Critical Appraisal Skills Programme Research Articles

Integrating Lean Management and Circular Economy for Sustainable Dentistry

The increasing focus on environmental sustainability has prompted the healthcare sector, including dentistry, to reconsider waste management practices. Dental offices generate various waste streams from outdated technologies, including single-use plastics, hazardous materials, and digital waste. This scoping review explores how integrating circular economy principles with lean management practices can enhance sustainability and operational efficiency in dental clinics. Using the PRISMA methodology, the review identifies 30 articles that passed the Cochrane Risk of Bias Tool and the Critical Appraisal Skills Program (CASP) checklist from 2000. Circular economy principles focus on reducing waste and maximizing resource reuse, while lean management seeks to improve efficiency and minimize process waste. Together, these approaches can significantly reduce resource consumption and enhance recycling efforts in dental practices. Despite barriers such as high technology costs, regulatory constraints, and limited recycling infrastructure, case studies highlight successful implementation in healthcare settings, demonstrating improved environmental and operational outcomes. Collaboration between dental professionals, policymakers, and industry leaders is essential for promoting the adoption of these sustainable practices.

An exploration of undergraduate health science students’ experiences of blended learning andragogy: A rapid review

Introduction: Blended learning is defined as the combined use of in-person and online learning, through interactive multimedia and face-to-face engagement with curriculum content. Recently, higher education institutions have experienced major inevitable changes in teaching and learning approaches, sparking interest in the exploration of these approaches- including blended learning. Aim: To explore undergraduate health sciences students’ experiences of blended learning. Method: A rapid review of articles published in English was conducted between 18th-22nd February 2022 using the following databases: Pubmed, Ebscohost, Web of Science, Scopus, Africawide Information and CINAHL. Articles found were exported to Endnote, version 20.2.1. The Preferred Reporting Items for Systematic Reviews and Meta-analysis flow chart was used to document the search. The Critical Appraisal Skills Programme was used to appraise the articles, which were analysed using thematic analysis. Findings: Eight quantitative articles were analysed and categorised on the hierarchy of evidence. Three themes emerged: 1. Student engagement and perceptions of blended learning, 2. Student academic performance, and 3. Challenges of blended learning. Conclusion: Positive experiences of blended learning were reported, including: significant improvement of student academic performance, higher levels of satisfaction and an increased student engagement. Ineffective online learning platforms and/or technological devices resulted in students experiencing anxiety and frustration. Implications for practice Blended learning may be a feasible option to maintain and enhance students learning experience. Students’ academic performance could improve with blended learning Blended learning could increase students’ engagement within the andragogical field.

The Effect of Internet-Based Cardiac Rehabilitation on Anxiety, Depression, and Quality of Life Among Patients With Ischemic Heart Disease

Background Internet-based cardiac rehabilitation (IBCR) is an innovative, alternative platform used in current practice for the secondary prevention of ischemic heart disease (IHD). The impact of IBCR on anxiety, depression, and quality of life (QoL) in patients with IHD remains inconclusive. Objective To explore the effect of IBCR on anxiety, depression, and QoL among patients with IHD. Methods Five databases (Embase, CINAHL, Medline, Cochrane, and Web of Science) and additional resources were searched to identify studies published between January 2014 and March 2024. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Critical Appraisal Skills Program checklist were used. Two reviewers independently assessed study quality, eligibility, and data extraction. RevMan (version 5.3) software was used for the meta-analysis. The protocol was registered in PROSPERO (CRD42023387666). Results Thirteen randomized controlled trials were included across 9 countries. A total of 2256 participants, with a mean age ranging from 55 to 63 years, the majority being men (73%), were identified. IBCR did not significantly reduce anxiety (P = .22) or depression (P = .44) or increase QoL (P = .21) compared with usual care. Intervention was delivered mainly via smartphones. Physical activities and risk factor management were mostly used, and behavioral changes less likely occurred. Hospital Anxiety and Depression Scale was mostly used. Conclusions IBCR was comparable to the effects of usual care in cardiac rehabilitation. Theory-driven interventions with larger and diverse sample sizes, and longer durations across different regions, are recommended for reliable findings.

The effectiveness of couples' lifestyle interventions on weight change: A systematic review and meta-analysis of Randomised Controlled Trials.

Introduction: Lifestyle interventions aiming to reduce excess body weight have been focusing on individuals living with overweight or obesity. However, many health-related behaviors including eating are concordant in couples indicating they might share an obesity risk or support each other's weight loss efforts. Aim: The aim of this systematic review and meta-analysis of randomized controlled trials was to assess the weight change effects of lifestyle interventions targeting couples in a romantic relationship regardless of marital status or sexual preference compared to individuals or no intervention. Methods: Four databases (MEDLINE Ovid, Scopus, CINHAL, and mySearch: EBSCO-Discovery-Service-Tool) were systematically searched from inception until 26th April 2021 with further email alerts. The risk of bias was assessed using the Critical Appraisal Skills Programme. Meta-analysis was conducted using the random-effect model to estimate the weighted mean difference with 95% confidence interval. Results: Seventeen studies were eligible for this review and 11 of them were included in the meta-analysis for weight change. Significant intervention effects were identified for body weight in couples' intervention vs. individual intervention (-2.25 kg, 95% CI-3.63 to-0.88), and vs. no intervention (-4.5 kg, 95% CI-6.62 to-2.38). Conclusion: This systematic review and meta-analysis was the first to investigate the effectiveness of lifestyle interventions targeting couples on weight loss, compared to interventions focused on individuals or standard care. The findings suggest that interventions aimed at couples lead to greater weight loss, though the results should be interpreted with caution due to the wide heterogeneity among the studies. Further research is needed with evidence-based study designs, targeting younger participants, and incorporating longer intervention durations and follow-up periods.

Emerging Radiopharmaceuticals in Pet Imaging for Mesothelioma: A Review of [18F]FDG Alternatives.

Mesothelioma is a malignant tumor associated primarily with asbestos exposure, characterized by an aggressive nature and poor prognosis. Accurate diagnosis, staging, and monitoring of therapeutic response are crucial for effective patient management. Along with a computed tomography (CT) scan, fluorodeoxyglucose labeled with fluorine-18 ([18F]FDG) positron emission tomography (PET) is commonly used in mesothelioma evaluation. However, it has some limitations, including lower sensitivity after pleurodesis and poor accuracy for involved lymph node evaluation. Thus, there is the need to explore other agents. The aim of the present review is to analyze the current literature on the use of alternative radiopharmaceuticals for PET imaging in patients with mesothelioma. A comprehensive search of scientific databases (PubMed, Scopus, and Web of Science) for studies published in the last decade was performed by using the following keywords: "mesothelioma" AND "PET" AND "PET/CT" "radiopharmaceuticals", "[18F]FDG alternatives". Articles focused solely on [18F]FDG, non-English publications or preclinical studies, reviews, meeting abstracts, letters to the editors, and editorials were excluded. A qualitative assessment was made by using the Critical Appraisal Skills Programme (CASP) checklist for diagnostic test studies, when applicable. In total, 14 papers were selected; in seven articles more than five patients were enrolled, while the other seven were only clinical cases (enrolling up to two subjects). [18F]/gallium-68 ([68Ga])-labeled fibroblast activation protein inhibitor (FAPI) compounds, [18F]Fluorothymidine ([18F]FLT), methionine labeled with carbon-11 ([11C]MET), and fluoromisonidazole labeled with fluorine-18 ([18F]FMISO) PET/CT were the alternative agents used most often. In 12 articles, [18F]FDG PET/CT was used as a comparator imaging modality. Detection rate of [18F]FDG was similar to the other radiopharmaceuticals ([68Ga]/[18F]-labeled FAPI compounds, [18F]FLT, [18F]FMISO, [11C]MET, and [68Ga]-Pentaxifor), although radiolabeled FAPI seems to exhibit a higher diagnostic performance. [18F]FDG is still a valuable agent in patients with mesothelioma. However, radiolabeled FAPI appears to be promising and its theranostic properties should therefore be further assessed.

Factors influencing the uptake of antenatal care in Uganda: a mixed methods systematic review

BackgroundIn 2016, the World Health Organization (WHO) recommended increasing antenatal care (ANC) visits from four to eight to reduce maternal morbidity and mortality. However, many low-middle income countries (LMICs), including Uganda, struggle to achieve even the basic four ANC visits. To further improve ANC attendance, understanding the perceptions and beliefs of end users is crucial. This systematic review explores the perceptions, experiences, and behavior of pregnant or previously pregnant women, their families and healthcare workers on ANC attendance in Uganda.MethodsThe review includes qualitative and quantitative studies published from January 2012 to September 2022. Outcomes include early initiation of ANC visits and any attendance or utilization of routine ANC services. The Critical Appraisal Skills Programme (CASP) checklist was used to assess the quality of included studies.ResultsWe searched 7 databases, identified 725 references and assessed 107 in full text for eligibility based on selected inclusion criteria. Forty-seven studies were eligible and are included in this review. Quantitative findings highlight socioeconomic factors like occupation, wealth index, and marital status as key determinants of ANC uptake and timely uptake of care, favoring higher wealth, younger age, marriage, and media access. Qualitative evidence reveals challenges to ANC attendance including financial constraints, cultural beliefs, gendered decision-making, and geographical distance from healthcare facilities. Potential solutions involve financially empowering women, providing reliable ANC equipment and medication, and community engagement and education.ConclusionsThis review offers valuable insights for policymakers and healthcare providers seeking to tailor interventions that address the unique needs and challenges faced by pregnant women, their families, and healthcare workers in Uganda. By doing so, it may enhance ANC accessibility and quality, ultimately aligning with the WHO’s recommendation of eight ANC contacts (ANC8) and contributing to reducing maternal morbidity and mortality rates.

A Meta-synthesis of Qualitative Research on Effective Return to Work Counseling for Individuals with Work Participation Restrictions - A Systematic Review.

The aim of this systematic review was to summarize the qualitative evidence on factors of effective counseling aiming at work participation for people with chronic diseases and/or disabilities. We conducted a systematic literature search in MEDLINE (PubMed), CINAHL, Web of Science, PsycINFO, and PubPsych in March 2023. Our inclusion criteria stipulated that counseling should be specifically designed for individuals experiencing constraints in work participation and published in German or English between 2013 and 2023. To assess the quality of the included studies, we used the checklist of the Critical Appraisal Skills Programme. We synthesized our findings according to the meta-ethnographic methodology by Noblit and Hare. Of the 2901 papers found in the systematic search, we included 16 qualitative studies in our meta-synthesis. Studies were conducted in Australia, the USA, Canada, Nordic countries, and Germany. Our "model of the effectiveness of counseling for work participation" consists of four levels. At the extended organizational level, potential factors include the provision of sufficient time and work resources for counselors or contact persons. At the team and stakeholder level, structural collaboration, for example, is crucial. In the counseling dyad, counselors can employ shared decision-makingand at the individual level, personal character traits and the client's motivation are exemplary factors. This study provides a comprehensive overview of factors contributing to effective counseling in the context of work participation. The delineation across various levels underscores that effectiveness in counseling is a collective outcome, involving not only the advisor but also other stakeholders.

Early Warning Systems for Acute Respiratory Infections: Scoping Review of Global Evidence.

Early warning systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increased risks of clinical deterioration, thus facilitating timely and appropriate interventions. EWSs can mitigate the impact of global infectious diseases by enhancing information exchange, monitoring, and early detection. We aimed to evaluate the effectiveness of EWSs in acute respiratory infections (ARIs) through a scoping review of EWSs developed, described, and implemented for detecting novel, exotic, and re-emerging ARIs. We searched Ovid MEDLINE ALL, Embase, Cochrane Library (Wiley), and CINAHL (Ebsco). The search was conducted on October 03, 2023. Studies that implemented EWSs for the detection of acute respiratory illnesses were included. Covidence was used for citation management, and a modified Critical Appraisal Skills Programme (CASP) checklist was used for quality assessment. From 5838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSs within community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms. Five studies focused on EWSs that used data from hospitalization and emergency department visits. These systems leveraged clinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused on the effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats and how they could be improved based on past performance. Four studies highlighted the integration of machine learning models to improve the predictive accuracy of EWSs. Three studies explored the applications of national EWSs in different health care settings and emphasized their potential in predicting clinical deterioration and facilitating early intervention. Lastly, 3 studies addressed the use of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and responding to health threats in environments housing vulnerable populations. The CASP tool revealed that most studies were relevant, reliable, and of high value (score 6: 11/29, 38%; score 5: 9/29, 31%). The common limitations included result generalizability, selection bias, and small sample size for model validation. This scoping review confirms the critical role of EWSs in enhancing public health responses to respiratory infections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologies suggest a need for continued innovation and standardization in EWS development.

The perception and understanding of the terminology used to describe malnutrition from the perspective of patients and health workers: A meta-synthesis of qualitative studies

Malnutrition is prevalent across healthcare settings and has adverse outcomes for patients and the health system. However, some patients do not recall being informed about their malnutrition risk/diagnosis. This meta-synthesis of qualitative studies aimed to identify and synthesise patient, carer and health worker perceptions and understanding of the terminology used by health workers for malnutrition risk/malnutrition. Four databases were searched (Medline, CINAHL, PsycINFO and Embase) up until August 2023. Title, abstract and full text screening were independently completed by 2 reviewers. The quality of the included studies was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were analysed by the review team using thematic synthesis. The resulting themes informed review findings. The confidence in each finding was assessed using GRADE-CERQual. Seventeen studies were included contributing perspectives from patients (n=7 studies), health workers (n=5 studies) or both patients and health workers (n=5 studies); no studies included carer perspectives. There were 5 themes: "Patients have differing understanding, interpretation of, and identification with malnutrition risk and malnutrition terminology" (very low confidence); "Health workers perceive that patients do not identify with or understand malnutrition risk and malnutrition terminology" (low confidence); "Patients do not routinely perceive their malnutrition risk or malnutrition diagnosis as problematic" (low confidence); "Health workers use varied terminology for malnutrition risk and malnutrition" (low confidence); "Action is required to improve malnutrition diagnostic communication" (low confidence). Findings highlighted disparity in patients' perspectives regarding the terms used for malnutrition risk and malnutrition. Varied terms were used by health workers and patients did not often associate these terms with a health condition that required treatment. Health workers and patients called for action to improve the communication of malnutrition. To do this, further research exploring malnutrition terminology and the broader concept of malnutrition communication is required with patients, carers and health workers.

Use and De-implementation of Fecal Occult Blood Tests in the Acute Care Setting: A Systematic Review and Meta-Analysis.

To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice. We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria. Of 2,471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n=7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders. Overall, all studies endorsed that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.

Experiences of Informal Caregivers Caring for Individuals With Chronic Schizophrenia in Asia: A Systematic Review and Meta-Synthesis.

In Asia, many caregivers are culturally obliged to assume the role of taking care of individuals experiencing chronic schizophrenia, even as they grapple with stigma and compassion fatigue. Despite the significance of this phenomenon, the collective experiences of Asian caregivers remain poorly understood. To synthesise qualitative evidence on the experiences of informal caregivers when caring for individuals with chronic schizophrenia in Asia. A search was conducted on seven databases for studies published between 2013 and 2023. The included studies were appraised using the Critical Appraisal Skills Program tool. Data extraction was based on the Joanna Briggs Institute (JBI) Qualitative Extraction Form. The data synthesis was based on the framework by Sandelowski and Barroso. Our review included the experiences of 1345 informal caregivers from 57 included studies. The analysis yielded the overarching theme of 'Navigating Challenges, Forging Resilience'. Three themes were identified: (i) challenges in caregiving, (ii) lack of support and (iii) coping and resilience. Our findings highlighted the Asian caregivers' stressors, particularly cultural and traditional factors, a facet often overlooked in the literature. Mental healthcare practitioners must provide caregivers with comprehensive information. Anticipatory guidance is essential during the initial stages of the diagnosis. To negate geographical limitations, caregiver-training sessions can be pre-recorded and posted to online platforms. Finally, cultural and spiritual beliefs can be integrated into the treatment plans for individuals with schizophrenia in the community. Within the institutional setting, mental healthcare practitioners are encouraged to provide caregivers with comprehensible information or training in person and through written or online platforms, which can transcend geographical limitations. Anticipatory guidance is essential, especially during the initial stages of the diagnosis, when confusion and uncertainties are prevalent. Periodic home visits by mental healthcare practitioners can help ease caregivers' concerns and enhance their caregiving confidence. Finally, cultural and spiritual beliefs should be integrated into the treatment plans for individuals with schizophrenia in the community as it promotes cultural acceptability, encourages referrals to appropriate institutions and reduces the stigma of mental healthcare.

Facilitating acculturation of internationally educated nurses: A meta-synthesis of social integration strategies.

To explore the social integration strategies adopted by internationally educated nurses during acculturation and to elucidate their role in facilitating successful adaptation to their host countries. With their remarkable resilience, internationally educated nurses navigate numerous challenges in their acculturation process in the host country. While the importance of effective social integration strategies in the acculturation and subsequent retention of internationally educated nurses is well known, the specific strategies adopted by these nurses have not been extensively explored. This study aims to fill this gap with its unique and significant focus on these strategies. Eight electronic databases were searched for English articles from inception to October 2023 to ensure a comprehensive review. The quality of the included studies was appraised using the Critical Appraisal Skills Program checklist. A meta-synthesis was performed using Sandelowski and Barroso's two-step approach, and a thematic analysis was performed according to Braun and Clarke's framework. This review included experiences of 258 internationally educated nurses across 16 primary studies and has yielded the overarching theme of 'fostering a sense of belonging'. The overarching theme is supported by three themes: (1) cultivating social capital, (2) employing effective communications, and (3) engaging with the community. Internationally educated nurses' social integration is a complex process that leverages support networks, establishing connections and overcoming communication barriers. However, the most crucial element is the active involvement of the host community, which plays a significant role in internationally educated nurses' acculturation journey. This review has highlighted the importance of social integration in internationally educated nurses' acculturation journey. Interventions such as having a supportive social network, providing a customised communication programme, organising engagement activities and granting overseas home leave are practical strategies that can enhance this journey.

Barriers and facilitators to self-management of chronic conditions reported by women: a systematic review of qualitative studies

ObjectivesThis systematic review aims to identify, appraise and synthesise the findings of published qualitative research exploring the barriers and facilitators to self-management of chronic conditions reported by women.DesignA systematic literature...

Barriers to and enablers of the early diagnosis of breast cancer among women from ethnic minority backgrounds in the UK: protocol for a qualitative evidence synthesis

IntroductionBreast cancer is the most commonly diagnosed cancer in women of all ethnic groups in the UK. The largest single ethnic groups in the UK are white, Indian, Pakistani, black...

Exploring the Impact of Social Support on Tuberculosis Treatment: A Thematic Review

Aims: Tuberculosis (TB) remains a critical global health issue, characterized by significant morbidity and mortality rates. Recent research highlights the potential of social support interventions to enhance TB treatment outcomes and improve patient quality of life. This study examines the positive effects of social support interventions on TB patients throughout their treatment process. Method: Utilizing a traditional review approach, this study applies thematic analysis to synthesize findings from the literature. The review encompasses 17 articles selected from reputable databases, including PubMed, Wiley Online Library, ProQuest, and Google Scholar, based on predefined inclusion criteria. These articles underwent quality assessment using the Critical Appraisal Skills Programme (CASP) tool. The PRISMA flowchart provided transparency in the selection process. Results: Key themes identified through the analysis include treatment adherence, psychological well-being, motivation to recover, health-related quality of life, prevention of TB transmission, successful TB treatment, and self-efficacy to recover. Conclusion: The findings suggest that social support interventions can play a crucial role in addressing the persistent challenges of TB management globally.

A systematic review on exploring the influence of Industry 4.0 technologies to enhance supply chain visibility and operational efficiency

This systematic review investigates the implications of Industry 4.0 technologies on supply chain visibility and operational efficiency. The primary aim is to discern the impact of technological integration on contemporary supply chain dynamics. Methods: A comprehensive search strategy identified 65 pertinent studies published between 2015 and 2023. The review adheres to systematic methodologies, employing the Critical Appraisal Skills Programme framework for quality assessment. Data synthesis incorporates qualitative and quantitative analyses to distill key themes and patterns. Results: The review unveils the pivotal role of information visibility in fortifying supply chain outcomes, emphasizing the need for a dual investment strategy encompassing technological solutions and a collaborative organizational culture. Regional variations in supply chain practices, insights from humanitarian supply chains, and the influence of environmental factors on agility broaden the understanding of Industry 4.0 implications. Organizations are urged to adopt a context-specific, adaptive approach, recognizing the significance of intangible assets and tailoring strategies to local contexts for optimal supply chain performance. This systematic review contributes a nuanced understanding of Industry 4.0’s transformative potential in supply chain management, emphasizing the interplay between technology, organizational culture, and regional contexts.

Factors Influencing the Engagement with Electronic Mental Health Technologies: A Systematic Review of Reviews.

Mental disorders impact approximately one-third of the global population, affecting adults, children, and youth worldwide. Recently, electronic mental health (e-mental health) technologies have been proposed to facilitate the provision of mental health care by professionals and other stakeholders, aiming to address the challenges associated with delivering mental health services. The objective of this study was to investigate the existing factors influencing engagement with e-mental health technologies. This study was a systematic review of existing reviews conducted in 2024. PubMed, Scopus, ProQuest, and Cochrane databases were searched. The authors assessed the quality of the studies using the CASP (Critical Appraisal Skills Programme) Checklist. Subsequently, they extracted and analyzed the data, utilizing the Boyatzis thematic analysis approach. The systematic review resulted in 15 papers, all of which exhibited an acceptable level of quality and risk of bias. The thematic analysis classified the data into five main themes: 'Technical', 'Ethical and Legal', 'Clinical', 'Organizational', and 'Social'. The study underscored the significance of ensuring accessibility, affordability, and reimbursement to effectively engage patients with e-mental health services. Additionally, transparency-facilitated by self-certification and user involvement-alongside critical factors like informed consent and privacy safeguards, was presented as playing a pivotal role in the process. Moreover, facilitators, including tailored interventions that consider the specific needs of particular groups and temporary project teams composed of individuals working together on specific initiatives, were identified as essential contributors. Overall, the factors influencing engagement with e-mental health technologies and potential solutions for enhancing such engagement appear to be interconnected.

Uncovering the story within the story: a scoping review of response shift in qualitative research.

The role of qualitative research in response-shift research has not been well characterized. This scoping review summarizes the status of qualitative studies on response shift. A scoping review of the medical literature was done using the keywords "response shift" and "qualitative" or "interview." After excluding ineligible works, each retained article was rated by two independent raters according to the modified Critical Appraisal Skill Program (CASP) criteria. A synthesis of adjudicated review results further characterized the articles. The search yielded 50 unique articles published from 1991 to 2023, 39 of which were retained after applying exclusion criteria. Most (69%) had the highest possible CASP score. Studies involved a broad range of patients by diagnosis or therapeutic context, caregivers, and healthcare professionals. While studies were often purely descriptive, many addressed components of response-shift theory or assumptions of response-shift methods. Study goals varied by design, time-focus (i.e., retrospective, present-focus or prospective), and by whether response-shift hypotheses were planned or post-hoc. The theoretical value added by the qualitative process involved examining the cognitive/emotional processes underlying quality-of-life ratings and response shifts. The methodological value added by the qualitative process facilitates understanding measurement error and non-responsiveness, and whether the methods used reflect the researchers' presumptions. The use of qualitative methods in response-shift research yields a nuanced understanding of what response-shift "looks like" in different patient populations, thereby helping to translate results more directly to clinical experience. Studies contributed to response-shift theory or methods in ways not easily captured by purely quantitative research.

Barriers to young people’s use of sexual and reproductive health services in Asia-Pacific

Abstract Background Qualitative literature extensively documents young people’s barriers to accessing sexual and reproductive health (SRH) services in Asia-Pacific countries. However, efforts to synthesise this research for practical use in healthcare policy and practice are lacking. This systematic review aims to systematically review and synthesise published qualitative literature focusing on young people’s utilisation of SRH services and understanding common access barriers. Methods We systematically searched five electronic databases from inception until 24 June 2022: MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science. Google Scholar and reference lists of all included studies were also searched. We used the Critical Appraisal Skills Programme (CASP) checklist for appraising the quality of included studies and analysed the data using a thematic synthesis approach. Results We included 31 papers reporting the experiences of over 1800 young people from 16 Asia-Pacific countries. Thematic synthesis identified several factors affecting adolescents’ utilisation of SRH services, which were grouped into six descriptive themes: navigating puberty; lack of SRH knowledge; embarrassment and confidentiality concerns; low decision-making autonomy; traditional practices and religious beliefs; and socio-cultural norms. Our overreaching analytical theme highlighted the role of shame as a key emotion hindering young people’s utilisation of SRH services. Conclusions Direct communication about SRH issues is crucial for teenagers. Embarrassment, privacy concerns, and stigma significantly affect their service utilisation decisions. Inclusive interventions for both youth and their communities by addressing socio-cultural factors are essential for optimising service accessibility and guiding evidence-based interventions and policies across diverse cultural contexts. Key messages • Understanding young people’s SRH service barriers in Asia-Pacific countries: Socio-cultural norms are highlighted as crucial for optimising service utilisation among young individuals in this area. • Inclusive interventions and policies are needed for enhanced accessibility.

The predisposing factors to heart failure diagnosis and early mortality among young adults in Africa: a narrative review

Abstract Introduction Heart failure (HF) is a major health concern mainly diagnosed among elderly individuals. Primarily, researchers have focused on this age group, nevertheless, compared to individuals from other regions of the world, Africans presents with HF two decades sooner (52 versus 79 years). Even though it manifests early, young persons (18–35 years old) are also diagnosed with HF with prognoses comparable to the older group. Less is known about how much study is concentrated on this age range, although globally, young adults of African origin make up the majority of those with an early onset of heart failure. Additionally, obtaining information about how HF impacts African youth remains challenging. Purpose To determine the cause of Africans' early HF diagnosis as well as the risk factors for HF diagnosis and early mortality among young adults. Methodology Three electronic databases— MEDLINE Ovid, Scopus, and CINAHL Plus—were searched using the Boolean operators. The first retrieved hits were checked for relevancy by titles and abstracts. Then, publications were fully screened for inclusion in the review based on the pre-established criteria. Also, reference lists of the articles were snowballed for pertinent studies. The scientific integrity of the studies was evaluated using a guided, in-depth peer-reviewed article on how to critically analyse clinical research and the Critical Appraisal Skill Programme (CASP) tool cohort checklist. Pertinent information regarding the study was analysed using a narrative review methodology. Eleven (11) articles out of the 135 pulled from the databases met the requirements for inclusion in the review after a thorough screening. One article was eliminated upon critical evaluation of the research's methodology, and an eligible article was discovered from snowballing reference lists. Therefore, only 11 articles qualified for this review study. Results Findings from the review show that HF is diagnosed earlier among Africans due to the early presentation of the major causes of HF before the age of 30 years. Rheumatic heart disease, cardiomyopathy, ischemic heart disease, HTN, and pulmonary illnesses (COPD, TB, and pulmonary arterial hypertension) are known aetiologies. More so, young adults who are diabetic, obese, have hyperlipidaemia or smoke cigarettes are more likely to develop HF. Furthermore, socioeconomic status, alcohol use, smoking, renal dysfunction, higher serum levels of brain natriuretic peptide (BNP) and creatine kinase (Isomer MB), cardiogenic shock, and decreased ejection fraction were the predictors of death with significant p-values (0.05). Conclusion Although HF affects young African adults disproportionately causing them to live lower quality of life and shorter lives, no research before this has been conducted. Therefore, further study is required to understand how HF affects this target age range (18 to 35 years) and to develop a long-term plan to fight this illness before it worsens.