Clinical Obesity Services in Public Hospitals in Australia: a position statement based on expert consensus.

We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m2 or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.

Assessing socioeconomic inequalities of hypertension among women in Indonesia's major cities.

Although hypertension has been recognized as one of the major public health problems, few studies address economic inequality of hypertension among urban women in developing countries. To assess this issue, we analysed data for 1400 women from four of Indonesia's major cities: Jakarta, Surabaya, Medan and Bandung. Women were aged ⩾15 years (mean age 35.4 years), and were participants in the 2007/2008 Indonesia Family Life Survey. The prevalence of hypertension measured by digital sphygmomanometer among this population was 31%. Using a multivariable logistic regression model, socioeconomic disadvantage (based on household assets and characteristics) as well as age, body mass index and economic conditions were significantly associated with hypertension (P<0.05). Applying the Fairlie decomposition model, results showed that 14% of the inequality between less and more economically advantaged groups could be accounted for by the distribution of socioeconomic characteristics. Education was the strongest contributor to inequality, with lower education levels increasing the predicted probability of hypertension among less economically advantaged groups. This work highlights the importance of socioeconomic inequality in the development of hypertension, and particularly the effects of education level.

Framework for assessing stewardship of the oral health system in Islamic Republic of Iran.

This study designed a framework for assessing the stewardship function of the oral health system in Islamic Republic of Iran. The modified RAND Corporation/University of California Los Angeles (RAND-UCLA) Appropriateness Method was used in a 2-step process that combined literature evidence and the collective judgement of experts. After a comprehensive literature review, policy instruments related to stewardship components were extracted as candidate standards and categorized according to the 6 sub-functions of stewardship (accountability; defining strategic direction; alignment of policy objectives and organizational structure; regulation; intersectoral leadership; and generation of intelligence). Five key informants then rated the appropriateness of the 85 standards on a 5-point Likert scale. The 38 highest ranked standards, including at least 2 standards in each of the 6 sub-functions, formed a set of proposed standards for evaluating the current stewardship of oral health system. Piloting of the instrument will be reported separately.

Framework for assessing stewardship of the oral health system in Islamic Republic of Iran

This study designed a framework for assessing the stewardship function of the oral health system in Islamic Republic of Iran.The modified RAND Corporation/University of California Los Angeles [RAND-UCLA]Appropriateness Method was used in a 2-step process that combined literature evidence and the collective judgement of experts.After a comprehensive literature review, policy instruments related to stewardship components were extracted as candidate standards and categorized according to the 6 sub-functions of stewardship (accountability; defining strategic direction; alignment of policy objectives and organizational structure; regulation; intersectoral leadership; and generation of intelligence). Five key informants then rated the appropriateness of the 85 standards on a 5-point Likert scale.The 38 highest ranked standards, including at least 2 standards in each of the 6 sub-functions, formed a set of proposed standards for evaluating the current stewardship of oral health system.Piloting of the instrument will be reported separately

وضعت هذه الدراسة إطار عمل لتقييم وظيفة القوامة في نظام صحة الفم في جمهورية إيران الإسلامية. وتم استخدام الطريقة المعدلة لمؤسسة البحث والتقييم التابعة لجامعة كاليفورنيا في لوس أنجلوس على خطوتين للربط بين البينات المنشورة والرأي الجماعي للخبراء. وبعد إجراء مراجعة شاملة للنشريات، تم استخلاص النصوص الخاصة بالسياسات المتعلقة بعنصر القوامة كمقاييس مقترحة، وتم تصنيفها وفقا للوظائف الفرعية الست للقوامة [المساءلة، والتوجهات الاستراتيجية المحددة؛ وترتيب أهداف السياسيات؛ والهيكل التنظيمي؛ والتنظيم، والقيادة المشتركة بين القطاعات، وإنتاج المعلومات]. ثم قام خمسة مبلغين رئيسيين بتقييم مدى ملاءمة المعايير البالغ عددها 85 مقياسا وفقا لمقياس ليكرت ذي النقاط الخمس. وقد شكلت المقاييس التي حصلت على أعلى ترتيب والبالغ عددها 38 مقياسا، بما فيها مقياسان على الأقل في كل من الوظائف الفرعية الست، مجموعة من المقاييس المقترحة لتقييم القوامة الحالية لنظام صحة الفم. وسيتم تقديم تقرير عن هذه الأداة بشكل منفصل

La présente étude a conçu un cadre d'évaluation de la fonction de gouvernance du système de santé bucco-dentaire en République islamique d'Iran.La Méthode modifiée de détermination de la pertinence des indications de la Rand Corporation et de l'Université de Californie Los Angeles [Rand/UCIA]a été utilisée, dans un processus en deux étapes, combinant les données probantes de la littérature et le point de vue collectif d'experts.Après un examen exhaustif de la littérature, des instruments de politiques liés aux composantes de gouvernance ont été extraits en tant que normes candidates puis classés en catégories selon les six sous-fonctions de gouvernance [responsabilisation, définition d'une orientation stratégique, harmonisation des objectifs politiques et de la structure organisationnelle, réglementation, direction intersectorielle et production de données]. Cinq informateurs clés ont ensuite attribué une note à la pertinence de 85 normes sur l'échelle de Likert en cinq points.Les 38 normes les mieux notées, dont au moins deux normes dans chacune des six sous-fonctions, ont formé un ensemble propose pour l'évaluation de la gouvernance actuelle du système de santé bucco-dentaire.Le pilotage de l'instrument fera l'objet d'un rapport distinct

Hepatic metastases: the value of quantitative assessment of contrast enhancement on computed tomography.

OBJECTIVE: Occult and overt hepatic metastases have been the target of research in an effort to improve detection and characterisation of cancer spread and, consequently, guidance of treatment. This paper aims to illustrate the value of two quantitative techniques for assessing contrast enhancement during CT in the detection of hepatic metastases. It outlines the applications to which they can be put, and the ease of incorporation into current protocols. METHODS AND MATERIAL: The first technique, perfusion CT, uses a single location dynamic CT sequence to obtain time attenuation data whilst a short, high concentration IV bolus of contrast passes through the abdominal vasculature. Quantitative hepatic arterial and portal values are calculated, along with a perfusion image map. The second technique uses densitometric analysis during a modified contrast enhanced dual-phase liver CT examination. Semi-quantitative values are calculated from the images obtained at the 25 and 40 s times. RESULTS: Both perfusion CT and densitometric analysis have been to shown to differentiate between normal and tumour-bearing liver as defined by structural CT. Hepatic metastases are associated with increased arterial perfusion and arterial phase enhancement. Increased arterial phase enhancement on densitometric analysis in the absence of overt lesions heralds the onset of visible metastases in the liver in the ensuing 18 months. Perfusion CT has also demonstrated a correlation between high arterial perfusion around a visible metastasis and increased survival. CONCLUSION: Both techniques can provide more information than is available from conventional enhanced CT scans alone. An algorithm for the clinical application of perfusion CT is proposed. The ease with which these quantitative techniques can be performed and the extra information they provide could lead to improved staging of cancer and more appropriate patient management.

CT measurement of perfusion and permeability within lymphoma masses and its ability to assess grade, activity, and chemotherapeutic response.

PURPOSE: Structural CT criteria such as nodal size and appearance have a poor correlation with the grade and activity of a lymphoma mass. This study investigates the potential for functional CT perfusion and permeability measurements to assess lymphoma grade and activity. METHOD: Thirty-nine patients with proven lymphoma underwent 47 dynamic contrast-enhanced CT studies. Lymphoma grade was classified as low or intermediate/high. In seven patients who underwent repeated studies, measurements were correlated against change in disease activity in the intervening period. RESULTS: Median perfusion values were higher in active disease (0.55 vs. 0.37 ml/min/ml) and intermediate/high-grade lymphoma (0.56 vs. 0.46 ml/min/ml). Perfusion below 0.2 ml/min/ml implied inactive disease (p < 0.03), whereas > 0.5 ml/min/ml suggested intermediate/high-grade lymphoma (p = 0.11). Median values of permeability were little different between patient groups. Only perfusion fell when disease became inactive. CONCLUSION: Only CT perfusion measurements of nodes have potential for assessing lymphoma grade, activity, and treatment response.