Introduction Prevalence of non-communicable diseases (NCDs) is increasing globally, with the greatest projected increases in low-income and middle-income countries. We sought to quantify the proportion of Cochrane evidence relating to NCDs derived from such countries.\r\n\r\nMethods We searched the Cochrane database of systematic reviews for reviews relating to NCDs highlighted in the WHO NCD action plan (cardiovascular, cancers, diabetes and chronic respiratory diseases). We excluded reviews at the protocol stage and those that were repeated or had been withdrawn. For each review, two independent researchers extracted data relating to the country of the corresponding author and the number of trials and participants from countries, using the World Bank classification of gross national income per capita.\r\n\r\nResults 797 reviews were analysed, with a reported total number of 12\u2005340 trials and 10\u2005937\u2005306 participants. Of the corresponding authors 90% were from high-income countries (41% from the UK). Of the 746 reviews in which at least one trial had met the inclusion criteria, only 55% provided a summary of the country of included trials. Analysis of the 633 reviews in which country of trials could be established revealed that almost 90% of trials and over 80% of participants were from high-income countries. 438 (5%) trials including 1\u2005145\u2005013 (11.7%) participants were undertaken in low-middle income countries. We found that only 13 (0.15%) trials with 982 (0.01%) participants were undertaken in low-income countries. Other than the five Cochrane NCD corresponding authors from South Africa, only one other corresponding author was from Africa (Gambia).\r\n\r\nDiscussion The overwhelming body of evidence for NCDs pertains to high-income countries, with only a small number of review authors based in low-income settings. As a consequence, there is an urgent need for research infrastructure and funding for the undertaking of high-quality trials in this area.
\n \n\n \n \nDomestic violence and abuse is threatening behavior, violence/abuse used by one person to control the other within an intimate or family-type relationship. Women experience more severe physical and sexual domestic violence and abuse and more mental health consequences than men. The current study aims at exploring of the role of hypothalamic-pituitary-adrenocortical axis activity in abuse impact on women's mental health. Study objectives: 1) To evaluate diurnal cortisol slope, cortisol awakening response, and the mean cortisol concentration in women with a current or recent experience of abuse; 2) To estimate whether cortisol secretion is associated with type, severity, duration and cessation of abuse; 3) To investigate whether cortisol acts as mediator between abuse and mental health condition; 4) To examine whether there is any distinction in cortisol levels between those women exposed to both childhood abuse and domestic violence and abuse and those experienced only the latter. 4) To explore whether cortisol secretion differs between women living in refuge and those still living in the community.
\n \n\n \n \nAlcohol misuse is a significant international public health problem. Screening and brief\r\nintervention (SBI) in primary care reduces alcohol consumption by about 15 \u2013 30%, sustained\r\nover 12 months in hazardous or harmful drinkers but implementation has proved difficult\r\nleading to growing interest in exploring the effectiveness of SBI in other settings, including\r\nthe workplace. Computerised interventions for alcohol misuse can be as effective as\r\ntraditional face-to-face interventions and may have advantages, including anonymity,\r\nconvenience and availability.
\n \n\n \n \nBackground\r\nPost-infectious cough is common in primary care, but has no proven effective treatments. Cysteinyl leukotrienes are involved in the pathogenesis of post-infectious cough and whooping cough (pertussis). We determined the effectiveness of montelukast, a cysteinyl leukotriene receptor antagonist, in the treatment of post-infectious cough.\r\n\r\nMethods\r\nNon-smoking adults aged 16 to 49 years with post-infectious cough of two to eight weeks\u2019 duration were recruited from 25 general practices in England. Patients were tested for pertussis (oral fluid anti-pertussis toxin IgG) and randomly assigned to montelukast 10 mg daily or image-matched placebo for two weeks. Patients chose whether to continue study medication for another two weeks. The randomisation sequence was computer-generated and stratified by general practice. Patients, healthcare professionals and researchers were blinded to treatment allocation. Effectiveness was assessed using the Leicester Cough Questionnaire to measure changes in cough-specific quality of life between baseline and two follow-up stages (two weeks and four weeks). The primary analysis was by intention to treat with imputation by last observation carried forward. Recruitment closed on 21st September 2012 and follow-up has been completed.\r\n\r\nFindings\r\nWe randomly assigned 276 patients to montelukast (n=137) or placebo (n=139). Seventy patients had laboratory-confirmed pertussis (25%). Improvements in cough-specific quality of life occurred in both groups after two weeks (montelukast: mean 2\u20227, [95% confidence interval 2\u20222 to 3\u20223]; placebo: 3\u20226 [2\u20229 to 4\u20223], p=0\u202204) but the difference between groups was not clinically significant (mean difference -0\u20229 [-1\u20227 to -0\u202204]). This difference was not statistically significant in any sensitivity analyses. After two weeks, 74\u20221% of patients elected to continue study medication (montelukast 76\u20227%; placebo 71\u20225%). After four weeks, there were no significant between-group differences in cough-specific quality of life improvement (montelukast: 5\u20222 [4\u20225 to 5\u20229]; placebo: 5\u20229 [5\u20221 to 6\u20227]; mean difference -0\u20225 [-1\u20225 to 0\u20226], p=0\u202238) or adverse event rates (montelukast 15\u20223%; placebo 22\u20223%, p=0\u202214). The most common adverse events reported were increased mucus production (montelukast, n=6; placebo, n=2) and headache (montelukast, n=2; placebo, n=6). One serious adverse event was reported (placebo, n=1), which was unrelated to study medication (shortness of breath and throat tightness after severe coughing bouts). This trial is registered with EudraCT (2010-019647-19), UKCRN Portfolio (ID 8360), and ClinicalTrials.gov (NCT01279668).\r\n\r\nInterpretation\r\nMontelukast is not an effective treatment for post-infectious cough. However, the burden of post-infectious cough in primary care is high, making it an ideal setting for future anti-tussive treatment trials.\r\n
\n \n\n \n \nObjectives: To assess the proportion of ED attendances that would be suitable for primary care and the inter-rater reliability of GP assessment of primary care suitability.\r\n\r\nDesign of Study: Survey of general practitioners\u2019 agreement of suitability for primary care on a random anonymised sample of all ED patients attending over a one month period.\r\n\r\nSetting: Emergency Department of a UK Hospital serving a population of 600,000\r\n\r\nMethod: Four GPs independently used data extracted from clinical notes to rate appropriateness for management in primary care as well as need for investigations, specialist review or admission. Agreement was assessed using Cohen\u2019s Kappa \r\n\r\nResults: The mean percentage of patients that GPs considered suitable for primary care management was 43% (range 38% to 47%). Kappa for agreement was 0.54 (95% CI 0.44 to 0.64) and 0.47(95% CI 0.38-0.59). In patients deemed not suitable for primary care, GPs were more likely to determine the need for specialist review (RR = 3.5, 95% CI 3.0 to 4.2, p<0.001) and admission (RR = 3.9, 95% CI 3.2 to 4.7, p<0.001). In patients assessed as suitable for primary care, GPs would initiate investigations in 51% of cases. Consensus over primary care appropriateness was higher for paediatric than adult attenders.\r\n\r\nConclusion: A significant number of patients attending ED could be managed by GPs, including those requiring investigations at triage. Stronger agreement among GPs over place of care may be seen for paediatric than for adult attenders. More effective signposting of patients presenting with acute or urgent problems, and supporting a greater role for primary care in relieving the severe workflow pressures in ED in the UK are potential solutions. \r\n
\n \n\n \n \nBackground: Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice.\r\nObjective: A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work.\r\nMethods: A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer.\r\nResults: Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency.\r\nConclusions: This scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research.
\n \n\n \n \nReports suggest approximately 21\u201323% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. \r\nAim \r\nTo understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. \r\nDesign and setting \r\nA qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. \r\nMethod \r\nA maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. \r\nResults \r\nIn total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the \u2018rules of engagement\u2019 in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. \r\nConclusion \r\nConsultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.
\n \n\n \n \nBackground\r\nAttentive eating means eating devoid of distraction and increasing awareness and memory for food being consumed. Encouraging individuals to eat more attentively could help reduce calorie intake, as a strong evidence base suggests that memory and awareness of food being consumed substantially influence energy intake.\r\n\r\nMethods\r\nThe development and feasibility testing of a smartphone based attentive eating intervention is reported. Informed by models of behavioral change, a smartphone application was developed. Feasibility was tested in twelve overweight and obese volunteers, sampled from university staff. Participants used the application during a four week trial and semi-structured interviews were conducted to assess acceptability and to identify barriers to usage. We also recorded adherence by downloading application usage data from participants\u2019 phones at the end of the trial.\r\n\r\nResults\r\nAdherence data indicated that participants used the application regularly. Participants also felt the application was easy to use and lost weight during the trial. Thematic analysis indicated that participants felt that the application raised their awareness of what they were eating. Analysis also indicated barriers to using a smartphone application to change dietary behavior.\r\n\r\nConclusions\r\nAn attentive eating based intervention using smartphone technology is feasible and testing of its effectiveness for dietary change and weight loss is warranted.\r\n\r\nKeywords: Attentive eating; Memory; Attention; Awareness; Food intake; Mobile phone
\n \n\n \n \nQuitting smokers gain weight. This deters some from trying to stop smoking and may explain the increased incidence of type 2 diabetes after cessation. Dieting when stopping smoking may be counterproductive. Hunger increases cravings for smoking and tackling two behaviours together may undermine quitting success. A meta-analysis of randomized controlled trials (RCTs) showed individualized dietary support may prevent weight gain, although there is insufficient evidence whether it undermines smoking cessation. Commercial weight management providers (CWMPs), such as Slimming World, provide individualized dietary support for National Health Service (NHS) patients; however, there is no evidence that they can prevent cessation-related weight gain.\r\n\r\nOur objective is to determine whether attending Slimming World from quit date, through referral from NHS Stop Smoking Services, is more effective than usual care at preventing cessation-related weight gain.\r\n\r\nMethods\r\nThis RCT will examine the effectiveness of usual cessation support plus referral to Slimming World compared to usual cessation support alone. Healthy weight, overweight and obese adult smokers attending Stop Smoking Services will be included. The primary outcome is weight change in quitters 12 weeks post-randomization. Multivariable linear regression analysis will compare weight change between trial arms and adjust for known predictors of cessation-related weight gain.\r\n\r\nWe will recruit 320 participants, with 160 participants in each arm. An alpha error rate of 5% and 90% power will detect a 2 kg (SD = 2.5) difference in weight gain at 12 weeks, assuming 20% remain abstinent by then.\r\n\r\nDiscussion\r\nThis trial will establish whether referral to the 12-week Slimming World programme plus usual care is an effective intervention to prevent cessation-related weight gain. If so, we will seek to establish whether weight control comes at the expense of a successful quit attempt in a further non-inferiority trial.\r\n\r\nPositive results from both these trials would provide a potential solution to cessation-related weight gain, which could be rolled out across England within Stop Smoking Services to better meet the needs of 0.75 million smokers stopping with NHS support every year.
\n \n\n \n \nBACKGROUND:\r\nPatient-reported outcomes (PROs), such as health-related quality of life (HRQL) are increasingly used to evaluate treatment effectiveness in clinical trials, are valued by patients, and may inform important decisions in the clinical setting. It is of concern, therefore, that preliminary evidence, gained from group discussions at UK-wide Medical Research Council (MRC) quality of life training days, suggests there are inconsistent standards of HRQL data collection in trials and appropriate training and education is often lacking. Our objective was to investigate these reports, to determine if they represented isolated experiences, or were indicative of a potentially wider problem.\r\nMETHODS AND FINDINGS:\r\nWe undertook a qualitative study, conducting 26 semi-structured interviews with research nurses, data managers, trial coordinators and research facilitators involved in the collection and entry of HRQL data in clinical trials, across one primary care NHS trust, two secondary care NHS trusts and two clinical trials units in the UK. We used conventional content analysis to analyze and interpret our data. Our study participants reported (1) inconsistent standards in HRQL measurement, both between, and within, trials, which appeared to risk the introduction of bias; (2), difficulties in dealing with HRQL data that raised concern for the well-being of the trial participant, which in some instances led to the delivery of non-protocol driven co-interventions, (3), a frequent lack of HRQL protocol content and appropriate training and education of trial staff, and (4) that HRQL data collection could be associated with emotional and/or ethical burden.\r\nCONCLUSIONS:\r\nOur findings suggest there are inconsistencies in the standards of HRQL data collection in some trials resulting from a general lack of HRQL-specific protocol content, training and education. These inconsistencies could lead to biased HRQL trial results. Future research should aim to develop HRQL guidelines and training programmes aimed at supporting researchers to carry out high quality data collection.
\n \n\n \n \nBackground: Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and\r\ndepression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective.\r\nMethods and Findings: Systematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle\r\ninterventions were associated with small reductions in symptoms of depression (standardised mean difference 20.28, 95% confidence interval 20.41 to 20.14) and anxiety (standardised mean difference 20.23, 95% confidence interval 20.38 to 20.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference 20.47, 95% confidence interval 20.66 to 20.28), and for anxiety (standardised mean difference 20.45, 95% confidence interval 20.71 to 20.18).\r\nConclusions: Complex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.
\n \n\n \n \nThe composite abuse scale (CAS) is a comprehensive tool used to measure intimate partner violence (IPV). The aim of the present study is to translate the CAS from English to Arabic.\r\n\r\nMethods\r\nThe translation of the CAS was conducted in four stages using a multi-method approach: 1) preliminary forward translation, 2) discussion with a panel of bilingual experts, 3) focus groups discussion, and 4) back-translation of the CAS. The discussion included a linguistic validation by a comparison of the Arabic translation with the original English by assessing conceptual and content equivalence.\r\n\r\nFindings\r\nIn all the stages of translation, there was an agreement to remove the question from the CAS that asked women about the use of objects in the vagina. Wording, format and order of the items were refined according to comments and suggestions made by the experts\u2019 panel and focus groups\u2019 members. The back-translated CAS showed similar wording and language of the original English version.\r\n\r\nConclusions\r\nThe Arabic version of the CAS will help to measure the problem of IPV among Saudi women and possibly other Arabic-speaking women in future studies. This is important, particularly, in longitudinal studies or intervention studies among abused women and it allows a comparison of the results of studies from different cultures. However, further validations studies are needed to ensure accurate and equivalent Arabic translation of the CAS.\r\n\r\nCitation: Alhabib S, Feder G, Horwood J (2013) English to Arabic Translation of the Composite Abuse Scale (CAS): A Multi-Method Approach. PLoS ONE 8(9): e75244. doi:10.1371/journal.pone.0075244
\n \n\n \n \nBackground Subclinical hypothyroidism (SCHo) is a common biochemical diagnosis in older age. Evidence of impact is inconclusive and guidelines are inconsistent. With increasing numbers of thyroid function tests (TFTs) performed, GPs frequently have to make management decisions regarding this diagnosis. However, little is known about how SCHo is currently being managed in primary care.\r\nAim To explore management of SCHo in primary care and GP reported rationale for treatment of SCHo in older individuals.\r\nDesign Descriptive study using retrospective case note review and GP survey.\r\nSetting Nineteen General Practices, Central England, UK.\r\nMethods Follow-up of a large cohort with subsequent detailed review of individuals for whom therapy had been initiated following diagnosis of SCHo. Data on practice policies, and rationale behind treatment were collected via GP questionnaire.\r\nResults Forty-two individuals were treated following identification of SCHo. Factors regarded as supporting instigation of therapy recorded by practitioners included symptoms, a positive antithyroid antibody test and history of radioiodine therapy. In all, 55% were registered at 3/19 practices suggesting significant between practice variation. Reasons for testing included chronic disease check-up (n = 14), presenting \u2018thyroid symptoms\u2019 (n = 5) and presenting other symptoms (n = 9). Reasons for therapy initiation were only recorded in 26 cases and included presence of symptoms, persistently high or increasing serum thyroid stimulating hormone concentration and patient request. Only 2/15 GPs reported having practice guidelines on management.\r\nConclusion Results suggest that GPs are uncertain how to interpret symptoms and TFT results in older individuals. There is considerable variation in management of SCHo between GPs with some GPs treating patients outside of all guideline recommendations.
\n \n\n \n \nWhile debate has focused on whether testing of minors for late onset genetic disorders should be carried out if there is no medical benefit, less is known about the impact on young people (<25 years) who have had predictive testing often many years before the likely onset of symptoms. We looked at the experiences of young people who had had predictive testing for a range of conditions with variable ages at onset and options for screening and treatment. A consecutive series of 61 young people who had a predictive test aged 15-25 years at the Clinical Genetic Service, Manchester, for HD, HBOC (BrCa 1 or 2) or FCM (Hypertrophic Cardiomyopathy or Dilated Cardiomyopathy), were invited to participate. Thirty-six (36/61; 59%) agreed to participate (10 HD, 16 HBOC and 10 FCM) and telephone interviews were audiotaped, transcribed and analysed using Interpretative Phenomenological Analysis. None of the participants expressed regret at having the test at a young age. Participants saw the value of pretest counselling not in facilitating a decision, but rather as a source of information and support. Differences emerged among the three groups in parent/family involvement in the decision to be tested. Parents in FCM families were a strong influence in favour of testing, in HBOC the decision was autonomous but usually congruent with the views of parents, whereas in HD the decision was autonomous and sometimes went against the opinions of parents/grandparents. Participants from all three groups proposed more tailoring of predictive test counselling to the needs of young people.European Journal of Human Genetics advance online publication, 17 July 2013; doi:10.1038/ejhg.2013.143.
\n \n\n \n \nObsessive\u2013compulsive disorder (OCD) is a disabling mental health condition. Despite effective psychological treatments for OCD, a significant percentage of patients fail to experience lasting benefit. Factors underlying variable treatment response are poorly understood. Moderators of outcome can help understand \u201cfor whom\u201d and \u201cunder what circumstances\u201d an intervention works best and thus improve service effectiveness. This paper synthesizes the evidence on predictors and moderators and assesses the quality of reporting of related analyses in psychological therapies for adults with OCD. Trialswere identified through electronic searches (CENTRAL, MEDLINE, PsycINFO, EMBASE), key author, and reference list searches of relevant systematic reviews. Fifty five percent (38/69) of relevant trials reported baseline factors associated with outcome; these encompassed clinical, demographic, interpersonal, OCD symptom-specific, psychological/psychosocial, and treatment-specific variables. Predictors were commonly assessed via a validated pre-randomization measure, though fewtrials adopted best practice by stating a priori hypotheses or conducting a test of interaction. Potential\r\nassociations emerged betweenworse OCD treatment outcome and the following factors: hoarding pathology, increased anxiety and OCD symptom severity, certain OCD symptom subtypes, unemployment, and being single/not married. However, the applied utility of these analyses is currently limited by methodological weaknesses.
\n \n\n \n \nBackground\r\nIncidence of sexually transmitted infections (STIs) among young people in the United Kingdom is increasing. The Internet can be a suitable medium for delivery of sexual health information and sexual health promotion, given its high usage among young people, its potential for creating a sense of anonymity, and ease of access. Online randomized controlled trials (RCTs) are increasingly being used to evaluate online interventions, but while there are many advantages to online methodologies, they can be associated with a number of problems, including poor engagement with online interventions, poor trial retention, and concerns about the validity of data collected through self-report online. We conducted an online feasibility trial that tested the effects of the Sexunzipped website for sexual health compared to an information-only website. This study reports on a qualitative evaluation of the trial procedures, describing participants\u2019 experiences and views of the Sexunzipped online trial including methods of recruitment, incentives, methods of contact, and sexual health outcome measurement.\r\n\r\nObjective\r\nOur goal was to determine participants\u2019 views of the acceptability and validity of the online trial methodology used in the pilot RCT of the Sexunzipped intervention.\r\n\r\nMethods\r\nWe used three qualitative data sources to assess the acceptability and validity of the online pilot RCT methodology: (1) individual interviews with 22 participants from the pilot RCT, (2) 133 emails received by the trial coordinator from trial participants, and (3) 217 free-text comments from the baseline and follow-up questionnaires. Interviews were audio-recorded and transcribed verbatim. An iterative, thematic analysis of all three data sources was conducted to identify common themes related to the acceptability and feasibility of the online trial methodology.\r\n\r\nResults\r\nInterview participants found the trial design, including online recruitment via Facebook, online registration, email communication with the researchers, and online completion of sexual health questionnaires to be highly acceptable and preferable to traditional methods. Incentives might assist in recruiting those who would not otherwise participate. Participants generally enjoyed taking part in sexual health research online and found the questionnaire itself thought-provoking. Completing the sexual health questionnaires online encouraged honesty in responding that might not be achieved with other methods. The majority of interview participants also thought that receiving and returning a urine sample for chlamydia testing via post was acceptable.\r\n\r\nConclusions\r\nThese findings provide strong support for the use of online research methods for sexual health research, emphasizing the importance of careful planning and execution of all trial procedures including recruitment, respondent validation, trial related communication, and methods to maximize follow-up. Our findings suggest that sexual health outcome measurement might encourage reflection on current behavior, sometimes leading to behavior change.
\n \n\n \n \nIn Press
\n \n\n \n \nHeterogeneity has a key role in meta-analysis methods and can greatly affect conclusions. However, true levels of heterogeneity are unknown and often researchers assume homogeneity. We aim to: a) investigate the prevalence of unobserved heterogeneity and the validity of the assumption of homogeneity; b) assess the performance of various meta-analysis methods; c) apply the findings to published meta-analyses.
\n \n\n \n \nOverweight and obesity are common and important causes of chronic disease. This should mean that primary care physicians feel tackling obesity is important, but it is uncommon for them to do so. Physicians perceive that this is not their job; they fear offending their patients and are unclear what may be effective. In this review we found two systematic reviews showing that motivational interviewing can lead to effective weight loss but it may not be practicable in this setting. Two trials show referral to specially trained nurses in primary care appears ineffective. Several randomized trials show referral to commercial weight management companies is effective. Observational data but no trials suggest that screening for and opportunistic brief interventions may motivate attempts to lose weight and lead to some weight loss. We conclude there is insufficient evidence to promote treatment opportunistically but sufficient evidence to refer patients wanting to lose weight to commercial weight management services.\r\n\r\nhttp://link.springer.com/article/10.1007/s13679-013-0073-8
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