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Fitzgerald N, Nicholls J, Winterbottom J, Katikireddi SV. Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030221. [PMID: 28241512 PMCID: PMC5369057 DOI: 10.3390/ijerph14030221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 11/16/2022]
Abstract
The public health objective for alcohol premises licensing, established in Scotland in 2005, is unique globally. We explored how public health practitioners engaged with the licensing system following this change, and what helped or hindered their efforts. Semi-structured interviews were conducted with 13 public health actors, audio-recorded, and analysed using an inductive framework approach. Many interviewees viewed the new objective as synonymous with reducing population-level alcohol consumption; however, this view was not always shared by licensing actors, some of whom did not accept public health as a legitimate goal of licensing, or prioritised economic development instead. Some interviewees were surprised that the public health evidence they presented to licensing boards did not result in their hoped-for outcomes; they reported that licensing officials did not always understand or value health data or statistical evidence. While some tried to give "impartial" advice to licensing boards, this was not always easy; others were clear that their role was one of "winning hearts and minds" through relationship-building with licensing actors over time. Notwithstanding the introduction of the public health objective, there remain significant, and political, challenges in orienting local premises licensing boards towards decisions to reduce the availability of alcohol in Scotland.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - James Nicholls
- Alcohol Research UK, London SW1H 0HW, UK.
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
| | - Jo Winterbottom
- West Dunbartonshire Health and Social Care Partnership, Dumbarton G82 3PU, UK.
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Mansfield M, Thacker M, Spahr N, Smith T. Factors associated with physical activity participation in adults with chronic cervical spine pain: a systematic review. Physiotherapy 2017; 104:54-60. [PMID: 28822600 DOI: 10.1016/j.physio.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the factors associated with physical activity participation in adults with chronic cervical spine pain. METHODS A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE and CINAHL from inception to June 12th, 2016. Grey literature and reference checking was also undertaken. Quantitative studies including factors related to physical activity participation in adults with chronic cervical spine pain were included. Two independent authors conducted the searches, extracted data and completed methodological quality assessment. RESULTS A total of seven studies met the selection criteria, however, four papers were finally included in the final review. A modified Downs and Black criteria was used to assess methodological quality, each study included was classed as moderate quality. A total of six factors were assessed against physical activity participation for people with chronic neck pain. These included: pain, fear of movement, smoking habits, socioeconomic status, gender, leisure and work time habits. A significant relationship was demonstrated between pain, leisure and work time habits and physical activity. Subjects were less likely to participate in physical activity if they were in pain. Subjects with neck pain were less likely to participate in physical activity in their leisure and work time. CONCLUSION This review, based on a small number of heterogeneous studies demonstrated key factors that are likely to affect physical activity in people with chronic neck pain, most notably, pain levels, leisure and work habits. This review suggests that more in-depth, high quality studies are required to fully understand the impact of chronic pain on physical activity. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42015027970.
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Affiliation(s)
- Michael Mansfield
- Guy's and St Thomas Hospital NHS Foundation Trust, Physiotherapy Department, St Thomas Hospital, Westminster Bridge Road, London, United Kingdom.
| | - Michael Thacker
- Guy's and St Thomas Hospital NHS Foundation Trust, Physiotherapy Department, St Thomas Hospital, Westminster Bridge Road, London, United Kingdom; Centre for Human and Aerospace Physiological Sciences, King's College London, United Kingdom; Pain Section, Neuroimaging, Institute of Psychiatry, Kings College London, United Kingdom; School of Health Sciences, University of South Australia, Australia.
| | - Nicolas Spahr
- Guy's and St Thomas Hospital NHS Foundation Trust, Physiotherapy Department, St Thomas Hospital, Westminster Bridge Road, London, United Kingdom; Pain Section, Neuroimaging, Institute of Psychiatry, Kings College London, United Kingdom.
| | - Toby Smith
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, United Kingdom.
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203
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Hauck KD, Wang S, Vincent C, Smith PC. Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From English Hospitals. Med Care 2017; 55:125-130. [PMID: 27753744 PMCID: PMC5266418 DOI: 10.1097/mlr.0000000000000631] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. OBJECTIVE To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. RESEARCH DESIGN The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals. Patients with 6 types of preventable incidents were identified. Total attributable loss of HLYs was estimated through propensity score matching by considering the hypothetical remaining length and quality of life had the incident not occurred. RESULTS The 6 incidents resulted in an annual loss of 68 HLYs and 934 excess bed-days per 100,000 population. Preventable pressure ulcers caused the loss of 26 HLYs and 555 excess bed-days annually. Deaths in low-mortality procedures resulted in 25 lost life-years and 42 bed-days. Deep-vein thrombosis/pulmonary embolisms cost 12 HLYs, and 240 bed-days. Postoperative sepsis, hip fractures, and central-line infections cost <6 HLYs and 100 bed-days each. DISCUSSION The burden caused by the 6 incidents is roughly comparable with the UK burden of Multiple Sclerosis (80 DALYs per 100,000), HIV/AIDS and Tuberculosis (63 DALYs), and Cervical Cancer (58 DALYs). There were marked differences in the harm caused by the incidents, despite the public attention all of them receive. Decision makers can use the results to prioritize resources into further research and effective interventions.
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Affiliation(s)
- Katharina D. Hauck
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London
| | | | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford
| | - Peter C. Smith
- Imperial College Business School, Imperial College London, London, UK
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204
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van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. Association between morning symptoms and physical activity in COPD: a systematic review. Eur Respir Rev 2017; 26:26/143/160033. [PMID: 28049127 DOI: 10.1183/16000617.0033-2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/02/2016] [Indexed: 11/05/2022] Open
Abstract
Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which they experience more symptoms and physical activity limitations.To systematically report evidence of the association between morning symptoms and physical activity in COPD patients, a literature search was conducted using relevant MESH terms and text words in PubMed, Embase, Web of Science, COCHRANE, CINAHL and PsycINFO. Quality of the articles was assessed with validated checklists.Eight studies were included. Morning symptoms were present in 39.8-94.4%. In 37.0-90.6% of all COPD patients, there was an association between physical activity and morning symptoms. However, causality could not be proved. Morning symptoms were associated with a sedentary lifestyle (p<0.05). Treatment in line with the guidelines improved the degree of activity limitations due to morning symptoms (p<0.0001).Across all disease stages, COPD patients experience morning symptoms which are negatively associated with physical activity. Physicians should consider morning symptoms as a treatment goal. Pharmacotherapy may improve the degree of activity limitations due to morning symptoms. More objective research should focus on symptoms, activity limitations and physical inactivity of COPD patients, especially in the morning.
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Affiliation(s)
- Amanda R van Buul
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marise J Kasteleyn
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian Taube
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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205
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Marchildon G. Canada, Health System of. INTERNATIONAL ENCYCLOPEDIA OF PUBLIC HEALTH 2017. [PMCID: PMC7149522 DOI: 10.1016/b978-0-12-803678-5.00044-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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206
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Son SJ, Kim H, Seeley MK, Hopkins JT. Efficacy of Sensory Transcutaneous Electrical Nerve Stimulation on Perceived Pain and Gait Patterns in Individuals With Experimental Knee Pain. Arch Phys Med Rehabil 2017; 98:25-35. [DOI: 10.1016/j.apmr.2016.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 12/17/2022]
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Flynn R, Scott SD, Rotter T, Hartfield D. The potential for nurses to contribute to and lead improvement science in health care. J Adv Nurs 2017. [DOI: 10.1111/jan.13164 pmid:27682155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dawn Hartfield
- Integrated Quality Management, Edmonton Zone; Alberta Health Services; Edmonton Alberta Canada
- Division of Pediatric Hospital Medicine; Department of Pediatrics; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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209
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Healey EL, Main CJ, Ryan S, McHugh GA, Porcheret M, Finney AG, Morden A, Dziedzic KS. A nurse-led clinic for patients consulting with osteoarthritis in general practice: development and impact of training in a cluster randomised controlled trial. BMC FAMILY PRACTICE 2016; 17:173. [PMID: 28003026 PMCID: PMC5178095 DOI: 10.1186/s12875-016-0568-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
Abstract
Background Despite a lack of service provision for people with osteoarthritis (OA), each year 1 in 5 of the general population consults a GP about a musculoskeletal condition such as OA. Consequently this may provide an opportunity for practice nurses to take an active role in helping patients manage their condition. A nurse led clinic for supporting patients with OA was developed for the MOSAICS study investigating how to implement the NICE 2014 OA Guideline core recommendations. This paper has two main objectives, firstly to provide an overview of the nurse-led OA clinic, and secondly to describe the development, key learning objectives, content and impact of the training to support its delivery. Methods A training programme was developed and delivered to provide practice nurses with the knowledge and skill set needed to run the nurse-led OA clinic. The impact of the training programme on knowledge, confidence and OA management was evaluated using case report forms and pre and post training questionnaires. Results The pre-training questionnaire identified a gap between what practice nurses feel they can do and what they should be doing in line with NICE OA guidelines. Evaluation of the training suggests that it enabled practice nurses to feel more knowledgeable and confident in supporting patients to manage their OA and this was reflected in the clinical management patients received in the nurse-led OA clinics. Conclusions A significant gap between what is recommended and what practice nurses feel they can currently provide in terms of OA management was evident. The development of a nurse training programme goes some way to develop a system in primary care for delivering the core recommendations by NICE. Trial registration The cluster trial linked to this training was conducted from May 2012 through February 2014 by the Arthritis Research UK Primary Care Centre, Keele University, UK (Trial registration number ISRCTN06984617). Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0568-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK.
| | - Chris J Main
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Sarah Ryan
- Staffordshire and Stoke on Trent Partnership NHS Trust, Haywood Hospital, Stoke-on-Trent, UK.,Keele University, School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Gretl A McHugh
- School of Healthcare, University of Leeds, Yorkshire, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Andrew G Finney
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK.,Keele University, School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Andrew Morden
- School of Social and Community Medicine, University of Bristol, Gloucestershire, UK
| | - Krysia S Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
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Calverley PM, Eriksson G, Jenkins CR, Anzueto AR, Make BJ, Persson A, Fagerås M, Postma DS. Early efficacy of budesonide/formoterol in patients with moderate-to-very-severe COPD. Int J Chron Obstruct Pulmon Dis 2016; 12:13-25. [PMID: 28031707 PMCID: PMC5182036 DOI: 10.2147/copd.s114209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objective Large clinical trials have confirmed the long-term efficacy of inhaled corticosteroid/long-acting β2-agonist combinations in patients with chronic obstructive pulmonary disease (COPD). It was hypothesized that significant treatment effects would already be present within 3 months after the initiation of treatment across a range of clinical outcomes, irrespective of COPD severity. Methods Post hoc analysis of 3-month post-randomization outcomes, including exacerbation rates, dropouts, symptoms, reliever use, and lung function, from three studies with similar inclusion criteria of moderate-to-very-severe COPD. Patients (n=1,571) were treated with budesonide/formoterol (B/F) 320/9 μg or placebo, twice daily; in one study, tiotropium 18 μg once daily was also given. Results Over the first 3 months of treatment, fewer patients randomized to B/F experienced exacerbations versus the placebo group (111 and 196 patients with ≥1 exacerbation, respectively). This was true in each COPD severity group. Compared with placebo, B/F treatment led to significantly lower 3-month exacerbation rates in the moderate and severe COPD severity groups (46% and 57% reduction, respectively), with a nonsignificant reduction (29%) in very severe COPD. Fewer dropouts occurred among patients treated with B/F versus placebo, this effect being greater with increasing COPD severity. B/F was associated with improved forced expiratory volume in 1 s, morning peak expiratory flow rate, total reliever use, and total symptom score versus placebo. Conclusion Treatment with B/F decreased exacerbations in patients with moderate-to-very-severe COPD within 3 months of commencing treatment. This effect was paralleled by improved lung function, less reliever medication use, and fewer symptoms, irrespective of disease severity.
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Affiliation(s)
- Peter M Calverley
- Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK
| | - Göran Eriksson
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - Christine R Jenkins
- George Institute for Global Health, The University of Sydney and Concord Clinical School, Sydney, Australia
| | - Antonio R Anzueto
- Department of Pulmonary Medicine and Allergology, University of Texas Health Sciences Center and South Texas Veterans' Health Care System, San Antonio, Texas
| | - Barry J Make
- Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado, Denver, Colorado, USA
| | | | | | - Dirkje S Postma
- Department of Pulmonary Medicine and Tuberculosis, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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211
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Myojin T, Ojima T, Kikuchi K, Okada E, Shibata Y, Nakamura M, Hashimoto S. Orthopedic, ophthalmic, and psychiatric diseases primarily affect activity limitation for Japanese males and females: Based on the Comprehensive Survey of Living Conditions. J Epidemiol 2016; 27:75-79. [PMID: 28142015 PMCID: PMC5328730 DOI: 10.1016/j.je.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Healthy life expectancy (HLE) is used as one of the primary objectives of fundamental health promotion plans and social development plans. Activity limitation is used to calculate HLE, but little study has been done to identify determinants of activity limitation in order to extend HLE. The purpose of this study is to identify diseases and injuries that commonly lead to activity limitation to prioritize countermeasures against activity limitation. Methods We used anonymous data from the 2007 “Comprehensive Survey of Living Conditions,” collected by the Ministry of Health, Labour and Welfare of Japan according to the Statistics Act, Article 36. We used logistic regression analyses and calculated odds ratios (ORs) after adjusting for age and sex. Limitation in daily activities was applied as the dependent variable, and each disease/injury was applied as an independent variable in this analysis. Furthermore, population attributable fractions (PAFs) were calculated. Results The provided data included 98,789 subjects. We used data for 75,986 valid subjects aged 12 years or older. The following diseases showed high PAF: backache (PAF 13.27%, OR 3.88), arthropathia (PAF 7.61%, OR 4.82), eye and optical diseases (PAF 6.39%, OR 2.01), and depression and other mental diseases (PAF 5.70%, OR 11.55). PAFs of cerebrovascular diseases, hypertension, and diabetes were higher for males than for females; on the other hand, PAFs of orthopedic diseases were higher among females. Conclusions Our results indicate that orthopedic diseases, ophthalmic diseases, and psychiatric diseases particularly affect activity limitation.
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Affiliation(s)
- Tomoya Myojin
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keiko Kikuchi
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Eisaku Okada
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yosuke Shibata
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Dyson JK, Rajasekhar P, Wetten A, Hamad AH, Ng S, Paremal S, Baqai MF, Lamb CA, Masson S, Hudson M, Dipper C, Cowlam S, Hussaini H, McPherson S. Implementation of a 'care bundle' improves the management of patients admitted to hospital with decompensated cirrhosis. Aliment Pharmacol Ther 2016; 44:1030-1038. [PMID: 27666418 PMCID: PMC5412833 DOI: 10.1111/apt.13806] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/09/2016] [Accepted: 08/31/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Since 1970, there has been a 400% increase in liver-related deaths due to the increasing prevalence of chronic liver disease in the United Kingdom (UK). The 2013 UK National Confidential Enquiry into Patient Outcome and Death report found that only 47% of patients who died from alcohol-related liver disease received 'good care' during their hospital stay. AIM To develop a 'care bundle' for patients with decompensated cirrhosis, aiming to ensure that evidence-based treatments are delivered within the first 24 h of hospital admission. METHODS This work gives practical advice about how to implement the bundle and examines its effects on patient care at three National Health Service Hospital Trusts in the UK by collecting data on patient care before and after introduction of the bundle. RESULTS Data were collected on 228 patients across three centres (59% male, median age 53 years). Alcohol-related liver disease was the aetiology of chronic liver disease in 85% of patients. The overall mortality rate during hospital admission was 15%. The audits demonstrated improvements in patient care for patients with a completed care bundle who were significantly more likely to have a diagnostic ascitic performed within the first 24 h (P = 0.020), have an accurate alcohol history documented (P < 0.0001) and be given antibiotics as prophylaxis against infection following a variceal haemorrhage (P = 0.0096). In Newcastle, the bundle completion rate increased from 25% to 90% during the review periods. CONCLUSIONS The introduction of a care bundle was associated with increased rates of diagnostic paracentesis and antibiotic prophylaxis with variceal haemorrhage in patients with decompensated cirrhosis.
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Affiliation(s)
- J. K. Dyson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | | | - A. Wetten
- City Hospitals SunderlandSunderlandUK
| | | | - S. Ng
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Paremal
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - C. A. Lamb
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Masson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. Hudson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - C. Dipper
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Cowlam
- City Hospitals SunderlandSunderlandUK
| | | | - S. McPherson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
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213
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Lee YR, Kim YA, Park SY, Oh CM, Kim YE, Oh IH. Application of a Modified Garbage Code Algorithm to Estimate Cause-Specific Mortality and Years of Life Lost in Korea. J Korean Med Sci 2016; 31 Suppl 2:S121-S128. [PMID: 27775249 PMCID: PMC5081293 DOI: 10.3346/jkms.2016.31.s2.s121] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/19/2016] [Indexed: 11/20/2022] Open
Abstract
Years of life lost (YLLs) are estimated based on mortality and cause of death (CoD); therefore, it is necessary to accurately calculate CoD to estimate the burden of disease. The garbage code algorithm was developed by the Global Burden of Disease (GBD) Study to redistribute inaccurate CoD and enhance the validity of CoD estimation. This study aimed to estimate cause-specific mortality rates and YLLs in Korea by applying a modified garbage code algorithm. CoD data for 2010-2012 were used to calculate the number of deaths. The garbage code algorithm was then applied to calculate target cause (i.e., valid CoD) and adjusted CoD using the garbage code redistribution. The results showed that garbage code deaths accounted for approximately 25% of all CoD during 2010-2012. In 2012, lung cancer contributed the most to cause-specific death according to the Statistics Korea. However, when CoD was adjusted using the garbage code redistribution, ischemic heart disease was the most common CoD. Furthermore, before garbage code redistribution, self-harm contributed the most YLLs followed by lung cancer and liver cancer; however, after application of the garbage code redistribution, though self-harm was the most common leading cause of YLL, it is followed by ischemic heart disease and lung cancer. Our results showed that garbage code deaths accounted for a substantial amount of mortality and YLLs. The results may enhance our knowledge of burden of disease and help prioritize intervention settings by changing the relative importance of burden of disease.
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Affiliation(s)
- Ye Rin Lee
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Ae Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So Youn Park
- Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang Mo Oh
- Cancer Registration and Statistic Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young Eun Kim
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - In Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
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Mergental H, Perera MTPR, Laing RW, Muiesan P, Isaac JR, Smith A, Stephenson BTF, Cilliers H, Neil DAH, Hübscher SG, Afford SC, Mirza DF. Transplantation of Declined Liver Allografts Following Normothermic Ex-Situ Evaluation. Am J Transplant 2016; 16:3235-3245. [PMID: 27192971 DOI: 10.1111/ajt.13875] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 01/25/2023]
Abstract
The demand for liver transplantation (LT) exceeds supply, with rising waiting list mortality. Utilization of high-risk organs is low and a substantial number of procured livers are discarded. We report the first series of five transplants with rejected livers following viability assessment by normothermic machine perfusion of the liver (NMP-L). The evaluation protocol consisted of perfusate lactate, bile production, vascular flows, and liver appearance. All livers were exposed to a variable period of static cold storage prior to commencing NMP-L. Four organs were recovered from donors after circulatory death and rejected due to prolonged donor warm ischemic times; one liver from a brain-death donor was declined for high liver function tests (LFTs). The median (range) total graft preservation time was 798 (range 724-951) min. The transplant procedure was uneventful in every recipient, with immediate function in all grafts. The median in-hospital stay was 10 (range 6-14) days. At present, all recipients are well, with normalized LFTs at median follow-up of 7 (range 6-19) months. Viability assessment of high-risk grafts using NMP-L provides specific information on liver function and can permit their transplantation while minimizing the recipient risk of primary graft nonfunction. This novel approach may increase organ availability for LT.
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Affiliation(s)
- H Mergental
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M T P R Perera
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R W Laing
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Muiesan
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J R Isaac
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Smith
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B T F Stephenson
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - H Cilliers
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D A H Neil
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S G Hübscher
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S C Afford
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D F Mirza
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. .,National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Conde-Sala JL, Portellano-Ortiz C, Calvó-Perxas L, Garre-Olmo J. Quality of life in people aged 65+ in Europe: associated factors and models of social welfare-analysis of data from the SHARE project (Wave 5). Qual Life Res 2016; 26:1059-1070. [PMID: 27766517 DOI: 10.1007/s11136-016-1436-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+ and to examine the relationship with models of social welfare in Europe. METHODS This was a cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). The instruments used in the present study were as follows: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis included bivariate and multilevel analyses. RESULTS In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared to Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4). CONCLUSIONS Perceived quality-of-life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live.
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Affiliation(s)
- Josep L Conde-Sala
- Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebron, 171, 08035, Barcelona, Spain.
| | | | | | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Salt, Spain.,Department of Medical Sciences, University of Girona, Girona, Spain
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Flynn R, Scott SD, Rotter T, Hartfield D. The potential for nurses to contribute to and lead improvement science in health care. J Adv Nurs 2016; 73:97-107. [DOI: 10.1111/jan.13164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dawn Hartfield
- Integrated Quality Management, Edmonton Zone; Alberta Health Services; Edmonton Alberta Canada
- Division of Pediatric Hospital Medicine; Department of Pediatrics; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
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Chesham RA, Shanmugam S. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review. Physiother Theory Pract 2016; 33:9-30. [PMID: 27736286 DOI: 10.1080/09593985.2016.1230660] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes. OBJECTIVES Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines. METHOD A literature search of Randomized Controlled Trials (RCTs), published April 2004-April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale. RESULTS Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs. CONCLUSION There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.
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Affiliation(s)
- Ross Alexander Chesham
- a Department of Psychology, Social Work and Allied Health Sciences , School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK
| | - Sivaramkumar Shanmugam
- a Department of Psychology, Social Work and Allied Health Sciences , School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK
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218
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Morris K, Syed A, Reid G, Spencer S. Occupational therapy delivered by specialists versus non-specialists for people with schizophrenia. Hippokratia 2016. [DOI: 10.1002/14651858.cd012398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Morris
- University of Cumbria; Department of Health, Psychology & Social Studies; Fusehill Street Carlisle UK CA1 2HH
| | - Aleena Syed
- Lancashire Care NHS Foundation Trust; The Lantern Centre; Preston UK PR2 8DY
| | - Graeme Reid
- Lancashire Care NHS Foundation Trust; Scarisbrick Centre, Ormskirk and District Hospital, Wigan Road Ormskirk UK L39 2AZ
| | - Sally Spencer
- Edge Hill University; Faculty of Health and Social Care; St Helens Road Ormskirk Lancashire UK L39 4QP
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Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, Brauer M, Burnett R, Cercy K, Charlson FJ, Cohen AJ, Dandona L, Estep K, Ferrari AJ, Frostad JJ, Fullman N, Gething PW, Godwin WW, Griswold M, Hay SI, Kinfu Y, Kyu HH, Larson HJ, Liang X, Lim SS, Liu PY, Lopez AD, Lozano R, Marczak L, Mensah GA, Mokdad AH, Moradi-Lakeh M, Naghavi M, Neal B, Reitsma MB, Roth GA, Salomon JA, Sur PJ, Vos T, Wagner JA, Wang H, Zhao Y, Zhou M, Aasvang GM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abera SF, Abraham B, Abu-Raddad LJ, Abyu GY, Adebiyi AO, Adedeji IA, Ademi Z, Adou AK, Adsuar JC, Agardh EE, Agarwal A, Agrawal A, Kiadaliri AA, Ajala ON, Akinyemiju TF, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Aldridge RW, Alemu ZA, Ali R, Alkerwi A, Alla F, Allebeck P, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Assadi R, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Basu S, Batis C, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bikbov B, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brenner H, Broday DM, Brugha TS, Brunekreef B, Butt ZA, Cahill LE, Calabria B, Campos-Nonato IR, Cárdenas R, Carpenter DO, Carrero JJ, Casey DC, Castañeda-Orjuela CA, Rivas JC, Castro RE, Catalá-López F, Chang JC, Chiang PPC, Chibalabala M, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Coates MM, Colquhoun SM, Manzano AGC, Cooper LT, Cooperrider K, Cornaby L, Cortinovis M, Crump JA, Cuevas-Nasu L, Damasceno A, Dandona R, Darby SC, Dargan PI, das Neves J, Davis AC, Davletov K, de Castro EF, De la Cruz-Góngora V, De Leo D, Degenhardt L, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribew A, Jarlais DCD, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Dicker D, Ding EL, Dorsey ER, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Elyazar I, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fischer F, Fitchett JRA, Fleming T, Foigt N, Foreman K, Fowkes FGR, Franklin RC, Fürst T, Futran ND, Gakidou E, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gessner BD, Giref AZ, Giroud M, Gishu MD, Giussani G, Goenka S, Gomez-Cabrera MC, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani HC, Guillemin F, Guo Y, Gupta R, Gupta R, Gutiérrez RA, Haagsma JA, Hafezi-Nejad N, Haile D, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Heredia-Pi IB, Hernández-Llanes NF, Heydarpour P, Hoek HW, Hoffman HJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hutchings SJ, Huybrechts I, Iburg KM, Idrisov BT, Ileanu BV, Inoue M, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jansen HAFM, Jassal SK, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang Y, Jibat T, Jin Y, Johnson CO, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimkhani C, Kasaeian A, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khan G, Khang YH, Khatibzadeh S, Khera S, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kimokoti RW, Kissoon N, Kivipelto M, Knibbs LD, Kokubo Y, Kopec JA, Koul PA, Koyanagi A, Kravchenko M, Kromhout H, Krueger H, Ku T, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lal DK, Lalloo R, Lallukka T, Lan Q, Larsson A, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leung J, Levi M, Li X, Li Y, Liang J, Liu S, Lloyd BK, Logroscino G, Lotufo PA, Lunevicius R, MacIntyre M, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Manamo WAA, Mapoma CC, Marcenes W, Martin RV, Martinez-Raga J, Masiye F, Matsushita K, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Medina C, Mehari A, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Mensink GBM, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Misganaw A, Mock CN, Mohammadi A, Mohammed S, Mola GLD, Monasta L, Hernandez JCM, Montico M, Morawska L, Mori R, Mozaffarian D, Mueller UO, Mullany E, Mumford JE, Murthy GVS, Nachega JB, Naheed A, Nangia V, Nassiri N, Newton JN, Ng M, Nguyen QL, Nisar MI, Pete PMN, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olsen H, Olusanya BO, Olusanya JO, Opio JN, Oren E, Orozco R, Ortiz A, Ota E, PA M, Pana A, Park EK, Parry CD, Parsaeian M, Patel T, Caicedo AJP, Patil ST, Patten SB, Patton GC, Pearce N, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Plass D, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Raju M, Ram U, Rana SM, Ranganathan K, Rao P, García CAR, Refaat AH, Rehm CD, Rehm J, Reinig N, Remuzzi G, Resnikoff S, Ribeiro AL, Rivera JA, Roba HS, Rodriguez A, Rodriguez-Ramirez S, Rojas-Rueda D, Roman Y, Ronfani L, Roshandel G, Rothenbacher D, Roy A, Saleh MM, Sanabria JR, Sanchez-Riera L, Sanchez-Niño MD, Sánchez-Pimienta TG, Sandar L, Santomauro DF, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidhuber J, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Servan-Mori EE, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Levy TS, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shi P, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Shishani K, Shiue I, Shrime MG, Sigfusdottir ID, Silva DAS, Silveira DGA, Silverberg JI, Simard EP, Sindi S, Singh A, Singh JA, Singh PK, Slepak EL, Soljak M, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steckling N, Steel N, Stein DJ, Stein MB, Stöckl H, Stranges S, Stroumpoulis K, Sunguya BF, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tavakkoli M, Taye BW, Taylor HR, Tedla BA, Tefera WM, Tegegne TK, Tekle DY, Terkawi AS, Thakur JS, Thomas BA, Thomas ML, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobe-Gai R, Tobollik M, Topor-Madry R, Topouzis F, Towbin JA, Tran BX, Dimbuene ZT, Tsilimparis N, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Donkelaar A, van Os J, Varakin YY, Vasankari T, Veerman JL, Venketasubramanian N, Violante FS, Vollset SE, Wagner GR, Waller SG, Wang JL, Wang L, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Wolfe CDA, Won S, Woolf AD, Wubshet M, Xavier D, Xu G, Yadav AK, Yakob B, Yalew AZ, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zhu J, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1659-1724. [PMID: 27733284 PMCID: PMC5388856 DOI: 10.1016/s0140-6736(16)31679-8] [Citation(s) in RCA: 2719] [Impact Index Per Article: 339.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/13/2016] [Accepted: 08/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). FINDINGS Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. INTERPRETATION Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. FUNDING Bill & Melinda Gates Foundation.
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Abstract
Child health in the United Kingdom has improved markedly over recent decades but has failed to match health gains and reductions in mortality achieved by other European countries. Child poverty and inequalities are rising in the United Kingdom. The National Health Service (NHS) is a universally accessible health service, funded by taxation and is free at the point of use. The NHS is undergoing substantial reform, aiming to improve care quality and experience, meet rising demands, and contain costs. The NHS is struggling to balance access with expertise for urgent and unscheduled care. There is increasing use of urgent and emergency care, and there are unexplained variations in outcomes. Quality of care for children and young people with chronic and long-term conditions, including transition services, is variable and sometimes poor. Many determinants of noncommunicable conditions are worsening. Key achievements include a universal service free at the point of use, providing generally accessible, and equitable care. Key challenges include increasing fragmentation of services, insufficient emphasis on preventive care, achieving an effective balance between access and expertise of care for children, and improving child health and well-being outcomes despite generally high quality inputs and high levels of spending.
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Affiliation(s)
- Ingrid Wolfe
- King's College London, Department of Public Health Sciences and Primary Care, Evelina London Children's Hospital, London, United Kingdom
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Steensma C, Loukine L, Orpana H, McRae L, Vachon J, Mo F, Boileau-Falardeau M, Reid C, Choi BC. Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada. Health Promot Chronic Dis Prev Can 2016; 36:205-213. [PMID: 27768557 PMCID: PMC5158123 DOI: 10.24095/hpcdp.36.10.01] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population. METHODS We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex. RESULTS For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap. CONCLUSION The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.
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Affiliation(s)
- C Steensma
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - L Loukine
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - H Orpana
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - L McRae
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - J Vachon
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - F Mo
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - M Boileau-Falardeau
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - C Reid
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - B C Choi
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
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Persson MSM, Fu Y, Bhattacharya A, Goh SL, van Middelkoop M, Bierma-Zeinstra SMA, Walsh D, Doherty M, Zhang W. Relative efficacy of topical non-steroidal anti-inflammatory drugs and topical capsaicin in osteoarthritis: protocol for an individual patient data meta-analysis. Syst Rev 2016; 5:165. [PMID: 27686859 PMCID: PMC5043618 DOI: 10.1186/s13643-016-0348-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/21/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pain is the most troubling issue to patients with osteoarthritis (OA), yet current pharmacological treatments offer only small-to-moderate pain reduction. Current guidelines therefore emphasise the need to identify predictors of treatment response. In line with these recommendations, an individual patient data (IPD) meta-analysis will be conducted. The study aims to investigate the relative treatment effects of topical non-steroidal anti-inflammatory drugs (NSAIDs) and topical capsaicin in OA and to identify patient-level predictors of treatment response. METHODS IPD will be collected from randomised controlled trials (RCTs) of topical NSAIDs and capsaicin in OA. Multilevel regression modelling will be conducted to determine predictors for the specific and the overall treatment effect. DISCUSSION Through the identification of treatment responders, this IPD meta-analysis may improve the current understanding of the pain mechanisms in OA and guide clinical decision-making. Identifying and prescribing the treatment most likely to be beneficial for an individual with OA will improve the efficiency of patient management. SYSTEMATIC REVIEW REGISTRATION CRD42016035254.
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Affiliation(s)
- Monica S. M. Persson
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - Yu Fu
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Siew-Li Goh
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M. A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, The Netherlands
| | - David Walsh
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
| | - OA Trial Bank Consortium
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
- Arthritis Research UK Pain Centre, Nottingham, UK
- School of Healthcare, University of Leeds, Leeds, UK
- Arthritis UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, The Netherlands
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Keenan K, Ploubidis GB, Silverwood RJ, Grundy E. Life-course partnership history and midlife health behaviours in a population-based birth cohort. J Epidemiol Community Health 2016; 71:232-238. [PMID: 27655423 PMCID: PMC5318654 DOI: 10.1136/jech-2015-207051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/02/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
Abstract
Background Marital and partnership history is strongly associated with health in midlife and later life. However, the role of health behaviours as an explanatory mechanism remains unclear. The aim of this study was to investigate prospective associations between life-course partnership trajectories (taking into account timing, non-marital cohabitation, remarriage and marital transitions) and health behaviours measured in midlife. Methods We analysed data from the British National Child Development Study, a prospective cohort study that includes all people born in 1 week of March 1958 (N=10 226). This study included men and women with prospective data on partnership history from age 23 to 42–44 and health behaviours collected at ages 42–46 (2000–2004). Latent class analysis was used to derive longitudinal trajectories of partnership history. We used multivariable regression models to estimate the association between midlife health behaviours and partnership trajectory, adjusting for various early and young adult characteristics. Results After adjustment for a range of potential selection factors in childhood and early adulthood, we found that problem drinking, heavy drinking and smoking were more common in men and women who experienced divorce or who had never married or cohabited. Women who married later had a lower prevalence of smoking and were less likely to be overweight than those who married earlier. Overall marriage was associated with a higher body mass index. Individuals who never married or cohabited spent less time exercising. Conclusions Some aspects of partnership history such as remaining unpartnered and experiencing divorce are associated with more smoking and drinking in midlife, whereas marriage is associated with midlife weight gain. Despite these offsetting influences, differences in health behaviours probably account for much of the association between partnership trajectories and health found in previous studies.
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Affiliation(s)
- Katherine Keenan
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - George B Ploubidis
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Richard J Silverwood
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Nielen JTH, Dagnelie PC, Emans PJ, Veldhorst-Janssen N, Lalmohamed A, van Staa TP, Boonen AERCH, van den Bemt BJF, de Vries F. Safety and efficacy of new oral anticoagulants and low-molecular-weight heparins compared with aspirin in patients undergoing total knee and hip replacements. Pharmacoepidemiol Drug Saf 2016; 25:1245-1252. [PMID: 27594378 DOI: 10.1002/pds.4089] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/26/2016] [Accepted: 08/07/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND There has been much debate recently on the best type of thromboprophylaxis following elective total joint replacement surgery. OBJECTIVE This study aims to compare rates of venous thromboembolism (VTE), gastro-intestinal (GI) bleeding and mortality events, with use of new oral anticoagulants (NOAC) or low-molecular-weight heparins (LMWHs) compared with aspirin in patients undergoing total joint replacement. METHODS A population-based retrospective cohort study was performed using the Clinical Practice Research Datalink. Patients ≥18 years of age who had undergone total knee (n = 3261) or hip replacement (THR (n = 4016)) between 2008 and 2012 were included. Within this population, three cohorts were selected, based on their first prescription within the 35-day period after surgery: use of NOACs only, LMWHs only and aspirin only. Incidence rates were calculated, and Cox proportional hazard models were fitted to estimate the risk of VTE, GI bleeding and all-cause mortality with the use of NOACs and LMWHs compared with aspirin use after total knee replacement and THR. We statistically adjusted our analyses for lifestyle factors, comorbidities and concomitant drug use. RESULTS Total knee replacement and THR patients currently on LMWHs had higher risk of VTE (HR = 17.2 (6.9-43.0) and HR = 39.5 (18.0-87.0), respectively), GI bleeding (HR = 20.9 (1.9-232.3) and HR = 2.0 (0.2-17.2), respectively) and all-cause mortality (HR = 4.3 (1.7-12.4) and HR = 4.0 (2.4-6.7), respectively). NOAC use was associated with an increased risk of GI bleeding in patients undergoing THR surgery. CONCLUSIONS In contrast to previous studies, we found an increased risk of VTE, GI bleeding and all-cause mortality with the use of LMWHs compared with aspirin. Risk of GI bleeding was increased with the use of NOACs compared with aspirin use after THR surgery. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Johannes T H Nielen
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands. .,Department of Epidemiology, CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - Pieter C Dagnelie
- Department of Epidemiology, CAPHRI and CARIM, Maastricht University, Maastricht, The Netherlands
| | - Pieter J Emans
- Department of Orthopaedics, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Nicole Veldhorst-Janssen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Arief Lalmohamed
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tjeerd-Pieter van Staa
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Annelies E R C H Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank de Vries
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, Maastricht, The Netherlands
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Cookson R, Asaria M, Ali S, Ferguson B, Fleetcroft R, Goddard M, Goldblatt P, Laudicella M, Raine R. Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them.ObjectivesThe objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format.DesignLongitudinal whole-population study at the small-area level.SettingEngland from 2001/2 to 2011/12.ParticipantsA total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people.Main outcome measuresSlope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality.Data sourcesPractice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8).ResultsBetween 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark.LimitationsGeneral practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible.ConclusionsNHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any administrative geography comprising ≥ 100,000 people.Future workExploration of quality improvement lessons from local areas performing well and badly on health-care equity, improved methods including better measures of need and risk and measures of health-care inequality over the life-course, and monitoring of other dimensions of equity. These indicators can also be used to evaluate the health-care equity impacts of interventions and make international health-care equity comparisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Shehzad Ali
- Centre for Health Economics, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Brian Ferguson
- Knowledge and Intelligence, Public Health England, York, UK
| | | | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Peter Goldblatt
- Institute of Health Equity, University College London, London, UK
| | | | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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Forster AS, Burgess C, Dodhia H, Fuller F, Miller J, McDermott L, Gulliford MC. Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records. J Public Health (Oxf) 2016; 38:552-559. [PMID: 26350481 PMCID: PMC5072161 DOI: 10.1093/pubmed/fdv119] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities. METHODS Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked deprivation scores. RESULTS There were 91 618 eligible participants who received a health check, of whom 75 123 (82%) were matched with 182 245 controls. After the health check, 90% of men and 92% of women had complete data for blood pressure, total cholesterol, smoking and body mass index; a net 51% increase (P < 0.001) over controls. After the check, gender and deprivation inequalities in recording of all risk factors were lower than for controls. Net increase in risk factor detection was greater for hypercholesterolaemia (men +33%; women +32%) than for obesity (men +8%; women +4%) and hypertension in men only (+5%) (all P < 0.001). Detection of smoking was 5% lower in health check participants than controls (P < 0.001). Over 4 years, statins were prescribed to 11% of health -check participants and 7.6% controls (hazard ratio 1.58, 95% confidence interval 1.53-1.63, P < 0.001). CONCLUSION NHS Health Checks are associated with increased detection of hypercholesterolaemia, and to a lesser extent obesity and hypertension, but smokers may be under-represented.
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Affiliation(s)
- Alice S Forster
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Caroline Burgess
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Hiten Dodhia
- Public Health Directorate, London Boroughs of Lambeth and Southwark, London, UK
| | - Frances Fuller
- Department of Public Health, London Borough of Lewisham, London, UK
| | - Jane Miller
- Department of Public Health, London Borough of Lewisham, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Lala R, Csikar J, Douglas G, Muarry J. Factors that influence delivery of tobacco cessation support in general dental practice: a narrative review. J Public Health Dent 2016; 77:47-53. [PMID: 27568867 DOI: 10.1111/jphd.12170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 07/15/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To review the literature reporting factors that are associated with the delivery of lifestyle support in general dental practice. METHODS A systematic review of the quantitative observational studies describing activities to promote the general health of adults in primary care general dental practice. Behavior change included tobacco cessation, alcohol reduction, diet, weight management, and physical activity. Tooth brushing and oral hygiene behaviors were excluded as the focus of this review was on the common risk factors that affect general health as well as oral health. RESULTS Six cross sectional studies met the inclusion criteria. Five studies only reported activities to support tobacco cessation. As well as tobacco cessation one study also reported activities related to alcohol usage, physical activity, and Body Mass Index. Perceptions of time availability consistently correlated with activities and beliefs about tobacco cessation, alongside the smoking status of the dental professional. Dentists who perceive having more available time were more likely to discuss smoking with patients, prescribe smoking cessation treatments and direct patients toward (signpost to) lifestyle support services. Dental professionals who smoke were less likely to give smoking cessation advice and counselling than nonsmokers. Finally, the data showed that professional support may be relevant. Professionals who work in solo practices or those who felt a lack of support from the wider professional team (peer support) were more likely to report barriers to delivering lifestyle support. CONCLUSION Organizational changes in dental practices to encourage more team working and professional time for lifestyle support may influence delivery. Dental professionals who are smokers may require training to develop their beliefs about the effectiveness of smoking cessation interventions.
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Affiliation(s)
- Rizwana Lala
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Julia Csikar
- Leeds School of Dentistry, University of Leeds, Leeds, Leeds, UK
| | - Gail Douglas
- Leeds School of Dentistry, University of Leeds, Leeds, Leeds, UK
| | - Jenni Muarry
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Lamarca A, Abdel-Rahman O, Salu I, McNamara MG, Valle JW, Hubner RA. Identification of clinical biomarkers for patients with advanced hepatocellular carcinoma receiving sorafenib. Clin Transl Oncol 2016; 19:364-372. [DOI: 10.1007/s12094-016-1537-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/25/2016] [Indexed: 01/04/2023]
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Kim LJ, Coelho FM, Araujo P, Tedesco RC, Souza RB, Tufik S, Andersen ML. Sleep restriction reduces the survival time and aggravates the neurological dysfunction and memory impairments in an animal model of cerebral hypoperfusion. Brain Res 2016; 1644:213-21. [DOI: 10.1016/j.brainres.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/02/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
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Caleyachetty R, Khaw KT, Surtees PG, Wainwright NWJ, Wareham N, Griffin SJ. Cumulative social risk exposure in childhood and smoking and excessive alcohol use in adulthood. Eur J Public Health 2016; 26:575-81. [PMID: 26847204 PMCID: PMC5548232 DOI: 10.1093/eurpub/ckv243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Social inequalities in adult smoking and excessive alcohol intake may be associated with exposure to multiple childhood social risk factors across different domains of risk within the household. METHODS We used data from a cross-sectional cohort study of adults (40-75 years) in 1993-97 living in England (N = 19466) to examine the association between clusters of childhood social risks across different domains with adult smoking and excessive alcohol use. Participants reported exposure to six childhood social risk factors, current smoking behaviour and alcohol intake. Factor analysis was used to identify domains of social risk. We created a childhood cumulative domain social risk score (range 0-2) from summing the total number of domains. RESULTS Factor analysis identified two domains of childhood social risk within the household: maladaptive family functioning (parental unemployment, substance misuse, physical abuse) and parental separation experiences : maternal separation, divorce, being sent away from home). Compared to those children with risk exposure in no single domain, children with risk exposure in both domains (i.e. maladaptive family functioning, parental separation experiences) had a higher prevalence of adult smoking [men: Prevalence ratio (PR) = 1.74, 95% confidence intervals (CI): 1.35-2.26; women: PR = 1.71 95% CI: 1.34-2.18]. There was a trend association between the number of childhood social risk domains and adult smoking (both sexes: P < 0.001) and excessive alcohol use (men: P <0.008). CONCLUSIONS Further work is needed to understand if addressing cumulative risk exposure to maladaptive family functioning and parental separation experiences can reduce social inequalities in adult smoking and excessive alcohol intake.
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Affiliation(s)
- Rishi Caleyachetty
- 1 Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- 2 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paul G Surtees
- 2 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Nicholas W J Wainwright
- 2 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Nicholas Wareham
- 1 Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- 1 Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK 2 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Michie S, Wood CE, Johnston M, Abraham C, Francis JJ, Hardeman W. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess 2016; 19:1-188. [PMID: 26616119 DOI: 10.3310/hta19990] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Meeting global health challenges requires effective behaviour change interventions (BCIs). This depends on advancing the science of behaviour change which, in turn, depends on accurate intervention reporting. Current reporting often lacks detail, preventing accurate replication and implementation. Recent developments have specified intervention content into behaviour change techniques (BCTs) - the 'active ingredients', for example goal-setting, self-monitoring of behaviour. BCTs are 'the smallest components compatible with retaining the postulated active ingredients, i.e. the proposed mechanisms of change. They can be used alone or in combination with other BCTs' (Michie S, Johnston M. Theories and techniques of behaviour change: developing a cumulative science of behaviour change. Health Psychol Rev 2012;6:1-6). Domain-specific taxonomies of BCTs have been developed, for example healthy eating and physical activity, smoking cessation and alcohol consumption. We need to build on these to develop an internationally shared language for specifying and developing interventions. This technology can be used for synthesising evidence, implementing effective interventions and testing theory. It has enormous potential added value for science and global health. OBJECTIVE (1) To develop a method of specifying content of BCIs in terms of component BCTs; (2) to lay a foundation for a comprehensive methodology applicable to different types of complex interventions; (3) to develop resources to support application of the taxonomy; and (4) to achieve multidisciplinary and international acceptance for future development. DESIGN AND PARTICIPANTS Four hundred participants (systematic reviewers, researchers, practitioners, policy-makers) from 12 countries engaged in investigating, designing and/or delivering BCIs. Development of the taxonomy involved a Delphi procedure, an iterative process of revisions and consultation with 41 international experts; hierarchical structure of the list was developed using inductive 'bottom-up' and theory-driven 'top-down' open-sort procedures (n = 36); training in use of the taxonomy (1-day workshops and distance group tutorials) (n = 161) was evaluated by changes in intercoder reliability and validity (agreement with expert consensus); evaluating the taxonomy for coding interventions was assessed by reliability (intercoder; test-retest) and validity (n = 40 trained coders); and evaluating the taxonomy for writing descriptions was assessed by reliability (intercoder; test-retest) and by experimentally testing its value (n = 190). RESULTS Ninety-three distinct, non-overlapping BCTs with clear labels and definitions formed Behaviour Change Technique Taxonomy version 1 (BCTTv1). BCTs clustered into 16 groupings using a 'bottom-up' open-sort procedure; there was overlap between these and groupings produced by a theory-driven, 'top-down' procedure. Both training methods improved validity (both p < 0.05), doubled the proportion of coders achieving competence and improved confidence in identifying BCTs in workshops (both p < 0.001) but did not improve intercoder reliability. Good intercoder reliability was observed for 80 of the 93 BCTs. Good within-coder agreement was observed after 1 month (p < 0.001). Validity was good for 14 of 15 BCTs in the descriptions. The usefulness of BCTTv1 to report descriptions of observed interventions had mixed results. CONCLUSIONS The developed taxonomy (BCTTv1) provides a methodology for identifying content of complex BCIs and a foundation for international cross-disciplinary collaboration for developing more effective interventions to improve health. Further work is needed to examine its usefulness for reporting interventions. FUNDING This project was funded by the Medical Research Council Ref: G0901474/1. Funding also came from the Peninsula Collaboration for Leadership in Applied Health Research and Care.
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Affiliation(s)
- Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Caroline E Wood
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marie Johnston
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Institute of Applied Health Sciences, College of Life Science and Medicine, University of Aberdeen, Health Sciences Building, Aberdeen, UK
| | - Charles Abraham
- University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, UK
| | - Jill J Francis
- School of Health Sciences, City University London, London, UK
| | - Wendy Hardeman
- Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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Hall M, Bogdanovica I, Britton J. Research funding for addressing tobacco-related disease: an analysis of UK investment between 2008 and 2012. BMJ Open 2016; 6:e011609. [PMID: 27377637 PMCID: PMC4947797 DOI: 10.1136/bmjopen-2016-011609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/29/2016] [Accepted: 05/25/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Tobacco use is the leading cause of preventable death in the UK. However, research spending on tobacco-related disease, and particularly smoking prevention, is thought to be low. We therefore aimed to assess the relation between tobacco-related research investment and disease burden from 2008 to 2012. METHODS We used the Health Research Classification System to classify UK government and charitable research funding by broad health category and then by tobacco prevention research and 18 WHO defined tobacco-related diseases. We used UK mortality figures to calculate disease-specific tobacco attributable deaths and then compared disease specific and tobacco prevention research investment with all cause and tobacco attributable mortality over the 5-year period and as annual averages. RESULTS 12 922 research grants were identified with a total value of £6.69bn, an annual average of £1.34bn. Annually an average of 110 000 people die from tobacco-related disease, approximately 20% of total deaths. £130m is invested in researching tobacco-related disease each year and £5m on tobacco prevention, 10.8% and 0.42% of total annual research funding, respectively. Prevention research equated to an annual average of £46 per tobacco attributable death or one pound for every £29 spent on tobacco-related disease. Funding varied widely for diseases with different numbers of deaths (eg, lung cancer £68 per all cause death, cervical cancer £2500), similar numbers of deaths (leukaemia £983 per death, stomach cancer £43) or similar numbers of tobacco attributable deaths (eg, colorectal cancer £5k, pancreatic cancer £670, bladder cancer £340). CONCLUSIONS Tobacco-related research funding is not related to burden of disease or level of risk. As a result certain diseases receive a disproportionately low level of research funding and disease prevention funding is even lower.
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Affiliation(s)
- Mary Hall
- StR Public Health, Public Health Department, LCC, Leicester, UK
| | - Ilze Bogdanovica
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health University of Nottingham, Nottingham, UK
| | - John Britton
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health University of Nottingham, Nottingham, UK
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Patel S, Hee SW, Mistry D, Jordan J, Brown S, Dritsaki M, Ellard DR, Friede T, Lamb SE, Lord J, Madan J, Morris T, Stallard N, Tysall C, Willis A, Underwood M. Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThere is good evidence that therapist-delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority.Aim and objectivesTo improve the clinical effectiveness and cost-effectiveness of LBP treatment by providing patients, their clinical advisors and health-service purchasers with better information about which participants are most likely to benefit from which treatment choices. Our objectives were to synthesise what is already known about the validity, reliability and predictive value of possible treatment moderators (patient factors that predict response to treatment) for therapist-delivered interventions; develop a repository of individual participant data from randomised controlled trials (RCTs) testing therapist-delivered interventions for LBP; determine which participant characteristics, if any, predict clinical response to different treatments for LBP; and determine which participant characteristics, if any, predict the most cost-effective treatments for LBP. Achieving these objectives required substantial methodological work, including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse the main effect of interventions and no such interpretations should be made.MethodsFirst, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with > 179 participants to share their data with us; some further smaller trials that were offered to us were also included. Using these trials we developed a repository of individual participant data of therapist-delivered interventions for LBP. Using this data set we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical effectiveness and cost-effectiveness outcomes. We undertook an analysis of covariance to identify potential moderators to apply in our main analyses. Subsequently, we developed and applied three methods of subgroup identification: recursive partitioning (interaction trees and subgroup identification based on a differential effect search); adaptive risk group refinement; and an individual participant data indirect network meta-analysis (NWMA) to identify subgroups defined by multiple parameters.ResultsWe included data from 19 RCTs with 9328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of subgroup identification that we identified. Additionally, we explored the application of Bayesian indirect NWMA. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile.ConclusionsThese data lack clinical effectiveness or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas. The pooled repository database will serve as a valuable resource to the LBP research community.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands (AWM) and the Wolfson Foundation.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jake Jordan
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Surrey Health Economic Centre, School of Economics, University of Surrey, Guildford, UK
| | - Sally Brown
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David R Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah E Lamb
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joanne Lord
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Colin Tysall
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Adrian Willis
- Warwick Medical School, University of Warwick, Coventry, UK
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Marshman Z, Ahern S, McEachan R, Rogers H, Gray-Burrows K, Day P. Parents' Experiences of Toothbrushing with Children: A Qualitative Study. JDR Clin Trans Res 2016; 1:122-130. [PMID: 28879241 PMCID: PMC5576048 DOI: 10.1177/2380084416647727] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Globally, dental caries is one of the most prevalent diseases and is more common in children living in deprived areas. Dental caries is preventable, and guidance in the United Kingdom recommends parental supervised brushing (PSB): a collection of behaviors-including twice-daily toothbrushing with fluoridated toothpaste-that should begin upon eruption of the first tooth (approximately 6 to 12 mo of age) and for which children need to be helped or supervised by an adult until at least 7 y of age. The aim of this study was to explore parents' experiences of toothbrushing with their young children and to establish barriers and facilitators to PSB at individual, interpersonal, and environmental levels according to the theoretical domains framework. Qualitative semistructured interviews guided by the framework were conducted with 27 parents of young children (<7 y) in 2 deprived areas of the United Kingdom. Framework analysis was used. Parents were not aware of national guidance concerning their active involvement in toothbrushing; however, they did have detailed knowledge of toothbrushing practices for children, and their intentions were to brush their children's teeth themselves twice every day as part of a family routine. Nonetheless, parents' difficulties experienced in managing their children's challenging behavior and the environmental context of their stressful lives meant that many parents adopted a role of simply reminding their children to brush or watching them brush. As such, the main barriers to PSB among parents living in deprived areas were skills in managing their children's behavior and environmental influences on family life. The results of our study have clear implications for the development of appropriate interventions to address the modifiable barriers to improve parental adoption of PSB. Knowledge Transfer Statement: The results of this study will be used to develop a behavior change intervention to encourage parental supervised brushing. The intervention-which is likely to be delivered through health practitioners rather than dental teams-will be developed to reduce dental caries among young children and will require evaluation in terms of its clinical and cost effectiveness.
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Affiliation(s)
| | - S.M. Ahern
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - R.R.C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - H.J. Rogers
- Department of Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield, UK
| | | | - P.F. Day
- School of Dentistry, University of Leeds, Leeds, UK
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235
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Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment. PLoS One 2016; 11:e0157403. [PMID: 27314953 PMCID: PMC4912063 DOI: 10.1371/journal.pone.0157403] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background Healthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents’ socio-demographic characteristics? Methods We conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels) were: type of incentive (none, cash, shopping vouchers or lottery tickets); value of incentive (a continuous variable); schedule of incentive (same value each week, or value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, or both); and recipients (all eligible individuals, people living in low-income households, or pregnant women). Results Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment. Conclusions Cash or shopping voucher-type financial incentives for healthy behaviours are not necessarily less acceptable than no incentives to UK adults.
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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237
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Yin RH, Li J, Tan L, Wang HF, Tan MS, Yu WJ, Tan CC, Yu JT, Tan L. Impact of SORL1 genetic variations on MRI markers in non-demented elders. Oncotarget 2016; 7:31689-98. [PMID: 27177090 PMCID: PMC5077969 DOI: 10.18632/oncotarget.9300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/16/2016] [Indexed: 12/11/2022] Open
Abstract
The sorting protein-related receptor 1 (SORL1 or LR11) gene has been verified to play an important role in the pathologic process of β-amyloid (Aβ) formation and trafficking in Alzheimer's Disease (AD) by plenty of cytological and molecular biological studies. But there were few studies investigated the association of SORL1 gene and neurodegeneration features from a rather macroscopic perspective. In the present study, we explored the effect of SORL1 genotypes on AD-related brain atrophy. We recruited 812 individuals with both baseline and two-year follow-up information from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database and applied multiple linear regression models to examine the association between eight single nucleotide polymorphisms (SNPs) and neuroimaging phenotypes. Finally, four SNPs (rs11219350, rs2298813, rs3781836, rs3824968) showed trend of association with the volume of hippocampus and parahippocampal gyrus but failed to survive the false discovery rate (FDR) correction. Only rs1784933 and rs753780 showed significant association with right parahippocampal gyrus. According to our findings, SORL1 variations influence the atrophy of specific AD-related brain structures, which suggested the potential role of SORL1 in the neurodegeneration of cognitive related regions.
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Affiliation(s)
- Rui-Hua Yin
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Jun Li
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Lin Tan
- Department of Radiology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Meng-Shan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Wan-Jiang Yu
- Department of Radiology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
- College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China
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Bhala N, Cézard G, Ward HJ, Bansal N, Bhopal R. Ethnic Variations in Liver- and Alcohol-Related Disease Hospitalisations and Mortality: The Scottish Health and Ethnicity Linkage Study. Alcohol Alcohol 2016; 51:593-601. [DOI: 10.1093/alcalc/agw018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/15/2016] [Indexed: 02/04/2023] Open
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Lewis FI, Torgerson PR. The current and future burden of late-onset dementia in the United Kingdom: Estimates and interventions. Alzheimers Dement 2016; 13:38-44. [PMID: 27157826 DOI: 10.1016/j.jalz.2016.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/26/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We estimate the burden of late-onset dementia in the United Kingdom through to 2025 and assess the impact of potential interventions. METHODS We compute disability adjusted life years (DALYs) through to 2025 and consider three interventions, all assumed launched in 2018; (1) an optimistic limiting case of a 100% preventive intervention with immediate uptake of 100% of the population at risk; (2) an intervention which delays onset by 5 years, linear uptake to 50% after 5 years; (3) as (2) but uptake 75% after 5 years. RESULTS By 2025, the DALY burden will have increased by 42% from the Global Disease Burden 2010 estimate. Intervention results: (1) a 9% decrease by 2025; (2) a 33% increase; and (3) a 28% increase. DISCUSSION At current prevalence rates, the ability of an intervention to offset the projected increase in DALY burden of dementia in the United Kingdom by 2025 appears low.
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Affiliation(s)
| | - Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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240
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Gray-Burrows KA, Day PF, Marshman Z, Aliakbari E, Prady SL, McEachan RRC. Using intervention mapping to develop a home-based parental-supervised toothbrushing intervention for young children. Implement Sci 2016; 11:61. [PMID: 27153832 PMCID: PMC4859968 DOI: 10.1186/s13012-016-0416-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/01/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Dental caries in young children is a major public health problem impacting on the child and their family in terms of pain, infection and substantial financial burden on healthcare funders. In the UK, national guidance on the prevention of dental caries advises parents to supervise their child's brushing with fluoride toothpaste until age 7. However, there is a dearth of evidence-based interventions to encourage this practice in parents. The current study used intervention mapping (IM) to develop a home-based parental-supervised toothbrushing intervention to reduce dental caries in young children. METHODS The intervention was developed using the six key stages of the IM protocol: (1) needs assessment, including a systematic review, qualitative interviews, and meetings with a multi-disciplinary intervention development group; (2) identification of outcomes and change objectives following identification of the barriers to parental-supervised toothbrushing (PSB), mapped alongside psychological determinants outlined in the Theoretical Domains Framework (TDF); (3) selection of methods and practical strategies; (4) production of a programme plan; (5) adoption and implementation and (6) Evaluation. RESULTS The comprehensive needs assessment highlighted key barriers to PSB, such as knowledge, skills, self-efficacy, routine setting and behaviour regulation and underlined the importance of individual, social and structural influences. Parenting skills (routine setting and the ability to manage the behaviour of a reluctant child) were emphasised as critical to the success of PSB. The multi-disciplinary intervention development group highlighted the need for both universal and targeted programmes, which could be implemented within current provision. Two intervention pathways were developed: a lower cost universal pathway utilising an existing national programme and an intensive targeted programme delivered via existing parenting programmes. A training manual was created to accompany each intervention to ensure knowledge and standardise implementation procedures. CONCLUSIONS PSB is a complex behaviour and requires intervention across individual, social and structural levels. IM, although a time-consuming process, allowed us to capture this complexity and allowed us to develop two community-based intervention pathways covering both universal and targeted approaches, which can be integrated into current provision. Further research is needed to evaluate the acceptability and sustainability of these interventions.
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Affiliation(s)
| | - P. F. Day
- School of Dentistry, Clarendon Way, Leeds, LS2 9JT UK
| | - Z. Marshman
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA UK
| | - E. Aliakbari
- School of Dentistry, Clarendon Way, Leeds, LS2 9JT UK
| | - S. L. Prady
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - R. R. C. McEachan
- Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ UK
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Briggs ADM, Wolstenholme J, Blakely T, Scarborough P. Choosing an epidemiological model structure for the economic evaluation of non-communicable disease public health interventions. Popul Health Metr 2016; 14:17. [PMID: 27152092 PMCID: PMC4857239 DOI: 10.1186/s12963-016-0085-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
Non-communicable diseases are the leading global causes of mortality and morbidity. Growing pressures on health services and on social care have led to increasing calls for a greater emphasis to be placed on prevention. In order for decisionmakers to make informed judgements about how to best spend finite public health resources, they must be able to quantify the anticipated costs, benefits, and opportunity costs of each prevention option available. This review presents a taxonomy of epidemiological model structures and applies it to the economic evaluation of public health interventions for non-communicable diseases. Through a novel discussion of the pros and cons of model structures and examples of their application to public health interventions, it suggests that individual-level models may be better than population-level models for estimating the effects of population heterogeneity. Furthermore, model structures allowing for interactions between populations, their environment, and time are often better suited to complex multifaceted interventions. Other influences on the choice of model structure include time and available resources, and the availability and relevance of previously developed models. This review will help guide modelers in the emerging field of public health economic modeling of non-communicable diseases.
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Affiliation(s)
- Adam D. M. Briggs
- />BHF Centre on Population Approaches for Non-Communicable Disease Prevention (BHF CPNP), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Jane Wolstenholme
- />Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Blakely
- />Health Inequalities Research Programme (HIRP), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Peter Scarborough
- />BHF Centre on Population Approaches for Non-Communicable Disease Prevention (BHF CPNP), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
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Nielen JTH, Emans PJ, Dagnelie PC, Boonen A, Lalmohamed A, de Boer A, van den Bemt BJF, de Vries F. Severity of Diabetes Mellitus and Total Hip or Knee Replacement: A Population-Based Case-Control Study. Medicine (Baltimore) 2016; 95:e3739. [PMID: 27196498 PMCID: PMC4902440 DOI: 10.1097/md.0000000000003739] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from osteoarthritis (OA) due to an increased body mass index (BMI), resulting in mechanical destruction of cartilage. However, previous studies have suggested a coexisting metabolic causality.To evaluate the risk of hip or knee replacement, as a proxy for severe OA, in patients with DM. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity.A population-based case-control study was performed, using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender, and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity.Current AD use was significantly associated with a lower risk of TKR (OR = 0.86 (95% CI = 0.78-0.94)) and THR (OR = 0.90 (95% CI = 0.82-0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c.This study does not support the theory that DM patients are more likely to suffer from severe OA as compared to patients without diabetes. Moreover, risk of severe OA necessitating TJR decreases with increasing DM severity. This is possibly due to dissimilarities in methodology, a decrease in eligibility for surgery, or variability of OA phenotypes.
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Affiliation(s)
- Johannes T H Nielen
- From the Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University (JTHN, AL, AdB, FdV), Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht (AL), Department of Epidemiology, CAPHRI School for Public Health and Primary Care (JTHN), Department of Epidemiology, CAPHRI School for Public Health and Primary Care, and CARIM School for Cardiovascular Diseases, Maastricht University (PCD), Department of Orthopaedics (PJE), Department of Internal Medicine, Division of Rheumatology (AB), Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht (FdV), Department of Pharmacy, Sint Maartenskliniek (BJFvdB), and Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands (BJFvdB)
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243
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The impact of PICALM genetic variations on reserve capacity of posterior cingulate in AD continuum. Sci Rep 2016; 6:24480. [PMID: 27117083 PMCID: PMC4846810 DOI: 10.1038/srep24480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/24/2016] [Indexed: 11/25/2022] Open
Abstract
Phosphatidylinositolbinding clathrin assembly protein (PICALM) gene is one novel genetic player associated with late-onset Alzheimer’s disease (LOAD), based on recent genome wide association studies (GWAS). However, how it affects AD occurrence is still unknown. Brain reserve hypothesis highlights the tolerant capacities of brain as a passive means to fight against neurodegenerations. Here, we took the baseline volume and/or thickness of LOAD-associated brain regions as proxies of brain reserve capacities and investigated whether PICALM genetic variations can influence the baseline reserve capacities and the longitudinal atrophy rate of these specific regions using data from Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset. In mixed population, we found that brain region significantly affected by PICALM genetic variations was majorly restricted to posterior cingulate. In sub-population analysis, we found that one PICALM variation (C allele of rs642949) was associated with larger baseline thickness of posterior cingulate in health. We found seven variations in health and two variations (rs543293 and rs592297) in individuals with mild cognitive impairment were associated with slower atrophy rate of posterior cingulate. Our study provided preliminary evidences supporting that PICALM variations render protections by facilitating reserve capacities of posterior cingulate in non-demented elderly.
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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245
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Cassidy S, Chau JY, Catt M, Bauman A, Trenell MI. Cross-sectional study of diet, physical activity, television viewing and sleep duration in 233,110 adults from the UK Biobank; the behavioural phenotype of cardiovascular disease and type 2 diabetes. BMJ Open 2016; 6:e010038. [PMID: 27008686 PMCID: PMC4800116 DOI: 10.1136/bmjopen-2015-010038] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Simultaneously define diet, physical activity, television (TV) viewing, and sleep duration across cardiometabolic disease groups, and investigate clustering of non-diet lifestyle behaviours. DESIGN Cross-sectional observational study. SETTING 22 UK Biobank assessment centres across the UK. PARTICIPANTS 502,664 adults aged 37-63 years old, 54% women. 4 groups were defined based on disease status; 'No disease' (n=103,993), 'cardiovascular disease' (CVD n=113,469), 'Type 2 diabetes without CVD' (n=4074) and 'Type 2 diabetes + CVD' (n=11,574). MAIN OUTCOMES Diet, physical activity, TV viewing and sleep duration. RESULTS People with 'CVD' report low levels of physical activity (<918 MET min/week, OR (95% CI) 1.23 (1.20 to 1.25)), high levels of TV viewing (>3 h/day; 1.42 (1.39 to 1.45)), and poor sleep duration (<7, >8 h/night; 1.37 (1.34 to 1.39)) relative to people without disease. People with 'Type 2 diabetes + CVD' were more likely to report low physical activity (1.71 (1.64 to 1.78)), high levels of TV viewing (1.92 (1.85 to 1.99)) and poor sleep duration (1.52 (1.46 to 1.58)) relative to people without disease. Non-diet behaviours were clustered, with people with 'CVD' or 'Type 2 diabetes + CVD' more likely to report simultaneous low physical activity, high TV viewing and poor sleep duration than those without disease (2.15 (2.03 to 2.28) and 3.29 (3.02 to 3.58), respectively). By contrast, 3 in 4 adults with 'Type 2 diabetes', and 2 in 4 adults with 'CVD' have changed their diet in the past 5 years, compared with only 1 in 4 in the 'No disease' group. Models were adjusted for gender, age, body mass index, Townsend Deprivation Index, ethnicity, alcohol intake, smoking and meeting fruit/vegetable guidelines. CONCLUSIONS Low physical activity, high TV and poor sleep duration are prominent unaddressed high-risk characteristics of both CVD and type 2 diabetes, and are likely to be clustered together.
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Affiliation(s)
- Sophie Cassidy
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Josephine Y Chau
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre D17, University of Sydney, New South Wales, Australia
| | - Michael Catt
- Faculty of Medical Sciences, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre D17, University of Sydney, New South Wales, Australia
| | - Michael I Trenell
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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246
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Shi-Min D, Shun-Kang R, Yuan-Qing Y, Jun Q, Jing H, Nan L, Ren-Jiang Z. Retrospective analysis of population-based causes of death and life expectancy in urban Western China from 2003 to 2012. BMC Public Health 2016; 16:237. [PMID: 26956019 PMCID: PMC4782393 DOI: 10.1186/s12889-016-2925-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hitherto, a population-based analysis of the cause of death in urban areas of Western China has not been undertaken over an extended period. The aims of this study were to calculate the overall and annual cause-specific mortality rates by age and sex in urban areas of Western China from 2003 to 2012 and to evaluate the quality of the data. METHODS We used Excel software, cause-of-death registrations, and International Classification of Diseases, 10th revision, codes to calculate the overall and yearly cause-specific crude mortality rates by age and sex, the Chinese age-standardized mortality rate, and life expectancies. RESULTS In the Jiulongpo District from 2003 to 2012, there was an increase in the number of death case reports in the census-registered population, a decrease in the number of omitted deaths, and rise in the crude mortality rate. Except for 2003, the Chinese age-standardized mortality rate was the lowest in 2012 (330.83/100,000) and highest in 2005 (390.08/100,000). Life expectancy increased from 78.36 years in 2005 to 81.67 years in 2012. CONCLUSIONS With the development of its social economy, the Chinese government and public attach greater importance to cause-of-death surveillance. The quality of cause-of-death registrations has gradually increased, crude mortality rates have risen, the Chinese age-standardized mortality rate has fallen, and life expectancies have increased.
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Affiliation(s)
- Deng Shi-Min
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Chronic and Non-communicable Disease Prevention and Control, Jiulongpo District Center for Disease Control and Prevention, Chongqing, China
| | - Rong Shun-Kang
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Yuan-Qing
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Jun
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huang Jing
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Li Nan
- Department of Chronic and Non-communicable Disease Prevention and Control, Jiulongpo District Center for Disease Control and Prevention, Chongqing, China
| | - Zhou Ren-Jiang
- Department of Chronic and Non-communicable Disease Prevention and Control, Jiulongpo District Center for Disease Control and Prevention, Chongqing, China
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247
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Public health nutrition in the civil service (England): approaches to tackling obesity. Proc Nutr Soc 2016; 75:356-66. [PMID: 26947185 DOI: 10.1017/s0029665116000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The seriousness and scale of the physical, psychological, economic and societal consequences relating to poor diets, inactivity and obesity is unprecedented. Consequently, the contextual factors underpinning the work of a nutritionist in the civil service are complex and significant; however, there are real opportunities to make a difference and help improve the health of the nation. The present paper describes the delivery of public health nutrition through two work programmes, namely action to support young people develop healthier lifestyle choices and more recently the investigation and deployment of local insights to develop action to tackle obesity. Combining the application of nutrition expertise along with broader skills and approaches has enabled the translation of research and evidence into programmes of work to better the public's health. It is evident that the appropriate evaluation of such approaches has helped to deliver engaging and practical learning opportunities for young people. Furthermore, efforts to build on local intelligence and seek collaborative development can help inform the evidence base and seek to deliver public health approaches, which resonate with how people live their lives.
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248
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Diet and nutrient intake of people receiving opioid agonist treatment (OAT): implications for recovery. DRUGS AND ALCOHOL TODAY 2016. [DOI: 10.1108/dat-08-2015-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose– The purpose of this paper is to provide new insights into the diet and nutrient intake of people receiving opioid agonist treatment (OAT) in the UK, offering implications for recovery-oriented treatment and care.Design/methodology/approach– Diet and nutrient intake were assessed using quantitative methods. The research tools used were: a socio-demographic and drug use questionnaire, 24-hour dietary recall interview and anthropometry measures. A four-month follow-up was conducted using the same methods.Findings– Mean (SD) body mass index for males (n=15) and females (n=10) exceeded the normal range (25.2 (5.9) kg/m2 and 33.3 (8.6) kg/m2, respectively) at baseline. Males decreased to the normal range at follow-up (mean (SD)=24.1 (±6.2) kg/m2]. Females increased to obesity Class II at follow-up (mean (SD)=35.1 (±8.0) kg/m2). Non-starch polysaccharide intakes were significantly lower than the reference nutrient intake (RNI). Iron intakes for females were significantly below the RNI. Saturated fat intake and sodium intake exceeded the RNI. In total, 11 (44 per cent) participants had multiple health conditions. Participants regularly consumed meals and reported frequent snacking events.Research limitations/implications– There is a need for better understanding of nutrition-related issues and dietary deficiencies amongst people receiving OAT, including larger studies that explore differences between males and females, other sub-groups and changes over time.Practical implications– Nutritional recommendations or guidelines and increased attention to nutrition and diet within treatment programmes are needed to help people receiving OAT.Originality/value– This paper demonstrates how diet and nutrient intake are essential to recovery processes and outcomes.
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249
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Hurley MV, Carter A. ESCAPE-into the community – a community-based rehabilitation programme for elderly people with chronic joint pain. Perspect Public Health 2016; 136:67-9. [DOI: 10.1177/1757913915626351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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250
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Waterall J, Greaves F, Kearney M, Fenton KA. NHS Health Check: an innovative component of local adult health improvement and well-being programmes in England. J Public Health (Oxf) 2016; 37:177-84. [PMID: 26022808 DOI: 10.1093/pubmed/fdv062] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamie Waterall
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK
| | - Felix Greaves
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK
| | - Matt Kearney
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK NHS England, London SE1 6LH, UK
| | - Kevin A Fenton
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK
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