ObjectiveInvestigators within many disciplines are using measures of well-being, but it is not always clear what they are measuring, or which instruments may best meet their objectives. The aims of ...this review were to: systematically identify well-being instruments, explore the variety of well-being dimensions within instruments and describe how the production of instruments has developed over time.DesignSystematic searches, thematic analysis and narrative synthesis were undertaken.Data sourcesMEDLINE, EMBASE, EconLit, PsycINFO, Cochrane Library and CINAHL from 1993 to 2014 complemented by web searches and expert consultations through 2015.Eligibility criteriaInstruments were selected for review if they were designed for adults (≥18 years old), generic (ie, non-disease or context specific) and available in an English version.ResultsA total of 99 measures of well-being were included, and 196 dimensions of well-being were identified within them. Dimensions clustered around 6 key thematic domains: mental well-being, social well-being, physical well-being, spiritual well-being, activities and functioning, and personal circumstances. Authors were rarely explicit about how existing theories had influenced the design of their tools; however, the 2 most referenced theories were Diener's model of subjective well-being and the WHO definition of health. The period between 1990 and 1999 produced the greatest number of newly developed well-being instruments (n=27). An illustration of the dimensions identified and the instruments that measure them is provided within a thematic framework of well-being.ConclusionsThis review provides researchers with an organised toolkit of instruments, dimensions and an accompanying glossary. The striking variability between instruments supports the need to pay close attention to what is being assessed under the umbrella of ‘well-being’ measurement.
ObjectiveTo investigate the importance of key characteristics relating to diagnostic testing for ovarian cancer and to understand how previous test experience influences priorities.DesignCase 1 ...best–worst scaling embedded in an online survey.SettingPrimary care diagnostic testing in England and Wales.Participants150 women with ovaries over 40 years old living in England and Wales.MethodsWe used best–worst scaling, a preference-based survey method, to elicit the relative importance of 25 characteristics relating to ovarian cancer testing following a systematic review. Responses were modelled using conditional logit regression. Subgroup analysis investigated variations based on testing history.Main outcome measuresRelative importance scores.Results‘Chance of dying from ovarian cancer’ (0.380, 95% CI 0.26 to 0.49) was the most important factor to respondents, closely followed by ‘test sensitivity’ (0.308, 95% CI 0.21 to 0.40). In contrast, ‘time away from usual activities’ (−0.244, 95% CI −0.33 to −0.15) and ‘gender of healthcare provider’ (−0.243, 95% CI −0.35 to −0.14) were least important to respondents overall. Women who had previously undergone testing placed higher importance on certain characteristics including ‘openness of healthcare providers’ and ‘chance of diagnosing another condition’ at the expense of reduced emphasis on characteristics such as ‘pain and discomfort’ and ‘time away from usual activities’.ConclusionsThe results clearly demonstrated items at the extreme, which were most and least important to women considering ovarian cancer testing. Differences in priorities by testing history demonstrate an experience effect, whereby preferences adapt over time based on evidence and experience. Acknowledging these differences helps to identify underlying barriers and facilitators for women with no test experience as well as shortcomings of current service based on women with experience.
Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have ...rarely been evaluated.
Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial.
3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm(3)) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 95%CI:685,845, translating into an adjusted incremental cost of $7386 3277,dominated per life-year gained and $7793 4442,39179 per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below $3.78 to become cost-effective (<3xper-capita GDP, following WHO benchmarks). CD4 monitoring at current costs as undertaken in DART was not cost-effective in the long-term.
There is no rationale for routine toxicity monitoring, which did not affect outcomes and was costly. Even though beneficial, there is little justification for routine 12-weekly CD4 monitoring of ART at current test costs in low-income African countries. CD4 monitoring, restricted to the second year on ART onwards, could be cost-effective with lower cost second-line therapy and development of a cheaper, ideally point-of-care, CD4 test.
IntroductionA mobile app, BlueIce, was codesigned with young people with a history of self-harm to provide them with more accessible and available evidence-based support at times of distress. A ...preliminary evaluation found that BlueIce was acceptable, safe and used by young people and helped to reduce self-harm. The present study is designed to assess the effectiveness and cost-effectiveness of adding BlueIce to usual Child and Adolescent Mental Health Service (CAMHS).Methods and analysisThis study is a single-blind, randomised controlled trial comparing usual CAMHS care with usual care plus BlueIce. A total of 138 adolescents aged 12–17 with current or a history of self-harm will be recruited through the Oxford Health National Health Service (NHS) Foundation Trust via their CAMHS clinician. The primary outcome is self-harm at 12 weeks assessed using the Risk Taking and Self-Harm Inventory for Adolescents. Secondary outcomes include mood, anxiety, hopelessness, general behaviour, sleep and impact on everyday life at 12 weeks and 6 months. Health-related quality of life and healthcare resource utilisation data will be collected at baseline, 12 weeks and 6 months. Postuse interviews at 12 weeks will determine the acceptability, safety and usability of BlueIce.Ethics and disseminationThe study was approved by the NHS South Central—Oxford B NHS Research Ethics Committee (19/SC/0212) and by the Health Research Authority (HRA) and Health and Care Research Wales. Findings will be disseminated in peer review open-access journals and at academic conferences.Trial registration numberISRCTN10541045.
Antimicrobial resistance and the COVID-19 pandemic Choudhury, Samira; Medina-Lara, Antonieta; Smith, Richard
Bulletin of the World Health Organization,
05/2022, Letnik:
100, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Before the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization (WHO) recognized antimicrobial resistance as one of the top 10 most urgent global health threats. Often referred ...to as the silent pandemic, antimicrobial resistance claims the lives of over 700 000 people annually. A study suggests that if no actions are taken, antimicrobial resistance will cause 10 million deaths per year by 2050 and an economic impact of over 100 trillion United States dollars.1 Efforts to tackle antimicrobial resistance as a critical global health concern have only recently intensified. Between 2017 and 2019, participation in the WHO Global Antimicrobial Resistance and Use Surveillance System increased exponentially, aggregating data from more than 64 000 surveillance sites from 66 countries.2 In August 2020, 94 countries were enrolled in this surveillance system.3 This high participation is a significant achievement in the global fight against this health threat. However, increasing concerns exist that the COVID-19 pandemic has set back the current and future progress against antimicrobial resistance.4 The pandemic has placed an enormous pressure on healthcare systems and diverted resources, personnel and attention from the diagnosis and management of antimicrobial resistance to COVID-19 diagnosis and contact tracking and tracing. Antimicrobial resistance research has been severely disrupted and surveillance and antimicrobial stewardship programmes have also been deprioritized, delayed or halted.5
A high burden of malaria, tuberculosis, and HIV infection contributes to national and individual poverty. We have reviewed a broad range of evidence detailing factors at individual, household, and ...community levels that influence vulnerability to malaria, tuberculosis, and HIV infection and used this evidence to identify strategies that could improve resilience to these diseases. This first part of the review explores the concept of vulnerability to infectious diseases and examines how age, sex, and genetics can influence the biological response to malaria, tuberculosis, and HIV infection. We highlight factors that influence processes such as poverty, livelihoods, gender discrepancies, and knowledge acquisition and provide examples of how approaches to altering these processes may have a simultaneous effect on all three diseases.
Encephalitis, brain inflammation and swelling, most often caused by an infection or the body's immune defences, can have devastating consequences, especially if diagnosed late. We looked for clinical ...predictors of different types of encephalitis to help clinicians consider earlier treatment. We conducted a multicentre prospective observational cohort study (ENCEPH-UK) of adults (> 16 years) with suspected encephalitis at 31 UK hospitals. We evaluated clinical features and investigated for infectious and autoimmune causes. 341 patients were enrolled between December 2012 and December 2015 and followed up for 12 months. 233 had encephalitis, of whom 65 (28%) had HSV, 38 (16%) had confirmed or probable autoimmune encephalitis, and 87 (37%) had no cause found. The median time from admission to 1.sup.st dose of aciclovir for those with HSV was 14 hours (IQR 5-50); time to 1.sup.st dose of immunosuppressant for the autoimmune group was 125 hours (IQR 45-250). Compared to non-HSV encephalitis, patients with HSV more often had fever, lower serum sodium and lacked a rash. Those with probable or confirmed autoimmune encephalitis were more likely to be female, have abnormal movements, normal serum sodium levels and a cerebrospinal fluid white cell count < 20 cells x10.sup.6 /L, but they were less likely to have a febrile illness. Initiation of treatment for autoimmune encephalitis is delayed considerably compared with HSV encephalitis. Clinical features can help identify patients with autoimmune disease and could be used to initiate earlier presumptive therapy.
Much attention has been given to how we can make consumption more responsible—better for the planet and society. However, research on the associations between consumer purchasing behavior and their ...psychological concern for health, the environment and ethics lacks consensus on the significance and directionality of these concerns. This study aims to examine how (relatively) important these concerns are in determining consumer purchasing behavior. Systematic searches were conducted in PubMed, EconLit, Web of Science and Scopus databases from 2000 to 2020. Results were summarized through narrative synthesis of the evidence and meta-analysis. The meta-analysis revealed a significant positive correlation between health, environmental and ethical concerns and purchasing behavior, indicating that changes in health, environmental and ethical concerns will result in a consistent shift in purchase behavior towards choices consistent with the concern. This association is susceptible to moderating factors including types of products (food, non-food and non-specific products) and country’s level of economic development. In addition, the health, environmental and ethical concerns appear to have a weaker impact on the actual purchase behavior than on purchase intention, suggesting that interventions should focus on translating these “purchasing intentions” into actual purchasing behaviors. Narrative review of the studies that were not subject to meta-analysis showed good agreement, with almost all relationships reported having the same direction as those indicated by the meta-analysis. Overall, this study suggests that there is substantial potential for marketing strategies aimed at encouraging pro-health, pro-environment and ethical purchasing behaviors.
BackgroundLittle is known about the social validity of self-harm prevention apps for young adolescents with severe mental health problems who repeatedly self-harm.ObjectiveWe assessed the ...acceptability, use and safety of BlueIce, a self-harm prevention app for young adolescents who self-harm.MethodsMixed methods study involving a content analysis of postuse interviews. Participants were a clinical group of 60 UK adolescents aged 12–17 with repeated self-harm, randomised to receive BlueIce.FindingsBlueIce was used by 57/60 (95%) respondents with 47/57 (82%) using BlueIce when thinking about self-harm. 17/47 (36%) who were thinking about self-harm used it on more than six occasions with 36/47 (77%) reporting that BlueIce prevented at least one episode of self-harm. 33/47 (70%) reported occasions when they used the app but still went on to self-harm. Reasons why the app was not used or not helpful included feeling too distressed, a negative mindset, prior decision to self-harm or forgetting. BlueIce was rated 4.09 (SD=0.75) out of 5 stars, with high mean ratings out of 10 for ease of use (8.70, SD=1.37) and good for acceptability (7.68, SD=2.05) and helpfulness (6.77, SD=1.72). No respondent identified BlueIce as triggering any episode of self-harm.ConclusionThese findings are consistent with previous evaluations and highlight the acceptability, use and safety of BlueIce. Self-reports indicate that BlueIce prevented some episodes of self-harm.Clinical implicationsOur results highlight the acceptability of the BlueIce self-harm app for young adolescents who repeatedly self-harm.
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