53417 research outputs found
Sort by
Public health policies and interventions to address health inequities in high-income countries: an umbrella review.
No full textBACKGROUND: Health inequity: defined as systematic and avoidable difference in health outcome, remain entrenched across high-income countries, with socioeconomic gaps in life expectancy exceeding 7-10 years. Upstream interventions addressing the social determinants of health are critical. This umbrella review evaluates which macro-level policies and public health interventions most effectively reduce health inequity. METHODS: We conducted an umbrella review of systematic reviews. Four databases (Embase, Medline, Scopus, Cochrane) were searched from May 2017, the date of the last umbrella review on the subject, to September 2024. Eligible reviews reported population-level interventions in OECD countries, with outcomes stratified by socioeconomic status or related disadvantage. Included systematic reviews were appraised using AMSTAR II. We devised a conceptual Health Equity Pyramid that classified interventions by their agentic demand and population reach. RESULTS: Thirty-five systematic reviews were included. This review evaluated evidence across six policy domains. Redistributive and welfare interventions, including cash transfers, basic income and food subsidies, consistently improved food security, household financial stability and maternal-child health outcomes. Legislative and regulatory measures, such as smoke-free policies and pharmaceutical subsidy reforms, demonstrated robust population-level gains, particularly in disadvantaged groups. Community and housing interventions improved psychological health, reduced morbidity and mortality in targeted populations, and enhanced housing stability. Health system interventions, notably tailored smoking cessation and hospital discharge coordination for people experiencing homelessness, were effective in narrowing disparities. By contrast, educational and behavioural programmes and telehealth interventions often demanded high individual agency; without contextual tailoring, may exacerbate intervention-generated inequality. CONCLUSIONS: This umbrella review demonstrates that interventions characterised by low agentic demand: welfare reform, housing support, and legislative measures; yield the most consistent reductions in inequity. High agentic interventions can be effective when carefully tailored to disadvantaged populations but may otherwise exacerbate disparities. Future policy should prioritise structural, population-level strategies to achieve sustainable equity in health outcomes. TRIAL REGISTRATION: CRD42024529176
Safety, antiviral activity, and pharmacokinetics of long-acting injectable cabotegravir–rilpivirine in virologically suppressed adolescents living with HIV-1 (IMPAACT 2017/MOCHA): 48-week results of a multinational, phase 1/2, single-arm study
No full textDietary guidelines for gastrointestinal disorders: key to optimizing practice but more work needed.
No full textCentralisation of specialist cancer surgery services in two areas of England: the RESPECT-21 mixed-methods evaluation
Get PDFBackground: Centralising specialist cancer surgical services is an example of major system change. High-volume centres are recommended to improve specialist cancer surgery care and outcomes. Objective: Our aim was to use a mixed-methods approach to evaluate the centralisation of specialist surgery for prostate, bladder, renal and oesophago-gastric cancers in two areas of England [i.e. London Cancer (London, UK), which covers north-central London, north-east London and west Essex, and Greater Manchester Cancer (Manchester, UK), which covers Greater Manchester]. Design: Stakeholder preferences for centralising specialist cancer surgery were analysed using a discrete choice experiment, surveying cancer patients (n = 206), health-care professionals (n = 111) and the general public (n = 127). Quantitative analysis of impact on care, outcomes and cost-effectiveness used a controlled before-and-after design. Qualitative analysis of implementation and outcomes of change used a multisite case study design, analysing documents (n = 873), interviews (n = 212) and non-participant observations (n = 182). To understand how lessons apply in other contexts, we conducted an online workshop with stakeholders from a range of settings. A theory-based framework was used to synthesise these approaches. Results: Stakeholder preferences – patients, health-care professionals and the public had similar preferences, prioritising reduced risk of complications and death, and better access to specialist teams. Travel time was considered least important. Quantitative analysis (impact of change) – only London Cancer’s centralisations happened soon enough for analysis. These changes were associated with fewer surgeons doing more operations and reduced length of stay [prostate ‒0.44 (95% confidence interval ‒0.55 to ‒0.34) days; bladder ‒0.563 (95% confidence interval ‒4.30 to ‒0.83) days; renal ‒1.20 (95% confidence interval ‒1.57 to ‒0.82) days]. The centralisation meant that renal patients had an increased probability of receiving non-invasive surgery (0.05, 95% confidence interval 0.02 to 0.08). We found no evidence of impact on mortality or re-admissions, possibly because risk was already low pre-centralisation. London Cancer’s prostate, oesophago-gastric and bladder centralisations had medium probabilities (79%, 62% and 49%, respectively) of being cost-effective, and centralising renal services was not cost-effective (12% probability), at the £30,000/quality-adjusted life-year threshold. Qualitative analysis, implementation and outcomes – London Cancer’s provider-led network overcame local resistance by distributing leadership throughout the system. Important facilitators included consistent clinical leadership and transparent governance processes. Greater Manchester Cancer’s change leaders learned from history to deliver the oesophago-gastric centralisation. Greater Manchester Cancer’s urology centralisations were not implemented because of local concerns about the service model and local clinician disengagement. London Cancer’s network continued to develop post implementation. Consistent clinical leadership helped to build shared priorities and collaboration. Information technology difficulties had implications for interorganisational communication and how reliably data follow the patient. London Cancer’s bidding processes and hierarchical service model meant that staff reported feelings of loss and a perceived ‘us and them’ culture. Workshop – our findings resonated with workshop attendees, highlighting issues about change leadership, stakeholder collaboration and implications for future change and evaluation. Limitations: The discrete choice experiment used a convenience sample, limiting generalisability. Greater Manchester Cancer implementation delays meant that we could study the impact of only London Cancer changes. We could not analyse patient experience, quality of life or functional outcomes that were important to patients (e.g. continence). Future research: Future research may focus on impact of change on care options offered, patient experience, functional outcomes and long-term sustainability. Studying other approaches to achieving high-volume services would be valuable. Study registration: National Institute for Health and Care Research (NIHR) Clinical Research Network Portfolio reference 19761
Thermal management of lithium-ion batteries: Numerical evaluation of phase change materials and fin designs against air cooling
No full textOptimal thermal management is critical for ensuring the safety and longevity of lithium-ion batteries (LIBs), yet efficient thermal regulation remains challenging. This study investigates air cooling and phase change material (PCM)-based strategies, examining how fin geometry (disk versus sinusoidal) and quantity affect thermal performance. A three-dimensional numerical model was developed using the enthalpy-porosity method to simulate PCM melting, with validation against experimental data. Seven cooling configurations were evaluated, including air cooling, PCM-only cooling, and PCM combined with copper fins of varying geometries (disk and sinusoidal) and quantities (one to three). The module comprised a tightly packed array of 18650-type LIB cells, with uniform heat generation applied under 3C discharge/charge conditions. Two key novelties are presented: a comparative evaluation of cooling strategies and a quantified thermal–mass trade-off relevant to electric vehicles and aerospace applications. Results show that air cooling produced a 12 K temperature gradient, with final row temperatures reaching 318 K. PCM reduced peak temperature by ∼16 K and improved temperature uniformity. Increasing fin count from 1 to 3 enhanced uniformity by 35.2 %, with fin number more influential than shape. The two-fin configuration offered optimal balance, lowering temperature variation by 28 % with only a 3.26 % increase in system mass
Visual Biographies: Constructing Algerian Jewish Family Photographic Practices, 1890-1962
No full textThis thesis explores the photographic practices of Algerian Jews living in Algeria’s northern coastal region from the 1890s, when Jewish families began using photography, until their mass departure in 1962 in the wake of Algerian Independence. By making family photographs the primary source of enquiry, this project reintegrates family photographs into the historiographies of Algerian Jewry and moves beyond the prevailing colonial perspective that dominates French Algerian visual histories. Drawing on a corpus of two thousand photographs and forty oral history interviews, this thesis investigates the evolution of Algerian Jewish identity in the past and its remembering in the present while delineating the particularities of vernacular photography. This research interrogates how Algerian Jews perceived photography, appropriated the medium and whether their practices reflected their unique position in colonial society. Unlike existing scholarship on Algerian Jews that used photographs solely as obvious visual proof of social changes, this analysis exposes the complexities of the construction of the self and the cultural hybridity they fashioned for themselves by bringing together the historiography of Algerian Jewry with scholarship on family photography. Through a thematic analysis of family photographs and oral histories, this thesis argues that Algerian Jews considered photography as a means of recognition and integration into French colonial society, producing Franco-Jewish identities anchored in Algerian space. The research exposes how Algerian Jews held agency in choosing what to make visible, what to exclude from the frame to signify the identities they wished to advance, their aspirations, and their visions of the world. Although Algerian Jews embraced family photographic conventions, this study illuminates distinct parameters in their use of photography that translated their ambiguous positions within colonial society and their struggle to be recognised as French citizens
Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn's and Colitis (PREdiCCt) prospective cohort study.
Get PDFBACKGROUND: IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. OBJECTIVE: The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. DESIGN: Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. RESULTS: Between November 2016 and March 2020, 2629 participants (1370 CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0-5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250 µg/g: adjusted HR (aHR) 2.22; FC 50-250 µg/g: aHR 1.52 (reference <50 µg/g)) and objective flares (FC ≥250 µg/g: aHR 3.25; FC 50-250 µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95% CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. CONCLUSION: Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups. TRIAL REGISTRATION NUMBER: NCT03282903
