Caroline Rudisill

Diabetic retinopathy screening in England involves labour intensive manual grading of digital retinal images. We present the plan for an observational retrospective study of whether automated systems could replace one or more steps of human grading. Patients aged 12 or older who attended the Diabetes Eye Screening programme, Homerton University Hospital (London) between 1 June 2012 and 4 November 2013 had macular and disc-centred retinal images taken. All screening episodes were manually graded and will additionally be graded by three automated systems. Each system will process all screening episodes, and screening performance (sensitivity, false positive rate, likelihood ratios) and diagnostic accuracy (95% confidence intervals of screening performance measures) will be quantified. A sub-set of gradings will be validated by an approved Reading Centre. Additional analyses will explore the effect of altering thresholds for disease detection within each automated system on screening performance. 2,782/20,258 diabetes patients were referred to ophthalmologists for further examination. Prevalence of maculopathy (M1), pre-proliferative retinopathy (R2), and proliferative retinopathy (R3) were 7.9%, 3.1% and 1.2%, respectively; 4749 (23%) patients were diagnosed with background retinopathy (R1); 1.5% were considered ungradable by human graders. Retinopathy prevalence was similar to other English diabetic screening programmes, so findings should be generalizable. The study population size will allow the detection of differences in screening performance between the human and automated grading systems as small as 2%. The project will compare performance and economic costs of manual versus automated systems.

The threat of a widespread avian flu influenza outbreak represented a significant public health challenge for the European region during late 2005 and early 2006. Little is known, however, about how individuals learn about new global-level health risks, especially influenza outbreaks. We empirically test the hypothesis that knowledge about and geographic proximity to avian flu play a role in individuals' consumption behavior regarding this health risk. This article employs Eurobarometer survey data collected in spring 2006 to examine how Europeans (from 27 European Union countries plus Croatia and Turkey) altered their consumption of poultry, eggs and egg-based products during the virus' emergence in Europe. Our findings are consistent with the hypothesis that behavioral change indeed depends on proximity to those risks. Significant differences emerged between individuals' likelihood of behavioral change in countries where avian flu had been found in humans either in individuals' countries of residence or in bordering countries. Furthermore, we find that those who were more knowledgeable about avian flu risks were less likely to have reduced their consumption of poultry, eggs or egg-related products in the spring of 2006 compared to six months prior. Yet, the influence knowledge has on consumption behavior is found to change depending on proximity to avian flu risks. These findings have implications for our larger understanding of how individuals alter their behavior in the face of new health risks.

Abstract Political affiliation can play a key role in shaping interest towards and emotions about new technologies such as genetically modified (GM) food. This paper examines the extent to which emotional feelings towards and interest in the issue of GM food in the United Kingdom are politically determined. We use the United Kingdom-representative UEA-MORI Risk Survey from 2002 containing information on people's feelings and interests towards GM food to undertake multivariate analysis investigating whether these feelings and interests ...

While many risks, especially new ones, are not objectively quantifiable, individuals still form perceptions of risks using incomplete or unclear evidence about the true nature of those risks. In the case of well known risks, such as smoking, individuals perceive risks to be smaller for themselves than others, exhibiting 'optimism bias'. Although existing evidence supports optimism bias occurring in the case of risks about which individuals are familiar, evidence does not yet exist to suggest that optimism bias applies for new risks. This paper ...

Of Russia's 142 million citizens, fewer than 20 million are enrolled in outpatient drug coverage plans. The current government aims to establish universal health insurance including outpatient medicines. Based on the current political and regulatory environment, this report explores pharmaceutical pricing options for Russia that balance greater access to medicines with achieving government plans of boosting local pharmaceutical production. To match innovative medicine prices with their health benefits, in the long run, we suggest that Russia consider adopting value-based pricing, and in the short term, that it introduce direct price negotiations and price drugs according to reference countries that use health technology assessment. Although generic market shares are high, generic medicine prices are higher than they should be. We propose tenders at the manufacturer level for the pricing of high-selling generics, and free pricing for products with sufficient market competition. These policy recommendations are a jumping-off point for further discussion about how pharmaceutical policy could aid this major economy to achieve its population health and health service goals.

This study aimed to estimate the cost-effectiveness of a universal strategy to promote physical activity in primary care. Data were analysed for a cohort of participants from the general practice research database. Empirical estimates informed a Markov model that included five long-term conditions (diabetes, coronary heart disease, stroke, colorectal cancer and depression). Simulations compared an intervention promoting physical activity in healthy adults with standard care. The intervention effect on physical activity was from a meta-analysis of randomised trials. The annual cost of intervention, in the base case, was one family practice consultation per participant year. The primary outcome was net health benefit in quality adjusted life years (QALYs). A cohort of 262,704 healthy participants entered the model. Intervention was associated with an increase in life years lived free from physical disease. With 5 years intervention the increase was 52 (95 % interval -11 to 115) per 1,000 participants entering the model (probability increased 91.9 %); with 10 years intervention the increase was 102 (42-164) per 1,000 (probability 99.7 %). Net health benefits at a threshold of £30,000 per QALY were 3.2 (-11.1 to 16.9) QALYs per 1,000 participants with 5 years intervention (probability cost-effective 64.7 %) and 5.0 (-9.5 to 19.3) with 10 years intervention (probability cost-effective 72.4 %). A universal strategy to promote physical activity in primary care has the potential to increase life years lived free from physical disease. There is only weak evidence that a universal intervention strategy might prove cost-effective.

The proliferation of new information and communication technologies such as the Internet has arguably changed the way individuals update the information they use to prevent illness and monitor their health. Compared with other information sources, Internet use reduces information access costs but comes with trade-offs in terms of quality and credibility of information sources. Limited evidence has been gathered on the behavioural consequences of new technologies such as the Internet on individuals' demand for healthcare ...