Social marketing is a commonly used strategy in global health. Social marketing programmes may sell subsidized products through commercial sector outlets, distribute appropriately priced products, ...deliver health services through social franchises and promote behaviours not dependent upon a product or service. We aimed to review evidence of the effectiveness of social marketing in low- and middle-income countries, focusing on major areas of investment in global health: HIV, reproductive health, child survival, malaria and tuberculosis. We searched PubMed, PsycInfo and ProQuest, using search terms linking social marketing and health outcomes for studies published from 1995 to 2013. Eligible studies used experimental or quasi-experimental designs to measure outcomes of behavioural factors, health behaviours and/or health outcomes in each health area. Studies were analysed by effect estimates and for application of social marketing benchmark criteria. After reviewing 18 974 records, 125 studies met inclusion criteria. Across health areas, 81 studies reported on changes in behavioural factors, 97 studies reported on changes in behaviour and 42 studies reported on health outcomes. The greatest number of studies focused on HIV outcomes (n = 45) and took place in sub-Saharan Africa (n = 67). Most studies used quasi-experimental designs and reported mixed results. Child survival had proportionately the greatest number of studies using experimental designs, reporting health outcomes, and reporting positive, statistically significant results. Most programmes used a range of methods to promote behaviour change. Programmes with positive, statistically significant findings were more likely to apply audience insights and cost-benefit analyses to motivate behaviour change. Key evidence gaps were found in voluntary medical male circumcision and childhood pneumonia. Social marketing can influence health behaviours and health outcomes in global health; however evaluations assessing health outcomes remain comparatively limited. Global health investments are needed to (i) fill evidence gaps, (ii) strengthen evaluation rigour and (iii) expand effective social marketing approaches.
Le marketing social est une stratégie couramment utilisée dans la santé mondiale. Les programmes de marketing social peuvent vendre des produits subventionnés à travers des points de vente du secteur commercial, distribuer des produits à un coût approprié, offrir des services de santé par le biais de franchises sociales et promouvoir des comportements qui ne dépendent pas d’un produit ou d’un service. Notre objectif était d’examiner les preuves de l’efficacité du marketing social dans les pays à revenu faible ou intermédiaire, en mettant l’accent sur les principaux domaines d’investissement de la santé mondiale: le VIH, la santé reproductive, la survie de l’enfant, le paludisme et la tuberculose. Nous avons effectué des recherches dans les bases de données PubMed, PsycInfo et ProQuest en utilisant des termes de recherche établissant un lien entre le marketing social et les résultats de santé dans les études publiées de 1995 à 2013. Les études retenues ont utilisé des modèles expérimentaux ou quasi expérimentaux pour mesurer les résultats des facteurs comportementaux, les comportements liés à la santé et/ou les résultats sanitaires dans chaque domaine de santé. Ces études ont été analysées par l’estimation des incidences et pour l’application des critères de référence du marketing social. Après avoir examiné 18 974 dossiers, 125 études ont répondu aux critères d’inclusion. À travers les domaines de la santé, 81 études ont relevé des changements dans les facteurs comportementaux, 97 études ont fait état de modifications dans le comportement et 42 études se sont intéressées aux résultats de santé. Le plus grand nombre d’études portait sur les résultats du VIH (n=45) et avait été effectué en Afrique subsaharienne (n=67). La plupart des études ont utilisé des modèles quasi expérimentaux et ont fait état de résultats mitigés. Proportionnellement, la survie de l’enfant présentait le plus grand nombre d’études utilisant des modèles expérimentaux, signalant des résultats sur le plan de la santé et rapportant des résultats positifs et statistiquement significatifs. La plupart des programmes utilisaient une gamme de méthodes pour promouvoir le changement de comportement. Les programmes présentant des résultats positifs et statistiquement significatifs étaient plus susceptibles de mettre en application les perceptions de l’auditoire et les analyses de rentabilité pour motiver les changements de comportement. D’importantes lacunes ont été constatées dans la circoncision masculine volontaire et la pneumonie chez l’enfant. Le marketing social peut influer sur les comportements et les résultats dans la santé mondiale; cependant, les évaluations des résultats sanitaires demeurent relativement limitées. Des investissements mondiaux dans le domaine de la santé sont nécessaires pour i) combler les lacunes en matière de données probantes, ii) renforcer la rigueur de l’évaluation et iii) développer des méthodes de marketing social efficaces.
社会营销是全球卫生中常用的策略, 可通过商业渠道销售补贴 产品, 分发定价适当的产品, 通过社会特许经营提供卫生服务, 或推广不依赖于产品或服务的某些行文。本研究旨在回顾社 会营销在中低收入国家的有效性的证据, 重点是全球卫生中资 金投入的主要领域： HIV、生殖健康、儿童生存、疟疾和结 核。我们使用PubMed、PsycInfo和ProQuest, 采用与社会营 销和健康产出相关的检索词, 检索 1995 年至 2013 年发表的 文献。选择文献的标准为：采用实验或准实验设计测量各个 卫生领域中行为因素的结局、健康行为和/或健康产出。为应 用社会营销基准, 采用效果估计值分析入选的研究。在检索到 的 18974 篇文献中, 有 125 篇符合纳入标准, 其中 81 篇报道 行为因素的变化, 97篇报道行为变化, 42篇报道健康产出。多 数研究关注HIV结局 （n= 45）, 研究地点为撒哈拉以南非洲 地区（n= 67）。多数研究采用准实验设计, 报道了混合结 果。按比例来看, 儿童生存领域采用实验设计、报道健康产 出、报道有统计学意义的阳性结果的研究最多。大多数项目 采取一系列方法来促进行为改变。产生有统计学意义的阳性 结果的项目更可能利用受众分析和成本效益分析来推动行为 改变。缺少证据的主要领域是自愿男性包皮环切和儿童肺 炎。社会营销可以影响全球卫生中的健康行为和健康产出, 但 健康产出的评估仍然较少。全球卫生投入需要以下三点： （1） 补充证据, （2） 加强评估的严谨性, （3） 推广有效的 社会营销方法。
El mercadeo social es una estrategia comúnmente usada en la salud global. Los programas de mercadeo social pueden vender productos subsidiados a través de puntos de venta del sector comercial, distribuir productos de precio adecuado, prestar servicios de salud a través de franquicias sociales y promover comportamientos que no dependen de un producto o servicio. Nuestro objetivo fue revisar la evidencia de la efectividad del mercadeo social en los países de ingresos bajos y medios, centrándonos en las principales áreas de inversión en salud global: VIH, salud reproductiva, supervivencia infantil, malaria y tuberculosis. Se realizaron búsquedas en PubMed, PsycInfo y ProQuest, usando los términos de búsqueda que vinculan el mercadeo social y los resultados de la salud para estudios publicados de 1995 a 2013. Los estudios escogidos usaron diseños experimentales o cuasi experimentales para medir los resultados de factores de comportamiento, comportamientos de la salud y/o resultados de la salud en cada área de la misma. Los estudios fueron analizados por los efectos estimados y por la aplicación de criterios de referencia de mercadeo social. Después de revisar 18,974 registros, 125 estudios cumplieron con los criterios de inclusión. En las áreas de salud, 81 estudios informaron sobre cambios en factores de comportamiento, 97 estudios informaron sobre cambios en el comportamiento y 42 estudios informaron sobre los resultados de salud. El mayor número de estudios se centró en los resultados del VIH (n=45) y tuvo lugar en el África subsahariana (n=67). La mayoría de los estudios usaron diseños cuasi-experimentales e informaron resultados variados. La supervivencia infantil tenía proporcionalmente el mayor número de estudios usando diseños experimentales, informando resultados de la salud e informando resultados positivos y estadísticamente significativos. La mayoría de los programas usaron una gama de métodos para promover cambio de comportamiento. Los programas con conclusiones positivas y estadísticamente significativas tenían más probabilidades de aplicar percepciones de audiencia y análisis de costo-beneficio para motivar el cambio de comportamiento. Las brechas claves en evidencia se encontraron en la circuncisión médica masculina voluntaria y en la neumonía infantil. El mercadeo social puede influenciar los comportamientos de la salud y los resultados de la misma en la salud global; sin embargo las evaluaciones calculando los resultados de la salud permanecen comparativamente limitadas. Las inversiones en la salud mundial son necesarias para (i) llenar los vacíos de pruebas, (ii) fortalecer el rigor de la evaluación y (iii) ampliar los enfoques de mercadeo social efectivo.
IMPORTANCE Alcohol use disorders cause substantial morbidity and early mortality yet remain greatly undertreated. Medications are considerably underused. OBJECTIVE To conduct a systematic review and ...meta-analysis of the benefits and harms of medications (US FDA-approved and others) for adults with alcohol use disorders. DATA SOURCES PubMed, Cochrane Library, PsycINFO, CINAHL, EMBASE, FDA website, and clinical trials registries (January 1, 1970, to March 1, 2014). STUDY SELECTION Two reviewers selected randomized clinical trials (RCTs) with at least 12 weeks’ duration that reported eligible outcomes and head-to-head prospective cohort studies reporting health outcomes or harms. DATA EXTRACTION AND SYNTHESIS We conducted meta-analyses using random-effects models and calculated numbers needed to treat for benefit (NNTs) or harm (NNHs). MAIN OUTCOMES AND MEASURES Alcohol consumption, motor vehicle crashes, injuries, quality of life, function, mortality, and harms. RESULTS We included 122 RCTs and 1 cohort study (total 22 803 participants). Most assessed acamprosate (27 studies, n = 7519), naltrexone (53 studies, n = 9140), or both. The NNT to prevent return to any drinking for acamprosate was 12 (95% CI, 8 to 26; risk difference RD, −0.09; 95% CI, −0.14 to −0.04) and was 20 (95% CI, 11 to 500; RD, −0.05; 95% CI, −0.10 to −0.002) for oral naltrexone (50 mg/d). The NNT to prevent return to heavy drinking was 12 (95% CI, 8 to 26; RD −0.09; 95% CI, −0.13 to −0.04) for oral naltrexone (50 mg/d). Meta-analyses of trials comparing acamprosate to naltrexone found no statistically significant difference between them for return to any drinking (RD, 0.02; 95% CI, −0.03 to 0.08) or heavy drinking (RD, 0.01; 95% CI, −0.05 to 0.06). For injectable naltrexone, meta-analyses found no association with return to any drinking (RD, −0.04; 95% CI, −0.10 to 0.03) or heavy drinking (RD, −0.01; 95% CI, −0.14 to 0.13) but found an association with reduction in heavy drinking days (weighted mean difference WMD, −4.6%; 95% CI, −8.5% to −0.56%). Among medications used off-label, moderate evidence supports an association with improvement in some consumption outcomes for nalmefene (heavy drinking days per month: WMD, −2.0; 95% CI, −3.0 to −1.0; drinks per drinking day: WMD, −1.02; 95% CI, −1.77 to −0.28) and topiramate (% heavy drinking days: WMD, −9.0%; 95% CI, −15.3% to −2.7%; drinks per drinking day: WMD, −1.0; 95% CI, −1.6 to −0.48). For naltrexone and nalmefene, NNHs for withdrawal from trials due to adverse events were 48 (95% CI, 30 to 112) and 12 (95% CI, 7 to 50), respectively; risk was not significantly increased for acamprosate or topiramate. CONCLUSIONS AND RELEVANCE Both acamprosate and oral naltrexone were associated with reduction in return to drinking. When directly compared with one another, no significant differences were found between acamprosate and naltrexone for controlling alcohol consumption. Factors such as dosing frequency, potential adverse events, and availability of treatments may guide medication choice.
Approximately 10% of ischemic strokes are caused by carotid artery stenosis (CAS). Estimated prevalence of asymptomatic CAS is 1%.
To evaluate evidence on screening and treating asymptomatic adults ...for CAS.
MEDLINE, the Cochrane Library, EMBASE, and trial registries through September 2013; MEDLINE through March 2014 for trials.
Good- or fair-quality trials of screening, carotid endarterectomy (CEA), or stenting compared with medical therapy or of intensification of medical therapy; systematic reviews; multi-institution studies reporting harms; and externally validated risk-stratification tools.
Dual extraction and quality assessment.
No trials compared screening with no screening or stenting with medical therapy or assessed intensification of medical therapy, and no externally validated, reliable risk-stratification tools were found. Given the specificity of ultrasonography (range, 88% to 94% for CAS ≥ 50% to ≥ 70%), its use in low-prevalence populations would yield many false-positive results. Absolute reduction of nonperioperative strokes was 5.5% (95% CI, 3.9% to 7.0%; 3 trials; 5223 participants) over approximately 5 years for CEA compared with medical therapy. The 30-day rates of stroke or death after CEA in trials and cohort studies were 2.4% (CI, 1.7% to 3.1%; 6 trials; 3435 participants) and 3.3% (CI, 2.7% to 3.9%; 7 studies; 17474 participants), respectively. Other harms of interventions included myocardial infarction, nerve injury, and hematoma.
Trials may have overestimated benefits and used highly selected surgeons. Medical therapy used in trials was outdated, and stroke rates have declined in recent decades. Harms may have been underreported.
Current evidence does not establish incremental overall benefit of CEA, stenting, or intensification of medical therapy. Potential for overall benefit is limited by low prevalence and harms.
Agency for Healthcare Research and Quality.
Fire is an essential component of tropical savannas, driving key ecological feedbacks and functions. Indigenous manipulation of fire has been practiced for tens of millennia in Australian savannas, ...and there is a renewed interest in understanding the effects of anthropogenic burning on savanna systems. However, separating the impacts of natural and human fire regimes on millennial timescales remains difficult. Here we show using palynological and isotope geochemical proxy records from a rare permanent water body in Northern Australia that vegetation, climate, and fire dynamics were intimately linked over the early to mid-Holocene. As the El Niño/Southern Oscillation (ENSO) intensified during the late Holocene, a decoupling occurred between fire intensity and frequency, landscape vegetation, and the source of vegetation burnt. We infer from this decoupling, that indigenous fire management began or intensified at around 3 cal kyr BP, possibly as a response to ENSO related climate variability. Indigenous fire management reduced fire intensity and targeted understory tropical grasses, enabling woody thickening to continue in a drying climate.
To assess whether response to medications for alcohol use disorders varies by genotype.
Systematic review and meta-analysis.
We found no studies that assessed the clinical utility of genotype-guided ...dosing strategies or genotype-guided medication selection, and none randomized by genotype. All included studies assessed the association between genotype and response to medication. Of 15 included studies, eight (n = 1365 participants) assessed variation in naltrexone response and polymorphisms of OPRM1. Our meta-analyses for return to heavy drinking found no significant difference between A allele homozygotes and those with at least one G allele, both without (risk difference: 0.26; 95% CI: -0.01-0.53; n = 174) and with inclusion of studies rated as high or unclear risk of bias (risk difference: 0.14; 95% CI: -0.03-0.3; n = 382). For all other polymorphism-medication pairs, we found just one eligible study.
Estimates of effect for return to heavy drinking suggest it is possible that patients with at least one G allele of A118G polymorphism of OPRM1 might be more likely to respond to naltrexone, but confidence intervals were wide; additional studies are needed to improve confidence in the estimates.
Pollen and charcoal analyses are presented from the islands of Mua and Badu, western Torres Strait (northern Australia). Sediment core collections from island interior Melaleuca swamps provide a ...record of hydrological and vegetation change through the period c.2700 BP to present. Seasonally moist-dry open herbaceous habitats are recorded prior to extensive stable boundary swamp and swamp-forest establishment. This island swamp development is important in supporting vegetation differentiated from eucalypt woodland growth. The swamps also constitute an important dry season resource and refugia. Eucalypt-dominated woodland is evident throughout the records, but is increasingly influenced by fire (in structure and composition). This palaeoecological study provides the unique opportunity to explore long term inter-island and island-mainland environmental connection in the Torres Strait. It also facilitates an examination of regional late Holocene human–environment interaction, including discussions of islander colonisation, occupation and identity as taking place within archaeological research.
Paleoecology has demonstrated potential to inform current and future land management by providing long-term baselines for fire regimes, over thousands of years covering past periods of lower/higher ...rainfall and temperatures. To extend this potential, more work is required for methodological innovation able to generate nuanced, relevant and clearly interpretable results. This paper presents records from Cape York Peninsula, Queensland, Australia, as a case study where fire management is an important but socially complex modern management issue, and where palaeofire records are limited. Two new multiproxy palaeofire records are presented from Sanamere Lagoon (8,150–6,600 cal BP) and Big Willum Swamp (3,900 cal BP to present). These records combine existing methods to investigate fire occurrence, vegetation types, and relative fire intensity. Results presented here demonstrate a diversity of fire histories at different sites across Cape York Peninsula, highlighting the need for finer scale palaeofire research. Future fire management planning on Cape York Peninsula must take into account the thousands of years of active Indigenous management and this understanding can be further informed by paleoecological research.
A palynological record from Girraween Lagoon sediments (Darwin region of the Northern Territory, Australia) provides detailed long-term insight into tropical savanna vegetation community patterns, ...climatic and fire relationships, through Marine Isotope Stage 4 (MIS 4: 71–57 thousand years ago, ka) and Marine Isotope Stage 3 (MIS 3: 57–29 ka). Owing to a lack of data in reconstructing northern Australian environments, this paper looks to define and describe to a greater degree the nature and scope of these stadial and interstadial stages for the region. Girraween Lagoon simultaneously provides proximal palaeoecological data for the time and region of Aboriginal people's first arrival into Australia, also encompassing the late Pleistocene continental decline of megafauna. This study provides a dataset enabling full exploration of long-term people-landscape and faunal-floral interactions. Sea levels and associated variations imposed on the transportation of moisture and heat, held implications for MIS 4 and MIS 3 monsoon strength, which was particularly consequential for Girraween regional ecology. Results reveal a prolonged transition from wooded- to grassy-savanna, into a cool drier semi-arid savanna. Increasingly episodic delivery of moisture influenced the permanency of freshwater in the landscape.
•A detailed picture of vegetation in monsoonal north Australia during MIS 4 and MIS 3.•An ultimate transition from grassy eucalypt savanna into semi-arid savanna revealed.•Changed monsoonal delivery particularly consequential for regional ecology.•An indication of baseline landscapes during people's first arrival into Australia.•Assisting to place megafaunal decline within an ecological landscape.
Fire has a long history in Australia and is a key driver of vegetation dynamics in the tropical savanna ecosystems that cover one quarter of the country. Fire reconstructions are required to ...understand ecosystem dynamics over the long term but these data are lacking for the extensive savannas of northern Australia. This paper presents a multiproxy palaeofire record for Marura sinkhole in eastern Arnhem Land, Northern Territory, Australia. The record is constructed by combining optical methods (counts and morphology of macroscopic and microscopic charcoal particles) and chemical methods (quantification of abundance and stable isotope composition of pyrogenic carbon by hydrogen pyrolysis). This novel combination of measurements enables the generation of a record of relative fire intensity to investigate the interplay between natural and anthropogenic influences. The Marura palaeofire record comprises three main phases: 4600–2800 cal BP, 2800–900 cal BP and 900 cal BP to present. Highest fire incidence occurs at ~4600–4000 cal BP, coinciding with regional records of high effective precipitation, and all fire proxies decline from that time to the present. 2800–900 cal BP is characterised by variable fire intensities and aligns with archaeological evidence of occupation at nearby Blue Mud Bay. All fire proxies decline significantly after 900 cal BP. The combination of charcoal and pyrogenic carbon measures is a promising proxy for relative fire intensity in sedimentary records and a useful tool for investigating potential anthropogenic fire regimes.
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