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This study widens the transferability of cost-utility results from the SCOT trial showing that administering 3 months of adjuvant, oxaliplatin-based chemotherapy is cost-effective and cost saving compared to 6 months from the perspective of all countries recruited to SCOT. The impact on healthcare budgets if the findings are implemented as predicted will amount to savings of at least US$150 million over 5 years. Background: The Short Course Oncology Treatment (SCOT) trial demonstrated non-inferiority, less toxicity, and cost-effectiveness from a UK perspective of 3 versus 6 months of oxaliplatin-based chemotherapy for patients with colorectal cancer. This study assessed the cost-effectiveness of shorter treatment and the budget impact of implementing trial findings from the perspectives of all countries recruited to SCOT: Australia, Denmark, New Zealand, Spain, Sweden, and the United Kingdom. Patients and Methods: Individual cost-utility analyses were performed from the perspective of each country. Resource, quality of life, and survival estimates from the SCOT trial (N = 6065) were used. Probabilistic sensitivity analysis and subgroup analyses were undertaken. Using undiscounted costs from these cost-utility analyses, the impact on country-specific healthcare budgets of implementing the SCOT trial findings was calculated over a 5-year period. The currency used was US dollars (US$), and 2019 was the base year. One-way and scenario sensitivity analysis addressed uncertainty within the budget impact analysis. Results: Three months of treatment were cost saving and cost-effective compared to 6 months from the perspective of all countries. The incremental net monetary benefit per patient ranged from US$8972 (Spain) to US$13,884 (Denmark). The healthcare budget impact over 5 years for the base-case scenario ranged from US$3.6 million (New Zealand) to US$61.4 million (UK) and totaled over US$150 million across all countries. Conclusion: This study has widened the transferability of results from the SCOT trial, showing that shorter treatment is cost-effective from a multi-country perspective. The vast savings from implementation could fully justify the investment in conducting the SCOT trial.

Many commentators have noted the impact that obesity is having both on society and health services across the world. The impact is wide ranging, from personal day‐to‐day issues through to the economic impact on health services and the wider economy. There is now general acceptance that we live in an obesogenic environment, and that the factors behind this are multifactorial and complex. However, a key question concerns the impact of weight management intervention and the cost or cost‐effective impact therein. By understanding this in more detail, informed decisions can be made around appropriate funding and commissioning for supporting people who wish to seek weight management interventions. This chapter aims to outline some key areas of impact being observed with the increasing rate of obesity and the resource burden of severe and complicated obesity. The impact of realistic and achievable weight change is also considered, as well as the cost‐effectiveness of currently available interventions for the management of obesity.

This 12-month, randomised study of individuals with established type 2 diabetes investigated whether dietary advice emphasising a single message to reduce fat intake, would improve weight loss, glycaemic and lipid control, compared to advice based on the once traditional lowfat, low-sucrose message. Participants (n=37, mean BMI 33.25 (+1.0) kg/m2, age 58.0 (+3.3) years, diabetes duration 6.8 (±0.9) yrs, 51% male), were randomised into 2 dietary groups. The 'moderate-sucrose' group (n=19) were advised to reduce total fat intake only; the 'low-sucrose' group (n=18), to reduce both total fat and total sugar intake. Repeated measures ANOVA determined group effects on anthropometric/biochemical variables and Spearman's rank correlations determined relationships between changes in diet and study variables. Reported energy and fat intake significantly reduced in both groups, with no difference in reported sucrose intake. HbA1c fell in both groups (7.7%-7.1% (low-sucrose) vs 7.6%-7.4% (moderate-sucrose), both p=0.003), with no additional effect of the single dietary message. HOMA-IR fell by 33.4% in the 'low-sucrose' group (p≤0.005), but not in the moderate sucrose group. Advice to relax sucrose intake restrictions in favour of a single low fat message had no additional effect on reported behaviour or glycaemic control.

Background: Group-based interventions for weight loss are popular; however, little is known about how health service groups compare with the commercial sector, from either the participant or the group leader perspective. Currently, health professionals have little guidance on how to deliver effective group interventions. The present study aimed to compare and contrast leaders’ and attendees’ experiences of health service and commercial weight loss groups, through in-depth interviews and group observations. Methods: Purposive sampling, guided by a sampling frame, was employed to identify diverse groups operating in Scotland with differing content, structures and style. Data collection and analysis took place concurrently in accordance with a grounded theory approach. Thirteen semi-structured group observations and in-depth audio-recorded interviews with 11 leaders and 22 attendees were conducted. Identification of themes and the construction of matrices to identify data patterns were guided by the Framework Method for qualitative analysis. Results: Compared to commercial groups, health service ‘groups’ or ‘classes’ tended to offer smaller periodic fixed term groups, involving gatekeeper referral systems. Commercial organisations provide a fixed branded package, for ‘club’ or ‘class’ members, and most commercial leaders share personal experiences of losing weight. Health service leaders had less opportunity for supervision, peer support or specific training in how to run their groups compared to commercial leaders. Conclusions: Commercial and health service groups differ in access; attendee and leader autonomy; engagement in group processes; and approaches to leadership and training, which could influence weight loss outcomes. Health service groups can provide different group content and experiences, particularly for those with chronic diseases and for populations less likely to attend commercial groups, such as men.

Background— Primary aldosteronism (PA) is common and associates with excess cardiovascular morbidity independent of blood pressure. Exposure to aldosterone and sodium leads to cardiac fibrosis and hypertrophy in humans and animals possibly mediated by inflammation and oxidative stress. We aimed to clarify the effects of aldosterone excess on myocardial structure and composition in human subjects with PA and essential hypertension using contrast-enhanced cardiac magnetic resonance imaging as well as explore the mechanistic basis for any observed differences. Methods and Results— Twenty-seven subjects with recently diagnosed PA and 54 essential hypertension controls were recruited. Subjects underwent gadolinium-enhanced cardiac magnetic resonance; noninfarct related myocardial fibrosis was identified by a diffuse pattern of late gadolinium enhancement. Patients also underwent assessment of pulse wave velocity, measurement of circulating superoxide anion and C-reactive protein, as well as blood pressure and biochemical assessment. Subjects were well matched with no difference in severity or duration of hypertension. There was a significant increase in the frequency of noninfarct late gadolinium enhancement in PA (70%) when compared with essential hypertension subjects (13%; P Conclusions— These data illustrate that patients with PA exhibit frequent myocardial fibrosis as demonstrated by late gadolinium enhancement using cardiac magnetic resonance imaging; this finding is independent of blood pressure. This may be mediated partly through inflammation and oxidative stress. This study highlights the importance of specific targeting of aldosterone excess as well as blood pressure reduction to minimize cardiac morbidity in PA.

Toxicity and quality of life data from SCOT : An international phase III randomized (1:1) noninferiority trial comparing 3 vs 6 months of oxaliplatin-based adjuvant chemotherapy.

Background Dust mites are the primary indoor allergen risk for increasing asthma attacks and morbidity. Adherence to allergen avoidance recommendations decreases bronchial reactivity and asthma morbidity. Objective This study compared the knowledge and practice of environmental control advice of families of children with asthma seen by an allergist or a pediatrician. Studies suggest that knowledge and practice of environmental control recommendations is inconsistent. Methods Subjects were aged 6 to 17 years, diagnosed with asthma, and had positive skin test to dust mites. There were 114 eligible pediatric patients, and 69 had also seen an allergist before the study. An in-home evaluation was completed during which parents were asked about environmental control knowledge and practice. An environmental technician then completed a walk-through evaluation to observe which recommendations were implemented in the home. Results Families who saw an allergist demonstrated significantly greater awareness of environmental control recommendations for dust mite allergens than those who had not. Knowledge and placement of allergen-proof mattress and pillow covers was significantly higher in these families. However, 30% of families who saw an allergist reported no knowledge of any environmental control recommendations for dust mites. Less than half of the allergist families (48%) who were advised to use mattress encasements actually had encasements on their children's beds. Conclusions The parents of dust mite-sensitive, asthmatic children who saw an allergist were more aware of dust mite allergen control recommendations and made more indoor environmental changes.

Background Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet "group" is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers. Methods We reviewed the wider literature on health improvement interventions delivered to patient groups and identified a gap in the literature for designing, evaluating and reporting these interventions. We drew on our experiences conducting systematic reviews, intervention, mixed method and ethnographic studies of groups for breastfeeding and weight management. A framework for health improvement group design and delivery evolved through an iterative process of primary research, reference to the literature and research team discussion. Results Although there is an extensive literature on group processes in education, work, politics and psychological therapies, far less is known about groups where the aim is health improvement. Theories of behaviour change which are validated for individual use are often assumed to be generalisable to group settings, without being rigorously tested. Health improvement or behaviour change interventions delivered in a group setting are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. Ecological models of health improvement, which embrace the complex relationship between behaviour, systems and the environment may be more relevant than an individual approach to behaviour change. Conclusion The evidence for effectiveness and cost-effectiveness of group compared with one-to-one interventions for many areas of health improvement in public health and primary care is weak or unknown. Our proposed framework is the first step towards advocating a more systematic approach to designing, evaluating and reporting interventions in group settings, which is necessary to improve this currently weak evidence base. This framework will enable policy makers and practitioners to be better informed about what works, how it works and in which contexts when aiming to improve health in a group setting.

Civic engagement, with its focus on involving citizens and civil society organizations in the development of policy and legislation to address matters of public concern, is one vehicle to promote active citizenship and more responsive legislation. In this respect governments consciously seek the views of citizens and social groups and have a genuine interest in achieving outcomes that incorporate their perspectives. Examples of civic engagement are: participation in elections, public policy/legislative processes, public consultations, advocacy, and participation in local community-level decision-making structures.