Health economics of health justice partnerships: A rapid review of the economic returns to society of promoting access to legal advice

BACKGROUND: Welfare legal problems and inadequate access to support services follow both the socioeconomic and the health inequalities gradients. Health Justice Partnership (HJP) is an international practitioner-led movement which brings together legal and healthcare professionals to address the root causes of ill health from negative social determinants. The aim of this paper was to identify the current evidence base for the cost-effectiveness of HJP or comparable welfare advice services. METHODS: A rapid review format was used, with a literature search of PubMed, CINAHL, ASSIA, PsycINFO, Medline, Cochrane Library, Global Health and Web of Science identifying 496 articles. After removal of duplicates, 176 papers were screened on titles and abstracts, and 20 papers met the eligibility criteria. Following a full-text screening, a further 14 papers were excluded due to lack of economic evaluations. Excluded papers' reference lists were scanned, with a further 3 further papers identified which met the inclusion criteria. A final pool of nine studies were included in this review. RESULTS: Studies focused on the financial benefit to service users, with only three studies reporting on cost effectiveness of the interventions. Only one study reported on the economic impact of change of health in service users and one study reported on changes in health service use. CONCLUSION: This review highlights the current evidence gap in evaluating the cost-effectiveness of adequate access to free legal welfare advice and representation. We propose that an interdisciplinary research agenda between health economics and legal-health services is required to address this research gap

The Effect of Agenda for Change on the Career Progression of the Radiographic Workforce 2009

Report compiled by the University of Hertfordshire in collaboration with the Inst for Employment Studies and Oxford Radcliffe Hospitals NHS Trust for the Society and College of RadiographersFinal Published versio

Nutritional status, growth and disease management in children with single and dual diagnosis of type 1 diabetes mellitus and coeliac disease

Background: The consequences of subclinical coeliac disease (CD) in Type 1 diabetes mellitus (T1DM) remain unclear. We looked at growth, anthropometry and disease management in children with dual diagnosis (T1DM + CD) before and after CD diagnosis.<p></p> Methods: Anthropometry, glycated haemoglobin (HbA1c) and IgA tissue transglutaminase (tTg) were collected prior to, and following CD diagnosis in 23 children with T1DM + CD. This group was matched for demographics, T1DM duration, age at CD diagnosis and at T1DM onset with 23 CD and 44 T1DM controls.<p></p> Results: No differences in growth or anthropometry were found between children with T1DM + CD and controls at any time point. Children with T1DM + CD, had higher BMI z-score two years prior to, than at CD diagnosis (p <0.001). BMI z-score change one year prior to CD diagnosis was lower in the T1DM + CD than the T1DM group (p = 0.009). At two years, height velocity and change in BMI z-scores were similar in all groups. No differences were observed in HbA1c between the T1DM + CD and T1DM groups before or after CD diagnosis. More children with T1DM + CD had raised tTg levels one year after CD diagnosis than CD controls (CDx to CDx + 1 yr; T1DM + CD: 100% to 71%, p = 0.180 and CD: 100% to 45%, p < 0.001); by two years there was no difference.<p></p> Conclusions: No major nutrition or growth deficits were observed in children with T1DM + CD. CD diagnosis does not impact on T1DM glycaemic control. CD specific serology was comparable to children with single CD, but those with dual diagnosis may need more time to adjust to gluten free diet

Vacancies, disorder-induced smearing of the electronic structure, and its implications for the superconductivity of anti-perovskite MgC0.93_{0.93}Ni2.85_{2.85}

The anti-perovskite superconductor MgC$_{0.93}$Ni$_{2.85}$ was studied using high-resolution x-ray Compton scattering combined with electronic structure calculations. Compton scattering measurements were used to determine experimentally a Fermi surface that showed good agreement with that of our supercell calculations, establishing the presence of the predicted hole and electron Fermi surface sheets. Our calculations indicate that the Fermi surface is smeared by the disorder due to the presence of vacancies on the C and Ni sites, but does not drastically change shape. The 20\% reduction in the Fermi level density-of-states would lead to a significant ($\sim 70\%$) suppression of the superconducting $T_c$ for pair-forming electron-phonon coupling. However, we ascribe the observed much smaller $T_c$ reduction at our composition (compared to the stoichiometric compound) to the suppression of pair-breaking spin fluctuations.Comment: 11 pages, 3 figure

A fuzzy synthetic evaluation of the challenges of smart city development in developing countries

© 2020, Emerald Publishing Limited. Purpose: This study presents a fuzzy synthetic evaluation of the challenges of smart city realisation in developing countries, using Nigeria as a case study. By defining and delineating the problems faced by the country, more viable directions to attaining smart city development can be achieved. Design/methodology/approach: The study adopted a post-positivist philosophical stance with a deductive approach. A structured questionnaire was used to gather data from built environment professionals involved in the delivery of Nigerian public infrastructures. Six dimensions of the challenges of smart cities were identified from literature and explored. They are governance, economic, social, technological, environmental and legal issues. Data gathered were analysed using Cronbach alpha test for reliability, Shapiro-Wilks test for normality, Kruskal-Wallis H-test for consistency and fuzzy synthetic evaluation test for the synthetic evaluation of the challenges of smart city attainment. Findings: The findings revealed that all six assessed dimensions have a significant impact on the attainment of smart cities in Nigeria. More specifically, issues relating to environmental, technological, social and legal challenges are more prominent. Originality/value: The fuzzy synthetic approach adopted provides a clear, practical insight on the issues that need to be addressed before the smart city development can be attained within developing countries

Chronicles of Oklahoma

Article presents the account of the Revered John Edwards, a missionary to the Choctaws at the Wheelock Mission in Oklahoma, about his leaving the South at the beginning of the Civil War. Edwards explains various personal views, including his distaste for slavery, his faith, and reasons for leaving

Comparison of clinical methods with the faecal gluten immunogenic peptide to assess gluten intake in coeliac disease

Objectives: Detection of faecal gluten immunogenic peptides (GIP) is a biomarker of recent gluten consumption. GIP levels can be used to monitor gluten intake and compliment clinical methods to evaluate compliance to gluten free diet (GFD). In this study, recent gluten intake was measured by GIP in CD children and compared to routine clinical measures to evaluate GFD compliance. Methods: GIP was measured in 90 samples from 63 CD children (44 previously and 19 newly diagnosed with follow-up samples at 6 and 12 months on GFD). Compliance to GFD was evaluated based on clinical assessment, tTG levels and Biagi score. Results: GIP was detectable in 16% of patients with previous CD diagnosis on GFD. BMI z-score (p=0.774), height z-score (p=0.723), haemoglobin concentration (p=0.233), age (p=0.448), gender (p=0.734) or disease duration (p=0.488) did not differ between those with detectable and non-detectable GIP. In newly diagnosed patients, on gluten containing diet, GIP was detectable in 95% of them. Following GFD initiation, GIP decreased (p<0.001); 17% and 27% had detectable levels at 6 and 12 months, respectively. Compared to GIP, the Biagi score, tTG and clinical assessment presented sensitivity of 17%, 42% and 17%. Likewise, GIP was detectable in 16%, 16%, 14% of patients evaluated as GFD compliant according to the Biagi score, tTG and clinical assessment. A combination of methods did not improve identification of patients who were non-compliant. Conclusions: Inclusion of faecal GIP measurements is likely to improve identification of GFD recent noncompliance in CD management and could be incorporated into current follow-up strategies

Novel Approach to Estimate Osteoarthritis Progression:Use of the Reliable Change Index in the Evaluation of Joint Space Loss

OBJECTIVE: Osteoarthritis-related changes in joint space measurements over time are small and sensitive to measurement error. The Reliable Change Index (RCI) determines whether the magnitude of change observed in an individual can be attributed to true change. This study aimed to examine the RCI as a novel approach to estimating osteoarthritis progression.METHODS: Data were from 167 men and 392 women with knee osteoarthritis (diagnosed using the American College of Rheumatology criteria) randomized to the placebo arm of the 3-year Strontium Ranelate Efficacy in Knee Osteoarthritis trial (SEKOIA) and assessed annually. The RCI was used to determine whether the magnitude of change in joint space width (JSW) on radiographs between study years was likely to be true or due to measurement error.RESULTS: Between consecutive years, 57-69% of participants had an apparent decrease (change &lt;0) in JSW, while 31-43% of participants had annual changes indicating improvement in JSW. The RCI identified JSW decreases in only 6.0% of patients between baseline and year 1, and in 4.5% of patients between the remaining study years. The apparent increases in JSW were almost eliminated between baseline and year 1, and between years 1 and 2 only 1.3% of patients had a significant increase, dropping to 0.9% between years 2 and 3.CONCLUSION: The RCI provides a method to identify change in JSW, removing many apparent changes that are likely to be due to measurement error. This method appears to be useful for assessing change in JSW from radiographs in clinical and research settings.</p

Walking the tightrope: communicating overdiagnosis in modern healthcare

Overdiagnosis and overtreatment have serious implications for individuals, healthcare systems, and society,1 2 and effective strategies are urgently needed to help the public, clinicians, and policy makers address this problem. Communication about overdiagnosis has been highlighted as essential for moving forward but presents several challenges, such as the potential to confuse the public, undermine trust, and adversely affect people who already have a diagnosis. Various communication based strategies offer real promise; we describe what is known and what we need to know to communicate effectively and safely about overdiagnosis and overtreatment. Key messages: Overdiagnosis provides no benefits to patients and is a challenge to the sustainability of modern healthcare systems Communication based strategies could help reduce overdiagnosis and its negative impact on individuals and health systems Mass media education, shared decision making, terminology changes for disease states, and deliberative methods (juries) all have potential as effective communication strategiesKJMcC is supported by a National Health and Medical Research Council (NHMRC) career development fellowship (1029241), JJ is supported by an NHMRC early career fellowship (1037028), and. JW is supported by a career development fellowship from Cancer Research UK (C7492/A17219)