Re: The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis (Rapid Response to Hollands et al)

Hollands et al provide an important contribution to evidence on the potential impact of DNA-based disease risk information on health behaviours. Based on the findings of their systematic review and meta-analysis, the authors conclude that: “existing evidence does not support expectations that such interventions could play a major role in motivating behaviour change to improve population health (1).” However, we contend that this conclusion is premature. In particular, there has been limited population-based research using risk estimates based on multiple genomic variants, for a broad range of health behaviours, and lack of evaluation of whether the impact may be influenced by the presence of other risk factors. We also agree with other rapid responses (Hay and McBride, Janssens, Burton) that highlight other limitations of the previous studies and the need for more research to more fully assess the potential role of genomics in facilitating behaviour change

Differentiation and dynamics of competitiveness impacts from the EU ETS

We summarises the main factors that differentiate impacts of the EU ETS on profitability and market share. By examining sampling a range of sectors, we present some simple metrics and indicators to help judge the nature of potential impacts. We also consider briefly the mitigation response to these impacts by sectors, and how they may evolve over time. The broad conclusion confirms the aggregate findings presented in the existing literature - most participating sectors are likely to profit under the current ETS structure out to 2012 at the cost of a modest loss of market share, but this may not hold for individual companies and regions. The period 2008-12 can assist participating sectors to build experience and financial reserves for longer term technology investments and diversification, providing the continuation and basic principles of the EU ETS post-2012 is quickly defined and incentives are in place for sectors to pursue this.Emissions trading, industrial competitiveness, spillovers, allowance allocation, perverse incentives.

Space and Time: Wind in an Investment Planning Model

Investment planning models inform investment decisions and government policies. Current models do not capture the intermittent nature of renewable energy sources, restricting the applicability of the models for high penetrations of renewables. We provide a methodology to capture spatial variation in wind output in combination with transmission constraints. The representation of wind distributions with stochastic approaches or an extensive historic data set would exceed computational constraints for real world application. Hence we restrict the amount of input data, and use boot-strapping to illustrate the robustness of the results. For the UK power system we model wind deployment and the value of transmission capacity

Interprofessional Education in a Child Mental Healthcare Context: Children's Nursing and Clinical Psychology Students Learning Together.

Interprofessional education (IPE) is said to occur when ‘two or more professions learn with, from, and about each other to improve collaboration and the quality of care’ (Freeth et al., 2005, p. 11). Four domains are believed to be core to inter-professional education: the ethics and values for inter-professional practice; knowledge and understanding of roles and responsibilities; communication; and collaborative teamwork (DeLeon et al., 2015). All healthcare professionals share a desire to provide high quality care for patients, and in providing that care, it is essential that they work together. It is therefore imperative that training providers find ways to establish collaborative learning, ideally early on in students’ professional careers, and to demonstrate how they facilitate IPE within their curricula (Williams et al., 2017)

Trading HIV for sheep: Risky sexual behavior and the response of female sex workers to Tabaski in Senegal

We use a cohort of female sex workers (FSWs) in Senegal to show how large anticipated economic shocks lead to increased risky sexual behavior. Exploiting the exogenous timing of interviews, we study the effect of Tabaski, the most important Islamic festival celebrated in Senegal, in which most households purchase an expensive animal for sacrifice. Condom use, measured robustly via the list experiment, falls by between 27.3 percentage points (pp) (65.5%) and 43.1 pp (22.7%) in the 9 days before Tabaski, or a maximum of 49.5 pp (76%) in the 7 day period preceding Tabaski. The evidence suggests the economic pressures from Tabaski are key to driving the behavior change observed through the price premium for condomless sex. Those most exposed to the economic pressure from Tabaski were unlikely to be using condoms at all in the week before the festival. Our findings show that Tabaski leads to increased risky behaviors for FSWs, a key population at high risk of HIV infection, for at least 1 week every year and has implications for FSWs in all countries celebrating Tabaski or similar festivals. Because of the scale, frequency, and size of the behavioral response to shocks of this type, policy should be carefully designed to protect vulnerable women against anticipated shocks

Economic evaluations of psychosocial interventions in cancer: A systematic review

Objective: Although the effectiveness of many psychosocial interventions for people with cancer has been established, one barrier to implementation in routine clinical care is a lack of data on cost-effectiveness. We conducted a systematic review to assess the cost-effectiveness of psychosocial interventions for improving psychological adjustment among people with cancer. Methods: Systematic review of the literature, study appraisal, and narrative synthesis. Results: Eight studies involving 1,668 patients were identified. Four of these reported outcomes in a cost per quality adjusted life year (QALY) framework. Six studies reported psychosocial interventions to be cost-effective for improving health-related quality of life, mood, pain, distress, or fear of cancer progression, compared to usual care. Of the six psychosocial interventions identified as cost-effective, three were cognitive behavioural therapy based interventions, one was a nurse-delivered telephone follow-up plus educational group program, one was a group-based exercise and psychosocial intervention, and one was a series of 10 face-to-face or telephone-based individual support sessions delivered by a nurse. The quality of studies according to the CHEC-list criteria was good overall; however, some studies were limited by their choice of outcome measure and omission of important categories of costs. Conclusions: Several psychosocial interventions, particularly those based on cognitive behavioural therapy, have been demonstrated to represent good value for money in cancer care. Future research should include a clear definition of the economic question, inclusion of all relevant costs, and consideration of utility-based quality of life measures for QALY estimation. Systematic review registration: PROSPERO Registration Number: CRD42014006370

Economic evaluations of psychosocial interventions in cancer: A systematic review

Objective: Although the effectiveness of many psychosocial interventions for people with cancer has been established, one barrier to implementation in routine clinical care is a lack of data on cost-effectiveness. We conducted a systematic review to assess the cost-effectiveness of psychosocial interventions for improving psychological adjustment among people with cancer. Methods: Systematic review of the literature, study appraisal, and narrative synthesis. Results: Eight studies involving 1,668 patients were identified. Four of these reported outcomes in a cost per quality adjusted life year (QALY) framework. Six studies reported psychosocial interventions to be cost-effective for improving health-related quality of life, mood, pain, distress, or fear of cancer progression, compared to usual care. Of the six psychosocial interventions identified as cost-effective, three were cognitive behavioural therapy based interventions, one was a nurse-delivered telephone follow-up plus educational group program, one was a group-based exercise and psychosocial intervention, and one was a series of 10 face-to-face or telephone-based individual support sessions delivered by a nurse. The quality of studies according to the CHEC-list criteria was good overall; however, some studies were limited by their choice of outcome measure and omission of important categories of costs. Conclusions: Several psychosocial interventions, particularly those based on cognitive behavioural therapy, have been demonstrated to represent good value for money in cancer care. Future research should include a clear definition of the economic question, inclusion of all relevant costs, and consideration of utility-based quality of life measures for QALY estimation. Systematic review registration: PROSPERO Registration Number: CRD42014006370

Improving subjective perception of personal cancer risk: systematic review and meta-analysis of educational interventions for people with cancer or at high risk of cancer

BACKGROUND: Newly diagnosed patients with cancer require education about the disease, the available treatments and potential consequences of treatment. Greater understanding of cancer risk has been found to be associated with greater health-related quality of life, improved psychological adjustment and greater health-related behaviours. The aim of this sytematic review was to assess the effectiveness of educational interventions in improving subjective cancer risk perception and to appraise the quality of the studies. METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) and prospective observational studies. Eligible studies were identified via Medline, PsycINFO, AMED, CINAHL and Embase databases. After screening titles and abstracts, two reviewers independently assessed the eligibility of 206 full-text articles. RESULTS: Forty papers were included in the review; the majority of studies were conducted among breast cancer patients (n = 29) and evaluated the effect of genetic counselling on personal perceived risk (n = 25). Pooled results from RCTs (n = 12) showed that, both in the short and long term, educational interventions did not significantly influence risk perception level (standardised mean difference 0.05, 95% CI -0.24-0.34; p = 0.74) or accuracy (odds ratio = 1.96, 95% CI: 0.61-6.25; p = 0.26). Only one RCT reported a short-term difference in risk ratings (p = 0.01). Of prospective observational studies (n = 28), many did demonstrate changes in the level of perceived risk and improved risk accuracy and risk ratings in both the short and long term. However, only one (of three) observational studies reported a short-term difference in risk ratings (p < = 0.003). CONCLUSION: Further development and investigation of educational interventions using good quality, RCTs are warranted

Holographic Principle bounds on Primordial Black Hole abundances

The generalized Second Law of thermodynamics and the Holographic Principle are combined to obtain the maximum mass of black holes formed inside a static spherical box of size $R$ filled with radiation at initial temperature $T_{i}$. The final temperature after the formation of black holes is evaluated, and we show that a critical threshold exists for the radiation to be fully consumed by the process. We next argue that if some form of Holographic Principle holds, upper bounds to the mass density of PBHs formed in the early universe may be obtained. The limits are worked out for inflationary and non-inflationary cosmological models. This method is independent of the known limits based on the background fluxes (from cosmic rays, radiation and other forms of energy) and applies to potentially important epochs of PBH formation, resulting in quite strong constraints to $\Omega_{pbh}$.Comment: Latex file, 2 .ps figures. To appear in Classical and Quantum Gravit

Doctors’ recognition and management of melanoma patients’ risk: an Australian population-based study

Background Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices. Objective A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors’ knowledge of melanoma patients’ risk and to identify factors associated with better identification and clinical management. Methods Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study. This study collected data on all melanoma diagnoses notified to the state’s cancer registry during a 12-month period from 2006 to 2007, as well as questionnaire data from the doctors involved in their care. Results Three-quarters (74%) of patients had doctors who were aware of their risk factor status with respect to personal and family history of melanoma and the presence of many moles. Doctors working in general practice, skin cancer clinics and dermatology settings had better knowledge of patients’ risk factors than plastic surgeons. Doctors were 15% more likely to know the family history of younger melanoma patients (<40 years) than of those ≥80 years (95% confidence interval 4–26%). Early detection-related follow-up advice was more likely to be given to younger patients, by doctors aware of their patients’ risk status, by doctors practising in plastic surgery, dermatology and skin cancer clinic settings, and by female doctors. Conclusion Both patient-related and doctor-related factors were associated with doctors’ recognition and management of melanoma patients’ risk and could be the focus of strategies for improving care