96 results found
Barrenho E, Halmai R, Miraldo M, et al., 2022, Inequities in cancer drug development in terms of unmet medical need, Social Science and Medicine, Vol: 302, ISSN: 0277-9536
This study measures inequality and inequity in the distribution of clinical trials on cancer drug development between 1996 and 2016, comparing the number of clinical trials with cancer need, proxied by prevalence, incidence, or survival rates for both rare and non-rare cancers. We leverage a unique global database of clinical trials activity and costs between 1996 and 2016, constructed for 227 different cancer types to measure for rare and non-rare cancers: i) inequalities and inequity of clinical trial activity, considering all trials as well as split by R&D stage; ii) inequalities and inequity in R&D investment proxied by trial enrollment and duration; iii) evolution of inequity over time. Inequalities are measured with concentration curves and indices and inequities measured with the health inequity index. We find four important results. First, we show pro-low need inequity across cancer types for both rare and non-rare cancers, for all need proxies. Second, we show inequity differs across R&D stages and between rare and non-rare cancers. The distribution of clinical trials for non-rare cancers disproportionately favors low-need non-rare cancers from earlier to later stages of R&D, whilst for rare cancers this only occurs in Phase 2 trials. Third, inequity analyses in R&D investment show that only trial enrollment for rare cancers and trial duration for non-rare cancers are disproportionately concentrated among low-need cancers. Finally, while pro-low need inequity has persisted between 1996 and 2016 for non-rare cancers, it has faded for rare cancers post-EU orphan drugs’ legislation.
Haw D, Forchini G, Doohan P, et al., 2022, Optimizing social and economic activity while containing SARS-CoV-2 transmission using DAEDALUS, Nature Computational Science, ISSN: 2662-8457
Kusuma D, Atanasova P, Pineda E, et al., 2022, Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data, PLoS Medicine, Vol: 19, ISSN: 1549-1277
BACKGROUND: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. METHODS AND FINDINGS: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odd
Galizzi M, Lau K, Miraldo M, et al., 2022, Bandwagoning, free-riding and heterogeneity in influenza vaccine decisions: an online experiment, Health Economics, Vol: 31, Pages: 614-646, ISSN: 1057-9230
‘Nudge’-based social norms messages conveying high population influenza vaccination coverage levels can encourage vaccination due to bandwagoning effects but also discourage vaccination due to free-riding effects on low risk of infection, making their impact on vaccination uptake ambiguous.We develop a theoretical framework to capture heterogeneity around vaccination behaviors, and empirically measure the causal effects of different messages about vaccination coverage rates on four self-reported and behavioral vaccination intention measures. In an online experiment, N = 1,365 UK adults are randomly assigned to one of seven treatment groups with different messages about their social environment’s coverage rate (varied between 10% and 95%), or a control group with no message. We find that treated groups have significantly greater vaccination intention than the control. Treatment effects increase with the coverage rate up to a 75% level, consistent with a bandwagoning effect. For coverage rates above 75%, the treatment effects, albeit still positive, stop increasing and remain flat (or even decline). Our results suggest that, at higher coverage rates, free-riding behavior may partially crowd out bandwagoning effects of coverage rates messages. We also find significant heterogeneity of these effects depending on the invidual perceptions of risks of infection and of the coverage rates.
Miraldo M, Atanasova PETYA, Kusuma DIAN, et al., 2022, The impact of the consumer and neighbourhood food environment on dietary intake and obesity-related outcomes: A systematic review of causal impact studies., Social Science and Medicine, Vol: 299, Pages: 1-16, ISSN: 0277-9536
BackgroundThe food environment has been found to impact population dietary behaviour. Our study aimed to systematically review the impact of different elements of the food environment on dietary intake and obesity.MethodsWe searched MEDLINE, Embase, PsychInfo, EconLit databases to identify literature that assessed the relationship between the built food environments (intervention) and dietary intake and obesity (outcomes), published between database inception to March 26, 2020. All human studies were eligible except for those on clinical sub-groups. Only studies with causal inference methods were assessed. Studies focusing on the food environment inside homes, workplaces and schools were excluded. A risk of bias assessment was conducted using the CASP appraisal checklist. Findings were summarized using a narrative synthesis approach.Findings58 papers were included, 55 of which were conducted in high-income countries. 70% of papers focused on the consumer food environments and found that in-kind/financial incentives, healthy food saliency, and health primes, but not calorie menu labelling significantly improved dietary quality of children and adults, while BMI results were null. 30% of the papers focused on the neighbourhood food environments and found that the number of and distance to unhealthy food outlets increased the likelihood of fast-food consumption and higher BMI for children of any SES; among adults only selected groups were impacted - females, black, and Hispanics living in low and medium density areas. The availability and distance to healthy food outlets significantly improved children's dietary intake and BMI but null results were found for adults.InterpretationEvidence suggests certain elements of the consumer and neighbourhood food environments could improve populations dietary intake, while effect on BMI was observed among children and selected adult populations. Underprivileged groups are most likely to experience and impact on BMI. Future research
Kusuma D, Atanasova P, Anjana RM, et al., 2022, Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data, PLoS Medicine, ISSN: 1549-1277
Background: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people’s diets and obesity positing they may play a role in the prevalence of diabetes. Yet there is scant evidence on the role they may play in the context of low- and middle-income countries. We examined the associations of food environments on T2DM among adults, and its heterogeneity by income and sex. Methods and Findings: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018-2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300m from study participant’s home: proximity was defined as having at least one outlet within 100m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socio-economic status, health status, healthcare utilization, and physical activities. Data were analysed in ArcMap 10.3 and STATA 15.1. A higher share of fast food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p <0.05). Having at least one FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p <0.01). A one percent increase in the share of FFR near an individual’s home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AME): 0.08; CI: 0.02, 0.14; p<0.05. Having at least one FFR near home was associated with 16% (OR: 1.16; CI: 1.01, 1.33; p<0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p<0.05) increases in the odds of higher bl
Atanasova P, Kusuma D, Pineda E, et al., 2022, Food environments and obesity: a geospatial analysis of the South Asia Biobank, income and sex inequalities., SSM - Population Health, Vol: 17, Pages: 101055-101055, ISSN: 2352-8273
Introduction: In low-middle income countries (LMICs) the role of food environments on obesity has been understudied. We address this gap by 1) examining the effect of food environments on adults' body size (BMI, waist circumference) and obesity; 2) measuring the heterogeneity of such effects by income and sex. Methods: This cross-sectional study analysed South Asia Biobank surveillance and environment mapping data for 12,167 adults collected between 2018 and 2020 from 33 surveillance sites in Bangladesh and Sri Lanka. Individual-level data (demographic, socio-economic, and health characteristics) were combined with exposure to healthy and unhealthy food environments measured with geolocations of food outlets (obtained through ground-truth surveys) within 300 m buffer zones around participants' homes. Multivariate regression models were used to assess association of exposure to healthy and unhealthy food environments on waist circumference, BMI, and probability of obesity for the total sample and stratified by sex and income. Findings: The presence of a higher share of supermarkets in the neighbourhood was associated with a reduction in body size (BMI, β = - 3∙23; p < 0∙0001, and waist circumference, β = -5∙99; p = 0∙0212) and obesity (Average Marginal Effect (AME): -0∙18; p = 0∙0009). High share of fast-food restaurants in the neighbourhood was not significantly associated with body size, but it significantly increased the probability of obesity measured by BMI (AME: 0∙09; p = 0∙0234) and waist circumference (AME: 0∙21; p = 0∙0021). These effects were stronger among females and low-income individuals. Interpretation: The results suggest the availability of fast-food outlets influences obesity, especially among female and lower-income groups. The availability of supermarkets is associated with reduced body size and obesity, but their effects do not outweigh the role of fast-food o
Downey LE, Harris M, Jan S, et al., 2021, Global health system resilience is in everyone's interest., BMJ, Vol: 375, Pages: 1-2, ISSN: 1759-2151
Shaikh M, Tymoszuk U, Williamon A, et al., 2021, Socioeconomic inequalities in arts engagement and depression among older adults in the United Kingdom: Evidence from the English Longitudinal Study of Ageing, Public Health, Vol: 198, Pages: 307-314, ISSN: 0033-3506
ObjectivesArts engagement has been positively linked with mental health and wellbeing; however, socioeconomic inequalities may be prevalent in access to and uptake of arts engagement reflecting on inequalities in mental health. This study estimated socioeconomic inequality and horizontal inequity (unfair inequality) in arts engagement and depression symptoms of older adults in England. Trends in inequality and inequity were measured over a period of ten years.Study DesignRepeated cross-sectional studyMethodsIn this analysis we used data from six waves (waves 2 to 7) of the nationally representative English Longitudinal Study of Ageing. We estimated socioeconomic inequality using concentration curves that plot the distribution of arts engagement and depression symptoms against the distribution of wealth. Concentration index was used to measure the magnitude of the inequality. Unfair inequality was then calculated for need-standardised arts engagement using a horizontal inequity index (HII).ResultsThe study sample included adults aged 50 and older from waves 2 (2004/2005, n=6,620) to 7 (2014/2015, n=3,329). Engagement with cinema, galleries, and theatre was pro-rich unequal i.e. concentrated among the wealthier, but inequality in depression was pro-poor unequal i.e. concentrated more among the less wealthy. While pro-rich inequality in arts engagement decreased from wave 2 (conc. index: 0·291, 95% CI 0·27 to 0·31) to wave 7 (conc. index: 0·275, 95% CI 0·24 to 0·30), pro-poor inequality in depression increased from wave 2 (conc. index: -0·164, 95% CI -0·18 to -0·14) to wave 7 (conc. index: -0·189, 95% CI -0·21 to -0·16). Depression-standardised arts engagement showed horizontal inequity that increased from wave 2 (HII: 0·455, 95% CI 0·42 to 0·48) to wave 7 (HII: 0·464, 95% CI 0·42 to 0·50).ConclusionsOur findings suggest that while socioeconomic
DAeth J, Ghosal S, Grimm F, et al., 2021, Optimal national prioritization policies for hospital care during the SARS-CoV-2 pandemic, Nature Computational Science, Vol: 1, Pages: 521-531, ISSN: 2662-8457
In response to unprecedent surges in the demand for hospital care during the SARS-CoV-2 pandemic, health systems have prioritized COVID patients to life-saving hospital care to the detriment of other patients. In contrast to these ad hoc policies, we develop a linear programming framework to optimally schedule elective procedures and allocate hospital beds among all planned and emergency patients to minimize years of life lost. Leveraging a large dataset of administrative patient medical records, we apply our framework to the National Health System in England and show that an extra 50,750-5,891,608 years of life can be gained in comparison to prioritization policies that reflect those implemented during the pandemic. Significant health gains are observed for neoplasms, diseases of the digestive system, and injuries & poisoning. Our open-source framework provides a computationally efficient approximation of a large-scale discrete optimization problem that can be applied globally to support national-level care prioritization policies.
Ohrnberger J, Segal A, Forchini G, et al., 2021, The impact of a COVID-19 lockdown on work productivity under good and poor compliance, European Journal of Public Health, Vol: 31, Pages: 1009-1015, ISSN: 1101-1262
BackgroundIn response to the COVID-19 pandemic, governments across the globe have imposed strict social distancing measures. Public compliance to such measures is essential for their success yet the economic consequences of compliance are unknown. This is the first study to analyse the effects of good compliance compared to poor compliance to a COVID-19 suppression strategy (i.e. lockdown) on work productivity. MethodsWe estimate the differences in work productivity comparing a scenario of good compliance with one of poor compliance to the UK government COVID-19 suppression strategy. We use projections of the impact of the UK suppression strategy on mortality and morbidity from an individual-based epidemiological model combined with an economic model representative of the labour force in Wales and England. ResultsWe find that productivity effects of good compliance significantly exceed those of poor compliance and increase with the duration of the lockdown. After three months of the lockdown, work productivity in good compliance is £398.58 million higher compared with that of poor compliance. 75% of the differences is explained by productivity effects due to morbidity and non-health reasons and 25% attributed to avoided losses due to pre-mature mortality.ConclusionGood compliance to social distancing measures exceeds positive economic effects, in addition to health benefits. This is an important finding for current economic and health policy. It highlights the importance to set clear guidelines for the public, to build trust and support for the rules and if necessary, to enforce good compliance to social distancing measures.
Simmons B, Ariyoshi K, Ohmagari N, et al., 2021, Progress towards antibiotic use targets in eight high-income countries, Bulletin of the World Health Organization, Vol: 99, Pages: 550-561, ISSN: 0042-9686
Objective To compare antibiotic sales in eight high-income countries using the 2019 World Health Organization (WHO) Access, Watch andReserve (AWaRe) classification and the target of 60% consumption of Access category antibiotics.Methods We analysed data from a commercial database of sales of systemic antibiotics in France, Germany, Italy, Japan, Spain, Switzerland,United Kingdom of Great Britain and Northern Ireland, and United States of America over the years 2013–2018. We classified antibioticsaccording to the 2019 AWaRe categories: Access, Watch, Reserve and Not Recommended. We measured antibiotic sales per capita in standardunits (SU) per capita and calculated Access group sales as a percentage of total antibiotic sales.Findings In 2018, per capita antibiotic sales ranged from 7.4 SU (Switzerland) to 20.0 SU (France); median sales of Access group antibioticswere 10.9 SU per capita (range: 3.5–15.0). Per capita sales declined moderately over 2013–2018. The median percentage of Access groupantibiotics was 68% (range: 22–77 %); the Access group proportion increased in most countries between 2013 and 2018. Five countriesexceeded the 60% target; two countries narrowly missed it (>55% in Germany and Italy). Sales of Access antibiotics in Japan were low(22%), driven by relatively high sales of oral cephalosporins and macrolides.Conclusion We have identified changes to prescribing that could allow countries to achieve the WHO target. The 60% Access group targetprovides a framework to inform national antibiotic policies and could be complemented by absolute measures and more ambitious valuesin specific settings.
Song P, Gupta A, Goon IY, et al., 2021, Data resource profile: Understanding the patterns and determinants of health in South Asians—the South Asia Biobank, International Journal of Epidemiology, Vol: 50, Pages: 717-718e, ISSN: 0300-5771
Christen P, D'Aeth J, Lochen A, et al., 2021, The J-IDEA pandemic planner: a framework for implementing hospital provision interventions during the COVID-19 pandemic, Medical Care, Vol: 59, Pages: 371-378, ISSN: 0025-7079
Background : Planning for extreme surges in demand for hospital care of patientsrequiring urgent life-saving treatment for COVID-19, whilst retaining capacity for otheremergency conditions, is one of the most challenging tasks faced by healthcareproviders and policymakers during the pandemic. Health systems must be wellpreparedto cope with large and sudden changes in demand by implementinginterventions to ensure adequate access to care. We developed the first planning toolfor the COVID-19 pandemic to account for how hospital provision interventions (suchas cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affectthe capacity of hospitals to provide life-saving care.Methods : We conducted a review of interventions implemented or considered in 12 European countries in March-April 2020, an evaluation of their impact on capacity, anda review of key parameters in the care of COVID-19 patients. This information wasused to develop a planner capable of estimating the impact of specific interventions ondoctors, nurses, beds and respiratory support equipment. We applied this to ascenario-based case study of one intervention, the set-up of field hospitals in England,under varying levels of COVID-19 patients.Results : The J-IDEA pandemic planner is a hospital planning tool that allows hospitaladministrators, policymakers and other decision-makers to calculate the amount ofcapacity in terms of beds, staff and crucial medical equipment obtained byimplementing the interventions. Flexible assumptions on baseline capacity, the numberof hospitalisations, staff-to-beds ratios, and staff absences due to COVID-19 make theplanner adaptable to multiple settings. The results of the case study show that whilefield hospitals alleviate the burden on the number of beds available, this intervention isfutile unless the deficit of critical care nurses is addressed first.Discussion : The tool supports decision-makers in delivering a fast and effectiveresponse to
Lau K, Dorigatti I, Miraldo M, et al., 2021, SARIMA-modelled greater severity and mortality during the 2010/11 post-pandemic influenza season compared to the 2009 H1N1 pandemic in English hospitals, International Journal of Infectious Diseases, Vol: 105, Pages: 161-171, ISSN: 1201-9712
ObjectiveThe COVID-19 pandemic demonstrates the need for understanding pathways to healthcare demand, morbidity, and mortality of pandemic patients. We estimate H1N1 (1) hospitalization rates, (2) severity rates (length of stay, ventilation, pneumonia, and death) of those hospitalized, (3) mortality rates, and (4) time lags between infections and hospitalizations during the pandemic (June 2009 to March 2010) and post-pandemic influenza season (November 2010 to February 2011) in England.MethodsEstimates of H1N1 infections from a dynamic transmission model are combined with hospitalizations and severity using time series econometric analyses of administrative patient-level hospital data.ResultsHospitalization rates were 34% higher and severity rates of those hospitalized were 20%–90% higher in the post-pandemic period than the pandemic. Adults (45–64-years-old) had the highest ventilation and pneumonia hospitalization rates. Hospitalizations did not lag infection during the pandemic for the young (<24-years-old) but lagged by one or more weeks for all ages in the post-pandemic period.DiscussionThe post-pandemic flu season exhibited heightened H1N1 severity, long after the pandemic was declared over. Policymakers should remain vigilant even after pandemics seem to have subsided. Analysis of administrative hospital data and epidemiological modelling estimates can provide valuable insights to inform responses to COVID-19 and future influenza and other disease pandemics.
Simmons B, Ariyoshi K, Ohmagari N, et al., 2021, Progress towards WHO AWaRe targets: an analysis of data from high-incomecountries, 2013-2018, Bulletin of the World Health Organization, ISSN: 0042-9686
Objectives: To compare antibiotic consumption in eight high-income countries in reference to the 2019 World Health Organization (WHO) AWaRe classification (Access, Watch, and Reserve) and the 60% Access use consumption target.Methods: Sales data (IQVIA) were analysed for systemic antibiotics from 2013-2018 for France, Italy, Japan, Germany, Spain, Switzerland, United Kingdom, and United States. Antibiotics were classified as Access, Watch, Reserve, and Not Recommended according to the 2019 WHO AWaRe categories. The primary objectives were to calculate: i) antibiotic sales per capita in standard units (SU/capita) overall and by AWaRe category; and ii) the Access percentage, defined as total SU of Access group antibiotics by the total antibiotic SU. Findings: In 2018, there was variability among countries in sales per capita, ranging from 7.4 (Switzerland) to 20.0 (France) SU/capita; median Access sales was 10.9 SU/capita (range 3.5-15.0). Per capita sales moderately declined over time (p<0.01). Median Access percentage was 68% (range 22-77%); Access proportion increased in most countries between 2013 and 2018. Five countries studied exceeded the 60% target; two narrowly missed it (≥55% in Italy and Germany). Access use in Japan was low (22%), driven by a relatively high use of oral cephalosporins and macrolides.Conclusion: Most countries studied are achieving the 60% Access target, however per capita consumption differed significantly. The AWaRe classification provides a framework to inform national antibiotic policies and the 60% indicator provides a target for optimised use. The target should be complemented by absolute measures and adapted to more ambitious values in specific settings.
Singh S, Shaikh M, Hauck K, et al., 2021, Impacts of introducing and lifting nonpharmaceutical interventions on COVID-19 daily growth rate and compliance in the United States, Proceedings of the National Academy of Sciences of USA, Vol: 118, ISSN: 0027-8424
We evaluate the impacts of implementing and lifting nonpharmaceutical interventions (NPIs) in US counties on the daily growth rate of COVID-19 cases and compliance, measured through the percentage of devices staying home, and evaluate whether introducing and lifting NPIs protecting selective populations is an effective strategy. We use difference-in-differences methods, leveraging on daily county-level data and exploit the staggered introduction and lifting of policies across counties over time. We also assess heterogenous impacts due to counties’ population characteristics, namely ethnicity and household income. Results show that introducing NPIs led to a reduction in cases through the percentage of devices staying home. When counties lifted NPIs, they benefited from reduced mobility outside of the home during the lockdown, but only for a short period. In the long term, counties experienced diminished health and mobility gains accrued from previously implemented policies. Notably, we find heterogenous impacts due to population characteristics implying that measures can mitigate the disproportionate burden of COVID-19 on marginalized populations and find that selectively targeting populations may not be effective.
Barrenho E, Miraldo M, Propper C, et al., 2021, The importance of surgeons and their peers in adoption and diffusion of innovation: an observational study of laparoscopic colectomy adoption and diffusion in England, Social Science and Medicine, Vol: 272, ISSN: 0277-9536
Little is known about the role of clinicians in accounting for adoption and diffusion of medical innovations, especially within the English National Health System. This study examines the importance of surgical consultants and their work-based networks on the diffusion of an important innovation, minimally invasive elective laparoscopic colectomy for colorectal cancer. The study used linked patient-level and workforce data on 260,110 elective colectomies and 1288 consultants between 2000 and 2014, to examine adoption of laparoscopic colectomy pre- and post-introduction of clinical guidelines and total share of colectomies performed laparoscopically by adopters. Laparoscopy as a share of elective colectomy increased from 0% in 2000 to 53% in 2014. Surgeons, rather than hospitals, were the principal agents accounting for the increase and explain 46.6% of the variance in laparoscopic colectomy use. Female surgeons, surgeons trained outside the United Kingdom, and recent graduates had higher rates of laparoscopy adoption. More experienced surgeons and surgeons with more peers who perform laparoscopy were more likely to adopt, adopt early and have greater use of laparoscopy. Targeting clinicians, rather than hospitals, is central to increasing adoption and diffusion of new medical technologies.
De Backer C, Teunissen L, Cuykx I, et al., 2021, An Evaluation of the COVID-19 Pandemic and Perceived Social Distancing Policies in Relation to Planning, Selecting, and Preparing Healthy Meals: An Observational Study in 38 Countries Worldwide, FRONTIERS IN NUTRITION, Vol: 7, ISSN: 2296-861X
D'Aeth J, Ghosal S, Grimm F, et al., 2020, Report 40: Optimal scheduling rules for elective care to minimize years of life lost during the SARS-CoV-2 pandemic: an application to England
SummaryCountries have deployed a wide range of policies to prioritize patients to hospital care to address unprecedent surges in demand during the course of the pandemic. Those policies included postponing planned hospital care for non-emergency cases and rationing critical care.We develop a model to optimally schedule elective hospitalizations and allocate hospital general and critical care beds to planned and emergency patients in England during the pandemic. We apply the model to NHS England data and show that optimized scheduling leads to lower years of life lost and costs than policies that reflect those implemented in England during the pandemic. Overall across all disease areas the model enables an extra 50,750 - 5,891,608 years of life gained when compared to standard policies, depending on the scenarios. Especially large gains in years of life are seen for neoplasms, diseases of the digestive system, and injuries & poisoning.
Haw D, Forchini G, Christen P, et al., 2020, Report 35: How can we keep schools and universities open? Differentiating closures by economic sector to optimize social and economic activity while containing SARS-CoV-2 transmission
There is a trade-off between the education sector and other economic sectors in the control of SARS-Cov-2 transmission. Here we integrate a dynamic model of SARS-CoV-2 transmission with a 63-sector economic model reflecting sectoral heterogeneity in transmission and economic interdependence between sectors. We identify COVID-19 control strategies which optimize economic production while keeping schools and universities operational and constraining infections such that emergency hospital capacity is not exceeded. The model estimates an economic gain of between £163bn and £205bn for the United Kingdom compared to a blanket lockdown of non-essential activity over six months, depending on hospital capacity. Sectors identified as potential priorities for closure are contact-intensive and/or less economically productive.
McCabe R, Schmit N, Christen P, et al., 2020, Adapting hospital capacity to meet changing demands during the COVID-19 pandemic, BMC Medicine, Vol: 18, Pages: 1-12, ISSN: 1741-7015
BackgroundTo calculate hospital surge capacity, achieved via hospital provision interventions implemented for the emergency treatment of coronavirus disease 2019 (COVID-19) and other patients through March to May 2020; to evaluate the conditions for admitting patients for elective surgery under varying admission levels of COVID-19 patients.MethodsWe analysed National Health Service (NHS) datasets and literature reviews to estimate hospital care capacity before the pandemic (pre-pandemic baseline) and to quantify the impact of interventions (cancellation of elective surgery, field hospitals, use of private hospitals, deployment of former medical staff and deployment of newly qualified medical staff) for treatment of adult COVID-19 patients, focusing on general and acute (G&A) and critical care (CC) beds, staff and ventilators.ResultsNHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated.ConclusionsUnless COVID-19 hospitalisations drop to low levels, there is a continued need to enhance critical care capacity in England with field hospitals, use of private hospitals or deployment of former and newly qualified medical staff to allow some or all elective surge
Hansen C, Miraldo M, Hauck K, et al., 2020, Is the road to good health paved in gold? HIV and mining in Sub-Saharan Africa, Publisher: OXFORD UNIV PRESS, Pages: V837-V837, ISSN: 1101-1262
Hauck K, Miraldo M, Singh S, 2020, Integrating motherhood and employment: a 22-year analysis investigatingimpacts of US workplace breastfeeding policy, Social Science and Medicine – Population Health, Vol: 11, ISSN: 2352-8273
The United States has one of the lowest exclusive breastfeeding rates among high-income countries. Most experts agree that there is a lack of mother-friendly workplace policies compared to other countries. Since 1995, 25 states have implemented workplace breastfeeding legislation allowing mothers to express and store breast milk in the workplace. There is heterogeneity in policy enforceability where 17 states have weak enforceability while eight states have strict enforceability and require employers to offer provisions to breastfeed at the workplace. Using difference-in-differences methods, we examine the impact of this policy on state-level breastfeeding rates and assess how that impact differs with policy enforceability. We use data from the Centers for Disease Control on breastfeeding, supplementing with socio-economic data from the Panel Study of Income Dynamics, Current Population Survey, the US Census Bureau and several other datasets over 22 years from 1990 to 2011. We find that states with legislation experienced a 2.3-percentage point increase in breastfeeding rates compared to states without legislation while states with weak enforceability experienced a 3.1-percentage point increase compared to states without legislation. We also find that policies do not start to have an impact until 1–2 years after they were signed into law. Considering the recent assault on breastfeeding from the current administration, our study is a timely and important contribution that strengthens the evidence base for the health benefits of workplace breastfeeding policies.
Aurino E, Olney J, Miraldo M, et al., 2020, Chronic Syndemic meets Viral pandemic, Publisher: BMJ Opinion
McCabe R, Schmit N, Christen P, et al., 2020, Report 27 Adapting hospital capacity to meet changing demands during the COVID-19 pandemic
To meet the growing demand for hospital care due to the COVID-19 pandemic, England implemented a range of hospital provision interventions including the procurement of equipment, the establishment of additional hospital facilities and the redeployment of staff and other resources. Additionally, to further release capacity across England’s National Health Service (NHS), elective surgery was cancelled in March 2020, leading to a backlog of patients requiring care. This created a pressure on the NHS to reintroduce elective procedures, which urgently needs to be addressed. Population-level measures implemented in March and April 2020 reduced transmission of SARS-CoV-2, prompting a gradual decline in the demand for hospital care by COVID-19 patients after the peak in mid-April. Planning capacity to bring back routine procedures for non-COVID-19 patients whilst maintaining the ability to respond to any potential future increases in demand for COVID-19 care is the challenge currently faced by healthcare planners.In this report, we aim to calculate hospital capacity for emergency treatment of COVID-19 and other patients during the pandemic surge in April and May 2020; to evaluate the increase in capacity achieved via five interventions (cancellation of elective surgery, field hospitals, use of private hospitals, and deployment of former and newly qualified medical staff); and to determine how to re-introduce elective surgery considering continued demand from COVID-19 patients. We do this by modelling the supply of acute NHS hospital care, considering different capacity scenarios, namely capacity before the pandemic (baseline scenario) and after the implementation of capacity expansion interventions that impact available general and acute (G&A) and critical care (CC) beds, staff and ventilators. Demand for hospital care is accounted for in terms of non-COVID-19 and COVID-19 patients. Our results suggest that NHS England would not have had sufficient daily capacity
Christen P, D'Aeth J, Lochen A, et al., 2020, Report 15: Strengthening hospital capacity for the COVID-19 pandemic
Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for COVID-19, and other conditions, is one of the most challenging tasks facing healthcare commissioners and care providers during the pandemic. Due to uncertainty in expected patient numbers requiring care, as well as evolving needs day by day, planning hospital capacity is challenging. Health systems that are well prepared for the pandemic can better cope with large and sudden changes in demand by implementing strategies to ensure adequate access to care. Thereby the burden of the pandemic can be mitigated, and many lives saved. This report presents the J-IDEA pandemic planner, a hospital planning tool to calculate how much capacity in terms of beds, staff and ventilators is obtained by implementing healthcare provision interventions affecting the management of patient care in hospitals. We show how to assess baseline capacity, and then calculate how much capacity is gained by various healthcare interventions using impact estimates that are generated as part of this study. Interventions are informed by a rapid review of policy decisions implemented or being considered in 12 European countries over the past few months￼ , an evaluation of the impact of the interventions on capacity using a variety of research methods, and by a review of key parameters in the care of COVID-19 patients.The J-IDEA planner is publicly available, interactive and adaptable to different and changing circumstances and newly emerging evidence. The planner estimates the additional number of beds, medical staff and crucial medical equipment obtained under various healthcare interventions using flexible inputs on assumptions of existing capacities, the number of hospitalisations, beds-to-staff ratios, and staff absences due to COVID-19. A detailed user guide accompanies the planner. The planner was developed rapidly and has limitations which we will address in future iterations. It support
Goiana-Da-Silva K, Cruz-e-Silva D, Bartlett O, et al., 2020, The ethics of taxing sugar-sweetened beverages to improve public health, Frontiers in Public Health, Vol: 8, ISSN: 2296-2565
The World Health Organization highlights fiscal policies as priority interventions for the promotion of healthy eating in its Action Plan for the Prevention and Control of Non-communicable Diseases. The taxation of sugar sweetened beverages (SSBs) in particular is noted to be an effective measure, and SSBs taxes have already been implemented in several countries worldwide. However, although the evidence base suggests that this will be effective in helping to combat rising obesity rates, opponents of SSBs taxation argue that it is illiberal and paternalistic, and therefore should be avoided. Bioethical analysis may play an essential role in clarifying whether policymakers should adopt SSBs taxes as part of wider obesity strategy. In this article we argue that no single ethical theory can account for the complexities inherent in obesity prevention strategy, especially the liberal theories relied upon by opponents of SSBs taxation. We contend that a pluralist approach to the ethics of SSBs taxation must be adopted as the only suitable way of accounting for the multiple overlapping, and sometimes, conflicting factors that are relevant to determining the moral acceptability of such an intervention.
Goiana-da-Silva F, Severo M, Cruz-E-Silva D, et al., 2020, Projected impact of the Portuguese sugar-sweetened beverages tax on obesity incidence across different age groups: a modelling study, PLoS Medicine, Vol: 17, Pages: 1-17, ISSN: 1549-1277
BackgroundExcessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal.Methods and findingsWe performed a national market analysis and population-wide modelling study using market data for the years 2014–2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015–2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40–78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases—despite our efforts to mitigate them—related to the methodological differences between these sources.ConclusionsThe tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels
Goiana-Da-Silva K, Cruz-e-Silva D, Allen L, et al., 2019, Portugal’s voluntary food reformulation agreement and the WHO reformulation targets, Journal of Global Health, Vol: 9, ISSN: 2047-2978
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