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Estimating the gains of early detection of hypertension over the marginal patient.

ABSTRACT: This study estimated the potential impact of early diagnosis programs on health outcomes in England. Specifically, if advising individuals to visit their family doctor due to a suspected case of mild hypertension would result in (i) an increase in the diagnosis and treatment of high blood pressure; (ii) an improved lifestyle reflected in objective measures such as the body-mass-index and blood pressure levels; (iii) a reduced probability of the onset of other cardiovascular diseases, such as diabetes. To address potential selection bias in screening, a feature of the English Longitudinal Study of Ageing is exploited, motivating a regression discontinuity design. If respondents' blood pressure measurements are above a standard clinical threshold, they are advised to visit their family doctor to confirm hypertension. Two years after the protocol, there is evidence of an increase in diagnosis (5.7 pp, p-val = 0.06) and medication use (6 pp, p-val = 0.007) for treating the condition. However, four years after the protocol, the difference in diagnosis and medication disappeared (4 pp, p-val = 0.384; 3.4 pp, p-val = 0.261). Moreover, there are no differences on observed blood pressure levels (systolic 0.026 mmHg, p-val = 0.815; diastolic -0.336 mmHg, p-val = 0.765), or Body-Mass-Index ((0.771, p-val = 0.154)). There are also no differences on diagnosis of diabetes (1.7 pp, p-val = 0.343) or heart related conditions (3.6 pp, p-value = 0.161). In conclusion, the nudge produces an earlier diagnosis of around two years, but there are no perceivable gains in health outcomes after four years.

SUBMITTER: Rodriguez-Lesmes P

PROVIDER: S-EPMC8270433 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:A species' distribution provides fundamental information on: climatic niche, biogeography, and conservation status. Species distribution models often use occurrence records from biodiversity databases, subject to spatial and taxonomic biases. Deficiencies in occurrence data can lead to incomplete species distribution estimates. We can incorporate other data sources to supplement occurrence datasets. The general public is creating (via GPS-enabled cameras to photograph wildlife) incidental occurrence records that may present an opportunity to improve species distribution models. We investigated (1) occurrence data of a cryptic group of animals: non-marine snakes, in a biodiversity database (Global Biodiversity Information Facility (GBIF)) and determined (2) whether incidental occurrence records extracted from geo-tagged social media images (Flickr) could improve distribution models for 18 tropical snake species. We provide R code to search for and extract data from images using Flickr's API. We show the biodiversity database's 302,386 records disproportionately originate from North America, Europe and Oceania (250,063, 82.7%), with substantial gaps in tropical areas that host the highest snake diversity. North America, Europe and Oceania averaged several hundred records per species; whereas Asia, Africa and South America averaged less than 35 per species. Occurrence density showed similar patterns; Asia, Africa and South America have roughly ten-fold fewer records per 100 km2than other regions. Social media provided 44,687 potential records. However, including them in distribution models only marginally impacted niche estimations; niche overlap indices were consistently over 0.9. Similarly, we show negligible differences in Maxent model performance between models trained using GBIF-only and Flickr-supplemented datasets. Model performance appeared dependent on species, rather than number of occurrences or training dataset. We suggest that for tropical snakes, accessible social media currently fails to deliver appreciable benefits for estimating species distributions; but due to the variation between species and the rapid growth in social media data, may still be worth considering in future contexts.

Project description:Brooke is a non-government organisation with working equine welfare programmes across Africa, Asia and Latin America. In 2014, staff from ten country programmes were asked to identify 'no-win' situations (subsequently reframed as 'hard-wins')-where improving equine welfare is proving difficult, expensive and/or marginal-in order to inform strategic decisions on how to approach, manage and mitigate for such situations.The Delphi-type consultation process had three phases. Round 1 posed five questions in the form of a workshop, survey and semi-structured interviews. Round 2 re-presented key themes and sense-checked initial conclusions. Round 3 reviewed the nature and prevalence of hard-win situations at an international meeting of all participants.Reasons given for hard-win situations included: no economic or social benefit from caring for working animals; poor resource availability; lack of empathy for working equids or their owners among wider stakeholders; deep-seated social issues, such as addiction or illegal working; areas with a high animal turnover or migratory human population; lack of community cooperation or cohesion; unsafe areas where welfare interventions cannot be adequately supported. Participants estimated the prevalence of hard-win situations as 40-70% of their work. They suggested some current ways of working that may be contributing to the problem, and opportunities to tackle hard-wins more effectively.Respondents agreed that if equine welfare improvements are to span generations of animals, interventions cannot rely on relatively simple, technical knowledge-transfer strategies and quick-wins alone. Programmes need to be more flexible and iterative and less risk-averse in their approaches to embedding good equine welfare practices in all relevant actors. Consultation recommendations informed development of Brooke's new global strategy, a revised organisational structure and redefinition of roles and responsibilities to streamline ways to approach hard-wins in the complex environments and socio-economic contexts in which working equids are found.

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Estimating the gains of early detection of hypertension over the marginal patient.

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