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Stipulating citizen’s fundamental right to healthcare: Inference from the Constitution of Federal Republic of Nepal 2015
Professor Padam Simkhada, Pramod Regmi, Puspa Pant, Edwin van Teijlingen, Brijesh Sathian
Nepal Journal of Epidemiology Volume 5, No 4, 2015.
Nepal has a great opportunity to learn from, and collaborate with, non-governmental development partners and private sectors, and from other governments and organizations around the world, but we must move promptly.
Alex Stevens, Rudi Fortson, Fiona Measham, Professor Harry Sumnall
International Journal of Drug Policy Volume 26, Issue 12, December 2015, Pages 1167–1170, 2015.
Introduction: This journal has often analysed legislation in the field of drug policy. Rarely has it discussed a proposed law that has such deep problems in its legal and scientific bases. The Psychoactive Substances Bill, which is currently proceeding through the UK Parliament, will (if enacted) create a ‘blanket ban’ on the production, importation, exportation and supply of all psychoactive substances for human consumption, except for those that are specifically exempted. The Bill provides for a range of civil and criminal penalties, with a maximum seven-year prison sentence. This editorial will discuss some of the legal flaws and scientific problems that the Bill displays. It will consider some of the likely adverse consequences of the legislation, alongside the possibility of positive effects. We argue that the extraordinarily broad scope of the Bill, its exclusion of any consideration of harms caused by the substances that it bans, and the difficulty of defining these substances by ‘psychoactivity’ mean that the legislation bans too wide a range of substances and activities and will be difficult to enforce. Such enforcement may also be disproportionate to the harms caused by some of the banned substances and activities, including ‘social supply’. The Bill is also likely to lead to a number of unintended consequences due to displacement between substances and markets. We provide examples of such displacement in the cases of the 2010 mephedrone ban and of more recent action against retail NPS outlets in Blackburn. We conclude with some unavoidably pessimistic predictions.
Illicit and over-the-counter codeine dependence after acute back pain-successful treatment and ongoing recovery after buprenorphine/naloxone taper
Heroin Addiction and Related Clinical Problems, Published Ahead of Print, October 18, 2015.
Abstract: Increased prescribing of opioids for pain has been associated with an increase in dependency and associated morbidity and mortality. There are no evidence-based guidelines to direct the treatment of prescription or over-the-counter codeine dependency, including the use of maintenance and tapered dosing, or its use in conjunction with psychosocial interventions (PSI). Here we report the case of a family man who developed opioid analgesic dependence after being prescribed opioids for acute back pain. After his repeat prescription was stopped, he sourced both illicit and over-the-counter codeine. After 4 years of escalating use to a daily codeine dose of 1250 mg, he presented to a substance misuse service, The Bridge Project, Bradford. After successful induction and stabilisation on buprenorphine/naloxone (8 mg/2 mg) over the course of one week, our client successfully tapered over a 4-month period. He remained in work during treatment, and experienced side effects that were limited to headaches and some depressive thoughts. Opioid substitution treatment—buprenorphine/naloxone within a holistic Change Programme that included structured behavioural change psychosocial interventions—was successful, supporting slow taper across a 4-month period conducted within Unity Recovery Centre, part of the Bridge Project.
Edwin van Teijlingen, Professor Padam Simkhada, Bhimsen Devkota, Padmadharini Fanning, Jillian Ireland, Dr Bibha Simkhada, Lokendra Sherchan, Ram Chandra Silwal, Samridhi Pradhan, Shyam Maharjan, Ram Maharjan
Nepal Journal of Epidemiology, Vol 5, No 3, 2015.
Abstract: Mental health of pregnant women and new mothers is a growing area of concern in both low- and high-income countries. Maternity services in the UK, for example, have focused more attention on maternal mental health. We recognise that pregnancy, birth and the postnatal period is a time of major psychological and social change for women.
Edwin van Teijlingen, Professor Padam Simkhada
Nepal Journal of Epidemiology, Vol 5, No 3, 2015.
Abstract: On too many occasions researchers conduct public health and/or epidemiological studies in low-income countries without the appropriate in-country ethical approval. This article reflects on some of the underlying reasons for not applying for ethical approval. The piece concludes that we need to start by educating our (junior) researchers and research students about the importance of research ethics. We conclude with a number of recommendations for researchers, scientific journal editors and reviewers and ethical committees in high-income countries to bring the message home to researchers that ethical approval should be sought in low-income countries if and when required.
Ak Narayan Poudel, David Newlands, Professor Padam Simkhada
Nepal Journal of Epidemiology, Vol 5, No 3, 2015.
Abstract: Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations. It is concluded that there was a considerable knowledge gap about the issue, and the economic burden exerted by HIV/AIDS was big enough to push the affected households into poverty. It is suggested that more studies need to be conducted to fill the knowledge gap. Similarly, Government of Nepal and other organisations working in the field of HIV/AIDS need to provide economic supports (e.g.- support for travel costs) to the HIV positive people and need to increase the awareness level among general population for reducing stigma and discrimination, and reducing economic burden on them.
A scoping review to understand the effectiveness of linking schemes from healthcare providers to community resources to improve the health and well-being of people with long-term conditions
Rahena Mossabir, Rebecca Morris, Anne Kennedy, Dr Christian Blickem, Anne Rogers
Health & Social Care in the Community Volume 23, Issue 5, pages 467–484, September, 2015.
Abstract: The prevalence of people living with long-term conditions is increasing, accompanied by an increased expectation that patients will become more involved in self-management. Long-term conditions are associated with increased social isolation and poor physical and mental health. But there remains a gap in health provision between providing medical treatment and effectively addressing psychosocial well-being. One potential way of addressing this gap is by utilising social interventions which link patients from health services to community-based sources of support. However, the mechanisms involved in the delivery of interventions providing that link and their effectiveness remain unclear. This review adopted the methodological framework for conducting scoping studies, searching for both academic and grey literature on social interventions which link people from healthcare settings to a range of community and voluntary sector organisations. A literature search between May and June 2013, involving five electronic databases, hand searching of two journals and the use of Google search engine, identified seven studies relevant to the review question. In terms of key characteristics and mechanisms of the interventions, mental health conditions and social isolation were the most common reasons for referral to the interventions, and referrals were usually made through general practices. Almost all the interventions were facilitator-led, whereby the facilitator worked to identify and link participants to appropriate community-based resources. In regard to health and social outcomes and their cost-effectiveness, studies reported improvement to participants' psychological and social well-being as well as their decreased use of health services, although there were limited measures of participants' physical health outcomes. Interventions for linking patients from healthcare setting to community-based resources target and address psychosocial needs of participants. The review identified involvement of health professionals in aiding the referral of patients to the intervention and the role of the intervention facilitators as key components of the interventions.
Graeme Mitchell, Peter Bohan
British Journal of Healthcare Management, Vol. 21, No. 8, pp 384–394, 2015.
Abstract: Clinical commissioning groups (CCGs) now control around two-thirds of the NHS budget, influencing healthcare provider priorities and playing a key role in implementing the NHS plan. However, significant failures in healthcare have highlighted a dissonance between expressed values of leaders and everyday routine practices. This research explores the leadership behaviour of commissioners and the role it plays in determining quality and safety in healthcare. The research took a two phase approach: phase 1 used focused video ethnography to observe commissioners in a mock board room setting; phase 2 employed a quantitative questionnaire to determine the leadership behaviours that subordinates would expect their commissioners to adopt. The findings of this research identified that the leadership style most prevalent within the commissioners was transactional in nature. The questionnaire to subordinates of commissioners identified that transformational leadership had the best outcome on staff performance if this was linked to positive leadership style. In addition, commissioners appear to lack consistency when analysing risks effectively and holding providers to account, citing issues such as ‘professional drift’ and concerns over further scrutiny, as validation for this approach. This confusion of leadership behaviours, allied with poor analyse of risk leaves commissioners prone to repeating previous healthcare failures.
A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)
Paul Galdas, Zoe Darwin, Jennifer Fell, Lisa Kidd, Peter Bower, Dr Christian Blickem, Kerri McPherson, Kate Hunt, Simon Gilbody, Gerry Richardson
Health Services and Delivery Research Volume: 3 Issue: 34, 2015.
Abstract: Background: Self-management support interventions can improve health outcomes, but their impact is limited by the numbers of patients able or willing to access them. Men’s attendance at, and engagement with, self-management support appears suboptimal despite their increased risk of developing serious and disabling long-term conditions (LTCs). Objectives: To assess the effectiveness, cost-effectiveness, accessibility and acceptability of self-management support interventions in men with LTCs. Methods: A quantitative systematic review with meta-analysis and a qualitative review using a metaethnography approach. The findings of the two reviews were integrated in parallel synthesis. Data sources: In the quantitative review, the Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by gender. In the qualitative review, the databases Cumulative Index to Nursing and Allied Health Literature, EMBASE, Medical Literature Analysis and Retrieval System Online, PsycINFO and Social Science Citation Index (July 2013) were searched from inception to July 2013. Review methods: In the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis. Results: Forty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men. Conclusions: Health professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities.
Sarah Lewis, Andrew Lee, Professor Padam Simkhada
BMC Pregnancy & Childbirth, 15:162, 2015.
Abstract: Background: The role of husbands in maternal health is often overlooked by health programmes in developing countries and is an under-researched area of study globally. This study examines the role of husbands in maternity care and safe childbirth, their perceptions of the needs of women and children, the factors which influence or discourage their participation, and how women feel about male involvement around childbirth. It also identifies considerations that should be taken into account in the development of health education for husbands. Methods: This qualitative study was conducted in four rural hill villages in the Gorkha district of Nepal. Semi-structured, in-depth interviews were conducted with husbands (n = 17), wives (n = 15), mothers-in-law (n = 3), and health workers (n = 7) in Nepali through a translator. Interviews were transcribed and analysed using axial coding. Results: We found that, in rural Nepal, male involvement in maternal health and safe childbirth is complex and related to gradual and evolving changes in attitudes taking place. Traditional beliefs are upheld which influence male involvement, including the central role of women in the domain of pregnancy and childbirth that cannot be ignored. That said, husbands do have a role to play in maternity care. For example, they may be the only person available when a woman goes into labour. Considerable interest for the involvement of husbands was also expressed by both expectant mothers and fathers. However, it is important to recognise that the husbands’ role is shaped by many factors, including their availability, cultural beliefs, and traditions. Conclusions: This study shows that, although complex, expectant fathers do have an important role in maternal health and safe childbirth. Male involvement needs to be recognised and addressed in health education due to the potential benefits it may bring to both maternal and child health outcomes. This has important implications for health policy and practice, as there is a need for health systems and maternal health interventions to adapt in order to ensure the appropriate and effective inclusion of expectant fathers.