Technologies for global health Howitt, Peter, MA; Darzi, Ara, Prof; Yang, Guang-Zhong, Prof ...
The Lancet (British edition),
08/2012, Volume:
380, Issue:
9840
Journal Article
Peer reviewed
Mechanical ventilation and intravenous sedation were initiated. Because of continuing spasms, intrathecal baclofen (1200 µg per day) was started on day 3 with a good clinical response. No ...recommendations about tetanus prophylaxis procedures for wound man agement in patients with blood diseases are available, except for bone-marrow transplantation.
Summary Cancer prevalence is increasing in the Middle East, partly because of increased life expectancy and adoption of western lifestyle habits. Suboptimum delivery of health care also contributes ...to late diagnosis and poor survival of people with cancer. Public awareness of cancer risk is frequently low and misconceptions high, thereby preventing patients from seeking treatment early and constituting a substantial barrier to improvement of cancer outcomes. Screening programmes might have low uptake in Arab populations because of social and health beliefs about cancer. This review outlines the opportunities available to Middle Eastern countries and their emerging economies to learn from global experiences in cancer care, service provision, and research partnerships. The Middle East has begun to develop several health-care transformation programmes. Qatar, in particular, has published a National Health Strategy, in which cancer is one of the main commitments; this Strategy provides the focus of this review. The development of effective health-care strategies and evidence-based medicine directly linked to innovative cancer research is needed to improve cancer care. Although the full extent of the proposed solutions are not necessarily implementable in all Middle Eastern countries, wealthy states can lead derivation of population-specific approaches that could have effects throughout the region. Key challenges are outlined—namely, human capacity and training, subspecialisation of services, building on international cancer research initiatives, and the need for earlier diagnosis and awareness in the population. Countries in the Gulf Region (ie, countries bordering the Persian Gulf, including Iran, Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, UAE, and Oman) need to address these challenges to be at the forefront of integrated cancer care and research and ensure that the latest innovations and best possible care are delivered to their populations.
Abstract Background According to the COM-B model of behaviour, three factors are essential for behaviour to occur: capability, opportunity, and motivation. Some evidence suggests that obese children ...tend to feel less capable of exercising. An instrument aiming to measure perceived exercise capability, opportunity, and motivation was created and subsequently used to investigate the association between perceived exercise capability and childhood obesity, and how perceived exercise capability could be improved through intervention. Methods A 19 item questionnaire about exercise capability, opportunity, and motivation was created systematically with the COM-B model. On arrival at a 6 week weight-management camp in northern England, children completed the questionnaire; Spanish schoolchildren attending after-school exercise sessions in Spain also completed the questionnaire to test generalisability of findings. Motion-sensor computer games were implemented at weekly sessions at the English weight-management camp to encourage exercise and improve attendees’ perceived exercise capability. No participants withdrew from the study. Linear regression was used to investigate associations between body-mass index SD scores (BMI SDS) and perceived exercise capability, opportunity, and motivation; confirmatory factor analysis was conducted to investigate scale construct validity; Cronbach's α tests were conducted to measure internal consistency. Informed consent was obtained from all children, and from their parents or guardians. Ethics approval was granted by the Imperial College Research Ethics Committee and the Ethics Committee for Clinical Research, University of La Rioja. Findings On arrival at the camp, questionnaires were completed by 71 English children (34 girls, 48%) aged 9–17 years (mean 12·2, SD 2·0) with BMI SDS 2·80 (SD 0·66) and by 45 Spanish schoolchildren (22 girls, 49%) aged 9–13 years (mean 10·5, SD 1·2) with mean BMI SDS 0·80 (SD 0·99). 22 attendees of the English camp (12 girls, 55%) aged 9–16 years (mean 12·1, SD 2·2) reported how much they enjoyed the games; and they completed the COM-B questionnaire on both arrival at, and departure from, the camp. Questionnaire composite capability, opportunity, and motivation scores tested adequately for internal consistency (Cronbach's α=0·712–0·796) and construct validity (χ2 /df=1·55, root mean square error of approximation 0·072, comparative fit index 0·92). Linear regression revealed an inverse association between perceived exercise capability and BMI SDS for both English (β=–0·289, p=0·010) and Spanish (β=–0·446, p=0·047) children; no association between BMI SDS and perceived exercise opportunity or motivation was found. A positive correlation was found between extent of motion-sensor game enjoyment and improvement in perceived exercise capability ( r (22)=0·538, p=0·010), but not opportunity or motivation improvement, during stays at the camp. Interpretation Perceived exercise capability can be measured with the instrument described here. This small-sample study provides preliminary evidence for an association between low perceived exercise capability and childhood obesity and for the possibility that perceived exercise capability can be improved through intervention. Funding This research was supported by the Engineering and Physical Sciences Research Council (grant EP/K012673/1).
Abstract Background Weight-management camp interventions for obese children are effective for short-term weight loss. However, there is little evidence indicating how gains made with such ...interventions can be maintained in the longer term. The present prospective cohort study investigated effectiveness of an intervention consisting of a weight-management camp followed by weekly lifestyle education sessions. Methods Obese children from eight Qatari schools participated in the intervention from Jan 27 to May 20, 2015. It started with a 2 week weight-management camp involving physical and social activities, lifestyle learning, and dietary control. Participants then attended school as usual for 3 weeks. Ten, weekly after-school club sessions were then held, each lasting 2 h, involving further lifestyle education and engagement of participants’ parents, with the aim of encouraging consolidation of learning that had taken place at the camp, and continuation of healthy behaviours. A control group of obese children from the same Qatari schools received no intervention. The primary outcome variable was body-mass index SD scores (BMI SDS). Wilcoxon signed rank tests were used to assess changes in BMI SDS. Informed consent was obtained from participants and their parents. Ethics approval was granted by the Qatar University Institutional Review Board. Findings 56 children (42 girls) aged 9–13 years (mean 10·9, SD 1·1) took part in the intervention. BMI SDS ranged from 1·17 to 4·00 (mean 2·51, SD 0·62). The control group consisted of 37 children (27 girls) aged 8–12 years (mean 10·3, SD 1·1) with BMI SDS 1·40–3·98 (2·78, 0·43). Between the start of camp and the end of the clubs, there was no significant change in control group BMI SDS (mean −0·004, SD 0·29; p=0·784), but significant reduction in the intervention group BMI SDS (−0·10, 0·20; p=0·0003). Significant BMI SDS reduction occurred for the intervention group during weight-management camp (−0·13, 0·12; p<0·0001) and after-school club (−0·12, 0·19; p<0·0001) stages; significant BMI SDS increase occurred between these stages (0·15, 0·16; p<0·0001). Interpretation This small-sample study suggests that weekly lifestyle education sessions can be effective in helping to sustain weight-loss achievements from more intensive childhood obesity interventions. Half of the intervention group achieved an overall BMI SDS reduction of at least 0·10, which has been shown to be associated with important reductions in insulin and total cholesterol. Funding This research was supported by the National Priorities Research Program Qatar Foundation (grant X-036-3–01).
Abstract Background Over the past decade image guidance systems have been widely adopted in specialties such as neurosurgery and otorhinolaryngology. Nonetheless, the evidence supporting the use of ...image guidance systems in surgery remains limited. New augmented reality systems offer the possibility of enhanced operating room workflow compared with existing triplanar image displays, but recent studies have highlighted several concerns, particularly the risk of inattentional blindness and impaired depth perception. The aim of this study was to compare simultaneously the effectiveness and safety of various image guidance systems against standard surgery. Methods In this preclinical randomised study design 50 novice surgeons were allocated to no image guidance, triplanar display, always-on solid overlay, always-on wire mesh overlay, or on-demand inverse realism overlay. Each participant was asked to identify a basilar tip aneurysm in a validated model head. The primary outcomes were time to task completion, and tool path length. The secondary outcomes were recognition of an unexpected finding (a surgical clip) and subjective depth perception (using a Likert scale). Findings Surgeons' time to task completion and tool path length were significantly lower in groups using any form of image guidance than in groups with no image guidance (p<0·001 and p=0·003, respectively). The tool path distance was also lower in groups using augmented reality than in those using triplanar display (p=0·010). Always-on solid overlay resulted in the greatest inattentional blindness (20% recognition of unexpected finding by all surgeons). Wire mesh and on-demand overlays mitigated but did not negate inattentional blindness, and were comparable with triplanar display (40% recognition of unexpected finding in all groups). Wire mesh and inverse realism overlays also resulted in better subjective depth perception than always-on solid overlay (p=0·031 and p=0·008, respectively). Interpretation This study suggests that new augmented reality platforms incorporating always-on wire mesh and on-demand inverse realism might improve surgical performance, at least in novice surgeons. All image display modalities, including existing triplanar display, carry a risk of inattentional blindness. Funding Wellcome Trust.
Abstract Background Childhood obesity tracks into adulthood, meaning obesogenic behaviours learned in early years are likely to be sustained throughout life. Studies of the neurocognitive mechanisms ...underlying obesity-related behaviours have implicated the role of impulsivity in weight gain. Food-related and physical-activity-related impulsive actions such as discounting of the future health benefits of present rewards or the inability to inhibit tempting unhealthy choices can lead to gradual weight gain. Impulsivity was compared in a group of obese and non-obese adolescents to test this hypothesis. Methods 47 obese adolescents (mean body-mass index BMI 33·22 SD 8·0) who attended a residential lifestyle summer camp with a mean age of 14·28 years (SD 1·7) were recruited with parental consent over two summers. A normal weight control group (BMI 20·6 SD 2·3) with a mean age of 13·83 years (SD 1·7) from a UK secondary school were used for comparison. Behavioural measures of impulsivity were tested using the stop signal reaction time (SSRT) as a marker of inhibitory control and the temporal discounting constant for monetary rewards. Self-reported scores of impulsivity using Cloninger's junior temperament and character inventory were correlated with behavioural measures by use of a Spearman's correlation. Findings The non-obese group had better inhibitory control as measured by the SSRT with a mean value of 156·93 ms (SD 43·12) compared with the obese group with a mean value of 218·42 ms (80·48; p=0·0001). Additionally, SSRT direction errors were significantly higher in the obese adolescents (5·48 SD 4·88) than in normal weight individuals (2·88 0·41; p=0·0001), and the proportion of successful stops were significantly higher in the normal weight adolescents (0·49 SD 0·1) than in the obese group (0·53 0·09; p=0·02). Those who were obese (k=0·56 SD 0·36) were found to discount the future value of money significantly more than normal weight individuals (0·40 0·29; p=0·018) and scored higher on the novelty seeking subscale of the junior temperament and character inventory (r=0·23; p=0·03). Interpretation Impulsivity is a unitary construct, which is an independent predictor of BMI in adults and may act as a causal factor in adolescents. Obese adolescents exhibit poor inhibitory control and discount the future for monetary rewards more than their non-obese counterparts. In addition, there were greater response errors and a failure to stop during the no-go paradigm, suggesting the presence of either inattention or hyperactive traits in addition to impulsive behaviours in the obese group. The difference in socioeconomic status between both groups may be a confounding factor and was not available for analysis. Bias was reduced by ensuring all participants were in full-time education, matched for age, and masked to testing. Understanding of the neurocognitive mechanisms underlining obesogenic behaviours such as impulsivity is needed to improve existing interventions, through the development of novel methods to train self-control and self-efficacy as part of a personalised approach to weight reduction. Funding None.
Abstract Background Traditional measures of patient experience have included surveys and, more recently, structured patient-reported outcome measures. There are also large amounts of unstructured, ...free-text information about the quality of health care available on the internet from blogs, social networks, and health-care rating websites that we are not scrutinising. In other industries, real-time natural language processing, such as sentiment analysis, of large datasets has provided a useful analytical approach to find patterns and understand data. If these techniques can be applied to health care, it opens up a novel approach to analyse large volumes of textual information about patient experience. The large number of free-text comments on the UK NHS Choices website allows an opportunity to examine these data through sentiment analysis. These comments are matched with the users' own quantitative ratings of the service, presenting an opportunity to measure the accuracy of natural language processing methods against the patient's own assessment. Simultaneously, the NHS has a developed programme of patient experience measurement via a national survey of hospital inpatients. Using these data sources, we have a natural opportunity to compare our sentiment analysis of comments to traditional patient surveys at an organisational level. Methods We tried to predict whether a patient would recommend a hospital, whether the hospital was clean, and whether they were treated with dignity from their free-text descriptions. We applied machine learning and natural language processing techniques to all (6400) online comments about hospitals on the NHS Choices website in 2010. We used open-source Weka data mining software. We used comments from NHS Choices data from 2008, 2009, and 2011 to train the software. Data from 2010 were used to test the predicting accuracy of the approach. We included our own a priori classification of the 1000 most common words and phrases in the analysis. Having calculated the accuracy of our prediction algorithm, we compared the results obtained with the national inpatient survey results for the same year (2010) at the hospital trust level with Spearman's test for rank correlation. Findings We were able to predict patients' rating of their care from their free-text comments with an accuracy of 81% for hospital cleanliness, 83% for treatment with dignity, and 89% for overall recommendation. We observed mild to moderate associations between our machine learning predictions and patient survey quantitative responses for the three categories examined: cleanliness (Spearman ρ=0·37, p<0·0001), dignity (ρ=0·50, p<0·0001), and overall recommendation (ρ=0·46, p<0·0001). Interpretation The prediction accuracy that we have achieved using this machine learning process suggests that we are able to predict, from free text, a reasonably accurate assessment of patients' opinion about different performance aspects of a hospital. We also find that these machine learning predictions are associated to an extent with results of more conventional surveys. This work is ongoing and an iterative process, but suggests that it might be possible to monitor the so-called online cloud of patient experience in real-time and by doing so harness the value of patient opinion. Funding Imperial College London is grateful for support from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care scheme, the National Institute for Health Research Biomedical Research Centre Funding scheme, and the Imperial Centre for Patient Safety and Service Quality.
Abstract Background Obesity is a complex multifactorial condition for which the treatment needs to be tailored to the individual patient. Cognitive behavioural therapy (CBT) is the mainstay for most ...obesity treatments. Obesity has been compared with addictive behaviours in which people show characteristics of dysfunctional impulsivity, which manifest as deficits in inhibitory control. We aimed to examine the effect of CBT on the objective behavioural manifestations of impulsivity during weight loss in obese adolescents. Methods 31 obese adolescents (21 boys, 17 girls) with a mean age of 14·0 years (SD 0·3) and a body-mass index (BMI) of 33·6 kg/m2 (0·9) attending an obesity camp were tested for impulsivity with the CANTAB (Cambridge, UK; Cambridge Cognition) Stop Signal Task. Tasks were undertaken before the CBT intervention, 6 weeks after the intervention (range 3–8 weeks), and at 6 month follow-up. The inclusion criteria were being obese when adjusted for age and sex, having had regular education up to GCSE level (at age 15–16 years), and being aged between 11 and 17 years. We excluded patients with a formal diagnosis of attention deficit hyperactivity disorder or an eating disorder, those receiving antipsychotic drugs, and those with a serious physical disability restricting physical activity. Findings Mean BMI fell from 33·60 kg/m2 (SD 5·0; n=31) before camp to 30·94 kg/m2 (4·5; n=31) at the end of camp (p=0·01). At 6 month follow-up, participants' weight loss had plateaued, with a mean BMI of 31·27 kg/m2 (SD 5·0; n=12, p=0·04). Reduction in impulsivity after the intervention remained when age and length of stay in camp were controlled for with a general linear model (23·9 ms 86·45; p=0·03). Impulsivity measurements were available in 26 of 31 adolescents at the end of camp. Reasons for loss to follow-up were being unwell (n=1) on the day of data collection and leaving camp for the day (n=4). Loss to follow-up was accounted for in the statistical analysis by use of a complete case analysis of all available covariates. Correlations showed a positive relation between length of stay in camp and reduction in stop signal reaction time (SSRT; r2 =0·20, p=0·03), whereas we noted an inverse relation between age and reduction in SSRT (F=7·723, p=0·011). At 6 months, 12 of 31 adolescents were followed up. In these patients, impulsivity scores decreased by a mean of 108·45 ms (SD 95·7; p=0·008) compared with baseline values. At 6 months, general linear regression did not show any significant associations; however, impulsivity scores were weakly associated with a reduction in BMI (r2 =0·139; p=0·061). Interpretation Impulsivity is an automatic behaviour pattern, thought to be stable over time. We showed that the stop signal task—a commonly used method to measure impulsivity—can be modified over time. Existing data suggest that impulsive individuals are more likely to be obese, but our data suggest that impulsivity might also be associated with weight loss and its maintenance. Limitations of the study include the before and after design in which participants could become familiar with the SSRT task, which could account for the improved scores after camp. We did not measure the intellectual ability of participants, which could be a confounding factor. The follow-up environments were also uncontrolled. This study further contributes to research of obesity based on an addictive behaviour model and treatment implications. Funding None.
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