Scaling up health interventions in resource-poor countries: What role does research in stated-preference framework play?

Despite improved supply of health care services in low-income countries in the recent past, their uptake continues to be lower than anticipated. This has made it difficult to scale-up those interventions which are not only cost-effective from supply perspectives but that might have substantial impacts on improving the health status of these countries. Understanding demand-side barriers is therefore critically important. With the help of a case study from Nepal, this commentary argues that more research on demand-side barriers needs to be carried out and that the stated-preference (SP) approach to such research might be helpful. Since SP techniques place service users' preferences at the centre of the analysis, and because preferences reflect individual or social welfare, SP techniques are likely to be helpful in devising policies to increase social welfare (e.g. improved service coverage). Moreover, the SP data are collected in a controlled environment which allows straightforward identification of effects (e.g. that of process attributes of care) and large quantities of relevant data can be collected at moderate cost. In addition to providing insights into current preferences, SP data also provide insights into how preferences are likely to respond to a proposed change in resource allocation (e.g. changing service delivery strategy). Finally, the SP-based techniques have been used widely in resource-rich countries and their experience can be valuable in conducting scaling-up research in low-income countries

Free Energy Calculations of Membrane Permeation: Challenges due to Strong Headgroup-Solute Interactions

Understanding how different classes of molecules move across biological membranes is a prerequisite to predicting a solute's permeation rate, which is a critical factor in the fields of drug design and pharmacology. We use biased Molecular Dynamics computer simulations to calculate and compare the free energy profiles of translocation of several small molecules across 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) lipid bilayers as a first step towards determining the most efficient method for free energy calculations. We study the translocation of arginine, a sodium ion, alanine, and a single water molecule using the Metadynamics, Umbrella Sampling, and Replica Exchange Umbrella Sampling techniques. Within the fixed lengths of our simulations, we find that all methods produce similar results for charge-neutral permeants, but not for polar or positively charged molecules. We identify the long relaxation timescale of electrostatic interactions between lipid headgroups and the solute to be the principal cause of this difference, and show that this slow process can lead to an erroneous dependence of computed free energy profiles on the initial system configuration. We demonstrate the use of committor analysis to validate the proper sampling of the presumed transition state, which in our simulations is achieved only in replica exchange calculations. Based on these results we provide some useful guidance to perform and evaluate free energy calculations of membrane permeation

Measuring the effect of opportunity cost of time on participation in sports and exercise

This article has been made available through the Brunel Open Access Publishing Fund.Background: There is limited research on the association between opportunity cost of time and sports and exercise due to lack of data on opportunity cost of time. Using a sample of 14142 adults from Health Survey for England (2006), we develop and test a composite index of op-portunity cost of time (to address the current issues with data constraint on opportunity cost of time) in order to explore the relationship between opportunity cost of time and sports participation. Methods: Probit regression models are fitted adjusting for a range of covariates. Opportunity cost of time is measured with two proxy measures: a) composite index (consisting of various indicators of wage earnings) con-structed using principal component analysis; and b) education and employment, approach in the literature. We estimate the relative impact of the composite index compared with current proxy measures, on prediction of sports participation. Findings: Findings suggest that higher opportunity cost of time is associated with increased likelihood of sports participation, regardless of the time intensity of activity or the measure of opportunity cost of time used. The relative impacts of the two proxy measures are comparable. Sports and exercise was found to be positively correlated with income. Another important positive correlate of sports and exercise is participation in voluntary activity. The research and policy implications of our findings are discussed

Physical activity in England: Who is meeting the recommended level of participation through sports and exercise?

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2012 Anokye et al.Background: Little is known about the correlates of meeting recommended levels of participation in physical activity (PA) and how this understanding informs public health policies on behaviour change. Objective: To analyse who meets the recommended level of participation in PA in males and females separately by applying ‘process’ modelling frameworks (single vs. sequential 2-step process). Methods: Using the Health Survey for England 2006, (n = 14 142; ≥16 years), gender-specific regression models were estimated using bivariate probit with selectivity correction and single probit models. A ‘sequential, 2-step process’ modelled participation and meeting the recommended level separately, whereas the ‘single process’ considered both participation and level together. Results: In females, meeting the recommended level was associated with degree holders [Marginal effect (ME) = 0.013] and age (ME = −0.001), whereas in males, age was a significant correlate (ME = −0.003 to −0.004). The order of importance of correlates was similar across genders, with ethnicity being the most important correlate in both males (ME = −0.060) and females (ME = −0.133). In females, the ‘sequential, 2-step process’ performed better (ρ = −0.364, P < 0.001) than that in males (ρ = 0.154). Conclusion: The degree to which people undertake the recommended level of PA through vigorous activity varies between males and females, and the process that best predicts such decisions, i.e. whether it is a sequential, 2-step process or a single-step choice, is also different for males and females. Understanding this should help to identify subgroups that are less likely to meet the recommended level of PA (and hence more likely to benefit from any PA promotion intervention).This study was funded by the Department of Health’s Policy Research Programme

Behaviour Change in Public Health: Evidence and Implications

Article ID 598672The evidence on the role of particular lifestyles, smoking, binge drinking, lack of physical activity, and poor health care seeking, in increased risks for mortality and morbidity is compelling [1]. Understanding the pathways through which these various “unhealthy” behaviours affect health is complicated by the broader ecological context in which they occur. The complexity is further enhanced because behaviours do not occur in isolation and there is often a convergence of associations. Interventions to achieve changes in either single or multiple behaviours have therefore often been limited in their effectiveness and longer term sustainability. In order to develop and implement a meaningful behaviour change agenda we need to establish innovative ways of operationalizing and understanding the complexity of behavioural factors and their dynamic interrelationships and how these collectively affect health. The Behaviour Change Research Cycle (BCRC) (Figure 1) provides a simple illustration of the life cycle of evidence required

What interventions increase commuter cycling? A systematic review.

OBJECTIVE: To identify interventions that will increase commuter cycling. SETTING: All settings where commuter cycling might take place. PARTICIPANTS: Adults (aged 18+) in any country. INTERVENTIONS: Individual, group or environmental interventions including policies and infrastructure. PRIMARY AND SECONDARY OUTCOME MEASURES: A wide range of 'changes in commuter cycling' indicators, including frequency of cycling, change in workforce commuting mode, change in commuting population transport mode, use of infrastructure by defined populations and population modal shift. RESULTS: 12 studies from 6 countries (6 from the UK, 2 from Australia, 1 each from Sweden, Ireland, New Zealand and the USA) met the inclusion criteria. Of those, 2 studies were randomised control trials and the remainder preintervention and postintervention studies. The majority of studies (n=7) evaluated individual-based or group-based interventions and the rest environmental interventions. Individual-based or group-based interventions in 6/7 studies were found to increase commuter cycling of which the effect was significant in only 3/6 studies. Environmental interventions, however, had small but positive effects in much larger but more difficult to define populations. Almost all studies had substantial loss to follow-up. CONCLUSIONS: Despite commuter cycling prevalence varying widely between countries, robust evidence of what interventions will increase commuter cycling in low cycling prevalence nations is sparse. Wider environmental interventions that make cycling conducive appear to reach out to hard to define but larger populations. This could mean that environmental interventions, despite their small positive effects, have greater public health significance than individual-based or group-based measures because those interventions encourage a larger number of people to integrate physical activity into their everyday lives

Sustainability and Replicability of Multiple-Use Water Systems (MUS)

The concept of multiple-use water services and systems (MUS) has received increasingattention in international water and development fora and has emerged as a promising wayto enhance the social and gender equity and productivity of water systems designed forsingle use, e.g. for irrigation or water supply. In Nepal, several MUS models have beenpiloted and implemented for more than a decade by the International DevelopmentEnterprises (iDE) and a few other development organizations. Whereas the short-termbenefits of these systems on gender relationships, women's empowerment, nutrition andhealth have been documented, the sustainability and resilience of these systems has not yetbeen analyzed. The latter is the focus of the research study presented in this report, whichwas conducted by the International Water Management Institute (IWMI) in Western Nepalas part of the USAID-funded Market Access and Water Technology for Women (MAWTW)project

Collective Gradient Sensing in Fish Schools

Throughout the animal kingdom, animals frequently benefit from living in groups. Models of collective behaviour show that simple local interactions are sufficient to generate group morphologies found in nature (swarms, flocks and mills). However, individuals also interact with the complex noisy environment in which they live. In this work, we experimentally investigate the group performance in navigating a noisy light gradient of two unrelated freshwater species: golden shiners (Notemigonuscrysoleucas) and rummy nose tetra (Hemigrammus bleheri). We find that tetras outperform shiners due to their innate individual ability to sense the environmental gradient. Using numerical simulations, we examine how group performance depends on the relative weight of social and environmental information. Our results highlight the importance of balancing of social and environmental information to promote optimal group morphologies and performance