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Articles by M. Smith
Total Records ( 3 ) for M. Smith
  A. Patel , E. Maissi , H.-C. Chang , I. Rodrigues , M. Smith , S. Thomas , T. Chalder , U. Schmidt , J. Treasure and K. Ismail
  Aims  To assess the cost-effectiveness of motivational enhancement therapy and cognitive behaviour therapy for poorly controlled Type 1 diabetes.

Methods  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of motivational enhancement therapy (ii) usual care plus four sessions of motivational enhancement therapy and eight sessions of cognitive behaviour therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA1c level at 1 year.

Results  Both intervention groups had significantly higher mean health and social care costs (+ £535 for motivational enhancement therapy and + £790 for combined motivational enhancement and cognitive behavioural therapy ), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA1c improvement in the combined motivational enhancement and cognitive behavioural therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the motivational enhancement therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA1c improvements). Imputing missing costs and outcomes confirmed these findings.

Conclusions  Neither therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

  F. Bragg , L. Li , M. Smith , Y. Guo , Y. Chen , I. Millwood , Z. Bian , R. Walters , J. Chen , L. Yang , R. Collins , R. Peto , Y. Lu , B. Yu , X. Xie , Y. Lei , G. Luo and Z. Chen


To examine the relationship of self-reported diabetes, and of random blood glucose levels among individuals without known diabetes, with the prevalence of cardiovascular disease in Chinese adults.


We examined cross-sectional data from the China Kadoorie Biobank of 0.5 million people aged 30-79 years recruited from 10 diverse regions of China in the period 2004-2008. Logistic regression was used to estimate the odds ratios of prevalent cardiovascular disease associated with self-reported diabetes, and with measured random blood glucose levels among participants with no history of diabetes, adjusting simultaneously for age, sex, area, education, smoking, alcohol, blood pressure and physical activity.


A total of 3.2% of participants had self-reported diabetes (men 2.9%; women 3.3%) and 2.8% had screen-detected diabetes (men 2.6%; women 2.8%), i.e. they had no self-reported history of diabetes but a blood glucose level suggestive of a diagnosis of diabetes. Compared with individuals without a history of diabetes, the odds ratios associated with self-reported diabetes were 2.18 (95% CI 2.06-2.30) and 1.88 (95% CI 1.75-2.01) for prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. Among participants without self-reported diabetes there was a positive association between random blood glucose and ischaemic heart disease and stroke/transient ischaemic attack prevalence (P for trend <0.0001). Below the diabetic threshold (<11.1 mmol/l) each additional 1 mmol/l of random blood glucose was associated with 4% (95% CI 2-5%) and 5% (95% CI 3-7%) higher odds of prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively.


In this adult Chinese population, self-reported diabetes was associated with a doubling of the odds of prevalent cardiovascular disease. Below the threshold for diabetes there was still a modest, positive association between random blood glucose and prevalent cardiovascular disease.

  A. Nassar , H. Al Najar , M. Smith and M. Ghannam
  Gaza wastewater treatment plant (GWWTP) is a well-established facility and was used to study the suitability of individual treatment components as possible low cost treatment systems for semi-arid regions in terms of removal efficiency. Samples were taken at weekly intervals over an 18 week period. During this period there were significant removals of BOD, COD and TSS. The removal efficiencies of BOD and TSS in the anaerobic component were 41 and 44%, respectively, while BOD removal efficiencies in the bio-towers and aerated lagoons were 56 and 51%, respectively. Calculations to predict the expected removal efficiencies of each individual component match those observed, based on analyzed samples, except for the anaerobic treatment facility where lagoons are partially filled with sludge, as a consequence of which the hydraulic retention time is less than assumed. Taken as a whole the average reductions for BOD, COD and TSS were 90, 86 and 88%, respectively. All these reductions mean that the final effluent is able to satisfy the guidelines for discharge to the sea.
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