Applying economic evaluation to public health interventions: The case of interventions to promote physical activity

Copyright @ 2012 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: This paper explores the application of alternative approaches to economic evaluation of public health interventions, using a worked example of exercise referral schemes (ERSs). METHODS: Cost-utility (CUA) and cost-consequence analyses (CCA) were used to assess the cost-effectiveness of ERSs. For the CUA, evidence was synthesized using a decision analytic model that adopts a lifetime horizon and NHS/Personal Social Services perspective. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). CCA was conducted from a partial-societal perspective, including health and non-healthcare costs and benefits. Outcomes were reported in natural units, such as cases of strokes or CHD avoided. RESULTS: Compared with usual care, the incremental cost per QALY of ERS is £20 876. Based on a cohort of 100 000 individuals, CCA estimates cost of ERS at £22 million to the healthcare provider and £12 million to participants. The benefits of ERS include additional 3900 people becoming physically active, 51 cases of CHD avoided, 16 cases of stroke avoided, 86 cases of diabetes avoided and a gain of ∼800 QALYs. CONCLUSIONS: CCA might provide greater transparency than CUA in reporting the outcomes of public health interventions and have greater resonance with stakeholders involved in commissioning these interventions.This work was supported by the NIHR Health Technology Assessment programme (project number 08/72/01). This article is made available through the Brunel Open Access Publishing Fund

Sensitive Coverage Saves Lives: Improving media portrayal of suicidal behaviour

The report outlines the results of consultations with journalists, suicide prevention agencies and mental health groups conducted by the journalism ethics charity MediaWise. It makes recommendations for action by media organisations and suicide prevention agencies

Snca and Bdnf gene expression in the VTA and raphe nuclei of midbrain in chronically victorious and defeated male mice

The study aimed to analyze the mRNA levels of Snca and Bdnf genes in the ventral tegmental area (VTA) and raphe nuclei of the midbrain in male mice that had each won or defeated 20 encounters in daily agonistic interactions. Groups of animals that had the same winning and losing track record followed by a no-fight period for 14 days were also studied. Snca mRNA levels were increased in the raphe nuclei in the losers and in the VTA of the winners. After fighting deprivation Snca mRNA levels were decreased to the control level in both groups. Snca mRNA levels were similar to the control level in the VTA of the losers and in the raphe nuclei of the winners. However Snca gene expression was increased in these areas after no-fight period in the winners and losers in comparison with respective mRNA levels in the undeprived animals. Significant positive correlations were found between the mRNA levels of Snca and Bdnf genes in the raphe nuclei. It was concluded, that social experience affects Snca gene expression depending on brain areas and functional activity of monoaminergic systems in chronically victorious or defeated mice

Late-onset bloodstream infection and perturbed maturation of the gastrointestinal microbiota in premature infants

Late-onset bloodstream infection (LO-BSI) is a common complication of prematurity, and lack of timely diagnosis and treatment can have life-threatening consequences. We sought to identify clinical characteristics and microbial signatures in the gastrointestinal microbiota preceding diagnosis of LO-BSI in premature infants.Daily faecal samples and clinical data were collected over two years from 369 premature neonates (<32 weeks gestation). We analysed samples from 22 neonates who developed LO-BSI and 44 matched control infants. Next-generation sequencing of 16S rRNA gene regions amplified by PCR from total faecal DNA was used to characterise the microbiota of faecal samples preceding diagnosis from infants with LO-BSI and controls. Culture of selected samples was undertaken, and bacterial isolates identified using MALDI-TOF. Antibiograms from bloodstream and faecal isolates were compared to explore strain similarity.From the week prior to diagnosis, infants with LO-BSI had higher proportions of faecal aerobes/facultative anaerobes compared to controls. Risk factors for LO-BSI were identified by multivariate analysis. Enterobacteriaceal sepsis was associated with antecedent multiple lines, low birth weight and a faecal microbiota with prominent Enterobacteriaceae. Staphylococcal sepsis was associated with Staphylococcus OTU faecal over-abundance, and the number of days prior to diagnosis of mechanical ventilation and of the presence of centrally-placed lines. In 12 cases, the antibiogram of the bloodstream isolate matched that of a component of the faecal microbiota in the sample collected closest to diagnosis.The gastrointestinal tract is an important reservoir for LO-BSI organisms, pathogens translocating across the epithelial barrier. LO-BSI is associated with an aberrant microbiota, with abundant staphylococci and Enterobacteriaceae and a failure to mature towards predominance of obligate anaerobes

Effect of Hydrophobic Polymer Application and Irrigation Rates on Yield of Field Grown Okra

Improving irrigation efficiency is of great importance in conserving water resources of arid countries. The effect of a hydrophobic polymer (called Guilspare) to improve yields and water use efficiencies of okra (Adelmoschus esculentus) plants was investigated using a 3x3 Latin Square field experiment. Soils were treated with Guilspare by spraying the surface with an aqueous solution and left to dry. Yields of okra, planted in April and October, were assessed from plots receiving two rates of Guilspare application against an untreated control. Each column within the design received irrigation water at separate rates. Yields and water use efficiencies were generally higher, and a higher proportion of the total yield was harvested earlier, from Guilspare treated than untreated plots. Comparisons of yields from treated plots receiving lowest irrigation rates and untreated plots receiving the highest irrigation rate, suggested that similar yields can be obtained by using the polymer with, approximately, 25% and 50% less water in summer and in winter, respectively

Effects of atmospheric pressure plasma on dye uptake by the surface of wool

A woven pure wool fabric has been exposed to atmospheric pressure plasma for 30 seconds using a pilot-scale. commercial machine. X-ray photoelectron spectral data revealed large increases in oxygen and nitrogen. and a large reduction in carbon. on the surfaces of the plasma-treated fibres. A CIN ratio of 3.55 for plasma-treated wool was consistent with removal of the covalently-bound fatty acids from the surface of the cuticle cells. resulting in exposure of the proteinaceous epicuticle. Dye staining experiments revealed that the back of the fabric had received the same, uniform level of treatment as the face, despite the fact that only the face had been directly exposed to the plasma. Dyes (1 % oww) were applied to fabric at 50&deg;C (liquor ratio =40: 1) and pH values from 3 to 6. The relatively low temperature of 50&deg;C was selected in order to accentuate the effects of plasma on the rate of dye uptake. Under these conditions, dye was adsOibed onto the fibre surfaces, with very little penetration into the fibres. Effects of the plasma treatment on the rate of dyes adsorption were dyespecific. No significant effects of plasma on the rate of dye uptake were observed with relatively hydrophobic dyes, but hydrophilic dyes were adsorbed more rapidly by the plasmatreated fabric. It would appear that for more hydrophobic dyes, hydrophobic effects are more important for the adsorption of dyes by the plasma-treated fibres, even though these fibres were quite hydrophilic. On the other hand. it is concluded that for more hydrophilic dyes, electrostatic effects are more important for adsorption by the plasma-treated fibre.<br /

Discriminating Between Coherent and Incoherent Light with Metasurfaces

Metasurfaces represent a powerful paradigm of optical engineering that enables one to control the flow of light across material interfaces. We report on a discovery that metallic metasurfaces of a certain type respond differently to spatially coherent and incoherent light, enabling robust speckle-free discrimination between different degrees of coherence. The effect has no direct analogue in conventional optics and may find applications in compact metadevices enhancing imaging, vision, detection, communication and metrology.Comment: 11 pages, 5 figure