Vasomotor symptoms resulting from natural menopause:a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause

Background: Vasomotor symptoms (VMS) are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women in the UK and are severe in 25%. Objectives: To identify which treatments are most clinically effective for the relief of VMS for non-hysterectomized women in natural menopause. Search Strategy: English publications in MEDLINE, Embase and The Cochrane Library up to 13th January 2015 were searched. Selection Criteria: Randomized trials (RCTs) of treatments for women with a uterus for the outcomes of frequency of VMS (up to 26 weeks), vaginal bleeding and discontinuation. Data Collection and Analysis: Bayesian network meta-analysis (NMA) using mean ratios (MRs) and odd ratios (ORs). Main Results: Across the three networks, 47 RCTs of 16 treatment classes (N=8326 women) were included. When compared to placebo, transdermal oestradiol and progestogen (O+P) had the highest probability of being the most effective treatment for VMS relief (69.8%) (MR: 0.23 [95%CrI (0.09, 0.57)] whereas oral O+P was ranked lower than transdermal O+P, although oral and transdermal O+P were no different for this outcome (MR: 2.23 [95%CrI (0.7, 7.1)]. Isoflavones and black cohosh were more effective than placebo, though not significantly better than O+P. Not only were SSRIs or SNRIs found ineffective in relieving VMS but they also had significantly higher odds of discontinuation than placebo. Limited data were available for bleeding therefore no conclusions could be made. Conclusions: For non-hysterectomized women, transdermal O+P was the most effective treatment for VMS relief

Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study

Background: Several countries are considering a minimum price policy for alcohol, but concerns exist about the potential effects on drinkers with low incomes. We aimed to assess the effect of a £0·45 minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions. Methods: We used the Sheffield Alcohol Policy Model (SAPM) version 2.6, a causal, deterministic, epidemiological model, to assess effects of a minimum unit price policy. SAPM accounts for alcohol purchasing and consumption preferences for population subgroups including income and socioeconomic groups. Purchasing preferences are regarded as the types and volumes of alcohol beverages, prices paid, and the balance between on-trade (eg, bars) and off-trade (eg, shops). We estimated price elasticities from 9 years of survey data and did sensitivity analyses with alternative elasticities. We assessed effects of the policy on moderate, hazardous, and harmful drinkers, split into three socioeconomic groups (living in routine or manual households, intermediate households, and managerial or professional households). We examined policy effects on alcohol consumption, spending, rates of alcohol-related health harm, and opportunity costs associated with that harm. Rates of harm and costs were estimated for a 10 year period after policy implementation. We adjusted baseline rates of mortality and morbidity to account for differential risk between socioeconomic groups. Findings: Overall, a minimum unit price of £0·45 led to an immediate reduction in consumption of 1·6% (−11·7 units per drinker per year) in our model. Moderate drinkers were least affected in terms of consumption (−3·8 units per drinker per year for the lowest income quintile vs 0·8 units increase for the highest income quintile) and spending (increase in spending of £0·04 vs £1·86 per year). The greatest behavioural changes occurred in harmful drinkers (change in consumption of −3·7% or −138·2 units per drinker per year, with a decrease in spending of £4·01), especially in the lowest income quintile (−7·6% or −299·8 units per drinker per year, with a decrease in spending of £34·63) compared with the highest income quintile (−1·0% or −34·3 units, with an increase in spending of £16·35). Estimated health benefits from the policy were also unequally distributed. Individuals in the lowest socioeconomic group (living in routine or manual worker households and comprising 41·7% of the sample population) would accrue 81·8% of reductions in premature deaths and 87·1% of gains in terms of quality-adjusted life-years. Interpretation: Irrespective of income, moderate drinkers were little affected by a minimum unit price of £0·45 in our model, with the greatest effects noted for harmful drinkers. Because harmful drinkers on low incomes purchase more alcohol at less than the minimum unit price threshold compared with other groups, they would be affected most by this policy. Large reductions in consumption in this group would however coincide with substantial health gains in terms of morbidity and mortality related to reduced alcohol consumption. Funding: UK Medical Research Council and Economic and Social Research Council (grant G1000043)

Detecting influenza and emerging avian influenza virus by influenza and pneumonia surveillance systems in a large city in China, 2005 to 2016.

BACKGROUND(#br)Detecting avian influenza virus has become an important public health strategy for controlling the emerging infectious disease.(#br)METHODS(#br)The HIS (hospital information system) modified influenza surveillance system (ISS) and a newly built pneumonia surveillance system (PSS) were used to monitor the influenza viruses in Changsha City, China. The ISS was used to monitor outpatients in two sentinel hospitals and to detect mild influenza and avian influenza cases, and PSS was used to monitor inpatients in 49 hospitals and to detect severe and death influenza cases.(#br)RESULTS(#br)From 2005 to 2016, there were 3,551,917 outpatients monitored by the ISS system, among whom 126,076 were influenza-like illness (ILI) cases, with the ILI proportion (ILI%) of 3.55%. After the HIS was used, the reported incident cases of ILI and ILI% were increased significantly. From March, 2009 to September, 2016, there were 5,491,560 inpatient cases monitored by the PSS system, among which 362,743 were pneumonia cases, with a proportion of 6.61%. Among pneumonia cases, about 10.55% (38,260/362,743) of cases were severe or death cases. The pneumonia incidence increased each year in the city. Among 15 avian influenza cases reported from January, 2005 to September, 2016, there were 26.7% (4/15) mild cases detected by the HIS-modified ISS system, while 60.0% (9/15) were severe or death cases detected by the PSS system. Two H5N1 severe cases were missed by the ISS system in January, 2009 when the PSS system was not available.(#br)CONCLUSIONS(#br)The HIS was able to improve the efficiency of the ISS for monitoring ILI and emerging avian influenza virus. However, the efficiency of the system needs to be verified in a wider area for a longer time span in China

Operation status and line optimization of Wanda Plaza Parking lot

Vehicle parking is not only an important problem in urban traffic, but also an important factor affecting the relationship between cities and within cities. In this paper, by investigating the parking conditions of Jiaozuo Wanda Plaza in 2018, important parameters such as average parking time on weekdays and holidays, berth turnover rate, parking utilization rate and centralized parking index were obtained. Based on the obtained parameters, multi-angle optimization analysis was conducted on the parking lot. In order to reduce the congestion of the entrance and exit of parking lots and improve parking efficiency, this paper adopts the method of increasing the entrance and exit of parking lots and optimizing the route. It has great reference value in practical application

Minimum unit pricing for alcohol: policy appraisal modelling of income and socioeconomic group-specific effects on consumption, spending, and health harms

Background UK legislatures are at different stages in the policy process for introducing a minimum price for alcohol. Although there is evidence about the effectiveness of such policies, political and public concern exists about the potential effects on low-income drinkers. We present appraisals of the effects of a £0·45 minimum unit price (MUP; 1 unit=8g/10mL ethanol) policy in England in 2014–15 across the income and socioeconomic distributions. Methods We undertook policy appraisals using the Sheffield Alcohol Policy Model (SAPM version 2.6), a causal, deterministic, epidemiological model. SAPM accounts for differential alcohol purchasing and consumption preferences for population subgroups defined, using self-reported survey data, by age, sex, consumption level, and income or socioeconomic group. We derived volumes purchased and prices paid for ten alcoholic beverage categories (beer, cider, wine, spirits, and ready-to-drink beverages [RTDs], purchased in the on trade [eg, bars] or off trade [eg, shops]) from household-level 2-week spending diaries. A 10 × 10 price elasticity matrix was estimated to describe the relation between price changes and purchasing changes (assumed to represent consumption changes). After a policy change, the elasticity matrix was used to adjust individual-level survey data on self-reported mean weekly and peak daily alcohol consumption. We modelled resulting effects on mortality and disease prevalence using functions relating consumption measures to risk of having 47 chronic or acute disorders wholly or partly attributable to alcohol. Baseline mortality and morbidity rates were those reported for England and Wales in 2005 by the North West Public Health Observatory. These rates are adjusted to account for socioeconomic variability in mortality and morbidity risk with Office for National Statistics socioeconomic group-specific alcohol-related mortality data for 2001–03. Findings On average, moderate drinkers purchase 36 below-MUP units per year whereas harmful drinkers in the lowest and highest income groups purchase 1610 and 712 units, respectively. The policy is estimated to have small effects on moderate drinkers' alcohol consumption (–1·6 units per drinker per year) and spending (£0·78 per year). Bigger behavioural changes are estimated to occur among harmful drinkers and these are largest in the lowest income quintile (–300 units, –£34·63) compared with the highest (–34 units, £16·35). The same pattern of results was noted in sensitivity analyses using (a) alternative elasticity matrices, and (b) population subgroups defined by socioeconomic status rather than income. A list of published sensitivity analyses undertaken with SAPM is provided in the appendix. Health benefits from the policy are also unequally distributed due to differential baseline harm risks and purchasing patterns. Lower socioeconomic groups that make up 41·7% of the population would accrue 81·8% of the reduction in deaths and 87·1% of the reduction in quality-adjusted life-years lost. Interpretation Moderate drinkers, regardless of income, are only marginally affected by the policy because it chiefly targets harmful drinkers. Because they purchase more below-MUP alcohol, low-income harmful drinkers would be affected more than those with higher incomes. Policymakers must balance low-income harmful drinkers' larger consumption reductions against their greater health gains from reduced alcohol-related morbidity and mortality. Limitations of the model include supply-side responses not being considered (eg, retailers increasing prices above the MUP threshold) and the data used for adjusting baseline health risks for socioeconomic groups only relating to mortality and not being condition specific

Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study.

Several countries are considering a minimum price policy for alcohol, but concerns exist about the potential effects on drinkers with low incomes. We aimed to assess the effect of a £0·45 minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions