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- Blach, S., et al.
(författare)
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Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study
- 2022
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Ingår i: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 7:5, s. 396-415
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Tidskriftsartikel (refereegranskat)abstract
- Background Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends. Methods This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age =0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories. Findings Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0.7% (95% UI 0.7-0.9), corresponding to 56.8 million (95% UI 55.2-67.8) infections, on Jan 1, 2020. This number represents a decrease of 6.8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63.6 million (61.8-75.8) infections (0.9% [0.8-1.0] prevalence). By the end of 2020, an estimated 12.9 million (12.5-15.4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641 000 (623 000-765 000) patients initiated treatment. Interpretation At the beginning of 2020, there were an estimated 56.8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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- de Haan, Anke, et al.
(författare)
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Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials
- 2024
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Ingår i: The Lancet Child and Adolescent Health. - 2352-4642. ; 8:1, s. 28-39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. Methods: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6−18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. Findings: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=−13·17, 95% CI −17·84 to −8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=−0·15, 95% CI −0·29 to −0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. Interpretation: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. Funding: Swiss National Science Foundation.
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| 7. |
- Iyadurai, L., et al.
(författare)
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Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department : a proof-of-concept randomized controlled trial
- 2018
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Ingår i: Molecular Psychiatry. - : NATURE PUBLISHING GROUP. - 1359-4184 .- 1476-5578. ; 23:3, s. 674-682
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Tidskriftsartikel (refereegranskat)abstract
- After psychological trauma, recurrent intrusive visual memories may be distressing and disruptive. Preventive interventions post trauma are lacking. Here we test a behavioural intervention after real-life trauma derived from cognitive neuroscience. We hypothesized that intrusive memories would be significantly reduced in number by an intervention involving a computer game with high visuospatial demands (Tetris), via disrupting consolidation of sensory elements of trauma memory. The Tetris-based intervention (trauma memory reminder cue plus c. 20 min game play) vs attention-placebo control (written activity log for same duration) were both delivered in an emergency department within 6 h of a motor vehicle accident. The randomized controlled trial compared the impact on the number of intrusive trauma memories in the subsequent week (primary outcome). Results vindicated the efficacy of the Tetris-based intervention compared with the control condition: there were fewer intrusive memories overall, and time-series analyses showed that intrusion incidence declined more quickly. There were convergent findings on a measure of clinical post-trauma intrusion symptoms at 1 week, but not on other symptom clusters or at 1 month. Results of this proof-of-concept study suggest that a larger trial, powered to detect differences at 1 month, is warranted. Participants found the intervention easy, helpful and minimally distressing. By translating emerging neuroscientific insights and experimental research into the real world, we offer a promising new low-intensity psychiatric intervention that could prevent debilitating intrusive memories following trauma.
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- Enqvist, Johan, 1982-, et al.
(författare)
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Pathways to urban environmental stewardship : Sense of place and civic engagement for urban waterfronts
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Participation of local residents is considered beneficial for urban environmental stewardship, but the understanding of how urban stewards relate to the places they work with is poorly developed. This study of civic groups working to steward urban waterfronts challenges the notion that stronger attachment drives deeper commitment to stewardship. The study looks at three types of groups doing stewardship work on waterfronts and water bodies in New York City: community groups, environmental groups and recreational groups. Using interviews and Likert scale surveys (n=31), we assessed stewardship activities, place attachment and place meanings that members associate with site that each group works with. Our findings show that community group members are more attached to the sites they work with than members of environmental or recreational groups, but environmental groups report the greatest effort put into stewardship work. Further, we show that place meanings reveal different categories of groups based on how they currently view the site (as a place of work, a place of home, or a place of use), and what they want to achieve for it in their stewardship work: some groups work to restore what the place was previously, others work to protect what it currently is, while a few work to create a new identity for their place. These findings demonstrate how pathways to stewardship differ and are not dependent on strong place attachment; however, they can generate fundamentally different outcomes depending on what place meanings stewardship seeks to protect.
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- Enqvist, Johan, 1982-
(författare)
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Stewardship in an urban world : Civic engagement and human–nature relations in the Anthropocene
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Never before have humans wielded a greater ability to alter and disrupt planetary processes. Our impact is becoming so noticeable that a new geological epoch has been proposed – the Anthropocene – in which Earth systems might no longer maintain the stable and predictable conditions of the past 12 millennia. This is particularly evident in the rapid expansion of urban areas, where a majority of humans now live and where environmental changes such as rising temperatures and habitat loss are happening faster than elsewhere. In light of this, questions have been raised about what a more responsible relationship between humans and the rest of the planet might look like. Scholars in sustainability science employ the concept of ‘stewardship’ in searching for an answer; however, with multiple different applications and definitions, there is a need to better understand what stewardship is or what novelty it might add to sustainability research. This thesis investigates stewardship empirically through two case studies of civic engagement for protecting nature in cities – Bengaluru, India and New York City, USA. Further, the thesis also proposes a conceptual framework for how to understand stewardship as a relation between humans and the rest of nature, based on three dimensions: care, knowledge and agency. This investigation into stewardship in the urban context uses a social–ecological systems approach to guide the use of mixed theory and methods from social and natural sciences. The thesis is organized in five papers. Paper I reviews defining challenges in managing urban social–ecological systems and proposes that these can more effectively be addressed by collaborative networks where public, civic, other actors contribute unique skills and abilities. Paper II and Paper III study water resource governance in Bengaluru, a city that has become dependent on external sources while its own water bodies become degraded and depleted.Paper II analyzes how locally based ‘lake groups’ are able to affect change through co-management arrangements, reversing decades of centralization and neglect of lakes’ role in Bengaluru’s water supply.Paper III uses social–ecological network analysis to analyze how patterns in lake groups’ engagements and collaborations show better fit with ecological connectivity of lakes.Paper IV employs sense of place methods to explore how personal bonds to a site shapes motivation and goals in waterfront stewardship in New York City. Finally,Paper V reviews literature on stewardship and proposes a conceptual framework to understand and relate different uses and underlying epistemological approaches in the field. In summary, this thesis presents an empirically grounded contribution to how stewardship can be understood as a human–nature relation emergent from a deep sense ofcare and responsibility, knowledge and learning about how to understand social–ecological dynamics, and theagency and skills needed to influence these dynamics in a way that benefits a greater community of humans as others. Here, the care dimension is particularly important as an underappreciated aspect of social–ecological relations, and asset for addressing spatial and temporal misalignment between management institutions and ecosystem. This thesis shows that care for nature does not erode just because green spaces are degraded by human activities – which may be crucial for promoting stewardship in the Anthropocene.
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