Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action

Introduction

It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing.

Methods

Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist–facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy.

Findings

Proposals ranged from radical, whole-systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual-level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate.

Conclusion

Young people contributed wide-ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for ‘upstream’ systemic change to achieve reductions in social inequalities and the health differences that flow from these.

Public Contribution

An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers.     

Therapeutic efficacy and safety of chamomile for state anxiety,generalized anxiety disorder,insomnia, and sleep quality: A systematic review and meta‐analysis of randomized trials and quasi‐randomized trials

This systematic review and meta‐analysis aimed to study the efficacy and safety of chamomile for the treatment of state anxiety, generalized anxiety disorders (GADs), sleep quality, and insomnia in human. Eleven databases including PubMed, Science Direct, Cochrane Central, and Scopus were searched to retrieve relevant randomized control trials (RCTs), and 12 RCTs were included. Random effect meta‐analysis was performed by meta package of R statistical software version 3.4.3 and RevMan version 5.3. Our meta‐analysis of three RCTs did not show any difference in case of anxiety (standardized mean difference = ?0.15, 95% CI [?0.46, 0.16], P = 0.4214). Moreover, there is only one RCT that evaluated the effect of chamomile on insomnia and it found no significant change in insomnia severity index (P > 0.05). By using HAM‐A scale, there was a significant improvement in GAD after 2 and 4 weeks of treatment (mean difference = ?1.43, 95% CI [?2.47, ?0.39], P = 0.007), (MD = ?1.79, 95% CI [?3.14, ?0.43], P = 0.0097), respectively. Noteworthy, our meta‐analysis showed a significant improvement in sleep quality after chamomile administration (standardized mean difference = ?0.73, 95% CI [?1.23, ?0.23], P < 0.005). Mild adverse events were only reported by three RCTs. Chamomile appears to be efficacious and safe for sleep quality and GAD. Little evidence is there to show its effect on anxiety and insomnia. Larger RCTs are needed to ascertain these findings.     

The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis

Introduction and hypothesis

The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP.

Methods

We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months.

Results

Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62–91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43–97%). The poorest results are described for the sacrospinal fixation (SSF; 35–81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5–9%). The highest percentage of complications were reported after ASC (2–19%), VM (6–29%), and RSC (54%). Mesh exposure was seen most often after VM (8–21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13–22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC.

Conclusions

A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review.

     

A new saponin from <Emphasis Type="Italic">Acanthopanax koreanum</Emphasis> with anti-inflammatory activity

Twelve saponins were isolated from the leaves of Acanthopanax koreanum, including one new lupane-type triterpene glycoside, named acankoreoside R (1), together with 11 known triterpenoid saponins (2–12). Their structures were elucidated by 1D and 2D nuclear magnetic resonance (NMR), mass spectroscopic data (MS). All of the fractions and isolated saponins were evaluated for anti-inflammatory activities in lipopolysaccharide (LPS)-stimulated bone marrow-derived dendritic cells (BMDCs) by ELISA. Among them, compounds 1–5, 7, 10, and 12 showed strong inhibitions towards interleukin-12 (IL-12) production with IC₅₀ values ranging from 1.59 to 5.46 µM. Other compounds were weak or inactive toward IL-12 p40 production.     

Cytotoxic steroid derivatives from the Vietnamese soft coral Sinularia brassica

Using various chromatographic separations, six ergostane-type steroids, including one new compound sinubrassione (1), and two pregnene-type steroid glycosides, including one new compound sinubrassioside (7), were isolated from methanol extract of the Vietnamese soft coral Sinularia brassica. The structure elucidation was confirmed by spectroscopic methods including 1D, 2D NMR and HR-ESI-MS. The cytotoxic activities of all the isolated compounds against three human cancer cell lines were also evaluated using MTT-based colorimetric assays.     

Hydrophobic binding peptide-conjugated hybrid lipid-mesoporous silica nanoparticles for effective chemo-photothermal therapy of pancreatic cancer

Nanoparticle-based drug delivery systems are designed to reach tumor sites based on their enhanced permeation and retention effects. However, a lack of interaction of these nanoparticles with cancer cells might lead to reduced uptake in the tumors, which might compromise the therapeutic efficacy of the system. Therefore, we developed bortezomib and IR-820-loaded hybrid-lipid mesoporous silica nanoparticles conjugated with the hydrophobic-binding peptide, cyclosporine A (CsA), and referred to them as CLMSN/BIR. Upon reaching the tumor site, CsA interacts hydrophobically with the cancer cell membranes to allow effective uptake of the nanoparticles. Nanoparticles ～160?nm in size were prepared and the stability of IR-820 significantly improved. High cellular uptake of the nanoparticles was evident with pronounced apoptotic effects in PANC-1 and MIA PaCa-2 cells that were mediated by the chemotherapeutic effect of bortezomib and the photothermal and reactive oxygen species generation effects of IR-820. An in vivo biodistribution study indicated there was high accumulation in the tumor with an enhanced photothermal effect in PANC-1 xenograft mouse tumors. Furthermore, enhanced antitumor effects in PANC-1 xenograft tumors were observed with minimal toxicity induction in the organs of mice. Cumulatively, these results indicated the promising effects of CLMSN/BIR for effective chemo-phototherapy of pancreatic cancers.     

Antibacterial activities of chemical constituents from the aerial parts of Hedyotis pilulifera

Context: Hedyotis pilulifera (Pit.) T.N. Ninh (Rubiaceae) has been used in Vietnamese ethnomedicine; the methanol extract exhibited antibacterial activity in our preliminary screening.

Objectives: In this study, compounds from H. pilulifera were isolated and their antibacterial activity in vitro was evaluated.

Materials and methods: The aerial parts of H. pilulifera (1.4?kg) were extracted with MeOH, suspended in water and ethyl acetate extract was chromatographed on a silica gel column. The structures of isolated compounds were elucidated by the combination analyses of spectroscopy including 1D-, 2D-NMR, HRMS and in comparison with the reported NMR data in the literature. All isolated compounds were evaluated for inhibitory effect using the microdilution method toward Staphylococcus aureus, Bacillus subtilis and Mycobacterium smegmatis, and MIC values were determined.

Results: Twenty compounds were isolated, including five triterpenoids, two steroids, two aromatic compounds, three fatty acids, one quinone derivative, one lignan glycoside, one ceramide and five glycolipids. Among these, oleanolic acid showed significant antibacterial activity against M. smegmatis with the MIC value of 2.5?μg/mL. Remarkably, rotungenic acid showed strong activity against S. aureus, B. subtilis, M. smegmatis with MIC values of 2.5, 2.5 and 1.25?μg/mL, respectively. Rotundic acid exhibited significant antibacterial activity against B. subtilis with the MIC value of 5?μg/mL. To the best of our knowledge, the antibacterial activity of rotungenic acid, stigmast-4-ene-3,6-dione and (2S,3S,4R,2′R)-2-(2′-hydroxytetracosanoylamino) octadecane-1,3,4-triol was reported for the first time.

Conclusions: Oleanolic acid, rotungenic acid, and rotundic acid were considered to be useful for developing new antimicrobial therapeutic agents for human.     

Individual Bayesian Information Matrix for Predicting Estimation Error and Shrinkage of Individual Parameters Accounting for Data Below the Limit of Quantification

Purpose

In mixed models, the relative standard errors (RSE) and shrinkage of individual parameters can be predicted from the individual Bayesian information matrix (M_BF). We proposed an approach accounting for data below the limit of quantification (LOQ) in M_BF.

Methods

M_BF is the sum of the expectation of the individual Fisher information (M_IF) which can be evaluated by First-Order linearization and the inverse of random effect variance. We expressed the individual information as a weighted sum of predicted M_IF for every possible design composing of measurements above and/or below LOQ. When evaluating M_IF, we derived the likelihood expressed as the product of the likelihood of observed data and the probability for data to be below LOQ. The relevance of RSE and shrinkage predicted by M_BF in absence or presence of data below LOQ were evaluated by simulations, using a pharmacokinetic/viral kinetic model defined by differential equations.

Results

Simulations showed good agreement between predicted and observed RSE and shrinkage in absence or presence of data below LOQ. We found that RSE and shrinkage increased with sparser designs and with data below LOQ.

Conclusions

The proposed method based on M_BF adequately predicted individual RSE and shrinkage, allowing for evaluation of a large number of scenarios without extensive simulations.

     

Incorporation of chemotherapeutic agent and photosensitizer in a low temperature-sensitive liposome for effective chemo-hyperthermic anticancer activity

Objectives: In this study, we combined chemo- and hyperthermia therapy in a low temperature-sensitive liposome (LTSL) for potential cancer treatment.

Methods: Docetaxel (DOC) and indocyanine green (ICG) as a therapeutic agent and photosensitizer, respectively, were incorporated in a low temperature-sensitive liposome (LTSL/DI). Nanoparticles were evaluated for the physicochemical characterizations, in vitro uptake and cytotoxicity, and furthermore in vivo anticancer activity.

Results: The particle size of LTSL/DI was 130.8 ± 2.3 nm, and its drug release profile was pH- and temperature-dependent, which are effective for tumor targeting. The in vitro anticancer activity of LTSL/DI was significantly enhanced compared with free DOC in SCC-7 and MCF-7 cell lines. Interestingly, near-infrared laser irradiation after the treatment resulted in better anticancer activity than in the non-irradiated condition. The in vivo tumor regression effect of LTSL/DI in combination with NIR irradiation was much greater compared with the control group in SCC-7 tumor-bearing mice. After intratumoral injection of LTSL/DI, local heat induced by NIR irradiation and the localized docetaxel burst release could completely ablate the tumor, and inhibit its recurrence.

Conclusions: These results suggest LTSL/DI formulation as a potential therapeutic strategy with effectively localized anti-tumor activity and low risk of side effect to non-target organs.     

Occupational exposure and respiratory health problems among nutmeg production workers in Grenada,the Caribbean

Background: The nutmeg industry is a major contributor to the Grenadian economy. However, workers in the industry face many environmental and occupational health risks.

Objectives: The goal of this study was to investigate respiratory health problems and possible related occupational exposures among nutmeg production workers.

Methods: A questionnaire, spirometry and allergen skin-prick test was given to 92 nutmeg workers. Samples for measurement of airborne dust, mold, and phosphine were also collected from work environments.

Results: Approximately half of the workers with lower respiratory symptoms such as dry cough (49.4%) and shortness of breath (42.9%) reported that their symptoms were work related. Spirometry results showed that 18.8% of workers had obstruction. Area geometric mean (GM) inhalable dust concentrations, GM personal concentrations, and total mold spores during work activities were found to be high.

Conclusions: High prevalence of respiratory symptoms among workers in this facility was consistent with measured levels of dust and mold, and was widespread over all work areas.