45 research outputs found
Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries:a qualitative case study
INTRODUCTION: Tobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs. METHODS: A qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method. RESULTS: In practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making. CONCLUSION: The scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs
Towards optimum smoking cessation interventions during pregnancy: a household model to explore costâeffectiveness
BACKGROUND AND AIMS: Previous economic evaluations of smoking cessation interventions for pregnant women are limited to single components, which do not in isolation offer sufficient potential impact to address smoking cessation targets. To inform the development of more appropriate complex interventions, we (1) describe the development of the Economics of Smoking in Pregnancy: Household (ESIP.H) model for estimating the lifeâtime costâeffectiveness of smoking cessation interventions aimed at pregnant women and (2) use a hypothetical case study to demonstrate how ESIP.H can be used to identify the characteristics of optimum smoking cessation interventions. METHODS: The hypothetical intervention was based on current evidence relating to component elements, including financial incentives, partner smoking, intensive behaviour change support, cigarettes consumption and duration of support to 12âmonths postâpartum. ESIP.H was developed to assess the lifeâtime health and cost impacts of multiâcomponent interventions compared with standard National Health Service (NHS) care in England. ESIP.H considers cigarette consumption, partner smoking and some health conditions (e.g. obesity) that were not included in previous models. The Markov model's parameters were estimated based on published literature, expert judgement and evidenceâbased assumptions. The hypothetical intervention was evaluated from an NHS perspective. RESULTS: The hypothetical intervention was associated with an incremental gain in quitters (mother and partner) at 12âmonths postpartum of 249 [95% confidence interval (CI)â=â195â304] per 1000 pregnant smokers. Over the longâterm, it had an incremental negative cost of ÂŁ193 (CIâ=ââÂŁ779 to 344) and it improved health, with a 0.50 (CIâ=â0.36â0.69) increase in qualityâadjusted life years (QALYs) for mothers, partners and offspring, with a 100% probability of being costâeffective. CONCLUSIONS: The Economics of Smoking in Pregnancy: Household model for estimating costâeffectiveness of smoking cessation interventions aimed at pregnant women found that a hypothetical smoking cessation intervention would greatly extend reach, reduce smoking and be costâeffective
What effect have NHS commissionersâ policies for body mass index had on access to knee replacement surgery in England?:An interrupted time series analysis from the National Joint Registry
ObjectiveTo assess the impact of local commissioners' policies for body mass index on access to knee replacement surgery in England.MethodsA Natural Experimental Study using interrupted time series and difference-in-differences analysis. We used National Joint Registry for England data linked to the 2015 Index of Multiple Deprivation for 481,555 patients who had primary knee replacement surgery in England between January 2009 and December 2019. Clinical Commissioning Group policies introduced before June 2018 to alter access to knee replacement for patients who were overweight or obese were considered the intervention. The main outcome measures were rate per 100,000 of primary knee replacement surgery and patient demographics (body mass index, Index of Multiple Deprivation, independently-funded surgery) over time.ResultsRates of surgery had a sustained fall after the introduction of a policy (trend change of -0.98 operations per 100,000 population aged 40+, 95% confidence interval -1.22 to -0.74, PConclusionsBody mass index policy introduction was associated with decreases in the rates of knee replacement surgery across localities that introduced policies. This affected all patient groups, not just obese patients at whom the policies were targeted. Changes in patient demographics seen after policy introduction suggest these policies may increase health inequalities and further qualitative research is needed to understand their implementation and impact
Evaluating a pre-surgical health optimisation programme: a feasibility study
BACKGROUND: Health optimisation programmes are increasingly popular and aim to support patients to lose weight or stop smoking ahead of surgery, yet there is little published evidence about their impact. This study aimed to assess the feasibility of evaluating a programme introduced by a National Health Service (NHS) clinical commissioning group offering support to smokers/obese patients in an extra 3 months prior to the elective hip/knee surgery pathway. METHODS: Feasibility study mapping routinely collected data sources, availability and completeness for 502 patients referred to the hip/knee pathway in FebruaryâJuly 2018. RESULTS: Data collation across seven sources was complex. Data completeness for smoking and ethnicity was poor. While 37% (184) of patients were eligible for health optimisation, only 28% of this comparatively deprived patient group accepted referral to the support offered. Patients who accepted referral to support and completed the programme had a larger median reduction in BMI than those who did not accept referral (â 1.8 BMI points vs. â 0.5). Forty-nine per cent of patients who accepted support were subsequently referred to surgery, compared to 61% who did not accept referral to support. CONCLUSIONS: Use of routinely collected data to evaluate health optimisation programmes is feasible though demanding. Indications of the positive effects of health optimisation interventions from this study and existing literature suggest that the challenge of programme evaluation should be prioritised; longer-term evaluation of costs and outcomes is warranted to inform health optimisation policy development. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13741-022-00255-2
Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom:a controlled interrupted time series study
OBJECTIVES: To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service. DESIGN: Controlled interrupted time series study. SETTING: Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site). PARTICIPANTS: Electronic patient records for all 58â418 attendances during the period 1âyear before and 1âyear after the intervention. INTERVENTION: Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways. OUTCOME MEASURES: Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations. RESULTS: Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%). CONCLUSIONS: The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services
Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: a cluster controlled study
YesPayment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services. Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level. The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1108, p<0001, 95% CI 1059 to 1160). Eighty-five providers held 'any qualified provider' contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings. Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services
Guillain-Barré syndrome: a century of progress
In 1916, Guillain, BarrĂ© and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts â novel findings that identified the disease we now know as GuillainâBarrĂ© syndrome (GBS). 100 years on, we have made great progress with the clinical and pathological characterization of GBS. Early clinicopathological and animal studies indicated that GBS was an immune-mediated demyelinating disorder, and that severe GBS could result in secondary axonal injury; the current treatments of plasma exchange and intravenous immunoglobulin, which were developed in the 1980s, are based on this premise. Subsequent work has, however, shown that primary axonal injury can be the underlying disease. The association of Campylobacter jejuni strains has led to confirmation that anti-ganglioside antibodies are pathogenic and that axonal GBS involves an antibody and complement-mediated disruption of nodes of Ranvier, neuromuscular junctions and other neuronal and glial membranes. Now, ongoing clinical trials of the complement inhibitor eculizumab are the first targeted immunotherapy in GBS
Protestant women in the late Soviet era: gender, authority, and dissent
At the peak of the anti-religious campaigns under Nikita Khrushchev,
communist propaganda depicted women believers as either naĂŻve
dupes, tricked by the clergy, or as depraved fanatics; the Protestant
âsektantkaâ (female sectarian) was a particularly prominent folk-devil.
In fact, as this article shows, womenâs position within Protestant
communities was far more complex than either of these mythical
figures would have one believe. The authors explore four important,
but contested, female roles: women as leaders of worship, particularly
in remote congregations where female believers vastly outnumbered
their male counterparts; women as unofficial prophetesses,
primarily within Pentecostal groups; women as mothers, replenishing
congregations through high birth rates and commitment to their
childrenâs religious upbringing; and women as political actors in the
defence of religious rights. Using a wide range of sources, which
include reports written by state officials, articles in the church journal,
letters from church members to their ecclesiastical leaders in
Moscow, samizdat texts, and oral history accounts, the authors
probe womenâs relationship with authority, in terms of both the
authority of the (male) ministry within the church, and the authority
of the Soviet state
Another Shipment of Six Short-Period Giant Planets from TESS
We present the discovery and characterization of six short-period, transiting
giant planets from NASA's Transiting Exoplanet Survey Satellite (TESS) --
TOI-1811 (TIC 376524552), TOI-2025 (TIC 394050135), TOI-2145 (TIC 88992642),
TOI-2152 (TIC 395393265), TOI-2154 (TIC 428787891), & TOI-2497 (TIC 97568467).
All six planets orbit bright host stars (8.9 <G< 11.8, 7.7 <K< 10.1). Using a
combination of time-series photometric and spectroscopic follow-up observations
from the TESS Follow-up Observing Program (TFOP) Working Group, we have
determined that the planets are Jovian-sized (R = 1.00-1.45 R),
have masses ranging from 0.92 to 5.35 M, and orbit F, G, and K stars
(4753 T 7360 K). We detect a significant orbital eccentricity
for the three longest-period systems in our sample: TOI-2025 b (P = 8.872 days,
= ), TOI-2145 b (P = 10.261 days, =
), and TOI-2497 b (P = 10.656 days, =
). TOI-2145 b and TOI-2497 b both orbit subgiant host
stars (3.8 g 4.0), but these planets show no sign of inflation
despite very high levels of irradiation. The lack of inflation may be explained
by the high mass of the planets; M (TOI-2145
b) and M (TOI-2497 b). These six new discoveries
contribute to the larger community effort to use {\it TESS} to create a
magnitude-complete, self-consistent sample of giant planets with
well-determined parameters for future detailed studies.Comment: 20 Pages, 6 Figures, 8 Tables, Accepted by MNRA