1,912 results on '"Lee, JT"'
Search Results
2. B02 The GSK3 Signaling Axis Regulates Adaptive Glutamine Metabolism in Lung Squamous Cell Carcinoma
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Momcilovic, M, Lee, JT, Braas, D, Graeber, TG, Parlati, F, Demo, S, Li, R, Gricowski, M, Shuman, R, Ibarra, J, Fridman, D, St.John, M, Bernthal, N, Federman, N, Yanagawa, J, Dubinett, SM, Sadeghi, S, Christofk, HR, and Shackelford, DB
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Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Published
- 2020
3. Review and Perspectives on Data Sharing and Privacy in Expanding Electricity Access
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Lee, JT, Freitas, J, Ferrall, IL, Kammen, DM, Brewer, E, and Callaway, DS
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Data privacy ,electric utilities ,energy management ,open systems ,power system planning ,smart grids ,smart meters ,social implications of technology ,sustainable development ,Artificial Intelligence and Image Processing ,Biomedical Engineering ,Electrical and Electronic Engineering - Abstract
Increased sensing and data collection in electric power systems from utility to minigrid to individual household scale are resulting in an explosion of data collection about users and providers of electricity services. In the push to expand energy access for poor communities, the collection, use, and curation of these data have historically taken a back seat to the goal of expanding energy access but are increasingly being recognized as important issues. We review the nascent literature on this topic, characterize current data management practices, and examine how expanding access to data and data sharing are likely to provide value and pose risks to key stakeholders: end users of electricity, microutilities, macroutilities, governments, development institutions, and researchers. We identify the key opportunities and tensions and provide recommendations for the design and implementation of new data-sharing practices and platforms. Our review and analysis suggest that although a common and open platform for sharing technical data can mitigate risks and enable efficiency, fewer benefits are likely to be realized from sharing detailed financial data. We also recommend codesigning practices with each stakeholder group, increasing legal protections for end users of electricity and using deep qualitative data in addition to quantitative metrics.
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- 2019
4. ENSO Drives interannual variation of forest woody growth across the tropics
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Rifai, Sami W, Girardin, Cécile AJ, Berenguer, Erika, del Aguila-Pasquel, Jhon, Dahlsjö, Cecilia AL, Doughty, Christopher E, Jeffery, Kathryn J, Moore, Sam, Oliveras, Imma, Riutta, Terhi, Rowland, Lucy M, Murakami, Alejandro Araujo, Addo-Danso, Shalom D, Brando, Paulo, Burton, Chad, Ondo, Fidèle Evouna, Duah-Gyamfi, Akwasi, Amézquita, Filio Farfán, Freitag, Renata, Pacha, Fernando Hancco, Huasco, Walter Huaraca, Ibrahim, Forzia, Mbou, Armel T, Mihindou, Vianet Mihindou, Peixoto, Karine S, Rocha, Wanderley, Rossi, Liana C, Seixas, Marina, Silva-Espejo, Javier E, Abernethy, Katharine A, Adu-Bredu, Stephen, Barlow, Jos, da Costa, Antonio CL, Marimon, Beatriz S, Marimon-Junior, Ben H, Meir, Patrick, Metcalfe, Daniel B, Phillips, Oliver L, White, Lee JT, and Malhi, Yadvinder
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Africa ,Borneo ,Brazil ,Droughts ,El Nino-Southern Oscillation ,Forests ,Seasons ,Trees ,Tropical Climate ,El Nino ,tropical forests ,woody net primary production ,drought ,meteorological anomalies ,El Niño ,Biological Sciences ,Medical and Health Sciences ,Evolutionary Biology - Abstract
Meteorological extreme events such as El Niño events are expected to affect tropical forest net primary production (NPP) and woody growth, but there has been no large-scale empirical validation of this expectation. We collected a large high-temporal resolution dataset (for 1-13 years depending upon location) of more than 172 000 stem growth measurements using dendrometer bands from across 14 regions spanning Amazonia, Africa and Borneo in order to test how much month-to-month variation in stand-level woody growth of adult tree stems (NPPstem) can be explained by seasonal variation and interannual meteorological anomalies. A key finding is that woody growth responds differently to meteorological variation between tropical forests with a dry season (where monthly rainfall is less than 100 mm), and aseasonal wet forests lacking a consistent dry season. In seasonal tropical forests, a high degree of variation in woody growth can be predicted from seasonal variation in temperature, vapour pressure deficit, in addition to anomalies of soil water deficit and shortwave radiation. The variation of aseasonal wet forest woody growth is best predicted by the anomalies of vapour pressure deficit, water deficit and shortwave radiation. In total, we predict the total live woody production of the global tropical forest biome to be 2.16 Pg C yr-1, with an interannual range 1.96-2.26 Pg C yr-1 between 1996-2016, and with the sharpest declines during the strong El Niño events of 1997/8 and 2015/6. There is high geographical variation in hotspots of El Niño-associated impacts, with weak impacts in Africa, and strongly negative impacts in parts of Southeast Asia and extensive regions across central and eastern Amazonia. Overall, there is high correlation (r = -0.75) between the annual anomaly of tropical forest woody growth and the annual mean of the El Niño 3.4 index, driven mainly by strong correlations with anomalies of soil water deficit, vapour pressure deficit and shortwave radiation.This article is part of the discussion meeting issue 'The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications'.
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- 2018
5. Insights into the Implications of Coexisting Type 2 Inflammatory Diseases
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McCormick JP and Lee JT
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type 2 inflammation ,th2 inflammation ,asthma ,atopic dermatitis ,eosinophilic esophagitis ,chronic rhinosinusitis ,Pathology ,RB1-214 ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Justin P McCormick, Jivianne T Lee Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USACorrespondence: Jivianne T LeeDepartment of Head and Neck Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USAEmail jtlee@mednet.ucla.eduAbstract: The role of type 2 inflammation in the pathogenesis of certain human diseases is an area of active investigation. Certain asthma, atopic dermatitis, eosinophilic esophagitis, and chronic rhinosinusitis phenotypes are characterized by a Th2 predominant inflammatory pathway and are frequently associated with comorbid conditions in patients. The purpose of this article is to review the evidence behind concurrent Th2-mediated diseases and explore how the presence of these comorbid conditions affect patient and disease outcomes.Keywords: type 2 inflammation, Th2 inflammation, asthma, atopic dermatitis, eosinophilic esophagitis, chronic rhinosinusitis
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- 2021
6. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study
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Wachter, Robert, Cowling, TE, Cecil, EV, Soljak, MA, Lee, JT, Millett, C, Majeed, A, Wachter, RM, and Harris, MJ
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Background:The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary c
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- 2013
7. SOCIO-DEMOGRAPHIC INEQUALITIES IN CARDIOVASCULAR RISK MANAGEMENT AND EARLY DETECTION OF VASCULAR CONDITIONS BY THE NHS HEALTH CHECK : A DIFFERENCE-IN-DIFFERENCES MATCHING ANALYSIS
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Chang, K, Lee, JT, Vamos, E, Palladino, R, Soljak, M, Majeed, A, and Millett, C
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- 2017
8. Phase II, double blind, placebo controlled, multi-site study to evaluate the safety, feasibility and desirability of conducting a phase III study of anamorelin for anorexia in people with small cell lung cancer: A study protocol (LUANA trial).
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Matsubara, J, Sousa, MS, Martin, P, Johnson, MJ, Lind, M, Maddocks, M, Bullock, A, Agar, M, Chang, S, Kochovska, S, Kinchin, I, Morgan, D, Fazekas, B, Razmovski-Naumovski, V, Lee, JT, Itchins, M, Bray, V, Currow, DC, Matsubara, J, Sousa, MS, Martin, P, Johnson, MJ, Lind, M, Maddocks, M, Bullock, A, Agar, M, Chang, S, Kochovska, S, Kinchin, I, Morgan, D, Fazekas, B, Razmovski-Naumovski, V, Lee, JT, Itchins, M, Bray, V, and Currow, DC
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Anorexia is experienced by most people with lung cancer during the course of their disease and treatment. Anorexia reduces response to chemotherapy and the ability of patients to cope with, and complete their treatment leading to greater morbidity, poorer prognosis and outcomes. Despite the significant importance of cancer-related anorexia, current therapies are limited, have marginal benefits and unwarranted side effects. In this multi-site, randomised, double blind, placebo controlled, phase II trial, participants will be randomly assigned (1:1) to receive once-daily oral dosing of 100mg of anamorelin HCl or matched placebo for 12 weeks. Participants can then opt into an extension phase to receive blinded intervention for another 12 weeks (weeks 13-24) at the same dose and frequency. Adults (≥18 years) with small cell lung cancer (SCLC); newly diagnosed with planned systemic therapy OR with first recurrence of disease following a documented disease-free interval ≥6 months, AND with anorexia (i.e., ≤ 37 points on the 12-item Functional Assessment of Anorexia Cachexia Treatment (FAACT A/CS) scale) will be invited to participate. Primary outcomes are safety, desirability and feasibility outcomes related to participant recruitment, adherence to interventions, and completion of study tools to inform the design of a robust Phase III effectiveness trial. Secondary outcomes are the effects of study interventions on body weight and composition, functional status, nutritional intake, biochemistry, fatigue, harms, survival and quality of life. Primary and secondary efficacy analysis will be conducted at 12 weeks. Additional exploratory efficacy and safety analyses will also be conducted at 24 weeks to collect data over longer treatment duration. The feasibility of economic evaluations in Phase III trial will be assessed, including the indicative costs and benefits of anamorelin for SCLC to the healthcare system and society, the choice of methods for data collection and the f
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- 2023
9. Advance care and resuscitation plans in a tertiary hospital: a multimodal approach.
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Suresh, S, Au, A, Mohan, S, Huang, J, Guthrie, C, Lee, JT, Aggarwal, G, Suresh, S, Au, A, Mohan, S, Huang, J, Guthrie, C, Lee, JT, and Aggarwal, G
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OBJECTIVES: Advance care planning (ACP) is the process of documenting a person's preference for medical treatment in the event of future deterioration. This audit aimed to improve discussion and documentation of ACP in patients who die during a hospital admission. METHODS: We performed a clinical audit in 2021 of inpatients at a tertiary hospital in Sydney, Australia to evaluate the benefit of multimodal interventions to improve ACP compared with previous audits from 2016 and 2011. RESULTS: In 2021, 97% of audited patients had a documented ACP prior to death compared with 80% in the 2016 audit. The completion of NFR documentation on admission in 2016 was 33%, while in 2021 65% of ACPs were completed within 24 hours of admission.In 2021, 94% of patients had a paper resuscitation form filled; however, identification stickers, which are associated with risk of error, were used in 64%; and 25% of forms were only partially completed. Palliative care was consulted for 44% of patients prior to death; 33% on the day of or prior to death. CONCLUSIONS: Improvement in prevalence and timing of ACP prior to death is seen in the postintervention audit. A repeat audit in 5 years will be conducted, with interventions focused on improving documentation of ACP.
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- 2023
10. Socio-demographic inequalities in the effectiveness of England’s NHS Health Check: Kiara Chang
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Chang, K, Lee, JT, Vamos, E, Palladino, R, Soljak, M, Majeed, A, and Millett, C
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- 2017
- Full Text
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11. Out-Of-Pocket Expenditure Associated with Physical Inactivity, Excessive Weight, and Obesity in China: Quantile Regression Approach.
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Zhao, Y, He, L, Marthias, T, Ishida, M, Anindya, K, Desloge, A, D'Souza, M, Cao, G, Lee, JT, Zhao, Y, He, L, Marthias, T, Ishida, M, Anindya, K, Desloge, A, D'Souza, M, Cao, G, and Lee, JT
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INTRODUCTION: Previous studies exploring associations of physical inactivity, obesity, and out-of-pocket expenditure (OOPE) mainly used traditional linear regression, and little is known about the effect of both physical inactivity and obesity on OOPE across the percentile distribution. This study aims to assess the effects of physical inactivity and obesity on OOPE in China using a quantile regression approach. METHODS: Study participants included 10,687 respondents aged 45 years and older from the recent wave of the China Health and Retirement Longitudinal Study in 2015. Linear regression and quantile regression models were used to examine the association of physical activity, body weight with annual OOPE. RESULTS: Overall, the proportion of overweight and obesity was 33.2% and 5.8%, respectively. The proportion of individuals performing high-level, moderate-level, and low-level physical activity was 55.2%, 12.7%, and 32.1%, respectively. The effects of low-level physical activity on annual OOPE were small at the bottom quantiles but more pronounced at higher quantiles. Respondents with low-level activity had an increased annual OOPE of 26.9 USD, 150.3 USD, and 1,534.4 USD, at the 10th, 50th, and 90th percentiles, respectively, compared with those with high-level activity. The effects of overweight and obesity on OOPE were also small at the bottom quantiles but more pronounced at higher quantiles. CONCLUSION: Interventions that improve the lifestyles and unhealthy behaviors among people with obesity and physical inactivity are likely to yield substantial financial gains for the individual and health systems in China.
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- 2022
12. The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample.
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Ihyauddin, Z, Marthias, T, Anindya, K, Ng, N, Dewi, FST, Hulse, ESG, Aji, RP, Putri, DAD, Lee, JT, Ihyauddin, Z, Marthias, T, Anindya, K, Ng, N, Dewi, FST, Hulse, ESG, Aji, RP, Putri, DAD, and Lee, JT
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BACKGROUND: Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia. METHODS: Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity. RESULTS: Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05). CONCLUSION: Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia.
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- 2022
13. Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens.
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Pati, S, Sinha, A, Ghosal, S, Kerketta, S, Lee, JT, Kanungo, S, Pati, S, Sinha, A, Ghosal, S, Kerketta, S, Lee, JT, and Kanungo, S
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Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017-2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, "family-level multimorbidity", defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit.
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- 2022
14. Provincial heterogeneity in the management of care cascade for hypertension, diabetes, and dyslipidaemia in China: Analysis of nationally representative population-based survey.
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Zhao, Y, Anindya, K, Atun, R, Marthias, T, Han, C, McPake, B, Duolikun, N, Hulse, E, Fang, X, Ding, Y, Oldenburg, B, Lee, JT, Zhao, Y, Anindya, K, Atun, R, Marthias, T, Han, C, McPake, B, Duolikun, N, Hulse, E, Fang, X, Ding, Y, Oldenburg, B, and Lee, JT
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BACKGROUND: This study aims to examine (1) province-level variations in the levels of cardiovascular disease (CVD) risk and behavioral risk for CVDs, (2) province-level variations in the management of cascade of care for hypertension, diabetes, and dyslipidaemia, and (3) the association of province-level economic development and individual factors with the quality of care for hypertension, diabetes, and dyslipidaemia. METHODS: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015, which included 12,597 participants aged 45 years. Using a care cascade framework, we examined the quality of care provided to patients with three prevalent NCDs: hypertension, diabetes, and dyslipidaemia. The proportion of WHO CVD risk based on the World Health Organization CVD risk prediction charts, Cardiovascular Risk Score (CRS) and Behavior Risk Score (BRS) were calculated. We performed multivariable logistic regression models to determine the individual-level drivers of NCD risk variables and outcomes. To examine socio-demographic relationships with CVD risk, linear regression models were applied. RESULTS: In total, the average CRS was 4.98 (95% CI: 4.92, 5.05), while the average BRS was 3.10 (95% confidence interval: 3.04, 3.15). The weighted mean CRS (BRS) in Fujian province ranged from 4.36 to 5.72 (P < 0.05). Most of the provinces had a greater rate of hypertension than diabetes and dyslipidaemia awareness and treatment. Northern provinces had a higher rate of awareness and treatment of all three diseases. Similar patterns of regional disparity were seen in diabetes and dyslipidaemia care cascades. There was no evidence of a better care cascade for CVDs in patients who reside in more economically advanced provinces. CONCLUSION: Our research found significant provincial heterogeneity in the CVD risk scores and the management of the cascade of care for hypertension, diabetes, and dyslipidaemia for persons aged 45 years or more. To im
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- 2022
15. Multimorbidity and Complex Multimorbidity in India: Findings from the 2017-2018 Longitudinal Ageing Study in India (LASI).
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Sinha, A, Kerketta, S, Ghosal, S, Kanungo, S, Lee, JT, Pati, S, Sinha, A, Kerketta, S, Ghosal, S, Kanungo, S, Lee, JT, and Pati, S
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Complex multimorbidity refers to the co-occurrence of three or more chronic illnesses across >2 body systems, which may identify persons in need of additional medical support and treatment. There is a scarcity of evidence on the differences in patient outcomes between non-complex (≥2 conditions) and complex multimorbidity groups. We evaluated the prevalence and patient outcomes of complex multimorbidity and compared them to non-complex multimorbidity. We included 30,489 multimorbid individuals aged ≥45 years from the Longitudinal Ageing Study in India (LASI) from wave-1 conducted in 2017−2018. We employed a log link in generalised linear models (GLM) to identify possible risk factors presenting the adjusted prevalence−risk ratio (APRR) and adjusted prevalence−risk difference (APRD) with 95% confidence interval. The prevalence of complex multimorbidity was 34.5% among multimorbid individuals. Participants residing in urban areas [APRR: 1.10 (1.02, 1.20)], [APRD: 0.04 (0.006, 0.07)] were more likely to report complex multimorbidity. Participants with complex multimorbidity availed significantly higher inpatient department services and had higher expenditure as compared to the non-complex multimorbidity group. Our findings have major implications for healthcare systems in terms of meeting the requirements of people with complicated multimorbidity, as they have significantly higher inpatient health service utilisation, higher medical costs, and poorer self-rated health.
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- 2022
16. Epidemiology of physical-mental multimorbidity and its impact among Aboriginal and Torres Strait Islander in Australia: a cross-sectional analysis of a nationally representative sample
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Carman, W, Ishida, M, Trounson, JS, Mercer, SW, Anindya, K, Sum, G, Armstrong, G, Oldenburg, B, McPake, B, Lee, JT, Carman, W, Ishida, M, Trounson, JS, Mercer, SW, Anindya, K, Sum, G, Armstrong, G, Oldenburg, B, McPake, B, and Lee, JT
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OBJECTIVES: This study aimed to examine the differences in multimorbidity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, and the effect of multimorbidity on health service use and work productivity. SETTING: Cross-sectional sample of the Household, Income and Labour Dynamics in Australia wave 17. PARTICIPANTS: A nationally representative sample of 16 749 respondents aged 18 years and above. OUTCOME MEASURES: Multimorbidity prevalence and pattern, self-reported health, health service use and employment productivity by Indigenous status. RESULTS: Aboriginal respondents reported a higher prevalence of multimorbidity (24.2%) compared with non-Indigenous Australians (20.7%), and the prevalence of mental-physical multimorbidity was almost twice as high (16.1% vs 8.1%). Multimorbidity pattern varies significantly among the Aboriginal and non-Indigenous Australians. Multimorbidity was associated with higher health service use (any overnight admission: adjusted OR=1.52, 95% CI=1.46 to 1.58), reduced employment productivity (days of sick leave: coefficient=0.25, 95% CI=0.19 to 0.31) and lower perceived health status (SF6D score: coefficient=-0.04, 95% CI=-0.05 to -0.04). These associations were found to be comparable in both Aboriginal and non-Indigenous populations. CONCLUSIONS: Multimorbidity prevalence was significantly greater among Aboriginal and Torres Strait Islanders compared with the non-Indigenous population, especially mental-physical multimorbidity. Strategies are required for better prevention and management of multimorbidity for the aboriginal population to reduce health inequalities in Australia.
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- 2022
17. Low physical activity is associated with adverse health outcome and higher costs in Indonesia: A national panel study.
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Anindya, K, Marthias, T, Zulfikar Biruni, M, Hage, S, Ng, N, Laverty, AA, McPake, B, Millett, C, Haregu, TN, Hulse, ESG, Cao, Y, Lee, JT, Anindya, K, Marthias, T, Zulfikar Biruni, M, Hage, S, Ng, N, Laverty, AA, McPake, B, Millett, C, Haregu, TN, Hulse, ESG, Cao, Y, and Lee, JT
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AIMS: To assess the association between low physical activity, cardiovascular disease (CVD) and risk factors, health service utilization, risk of catastrophic health expenditure, and work productivity in Indonesia. METHODS: In this population-based, panel data analysis, we used data from two waves of the Indonesian Family Life Survey (IFLS) for 2007/2008 and 2014/2015. Respondents aged 40-80 years who participated in both waves were included in this study (n = 5,936). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-SF). Multinomial logistic regression model was used to examine factors associated with physical activity levels (low, moderate, and high). We applied a series of multilevel mixed-effect panel regression to examine the associations between physical activity and outcome variables. RESULTS: The prevalence of low physical activity increased from 18.2% in 2007 to 39.6% in 2014. Compared with those with high physical activity, respondents with low physical activity were more likely to have a 10-year high CVD risk (AOR: 2.11, 95% CI: 1.51-2.95), use outpatient care (AOR: 1.26, 95% CI: 1.07-1.96) and inpatient care (AOR 1.45, 95% CI: 1.07-1.96), experience catastrophic health expenditure of 10% of total household expenditure (AOR: 1.66, 95% CI: 1.21-2.28), and have lower labor participation (AOR: 0.24, 95% 0.20-0.28). CONCLUSIONS: Low physical activity is associated with adverse health outcomes and considerable costs to the health system and wider society. Accelerated implementation of public health policies to reduce physical inactivity is likely to result in substantial population health and economic benefits.
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- 2022
18. Multimorbidity and out-of-pocket expenditure for medicines in China and India
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La, DTV, Zhao, Y, Arokiasamy, P, Atun, R, Mercer, S, Marthias, T, McPake, B, Pati, S, Palladino, R, Lee, JT, La, DTV, Zhao, Y, Arokiasamy, P, Atun, R, Mercer, S, Marthias, T, McPake, B, Pati, S, Palladino, R, and Lee, JT
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INTRODUCTION: Using nationally representative survey data from China and India, this study examined (1) the distribution and patterns of multimorbidity in relation to socioeconomic status and (2) association between multimorbidity and out-of-pocket expenditure (OOPE) for medicines by socioeconomic groups. METHODS: Secondary data analysis of adult population aged 45 years and older from WHO Study on Global Ageing and Adult Health (SAGE) India 2015 (n=7397) and China Health and Retirement Longitudinal Study (CHARLS) 2015 (n=11 570). Log-linear, two-parts, zero-inflated and quantile regression models were performed to assess the association between multimorbidity and OOPE for medicines in both countries. Quantile regression was adopted to assess the observed relationship across OOPE distributions. RESULTS: Based on 14 (11 self-reported) and 9 (8 self-reported) long-term conditions in the CHARLS and SAGE datasets, respectively, the prevalence of multimorbidity in the adult population aged 45 and older was found to be 63.4% in China and 42.2% in India. Of those with any long-term health condition, 38.6% in China and 20.9% in India had complex multimorbidity. Multimorbidity was significantly associated with higher OOPE for medicines in both countries (p<0.05); an additional physical long-term condition was associated with a 18.8% increase in OOPE for medicine in China (p<0.05) and a 20.9% increase in India (p<0.05). Liver disease was associated with highest increase in OOPE for medicines in China (61.6%) and stroke in India (131.6%). Diabetes had the second largest increase (China: 58.4%, India: 91.6%) in OOPE for medicines in both countries. CONCLUSION: Multimorbidity was associated with substantially higher OOPE for medicines in China and India compared with those without multimorbidity. Our findings provide supporting evidence of the need to improve financial protection for populations with an increased burden of chronic diseases in low-income and middle-incom
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- 2022
19. The impact of depression and physical multimorbidity on health-related quality of life in China: a national longitudinal quantile regression study
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Pan, T, Anindya, K, Devlin, N, Mercer, SW, McPake, B, van Heusden, A, Zhao, Y, Hao, X, Marthias, T, Lee, JT, Pan, T, Anindya, K, Devlin, N, Mercer, SW, McPake, B, van Heusden, A, Zhao, Y, Hao, X, Marthias, T, and Lee, JT
- Abstract
The co-occurrence of mental and physical chronic conditions is a growing concern and a largely unaddressed challenge in low-and-middle-income countries. This study aimed to investigate the independent and multiplicative effects of depression and physical chronic conditions on health-related quality of life (HRQoL) in China, and how it varies by age and gender. We used two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 9227 participants aged ≥ 45 years, 12 physical chronic conditions and depressive symptoms. We used mixed-effects linear regression to assess the effects of depression and physical multimorbidity on HRQoL, which was measured using a proxy measure of Physical Component Scores (PCS) and Mental Component Scores (MCS) of the matched SF-36 measure. We found that each increased number of physical chronic conditions, and the presence of depression were independently associated with lower proxy PCS and MCS scores. There were multiplicative effects of depression and physical chronic conditions on PCS (- 0.83 points, 95% CI - 1.06, - 0.60) and MCS scores (- 0.50 points, 95% CI - 0.73, - 0.27). The results showed that HRQoL decreased markedly with multimorbidity and was exacerbated by the presence of co-existing physical and mental chronic conditions.
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- 2022
20. Dying of mesothelioma: A qualitative exploration of caregiver experiences.
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Lee, JT, Mittal, DL, Warby, A, Kao, S, Dhillon, HM, Vardy, JL, Lee, JT, Mittal, DL, Warby, A, Kao, S, Dhillon, HM, and Vardy, JL
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OBJECTIVE: To explore the experience of family caregivers of people with mesothelioma with focus on end-of-life issues. METHODS: A qualitative sub-study using semi-structured interviews and thematic analysis. RESULTS: Fourteen caregivers were interviewed; 11 were bereaved. The overarching theme was the impact of patients' diagnosis, treatment and death on caregivers and families. Three main themes were identified: (i) information provision and decision-making; (ii) grief and bereavement; and (iii) involvement and timing of palliative care. Caregivers initially had minimal knowledge of mesothelioma and wanted more information. Prognostic uncertainty caused distress. Grief and bereavement sub-themes were (i) coping and personal priorities; (ii) reflections on dying; and (iii) reflections on care. Caregivers highlighted the importance of creating meaningful events, having hope, 'doing something' and support from family and external sources. Reflections on dying contrasted regret after a 'bad', often unexpected death, with 'good' deaths. Care was made difficult by challenges navigating the health system and perceived gaps. Caregivers reported late referral to palliative care. CONCLUSION: Lack of information caused challenges for caregivers. Grief and bereavement outcomes varied and may have been adversely impacted by lack of engagement with palliative care. Integrated care with lung cancer coordinators and improved palliative care access may reduce caregiver burden.
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- 2022
21. OP06 Socio-demographic inequalities in cardiovascular risk management and early detection of vascular conditions by the nhs health check: a difference-in-differences matching analysis
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Chang, K, Lee, JT, Vamos, E, Palladino, R, Soljak, M, Majeed, A, and Millett, C
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- 2017
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22. Metal on metal - removal of an extruding mandibular titanium reconstruction plate with a high-speed electrical surgical drill
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Hung, J, primary, Low, OW, additional, Lee, JT, additional, Lee, H, additional, Nallathamby, V, additional, Yap, YL, additional, Lim, J, additional, and Lim, TC, additional
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- 2021
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23. Real-time alerts from AI-enabled camera traps using the Iridium satellite network: a case-study in Gabon, Central Africa
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Whytock, Robin C, primary, Suijten, Thijs, additional, van Deursen, Tim, additional, Świeżewski, Jędrzej, additional, Mermiaghe, Hervé, additional, Madamba, Nazaire, additional, Moukoumou, Narcys, additional, Zwerts, Joeri A, additional, Koumba Pambo, Aurélie Flore, additional, Bahaa-el-din, Laila, additional, Brittain, Stephanie, additional, Cardoso, Anabelle W, additional, Henschel, Philipp, additional, Lehmann, David, additional, Momboua, Brice Roxan, additional, Makaga, Loïc, additional, Orbell, Christopher, additional, White, Lee JT, additional, Iponga, Donald Midoko, additional, and Abernethy, Katharine A, additional
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- 2021
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24. The Prevalence of Metabolic Disease Multimorbidity and Its Associations With Spending and Health Outcomes in Middle-Aged and Elderly Chinese Adults
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Zhao, Y, Zhang, P, Lee, JT, Oldenburg, Brian, Heusden, AV, Haregu, TN, and Wang, H
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Uncategorized - Abstract
Objective: Metabolic diseases have been a clinical challenge worldwide and a major public health issue. Very few studies from China investigated the impact of metabolic multimorbidity on healthcare and health outcomes at the national level. This study aims to examine the association of metabolic multimorbidity with health service utilization, spending, functional and mental health. Materials and Methods: This is a nationally representative cross-sectional study, utilizing the data from the China Health and Retirement Longitudinal Study in 2015, including 11,377 participants aged 45 years and older. Multivariable regression models were used to assess the association of metabolic multimorbidity with healthcare, out-of-pocket expenditure (OOPE), the activities of daily living (ADL) limitation, the instrumental activities of daily living (IADL) limitation, and depression. Results: Overall, 30.50% of total participants had metabolic multimorbidity in 2015 in China. Compared with single disease, metabolic multimorbidity were associated with the number of outpatient visits [incident rate ratio (IRR) = 1.30, 95% CI = 1.05, 1.62] and days of inpatient care (IRR = 1.52, 95% CI = 1.28, 1.81). Metabolic multimorbidity was positively associated with the OOPE on outpatient care (coefficient = 82.99, 95% CI = 17.70, 148.27) and physical functional difficulties, including ADL limitation (odds ratio = 1.36, 95% CI = 1.18, 1.57). Conclusions: Metabolic multimorbidity is associated with higher levels of health-care service use, greater expenditure for outpatient care, and more difficulties in ADL among Chinese adults. China's health-care systems need to shift from single-disease models to new financing and service delivery models to effectively manage metabolic multimorbidity.
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- 2021
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25. Resistance of African tropical forests to an extreme climate anomaly
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Bennet, Amy, Dargie, Greta, Cuni-Sanchez, Aida, Mukendi, John Tshibamba, Hubau, Wannes, Mukenzi, Jacques, Phillips, Oliver, Mahli, Yadvinder, Sullivan, Martin, Bredu, Stephen Adu, Affum-Baffoe, Kofi, Amani, Christian A, Banin, Lindsay F, Beeckman, Hans, Begne, Serge K, Bocko, Yannick E, Boeckx, Pascal, Bogaert, Jan, Brncic, Terry, Chezeaux, Eric, Clark, Connie J, Cooper, Declan LM, Daniels, Armandu K, de Haulleville, Thales, Doucet, Jean-Louis, Evouna Ondo, Fidèle, Ewango, Corneille EN, Feldpausch, Ted R, Foli, Ernest G, Gonmadje, Christelle, Hall, Jefferson S, Hardy, Olivier J, Harris, David J, Ifo, Suspense A, Jeffery, Kathryn J, Kamdem Djuikouo, Marie-Noël, Kearsley, Elizabeth, Leal, Miguel, Levesley, Aurora, Makana, Jean-Remy, Mbayu Lukasu, Faustin, Medjibe, Vincent P, Mihindu, Vianet, Moore, Sam, Natacha Nssi Begone, Pickavance, Georgia C, Poulsen, John R, Reitsma, Jan, Sonké, Bonaventure, Sunderland, Terry CH, Taedoumg, Hermann, Talbot, Joey, Tuagben, Darlington S, Umunay, Peter M, Verbeeck, Hans, Vleminckx, Jason, White, Lee JT, Woell, Hannsjoerg, Woods, John T, Zemagho, Lise, Lewis, Simon, Bennet, Amy, Dargie, Greta, Cuni-Sanchez, Aida, Mukendi, John Tshibamba, Hubau, Wannes, Mukenzi, Jacques, Phillips, Oliver, Mahli, Yadvinder, Sullivan, Martin, Bredu, Stephen Adu, Affum-Baffoe, Kofi, Amani, Christian A, Banin, Lindsay F, Beeckman, Hans, Begne, Serge K, Bocko, Yannick E, Boeckx, Pascal, Bogaert, Jan, Brncic, Terry, Chezeaux, Eric, Clark, Connie J, Cooper, Declan LM, Daniels, Armandu K, de Haulleville, Thales, Doucet, Jean-Louis, Evouna Ondo, Fidèle, Ewango, Corneille EN, Feldpausch, Ted R, Foli, Ernest G, Gonmadje, Christelle, Hall, Jefferson S, Hardy, Olivier J, Harris, David J, Ifo, Suspense A, Jeffery, Kathryn J, Kamdem Djuikouo, Marie-Noël, Kearsley, Elizabeth, Leal, Miguel, Levesley, Aurora, Makana, Jean-Remy, Mbayu Lukasu, Faustin, Medjibe, Vincent P, Mihindu, Vianet, Moore, Sam, Natacha Nssi Begone, Pickavance, Georgia C, Poulsen, John R, Reitsma, Jan, Sonké, Bonaventure, Sunderland, Terry CH, Taedoumg, Hermann, Talbot, Joey, Tuagben, Darlington S, Umunay, Peter M, Verbeeck, Hans, Vleminckx, Jason, White, Lee JT, Woell, Hannsjoerg, Woods, John T, Zemagho, Lise, and Lewis, Simon
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The responses of tropical forests to environmental change are critical uncertainties in predicting the future impacts of climate change. The positive phase of the 2015–2016 El Niño Southern Oscillation resulted in unprecedented heat and low precipitation in the tropics with substantial impacts on the global carbon cycle. The role of African tropical forests is uncertain as their responses to short-term drought and temperature anomalies have yet to be determined using on-the-ground measurements. African tropical forests may be particularly sensitive because they exist in relatively dry conditions compared with Amazonian or Asian forests, or they may be more resistant because of an abundance of drought-adapted species. Here, we report responses of structurally intact old-growth lowland tropical forests inventoried within the African Tropical Rainforest Observatory Network (AfriTRON). We use 100 long-term inventory plots from six countries each measured at least twice prior to and once following the 2015–2016 El Niño event. These plots experienced the highest temperatures and driest conditions on record. The record temperature did not significantly reduce carbon gains from tree growth or significantly increase carbon losses from tree mortality, but the record drought did significantly decrease net carbon uptake. Overall, the long-term biomass increase of these forests was reduced due to the El Niño event, but these plots remained a live biomass carbon sink (0.51 ± 0.40 Mg C ha−1 y−1) despite extreme environmental conditions. Our analyses, while limited to African tropical forests, suggest they may be more resistant to climatic extremes than Amazonian and Asian forests.
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- 2021
26. Association of Oral Health with Multimorbidity among Older Adults: Findings from the Longitudinal Ageing Study in India, Wave-1, 2017-2019
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Kanungo, S, Ghosal, S, Kerketta, S, Sinha, A, Mercer, SW, Lee, JT, Pati, S, Kanungo, S, Ghosal, S, Kerketta, S, Sinha, A, Mercer, SW, Lee, JT, and Pati, S
- Abstract
India is witnessing an increase in the prevalence of multimorbidity. Oral health is related to overall health but is seldom included in the assessment of multimorbidity. Hence, this study aimed to estimate the prevalence of oral morbidity and explore its association with physical multimorbidity using data from Longitudinal Ageing Study in India (LASI). LASI is a nationwide survey amongst adults aged ≥ 45 years conducted in 2018. Descriptive analysis was performed on included participants (n = 59,764) to determine the prevalence of oral morbidity. Multivariable logistic regression assessed the association between oral morbidity and physical multimorbidity. Self-rated health was compared between multimorbid participants with and without oral morbidity. Oral morbidity was prevalent in 48.56% of participants and physical multimorbidity in 50.36%. Those with multimorbidity were at a higher risk of having any oral morbidity (AOR: 1.60 (1.48-1.73)) than those without multimorbidity. Participants who had only oral morbidity rated their health to be good more often than those who had physical multimorbidity and oral morbidity (40.84% vs. 32.98%). Oral morbidity is significantly associated with physical multimorbidity. Multimorbid participants perceived their health to be inferior to those with only oral morbidity. The findings suggest multidisciplinary health teams in primary care should include the management of oral morbidity and physical multimorbidity.
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- 2021
27. Is there an association between public spending on health and choice of healthcare providers across socioeconomic groups in India?-Evidence from a national sample
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Mulcahy, P, Mahal, A, McPake, B, Kane, S, Ghosh, PK, Lee, JT, Mulcahy, P, Mahal, A, McPake, B, Kane, S, Ghosh, PK, and Lee, JT
- Abstract
The role of public spending on health in reducing socioeconomic inequalities in healthcare is an emerging area of research, little supporting empirical evidence is available from low- and middle-income countries. This study examined: (1) the relationship between public spending on health per capita and the decision whether to seek healthcare or not, (2) the relationships between public spending on health per capita and choice of medical provider, and (3) whether these relationships varied by socioeconomic groups in India. Our study utilized the nationally representative 71st National Sample Survey of India, using 26,142 people who had been ailing in the past 15 days, the survey took place between the 1st of January and June 30, 2014. Two regression-based approaches were used to examine the association between public spending and choice of medical providers: (1) Multilevel multinomial regression; and (2) Instrumental variable regression. We examined the differential impacts of public spending on healthcare utilisation by socioeconomic groups. Increased public spending on health was not associated with changes in ailing people's decision whether to seek care or not (p > 0.05 in all analyses). However, increased public spending on health was associated with reductions in patients choosing private medical providers [adjusted odds ratio = 0.88 (95%CI 0.85-0.91) for outpatient private clinics] compared to outpatient government clinics. These associations may be greater among the lower economic groups compared with their counterparts. Across India, higher levels of government investment in health services are recognised by healthcare users and shown in their pattern of healthcare utilisation. That an increase in public spending on health results in a decrease in the use of private providers, particularly outpatient facilities with no inpatient capabilities, provides strong evidence for the effectiveness of 'regulation by competition'. This is a strong argument for focusing
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- 2021
28. Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study
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Marthias, T, Anindya, K, Ng, N, McPake, B, Atun, R, Arfyanto, H, Hulse, ESG, Zhao, Y, Jusril, H, Pan, T, Ishida, M, Lee, JT, Marthias, T, Anindya, K, Ng, N, McPake, B, Atun, R, Arfyanto, H, Hulse, ESG, Zhao, Y, Jusril, H, Pan, T, Ishida, M, and Lee, JT
- Abstract
OBJECTIVES: To examine non-communicable diseases (NCDs) multimorbidity level and its relation to households' socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss. DESIGN: This study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5). SETTING: The original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population. PARTICIPANTS: We included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents. PRIMARY OUTCOME MEASURES: We examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables, RESULTS: Women were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD. CONCLUSIONS: NCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidi
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- 2021
29. Associations between mental health disorder and management of physical chronic conditions in China: a pooled cross-sectional analysis
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Zhang, Z, Sum, G, Qin, VM, Zhao, Y, Haregu, TN, Oldenburg, B, Lee, JT, Zhang, Z, Sum, G, Qin, VM, Zhao, Y, Haregu, TN, Oldenburg, B, and Lee, JT
- Abstract
Physical non-communicable diseases (NCDs) and mental health disorders are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental health disorders and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of unadjusted and adjusted mixed-effect logistic regression was applied to evaluate the association between presence of mental health disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR 1.81, 95% CI 1.36-2.39) and kidney disease awareness (AOR 2.88, 95% CI 2.12-3.92) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental health disorder, compared to those without (AOR 1.32, 95% CI 1.02-1.70). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions (P > 0.05). These results indicated that adults with mental health disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address the growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.
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- 2021
30. Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis.
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Anindya, K, Ng, N, Atun, R, Marthias, T, Zhao, Y, McPake, B, van Heusden, A, Pan, T, Lee, JT, Anindya, K, Ng, N, Atun, R, Marthias, T, Zhao, Y, McPake, B, van Heusden, A, Pan, T, and Lee, JT
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BACKGROUND: Multimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE). METHODS: We conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE. RESULTS: Overall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07-0.14 for outpatient care and coefficient 0.09 (95% CI 0.02-0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4-42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5-1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9-46.2). CONCLUSION: Multimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation.
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- 2021
31. Use of social impact bonds in financing health systems responses to non-communicable diseases: scoping review
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Hulse, ESG, Atun, R, McPake, B, Lee, JT, Hulse, ESG, Atun, R, McPake, B, and Lee, JT
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There is an interest to understand how social impact bonds (SIBs), a type of innovative financing instrument used in impact investment, can be used to finance the prevention of non-communicable diseases (NCDs). This is the first scoping review that explores the evidence of SIBs for NCDs and their key characteristics and performance. The review used both published and grey literature from eight databases (MEDLINE, NCBI, Elsevier, Cochrane Library, Google, Google Scholar, WHO publications and OECD iLibrary). A total of 83 studies and articles were eligible for inclusion, identifying 11 SIBs implemented in eight countries. The shared characteristics of the SIBs used for NCDs were impact investment companies as investors, local governments as outcome payers, not-for-profit service providers and an average US$2 015 456 private initial investment. The review revealed a lack of empirical evidence on SIBs for NCDs. Conflict of interest and lack of public disclosure were common issues in both the published and grey literature on SIBs. Furthermore, only three SIBs implemented for financing NCDs were meeting all their target outcomes. The common characteristics of the SIBs meeting their target outcomes were evidence-based interventions, multiple service providers and an intermediated structure. Overall, there is a need for more high-quality studies, particularly economic evaluations and qualitative studies on the benefits to target populations, and greater transparency from the private sector, in order to ensure improved SIBs for preventing NCDs.
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- 2021
32. Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011-2015
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Qin, VM, Zhang, Y, Chia, KS, McPake, B, Zhao, Y, Hulse, ESG, Legido-Quigley, H, Lee, JT, Qin, VM, Zhang, Y, Chia, KS, McPake, B, Zhao, Y, Hulse, ESG, Legido-Quigley, H, and Lee, JT
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OBJECTIVES: This study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015; (2) factors associated with cost-sharing and OOPE; and (3) the relationships between province-level economic development and cost-sharing and OOPE in China. SETTING: A total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE. RESULTS: Based on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for individual factors. CONCLUSION: Reducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted.
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- 2021
33. The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China
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He, L, Biddle, SJH, Lee, JT, Duolikun, N, Zhang, L, Wang, Z, Zhao, Y, He, L, Biddle, SJH, Lee, JT, Duolikun, N, Zhang, L, Wang, Z, and Zhao, Y
- Abstract
BACKGROUND: Preventing chronic disease is important in health policy in countries with significantly ageing populations. This study aims to examine the prevalence of chronic disease multimorbidity and its association with physical activity and sleep duration; and to understand whether physical activity modifies associations between sleep duration and multimorbidity. METHODS: We utilized longitudinal data of a nationally-representative sample from the China Health and Retirement Longitudinal Study (in year 2011 and 2015; N = 5321; 54.7% female; age ≥ 45 years old). Fourteen chronic diseases were used to measure multimorbidity (ten self-reported, and four by blood test). Participants were grouped into high, moderate, and low level based on self-reported frequencies and durations of physical activity with different intensities for at least 10 min at a time in a usual week. Poor and good sleepers were categorized according to average hours of actual sleep at each night during the past month. Panel data method of random-effects logistic regression model was applied to estimate the association of physical activity and sleep with multimorbidity, adjusting for social-demographic and behavioural confounders. RESULTS: From 2011 to 2015, the prevalence of multimorbidity increased from 52.2 to 62.8%. In 2015, the proportion of participants engaging in high, moderate, and low level of physical activity was 30.3, 24.4 and 45.3%, respectively, and 63.6% of adults had good sleep. For both genders, compared with good sleep, poor sleep was associated with higher odds of multimorbidity (OR = 1.527, 95% CI: 1.277, 1.825). Compared to the high-level group, participants with a low level of physical activity were significantly more likely to have multimorbidity (OR = 1.457, 95% CI: 1.277, 1.825), but associations were stronger among women. The relative excess risk due to interaction between poor sleep and moderate or low physical activity was positive but non-significant on multimorbidity
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- 2021
34. Health Service Utilization and Out-of-Pocket Expenditure Associated with the Continuum of Disability in Vietnam
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Nguyen, L, Lee, JT, Hulse, ESG, Hoang, MV, Kim, GB, Le, DB, Nguyen, L, Lee, JT, Hulse, ESG, Hoang, MV, Kim, GB, and Le, DB
- Abstract
Reducing the burden of disability is key priority in many countries where the population is aging rapidly. The relationships between disability, health expenditure and economic burden are complex, particularly when disability is recognized as a continuum rather than a dichotomous phenomenon. However, these complex relationships are not adequately addressed in national health policy and management plans in Vietnam. This paper examines the economic consequences of disability across its continuum or levels of severity. Two-part regression models were applied to assess the relationships between disability, health service use and the out-of-pocket expenditure. We found that Vietnamese adults with disabilities had multiple characteristics of vulnerability, e.g., older, less likely to be employed, lower education, and poorer than adults without disabilities. These characteristics are associated with poorer health and higher need of healthcare utilization but, after controlling for these factors, disability still had an independent association with higher health expenditure and greater economic burden at their household (p < 0.05). Our study provides empirical evidence of the economic burden associated across the continuum of disability in Vietnam. Decisive action is critical for protecting persons with disability from medical impoverishment, and such targeted interventions should include those with moderate disability rather than the current focus on severe disability.
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- 2021
35. Non-communicable disease risk factors and management among internal migrant in China: systematic review and meta-analysis
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Qian, CX, Zhao, Y, Anindya, K, Tenneti, N, Desloge, A, Atun, R, Qin, VM, Mulcahy, P, Lee, JT, Qian, CX, Zhao, Y, Anindya, K, Tenneti, N, Desloge, A, Atun, R, Qin, VM, Mulcahy, P, and Lee, JT
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BACKGROUND: In 2019, there are more than 290 million people who have ever migrated from rural to urban areas in China. These rural-to-urban internal migrants account for more than one-fifth of China's population and is the largest internal migrant group globally. We present the first systematic review that examines whether internal migrants are more likely to exhibit non-communicable diseases (NCDs) risk factors and have worse NCD management outcomes than non-migrant counterparts in China. METHODS: A systematic review was conducted via medical, public health, and economic databases including Scopus, MEDLINE, JSTOR, WHO Library Database and World Bank e-Library from 2000 to 2020. Study quality was assessed using the National Institute of Health Quality Assessment tool. We conducted a narrative review and synthesised differences for all studies included, stratified by different types of outcomes. We also conducted random-effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO: CRD42019139407. RESULTS: For most NCD risk factors and care cascade management, comparisons between internal migrants and other populations were either statistically insignificant or inconclusive. While most studies found migrants have a higher prevalence of tobacco use than urban residents, these differences were not statistically significant in the meta-analysis. Although three out four studies suggested that migrants may have worse access to NCD treatment and both studies suggested migrants have lower blood pressure control rates than non-migrants, these findings were not statistically significant. CONCLUSION: Findings from this systematic review demonstrate that there is currently insufficient evidence on migrant and non-migrant differences in NCD risk factors and management in China. Further research is expected to investigate access to healthcare among internal and its effect on both their NCD outcomes and long
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- 2021
36. The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis
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Pan, T, Mercer, SW, Zhao, Y, McPake, B, Desloge, A, Atun, R, Hulse, ESG, Lee, JT, Pan, T, Mercer, SW, Zhao, Y, McPake, B, Desloge, A, Atun, R, Hulse, ESG, and Lee, JT
- Abstract
BACKGROUND: The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China. METHODS: Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes. RESULTS: After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss. CONCLUSION: Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.
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- 2021
37. Socioeconomic inequalities in effective service coverage for reproductive, maternal, newborn, and child health: a comparative analysis of 39 low-income and middle-income countries
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Anindya, K, Marthias, T, Vellakkal, S, Carvalho, N, Atun, R, Morgan, A, Zhao, Y, Hulse, ES, McPake, B, Lee, JT, Anindya, K, Marthias, T, Vellakkal, S, Carvalho, N, Atun, R, Morgan, A, Zhao, Y, Hulse, ES, McPake, B, and Lee, JT
- Abstract
BACKGROUND: Reducing socioeconomic inequalities in access to good quality health care is key for countries to achieve Universal Health Coverage. This study aims to assess socioeconomic inequalities in effective coverage of reproductive, maternal, newborn and child health (RMNCH) in low- and middle-income countries (LMICs). METHODS: Using the most recent national health surveys from 39 LMICs (between 2014 and 2018), we calculated coverage indicators using effective coverage care cascade that consists of service contact, crude coverage, quality-adjusted coverage, and user-adherence-adjusted coverage. We quantified wealth-related and education-related inequality using the relative index of inequality, slope index of inequality, and concentration index. FINDINGS: The quality-adjusted coverage of RMNCH services in 39 countries was substantially lower than service contact, in particular for postnatal care (64 percentage points [pp], p-value<0·0001), family planning (48·7 pp, p<0·0001), and antenatal care (43·6 pp, p<0·0001) outcomes. Upper-middle-income countries had higher effective coverage levels compared with low- and lower-middle-income countries in family planning, antenatal care, delivery care, and postnatal care. Socioeconomic inequalities tend to be wider when using effective coverage measurement compared with crude and service contact measurements. Our findings show that upper-middle-income countries had a lower magnitude of inequality compared with low- and lower-middle-income countries. INTERPRETATION: Reliance on the average contact coverage tends to underestimate the levels of socioeconomic inequalities for RMNCH service use in LMICs. Hence, the effective coverage measurement using a care cascade approach should be applied. While RMNCH coverages vary considerably across countries, equitable improvement in quality of care is particularly needed for lower-middle-income and low-income countries. FUNDING: None.
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- 2021
38. Real-time alerts from AI-enabled camera traps using the Iridium satellite network: a case-study in Gabon, Central Africa
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Animal Behaviour and Cognition, Sub Animal Behaviour and Cognition, Sub Ecology and Biodiversity, Ecology and Biodiversity, Whytock, Robin C, Suijten, Thijs, Deursen, Tim van, Świeżewski, Jędrzej, Mermiaghe, Hervé, Madamba, Nazaire, Moukoumou, Narcys, Zwerts, Joeri A, Pambo, Aurélie Flore Koumba, Bahaa-el-din, Laila, Brittain, Stephanie, Cardoso, Anabelle W, Henschel, Philipp, Lehmann, David, Momboua, Brice Roxan, Makaga, Loïc, Orbell, Christopher, White, Lee JT, Iponga, Donald Midoko, Abernethy, Katharine A, Animal Behaviour and Cognition, Sub Animal Behaviour and Cognition, Sub Ecology and Biodiversity, Ecology and Biodiversity, Whytock, Robin C, Suijten, Thijs, Deursen, Tim van, Świeżewski, Jędrzej, Mermiaghe, Hervé, Madamba, Nazaire, Moukoumou, Narcys, Zwerts, Joeri A, Pambo, Aurélie Flore Koumba, Bahaa-el-din, Laila, Brittain, Stephanie, Cardoso, Anabelle W, Henschel, Philipp, Lehmann, David, Momboua, Brice Roxan, Makaga, Loïc, Orbell, Christopher, White, Lee JT, Iponga, Donald Midoko, and Abernethy, Katharine A
- Published
- 2021
39. “SQiD, the Single Question in Delirium; can a single question help clinicians to detect delirium in hospitalised cancer patients?” running heading Single Question in Delirium” (Bcan-D-20-01665)
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Sands, MB, Sharma, S, Carpenter, L, Hartshorn, A, Lee, JT, Lujic, S, Congdon, ME, Buchanan, AM, Agar, M, Vardy, JL, Sands, MB, Sharma, S, Carpenter, L, Hartshorn, A, Lee, JT, Lujic, S, Congdon, ME, Buchanan, AM, Agar, M, and Vardy, JL
- Abstract
Aim
A serious syndrome for cancer in-patients, delirium risk increases with age and medical acuity. Screening tools exist but detection is frequently delayed or missed. We test the 'Single Question in Delirium' (SQiD), in comparison to psychiatrist clinical interview.Methods
Inpatients in two comprehensive cancer centres were prospectively screened. Clinical staff asked informants to respond to the SQiD: "Do you feel that [patient's name] has been more confused lately?". The primary endpoint was negative predictive value (NPV) of the SQiD versus psychiatrist diagnosis (Diagnostic and Statistics Manual criteria). Secondary endpoints included: NPV of the Confusion Assessment Method (CAM), sensitivity, specificity and Cohen's Kappa coefficient.Results
Between May 2012 and July 2015, the SQiD plus CAM was applied to 122 patients; 73 had the SQiD and psychiatrist interview. Median age was 65 yrs. (interquartile range 54-74), 46% were female; median length of hospital stay was 12 days (5-18 days). Major cancer types were lung (19%), gastric or other upper GI (15%) and breast (14%). 70% of participants had stage 4 cancer. Diagnostic values were similar between the SQiD (NPV = 74, 95% CI 67-81; kappa = 0.32) and CAM (NPV = 72, 95% CI 67-77, kappa = 0.32), compared with psychiatrist interview. Overall the CAM identified only a small number of delirious cases but all were true positives. The specificity of the SQiD was 87% (74-95) The SQiD had higher sensitivity than CAM (44% [95% CI 41-80] vs 26% [10-48]).Conclusion
The SQiD, administered by bedside clinical staff, was feasible and its psychometric properties are now better understood. The SQiD can contribute to delirium detection and clinical care for hospitalised cancer patients.- Published
- 2021
40. Resistance of African tropical forests to an extreme climate anomaly
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Bennett, Amy C., Dargie, Greta, Cuni-Sanchez, Aida, Tshibamba Mukendi, John, Hubau, Wannes, Mukinzi, Jacques M., Phillips, Oliver L., Malhi, Yadvinder, Sullivan, Martin J P, Cooper, Declan L. M., Adu-Bredu, Stephen, Affum-Baffoe, Kofi, Amani, Christian, Banin, Lindsay F., Beeckman, Hans, Kouob Bégné, Serge, Bocko, Yannick, Boeckx, Pascal, Bogaert, Jan, Brncic, Terry, Chezeaux, Eric, Clark, Connie J., Daniels, Armandu K., De Haulleville, Thales, Djuikouo Kamdem, Marie-Noël, Doucet, Jean-Louis, Evouna Ondo, Fidèle, Ewango, Corneille, Feldpausch, Ted R., Foli, Ernest, Gonmadje, Christelle Flore, Hall, Jefferson S., Hardy, Olivier J., Harris, David J., Ifo, Suspense, Jeffery, Kathryn, Kearsley, Elizabeth, Leal, Miguel, Levesley, Aurora, Makana, Jean Rémy, Mbayu Lukasu, Faustin, Medjibe, Vincent, Mihindu, Vianet, Moore, Sam, Nssi Begone, Natacha, Pickavance, Georgia C., Poulsen, John R., Reitsma, Jan, Sonke, Bonaventure, Sunderland, Terry C H, Taedoumg, Hermann, Talbot, Joey, Tuagben, Darlington, Umunay, Peter M., Verbeeck, Hans, Vleminckx, Jason, White, Lee Jt T, Woell, Hannsjoerg, Woods, John T., Zemagho, Lise L.A., Lewis, Simon L., Bennett, Amy C., Dargie, Greta, Cuni-Sanchez, Aida, Tshibamba Mukendi, John, Hubau, Wannes, Mukinzi, Jacques M., Phillips, Oliver L., Malhi, Yadvinder, Sullivan, Martin J P, Cooper, Declan L. M., Adu-Bredu, Stephen, Affum-Baffoe, Kofi, Amani, Christian, Banin, Lindsay F., Beeckman, Hans, Kouob Bégné, Serge, Bocko, Yannick, Boeckx, Pascal, Bogaert, Jan, Brncic, Terry, Chezeaux, Eric, Clark, Connie J., Daniels, Armandu K., De Haulleville, Thales, Djuikouo Kamdem, Marie-Noël, Doucet, Jean-Louis, Evouna Ondo, Fidèle, Ewango, Corneille, Feldpausch, Ted R., Foli, Ernest, Gonmadje, Christelle Flore, Hall, Jefferson S., Hardy, Olivier J., Harris, David J., Ifo, Suspense, Jeffery, Kathryn, Kearsley, Elizabeth, Leal, Miguel, Levesley, Aurora, Makana, Jean Rémy, Mbayu Lukasu, Faustin, Medjibe, Vincent, Mihindu, Vianet, Moore, Sam, Nssi Begone, Natacha, Pickavance, Georgia C., Poulsen, John R., Reitsma, Jan, Sonke, Bonaventure, Sunderland, Terry C H, Taedoumg, Hermann, Talbot, Joey, Tuagben, Darlington, Umunay, Peter M., Verbeeck, Hans, Vleminckx, Jason, White, Lee Jt T, Woell, Hannsjoerg, Woods, John T., Zemagho, Lise L.A., and Lewis, Simon L.
- Abstract
The responses of tropical forests to environmental change are critical uncertainties in predicting the future impacts of climate change. The positive phase of the 2015–2016 El Niño Southern Oscillation resulted in unprecedented heat and low precipitation in the tropics with substantial impacts on the global carbon cycle. The role of African tropical forests is uncertain as their responses to short-term drought and temperature anomalies have yet to be determined using on-the-ground measurements. African tropical forests may be particularly sensitive because they exist in relatively dry conditions compared with Amazonian or Asian forests, or they may be more resistant because of an abundance of drought-adapted species. Here, we report responses of structurally intact old-growth lowland tropical forests inventoried within the African Tropical Rainforest Observatory Network (AfriTRON). We use 100 long-term inventory plots from six countries each measured at least twice prior to and once following the 2015–2016 El Niño event. These plots experienced the highest temperatures and driest conditions on record. The record temperature did not significantly reduce carbon gains from tree growth or significantly increase carbon losses from tree mortality, but the record drought did significantly decrease net carbon uptake. Overall, the long-term biomass increase of these forests was reduced due to the El Niño event, but these plots remained a live biomass carbon sink (0.51 ± 0.40 Mg C ha −1 y −1 ) despite extreme environmental conditions. Our analyses, while limited to African tropical forests, suggest they may be more resistant to climatic extremes than Amazonian and Asian forests., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2021
41. Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries
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Sum, G, Koh, GC-H, Mercer, SW, Wei, LY, Majeed, A, Oldenburg, B, Lee, JT, Sum, G, Koh, GC-H, Mercer, SW, Wei, LY, Majeed, A, Oldenburg, B, and Lee, JT
- Abstract
BACKGROUND: The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. METHODS: Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007-10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). RESULTS: A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. CONCLUSION: Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.
- Published
- 2020
42. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
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Qin, VM, McPake, B, Raban, MZ, Cowling, TE, Alshamsan, R, Chia, KS, Smith, PC, Atun, R, Lee, JT, Qin, VM, McPake, B, Raban, MZ, Cowling, TE, Alshamsan, R, Chia, KS, Smith, PC, Atun, R, and Lee, JT
- Abstract
Background Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equi
- Published
- 2020
43. The Joint Effect of Physical Multimorbidity and Mental Health Conditions Among Adults in Australia
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Ishida, M, Hulse, ESG, Mahar, RK, Gunn, J, Atun, R, McPake, B, Tenneti, N, Anindya, K, Armstrong, G, Mulcahy, P, Carman, W, Lee, JT, Ishida, M, Hulse, ESG, Mahar, RK, Gunn, J, Atun, R, McPake, B, Tenneti, N, Anindya, K, Armstrong, G, Mulcahy, P, Carman, W, and Lee, JT
- Abstract
INTRODUCTION: The prevalence of chronic physical and mental health conditions is rising globally. Little evidence exists on the joint effect of physical and mental health conditions on health care use, work productivity, and health-related quality of life in Australia. METHODS: We analyzed data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, waves 9 (2009), 13 (2013), and 17 (2017). Economic effects associated with multimorbidity were measured through health service use, work productivity loss, and health-related quality of life. We used generalized estimating equations to assess the effect of the association between physical multimorbidity and mental health conditions and economic outcomes. RESULTS: From 2009 through 2017 the prevalence of physical multimorbidity increased from 15.1% to 16.2%, and the prevalence of mental health conditions increased from 11.2% to 17.3%. The number of physical health conditions was associated with the number of health services used (general practitioner visits, incidence rate ratio = 1.41), work productivity loss (labor force participation, adjusted odds ratio = 0.71), and reduced health-related quality of life (SF-6D score: Coefficient = -0.03). These effects were exacerbated by the presence of mental health conditions and low socioeconomic status. CONCLUSION: Having multiple physical health conditions (physical multimorbidity) creates substantial health and financial burdens on individuals, the health system, and society, including increased use of health services, loss of work productivity, and decreased health-related quality of life. The adverse effects of multimorbidity on health, quality of life, and economic well-being are exacerbated by the co-occurrence of mental health conditions and low socioeconomic status.
- Published
- 2020
44. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data
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Zhao, Y, Atun, R, Oldenburg, B, McPake, B, Tang, S, Mercer, SW, Cowling, TE, Sum, G, Qin, VM, Lee, JT, Zhao, Y, Atun, R, Oldenburg, B, McPake, B, Tang, S, Mercer, SW, Cowling, TE, Sum, G, Qin, VM, and Lee, JT
- Abstract
BACKGROUND: Multimorbidity, the presence of two or more mental or physical chronic non-communicable diseases, is a major challenge for the health system in China, which faces unprecedented ageing of its population. Here we examined the distribution of physical multimorbidity in relation to socioeconomic status; the association between physical multimorbidity, health-care service use, and catastrophic health expenditures; and whether these associations varied by socioeconomic group and social health insurance schemes. METHODS: In this population-based, panel data analysis, we used data from three waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) for 2011, 2013, and 2015. We included participants aged 50 years and older in 2015, who had complete follow-up for the three waves. We used 11 physical non-communicable diseases to measure physical multimorbidity and annual per-capita household consumption spending as a proxy for socioeconomic status. FINDINGS: Of 17 708 participants in CHARLS, 11 817 were eligible for inclusion in our analysis. The median age of participants was 62 years (IQR 56-69) in 2015, and 5766 (48·8%) participants were male. 7320 (61·9%) eligible participants had physical multimorbidity in China in 2015. The prevalence of physical multimorbidity was increased with older age (odds ratio 2·93, 95% CI 2·71-3·15), among women (2·70, 2·04-3·57), within a higher socioeconomic group (for quartile 4 [highest group] 1·50, 1·24-1·82), and higher educational level (5·17, 3·02-8·83); however, physical multimorbidity was more common in poorer regions than in the more affluent regions. An additional chronic non-communicable disease was associated with an increase in the number of outpatient visits (incidence rate ratio 1·29, 95% CI 1·27-1·31), and number of days spent in hospital as an inpatient (1·38, 1·35-1·41). We saw similar effects in health service use of an additional chronic non-communicable disease in different
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- 2020
45. Impact of Indonesia's national health insurance scheme on inequality in access to maternal health services: A propensity score matched analysis
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Anindya, K, Lee, JT, McPake, B, Wilopo, SA, Millett, C, Carvalho, N, Anindya, K, Lee, JT, McPake, B, Wilopo, SA, Millett, C, and Carvalho, N
- Abstract
BACKGROUND: Reducing inequality in maternal, neonatal and infant mortality are key targets in the Sustainable Development Goals. This study is the first to evaluate the impact of Indonesia's national health insurance scheme, Jaminan Kesehatan Nasional (JKN), on access to maternal health services by sociodemographic status. METHODS: Using data from the 2017 Indonesia Demographic and Health Survey (IDHS) on women with live births in 2016-2017, we conducted propensity score matching (PSM) analysis to evaluate the association of JKN enrollment on the following maternal health care utilisation outcomes: (1) at least four antenatal care (ANC4+) visits; (2) ANC4+ visits and received essential components of ANC; (3) skilled birth attendance; (4) facility-based delivery; (5) post-natal care (PNC); and (6) PNC with skilled provider. Analyses were conducted at the national level and by economic subgroup and region of residence. Additionally, we investigated the potential negative impact of JKN on access to maternal health services among the uninsured population by looking at trends over time using data from the 2012 and 2017 IDHS. RESULTS: Of the 5429 women who had recently given birth, 61% were insured by JKN in 2017. After matching treated and untreated women on key sociodemographic characteristics, enrollment in JKN was associated with a higher prevalence of receiving ANC4+ visits (7.4%, 95% confidence interval (CI) = 4.8-9.39); ANC4+ visits and received essential components of ANC (5.6%, 95% CI = 3.3-7.9); skilled birth attendance (3.0%, 95% CI = 1.5-4.5; facility-based delivery (10.2%, 95% CI = 7.5-12.7); PNC (4.0%, 95% CI = 2.2-5.7); PNC with skilled provider (4.5%, 95% CI = 2.6-6.5). Effect sizes were larger among the poor and those living in less-developed areas, such as Eastern Indonesia and Sulawesi, except for at least ANC4+ and received clinical components. CONCLUSIONS: Expansion of health insurance coverage was associated with reductions in sociodemographic inequa
- Published
- 2020
46. Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017
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Saputri, NS, Spagnoletti, BRM, Morgan, A, Wilopo, SA, Singh, A, McPake, B, Atun, R, Dewi, RK, Lee, JT, Saputri, NS, Spagnoletti, BRM, Morgan, A, Wilopo, SA, Singh, A, McPake, B, Atun, R, Dewi, RK, and Lee, JT
- Abstract
BACKGROUND: Improving breastfeeding practice is important for reducing child health inequalities and achieving several Sustainable Development Goals. Indonesia has enacted legislation to promote optimal breastfeeding practices in recent years. We examined breastfeeding practices among Indonesian women from 2002 to 2017, comparing trends within and across sociodemographic subgroups. METHODS: Data from four waves of the Indonesia Demographic and Health Surveys were used to estimate changes in breastfeeding practices among women from selected sociodemographic groups over time. We examined three breastfeeding outcomes: (1) early initiation of breastfeeding; (2) exclusive breastfeeding; and (3) continued breastfeeding at 1 year. Multivariate logistic regression was used to assess changes in time trends of each outcome across population groups. RESULTS: The proportion of women reporting early initiation of breastfeeding and exclusive breastfeeding increased significantly between 2002 to 2017 (p < 0.05), with larger increases among women who: were from higher wealth quintiles; worked in professional sectors; and lived in Java and Bali. However, 42.7% of women reported not undertaking early initiation of breastfeeding, and 48.9% of women reported not undertaking exclusive breastfeeding in 2017. Women who were employees had lower exclusive breastfeeding prevalence, compared to unemployed or self-employed women. Women in Java and Bali had higher increase in early initiation of breastfeeding and exclusive breastfeeding compared to women in Sumatra. We did not find statistically significant decline in continued breastfeeding at 1 year over time for the overall population, except among women who: were from the second poorest wealth quintile; lived in rural areas; did not have a health facility birth; and lived in Kalimantan and Sulawesi (p < 0.05). CONCLUSIONS: There were considerable improvements in breastfeeding practices in Indonesia during a period of sustained policy reform
- Published
- 2020
47. Comorbid Depression and Obesity: Correlates and Synergistic Association With Noncommunicable Diseases Among Australian Men
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Haregu, TN, Lee, JT, Oldenburg, B, Armstrong, G, Haregu, TN, Lee, JT, Oldenburg, B, and Armstrong, G
- Abstract
INTRODUCTION: Obesity and depression are among the leading causes of disease worldwide. Their bidirectional relationship often results in comorbid depression and obesity, which further increases the risk of adverse health outcomes. Further evidence is needed on the correlates and synergistic association with other noncommunicable diseases. The objective of our study was to examine the correlates and synergistic association of comorbid depression and obesity with other noncommunicable diseases in a large sample of Australian men. METHODS: Our cross-sectional study used data on 13,763 men aged 18 to 55 from the first wave (2013-2014) of the Australian Ten to Men study. Body mass index was calculated from self-reported weight and height. The Patient Health Questionnaire-9 was used to assess depression. We calculated the weighted prevalence of depression, obesity, and comorbid depression and obesity and examined correlates of comorbid depression and obesity by using logistic regression. We used the synergy index to measure the synergistic association of depression and obesity with other noncommunicable diseases. RESULTS: The weighted prevalence of depression, obesity, and comorbid depression and obesity among Australian men were 12.5%, 22.2%, and 3.7%, respectively. Age, marital status, area-level socioeconomic index, educational attainment, household income, employment status, and physical activity were significantly associated with comorbid depression and obesity. Men with comorbid depression and obesity, compared with men without comorbid depression and obesity, had 7.6 times the risk of diabetes and 6.7 times the risk of hypertension. CONCLUSION: Co-occurrence of depression and obesity among Australian men is associated with a set of individual- and area-level correlates and a higher risk of noncommunicable diseases. The correlates identified in our study are useful in planning interventions and screening in primary care settings.
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- 2020
48. Implications of multimorbidity on healthcare utilisation and work productivity by socioeconomic groups: Cross-sectional analyses of Australia and Japan
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Kabir, R, Sum, G, Ishida, M, Koh, GC-H, Singh, A, Oldenburg, B, Lee, JT, Kabir, R, Sum, G, Ishida, M, Koh, GC-H, Singh, A, Oldenburg, B, and Lee, JT
- Abstract
BACKGROUND: Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups. METHODS: Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models. RESULTS: Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only. CONCLUSION: Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment.
- Published
- 2020
49. A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps
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Anna K. Gawlicka, Langford Fpj, Robert C. Kern, Ameet Singh, Boris Karanfilov, Iloreta Amc, Silvers Sl, James W. Stambaugh, Keith E. Matheny, Stolovitzky Jp, David M Yen, and Lee Jt
- Subjects
medicine.medical_specialty ,business.industry ,Standard treatment ,Mometasone furoate ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Otorhinolaryngology ,Ethmoid sinus ,otorhinolaryngologic diseases ,medicine ,Immunology and Allergy ,Nasal polyps ,Nasal administration ,Implant ,030223 otorhinolaryngology ,Adverse effect ,business ,Sinus (anatomy) ,medicine.drug - Abstract
Background Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid-eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days. Methods A randomized, sham-controlled, double-blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in-office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 μg once daily. Co-primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review. Results Patients treated with implants experienced significant reductions in both nasal obstruction/congestion score (p = 0.0074) and bilateral polyp grade (p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery (p = 0.0004), percent ethmoid sinus obstruction (p = 0.0007), nasal obstruction/congestion (p = 0.0248), and decreased sense of smell (p = 0.0470), but not facial pain/pressure (p = 0.9130). One patient experienced an implant-related serious adverse event (epistaxis). Conclusion Significant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.
- Published
- 2018
50. Enhanced ability of daniplestim and myelopoietin-1 to suppress apoptosis in human hematopoietic cells
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McCubrey, JA, Blalock, WL, Saleh, O, Pearce, M, Burrows, C, Steelman, LS, Lee, JT, Franklin, RA, Oberhaus, SM, Moye, PW, Doshi, PD, and McKearn, JP
- Published
- 2001
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