The health and sport engagement (HASE) intervention and evaluation project: protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity.

INTRODUCTION: Sport is being promoted to raise population levels of physical activity for health. National sport participation policy focuses on complex community provision tailored to diverse local users. Few quality research studies exist that examine the role of community sport interventions in raising physical activity levels and no research to date has examined the costs and cost-effectiveness of such provision. This study is a protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity, the Health and Sport Engagement (HASE) project part of the national Get Healthy Get Active programme led by Sport England. METHODS AND ANALYSIS: The HASE study is a collaborative partnership between local community sport deliverers and sport and public health researchers. It involves designing, delivering and evaluating community sport interventions. The aim is to engage previously inactive people in sustained sporting activity for 1×30 min a week and to examine associated health and well-being outcomes. The study uses mixed methods. Outcomes (physical activity, health, well-being costs to individuals) will be measured by a series of self-report questionnaires and attendance data and evaluated using interrupted time series analysis controlling for a range of sociodemographic factors. Resource use will be identified and measured using diaries, interviews and records and presented alongside effectiveness data as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. A longitudinal process evaluation (focus groups, structured observations, in-depth interview methods) will examine the efficacy of the project for achieving its aim using the principles of thematic analysis. ETHICS AND DISSEMINATION: The results of this study will be disseminated through peer-reviewed publications, academic conference presentations, Sport England and national public health organisation policy conferences, and practice-based case studies. Ethical approval was obtained through Brunel University London's research ethics committee (reference number RE33-12)

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

Assessing portfolio and asset returns of some financial and non- financial companies on the Ghana stock exchange using a 3-factor model

This study on the Ghana Stock Exchange (GSE), investigated, if the overall size of the market, affects the fundamentals of the Fama French 3-Factor model, and to ascertain if the Fama French model can be used effectively to assess portfolio and assets return for companies listed on the Ghana Stock Exchange. In this paper, portfolios of assets of companies on the Ghana Stock Exchange are constructed and analyzed using the Fama-French 3-factor model. The empirical data which consists of assets of 15 companies listed on the GSE, including assets of both financial and non-financial companies for good representation of the Ghana Stock Exchange. We found that the basic principle of the model is not satisfied. This is attributed to a number of factors which include overall size of the market, volume of trade, and high leverage (more debt than equity) associated with financial firms. High debt/equity ratio is linked to high risk. Keywords: Market Capitalization, Book-to-market ratio, Portfolio, Small minus big, High minus lo

Developing a Science Gateway for Physical Activity Lifelong Modelling & Simulation

There are major health concerns that relate to the lack of physical activity in a general population. In the UK, a major study has been carried out that brought together health assessment audits across a range of health conditions influenced by physical activity (cardiovascular diseases, musculoskeletal conditions, mental health, etc.) This was used to create PALMS (Physical Activity Lifelong Modelling & Simulation). PALMS is a microsimulation that predicts the lifelong physical activity behaviour of a population taking into account individual characteristics and their effect on physical activity over time. The model produces individual and aggregated quantitative outputs for quality of life and health conditions related costs. Thus, PALMS can be used to assess the impact of physical activity on the aforementioned health conditions across the population

The economic burden of multimorbidity: Protocol for a systematic review

Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.Supporting information is available online at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0301485#sec019 .Multimorbidity, also known as multiple long-term conditions, leads to higher healthcare utilisation, including hospitalisation, readmission, and polypharmacy, as well as a financial burden to families, society, and nations. Despite some progress, the economic burden of multimorbidity remains poorly understood. This paper outlines a protocol for a systematic review that aims to identify and synthesise comprehensive evidence on the economic burden of multimorbidity, considering various definitions and measurements of multimorbidity, including their implications for future cost-of-illness analyses. The review will include studies involving people of all ages with multimorbidity without any restriction on location and setting. Cost-of-illness studies or studies that examined economic burden including model-based studies will be included, and economic evaluation studies will be excluded. Databases including Scopus (that includes PubMed/MEDLINE), Web of Science, CINAHL Plus, PsycINFO, NHS EED (including the HTA database), and the Cost-Effectiveness Analysis Registry, will be searched until March 2024. The risk of bias within included studies will be independently assessed by two authors using appropriate checklists. A narrative synthesis of the main characteristics and results, by definitions and measurements of multimorbidity, will be conducted. The total economic burden of multimorbidity will be reported as mean annual costs per patient and disaggregated based on counts of diseases, disease clusters, and weighted indices. The results of this review will provide valuable insights for researchers into the key cost components and areas that require further investigation in order to improve the rigour of future studies on the economic burden of multimorbidity. Additionally, these findings will broaden our understanding of the economic impact of multimorbidity, inform us about the costs of inaction, and guide decision-making regarding resource allocation and cost-effective interventions. The systematic review’s results will be submitted to a peer-reviewed journal, presented at conferences, and shared via an online webinar for discussion.The author(s) received no specific funding for this work. This study is part of the first author's PhD project and that the first author is sponsored by the Department of Health Sciences at Brunel University London

Health State Utility Values Among Children and Adolescents with Disabilities: Protocol for a Systematic Review

Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. INTRODUCTION: Increasingly, assessment of healthcare technologies and interventions requires the assessment of both costs and utilities. Health state utility values (HSUVs) are measured using a range of generic and condition-specific measures. While reviews have identified that generic measures of HSUVs may lack validity in adults with conditions that result in physical disability, there is little information available on the methods used to obtain HSUVs in children and adolescents with disabilities. The objectives of this systematic review are to describe the methods used to obtain HSUVs, including mode of administration and psychometric properties, and provide summary statistics for HSUVs among children and adolescents with disabilities. METHODS AND ANALYSIS: The following databases will be searched from inception for English-language studies of any design: PubMed, PsychInfo, Medline, Scopus, CINAHL Plus, Econlit and EMBASE databases. Two reviewers will independently screen titles, abstracts and full text articles for studies reporting HSUVs and/or data on the psychometric properties of preference-based measures for children and adolescents with disabilities aged up to 19 years. Two reviewers will independently extract data items including descriptors of the study methods and sample, instruments used to capture HSUVs, summary statistics for HSUVs and items relating to the quality of reporting. A descriptive summary of results from included studies and summary statistics for HSUVs will be presented. If sufficient data is identified, we will pool summary statistics for HSUVs according to the method used to obtain the HSUV using a random effects model. In addition, we will explore the determinants of the HSUVs using a meta-regression. ETHICS AND DISSEMINATION: Ethical approval will not be required as no original data will be collected as part of this review. The completed review will be submitted for publication in a peer-reviewed journal and presentation at conferences.Research Catalyst Award from the Institute of Environment, Health and Societies, Brunel University London

Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer- reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.Correction notice This article has been corrected since it was first published online. The corresponding author has been updated to Nana Anokye and the licence has been updated to CC- BY.Copyright © Author(s) (or their employer(s)) 2022. To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer- reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise

Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis

This is an open access article - Copyright @ 2011 BMJObjective: To assess the impact of exercise referral schemes on physical activity and health outcomes. Design: Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references. Study selection Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. Population: sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes. Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings. Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 08/72/01) (www.hta.ac.uk/)

Effectiveness of a population-based integrated care model in reducing hospital activity: an interrupted time series analysis

Data availability statement: Data may be obtained from a third party and are not publicly available. The NHS's data policy prevents sharing the data with anybody but the authors participating in the study. Any individual intending to access the data must first apply and be granted WSIC access.Copyright © Author(s) (or their employer(s)) 2022. Objectives First impact assessment analysis of an integrated care model (ICM) to reduce hospital activity in the London Borough of Hillingdon, UK. Methods We evaluated a population-based ICM consisting of multiple interventions based on self-management, multidisciplinary teams, case management and discharge management. The sample included 331 330 registered Hillingdon residents (at the time of data extraction) between October 2018 and July 2020. Longitudinal data was extracted from the Whole Systems Integrated Care database. Interrupted time series Poisson and Negative binomial regressions were used to examine changes in non-elective hospital admissions (NEL admissions), accident and emergency visits (A&E) and length of stay (LoS) at the hospital. Multiple imputations were used to replace missing data. Subgroup analysis of various groups with and without long-term conditions (LTC) was also conducted using the same models. Results In the whole registered population of Hillingdon at the time of data collection, gradual decline over time in NEL admissions (RR 0.91, 95% CI 0.90 to 0.92), A&E visits (RR 0.94, 95% CI 0.93 to 0.95) and LoS (RR 0.93, 95% CI 0.92 to 0.94) following an immediate increase during the first months of implementation in the three outcomes was observed. Subgroup analysis across different groups, including those with and without LTCs, showed similar effects. Sensitivity analysis did not show a notable change compared with the original analysis. Conclusion The Hillingdon ICM showed effectiveness in reducing NEL admissions, A&E visits and LoS. However, further investigations and analyses could confirm the results of this study and rule out the potential effects of some confounding events, such as the emergence of COVID-19 pandemic.Department of Health Sciences, Brunel University London

Co-Benefits of Physical Activity in LMIC

Copyright The Authors © 2021. Introduction: Nana Anokye, Brunel University London; ISPAH LMIC Research Chair of Council. Title: Setting the scene and introducing the speakers Speaker 1: Andrea Ramírez Varela, Universidad de los Andes in Colombia; Coordinator, Global Observatory for Physical Activity – GoPA! Title: COVID and Physical Activity in LMIC. Description: Andrea will reflect on data in the past year on the correlations between physical inactivity and COVID-19 outcomes and vice versa, the effects of COVID-19 on physical activity, and the wider impacts of the pandemic on physical activity. Speaker 2: Deborah Salvo, Washington University and Prarthna Mukerjee, Public Health Foundation India Title: Roll call on Sustainable Development Goals and Physical Activity. Description: This session will provide up to date evidence on the linkages, supported by science, between SDGs and PA; focussing on the portions relevant to LMICs. This will include findings on simulated gains to SDGs due to different PA promotion strategies in cities of LMIC. Presenter 3: Prarthna Mukerjee, Public Health Foundation of India, Centre for Chronic Disease Control Title: Urban Forests, Parks in Delhi enhance Physical Activity, SDGs 3, 5, 10 Presenter 4: Alejandra Jauregui, Jefa del Departamento de Actividad Física y Estilos de Vida Saludable; Centro de Invesitgación en Nurtición y Salud Title: Nexus between Obesity, Physical Activity and Diet in LMIC: The experiences in Mexico Speaker 5: Kingsley Agyemang, Brunel University London and Alejandra Jauregui, National Institute of Public Health of Mexico Title: Nexus between Obesity, Physical Activity and Diet in LMIC. Description: The speakers will present findings of recent empirical analyses using data from West Africa and Latin America. This will include an overview of the findings from the 2021 Ghana Obesity Survey, the first comprehensive survey on lifestyle behaviour in Ghana. Purpose: This symposium is organised by the LMIC Research council. The aim is to highlight the co-benefits of physical activity using evidence base in LMIC settings. The symposium will comprise three main parts; featuring research conducted in sub-Saharan Africa, Asia and the Americas