Considering equity in priority setting using transmission models: recommendations and data needs

Objectives Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. Methods We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. Results We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. Conclusions Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies

Do we (need to) care about canopy radiation schemes in DGVMs? Caveats and potential impacts

Dynamic global vegetation models (DGVMs) are an essential part of current state-of-the-art Earth system models. In recent years, the complexity of DGVMs has increased by incorporating new important processes like, e.g., nutrient cycling and land cover dynamics, while biogeophysical processes like surface radiation have not been developed much further. Canopy radiation models are however very important for the estimation of absorption and reflected fluxes and are essential for a proper estimation of surface carbon, energy and water fluxes. The present study provides an overview of current implementations of canopy radiation schemes in a couple of state-of-the-art DGVMs and assesses their accuracy in simulating canopy absorption and reflection for a variety of different surface conditions. Systematic deviations in surface albedo and fractions of absorbed photosynthetic active radiation (faPAR) are identified and potential impacts are assessed. The results show clear deviations for both, absorbed and reflected, surface solar radiation fluxes. FaPAR is typically underestimated, which results in an underestimation of gross primary productivity (GPP) for the investigated cases. The deviation can be as large as 25% in extreme cases. Deviations in surface albedo range between −0.15 ≤ Δα ≤ 0.36, with a slight positive bias on the order of Δα ≈ 0.04. Potential radiative forcing caused by albedo deviations is estimated at −1.25 ≤ RF ≤ −0.8 (W m−2), caused by neglect of the diurnal cycle of surface albedo. The present study is the first one that provides an assessment of canopy RT schemes in different currently used DGVMs together with an assessment of the potential impact of the identified deviations. The paper illustrates that there is a general need to improve the canopy radiation schemes in DGVMs and provides different perspectives for their improvement

Preventing and responding to depression, self-harm, and suicide in older people living in long term care settings: a systematic review

Abstract Objective: The well documented demographic shift to an aging population means that more people will in future be in need of long term residential care. Previous research has reported an increased risk of mental health issues and suicidal ideation among older people living in residential care settings. However, there is little information on the actual prevalence of depression, self-harm, and suicidal behavior in this population, how it is measured and how care homes respond to these issues. Method: This systematic review of international literature addressed three research questions relating to; the prevalence of mental health problems in this population; how they are identified and; how care homes try to prevent or respond to mental health issues. Results: Findings showed higher reported rates of depression and suicidal behavior in care home residents compared to matched age groups in the community, variation in the use of standardised measures across studies and, interventions almost exclusively focused on increasing staff knowledge about mental health but with an absence of involvement of older people themselves in these programmes. Conclusion: We discuss the implications of these findings in the context of addressing mental health difficulties experienced by older people in residential care and future research in this area

John Askin Papers Volume 2: 1796-1820

Burton Historical Records, volume 2https://scholar.uwindsor.ca/swoda-windsor-region/1046/thumbnail.jp

John Askin Papers Volume 1: 1747-1795

Burton historical records, volume 1https://scholar.uwindsor.ca/swoda-windsor-region/1045/thumbnail.jp

Using stated preferences to estimate the impact and cost-effectiveness of new HIV prevention products in South Africa

This thesis aims to deepen our understanding of the impact and cost-effectiveness of new HIV prevention products in South Africa. It explores how stated preferences for products vary across groups, and uses these data to estimate their cost-effectiveness in different populations. Also, it seeks to predict how products themselves may change the economics of sex work and lead to risk compensation among female sex workers (FSWs). The validity of predicting behaviours through the use of stated preference methods is explored through a systematic review and meta-analysis. By integrating methods from the fields of health economics and infectious disease modelling, this thesis aims to give better predictions of the potential impact and cost-effectiveness of HIV prevention products. This is a paper-style thesis which incorporates seven papers and a short correspondence publication, linked by short pieces of supporting material. The thesis finds that products offering effective multipurpose protection would be cost-effective among younger female groups and FSWs. However, it predicts that products could change the economics of sex work, potentially leading to risk compensation among FSWs. A dynamic transmission model is used to show how this risk compensation could meaningfully reduce product impact. This thesis demonstrates the value of combining economic and epidemiological modelling methods to explore preventative behaviours in HIV. Further work is needed to assess the external validity of these methods

Pulmonary nodules and CT screening: the past, present and future

Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention. This review summarises and differentiates the many recent guidelines on pulmonary nodule management, discusses screening activity in other countries and exposes the present barriers to implementation in the UK

Mapping the spectrum of psychological and behavioural responses to low-dose CT lung cancer screening offered within a Lung Health Check

BACKGROUND: Research on the psychological impact of low-dose computed tomography (LDCT) lung cancer screening has typically been narrow in scope and restricted to the trial setting. OBJECTIVE: To explore the range of psychological and behavioural responses to LDCT screening offered as part of a Lung Heath Check (LHC), including lung cancer risk assessment, spirometry testing, a carbon monoxide reading and smoking cessation advice. METHODS: Semi-structured interviews were carried out with 28 current and former smokers (aged 60-75), who had undergone LDCT screening as part of a LHC appointment and mostly received an incidental or indeterminate result (n = 23). Framework analysis was used to map the spectrum of responses participants had across the LHC appointment and screening pathway, to their LDCT results and to surveillance. RESULTS: Interviewees reported a diverse range of both positive and negative psychological responses, beginning at invitation and spanning the entire LHC appointment (including spirometry) and LDCT screening pathway. Similarly, positive behavioural responses extended beyond smoking cessation to include anticipated implications for other cancer prevention and early detection behaviours, such as symptom presentation. Individual differences in responses appeared to be influenced by smoking status and LDCT result, as well as modifiable factors including perceived risk and health status, social support, competing priorities, fatalism and perceived stigma. CONCLUSIONS: The diverse ways in which participants responded to screening, both psychologically and behaviourally, should direct a broader research agenda to ensure all stages of screening delivery and communication are designed to promote well-being, motivate positive behaviour change and maximize patient benefit