Complex interventions reduce use of urgent healthcare in adults with asthma: systematic review with meta-regression.

Open access article.INTRODUCTION: Asthma accounts for considerable healthcare expenditure, a large proportion of which is attributable to use of expensive urgent healthcare. This review examines the characteristics of complex interventions that reduce urgent healthcare use in adults with asthma. METHOD: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to January 2013 were conducted. Studies were eligible for inclusion if they: i) included adults with asthma ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up. Data on participants recruited, methods, characteristics of complex interventions and the effects of the intervention on urgent healthcare use were extracted. RESULTS: 33 independent studies were identified resulting in 39 comparisons altogether. Pooled effects indicated that interventions were associated with a reduction in urgent healthcare use (OR = 0.79, 95% CI = 0.67, 0.94). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.77, 95% CI = 0.64, 0.91), skills training (OR = 0.64, 95% CI = 0.48, 0.86) and relapse prevention (OR = 0.75, 95% CI = 0.57, 0.98). In multivariate meta-regression analysis, only skills training remained significant. CONCLUSIONS: Complex interventions reduced the use of urgent healthcare in adults with asthma by 21%. Those complex interventions including skills training, education and relapse prevention may be particularly effective in reducing the use of urgent healthcare in adults with asthma.National Institute for Health Research (NIHR

Magnetic irreversibility and Verwey transition in nano-crystalline bacterial magnetite

The magnetic properties of biologically-produced magnetite nanocrystals biomineralized by four different magnetotactic bacteria were compared to those of synthetic magnetite nanocrystals and large, high quality single crystals. The magnetic feature at the Verwey temperature, $T_{V}$, was clearly seen in all nanocrystals, although its sharpness depended on the shape of individual nanoparticles and whether or not the particles were arranged in magnetosome chains. The transition was broader in the individual superparamagnetic nanoparticles for which $T_{B}<T_{V}$, where $T_{B}$ is the superparamagnetic blocking temperature. For the nanocrystals organized in chains, the effective blocking temperature $T_{B}>T_{V}$ and the Verwey transition is sharply defined. No correlation between the particle size and $T_{V}$ was found. Furthermore, measurements of $M(H,T,time)$ suggest that magnetosome chains behave as long magnetic dipoles where the local magnetic field is directed along the chain and this result confirms that time-logarithmic magnetic relaxation is due to the collective (dipolar) nature of the barrier for magnetic moment reorientation

Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis.

Published onlineJournal ArticleMeta-AnalysisResearch Support, Non-U.S. Gov'tReviewBACKGROUND: The causal association between depression, anxiety, and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) is unclear. We therefore conducted a systematic review of prospective cohort studies that measured depression, anxiety, and HRQoL in COPD. METHODS: Electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], British Nursing Index and Archive, PsycINFO and Cochrane database) were searched from inception to June 18, 2013. Studies were eligible for inclusion if they: used a nonexperimental prospective cohort design; included patients with a diagnosis of COPD confirmed by spirometry; and used validated measures of depression, anxiety, and HRQoL. Data were extracted and pooled using random effects models. RESULTS: Six studies were included in the systematic review; of these, three were included in the meta-analysis for depression and two were included for the meta-analysis for anxiety. Depression was significantly correlated with HRQoL at 1-year follow-up (pooled r=0.48, 95% confidence interval 0.37-0.57, P<0.001). Anxiety was also significantly correlated with HRQoL at 1-year follow-up (pooled r=0.36, 95% confidence interval 0.23-0.48, P<0.001). CONCLUSION: Anxiety and depression predict HRQoL in COPD. However, this longitudinal analysis does not show cause and effect relationships between depression and anxiety and future HRQoL. Future studies should identify psychological predictors of poor HRQoL in well designed prospective cohorts with a view to isolating the mediating role played by anxiety disorder and depression.NIHRUniversity of ManchesterCLAHR

Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis

Background: The causal association between depression, anxiety, and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) is unclear. We therefore conducted a systematic review of prospective cohort studies that measured depression, anxiety, and HRQoL in COPD. Methods: Electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], British Nursing Index and Archive, PsycINFO and Cochrane database) were searched from inception to June 18, 2013. Studies were eligible for inclusion if they: used a nonexperimental prospective cohort design; included patients with a diagnosis of COPD confirmed by spirometry; and used validated measures of depression, anxiety, and HRQoL. Data were extracted and pooled using random effects models. Results: Six studies were included in the systematic review; of these, three were included in the meta-analysis for depression and two were included for the meta-analysis for anxiety. Depression was significantly correlated with HRQoL at 1-year follow-up (pooled r=0.48, 95% confidence interval 0.37–0.57, P<0.001). Anxiety was also significantly correlated with HRQoL at 1-year follow-up (pooled r=0.36, 95% confidence interval 0.23–0.48, P<0.001). Conclusion: Anxiety and depression predict HRQoL in COPD. However, this longitudinal analysis does not show cause and effect relationships between depression and anxiety and future HRQoL. Future studies should identify psychological predictors of poor HRQoL in well designed prospective cohorts with a view to isolating the mediating role played by anxiety disorder and depressio

Does anxiety predict the use of urgent care by people with long term conditions? A systematic review with meta-analysis

Objective: The role of anxiety in the use of urgent care in people with long term conditions is not fully understood. A systematic review was conducted with meta-analysis to examine the relationship between anxiety and future use of urgent healthcare among individuals with one of four long term conditions: diabetes; coronary heart disease, chronic obstructive pulmonary disease and asthma. Methods: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library were conducted These searches were supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts within the field about relevant studies. Studies were eligible for inclusion if they: a) used a standardised measure of anxiety, b) used prospective cohort design, c) included adult patients diagnosed with coronary heart disease (CHD), asthma, diabetes or chronic obstructive pulmonary disease (COPD), d) assessed urgent healthcare use prospectively. Data regarding participants, methodology, and association between anxiety and urgent care use was extracted from studies eligible for inclusion. Odds ratios were calculated for each study and pooled using random effects models. Results: 8 independent studies were identified for inclusion in the meta-analysis, with a total of 28,823 individual patients. Pooled effects indicate that anxiety is not associated with an increase in the use of urgent care (OR. =. 1.078, p. =. 0.476), regardless of the type of service, or type of medical condition. Conclusions: Anxiety is not associated with increased use of urgent care. This finding is in contrast to similar studies which have investigated the role of depression as a risk factor for use of urgent care.This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0707-10162)

Vegetation and peat characteristics of restiad bogs on Chatham Island (Rekohu), New Zealand

Restiad bogs dominated by Sporadanthus traversii on Chatham Island, New Zealand, were sampled to correlate vegetation patterns and peat properties, and to compare with restiad systems dominated by Sporadanthus ferrugineus and Empodisma minus in the Waikato region, North Island, New Zealand. Classification and ordination resulted in five groups that reflected a disturbance gradient. The largest S. traversii group, which comprised plots from central, relatively intact bogs, had the lowest levels of total nitrogen (mean 1.20 mg cm-3), total phosphorus (mean 0.057 mg cm-3), total potassium (mean 0.083 mg cm-3), and available phosphorus (mean 18.6 μg cm-3). Modification by drainage, stock, and fires resulted in a decline of S. traversii and an increase of Gleichenia dicarpa fern cover, together with elevated peat nutrient levels and higher bulk density. Compared with peat dominated by Sporadanthus ferrugineus or Empodisma minus in relatively unmodified Waikato restiad bogs, Chatham Island peat under S. traversii has significantly higher total potassium, total nitrogen, available phosphorus, bulk density, and von Post decomposition indices, and significantly lower pH. Sporadanthus traversii and Empodisma minus have similar ecological roles in restiad bog development, occupying a relatively wide nutrient range, and regenerating readily from seed after fire. Despite differences in root morphology, S. traversii and E. minus are the major peat formers in raised restiad bogs on Chatham Island and in Waikato, respectively, and could be regarded as ecological equivalents

Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol

Introduction Medically unexplained symptoms (MUS) are common in primary-care and secondary-care settings. Persistent symptoms of MUS are associated with a variety of poor outcomes including increased disability, poor quality of life and high healthcare costs. The aim of this systematic review is to review the relevant literature to determine the prevalence of MUS in patients who are high users of healthcare and/or who accrue high healthcare costs. Methods and analysis This review will include studies with cases that are either high users of general healthcare or are patients who accrue high healthcare costs, aged ≥18 years and where a recognised measure of MUS, either a standardised clinical interview or questionnaire, was employed. The following citation databases MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and the Cochrane library will be systematically searched from inception to 30 June 2018. The Cochrane library was included because of the significant proportion of non-observational studies currently published in the database. The prevalence of MUS and associated disorders along with the costs or use of healthcare associated with the presence of MUS will be estimated with 95% CI. If possible, study results will be pooled into a meta-analysis. However, if heterogeneity is high, data analysis will be presented descriptively. Ethics and dissemination Ethical approval is not required for this systematic review since only data from existing studies will be used. Results of this review will be disseminated in peer-reviewed publications and at national and international conferences. PROSPERO registration number CRD4201810038

Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis

Introduction In all healthcare settings, a small proportion of patients account for a large level of healthcare use and associated high healthcare costs. Depression and anxiety are common co-morbidities in patients who are high users of care. The aims of this systematic review are to: (1) estimate the prevalence of anxiety/depression in adults who are high users of general physical healthcare services and/or who accrue high healthcare costs (2) estimate the magnitude of healthcare use associated with the presence of anxiety/depression. Methods and analysis This review will include any studies where patients are high users of primary, secondary or emergency healthcare services and/or accrue high healthcare costs. This is the first systematic review to focus on patients who are over the age of 18, whose degree of anxiety/depression has been evaluated with a standardised questionnaire or by a clinical interview generating a diagnosis according to international diagnostic criteria. The review will include eligible studies indexed in Medline, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, Prospective Register of Systematic Reviews, Cochrane Library from inception to 1 April 2019. We will estimate the prevalence of anxiety/depression in these populations and the magnitude of use associated with anxiety/depression across various general physical healthcare settings. We will provide a narrative description of findings and factors that may influence them. A meta-analysis may be pursued if the degree of heterogeneity across studies is acceptable. Ethics and dissemination This systematic review will use data from existing studies, hence no ethical approvals are required. Findings will be disseminated in a peer-reviewed publication and at relevant academic meetings. PROSPERO registration number PROSPERO CRD42018102628

Spectroscopic determination of hole density in the ferromagnetic semiconductor Ga1−x_{1-x}Mnx_{x}As

The measurement of the hole density in the ferromagnetic semiconductor Ga$_{1-x}$Mn$_{x}$As is notoriously difficult using standard transport techniques due to the dominance of the anomalous Hall effect. Here, we report the first spectroscopic measurement of the hole density in four Ga$_{1-x}$Mn$_{x}$As samples ($x=0, 0.038, 0.061, 0.083$) at room temperature using Raman scattering intensity analysis of the coupled plasmon-LO-phonon mode and the unscreened LO phonon. The unscreened LO phonon frequency linearly decreases as the Mn concentration increases up to 8.3%. The hole density determined from the Raman scattering shows a monotonic increase with increasing $x$ for $x\leq0.083$, exhibiting a direct correlation to the observed $T_c$. The optical technique reported here provides an unambiguous means of determining the hole density in this important new class of ``spintronic'' semiconductor materials.Comment: two-column format 5 pages, 4 figures, to appear in Physical Review

Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness

PublishedObjective More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. Method 1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. Results The number of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital; having no partner OR 1.49 (95% CI 1.04 to 2.15); having ischaemic heart disease OR 1.60 (95% CI 1.04 to 2.46); having a threatening experience OR 1.16 (95% CI 1.04 to 1.29) per experience; depression OR 1.58 (95% CI 1.04 to 2.40); emergency hospital admission in year prior to questionnaire completion OR 3.41 (95% CI (1.98 to 5.86). Conclusion To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and who have had a recent emergency hospital admission.National Institute for Health Research (NIHR