Understanding the patterns and health impact of indoor air pollutant exposures in Bradford, UK: a study protocol.

INTRODUCTION: Relative to outdoor air pollution, there is little evidence examining the composition and concentrations of indoor air pollution and its associated health impacts. The INGENIOUS project aims to provide the comprehensive understanding of indoor air pollution in UK homes. METHODS AND ANALYSIS: 'Real Home Assessment' is a cross-sectional, multimethod study within INGENIOUS. This study monitors indoor air pollutants over 2 weeks using low-cost sensors placed in three rooms in 300 Born in Bradford (BiB) households. Building audits are completed by researchers, and participants are asked to complete a home survey and a health and behaviour questionnaire, in addition to recording household activities and health symptoms on at least 1 weekday and 1 weekend day. A subsample of 150 households will receive more intensive measurements of volatile organic compound and particulate matter for 3 days. Qualitative interviews conducted with 30 participants will identify key barriers and enablers of effective ventilation practices. Outdoor air pollution is measured in 14 locations across Bradford to explore relationships between indoor and outdoor air quality. Data will be analysed to explore total concentrations of indoor air pollutants, how these vary with building characteristics, and whether they are related to health symptoms. Interviews will be analysed through content and thematic analysis. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the NHS Health Research Authority Yorkshire and the Humber (Bradford Leeds) Research Ethics Committee (22/YH/0288). We will disseminate findings using our websites, social media, publications and conferences. Data will be open access through the BiB, the Open Science Framework and the UK Data Service.

Examination of promotive and protective effects on early adolescent prosocial behavior through a bioecological lens.

Introduction: Prosocial behavior during childhood has been associated with numerous positive developmental and behavioral outcomes in adolescence and adulthood. Prosocial behavior, which includes cooperation and helping others, develops within a bioecological context. Considering it through such a lens enhances the understanding of the roles of different bioecological factors in its development. Methods: Using data from a longitudinal study of adopted children and children reared with their biological parents, this paper examined if positive aspects of a child's bioecological system at age 7 predict prosocial behavior in early adolescence (age 11), and whether these bioecological factors could offset risk due to biological family psychopathology and/or maternal prenatal substance use. The analyses incorporated variables from different levels of Bronfenbrenner's bioecological model (the individual, microsystem, exosystem, and macrosystem) and examined the promotive, and potentially protective, effect of each contextual factor, while also considering their interplay with biological family psychopathology and prenatal substance use. Results: Results from linear regression models indicated that the microsystem variable of parental warmth at age 7 had a promotive effect on age 11 prosocial behavior. Further, in addition to its main effect, parental warmth was protective against maternal substance use during pregnancy when children were raised with their biological parent (s). Household type (biological family) and biological family internalizing psychopathology were the only other significant predictors in the model, with each associated with lower prosocial behavior at age 11. Discussion: Study results extend prior work on the benefits of parental warmth on child outcomes by employing a strength-based, bioecological approach to the development of prosocial behavior during early adolescence and examining "for whom" the effects of parental warmth are most protective.

Effectiveness of the COVID-19 vaccines on preventing symptomatic SARS-CoV-2 infections and hospitalizations in Southwestern Alaska, January-December 2021.

The population in rural southwest Alaska has been disproportionately affected by COVID-19. To assess the benefit of COVID-19 vaccines, we analyzed data from the regional health system. We estimated vaccine effectiveness (VE) during January 16-December 3, 2021, against symptomatic SARS-CoV-2 infection after a primary series or booster dose, and overall VE against hospitalization. VE of a primary series against symptomatic infection among adult residents was 91.3% (95% CI: 85.7, 95.2) during January 16-May 7, 2021, 50.3% (95% CI, 41.1%-58.8%) during July 17-September 24, and 37.0% (95% CI, 27.8-45.0) during September 25-December 3, 2021; VE of a booster dose during September 25-December 3, 2021, was 92.1% (95% CI: 87.2-95.2). During the overall study period, VE against hospitalization was 91.9% (95% CI: 85.4-95.5). COVID-19 vaccination offered strong protection against hospitalization and a booster dose restored protection against symptomatic infection.

The impact of epilepsy on quality of life: Findings from a European survey.

INTRODUCTION: Epilepsy is a serious neurological disorder affecting the quality of life (QoL) of people with this condition. A survey was conducted in five European countries (France, Germany, Italy, Spain, and the UK) to understand the impact and burden of epilepsy and its treatment on the lives of people with epilepsy (PWE). METHODS: Five hundred PWE (taking >1 antiseizure medication [ASM]) and 500 matched controls completed a 30-minute online questionnaire. The 12-Item Short Form Survey (SF-12) was used to measure QoL and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was used to screen for major depressive disorder (MDD) symptoms. RESULTS: Comorbidities such as migraine, high cholesterol, osteoporosis, and Type 1 diabetes were reported more commonly in PWE, while anxiety disorders, high blood pressure, skin disorders, and mood disorders were more common in controls. However, compared to controls, a significantly higher percentage of PWE had an NDDI-E score of 15-24 (54% vs 35%; p < 0.0001), indicative of MDD symptoms. Significantly more PWE than controls were part-time employed (15% vs 11%; p = 0.03). People with epilepsy had a significantly lower total SF-12 score than controls across the physical and the mental components; compared to controls, a significantly higher proportion of PWE defined their general health as 'poor' or 'fair' and felt limited in carrying out daily and work activities. Among PWE, those taking ≥3 ASMs were more likely to experience difficulties in carrying out these activities than those on two ASMs. Ability to drive, mood, and level of self-esteem were reported as concerns for PWE. CONCLUSION: Epilepsy has a major impact on the physical and mental health of PWE, interfering with their daily and work activities and overall QoL, and its treatment might also contribute to a lower QoL. The impact of epilepsy on mood and mental health might be under-recognized.

Criminal offense charges in women: A 10-year follow-up of an RCT of treatment foster care Oregon.

OBJECTIVE: The prevention of delinquency can have long-term benefits for both the individual and society. Previous work has demonstrated positive effects of Treatment Foster Care Oregon (TFCO) on reducing delinquency across a 2-year period for adolescent females involved in the juvenile justice system. The present study examined whether the effects of TFCO are present across a 10-year period, and whether criminal offenses accrued in the juvenile justice system mediate the association between intervention condition and cumulative criminal offenses through emerging adulthood. METHOD: The sample included 166 women (68% non-Hispanic White) who had been court mandated to out-of-home care as adolescents, randomly assigned to one of two interventions, and followed for an average of 10 years. Juvenile (< 18 years of age) and adult criminal records data were collected and coded for offense severity. RESULTS: Analyses revealed a significant effect of the TFCO intervention on cumulative criminal offense charge severity across the 10-year follow-up period (ß = -.15, p < .05). This effect was mediated by offense charges that occurred after the baseline assessment and prior to Age 18, as shown through a significant indirect effect, ß = -.09, p < .05, suggesting the importance of reductions in juvenile delinquency on later criminal offending. CONCLUSIONS: Intensive out-of-home interventions that reduce juvenile offenses for youth with chronic delinquency may have sustained effects on adult criminality. Implications for prevention programs for female adolescents are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Antigen Test Positivity After COVID-19 Isolation - Yukon-Kuskokwim Delta Region, Alaska, January-February 2022.

Isolation is recommended during acute infection with SARS-CoV-2, the virus that causes COVID-19, but the duration of infectiousness varies among individual persons. Rapid antigen test results have been correlated with detection of viable virus (1-3) and might inform isolation guidance, but data are limited for the recently emerged SARS-CoV-2 B.1.1.529 (Omicron) variant. On January 5, 2022, the Yukon-Kuskokwim Health Corporation (YKHC) recommended that persons with SARS-CoV-2 infection isolate for 10 days after symptom onset (or, for asymptomatic persons, 10 days after a positive nucleic acid amplification or antigen test result). However, isolation could end after 5-9 days if symptoms were resolving or absent, fever was absent for ≥24 hours without fever-reducing medications, and an Abbott BinaxNOW COVID-19 Ag (BinaxNOW) rapid antigen test result was negative. Antigen test results and associated individual characteristics were analyzed among 3,502 infections reported to YKHC during January 1-February 9, 2022. After 5-9 days, 396 of 729 persons evaluated (54.3%) had a positive antigen test result, with a declining percentage positive over time. In a multivariable model, a positive antigen test result was more likely after 5 days compared with 9 days (adjusted odds ratio [aOR] = 6.39) or after symptomatic infection (aOR = 9.63), and less likely after previous infection (aOR = 0.30), receipt of a primary COVID-19 vaccination series (aOR = 0.60), or after both previous infection and receipt of a primary COVID-19 vaccination series (aOR = 0.17). Antigen tests might be a useful tool to guide recommendations for isolation after SARS-CoV-2 infection. During the 10 days after infection, persons might be infectious to others and are recommended to wear a well-fitting mask when around others, even if ending isolation after 5 days.

Injury patterns and associated demographics of intimate partner violence in men presenting to U.S. emergency departments.

Research suggests that there are differences between sexes in physical intimate partner violence (IPV) victimization that could lead to different injury patterns. In addition, research shows that men under-report their injuries yet may suffer grave consequences. It is, thus, vital to establish physical injury patterns in male IPV victims. A retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System-All Injury Program data from 2005 to 2015 for all IPV-related injuries in both male and female patients. Sex differences by demographics, mechanism, anatomic location, and diagnoses of IPV injuries were analyzed using statistical methods accounting for the weighted stratified nature of the data. IPV accounted for 0.61% of all emergency department visits; 17.2% were in males and 82.8% in females. Male patients were older (36.1% vs. 16.8% over 60 years), more likely to be Black (40.5% vs. 28.8%), sustained more injuries due to cutting (28.1% vs. 3.5%), more lacerations (46.9% vs. 13.0%), more injuries to the upper extremity (25.8% vs. 14.1%), and fewer contusions/abrasions (30.1% vs. 49.0%), compared to female IPV patients (p < .0001). There were also more hospitalizations in men (7.9% vs. 3.7% p = .0002). Knowledge of specific IPV-related injury characteristics in men will enable healthcare providers to counteract underreporting of IPV.

Barriers to Men's Help Seeking for Intimate Partner Violence.

Evidence suggests that male victims of intimate partner violence (IPV) are less likely to seek help for their victimization than female victims. Studies exploring barriers to help seeking are relatively scarce in the United Kingdom (UK) and those that have been undertaken across Europe, United States, Canada, and Australia have tended to rely on small samples of help-seeking men who have self-identified as victims of IPV. With a view to include more male victim voices in the literature, an anonymous qualitative questionnaire was distributed via social media. In total, 147 men (85% from the UK) who self-identified as being subject to abuse from their female partners, completed the questionnaire. The data was subjected to a deductive thematic analysis and one superordinate and two overarching themes were identified. The superordinate theme was stigmatized gender and the two overarching themes (subthemes in parentheses) were barriers prohibiting help seeking (status and credibility, health and well-being) and responses to initial help seeking (discreditation, exclusion/isolation, and helpfulness). The findings are discussed in the context of Overstreet and Quinn's (2013) interpersonal violence and stigma model and findings from previous research. The conclusions and recommendations promote education and training and advocate a radical change to policy.

"I Want My Mum to Know That I Am a Good Guy ": A Thematic Analysis of the Accounts of Adolescents Who Exhibit Child-to-Parent Violence in the United Kingdom.

This qualitative study explores child-to-parent violence (CPV) in the United Kingdom based on the accounts of adolescents who exhibit this type of family violence. The key areas of interest concern the familial relationships and contexts within which adolescents are embedded, and their perceptions about their emotional states and how these interplay with CPV. Eight participants were recruited in total from a community sample from two different intervention programs aiming to tackle CPV in England. Methods included participant-observation, face-to-face interviews, and handwritten interviews; all data were analyzed thematically. Results suggest that CPV is linked with adverse childhood experiences (ACEs), unsatisfactory relationships with parents, perceived emotional rejection from parents, and emotional dysregulation in young people. In this study, violent behavior was directed not only against mothers but in all cases against siblings and stepfathers. The findings address the complexity of the subject and the need for tailored, evidence-based interventions in the field of CPV.

"I Have Guys Call Me and Say 'I Can't Be the Victim of Domestic Abuse'": Exploring the Experiences of Telephone Support Providers for Male Victims of Domestic Violence and Abuse.

While previous studies have begun to provide evidence on the experiences of male victims of domestic violence and abuse (DVA), current understanding in this area is still limited, and subject to narrow methods of inquiry. Moreover, little is known regarding the challenges of providing support to men in abusive relationships, and how barriers to effective service engagement are experienced by both men and service practitioners. This is an important area for exploration, as the gender-specific experiences and needs of men have been historically overlooked within academic research and service provision. The present study therefore had two principal aims: first, to provide more detailed information regarding the nature and context of abuse toward, and help-seeking experiences of, male victims, and second, to explore the experiences of those supporting abused men. Semi-structured interviews were conducted with four call handlers at a U.K. domestic abuse charity supporting male victims. Transcribed interviews were subjected to thematic analysis, revealing a superordinate theme of stereotypes and expectations of men which affected all the other three overarching and eight subthemes, including those detailing the range and severity of abuse suffered, the role of family and friends, barriers to reporting for abused men, and challenges in supporting them. Implications for services working with male victims of DVA are discussed: centered around the need for recognition, increased awareness, increased resourcing, and the provision of gender-inclusive services catering for the gender-specific needs of men.

But, Who Is the Victim Here? Exploring Judgments Toward Hypothetical Bidirectional Domestic Violence Scenarios.

Gendered models of abuse describe intimate partner violence (IPV) as unilaterally perpetrated by dominant, aggressive men toward vulnerable women. This unidirectional conceptualization has contributed to a "domestic violence stereotype" which, alongside broader attitudes regarding gender, influences attitudes toward "non-typical" victim and perpetrator groups (e.g., male victims, female perpetrators, those within same-sex relationships), and has significant outcomes for help-seeking decision-making, as well as responses from service providers and the criminal justice system. While prevalence data and research suggest bidirectional violence is in fact the most common pattern, there is still little known about how the stereotypes and attitudes described above manifest in scenarios where both parties occupy "victim" and "perpetrator" labels. The present pilot study therefore asked 178 undergraduate students to allocate "victim" and "perpetrator" labels, and make judgments of severity, resolution, and justice outcomes, toward hypothetical opposite-sex IPV scenarios varying on the proportion of abuse perpetrated by each party, and type of violence. Results showed that participants were infrequently labelled men as "victims," and women as "perpetrators," across scenarios. They were also less likely to recommend that the man should call the police. These exploratory results suggest that powerful stereotypes about IPV and gender may serve to influence perceptions of bidirectional violence and point to a need to study this issue in more detail to elucidate the most appropriate way to begin to address these issues.

Understanding the Profile and Needs of Abused Men: Exploring Call Data From a Male Domestic Violence Charity in the United Kingdom.

Current understandings on service engagement by male victims of domestic violence and abuse (DVA) within the United Kingdom (UK) have generally been captured by qualitative research. As such, large-scale quantitative data detailing the profile, needs and outcomes of abused men, upon both presentation and use of services, is currently lacking. The present study analyzed the client data of 719 callers to a domestic abuse helpline for men in the UK. Findings showed that the overwhelming majority of callers reported they were abused by female perpetrators, most of whom were still their current partner, and that many of the men were fathers. Vulnerable populations (GBTQ+ and disabled men) were under-represented in the sample. Most men were seeking emotional support, along with a range of practical advice and signposting to other services. The confidentiality of the helpline was crucial for many men, and almost half had struggled to access the service (suggesting a severe lack of resourcing). Findings are discussed in relation to the need for gender-inclusive services, which cater for the unique challenges and barriers experienced by abused men.

Use of Rapid Antigen Testing for SARS-CoV-2 in Remote Communities - Yukon-Kuskokwim Delta Region, Alaska, September 15, 2020-March 1, 2021.

Controlling the spread of SARS-CoV-2, the virus that causes COVID-19, in Alaska is challenging. Alaska includes many remote and isolated villages with small populations (ranging from 15 to >1,000 persons) that are accessible only by air from larger communities. Until rapid point-of-care testing became widely available, a primary challenge in the diagnosis of COVID-19 in rural Alaska was slow turnaround times for SARS-CoV-2 test results, attributable to the need to transport specimens to testing facilities. To provide more timely test results and isolation of cases, the Yukon Kuskokwim Health Corporation (YKHC) introduced Abbott BinaxNOW COVID-19 Ag rapid antigen test (BinaxNOW) on November 9, 2020, in the rural Yukon-Kuskokwim Delta region in southwestern Alaska. To evaluate the impact of implementing antigen testing, YKHC reviewed the results of 54,981 antigen and molecular tests for SARS-CoV-2 performed in the Yukon-Kuskokwim Delta during September 15, 2020-March 1, 2021. Introduction of rapid, point-of-care testing was followed by a more than threefold reduction in daily SARS-CoV-2 case rates during approximately 1 month before the introduction of COVID-19 vaccination. The median turnaround time for SARS-CoV-2 test results decreased by >30%, from 6.4 days during September 15-November 8, 2020, to 4.4 days during November 9, 2020-March 1, 2021 (p<0.001). Daily incidence decreased 65% after the introduction of BinaxNOW, from 342 cases per 100,000 population during the week of November 9 to 119 during the week of December 13 (p<0.001). These findings indicate that point-of-care rapid antigen testing can be a valuable tool in reducing turnaround times in rural communities where local access to laboratory-based nucleic acid amplification testing (NAAT) is not readily available and could thereby reduce transmission by facilitating rapid isolation of infected persons, contact tracing, and implementation of local mitigation strategies.

How Dark Personalities Perpetrate Partner and General Aggression in Sweden and the United Kingdom.

Research has demonstrated, in Western nations, men and women are both perpetrators and victims of intimate partner violence (IPV). However, to the best of our knowledge, IPV and the Dark Tetrad (Machiavellianism, subclinical narcissism, subclinical psychopathy, and subclinical sadism) have not been included in this research fully. We investigated how these dark personalities influenced the perpetration of IPV in a cross-cultural study between Sweden and the United Kingdom through surveys with university students. We furthermore compared IPV perpetration with same-sex aggression of a non-romantic partner to explore sex- and aggression-specific effects. In a sample of 342 participants, our main findings were the following: (a) the only significant difference in IPV perpetration was women were more verbally aggressive; (b) men reported more verbal and physical same-sex aggression of a non-romantic partner; (c) men scored higher on all the Dark Tetrad personalities regardless of culture, while the Swedish sample scored significantly higher on subclinical narcissism and sadism; (d) the Dark Tetrad and aggression perpetration were significantly correlated; (e) different Dark Tetrad personalities predicted different forms of aggression perpetration with some gender differences; and (f) being high on subclinical psychopathy predicted most types of aggression regardless of target. Our study highlights that dark personalities engage in particular types of aggression, which helps to determine how and when distinctive personalities aggress for potential interventions.

Psychological Intimate Partner Violence and Childhood Cumulative Trauma: The Mediating Role of Affect Dysregulation, Maladaptive Personality Traits, and Negative Urgency.

The current study examined the mediating role of affect dysregulation, maladaptive personality traits, and negative urgency in the association between childhood cumulative trauma (CCT) and psychological intimate partner violence (IPV). A total of 241 men and women from the general population answered self-report questionnaires assessing these variables. Results indicated that 70% of participants reported at least two different types of childhood trauma, while, over the past year, 80% indicated having perpetrated or experienced psychological IPV. Path analyses of a sequential mediation model confirmed that the CCT-IPV association is explained by affect dysregulation, maladaptive personality traits, and negative urgency. These findings support the need to assess affect regulation and personality traits in CCT survivors. Psychosocial interventions should aim to increase self-soothing skills and decrease negative urgency to prevent psychological IPV.

Attitudes Towards Family Planning among Bhutanese, Burmese, and Iraqi Refugee Women: A Qualitative Study.

The number of foreign-born people living in the United States continues to increase yearly. Foreign-born women in the United States, a group that includes both refugees and immigrants, continue to have higher birth rates when compared to their US-born counterparts. This study examines the cultural and socioeconomic factors influencing family planning choices of resettled refugee women living in the United States. Thirty-two Bhutanese, Burmese, and Iraqi women living in Philadelphia participated in interviews and focus groups. A grounded theory approach was used for analysis. Three overarching themes were identified: knowledge acquisition and experiential learning with trans-border migration and resettlement, changes in gender roles and family relations, and provider relationships and provision of care. Findings from the study show that a stable environment results in increased opportunities and personal freedoms, a sense of empowerment, and the desire for family planning. Women want to discuss options, but healthcare providers must begin the conversation. As health care providers in Hawai'i, a state with about 18% of residents being foreign-born, what can be learned from the Philadelphia refugee experience and family planning?

Do the same risk and protective factors influence aggression toward partners and same-sex others?

The current studies examined whether several risk and protective factors operate similarly for intimate partner violence (IPV) and same-sex aggression (SSA) in the same sample, and to assess whether they show similar associations for men and women. Study 1 (N = 345) tested perceived benefits and costs, and instrumental and expressive beliefs about aggression: perceived costs predicted IPV and SSA for both men and women. Expressive beliefs predicted IPV (more strongly for women), and instrumental beliefs predicted SSA. Study 2 (N = 395) investigated self-control, anxiety and empathy, finding that self-control strongly predicted both types of aggression in both sexes. Study 3 (N = 364) found that primary psychopathy (involving lack of anxiety) was associated with IPV for men and SSA in both sexes, whereas secondary psychopathy (involving lack of self-control) was associated with IPV and SSA in both sexes. Overall there were both similarities and differences in the risk factors associated with IPV and SSA, and for men and women. The implications of the findings for theoretical debates about the study of IPV are discussed. Aggr. Behav. 43:163-175, 2017. © 2016 Wiley Periodicals, Inc.

A pharmacoeconomic approach to assessing the costs and benefits of air quality interventions that improve health: a case study.

OBJECTIVE: This paper explores the use of pharmacoeconomic methods of valuation to health impacts resulting from exposure to poor air quality. In using such methods, interventions that reduce exposure to poor air quality can be directly compared, in terms of value for money (or cost-effectiveness), with competing demands for finite resources, including other public health interventions. DESIGN: Using results estimated as part of a health impact assessment regarding a West Yorkshire Low Emission Zone strategy, this paper quantifies cost-saving and health-improving implications of transport policy through its impact on air quality. DATA SOURCE: Estimates of health-related quality of life and the National Health Service (NHS)/Personal Social Services (PSS) costs for identified health events were based on data from Leeds and Bradford using peer-reviewed publications or Office for National Statistics releases. POPULATION: Inhabitants of the area within the outer ring roads of Leeds and Bradford. MAIN OUTCOMES MEASURES: NHS and PSS costs and quality-adjusted life years (QALYs). RESULTS: Averting an all-cause mortality death generates 8.4 QALYs. Each coronary event avoided saves £28 000 in NHS/PSS costs and generates 1.1 QALYs. For every fewer case of childhood asthma, there will be NHS/PSS cost saving of £3000 and a health benefit of 0.9 QALYs. A single term, low birthweight birth avoided saves £2000 in NHS/PSS costs. Preventing a preterm birth saves £24 000 in NHS/PSS costs and generates 1.3 QALYs. A scenario modelled in the West Yorkshire Low Emission Zone Feasibility Study, where pre-EURO 4 buses and HGVs are upgraded to EURO 6 by 2016 generates an annual benefit of £2.08 million and a one-off benefit of £3.3 million compared with a net present value cost of implementation of £6.3 million. CONCLUSIONS: Interventions to improve air quality and health should be evaluated and where improvement of population health is the primary objective, cost-effectiveness analysis using a NHS/PSS costs and QALYs framework is an appropriate methodology.

Self-management of health care behaviors for COPD: a systematic review and meta-analysis.

PURPOSE: This systematic review aimed to identify the most effective components of interventions to facilitate self-management of health care behaviors for patients with COPD. PROSPERO registration number CRD42011001588. METHODS: We used standard review methods with a systematic search to May 2012 for randomized controlled trials of self-management interventions reporting hospital admissions or health-related quality of life (HRQoL). Mean differences (MD), hazard ratios, and 95% confidence intervals (CIs) were calculated and pooled using random-effects meta-analyses. Effects among different subgroups of interventions were explored including single/multiple components and multicomponent interventions with/without exercise. RESULTS: One hundred and seventy-three randomized controlled trials were identified. Self-management interventions had a minimal effect on hospital admission rates. Multicomponent interventions improved HRQoL (studies with follow-up >6 months St George's Respiratory Questionnaire (MD 2.40, 95% CI 0.75-4.04, I (2) 57.9). Exercise was an effective individual component (St George's Respiratory Questionnaire at 3 months MD 4.87, 95% CI 3.96-5.79, I (2) 0%). CONCLUSION: While many self-management interventions increased HRQoL, little effect was seen on hospital admissions. More trials should report admissions and follow-up participants beyond the end of the intervention.