Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men

<b>Background</b><p></p> Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services.<p></p> <b>Objective</b><p></p> The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by integrating the quantitative, qualitative and health economic evidence base.<p></p> <b>Data sources</b><p></p> Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database were searched from inception to January 2012, with a limited update search in July 2012. Subject-specific websites, reference lists and professional health-care and commercial organisations were also consulted.<p></p> <b>Review methods</b><p></p> Six systematic reviews were conducted to consider the clinical effectiveness, cost-effectiveness and qualitative evidence on interventions for treating obesity in men, and men in contrast to women, and the effectiveness of interventions to engage men in their weight reduction. Randomised controlled trials (RCTs) with follow-up data of at least 1 year, or any study design and length of follow-up for UK studies, were included. Qualitative and mixed-method studies linked to RCTs and non-randomised intervention studies, and UK-based, men-only qualitative studies not linked to interventions were included. One reviewer extracted data from the included studies and a second reviewer checked data for omissions or inaccuracies. Two reviewers carried out quality assessment. We undertook meta-analysis of quantitative data and a realist approach to integrating the qualitative and quantitative evidence synthesis.<p></p> <b>Results</b><p></p> From a total of 12,764 titles reviewed, 33 RCTs with 12 linked reports, 24 non-randomised reports, five economic evaluations with two linked reports, and 22 qualitative studies were included. Men were more likely than women to benefit if physical activity was part of a weight-loss programme. Reducing diets tended to produce more favourable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise programme -3.2 kg, 95% CI -4.8 kg to -1.6 kg). The type of reducing diet did not affect long-term weight loss. A reducing diet plus physical activity and behaviour change gave the most effective results. Low-fat reducing diets, some with meal replacements, combined with physical activity and behaviour change training gave the most effective long-term weight change in men [-5.2 kg (standard error 0.2 kg) after 4 years]. Such trials may prevent type 2 diabetes in men and improve erectile dysfunction. Although fewer men joined weight-loss programmes, once recruited they were less likely to drop out than women (difference 11%, 95% CI 8% to 14%). The perception of having a health problem (e.g. being defined as obese by a health professional), the impact of weight loss on health problems and desire to improve personal appearance without looking too thin were motivators for weight loss amongst men. The key components differ from those found for women, with men preferring more factual information on how to lose weight and more emphasis on physical activity programmes. Interventions delivered in social settings were preferred to those delivered in health-care settings. Group-based programmes showed benefits by facilitating support for men with similar health problems, and some individual tailoring of advice assisted weight loss in some studies. Generally, men preferred interventions that were individualised, fact-based and flexible, which used business-like language and which included simple to understand information. Preferences for men-only versus mixed-sex weight-loss group programmes were divided. In terms of context, programmes which were cited in a sporting context where participants have a strong sense of affiliation showed low drop out rates and high satisfaction. Although some men preferred weight-loss programmes delivered in an NHS context, the evidence comparing NHS and commercial programmes for men was unclear. The effect of family and friends on participants in weight-loss programmes was inconsistent in the evidence reviewed - benefits were shown in some cases, but the social role of food in maintaining relationships may also act as a barrier to weight loss. Evidence on the economics of managing obesity in men was limited and heterogeneous.<p></p> <b>Limitations</b><p></p> The main limitations were the limited quantity and quality of the evidence base and narrow outcome reporting, particularly for men from disadvantaged and minority groups. Few of the studies were undertaken in the UK.<p></p> <b>Conclusions</b><p></p> Weight reduction for men is best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques. Tailoring interventions and settings for men may enhance effectiveness, though further research is needed to better understand the influence of context and content. Future studies should include cost-effectiveness analyses in the UK setting

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms.

BackgroundDepressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.MethodsA prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation.ResultsOf the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.ConclusionsOur findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.Trial registrationClinicaltrials.gov identifier: NCT01407926

The Bellagio Global Dialogues on Intellectual Property

Reviews Rockefeller's conference series on intellectual property and its efforts to promote policies and institutional capacities that better serve the poor, with a focus on food security and public health. Discusses global policy, development, and trade

Developing the Curriculum for Collaborative Intellectual Property Education

Intellectual property education, i.e. how intellectual property should be taught or more importantly how intellectual property is learnt, is a recent addition to the academic 'intellectual property' agenda. The regulation, acquisition and management of intellectual property rights presents economic, ethical, social and policy challenges across the international academic and business communities. Intellectual property is also the starting point of interesting academic cross-disciplinary collaborations in learning and teaching and in research. It will probably always be primarily a law subject taught by lawyers to law students hoping to practice. At the same time there is a growing array of disciplines demanding an awareness of and a competence in handling intellectual property concepts and regulations. At Bournemouth, we have been teaching IP across the disciplines for more than a decade. Recently, the Higher Education Academy subject centres in Law and in Engineering jointly funded a project to research 'IP for Engineers'. WIPO has begun addressing IP Education in earnest. At an international symposium in July 2005, papers addressed different aspects of IP Education, including Collaboration between Law Faculties and other disciplines. In November 2005, they jointly sponsored a National Conference in China to consider IP Education from primary school thru postgraduate research. IP education beyond the law school raises interesting questions for anyone contemplating teaching this complex law subject to non-lawyers. What constitutes the IP syllabus? Who should be teaching IP? When should it be taught? How should it be taught? What resources should be available? This paper begins to explore some of the answers

Intellectual Property Management Strategies to Accelerate the Development and Access of Vaccines and Diagnostics: Case Studies on Pandemic Influenza, Malaria and SARS

Achieving global access to vaccines, diagnostics, and pharmaceuticals remains a challenge. Throughout the developing world, intellectual property (IP) constraints complicate access to critically essential medical technologies and products. Vaccines for malaria and pandemic strains of influenza, as well as diagnostic and vaccine technologies for SARS, are not only relevant to global public health but are particularly critical to the needs of developing countries. A global access solution is urgently needed. This article offers a timely case‐by‐case analysis of preliminary patent landscape surveys and formulates options via patent pools and other forms of creative IP management to accelerate development and access. The analysis of the feasibility of patent pools reveals several impediments to patent pools: these include antitrust considerations, bargaining difficulties caused by asymmetric interests and asymmetric rights among IP holders (e.g. improvement vs. foundational patents), and the difficulties of securing financial support given the significant transaction costs associated with pools. Because of the above conceptual and operational hurdles, patent pools do not appear to be a feasible way to accelerate development. Other mechanisms, however, can ameliorate IP constraints. For example, a key IP constraint related to pandemic influenza vaccines R&D appears to have been resolved when Medimmune secured the assembly of all relevant reverse genetics IP and pledged broad access. Clearly, the landscape is complex and multidimensional. Licensing systems are not the only issue. Measures must also be taken to limit regulatory hurdles and enable the swift, legal production of pandemic influenza vaccines to meet the needs of developing countries. This is why a comprehensive analysis is so necessary. From a strictly legal perspective, IP systems work through the power to exclude. However, as this study’s exploration and formulation of creative licensing strategies reveals, it is also true that IP can be structured and managed to work through the “power to include.

The Intersections of Biological Diversity and Cultural Diversity: Towards Integration

There is an emerging recognition that the diversity of life comprises both biological and cultural diversity. In the past, however, it has been common to make divisions between nature and culture, arising partly out of a desire to control nature. The range of interconnections between biological and cultural diversity are reflected in the growing variety of environmental sub-disciplines that have emerged. In this article, we present ideas from a number of these sub-disciplines. We investigate four bridges linking both types of diversity (beliefs and worldviews, livelihoods and practices, knowledge bases and languages, and norms and institutions), seek to determine the common drivers of loss that exist, and suggest a novel and integrative path forwards. We recommend that future policy responses should target both biological and cultural diversity in a combined approach to conservation. The degree to which biological diversity is linked to cultural diversity is only beginning to be understood. But it is precisely as our knowledge is advancing that these complex systems are under threat. While conserving nature alongside human cultures presents unique challenges, we suggest that any hope for saving biological diversity is predicated on a concomitant effort to appreciate and protect cultural diversity

Impact of infection preventionists on Centers for Medicare and Medicaid quality measures in Maryland nursing homes.

BackgroundHealth care-associated infections are the leading cause of morbidity and mortality in US nursing homes (NHs). The objective of the research is to assess the impact of Maryland NH infection preventionists (IPs) on NH quality measures.MethodsTwo hundred thirty-four NHs were queried through mailed survey. These survey data were then linked with 2008 quality data from Nursing Home Compare and the On-line Survey Certification of Automated Records.ResultsThree of the 8 quality measures examined-influenza vaccination for both short- and long-stay residents and pressure ulcer prevention in high-risk residents-were significantly associated with the number of IPs. None of the quality measures were shown to be significant with IPs who received specialized training on infection prevention and management compared with those who did not receive specialized training.ConclusionIPs play a critical role in preventing and managing health care-associated infections in nursing homes, especially in the areas of influenza vaccination and pressure ulcer prevention among high-risk nursing home residents. Quality measures that reflect the effects of IP training may not have been elucidated yet. Further research is needed to support the IP role in order for policy to advocate for increased IP funding

Costs of publicly provided maternity services in Rosario, Argentina

This material is posted here with permission of the publishers, Instituto Nacional de Salud Pública. Internal or personal use of this material is permitted. However, permission to reprint/republish this material must be obtained from the Publisher.Objective. This study estimates the costs of maternal health services in Rosario, Argentina. Material and Methods. The rovider costs (US$1999) of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. Results. The average cost per hospital day is$114.62. The average cost of a caesarean section ($525.57) is five times greater than that of a normal vaginal delivery ($105.61). A normal delivery costs less at the general hospital and a c-section less at the aternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94$4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. Conclusions. These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.Josephine Borghi is funded by the Department for International Development through the Maternal Health Programme at the London School of Hygiene and Tropical Medicine. This project was conducted for and funded by the Human Reproduction Programme at WHO, Geneva

Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

Portrait: Anatole Krattiger—Intellectual Property Management in The Global Public Interest

[Excerpt] What do cows in green Alpine landscapes have in common with IP? Not much unless you ask Dr. Krattiger. As a young farmer in his native Switzerland, and later in the South of France where he cultivated vineyards, he developed a practical approach to solving problems. During these formative years as a farmer, Dr. Krattiger particularly enjoyed tending dairy herds in the green pastures of the Swiss Alps. There he learned and practiced the art of fine cheese making: an age-old and fundamental application of traditional biotechnology. Working in sight of the sublime peaks of the Alps must have spurred his mind to lofty goals, for Dr. Krattiger has since gone on to pursue a career focused on providing developing countries with access to new agricultural and health technologies. This idealism, however, remains rooted in a farmer’s sensibility: his professional life has been grounded in a results driven pragmatism.