The effectiveness of an intervention to reduce alcohol-related violence in premises licensed for the sale and on-site consumption of alcohol: a randomized controlled trial

Background and Aims: Premises licensed for the sale and consumption of alcohol can contribute to levels of assault-related injury through poor operational practices that, if addressed, could reduce violence. We tested the real-world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose. Design: A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises. Setting: All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK. Participants: A randomly selected subsample (n=600) of eligible premises (that had one or more violent incidents recorded in police-recorded crime data; n=837) were randomized into control and intervention groups. Intervention and comparator: Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow-up visits) on how risks could be addressed. Control premises received usual practice. Measurements: Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455-day period following randomization. Findings: Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention-to-treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio=1.34, 95% confidence interval=1.20–1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow-up visits). Conclusion: An Environmental Health Practitioner-led intervention in premises licensed for the sale and on-site consumption of alcohol resulted in an increase in police recorded violence

Overweight/Obesity and time preference: evidence from a survey among adults in the UK

Introduction: Overweight and obesity is a global problem incurring substantial health and economic implications. This has also been highlighted by the ongoing COVID-19 pandemic which has disproportionately affected overweight and obese individuals. Most of the interventions have concentrated on promotion of physical activities and healthy eating which may involve current sacrifices for future health gains. The purpose of this study was to explore the relationship between bodyweight and how individuals state they would trade-off immediate income for higher amounts in the future (time preference). Methods: An online survey was conducted targeting adults aged >16 years in the UK (England, Northern Ireland, Scotland, and Wales) from January 1, 2016 to July 31, 2016. Using paid online adverts, as well as personal and professional networks for distribution of links to the online survey, the questionnaire asked respondents to report socio-economic and demographic information, height, and weight and to complete a time preference exercise. Data were analysed using descriptive statistics; associations were explored between BMI and respondents’ characteristics and time preference using Spearman rank-order correlation and χ2 tests as appropriate. We adopted STROBE guidelines for the reporting of the study. Results: A total of 561 responses were analysed (female = 293, males = 268). The relationship between time preference and overweight/obesity, using BMI as the measure is highly significant (χ2 = 95.92: p < 0.001). Individuals of normal weight have low time preferences and are more likely to invest in activities in a bid to reap future health benefits. There are also significant relationships between BMI and employment status (χ2 = 37.03

Randomised controlled trial. Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis:Trial design and protocol (CONSTRUCT)

Introduction: Many patients with ulcerative colitis (UC) present with acute exacerbations needing hospital admission. Treatment includes intravenous steroids but up to 40% of patients do not respond and require emergency colectomy. Mortality following emergency colectomy has fallen, but 10% of patients still die within 3 months of surgery. Infliximab and ciclosporin, both immunosuppressive drugs, offer hope for treating steroid-resistant UC as there is evidence of their short-term effectiveness. As there is little long-term evidence, this pragmatic randomised trial, known as Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: a Trial (CONSTRUCT), aims to compare the clinical and cost-effectiveness of infliximab and ciclosporin for steroid-resistant UC. Methods and analysis: Between May 2010 and February 2013, 52 UK centres recruited 270 patients admitted with acute severe UC who failed to respond to intravenous steroids but did not need surgery. We allocated them at random in equal proportions between infliximab and ciclosporin.The primary clinical outcome measure is quality-adjusted survival, that is survival weighted by Crohn's and Colitis Questionnaire (CCQ) participants' scores, analysed by Cox regression. Secondary outcome measures include: the CCQ—an extension of the validated but community-focused UK Inflammatory Bowel Disease Questionnaire (IBDQ) to include patients with acute severe colitis and stoma; two general quality of life measures—EQ-5D and SF-12; mortality; survival weighted by EQ-5D; emergency and planned colectomies; readmissions; incidence of adverse events including malignancies, serious infections and renal disorders; disease activity; National Health Service (NHS) costs and patient-borne costs. Interviews investigate participants’ views on therapies for acute severe UC and healthcare professionals’ views on the two drugs and their administration. Ethics and dissemination: The Research Ethics Committee for Wales has given ethical approval (Ref. 08/MRE09/42); each participating Trust or Health Board has given NHS Reseach & Development approval. We plan to present trial findings at international and national conferences and publish in high-impact peer-reviewed journals.11 page(s

Linked randomised controlled trials of face-to-face and electronic brief intervention methods to prevent alcohol related harm in young people aged 14–17 years presenting to Emergency Departments (SIPS junior)

Background: Alcohol is a major global threat to public health. Although the main burden of chronic alcohol-related disease is in adults, its foundations often lie in adolescence. Alcohol consumption and related harm increase steeply from the age of 12 until 20 years. Several trials focusing upon young people have reported significant positive effects of brief interventions on a range of alcohol consumption outcomes. A recent review of reviews also suggests that electronic brief interventions (eBIs) using internet and smartphone technologies may markedly reduce alcohol consumption compared with minimal or no intervention controls. Interventions that target non-drinking youth are known to delay the onset of drinking behaviours. Web based alcohol interventions for adolescents also demonstrate significantly greater reductions in consumption and harm among ‘high-risk’ drinkers; however changes in risk status at follow-up for non-drinkers or low-risk drinkers have not been assessed in controlled trials of brief alcohol interventions

QCovSML: A reliable COVID-19 detection system using CBC biomarkers by a stacking machine learning model

The reverse transcription-polymerase chain reaction (RT-PCR) test is considered the current gold standard for the detection of coronavirus disease (COVID-19), although it suffers from some shortcomings, namely comparatively longer turnaround time, higher false-negative rates around 20–25%, and higher cost equipment. Therefore, finding an efficient, robust, accurate, and widely available, and accessible alternative to RT-PCR for COVID-19 diagnosis is a matter of utmost importance. This study proposes a complete blood count (CBC) biomarkers-based COVID-19 detection system using a stacking machine learning (SML) model, which could be a fast and less expensive alternative. This study used seven different publicly available datasets, where the largest one consisting of fifteen CBC biomarkers collected from 1624 patients (52% COVID-19 positive) admitted at San Raphael Hospital, Italy from February to May 2020 was used to train and validate the proposed model. White blood cell count, monocytes (%), lymphocyte (%), and age parameters collected from the patients during hospital admission were found to be important biomarkers for COVID-19 disease prediction using five different feature selection techniques. Our stacking model produced the best performance with weighted precision, sensitivity, specificity, overall accuracy, and F1-score of 91.44%, 91.44%, 91.44%, 91.45%, and 91.45%, respectively. The stacking machine learning model improved the performance in comparison to other state-of-the-art machine learning classifiers. Finally, a nomogram-based scoring system (QCovSML) was constructed using this stacking approach to predict the COVID-19 patients. The cut-off value of the QCovSML system for classifying COVID-19 and Non-COVID patients was 4.8. Six datasets from three different countries were used to externally validate the proposed model to evaluate its generalizability and robustness. The nomogram demonstrated good calibration and discrimination with the area under the curve (AUC) of 0.961 for the internal cohort and average AUC of 0.967 for all external validation cohort, respectively. The external validation shows an average weighted precision, sensitivity, F1-score, specificity, and overall accuracy of 92.02%, 95.59%, 93.73%, 90.54%, and 93.34%, respectively

Socio-economic drivers of specialist anglers targeting the non-native European catfish (Silurus glanis) in the UK.

Information about the socioeconomic drivers of Silurus glanis anglers in the UK were collected using questionnaires from a cross section of mixed cyprinid fisheries to elucidate human dimensions in angling and non-native fisheries management. Respondents were predominantly male (95%), 30-40 years of age with £500 per annum. The proportion of time spent angling for S. glanis was significantly related to angler motivations; fish size, challenge in catch, tranquil natural surroundings, escape from daily stress and to be alone were considered important drivers of increased time spent angling. Overall, poor awareness of: the risks and adverse ecological impacts associated with introduced S. glanis, non-native fisheries legislation, problems in use of unlimited ground bait and high fish stocking rates in angling lakes were evident, possibly related to inadequate training and information provided by angling organisations to anglers, as many stated that they were insufficiently informed

Opportunistic screening for alcohol use problems in adolescents attending emergency departments: an evaluation of screening tools

Objective To estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England. Design Opportunistic cross-sectional survey. Setting 10 emergency departments across England. Participants Adolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013. Measures Scores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID. Findings AUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%). Conclusions The 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence

Utilisation of healthcare services for respiratory tract infections in patients with and without diabetes in Qatar: a cross-sectional study

Objective People with diabetes mellitus have a high risk of acquiring respiratory tract infections (RTIs), yet little is known about their utilisation of healthcare services compared with people without diabetes. This study aimed to compare the utilisation of healthcare services for RTIs between individuals with and without diabetes attending primary healthcare centres (PHCCs) in Qatar.Design A retrospective cross-sectional study was conducted using an electronic database of all individuals who had a diagnosis of RTI.Setting PHCCs in Qatar from July 2015 to December 2017.Participants Participants in the study were all adult individuals (aged ≥18 years) who visited the primary healthcare facilities and were diagnosed with an RTI during the study period.Primary and outcome measures For each participant, visits to the healthcare facility, antibiotic use and use of other medications were extracted from the electronic database and compared between participants with and without a diabetes diagnosis.Results A total of 32 857 participants were included, of whom 7407 (22.5%) had a diabetes diagnosis. Results from a negative binomial regression indicate that diabetes diagnosis was significantly associated with increased visits to the healthcare facility (incidence rate ratio (IRR) 1.10, 95% CI 1.076 to 1.134, p&lt;0.001), antibiotic use (IRR 1.09, 95% CI 1.046 to 1.145, p&lt;0.001) and use of other medications (IRR 1.11, 95% CI 1.078 to 1.143, p&lt;0.001).Conclusions A diabetes diagnosis among patients with RTI was associated with higher utilisation of healthcare services. Given the added costs to the healthcare system, prevention of diabetes will have additional benefits to the healthcare system, apart from diabetes-associated costs alone

Artificial neural network metamodel for sensitivity analysis in a total hip replacement health economic model.

: Metamodels have been used to approximate complex simulations and have many applications with sensitivity analysis, optimization, etc. However, their use in health economics is very limited. Application of artificial neural network (ANN) with a health economic model has never been investigated. The study intends to introduce ANN as a metamodeling method to conduct sensitivity analysis in a total hip replacement decision analytical model and compare its performance with two other counterparts. : First, a nonlinear factor screening method was adopted to screen out unimportant factors from the simulation. Second, an ANN was developed using the important variables to approximate the simulation. Performance of the ANN metamodel was then compared with its Gaussian Process (GP) and multiple linear regression (MLR) counterparts. : Out of 31, the factor screening method identified 12 important variables from the simulation. ANN metamodels showed best predictive capabilities in terms of performance measures (mean squared error of prediction, MSEP and mean absolute percentage deviation, MAPD) used for predicting both costs and quality-adjusted life years (QALYs) for two prostheses. : The study provides a methodological development in sensitivity analysis and demonstrates that an ANN metamodel is a potential approximation method for computationally expensive health economic simulations

Utilisation of healthcare services for respiratory tract infections in patients with and without diabetes in Qatar: a cross-sectional study

People with diabetes mellitus have a high risk of acquiring respiratory tract infections (RTIs), yet little is known about their utilisation of healthcare services compared with people without diabetes. This study aimed to compare the utilisation of healthcare services for RTIs between individuals with and without diabetes attending primary healthcare centres (PHCCs) in Qatar. A retrospective cross-sectional study was conducted using an electronic database of all individuals who had a diagnosis of RTI. PHCCs in Qatar from July 2015 to December 2017. Participants in the study were all adult individuals (aged ≥18 years) who visited the primary healthcare facilities and were diagnosed with an RTI during the study period. For each participant, visits to the healthcare facility, antibiotic use and use of other medications were extracted from the electronic database and compared between participants with and without a diabetes diagnosis. A total of 32 857 participants were included, of whom 7407 (22.5%) had a diabetes diagnosis. Results from a negative binomial regression indicate that diabetes diagnosis was significantly associated with increased visits to the healthcare facility (incidence rate ratio (IRR) 1.10, 95% CI 1.076 to 1.134, p<0.001), antibiotic use (IRR 1.09, 95% CI 1.046 to 1.145, p<0.001) and use of other medications (IRR 1.11, 95% CI 1.078 to 1.143, p<0.001). A diabetes diagnosis among patients with RTI was associated with higher utilisation of healthcare services. Given the added costs to the healthcare system, prevention of diabetes will have additional benefits to the healthcare system, apart from diabetes-associated costs alone