Healthcare utilisation in overweight and obese children: a systematic review and meta-analysis

Objective: This systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood. Data sources: PubMed, MEDLINE, CINAHL, EMBASE and Web of Science. Methods: Observational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies. Outcome measures: Included studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay. Results: Thirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children. Conclusions: Obesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity. PROSPERO registration number: CRD4201809175

Patients' beliefs towards contingency management: target behaviours, incentives and the remote application of these interventions

Abstract: Introduction: Contingency management interventions are among the most efficacious psychosocial interventions in promoting abstinence from smoking, alcohol and substance use. The aim of this study was to assess the beliefs and objections towards contingency management among patients in UK‐based drug and alcohol services to help understand barriers to uptake and support the development and implementation of these interventions. Methods: The Service User Survey of Incentives was developed and implemented among patients (N = 181) at three UK‐based drug and alcohol treatment services. Descriptive analyses were conducted to ascertain positive and negative beliefs about contingency management, acceptability of different target behaviours, incentives and delivery mechanisms including delivering incentives remotely using technology devices such as mobile telephones. Results: Overall, 81% of participants were in favour of incentive programs, with more than 70% of respondents agreeing with the majority of positive belief statements. With the exception of two survey items, less than a third of participants agreed with negative belief statements. The proportion of participants indicating a neutral response was higher for negative statements (27%) indicating greater levels of ambiguity towards objections and concerns regarding contingency management. Discussion and Conclusions: Positive beliefs towards contingency management interventions were found, including high levels of acceptability towards a range of target behaviours, incentives and the use of technology devices to remotely monitor behaviour and deliver incentives. These findings have implications for the development and implementation of remote contingency management interventions within the UK drug treatment services

Contingency management for tobacco smoking during opioid addiction treatment: Implementation challenges

Introduction and Aims Tobacco smoking prevalence in opioid addiction patients is approximately six times that of the general population, highlighting the need for novel interventions. A pilot/feasibility study was conducted to investigate whether a contingency management (CM) intervention could be added to UK standard smoking cessation treatment. The aim of this report is to describe the challenges experienced during the implementation of this CM intervention. Design and Methods A two‐armed, randomised, pilot/feasibility study of a 5‐week escalating with reset CM intervention, conducted as an adjunct to smoking cessation treatment in an outpatient drug and alcohol treatment centre. Results Forty participants were recruited, but only 19 attended the baseline session. Ten participants attended all treatment sessions (25% retention), with only one contactable at 6‐month follow‐up. While smoking cessation clinic engagement was higher than previously, implementation issues included limited operating hours of the smoking treatment clinic, ineffective biochemical verification of abstinence and overly restrictive inclusion criteria. Discussion and Conclusions This study highlighted not only the difficulty of integrating CM interventions into standard smoking cessation treatment for this population, but also the potential of CM to engage this group with smoking cessation treatment. Future research in this area should consider increasing the availability and flexibility of smoking cessation treatment, and relaxing inclusion criteria to be more reflective of the opioid‐treatment‐seeking population. This study is registered on ClinicalTrials.gov (NCT03015597, https://clinicaltrials.gov/ct2/show/NCT03015597)

Initial sequencing and analysis of the human genome.

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence