̽��ֱ�� of Cambridge - Cambridge Institute of Public Health

Clare Oliver-Williams: a Public Engagement Explorer

zs332 — Tue, 07 Dec 2021 15:24:28 +0000

Since her PhD, Clare said yes to any opportunity to build her confidence and communication skills. Collaborating with art professionals and supported by an enthusiastic network, she blazed her trail to deliver to women who experienced pregnancy complications the call to action arising from her research findings.

Sugar purchased in soft drinks fell 10% following introduction of industry levy

cjb250 — Wed, 10 Mar 2021 23:30:06 +0000

Following publication of this study, subsequent analysis by the research team identified that the analysis presented in the original paper contained an error. ̽��ֱ��authors alerted the BMJ, who have now retracted the original paper and published a corrected version in BMJOpen.

Overall, the estimate of change in purchasing of sugar from all soft drinks combined at one year post implementation of the levy reduces from a 30g (or 10%) fall per household per week to an 8g (or 3%) fall per household per week. Alongside, the estimate of change in volume of soft drinks purchases increases from no change to a 189g (or 3%) increase per household per week.

̽��ֱ��authors believe that the results still have important public health implications and indicate that the UK Soft Drinks Industry Levy may have had a public health benefit (by reducing household purchasing of sugar from soft drinks) without harming, and indeed potentially benefiting, industry (by increasing total volume of soft drinks purchased).

For further details, visit: https://www.bmj.com/content/372/bmj.n254

While the volume of soft drinks purchased did not change, the amount of sugar in those drinks was 30g lower per household per week, which the researchers say represents a ‘win-win’ for public health and industry.

Sugary drinks have been linked to a number of health issues, including dental caries, obesity, type 2 diabetes and heart disease. In April 2018, the UK introduced a Soft Drinks Industry Levy explicitly designed to incentivise manufacturers to reduce the sugar content of soft drinks. ̽��ֱ��levy was placed on manufacturers, importers and bottlers rather than on consumers. It included two levy tiers: 24p per litre for ‘high tier’ drinks containing more than or equal to 8g total sugar per 100ml; and 18p per litre for ‘low tier’ drinks containing more than or equal to 5g and less than 8g total sugar per 100ml.

A team led by researchers from Cambridge’s Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit analysed data from the Kantar Worldpanel, in which participating households are asked to record all food and drink purchases brought into the home. This included approximately 31 million purchases of drinks, confectionery and toiletries from March 2014 to March 2019.

̽��ֱ��team divided soft drinks into three categories based on sugar content: high tier drinks, low tier drinks and no levy drinks (those with less than 5g total sugar per 100ml). As the Soft Drinks Industry Levy may have led households to substitute other drinks, they also examined purchasing of drinks exempt from the levy, including milk-based drinks, alcoholic drinks and no-added-sugar fruit juices.

̽��ֱ��researchers compared purchases in March 2019 against a ‘counterfactual’ estimate – that is, an estimate based on pre-existing trends of how the purchases would look had the levy not taken place at all. This is the first analysis of the impact of the UK Soft Drinks Industry Levy on drink purchases that takes pre-existing trends into account. ̽��ֱ��results of the study, funded by the NIHR, are published today in ̽��ֱ��BMJ.

Prior to the introduction of the levy, the volume of high-tier drinks and amount of sugar associated was on a downward trend. However, even taking this trend into consideration, by March 2019, the volume of high tier drinks purchased had fallen by 155ml (44%) per household per week compared to the counterfactual estimate. ̽��ֱ��amount of sugar purchased in these drinks reduced by 18.0g per household per week, a 46% decrease.

For low tier drinks, the volume of drinks purchased was 177ml (86%) lower per household per week in March 2019 compared with the counterfactual estimate. ̽��ֱ��amount of sugar fell by 12.5g (an 86% decrease).

Although the volume of no levy drinks purchased didn’t change, as these soft drinks are not sugar-free and some increased in their sugar content, this meant that the sugar purchased from these drinks increased by 15.3g, equivalent to a 166% increase.

Overall, compared to the counterfactual estimate, there was no change in the volume of all soft drinks purchased in March 2019. However, there was a reduction in sugar purchased in all soft drinks (including exempt drinks) combined of 29.5g per household per week, equivalent to a 10% decrease.

̽��ֱ��introduction of the Soft Drinks Industry Levy also coincided with significant decreases in purchasing of bottled water. However, the team say this reduction may be due to increases in concern about single-use plastic, which have been attributed, in the UK, to the broadcast of the BBC’s nature documentary series Blue Planet 2.

Dr David Pell from CEDAR, the study’s first author, said: “A 10% drop in the amount of sugar purchased from soft drinks might sound modest, but we know there’s an association between the amount of sugar drinks we consume and the risk of developing conditions such as obesity, type 2 diabetes and high blood pressure. Cutting out even a relatively small amount of sugar should have important impacts on the number of people with obesity and diabetes.”

Professor Martin White, also from the CEDAR, and the project lead, added: “ ̽��ֱ��Soft Drinks Industry Levy appears to have led to a reduction in the amount of sugar that people are purchasing in soft drinks without impacting on the overall volume of soft drinks sold. It’s likely that this is due to manufacturers reformulating their products and reducing the sugar concentration in their drinks, as well as to consumers switching to lower sugar alternatives.

“This represents a valuable win-win for public health and the food industry – potentially improving people’s health with no detrimental effect on the volume of soft drinks that companies are selling.”

̽��ֱ��research was funded by the National Institute for Health Research and the Medical Research Council. ̽��ֱ��Centre for Diet and Activity Research is funded by the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the National Institute for Health Research, and Wellcome.

Reference
Pell, D et al. Changes in British household purchases of soft drinks associated with implementation of the Soft Drinks Industry Levy: a controlled interrupted time series analysis. BMJ; 11 Mar 2021; DOI: 10.1136/bmj.n254

̽��ֱ��amount of sugar purchased by households through soft drinks fell by 10% in the year following the introduction of the UK Soft Drinks Industry Levy, say researchers at the ̽��ֱ�� of Cambridge. [RETRACTED]

marsjo

Bottles of soft drink

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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A silent epidemic of grief

cjb250 — Mon, 01 Mar 2021 08:48:01 +0000

Major changes in bereavement care have occurred during the COVID-19 pandemic, amid a flood of demand for help from bereaved people, according to new research from the ̽��ֱ�� of Cambridge.

Successive governments’ approaches to obesity policies have destined them to fail, say researchers

cjb250 — Tue, 19 Jan 2021 08:52:28 +0000

This is the conclusion of new research by a team at the ̽��ֱ�� of Cambridge funded by the NIHR School for Public Health Research.

̽��ֱ��researchers say their findings may help to explain why, after nearly thirty years of government obesity policies, obesity prevalence in England has not fallen and substantial inequalities persist. According to a report by NHS Digital in May 2020, 67% of men and 60% of women live with overweight or obesity, including 26% of men and 29% of women who suffer clinical obesity. More than a quarter of children aged two to 15 years live with obesity or overweight and the gap between the least and most deprived children is growing.

Successive governments have tried to tackle the obesity problem: in research published today in ̽��ֱ��Milbank Quarterly, Dolly Theis and Martin White in the Centre for Diet and Activity Research (CEDAR) at the ̽��ֱ�� of Cambridge identified 14 government-led obesity strategies in England from 1992 to 2020. They analysed these strategies – which contained 689 wide-ranging policies – to determine whether they have been fit for purpose in terms of their strategic focus, content, basis in theory and evidence, and implementation viability.

Seven of the strategies were broad public health strategies containing obesity as well as non-obesity policies such as on tobacco smoking and food safety. ̽��ֱ��other seven contained only obesity-related policies, such as on diet and/or physical activity. Twelve of the fourteen strategies contained obesity reduction targets. However, only five of these were specific, numerical targets rather than statements such as ‘aim to reduce obesity’.

Theis said: “In almost 30 years, successive UK governments have proposed hundreds of wide-ranging policies to tackle obesity in England, but these are yet to have an impact on levels of obesity or reduce inequality. Many of these policies have largely been flawed from the outset and proposed in ways that make them difficult to implement. What’s more, there’s been a fairly consistent failure to learn from past mistakes. Governments appear more likely to publish another strategy containing the same, recycled policies than to implement policies already proposed.

“If we were to produce a report card, overall we might only give them 4 out of 10: could do much better.”

Theis and White identified seven criteria necessary for effective implementation, but found that only 8% of policies fulfilled all seven criteria, while the largest proportion of policies (29%) did not fulfil a single one of the criteria. Fewer than a quarter (24%) included a monitoring or evaluation plan, just 19% cited any supporting scientific evidence, and less than one in ten (9%) included details of likely costs or an allocated budget.

̽��ֱ��lack of such basic information as the cost of implementing policies was highlighted in a recent National Audit Office report on the UK Government’s approach to tackling childhood obesity in England, which found that the Department of Health and Social Care did not know how much central government spent tackling childhood obesity.

“No matter how well-intended and evidence-informed a policy, if it is nebulously proposed without a clear plan or targets it makes implementation difficult and it is unlikely the policy will be deemed successful,” added Theis. “One might legitimately ask, what is the purpose of proposing policies at all if they are unlikely to be implemented?”

Thirteen of the 14 strategies explicitly recognised the need to reduce health inequality, including one strategy that was fully focused on reducing inequality in health. Yet the researchers say that only 19% of policies proposed were likely to be effective in reducing inequalities because of the measures proposed.

UK governments have to date largely favoured a less interventionist approach to reducing obesity, regardless of political party, prioritising provision of information to the public in their obesity strategies, rather than more directly shaping the choices available to individuals in their living environments through regulation or taxes. ̽��ֱ��researchers say that governments may have avoided a more deterrence-based, interventionist approach for fear of being perceived as ‘nannying’ – or because they lacked knowledge about what more interventionist measures are likely to be effective.

There is, however, evidence to suggest that policymaking is changing. Even though the current UK government still favours a less interventionist approach, more recent strategies have contained some fiscal and regulatory policies, such as banning price promotions of unhealthy products, banning unhealthy food advertisements and the Soft Drinks Industry Levy. This may be because the government has come under increasing pressure and recognises that previous approaches have not been effective, that more interventionist approaches are increasingly acceptable to the public, and because evidence to support regulatory approaches is mounting.

̽��ֱ��researchers found little attempt to evaluate the strategies and build on their successes and failures. As a result, many policies proposed were similar or identical over multiple years, often with no reference to their presence in a previous strategy. Only one strategy (Saving Lives, published in 1999) commissioned a formal independent evaluation of the previous government’s strategy.

“Until recently, there seems to have been an aversion to conducting high quality, independent evaluations, perhaps because they risk demonstrating failure as well as success,” added White. “But this limits a government’s ability to learn lessons from past policies. This may be potentially compounded by the often relatively short timescales for putting together a strategy or implementing policies.

“Governments need to accompany policy proposals with information that ensures they can be successfully implemented, and with built-in evaluation plans and time frames. Important progress has been made with commissioning evaluations in the last three years. But, we also need to see policies framed in ways that make them readily implementable. We also need to see a continued move away from interventions that rely on individual’s changing their diet and activity, and towards policies that change the environments that encourage people to overeat and to be sedentary in the first place.”

Living with obesity or excess weight is associated with long-term physical, psychological and social problems. Related health problems, such as type-2 diabetes, cardiovascular disease and cancers, are estimated to cost NHS England at least £6.1 billion per year and the overall cost of obesity to wider society in England is estimated to be £27 billion per year. ̽��ֱ��COVID-19 pandemic has brought to light additional risks for people living with obesity, such as an increased risk of hospitalisation and more serious disease.

̽��ֱ��research was funded by the NIHR School for Public Health Research, with additional support by the British Heart Foundation, Cancer Research UK, Economic & Social Research Council, Medical Research Council, and Wellcome Trust.

Reference
Dolly R Z Theis, Martin White. Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992-2020. Milbank Quarterly; 19 Jan 2021; DOI: https://doi.org/10.1111/1468-0009.12498

Government obesity policies in England over the past three decades have largely failed because of problems with implementation, lack of learning from past successes or failures, and a reliance on trying to persuade individuals to change their behaviour rather than tackling unhealthy environments.

In almost 30 years, successive UK governments have proposed hundreds of wide-ranging policies to tackle obesity in England, but these are yet to have an impact on levels of obesity or reduce inequality

Dolly Theis

Fitsum Admasu

Silhouettes of three women running

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Lack of understanding of common heart condition leads to missed treatment opportunities, study suggests

cjb250 — Tue, 03 Nov 2020 00:05:11 +0000

HFpEF – pronounced ‘heff peff’ – is a condition whereby heart muscles are too stiff, preventing the organ’s chambers from filling properly with blood. Symptoms include shortness of breath, swelling in the legs, ankles, feet or in the lower back or abdomen, and extreme tiredness. It affects half of the 920,000 people in the UK with heart failure but frequently goes undiagnosed.

̽��ֱ��National Institute of Clinical Excellence (NICE) recommends that ‘integrated’ care should be provided for HFpEF, bringing together specialist clinicians with GPs and primary care, and including support for patients to help them manage their condition.

In a new study published today in the British Journal of General Practice, the researchers argue that the problems they have identified may help to explain why the condition is difficult to diagnose and why there is a persistent gap between the national guidance on managing the condition and the kind of service patients receive.

̽��ֱ��problems were uncovered in a study carried out in the East of England, Greater Manchester and the West Midlands, in which 50 people with HFpEF, nine carers and 73 clinicians, were interviewed. ̽��ֱ��clinicians included GPs and nurses from 26 GP practices, as well as heart failure specialist nurses and cardiologists from nine hospitals.

̽��ֱ��team used a theoretical framework known as Normalisation Process Theory to make sense of the large amount of data generated by the interviews. ̽��ֱ��theory considers how healthcare interventions are integrated into routine practice, or ‘normalised’.

For any intervention to be routinely adopted, there needs to be a clear understanding – and differentiation between – aspects of the illness, tests and treatments, for example. ̽��ֱ��team found that this understanding is often missing for the clinicians dealing with patients experiencing HFpEF. In addition, some patients described how they were not aware they had the condition despite severe symptoms and, in some cases, multiple hospital admissions, and were unclear on how the condition can be best managed.

̽��ֱ��data confirmed that diagnosis and treatment of HFpEF is not part of everyday practice in general practice, and that the condition was not widely visible, understood, or diagnosed within primary care. ̽��ֱ��researchers identified three clear tensions that contributed to this.

First, diagnosis of HFpEF is difficult and often delayed. A common method for identifying heart disorders is through the use of an echocardiogram, but in patients with HFpEF, the ‘ejection fraction’ – the percentage of blood leaving the heart each time it contracts – often appears normal or almost normal, confusing diagnosis. Many clinicians indicated a need for specialist opinion but referral systems were varied and inconsistent.

Patients’ descriptions of their diagnoses frequently conveyed a convoluted and protracted series of hospital admissions or visits to specialist clinics. Diagnosis was often slowed down by the presence of other co-existing health conditions, non-specific symptoms and breathlessness.

Second, there are varying perceptions of this complex condition and the data show little shared understanding between clinicians, patients and carers. Several clinicians indicated there is professional scepticism with the label of HFpEF, and most expressed a need for more knowledge and understanding of the condition.

Many patients had partial or incomplete knowledge of the condition, which often related to existing heart problems. Few patients provided a clear understanding of their heart failure.

Finally, once patients are diagnosed, the services they can access are variable. Roles and responsibilities are not well understood and there are big gaps in care. A sense of clinical inertia was revealed within some patient and clinician accounts, apparently due to a lack of evidence-based practice and a feeling that there was little that could be done.

“Our research paints a picture of a cloud of clinical uncertainty surrounding the diagnosis and treatment of HFpEF, which often leads to a failure to manage the condition,” said lead author Dr Emma Sowden from the ̽��ֱ�� of Manchester. “Patients’ descriptions of their diagnoses suggest they are far more convoluted than the clinical guidelines spell out, leading to a protracted series of hospital admissions or specialist visits.”

Professor Christi Deaton, Chief Investigator from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge and a Fellow at Wolfson College, added: “We heard some clinicians asking: what’s the point of diagnosis if there is no specific treatment? But identification of HFpEF is critical if we are going to develop new treatments and ways for patients to better manage their condition, and there are actions that we can take now.”

̽��ֱ��study is part of a larger programme of work on HFpEF, which aims to improve the management of people with HFpEF in primary care. ̽��ֱ��programme is funded by the NIHR School for Primary Care Research.

Reference
Sowden, E et al. Understanding the management of Heart Failure with Preserved Ejection Fraction: a qualitative multi-perspective study. BJGP; 3 Nov 2020; DOI: 10.3399/bjgp20X713477

Poor awareness of a condition known as Heart Failure with preserved Ejection Fraction (HFpEF) – the cause of a half of all cases of heart failure in England – could be hindering opportunities to improve care for patients, say researchers from the Universities of Cambridge, Manchester, and Keele.

We heard some clinicians asking: what’s the point of diagnosis if there is no specific treatment?

Christi Deaton

Aaron Andrew Ang

Man sitting holding a book

Living with HFpEF: Mike and Anna

Mike and Anna, who live in Mossley, Greater Manchester, are, in their own words, ‘glass-half-full’ people. But Mike has heart failure with HFpEF.

Until he retired on health grounds two years ago, aged 66, Mike was a police community support officer, a job that he loved. Anna, his wife of 17 years, is a retired health visitor and nurse midwife – “It’s a good thing I have medical knowledge,” she said. “I’ve needed it.”

HFpEF comes on slowly, Mike explained. He has had heart problems for 24 years and despite a pacemaker and later a stent, and now a regime of 13 different medications a day, his symptoms don’t seem any better. He is tired all the time, breathless and his activity is severely limited.

“From a personal point of view it is so frustrating to go from being someone who swam three times a week and walked eight miles a day to being all washed up,” said Mike.

“My GP says it’s multifactorial. But no matter what you say to a consultant, [they say] it’s because I eat too much. You do get a condescending attitude about food. I get conflicting advice from various professionals about what I should and shouldn't be doing. They say exercise and lose weight, but I set all the alarms off on the monitors when the cardiac physiotherapist was assessing me and she told me to stop right there.

“I do end up asking: why am I taking all these medications and I still feel so bad? I’m treading water just waiting for the next consultation.”

Anna is determined to help Mike get access to treatment that might improve his quality of life.

“I’m like a dog with a bone,” said Anna. “I said, why is he still breathless if he has the stent and all the medications? I think I was the one who found out about the possibility of HFpEF, and I researched the medical terminology, like diastolic dysfunction and what ejection fraction means.

“HFpEF seems to be classed as a second class citizen of heart failure. ̽��ֱ��medics don’t tell you that you have it and they don’t tell you it’s serious. It’s frustrating for the doctors too, because the test results are not clear and they don’t know how to treat it. But we have had to fight for every little bit [of help].”

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Tackling COVID-19: Professor Daniela De Angelis

jg533 — Thu, 20 Aug 2020 07:00:00 +0000

This article is part of a series in which we speak to some of the many Cambridge researchers tackling COVID-19. For other articles about our latest COVID-19-related research, click here.

I work for the Medical Research Council (MRC) Biostatistics Unit (BSU), a department in the ̽��ֱ��’s School of Clinical Medicine. I am a Programme Leader and Deputy Director of the Unit. ̽��ֱ��Unit is physically based at the Cambridge Institute of Public Health on the Cambridge Biomedical Campus. However since lockdown, all members of the Unit - including myself - have been working from home.

My research focuses on developing and applying statistical methods to characterise epidemics, using information on different aspects of the disease. This includes estimating transmission, severity (eg. the proportion of infected individuals who die), and reconstructing and predicting epidemics’ evolution. ̽��ֱ��goal is to provide accurate and timely quantitative support to the implementation and evaluation of public health policies. Historically we have worked on HIV, hepatitis and influenza, but since January this year our expertise has been used to understand the COVID-19 pandemic.

One of the most critical aspects of our COVID-19 work is to provide regular ‘now-casts’ and ‘forecasts’. ‘Now-casts’ refer to estimates of the current level of key epidemiological quantities, in our case, estimates of ongoing transmission and the number of new infections. ‘Forecasts’ mean estimates of future levels, in this instance, of the future number of deaths. Our results feed directly to the Scientific Pandemic Influenza sub-group on Modelling (SPI-M), a SAGE sub-group, and to regional Public Health England (PHE) teams.

I build models that allow us to reconstruct the pandemic and predict its future course. Our work on nowcasting and forecasting uses a model of disease transmission, data on daily COVID-19 deaths of infected individuals (by NHS region and age group), published information on the risk of dying and the time from infection to death, and data on antibodies levels in the population. This allows us to reconstruct the number of new COVID-19 infections and estimate changes in transmission (the famous reproduction number R) over time; and predict the number of COVID-19 deaths in different NHS regions and age groups.

I think the biggest challenge in dealing with COVID-19 is to understand what drives transmission of infection, and how to best use this knowledge to keep the pandemic under control - including when to introduce social restrictions and when to lift them. It is also important to use communication effectively, to build public understanding and trust so that people can react responsibly to the advice and recommendations given by the government and the scientific community.

There has been an enormous effort from the whole scientific community to contribute to the understanding of this pandemic. However, often these efforts have not been well coordinated and there are still lots of aspects of the SARS-CoV-2 infection that are not understood. We need to develop a more collaborative approach to working, building multidisciplinary teams where expertise is shared for a faster advancement of science.

I would like to see the creation of infrastructures that enable effective sharing of sensitive data. So much time has been spent in this pandemic waiting for authorised access to information that in an emergency situation should be available to any group with relevant expertise. It’s an important lesson to have learned, and we need to be better prepared for similar challenges in the future.

This has been one of the most challenging and exciting times to be in scientific research. I am glad to be playing a role in understanding this pandemic and making a difference to public health. Tracking COVID-19 will continue to be a major priority for my team at the BSU. ̽��ֱ��many important questions that still remain will keep us busy for years.

When the pandemic is over I’m looking forward to a nice holiday, and going back to normal life to enjoy the company of family and friends!

Professor Daniela De Angelis is Deputy Director of the MRC Biostatistics Unit. Read more about the Unit’s Nowcasting and Forecasting of COVID-19 here.

How you can support Cambridge’s COVID-19 research

Since January this year, Daniela De Angelis and her team have been informing the UK Government’s response to the COVID-19 pandemic. Their real-time model of transmission of the virus is helping to track and predict its course as information accumulates over time.

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Existing evidence suggests face coverings do not lead to false sense of security

cjb250 — Sun, 26 Jul 2020 23:01:48 +0000

Writing in BMJ Analysis, the researchers say that the concept of ‘risk compensation’ is itself the greater threat to public health as it may discourage policymakers from implementing potentially effective measures, such as wearing face coverings.

Wearing face coverings, particularly in shared indoor spaces, is now mandated or recommended in more than 160 countries to reduce transmission of SARS-CoV-2, the virus that causes COVID-19. Worn correctly, face coverings can reduce transmission of the virus as part of a set of protective measures, including maintaining physical distance from others and good hand hygiene.

While it is not clear how much of an effect face coverings have, scientists have urged policymakers to encourage the wearing of face coverings because the risks are minimal while the potential impact is important in the context of the COVID-19 pandemic.

However, early in the pandemic, the World Health Organization warned that wearing face coverings could “create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices”. This type of behaviour is known as ‘risk compensation’.

A team led by Professor Dame Theresa Marteau at the Behaviour and Health Research Unit, ̽��ֱ�� of Cambridge, has examined the evidence for risk compensation to see whether concerns might be justified in the context of face coverings to reduce transmission of SARS-CoV-2.

̽��ֱ��idea behind risk compensation is that people have a target level of risk they are comfortable with and they adjust their behaviour to maintain that level risk. At an individual level, risk compensation is commonplace: for example, people run for longer to offset an eagerly anticipated indulgent meal and a cyclist may wear a helmet to cycle at speed.

At a population level, evidence for risk compensation is less clear. A commonly-cited example is the mandated wearing of bike helmets purportedly leading to an increase in the number of bike injuries and fatalities. Another often-cited example is the introduction of HIV pre-exposure prophylaxis (PrEP) and HPV vaccination purportedly leading to an increase in unprotected sex.

Professor Marteau and colleagues say the results of the most recent systematic reviews – a technique that involves examining all available evidence on a topic – do not justify the concerns of risk compensation for either of these examples. In fact, for HPV vaccination, the opposite effect was found: those who were vaccinated were less likely to engage in unprotected sexual behaviour as measured by rates of sexually transmitted infection.

At least 22 systematic reviews have assessed the effect of wearing a mask on transmission of respiratory virus infections. These include six experimental studies, involving over 2,000 households in total – conducted in community settings that also measured hand hygiene. While none of the studies was designed to assess risk compensation or looked at social distancing, their results suggest that wearing masks does not reduce the frequency of hand washing or hand sanitising. In fact, in two studies, self-reported rates of hand washing were higher in the groups allocated to wearing masks.

̽��ֱ��team also found three observational studies that showed people tended to move away from those wearing a mask, suggesting that face coverings do not adversely affect physical distancing at least by those surrounding the wearer. However, they say that as none of these studies have been peer-reviewed, they should be treated with caution.

“ ̽��ֱ��concept of risk compensation, rather than risk compensation itself, seems the greater threat to public health through delaying potentially effective interventions that can help prevent the spread of disease,” said Professor Marteau.

“Many public health bodies are coming to the conclusion that wearing a face covering might help reduce the spread of SARS-CoV-2, and the limited evidence available suggests their use doesn’t have a negative effect on hand hygiene,” added co-author Dr James Rubin from the Department of Psychological Medicine, King’s College London.

In their article, the team argue that it is time to lay risk compensation theory to rest. Professor Barry Pless from McGill ̽��ֱ��, Montreal, Canada, once described it as “a dead horse that no longer needs to be beaten.” ̽��ֱ��authors go further, saying “this dead horse now needs burying to try to prevent the continued threat it poses to public health, from by slowing the adoption of more effective interventions”.

̽��ֱ��researchers are supported by the National Institute for Health Research.

Reference
Mantzari, E et al. Is risk compensation threatening public health in the covid-19 pandemic? BMJ Analysis; 27 July 2020: DOI: 10.1136/bmj.m2913

How you can support Cambridge’s COVID-19 research

Existing limited evidence suggests that wearing face coverings to protect against COVID-19 does not lead to a false sense of security and is unlikely to increase the risk of infection through wearers foregoing other behaviours such as good hand hygiene, say researchers from the ̽��ֱ�� of Cambridge and King’s College London.

̽��ֱ��concept of risk compensation, rather than risk compensation itself, seems the greater threat to public health through delaying potentially effective interventions that can help prevent the spread of disease

Theresa Marteau

Claudio Schwarz

Man wearing face covering to protect against COVID-19

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Phone-based HIV support system repurposed for COVID-19 monitoring in Uganda

lw355 — Wed, 22 Jul 2020 07:50:39 +0000

People entering Uganda have been required to quarantine for 14 days as part of the country’s lockdown measures, during which time they are monitored by the Ugandan Ministry of Health for development of COVID-19 symptoms.

Cambridge researcher Dr Rosalind Parkes-Ratanshi and her team have been helping the Ministry monitor and support quarantined individuals using a voice and SMS messaging system, Call for Life Uganda (C4LU). ̽��ֱ��tool was rapidly adapted for COVID-19 by Parkes-Ratanshi, who is based jointly at Cambridge’s Institute of Public Health and leads the Academy for Health Innovation at Infectious Diseases Institute, Makerere ̽��ֱ��, Uganda.

̽��ֱ��C4LU system regularly phones quarantined individuals to request they report any symptoms. ̽��ֱ��automated system then generates symptom reports and anything of potential concern is flagged to healthcare professionals for triaging. This eases the burden on healthcare workers of widespread check-ups in person or by phone.

Parkes-Ratanshi and colleagues at the Infectious Diseases Institute have been using the tool for the past four years to monitor HIV patients, in collaboration with Janssen: Pharmaceutical companies of Johnson & Johnson. When the coronavirus pandemic reached Uganda, the team rapidly repurposed the system they had developed, re-scripting for COVID-19 and recording the messages in 11 of the languages spoken in Uganda.

“ ̽��ֱ��total number of COVID-19 cases in Uganda has been low so far, with just over 1,000 cases across the whole country,” says Parkes-Ratanshi, who is currently based in Uganda. “Almost all cases seem to be linked to returning travellers and so the quarantine system and lockdown have been vital to slow the spread of the pandemic.”

Currently, the team are monitoring around 250 people using C4LU, with a total of 599 having participated so far. “Only a very small number of people have then needed to be tested for COVID-19, which shows the benefits of having a tool that can take pressure off the health system by reducing unnecessary visits,” she says.

Although Uganda has been fortunate in not suffering the scale of cases seen in some countries, Parkes-Ratanshi is mindful that there could be a future surge in infection. “We could see a time when regular monitoring on a wider scale would be beneficial. A system like this could reduce the number of individual calls coming in to the Ministry of Health – it could take some of the burden.”

So far, the team has focused on implementation – getting the system up and running, and triaging for possible COVID-19 cases that require confirmatory tests. They are now adding a research component, so that they can learn more about the impact of the technology, with funding from Cambridge ̽��ֱ��’s Global Challenges Research Fund QR.

̽��ֱ��team has been asked by the Ugandan Ministry of Health to add a layer of mental health support to the tool, adds Parkes-Ratanshi. “Once you’ve gone through your symptom reporting, you might then be asked a couple of screening questions about anxiety or mental health issues. Depending on the answer, we could then offer mental health support for those people who may not need active care or active testing, but have got anxiety or mental health issues related to COVID. We think that this will also be exceedingly important to help in a situation where the health care system is very stretched.”

Crucially, the technology is appropriate to the context, says Parkes-Ratanshi: “Around 75% of people have phones in Uganda, so phone-based technology seems to be a very good way of doing this kind of public health monitoring. But it would be no good taking say a smartphone app developed in the UK and thinking it would work for Africa. Even those people who’ve got smartphones may not have access to the internet on the day they need it. So our technology is developed to work on low-cost mobile and analogue phones.”

C4LU itself is based on an open source digital system developed originally for tuberculosis patients by Janssen. “Time and resources are limited in sub-Saharan Africa. We don’t really want to be experimenting with new stuff in a pandemic, which is why we’re glad to apply our experience using this tool for HIV to COVID-19.”

Rosalind Parkes-Ratanshi is supported by several of Cambridge’s interdisciplinary networks and initiatives – Public Health, Cambridge-Africa, Infectious Diseases and Global Challenges.

How you can support Cambridge’s COVID-19 research

A cost-effective phone-based system developed by a Cambridge researcher and her Ugandan colleagues to support HIV patients has been rapidly adapted by the team to help the Ugandan Ministry of Health monitor those in quarantine during the coronavirus pandemic.

We could see a time when regular monitoring on a wider scale would be beneficial. A system like this could reduce the number of individual calls coming in to the Ministry of Health – it could take some of the burden

Rosalind Parkes-Ratanshi

Infectious Diseases Institute

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