Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study

Abstract Background Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. Methods We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Results Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential ‘gaming’, and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for ‘gaming the system’. Secondly, a tension between participants’ own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants’ personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. Conclusions There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions

Bottom sediments of Lake Rotoma

Lake Rotoma is a deep (70-80 m), oligotrophic, warm monomictic lake of volcanic origin with insignificant stream inflow and no clearly defined outflow. For at least 60 years up to 1972 the lake level fluctuated markedly about an overall rising trend of some 6-10 m. Nearshore profiles are related to the prevailing wave climate superimposed upon the overall rising lake level, shelves being wider, less steep, and deeper about the more exposed eastern and southern shorelines. The outer portions of shelves extending well below modern storm wave base into waters as deep as 15-25 m are relict features from lower lake level stands. Sediments fine from sand-gravel mixtures nearshore to silts in basinal areas. Their composition reflects a composite provenance involving the lavas and tephras about the lake, as well as intralake diatom frustules and organic matter. The distribution pattern of surficial bottom sediments is an interplay between grains of both biological and terrigenous origin, supplied presently and in the past by a variety of processes, that have been dispersed either by the modern hydrodynamic regime or by former ones associated with lower lake levels. These interrelationships are structured by erecting 5 process-age sediment classes in the lake, namely neoteric, amphoteric, proteric, palimpsest, and relict sediments, analogous to categories postulated for sediments on oceanic continental shelves. Short-core stratigraphy includes the Kaharoa (A.D. -1020) and Tarawera (A.D. 1886) tephras. The rates of sedimentation of diatomaceous silts in basinal areas have more than doubled since the Tarawera eruption, indicating an overall increase in the fertility level of lake waters associated, perhaps, with recent farm development in the catchment

Factorial structure and reliability of the academic satisfaction questionnaire on Chilean medical students

Indexación: Web of Science; Scopus.El presente estudio analiza la estructura factorial y confiabilidad del cuestionario de satisfacción académica (CSA) en una muestra de 563 estudiantes de medicina, entre 19 y 29 años (media de 20,42); provenientes de cuatro universidades chilenas. Una vez finalizada la traducción al castellano se exploró la validez de contenido de los ítems mediante un juicio de expertos. La estructura factorial del cuestionario se analizó a través de un análisis factorial exploratorio empleando el método Análisis de Ejes Principales (AEP). Los resultados preliminares de la fiabilidad y validez del instrumento han mostrado que la estructura de un factor es viable y adecuada de acuerdo a los requisitos psicométricos establecidos, aunque se recomiendan futuros estudios que evalúen su validez y confiabilidad en otros programas de pregrado.The present study examines the factorial structure and reliability of the academic satisfaction questionnaire (CSA) in a sample of 563 medical students, between 19 and 29 years (average of 20.42); from four Chilean universities. Once translated into Spanish explored the validity of the items content was evaluated through experts opinions. The factorial structure of the scale was analyzed through an exploratory factor analysis using the Principal Axis Analysis method (AEP).The preliminary results of the reliability and validity of the instrument have shown that a factor structure is viable and appropriate according to the established psychometric requirements, although future studies to evaluate its validity and reliability in other undergraduate programs are recommended.http://www.redalyc.org/articulo.oa?id=45964543200

TLR7-mediated skin inflammation remotely triggers chemokine expression and leukocyte accumulation in the brain

Background: The relationship between the brain and the immune system has become increasingly topical as, although it is immune-specialised, the CNS is not free from the influences of the immune system. Recent data indicate that peripheral immune stimulation can significantly affect the CNS. But the mechanisms underpinning this relationship remain unclear. The standard approach to understanding this relationship has relied on systemic immune activation using bacterial components, finding that immune mediators, such as cytokines, can have a significant effect on brain function and behaviour. More rarely have studies used disease models that are representative of human disorders. Methods: Here we use a well-characterised animal model of psoriasis-like skin inflammation—imiquimod—to investigate the effects of tissue-specific peripheral inflammation on the brain. We used full genome array, flow cytometry analysis of immune cell infiltration, doublecortin staining for neural precursor cells and a behavioural read-out exploiting natural burrowing behaviour. Results: We found that a number of genes are upregulated in the brain following treatment, amongst which is a subset of inflammatory chemokines (CCL3, CCL5, CCL9, CXCL10, CXCL13, CXCL16 and CCR5). Strikingly, this model induced the infiltration of a number of immune cell subsets into the brain parenchyma, including T cells, NK cells and myeloid cells, along with a reduction in neurogenesis and a suppression of burrowing activity. Conclusions: These findings demonstrate that cutaneous, peripheral immune stimulation is associated with significant leukocyte infiltration into the brain and suggest that chemokines may be amongst the key mediators driving this response

The nature of weather and climate impacts in the energy sector

The power sector’s meteorological information needs are diverse and cover many different distinct applications and users. Recognising this diversity, it is important to understand the general nature of how weather and climate influence the energy sector and the implications they have for quantitative impact modelling. Using conceptual examples and illustrations from recent research, this chapter argues that the traditional ‘transfer function’ approach that is common to many industrial applications of weather and climate science—whereby weather can be directly mapped to an energy impact—is inadequate for many important power system applications (such as price forecasting and system operations and planning). The chapter concludes by arguing that a deeper understanding of how meteorological impacts in the energy sector are modelled is required

Interleukin-1 polymorphisms associated with increased risk of gastric cancer

Helicobacter pylori infection is associated with a variety of clinical outcomes including gastric cancer and duodenal ulcer disease. The reasons for this variation are not clear, but the gastric physiological response is influenced by the severity and anatomical distribution of gastritis induced by H. pylori. Thus, individuals with gastritis predominantly localized to the antrum retain normal (or even high) acid secretion, whereas individuals with extensive corpus gastritis develop hypochlorhydria and gastric atrophy, which are presumptive precursors of gastric cancer. Here we report that interleukin-1 gene cluster polymorphisms suspected of enhancing production of interleukin-1-beta are associated with an increased risk of both hypochlorhydria induced by H. pylori and gastric cancer. Two of these polymorphism are in near-complete linkage disequilibrium and one is a TATA-box polymorphism that markedly affects DNA-protein interactions in vitro. The association with disease may be explained by the biological properties of interleukin-1-beta, which is an important pro-inflammatory cytokine and a powerful inhibitor of gastric acid secretion. Host genetic factors that affect interleukin-1-beta may determine why some individuals infected with H. pylori develop gastric cancer while others do no

Meaning behind measurement : self-comparisons affect responses to health related quality of life questionnaires

Purpose The subjective nature of quality of life is particularly pertinent to the domain of health-related quality of life (HRQOL) research. The extent to which participants’ responses are affected by subjective information and personal reference frames is unknown. This study investigated how an elderly population living with a chronic metabolic bone disorder evaluated self-reported quality of life. Methods Participants (n = 1,331) in a multi-centre randomised controlled trial for the treatment of Paget’s disease completed annual HRQOL questionnaires, including the SF-36, EQ-5D and HAQ. Supplementary questions were added to reveal implicit reference frames used when making HRQOL evaluations. Twenty-one participants (11 male, 10 female, aged 59–91 years) were interviewed retrospectively about their responses to the supplementary questions, using cognitive interviewing techniques and semi-structured topic guides. Results The interviews revealed that participants used complex and interconnected reference frames to promote response shift when making quality of life evaluations. The choice of reference frame often reflected external factors unrelated to individual health. Many participants also stated that they were unclear whether to report general or disease-related HRQOL. Conclusions It is important, especially in clinical trials, to provide instructions clarifying whether ‘quality of life’ refers to disease-related HRQOL. Information on selfcomparison reference frames is necessary for the interpretation of responses to questions about HRQOL.The Chief Scientist Office of the Scottish Government Health Directorates, The PRISM funding bodies (the Arthritis Research Campaign, the National Association for the Relief of Paget’s disease and the Alliance for Better Bone Health)Peer reviewedAuthor final versio

The International Surface Pressure Databank version 2

The International Surface Pressure Databank (ISPD) is the world's largest collection of global surface and sea-level pressure observations. It was developed by extracting observations from established international archives, through international cooperation with data recovery facilitated by the Atmospheric Circulation Reconstructions over the Earth (ACRE) initiative, and directly by contributing universities, organizations, and countries. The dataset period is currently 1768–2012 and consists of three data components: observations from land stations, marine observing systems, and tropical cyclone best track pressure reports. Version 2 of the ISPD (ISPDv2) was created to be observational input for the Twentieth Century Reanalysis Project (20CR) and contains the quality control and assimilation feedback metadata from the 20CR. Since then, it has been used for various general climate and weather studies, and an updated version 3 (ISPDv3) has been used in the ERA-20C reanalysis in connection with the European Reanalysis of Global Climate Observations project (ERA-CLIM). The focus of this paper is on the ISPDv2 and the inclusion of the 20CR feedback metadata. The Research Data Archive at the National Center for Atmospheric Research provides data collection and access for the ISPDv2, and will provide access to future versions

Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian childhood obesity treatment trial (MASCOT)

Context. Few randomized controlled trials (RCTs) of interventions for the treatment of childhood obesity have taken place outside the Western world. Aim. To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur, Malaysia. Methods. Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds. The intervention was relatively low intensity (8 hours contact over 26 weeks, group based), aiming to change child sedentary behavior, physical activity, and diet using behavior change counselling. Outcomes were measured at baseline and six months after the start of the intervention. Primary outcome was BMI z-score, other outcomes were weight change, health-related quality of life (Peds QL), objectively measured physical activity and sedentary behavior (Actigraph accelerometry over 5 days). Results. The intervention had no significant effect on BMI z score relative to control. Weight gain was reduced significantly in the intervention group compared to the control group (+1.5 kg vs. +3.5 kg, respectively, t-test p < 0.01). Changes in health-related quality of life and objectively measured physical activity and sedentary behavior favored the intervention group. Conclusions. Treatment was associated with reduced rate of weight gain, and improvements in physical activity and quality of life. More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes