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Böger S, van Bergen I, Beaudart C, Cheung KL, Hiligsmann M. Preference of young adults for COVID-19 vaccination in the United Kingdom: a discrete choice experiment. Expert Rev Pharmacoecon Outcomes Res 2023; 23:921-931. [PMID: 37294709 DOI: 10.1080/14737167.2023.2223983] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/17/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine preferences for COVID-19 vaccinations in the young adult population in the United Kingdom (UK). METHOD A discrete choice experiment survey was conducted in UK young adults. Participants were asked to choose between two hypothetical vaccines the one they preferred the most. Vaccines were defined by five attributes (effectiveness, risk of side effects, duration of protection, number of doses, confidence in available evidence), identified following a systematic literature review and qualitative interviews with 13 young adults. A random parameters logit model, a latent class model, and subgroup analyses were used to identify preferences. RESULTS One hundred and forty-nine respondents were included (70% women, mean age 23 years). All five attributes significantly influenced respondents' vaccination decisions. Respondents valued higher effectiveness, lower risk of side effects, longer protection duration, and a smaller number of doses. Based on the range of levels of each attribute, vaccine effectiveness was the most important attribute (relative importance 34%), followed by risk of side effects (32%), and duration of vaccine protection (22%). CONCLUSIONS The five investigated vaccine attributes appear to play an important role in young adults' decision-making process. Results of this study may help health authorities designing appropriate strategies in future vaccines campaigns in the younger UK population.
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Affiliation(s)
- Sophie Böger
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Ilja van Bergen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Charlotte Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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van Bergen I, Böger S, Beaudart C, Hiligsmann M, Cheung KL. Beliefs regarding COVID-19 vaccinations of young adults in the United Kingdom: An interview study applying the Integrated Change Model. PLoS One 2022; 17:e0277109. [PMID: 36472977 PMCID: PMC9725152 DOI: 10.1371/journal.pone.0277109] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Young adults are considered one of the most hesitant groups towards getting vaccinated in the UK, which threatens the success of the vaccination program in ending the pandemic. Identifying and understanding the socio-cognitive beliefs is important to effectively design and implement health communication interventions. Therefore, the aim of this study was to identify the underlying beliefs regarding COVID-19 vaccinations among young adults in the UK. METHODS The study consisted of online, one-on-one interviews with 18 individuals (6 males, 12 females) aged between 18 and 29 years, conducted in June 2021. The guiding theoretical framework was the I-Change Model. Interviews were recorded and transcribed verbatim. The transcripts were independently coded by two researchers by using the constructs of the I-Change Model. Belief statements were elicited from the codes and the frequency of belief statements was recorded and compared between intenders and non-intenders. RESULTS Similar beliefs were observed in intenders and non-intenders for most constructs of the I-Change Model. However, non-intenders distinguished themselves from intenders by their higher perceived risks of side effects and higher perceived disadvantages of being vaccinated. Non-intenders expressed the belief that the risk of unknown or long-term side effects, such as blood clotting and impact on fertility, were the main reason for them not to be willing to vaccinate. In addition, in both groups, participants had mostly similar beliefs as their friends and family. CONCLUSION This research provides insights in the specific beliefs of the young adult population of the UK regarding COVID-19 vaccinations, which could have implications for health communication interventions. The findings suggest that such interventions should focus on reducing the uncertainty regarding short- and long-term effects and potentially having a focus on the entire social environment of young adults.
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Affiliation(s)
- Ilja van Bergen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Sophie Böger
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Charlotte Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, United Kingdom
- * E-mail:
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Kruisbrink M, Crutzen R, Kempen GIJM, Delbaere K, Ambergen T, Cheung KL, Kendrick D, Iliffe S, Zijlstra GAR. Disentangling interventions to reduce fear of falling in community-dwelling older people: a systematic review and meta-analysis of intervention components. Disabil Rehabil 2022; 44:6247-6257. [PMID: 34511009 DOI: 10.1080/09638288.2021.1969452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Fear of falling (FoF) is a common and debilitating problem for older people. Most multicomponent interventions show only moderate effects. Exploring the effective components may help in the optimization of treatments for FoF. MATERIALS AND METHODS In a systematic review of five scientific literature databases, we identified randomized controlled trials with older community-dwelling people that included FoF as an outcome. There was no restriction on types of interventions. Two reviewers extracted information about outcomes and content of interventions. Intervention content was coded with a coding scheme of 68 intervention components. We compared all studies with a component to those without using univariate meta-regressions. RESULTS Sixty-six studies, reporting on 85 interventions, were included in the systematic review. In the meta-regressions (n = 49), few components were associated with intervention effects at the first available follow up after the intervention, but interventions with meditation, holistic exercises (such as Tai Chi or Pilates) or body awareness were significantly more effective than interventions without these components. Interventions with self-monitoring, balance exercises, or tailoring were less effective compared to those without these components. CONCLUSIONS The identified components may be important for the design and optimization of treatments to reduce FoF. Implications for rehabilitationFear of falling (FoF) is a common and debilitating issue among older people and multicomponent interventions usually show only small to moderate effects on FoF.This review and meta-analysis investigated 68 intervention components and their relation to intervention effects on FoF.Interventions with meditation, holistic exercises (such as Tai Chi), or body awareness are more effective than interventions without these components.Clinicians aiming to reduce FoF may recommend selected interventions to older people taking into account the current knowledge of intervention components.
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Affiliation(s)
- Marlot Kruisbrink
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kim Delbaere
- School of Public Health and Community Medicine, Neuroscience Research Australia, UNSW, Randwick, Australia
| | - Ton Ambergen
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Jakovljevic M, Tan CJ, Chaiyakunapruk N, Silva Julian G, Cheung KL, Hiligsmann M, Godman B, Opanga S, Scuffham PA, Gregg M. Global article collection: essential reads from around the world. J Med Econ 2022; 25:864-869. [PMID: 35678118 DOI: 10.1080/13696998.2022.2087960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
- Department Global Health Economics & Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
| | - Chia Jie Tan
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | | | - Kei Long Cheung
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michael Gregg
- Executive Editor, Journal of Medical Economics, Taylor & Francis, London, UK
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Morgan JL, Shrestha A, Reed MWR, Herbert E, Bradburn M, Walters SJ, Martin C, Collins K, Ward S, Holmes G, Burton M, Lifford K, Edwards A, Ring A, Robinson T, Chater T, Pemberton K, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Thomson AM, Gosney M, Hatton M, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeschwar R, Wyld L. Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes. Br J Surg 2021; 108:315-325. [PMID: 33760065 PMCID: PMC10364859 DOI: 10.1093/bjs/znaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. METHODS This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage. RESULTS The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains. CONCLUSION Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
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Affiliation(s)
- J L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - E Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - K Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - M Burton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Ring
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - T Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - R Audisio
- Department of Surgery, University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Brighton, UK
| | - A M Thomson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - M Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - M Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - T Green
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - D Revill
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - J Gath
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Department of Breast Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - J Naik
- Department of General Surgery, Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeschwar
- Department of Breast Surgery, University Hospitals of Morecambe Bay, Lancaster, UK
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Parks RM, Green AR, Cheung KL. O14 Optimising the management of primary breast cancer in older women. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.019] [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: 11/14/2022]
Abstract
Abstract
Introduction
The risk of breast cancer increases with age and our global population is ageing. By 2040 the number of breast cancer cases diagnosed per year worldwide will double and over 40% of these will be in patients aged 70 or over. Despite this, there are few treatment guidelines specific to breast cancer in older women and none which consider the unique biological differences of this cohort.
Method
Surgical and core needle biopsy (CNB) specimens were obtained from an existing series of 1,785 women over the age of 70 with primary breast cancer, treated in a single institution with long-term (37+ years) follow-up. Of this cohort, 813 had primary surgical treatment. As part of previous work, it was possible to construct good quality tissue microarrays (TMAs) in 575 surgical specimens and 693 CNB specimens. Immunohistochemical staining for 32 biomarkers has been performed in all of the available TMAs. Association between histological score for each biomarker and tumour size, grade, recurrence rate, breast cancer specific and overall survival is currently being investigated in the whole cohort.
Results
Results to date have revealed a unique biological cluster in older women with primary breast cancer that is not seen in a comparative younger cohort. In the future, bioinformatics analysis will determine which biomarkers and in what combination, can predict chance of recurrence/overall survival in this cohort.
Conclusions
This information will be used to create a prognostic tool specific to assist older women with decision making regarding primary treatment of breast cancer.
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Affiliation(s)
- R M Parks
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - A R Green
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Parks RM, Alfarsi LH, Green AR, Cheung KL. Biology of primary breast cancer in older women beyond routine biomarkers. Breast Cancer 2021; 28:991-1001. [PMID: 34165702 PMCID: PMC8354915 DOI: 10.1007/s12282-021-01266-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/13/2021] [Indexed: 11/15/2022]
Abstract
Purpose There are numerous biomarkers which may have potential predictive and prognostic significance in breast cancer. This is extremely important in older adults, who may opt for less aggressive therapy. This work outlines the literature on biological assessment outside of standard biomarkers (defined as ER, PgR, HER2, Ki67) in women ≥ 65 years with primary operable invasive breast cancer, to determine which additional biomarkers are relevant to outcome in older women. Methods Medline and Embase databases were searched. Studies were eligible if included ≥ 50 patients aged ≥ 65 years; stratified results by age; measured a biomarker outside of standard assay and reported patient data. Results A total of 12 studies were appraised involving 5000 patients, measuring 28 biomarkers. The studies were extremely varied in methodology and outcome but three themes emerged: 1. Differences in biomarker expression between younger and older women, indicating that breast cancer in older women is generally less aggressive compared to younger women; 2. Relationship of biomarker expression with survival, suggesting biomarkers which may exclusively predict response to primary treatment in older women; 3. Association of biomarker with chemotherapy, suggesting that older patients should not be declined chemotherapy based on age alone. Conclusion There is evidence to support further investigation of B-cell lymphoma (BCL2), liver kinase (LK)B1, epidermal growth factor receptor (EGFR), cytoplasmic cyclin-E, mucin (MUC)1 and cytokeratins (CKs) as potential predictive or prognostic markers in older women with breast cancer undergoing surgery. Studies exploring these biomarkers in larger cohorts and in women undergoing non-operative therapies are required. Supplementary Information The online version contains supplementary material available at 10.1007/s12282-021-01266-5.
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Affiliation(s)
- R M Parks
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | - L H Alfarsi
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | - A R Green
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK.
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Kafadar AH, Barrett C, Cheung KL. Knowledge and perceptions of Alzheimer's disease in three ethnic groups of younger adults in the United Kingdom. BMC Public Health 2021; 21:1124. [PMID: 34118921 PMCID: PMC8196265 DOI: 10.1186/s12889-021-11231-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a global public health problem with an ageing population. Knowledge is essential to promote early awareness, diagnosis and treatment of AD symptoms. AD knowledge is influenced by many cultural factors including cultural beliefs, attitudes and language barriers. This study aims: (1) to define AD knowledge level and perceptions amongst adults between 18 and 49 years of age in the UK; (2) to compare knowledge and perceptions of AD among three main ethnic groups (Asian, Blacks, and Whites); and (3) to assess potential associations of age, gender, education level, affinity with older people (65 or over), family history and caregiving history with AD knowledge. METHODS Data was collected from 186 participants as a convenience sample of younger adults of three different ethnicities (16.1% Asian, 16.7% Black, 67.2% White), living in the UK, recruited via an online research platform. The majority of the participants were in the 18-34 years age group (87.6%). Demographic characteristics of participants and AD knowledge correlation were assessed by the 30-item Alzheimer's Disease Knowledge Scale (ADKS), comprising 7 content domains. ANOVA/ANCOVA were used to assess differences in AD knowledge by ethnicity, gender, education level, age and affinity with dementia and Alzheimer's patients. RESULTS For AD general knowledge across all respondents only 45.0% answers were correct. No significant differences were found for the total ADKS score between ethnicities in this younger age group, who did not differ in education level. However, there were significant knowledge differences for the ADKS symptom domain score even after controlling for other demographics variables such as gender, education level (p = 0.005). White respondents were more likely to know about AD symptoms than their Black counterparts (p = 0.026). CONCLUSION The study's findings suggest that the AD knowledge level is not adequate for all ethnic groups. Meanwhile, significant differences were observed in symptoms, between ethnic groups, and therefore, differ in their needs regards health communication. The study contributes to an understanding of ethnicity differences in AD knowledge amongst adults from 18 to 49 years of age in the UK and may also provide input into an intervention plan for different ethnicities' information needs.
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Affiliation(s)
| | - Christine Barrett
- Department of Health Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - Kei Long Cheung
- Department of Health Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
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Harrison CA, Parks RM, Cheung KL. The impact of breast cancer surgery on functional status in older women - A systematic review of the literature. Eur J Surg Oncol 2021; 47:1891-1899. [PMID: 33875285 DOI: 10.1016/j.ejso.2021.04.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022] Open
Abstract
Primary endocrine therapy as treatment of breast cancer is only recommended in older women with limited life expectancy. However, many older women opt for endocrine therapy due to concerns regarding frailty and potential decline in function after surgery. A decline in functional status after surgery is documented in some cancer types, such as colorectal, however, the full impact of breast cancer surgery is less understood. A systematic review was performed to examine the evidence for impact of breast cancer surgery on functional status in older women. PubMed and Embase databases were searched. Studies were eligible if performed within the last 10 years; included patients over the age of 65 years undergoing breast cancer surgery; included stratification of results by age; measured functional status pre-operatively and at least six months following surgery. A total of 11 studies including 12 030 women were appraised. Two studies represented level-II and nine level-IV evidence. Overall, physical activity level was negatively impacted by breast cancer surgery and this was compounded by the extent of surgery. Evidence for impact of breast cancer surgery on quality of life, fatigue and cognition, was conflicting. The possibility of decline in functional status after breast cancer surgery should be discussed in all older women considering surgery. A structured exercise program may improve the negative effects of surgery on physical activity. Further work is required in the areas of quality of life, fatigability and cognition.
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Affiliation(s)
- C A Harrison
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK
| | - R M Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK.
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Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Barrett C, Cheung KL. Knowledge, socio-cognitive perceptions and the practice of hand hygiene and social distancing during the COVID-19 pandemic: a cross-sectional study of UK university students. BMC Public Health 2021; 21:426. [PMID: 33648486 PMCID: PMC7919985 DOI: 10.1186/s12889-021-10461-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 08/11/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, social distancing and hand hygiene have been the primary means of reducing transmission in the absence of effective treatments or vaccines, but understanding of their determinants is limited. This study aimed to investigate knowledge and socio-cognitive perceptions, and their associations with such protective behaviours, in UK university students. METHODS A cross-sectional online survey of 293 students was undertaken on 13 May 2020. Survey questions addressed demographics, knowledge of the disease and effectiveness of the protective measures, risk perception, socio-cognitive perceptions (e.g. attitude, social support, and self-efficacy), habit, time factors and trust, as well as the hand hygiene and social distancing behaviours. Multiple linear regression was used to identify the strongest associations of potential determinants with behaviour. RESULTS Participants reported high levels of social distancing with 88.9% answering "Mostly" or "Always" for every activity, but only 42.0% reporting the same for all hand hygiene activities. Knowledge of the effectiveness of each activity in preventing transmission was high, with 90.7% and 93.5% respectively identifying at least 7 of 8 hand hygiene or 9 of 10 social distancing activities correctly. Habit (β = 0.39, p = 0.001) and time factors (β = 0.28, p = 0.001) were the greatest contributors to unique variance in hand hygiene behaviour, followed by ethnicity (β = - 0.13, p = 0.014) and risk perception (β = 0.13, p = 0.016). For social distancing behaviour, the determinants were self-efficacy (β = 0.25, p < 0.001), perceived advantages (β = 0.15, p = 0.022), trust in policy (β = 0.14, p = 0.026) and gender (β = - 0.14, p = 0.016). Regression models explained 40% hand hygiene and 25% social distancing variance. CONCLUSIONS This study indicated that communications about effectiveness of hand hygiene and social distancing behaviours had been effective in terms of knowledge acquisition. However, in the light of likely second waves of COVID-19, attention to maintaining social distancing behaviour and improving hand hygiene behaviour may need to address more difficult areas of changing habits, overcoming time factors and building trust, as well as interventions to increase self-efficacy and address risk perception concerns.
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Affiliation(s)
- Christine Barrett
- Department of Health Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Kei Long Cheung
- Department of Health Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
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12
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Wranik WD, Székely RR, Mayer S, Hiligsmann M, Cheung KL. The most important facilitators and barriers to the use of Health Technology Assessment in Canada: a best-worst scaling approach. J Med Econ 2021; 24:846-856. [PMID: 34162282 DOI: 10.1080/13696998.2021.1946326] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Health Technology Assessment (HTA), which can support public drug reimbursement decisions will play a core function in the planned national Pharmacare program in Canada. To address existing barriers to the use of HTA, these must be ranked in order of priority. The goal of this study was to access the relative importance of known facilitators and barriers to the use of HTA in the context of the Canadian health care system, with attention to differences between regions and stakeholder groups. METHODS We used the best-worst scaling object case approach to elicit a quantitative ranking of a list of 20 facilitators and 22 barriers. A sample of 68 Canadian HTA stakeholders, including members of expert committees, decision/policymakers, researchers/academics, and others participated in the study. Their task was to identify the most important and the least important item in 12 sub-sets of five facilitators and 14 sub-sets of five barriers. FINDINGS Relative Importance Scores derived via hierarchical Bayes analysis revealed relations, engagement, and contact between stakeholders as most important on both the barrier and facilitator sides. Other top-ranked facilitators included the availably of credible and relevant research. Other top-ranked barriers included inconsistencies in the evidence and limited generalizability. The availability of HTA guidelines did not rank highly on either side. The main limitation of the study was the challenge with reaching the relevant respondents; this was mitigated by involving the national HTA agency in the research. CONCLUSION Canadian stakeholders consider the relationships within the HTA network among the most important. Policies should focus on strengthening these relationships. Future research should focus on the connectivity and distribution of knowledge and power within the HTA network.
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Affiliation(s)
- Wiesława Dominika Wranik
- Faculty of Management, School of Public Administration, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
- Jean Monnet European Union Centre of Excellence, Dalhousie University, Halifax, Canada
| | - Ronaldo-Raul Székely
- Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Mickaël Hiligsmann
- Faculty of Health Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health and Life Sciences, Brunel University London, London, UK
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13
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Cheung KL, Hors-Fraile S, de Vries H. How to use the Integrated-Change Model to design digital health programs. Digit Health 2021. [DOI: 10.1016/b978-0-12-820077-3.00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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de Vries H, Vahl J, Muris J, Evers S, van der Horst H, Cheung KL. Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts. Health Policy 2020; 125:27-33. [PMID: 33189409 DOI: 10.1016/j.healthpol.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 2006 a major healthcare reform was introduced in the Netherlands, implying managed competition. This study explored the level of consensus on the outcomes and desired changes of this new system, and differences between stakeholder groups. METHODS A three-round Delphi-study was conducted among Dutch healthcare insurers, health economists, and professionals in general practice (GP) care and mental health (MH) care. In the first round, 20 experts indicated the most important advantages and disadvantages of the Dutch managed competition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated the importance of the 88 factors identified in the first round. RESULTS Only healthcare insurers reached consensus on important advantages (i.e. improved efficiency; room for choice). Health economists reached almost no consensus on any factors. GP and MH-care professionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy) and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care of complex patients); half of them suggested abolishment of managed competition. CONCLUSION GP and MH-care professionals were most dissatisfied and suggested several changes or even abolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfaction among health care professionals indicates that there is room for improvement, preferably developed in conjunction with stakeholders.
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Affiliation(s)
- Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands.
| | - Jos Vahl
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Jean Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Henriëtte van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Free University Amsterdam, the Netherlands
| | - Kei Long Cheung
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health and Life Sciences, Brunel University London, United Kingdom
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15
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Affiliation(s)
- Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
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16
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Goossens AJM, Cheung KL, Sijstermans E, Conde R, Gonzalez JGR, Hiligsmann M. A discrete choice experiment to assess patients' preferences for HIV treatment in the rural population in Colombia. J Med Econ 2020; 23:803-811. [PMID: 32098539 DOI: 10.1080/13696998.2020.1735398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 10/24/2022]
Abstract
Aim: To elicit patients' preferences for HIV treatment of the rural population in Colombia.Methods: A discrete choice experiment (DCE), conducted in a HIV clinic in Bogotá, was used to examine the trade-off between five HIV treatment attributes: effect on life expectancy, effect on physical activity, risk of moderate side-effects, accessibility to clinic, and economic costs to access controls. Attributes selection was based on literature review, expert consultation and a focus group with six patients. An efficient experimental design was used to define two versions of the questionnaire with each of 12 choice sets and a dominance task was added to check reliability. A mixed logit model was then used to analyse the data and sub-group analyses were conducted on the basis of age, gender, education, and sexual preference.Results: A total of 129 HIV patients were included for analysis. For all treatment attributes, significant differences between at least two levels were observed, meaning that all attributes were significant predictors of choice. Patients valued the effect on physical activity (conditional relative importance of 27.5%) and the effect on life expectancy (26.0%) the most. Sub-group analyses regard age and education showed significant differences: younger patients and high educated patients valued the effect on physical activity the most important, whereas older patients mostly valued the effect on life expectancy and low educated patients mostly valued the accessibility to clinic.Limitations: One potential limitation is selection bias, as only patients from one HIV clinic were reached. Additionally, questionnaires were partly administered in the waiting rooms, which potentially led to noise in the data.Conclusions: This study suggests that all HIV treatment characteristics included in this DCE were important and that HIV patients from rural Colombia valued short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) the most.
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Affiliation(s)
- Anne J M Goossens
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Eric Sijstermans
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rafael Conde
- Centro de Investigación Clínica ACISC, Asistencia Científica de Alta Complejida, Bogota, Colombia
| | - Javier G R Gonzalez
- Rosario Graduate School of Business, School of Business, Administración en Salud, Universidad del Rosario, Bogotá, Colombia
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Sijstermans E, Cheung KL, Goossens AJM, Conde R, Gonzalez JGR, Hiligsmann M. A discrete choice experiment to assess patients' preferences for HIV treatment in the urban population in Colombia. J Med Econ 2020; 23:812-818. [PMID: 32098614 DOI: 10.1080/13696998.2020.1735399] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 01/08/2023]
Abstract
Aim: This study aimed to assess patients' preferences for HIV treatment in an urban Colombian population.Methods: A Discrete Choice Experiment (DCE) was conducted. Urban Colombian HIV patients were asked to repetitively choose between two hypothetical treatments that differ in regard to five attributes 'effect on life expectancy', 'effect on physical activity', 'risk of moderate side effects, 'accessibility to clinic' and 'economic cost to access controls'. Twelve choice sets were made using an efficient design. A Mixed Logit Panel Model was used for the analysis and subgroup analyses were performed according to age, gender, education level and sexual preference.Results: A total of 224 HIV patients were included. All attributes were significant, indicating that there were differences between at least two levels of each attribute. Patients preferred to be able to perform all physical activity without difficulty, to have large positive effects on life expectancy, to travel less than 2 h, to have lower risk of side-effects and to have subsidized travel costs. The attributes 'effect on physical activity' and 'effects on life expectancy' were deemed the most important. Sub-analyses showed that higher educated patients placed more importance on the large positive effects of HIV treatment, and a more negative preference for subsidized travel cost (5% level).Limitations: A potential limitation is selection bias as it is difficult to make a systematic urban/rural division of respondents. Additional, questionnaires were partly administered in the waiting rooms, which potentially led to some noise in the data.Conclusions: Findings suggests that short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) are the most important treatment characteristics for HIV urban patients in Colombia. Preference data could provide relevant information for clinical and policy decision-making to optimize HIV care.
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Affiliation(s)
- Eric Sijstermans
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Anne J M Goossens
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rafael Conde
- Centro de Investigación Clínica ACISC, Asistencia Científica de Alta Complejida, Bogota, Colombia
| | - Javier G R Gonzalez
- Rosario Graduate School of Business, School of Business, Administración en Salud, Universidad del Rosario, Bogotá, Colombia
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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van Het Schip C, Cheung KL, Vluggen S, Hoving C, Schaper NC, de Vries H. Spoken Animated Self-Management Video Messages Aimed at Improving Physical Activity in People With Type 2 Diabetes: Development and Interview Study. J Med Internet Res 2020; 22:e15397. [PMID: 32324138 PMCID: PMC7206523 DOI: 10.2196/15397] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background Web-based tailored interventions are a promising approach to help people with type 2 diabetes successfully adopt regular physical activity. Spoken animation seems to be effective regardless of the characteristics of the user and may be a relevant strategy to communicate complex health information Objective The objectives of our study were to evaluate (1) pretesting communication elements and user appreciation, and (2) the applied behavior change techniques of the previously designed spoken animated video messages in a tailored self-management program for people with type 2 diabetes. Methods We conducted semistructured interviews with patients with type 2 diabetes recruited from general practices located in different socioeconomic status urban neighborhoods. Based on the pretesting key communication elements of Salazar’s model, we asked participants about the spoken animated video messages’ attractiveness, comprehensibility, acceptance, believability, involvement, and relevance and to what extent the video messages motivated them to become more physically active. We also assessed participants’ intention to use the spoken animated video messages and to recommend them to others. To evaluate participants’ appreciation of the different applied behavior change techniques, we conducted a post hoc analysis of the qualitative data using the MAXQDA program. Transcripts were coded by 2 coders using iterative qualitative content analysis methods to uncover key health communication issues. Results Of 23 patients who expressed an interest in participating, 17 met the inclusion criteria and 15 took part in the interviews. The positive appreciation of the comprehensibility, believability, and personalization was supported by participants’ statements on behavior change techniques and other communication elements. Reinforcement of and feedback on participants’ answers were positively evaluated as was the simplicity and concreteness of the spoken animated video messages. Most participants indicated reasons for not feeling motivated to increase their physical activity level, including being already sufficiently physically active and the presence of other impeding health factors. Conclusions Spoken animated video messages should be simple, short, concrete, and without the use of medical terminology. Providing positive reinforcement, feedback on participants’ answers, examples that match user characteristics, and the possibility to identify with the animation figures will enhance involvement in the health message. To connect more with patients’ needs and thereby increase the perceived relevance of and motivation to use an animated video program, we suggest offering the program soon after diabetes mellitus is diagnosed. We recommend piloting behavior change techniques to identify potential resistance.
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Affiliation(s)
- Colette van Het Schip
- Department of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Stan Vluggen
- Caphri School of Public Health and Primary Care, Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- Caphri School of Public Health and Primary Care, Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Nicolaas C Schaper
- Department of Endocrinology and Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Hein de Vries
- Caphri School of Public Health and Primary Care, Health Promotion, Maastricht University, Maastricht, Netherlands
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Dunleavy G, Bajpai R, Comiran Tonon A, Chua AP, Cheung KL, Soh CK, Christopoulos G, de Vries H, Car J. Examining the Factor Structure of the Pittsburgh Sleep Quality Index in a Multi-Ethnic Working Population in Singapore. Int J Environ Res Public Health 2019; 16:E4590. [PMID: 31756941 PMCID: PMC6926964 DOI: 10.3390/ijerph16234590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure for assessing sleep impairment. Although it was developed as a unidimensional instrument, there is much debate that it contains multidimensional latent constructs. This study aims to investigate the dimensionality of the underlying factor structure of the PSQI in a multi-ethnic working population in Singapore. The PSQI was administered on three occasions (baseline, 3 months and 12 months) to full-time employees participating in a workplace cohort study. Exploratory factor analysis (EFA) investigated the latent factor structure of the scale at each timepoint. Confirmatory factor analysis (CFA) evaluated the model identified by EFA, and additionally evaluated it against a single factor and a three-factor model. The EFA identified a two-factor model with similar internal consistency and goodness-of-fit across each timepoint. In the CFA, the two- and three-factor models were both superior to the unidimensional model. The two- and three-factor models of the PSQI were reliable, consistent and provided similar goodness-of-fit over time, and both models were superior to the unidimensional measure. We recommend using the two-factor model to assess sleep characteristics in working populations in Singapore, given that it performs as well as the three-factor model and is simpler compared to the latter.
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Affiliation(s)
- Gerard Dunleavy
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore 308232, Singapore; (R.B.); (J.C.)
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6022 MD Maastricht, The Netherlands;
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore 308232, Singapore; (R.B.); (J.C.)
- Research Institute for Primary Care and Health Sciences, Keele University, David Weatherall Building, Staffordshire ST5 5BG, UK
| | - André Comiran Tonon
- Laboratório de Cronobiologia e Sono, Porto Alegre Clínicas Hospital (HCPA), R. Ramiro Barcelos, 2350—Santa Cecilia, Porto Alegre 90035-007, RS, Brazil;
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande Do Sul (UFRGS), Av. Paulo Gama, 110—Farroupilha, Porto Alegre 90040-060, RS, Brazil
| | - Ai Ping Chua
- Department of Medicine, Jurong Health Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore;
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex, London UB8 3PH, UK;
| | - Chee-Kiong Soh
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, 50 Nanyang Avenue, Singapore 639798, Singapore;
| | - Georgios Christopoulos
- Division of Leadership, Management and Organisation, Nanyang Business School, College of Business, Nanyang Technological University Singapore, 50 Nanyang Avenue, Singapore 639798, Singapore;
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6022 MD Maastricht, The Netherlands;
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore 308232, Singapore; (R.B.); (J.C.)
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London SW7 2AZ, UK
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20
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Dunleavy G, Sathish T, Nazeha N, Soljak M, Visvalingam N, Bajpai R, Yap HS, Roberts AC, Thach TQ, Tonon AC, Soh CK, Christopoulos G, Cheung KL, de Vries H, Car J. Health Effects of Underground Workspaces cohort: study design and baseline characteristics. Epidemiol Health 2019; 41:e2019025. [PMID: 31623427 PMCID: PMC6815877 DOI: 10.4178/epih.e2019025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
The development of underground workspaces is a strategic effort towards healthy urban growth in cities with ever-increasing land scarcity. Despite the growth in underground workspaces, there is limited information regarding the impact of this environment on workers' health. The Health Effects of Underground Workspaces (HEUW) study is a cohort study that was set up to examine the health effects of working in underground workspaces. In this paper, we describe the rationale for the study, study design, data collection, and baseline characteristics of participants. The HEUW study recruited 464 participants at baseline, of whom 424 (91.4%) were followed-up at 3 months and 334 (72.0%) at 12 months from baseline. We used standardized and validated questionnaires to collect information on socio-demographic and lifestyle characteristics, medical history, family history of chronic diseases, sleep quality, health-related quality of life, chronotype, psychological distress, occupational factors, and comfort levels with indoor environmental quality parameters. Clinical and anthropometric parameters including blood pressure, spirometry, height, weight, and waist and hip circumference were also measured. Biochemical tests of participants' blood and urine samples were conducted to measure levels of glucose, lipids, and melatonin. We also conducted objective measurements of individuals' workplace environment, assessing air quality, light intensity, temperature, thermal comfort, and bacterial and fungal counts. The findings this study will help to identify modifiable lifestyle and environmental parameters that are negatively affecting workers' health. The findings may be used to guide the development of more health-promoting workspaces that attempt to negate any potential deleterious health effects from working in underground workspaces.
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Affiliation(s)
- Gerard Dunleavy
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Thirunavukkarasu Sathish
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Nuraini Nazeha
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Michael Soljak
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Nanthini Visvalingam
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Research institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Hui Shan Yap
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Adam C. Roberts
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Thuan Quoc Thach
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - André Comiran Tonon
- Laboratório de Cronobiologia e Sono, Porto Alegre Clínicas Hospital (HCPA), Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Chee Kiong Soh
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Georgios Christopoulos
- Division of Leadership, Management and Organisation, Nanyang Business School, College of Business, Nanyang Technological University Singapore, Singapore, Singapore
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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21
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Mohammed M, Cheung KL, Winkens B, de Vries N, de Vries H. Factors associated with smoking initiation among Saudi male adolescents: A longitudinal study. Tob Prev Cessat 2019; 5:21. [PMID: 32411884 PMCID: PMC7205146 DOI: 10.18332/tpc/109167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/18/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Knowing country-specific predictors of smoking behaviour for adolescents is crucial for successful smoking prevention programs. This study aims to assess demographic and socio-cognitive variables related to smoking initiation among Saudi male adolescents. METHODS Longitudinal data were collected at T1 (baseline) and at T2 (followup at 6 months) using a self-administered questionnaire. We assessed smoking behaviour and related demographic variables and socio-cognitive variables. Chi-squared tests and independent-samples t-tests were used to identify differences in baseline characteristics between smokers and non-smokers at T1. Furthermore, non-smokers at T1 were included in logistic regression analyses to examine the predictors of smoking initiation between T1 and T2. RESULTS At T1, the non-smokers who were included in further analysis were 523 (84.9%) of whom 48 (9.2%) had initiated smoking at T2. They differed significantly from non-initiators, including having a more positive attitude towards smoking, reporting more social norms, modelling and pressure to smoke, having a lower self-efficacy to refrain from smoking and higher intention to smoke in the future (all p<0.001). The regression analysis revealed that: adolescents with disrupted-families, being of low academic achievement, with relatively high monthly-income families, having more smoking-peers, high-perceived pressure to smoke from parents (p=0.002) and teachers (p=0.001), have smoking supportive-norms of parents and having high intention to smoke in the future (p<0.001) were at higher risk of being smokers. CONCLUSIONS Findings suggest that health-promoting programs should address strengthening of self-efficacy and enhancing refusal skills against modelling of peers, pressure and norms of parents.
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Affiliation(s)
- Mutaz Mohammed
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht, Netherlands
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, United Kingdom
| | - Bjorn Winkens
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht, Netherlands
| | - Nanne de Vries
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht, Netherlands
| | - Hein de Vries
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht, Netherlands
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22
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Abstract
Aims: Different methods have been used to analyze "object case" best-worst scaling (BWS). This study aims to compare the most common statistical analysis methods for object case BWS (i.e. the count analysis, multinomial logit, mixed logit, latent class analysis, and hierarchical Bayes estimation) and to analyze their potential advantages and limitations based on an applied example. Methods: Data were analyzed using the five analysis methods. Ranking results were compared among the methods, and methods that take respondent heterogeneity into account were presented specifically. A BWS object case survey with 22 factors was used as a case study, tested among 136 policy-makers and HTA experts from the Netherlands, Germany, France, and the UK to assess the most important barriers to HTA usage. Results: Overall, the five statistical methods yielded similar rankings, particularly in the extreme ends. Latent class analysis identified five clusters and the mixed logit model revealed significant preference heterogeneity for all, with the exception of three factors. Limitations: The variety of software used to analyze BWS data may affect the results. Moreover, this study focuses solely on the comparison of different analysis methods for the BWS object case. Conclusions: The most common statistical methods provide similar rankings of the factors. Therefore, for main preference elicitation, count analysis may be considered as a valid and simple first-choice approach. However, the latent class and mixed logit models reveal additional information: identifying latent segments and/or recognizing respondent heterogeneity.
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Affiliation(s)
- Kei Long Cheung
- a Department of Health Services Research , Care and Public Health Research Institute (CAPHRI), Maastricht University , The Netherlands
- b Department of Health Promotion , Care and Public Health Research Institute (CAPHRI), Maastricht University , The Netherlands
- c Department of Health Economics , Center for Public Health, Medical University of Vienna , Austria
| | - Susanne Mayer
- c Department of Health Economics , Center for Public Health, Medical University of Vienna , Austria
| | - Judit Simon
- c Department of Health Economics , Center for Public Health, Medical University of Vienna , Austria
- d Ludwig Boltzmann Institute Applied Diagnostics , Vienna , Austria
| | - Hein de Vries
- b Department of Health Promotion , Care and Public Health Research Institute (CAPHRI), Maastricht University , The Netherlands
| | - Silvia M A A Evers
- a Department of Health Services Research , Care and Public Health Research Institute (CAPHRI), Maastricht University , The Netherlands
- e Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Centre for Economic Evaluation Utrecht , The Netherlands
| | - Ingrid E H Kremer
- a Department of Health Services Research , Care and Public Health Research Institute (CAPHRI), Maastricht University , The Netherlands
| | - Mickaël Hiligsmann
- a Department of Health Services Research , Care and Public Health Research Institute (CAPHRI), Maastricht University , The Netherlands
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23
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Kalaitzi S, Cheung KL, Hiligsmann M, Babich S, Czabanowska K. Exploring Women Healthcare Leaders' Perceptions on Barriers to Leadership in Greek Context. Front Public Health 2019; 7:68. [PMID: 31024874 PMCID: PMC6465948 DOI: 10.3389/fpubh.2019.00068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/14/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Gender inequalities have been identified as important derailment factors for health workforce and health system sustainability. Literature holds responsible a list of gendered barriers faced by female health workforce. However, there is a gap in the evidence based research on women leaders' own perceptions of barriers to leading positions advancement. This study aims to explore leadership barriers perceived by women healthcare leaders within country's context; research focused on Greece due to country's poor performance on gender equality index and current economic turbulence. Study supplements survey data and provides orientation for further gender sensitive research in health workforce development through country's specificity lens to better inform education and policy makers. Methods: The best-worst object case survey method was used, applying an online questionnaire designed in Qualtrics. The online questionnaire was sent to 30 purposively invited participants. Respondents were asked to tick the most and the least important barriers to women's leadership in provided choice scenarios. Descriptive data analysis was used to understand and interpret the results. Results: Women leaders perceived stereotypes, work/life balance, lack of equal career advancement, lack of confidence, gender gap and gender bias to be the barriers with the greatest relative importance in constraining opportunities for pursuing leading positions in Greek healthcare setting. Twenty more barriers were identified and ranked lower in relative importance. The results are considered exploratory and not to obtain population based outcomes. Conclusion: This exploratory study reports the perceived barriers of women leaders in pursuing leading positions within Greek healthcare context. The findings point mainly to organizational and socio-cultural related barriers potentially aggravated by country's unfortunate current economic turbulence. Further extensive research is required to establish grounded conclusions and better inform education and policy makers in developing gender sensitive strategies to sustainable health workforce development.
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Affiliation(s)
- Stavroula Kalaitzi
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - K L Cheung
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, United Kingdom
| | - M Hiligsmann
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - S Babich
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - K Czabanowska
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Health Policy and Management, Faculty of Health Sciences, Institute of Public Health, Jagellonian University, Kraków, Poland
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24
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Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Abstract P2-12-01: Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-12-01] [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: 11/16/2022]
Abstract
Abstract
Background: Capivasertib (AZD5363), an AKT1,2,3 inhibitor, significantly improved progression-free and overall survival when added to paclitaxel in triple negative breast cancer (BC) patients (Schmid et al. ASCO 2018). We have previously reported in STAKT, robust target inhibition at 480mg BD versus placebo, including significant decreases in the primary biomarkers (PBs) - Ki67, pPRAS40 & pGSK3β - in primary BCs (Robertson et al. SABCS 2017). We now report the dose- and exposure-response relationship of capivasertib and the correlation between primary and secondary (pAKT, pS6, nuclear FOXO3a) tumor biomarkers.
Design: STAKT was a two-stage, double blind, randomized, placebo controlled 'window-of-opportunity' trial in newly diagnosed ER+ BC patients. Stage 1 assessed capivasertib at a dose of 480mg BD p.o. versus placebo. Stage 2 assessed capivasertib at two lower doses 360mg and 240mg BD. Tumor biopsies were taken prior to 1st dose and after 4.5 days of dosing. Evaluable patients (who required pre-defined minimum baseline PD values for PBs) included placebo (n=11), capivasertib at 480mg (n=17), 360mg (n=5) and 240mg (n=6). Blood samples for pharmacokinetic (PK) studies were scheduled at pre-dose; 2, 4, optional 6 & 8 hrs post first dose on Day 1; ˜2-4 h post last dose on Day 5 (before biopsy). The % change from baseline for PBs were evaluated against the following exposure variables (placebo=0): i) Dose, ii) Observed Cmax Day 1 (˜2h post-dose), iii) Observed plasma concentration on Day 5, iv) Model-predicted plasma concentration Day 5 at time of biopsy, and v) Model-predicted AUC on Day 5. Spearman correlation coefficient measured the strength and direction of association between biomarkers.
Results:
· Significant mean reductions in % change from baseline were observed for the PBs pGSK3β (-39%; p<0.006), pPRAS40 (-50%; p<0.0001) and Ki67 (-23%; p=0.052) at 480mg versus placebo. At 360mg and 240mg, mean % changes from baseline in pGSK3β were -27% and -9%, respectively; in pPRAS40 -45% and -28%, respectively; and in Ki67 0% and +22%, respectively.
· Dose-response relationships for individual % change from baseline could be described by an Emax model for all PBs. Overall, the correlation to PK exposure (observed or predicted) was similar to the correlation to dose.
· Correlation coefficient analyses between biomarkers at capivasertib 480mg BD identified- i) Positive correlations for pGSK3β with Ki67 (ρ = 0.52, p-value < 0.05) & with pS6 (ρ = 0.54, p-value<0.05); ii) Negative correlations between FOXO3a and Ki67 (ρ = -0.75, p-value<0.001) pGSK3β (ρ = -0.71, p-value<0.001) & also pS6 (ρ = -0.61, p-value<0.001).Correlation coefficients for lower doses are not robust due to small sample size in these groups.
Conclusions
· Capivasertib caused dose- and concentration- dependent effects on biomarkers after only 4.5 days.
· Significant changes in the PBs were demonstrated at 480 mg BD. Biomarker changes was observed at 360mg and 240mg BD, but statistical analysis was limited by the small sample size at lower doses.
· Correlation between a number of tumor biomarkers (relative changes) were identified for capivasertib 480mg BD.
Citation Format: Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-12-01.
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Affiliation(s)
- J Gee
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - RE Coleman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - KL Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Evans
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - C Holcombe
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Skene
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - D Rea
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - S Ahmed
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Jahan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - K Horgan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rauchhaus
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Littleford
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Finlay
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Cullberg
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - E de Bruin
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Foxley
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - L Koulai
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Pass
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - G Schiavon
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rugman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Deb
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - JFR Robertson
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
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Yeo W, Lei YY, Cheng AC, Kwok CC, Cheung KL, Lee R, Lee IC, He YQ, Ho S. Abstract P1-12-07: Prospective 36-month follow-up to determine changes in body mass index and weight among Chinese breast cancer survivors. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-07] [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: 11/16/2022]
Abstract
Abstract
Background:Anticancer treatment for breast cancer has been associated with weight gain but such observation has mainly been reported in western patients. More recent data in Asian patients have inconsistent findings. Factors including socio-demographic, clinical and lifestyle may be associated with post-diagnosis weight gain. In this prospective cohort study of women with breast cancer, the objectives were to determine the body mass index (BMI) and weight changes over 36 months after initial diagnosis and the factors associated with such changes.
Methods: Chinese women with newly diagnosed early-stage breast cancer were recruited. Individual woman had her weight measured at breast cancer diagnosis (W0), at study entry (W1) and at 36-month follow-up (W2). Body height was measured at W0. We evaluated change in weight and body mass index (BMI) before and after breast cancer diagnosis.Socio-demographic, clinical and lifestyle factors were assessed to identify potential associated factors with weight changes.
Results: A total of 1133 women with breast cancer had detailed weight measurements at the 3 time-points of assessment. The mean age at diagnosis was 52 years. Fifty-four percent were premenopausal at W1. The proportion of patients with stage 0-I, II and III diseases were 35%, 46% and 19%, respectively.
The proportions of patients who were overweight and obese at the three assessment time-points were 21.2% and 28.5% at W0, 19.7% and 26.6% at W1, and 21.7% and 30.9% at W2 assessment, respectively. When compared to W0, the proportions of women who gained weight within 2-5kg at W1 and W2 were 2.4% and 20.6% respectively, that with weight gain of >5kg at W1 and W2 were 0.5% and 10.0% respectively; 6.1% and 19.6% of women had weight loss >2kg at W1 and W2 respectively.
Compared to W0, the median value of weight change was -0.5 kg (range: -11.4, 18.3) at W1 and 0.6 kg (range: -19.6, 20.5) at W2. On multivariate analysis, only BMI at diagnosis were significantly associated with weight change betweenassessments at diagnosis and W2; the median (range) for weight changes for women who were underweight, normal, overweight and obese were respectively 0.9 (-4.8, 7.6), 0.6 (-13.2, 20.5), 0.5 (-11.5, 13.0) and 0.5 (-19.6, 12.6) kg, p <0.001.
Conclusions: In this prospective study of Chinese women with a history of breast cancer who were followed-up over a 36-months' period, the proportions of women with overweight and obese statuses were relatively stable; weight gain was uncommon among Hong Kong women with breast cancer during the same period. These findings are in contrast with studies conducted in the West, where weight gains were more commonly reported.
Funding: World Cancer Research Fund International (Grant Number WCRF 2010/249 and WCRF 2014/1197)
Citation Format: Yeo W, Lei YY, Cheng AC, Kwok CC, Cheung KL, Lee R, Lee IC, He YQ, Ho S. Prospective 36-month follow-up to determine changes in body mass index and weight among Chinese breast cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-07.
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Affiliation(s)
- W Yeo
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - YY Lei
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - AC Cheng
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - CC Kwok
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - KL Cheung
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - R Lee
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - IC Lee
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - YQ He
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - S Ho
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
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Cheung KL, Durusu D, Sui X, de Vries H. How recommender systems could support and enhance computer-tailored digital health programs: A scoping review. Digit Health 2019; 5:2055207618824727. [PMID: 30800414 PMCID: PMC6379797 DOI: 10.1177/2055207618824727] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Accepted: 12/11/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Tailored digital health programs can promote positive health-related
lifestyle changes and have been shown to be (cost) effective in trials.
However, such programs are used suboptimally. New approaches are needed to
optimise the use of these programs. This paper illustrates the potential of
recommender systems to support and enhance computer-tailored digital health
interventions. The aim is threefold, to explore: (1) how recommender systems
provide health recommendations, (2) to what extent recommender systems
incorporate theoretical models and (3) how the use of recommender systems
may enhance the usage of computer-tailored interventions. Methods A scoping review was conducted, using MEDLINE and ScienceDirect, to identify
health recommender systems reported in studies between January 2007 and
December 2017. Information was subsequently extracted to understand the
potential benefits of recommender systems for computer-tailored digital
health programs. Titles and abstracts of 1184 studies were screened for the
full-text screening, in which two reviewers independently selected articles
and systematically extracted data using a predefined extraction form. Results A total of 26 articles were included for data extraction. General
characteristics were reported, with eight studies reporting hybrid
filtering. A description of how each recommender system provides a
recommendation is described; the majority of recommender systems used
messages as recommendation. We identified the potential effects of
recommender systems on efficiency, effectiveness, trustworthiness and
enjoyment of the digital health program. Conclusions Incorporating a collaborative method with demographic filtering as a second
step to knowledge-based filtering could potentially add value to traditional
tailoring with regard to enhancing the user experience. This study
illustrates how recommender systems, especially hybrid programs, may have
the potential to bring tailored digital health forward.
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Affiliation(s)
- Kei Long Cheung
- Department of Health Promotion, CAPHRI Research School for Public Health and Primary Care, Maastricht University, the Netherlands
| | - Dilara Durusu
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, the Netherlands
| | - Xincheng Sui
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Research School for Public Health and Primary Care, Maastricht University, the Netherlands
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Cheung KL, Zakai NA, Callas PW, Howard G, Mahmoodi BK, Peralta CA, Judd SE, Kurella Tamura M, Cushman M. Mechanisms and mitigating factors for venous thromboembolism in chronic kidney disease: the REGARDS study. J Thromb Haemost 2018; 16:1743-1752. [PMID: 29984467 PMCID: PMC6123283 DOI: 10.1111/jth.14235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/15/2018] [Indexed: 12/26/2022]
Abstract
Essentials Chronic kidney disease (CKD) is associated with procoagulant and inflammatory biomarkers. We studied the association of CKD and venous thromboembolism (VTE) in a case-cohort study. Factor VIII, D-dimer and C-reactive protein appeared to explain the association of CKD and VTE. Statin use was protective against VTE in those with and without CKD. SUMMARY Background Chronic kidney disease (CKD) is associated with venous thromboembolism (VTE) risk via unknown mechanisms. Whether factors associated with reduced VTE risk in the general population might also be associated with reduced VTE risk in CKD patients is unknown. Objectives To determine whether thrombosis biomarkers attenuate VTE risk, and whether factors associated with reduced VTE risk are similarly effective in CKD patients. Methods Baseline biomarkers were measured in a cohort (294 VTE cases; 939 non-cases) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a nationwide prospective cohort study of 30 239 persons aged ≥45 years with 4.3 years of follow-up. The hazard ratio (HR) of VTE per 10 mL min-1 1.73 m-2 decrease in estimated glomerular filtration rate (eGFR), and the percentage attenuation of this HR by each biomarker, were calculated. Associations of protective factors (physical activity, lower body mass index [BMI], and aspirin, warfarin and statin use) with VTE were estimated in those with and without CKD. Results The HR for VTE with lower eGFR was 1.13 (95% confidence interval [CI] 1.02-1.25), and VTE risk was attenuated by 23% (95% CI 5-100) by D-dimer, by 100% (95% CI 50-100) by factor VIII, and by 15% (95% CI 2-84) by C-reactive protein. Normal BMI was associated with lower VTE risk in those without CKD (HR 0.47, 95% CI 0.32-0.70), but not in those with CKD (HR 1.07, 95% CI 0.51-2.22). Statin use, physical activity and warfarin use were associated with lower VTE risk in both groups. Conclusions Procoagulant and inflammatory biomarkers mediated the association of eGFR with VTE. Higher physical activity, statin use and warfarin use mitigated VTE risk in those with CKD and those without CKD, but normal BMI did not mitigate VTE risk in CKD patients.
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Affiliation(s)
- K L Cheung
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - N A Zakai
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - P W Callas
- University of Vermont, Burlington, VT, USA
| | - G Howard
- University of Alabama Birmingham, Birmingham, AL, USA
| | - B K Mahmoodi
- University of Groningen, Groningen, The Netherlands
| | - C A Peralta
- University of California San Francisco, San Francisco, CA, USA
| | - S E Judd
- University of Alabama Birmingham, Birmingham, AL, USA
| | - M Kurella Tamura
- Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - M Cushman
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Trapero-Bertran M, Muñoz C, Coyle K, Coyle D, Lester-George A, Leidl R, Bertalan N, Cheung KL, Pokhrel S, Lopez-Nicolás A. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trapero-Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak-Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S, EQUIPT Study Group OBOT. Estimating costs for modelling return on investment from smoking cessation interventions. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trapero‐Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak‐Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S. Estimates of costs for modelling return on investment from smoking cessation interventions. Addiction 2018; 113 Suppl 1:32-41. [PMID: 29532538 PMCID: PMC6033022 DOI: 10.1111/add.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 06/20/2017] [Revised: 07/20/2017] [Accepted: 11/02/2017] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIMS Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. SETTING AND PARTICIPANTS Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. MEASUREMENTS Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. FINDINGS Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 106 (Germany); coronary heart disease between €1521 (Spain) and €3955 (Netherlands); chronic obstructive pulmonary disease between €1280 (England) and €4199 (Spain); stroke between €1829 (Hungary) and €14 880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioural support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); and €27 (Spain). CONCLUSIONS Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across Hungary, Netherlands, Germany, Spain and England. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Puttarin Kulchaitanaroaj
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
| | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
- Department of Epidemiology and Community Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Maximilian Präger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
| | - Judit Józwiak‐Hagymásy
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei Long Cheung
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Mickael Hiligsmann
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
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Huber MB, Präger M, Coyle K, Coyle D, Lester‐George A, Trapero‐Bertran M, Nemeth B, Cheung KL, Stark R, Vogl M, Pokhrel S, Leidl R. Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:52-64. [PMID: 29243347 PMCID: PMC6033002 DOI: 10.1111/add.14062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/07/2017] [Accepted: 10/03/2017] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany. DESIGN A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. SETTING Germany. PARTICIPANTS Cohort of current smoking population (18+ years) in Germany. INTERVENTIONS Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. MEASUREMENTS EQUIPTMOD considered reach, intervention cost, number of quitters, quality-of-life years (QALYs) gained, cost-effectiveness and return on investment. FINDINGS The highest returns through reduction in smoking-related health-care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group-based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5000, the probability of being cost-effective is approximately 75% for prospective scenario 1. CONCLUSIONS Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost-effective.
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Affiliation(s)
- Manuel B. Huber
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Maximilian Präger
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Doug Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
- School of Epidemiology, Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Marta Trapero‐Bertran
- Centre for Research on Economics an Health (CRES) Universitat Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | | | - Kei Long Cheung
- Caphri School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Renee Stark
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Matthias Vogl
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Reiner Leidl
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
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Abstract
OBJECTIVES Several studies, mostly from developed countries, have identified barriers and facilitators with regard to the uptake of health technology assessment (HTA). This study elicited, using best-worst scaling (BWS), what HTA experts in Colombia consider to be the most important barriers and facilitators in the use of HTA, and makes a comparison to results from the Netherlands. METHODS Two object case surveys (one for barriers, one for facilitators) were conducted among 18 experts (policymakers, health professionals, PhD students, senior HTA-researchers) from Colombia. Seven respondents were employees of the national HTA agency Instituto de Evaluación Tecnológica de Salud (IETS). In total, 22 barriers and 19 facilitators were included. In each choice task, participants were asked to choose the most and least important barrier/facilitator from a set of five. Hierarchical Bayes modeling was used to compute the mean relative importance scores (RIS) for each factor, and a subgroup analysis was conducted to assess differences between IETS and non-IETS respondents. The final ranking was further compared to the results from a similar study conducted in the Netherlands. RESULTS The three most important barriers (RIS >6.00) were "Inadequate presentation format", "Absence of policy networks", and "Insufficient legal support". The six most important facilitators (RIS >6.00) were "Appropriate timing", "Clear presentation format", "Improving longstanding relation", "Appropriate incentives", "Sufficient qualified human resources", and "Availability to relevant HTA research". The perceived relevance of the barriers and facilitators differed slightly between IETS and non-IETS employees, while the differences between the rankings in Colombia and the Netherlands were substantial. CONCLUSION The study suggests that barriers and facilitators related to technical aspects of processing HTA reports and to the contact and interaction between researchers and policymakers had the greatest importance in Colombia.
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Affiliation(s)
- Florian Dams
- a Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
- b Center of Competence for Public Management , University of Bern , Bern , Switzerland
- c Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel AG , Bern , Switzerland
| | | | - Kei Long Cheung
- e Department of Health Services Research , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
- f Department of Health Promotion , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Ben F M Wijnen
- e Department of Health Services Research , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Mickaël Hiligsmann
- e Department of Health Services Research , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
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Wong KS, Fu SN, Cheung KL, Dao MC, Sy WM. Effect of a financial incentive on the acceptance of a smoking cessation programme with service charge: a cluster-controlled trial. Hong Kong Med J 2018; 24:128-136. [PMID: 29622760 DOI: 10.12809/hkmj176960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Frontline health care professionals in Hong Kong may encounter high refusal rates for the Hospital Authority's Smoking Counselling and Cessation Programme (SCCP) when smokers know it is subject to a service charge. We compared SCCP booking and attendance rates among smokers with or without a financial incentive. METHODS In this multicentre non-randomised cluster-controlled trial, adult smokers who attended one of six general out-patient clinics between November 2015 and April 2016 were invited to join an SCCP. Attendees in the three intervention-group centres but not the three control-group centres received a supermarket coupon to offset the service charge. RESULTS A total of 173 smokers aged 18 years or older (92 in the intervention group and 81 in the control group) were recruited into the study. In the intervention group, 47 smokers (51%) agreed via a questionnaire that they would join the SCCP, compared with only 23 smokers in the control group (28%). The booking rates were 83% (n=39) in the intervention group and 83% (n=19) in the control group. Among those who had booked a place, 19 (49%) intervention-group participants and 11 (58%) control-group participants attended an SCCP session. Multivariable logistic regression revealed that offering a coupon was associated with agreeing to join an SCCP (odds ratio=4.963, 95% confidence interval=2.173-11.334; P<0.001) and booking an SCCP place (odds ratio=4.244, 95% confidence interval=1.838-9.799; P<0.001). CONCLUSION Provision of a financial incentive was positively associated with agreement to join an SCCP and booking an SCCP place. Budget holders should consider providing the SCCP free of charge to increase smokers' access to the service.
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Affiliation(s)
- K S Wong
- Family Medicine and General Out-patient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong
| | - S N Fu
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - K L Cheung
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - M C Dao
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - W M Sy
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
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Cheung KL, Pinder SE, Paish C, Sadozye AH, Chan SY, Evans AJ, Blamey RW, Robertson JF. The Role of Blood Tumor Marker Measurement (Using a Biochemical Index Score and C-Erbb2) in Directing Chemotherapy in Metastatic Breast Cancer. Int J Biol Markers 2018; 15:203-9. [PMID: 11012094 DOI: 10.1177/172460080001500310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 11/17/2022]
Abstract
The role of blood tumor markers in monitoring response in advanced breast cancer is established in endocrine therapy and standard chemotherapy. This study examines marker levels in patients receiving new chemotherapy regimens. Thirty patients were recruited into two multicenter trials in which docetaxel-based regimens were used in 15 patients. The other 15 received doxorubicin-based regimens. Biochemical response calculated from a score using CA15.3, CEA and ESR was compared with UICC response. Marker changes at 2, 4 and 5 months correlated with UICC response at 3, 41/2 and 6 months, respectively (p < 0.03). Eleven patients achieved both clinical/radiological and biochemical response at the end of treatment; markers had not yet returned to below cutoffs in seven, suggesting a possible advantage to continue chemotherapy. No patient showed a biochemical response whilst judged clinically/radiologically progressive. Nineteen patients had progressed either clinically/radiologically or biochemically at six months; of these, eight showed progression assessed earlier by markers so that a median of four cycles of chemotherapy could have been saved. Measurements of serum c-erbB2 showed a correlation with tissue c-erbB2 staining in the primary tumor (p < 0.003). Among the patients with positive tissue staining, sequential changes in serum c-erbB2 completely paralleled initial response.
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Affiliation(s)
- K L Cheung
- Department of Surgery, City Hospital, Nottingham, UK.
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Affiliation(s)
- W H Chow
- Department of Medicine, Grantham Hospital, Hong Kong
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Lei YY, Lee ICK, Cheung KL, Lee R, He Y, Yeo W. Abstract P6-12-04: Quality of life of Chinese breast cancer survivors in association with lifestyle changes before and after cancer diagnosis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-04] [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: 11/16/2022]
Abstract
Abstract
Background: Epidemiologic studies in the West have found that lifestyle factors, including maintaining normal body weight, being physically active and eating a healthy diet are individually associated with better quality of life (QOL) among breast cancer survivors. Limited data is available on lifestyle modifications in association with quality of life of breast cancer survivors in Asian region. The objectives of this study were to [1] determine the lifestyle changes among Chinese breast cancer survivors at diagnosis and 18-month post diagnosis; and [2] to assess the association of lifestyle changes with QOL.
Methods: In this prospective cohort study, 1300 Chinese breast cancer patients were assessed at breast cancer diagnosis (baseline; reflecting pre-diagnosis) and at 18-month post-diagnosis. During each assessment, individual patient's lifestyle within the previous 12 months were recorded and included exercise, diet, and body mass index (BMI) data; each patient also underwent self-administered QOL assessment. Assessment of lifestyle modifications were based on World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendation adherence scores (range: 0-6).QOL was evaluated by European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire C-30 (EORTC-QLQ-C30). Paired t-test was performed to compare the overall recommendation adherence score before and after diagnosis.To investigate the association between recommendation adherence score and HRQoL, generalized linear models were used to compare the least-square means by tertiles of adherence score (T1, T2, and T3) and continuous adherence score. In the multivariate models, adjustment were made for age, stage of cancer, education level, marital status, comorbidities, smoking status, current hormonal therapy and energy intake.
Results: The mean recommendation adherence score significantly increased from baseline of 3.2 (SD=1.1) to 3.9 (SD=1.1, p<0.001) at 18-month follow-up. Overall, increasing adherence to WCRF/AICR guideline was associated with higher scores of global health status (P=0.01), physical functioning (P<0.001) and role functioning (P=0.03), and lower scores of fatigue (P=0.001), nausea and vomiting (P=0.003), pain (P<0.001), dyspnea (P=0.006), loss of appetite (P=0.001) and diarrhea (P<0.001).
Conclusions: Positive lifestyle changes were made among Chinese breast cancer survivors after cancer diagnosis. Increased adherence to WCRF/AICR recommendations after cancer diagnosis improves QOL, suggesting that Chinese breast cancer survivors should follow the WCRF/AICR guideline for cancer prevention.
Acknowledgments: This study is funded by the World Cancer Research Fund International (Grant Number WCRF 2010/249and WCRF 2014/1197) and Madam Diana Hon Fun Kong Donation for Cancer Research.
Citation Format: Lei Y-Y, Lee IC-K, Cheung KL, Lee R, He Y, Yeo W. Quality of life of Chinese breast cancer survivors in association with lifestyle changes before and after cancer diagnosis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-04.
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Affiliation(s)
- Y-Y Lei
- Chinese University of Hong Kong
| | | | | | - R Lee
- Chinese University of Hong Kong
| | - Y He
- Chinese University of Hong Kong
| | - W Yeo
- Chinese University of Hong Kong
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Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Kelly S, Horgan K, Rauchhaus P, Littleford R, Foxley A, Lindemann JPO, Pass M, Rugman P, Deb R, Finlay P, Gee JMW. Abstract P4-04-06: AZD5363, an AKT inhibitor, significantly inhibits key biomarkers of the AKT pathway and Ki67, in a randomized, placebo, controlled study (STAKT) in human breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-04-06] [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: 11/16/2022]
Abstract
Abstract
Background: AKT is an important intracellular control point through which Type 1 growth factors and IGFR signal. Mutations in PIK3CA, AKT and PTEN are prevalent in estrogen receptor positive (ER+) breast cancer (BC) and have been implicated in resistance to endocrine therapies. AZD5363 is an inhibitor of AKT 1, 2 and 3 currently in Phase 2 trials for BC and other solid cancers.
Design: The study examined whether AZD5363 impacts on key biomarkers within the AKT pathway and their subsequent effects on Ki67, a marker of tumor proliferation. STAKT is a multi-center, two-stage, double blind, randomized, placebo controlled, biomarker 'window-of-opportunity' trial in women with newly diagnosed, previously untreated ER+ BC who were deemed would require chemotherapy as part of their primary treatment regimen. Stage 1 assessed AZD5363 at a dose of 480mg bd p.o. versus matching placebo. Up to 30 patients per arm were permitted, to allow 12 subjects per arm with evaluable paired biopsies - obtained at baseline, and after 4.5 days of AZD5363 / placebo. Primary endpoint markers were pPRAS40, pGSK3β and Ki67 assessed by immunohistochemistry. pPRAS40 and pGSK3β were assessed by H-scores and measured separately for cytoplasmic (cyto), nuclear (nuc) and total (cyto+nuc) staining. Ki67 was assessed as % positive staining of 500 tumor nuclei. Laboratory staff were blinded to treatment arm and whether the biopsies were taken before or after AZD5363/placebo. Changes in marker expression (both absolute and %) between biopsies were calculated, and compared between the two groups. An ANOVA test was applied for normally distributed data and Wilcoxon Mann-Whitney used if not normally distributed.
Results: 28/36 patients were evaluable with patient & tumor characteristics as follows: 17 received AZD5363 and 11 placebo; the median ages were 48 & 49 years respectively. 27 patients were Caucasian and 1 African-American. Tumors were all ER+. For HER2 status 8 were positive & 9 negative in the AZD5363 treated group compared to 2 & 9 respectively in the placebo group.
For pPRAS40 and pGSK3β cyto was the predominant staining while for Ki67 staining was nuclear. Changes in each marker with associated p-values are shown in the table.
MarkerType of change vs baselineDegree of change in AZD5363 arm (n=17)p-value versus placebo arm (n=11)pPRAS40 (H-score)TotalAbsolute-83.8<0.0001Total%-50.2<0.0001CytoAbsolute-90.0<0.0001Cyto%-55.8<0.0001NucAbsolute+6.90.42Nuc%+8.90.94pGSK3β (H-score)TotalAbsolute-55.30.006Total%-39.00.006CytoAbsolute-53.60.006Cyto%-39.20.006NucAbsolute-2.80.065Nuc%-36.50.058Ki67 (% cells+)Absolute-9.60.031%-29.40.052
Conclusions• AZD5363 for 4.5 days caused highly significant falls in pGSK3β and pPRAS40, key markers of AKT pathway activation
• AZD53643 also caused a significant decline in Ki67 even after only 4.5 days of drug. This is one of the shortest 'window'-studies to report such an early effect on proliferation.
• Placebo controlled 'window' studies of this short duration can provide important evidence of the therapeutic potential early in a drug's development.
Citation Format: Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Kelly S, Horgan K, Rauchhaus P, Littleford R, Foxley A, Lindemann JPO, Pass M, Rugman P, Deb R, Finlay P, Gee JMW. AZD5363, an AKT inhibitor, significantly inhibits key biomarkers of the AKT pathway and Ki67, in a randomized, placebo, controlled study (STAKT) in human breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-06.
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Affiliation(s)
- JFR Robertson
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - RE Coleman
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - KL Cheung
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Evans
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - C Holcombe
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Skene
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - D Rea
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - S Ahmed
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Jahan
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - S Kelly
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - K Horgan
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Rauchhaus
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - R Littleford
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Foxley
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - JPO Lindemann
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - M Pass
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Rugman
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - R Deb
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Finlay
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - JMW Gee
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
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Kulchaitanaroaj P, Kaló Z, West R, Cheung KL, Evers S, Vokó Z, Hiligsmann M, de Vries H, Owen L, Trapero-Bertran M, Leidl R, Pokhrel S. Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic model: a cross-sectional study. BMC Health Serv Res 2018; 18:115. [PMID: 29444679 PMCID: PMC5813331 DOI: 10.1186/s12913-018-2923-2] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders' views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data. METHODS An interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team's contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders' views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review. RESULTS Ninety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [- 0.09, 0.89]). CONCLUSIONS The intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.
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Affiliation(s)
- Puttarin Kulchaitanaroaj
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Robert West
- Health Behaviour Research Centre, University College London, London, UK
- National Centre for Smoking Cessation and Training, Birmingham, UK
| | - Kei Long Cheung
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Mickael Hiligsmann
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Lesley Owen
- National Institute for Health and Care Excellence, London, UK
| | - Marta Trapero-Bertran
- Centre for Research in Economics and Health, University Pompeu Fabra, Barcelona, Spain
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Abstract
Purpose
Serious gaming provides opportunities to harmonize the views of stakeholders regarding integrated care. In order to provide first insights on the effects and stakeholders’ satisfaction of serious gaming, the purpose of this paper is to explore what effects serious gaming has on the perceptions of different stakeholders regarding integrated care, and to evaluate a trial case of serious gaming on integrated care.
Design/methodology/approach
A pre- and post-test design was used, with two questionnaires. The first questionnaire focused on integrated care, based on the integrated change model, and was given to participants twice, once before and once after the serious game “Long Life Lab” was completed, to assess changes in perception. The second questionnaire focused on the evaluation of serious gaming, and was given to the participants only after the serious game.
Findings
With nine participants, the results yielded no statistical effects with the exception of three salient beliefs. Despite the small sample, differences in specific beliefs were found for knowledge, attitude and self-efficacy. Furthermore, the game was positively evaluated, but participants indicated that there is room for improvement.
Originality/value
Participants have positive beliefs toward the use of serious gaming as a tool for changing stakeholders’ perspectives on integrated care. Further studies in greater sample size are needed to confirm the potential value of serious gaming to improve integrated care.
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Syed BM, Morgan D, Setty T, Green AR, Paish EC, Ellis IO, Cheung KL. Oestrogen receptor negative early operable primary breast cancer in older women-Biological characteristics and long-term clinical outcome. PLoS One 2017; 12:e0188528. [PMID: 29284000 PMCID: PMC5746234 DOI: 10.1371/journal.pone.0188528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Older women are at the greatest risk of breast cancer development and a considerable number present with comorbidities. Although the majority of breast cancers in this age group express oestrogen receptor (ER), which makes endocrine therapy (primary or adjuvant) feasible, given the huge size of the elderly population, there remains a significant number of patients, in absolute term, whose tumours do not express ER and their management is challenging. Methods Of a consecutive series of 1,758 older (≥70 years) women with early operable primary breast cancer managed in a dedicated service from 1973–2010, 252(14.3%) had ER-negative (histochemical (H) score ≤50) tumours. Their clinical outcome was retrospectively reviewed and tumour samples collected from diagnostic core biopsies were analysed for progesterone receptor (PgR), HER2 and Ki67 using immunohistochemistry. Results The commonest primary treatment was surgery (N = 194, 77%) followed by primary endocrine therapy (14.3%), primary radiotherapy (5.6%) and supportive treatment only (3.1%). Among the patients undergoing surgery, most of them had grade 3 (78.1%) and node-negative disease (62.2%). Some of them (21.1%) received postoperative radiotherapy. At a median follow-up of 37.5 months, 117 patients had died, out of which 48.6% were due to breast cancer. For those who underwent surgery, the regional and local recurrence rates were 2% and 1.1% per annum respectively. For those who received primary endocrine therapy, 38% progressed at 6 months, however all patients who had primary radiotherapy achieved clinical benefit at 6 months. Regardless of treatment given, the 5-year breast cancer specific and overall survival rates were 70% and 50% respectively. Biological analysis based on good quality needle core biopsy specimensfrom181 patients showed that 26.8% (N = 49), 16.9% (N = 31) and 70.7% (N = 70)expressed positivity for PgR, HER2 and Ki67 respectively. No correlation between these biomarkers and breast cancer specific survival was demonstrated. Conclusion Oestrogen receptor negative early operable primary breast cancer in older women is associated with poor prognostic features in terms of biology and clinical outcome. Surgery appears to produce the best outcome as a primary treatment, however for those where neither surgery nor chemotherapy is appropriate, primary radiotherapy can be beneficial.
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Affiliation(s)
- Binafsha Manzoor Syed
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Dal Morgan
- Department of Oncology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Tulassi Setty
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Andrew R Green
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Emma C Paish
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Ian O Ellis
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - K L Cheung
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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Cheung KL, de Ruijter D, Hiligsmann M, Elfeddali I, Hoving C, Evers SMAA, de Vries H. Exploring consensus on how to measure smoking cessation. A Delphi study. BMC Public Health 2017; 17:890. [PMID: 29162043 PMCID: PMC5696733 DOI: 10.1186/s12889-017-4902-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 04/20/2017] [Accepted: 11/12/2017] [Indexed: 01/25/2023] Open
Abstract
Background Different criteria regarding outcome measures in smoking research are used, which can lead to confusion about study results. Consensus in outcome criteria may enhance the comparability of future studies. This study aims (1) to provide an overview of tobacco researchers’ considered preferences regarding outcome criteria in randomized controlled smoking cessation trials, and (2) to identify the extent to which researchers can reach consensus on the importance of these outcome criteria. Methods A three-round online Delphi study was conducted among smoking cessation experts. In the first round, the most important smoking cessation outcome measures were collected by means of open-ended questions, which were categorized around self-reported and biochemical validation measures. Experts (n = 17) were asked to name the outcome measures (as well as their assessment method and ideal follow-up period) that they thought were important when assessing smoking-related outcomes. In the second (n = 48) and third rounds (n = 37), a list of outcome measures—identified in the first round—was presented to experts. Asking them to rate the importance of each measure on a seven-point scale. Results Experts reached consensus on several items. For self-reports, experts agreed that prolonged abstinence (6 or/and 12 months), point prevalence abstinence (7 days), continuous abstinence (6 months), and the number of cigarettes smoked (7 days) are important outcome measures. Experts reached consensus that biochemical validation methods should not always be used. The preferred biochemical validation methods were carbon monoxide (expired air) and cotinine (saliva). Preferred follow-ups included 6 and/or 12 months, with or without intermediate measurements. Conclusions Findings suggest only partial compliance with the Russell standard and that more outcome measures may be important (including seven-day point-prevalence abstinence, number of cigarettes smoked, and cotinine when using biochemical validation). This study showed where there is and is not consensus, reflecting the need to develop a more comprehensive standard. For these purposes we provided suggestions for the Russell 2.0 standard.
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Affiliation(s)
- Kei Long Cheung
- Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, the Netherlands. .,Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
| | - Dennis de Ruijter
- Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Mickaël Hiligsmann
- Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, the Netherlands
| | - Iman Elfeddali
- GGzBreburg, Tilburg, the Netherlands.,Tranzo Department, Tilburg University, Tilburg, the Netherlands
| | - Ciska Hoving
- Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, the Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Hein de Vries
- Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
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Feig C, Cheung KL, Hiligsmann M, Evers SMAA, Simon J, Mayer S. Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria. Expert Rev Pharmacoecon Outcomes Res 2017; 18:223-232. [DOI: 10.1080/14737167.2017.1375407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Chiara Feig
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Kei Long Cheung
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Silvia M. A. A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Cheung KL, Wijnen B, de Vries H. A Review of the Theoretical Basis, Effects, and Cost Effectiveness of Online Smoking Cessation Interventions in the Netherlands: A Mixed-Methods Approach. J Med Internet Res 2017. [PMID: 28645889 PMCID: PMC5501927 DOI: 10.2196/jmir.7209] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population aged 18 years and older smoked, 74.4% of them daily. More and more people have access to the Internet worldwide; approximately 94% of the Dutch population have online access. Internet-based smoking cessation interventions (online cessation interventions) provide an opportunity to tackle the scourge of tobacco. OBJECTIVE The goal of this paper was to provide an overview of online cessation interventions in the Netherlands, while exploring their effectivity, cost effectiveness, and theoretical basis. METHODS A mixed-methods approach was used to identify Dutch online cessation interventions, using (1) a scientific literature search, (2) a grey literature search, and (3) expert input. For the scientific literature, the Cochrane review was used and updated by two independent researchers (n=651 identified studies), screening titles, abstracts, and then full-text studies between 2013 and 2016 (CENTRAL, MEDLINE, and EMBASE). For the grey literature, the researchers conducted a Google search (n=100 websites), screening for titles and first pages. Including expert input, this resulted in six interventions identified in the scientific literature and 39 interventions via the grey literature. Extracted data included effectiveness, cost effectiveness, theoretical factors, and behavior change techniques used. RESULTS Overall, many interventions (45 identified) were offered. Of the 45 that we identified, only six that were included in trials provided data on effectiveness. Four of these were shown to be effective and cost effective. In the scientific literature, 83% (5/6) of these interventions included changing attitudes, providing social support, increasing self-efficacy, motivating smokers to make concrete action plans to prepare their attempts to quit and to cope with challenges, supporting identity change and advising on changing routines, coping, and medication use. In all, 50% (3/6) of the interventions included a reward for abstinence. Interventions identified in the grey literature were less consistent, with inclusion of each theoretical factor ranging from 31% to 67% and of each behavior change technique ranging from 28% to 54%. CONCLUSIONS Although the Internet may provide the opportunity to offer various smoking cessation programs, the user is left bewildered as far as efficacy is concerned, as most of these data are not available nor offered to the smokers. Clear regulations about the effectiveness of these interventions need to be devised to avoid disappointment and failed quitting attempts. Thus, there is a need for policy regulations to regulate the proliferation of these interventions and to foster their quality in the Netherlands.
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Affiliation(s)
- Kei Long Cheung
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Ben Wijnen
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Berg ML, Cheung KL, Hiligsmann M, Evers S, de Kinderen RJA, Kulchaitanaroaj P, Pokhrel S. Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review. Addiction 2017; 112:946-967. [PMID: 28060453 PMCID: PMC5434798 DOI: 10.1111/add.13748] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 12/30/2016] [Indexed: 12/04/2022]
Abstract
AIMS To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. METHODS A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist-based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model-based economic evaluation, that did not consider adult population and not from a high-income country were excluded. FINDINGS Among the 64 economic evaluations included in the review, the state-transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life-time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35-0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. CONCLUSION All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.
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Affiliation(s)
- Marrit L. Berg
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Kei Long Cheung
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Reina J. A. de Kinderen
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | | | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
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Cheung KL, ten Klooster PM, Smit C, de Vries H, Pieterse ME. The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health. BMC Public Health 2017; 17:276. [PMID: 28330465 PMCID: PMC5363011 DOI: 10.1186/s12889-017-4189-8] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [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] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 03/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In public health monitoring of young people it is critical to understand the effects of selective non-response, in particular when a controversial topic is involved like substance abuse or sexual behaviour. Research that is dependent upon voluntary subject participation is particularly vulnerable to sampling bias. As respondents whose participation is hardest to elicit on a voluntary basis are also more likely to report risk behaviour, this potentially leads to underestimation of risk factor prevalence. Inviting adolescents to participate in a home-sent postal survey is a typical voluntary recruitment strategy with high non-response, as opposed to mandatory participation during school time. This study examines the extent to which prevalence estimates of adolescent health-related characteristics are biased due to different sampling methods, and whether this also biases within-subject analyses. METHODS Cross-sectional datasets collected in 2011 in Twente and IJsselland, two similar and adjacent regions in the Netherlands, were used. In total, 9360 youngsters in a mandatory sample (Twente) and 1952 youngsters in a voluntary sample (IJsselland) participated in the study. To test whether the samples differed on health-related variables, we conducted both univariate and multivariable logistic regression analyses controlling for any demographic difference between the samples. Additional multivariable logistic regressions were conducted to examine moderating effects of sampling method on associations between health-related variables. RESULTS As expected, females, older individuals, as well as individuals with higher education levels, were over-represented in the voluntary sample, compared to the mandatory sample. Respondents in the voluntary sample tended to smoke less, consume less alcohol (ever, lifetime, and past four weeks), have better mental health, have better subjective health status, have more positive school experiences and have less sexual intercourse than respondents in the mandatory sample. No moderating effects were found for sampling method on associations between variables. CONCLUSIONS This is one of first studies to provide strong evidence that voluntary recruitment may lead to a strong non-response bias in health-related prevalence estimates in adolescents, as compared to mandatory recruitment. The resulting underestimation in prevalence of health behaviours and well-being measures appeared large, up to a four-fold lower proportion for self-reported alcohol consumption. Correlations between variables, though, appeared to be insensitive to sampling bias.
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Affiliation(s)
- Kei Long Cheung
- CAPHRI Care and Public Health Research Institute, Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, the Netherlands
| | | | - Cees Smit
- CHS of Twente, Enschede, the Netherlands
| | - Hein de Vries
- CAPHRI Care and Public Health Research Institute, Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Marcel E. Pieterse
- Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
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Roberston JFR, Cheung KL, Ahmed S, Coleman RE, Evans A, Holcombe C, Rea D, Rauchhaus P, Skene A, Littleford R, Jahan A, Kelly S, Lindermann JPO, Horgan K, Foxley A, Rugman P, Pass M. Abstract P3-06-03: The short term effects of an AKT inhibitor (AZD5363) on biomarkers of the AKT pathway and anti-tumour activity in a breast cancer paired biopsy study (STAKT trial). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-06-03] [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: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- JFR Roberston
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - KL Cheung
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - S Ahmed
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - RE Coleman
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Evans
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - C Holcombe
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - D Rea
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - P Rauchhaus
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Skene
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - R Littleford
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Jahan
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - S Kelly
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - JPO Lindermann
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - K Horgan
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Foxley
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - P Rugman
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - M Pass
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
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Cheung KL, Wijnen BFM, Hollin IL, Janssen EM, Bridges JF, Evers SMAA, Hiligsmann M. Using Best-Worst Scaling to Investigate Preferences in Health Care. Pharmacoeconomics 2016; 34:1195-1209. [PMID: 27402349 PMCID: PMC5110583 DOI: 10.1007/s40273-016-0429-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Best-worst scaling (BWS) is becoming increasingly popular to elicit preferences in health care. However, little is known about current practice and trends in the use of BWS in health care. This study aimed to identify, review and critically appraise BWS in health care, and to identify trends over time in key aspects of BWS. METHODS A systematic review was conducted, using Medline (via Pubmed) and EMBASE to identify all English-language BWS studies published up until April 2016. Using a predefined extraction form, two reviewers independently selected articles and critically appraised the study quality, using the Purpose, Respondents, Explanation, Findings, Significance (PREFS) checklist. Trends over time periods (≤2010, 2011, 2012, 2013, 2014 and 2015) were assessed further. RESULTS A total of 62 BWS studies were identified, of which 26 were BWS object case studies, 29 were BWS profile case studies and seven were BWS multi-profile case studies. About two thirds of the studies were performed in the last 2 years. Decreasing sample sizes and decreasing numbers of factors in BWS object case studies, as well as use of less complicated analytical methods, were observed in recent studies. The quality of the BWS studies was generally acceptable according to the PREFS checklist, except that most studies did not indicate whether the responders were similar to the non-responders. CONCLUSION Use of BWS object case and BWS profile case has drastically increased in health care, especially in the last 2 years. In contrast with previous discrete-choice experiment reviews, there is increasing use of less sophisticated analytical methods.
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Affiliation(s)
- Kei Long Cheung
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Ben F M Wijnen
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Ilene L Hollin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John F Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Hope C, Robertshaw A, Cheung KL, Idris I, English E. Relationship between HbA1c and cancer in people with or without diabetes: a systematic review. Diabet Med 2016; 33:1013-25. [PMID: 26577885 DOI: 10.1111/dme.13031] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/25/2022]
Abstract
AIM To identify the relationship between HbA1c and cancers in people with or without diabetes. BACKGROUND Cancer is a major public health problem, accounting for 8.2 million deaths worldwide in 2012. HbA1c level has been associated with the risk of developing certain cancers, although the existing evidence is conflicting. METHODS EMBASE, MEDLINE, CINAHL and the Cochrane Library were searched. Eligible articles included randomized controlled trials, cohort studies, case-control studies, systematic reviews and meta-analyses. Participants of either sex, with or without Type 1 or 2 diabetes, were included. The studies were assessed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria by two independent assessors. No meta-analysis was performed because of the heterogeneity of results. RESULTS A total of 19 studies from 1006 met the inclusion criteria, of which 14 were cohort studies and five were nested case-control studies. Eight studies investigated outcomes for all cancer sites. Four of these studies reported that higher HbA1c levels were associated with higher incidence and/or mortality risk for all cancers. One study observed a U-shaped relationship between HbA1c and cancer incidence and mortality. Increasing HbA1c levels were associated with increasing risk of developing colorectal, pancreatic, respiratory and female genital tract cancers. No increased risk was observed for breast cancer, gastrointestinal or urological malignancies. CONCLUSION HbA1c appears to be associated with cancer incidence and/or cancer mortality, but further studies are needed to fully understand the complex relationship between HbA1c and cancer.
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Affiliation(s)
- C Hope
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Robertshaw
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - I Idris
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - E English
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
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Vokó Z, Cheung KL, Józwiak-Hagymásy J, Wolfenstetter S, Jones T, Muñoz C, Evers SMAA, Hiligsmann M, de Vries H, Pokhrel S. Similarities and differences between stakeholders' opinions on using Health Technology Assessment (HTA) information across five European countries: results from the EQUIPT survey. Health Res Policy Syst 2016; 14:38. [PMID: 27230485 PMCID: PMC4882811 DOI: 10.1186/s12961-016-0110-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background The European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) project aimed to study transferability of economic evidence by co-creating the Tobacco Return On Investment (ROI) tool, previously developed in the United Kingdom, for four sample countries (Germany, Hungary, Spain and the Netherlands). The EQUIPT tool provides policymakers and stakeholders with customized information about the economic and wider returns on the investment in evidence-based tobacco control, including smoking cessation interventions. A Stakeholder Interview Survey was developed to engage with the stakeholders in early phases of the development and country adaptation of the ROI tool. The survey assessed stakeholders’ information needs, awareness about underlying principles used in economic analyses, opinion about the importance, effectiveness and cost-effectiveness of tobacco control interventions, and willingness to use a Health Technology Assessment (HTA) tool such as the ROI tool. Methods A cross sectional study using a mixed method approach was conducted among participating stakeholders in the sample countries and the United Kingdom. The individual questionnaire contained open-ended questions as well as single choice and 7- or 3-point Likert-scale questions. The results corresponding to the priority and needs assessment and to the awareness of stakeholders about underlying principles used in economic analysis are analysed by country and stakeholder categories. Results Stakeholders considered it important that the decisions on the investments in tobacco control interventions should be supported by scientific evidence, including prevalence of smoking, cost of smoking, quality of life, mortality due to smoking, and effectiveness, cost-effectiveness and budget impact of smoking cessation interventions. The proposed ROI tool was required to provide this granularity of information. The majority of the stakeholders were aware of the general principles of economic analyses used in decision making contexts but they did not appear to have in-depth knowledge about specific technical details. Generally, stakeholders’ answers showed larger variability by country than by stakeholder category. Conclusions Stakeholders across different European countries viewed the use of HTA evidence to be an important factor in their decision-making process. Further, they considered themselves to be capable of interpreting the results from a ROI tool and were highly motivated to use it. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0110-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zoltan Vokó
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, 1117, Budapest, Pázmány Péter sétány 1/a, Hungary. .,Syreon Research Institute, 1142, Budapest, Mexikói út 65/A, Hungary.
| | - Kei Long Cheung
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, The Netherlands
| | | | - Silke Wolfenstetter
- Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Teresa Jones
- Health Economics Research Group, Brunel University London, Uxbridge, UB8 3PH, United Kingdom
| | - Celia Muñoz
- Centre for Research in Health and Economics, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain
| | - Silvia M A A Evers
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, The Netherlands
| | - Hein de Vries
- Caphri School of Public Health and Primary Care, Health Promotion, Maastricht University, POB 616, 6200, MD, Maastricht, The Netherlands
| | - Subhash Pokhrel
- Health Economics Research Group, Brunel University London, Uxbridge, UB8 3PH, United Kingdom
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Muñoz C, Trapero-Bertran M, Cheung KL, Evers S, Hiligsmann M, de Vries H, López-Nicolás Á. [A return on investment tool in tobacco control: what do stakeholders think?]. Gac Sanit 2016; 30:121-5. [PMID: 26656947 DOI: 10.1016/j.gaceta.2015.10.012] [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] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The European EQUIPT study will co-create a return on investment tool in several countries, aiming to provide decision makers with information and justification on the returns that can be generated by investing in tobacco control. This study aimed to identify the needs of potential users in Spain in order to provide information on the transferability of the tool. METHODS Telephone interviews with stakeholders were conducted including questions about the implementation of the tool, intended use and tobacco control interventions. RESULTS Implementing the tool could provide added value to the information used in decision-making to advocate for cost-effective policies. The main drawback would be the training and time needed to learn how the tool works and for internal calculations. CONCLUSION Knowledge and ideas from potential users collected in this study could inform the EQUIPT Tool adaptation. Thus, stakeholders could have an instrument that assists them on making healthcare decisions.
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Affiliation(s)
- Celia Muñoz
- Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra, Barcelona, España.
| | - Marta Trapero-Bertran
- Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra, Barcelona, España
| | - Kei Long Cheung
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
| | - Silvia Evers
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
| | - Mickaël Hiligsmann
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
| | - Hein de Vries
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
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