Riviste scientifiche

Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Karina Lovell, Peter Bower, Judith Gellatly, Sarah Byford, Penny Bee, Dean McMillan, Catherine Arundel, Simon Gilbody, Lina Gega, Gillian Hardy, Shirley Reynolds, Michael Barkham, Patricia Mottram, Nicola Lidbetter, Rebecca Pedley, Jo Molle, Emily Peckham, Jasmin Knopp-Hoffer, Owen Price, Janice Connell, Margaret Heslin, Christopher Foley, Faye Plummer, Christopher Roberts

Background

Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD.

Methods and findings

This study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = −1.91, 95% CI −3.27 to −0.55). These effects did not reach a prespecified level of “clinically significant benefit.” cCBT did not demonstrate significant benefit (adjusted mean difference = −0.71, 95% CI −2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment.

Conclusions

We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT.

Trial registration

International Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.

A Collection on the prevention, diagnosis, and treatment of sexually transmitted infections: Call for research papers

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Nicola Low, Nathalie Broutet, Richard Turner

Nicola Low and colleagues announce a call for research papers on sexually transmitted infections, to accompany a Collection on the topic.

Assessing process, content, and politics in developing the global health sector strategy on sexually transmitted infections 2016–2021: Implementation opportunities for policymakers

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Andy Seale, Nathalie Broutet, Manjulaa Narasimhan

Andrew Seale and colleagues discuss the development of a global strategy to counter sexually transmitted infections.

Elimination of mother-to-child transmission of HIV and Syphilis (EMTCT): Process, progress, and program integration

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Melanie Taylor, Lori Newman, Naoko Ishikawa, Maura Laverty, Chika Hayashi, Massimo Ghidinelli, Razia Pendse, Lali Khotenashvili, Shaffiq Essajee

Melanie Taylor and colleagues discuss progress towards eliminating vertical transmission of HIV and syphilis.

Pathways and progress to enhanced global sexually transmitted infection surveillance

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Melanie M. Taylor, Eline Korenromp, Teodora Wi

Melanie Taylor and colleagues discuss global initiatives for surveillance of sexually transmitted diseases.

Effectiveness and equity of sugar-sweetened beverage taxation

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Sanjay Basu, Kristine Madsen

Sanjay Basu and Kristine Madsen discuss the effects of taxes on sugar-sweetened beverages in both Australia and Berkeley, USA.

Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Anita Lal, Ana Maria Mantilla-Herrera, Lennert Veerman, Kathryn Backholer, Gary Sacks, Marjory Moodie, Mohammad Siahpush, Rob Carter, Anna Peeters

Background

A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia.

Methods and findings

Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011–12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence.

Conclusions

This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs saved would accrue to the most disadvantaged quintiles in Australia. Whilst those in more disadvantaged areas would pay more SSB tax, the difference between areas is small. The equity of the tax could be further improved if the tax revenue were used to fund initiatives benefiting those with greater disadvantage.

Vaccination to prevent human papillomavirus infections: From promise to practice

PLoS Medicine - Ma, 27/06/2017 - 23:00

by Paul Bloem, Ikechukwu Ogbuanu

In an essay, Paul Bloem and Ikechukwu Ogbuanu discuss the public health implications of HPV vaccination.

New ransomware outbreak hits organisations around the world

New Scientist - Ma, 27/06/2017 - 18:37
Chocolate company Cadbury’s, Danish shipping giant Maersk and Ukraine’s national bank are among those affected by a new global ransomware outbreak

Birds use cigarette butts for chemical warfare against ticks

New Scientist - Ma, 27/06/2017 - 18:30
Urban house finches incorporate more fibres from cigarette butts into their nests if they have live ticks in them, suggesting the toxic chemicals in the butts may deter the parasites

Ozone layer recovery will be delayed by chemical leaks

New Scientist - Ma, 27/06/2017 - 18:00
Leaks of a common chemical used in paints and for manufacturing are harming the ozone layer and could delay recovery of the ozone hole until 2095

Living near noisy roads could make it harder to get pregnant

New Scientist - Ma, 27/06/2017 - 17:50
Women who live near noisy roads are more likely to take 6 to 12 months to get pregnant, even when factors like poverty and pollution are taken into account

The death of King Coal hints we are at a climate turning point

New Scientist - Ma, 27/06/2017 - 17:00
Coal use is dying out and wind and solar energy are booming. This means the world is changing around you despite inaction by backward-looking politicians

Google’s multitasking neural net can juggle eight things at once

New Scientist - Ma, 27/06/2017 - 16:00
Deep-learning systems can struggle to handle more than one task, but a fresh approach by Google Brain could turn neural networks into jacks of all trades

Consciousness helps us learn quickly in a changing world

New Scientist - Ma, 27/06/2017 - 13:54
What's the point of consciousness? Experiments suggest it evolved to help us learn and adapt more rapidly than we could without it

Can we count on utopian dreamers to change the world?

New Scientist - Ma, 27/06/2017 - 13:03
Offsetting social problems posed by financial overheating and tech disruption puts utopian ideas such as basic income centre stage, argue two new books

Why bird flu risk is like the Grenfell Tower tragedy

New Scientist - Ma, 27/06/2017 - 12:00
We know the dangers, we know how to mitigate them, and it won't even cost that much – but nobody in power seems to care

Contribution of cognitive performance and cognitive decline to associations between socioeconomic factors and dementia: A cohort study

PLoS Medicine - Lu, 26/06/2017 - 23:00

by Jennifer Rusmaully, Aline Dugravot, Jean-Paul Moatti, Michael G. Marmot, Alexis Elbaz, Mika Kivimaki, Séverine Sabia, Archana Singh-Manoux

Background

Socioeconomic disadvantage is a risk factor for dementia, but longitudinal studies suggest that it does not affect the rate of cognitive decline. Our objective is to understand the manner in which socioeconomic disadvantage shapes dementia risk by examining its associations with midlife cognitive performance and cognitive decline from midlife to old age, including cognitive decline trajectories in those with dementia.

Methods and findings

Data are drawn from the Whitehall II study (N = 10,308 at study recruitment in 1985), with cognitive function assessed at 4 waves (1997, 2002, 2007, and 2012). Sociodemographic, behavioural, and cardiometabolic risk factors from 1985 and chronic conditions until the end of follow-up in 2015 (N dementia/total = 320/9,938) allowed the use of inverse probability weighting to take into account data missing because of loss to follow-up between the study recruitment in 1985 and the introduction of cognitive tests to the study in 1997. Generalized estimating equations and Cox regression were used to assess associations of socioeconomic markers (height, education, and midlife occupation categorized as low, intermediate, and high to represent hierarchy in the socioeconomic marker) with cognitive performance, cognitive decline, and dementia (N dementia/total = 195/7,499). In those with dementia, we examined whether retrospective trajectories of cognitive decline (backward timescale) over 18 years prior to diagnosis differed as a function of socioeconomic markers. Socioeconomic disadvantage was associated with poorer cognitive performance (all p < 0.001). Using point estimates for the effect of age, the differences between the high and low socioeconomic groups corresponded to an age effect of 4, 15, and 26 years, for height, education, and midlife occupation, respectively. There was no evidence of faster cognitive decline in socioeconomically disadvantaged groups. Low occupation, but not height or education, was associated with risk of dementia (hazard ratio [HR] = 2.03 [95% confidence interval (CI) 1.23–3.36]) in an analysis adjusted for sociodemographic factors; the excess risk was unchanged after adjustment for cognitive decline but was completely attenuated after adjustment for cognitive performance. In further analyses restricted to those with dementia, retrospective cognitive trajectories over 18 years prior to dementia diagnosis showed faster cognitive decline in the high education (p = 0.006) and occupation (p = 0.001) groups such that large differences in cognitive performance in midlife were attenuated at dementia diagnosis. A major limitation of our study is the use of electronic health records rather than comprehensive dementia ascertainment.

Conclusions

Our results support the passive or threshold cognitive reserve hypothesis, in that high cognitive reserve is associated with lower risk for dementia because of its association with cognitive performance, which provides a buffer against clinical expression of dementia.

Chimps are not as superhumanly strong as we thought they were

New Scientist - Lu, 26/06/2017 - 22:00
We sacrificed strength for endurance after our split from other apes, but it turns out our muscles are only a third weaker than those of our ape cousins

SpaceX has launched and landed two used rockets in one weekend

New Scientist - Lu, 26/06/2017 - 19:22
On 23 and 25 June, SpaceX launched two Falcon 9 rockets using boosters that had already been to space, the second and third time SpaceX has flown used boosters
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