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Key action areas for transforming the UK food system: Insights from the Transforming UK Food Systems (TUKFS) Programme project portfolio
Get PDFThe UK food system is a driver of the public health crisis of non-communicable disease, is linked to the cost-of-living crisis, and contributes to climate change, biodiversity loss and soil degradation. The economy relies strongly on the health of its people and food businesses, while also impacting the livelihoods of food system actors. However, action towards more resilient, equitable and regenerative food systems remains too slow and unambitious to adequately address these challenges. The Transforming UK Food Systems Programme comprises a wide range of research projects which address these challenges in a novel place-based, co-produced and action-oriented way. We provide 27 suggested action areas for supporting food system transformation, grouped in five themes spanning production, manufacturing, supply chain and consumption. Among the suggestions, there is a strong emphasis on the importance of co-production with food system actors and affected citizens. We highlight the vital role of governance and policy in supporting these action areas in both a structural and financial way, noting that this needs both national policy and regional approaches to take into account geographically varying cultural circumstances and values, and to allow the high level of co-production necessary
Live Online Video Interviewing as a Complementary Mode to In-Person Interviews: Evidence from the European Social Survey
Get PDFLive video interviewing emerged as a method for collecting survey data during the COVID-19 pandemic, having rarely been used for survey data collection prior to this. There is now a need to assess experiences and outcomes from studies that utilised video interviewing, partly with a view to informing the future feasibility of the method in different contexts. This paper reports on the experience of the European Social Survey (ESS) with video interviewing, having used this approach as a complementary method to in-person interviewing at its 10th round (2020-2022). The ESS can provide a unique perspective, being the first cross-national survey to use video interviews. In total, 17 countries offered video interviewing alongside in-person interviewing at ESS Round 10. In this paper, we present a range of results based on ESS Round 10 in two main categories. We first look at the effectiveness of the implementation of video interviewing and then compare quality between video interviews and in-person interviews across various indicators, including interviewer effects. The results show that the prevalence of video interviews varied widely between countries, likely relating to national contextual factors. However, in countries where a large share of video interviews was carried out, we found that the interview experience was rated positively, and quality indicators were closely comparable with in-person interviews. These results suggest that future use of video interviewing may be more feasible in some countries that others, but in certain contexts it has the potential to offer an effective complementary option to in-person interviewing
A case study on drug-assisted psychotherapy and recovering and retracting beliefs of abuse
No full textWe present the case of a man, JK, who initially came to believe during therapy that he had been abused by his father, but later repudiated this claim. We had access to JK’s clinical records, including detailed notes from a psychiatrist who had intensively treated him. In total, we analyzed and coded 143 documents, including therapy notes, with two primary aims: (1) to examine the veracity of JK’s retraction narrative, and (2) to identify factors relevant to the formation of false beliefs or memories. The records indicated that JK underwent narcoanalysis intended to uncover repressed memories, during which the psychiatrist used suggestive techniques to elicit memories of abuse. As a result, JK came to believe that he had been abused by his father in childhood. Later, after reading a newspaper article discussing the potential for psychiatrists to implant false memories, JK retracted this belief. This case study offers insight into the complex processes by which traumatic experiences can be both recovered and subsequently retracted, highlighting the potential influence of therapeutic techniques and external information on memory formation
Timing of Term Births and Associated Mortality Risks: Ecological Analysis Across 28 European Countries
Get PDFObjective
To explore term mortality rates in relation to rates of early‐term birth (gestational ages 37 + 0 to 38 + 6 weeks), regarded as a proxy indicator of practices of elective birth by induction or caesarean.
Design
Ecological study using national birth data.
Setting
28 European countries.
Population
Births ≥ 37 weeks between 2015 and 2020.
Methods
Aggregated data on live and stillbirths by completed week of gestation was compiled from routine sources in the Euro‐Peristat network. Countries were divided into three groups based on their percentages of early‐term births using terciles (high, medium and low) and mortality rates were compared between groups with random‐effects meta‐analysis of proportions.
Main Outcome Measures
Stillbirths (antepartum or intrapartum fetal death) and perinatal death (stillbirth or early neonatal death) per 1000 total births ≥ 37 weeks.
Results
Early‐term birth rates ranged from 17.8% (Iceland) to 49.1% (Cyprus), with terciles being < 21%, 21%–27%, and > 27%. Post‐term birth rates were low in countries with higher early‐term birth rates. The pooled stillbirth rate ≥ 37 weeks was 1.28 per 1000 total births (95% CI: 1.13–1.46) in the lowest tercile and 1.05 (95% CI: 0.95–1.16) in the highest (p = 0.05), but prediction intervals were wide reflecting heterogeneity within groups. No evidence of difference was seen between perinatal mortality rates by tercile (p = 0.71).
Conclusion
On average, the stillbirth rate was lower in countries where early‐term birth rates were highest, but no difference was found in perinatal mortality rates. Heterogeneity was high within groups
From Theory to Practice: Viewpoint on Economic Indicators for Trust in Digital Health
Get PDFUser trust is pivotal for the adoption of digital health systems interventions (DHI). In response, numerous trust-building guidelines have recently emerged targeting DHIs such as artificial intelligence. The common aim of these guidelines aimed at private sector actors and government policy makers is to build trustworthy DHI. While these guidelines provide some indication of what trustworthiness is, the guidelines typically only define trust and trustworthiness in broad terms, they rarely offer guidance about economic considerations that would allow implementers to measure and balance trade-offs between costs and benefits. These considerations are important when deciding how best to allocate scarce resources (eg, financial capital, workforce, or time). The missing focus on economics undermines the potential usefulness of such guidelines. We propose the development of actionable trust-performance-indicators (including but not limited to surveys) to gather evidence on the cost-effectiveness of trust-building principles as a crucial step for successful implementation. Furthermore, we offer guidance on navigating the conceptual complexity surrounding trust and on how to sharpen the trust discourse. Successful implementation of economic considerations is critical to successfully build user trust in DHI
Monte Carlo Simulation of the Effect of Melanin Concentration on Light–Tissue Interactions in Reflectance Pulse Oximetry
Get PDFOver the past ten years, there has been an increasing demand for reliable consumer wearables as users are inclined to monitor their health and fitness metrics in real-time, especially since the COVID-19 pandemic. Reflectance pulse oximeters in fitness trackers and smartwatches provide convenient, non-invasive SpO2 measurements but face challenges in achieving medical-grade accuracy, particularly due to difficulties in capturing physiological signals, which may be affected by skin pigmentation. Hence, this study sets out to investigate the influence of skin pigmentation, particularly in individuals with darker skin, on the accuracy and reliability of SpO2 measurement in consumer wearables that utilise reflectance pulse oximeters. A Monte Carlo model is developed to assess the effect on simulated reflectance pulse oximetry measurements across light, moderate, and dark skin types for oxygen saturation levels between 70 and 100%. The results indicate that a one-algorithm-fits-all calibration approach may be insufficient, and root mean square errors (RMSEs) of at least 0.3956%, 0.9132%, and 8.4111% for light, moderate, and dark skin are observed when compared to transmittance calibration algorithms. Further research is required to validate these findings and improve the performance of reflectance pulse oximeters in real-world applications, particularly in the context of consumer wearables
Prevalence and predictors of catastrophic health expenditure due to out-of-pocket payment among rural households in Delta State, Nigeria: A community-based cross-sectional study
Get PDFBackground: Any healthcare expenditure that threatens a household’s financial capacity to maintain its subsistence living is regarded as catastrophic health expenditure (CHE). Many people in low- and middle-income countries such as Nigeria face financial difficulties when they fall sick. This study assessed the prevalence and predictors of CHE due to out-of-pocket (OOP) payments among rural households in Delta state, Nigeria.
Methods: A cross-sectional study design was employed to assess the prevalence of CHE among a random multistage sample of 412 households. Data was collected using an interviewer-administered semi-structured questionnaire. Descriptive and inferential analyses of data collected were carried out using the IBM SPSS version 22 software.
Results: The sex distribution revealed that 50.5% (n=208) of the household heads were females, while 49.5% (n=204) were males. The prevalence of household CHE at 5% and 10% thresholds of household income was 30.3% (n=125) and 21.8% (n=90) respectively. When both direct medical and direct non-medical costs were considered the prevalence of household CHE increased to 35.4% (n=146) and 25.5% (n=105) respectively. Households with no history of hospitalisation, with less than seven persons, whose heads were aged below 40 years, and had no formal education had 88% (AOR=0.12; 95% CI: 0.05-0.32), 79% (AOR=0.21; 95% CI: 0.09-0.49), 93% (AOR=0.07; 95% CI: 0.01-0.45), and 43% (AOR=0.57; 95% CI: 0.34-0.96) decreased odds respectively of experiencing CHE.
Conclusion: This study revealed a relatively high prevalence of CHE due to OOP payments among rural households. There is an urgent need to scale up health insurance coverage to reduce the burden of CHE experienced by rural households
European Union Approaches to Europe’s Romani People: The Potential of a Capabilities Approach to Law and Policy Making
No full textThis chapter critiques the European Union’s efforts to support Romani people in overcoming the disadvantaged positions they hold in EU Member States (MS). It reviews current EU measures and developments and argues that these have produced limited results for the improvement of the lives of Romani people in Europe. The chapter argues that the EU should revise its approach for potentially more effective impacts, by gearing its efforts towards empowering Romani people to take up the opportunities that the EU and its MS offer in a manner which allows them to lead lives of their choosing. To this end, this chapter adopts Sen’s capabilities approach as a way forward, which suggests that people need to have the freedom (capability) to choose a variety of lifestyles, and thus require empowerment to make choices and implement these in their lives. The capabilities approach goes beyond having access to goods and services and requires authorities to create the conditions to empower citizens to make effective use of those goods and services. This chapter elaborates on Sen’s capabilities theory and assesses whether the EU supports it, and how it might (further) do so in the future. It concludes that to enhance the capabilities of Romani people in the EU, the EU institutions should adopt a multipronged strategy based on: greater use of Article 7 TEU and infringement procedures; the introduction of a hard law, Romani-specific measure; and the creation of a Roma Truth and Reconciliation Commission
The problem with uptake as a quality metric for population-based screening programmes
Get PDFQuality measurement that focuses on important processes and outcomes within healthcare is typically seen as an essential feature of well-functioning healthcare systems.1 While outcome measures are concerned with assessing the impact of healthcare interventions (eg, the number of adverse drug events or the average length of stay for inpatients), process measures focus instead on assessing whether elements or steps within healthcare systems are happening as planned (eg, the number of patients seen in a clinic or the proportion of patients receiving a particular intervention). The relationship between processes and outcomes is acknowledged to be complex.
Many population-based screening programmes, both in the UK and internationally, have as a key performance indicator (KPI) some sort of measure that assesses how many of the population eligible for that screening intervention participate in it (typically referred to as either ‘uptake’ or ‘coverage’). For example, for the adult (non-pregnancy) screening programmes offered by the NHS in the UK, all five programmes include a KPI of this kind, with acceptable (ie, minimum) thresholds made explicit.
But is this simple process measure of the uptake of screening programmes a good assessment of healthcare quality? In this viewpoint paper, we highlight some of the shortcomings in using uptake to measure quality in this context and offer some possible ways forward
A web-based intervention to support the mental well-being of sexual and gender minoritised adolescents: Formative evaluation of Oneself
Get PDFBackground: Sexual and gender minoritised adolescents are at an increased risk of mental health problems. However, few interventions have been specifically designed to support their mental wellbeing.
Objective: The purpose of this study was to evaluate Oneself; a prototype bespoke digital mental well-being intervention co-developed with and for sexual and gender minoritised adolescents.
Methods: Think aloud testing of Oneself was conducted with sexual and gender minoritised adolescents. Adult experts appraised Oneself via semi-structured interviews. Additionally, participants completed questionnaires including the System Usability Scale (SUS). Qualitative data were analysed using a general inductive approach.
Results: Participants included 11 sexual and gender minoritised adolescents (aged 14-19, mean 16.3 years) and 14 adult experts (78.6% 30 years or older). Usability, satisfaction and wellbeing results indicated that Oneself is a promising intervention. The mean SUS score was 78.8% (n=25), which corresponds to a B+ on the Sauro–Lewis Curved Grading Scale. Six themes were identified across the qualitative data: “Clarity and accessibility” (e.g., refine audio visual content as well as text), “Appeal and depictions” (e.g., enhance the perspectives and representation), “Functionality and development” (e.g., extend the choice and user options), “Safety and privacy” (e.g., harsh world warnings needed for LGBTQ+ youth), “Reaching the end users” (e.g., promoting Oneself in a youth-friendly way) and “Mechanisms of impact” (e.g., sharing lived experience).
Conclusion: Oneself could be used to help support the mental well-being of users, but modifications are indicated prior to any further testing and consideration of a roll ou
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