Cost-effectiveness of breast cancer screening programme for women in rural China.

In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35-64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost-effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality-adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost-effectiveness ratio (ICER) of$-916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms

"Why would you want to stand?" an account of the lived experience of employees taking part in a workplace sit-stand desk intervention

BACKGROUND: Sit-stand desk interventions have the potential to reduce workplace sedentary behaviour and improve employee health. However, the extent of sit-stand desk use varies between employees and in different organisational contexts. Framed by organisational cultural theory and product design theory, this study examined employees' lived experience of taking part in a workplace sit-stand desk intervention, to understand the processes influencing feasibility and acceptability. METHODS: Participant observations and qualitative interviews were conducted with 15 employees from two office-based workplaces in the UK, as part of a process evaluation that ran alongside a pilot RCT of a workplace sit-stand desk intervention. Observational field notes and transcripts were analysed using thematic analysis. RESULTS: Three themes related to the experience of using a sit-stand desk at work were generated: employees' relationship with their sit-stand desk; aspirations and outcomes related to employee health and productivity; and cultural norms and interpersonal relationships. The perceived usability of the desk varied depending on how employees interacted with the desk within their personal and organisational context. Employees reported that the perceived influence of the desk on their productivity levels shaped use of the desk; those who perceived that standing increased energy and alertness tended to stand more often. Sit-stand desks were voiced as being more acceptable than intervention strategies that involve leaving the desk, as productivity was conflated with being at the desk. CONCLUSIONS: The findings indicate a range of organisational, social-cultural and individual-level factors that shape the feasibility and acceptability of sit-stand desk use, and suggest strategies for improving employees' experiences of using a sit-stand desk at work, which might positively influence sedentary behaviour reduction and health. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02172599, 22nd June 2014 (prospectively registered).Macmillan Cancer Support

Sources of Terrestrial Organic Carbon in the Mississippi Plume Region: Evidence for the Importance of Coastal Marsh Inputs

High sedimentation rates along river-dominated margins make these systems important repositories for organic carbon derived from both allochthonous and autochthonous sources. Using elemental carbon/nitrogen ratios, molecular biomarker (lignin phenol), and stable carbon isotopic (bulk and compound-specific) analyses, this study examined the sources of organic carbon to the Louisiana shelf within one of the primary dispersive pathways of the Mississippi River. Surface sediment samples were collected from stations across the inner, mid, and outer Louisiana shelf, within the Mississippi River plume region, during two cruises in the spring and fall of 2000. Lignin biomarker data showed spatial patterns in terrestrial source plant materials within the river plume, such that sediments near the mouth of the Mississippi River were comparatively less degraded and richer in C 4 plant carbon than those found at mid-depth regions of the shelf. A molecular and stable isotope-based mixing model defining riverine, marsh, and marine organic carbon suggested that the highest organic carbon inputs to the shelf in spring were from marine sources (55–61% marine organic carbon), while riverine organic carbon was the highest (63%) in fall, likely due to lower inputs of marine organic carbon at this time compared with the spring season. This model also indicated that marsh inputs, ranging from 19 to 34% and 3–15% of the organic carbon in spring and fall, respectively, were significantly more important sources of organic carbon on the inner Louisiana shelf than previously suggested. Finally, we propose that the decomposition of terrestrial-derived organic carbon (from the river and local wetlands sources) in mobile muds may serve as a largely unexplored additional source of oxygen-consuming organic carbon in hypoxic bottom waters of the Louisiana shelf