Imperial College London

DrLorainneTudor Car

Faculty of MedicineSchool of Public Health

Honorary Senior Research Fellow
 
 
 
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l.tudor.car

 
 
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Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
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154 results found

Tudor Car L, Kyaw BM, Teo A, Fox TE, Vimalesvaran S, Apfelbacher C, Kemp S, Chavannes Net al., 2022, Outcomes, measurement instruments and their validity evidence in randomised trials on virtual, augmented and mixed reality in undergraduate medical education: a systematic mapping review, JMIR Serious Games, Vol: 10, ISSN: 2291-9279

Background: Extended reality, encompassing virtual, augmented and mixed reality, is increasingly used in medical education. Studies assessing effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence. Our aim was to determine the choice of outcomes, measurement instruments and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of virtual reality (VR), augmented reality (AR) and mixed reality (MR) in medical student education.Methods: We conducted a systematic mapping review. We searched seven major bibliographic databases from January 1990 to April 2020. Two reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with PRISMA guidelines.Results: Of 127 retrieved RCTs, 116 were on VR, eleven on AR. No RCTs on MR in medical student education were found. Of the studies on VR, 64 studies were on VR simulators, 31 studies on screen-based VR, 9 on VR patient simulations and 12 on VR serious games. Most studies reported only one outcome and immediate, post-intervention assessment data. Skills outcome was the most common outcome in studies on VR simulators, VR patient simulations and AR. Knowledge was the most common outcome in studies on screen-based VR and VR serious games. Less common outcomes included participants’ attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement and/or self-efficacy beliefs, emotional state, competency developed and patient outcomes. At least one form of validity evidence was found in around half of the studies on VR simulator, VR patient simulations, VR serious games and AR, and in only a quarter of studies on screen-based VR. Most studies used assessment methods that were implemented in a non-digital format such as paper-based written exercises or in-person assessments where examiners observed performan

Journal article

Martinengo L, Stona A-C, Car LT, Lee J, Griva K, Car Jet al., 2022, Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871

Journal article

Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R, Abolhassani H, Abu-Gharbieh E, Accrombessi MMK, Adnani QES, Afzal MS, Agarwal G, Agrawaal KK, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi K, Ahmadi S, Ahmadi A, Ahmed A, Ahmed Salih Y, Akande-Sholabi W, Akram T, Al Hamad H, Al-Aly Z, Alcalde-Rabanal JE, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Ancuceanu R, Andrei T, Andrei CL, Anjana RM, Ansar A, Antonazzo IC, Antony B, Anyasodor AE, Arabloo J, Arizmendi D, Armocida B, Artamonov AA, Arulappan J, Aryan Z, Asgari S, Ashraf T, Astell-Burt T, Atorkey P, Atout MMW, Ayanore MA, Badiye AD, Baig AA, Bairwa M, Baker JL, Baltatu OC, Banik PC, Barnett A, Barone MTU, Barone-Adesi F, Barrow A, Bedi N, Belete R, Belgaumi UI, Bell AW, Bennett DA, Bensenor IM, Beran D, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bijani A, Bikbov B, Birara S, Bodolica V, Bonny A, Brenner H, Briko NI, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Cao Y, Cao C, Cerin E, Chakraborty PA, Chandan JS, Chattu VK, Chen S, Choi J-YJ, Choudhari SG, Chowdhury EK, Chu D-T, Corso B, Dadras O, Dai X, Damasceno AAM, Dandona L, Dandona R, Dávila-Cervantes CA, De Neve J-W, Denova-Gutiérrez E, Dhamnetiya D, Diaz D, Ebtehaj S, Edinur HA, Eftekharzadeh S, El Sayed I, Elgendy IY, Elhadi M, Elmonem MA, Faisaluddin M, Farooque U, Feng X, Fernandes E, Fischer F, Flood D, Freitas M, Gaal PA, Gad MM, Gaewkhiew P, Getacher L, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Gill PS, Ginawi IA, Glushkova EV, Golechha M, Gopalani SV, Guimarães RA, Gupta RD, Gupta R, Gupta VK, Gupta VB, Gupta S, Habtewold TD, Hafezi-Nejad N, Halwani R, Hanif A, Hankey GJ, Haque S, Hasaballah AI, Hasan SS, Hashi A, Hassanipour S, Hay SI, Hayat K, Heidari M, Hossain MBH, Hossain S, Hosseini M, Hoveidamanesh S, Huang J, Humayun A, Hussain R, Hwang B-F, Ibitoye SE, Ikuta KS, Inbaraj LR, Iqbal U, Islam Met al., 2022, Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019, The Lancet Diabetes & Endocrinology, Vol: 10, Pages: 177-192, ISSN: 2213-8587

BackgroundDiabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals.FindingsIn 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−

Journal article

Haowen J, Vimalesvaran S, King Wang J, Boon LK, Mogali SR, Tudor Car Let al., 2022, Virtual reality in medical students’ education: a scoping review, JMIR Medical Education, Vol: 8, Pages: 1-24, ISSN: 2369-3762

Purpose: Virtual reality (VR) is a digital education modality that produces a virtual manifestation of the real world and it has been increasingly used in medical education. As VR encompasses different modalities, tools and applications, there is a need to explore how VR has been employed in medical education. The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.Method: We performed a search of 4 bibliographic databases in December 2020, with data extracted using a standardized data extraction form. The data was narratively synthesized and reported in line with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Results: Of 114 included studies, 69 studies (61%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15 [14%]) and virtual worlds (20 [18%]), mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68 [60%]) and of high interactivity (79 [70%]). There is limited evidence on the use of more novel VR modalities such as mobile VR and virtual dissection tables (8 [7%]), as well as the use of VR for training of non-surgical and non-psychomotor skills (20 [18%]) or in group setting (16 [14%]). Only 3 studies reported the use conceptual frameworks or theories in the design of VR.Conclusion: Despite extensive research available on VR in medical education, there continues to be important gaps in the evidence. Future studies should explore the use of VR for the development of non-psychomotor skills and in areas other than surgery and anatomy.

Journal article

Keller R, Hartmann S, Teepe GW, Lohse K-M, Alattas A, Car LT, Muller-Riemenschneider F, von Wangenheim F, Mair JL, Kowatsch Tet al., 2022, Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871

Journal article

Tan BY, Thach T, Munro YL, Skou ST, Thumboo J, Car J, Car LTet al., 2021, Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 18

Journal article

Ollier J, Neff S, Dworschak C, Sejdiji A, Santhanam P, Keller R, Xiao G, Asisof A, Rueegger D, Berube C, Hilfiker Tomas L, Neff J, Yao J, Alattas A, Varela-Mato V, Pitkethly A, Vara MD, Herrero R, Banos RM, Parada C, Agatheswaran RS, Villalobos V, Keller OC, Chan WS, Mishra V, Jacobson N, Stanger C, He X, von Wyl V, Weidt S, Haug S, Schaub M, Kleim B, Barth J, Witt C, Scholz U, Fleisch E, von Wangenheim F, Car LT, Mueller-Riemenschneider F, Hauser-Ulrich S, Asomoza AN, Salamanca-Sanabria A, Mair JL, Kowatsch Tet al., 2021, Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol (vol 9, 625640,2021), FRONTIERS IN PUBLIC HEALTH, Vol: 9

Journal article

Tudor Car L, 2021, Digital education for health professionals: An evidence map, conceptual framework and research agenda., Journal of Medical Internet Research, ISSN: 1438-8871

BackgroundHealth professions education has undergone major changes with the advent and adoption of digital technologies worldwide. To enable robust and relevant research in digital health professions education, it is essential to map the existing evidence, identify gaps and research priorities.MethodsWe searched for systematic reviews on digital education of practicing and student healthcare professionals. We searched Medline, Embase, Cochrane Library, ERIC, CINAHL, and grey literature sources from January 2014 to July 2020. Two authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empiric findings and research recommendations against a newly developed conceptual framework. ResultsWe identified 77 eligible systematic reviews. All included experimental studies and evaluated the effectiveness of digital education interventions in different healthcare disciplines or of different digital education modalities. Most reviews included studies on various digital education modalities (N=22), virtual reality (N=19) and online education (N=10). Most reviews focused on health professions education in general (N=36), surgery (N=13) and nursing (N=11). The reviews mainly assessed participants’ skills (N=51) and knowledge (N=49) and included data from high-income countries (N=53). Our novel conceptual framework of digital health professions education comprises six key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified in these reviews 61 unique questions for future research; these mapped to framework domains of education (29 recommendations), context (17), infrastructure (9), learners (3), and research (3). Conclusions We have identified a large number of research questions regarding digital educat

Journal article

Car LT, Teng YS, How JW, Nazri NNBM, Tan ALX, Quah J, Peckham S, Smith Het al., 2021, Priorities for family physician and general practitioner recruitment and retention in Singapore: a PRIORITIZE study, BMC FAMILY PRACTICE, Vol: 22

Journal article

Dhinagaran DA, Sathish T, Kowatsch T, Griva K, Best JD, Tudor Car Let al., 2021, Public perceptions of diabetes, healthy living and conversational agents in Singapore: a needs assessment, JMIR Formative Research, Vol: 5, Pages: 1-15, ISSN: 2561-326X

Background:The incidence of chronic diseases such as type 2 diabetes is on the rise in countries worldwide, including Singapore. Health professional-delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. Yet ongoing personalised guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology such as conversational agents are a potential alternative for delivery of healthy lifestyle change behavioural interventions to the public.Objective:We explored Singaporeans’ perceptions on and experience of healthy living, diabetes and mobile health interventions (apps and conversational agents). This survey was done to help inform the design and development of a conversational agent focusing on healthy lifestyle change.Methods:This qualitative study was conducted over Aug and Sept 2019. 20 participants were recruited from relevant healthy living Facebook pages and groups. Semi-structured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analysed in parallel by two researchers using Burnard’s method, a structured approach for thematic content analysis.Results:The collected data was organised into four main themes: (1) use of conversational agents, (2) ubiquity of smartphone applications, (3) understanding of diabetes and (4) barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile applications as well as conversational agents unrelated to healthcare. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. In terms of barriers to healthy living, frequent dining out, high stress levels, lack of work-life balance and dearth of free time to engage in physical activity were mentioned. In contrast, discipline, pre

Journal article

Ward JL, Azzopardi PS, Francis KL, Santelli JS, Skirbekk V, Sawyer SM, Kassebaum NJ, Mokdad AH, Hay SI, Abd-Allah F, Abdoli A, Abdollahi M, Abedi A, Abolhassani H, Abreu LG, Abrigo MRM, Abu-Gharbieh E, Abushouk AI, Adebayo OM, Adekanmbi V, Adham D, Advani SM, Afshari K, Agrawal A, Ahmad T, Ahmadi K, Ahmed AE, Aji B, Akombi-Inyang B, Alahdab F, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Alemu BW, Al-Hajj S, Alhassan RK, Ali S, Alicandro G, Alijanzadeh M, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini S, Aminorroaya A, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari I, Antonio CAT, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Atout MMW, Ausloos M, Avenyo EK, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Aynalem YA, Azari S, Azene ZN, Bakhshaei MH, Bakkannavar SM, Banach M, Banik PC, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Bekuma TT, Bell AW, Bell ML, Benjet C, Bensenor IM, Berhe AK, Berhe K, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Biondi A, Birhanu TTM, Biswas RK, Bohlouli S, Bolla SR, Boloor A, Borschmann R, Boufous S, Bragazzi NL, Braithwaite D, Breitborde NJK, Brenner H, Britton GB, Burns RA, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Cerin E, Chandan JS, Chang H-Y, Chang J-C, Charan J, Chattu VK, Chaturvedi S, Choi J-YJ, Chowdhury MAK, Christopher DJ, Chu D-T, Chung MT, Chung S-C, Cicuttini FM, Constantin TV, Costa VM, Dahlawi SMA, Dai H, Dai X, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Dávila-Cervantes CA, Davletov K, De la Hoz FP, De Let al., 2021, Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 1593-1618, ISSN: 0140-6736

BackgroundDocumentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017).FindingsIn 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or mater

Journal article

Ollier J, Neff S, Dworschak C, Sejdiji A, Santhanam P, Keller R, Xiao G, Asisof A, Ruegger D, Berube C, Tomas LH, Neff J, Yao J, Alattas A, Varela-Mato V, Pitkethly A, Vara MD, Herrero R, Banos RM, Parada C, Agatheswaran RS, Villalobos V, Keller OC, Chan WS, Mishra V, Jacobson N, Stanger C, He X, von Wyl V, Weidt S, Haug S, Schaub M, Kleim B, Barth J, Witt C, Scholz U, Fleisch E, von Wangenheim F, Car LT, Mueller-Riemenschneider F, Hauser-Ulrich S, Nunez Asomoza A, Salamanca-Sanabria A, Mair JL, Kowatsch Tet al., 2021, Elena plus Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol, FRONTIERS IN PUBLIC HEALTH, Vol: 9

Journal article

Micah AE, Cogswell IE, Cunningham B, Ezoe S, Harle AC, Maddison ER, McCracken D, Nomura S, Simpson KE, Stutzman HN, Tsakalos G, Wallace LE, Zhao Y, Zende RR, Abbafati C, Abdelmasseh M, Abedi A, Abegaz KH, Abhilash ES, Abolhassani H, Abrigo MRM, Adhikari TB, Afzal S, Ahinkorah BO, Ahmadi S, Ahmed H, Ahmed MB, Ahmed Rashid T, Ajami M, Aji B, Akalu Y, Akunna CJ, Al Hamad H, Alam K, Alanezi FM, Alanzi TM, Alemayehu Y, Alhassan RK, Alinia C, Aljunid SM, Almustanyir SA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amu H, Ancuceanu R, Andrei CL, Andrei T, Angell B, Anjomshoa M, Antonio CAT, Antony CM, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Arrigo A, Ashraf T, Atnafu DD, Ausloos M, Avila-Burgos L, Awan AT, Ayano G, Ayanore MA, Azari S, Azhar GS, Babalola TK, Bahrami MA, Baig AA, Banach M, Barati N, Bärnighausen TW, Barrow A, Basu S, Baune BT, Bayati M, Benzian H, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhaskar S, Bibi S, Bijani A, Bodolica V, Bragazzi NL, Braithwaite D, Breitborde NJK, Breusov AV, Briko NI, Busse R, Cahuana-Hurtado L, Callander EJ, Cámera LA, Castañeda-Orjuela CA, Catalá-López F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chen S, Cicero AFG, Dadras O, Dahlawi SMA, Dai X, Dalal K, Dandona L, Dandona R, Davitoiu DV, De Neve J-W, de Sá-Junior AR, Denova-Gutiérrez E, Dhamnetiya D, Dharmaratne SD, Doshmangir L, Dube J, Ehsani-Chimeh E, El Sayed Zaki M, El Tantawi M, Eskandarieh S, Farzadfar F, Ferede TY, Fischer F, Foigt NA, Freitas A, Friedman SD, Fukumoto T, Fullman N, Gaal PA, Gad MM, Garcia-Gordillo MA, Garg T, Ghafourifard M, Ghashghaee A, Gholamian A, Gholamrezanezhad A, Ghozali G, Gilani SA, Glăvan I-R, Glushkova EV, Goharinezhad S, Golechha M, Goli S, Guha A, Gupta VB, Gupta VK, Haakenstad A, Haider MR, Hailu A, Hamidi S, Hanif A, Harapan H, Hartono RK, Hasaballah AI, Hassan S, Hassanein MH, Hayat K, Hegazy MI, Heidari G, Hendrie D, Heredia-Pi I, Herteliu C, Hezam K, Holla R, Hossain SJ, Hosseinzadeh M, Hostiuc S, Huda Tet al., 2021, Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050, The Lancet, Vol: 398, Pages: 1317-1343, ISSN: 0140-6736

BackgroundThe rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.MethodsWe estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050.FindingsIn 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geogra

Journal article

Teepe GW, Da Fonseca A, Kleim B, Jacobson NC, Sanabria AS, Car LT, Fleisch E, Kowatsch Tet al., 2021, Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871

Journal article

Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abd-Elsalam SM, Abdoli A, Abedi A, Abolhassani H, Abreu LG, Abu-Gharbieh E, Abu-Rmeileh NME, Abushouk AI, Adamu AL, Adebayo OM, Adegbosin AE, Adekanmbi V, Adetokunboh OO, Adeyinka DA, Adsuar JC, Afshari K, Aghaali M, Agudelo-Botero M, Ahinkorah BO, Ahmad T, Ahmadi K, Ahmed MB, Aji B, Akalu Y, Akinyemi OO, Aklilu A, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Al-Eyadhy A, Ali T, Alicandro G, Alif SM, Alipour V, Alizade H, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amini S, Amini-Rarani M, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antriyandarti E, Anvari D, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Ärnlöv J, Artanti KD, Arzani A, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari Jafarabadi M, Athari SS, Athari SM, Atnafu DD, Atreya A, Atteraya MS, Ausloos M, Awan AT, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, B DB, Babaee E, Badiye AD, Baig AA, Banach M, Banik PC, Barker-Collo SL, Barqawi HJ, Bassat Q, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Beghi M, Bell ML, Bendak S, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bezabih YM, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bikbov B, Biondi A, Birihane BM, Biswas RK, Bohlouli S, Bragazzi NL, Breusov AV, Brunoni AR, Burkart K, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Camargos P, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Cerin E, Chang J-C, Chanie WF, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chaturvedi S, Chen S, Cho DY, Choi J-YJ, Chu D-T, Ciobanu LG, Cirillo M, Conde J, Costa VM, Couto RAS, Dachew BA, Dahlaet al., 2021, Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 870-905, ISSN: 0140-6736

BackgroundSustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.MethodsWe completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.FindingsGlobal U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019.

Journal article

Dhinagaran DA, Sathish T, Soong A, Theng Y-L, Best JD, Tudor Car Let al., 2021, Conversational agent for healthy lifestyle behaviour change: an online feasibility study, JMIR Formative Research, ISSN: 2561-326X

Journal article

Kingsland M, Barnes C, Doherty E, McCrabb S, Finch M, Cumpston M, Armstrong R, Tudor Car L, Doyle J, Wolfenden Let al., 2021, Identifying topics for future Cochrane Public Health reviews., J Public Health (Oxf)

Journal article

Tudor Car L, 2021, The choice of behavioral change techniques in conversational agents in healthcare: a scoping review protocol, JMIR Research Protocols, Vol: 10, Pages: 1-5, ISSN: 1929-0748

Background:Conversational agents or chatbots are computer programs that simulate conversations with users. Conversational agents are increasingly used for delivery of behavior change interventions in health care. Behavior change is complex and comprises the use of one or several components collectively known as behavioral change techniques (BCTs).Objective:The objective of this scoping review is to identify the BCTs that are used in behavior change–focused interventions delivered via conversational agents in health care.Methods:This scoping review will be performed in line with the Joanna Briggs Institute methodology and will be reported according to the PRISMA extension for scoping reviews guidelines. We will perform a comprehensive search of electronic databases and grey literature sources, and will check the reference lists of included studies for additional relevant studies. The screening and data extraction will be performed independently and in parallel by two review authors. Discrepancies will be resolved through consensus or discussion with a third review author. We will use a data extraction form congruent with the key themes and aims of this scoping review. BCTs employed in the included studies will be coded in line with BCT Taxonomy v1. We will analyze the data qualitatively and present it in diagrammatic or tabular form, alongside a narrative summary.Results:To date, we have designed the search strategy and performed the search on April 26, 2021. The first round of screening of retrieved articles is planned to begin soon.Conclusions:Using appropriate BCTs in the design and delivery of health care interventions via conversational agents is essential to improve long-term outcomes. Our findings will serve to inform the development of future interventions in this area.International Registered Report Identifier (IRRID):PRR1-10.2196/30166JMIR Res Protoc 2021;10(7):e30166

Journal article

Tudor Car L, Myint Kyaw B, Nannan Panday RS, van der Kleij R, Chavannes N, Majeed A, Car Jet al., 2021, Digital health training programs for medical students: a scoping review, Journal of Medical Internet Research, Vol: 7, Pages: 1-11, ISSN: 1438-8871

Background: Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. This review collated and analyzed the literature evaluating digital health education for medical students to inform development of future courses and identify areas where curricula may need to be strengthened.Methods: We carried out a scoping review following the Joanna Briggs Institute’s guidance and reported in line with PRISMA-ScR guidelines. We searched six major bibliographic databases and grey literature sources for the articles published from January 2000 to November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussion between the authors. The findings were analyzed using thematic analysis and presented narratively.Results: A total of 34 studies focusing on different digital courses were included in this review. Most (n=22) were published from 2010 to 2019 and originated from the US (n=20). The reported digital health courses were mostly elective (n=20), integrated into the existing curriculum (n=24) and focused mainly on medical informatics (n=17). Most of the courses targeted medical students from first to third year (n=17) and the duration of the courses ranged from an hour to three academic years. Most (n=22) reported the use of blended education. Six of 34 delivered courses entirely digitally using online modules, offline learning, Massive Open Online Courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in person observations and/or online-based assessment. Thirty studies evaluated courses mostly using uncontrolled before and after design and generally reported improvements in students’ learning outcomes. ConclusionsDigital health courses reported in the literature were mostly elective, focused on a single area of digital health and lac

Journal article

Tudor Car L, Poon S, Kyaw BM, Cook DA, Ward V, Atun R, Majeed A, Johnston J, Kleij RVD, Molokhia M, Florian W, Lupton M, Chavannes N, Ajuebor O, Prober CG, Car Jet al., 2021, An evidence map, a conceptual framework and a research agenda for health professions digital education (Preprint), Journal of Medical Internet Research

Journal article

See YKC, Smith HE, Car LT, Protheroe J, Wong WC, Bartlam Bet al., 2021, Health literacy and health outcomes in patients with low back pain: a scoping review, BMC MEDICAL INFORMATICS AND DECISION MAKING, Vol: 21

Journal article

Tudor Car L, Kyaw BM, Nannan Panday RS, van der Kleij R, Chavannes N, Majeed A, Car Jet al., 2021, Digital Health Training Programs for Medical Students: Scoping Review (Preprint), DH

<sec> <title>BACKGROUND</title> <p>Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. The COVID-19 pandemic has contributed to this swift and widespread transition to digital health and education. However, the need for digital health competencies goes beyond the COVID-19 pandemic because they are becoming essential for the delivery of effective, efficient, and safe care.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This review aims to collate and analyze studies evaluating digital health education for medical students to inform the development of future courses and identify areas where curricula may need to be strengthened.</p> </sec> <sec> <title>METHODS</title> <p>We carried out a scoping review by following the guidance of the Joanna Briggs Institute, and the results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 6 major bibliographic databases and gray literature sources for articles published between January 2000 and November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussions between the authors. The findings were analyzed using thematic analysis and presented narratively.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 34 studies focusing on different digital courses were included in this review. Most of the studies (22/34, 65%) wer

Journal article

Tudor Car L, 2021, Virtual reality in medical students’ education: A scoping review protocol, BMJ Open, Vol: ``, Pages: 1-5, ISSN: 2044-6055

Background Virtual reality (VR) is a technology that produces a virtual manifestation of the real world. In recent years, VR has been increasingly used as a tool in medical education. The use of VR in medical education has large potential, as it allows for distance learning and training which may be challenging to deliver in real life. VR encompasses different tools and applications. There is a need to explore how VR has been employed in medical education to date.Objective The objective of this scoping review is to conceptualise the VR tools available and the applications of VR in undergraduate medical education as reported in the literature. This scoping review will identify any gaps in this field and provide suggestions for future research.Methods and analysis The relevant studies will be examined using the Joanna Briggs Institute methodological framework for scoping studies. A comprehensive search from a total of six electronic databases and grey literature sources will be performed. The reference list of included studies will be screened for additional studies. The screening and data extraction will be done in parallel and independently by two review authors. Any discrepancies will be resolved through consensus or discussion with a third review author. A data extraction form has been developed using key themes from the research questions. The extracted data will be qualitatively analysed and presented in a diagrammatic or tabular form, alongside a narrative summary, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews reporting guidelines.Ethics and dissemination All data will be collected from published and grey literature. Ethics approval is therefore not a requirement. We will present our findings at relevant conferences and submit them for publications in peer-reviewed journals.

Journal article

Ng DY, Tudor Car L, Ng MJM, Lu J, Leung J, Goo TT, Chia CLKet al., 2021, Identifying barriers to early presentation in patients with locally advanced breast cancer (LABC) in Northern Singapore: qualitative study, PLoS One, Vol: 16, ISSN: 1932-6203

Introduction:Breast cancer is the leading cause of death in Singaporean women, with advanced stage rendering a poorer prognosis. This study aims to explore the barriers to early presentation, information needs and sources in patients with locally advanced breast cancer (LABC).Materials & methods:A convenience sample of patients who presented with locally advanced breast cancer to the Department of General Surgery in a teaching tertiary hospital were recruited for the study. We conducted semi-structured interviews face to face with the recruited patients. We recorded the interviews, transcribed them verbatim and analysed using thematic content analysis.Results:Twenty-three participants were recruited of which 12 were Chinese and 11 were Malay women. Mean age was 60 years (± 13 SD). The most common knowledge barrier resulting in delay was the misconception that a breast lump must be painful to be malignant. Other knowledge barriers include the lack of knowledge and misinformation from the internet or other social media platforms. Some perceived barriers include fear of diagnosis, fear of treatment and fear of imposing financial burden on family members. A significant proportion of participants were also not aware of a national breast screening programme.Conclusions:Our study has found that barriers to early presentation of women with locally advanced breast cancer remain similar and have persisted over the years despite targeted efforts. There is a need for a rethink of existing strategies and to develop new innovative ways to reach out to this group of patients.

Journal article

Moenninghoff A, Kramer JN, Hess AJ, Ismailova K, Teepe GW, Car LT, Mueller-Riemenschneider F, Kowatsch Tet al., 2021, Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871

Journal article

Tudor KI, Pašiü MB, Škegro SN, Bakula M, Nemir J, Mustaþ F, Vidrih B, Pašiü H, Vujeviü L, Rajiþ F, Car LTet al., 2021, Lower urinary tract symptoms and depression in patients with multiple sclerosis, Psychiatria Danubina, Vol: 32, Pages: 113-121, ISSN: 0353-5053

Background: Both depression and lower urinary tract symptoms (LUTS) may be present in patients with multiple sclerosis (MS). The objective of this study was to give an insight on depression and LUTS in patients with MS in Croatia and to determine the possible association between LUTS and depression in patients with MS. Subjects and methods: This was a prospective cross-sectional study conducted in a tertiary healthcare center in Croatia. Hundred and one consecutive patients with MS (75 female, 26 male, mean age 42.09 (range 19-77) years, mean Expanded Disability Status Scale (EDSS) score 3.1 (range 0.0-7.0)) participated in this study. We evaluated LUTS and related quality of life (QoL) using three International Consultation on Incontinence Questionnaires (ICIQ) enquiring about overactive bladder (ICIQ-OAB), urinary incontinence short form (ICIQ-UI SF) and lower urinary tract symptoms related quality of life (ICIQLUTS-QoL). ICIQ-OAB and ICIQLUTS-QoL were for this purpose with permission successfully translated and validated into Croatian, while ICIQ-UI SF was already previously validated for the Croatian language. Information regarding treatment for depression was obtained during the medical interview. Data were analyzed and interpreted using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). Results: 89.10% (N=90) patients with MS reported urgency with urge urinary incontinence (UUI) present in 70.29% (N=71). 81.18% (N=82) patients reported nocturia, and 90.09% (N=91) reported feeling drowsy or sleepy during the day due to bladder symptoms. Neurological deficit measured by EDSS was found to positively correlate with LUTS on all three questionnaires: ICIQ-OAB (r=0.390, p<0.05), ICIQ-UI SF (r=0.477, p<0.01) and ICIQ-LUTSQoL (r=0.317, p<0.05). 25 patients were in treatment for depression. There were no significant differences between female and male patients regarding treatment for depression (Ȥ2=0.018, df=1, p>0.05). Results on

Journal article

Alattas A, Teepe GW, Leidenberger K, Fleisch E, Car LT, Salamanca-Sanabria A, Kowatsch Tet al., 2021, To What Scale Are Conversational Agents Used by Top-funded Companies Offering Digital Mental Health Services for Depression?, 14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC) / 14th Int Conf on Bio-inspired Systems and Signal Processing (BIOSIGNALS) / 14th Int Conf on Biomedical Electronics and Devices (BIODEVICES), Publisher: SCITEPRESS, Pages: 801-808

Conference paper

Nazeha N, Pavagadhi D, Kyaw BM, Car J, Larrain GJ, Tudor Car Let al., 2020, Digitally competent health workforce: a scoping review of educational frameworks, Journal of Medical Internet Research, Vol: 22, Pages: 1-20, ISSN: 1438-8871

Background: Digital health technologies can be key to improving health outcomes, provided health workers are adequately trained to utilize these technologies. There have been efforts to identify digital competencies for different health worker groups, however, an overview of these efforts has yet to be consolidated and analysed.Objective: The objective of this review is to identify and study the existing digital health competency frameworks for health workers and provide recommendations for future digital health training initiatives and framework development.Methods: A literature search was performed to collate digital health competency frameworks published from year 2000. Six databases, including grey literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks. Findings: Thirty frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, published since 2016 and developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains were pertaining to basic IT literacy, health information management, digital communication, ethical/legal/regulatory requirements, and data privacy/security. The HITCOMP framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health workers.Conclusions: Digital health training initiatives should focus on competencies relevant to a particular health worker grou

Journal article

Tudor KI, Bošnjak Pašić M, Nađ Škegro S, Bakula M, Nemir J, Mustač F, Vidrih B, Pašić H, Vujević L, Rajič F, Tudor Car Let al., 2020, Lower Urinary Tract Symptoms and Depression in Patients with Multiple Sclerosis., Psychiatr Danub, Vol: 32, Pages: 511-519, ISSN: 0353-5053

BACKGROUND: Both depression and lower urinary tract symptoms (LUTS) may be present in patients with multiple sclerosis (MS). The objective of this study was to give an insight on depression and LUTS in patients with MS in Croatia and to determine the possible association between LUTS and depression in patients with MS. SUBJECTS AND METHODS: This was a prospective cross-sectional study conducted in a tertiary healthcare center in Croatia. Hundred and one consecutive patients with MS (75 female, 26 male, mean age 42.09 (range 19-77) years, mean Expanded Disability Status Scale (EDSS) score 3.1 (range 0.0-7.0)) participated in this study. We evaluated LUTS and related quality of life (QoL) using three International Consultation on Incontinence Questionnaires (ICIQ) enquiring about overactive bladder (ICIQ-OAB), urinary incontinence short form (ICIQ-UI SF) and lower urinary tract symptoms related quality of life (ICIQLUTS-QoL). ICIQ-OAB and ICIQLUTS-QoL were for this purpose with permission successfully translated and validated into Croatian, while ICIQ-UI SF was already previously validated for the Croatian language. Information regarding treatment for depression was obtained during the medical interview. Data were analyzed and interpreted using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). RESULTS: 89.10% (N=90) patients with MS reported urgency with urge urinary incontinence (UUI) present in 70.29% (N=71). 81.18% (N=82) patients reported nocturia, and 90.09% (N=91) reported feeling drowsy or sleepy during the day due to bladder symptoms. Neurological deficit measured by EDSS was found to positively correlate with LUTS on all three questionnaires: ICIQ-OAB (r=0.390, p<0.05), ICIQ-UI SF (r=0.477, p<0.01) and ICIQ-LUTSQoL (r=0.317, p<0.05). 25 patients were in treatment for depression. There were no significant differences between female and male patients regarding treatment for depression (χ2=0.018, df=1, p>0.05). Results

Journal article

Lozano R, Fullman N, Mumford JE, Knight M, Barthelemy CM, Abbafati C, Abbastabar H, Abd-Allah F, Abdollahi M, Abedi A, Abolhassani H, Abosetugn AE, Abreu LG, Abrigo MRM, Abu Haimed AK, Abushouk AI, Adabi M, Adebayo OM, Adekanmbi V, Adelson J, Adetokunboh OO, Adham D, Advani SM, Afshin A, Agarwal G, Agasthi P, Aghamir SMK, Agrawal A, Ahmad T, Akinyemi RO, Alahdab F, Al-Aly Z, Alam K, Albertson SB, Alemu YM, Alhassan RK, Ali M, Ali S, Alipour V, Aljunid SM, Alla F, Almadi MAH, Almasi A, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Almulhim AM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amiri F, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Aremu O, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Athari SS, Atout MMW, Ausloos M, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Aynalem GL, Ayza MA, Azari S, Azzopardi PS, B DB, Babaee E, Badiye AD, Bahrami MA, Baig AA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Balachandran A, Balassyano S, Banach M, Banerjee SK, Banik PC, Bante AB, Bante SA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Bassat Q, Basu S, Baune BT, Bayati M, Baye BA, Bedi N, Beghi E, Behzadifar M, Bekuma TTT, Bell ML, Bensenor IM, Berman AE, Bernabe E, Bernstein RS, Bhagavathula AS, Bhandari D, Bhardwaj P, Bhat AG, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Bilano V, Biondi A, Birihane BM, Bockarie MJ, Bohlouli S, Bojia HA, Bolla SRR, Boloor A, Brady OJ, Braithwaite D, Briant PS, Briggs AM, Briko NI, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AY, Charan Jet al., 2020, Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1250-1284, ISSN: 0140-6736

BackgroundAchieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.MethodsBased on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified

Journal article

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