Behaviour Change in Public Health: Evidence and Implications

Article ID 598672The evidence on the role of particular lifestyles, smoking, binge drinking, lack of physical activity, and poor health care seeking, in increased risks for mortality and morbidity is compelling [1]. Understanding the pathways through which these various “unhealthy” behaviours affect health is complicated by the broader ecological context in which they occur. The complexity is further enhanced because behaviours do not occur in isolation and there is often a convergence of associations. Interventions to achieve changes in either single or multiple behaviours have therefore often been limited in their effectiveness and longer term sustainability. In order to develop and implement a meaningful behaviour change agenda we need to establish innovative ways of operationalizing and understanding the complexity of behavioural factors and their dynamic interrelationships and how these collectively affect health. The Behaviour Change Research Cycle (BCRC) (Figure 1) provides a simple illustration of the life cycle of evidence required

Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal

Introduction: Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese government and with the support from the International Federation of Obstetrics and Gynecology has implemented an initiative to institutionalize postpartum family planning services in selected major referral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal. The aim of the study is to find the prevalence of the service coverage of postpartum contraception in the selected facilities. Methods: A descriptive cross-sectional study was conducted in seven major referral facilities across Nepal. Data were collected from the hospital records of all women who delivered in these facilities between October 2018 and March 2019. Ethical approval for this study was obtained from Nepal Health Research Council. Data analysis was done with SPSS version 23. Results: Among the 29,072 deliveries from all the facilities, postpartum family planning counseling coverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581 (5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention to choose a postpartum family planning method. However, 36% of mothers neither used nor had the intention to choose a postpartum family planning method. Conclusions: The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal is higher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum Intrauterine Device initiatives. However, the prevalence of service coverage of immediate Postpartum Family Planning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to 2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More efforts are needed to encourage mothers delivering in the facilities to use the postpartum family planning method

The challenge of forecasting high streamflows 1–3 months in advance with lagged climate indices in southeast Australia

Skilful forecasts of high streamflows a month or more in advance are likely to be of considerable benefit to emergency services and the broader community. This is particularly true for mesoscale catchments (< 2000 km²) with little or no seasonal snowmelt, where real-time warning systems are only able to give short notice of impending floods. In this study, we generate forecasts of high streamflows for the coming 1-month and coming 3-month periods using large-scale ocean–atmosphere climate indices and catchment wetness as predictors. Forecasts are generated with a combination of Bayesian joint probability modelling and Bayesian model averaging. High streamflows are defined as maximum single-day streamflows and maximum 5-day streamflows that occur during each 1-month or 3-month forecast period. Skill is clearly evident in the 1-month forecasts of high streamflows. Surprisingly, in several catchments positive skill is also evident in forecasts of large threshold events (exceedance probabilities of 25%) over the next month. Little skill is evident in forecasts of high streamflows for the 3-month period. We show that including lagged climate indices as predictors adds little skill to the forecasts, and thus catchment wetness is by far the most important predictor. Accordingly, we recommend that forecasts may be improved by using accurate estimates of catchment wetness

Social sciences research in neglected tropical diseases 3: Investment in social science research in neglected diseases of poverty: a case study of Bill and Melinda Gates Foundation

This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: The level of funding provides a good proxy for the level of commitment or prioritisation given to a particular issue. While the need for research relevant to social, economic, cultural and behavioural aspects of neglected tropical diseases (NTD) control has been acknowledged, there is limited data on the level of funding that supports NTD social science research. METHOD: A case study was carried out in which the spending of a major independent funder, the Bill and Melinda Gates Foundation (BMGF) - was analysed. A total of 67 projects funded between October 1998 and November 2008 were identified from the BMGF database. With the help of keywords within the titles of 67 grantees, they were categorised as social science or non-social science research based on available definition of social science. A descriptive analysis was conducted. RESULTS: Of 67 projects analysed, 26 projects (39%) were social science related while 41 projects (61%) were basic science or other translational research including drug development. A total of US$697 million was spent to fund the projects, of which 35$ 241 million) went to social science research. Although the level of funding for social science research has generally been lower than that for non-social science research over 10 year period, social science research attracted more funding in 2004 and 2008. CONCLUSION: The evidence presented in this case study indicates that funding on NTD social science research compared to basic and translational research is not as low as it is perceived to be. However, as there is the acute need for improved delivery and utilisation of current NTD drugs/technologies, informed by research from social science approaches, funding priorities need to reflect the need to invest significantly more in NTD social science research

EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.This article has been made available through the Brunel Open Access Publishing Fund.Tobacco smoking claims 700 000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base-the English Tobacco Return on Investment (ROI) tool-to other EU member states

Social sciences research in neglected tropical diseases 1: the ongoing neglect in the neglected tropical diseases

Centuries of scientific advances and developments in biomedical sciences have brought us a long way to understanding and managing disease processes, by reducing them to simplified cause-effect models. For most of the infectious diseases known today, we have the methods and technology to identify the causative agent, understand the mechanism by which pathology is induced and develop the treatment (drugs, vaccines, medical or surgical procedures) to cure, manage or control

Social sciences research in neglected tropical diseases 2: A bibliographic analysis

The official published version of the article can be found at the link below.Background There are strong arguments for social science and interdisciplinary research in the neglected tropical diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent to which the social sciences are a part of that. Methods A bibliographic analysis was conducted of neglected tropical diseases related research papers published over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis. Results There is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however, reveals a degree of misclassification by the abstracting service where a surprising proportion of the "social sciences" research was pure clinical research. Much of the social sciences research also tends to be "hand maiden" research focused on the implementation of biomedical solutions. Conclusion There is little evidence that scientists pay any attention to the complex social, cultural, biological, and environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises

A Numerical Investigation of the Performance of Damaged Concrete Barriers Under Sequential Vehicular Impacts

Concrete median barriers are prone to damage from low-velocity impacts. However, there is a limited understanding of how damage from initial impacts affects barriers’ long-term performance and whether they maintain safe continued service or must be replaced. Therefore, this paper evaluates the performance of the concrete barriers under sequential low-velocity impact using finite-element analysis. Crash test simulations were performed by impacting the concrete barrier twice with an 80,000 lb (36-ton) tractor-trailer at a target impact velocity and angle. The first impact’s velocities varied between 30 mph (48 kmph) and 54 mph (87 kmph) at 10◦ , 15◦ , and 20◦ crash angles, and the damaged barrier was subsequently subjected to the second impact conforming to the American Association of State Highway and Transportation Officials’ (AASHTO) Manual for Assessing Safety Hardware (MASH) for Test Level 5 criteria (i.e., representative velocity of 52.7 mph (85 kmph) at 15◦ ). Therefore, a total of 78 impact simulations were conducted, and statistical analysis was performed to investigate the relationship between the peak impact forces of the first and second impacts and the crash angle and velocity across distinct phases of the crash simulation and over the entire crash history. The results show that while the peak impact force of the first impact was linearly related to both velocity and angle, the maximum impact force at the second impact did not follow the same trend. However, when considering the localized peak forces in each phase of the crash, the peak forces from the later stages of the second impact (i.e., rebound and final interaction phases) were highly correlated with the initial impact’s velocity and angle, substantially reducing the barrier’s capability to resist vehicular impact loads. In particular, for initial velocities above 46 mph (74 kmph) at angles of 15◦ and 20◦ , barriers formed shear cracks traversing across their cross-section, which resulted in excessive fragmentation during the second impact and consequent failure to meet the MASH criteria in terms of structural adequacy

Smoking and health-related quality of life in English general population: Implications for economic evaluations

Copyright @ 2012 Vogl et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Little is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions. Methods: Using the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age- and gender-specific predicted values according to smoking status are offered as the potential 'utility' values to be used in future economic evaluation models. Results: The observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains - mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%) -. 'Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations. Conclusion: Smoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e.g. tobacco control) or is affected (e.g. treatment for lung cancer) by individual's (or patients') smoking status