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British Medical Bulletin Sep 2018Sudden cardiac death (SCD) of young athletes during competition or training is a tragic event. The long QT syndrome (LQTS) is an arrythmogenic disorder characterized by...
INTRODUCTION
Sudden cardiac death (SCD) of young athletes during competition or training is a tragic event. The long QT syndrome (LQTS) is an arrythmogenic disorder characterized by prolonged ventricular repolarization leading to torsade de pointes evident at electrocardiogram (ECG). Implantable cardioverter defibrillator is an option to revert ventricular fibrillation to sinus rhythm, although the implantation may result in denial of sports participations to the athlete. The authors reviewed the current literature on LQTS in young athletes, to clarify the role of different screening technologies to prevent SCD.
SOURCES OF DATA
A systematic review of the literature was performed applying the PRISMA guidelines according to the PRISMA checklist and algorithm. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using various combinations of the keywords: 'QT', 'syndrome', 'screening', 'young', 'athletes', 'genetic', 'electrocardiogram', 'echocardiography' and 'prevention' were used.
AREAS OF AGREEMENT
Young athletes with LQTS are at greater risk of SCD.
AREAS OF CONTROVERSY
Different detection screening technologies, including ECG monitoring and genetic testing, are recommended, even though their role is not fully understood.
GROWING POINTS
ECG and genetic testing screening programmes could reduce the incidence of SCD, and they may positively impact on the health and safety of young athletes during sport.
AREAS TIMELY FOR DEVELOPING RESEARCH
Further studies should analyze other modalities of screening to allow early detection of cardiovascular conditions to prevent SCD in young athletes.
Topics: Athletes; Death, Sudden, Cardiac; Electrocardiography; Genetic Predisposition to Disease; Genetic Testing; Humans; Long QT Syndrome; Mass Screening
PubMed: 29931253
DOI: 10.1093/bmb/ldy017 -
Epidemiologic Reviews Jun 2018Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental...
Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.
Topics: Crime Victims; Female; Global Health; HIV Infections; Health Status Disparities; Hepatitis, Viral, Human; Humans; Male; Prevalence; Prisoners; Risk Factors; Sexually Transmitted Diseases; Transgender Persons; Tuberculosis
PubMed: 29554240
DOI: 10.1093/epirev/mxx012 -
Journal of Clinical Hypertension... Apr 2018Impaired illness awareness or not accepting that one has hypertension (HTN) may be an important predictor of treatment adherence and optimal blood pressure control. The...
Impaired illness awareness or not accepting that one has hypertension (HTN) may be an important predictor of treatment adherence and optimal blood pressure control. The purpose of this study was to perform a systematic review of available instruments to evaluate HTN awareness, and subsequently present a novel scale that measures the core domains of subjective illness awareness in HTN. Based on the absence of any validated HTN specific measure identified through our review, the Blood Pressure Awareness and Insight Scale (BASIS) was developed (www.illnessawarenessscales.com). An online survey platform was used to collect data on 100 participants. BASIS showed good concurrent (r(98) = .65, P < 0.001) and discriminant validity, internal consistency (Cronbach's α = .75), and 1-month test-retest reliability (ICC = 0.77). BASIS is a comprehensive, easy-to-use instrument specifically designed to measure subjective HTN awareness. BASIS may be used in research studies and clinical practice to assess the impact of HTN awareness on treatment adherence and clinical outcomes.
Topics: Adult; Aged; Blood Pressure Determination; Female; Health Knowledge, Attitudes, Practice; Humans; Hypertension; Internet; Male; Middle Aged; Software; Treatment Adherence and Compliance
PubMed: 29524293
DOI: 10.1111/jch.13248 -
Ethnicity & Health Jul 2020Domestic violence and abuse has been recognised as an international public health problem. However, the pervasiveness of the problem is unknown due in part to...
Domestic violence and abuse has been recognised as an international public health problem. However, the pervasiveness of the problem is unknown due in part to underreporting, especially among women from ethnic minority populations. In relation to this group, this review seeks to explore: (1) the barriers to disclosure; (2) the facilitators of help-seeking; and (3) self-perceived impacts of domestic violence. We systematically identified published qualitative studies conducted among women from ethnic minority populations in the UK. Data analysis was completed using thematic analysis approach. 562 papers were identified and eight papers from four studies conducted among women from ethnic minority populations in the UK met the inclusion criteria and were reviewed. Barriers to disclosure include: Immigration status, community influences, problems with language and interpretation, and unsupportive attitudes of staff within mainstream services. Facilitators of help-seeking were: escalation of abuse and safety of children. Self-perceived impact of abuse includes: shame, denial, loss of identity and lack of choice. There is an on-going need for staff from domestic violence services to be aware of the complexities within which women from ethnic minority populations experience domestic violence and abuse.
Topics: Black People; Disclosure; Domestic Violence; Emigrants and Immigrants; Ethnicity; Female; Humans; Minority Groups; Patient Acceptance of Health Care; Qualitative Research; Social Environment; United Kingdom
PubMed: 29514473
DOI: 10.1080/13557858.2018.1447652 -
Journal of Mental Health (Abingdon,... Oct 2018There is evidence that "Type II trauma" (TTT) - repeated exposure to traumatic events - can lead to the development of post-traumatic stress disorder (PTSD). TTT...
BACKGROUND
There is evidence that "Type II trauma" (TTT) - repeated exposure to traumatic events - can lead to the development of post-traumatic stress disorder (PTSD). TTT frequently occurs in occupational groups working with children who are themselves victims of trauma.
AIM
To conduct a systematic review identifying risk factors for/protective factors against TTT-associated mental ill-health in employees working with traumatised children and explore how this type of work impacts upon social functioning.
METHOD
Databases were searched for relevant studies and supplemented by hand searches.
RESULTS
836 papers were found and 13 were included in the review. The key themes identified were coping mechanisms; social support; personality; demographics; occupational support; work-related stressors; traumatic exposure; organisational satisfaction; training/experience and impact on life.
CONCLUSION
Unhelpful coping strategies (e.g. denial) appeared to increase the risk of TTT. Training and strong support may be protective and work-related stressors (e.g. excessive workload) appeared detrimental. Despite some positive impacts of the work (e.g. becoming more appreciative of life) many negative impacts were identified, demonstrating the importance of minimising risk factors and maximising protective factors for staff at risk of TTT.
Topics: Adaptation, Psychological; Child; Humans; Occupational Stress; Risk Factors; Stress Disorders, Post-Traumatic
PubMed: 28898109
DOI: 10.1080/09638237.2017.1370630 -
European Journal of Cardiovascular... Oct 2017There is a growing interest in the impact of family-witnessed resuscitation. However, evidence about the effect of hospitalised patients witnessing other patients'...
BACKGROUND
There is a growing interest in the impact of family-witnessed resuscitation. However, evidence about the effect of hospitalised patients witnessing other patients' resuscitations is limited.
AIM
The aim of this systematic review is to explore the existing evidence related to the impact on patients who witness resuscitation attempts on other patients in hospital settings.
METHODS
The databases BNI, CINAHL, EMBASE, MEDLINE and PsycINFO were searched with the terms 'patient', 'inpatient', 'resuscitation', 'CPR', 'cardiopulmonary resuscitation' and 'witness'. The search strategy excluded the terms 'out-of-hospital', 'family' and 'relative'. The inclusion criteria were: studies related to patients exposed to a resuscitation attempt performed on another patient; quantitative and qualitative design; and physiological or psychological outcome measures. No limitations of date, language or settings were applied.
RESULTS
Five of the 540 identified studies were included: two observational studies with control groups and three qualitative studies with interviews and focus groups. Articles were published between 1968 and 2006 and were mostly rated to have a low quality of evidence. Quantitative results of the observational studies showed an increased heart rate in the study group witnessing a resuscitation ( p = 0.05), increased systolic blood pressure ( p < 0.01) and increased anxiety ( p < 0.01). The qualitative studies highlighted the coping strategies adopted by exposed patients in response to witnessing resuscitation, including denial and dissociation.
CONCLUSIONS
Our findings suggest that patients may find witnessing resuscitation to be a stressful experience. However, the evidence is sparse and mainly of poor quality. Further research is needed in order to better understand the impacts of patients witnessing a resuscitation of another patient and to identify effective support systems.
Topics: Adult; Aged; Aged, 80 and over; Attitude to Death; Cardiopulmonary Resuscitation; Emergency Medical Services; Female; Heart Arrest; Humans; Inpatients; Male; Middle Aged; United Kingdom
PubMed: 28406321
DOI: 10.1177/1474515117705938 -
Psychopathology 2017According to the concept of "male depression," depression among men might be underdiagnosed and undertreated because of gender differences in symptoms and coping. There... (Review)
Review
BACKGROUND
According to the concept of "male depression," depression among men might be underdiagnosed and undertreated because of gender differences in symptoms and coping. There is evidence that men experience atypical depressive symptoms including irritability, aggression, substance abuse, and increased risk behavior. To date, a substantial number of qualitative studies on men's views on depression has been conducted in the last few decades.
METHODS
Based on a systematic review and metasynthesis of qualitative studies on men's subjective perspectives on depression, we aim at a comprehensive understanding of men's subjective views on depression with a specific focus on masculinity constructions.
RESULTS
Based on 34 studies assessed as appropriate for the study, 2 overarching subthemes could be identified: normative expectations regarding masculinity ideals and men's subjective perspectives of depression as "weakness." Men's strategies include denial of "weakness" and "closing up." Further themes include suicide, masculinity ideals as a healthy resource, and alternative masculinities.
DISCUSSION/CONCLUSIONS
Traditional masculinity values might serve as barriers but also as facilitators to adaptive coping strategies in depressed men. More research is needed to study the dimensions and role of alternative masculinities in the context of depression.
Topics: Adult; Aggression; Depression; Female; Humans; Interpersonal Relations; Male; Masculinity; Men's Health; Middle Aged; Qualitative Research; Sexual Partners
PubMed: 28285304
DOI: 10.1159/000455256 -
Obesity Reviews : An Official Journal... Feb 2017The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle... (Review)
Review
Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review.
The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.
Topics: Adolescent; Child; Humans; Life Style; Overweight; Patient Compliance; Patient Dropouts; Pediatric Obesity
PubMed: 27862851
DOI: 10.1111/obr.12478 -
The Journal of Trauma and Acute Care... Nov 2016In the past decade, more than 300,000 people in the United States have died from firearm injuries. Our goal was to assess the effectiveness of two particular prevention... (Review)
Review
BACKGROUND
In the past decade, more than 300,000 people in the United States have died from firearm injuries. Our goal was to assess the effectiveness of two particular prevention strategies, restrictive licensing of firearms and concealed carry laws, on firearm-related injuries in the US Restrictive Licensing was defined to include denials of ownership for various offenses, such as performing background checks for domestic violence and felony convictions. Concealed carry laws allow licensed individuals to carry concealed weapons.
METHODS
A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions.
RESULTS
A total of 4673 studies were initially identified, then seven more added after two subsequent, additional literature reviews. Of these, 3,623 remained after removing duplicates; 225 case reports, case series, and reviews were excluded, and 3,379 studies were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of 14 studies which merited inclusion for PICO 1 and 13 studies which merited inclusion for PICO 2.
CONCLUSION
PICO 1: We recommend the use of restrictive licensing to reduce firearm-related injuries.PICO 2: We recommend against the use of concealed carry laws to reduce firearm-related injuries.This committee found an association between more restrictive licensing and lower firearm injury rates. All 14 studies were population-based, longitudinal, used modeling to control for covariates, and 11 of the 14 were multi-state. Twelve of the studies reported reductions in firearm injuries, from 7% to 40%. We found no consistent effect of concealed carry laws. Of note, the varied quality of the available data demonstrates a significant information gap, and this committee recommends that we as a society foster a nurturing and encouraging environment that can strengthen future evidence based guidelines.
LEVEL OF EVIDENCE
Systematic review, level III.
Topics: Firearms; Humans; Licensure; Societies, Medical; Traumatology; United States; Wounds, Gunshot
PubMed: 27602894
DOI: 10.1097/TA.0000000000001251 -
The International Journal of Eating... Jan 2017To systematically review the literature on perceived barriers and facilitators of help-seeking for eating disorders. (Review)
Review
OBJECTIVE
To systematically review the literature on perceived barriers and facilitators of help-seeking for eating disorders.
METHOD
Three databases (PubMed, PsychInfo, Cochrane) were searched using keywords and Medical Subject Headings (MeSH) terms. Retrieved abstracts (N = 3493) were double screened and relevant papers (n = 13) were double coded. Qualitative and quantitative studies were included if they reported perceived barriers and facilitators towards seeking help for eating disorders. Barriers and facilitators were extracted from the included papers and coded under themes. The most prominent barriers and facilitators were determined by the number of studies reporting each theme.
RESULTS
Eight qualitative, three quantitative, and two mixed-methods studies met the inclusion criteria for the current review. The most prominent perceived barriers to help-seeking were stigma and shame, denial of and failure to perceive the severity of the illness, practical barriers (e.g., cost of treatment), low motivation to change, negative attitudes towards seeking help, lack of encouragement from others to seek help and lack of knowledge about help resources. Facilitators of help-seeking were reported in six studies, with the most prominent themes identified as the presence of other mental health problems or emotional distress, and concerns about health.
DISCUSSION
Programs targeting prevention and early intervention for eating disorders should focus on reducing stigma and shame, educating individuals about the severity of eating disorders, and increasing knowledge around help-seeking pathways for eating disorders. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:9-21).
Topics: Denial, Psychological; Feeding and Eating Disorders; Female; Health Education; Humans; Patient Acceptance of Health Care; Shame; Social Stigma
PubMed: 27526643
DOI: 10.1002/eat.22598