22 research outputs found
Evidence on treat to target strategies in polymyalgia rheumatica and giant cell arteritis: a systematic literature review
No full textObjectives To inform an international task force about current evidence on Treat to Target (T2T) strategies in PMR and GCA.Methods A systematic literature research (SLR) was conducted in Medline, EMBASE, Cochrane Library, clinicaltrials.gov from their inception date to May 2022, and in the EULAR/ACR abstract database (2019-2021). Randomised clinical trials (RCTs) and non-randomised interventional studies published in English and answering at least one of the eleven PICO questions on T2T strategies, treatment targets and outcomes, framed by the taskforce, were identified. Study selection process, data extraction and risk of bias assessment were conducted independently by two investigators.Results Of 7809 screened abstracts, 397 were selected for detailed review and 76 manuscripts were finally included (31 RCTs, eight subgroup/exploratory analyses of RCTs and 37 non-randomised interventional studies). No study comparing a T2T strategy against standard of care was identified. In PMR RCTs, the most frequently applied outcomes concerned treatment (90.9% of RCTs), particularly the cumulative glucocorticoids (GC) dose and GC tapering, followed by clinical, laboratory and safety outcomes (63.3% each). Conversely, the most commonly reported outcomes in RCTs in GCA were prevention of relapses (72.2%), remission as well as treatment-related and safety outcomes (67.0% each).Conclusions This SLR provides evidence and highlights the knowledge gaps on T2T strategies in PMR and GCA, informing the task force developing T2T recommendations for these diseases
National Hypertension Taskforce of Australia: A roadmap to achieve 70% blood pressure control in Australia by 2030
No full textBackground: Raised blood pressure is the leading preventable cause of death in Australia. One in three Australian adults (6.8 million people) have hypertension, defined as clinic or office blood pressure greater than or equal to 140/90mmHg, based on randomised population data.10 Screening campaigns found that about half of these adults (3.4 million) have not had their high blood pressure values detected and are unaware of their hypertension,11 hence are not receiving appropriate treatment. Of those who are diagnosed with hypertension, and treated in the general population, only 32% (2.2 million) are treated effectively, that is, reducing their blood pressure to less than 140/90mmHg (Box 1).10,11 Australians who visit primary care centres have somewhat different rates, where 55% of patients are treated and have their blood pressure effectively controlled.12
Goal: Increase current population blood pressure control rates (\u3c140/90mmHg) from 32% to at least 70% by 2030.5,10
Targets and strategies: The roadmap for 2024–2030 (Box 2) is built on three pillars: (A) prevent; (B) detect; and (C) effectively treat raised blood pressure. An international modelling study recommended 80–80–80 blood pressure targets, which translates to 80% of individuals with hypertension being screened and aware of their diagnosis; 80% of those who are aware being prescribed treatment; and 80% of those on treatment having achieved blood pressure targets.13 However, because 20% remain unaware, and 20% of those aware remain untreated, and 20% of those treated not achieving target, this model would only achieve 51% blood pressure control. To achieve the Taskforce’s target of 70%, a 90–90–90 model is required for Australia, as this approach would achieve a 73% blood pressure control rate
Treating Rheumatoid Arthritis to Target: multinational recommendations assessment questionnaire
No full textTo measure the level of agreement and application of 10 international recommendations for treating rheumatoid arthritis (RA) to a target of remission/low disease activity
Young people and illicit drug use: A health promotion model to differentiate abstinence or recreational drug use from misuse
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 27/04/2004.The thesis is a study of illicit drug use and attitudes to drugs education amongst young people from different socio-economic backgrounds. The thesis reviews the existing literature and finds that there may be a link between poverty and drug use that hasn't been fully explored and that there has been a lack of attention to young people's perspectives and views on drug use. The findings are reported of an empirical research project that consisted of quantitative and qualitative research with 206 young people in five different settings: at university, in a youth club, in schools, in a pupil referral unit, and service for young offenders. The data from these different sources are analysed and a conceptual model has been developed, setting out some factors that are indicative of problematic or non-problematic drug use. The model was circulated amongst a small group of professionals in relevant fields for comment. The thesis concludes that young people in university settings reported using illicit drugs recreationally and apparently without problems, while the 'vulnerable' young people reported using more drugs, at an earlier age, and more frequently, and for reasons to do with boredom, depression and anxiety. The author suggests that 'vulnerable' young people are disadvantaged by their circumstances at home, including social deprivation and parental separation, and their lack of engagement with education. It is argued that health promotion models need to recognise the importance of contextual and broader structural factors influencing drug use among young people, and that health promotion efforts need to play a role in tackling inequalities and reducing deprivation, as well as making health promotion messages relevant to their target audience
Supplementary information files for "Transitioning to net Zero: assessing the impacts on asset impairment, write-downs and the going concern of oil and gas companies operating in the UK"
No full textSupplementary files for article "Transitioning to net Zero: assessing the impacts on asset impairment, write-downs and the going concern of oil and gas companies operating in the UK"In June 2019, the UK government legislated a net zero target by 2050. This will directly impact the UK oil and gas industry. This study reports perceptions of key oil and gas professionals regarding the impact of transitioning to net zero on impairment, values, write-downs, and going concern in the UK oil and gas industry, as well as required net-zero-related disclosures. Data were collected through 22 interviews, two written responses to our interview questions, and disclosures made by oil and gas companies in their annual reports. We use conservatism and stakeholder theory to inform our results. Our findings confirm there will be serious impacts of the transition to net zero on impairments, asset write-downs, and on the value and going concern of several oil and gas companies. However, these impacts will not fall equally across the industry, and it is likely therefore that stakeholders will be affected differently. Our results contribute, first, to the debate on the impacts of the transition to net zero on key accounting measures of oil and gas companies; second, we identify risks associated with the transition to net zero for these companies and their stakeholders, and we classify the at-risk oil and gas companies operating in the UK; third, we present a collection of disclosure items deemed necessary by our interviewees. Our specified disclosure items may complement those of the Task Force on Climate-related Financial Disclosures (TCFD) and the Transition Plan Taskforce (TPT).© The Author(s), CC BY 4.0</p
Молекулярные особенности почечно-клеточного рака: ранняя диагностика и перспективы терапии
No full textKidney cancer (renal cell carcinoma) is one of the major problems of modern urological oncology. In Russia renal cell carcinoma accountsfor 4.3 % of all cancers. The global incidence of renal cell carcinoma has increased over the past two decades. Worldwide renal cell carcinoma accounts for 3.6 % of all cancers and is 10th frequent malignancy. For some malignancies, for instance tumours of prostate, there are markers known that allowed improved early diagnostics. Kidney cancer, however, remains to be hard to diagnose and to treat, since the symptoms can be detected on advanced stages of the disease. In Russia 75.4 % of renal cell carcinoma cases detected at the stage of local and locally advanced disease. Though there are various target drugs on the market aimed to treat this disease, the results of renal cell carcinoma treatment did not reach any substantial success. Most of existing target drugs for kidney cancer treatment include inhibitors of a single signalingpathway regulated by VHL1, which expression is lost in the vast majority of renal-cell carcinomas. Till now existing drugs did not reach sufficient efficacy. Therefore, it is highly important to search for new signaling pathways, regulating such cellular processes as proliferation, migration and apoptosis. Further, prognostic markers and therapy targets identified so far are not sufficient and poorly specific. Therefore identification and validation of new markers, and especially new specific targets for the treatment of kindey oncopathologies is highly important and timely task
Tackling cervical cancer in Europe amidst the COVID-19 pandemic
No full textAccording to estimates for 2018, approximately 33 000 cases of cervical cancer occurred and 15 000 people died from the disease in Europe (see map in appendix). Human papillomavirus (HPV) vaccine coverage is relatively low in countries with the highest incidence and screening performance is heterogeneous among European countries. Cytological screening followed by treatment of screen-detected cervical lesions has resulted in substantial decreases in the burden of cervical cancer in western and northern Europe; but in eastern Europe, cervical cancer incidence and mortality remain comparatively high.
Today, new powerful tools are available for primary and secondary prevention of cervical cancer, among which prophylactic HPV vaccines, and screening using validated HPV tests for women—including some tests that can be applied on self-collected samples, a strategy that might be used to reach underscreened populations.
In May, 2018, the WHO Director General launched a call to eliminate cervical cancer by vaccinating at least 90% of girls by age 15 years, by offering screening at least twice in a lifetime to 70% or more of the target age populations and treat more than 90% of women with screen-detected lesions.
Recently, a large group of experts from diverse professional societies and cancer organisations supporting WHO’s call to eliminate cervical cancer, proposed a series of concerted actions to implement organised integrated HPV vaccination and HPV-based screening, and requested European health authorities to endorse the principles of the WHO elimination initiative, mobilise resources to update evidence-based guidelines, and translate them into quantified and monitored preventive activities.
However, in the first half of 2020, due to the dramatic COVID-19 pandemic, cervical cancer prevention activities have been disrupted in many European countries. We are concerned and urge the public health community to maintain sufficient resources to sustain HPV vaccination and cancer screening in the future.
Importantly, the COVID-19 pandemic might also generate opportunities for more efficient prevention, by promoting more cost-effective, evidence-based protocols, by focusing on women who are at high-risk, extending HPV testing on self-collected samples, and discouraging inefficient policies, such as screening with two tests. We welcome the unprecedented collaborations between the cancer and infectious disease communities, who have been working jointly to tackle the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by applying the experience of HPV test evaluation to protocols for comparing and validating SARS-CoV-2 assays and by bringing modellers together in the COVID-19 and Cancer Taskforce Global Modelling Consortium.</p
Workplace screening programs for chronic disease prevention: a rapid review
No full textThis review examined the effectiveness of workplace screening programs for chronic disease prevention based on evidence retrieved from the main databases of biomedical and health economic literature published to March 2012, supplemented with relevant reports. The review found: 1. Strong evidence of effectiveness of HRAs (when used in combination with other interventions) in relation to tobacco use, alcohol use, dietary fat intake, blood pressure and cholesterol 2. Sufficient evidence for effectiveness of worksite programs to control overweight and obesity 3. Sufficient evidence of effectiveness for workplace HRAs in combination with additional interventions to have favourable impact on the use of healthcare services (such as reductions in emergency department visits, outpatient visits, and inpatient hospital days over the longer term) 4. Sufficient evidence for effectiveness of benefits-linked financial incentives in increasing HRA and program participation 5. Sufficient evidence that for every dollar invested in these programs an annual gain of 1.40 to $4.60) can be achieved 6. Promising evidence that even higher returns on investment can be achieved in programs incorporating newer technologies such as telephone coaching of high risk individuals and benefits-linked financial incentive
Addressing uncomfortable issues: the role of White health professionals in Aboriginal health
No full textThis research investigated the role of White health professionals in addressing Aboriginal health in South Australia. Set within the discipline of nutrition and dietetics and the area of obesity prevention, it explored the practice of White health professionals from the point of view of Aboriginal and White workers.
This research, currently in the form of an unpublished Doctor of Philosophy thesis, arose from practice dilemmas the author experienced as a dietitian working in rural and remote South Australia.
The setting for this research was the eat well be active Community Programs, a community-based, childhood obesity prevention program in South Australia. In order to conduct ethical research, the author worked closely with Aboriginal community members and workers, through building and maintaining relationships and activities of reciprocity.
This research is positioned in a social constructionist epistemology and uses a critical theoretical approach. Critical social research and reflexivity are the methodological approaches. The kept a reflexive journal and conducted 41 semi-structured interviews with White health professionals and Aboriginal health workers and one focus group with White health professionals; all of which formed the data for this research.
This research identified that there are a number of elements to the practice of White health professionals that make it ideal when they are working with Aboriginal communities. However, such ideal practice does not always occur and this research sought to identify why. The organisation, profession and individual were identified as systems within the wider system of Aboriginal health.
Within these systems, the author identified structures (rules and resources) that either constrain or enable the practice of White health professionals with Aboriginal people. While many White health professionals focussed on external factors that constrained their practice, this thesis identifies the role of individuals in creating and maintaining barriers and enablers, thus highlighting their agency. It was also identified that White health professionals progress through a number of stages in their work in Aboriginal health, from not knowing how, to being scared, to finding it too hard and ultimately being able to practice regardless of barriers.
In summary, this research identified that moving forward in Aboriginal health requires White health professionals to look at themselves, which generally requires them to address uncomfortable issues
