Benefits For Health Outcomes Research Articles

Harnessing AI and Gut Microbiome Research for Precision Health

The gut microbiome's impact on physiological processes, influenced by diet and lifestyle, is profound. Dysbiosis, an imbalance in microbiota composition, is associated with diseases like obesity. This review explores the gut microbiome's role in metabolism and calorie intake, alongside recent AI advancements impacting personalized nutrition. AI has revolutionized microbiome research, especially in multi-omics data analysis. AI-driven approaches enable the integration and interpretation of diverse omics datasets, including genomics, metabolomics, and proteomics, providing comprehensive insights into the gut microbiome's functional dynamics and its impact on host metabolism. These facilitate the identification of microbial biomarkers associated with disease states and dietary interventions, paving the way for personalized nutrition strategies tailored to individual gut microbiome profiles. AI platforms can also offer tailored dietary recommendations based on microbiome composition and health objectives. Healthcare professionals leverage AI to optimize dietary interventions, promoting gut microbiome modulation and preventing chronic diseases. Challenges like data standardization and privacy persist, yet addressing them is vital for maximizing AI's benefits in health outcomes and precision medicine. Ongoing AI and microbiome research promise to revolutionize personalized nutrition and metabolic health worldwide.

A Framework for Protecting and Promoting Employee Mental Health through Supervisor Supportive Behaviors

The attention to workplace mental health is timely given extreme levels of burnout, anxiety, depression and trauma experienced by workers due to serious extraorganizational stressors – the COVID-19 pandemic, threats to climate change, and extreme social and political unrest. Workplace-based risk factors, such as high stress and low support, are contributing factors to poor mental health and suicidality (Choi, 2018; Milner et al., 2013, 2018), just as low levels of social connectedness and belonging are established risk factors for poor mental health (Joiner et al., 2009), suggesting that social support at work (e.g., from supervisors) may be a key approach to protecting and promoting employee mental health. Social connections provide numerous benefits for health outcomes and are as, or more, important to mortality as other well-known health behaviors such as smoking and alcohol consumption (Holt-Lundstad et al., 2015), and can serve as a resource or buffer against the deleterious effects of stress or strain on psychological health (Cohen & Wills, 1985). This manuscript provides an evidence-based framework for understanding how supervisor supportive behaviors can serve to protect employees against psychosocial workplace risk factors and promote social connection and belongingness protective factors related to employee mental health. We identify six theoretically-based Mental Health Supportive Supervisor Behaviors (MHSSB; i.e., emotional support, practical support, role modeling, reducing stigma, warning sign recognition, warning sign response) that can be enacted and used by supervisors and managers to protect and promote the mental health of employees. A brief overview of mental health, mental disorders, and workplace mental health is provided. This is followed by the theoretical grounding and introduction of MHSSB. Suggestions for future research and practice follow, all with the focus of developing a better understanding of the role of supervisors in protecting and promoting employee mental health in the workplace.

Measuring the impact of monoclonal antibody therapies.

Monoclonal antibody (Mab) treatments have significantly improved the quality and quantity of life, but they are some of the most expensive treatments, resulting in a degree of hesitancy to introduce new Mab agents. A system for estimating the effect of Mab drugs, in general, would optimally inform health strategy and fully realize how a single scientific discovery can deliver health benefits. We evaluated such a method with several well-established Mab regimens. We selected five different Mab regimens in oncology and rheumatology in England. We carried out two systematic literature reviews and meta-analyses to assess health outcomes (Health Assessment Questionnaire-Disability Index for rheumatoid arthritis; overall mortality for melanoma) from real-world data and compared them to the outcomes from randomized control trials (RCTs). We applied economic modeling to estimate the net monetary benefits for health outcomes for the estimated patient population size for each Mab regimen. Meta-analyses of 27 eligible real-world data (RWD) sets and 26 randomized controlled trial (RCT) sets found close agreement between the observed and expected health outcomes. A Markov model showed the net positive monetary benefit in three Mab regimens and the negative benefit in two regimens. However, because of limited access to NHS data, the economic model made several assumptions about the number of treated patients and the cost of treatment to the NHS, the accuracy of which may affect the estimation of the net monetary benefit. RCT results reliably inform the real-world experience of Mab treatments. Calculation of the net monetary benefit by the algorithm described provides a valuable overall measure of the health impact, subject to the accuracy of data inputs. This study provides a compelling case for building a comprehensive, systematized, and accessible database and related analytics, on all Mab treatments within health services.

Adolescent Health Care Education: A Community Intervention


 
 
 
 
 
 
 
 
 
 This study addresses the imperative of imparting effective hygiene practices to adolescents to mitigate menstrual health issues and infectious diseases. Focused on the Ketegan Village area, our Youth Health Care Education program aimed to instill the significance of proper hand hygiene, particularly in the context of viral and bacterial infections, among children aged 6-10 and adolescents aged 11-14. Employing a community-based approach, the program integrated educational activities to encourage consistent hand washing with soap before and after daily tasks. The outcomes revealed a substantial increase in awareness and adherence to hand hygiene practices among the targeted age groups. By equipping adolescents with essential knowledge during formative years, this initiative bears implications for sustained hygiene habits, thereby reducing the susceptibility to health complications associated with inadequate hygiene practices.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Highlights:
 
 Community-based approach: The program utilized a community-focused strategy to ensure effective education and behavior change.
 Age-specific targeting: The initiative catered to different age groups, emphasizing the importance of hygiene practices among children and adolescents.
 Sustained impact: The study showed increased awareness and adherence to hand hygiene, indicating potential long-term benefits for health outcomes.
 
 Keywords: Adolescents, Hygiene practices, Youth Health Care Education program, Hand washing, Infectious diseases
 
 

A New Model of Learning: Environmental Health in a Global World.

Environmental Health in a Global World at New York University was re-designed as a class participatory effort, challenging undergraduate students to understand environmental hazards and the resultant adverse health outcomes by embracing the inherent complexity of environmental risks and proposing solutions. Following introductory lectures, students are placed into teams and assigned a specific perspective, or avatar, which includes learning to see the challenge from the perspective of a technical expert such as a biologist, an engineer, or an anthropologist. The teams then design specific systems maps to visualize the complex interactions that lead to adverse health outcomes after a given environmental exposure. The maps highlight potential leverage points where relatively minor interventions can provide a disproportionate benefit in health outcomes. The teams then explore potential interventions and identify the potential unintended consequences of those actions, develop and advocate for innovative new strategies to mitigate risk and improve outcomes. Over the past 5 years, we have taught this methodology to over 680 students with strong, student-oriented results. The teams created and presented more than 100 strategies, addressing a diverse set of environmental challenges that include water contamination, gun violence, air pollution, environmental justice, health security, and climate change. Developing the strategies helped the students understand environmental threats in a more holistic way, provided them with some agency in finding solutions, and offered an opportunity for them to improve their presentation skills. The responses in course evaluations have been enthusiastic, with many students reporting a deep impact on their college experience.

Persistence on Novel Cardioprotective Antihyperglycemic Therapies in the United States

Selected glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have cardioprotective effects in patients with type 2 diabetes mellitus (T2D) and elevated cardiovascular risk. Prescription and consistent use of these medications are essential to realizing their benefits. In a nationwide deidentified United States administrative claims database of adults with T2D, the prescription practices of GLP-1RAs and SGLT-2i were evaluated across guideline-directed co-morbidity indications from 2018 to 2020. The monthly fill rates were assessed for 12months after the initiation of therapy by calculating the proportion of days with consistent medication use. Of 587,657 subjects with T2D, 80,196 (13.6%) were prescribed GLP-1RAs and 68,149 (11.5%) SGLT-2i from 2018 to 2020, representing 12.9% and 11.6% of patients with indications for each medication, respectively. In new initiators, 1-year fill rate was 52.5% for GLP-1RAs and 52.9% for SGLT-2i, which was higher for patients with commercial insurance than those with Medicare Advantage plans for both GLP-1RAs (59.3% vs 51.0%, p<0.001) and SGLT-2i (63.4% vs 50.3%, p <0.001). After adjusting for co-morbidities, there were higher rates of prescription fills for patients with commercial insurance (odds ratio1.17, 95% confidence interval 1.06 to 1.29 for GLP-1RAs, and 1.59 [1.42 to 1.77] for SGLT-2i); and higher income (odds ratio1.09 [1.06 to 1.12] for GLP-1RAs, and 1.06 [1.03 to 1.1] for SGLT-2i). From 2018 to 2020, the use of GLP-1RAs and SGLT-2i remained limited to fewer than 1 in 8 patients with T2D and indications, with 1-year fill rates around 50%. The low and inconsistent use of these medications compromises their longitudinal health outcome benefits in a period of expanding indications for their use.

The Sedentary Time and Physical Activity Level of Adulthood: Comparative by Age and Gender Group

In adulthood, physical activity provides benefits for health outcomes. Watching television, using a computer while sitting, and driving too long can make the sedentary time longer, eventually reducing physical activity. Therefore, this study aimed to associate sedentary time with physical activity level and compared the sedentary time and physical activity levels by age and gender. This study uses a descriptive-analytic with a cross-sectional approach to finding the association of sedentary time with physical activity level compared by age and gender group. The data was conducted from 179 adult participants located from inside and outside of Java Island, Indonesia was invited to participate in this study. Measurement of sedentary time and physical activity level used the International Physical Activity Questionnaire short-form (IPAQ-SF). Through the research process, this study found that the average age of study participants is 38.69 years old (SD±11.99; min-max=19-65 years old). Sedentary time, described through sitting time, is associated with physical activity level (OR 18.67; 95%CI= 8.48-41.08). Males on 19-44 years old group had greater physical activity total scores (1694.93 MET-minutes a week; SD ± 1256.46; min-max=0-4620) than females (1095.95 MET-minutes a week SD ± 824.66; min-max=0-3756). There are no different physical activity scores between males and females in the 45-65 age group. In conclusion, sedentary time is related to the level of physical activity performed. Individuals who do low physical activity spend more time on sedentary behaviours, which ultimately have an impact on decreasing their health outcomes and have a higher risk of developing NCD.

A prospective randomised controlled mixed-methods pilot study of home monitoring in adults with cystic fibrosis.

Background:Home monitoring (HM) is able to detect more pulmonary exacerbations (PEx) than routine care (RC) in individuals with cystic fibrosis (CF), but there is currently no evidence for benefits in health outcomes. Patient experiences of using HM and a health economics assessment have not been rigorously assessed to date. This study aimed to assess the effects of HM on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience.Methods:This randomised controlled mixed-methods pilot study recruited CF adults cared for in one large regional CF centre. Participants were randomly allocated 1:1 to the intervention cohort [twice-weekly HM of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary – Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and forced expiratory volume in one second (FEV1)] or a control cohort (routine clinical care) for the 12-month study period. Measurements were recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, comorbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous) and PEx (defined by the modified Fuchs criteria) were recorded at each study visit. Health status, capability and cost-effectiveness were measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience of HM was assessed by semi-structured qualitative interviews at baseline and 12 months.Results:Eighty-eight participants were recruited, with 44 (50%) randomised to receive HM and 44 (50%) randomised to receive RC. Patient hospital inpatient bed days per annum and overall health-related quality of life were similar between the groups. Protocol-defined PEx requiring intravenous and oral antibiotics were detected more frequently in the HM group, with no other differences between the groups in the secondary outcomes. The total mean National Health Service (NHS) costs were approximately £1500 more per patient for the RC arm than the HM group. The qualitative analysis demonstrated that the patient experience of HM was generally positive and overall the intervention was well accepted.Conclusion:The findings of this trial confirm that HM is effective in detecting PEx in adults with CF. There were no significant differences in hospital inpatient bed days and overall health-related quality of life between the groups. Despite the cost of the HM equipment and the salary of the research fellow to respond to the results, health economics analysis suggests the intervention was less expensive than RC. HM was generally well accepted, with most participants reporting that it resulted in them feeling more empowered and reassured.Trial registrationThe study protocol was registered with Clinicaltrials.gov (NCT02994706) on 16 July 2014 and published in a peer reviewed journal.Data from this trial has been presented in abstract form at the ECFS Conference in Lyon in September 2020.

PHYSICAL ACTIVITY AND SARCOPENIC OBESITY IN OLDER ADULTS

Background: Sarcopenic obesity causes a decline in the ability to perform activities of daily living and instrumental activities of daily living in older adults. Physical activity is defined as the movement of any body part derived from the work of skeletal muscle, which leads to energy consumption. Physical activity comprises not only exercise but also all activities of daily life and promotes benefits of health outcomes, with the shift from a sedentary lifestyle to that including physical activity of any intensity (including light intensity) even leading to health benefits. Objective: The current study aims to review the associations of aerobic exercise, resistance exercise, and physical activity with body composition, physical performance, and activities of daily living in older adults with sarcopenic obesity, including older adults requiring assistance with the performance of activities of daily living. Results: Resistance and aerobic exercises could have positive effects on muscle mass, body fat, and physical performance in older adults with sarcopenic obesity. Besides, physical activity may reduce the risk of sarcopenic obesity in older adults. Conclusion: There has been a paucity of studies particularly on whether physical activity could still prevent the risk of sarcopenic obesity and improve muscle mass, body fat, physical performance, and the capacity for activities of daily living and instrumental activities of daily living in older adults with sarcopenic obesity, including older adults with sarcopenic obesity requiring care. Future studies need to additionally clarify whether physical activity affects the risk of sarcopenic obesity and promotes benefits in body composition, physical performance, and the capacity for activities of daily living in older adults and older adults with sarcopenic obesity requiring care.

Practising brain health through traditional teachings and arts: A project funded by the Centre for Aging and Brain Health Innovation

AbstractBackgroundThe loss of Indigenous culture in Canada through colonial interventions such as Residential Schools and the 60’s Scoop have left Indigenous Peoples and communities with deep‐rooted trauma. This type of trauma, in addition to the social isolation of living in remote communities, places Indigenous populations at risk for developing dementia. There is a need to increase opportunities for aging Indigenous populations to engage in social interaction that is culturally‐relevant and based in Traditional ways and culture.MethodMorning Star Lodge, an Indigenous Health Research lab, has developed workshops for aging Indigenous adults who are at risk for developing dementia and their caregiver(s) to engage in traditional activities such as: games, arts and crafts, prayer (smudging). Research circles were conducted with Indigenous community members aging in place along with their caregiver(s) to discuss their perceived impacts on social functioning and cognitive health.ResultThe community members engaged in social interaction through Indigenous languages and story‐sharing. Traditional Knowledges and teachings were also weaved into the project design as many aging individuals expressed a feeling of isolation from cultural events and ceremonies due to immobility or lack of assistance with transportation, other needs, and the COVID‐19 pandemic. Through the data collected via an Indigenous, community‐led qualitative data analysis method the research team was able to identify central themes regarding practising Traditional arts and the cognitive health benefits that caregivers would like integrated in their communities.ConclusionFurther research is needed to evaluate the long‐term benefits of health outcomes for Indigenous Peoples living with dementia and the effects on caregiver stress. Indigenous caregivers have expressed a desire for Traditional arts and teachings in their communities to alleviate stressors caused by dementia.

Cost-effectiveness and budget impact of dolutegravir/lamivudine for treatment of human immunodeficiency virus (HIV-1) infection in the United States.

BACKGROUND: Dolutegravir(DTG)/lamivudine(3TC) is the first 2-drug regimen recommended as an initial treatment for people living with HIV (PLHIV). OBJECTIVE: To assess the cost-effectiveness and potential budget impact of DTG/3TC in the US healthcare setting. METHODS: A previously published hybrid decision-tree and Markov cohort state transition model was adapted to estimate the incremental costs and health outcome benefits over a patients' lifetime. DTG/3TC was compared with current standard of care in treatment naive and treatment experienced virologically suppressed PLHIV. Health states included in the model were based upon virologic response and CD4 cell count, with death as an absorbing state. Clinical data was informed by the Phase III GEMINI 1 and 2 clinical trials, a published network meta-analysis (NMA) in treatment-naive patients and the Phase III TANGO clinical trial in treatment experienced patients. Costs and utilities were informed by published data and discounted annually at a rate of 3%. A separate 5-year budget impact analysis was conducted assuming 5%-15% uptake in eligible treatment naive and 10%-30% uptake in eligible treatment experienced patients. RESULTS: In the treatment naive analyses based on GEMINI 1 and 2, DTG/3TC dominated, i.e., was less costly and more effective, than all comparators. DTG/3TC resulted in 0.083 incremental quality-adjusted life-years (QALYs) at a cost saving of $199,166 compared with the DTG + tenofovir disoproxil(TDF)/emtricitabine(FTC) comparator arm. The incremental QALY and cost savings for DTG/3TC compared with DTG/abacavir(ABC)/3TC, cobicistat-boosted darunavir(DRV/c)/tenofovir alafenamide(TAF)/FTC, and bictegravir (BIC)/TAF/FTC, based on NMA results were 0.465, 0.142, and 0.698, and $42,948, $122,846, and $44,962, respectively. In the analyses of treatment-experienced virologically suppressed patients based on TANGO, DTG/3TC offered slightly lower QALYs (-0.037) with an estimated savings of $78,730 when compared with continuation of TAF-based regimen (TBR). Sensitivity analyses demonstrated that these conclusions were relatively insensitive to alternative parameter estimates. The budget impact analysis estimated that by 5th year a total of 70,240 treatment naive patients and 1,340,480 treatment experienced patients could be eligible to be prescribed DTG/3TC. The estimated budget savings over 5 years ranged from $1.12b to $3.35b (corresponding to 27,512 to 82,536 on DTG/3TC by year 5) in the lowest and highest uptake scenarios, respectively. CONCLUSION: In conclusion, DTG/3TC with its comparable efficacy and lower drug acquisition costs, has the potential to offer significant cost savings to US healthcare payers for the initial treatment of treatment naive patients and as a treatment switching option for virologically suppressed patients. DISCLOSURES: This study was funded in full by ViiV healthcare, Brentford, UK. Medical writing to support this study was also funded in full by ViiV Healthcare, Brentford, UK. Butler, Hayward, and Jacob are employees of HEOR Ltd, the company performing this study funded by ViiV Healthcare. Anderson is an employee of GlaxoSmithKline and owns shares in the company. Punekar, Evitt, and Oglesby are employees of ViiV Healthcare and own stocks in GlaxoSmithKline.

The Relationships Among the Organizational Factors of a Tertiary Healthcare Center for Type 2 Diabetic Patients in Palestine.

Diabetes prevalence at Palestine was 10%, with a rising fund crisis, and diabetes healthcare problems. There was a limited research concerning diabetes healthcare dimensions including organizational factors and their predictors. This study described patient characteristics and organizational factors, and assessed relationships among organizational factors of type 2 diabetes health care in Palestine. This study is a retrospective cross sectional study, recruited by convenience sampling method in 330 participants from a type 2 diabetes patients list. It was carried out at Ramallah, Palestine. The Statistical Package for Social Sciences (SPSS v 19) was used to analyze data on patient characteristics and organizational factors collected from personal interview and medical records review. The results showed that 51.2% were males, and 88.5% had additional chronic diseases. Preventive healthcare and patient-healthcare professionals' relationship were the most prominent organizational factors in statistically significant relationships among organizational factors. This study reflected the need for reviewing prescription mode, and educational programs that emphasize the diabetes self-care management and the health care providers' role that would be of great benefit in health outcomes further.

Can Precision Medicine Actually Help People Like Me? African American and Hispanic Perspectives on the Benefits and Barriers of Precision Medicine.

To better understand African American and Hispanic perspectives on the potential benefits of precision medicine, along with the potential barriers that may prevent precision medicine from being equally beneficial to all. We also sought to identify if there were differences between African American and Hispanic perspectives. Six semi-structured focus groups were conducted between May 2017 and February 2018 to identify benefits and barriers to precision medicine. Three groups occurred in Nashville, TN with African American participants and three groups occurred in Miami, FL with Hispanic participants. At community-based and university sites convenient to community partners and participants. A total of 55 individuals participated (27 in Nashville, 28 in Miami). The majority of participants were women (76.5%) and the mean age of participants was 56.2 years old. Both African Americans and Hispanics believed precision medicine has the potential to improve medicine and health outcomes by individualizing care and decreasing medical uncertainty. However, both groups were concerned that inadequacies in health care institutions and socioeconomic barriers would prevent their communities from receiving the full benefits of precision medicine. African Americans were also concerned that the genetic and non-genetic personal information revealed through precision medicine would make African Americans further vulnerable to provider racism and discrimination in and outside of health care. While these groups believed precision medicine might yield benefits for health outcomes, they are also skeptical about whether African Americans and Hispanics would actually benefit from precision medicine given current structural limitations and disparities in health care access and quality.

Economic Preferences and Obesity: Evidence from a Clinical Lab-in-Field Experiment

We study economic decision-making of 284 people with obesity and pre-diabetes who participated in a 6-months randomised controlled trial to control weight and prevent diabetes. To elicit preferences, we use incentive-compatible experimental tasks that participants completed during their medical screening examination. We find that, on average, participants are risk averse, show no evidence of present bias, and have impatience levels comparable to healthy samples described in the international literature. Variations in present bias and impatience are not significantly associated with variations in markers of obesity. But we find a significant negative association between risk tolerance and BMI and other markers of obesity for women. A 1 standard deviation increase in risk tolerance is associated with a 0.2 standard deviation drop in BMI and waist circumference. Impatience moderates the link between risk tolerance and obesity. We replicate the key finding of interaction effects between risk and time preferences using survey data from a nationally representative sample of 6,281 Australians with similar characteristics. Deviating markedly from the literature, we conclude that risk tolerance brings benefits for health outcomes if combined with patience in this understudied but highly policy-relevant population.

Enhancing access to care in northern rural communities via telehealth

ABSTRACTThe cost of providing health care in northern Canada is higher than the rest of Canada. Telehealth has the potential to reduce health care expenditures. Yet this is still underutilised in Canada and globally. This paper describes the services provided through telehealth in some northern regions of Canada. It provides recommendations on the requirements for setting up real presence telehealth and how utilisation can be enhanced. Telehealth offers potential benefits for health outcomes by increasing access to healthcare, and reducing expenditures.

Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults.

BackgroundOlder adults are at risk of multiple chronic diseases, most of which could be prevented by engaging in regular physical activity. Frailty is a state of increased vulnerability to diseases. Worsening symptoms of frailty, such as decrease in physical functionality, can compromise health-related quality of life (HR-QOL). Previous findings suggest that frailty moderates the relationship between physical activity and HR-QOL, yet intervention findings are limited, particularly in dose–response analyses. Hence, this study was conducted to test if lower-dose physical activity (120 minutes/week) would provide the same benefits in health outcomes (physical functionality and HR-QOL) as higher-dose physical activity (180 minutes/week).MethodsParticipants (n=110) were older adults comprising higher-dose, lower-dose, and control groups who were combined from recent randomized controlled trials. Experimental groups participated in a multimodal exercise program in a supervised laboratory setting for 12 weeks.ResultsThe higher-dose group showed a significant improvement in physical functionality (β=0.23, P=0.03) and in overall HR-QOL (β=0.44, P=0.001) including its subcategories over the control group. A group × frailty interaction revealed that frail individuals significantly improved in capacity HR-QOL when they exercised at a higher dose (F (1, 49)=4.57, P=0.038).ConclusionThis study identifies a positive, predictive relationship between exercise duration and health outcomes (HR-QOL dimensions and frailty) among older adults. Frail individuals in the higher-dose group demonstrated significant recovery of capacity HR-QOL, thus reflecting improvement in their daily activities.

Effect of global atmospheric aerosol emission change on PM2.5-related health impacts

ABSTRACTBackground: Previous research has highlighted the importance of major atmospheric aerosols such as sulfate, through its precursor sulfur dioxide (SO2), black carbon (BC), and organic carbon (OC), and their effect on global climate regimes, specifically on their impact on particulate matter measuring ≤ 2.5 μm (PM2.5). Policy regulations have attempted to address the change in these major active aerosols and their impact on PM2.5, which would presumably have a cascading effect toward the change of health risks.Objective: This study aimed to determine how the change in the global emissions of anthropogenic aerosols affects health, particularly through the change in attributable mortality (AN) and years of life lost (YLL). This study also aimed to explore the importance of using AM/YLL in conveying air pollution health impact message.Methods: The Model for Interdisciplinary Research on Climate was used to estimate the gridded atmospheric PM2.5 by changing the emission of SO2, BC, and OC. Next, the emissions were utilized to estimate the associated cause-specific risks via an integrated exposure–response function, and its consequent health indicators, AM and YLL, per country.Results: OC change yielded the greatest benefit for all country income groups, particularly among low-middle-income countries. Utilizing either AM or YLL did not alter the order of benefits among upper-middle and high-income countries (UMIC/HIC); however, using either health indicator to express the order of benefit varied among low- and low-middle-income countries (LIC/LMIC).Conclusions: Global and country-specific mitigation efforts focusing on OC-related activities would yield substantial health benefits. Substantial aerosol emission reduction would greatly benefit high-emitting countries (i.e. China and India). Although no difference is found in the order of health outcome benefits in UMIC/HIC, caution is warranted in using either AM or YLL for health impact assessment in LIC/LMIC.

Reducing wait time from referral to first visit for community outpatient services may contribute to better health outcomes: a systematic review

BackgroundMany people wait long periods for community outpatient services. However little is known about the impact of waiting from referral to first visit on patient outcomes. The aim of this systematic review is to investigate whether waiting for community outpatient services is associated with adverse effects on patient outcomes.MethodsMedline, Embase, Psych Info and CINAHL databases were searched, combining the key concepts of waiting for healthcare and patient outcomes. Studies were included if they reported data comparing health outcomes for patients with different waiting times for the same period. Three reviewers applied inclusion and exclusion criteria to identified studies and assessed quality using the McMaster Critical Review Forms. Levels of evidence were assessed using National Health and Medical Research Council guidelines. Included studies were analysed using a descriptive synthesis, and summarised according to levels of evidence and clinical significance for key outcomes.ResultsFourteen studies that included 69,606 adult patients were selected. Selected studies included patients referred for treatment for musculoskeletal disorders (n = 28,722) or to cardiac rehabilitation (n = 40,884). There was low-level evidence that reduced wait time is associated with moderate improvement in workplace participation for patients seeking care for musculoskeletal conditions; and moderate improvement in exercise tolerance for patients referred to cardiac rehabilitation. There was inconsistent evidence that improvements in quality of life, patient satisfaction and psychological symptoms may be associated with shorter wait times. Pain, function and physical activity outcomes were not associated with wait time.ConclusionsThis review found low-level evidence suggesting an association between early access to community outpatient services and improvement of some patient outcomes. Specifically, shorter wait times from referral to first visit for musculoskeletal pain services may improve patient work participation. Shorter wait times for cardiac rehabilitation may improve patient exercise capacity. The effects of a short wait time for other patient conditions and patient outcomes, including quality of life, psychological symptoms and patient experience, are inconclusive. The modest benefits in health outcomes observed in reducing wait time for community outpatient services suggest that other possible benefits such as increasing patient flow should be explored.Trial registrationPROSPERO registration no: CRD42016047003

Study protocol for Vitality: a proof-of-concept randomised controlled trial of exercise training or complex mental and social activities to promote cognition in adults with chronic stroke

IntroductionCerebrovascular disease—such as stroke—is the second most common cause of dementia (ie, vascular dementia). Specifically, a stroke increases one’s risk for dementia by a factor of two. Thus, stroke survivors...

Nutrition Counseling by Medical Students at a Student-Run Free Clinic Using Goal-Setting and the MyPlate Method

Background: Lifestyle counseling in the primary care setting has been shown to have significant health outcome benefits for patients with chronic diseases like diabetes, obesity, and cardiovascular disease. General physicians often do not provide adequate lifestyle and nutrition counseling due to time constraints or lack of knowledge and training. In order to increase access to nutrition counseling in a low-resource setting and to increase physician comfort in counseling patients, we designed an intervention in which medical students conducted nutrition counseling using goal-setting and teaching MyPlate.Methods: This study was conducted at the East Harlem Health Outreach Partnership, a student-run, physician-supervised free clinic that serves uninsured adults. Student clinicians used a standardized script to provide nutrition counseling to patients, and patients’ pre- and post-intervention knowledge of MyPlate and nutrition goals were recorded. Results: Fifty-seven patients and 36 students participated in the intervention with a significant increase in patients’ knowledge of MyPlate and health goals. Conclusions: We posit that this simple intervention can be implemented in primary care clinics, especially those in which medical students rotate.