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The home of collaborative applied health and social care research in Oxford and the Thames Valley.
Transdiagnostic early warning score for psychiatric hospitalisation: development and evaluation of a prediction model.
BACKGROUND: The lack of an early warning score for psychiatric hospitalisation means that the decision to initiate preventative interventions is based solely on clinical judgement, which is prone to bias. OBJECTIVE: The objective is to develop and externally validate a transdiagnostic score that predicts psychiatric hospitalisation. METHODS: In this retrospective cohort study using deidentified electronic health records from 20 healthcare organisations in the NeuroBlu Data, we identified all patients with any of seven major psychiatric disorders with at least five Clinical Global Impressions of Severity and five Global Assessment of Functioning measured over a period of 6 consecutive months before any hospitalisation. From these measurements, metrics of clinical severity and instability and functional severity and instability were derived and incorporated into a score predicting the 6-month risk of incident psychiatric hospitalisation. Discrimination and calibration of this score were validated in an external sample. The transdiagnostic validity of the score was evaluated and its performance was compared between white and non-white people. FINDINGS: Altogether, 37 049 individuals (531 incident hospitalisations) were included. The predictive model showed good discrimination in the training (optimism-adjusted c-index: 0.74, 95% CI 0.72 to 0.76) and external validation (c-index: 0.80, 95% CI 0.78 to 0.82) samples, with adequate calibration. Discrimination improved with adjustment for organisation-level hospitalisation rates (c-index: 0.80, 95% CI 0.78 to 0.82 and 0.84, 95% CI 0.82 to 0.86 in the derivation and validation samples). Good discrimination was also achieved for each diagnostic category (c-index: 0.71-0.82 and 0.64-0.75 with/without adjustment for organisation-level hospitalisation rates, respectively). There was no significant difference in model performance between white and non-white people. DISCUSSION: A transdiagnostic early warning system based on simple longitudinal measurements can reliably and robustly predict psychiatric hospitalisation. It will help target preventative interventions to individuals most at risk.
Accuracy of online surveys in predicting COVID-19 uptake and demand: A cohort study investigating vaccine sentiments and switching in 13 countries from 2020 to 2022.
During pandemic conditions, efficient use of resources is essential, but vaccine hesitancy threatens to render vaccine deployment ineffective and inefficient. This study investigated the sensitivity and specificity of a straightforward ex-ante online survey question in predicting ex-post vaccine uptake, and the sociodemographic characteristics associated with individual changes (e.g., false positive or negative responses) in vaccine preferences. We conducted a pooled analysis on stated vaccine preferences and self-reported uptake of a convenience sample of 5213 individuals who were sampled in 13 countries in 2020/21 and 2022. We found online survey response of vaccine intention to be a strong determinant of vaccine uptake. The survey sensitivity was 80.5 %, while specificity was 51.8 %. Though we found evidence of stronger consistency between ex-ante intention and ex-post action in university educated respondents, and weaker consistency amongst those with right leaning political tendencies, further work is required to generalize these results by using representative datasets within each country. In situations where health technologies need to be rolled out urgently, simple and rapid surveys linked to individual health profiles have potential to increase the speed and efficiency of deployment (e.g., Personal Level Integrated Data Asset (PLIDA) in Australia), though low specificity threatens to undermine efficiency gains and sensitivity requirements in risk-averse medical decision making settings may be beyond the capabilities of simple surveys.
Pramipexole augmentation for the acute phase of treatment-resistant, unipolar depression: a placebo-controlled, double-blind, randomised trial in the UK.
BACKGROUND: About 30% of patients with depression treated with antidepressant medication do not respond sufficiently to the first agents used. Pramipexole might usefully augment antidepressant medication in such cases of treatment-resistant depression, but data on its effects and tolerability are scarce. We aimed to assess the efficacy and tolerability of pramipexole augmentation of ongoing antidepressant treatment, over 48 weeks, in patients with treatment-resistant depression. METHODS: We did a multicentre, double-blind, placebo-controlled randomised trial in which adults with resistant major depressive disorder were randomly assigned (1:1; using an online randomisation system) to 48 weeks of pramipexole (titrated to 2·5 mg) or placebo added to their ongoing antidepressant medication. The study was conducted in nine National Health Service Trusts in England. Participants, investigators, and researchers involved in recruitment and assessment were masked to group allocation, and the central pharmacy team dispensing the medication was not masked. The primary outcome was change from baseline to week 12 in the total score of the 16-item Quick Inventory of Depressive Symptomology self-report version (QIDS-SR16). The primary analysis was performed on the intention-to-treat population that included all eligible, randomly assigned participants. People with lived experience were involved in the design, oversight, and interpretation of the study. The trial was registered with ISCTRN (ISRCTN84666271) and EudraCT (2019-001023-13) and is complete. FINDINGS: Between Feb 16 and May 29, 2024, 217 participants attended a screening visit, of whom 66 were excluded due to ineligibility. 151 participants were randomly assigned (75 to the pramipexole group and 75 to the placebo group, after one participant was found to be ineligible after randomisation). 84 (56%) participants were female and 66 (44%) were male and the mean age of participants was 44·9 years (SD 14·0). Ethnicity data were not available. The mean QIDS-SR16 total score at baseline was 16·4 (SD 3·4) in the pramipexole group and 16·2 (3·5) in the placebo group. The mean dose of pramipexole received at week 12 was 2·3 mg (SD 0·45). Adjusted mean decrease from baseline to week 12 of the QIDS-SR16 total score was 6·4 (SD 4·9) for the pramipexole group and 2·4 (4·0) for the placebo group; the mean difference between groups was -3·91 (95% CI -5·37 to -2·45; p<0·0001). Termination of trial treatment due to adverse events was more frequent in the pramipexole group (15 participants [20%]) than in the placebo group (four participants [5%]), with reported adverse events consistent with known side-effects of pramipexole, in particular nausea, headache, and sleep disturbance or somnolence. INTERPRETATION: In this trial involving participants with treatment-resistant depression, pramipexole augmentation of antidepressant treatment, at a target dose of 2·5 mg, demonstrated a reduction in symptoms relative to placebo at 12 weeks but was associated with some adverse effects. These results suggest that pramipexole is a clinically effective option for reducing symptoms in patients with treatment-resistant depression. Future trials directly comparing pramipexole with existing treatments for this disorder are needed. FUNDING: National Institute of Health and Care Research, Efficacy and Mechanism Evaluation Programme.
Call up the (cognitive) reserves: how adult socialisation and education influences cognition in the UK Biobank.
INTRODUCTION: Dementia involves the loss of memory and degradation of cognitive function. Crucially, the onset of dementia may be prevented by identifying and modifying relevant risk factors years before disease onset in midlife. Commonly described modifiable risk factors include social isolation and educational attainment. Here, we aim to understand the relationships between adult activities and their effects on cognition related to mid-life aging in terms of where and how people live. METHODS: We analysed data from the UK Biobank (N = 502,165, Mage = 56.53, SDage = 8.09, 54.40% female). In particular, our path analysis investigated the associations between years of education in childhood, education later in life, social activities in adulthood, built environment (i.e., coastal distance and percentage of greenspace), socioeconomic status (i.e., Townsend deprivation index), and cognitive functions (i.e., memory, executive function, and abstract reasoning). RESULTS: Adult education and social activities predict better cognition. Being deprived predicts attendance in adult education classes, but fewer social activities and poorer cognition. Moreover, living in areas with less greenspace and being further away from coastlines predict attendance in adult education classes; however, only greenspace predicts participation in social activities. Finally, less greenspace and further coastal distance support abstract reasoning, whereas further coastal distance predicts poorer executive function. CONCLUSION: We demonstrate the potential utility of adult education and social activities which may offset the detrimental effects of deprivation. Accordingly, we argue for improved access to adult social programs in deprived/underserviced areas in the United Kingdom.
Fragmentation in adolescent health care provision.
This editorial argues for integrated, developmentally informed models of mental health care for adolescents that address pervasive structural misalignments across health, education and social care. Adolescent admissions must be understood within a whole-system and lifespan framework, recognising varied reasons for admission and long-term impacts on engagement, trust and identity.
Commentary: The wars within – uncomfortable truths about the bullying of girls in conflict-affected societies
This commentary reflects on a timely and methodologically significant study by Silwal et al., which investigates bullying victimization among adolescents in conflict-affected Eastern Ukraine. Conducted in a context of fragility, social fragmentation, and resource scarcity, the study offers vital insights into how war and its aftermath shape adolescent experiences. It reveals higher rates of bullying in conflict-affected regions, with girls disproportionately targeted—an uncomfortable finding that challenges conventional gender patterns in bullying. Drawing on emerging evidence, the commentary considers the role of desensitization, emotional regulation, and digital exposure in shaping youth aggression. It also highlights the need to address the structural stressors facing adolescents in both post-conflict and post-migration contexts, particularly within disrupted school systems. In response, the commentary calls for integrated and context-responsive interventions that strengthen emotional and social competencies without reinforcing stigma. It further urges researchers and policymakers to acknowledge the politicized nature of post-migration violence discourse and to maintain commitment to nuanced and context-sensitive analysis. The findings underscore that bullying in such settings is a social indicator of wider systemic pressures—an expression of the hidden wars adolescents carry in their daily lives and into their schools.
Process evaluation of two large randomized controlled trials to understand factors influencing family physicians' use of antibiotic audit and feedback reports.
BACKGROUND: Unnecessary antibiotic prescriptions in primary care are common and contribute to antimicrobial resistance in the population. Audit and feedback (A&F) on antibiotic prescribing to primary care can improve the appropriateness of antibiotic prescribing, but the optimal approach is uncertain. We performed two pragmatic randomized controlled trials of different approaches to audit and feedback. The trial results showed that A&F was associated with significantly reducing antibiotic prescribing. Still, the effect size was small, and the modifications to the A&F interventions tested in the trials were not associated with any change. Herein, we report a theory-informed qualitative process evaluation to explore potential mechanisms underlying the observed effects. METHODS: Ontario family physicians in the intervention arms of both trials who were sent A&F letters were invited for one-on-one interviews. Purposive sampling was used to seek variation across interested participants in personal and practice characteristics. Qualitative analysis utilized inductive and deductive techniques informed by the Clinical Performance Feedback Intervention Theory. RESULTS: Modifications to the intervention design tested in the trial did not alter prescribing patterns beyond the changes made in response to the A&F overall for various reasons. Change in antibiotic prescribing in response to A&F depended on whether it led to the formation of specific intentions and whether those intentions translated to particular behaviours. Those without intentions to change tended to feel that their unique clinical context was not represented in the A&F. Those with intentions but without specific actions taken tended to express a lack of self-efficacy for avoiding a prescription in contexts with time constraints and/or without an ongoing patient relationship. Many participants noted that compared to overall prescribing, A&F on antibiotic prescription duration was perceived as new information and easily actionable. CONCLUSION: Our findings indicate that contextual factors, including the types of patients and the setting where they are seen, affect how clinicians react to audit and feedback. These results suggest a need to test tailored feedback reports that reflect the context of how, where, and why physicians prescribe antibiotics so that they might be perceived as more personal and more actionable. TRIAL REGISTRATION: Clinical Trial registration IDs: NCT04594200, NCT05044052.
Evidence for Low‐Pressure Crustal Anatexis During the Northeast Atlantic Break‐Up
While basaltic volcanism is dominant during rifting and continental breakup, felsic magmatism may be a significant component of some rift margins. During International Ocean Discovery Program (IODP) Expedition 396 on the continental margin of Norway, a graphite‐garnet‐cordierite bearing dacitic unit (the Mimir dacite) was recovered in two holes within early Eocene sediments on Mimir High (Site U1570), a marginal high on the Vøring Transform Margin. Here, we present a comprehensive textural, petrological, and geochemical study of the Mimir dacite in order to assess its origin and discuss the geodynamic implications. The major mineral phases (garnet, cordierite, quartz, plagioclase, alkali feldspar) are hosted in a fresh rhyolitic, vesicular, glassy matrix that is locally mingled with sediments. The major element chemistry of garnet and cordierite, the presence of zircon inclusions with inherited cores, and thermobarometric calculations all support an upper crustal metapelitic origin. While most magma‐rich margin models favor crustal anatexis in the lower crust, thermobarometric calculations performed here show that the Mimir dacite was produced at upper‐crustal depths (<5 kbar, 18 km depth) and high temperature (750–800°C) with up to 3 wt% water content. In situ U‐Pb analyses on zircon inclusions give a magmatic crystallization age of 54.6 ± 1.1 Ma, consistent with emplacement that post‐dates the Paleocene‐Eocene Thermal Maximum. Our results suggest that the opening of the Northeast Atlantic was associated with a phase of low‐pressure, high‐temperature crustal anatexis preceding the main phase of magmatism.
Getting Recovery Right After Neck Dissection (GRRAND-F): Mixed-methods feasibility study to design a pragmatic randomised controlled trial.
OBJECTIVE: To determine the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention following neck dissection (ND) after head and neck cancer (HNC). DESIGN: Two-arm, open, pragmatic, parallel, multicentre, randomised controlled feasibility trial. SETTING: Two UK NHS hospitals. PARTICIPANTS: People who had HNC in whom a ND was part of their care. We excluded those with a life expectancy of six months or less, pre-existing, long-term neurological disease affecting the shoulder and cognitive impairment. INTERVENTION: Usual care (standard care supplemented with a booklet on postoperative self-management) was received by all participants. The GRRAND intervention programme consisted of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion and progressive resistance exercises, advice and education. Between sessions, participants were advised to complete a home exercise programme. RANDOMISATION: 1:1 randomisation. Allocation was based on minimisation, stratified by hospital site and spinal accessory nerve sacrifice. It was not possible to mask treatment received. MAIN OUTCOME MEASURES: Primary: Participant recruitment, retention and fidelity to the study protocol and interventions from study participants and staff at six months post-randomisation (and 12 months for those reaching that time-point). Secondary: clinical measures of pain, function, physical performance, health-related quality of life, health utilisation and adverse events. RESULTS: 36 participants were recruited and enrolled. The study achieved five of its six feasibility targets. These included consent - 70% of eligible participants were consented; intervention fidelity - 78% participants discharged completed the intervention sessions; contamination - none - no participants in the control arm received the GRRAND-F intervention and retention - 8% of participants were lost to follow-up. The only feasibility target that was not achieved was the recruitment target where only 36 of the planned 60 participants were recruited over 18 months. This was principally due to the COVID-19 pandemic which caused all research activity to be paused or reduced, with a subsequent reduction in. CONCLUSIONS: Based on the findings a full-trial can now be designed to better understand whether this proposed intervention is effective. CLINICAL TRIAL REGISTRATION: https://www.isrctn.com/ISRCTN1197999, identifier ISRCTN11979997.
Patient and physiotherapist perceptions of the Getting Recovery Right After Neck Dissection (GRRAND) rehabilitation intervention: a qualitative interview study embedded within a feasibility trial.
OBJECTIVE: The Getting Recovery Right After Neck Dissection (GRRAND) intervention is a physiotherapy programme for patients with head and neck cancer who have undergone neck dissection. The aim of this qualitative study was to understand if the intervention was useful, acceptable and whether it was feasible to conduct a randomised controlled trial (RCT). DESIGN: This qualitative study was embedded within the GRRAND-Feasibility (GRRAND-F) Study. SETTING: Participants were recruited from four acute National Health Service hospitals in England between 2020 and 2021. PARTICIPANTS: We interviewed four usual care and four intervention patient-participants from a single study site (Oxford). Six were male, two were female. All were white British ethnicity. We interviewed two physiotherapists from Oxford who delivered the GRRAND-F intervention, and physiotherapists from Birmingham, Poole and Norwich who were trained to deliver the intervention but were not able to deliver it within the study time frame. RESULTS: The analysis identified five themes: (1) Acceptability, (2) Adherence, (3) Outcomes, (4) Feasibility and (5) Stand-alone themes (prehabilitation, video consultations, healthcare use).Patient-participants and physiotherapist-participants agreed that usual care was not meeting patients' rehabilitation needs. The GRRAND intervention provided biopsychosocial support. In comparison to the usual care group, patient-participants who received the intervention were more confident that they could perform rehabilitation exercises and were more motivated to engage in long-term adaptive behaviour change. Physiotherapists felt they needed more administrative support to participate in an RCT. CONCLUSION: Participants felt that usual care was insufficient. GRRAND provided much needed, biopsychosocial support to patients. Participants were supportive that it would be feasible to test GRRAND in an RCT. TRIAL REGISTRATION NUMBER: ISRCTN11979997.
Excess cost of care associated with sepsis in cancer patients: Results from a population-based case-control matched cohort.
BACKGROUND: Cancer patients are at significant risk of developing sepsis due to underlying malignancy and necessary treatments. Little is known about the economic burden of sepsis in this high-risk population. We estimate the short- and long-term healthcare costs of care of cancer patients with and without sepsis using individual-level linked-administrative data. METHODS: We conducted a population-based matched cohort study of cancer patients aged ≥18, diagnosed between 2010 and 2017. Cases were identified if diagnosed with sepsis during the study period, and were matched 1:1 by age, sex, cancer type and other variables to controls without sepsis. Mean costs (2018 Canadian dollars) for patients with and without sepsis up to 5 years were estimated adjusted using survival probabilities at partitioned intervals. We estimated excess cost associated with sepsis presented as a cost difference between the two cohorts. Haematological and solid cancers were analysed separately. RESULTS: 77,483 cancer patients with sepsis were identified and matched. 64.3% of the cohort were aged ≥65, 46.3% female and 17.8% with haematological malignancies. Among solid tumour patients, the excess cost of care among patients who developed sepsis was $29,081 (95%CI, $28,404-$29,757) in the first year, rising to $60,714 (95%CI, $59,729-$61,698) over 5 years. This was higher for haematology patients; $46,154 (95%CI, $45,505-$46,804) in year 1, increasing to $75,931 (95%CI, $74,895-$76,968). CONCLUSIONS: Sepsis imposes substantial economic burden and can result in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to deploy targeted strategies to alleviate this burden.
Tacrolimus monitoring in renal transplantation: A comparison between high-performance liquid chromatography and immunoassay
It is recommended that specific methods of tacrolimus monitoring rather than immunoassays, which overestimate tacrolimus levels, should be used in transplant recipients. Direct comparison of these techniques, however, has not been conducted in renal transplantation. In this study, 40 renal transplant recipients with tacrolimus monitoring by microparticle enzyme immunoassay (MEIA; target trough level 10 to 15 ng/mL) were compared with 40 patients monitored by high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS; target trough level 8 to 13 ng/mL). All patients received anti CD25 antibody induction and mycophenolate mofetil in a steroid-sparing protocol. No differences were seen between MEIA and HPLC-MS groups in patient demographics. All patients were followed for 6 months. Patient survival was 100% in both groups; graft survival was 100% in the MEIA group and 97.5% in the HPLC-MS group. The groups did not differ in the number of dose changes required in the first 6 months or in the number of patients displaying tacrolimus levels within target range at 3 and 6 months. Delayed graft function occurred in 14 patients in the MEIA group and 12 patients in the HPLC-MS group (P = NS). Biopsy-proven acute rejection occurred in four patients in the MEIA group and one patient in the HPLC-MS group (P
Oral glucocorticoids and risk of psychiatric and suicidal behaviour outcomes: population-based cohort study.
BACKGROUND: Despite evidence of associations between glucocorticoid treatment and adverse psychiatric and suicidal behaviour outcomes, large-scale observational evidence for serious outcomes is lacking. AIMS: To assess the risk of psychiatric and suicidal behaviour outcomes during glucocorticoid treatment. METHOD: Using Swedish population registers, we identified 1 105 964 individuals aged 15-54 years who collected a glucocorticoid prescription in oral form between 2006 and 2020. We investigated associations with a range of psychiatric outcomes: unplanned specialist healthcare contacts due to depressive, bipolar, anxiety or schizophrenia-spectrum disorders; and deaths by suicide or unplanned specialist healthcare contacts due to self-harm ('suicidal behaviour'). We estimated hazard ratios from Cox proportional hazards models in a medication-only cohort by comparing outcome rates during and outside treated periods within individuals. We further identified individuals with an autoimmune or gastrointestinal autoimmune disorder diagnosis and compared hazards of the outcomes between those who did and did not initiate a glucocorticoid using a target trial emulation approach. RESULTS: We found increased risks for psychiatric outcomes, with within-individual hazard ratios ranging from 1.08 (95% CI, 1.00-1.16) for depressive disorders to 1.23 (95% CI, 1.12-1.36) for bipolar disorder and 1.25 (95% CI, 1.20-1.31) for anxiety disorders. We found no clear association with suicidal behaviour (hazard ratio: 1.06; 95% CI, 0.96-1.17). These findings were similar when stratified by age and gender. Within-individual associations were attenuated in those diagnosed with an autoimmune disorder. The risk of anxiety and bipolar disorder outcomes appeared particularly elevated in the first weeks of treatment. Absolute rates were modestly elevated during treatment, and higher in those with a history of psychiatric disorders. CONCLUSIONS: Glucocorticoid treatment is associated with elevated risks of serious psychiatric outcomes, including the onset and relapse of common psychiatric disorders. Individuals with psychiatric histories may require additional monitoring during glucocorticoid treatment.
The prevalence of prolonged grief disorder according to the international classification of diseases 11: a scoping review
Background: The eleventh revision of the International Classification of Diseases (ICD-11) introduces Prolonged Grief Disorder (PGD) as a new diagnostic category. This paper summarizes methodological approaches and prevalence estimates of studies on PGD in ICD-11. Methods: This review follows the JBI Manual of Evidence Synthesis and PRISMA-ScR guidelines. We searched MEDLINE, Embase, Web of Science, and PsycINFO (2011–2024), along with grey literature sources (Web of Science, Science.gov, NDLTD Global ETD Search). Included studies were cross-sectional or longitudinal, evaluating PGD prevalence using ICD-11 criteria. Two reviewers (KN, SK) independently screened studies, with a third (SG) resolving disagreements. Methodological quality was not assessed. Data extraction covered bibliographic details, study period, location, sample characteristics, diagnostic tools, algorithms, and prevalence. Results: Of 124 screened records, 35 studies were included in a qualitative synthesis. Seven main study categories emerged, primarily bereaved adults and representative national samples. Of 46 study samples, 24 were from Europe, followed by North America (n = 10) and Asia (n = 5), with none from South America. The PG-13 was the most commonly used tool, often omitting and raising ICD-11 PGD criteria simultaneously. ICD-11 PGD prevalence ranged from 1.5 to 15.3% in bereaved adults and 9.9–11.4% in national samples. Conclusions: Findings reveal heterogeneous study populations but limited geographic diversity. Standardized PGD assessments aligned with ICD-11 criteria, using tools specifically designed for ICD-11, along with detailed sample reporting, are needed to improve study comparability and consistency of prevalence. Important gaps by geographical and demographic groups remain.
How well can commonly used anxiety scales detect treatment outcomes in the context of autism?
Anxiety is one of the most prevalent mental health challenges in autistic children, yet there is limited evidence on effective tools to measure treatment outcomes. Previous research with non-autistic children has found that the Child Anxiety Impact Scale, Parent Version achieved good diagnostic accuracy when measuring treatment outcomes and performed better than a commonly used symptom measure. However, this has not been evaluated for autistic children. The present study examined the psychometric properties of the Child Anxiety Impact Scale, Parent Version in autistic children and compared its utility against other anxiety symptom measures, to detect treatment outcomes as assessed by a gold-standard diagnostic interview, the Anxiety and Related Disorders Interview Schedule, Child Version, Parent Interview with the Autism Spectrum Addendum. Data were used from 212 children (aged 7-13 years) who participated in a randomised controlled trial. Receiver-operating characteristic curve analyses were conducted, and subsequent subgroup analyses were conducted using DeLong tests. Results demonstrated that the Child Anxiety Impact Scale, Parent Version had strong psychometric properties, with total scores significantly outperforming other measures in predicting post-treatment recovery from anxiety diagnoses. These findings have implications for future choices of treatment outcome measures in research and clinical practice.Lay abstractStudy on the utility of anxiety scales to detect anxiety diagnostic treatment outcomes in autistic childrenWhy was the study done? The importance of having valid and reliable anxiety measures for autistic children has been highlighted as a research priority by professionals and people with lived experience. Yet, while anxiety has been frequently assessed in autistic children, we do not currently know much about how well commonly used anxiety measures work, especially parent reports, in this context. This has significant implications for care planning and resource allocation for autistic children who experience significant anxiety problems.What did the researchers do? The research team studied data collected in a previously published multi-centred randomised controlled trial (RCT) testing an adapted cognitive behavioural therapy for anxiety (Wood et al., 2020) to better understand how different anxiety measures did, compared to gold-standard anxiety diagnostic assessments, in detecting treatment outcomes. They focused in particular on the Child Anxiety Impact Scale, Parent Version (CAIS-P).What did the researchers find? This study found that the CAIS-P did better than conventional anxiety symptom measures in detecting treatment outcomes for anxiety problems in autistic children.What do the findings mean? This study adds to the current evidence base to inform choices of measurement of anxiety problems in the context of autism.
Comparison of Empirically Derived and Model-Based Estimates of Key Population HIV Incidence and the Distribution of New Infections by Population Group in Sub-Saharan Africa.
BACKGROUND: The distribution of new HIV infections among key populations, including female sex workers (FSWs), gay men and other men who have sex with men (MSM), and people who inject drugs (PWID) are essential information to guide an HIV response, but data are limited in sub-Saharan Africa (SSA). We analyzed empirically derived and mathematical model-based estimates of HIV incidence among key populations and compared with the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates. METHODS: We estimated HIV incidence among FSW and MSM in SSA by combining meta-analyses of empirical key population HIV incidence relative to the total population incidence with key population size estimates (KPSE) and HIV prevalence. Dynamic HIV transmission model estimates of HIV incidence and percentage of new infections among key populations were extracted from 94 country applications of 9 mathematical models. We compared these with UNAIDS-reported distribution of new infections, implied key population HIV incidence and incidence-to-prevalence ratios. RESULTS: Across SSA, empirical FSW HIV incidence was 8.6-fold (95% confidence interval: 5.7 to 12.9) higher than total population female 15-39 year incidence, and MSM HIV incidence was 41.8-fold (95% confidence interval: 21.9 to 79.6) male 15-29 year incidence. Combined with KPSE, these implied 12% of new HIV infections in 2021 were among FSW and MSM (5% and 7% respectively). In sensitivity analysis varying KPSE proportions within 95% uncertainty range, the proportion of new infections among FSW and MSM was between 9% and 19%. Insufficient data were available to estimate PWID incidence rate ratios. Across 94 models, median proportion of new infections among FSW, MSM, and PWID was 6.4% (interquartile range 3.2%-11.7%), both much lower than the 25% reported by UNAIDS. CONCLUSION: Empirically derived and model-based estimates of HIV incidence confirm dramatically higher HIV risk among key populations in SSA. Estimated proportions of new infections among key populations in 2021 were sensitive to population size assumptions and were substantially lower than estimates reported by UNAIDS.