Patient preferences for key drivers and facilitators of adoption of mHealth technology to manage depression: A discrete choice experiment.

BACKGROUND: In time, we may be able to detect the early onset of symptoms of depression and even predict relapse using behavioural data gathered through mobile technologies. However, barriers to adoption exist and understanding the importance of these factors to users is vital to ensure maximum adoption. METHOD: In a discrete choice experiment, people with a history of depression (N = 171) were asked to select their preferred technology from a series of vignettes containing four characteristics: privacy, clinical support, established benefit and device accuracy (i.e., ability to detect symptoms), with different levels. Mixed logit models were used to establish what was most likely to affect adoption. Sub-group analyses explored effects of age, gender, education, technology acceptance and familiarity, and nationality. RESULTS: Higher level of privacy, greater clinical support, increased perceived benefit and better device accuracy were important. Accuracy was the most important, with only modest compromises willing to be made to increase other factors such as privacy. Established benefit was the least valued of the attributes with participants happy with technology that had possible but unknown benefits. Preferences were moderated by technology acceptance, age, nationality, and educational background. CONCLUSION: For people with a history of depression, adoption of technology may be driven by the desire for accurate detection of symptoms. However, people with lower technology acceptance and educational attainment, those who were younger, and specific nationalities may be willing to compromise on some accuracy for more privacy and clinical support. These preferences should help shape design of mHealth tools.

The household economic burden of drug-susceptible TB diagnosis and treatment in The Gambia.

OBJECTIVE: To determine the costs and catastrophic costs incurred by drug-susceptible (DS) pulmonary TB patients in The Gambia.METHODS: This observational study collected cost and socio-economic data using a micro-costing approach from the household perspective from 244 adult DS-TB patients with pulmonary TB receiving treatment through the national treatment programme in The Gambia. We used data collected between 2017 and 2020 using an adapted version of the WHO generic patient cost survey instrument to estimate costs and the proportion of patients experiencing catastrophic costs (≥20% of household income).RESULTS: The mean total cost of the TB episode was $104.11 (2018 USD). Direct costs were highest before treatment ($22.93). Indirect costs accounted for over 50% of the entire episode costs. Using different income estimation approaches and catastrophic cost thresholds, 0.4-75% of participants encountered catastrophic costs, showing the variability of results given the different assumptions we utilised.CONCLUSIONS: We show that despite the benefits of free TB care and treatment, DS-TB patients still incur substantial direct and indirect costs, and cases of impoverishing expenditure varied vastly depending on the income estimation approaches used.

Considering equity in priority setting using transmission models: Recommendations and data needs.

OBJECTIVES: Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS: We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS: We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS: Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.

Regional cerebral blood flow in schizophrenics. Tests using the xenon Xe 133 inhalation method.

Measurements of intrahemispheric and bilateral regional cerebral blood flow (CBF) for gray and white matter were compared in 29 schizophrenic patients and 22 normal controls, using the xenon Xe 133 inhalation method. Results showed significantly lower CBF values for all brain regions in the schizophrenic group, and post hoc comparisons showed relatively greater reduced gray-matter CBF values in the anterior areas of the brain. There was also a left-hemisphere frontal loss similar to that reported previously, although it was in the context of a generalized loss in anterior functioning. Interhemispheric comparison within both groups showed no differences between homologous regions for gray matter, and greater white-matter CBF values in the right hemisphere than in the left hemisphere. The findings support a hypothesis of a bilateral anterior deficit in schizophrenia.

Clinical decision-making with treadmill testing and thallium 201.

Fifty patients were prospectively evaluated for myocardial ischemia utilizing treadmill testing and thallium-201 imaging. By coronary angiography, 43 had significant coronary stenosis and seven were normal. The sensitivity, specificity, accuracy and predictive value of treadmill testing alone (81 per cent, 71 per cent, 80 per cent and 95 per cent) did not statistically differ from that of thallium-201 imaging (70 per cent, 86 per cent, 72 per cent and 97 per cent). Combined treadmill testing and thallium-201 imaging (84 per cent, 71 per cent, 80 per cent and 98 per cent) did not significantly affect the results of treadmill testing alone. Thallium-201 imaging failed to identify a number of patients with high risk lesions. The high prevalence of disease, the presentation of typical angina, preselection bias, multiple lead monitoring and exclusion of patients with abnormalities on the resting electrocardiogram probably accounted for failure of thallium-201 imaging to improve the results obtained with treadmill testing. The use of thallium-201 imaging in certain subsets of patient (resting electrocardiographic abnormalities, nondiagnostic treadmill testing, atypical chest pain or asymptomatic patients with abnormalities on treadmill testing) may be of value. However, the use of thallium-201 imaging as a routine screening procedure for myocardial ischemia in patients with typical angina, without due consideration of the prevalence of the disease in the population, is not justified.

Myocardial accumulation of labeled phosphate in malignant pericardial effusion.

Recognition of the presence of a malignant pericardial effusion is important because of the insidious onset and life-threatening potential. This report presents data on three patients with metastasizing carcinoma of the breast, all admitted with a presumptive clinical diagnosis of malignant pericardial effusion. Two of the three revealed a diffuse concentration of Tc-99m PPi within the myocardium. In these cases the diagnosis was confirmed by identification of malignant cells in the pericardial fluid. We suggest that the use of labeled phosphate agents may allow early recognition of myocardial involvement in patients with disseminated neoplasm that results in malignant pericardial effusion.

Current procedural terminology coding of nuclear medicine procedures.

The future of nuclear medicine is dependent on payment for new procedures. Today, the basis of payment by the federal government is a relative value unit (RVU) system; the RVUS employed in this system are for medical services and procedures listed and described in Physicians' Current Procedural Terminology, fourth edition. Current procedural terminology (CPT) is maintained by the AMA; annual revisions include adding new codes or revised or deleted old codes. This process involves all national medical specialty societies. Starting in 1992 a new process, the Relative Updating Committee, which was initiated by the AMA, organized medicine to formalize a method for recommending relative values for physician procedures and services. In this rapidly changing scenario, all nuclear medicine procedure codes are under review by the coding and nomenclature committees of the medical societies interested in imaging. Significant CPT changes and additions were made in the cardiovascular nuclear medicine codes in 1992, reflecting the current imaging protocols and pharmacological agents for performing cardiac stress testing and new codes that recognize combinations of ventricular function measurements in patients undergoing myocardial perfusion imaging with technetium-99m agents.

Brain structure and function in sexual molesters of children and adolescents.

Sixteen men incarcerated in a state psychiatric facility pursuant to sexual molestation of children and/or adolescents were evaluated by computed tomography (CT) head scans and regional cerebral blood flow (rCBF) estimation. Compared with controls, child molesters were found to have thinner and less dense skulls and lower rCBF values. Variations from control values in rCBF and characteristics of CT head scans for the sex offenders suggest a role for cerebral dysfunction in the etiology of their aberrant behavior.

Aging, regional cerebral blood flow, and neuropsychological functioning.

Previous studies found changes in regional cerebral blood flow (rCBF) patterns related to both age and various cognitive tasks. However, no study has yet demonstrated a relationship between rCBF and performance on the Luria-Nebraska Neuropsychological Battery (LNNB) in an elderly group. Seventy-nine elderly volunteers (56-88 years old), both healthy and demented, underwent the 133xenon inhalation rCBF procedure and were given the LNNB. The decrements in the gray-matter blood flow paralleled decrements in performance on the LNNB. Using partial correlations, a significant proportion of shared variance was observed between gray-matter blood flow and the LNNB scales. However, there was much less of a relationship between white-matter blood flow and performance on the LNNB. This study suggests that even within a restricted age sample rCBF is related in a global way to neuropsychological functioning.

Diagnostic efficiency of gallium 67 citrate scans in Hodgkin's disease.

The findings of 49 67Ga citrate scans were correlated with all clinical information obtained by other diagnostic modalities in untreated and treated patients with histopathologically proven Hodgkin's disease (539 sites). Eleven nodal and extranodal sites were analyzed in terms of sensitivity, specificity, accuracy and, subsequently, by calculations of the posterior probability for the presence of disease at positive and negative sites by scan using Bayes' theorem. Lowest posterior probabilities for the presence of disease at positive sites were seen in lung parenchyma (66 percent) and spleen (67 percent) in untreated patients and for treated patients in adbominal nodes an inguinal nodes (both 66 percent), whereas the scan was a good method for detecting Hodgkin's disease at all other sites where posterior probabilities were near 100 percent. Figures for the posterior probability of disease at negative sites by scan showed it was a good modality for ruling out Hodgkin's involvement in axillary nodes, perihilar nodes, lung parenchyma, inguinal nodes, and bone marrow (all less than 10 percent); however, it was not as satisfactory in ruling out disease in untreated cervical nodes (20 percent), supraclavicular nodes (11 percent), and especially in the intraabdominal sites of spleen (35 percent), abdominal nodes (33 percent), and periaortic nodes (27 percent).

Longitudinal changes in regional cerebral blood flow in a normal elderly group.

Only one published study to date has examined longitudinal age-changes in regional cerebral blood flow (rCBF) in an elderly group. It found rCBF declined significantly in their elderly sample over a 24 to 42 month period. The current study attempts to cross-validate the earlier study's findings with an older normal elderly group and a longer time interval between rCBF studies. This study is consistent with that investigation. The normal elderly did exhibit significant declines in blood flow across a variety of indices including: gray and white matter and the Initial Slope Index. These declines were generally on the order of.50 to.75 of a standard deviation loss. No significant differences in blood flow decline between males and females were discerned. While the young-old did exhibit greater blood flow than the old-old there were no significant differences in the rate of decline between the two age-groups.

Hypovolemic pregnant women and their risk determinants.

Among hypovolemic pregnant women there is a high risk of premature labor, fetal growth retardation, and/or hypertension. Arterial wave velocity was determined and Evan's blue disappearance rates measured in hypovolemic gravidas with complications. It appeared that those hypovolemic gravidas without increased cardiac performance are more likely to give birth prematurely, while those with increased cardiac performance and delayed in vivo mixing of Evan's blue dye develop hypertension.

Characteristics of red blood cell survival from subjects with hereditary elliptocytosis.

Hereditary elliptocytosis is an intrinsic red cell abnormality and 12% of elliptocytic individuals demonstrate hemolysis. Using tracer kinetic methodology (51Cr labeled RBC's) the destructive phase of erythropoesis was assessed in two healthy subjects receiving labeled donor red blood cells from individuals with hereditary elliptocytosis. The red blood cell survival time of transfused elliptocytes was significantly decreased in both recipients, with a survival half-time (T 1/2) of 19 days in one recipient and 20 days in the other (N 27 days). Abnormal splenic sequestration was also demonstrated. The decreased survival of transfused cells suggests that caution should be exercised in utilizing patients with hereditary elliptocyosis as donors in blood banking operations even in the absence of evidence of hemolysis.

Red blood cell volume in preterm neonates.

In the high-risk neonate, the direct determination of the red cell volume by radionuclide dilution technique appears to be the singularly definitive method of defining treatment efficacy, and is thus a useful evaluation and management tool for the pediatrician. For effective patient management, the red blood cell(RBC) volume of 69 preterm and term neonates was determined. The method utilized, Tc-99m-labeled RBCs, provided a fast and accurate answer with a large reduction in the absorbed radiation dose. In the population studied within a high-risk newborn ICU, the mean RBC volumes between the preterm and term neonates were without significant difference. Grouping and analysis of the RBC volume data with respect to birth weight, gestational ages, and 1- and 5-minute Apgar scores revealed on statistical difference. The mean value found in our population, 32.2 +/- 9.2 ml/kg, however, does differ from those previously reported in which the determinations were made using an indirect estimation from the plasma compartment.

An integrated model for measuring management performance.

A model of organizational performance measurement that compels attention to the proper balance among quality, cost, and access; takes into account patient perceptions; produces clear targets for continual quality improvement (CQI); yields easily understood graphical displays; and captures health care organizations in simultaneous operation across the functions of cost, quality, and access was designed for the 22 medical treatment facilities of the Strategic Air Command. Such a tool provides practitioners, payers, and patients a range of information--from systemwide, facility, clinical service, and practitioner-specific insights on current performance to resource forecasts and easily understood targets for CQI. This case study shows that integrated performance modeling may be useful in examining many health management and reform issues.