Applied public health research - falling through the cracks?

<p>Abstract</p> <p>Background</p> <p>There is a degree of dissonance between the types of evaluative research required by organisations providing or commissioning health care, those recommended by organisations developing evidence-based guidance, and those which research funding bodies are prepared to support.</p> <p>Methods</p> <p>We present a case study of efforts to establish a pragmatic but robust evaluation of local exercise referral schemes. We considered the epidemiological, ethical and practical advantages and disadvantages of a number of study designs and applied for research funding based on an uncontrolled design, outlining the difficulties of carrying out a randomised controlled trial to evaluate an existing service.</p> <p>Results</p> <p>Our proposal was praised for its relevance and clear patient outcomes, but the application was twice rejected because both funders and reviewers insisted on a randomised controlled trial design, which we had found to be impractical, unacceptable to service users and potentially unethical.</p> <p>Conclusion</p> <p>The case study highlights continuing challenges for applied public health research in the current funding climate.</p

Sinusoidal Endothelial Dysfunction Precedes Inflammation and Fibrosis in a Model of NAFLD

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Most morbidity associated with the metabolic syndrome is related to vascular complications, in which endothelial dysfunction is a major pathogenic factor. However, whether NAFLD is associated with endothelial dysfunction within the hepatic vasculature is unknown. The aims of this study were to explore, in a model of diet-induced overweight that expresses most features of the metabolic syndrome, whether early NAFLD is associated with liver endothelial dysfunction. Wistar Kyoto rats were fed a cafeteria diet (CafD; 65% of fat, mostly saturated) or a control diet (CD) for 1 month. CafD rats developed features of the metabolic syndrome (overweight, arterial hypertension, hypertryglyceridemia, hyperglucemia and insulin resistance) and liver steatosis without inflammation or fibrosis. CafD rats had a significantly higher in vivo hepatic vascular resistance than CD. In liver perfusion livers from CafD rats had an increased portal perfusion pressure and decreased endothelium-dependent vasodilation. This was associated with a decreased Akt-dependent eNOS phosphorylation and NOS activity. In summary, we demonstrate in a rat model of the metabolic syndrome that shows features of NAFLD, that liver endothelial dysfunction occurs before the development of fibrosis or inflammation

Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on existing systematic reviews

BACKGROUND: With smoking increasingly confined to lower socio-economic groups, the tobacco control community has been urged to identify which population-level tobacco control interventions work in order to help tackle smoking-related health inequalities. Systematic reviews have a crucial role to play in this task. This overview was therefore carried out in order to (i) summarise the evidence from existing systematic reviews of population-level tobacco control interventions, and (ii) assess the need for a new systematic review of primary studies, with the aim of assessing the differential effects of such interventions. METHODS: Systematic review methods were used to evaluate existing systematic reviews that assessed a population-level tobacco control intervention and which reported characteristics of included participants in terms of at least one socio-demographic or socio-economic factor. RESULTS: Nineteen systematic reviews were included. Four reviews assessed interventions aimed at the population level alone, whilst fifteen included at least one primary study that examined this type of intervention. Four reviews assessed youth access restrictions, one assessed the effects of increasing the unit price of tobacco, and six assessed smoking bans or restrictions. Of the eight remaining reviews, six assessed multi-component community based interventions, in which the population-level interventions were part of a wider tobacco control programme, and two assessed the impact of smoking bans or restrictions in reducing exposure to environmental tobacco smoke. We found tentative evidence that the effect of increasing the unit price of tobacco products may vary between ethnic and socio-economic groups, and between males and females. However, differences in the context and the results of different reviews made it difficult to draw any firm conclusions. Few identified reviews explicitly attempted to examine differences in intervention effects between socio-demographic groups. Therefore on the basis of these reviews the potential for smoking bans, and youth access restrictions to decrease social inequalities in smoking remains unknown. CONCLUSION: There is preliminary evidence that increases in the unit price of tobacco may have the potential to reduce smoking related health inequalities. There is a need for equity effects to be explicitly evaluated in future systematic reviews and in primary research assessing the effects of population tobacco control interventions

Comparing post-release survival and habitat use by captive-bred Cabot’s Tragopan (Tragopan caboti) in an experimental test of soft-release reintroduction strategies

Background: Restoring a viable population by reintroduction is the ultimate goal of a large number of ex situ conservation projects for endangered animals. However, many reintroductions fail to establish a population in the wild, partly because released animals cannot acclimate to the native environment of the release site, resulting in very low survival rates. Acclimation training is a technique to resolve this problem, although it does not have positive results in all species. We tested whether acclimation training and soft-release could improve the reintroduction success for captive-bred Cabot’s Tragopan (Tragopan caboti), an endangered pheasant in southern China. Methods: Reintroduction of captive-bred Cabot’s Tragopan was carried out in the Taoyuandong National Nature Reserve, China from 2010 to 2011. We built a soft-release enclosure for acclimation training in the typical montane habitat of this pheasant. Nine birds were acclimated to the environment of this release site in this cage for more than 50 days before release (“trained birds”), while 11 birds remained only in the cage for 3 days prior to release (“untrained birds”). Released birds were tagged with a collar radio-transmitter. Results: Post-release monitoring revealed that the survival rate of trained birds was higher than that of untrained birds after 50 days (trained: 85.7%; untrained: 20.0%). Cox regression analysis showed that there was a significant difference in the mortality rates between the trained and untrained birds. In addition, a survey of the habitat of the experimental and the control groups showed significant differences in habitat selection between the groups. Conclusion: Our study suggests that pre-release acclimatization training is an important factor that can lead to improved survival and habitat selection of captive-bred reintroduced tragopans

The origin of coarse garnet peridotites in cratonic lithosphere: New data on xenoliths from the Udachnaya kimberlite, central Siberia

We report new textural and chemical data for 10 garnet peridotite xenoliths from the Udachnaya kimberlite and examine them together with recent data on another 21 xenoliths from the 80-220 km depth range. The samples are very fresh (LOI near zero), modally homogeneous and large ( &gt; 100 g). Some coarse-grained peridotites show incipient stages of deformation with &lt; 10 % neoblasts at grain boundaries of coarse olivine. Such microstructures can only be recognized in very fresh rocks, because fine-grained interstitial olivine is strongly affected by alteration, and may have been overlooked in previous studies of altered peridotite xenoliths in the Siberian and other cratons. Some of the garnet peridotites are similar in composition to low-opx Udachnaya spinel harzburgites (previously interpreted as pristine melt extraction residues), but the majority show post-melting enrichments in Fe and Ti. The least metasomatized coarse peridotites were formed by 30-38 % of polybaric fractional melting between 7 and 4 GPa and =1-3 GPa. Our data together with experimental results suggest that garnet in these rocks, as well as in some other cratonic peridotites elsewhere, may be a residual mineral, which has survived partial melting together with olivine and opx. Many coarse and all deformed garnet peridotites from Udachnaya underwent modal metasomatism through interaction of the melting residues with Fe-, Al-, Si-, Ti-, REE-rich melts, which precipitated cpx, less commonly additional garnet. The xenoliths define a complex geotherm probably affected by thermal perturbations shortly before the intrusion of the host kimberlite magmas. The deformation in the lower lithosphere may be linked to metasomatism. © 2013 Springer-Verlag Berlin Heidelberg