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We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation
Background: Randomised controlled trials have shown that total diet replacement (TDR) can lead to remission of type 2 diabetes. In 2019, the English National Health Service (NHS) committed to establishing a TDR-based interventional programme delivered at scale within real-world environments; development followed of the NHS Type 2 Diabetes Path to Remission (T2DR) programme, a 12-month behavioural intervention to support weight loss involving an initial 3-month period of TDR. We assessed remission of type 2 diabetes for programme participants. Methods: In this national prospective service evaluation of programme implementation, people in England aged 18–65 years and diagnosed with type 2 diabetes in the last 6 years were referred to the programme between programme launch on Sept 1, 2020, and Dec 31, 2022. Programme data were linked to the National Diabetes Audit to ascertain HbA1c measurements and glucose-lowering medication prescriptions. The primary outcome was remission of type 2 diabetes at 1 year, defined as two HbA1c measurements of less than 48 mmol/mol recorded at least 3 months apart with no glucose-lowering medications prescribed from 3 months before the first HbA1c measurement, and the second HbA1c measurement recorded 11–15 months after the programme start date. Outcomes were assessed in two ways: for all participants who started TDR on the 12-month programme before January, 2022, for whom there were no missing data; and for all participants who started TDR on the 12-month programme before January, 2022, and had completed the programme (ie, had a valid weight recorded at month 12) by Dec 31, 2022, for whom there were no missing data. Findings: Between Sept 1, 2020, and Dec 31, 2022, 7540 people were referred to the programme; of those, 1740 started TDR before January, 2022, and therefore had a full 12-month opportunity to undertake the programme by the time of data extraction at the end of December, 2022. Of those who started TDR before January, 2022, 960 (55%) completed the programme (defined as having a weight recorded at 12 months). The mean weight loss for the 1710 participants who started the programme before January, 2022 and had no missing data was 8·3% (95% CI 7·9–8·6) or 9·4 kg (8·9–9·8), and the mean weight loss for the 945 participants who completed the programme and had no missing data was 9·3% (8·8–9·8) or 10·3 kg (9·7–10·9). For the subgroup of 710 (42%) of 1710 participants who started the programme before January, 2022, and also had two HbA1c measurements recorded, 190 (27%) had remission, with mean weight loss of 13·4% (12·3–14·5) or 14·8 kg (13·4–16·3). Of the 945 participants who completed the programme, 450 (48%) had two HbA1c measurements recorded; of these, 145 (32%) had remission, with mean weight loss of 14·4% (13·2–15·5) or 15·9 kg (14·3–17·4). Interpretation: Findings from the NHS T2DR programme show that remission of type 2 diabetes is possible outside of research settings, through at-scale service delivery. However, the rate of remission achieved is lower and the ascertainment of data is more limited with implementation in the real world than in randomised controlled trial settings. Funding: None.
Calorie (energy) labelling for changing selection and consumption of food or alcohol
Background: Overconsumption of food and consumption of any amount of alcohol increases the risk of non-communicable diseases. Calorie (energy) labelling is advocated as a means to reduce energy intake from food and alcoholic drinks. However, there is continued uncertainty about these potential impacts, with a 2018 Cochrane review identifying only a small body of low-certainty evidence. This review updates and extends the 2018 Cochrane review to provide a timely reassessment of evidence for the effects of calorie labelling on people's selection and consumption of food or alcoholic drinks. Objectives: – To estimate the effect of calorie labelling for food (including non-alcoholic drinks) and alcoholic drinks on selection (with or without purchasing) and consumption. – To assess possible modifiers – label type, setting, and socioeconomic status – of the effect of calorie labelling on selection (with or without purchasing) and consumption of food and alcohol. Search methods: We searched CENTRAL, MEDLINE, Embase, PsycINFO, five other published or grey literature databases, trial registries, and key websites, followed by backwards and forwards citation searches. Using a semi-automated workflow, we searched for and selected records and corresponding reports of eligible studies, with these searches current to 2 August 2021. Updated searches were conducted in September 2023 but their results are not fully integrated into this version of the review. Selection criteria: Eligible studies were randomised controlled trials (RCTs) or quasi-RCTs with between-subjects (parallel group) or within-subjects (cross-over) designs, interrupted time series studies, or controlled before-after studies comparing calorie labelling with no calorie labelling, applied to food (including non-alcoholic drinks) or alcoholic drinks. Eligible studies also needed to objectively measure participants' selection (with or without purchasing) or consumption, in real-world, naturalistic laboratory, or laboratory settings. Data collection and analysis: Two review authors independently selected studies for inclusion and extracted study data. We applied the Cochrane RoB 2 tool and ROBINS-I to assess risk of bias in included studies. Where possible, we used (random-effects) meta-analyses to estimate summary effect sizes as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and subgroup analyses to investigate potential effect modifiers, including study, intervention, and participant characteristics. We synthesised data from other studies in a narrative summary. We rated the certainty of evidence using GRADE. Main results: We included 25 studies (23 food, 2 alcohol and food), comprising 18 RCTs, one quasi-RCT, two interrupted time series studies, and four controlled before-after studies. Most studies were conducted in real-world field settings (16/25, with 13 of these in restaurants or cafeterias and three in supermarkets); six studies were conducted in naturalistic laboratories that attempted to mimic a real-world setting; and three studies were conducted in laboratory settings. Most studies assessed the impact of calorie labelling on menus or menu boards (18/25); six studies assessed the impact of calorie labelling directly on, or placed adjacent to, products or their packaging; and one study assessed labels on both menus and on product packaging. The most frequently assessed labelling type was simple calorie labelling (20/25), with other studies assessing calorie labelling with information about at least one other nutrient, or calories with physical activity calorie equivalent (PACE) labelling (or both). Twenty-four studies were conducted in high-income countries, with 15 in the USA, six in the UK, one in Ireland, one in France, and one in Canada. Most studies (18/25) were conducted in high socioeconomic status populations, while six studies included both low and high socioeconomic groups, and one study included only participants from low socioeconomic groups. Twenty-four studies included a measure of selection of food (with or without purchasing), most of which measured selection with purchasing (17/24), and eight studies included a measure of consumption of food. Calorie labelling of food led to a small reduction in energy selected (SMD −0.06, 95% CI −0.08 to −0.03; 16 randomised studies, 19 comparisons, 9850 participants; high-certainty evidence), with near-identical effects when including only studies at low risk of bias, and when including only studies of selection with purchasing. There may be a larger reduction in consumption (SMD −0.19, 95% CI −0.33 to −0.05; 8 randomised studies, 10 comparisons, 2134 participants; low-certainty evidence). These effect sizes suggest that, for an average meal of 600 kcal, adults exposed to calorie labelling would select 11 kcal less (equivalent to a 1.8% reduction), and consume 35 kcal less (equivalent to a 5.9% reduction). The direction of effect observed in the six non-randomised studies was broadly consistent with that observed in the 16 randomised studies. Only two studies focused on alcoholic drinks, and these studies also included a measure of selection of food (including non-alcoholic drinks). Their results were inconclusive, with inconsistent effects and wide 95% CIs encompassing both harm and benefit, and the evidence was of very low certainty. Authors' conclusions: Current evidence suggests that calorie labelling of food (including non-alcoholic drinks) on menus, products, and packaging leads to small reductions in energy selected and purchased, with potentially meaningful impacts on population health when applied at scale. The evidence assessing the impact of calorie labelling of food on consumption suggests a similar effect to that observed for selection and purchasing, although there is less evidence and it is of lower certainty. There is insufficient evidence to estimate the effect of calorie labelling of alcoholic drinks, and more high-quality studies are needed. Further research is needed to assess potential moderators of the intervention effect observed for food, particularly socioeconomic status. Wider potential effects of implementation that are not assessed by this review also merit further examination, including systemic impacts of calorie labelling on industry actions, and potential individual harms and benefits.
Adolescent and parental views on weight and weight management: A qualitative study
Objective: To examine the views of adolescents with excess weight and parents of adolescents with excess weight towards weight and weight management. Design: A qualitative study design using semi-structured phone interviews. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis to interpret the data. Settings: Parents and adolescents based in the UK and recruited through schools, social media and youth centres. Participants: Ten parents and 16 adolescents, including four linked parent-child dyads. Results: Both parents and adolescents reported that adolescents felt societal pressure to achieve an 'ideal body' and that this pressure was the primary motivator for weight loss. All interviewed parents perceived themselves as overweight; however, those who had minimal weight-based shame were more likely to normalise weight discussions, reducing weight shame in their children. Adolescents preferred parents to display healthy behaviours rather than initiate weight-based discussions; however, they wanted to feel supported if the conversations were self-initiated. Conclusion: Weight is a sensitive issue in intergenerational relationships, primarily driven by feelings of shame. Adolescents feel supported by a 'show not tell' approach from parents, which is more likely in families with less shame. While guidelines encourage clinicians to initiate weight-related conversations, this may not be welcomed by adolescents, although they do want confidence that they could access weight management support if they choose to seek help.
Weight control efforts and practices and health professional advice: a cross-sectional national survey in England
OBJECTIVES: There is evidence that general practitioners (GPs) can increase the uptake of weight management programmes that enhance weight loss compared with self-directed efforts, but the rate at which they do so is unclear. This study examined the prevalence of weight control efforts and practices, the reported frequency and impact of receipt of GP advice on weight loss attempts and perceptions of the appropriateness of health professionals delivering weight loss advice. DESIGN: A nationally representative cross-sectional survey.England. PARTICIPANTS: 1722 adults (≥16 years) surveyed in October 2018 (mean (SD) age=47.4 (19.2), 51.1% women). MAIN OUTCOME MEASURES: Weight control efforts and practices, whether a GP gave advice or a specific referral/prescription medication, perception of the appropriateness of GP weight loss advice. RESULTS: Two-thirds (64.7% (95% CI 58.1% to 71.3%)) of people with obesity reported trying to lose weight. Of people with obesity who visited their GP in the past year, 40% (95% CI 32.2% to 47.7%) recalled receiving any advice on weight loss: 30.8% (95% CI 23.5% to 38.2%) general advice and 9.2% (95% CI 4.6% to 13.7%) a referral to a weight loss service or prescription medication for weight loss. Having received weight loss advice from a GP was strongly associated with a greater likelihood of trying to lose weight (general advice: ORadj=4.49, 95% CI 2.52 to 8.00; referral/medication: ORadj=9.25, 95% CI 2.65 to 32.3). Views on whether health professionals should deliver weight loss advice were mixed, with a substantial minority (19.4% (95% CI 17.5% to 21.4%)) finding it unacceptable. People with a BMI outside of the healthy weight range (underweight/overweight/obesity), women and those from more disadvantaged social grades were less likely to find it acceptable. CONCLUSIONS: Most people with obesity reported trying to lose weight but less than half recalled receiving advice on weight loss from their GP in the past year and few were referred to community weight-loss programmes. Those who recalled receiving GP advice on weight loss were substantially more likely to report taking action to lose weight. One in five people thought GP advice on weight loss was inappropriate.
Changing the availability and positioning of more vs. less environmentally sustainable products: A randomised controlled trial in an online experimental supermarket
Food purchasing behaviours are shaped by the choices available to shoppers and the way they are offered for sale. This study tested whether prominent positioning of more sustainable food items online and increasing their relative availability might reduce the environmental impact of foods selected in a 2x2 (availability x position) factorial randomised controlled trial. Participants (n = 1179) selected items in a shopping task in an experimental online supermarket. The availability intervention added lower-impact products to the regular range. The positioning intervention biased product order to give prominence to lower-impact products. The primary outcome was the environmental impact score (ranging from 1 “least impact” to 5 “most impact”, of each item in shopping baskets) analysed using Welch's ANOVA. Secondary outcomes included interactions (analysed via linear regression) by gender, age group, education, income and meat consumption and we assessed intervention acceptability (using different frames) in a post-experiment questionnaire. Compared to control (mean = 21.6), mean eco quintile score was significantly reduced when availability & order was altered (−2.30; 95%CI: 3.04; −1.56) and when order only was changed (−1.67; 95%CI: 2.42; −0.92). No significant difference between availability only (−0.02; 95%CI: 0.73; 0.69) and control was found. There were no significant interactions between interventions or by demographic characteristics. Both interventions were acceptable under certain frames (positioning emphasising lower-impact products: 70.3% support; increasing lower-impact items: 74.3% support). Prominent positioning of more sustainable products may be an effective strategy to encourage more sustainable food purchasing. Increasing availability of more sustainable products alone did not significantly alter the environment impact of products selected.
Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: Systematic review and meta-analysis
Objective: To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults. Design: Systematic review and meta-analysis. Study selection: A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time. Data extraction and synthesis: Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined. Results: 129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples. Conclusions: Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year.
Emotional Processing Following Digital Cognitive Behavioral Therapy for Insomnia in People With Depressive Symptoms: A Randomized Clinical Trial.
IMPORTANCE: Cognitive behavioral therapy for insomnia (CBT-I) has been shown to reduce depressive symptoms, but the underlying mechanisms are not well understood and warrant further examination. OBJECTIVE: To investigate whether CBT-I modifies negative bias in the perception of emotional facial expressions and whether such changes mediate improvement in depressive symptoms. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of digital CBT-I vs sleep hygiene education was conducted. Adults living in the UK who met diagnostic criteria for insomnia disorder and Patient Health Questionnaire-9 criteria (score ≥10) for depression were recruited online from the community and randomly assigned to either a 6-session digital CBT-I program or a sleep hygiene webpage. Participant recruitment took place between April 26, 2021, and January 24, 2022, and outcomes were assessed at 5 and 10 weeks post randomization. Data analysis was performed from December 1, 2022, to March 1, 2023. MAIN OUTCOMES AND MEASURES: Coprimary outcomes were recognition accuracy (percentage) of happy and sad facial expressions at 10 weeks assessed with the facial expression recognition task. Secondary outcomes were self-reported measures of insomnia, depressive symptoms, affect, emotional regulation difficulties, worry, perseverative thinking, midpoint of sleep, social jet lag, and the categorization of and recognition memory for emotional words. Intention-to-treat analysis was used. RESULTS: A total of 205 participants were randomly assigned to CBT-I (n = 101) or sleep hygiene education (n = 104). The sample had a mean (SD) age of 49.3 (10.1) years and was predominately female (165 [80.8%]). Retention was 85.7% (n = 175). At 10 weeks, the estimated adjusted mean difference for recognition accuracy was 3.01 (97.5% CI, -1.67 to 7.69; P = .15; Cohen d = 0.24) for happy facial expressions and -0.54 (97.5% CI, -3.92 to 2.84; P = .72; Cohen d = -0.05) for sad facial expressions. At 10 weeks, CBT-I compared with control decreased insomnia severity (adjusted difference, -4.27; 95% CI, -5.67 to -2.87), depressive symptoms (adjusted difference, -3.91; 95% CI, -5.20 to -2.62), negative affect (adjusted difference, -2.75; 95% CI, -4.58 to -0.92), emotional regulation difficulties (adjusted difference, -5.96; 95% CI, -10.61 to -1.31), worry (adjusted difference, -8.07; 95% CI, -11.81 to -4.33), and perseverative thinking (adjusted difference, -4.21; 95% CI, -7.03 to -1.39) and increased positive affect (adjusted difference, 4.99; 95% CI, 3.13-6.85). Improvement in negative affect, emotional regulation difficulties, and worry at week 5 mediated the effect of CBT-I on depression severity at 10 weeks (% mediated: 21.9% Emotion regulation difficulties; 24.4% Worry; and 29.7% Negative affect). No serious adverse events were reported to the trial team. CONCLUSIONS AND RELEVANCE: This randomized clinical trial did not find evidence that CBT-I engenders change in the perception of facial expressions at post treatment, despite improvements in insomnia and depressive symptoms. Early change in negative affect, emotional regulation difficulties, and worry mediated lagged depression outcomes and deserve further empirical scrutiny. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN17117237.
Genome-wide association analysis of composite sleep health scores in 413,904 individuals
Recent genome-wide association studies (GWASs) of several individual sleep traits have identified hundreds of genetic loci, suggesting diverse mechanisms. Moreover, sleep traits are moderately correlated, so together may provide a more complete picture of sleep health, while illuminating distinct domains. Here we construct novel sleep health scores (SHSs) incorporating five core self-report measures: sleep duration, insomnia symptoms, chronotype, snoring, and daytime sleepiness, using additive (SHS-ADD) and five principal components-based (SHS-PCs) approaches. GWASs of these six SHSs identify 28 significant novel loci adjusting for multiple testing on six traits (p
Blood pressure measurement at kiosks in public spaces: systematic review and consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability endorsed by the International Society of Hypertension and the World Hypertension League
Kiosk devices for unsupervised self-measurement of blood pressure (BP) are being used in public spaces and healthcare settings in several countries. This statement by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability provides a review of the published evidence on kiosk BP devices and consensus recommendations for their requirements and clinical use. A systematic literature search identified 54 relevant studies. Kiosk BP measurements appeared to be close to office BP [mean difference systolic 0.2 mmHg (95% confidence intervals -1.3 to 1.8); diastolic -0.4 mmHg (-3.5 to 2.7)], and higher than daytime ambulatory and home BP [mean difference 6.0 mmHg (1.6-10.4)/5.0 (2-8) and 8.1 mmHg (-2.6 to 18.9)/0.2 (-9.6 to 10.0), respectively]. Randomized or observational studies using kiosk BP measurements for hypertension screening or for assessing hypertension control were also included, as well as studies investigating users' and healthcare professionals' opinions, acceptability, and perspectives regarding kiosk BP measurements, and validation studies of kiosk BP devices. These studies had considerable heterogeneity in design, setting, methodology, measurement protocol, and sample size. Thus, at present, the clinical utility of kiosk BP measurements is uncertain. This ESH consensus statement acknowledges the potential of kiosk BP measurement as an emerging method for unsupervised self-measurement in the context of opportunistic screening for hypertension in apparently healthy people and the long-term monitoring of people with diagnosed hypertension. Requirements for the design, validation, function, and use of kiosk BP monitors are provided, together with the pending research questions on their optimal implementation in clinical practice.
Oral nicotine pouches for cessation or reduction of use of other tobacco or nicotine products.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objectives To evaluate the benefits and harms of oral nicotine pouches when used to help people transition away from combustible tobacco use (smoking) To evaluate the impact of oral nicotine products on the prevalence of combustible tobacco use Secondary objectives To evaluate the benefits and harms of oral nicotine pouches when used to help people transition away from other non-combustible tobacco/commercial nicotine product use To evaluate the impact of oral nicotine products on the prevalence of use of other non-combustible tobacco/commercial nicotine products.
Methodological literature on the reporting of systematic reviews of health economic evaluations: a scoping review protocol.
Systematic reviews of health economic evaluations play a crucial role in informing evidence-based healthcare decisions, yet they lack standardized reporting guidelines. A project has been initiated that aims to extend the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for systematic reviews of health economic evaluations (PRISMA-EconEval). This scoping review forms a foundation for the PRISMA-EconEval project, aiming to identify, map, and extract candidate reporting items from the methodological literature. The scoping review will follow the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist and involve comprehensive searches in databases such as PubMed MEDLINE, Embase, and Web of Science, covering the period from 2015 to 2024. Supplementary searching, reference checking and citation searching will target grey literature, overlooked studies and evidence prior to 2015. Inclusion criteria will focus on methodological papers that provide frameworks or recommendations for reporting systematic reviews of health economic evaluations and enhanced case studies that critically discuss methods and reporting structures. The extracted data will be coded and analyzed to produce an initial list of candidate reporting items, structured according to conventional sections of a systematic review (e.g., title, abstract, methods, results). This initial list will be used in the subsequent stages of the project and disseminated through a peer-reviewed publication and presentations at international conferences. The outcome of this scoping review will significantly contribute to the development of a comprehensive PRISMA-EconEval reporting guideline, aimed at enhancing the transparency, consistency, and quality of systematic reviews of health economic evaluations, and provide an essential tool for authors, editors, peer-reviewers, and stakeholders.
The impacts of e-cigarette flavours: An overview of systematic reviews.
BACKGROUND AND AIMS: E-cigarette flavours have the potential to impact the appeal, harms and use of e-cigarettes and combustible tobacco. Systematic reviews have synthesised evidence on their impacts but have always focused on specific outcomes or populations. This overview aimed to draw together syntheses from past systematic reviews of e-cigarette flavours to provide a holistic, population-wide view. METHODS: Overview of systematic reviews investigating the impacts of e-cigarette flavours on any outcome. We searched six databases to February 2024, and appraised reviews using AMSTAR2. We used association direction plots and narratively synthesised results. RESULTS: We included 32 reviews (11 higher quality; 21 lower). Reviews reported impacts of e-cigarette flavours on: appeal/perceptions of vaping (13 reviews); harms (12); smoking (7); and vaping (13) behaviours. Availability of non-tobacco e-cigarette flavours may increase the appeal of (8 reviews) and motivation to try/continue using e-cigarettes (5) and decrease harm perceptions (5). There were no clear differences in impacts based on age or history of combustible tobacco use, and little difference in findings between higher and lower quality reviews. Two reviews indicated that among adolescents, experimenting with different flavours increased e-cigarette appeal. Twelve reviews indicated that a range of specific flavours (including cinnamon, menthol and various sweet/fruity flavours) may be harmful; this often came from in vitro experiments and chemical analyses. Findings were inconclusive on the impact of e-cigarette flavours on smoking cessation (six reviews not showing clear impact), smoking initiation (two reviews not showing clear impact) and vaping initiation (two reviews showing increased initiation and two not showing clear impact). CONCLUSIONS: Non-tobacco flavourings for e-cigarettes may increase e-cigarette appeal and harms; this increase may vary by flavour and apply across different population groups. The impacts of e-cigarette flavours on e-cigarette and cigarette use are inconclusive.
A "new" autosomal dominant genodermatosis characterized by hyperpigmented spots and plamoplantar hyperkeratosis.
A previously undescribed genodermatosis consisting of tiny hyperpigmented spots aggregated in irregular maculae and mainly localized in the regions exposed to light is reported. Hyperkeratotic papules in the palms and soles were also present. Autosomal dominant inheritance is concluded.
Profiling Databases to Facilitate Comparison of Child Health Systems Across Europe Using Standardised Quality Markers
Models of child primary health care vary across Europe. There are three categories, primary care paediatricians, general practitioner based, or mixed. This paper describes the metadata schema used in the profiling process of candidate data sources for appraisal for the Models of Child Health Appraised (MOCHA) project using the MOCHA International Research Opportunity Instrument (MIROI). The ten clinical indicators included: asthma, antibiotic stewardship, immunisation, rickets, diarrhea, epilepsy, depression, ADHD, enuresis and care of women during pregnancy. Our metadata allows us to identify data within included data sources concerning any of the 10 clinical indicators identified for comparative analysis within the MOCHA project. From the 30 countries we found a minimum of 5 and a maximum of 36 different databases for each indicator.
Cost-effectiveness of health insurance among women engaged in transactional sex and impacts on HIV transmission in Cameroon: a mathematical model.
INTRODUCTION: HIV prevalence disproportionately affects high-risk populations, particularly female sex workers in Africa. Women and girls engaging in transactional sex (WGTS) face similar health risks from unsafe practices, economic vulnerabilities and stigma. However, they are not recognised. METHODS: Using existing literature and data from the POWER randomised controlled trial, we developed a deterministic compartmental model to assess HIV dynamics among WGTS, their sugar daddies and low-risk populations. We evaluated the cost-effectiveness of a new structural intervention to prevent HIV among WGTS in urban Cameroon by reducing the financial need to engage in transactional sex in the case of illness and injury shocks to the household. The intervention provided free healthcare to WGTS and their economic dependents through a zero-cost health insurance package. We explored the cost-effectiveness of this intervention considering various population coverage levels (0%, 25%, 50%, 75% and 100%). We calculated the incremental cost-effectiveness ratio (ICER) per disability-adjusted life-year (DALY) and HIV infections averted, employing both univariable and global sensitivity analyses. Probabilistic sensitivity analyses considered all parameters, including the insurance effect in reducing HIV, comparing simulated ICERs to willingness-to-pay thresholds. We also compared the health insurance strategy with expanding pre-exposure prophylaxis (PrEP) coverage. All costs were evaluated in 2023 UK pounds (£) using a 3% discount rate, with Cameroon's gross domestic product (GDP) per capita recorded at £1239. RESULTS: Implementing health insurance coverage levels of 25%, 50%, 75% and 100% yielded ICERs/DALY averted of £2795 (£2483-£2824), £2541 (£2370-£2592), £2263 (£2156-£2316) and £1952 (£1891-£1998), respectively, compared with 0% coverage. Probabilistic sensitivity analysis indicated an ICER=£2128/DALY averted at 100% coverage, with 58% of simulations showing ICERs