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Mead R, Rinaldi C, McGill E, Egan M, Popay J, Hartwell G, Daras K, Edwards A, Lhussier M. Does better than expected life expectancy in areas of disadvantage indicate health resilience? Stakeholder perspectives and possible explanations. Health Place 2024; 87:103242. [PMID: 38692227 DOI: 10.1016/j.healthplace.2024.103242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/08/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
Some places have better than expected health trends despite being disadvantaged in other ways. Thematic analysis of qualitative data from stakeholders (N = 25) in two case studies of disadvantaged local authorities the North West and South East of England assessed explanations for the localities' apparent health resilience. Participants identified ways of working that might contribute to improved life expectancy, such as partnering with third sector, targeting and outcome driven action. Stakeholders were reluctant to assume credit for better-than-expected health outcomes. External factors such as population change, national politics and finances were considered crucial. Local public health stakeholders regard their work as important but unlikely to cause place-centred health resilience.
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Affiliation(s)
- Rebecca Mead
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Chiara Rinaldi
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Elizabeth McGill
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Matt Egan
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Greg Hartwell
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Konstantinos Daras
- Institute of Population Health, Department of Public Health, Policy, and Systems, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK.
| | | | - Monique Lhussier
- Department: Social Work, Education and Community, Wellbeing, Northumbria University, Coach Lane Campus, Benton, Newcastle Upon Tyne, NE7 7XA, UK.
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Halliday E, Tompson A, McGill E, Egan M, Popay J. Strategies for knowledge exchange for action to address place-based determinants of health inequalities: an umbrella review. J Public Health (Oxf) 2023; 45:e467-e477. [PMID: 36451281 PMCID: PMC10470361 DOI: 10.1093/pubmed/fdac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Place-based health inequalities persist despite decades of academics and other stakeholders generating ideas and evidence on how to reduce them. This may in part reflect a failure in effective knowledge exchange (KE). We aim to understand what KE strategies are effective in supporting actions on place-based determinants and the barriers and facilitators to this KE. METHODS An umbrella review was undertaken to identify relevant KE strategies. Systematic reviews were identified by searching academic databases (Medline, Embase, Scopus, Web of Science) and handsearching. Synthesis involved charting and thematic analysis. RESULTS Fourteen systematic reviews were included comprising 105 unique, relevant studies. Four approaches to KE were identified: improving access to knowledge, collaborative approaches, participatory models and KE as part of advocacy. While barriers and facilitators were reported, KE approaches were rarely evaluated for their effectiveness. CONCLUSIONS Based on these four approaches, our review produced a framework, which may support planning of future KE strategies. The findings also suggest the importance of attending to political context, including the ways in which this may impede a more upstream place-based focus in favour of behavioural interventions and the extent that researchers are willing to engage with politicized agendas.
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Affiliation(s)
- E Halliday
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YG, UK
| | - A Tompson
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - E McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - M Egan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - J Popay
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YG, UK
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Albers PN, Rinaldi C, Brown H, Mason KE, d'Apice K, McGill E, McQuire C, Craig P, Laverty AA, Beeson M, Campbell M, Egan M, Gibson M, Fuller M, Dillon A, Taylor-Robinson D, Jago R, Tilling K, Barr B, Sniehotta FF, Hickman M, Millett CJ, de Vocht F. Natural experiments for the evaluation of place-based public health interventions: a methodology scoping review. Front Public Health 2023; 11:1192055. [PMID: 37427271 PMCID: PMC10323422 DOI: 10.3389/fpubh.2023.1192055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Place-based public health evaluations are increasingly making use of natural experiments. This scoping review aimed to provide an overview of the design and use of natural experiment evaluations (NEEs), and an assessment of the plausibility of the as-if randomization assumption. Methods A systematic search of three bibliographic databases (Pubmed, Web of Science and Ovid-Medline) was conducted in January 2020 to capture publications that reported a natural experiment of a place-based public health intervention or outcome. For each, study design elements were extracted. An additional evaluation of as-if randomization was conducted by 12 of this paper's authors who evaluated the same set of 20 randomly selected studies and assessed 'as-if ' randomization for each. Results 366 NEE studies of place-based public health interventions were identified. The most commonly used NEE approach was a Difference-in-Differences study design (25%), followed by before-after studies (23%) and regression analysis studies. 42% of NEEs had likely or probable as-if randomization of exposure (the intervention), while for 25% this was implausible. An inter-rater agreement exercise indicated poor reliability of as-if randomization assignment. Only about half of NEEs reported some form of sensitivity or falsification analysis to support inferences. Conclusion NEEs are conducted using many different designs and statistical methods and encompass various definitions of a natural experiment, while it is questionable whether all evaluations reported as natural experiments should be considered as such. The likelihood of as-if randomization should be specifically reported, and primary analyses should be supported by sensitivity analyses and/or falsification tests. Transparent reporting of NEE designs and evaluation methods will contribute to the optimum use of place-based NEEs.
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Affiliation(s)
- Patricia N. Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chiara Rinaldi
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heather Brown
- Health Research, Lancaster University, Lancaster, United Kingdom
| | - Kate E. Mason
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Centre for Health Policy, University of Melbourne, Parkville, VIC, Australia
| | - Katrina d'Apice
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elizabeth McGill
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Anthony A. Laverty
- School of Public Health, Imperial College London, London, United Kingdom
| | - Morgan Beeson
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marcia Gibson
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Maxwell Fuller
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Amy Dillon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems. University of Liverpool, Liverpool, United Kingdom
| | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Benjamin Barr
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Falko F. Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Dun-Campbell K, van Schalkwyk MCI, Petticrew M, Maani N, McGill E. How Do Industry-Funded Alcohol and Gambling Conferences Frame the Issues? An Analysis of Conference Agendas. J Stud Alcohol Drugs 2023; 84:309-317. [PMID: 36972028 DOI: 10.15288/jsad.22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is a growing evidence base that unhealthy commodity industries (including alcohol and gambling) promote industry-favorable framings of product harms and solutions. These framings adopt a focus on the individual while overlooking broader influences and solutions. One potential method to influence the framing of harms and solutions is funding and organizing conferences. This study aims to examine how industry-funded alcohol and gambling conferences present themselves and frame product harms and solutions. METHOD We conducted a descriptive examination and framing analysis of industry-funded alcohol and gambling conference descriptions and agendas or programs to examine how conferences were presented. We also examined how the included topics framed the issues of product harm and solutions. A hybrid approach (using both deductive and inductive coding) was used for framing analysis, informed by previous research. RESULTS All the included conferences were targeted at professionals outside of the respective industry, many specifically mentioning researchers or policy makers. Several of the conferences offered professional credits for attendance. We identified four key frames that are consistent with the existing evidence base: a complex link between product consumption and harm, focus on the individual, deflection from population-level approaches, and medicalization/specialization of solutions. CONCLUSIONS We found industry-favorable framings of harms and solutions within the alcohol and gambling conferences included in our sample. These conferences are aimed at professionals outside of the industry, including researchers and policy makers, with several offering professional credits for attendance. Greater awareness of the potential for industry-favorable framings at conference settings is required.
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Affiliation(s)
- Kate Dun-Campbell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Elizabeth McGill
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bhuptani S, Boniface S, Severi K, Hartwell G, McGill E. A comparative study of industry responses to government consultations about alcohol and gambling in the UK. Eur J Public Health 2023; 33:305-311. [PMID: 36850047 PMCID: PMC10066481 DOI: 10.1093/eurpub/ckad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND There is growing evidence that common strategies are used across unhealthy commodity industries (UCIs) to influence policy decisions in line with their commercial interests. To date, there have been relatively few studies comparing corporate political activity (CPA) across UCIs, especially comparing the alcohol and gambling industries. METHODS A comparative and inductive thematic analysis of alcohol and gambling industry submissions to two House of Lords (HoL) inquiries in the UK was conducted. Themes in the framing, arguments and strategies used by the alcohol and gambling industries in CPA were compared. RESULTS Alcohol and gambling industry responses largely used the same framings, both in terms of the problems and solutions. This included arguing that harms are only experienced by a 'minority' of people, emphasising individual responsibility and shifting blame for harms to other industry actors. They promoted targeted or localised solutions to these harms, in place of more effective population level solutions, and emphasised the perceived harms of introducing regulation not in the industries' interests. CONCLUSIONS These findings are consistent with previous literature suggesting that UCIs use the same framing and arguments to shape the narrative around their harms and solutions to those harms. This study also identified novel strategies such as shifting blame of harms to other industry actors. Policy makers should be aware of these strategies to avoid undue industry influence on policy decisions and understanding commonalities in strategies may help to inform more effective public health responses across all UCIs.
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Affiliation(s)
| | - Sadie Boniface
- Institute of Alcohol Studies, London, UK.,Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | | | - Greg Hartwell
- LSHTM, Faculty of Public Health and Policy, London, UK
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Astbury CC, Lee KM, McGill E, Clarke J, Egan M, Halloran A, Malykh R, Rippin H, Wickramasinghe K, Penney TL. Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review. Int J Health Policy Manag 2023; 12:6772. [PMID: 37579437 PMCID: PMC10125079 DOI: 10.34172/ijhpm.2023.6772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy. METHODS Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS. RESULTS 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use. CONCLUSION This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.
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Affiliation(s)
- Chloe Clifford Astbury
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Kirsten M. Lee
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Janielle Clarke
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Afton Halloran
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
- Department of Nutrition, ExercDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.ise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Regina Malykh
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Tarra L. Penney
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
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McGill E, Marks D, Petticrew M, Egan M. Addressing alcohol-related harms in the local night-time economy: a qualitative process evaluation from a complex systems perspective. BMJ Open 2022; 12:e050913. [PMID: 36008081 PMCID: PMC9422880 DOI: 10.1136/bmjopen-2021-050913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES English local authorities (LAs) are interested in reducing alcohol-related harms and may use discretionary powers such as the Late Night Levy (LNL) to do so. This study aims to describe how system stakeholders hypothesise the levy may generate changes and to explore how the system, its actors and the intervention adapt and co-evolve over time. DESIGN A process evaluation from a complex systems perspective, using qualitative methods. SETTING A London LA with high densities of residential and commercial properties, which implemented the LNL in 2014. PARTICIPANTS Data were generated through interviews with LNL implementers and alcohol consumers, observations in bars and during LNL patrols and documentary review. INTERVENTION The LNL allows LAs to charge late-night alcohol retailers an annual fee (£299-£4440) to manage and police the night-time economy (NTE). RESULTS When the LNL was being considered, stakeholders from different interest groups advanced diverse opinions about its likely impacts while rarely referencing supporting research evidence. Proponents of the levy argued it could reduce crime and anti-social behaviour by providing additional funds to police and manage the NTE. Critics of the levy hypothesised adverse consequences linked to claims that the intervention would force venues to vary their hours or close, cluster closing times, reduce NTE diversity and undermine public-private partnerships. In the first 2 years, levy-funded patrols developed relationships with the licensed trade and the public. The LNL did not undermine public-private partnerships and while some premises varied their hours, these changes did not undermine the intervention's viability, nor significantly cluster venue closing times, nor obviously damage the area's reputation for having a diverse NTE. CONCLUSIONS This study applies a framework for process evaluation from a complex systems perspective. The evaluation could be extended to measure alcohol-related outcomes and to consider the interplay between the national and local systems.
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Affiliation(s)
- Elizabeth McGill
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Barros TL, Vuong CN, Latorre JD, Cuesta RS, McGill E, Rochell SJ, Tellez-Isaias G, Hargis BM. Feed Composition and Isolate of Histomonas meleagridis Alter Horizontal Transmission of Histomonosis in Turkeys. Proof of Concept. Front Vet Sci 2022; 9:937102. [PMID: 35847644 PMCID: PMC9277661 DOI: 10.3389/fvets.2022.937102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Outbreaks of histomonosis in turkeys are typically initiated by the ingestion of contaminated embryonated eggs of Heterakis gallinarum, potentially present in earthworms and mechanical vectors. Once an outbreak is started, infected turkeys can transmit the disease by horizontal transmission. Factors influencing horizontal transmission of histomonosis are poorly understood. Replication of horizontal transmission in experimental conditions has not been consistent, presenting an obstacle in searching for alternatives to prevent or treat the disease. Two pilot experiments and three validation experiments were conducted in the present study. In pilot experiment 1, one isolate of Histomonas meleagridis (named Buford) was used. Turkeys were fed a low-nutrient density diet corn-soy based (LOW-CS) and raised in floor pens. In pilot experiment 2, another isolate of H. meleagridis was used (named PHL). Turkeys were fed a low-nutrient density diet with the addition of wheat middlings (LOW-WM) and raised in floor pens. In experiment 3, conducted on floor pens, both isolates and diets were used in different groups. In experiment 4, turkeys were raised on battery cages and only the PHL isolate was used. Both diets (LOW-WM and LOW-CS) were used, in addition to a diet surpassing the nutritional needs of young poults (turkey starter, TS). In experiment 5, conducted in battery cages, only the PHL isolate was used, and the LOW-WM and TS diets were in different groups. The horizontal transmission was achieved only with the PHL isolate from all experiments. The transmission rate varied among experimental diets, with the TS diet having the lowest transmission rate in experiments 4 and 5. Variation was observed between experiments and within experimental groups.
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Affiliation(s)
- Thaina L. Barros
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
- *Correspondence: Thaina L. Barros
| | - Christine N. Vuong
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | - Juan D. Latorre
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | - Roberto S. Cuesta
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | | | - Samuel J. Rochell
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | - Guillermo Tellez-Isaias
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | - Billy M. Hargis
- Center of Excellence for Poultry Science, University of Arkansas, Fayetteville, AR, United States
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Moerschel KS, von Philipsborn P, Hawkins B, McGill E. Concepts of responsibility in the German media debate on sugar taxation: a qualitative framing analysis. Eur J Public Health 2021; 32:267-272. [PMID: 34941999 PMCID: PMC9090278 DOI: 10.1093/eurpub/ckab200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Framing plays an important role in health-policy processes. Responsibility for health is a salient and contested concept in the framing around food policies, such as sugar taxes. To deepen the understanding of the sugar tax process in Germany and contribute to a better understanding of how responsibility frames are used in debates on health policies, this study investigated responsibility concepts underlying the German media debate on sugar taxation. Methods We analyzed 114 national German newspaper articles, published between January 2018 and March 2019, following an inductive thematic analysis approach with an additional deductive focus on responsibility. We identified important contested concepts around sugar taxation, analyzed their combination into narrative frames, and scrutinized those narrative frames for underlying responsibility concepts. Results First, we identified important contested concepts regarding problems, actors and solutions (i.e. sugar tax and its potential alternatives). Those laid the basis for 13 narrative frames, of which the ‘unscrupulous industry’, ‘government failure’, ‘vulnerable youth’ and the ‘oversimplification’, ‘responsible industry’ and ‘nanny state’ frames were most salient. Within the narrative frames, we found a dominance of societal responsibility framing with a conflict between binding, legislative measures and voluntary solutions in cooperation with the food and beverages industry. Conclusions Questions around societal responsibility for health and corporate social responsibility framing become more salient in sugar tax debates. Future research should, therefore, investigate how public health advocates can successfully engage with corporate social responsibility narratives, and how legislative measures can be framed in ways that engender trust in governmental actions.
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Affiliation(s)
- Katharina S Moerschel
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, and Pettenkofer School of Public Health, Munich, Germany
| | | | - Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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McGowan VJ, Buckner S, Mead R, McGill E, Ronzi S, Beyer F, Bambra C. Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. BMC Public Health 2021; 21:1888. [PMID: 34666742 PMCID: PMC8524206 DOI: 10.1186/s12889-021-11852-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. METHODS Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). RESULTS Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. CONCLUSIONS Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. TRIAL REGISTRATION PROSPERO CRD42019158309.
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Affiliation(s)
- V J McGowan
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - S. Buckner
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - R. Mead
- Department of Health Research, Lancaster University, Lancaster, UK
- LiLaC – Liverpool and Lancaster Universities Collaboration for Public Health Research, Lancaster, UK
| | - E. McGill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S. Ronzi
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - F. Beyer
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C. Bambra
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Clifford Astbury C, McGill E, Egan M, Penney TL. Systems thinking and complexity science methods and the policy process in non-communicable disease prevention: a systematic scoping review protocol. BMJ Open 2021; 11:e049878. [PMID: 34475176 PMCID: PMC8413942 DOI: 10.1136/bmjopen-2021-049878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Given the complex causal origins of many non-communicable diseases (NCDs), and the complex landscapes in which policies designed to tackle them are made and unfold, the need for systems thinking and complexity science (STCS) in developing effective policy solutions has been emphasised. While numerous methods informed by STCS have been applied to the policy process in NCD prevention, these applications have not been systematically catalogued. The aim of this scoping review is to identify existing applications of methods informed by STCS to the policy process for NCD prevention, documenting which domains of the policy process they have been applied to. METHODS AND ANALYSIS A systematic scoping review methodology will be used. IDENTIFICATION We will search Medline, SCOPUS, Embase and Web of Science using search terms combining STCS, NCD prevention and the policy process. All records published in English will be eligible for inclusion, regardless of study design. SELECTION We will screen titles and abstracts and extract data according to published guidelines for scoping reviews. In order to determine the quality of the included studies, we will use the approach developed by Dixon-Woods et al, excluding studies identified as fatally flawed, and determining the credibility and contribution of included studies. SYNTHESIS We will identify relevant studies, summarising key data from each study and mapping applications of methods informed by STCS to different parts of the policy process. Review findings will provide a useful reference for policy-makers, outlining which domains of the policy process different methods have been applied to. ETHICS AND DISSEMINATION Formal ethical approval is not required, as the study does not involve primary data collection. The findings of this study will be disseminated through a peer-reviewed publication, presentations and summaries for key stakeholders.
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Affiliation(s)
- Chloe Clifford Astbury
- Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Elizabeth McGill
- Deaprtment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Tarra L Penney
- Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, Ontario, Canada
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McGill E, Petticrew M, Marks D, McGrath M, Rinaldi C, Egan M. Applying a complex systems perspective to alcohol consumption and the prevention of alcohol-related harms in the 21st century: a scoping review. Addiction 2021; 116:2260-2288. [PMID: 33220118 DOI: 10.1111/add.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/09/2020] [Accepted: 11/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS A complex systems perspective has been advocated to explore multi-faceted factors influencing public health issues, including alcohol consumption and associated harms. This scoping review aimed to identify studies that applied a complex systems perspective to alcohol consumption and the prevention of alcohol-related harms in order to summarize their characteristics and identify evidence gaps. METHODS Studies published between January 2000 and September 2020 in English were located by searching for terms synonymous with 'complex systems' and 'alcohol' in the Scopus, MEDLINE, Web of Science and Embase databases, and through handsearching and reference screening of included studies. Data were extracted on each study's aim, country, population, alcohol topic, system levels, funding, theory, methods, data sources, time-frames, system modifications and type of findings produced. RESULTS Eighty-seven individual studies and three systematic reviews were identified, the majority of which were conducted in the United States or Australia in the general population, university students or adolescents. Studies explored types and patterns of consumption behaviour and the local environments in which alcohol is consumed. Most studies focused on individual and local interactions and influences, with fewer examples exploring the relationships between these and regional, national and international subsystems. The body of literature is methodologically diverse and includes theory-led approaches, dynamic simulation models and social network analyses. The systematic reviews focused on primary network studies. CONCLUSIONS The use of a complex systems perspective has provided a variety of ways of conceptualizing and analyzing alcohol use and harm prevention efforts, but its focus ultimately has remained on predominantly individual- and/or local-level systems. A complex systems perspective represents an opportunity to address this gap by also considering the vertical dimensions that constrain, shape and influence alcohol consumption and related harms, but the literature to date has not fully captured this potential.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael McGrath
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Chiara Rinaldi
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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13
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McGill E, Er V, Penney T, Egan M, White M, Meier P, Whitehead M, Lock K, Anderson de Cuevas R, Smith R, Savona N, Rutter H, Marks D, de Vocht F, Cummins S, Popay J, Petticrew M. Evaluation of public health interventions from a complex systems perspective: A research methods review. Soc Sci Med 2021; 272:113697. [PMID: 33508655 DOI: 10.1016/j.socscimed.2021.113697] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/27/2020] [Accepted: 01/07/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Applying a complex systems perspective to public health evaluation may increase the relevance and strength of evidence to improve health and reduce health inequalities. In this review of methods, we aimed to: (i) classify and describe different complex systems methods in evaluation applied to public health; and (ii) examine the kinds of evaluative evidence generated by these different methods. METHODS We adapted critical review methods to identify evaluations of public health interventions that used systems methods. We conducted expert consultation, searched electronic databases (Scopus, MEDLINE, Web of Science), and followed citations of relevant systematic reviews. Evaluations were included if they self-identified as using systems- or complexity-informed methods and if they evaluated existing or hypothetical public health interventions. Case studies were selected to illustrate different types of complex systems evaluation. FINDINGS Seventy-four unique studies met our inclusion criteria. A framework was developed to map the included studies onto different stages of the evaluation process, which parallels the planning, delivery, assessment, and further delivery phases of the interventions they seek to inform; these stages include: 1) theorising; 2) prediction (simulation); 3) process evaluation; 4) impact evaluation; and 5) further prediction (simulation). Within this framework, we broadly categorised methodological approaches as mapping, modelling, network analysis and 'system framing' (the application of a complex systems perspective to a range of study designs). Studies frequently applied more than one type of systems method. CONCLUSIONS A range of complex systems methods can be utilised, adapted, or combined to produce different types of evaluative evidence. Further methodological innovation in systems evaluation may generate stronger evidence to improve health and reduce health inequalities in our complex world.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Vanessa Er
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tarra Penney
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR) and University of Cambridge, Cambridge, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Martin White
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR) and University of Cambridge, Cambridge, United Kingdom
| | - Petra Meier
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Karen Lock
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Richard Smith
- University of Exeter Medical School, Exeter, United Kingdom
| | - Natalie Savona
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, United Kingdom
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Jennie Popay
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
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Barrera J, Greene S, Petyak E, Kenneson S, McGill E, Howell H, Billing D, Taylor S, Ewing A, Cull J. Reported rationales for HPV vaccination vs. Non-vaccination among undergraduate and medical students in South Carolina. J Am Coll Health 2021; 69:185-189. [PMID: 31513465 DOI: 10.1080/07448481.2019.1659279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/28/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
Objective: We sought to identify factors that influence Human Papillomavirus (HPV) vaccination rates in individuals at two higher education institutions in South Carolina (SC).Participants: We surveyed 1007 students with a mean age and standard deviation of 20.3 ± 3.3 from September 2018 to December 2018.Methods: Participants answered 13 questions, assessing HPV vaccination rates, demographics, and rationales for vaccination vs. non-vaccination.Results: Of 1007 respondents, 700 received HPV vaccination, 165 were unvaccinated, 75 received partial vaccination and 138 were uncertain. Commonalities in HPV vaccination existed between females (p = 0.037), individuals who received standard childhood vaccinations (p = 0.04), and those not native-born in SC (p < 0.001). Of non-vaccinated individuals, 37% "never thought about vaccination," 32% did not perceive a need for vaccination, and 31% reported vaccine safety as reasons for not receiving the vaccine.Conclusions: Promotion of HPV vaccination may benefit from targeting SC natives, males, and individuals who are under-vaccinated or unvaccinated.
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Affiliation(s)
- J Barrera
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | - S Greene
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | | | | | | | | | | | | | - A Ewing
- Prisma Health-Upstate Health Sciences Center, Greenville, SC
| | - J Cull
- Department of Surgery, Prisma Health-Upstate, Greenville, SC
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Egan M, McGill E. Applying a Systems Perspective to Preventive Health: How Can It Be Useful? Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health". Int J Health Policy Manag 2020; 10:343-346. [PMID: 32668892 PMCID: PMC9056150 DOI: 10.34172/ijhpm.2020.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
Advocates suggest that a paradigm shift in preventive health towards systems thinking is desirable and may be underway. In a recent study of policy-makers’ opinions, Haynes and colleagues found a mixed response to an Australian initiative that sought to apply systems theories and associated methods to preventive health. Some were enthusiastic about systems, but others were concerned or unconvinced about its usefulness. This commentary responds to such concerns. We argue that a systems perspective can help provide policy-makers with timely evidence to inform decisions about intervention planning and delivery. We also suggest that research applying a systems perspective could provide policy-makers with evidence to support planning and incremental decision-making; make recommendations to support intervention adaptability; consider potential barriers due to incoherent systems, and consider the political consequences of interventions.
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Affiliation(s)
- Matt Egan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth McGill
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Petticrew M, Knai C, Thomas J, Rehfuess EA, Noyes J, Gerhardus A, Grimshaw JM, Rutter H, McGill E. Implications of a complexity perspective for systematic reviews and guideline development in health decision making. BMJ Glob Health 2019; 4:e000899. [PMID: 30775017 PMCID: PMC6350708 DOI: 10.1136/bmjgh-2018-000899] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/02/2018] [Accepted: 08/26/2018] [Indexed: 01/03/2023] Open
Abstract
There is growing interest in the potential for complex systems perspectives in evaluation. This reflects a move away from interest in linear chains of cause-and-effect, towards considering health as an outcome of interlinked elements within a connected whole. Although systems-based approaches have a long history, their concrete implications for health decisions are still being assessed. Similarly, the implications of systems perspectives for the conduct of systematic reviews require further consideration. Such reviews underpin decisions about the implementation of effective interventions, and are a crucial part of the development of guidelines. Although they are tried and tested as a means of synthesising evidence on the effectiveness of interventions, their applicability to the synthesis of evidence about complex interventions and complex systems requires further investigation. This paper, one of a series of papers commissioned by the WHO, sets out the concrete methodological implications of a complexity perspective for the conduct of systematic reviews. It focuses on how review questions can be framed within a complexity perspective, and on the implications for the evidence that is reviewed. It proposes criteria which can be used to determine whether or not a complexity perspective will add value to a review or an evidence-based guideline, and describes how to operationalise key aspects of complexity as concrete research questions. Finally, it shows how these questions map onto specific types of evidence, with a focus on the role of qualitative and quantitative evidence, and other types of information.
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Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Thomas
- EPPI-Centre, SSRU, Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Ansgar Gerhardus
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany,Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Harry Rutter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK,Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Elizabeth McGill
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Wickremaarachchi C, McGill E, Bosco A, Kidson-Gerber G. Improving transfusion practice in transfusion dependent thalassaemia patients. Thal Rep 2017. [DOI: 10.4081/thal.2017.6821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to improve current transfusion practice in transfusiondependent thalassaemia patients by determining whether safe transition from triplewashed red cells (TWRC) to leucodepleted red cells (LDRC), increasing transfusion rates, reducing the use of frusemide and creating uniform practice across patients is possible. In patients receiving regular transfusions (50), triple-washed red blood cells were changed to LDRC, transfusion rates were increased to 5 mL/kg/h (in line with the Cooley’s Foundation guidelines) to a maximum of 300 mL/h and frusemide was ceased. Medical review occurred at completion of the transfusion. Of the 20 patients on TWRC, 18 were transitioned to leucodepleted red cells (90%). Recurrent allergic reactions in 2 patients required re-institution of TWRC. 7 of the 8 patients on regular frusemide ceased this practice with no documented transfusion-related fluid overload. One patient refused. Of the eligible 50 patients, 20 patients (40%) were increased to the maximum transfusion rate of 300 mLs/h; 6 (12%) increased rate but refused to go to the maximum; 9 (18%) refused a change in practice and 15 (30%) were already at the maximum rate. There was only one documented transfusion reaction (palpitations) however this patient was able to tolerate a higher transfusion rate on subsequent transfusions. Thalassemia patients on TWRC were safely transitioned to LDRC. Transfusion rates were safely increased, with a calculated reduction in day-stay bed time of 17.45 h per month. This confirms a guideline of 5 mL/kg/h for transfusion-dependant thalassaemia patients with preserved cardiac function is well tolerated and may be translated to other centres worldwide. 本研究的目的是通过确定是否有可能进行从三洗红细胞(TWRC)到去白细胞红细胞(LDRC)的安全过渡,提高输血速率,减少速尿的使用,并在患者中实施统一规则,从而改进输血依赖型地中海贫血患者中现有的输血实践。在接受定期输血的患者(50例)中,将三洗红细胞改为 LDRC,输血速率提高至5 mL/kg/h(符合库利氏贫血基金会的指引),最高可达到300 mL/h,并停止使用速尿。输血完成后进行体检。在使用TWRC的20例患者中,18例转为去白细胞红细胞(90%)。2例患者产生的复发性过敏反应需要重新输以TWRC。8名定期使用速尿的患者中,7名中止了使用该药物,并且没有输血相关液体超负荷的相关记录。一名病人拒绝。在符合条件的50例患者中,20例(40%)增加至300 mL/h的最大输血速率;6例(12%)输血速率提高但拒绝增加至最大;9例(18%)拒绝做出改变,15例(30%)已经达到了最大速率。只产生一例有记录的输血反应(心悸),但是该患者在随后的输血中能够耐受更高的输血速率。使用TWRC的地中海贫血患者安全转用LDRC。输血速率安全地得到提高,计算出减少的白天卧床时间为每月17.45小时。这证实了5 mL/kg/h的指引在心功能得到保护的输血依赖型地中海贫血患者中有良好的耐受性,可以推广至全球其他中心。
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Abstract
OBJECTIVES Increasingly, English local authorities have encouraged the implementation of an intervention called 'Reducing the Strength' (RtS) whereby off-licences voluntarily stop selling inexpensive 'super-strength' (≥6.5% alcohol by volume (ABV)) beers and ciders. We conceptualised RtS as an event within a complex system in order to identify pathways by which the intervention may lead to intended and unintended consequences. DESIGN A qualitative study including a focus group and semistructured interviews. SETTING An inner-London local authority characterised by a high degree of residential mobility, high levels of social inequality and a large homeless population. Intervention piloted in three areas known for street drinking with a high alcohol outlet density. PARTICIPANTS Alcohol service professionals, homeless hostel employees, street-based services managers and hostel dwelling homeless alcohol consumers (n=30). RESULTS Participants describe a range of potential substitution behaviours to circumvent alcohol availability restrictions including consuming different drinks, finding alternative shops, using drugs or committing crimes to purchase more expensive drinks. Service providers suggested the intervention delivered in this local authority missed opportunities to encourage engagement between the council, alcohol services, homeless hostels and off-licence stores. Some participants believed small-scale interventions such as RtS may facilitate new forms of engagement between public and private sector interests and contribute to long-term cultural changes around drinking, although they may also entrench the view that 'problem drinking' only occurs in certain population groups. CONCLUSIONS RtS may have limited individual-level health impacts if the target populations remain willing and able to consume alternative means of intoxication as a substitute for super-strength products. However, RtS may also lead to wider system changes not directly related to the consumption of super-strengths and their assumed harms.
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Affiliation(s)
- Elizabeth McGill
- NIHR School for Public Health Research (SPHR), London School of Hygiene & Tropical Medicine, London, UK
| | - Dalya Marks
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Colin Sumpter
- Camden and Islington Public Health, London Boroughs of Camden and Islington, London, UK
| | - Matt Egan
- NIHR School for Public Health Research (SPHR), London School of Hygiene & Tropical Medicine, London, UK
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Sumpter C, McGill E, Dickie E, Champo E, Romeri E, Egan M. Reducing the Strength: a mixed methods evaluation of alcohol retailers' willingness to voluntarily reduce the availability of low cost, high strength beers and ciders in two UK local authorities. BMC Public Health 2016; 16:448. [PMID: 27230466 PMCID: PMC4882838 DOI: 10.1186/s12889-016-3117-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/14/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Reducing the Strength is an increasingly popular intervention in which local authorities ask retailers to stop selling 'super-strength' beers and ciders. The intervention cannot affect alcohol availability, nor consumption, unless retailers participate. In this paper, we ask whether and why retailers choose or refuse to self-impose restrictions on alcohol sales in this way. METHODS Mixed method assessment of retailers' participation in Reducing the Strength in two London (UK) local authorities. Compliance rates and the cheapest available unit of alcohol at each store were assessed. Qualitative interviews with retailer managers and staff (n = 39) explored attitudes towards the intervention and perceptions of its impacts. RESULTS Shops selling super-strength across both areas fell from 78 to 25 (18 % of all off-licences). The median price of the cheapest unit of alcohol available across all retailers increased from £0.29 to £0.33 and in shops that participated in Reducing the Strength it rose from £0.33 to £0.43. The project received a mixed response from retailers. Retailers said they participated to deter disruptive customers, reduce neighbourhood disruptions and to maintain a good relationship with the local authority. Reducing the Strength participants and non-participants expressed concern about its perceived financial impact due to customers shopping elsewhere for super-strength. Some felt that customers' ability to circumvent the intervention would limit its effectiveness and that a larger scale compulsory approach would be more effective. CONCLUSIONS Reducing the Strength can achieve high rates of voluntary compliance, reduce availability of super-strength and raise the price of the cheapest available unit of alcohol in participating shops. Questions remain over the extent to which voluntary interventions of this type can achieve wider social or health goals if non-participating shops attract customers from those who participate.
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Affiliation(s)
- Colin Sumpter
- Camden and Islington Public Health, 222 Upper Street, London, N1 1XR, England
| | - Elizabeth McGill
- National Institute for Health Research School for Public Health Research (NIHR SPHR), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England.
| | - Esther Dickie
- Camden and Islington Public Health, 222 Upper Street, London, N1 1XR, England
| | - Enes Champo
- Camden and Islington Public Health, 222 Upper Street, London, N1 1XR, England
| | - Ester Romeri
- Camden and Islington Public Health, 222 Upper Street, London, N1 1XR, England
| | - Matt Egan
- National Institute for Health Research School for Public Health Research (NIHR SPHR), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England
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Kashaf MS, McGill E. Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review. Med Decis Making 2015; 35:1037-48. [DOI: 10.1177/0272989x15598529] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/22/2015] [Indexed: 11/15/2022]
Abstract
Background. The growing consensus espousing the use of shared decision making (SDM) in cancer treatment has coincided with the rise of health care evaluation paradigms that emphasize quality of life (QOL) as a central outcome measure. This review systematically examines the association between treatment SDM and QOL outcomes in cancer. Methods. A range of bibliographic databases and gray literature sources was searched. The search retrieved 16,726 records, which were screened by title, abstract, and full text to identify relevant studies. The review included 17 studies with a range of study designs and populations. Data were extracted on study methods, participants, setting, study or intervention description, outcomes, main findings, secondary findings, and limitations. Quality appraisal was used, in conjunction with a narrative approach, to synthesize the evidence. Results. The review found weak, but suggestive, evidence for a positive association between perceived patient involvement in decision making, a central dimension of SDM, and QOL outcomes in cancer. The review did not find evidence for an inverse association between SDM and QOL. The poor methodological quality and heterogeneity of the extant literature constrained the derived conclusions. In addition, the literature commonly treated various subscales of QOL instruments as separate outcomes, increasing the probability of spurious findings. Conclusions. There is weak evidence that aspects of shared decision-making approaches are positively associated with QOL outcomes and very little evidence of a negative association. The extant literature largely assessed patient involvement, only capturing one aspect of the shared decision-making construct, and is of poor quality, necessitating robust studies examining the association.
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Affiliation(s)
- Michael Saheb Kashaf
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
| | - Elizabeth McGill
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
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McGill E, Egan M, Petticrew M, Mountford L, Milton S, Whitehead M, Lock K. Trading quality for relevance: non-health decision-makers' use of evidence on the social determinants of health. BMJ Open 2015; 5:e007053. [PMID: 25838508 PMCID: PMC4390684 DOI: 10.1136/bmjopen-2014-007053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment. DESIGN A qualitative study using three focus groups. A thematic analysis was undertaken. SETTING The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada. PARTICIPANTS UK and international practitioners working in the design and management of the built environment at a local government level. RESULTS Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own. CONCLUSIONS Local-level built environment practitioners utilise evidence to make decisions, but their view of 'best evidence' appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Matt Egan
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Lesley Mountford
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
- Stoke-on-Trent City Council, Stoke-on-Trent, UK
| | - Sarah Milton
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, NIHR School for Public Health Research, Liverpool, UK
| | - Karen Lock
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
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McGill E, Kamyab A, Firman J. Low Crude Protein Corn and Soybean Meal Diets with Amino Acid Supplementation
for Broilers in the Starter Period 1. Effects of Feeding 15% Crude Protein. ACTA ACUST UNITED AC 2012. [DOI: 10.3923/ijps.2012.161.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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McGill J, McGill E, Kamyab A, Firman J. Effect of High Peroxide Value Fats on Performance of Broilers in an Immune Challenged State. ACTA ACUST UNITED AC 2011. [DOI: 10.3923/ijps.2011.665.669] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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McGill J, McGill E, Kamyab A, Firman J. Effect of High Peroxide Value Fats on Performance of Broilers in a Normal Immune State. ACTA ACUST UNITED AC 2011. [DOI: 10.3923/ijps.2011.241.246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chang TS, McGill E, Hay DA, Ross WH, Maberley AL, Sibley LM, Ma PE, Potter MJ. Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole. Br J Ophthalmol 1999; 83:944-8. [PMID: 10413699 PMCID: PMC1723162 DOI: 10.1136/bjo.83.8.944] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To review the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone. METHODS All patient charts and hospital records were examined for patients who underwent vitrectomy surgery for macular hole between September 1993 and June 1997. A total of 326 patients were identified and all were followed for a minimum of 6 months. Clinical records were examined for details of the surgical procedure, visual acuity, hole closure status, adjuvant therapies used, and postoperative retinal attachment status. Relative risks (the ratio of the incidence rate in the exposed to that in the unexposed) with 95% confidence intervals and chi(2) tests were calculated to determine which variables were associated with retinal detachment. The primary outcome measure in this review was retinal attachment status. RESULTS Of 326 eyes which underwent surgery for macular hole during the study period, scleral buckles were utilised in 152 (46.6%) patients. Analysis revealed a detachment rate of 13.2% in patients who did not receive a scleral buckle compared with 5.9% detachment rate in those who did. Analysis of these results indicated a 2.42 times greater risk of developing a retinal detachment in patients without a scleral buckle. Complications related to the use of scleral buckles occurred in two of 152 cases (1.3%) CONCLUSIONS A reduction in the rate of retinal detachment was noted in patients receiving prophylactic scleral buckles. Those finding suggest a possible beneficial effect of this adjunctive procedure in preventing postoperative retinal detachments. The authors are currently preparing a multicentred, prospective, clinical trial to further study this hypothesis
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Affiliation(s)
- T S Chang
- Division of Vitreo-Retinal Surgery, Department of Ophthalmology, University of British Columbia, Vancouver, Canada
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McGill E. Nutrition and diabetes. Nurs Times 1997; 93:suppl 1-6. [PMID: 9455302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
One of the advantages suggested for contact lens bifocals over monovision treatment of presbyopia is that there may be less impairment of binocular function. We evaluated nearpoint stereoposis on the Titmus stereotest for 10 presbyopic patients. Testing was done under five conditions; monovision and binocular correction with each of four marketed simultaneous bifocal contact lenses. Simultaneous vision bifocals tested produced at least as much reduction in stereopsis as monovision compared to baseline spectacle correction. Repeat testing of bifocal stereopsis with best near over-refraction suggested that a substantial portion of the stereo reduction could be attributed to insufficient effective adds with the bifocal contacts.
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Affiliation(s)
- E McGill
- Professional Products Division, Bausch & Lomb, Inc., Rochester, New York
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Grimm RH, Neaton JD, McDonald M, Case J, McGill E, Allen R, Bailey-Hoffman G, Kousch D, Childs J, Hulley SB. Beneficial effects from systematic dosage reduction of the diuretic, chlorthalidone: a randomized study within a clinical trial. Am Heart J 1985; 109:858-64. [PMID: 3885701 DOI: 10.1016/0002-8703(85)90651-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to determine the effects on blood pressure and selected biochemical measures of reducing the dosage of chlorthalidone from 100 mg to 50 mg. Within the larger study (Multiple Risk Factor Intervention Trial), 140 Special Intervention hypertensive men, taking 100 mg of chlorthalidone daily, were randomly assigned to either a continuation of 100 mg or a dosage reduction to 50 mg daily. Men were followed monthly for 4 months. Measures were made of blood pressure, serum potassium, serum uric acid, serum glucose, serum cholesterol, and triglycerides. Blood pressure change from baseline to 4 months revealed a significantly higher diastolic blood pressure in the group continued on the 100 mg dose compared to the dose reduction group. However, analysis of covariance, which took into account baseline differences in blood pressure, resulted in a nonsignificant difference in follow-up blood pressure (systolic and diastolic) between groups. Serum potassium increased significantly in the dose reduction group, especially in those participants taking supplemental potassium chloride. The results of this study demonstrate that a reduced dose of 50 mg chlorthalidone over the 4-month period was as effective as the 100 mg dose in long-term, well-controlled hypertensive men. Careful study of other antihypertensive agents is warranted to determine the drug dose that is maximally effective for blood pressure lowering and that also minimized toxic and adverse effects.
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Abstract
Chromostereopsis is a perceived depth difference between coplanar objects of different color and can be used for highly accurate measurement of interocular separation (PD). A survey of PD measurement with chromostereopsis and with the PD rule on 83 subjects shows that these methods on average result in the same PD, indicating that chromostereopsis is a valid technique for PD measurement. Repeated PD measures by these 83 individuals on the authors, using the PD rule and chromostereopsis, shows that the chromostereopsis result is far more repeatable than the PD rule. Suggestions are made for the use of the chromostereopsis technique in optometric practice.
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