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    ABSTRACT: Introduction There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. Objectives Through a narrative review of empirical literature, to identify: (1) What are the key components of health visiting practice? (2) How are they reflected in implementing the universal service/provision envisaged in the English Health Visitor Implementation Plan (HVIP)? Design The paper draws upon a scoping study and narrative review. Review Methods We used three complementary approaches to search the widely dispersed literature: (1) broad, general search, (2) structured search, using topic-specific search terms (3) seminal paper search. Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). Results The analysis revealed health visiting practice as potentially characterized by a particular ‘orientation to practice.’ This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors’ skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. Conclusions Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future.
    International Journal of Nursing Studies 07/2014; 52(1). DOI:10.1016/j.ijnurstu.2014.07.013
  • Midwifery 04/2014; 30(4):385–386. DOI:10.1016/j.midw.2014.03.007
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    ABSTRACT: Biofeedback therapy has been used to treat the symptoms of people with chronic constipation referred to specialist services within secondary and tertiary care settings. However, different methods of biofeedback are used within different centres and the magnitude of suggested benefits and comparable effectiveness of different methods of biofeedback has yet to be established. To determine the efficacy and safety of biofeedback for the treatment of chronic idiopathic (functional) constipation in adults. We searched the following databases from inception to 16 December 2013: CENTRAL, the Cochrane Complementary Medicine Field, the Cochrane IBD/FBD Review Group Specialized Register, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsychINFO. Hand searching of conference proceedings and the reference lists of relevant articles was also undertaken. All randomised trials evaluating biofeedback in adults with chronic idiopathic constipation were considered for inclusion. The primary outcome was global or clinical improvement as defined by the included studies. Secondary outcomes included quality of life, and adverse events as defined by the included studies. Where possible, we calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes and the mean difference (MD) and 95% CI for continuous outcomes. We assessed the methodological quality of included studies using the Cochrane risk of bias tool. The overall quality of the evidence supporting each outcome was assessed using the GRADE criteria. Seventeen eligible studies were identified with a total of 931 participants. Most participants had chronic constipation and dyssynergic defecation. Sixteen of the trials were at high risk of bias for blinding. Attrition bias (4 trials) and other potential bias (5 trials) was also noted. Due to differences between study populations, the heterogeneity of the different samples and large range of different outcome measures, meta-analysis was not possible. Different effect sizes were reported ranging from 40 to 100% of patients who received biofeedback improving following the intervention. While electromyograph (EMG) biofeedback was the most commonly used, there is a lack of evidence as to whether any one method of biofeedback is more effective than any other method of biofeedback. We found low or very low quality evidence that biofeedback is superior to oral diazepam, sham biofeedback and laxatives. One study (n = 60) found EMG biofeedback to be superior to oral diazepam. Seventy per cent (21/30) of biofeedback patients had improved constipation at three month follow-up compared to 23% (7/30) of diazepam patients (RR 3.00, 95% CI 1.51 to 5.98). One study compared manometry biofeedback to sham biofeedback or standard therapy consisting of diet, exercise and laxatives. The mean number of complete spontaneous bowel movements (CSBM) per week at three months was 4.6 in the biofeedback group compared to 2.8 in the sham biofeedback group (MD 1.80, 95% CI 1.25 to 2.35; 52 patients). The mean number of CSBM per week at three months was 4.6 in the biofeedback group compared to 1.9 in the standard care group (MD 2.70, 95% CI 1.99 to 3.41; 49 patients). Another study (n = 109) compared EMG biofeedback to conventional treatment with laxatives and dietary and lifestyle advice. This study found that at both 6 and 12 months 80% (43/54) of biofeedback patients reported clinical improvement compared to 22% (12/55) laxative-treated patients (RR 3.65, 95% CI 2.17 to 6.13). Some surgical procedures (partial division of puborectalis and stapled transanal rectal resection (STARR)) were reported to be superior to biofeedback, although with a high risk of adverse events in the surgical groups (wound infection, faecal incontinence, pain, and bleeding that required further surgical intervention). Successful treatment, defined as a decrease in the obstructed defecation score of > 50% at one year was reported in 33% (3/39) of EMG biofeedback patients compared to 82% (44/54) of STARR patients (RR 0.41, 95% CI 0.26 to 0.65). For the other study the mean constipation score at one year was 16.1 in the balloon sensory biofeedback group compared to 10.5 in the partial division of puborectalis surgery group (MD 5.60, 95% CI 4.67 to 6.53; 40 patients). Another study (n = 60) found no significant difference in efficacy did not demonstrate the superiority of a surgical intervention (posterior myomectomy of internal anal sphincter and puborectalis) over biofeedback. Conflicting results were found regarding the comparative effectiveness of biofeedback and botulinum toxin-A. One small study (48 participants) suggested that botulinum toxin-A injection may have short term benefits over biofeedback, but the relative effects of treatments were uncertain at one year follow-up. No adverse events were reported for biofeedback, although this was not specifically reported in the majority of studies. The results of all of these studies need to be interpreted with caution as GRADE analyses rated the overall quality of the evidence for the primary outcomes (i.e. clinical or global improvement as defined by the studies) as low or very low due to high risk of bias (i.e. open label studies, self-selection bias, incomplete outcome data, and baseline imbalance) and imprecision (i.e. sparse data). Currently there is insufficient evidence to allow any firm conclusions regarding the efficacy and safety of biofeedback for the management of people with chronic constipation. We found low or very low quality evidence from single studies to support the effectiveness of biofeedback for the management of people with chronic constipation and dyssynergic defecation. However, the majority of trials are of poor methodological quality and subject to bias. Further well-designed randomised controlled trials with adequate sample sizes, validated outcome measures (especially patient reported outcome measures) and long-term follow-up are required to allow definitive conclusions to be drawn.
    Cochrane database of systematic reviews (Online) 03/2014; 3(3):CD008486. DOI:10.1002/14651858.CD008486.pub2
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    ABSTRACT: Cel pracy Przegląd piśmiennictwa w celu zweryfikowania następującej hipotezy: zastosowanie leków przeciwgorączkowych u dzieci z ostrymi zakażeniami opóźnia wyzdrowienie. Schemat badania Przeprowadzono przegląd systematyczny i metaanalizę piśmiennictwa w celu oceny wpływu leków przeciwgorączkowych na ustąpienie objawów klinicznych chorób infekcyjnych u dzieci. Przeszukano bazy piśmiennictwa Medline (od 1946 roku do listopada 2012 roku) i EMBASE (od 1980 roku do 1 listopada 2012 roku) w celu znalezienia badań klinicznych, w których autorzy porównali zastosowanie leków przeciwgorączkowych z niefarmakologicznymi sposobami zwalczania gorączki. Wyniki Znaleziono 6 artykułów, z których 5 włączono do metaanalizy. Trzy badania przeprowadzono u dzieci chorych na malarię, a pozostałe trzy dotyczyły ogólnych zakażeń wirusowych, zakażeń wirusowych układu oddechowego oraz ospy wietrznej. Średnia różnica w czasie ustąpienia gorączki na podstawie połączonych danych wyniosła 4,16 godziny. Czas ten był krótszy u dzieci otrzymujących leki przeciwgorączkowe w porównaniu z dziećmi, które leczono bez stosowania tych leków (95% CI -6,35 do -1,96 godziny; p = 0,0002). Wykazano niewielkie różnice znamienne statystycznie (χ2 4,84; 4 df; p = 0,3; I2 17%). Wnioski Na podstawie analizowanych badań nie potwierdzono, że zastosowanie leków przeciwgorączkowych wydłuża czas ustępowania gorączki u dzieci.
    Pediatria polska 03/2014; 89(2). DOI:10.1016/j.pepo.2014.02.002
  • Nursing History Review 01/2014; 22(1):107-13. DOI:10.1891/1062-8061.22.107
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    ABSTRACT: Health professionals' personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals' alcohol-related health promotion practices; and (2) explore the relationship between health professionals' personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007-2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals' alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base.
    International Journal of Environmental Research and Public Health 01/2014; 11(1):218-48. DOI:10.3390/ijerph110100218
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    ABSTRACT: The purpose of this study was to enhance our understanding of factors that influence help-seeking in people with inflammatory bowel disease (IBD)-related fecal incontinence (FI), and their needs or desire for continence services. We conducted a survey of FI in community-dwelling people with IBD, all members of a United Kingdom IBD charity, and received 3264 responses. As part of the study, we asked 3 questions about help-seeking for IBD-related FI to which respondents were able to give free-text responses. We analyzed the responses to these help-seeking questions, continuing until data saturation when no new themes emerged (617 free text comments analyzed, 19% of total respondents). For the full survey, a mixed-methods design was used to collect and analyze quantitative and qualitative data. Qualitative (free-text) responses relating to help-seeking behavior reported in this article were analyzed using a pragmatic thematic approach. Seventy-four percent of the total sample (2415 out of 3264 respondents) reported some degree of FI. Of these, only 38% (n = 927) reported seeking help for FI. In the data reported in this article (n = 617), only 13.5% reported seeking help for FI. Help was described as satisfactory, unsatisfactory, or alternative (acupuncture, counseling, hypnotherapy). Reasons for not seeking help included believing nothing could be done, not knowing who to ask, feeling too embarrassed, ashamed or dirty, and perceived lack of interest, sympathy, or understanding from health care professionals. Although respondents wanted to talk to "someone with specialist knowledge about incontinence" only 6 out of 617 (0.9%) reported awareness of specialist continence services. Standard treatments were rarely mentioned (n = 2). Respondents' focus was on better management of FI rather than on cure. Many people with IBD-related FI are not aware of the services or treatments that are available to help them manage this distressing problem, and most do not seek help, often due to embarrassment and lack of knowledge that help might be possible. Clinical staff could communicate their awareness for the potential for FI to occur by proactively asking about symptoms during clinic appointments to provide an opportunity for symptoms to be disclosed and described.
    Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 11/2013; 40(6):631-8. DOI:10.1097/WON.0b013e3182a9a8b5
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    ABSTRACT: There is increasing evidence that exercise may improve symptoms in individuals with inflammatory bowel disease (IBD). This study aims to explore issues that clinicians may need to consider when giving advice on exercise to such individuals. Limited existing evidence suggests that low to moderate physical activity may improve symptoms without any adverse effects in individuals with IBD. This is largely supported by the findings of the current case series of "exercising" individuals with IBD who reported that low- to moderate-intensity exercise (most commonly walking) had a positive effect on their mood, fatigue, weight maintenance, and osteoporosis. Overexertion was reported as a potential problem. Scant advice regarding exercise had been given by their healthcare professionals according to participants. The current literature and findings of this small case series suggest that exercise is likely to be beneficial and safe for individuals with IBD. However, more research is required on which recommendations for exercise could be based.
    Gastroenterology nursing: the official journal of the Society of Gastroenterology Nurses and Associates 11/2013; 36(6):437-42. DOI:10.1097/SGA.0000000000000005
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    International journal of nursing studies 10/2013; 51(1). DOI:10.1016/j.ijnurstu.2013.10.014
  • Midwifery 10/2013; 29(12). DOI:10.1016/j.midw.2013.10.009
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