancer after primary treatment

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the clinical effectiveness and cost-effectiveness of different strategies in the follow-up of women with endometrial cancer after completion of primary treatment.

Interventions for preventing unintended repeat pregnancies among adolescents

This is the protocol for a review and there is no abstract. The objectives are as follows: To identify and evaluate the effectiveness of interventions for preventing repeat unintended pregnancies among adolescents, and to determine the barriers and facilitators for their implementation and uptake. Specific review question are to determine: What are the barriers and facilitators to the acceptability, uptake and implementation of interventions? What factors characterise subgroups who are at greater risk of repeat unintended pregnancies (i.e. what are the predictors of repeat unintended pregnancy)? Which (elements of) interventions appear to be effective, how do they work, in what setting and for whom (conversely, why are they ineffective, why do they not work)? What evidence is there on the relative cost-effectiveness of interventions to prevent teenage pregnancy? What specific methodological challenges does application of health economics to this area raise and how are these challenges being overcome?