Willingness to pay for policies to reduce future deaths from climate change: evidence from a British survey

Objectives: Without urgent action, climate change will put the health of future populations at risk. Policies to reduce these risks require support from today's populations; however, there are few studies assessing public support for such policies. Willingness to pay (WtP), a measure of the maximum a person is prepared to pay for a defined benefit, is widely used to assess public support for policies. We used WtP to investigate whether there is public support to reduce future health risks from climate change and if individual and contextual factors affect WtP, including perceptions of the seriousness of the impacts of climate change. Study design: A cross-sectional British survey. Methods: Questions about people's WtP for policies to reduce future climate change-related deaths and their perceptions of the seriousness of climate change impacts were included in a British survey of adults aged 16 years and over (n=1859). We used contingent valuation, a survey-based method for eliciting WtP for outcomes like health which do not have a direct market value. Results: The majority (61%) were willing to pay to reduce future increases in climate change-related deaths in Britain. Those regarding climate change impacts as not at all serious were less willing to pay than those regarding the impacts as extremely serious (OR 0.04, 95% CI 0.02-0.09). Income was also related to WtP; the highest-income group were twice as likely to be willing to pay as the lowest-income group (OR 2.14, 95% CI 1.40-3.29). Conclusions: There was public support for policies to address future health impacts of climate change; the level of support varied with people's perceptions of the seriousness of these impacts and their financial circumstances. Our study adds to evidence that health, including the health of future populations, is an outcome that people value and suggests that framing climate change around such values may help to accelerate action

The role of managed natural spaces in connecting people with urban nature : a comparison of local user, researcher, and provider views

Increasing evidence of the health and wellbeing benefits of urban natural spaces has resulted in policy goals to increase their use. Making these spaces accessible and attractive to potential users is fundamental to achieving these goals since a mismatch between design and use can mean that the potential benefits of these spaces are not fully realised. Yet there has been limited investigation of whether the ambitions of providers align with local user preferences. Using a qualitative approach, we combined interviews of providers and researchers with focus groups of local users to reflect on the provision and use of urban natural spaces in the UK, and analysed the resulting transcripts using framework analysis. Three overarching themes were identified: (i) the role of managed environments in connecting people with nature; (ii) built features as facilitators of connection with nature; and (iii) challenges to connecting with nature arising from built features and the management of natural spaces. Although there were points of agreement between the stakeholder groups, we identified some key differences. Local users expressed a preference for both wilder and more formal urban natural spaces and opposed the removal of built features significant to the local history of the area. Whilst researchers recognised these views, providers were not aware of local user preferences for wilder spaces or the extent that local users considered the local heritage and its artefacts important. Understanding these differing perspectives on local natural spaces is important for maximising the value of these spaces to provide co-benefits for the environment and health

EXPO-ENGAGE: Facilitating participation in air quality citizen science

Achieving net zero emissions targets in the UK is essential to combat the climate crisis. This will require major changes in the way that we live, so citizen support will be essential. Citizen science is one way of engaging communities with energy transitions

Older people's experiences of everyday travel in the urban environment : a thematic synthesis of qualitative studies in the United Kingdom

Compared to younger age groups, older people spend more time in their locality and rely more heavily on its pedestrian and public transport infrastructure. Qualitative studies provide unique insight into people's experiences. We conducted a qualitative evidence synthesis of United Kingdom-based studies of older people's experiences of travelling in the urban environment. We searched health, social science, age-related and transport-related databases from 1998 to 2017. Fourteen papers (from 12 studies) were included in a thematic synthesis, a three-staged process that moves iteratively between codes, descriptive themes and cross-cutting analytical themes. Emerging themes were discussed with policy advisers. Four overarching themes were identified. The first and second theme pointed to the importance of 'getting out' and of being independent travellers. The third and fourth themes highlighted how local environments and travel systems enabled (or prevented) older people from realising these valued dimensions of travel. The loss of local amenities and micro-environmental features, such as pavement quality, personal safety and aesthetic appearance, were recurrent concerns. Free modes of travel like walking and bus travel were highly valued, including the social engagement they facilitated. Our review suggests that, while its extrinsic value (reaching destinations) matters, the intrinsic value of travel matters too. The process of travel is experienced and enjoyed for its own sake, with older people describing its contribution to their wellbeing

Integrative policy development for healthier people and ecosystems : a European case analysis

There is growing evidence of the inter‐relationships between ecosystems and public health. This creates opportunities for the development of cross‐sectoral policies and interventions that provide dual benefits to public health and to the natural environment. These benefits are increasingly articulated in strategy documents at national and regional level, yet implementation of integrative policies on the ground remains limited and fragmented. Here, we use a workshop approach to identify some features of this evidence–implementation gap based on policy and practice within a number of western European countries. The driving forces behind some recent moves towards more integrative policy development and implementation show important differences between countries, reflecting the non‐linear and complex nature of the policy‐making process. We use these case studies to illustrate some of the key barriers to greater integrative policy development identified in the policy analysis literature. Specific barriers we identify include: institutional barriers; differing time perspectives in public health and ecosystem management; contrasting historical development of public health and natural environment disciplinary policy agendas; an incomplete evidence base relating investment in the natural environment to benefits for public health; a lack of appropriate outcome measures including benefit–cost trade‐offs; and finally a lack of integrative policy frameworks across the health and natural environment sectors. We also identify opportunities for greater policy integration and examples of good practice from different countries. However, we note there is no single mechanism that will deliver integrative policy for healthier people and ecosystems in all countries and situations. National governments, national public agencies, local governments, research institutions, and professional bodies all share a responsibility to identify and seize opportunities for influencing policy change, whether incremental or abrupt, to ensure that ecosystems and the health of society are managed so that the interests of future generations, as well as present generations, can be protected

Incentivando o vínculo mãe-filho em situação de prematuridade: as intervenções de enfermagem no Hospital das Clínicas de Ribeirão Preto

This study aims at describing nursing actions performed in the high-risk neonatal units at a university hospital of the University of São Paulo at Ribeirão Preto so as to favor mother-child attachment in prematurity situations. The nurse accompanies parents in their first visit, giving them support as well as information concerning the equipment surrounding the newborn and encouraging skin-to-skin contact, touching and talking. Parents' access to and staying with high-risk newborns is permanently allowed. A visiting program by grandparents and siblings of pre-term newborns was implemented, even when under intensive care, which encourages family contact. Parents participate in a support group with other parents who experienced the situation of having their pre-term children in serious conditions and hospitalized. We consider that our experience has favored the establishment of mother-child and family attachment, observing greater interaction between the family and the newborn, particular involving the mother. Greater interest in learning about care as well as satisfaction concerning the assistance received have also been expressed by families.El objetivo de este estudio es describir las acciones de enfermería realizadas en las unidades neonatales de riesgo de un hospital-escuela de la ciudad de Ribeirão Preto - USP, en el sentido de favorecer el vinculo y apego madre-hijo en situación de prematuridad. La enfermera acompaña los padres en la primera visita, procurando apoyarlos e informar sobre los equipos que cercan al recién-nacido, incentivando el contacto piel a piel, el toque y habla. El acceso y permanencia de los padres junto a los bebes de riesgo son permitidos. Implantamos un programa de visitas de los abuelos y hermanos del prematuro, aunque estén en cuidado intensivo, con el objetivo de incentivar el contacto familiar. Los padres participan en un grupo de apoyo, conjuntamente con otros padres que pasan por la experiencia de tener sus hijos prematuros en estado grave y hospitalizados. Consideramos que nuestra experiencia favoreció el establecimiento del vinculo y apego madre-hijo y familia, resultando en una mayor interacción de la familia con el bebe, en especial, de la madre, y mayor interés en el aprendizaje de sus cuidados, además de la satisfacción manifestada por la atención recibida.O objetivo deste estudo é descrever as ações da enfermagem realizadas nas unidades neonatais de risco de um hospital-escola de Ribeirão Preto-USP, no sentido de favorecer o vínculo e apego mãe-filho em situação de prematuridade. A enfermeira acompanha os pais na primeira visita, procurando apoiá-los e informando-os sobre os equipamentos que cercam o recém-nascido, incentivando o contato pele-a-pele, o toque e a fala. O acesso e permanência dos pais junto aos bebês de risco são liberados.Foi implantado programa de visitas dos avós e irmãos do prematuro aos bebês, mesmo quando em cuidado intensivo, incentivando o contato familiar. Os pais participam de um grupo de apoio, juntamente com outros pais que passam pela experiência de terem seus filhos prematuros em estado grave e hospitalizados. Consideramos que a nossa experiência tem favorecido o estabelecimento do vínculo e apego mãe-filho e família, observando-se maior interação da família com o bebê, em especial da mãe, e maior interesse no aprendizado de seus cuidados, além da satisfação manifestada pela assistência recebida

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

The genetic architecture of type 2 diabetes

The genetic architecture of common traits, including the number, frequency, and effect sizes of inherited variants that contribute to individual risk, has been long debated. Genome-wide association studies have identified scores of common variants associated with type 2 diabetes, but in aggregate, these explain only a fraction of heritability. To test the hypothesis that lower-frequency variants explain much of the remainder, the GoT2D and T2D-GENES consortia performed whole genome sequencing in 2,657 Europeans with and without diabetes, and exome sequencing in a total of 12,940 subjects from five ancestral groups. To increase statistical power, we expanded sample size via genotyping and imputation in a further 111,548 subjects. Variants associated with type 2 diabetes after sequencing were overwhelmingly common and most fell within regions previously identified by genome-wide association studies. Comprehensive enumeration of sequence variation is necessary to identify functional alleles that provide important clues to disease pathophysiology, but large-scale sequencing does not support a major role for lower-frequency variants in predisposition to type 2 diabetes

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology