A systematic review of barriers to and facilitators of physical activity for people with autism spectrum disorder

Liam graduated from the Master of Public Health (MPH) programme at ScHARR in 2016 with Distinction. He decided to study for an MPH because he wanted to develop the skills he had learnt in his undergraduate psychology degree in public health research, a field of study that combined his interests in biology, sociology and medicine at a population level. Throughout the programme, Liam was able to advance his knowledge of statistics and health psychology, while learning completely new skills in epidemiology, disease control and systematic reviewing. He also worked outside the taught modules as Vice-President of the Public Health Society, where he was primarily responsible for planning activities and events for students on the programme. Liam is currently working as a Research Assistant at the University College London Research Department of Primary Care and Population Health. He is working on a project exploring factors influencing STI testing behaviour of young people in the UK, using a theory-based online questionnaire.

Abstract 

Background
Autism spectrum disorder is a lifelong neurodevelopmental disorder that affects people of all ages and across cultures. It is believed that autism spectrum disorder can contribute to lower levels of physical activity in people with the condition. Interest in the factors mediating this relationship has increased in recent years.

Aim
To identify the barriers to and facilitators of physical activity for people with autism spectrum disorder.

Design
Systematic review.

Data Sources
ASSIA, ERIC, MEDLINE, PsycINFO, Social Care Online, Web of Science, IBSS, LISA PEI, Social Services Abstracts, Sociological Abstracts and NAS Library Catalogue. Hand searching of reference lists of identified articles was also conducted.

Eligibility Criteria
Journal articles published in the English language from 1943 to March 2016. Journal articles were required to contain qualitative data relating to physical activity in people with autism spectrum disorder.

Results
Seventeen studies were included in the data synthesis. Most of the barriers and facilitators were labelled as either personal, social, environmental or policy and programme related. Using physical activity to reduce social stress was also a facilitator of physical activity.

Conclusions
Results from this synthesis can inform interventions and policies to encourage people with autism spectrum disorder to engage in physical activity. Further qualitative research would be beneficial to developing a more accurate picture of barriers and facilitators relevant to adults with autism spectrum disorder.

Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review

Simbiat Olayinka Lawal recently completed the Master of Public Health (MPH) programme at ScHARR. Simbiat chose to study the MPH to gain more knowledge on the role of healthcare policy and management and also to develop her research skills, especially in health services research. In particular, the course developed Simbiat's knowledge of healthcare financing systems and enabled her to develop and refine her research skills. Taking part in the MPH program at ScHARR also equipped Simbiat with several other skills such as team work, time management and an ability to strive. Simbiat believes that the new skills she has obtained from studying the MPH  will enable her to work in a role that will help Africa, and particularly her home country, Nigeria, to achieve universal health coverage and health equality as well as working towards sustainable development goals. In the future, Simbiat plans to pursue a doctorate degree in public health policy and management, alongside conducting research into the Nigerian healthcare system.

The title of Simbiat's dissertation project was: Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review.

Abstract

Background: Universal health coverage (UHC) refers to equal access to healthcare services across all socio-economic quintiles and reduction in financial risk incurred from the utilisation of health services. It is an important goal which would help reduce maternal mortality rates. However, the effectiveness of different healthcare financing (UHC) schemes on improving access and utilisation of maternal health services and on selected pregnancy outcomes amongst women of different socio-economic, educational and residential (rural or urban) backgrounds in developing countries, is not well understood.

Aim: This study aimed to examine the utility of UHC in improving access, utilization and pregnancy outcomes in women in developing countries.

Method: A systematic literature review was performed to answer the research question. Electronic databases; Medline, ASSIA, Cochrane library, TRIP, PubMed REMINER, CINAHL and Google scholar were used to retrieve all relevant studies on universal health coverage. Also, references of included studies and online resources of organisations such as WHO, UN and WORLD BANK were also searched to avoid omission of important literature. The inclusion and exclusion criteria were developed using the PICO (population, intervention, comparator and outcome) framework.

Result: A total of 13 studies were included in the review; of which 2 studies were from Bangladesh, 6 from Ghana, 1 from Uganda, 1 from Congo and 3 studies from two or more of the following countries: - (Ghana, Rwanda, Philippines, Senegal and Mali). There was a positive association between UHC and improved access, utility of antenatal health services and better increased access to emergency obstetric care (e.g. C-sections) despite women socioeconomic status, educational and residential (rural and urban) backgrounds: Antenatal health care (three to four or more ANC visits); NHIS (OR=1.182, p=0.05, OR=1.09, p=<0.01), other insurance (OR=2.37, p=<0.05 and OR=2.41, p=<0.05), voucher (OR=2.787, p=<0.001, OR=1.913, p= ≤0.001, (OR=0.2855, p=<0.001). Delivery at a healthcare facility; free delivery policy increased facility delivery by 2.3%, p=0.015, CI 0.50-4.05, NHIS policy increased facility delivery by 7.5%, p= ≤0.001, CI 4.97-9.92, other insurance coverage (e.g. CBHI) (OR=4.74, p= <0.10), and vouchers (OR=2.539, p= ≤0.001). Births attended by a skilled birth attendant; free delivery policy (OR=1.67, p= <0.01), NHIS policy (OR=1.65, p =<0.01 and OR=1.375, p=0.05), other insurance policy (free ANC policy) (OR=1.17, p= <0.01) and voucher scheme (OR=3.582, p= ≤0.001) and (OR=0.2119, p= <0.001). Emergency obstetric care (e.g. C-section); Fee exemption (OR=0.329, p= <0.0001), other insurance OR=1.13 vs. OR=1.26, p=<0.001, vouchers (OR=1.536, p= <0.01).

Conclusion: Universal health coverage through various strategies, if implemented adequately, sufficiently increases the utilization of maternal health care services. More women on UHC received emergency obstetric care such as C-section than those without. Future studies should endeavour to examine whether these benefits spill over to reducing maternal mortality. There should also be efforts to find out the barriers to universal adoption of UHC policies by developing countries, such as sources of funding, suitability of different policies in different developing economies.

Polio Eradication: What are the final steps required to eradicate polio by 2018?

Richard Vis graduated from the MPH (online) at the School of Health and Related Research at the University of Sheffield in January 2016. Richard chose the programme as it has an excellent reputation with the medical profession with a national and international focus to the course. The distance learning route enabled him to continue in his job at Sanofi Pasteur MSD, a pharmaceutical company, alongside learning about the many different aspects of public health.


For his MPH dissertation project Richard chose to explore the eradication of polio because he was interested to see how achievable this goal is, and to explore how key initiatives, as well as vaccines, are being used to eradicate the disease. He found that many of the topics explored in his dissertation were covered in the MPH syllabus and became more relevant when conducting his research.

The title of Richard's dissertation project was 'Polio Eradication: What are the final steps required to eradicate polio by 2018?'

Abstract

Introduction: In 1988 the World Assembly first set the goal of polio eradication for the year 2000. It was revised  to 2005, then again to 2012. The current date set for polio eradication and certification is by 2018 but wild polio virus still continues to circulate in Pakistan and Afghanistan. Nigeria has been free from polio for just over a year now but remains at risk of re-infection. Unless effective measures are taken this latest deadline will also be missed and the momentum towards eradication will be cause further disability and cost lives.

Aim: This dissertation sought to identify and highlight what the current barriers are to the completion of the eradication of polio, and to outline what final steps are needed to finally eliminate polio from Afghanistan and Pakistan, as well as Nigeria, that only recently become polio free. 

Methods: A narrative literature review was undertaken that identified key interventions that have made significant impact on the reduction in the number of cases of polio and also identified recommendations of interventions required for each country to eradicate polio over the next three years. 

Results: Five main interventions were identified: political, diplomatic stakeholder solutions; improvements in polio surveillance; strengthening of polio immunisation programme delivery; improvement in the management of programmes; improvements in social engagement and community advocacy. Specific recommendations were made for each country which need to be implemented effectively and rapidly to maintain the progress and momentum towards eradication. 

Conclusion: Each of these three key countries, Afghanistan, Nigeria and Pakistan have specific challenges that are unique to them. Implementation of the standard polio eradication programme interventions more effectively should ensure that polio is finally eradicated from their countries, and globally.  When this is finally achieved it will be the second major infectious disease to be eradicated after smallpox due to vaccination. This should drive forward the elimination of the next vaccine preventable disease targeted by the WHO, namely measles, by 2020. 

Click on this link to read more about Richard's research.

Light-emitting diode fluorescence microscopy for tuberculosis diagnosis: a meta-analysis

Eva Chang is a graduate of the Europubhealth (EPH) program and studied at ScHARR in 2012-2013. Prior to pursuing her MPH degrees, Eva had years of industry experience in monitoring clinical trials. Long interested in the multidrug-resistant tuberculosis (MDR-TB) crisis in Central Asia, Eva started the EPH program to study epidemiology and operational research methods.
Eva is currently working as a Trial Manager at the Harvard Medical School for a clinical trial that aims to test for shorter and simpler treatment regimens for MDR-TB patients.


The focus of Eva's project work was light-emitting diode fluorescence microscopy for tuberculosis diagnosis. Along with her co-authors Eva has recently published her work in the European Respiratory Journal.

Citation: Chang EW, Page A-L and Bonnet M. Light-emitting diode fluorescence microscopy for tuberculosis diagnosis: a meta-analysis Dec 2015 DOI: 10.1183/13993003.00978-2015 s

Abstract

Light-emitting diode fluorescence microscopy (LED-FM) is recommended by the World Health Organization to replace conventional Ziehl–Neelsen microscopy for pulmonary tuberculosis diagnosis. Uptake of LED-FM has been slow. One reason is its reported loss of specificity compared with Ziehl–Neelsen microscopy. We aimed to determine the diagnostic accuracy of LED-FM for tuberculosis detection and explore potential factors that might affect its performance.

A comprehensive search strategy based on pre-specified criteria was employed to identify eligible studies between January 1, 2000 and April 1, 2014 in 11 databases. Standardised study selection, data extraction and quality assessment were conducted. Pooled sensitivity and specificity of LED-FM using culture as the reference standard were estimated through meta-analyses using a bivariate random-effects model. Investigation of heterogeneity was performed by subgroup analyses.

We identified 12 unique studies, half of which were from peripheral healthcare facilities. LED-FM achieved a pooled sensitivity of 66.9% (95% CI 60.5–72.7) and pooled specificity of 96.8% (95% CI 93.1–98.6). A pooled sensitivity of 53.0% (95% CI 42.8–63.0) and pooled specificity of 96.1% (95% CI 86.0–99.0) were obtained by LED-FM among HIV-infected patients. Study methodology factors and differences in the LED-FM procedure or device could also affect the performance.

LED-FM specificity is high and should not be a barrier to device introduction, particularly among peripheral healthcare settings where this technology is meant to be used. Sensitivity is reduced in HIV-infected patients.

Reproduced with permission of the European Respiratory Society ©: European Respiratory Journal Dec 2015, DOI: 10.1183/13993003.00978-2015 

Effectiveness of limiting the time of alcohol sales as a means of preventing alcohol-related violence or crime

Olubusayo Abegunde completed the Master of Public Health programme at ScHARR in September 2015 and will graduate with merit in January. Her passion for public health was ignited during her undergraduate studies where she took a course in community health and epidemiology, which eventually led her to pursue the MPH programme. With the knowledge and skills gained from studying the MPH modules such as Health Promotion,  Disaster and Emergency Management and Communicable Disease Control, Olubusayo wishes to return to her home country, Nigeria, to pursue a career with a Governmental or Non-Governmental Organisation so that she can help combat the public health challenges that the country faces. She is also interested in further postgraduate, study either in Communicable Disease Control or Disaster and Emergency Management.

The title of Olubusayo's dissertation project was 'Effectiveness of limiting the time of alcohol sales as a means of preventing alcohol-related violence or crime'.

Abstract

Introduction: Alcohol-related violence is a major global public health challenge, ranging from mere nuisance inconveniences to debilitating injuries and even death in people other than the drinker. Apart from the physical and emotional harm suffered by victims of alcohol-related violence, there is also pressure on the health and criminal justice services resulting in huge financial cost to the society. Previous reviews have reported that limiting the time of alcohol sales is an effective means of reducing alcohol-related harms, however, no review has been conducted to assess the effectiveness of this intervention specifically on alcohol related-violence or crime.

Objective: To systematically review existing literature on the effectiveness of limiting the time of alcohol sales as a means of preventing alcohol-related violence or crime.

Search strategy: Six electronic databases (Medline, PsycINFO, ETOH, EMBASE, Sociological abstracts and Econlit) were searched using pre-specified search terms. Reference and citation lists of relevant articles were also searched.

Selection criteria: Quasi-experimental studies (before and after, interrupted time series designs) evaluating the effect of change (increase or decrease or both) in time of alcohol sales in relation to violence or crime were included in this review.

Data collection and analysis: Forms adapted from “Data Collection Instrument and Procedure for Systematic Reviews in the Guide to Community Preventive Services” were used for data extraction and quality assessment of included studies. Narrative synthesis was employed to explore the findings of this review.

Results: Fifteen studies were included in this review and were divided into three groups: Findings from increased time of alcohol sales; Findings from decreased time of alcohol sales and Findings from increased and decreased time of alcohol sales. Findings from ten studies where the time of alcohol sales was increased were inconsistent. Four studies where the time of alcohol sales was decreased showed a corresponding decrease in violence, this was corroborated by the finding from the study that assessed the effect of both increased and decreased time of alcohol sales.

Conclusion: This review suggests that limiting the time of alcohol sales is an effective means of preventing alcohol-related violence or crime. More rigorous studies are needed to provide stronger evidence.

The use of antiretroviral therapy among HIV-infected individuals with serious mental illness: A realist synthesis

Rosetta Okeleke studied on the Master of Public Health Management and Leadership programme at ScHARR and graduated in January 2014 with a merit. It was Rosetta's interest and love for research and academia that prompted her to complete the MPH program. Since completing the program, Rosetta has continued to work for Lloyds Pharmacy Ltd as a Pharmacist Relief Manager.





The title of Rosetta's MPH dissertation project was 'The use of antiretroviral therapy among HIV-infected individuals with serious mental illness: A realist synthesis'.


Abstract

Introduction: Though antiretroviral therapy (ART) transformed acquired immune deficiency syndrome (AIDS) from a fatal disease to a chronic one, inappropriate use is considered a reason for treatment failures. Adherence to ART by individuals with serious mental illness (SMI) is thought to be poor. This realist synthesis, that harnessed some aspects of the systematic review methodology, was undertaken to interrogate this claim.

Objectives: The aim of this review was to report a synthesis of evidence for the interrelationship between SMI and adherence to ART. It was undertaken using relevant studies to explore the impact of SMI on adherence to ART.

Method: Studies describing adherence to ART in patients with SMI and in the general public were identified from the following data sources: Medline, Embase, Psych Info, CINAHL, Web of Knowledge and Google Scholar by applying the acronym PICO. Relevant themes were identified at the onset from three core studies as demiregularities.These were proposed as statements and conceptualised into a framework. These concepts were then applied in coding subsequent studies for selection and appraisal purposes.

Results: A total of 17 relevant studies were identified. The relationship between SMI and adherence to ART in the included studies was best explained by applying the middle range theory ‘acceptance of patient’s role’. This demonstrated how encounters with doctors, belief in the care team, monetary incentives, mood disorder, persistence in risky behaviour, self efficacy, gender, prior use of psychiatric medication, age, awareness and knowledge, status disclosure and integration all impact on adherence to ART.

Conclusion:  The impact of SMI on adherence to ART may vary according to the type of SMI. This impact may operate via a mechanism of acceptance of the patient's role.

Key words: Realist synthesis, systematic review, serious mental illness, adherence to ART, acceptance of patient’s role.


Click this link to read the full details about Rosetta's research.

Preference for a larger body size among African women

Tope Owolabi graduated from the Master of Public Health course at ScHARR in January 2014 with a distinction. Tope decided to do the MPH course to acquire knowledge on how to have an impact on the health of the nation as a whole, especially with regards to providing preventive healthcare. Tope is currently working as a senior house officer in plastic and reconstructive surgery at Charing Cross Hospital, London, with the intention of going into general practice.



The title of Tope's MPH research project was "Preference for a larger body size among African women".


Abstract
Introduction:  The study of body weight and image perception has become a necessity with the rise in obesity among women globally. Several factors including race, ethnicity and culture have been linked to the diversity in body image perceptions among women and hence a preference for a particular body size. There is a general assumption that African women have a preference for a larger body size. However, there has been no report based on accumulated evidence on an African level in support of or against this assumption. If this assumption holds true, it serves as a factor which can affect planned public health interventions against overweight and obesity.
Objectives: This review sought to assess beliefs about body size in African women, determine if African women prefer to be of larger body size, identify factors responsible for preferences and to assess body size satisfaction.

Methods: Although a narrative literature review, the search for relevant studies was conducted in a systematic way. The following electronic bibliographic databases were searched for studies from 1990 till present: MEDLINE, CINAHL, ASSIA, Web of Knowledge, EMBASE, Psycinfo and Google scholar. Search terms used included all African countries listed separately, women, females, girls, perception, body size, body weight, body image, body satisfaction, body dissatisfaction, body mass index (BMI), obesity and overweight.
Studies included were limited to those published in English Language, conducted in African countries and focused on body size preferences in women and adolescent girls (girls aged between 10 – 19 years). Body size was categorized using BMI and waist to hip ratio (WHR). Studies in which views of both men and women were explored were also included.
The critical appraisal checklist for surveys by the center of evidence based management (CEBM) was used in the quality assessment of this review as most of the studies included were surveys.

Results: A total of eighty nine studies were retrieved with nineteen studies finally included after meeting the inclusion criteria. In this review it was revealed that some of the beliefs about determinants of large body size included purchase and consumption of cheap foods with high fat content due to financial problems or poverty, lack of exercise and genetics. There is a general preference for a larger body size tending towards overweight rather than obese body size. However, it was also revealed that there is a growing rise in a change of preference towards a slimmer body figure especially among the young and urbanized women. Factors influencing preferences include husband’s preference, cultural views where large body size is regarded as a symbol of wealth and health. In addition to these, the HIV epidemic was shown to have had a great impact with regards to perception towards having a slimmer body size. With regards to body size satisfaction, there was some form of dissatisfaction with current body sizes in women across the studies with women idealizing body sizes larger or slimmer than their current sizes, thus no clear trend emerged.

Conclusion: Several factors may play a role in African women’s body size preference including influence of immediate family members, discordance between actual medical body size and perceived body size as well as individual beliefs. Thus, studies focusing on factors that may encourage healthier body sizes among women in several African countries should be attempted as these may provide insight into planning and implementation of programmes or services towards prevention of obesity specifically for each country.

Comparative effectiveness and acceptability of home-based and clinic-based sampling methods for sexually transmissible infections screening in females aged 14-50 years: A systematic review and meta-analysis

Tolulope Odesanmi graduated from the Master of Public Health course at ScHARR in 2013 with a distinction. Tolulope's main reason for doing the MPH was to improve her research skills and to provide a platform to influence social and health policies in her home country, particularly in the area of maternal, adolescent and child health. Tolulope returned to the Lagos University Teaching Hospital, Nigeria, and is now lecturing in infection control. She is currently involved in a systematic review aimed at increasing uptake of STI screening programs and  reducing surgical site infections in ceasarean sections at the facility.

Tolulope is interested in collaborative research in the area of systematic reviewing and adolescent and sexual health.

The title of Tolulope's research proejct was 'Comparative effectiveness and acceptability of home-based and clinic-based sampling methods for sexually transmissible infections screening in females aged 14-50 years: A systematic review and meta-analysis'. Along with co-authors, S P Wasti , O S Odesanmi, O Adegbola, O O Oguntuase, and S Mahmood, Tolulope has recently published her paper in Sexual Health.

Citation: Odesanmi TY, Wasti SP, Odesanmi OS, Adegbola O, Oguntuase OO, Mahmood S (2013) Comparative effectiveness and acceptability of home-based and clinic-based sampling methods for sexually transmissible infections screening in females aged 14-50 years: a systematic review and meta-analysis. Sexual Health 10(6): 559-69 doi: 10.1071/SH13029.

Abstract
Background: Home-based sampling is a strategy to enhance uptake of sexually transmissible infection (STI) screening. This review aimed to compare the screening uptake levels of home-based self-sampling and clinic-based specimen collection for STIs (chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and trichomoniasis) in females aged 14–50 years. Acceptability and effect on specimen quality were determined. Methods: Sixteen electronic databases were searched from inception to September 2012. Randomised controlled trials (RCTs) comparing the uptake levels of home-based self-sampling and clinic-based sampling for chlamydia, gonorrhoea and trichomoniasis in females aged 14–50 years were eligible for inclusion. The risk of bias in the trials was assessed. Risk ratios (RRs) for dichotomous outcomes were meta-analysed. Results: Of 3065 papers, six studies with seven RCTs contributed to the final review. Compared with clinic-based methods, home-based screening increased uptake significantly (P = 0.001–0.05) in five trials and was substantiated in a meta-analysis (RR: 1.55; 95% confidence interval: 1.30–1.85; P = 0.00001) of two trials. In three trials, a significant preference for home-based testing (P = 0.001–0.05) was expressed. No significant difference was observed in specimen quality. Sampling was rated as easy by a significantly higher number of women (P = 0.01) in the clinic group in one trial. Conclusions: The review provides evidence that home-based testing results in greater uptake of STI screening in females (14–50 years) than clinic-based testing without compromising quality in the developed world. Home collection strategies should be added to clinic-based screening programs to enhance uptake.

Review of socio-economic factors in reducing maternal mortality in Nepal

Sarita Panday is studying for a PhD at the School of Health and Related Research. Her project work is about the social determinants of maternal mortality in Nepal. The focus will be more specifically on the role of female community health volunteers in maternal health improvements in Nepal. Using a qualitative methodology Sarita will explore the perceptions of female community health volunteers, and their service users, in the two rural villages in Nepal.


Click this link to view a poster about Sarita's research to date: Review of socio-economic factors in reducing maternal mortality in Nepal.

What are the attitudes and opinions of immigrant women towards Female Genital Mutilation (FGM)? – A Narrative Review

Elsie Acheampong studied on the Master of Public Health (MPH) programme at ScHARR, 2012-2013. She decided to do the course purely out of her passion for health care in general and to equip her with the knowledge and expertise that would be instrumental for her career. Elsie is currently working within the field of sexual health in the NHS. She is planning to undertake a doctorate degree in maternal and reproductive health or health inequalities in the near future.



The title of Elsie's MPH dissertation project was 'What are the attitudes and opinions of immigrant women towards Female Genital Mutilation (FGM)? – A Narrative Review'

Abstract

Background:  Female genital mutilation (FGM) is a procedure undertaken on women and young girls which has no known benefits. However it still occurs due to the belief that it prepares a girl for marriage, maintains marital fidelity and also is a religious requirement. In recent decades, the procedure has become of global public health concern due to the increased migration of women from countries where the procedure is highly prevalent to new host countries where it is not the norm. This has critical implications for medical and healthcare professionals, especially in delivering culturally-sensitive health care and services that take into consideration the physical, sexual and psycho-social consequences of the procedure.

Aim: To explore the attitudes and opinions of immigrant women towards FGM.

Methods: Searches were undertaken in three main electronic databases namely Medline, ASSIA and Web of Knowledge in order to extract available information on the attitudes and opinions of immigrant women in relation to FGM. Data was retrieved using a pre-defined inclusion and exclusion criteria. Only articles published in English between 1993 and 2013 and also articles that looked at the opinions and attitudes of immigrant women were included.

Findings: The narrative review demonstrated that for the majority of immigrant women living in Western countries, they had generally negative attitudes and opinions of FGM. These attitudes and opinions had been influenced by myriad of factors. These include acculturation, the laws and legislation against FGM and also the impact of FGM on the health of women. The opinions also shared by the majority of these immigrant women was that FGM needed to be abandoned and also that laws and legislation should be made stricter for the benefit of their children.

Recommendations: The recommendations for research and practice that have consequently been put forward based on the findings retrieved are; to investigate the impact of UK anti-FGM laws on immigrants and also to strengthen the knowledge and skill base of medical and healthcare professionals.

Click on this link to read the full details about Elsie's research.