Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment.

Background: An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation. Objective: A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential. Methods: A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms "vape"; "vaping"; "e-cigarette"; and "cessation," "quit," or "quitting" in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21. Results: An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user's willingness for behavior change and providing feedback on current actions in comparison to future goals. Conclusions: The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development.

Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study.

PURPOSE: Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations. METHODS: This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to "During the past ten years, who did you usually see when you were sick or needed advice about your health?") were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified. RESULTS: Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8-13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2-6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76-3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15-4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina. CONCLUSIONS: Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.

Disparities in OncotypeDx Testing and Subsequent Chemotherapy Receipt by Geography and Socioeconomic Status.

BACKGROUND: OncotypeDx is a prognostic and predictive genomic assay used in early-stage hormone receptor-positive, HER2- (HR+/HER2-) breast cancer. It is used to inform adjuvant chemotherapy decisions, but not all eligible women receive testing. We aimed to assess variation in testing by demographics and geography, and to determine whether testing was associated with chemotherapy. METHODS: For 1,615 women in the Carolina Breast Cancer Study with HR+/HER2-, Stage I-II tumors, we estimated prevalence differences (PD) and 95% confidence intervals (CI) for receipt of OncotypeDx genomic testing in association with and sociodemographic characteristics. We assessed associations between testing and chemotherapy receipt overall and by race. Finally, we calculated the proportion of eligible women receiving OncotypeDx by county-level rurality, census tract-level socioeconomic status, and Area Health Education Center regions. RESULTS: 38% (N = 609) of potentially eligible women were tested, with lower testing prevalences in Black (31%; PD, -11%; 95% CI, -16%-6%) and low-income women (24%; PD, -20%; 95% CI, -29% to -11%) relative to non-Black and higher income women. Urban participants were less likely to be tested than rural participants, though this association varied by region. Among women with low genomic risk tumors, tested participants were 29% less likely to receive chemotherapy than untested participants (95% CI, -40% to -17%). Racial differences in chemotherapy were restricted to untested women. CONCLUSIONS: Both individual and area-level socioeconomics predict likelihood of OncotypeDx testing. IMPACT: Variable adoption of OncotypeDx by socioeconomics and across geographic settings may contribute to excess chemotherapy among patients with HR+/HER2- cancers. See related In the Spotlight, p. 635.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study.

BACKGROUND: Women referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AIMS: This study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. METHODS: A qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FINDINGS: Continuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. CONCLUSIONS: Continuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

How, why and for whom does a basic income contribute to health and wellbeing: a systematic review.

Ensuring that people have a sufficient income to meet their basic needs and that it keeps pace with costs of living are important when considering ways to reduce health inequities. Many have argued that providing a basic income is one way to do this. The aim of this review is to provide an overview of the existing peer reviewed evidence on the health and wellbeing impacts of basic income interventions. A systematic search of ten electronic databases was conducted in June 2022. Eligible publications examined any effect on health and wellbeing from unconditional cash transfers. All study designs were included, and no limitations were placed on duration of cash transfer trials, location of study, study population or on amount of money provided through the cash transfer. Ten studies were included in this review. Studies employed a range of methods. All studies reported on a trial of Universal Basic Income in either a region or a town. Studies explored a range of health and wellbeing related outcomes including crime, quality of life, employment, subjective wellbeing, tuberculosis and hospitalization. Basic income programs can mitigate poverty in a time of economic upheaval and have the potential to become a powerful policy tool to act upon the determinants of health and reduce health inequality. This review found a small number of trials indicating a positive impact on health and wellbeing. More trials which track recipients over a longer period are needed to provide more robust evidence for the impact of basic income programs.

Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis.

BACKGROUND: Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. METHODS AND FINDINGS: We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was -0.46% (95% CI -0.60% to -0.31%, I2 87.8%, p < 0.001) overall, -0.37% (95% CI -0.64% to -0.10%, I2 60.0%, n = 7, p = 0.020) in multicomponent clinic-based interventions, -0.87% (-1.20% to -0.53%, I2 91.0%, n = 13, p < 0.001) in pharmacist task-sharing studies, and -0.27% (-0.50% to -0.04%, I2 64.1%, n = 7, p = 0.010) in trials of diabetes education or support alone. Other types of interventions had few included studies. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. The certainty of evidence for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types. Limitations include the lack of consensus definitions for health system interventions, differences in the quality of underlying studies, and sparse data availability for non-glycemic outcomes. CONCLUSIONS: In this meta-analysis, we found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies are available from rural areas or low- or lower-middle-income countries. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings.

The availability and acquisition of modafinil on the internet.

INTRODUCTION AND AIMS: Prescription medications are readily accessible on both the dark and surface web. This study focuses specifically on modafinil. Modafinal is a medication that is used to treat sleepiness due to a range of sleep disorders, but is also used off-label as a cognitive enhancer. This study aimed to evaluate surface websites which sold modafinil to Australia to provide an overview of and to document the characteristics of surface web retailers. DESIGN AND METHODS: An online search to identify online retailers selling modafinil was performed using three search engines. Retailers were included if they sold modafinil to Australia, as verified through the purchasing process. Thirteen retailers were included in the final sample. RESULTS: Most retailers sold more than one product, with products being sold in tablet form the most common (88%). Retailers offered products of multiple strength, with the 200 mg product most common (51%). Most retailers included information on the side effects of the substances (77%), few listed any supporting evidence. Few listed information regarding legal status (24%). Most retailers used a number of features to indicate legitimacy. DISCUSSION AND CONCLUSION: This is the first study to document the characteristics of surface web retailers purporting to sell modafinil to Australia. Future studies may analyse purchased samples to identify potential counterfeit or poor-quality medications.

Seeking legitimacy for broad understandings of substance use.

This commentary invites discussion about implicit and explicit factors that impede research about substance use from a nuanced perspective that recognises potential benefits and advantages. It is argued that explicit efforts to engage in scholarship beyond those informed by theoretical and philosophical assumptions that substance use is inherently risky and problematic can enhance genuine inquisition about substance use and transform which discourses and interpretations are legitimised. Prioritisation of scholarly funding and publication has largely been predicated on the notion that illicit substances pose an inherent risk for individual and social harm. This has implicitly and explicitly influenced what type of research has been conducted and how substance use is constructed. Researchers who engage in scholarship that suspends assumptions of risk and problems associated with substance use may become subject to judgement about their credibility, ethics, and expertise. Moving forward, we suggest that conscientiously attending to broad, nuanced experiences associated with substance use will contribute to a stronger evidence base. Equal opportunity should be given to examine the complexity of lived experiences. It may also be timely to consider what brings value to scholarly pursuit, recognising that health is but one valued social outcome. Perhaps other outcomes, such as human rights, compassion, and justice are equally commendable. To advance substance use scholarship, it is essential that decision-makers (e.g., funding bodies, editors) embrace research that does not conform to assumptions of risk or inherent problems as exclusively legitimate, advocate for scholarship that resists conforming to dominant discourses, and create spaces for critical perspectives and interpretations.

HealthPathways improving access to care.

Objective HealthPathways (HPW) is an international web-based information portal that provides health practitioners with guidelines and referral pathways to specialists and services. The present study explored usage of HPW by general practitioners (GPs) in the Barwon region, south-west Victoria, and any benefits and barriers to its use. Methods Approximately 421 GPs provide services in 86 clinics across the Barwon region, south-west Victoria and Barwon Health is the public health service providing acute, subacute, residential aged care and community health services to approximately 350000 people. The present study was a mixed-methods analysis of all GPs in the region, who were invited to complete a survey in two waves (2014 and 2016) and participate in focus groups. Data were survey/questionnaire (fixed response and free text options, analysed with descriptive statistics and content analysis), and focus groups (interview and facilitated group discussion, analysed using the principles of thematic analysis). Results Most GPs surveyed used HPW and usage increased over time from 2014 to 2016 (67% vs 77% respectively). Junior GPs used HPW more often than the more experienced practitioners. GPs reported that HPW was easy to access and navigate, improved their knowledge of local services, improved their confidence, changed their clinical management and saved them time. Main barriers to use of HPW were: GPs did not think to look at HPW, or simply did not know about it. Conclusions HPW has the potential to improve patient management and health outcomes, and use of HPW is increasing over time. What is known about the topic? Initiatives such as HPW are viewed positively by clinicians and have the potential to address challenges at the primary-secondary care interface, specifically, referral to secondary specialists. What does this paper add? Proof of concept that the ongoing availability of localised HPW for common clinical conditions improves GP usage of HPW and has increased access to HPW as the first source of clinical information. Benefits and barriers to use have been identified. What are the implications for practitioners? HPW improves knowledge of local services and provides GPs with easy access to referral pathways.

The role of social enterprise in food insecurity among asylum seekers.

People seeking asylum in high-income countries are vulnerable to food insecurity due to limited opportunities for social and economic participation. Given this vulnerability, nongovernment organisations are attempting to improve food security outcomes through targeted programmes. This study explored the role of a subsidised mobile fresh fruit and vegetable market (the Food Justice Truck-FJT) on the experience of food insecurity for people seeking asylum living in Melbourne, Australia. This research uses a mixed methods approach, employing surveys and semistructured interviews to explore the lived experiences of asylum seekers using the FJT, including their experiences of food insecurity. Half of the asylum seekers interviewed in this study were found to be experiencing food insecurity. Participants in this study sourced food from multiple locations, with the FJT providing a supplemental, but highly valued source of fresh produce. The FJT was identified as positive social setting for some participants included in this research. This research has identified the ability of programmes such as the FJT to act as positive social settings.

Food-Based Social Enterprises and Asylum Seekers: The Food Justice Truck.

People seeking asylum in high-income countries are vulnerable to food insecurity due to limited opportunities for social and economic participation. While charity organizations have long sought to provide food aid to those in need, the increasing number of people seeking this assistance requires alternatives. Using a case study approach, this research investigates The Food Justice Truck, which is a social enterprise designed to provide low cost, nutritious food to people seeking asylum with an aim to reduce the food insecurity burden. Twenty-seven people seeking asylum completed a structured interview (n = 15) or a semi-structured interview (n = 12). The majority of participants were female (n = 20) with an average age of 38.3 years (Standard Deviation (SD) 7.3; range 30⁻59) and over half were from Iran (n = 16, 59.2%) with most holding a temporary visa to stay in Australia (n = 15, 55.5%). Two key findings were identified including the fact that the FJT is at risk of creating and perpetuating a power imbalance. However, as a social setting, the FJT has the potential to promote and enable a social connection and create a positive experience. This research study adds valuable information to the literature by providing research on one alternative to traditional food aid. It was found that alternatives to traditional food aid may play a role in reducing the food security burden.

The Role of Food Banks in Addressing Food Insecurity: A Systematic Review.

Food banks play a major role in the food aid sector by distributing donated and purchased groceries directly to food insecure families. The public health implications of food insecurity are significant, particularly as food insecurity has a higher prevalence among certain population groups. This review consolidates current knowledge about the function and efficacy of food banks to address food insecurity. A systematic review was conducted. Thirty-five publications were reviewed, of which 14 examined food security status, 13 analysed nutritional quality of food provided, and 24 considered clients' needs in relation to food bank use. This review found that while food banks have an important role to play in providing immediate solutions to severe food deprivation, they are limited in their capacity to improve overall food security outcomes due to the limited provision of nutrient-dense foods in insufficient amounts, especially from dairy, vegetables and fruits. Food banks have the potential to improve food security outcomes when operational resources are adequate, provisions of perishable food groups are available, and client needs are identified and addressed.

Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services?

INTRODUCTION AND AIM: To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. DESIGN AND METHODS: Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. RESULTS: Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. DISCUSSION AND CONCLUSION: Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2016;35:377-382].

Food security among asylum seekers in Melbourne.

OBJECTIVES: This research explores food insecurity among asylum seekers who are members of the Asylum Seeker Resource Centre (ASRC) in Melbourne, Australia. METHODS: Structured person-assisted questionnaires were conducted with 56 asylum seekers. The questionnaires examined issues around access to food, cultural appropriateness of available food, transport issues, use of the ASRC Foodbank and questions about general health. RESULTS: Findings suggest that: 1) almost all asylum seekers in this study were food insecure; 2) most of the asylum seekers using the ASRC Foodbank have no access to food other than that provided at the centre; and 3) the reason that most asylum seekers are food insecure is related to structural problems associated with limitations imposed by different visas. CONCLUSIONS AND IMPLICATIONS: The ability of asylum seekers to achieve food security is limited by their restricted access to welfare and government or work-related income. Given that the current policy situation is likely to continue, providers such as the ASRC will find continuing demands on their services and increasing pressures to provide more than a 'supplemental' food supply.

What the radiologist needs to know about urolithiasis: part 1--pathogenesis, types, assessment, and variant anatomy.

OBJECTIVE: This article reviews types of urinary calculi and their imaging appearances, presents direct and secondary imaging findings of urolithiasis, and provides an overview of treatment methods. Pertinent imaging findings that impact clinical management are highlighted. The implications of complex or variant genitourinary anatomy are reviewed. We outline a standard format for the reporting of urolithiasis to facilitate informed clinical management decisions. CONCLUSION: Unenhanced CT is the preferred examination for evaluation of urolithiasis because of its availability, ease of performance, and high sensitivity. An awareness of the important imaging findings to report allows appropriate and efficient therapy.

EMS provider findings and interventions with a statewide EMS spine-assessment protocol.

OBJECTIVE: To describe the utilization and findings with a statewide, prehospital spine-assessment protocol for emergency medical services (EMS) providers in a rural state. METHODS: The study was a prospective sample of EMS patients evaluated by prehospital providers for trauma-related injury during a one-year investigation period. Prehospital providers prospectively completed supplementary spine data-collection forms that reported patient demographics and EMS provider findings with the spine-assessment protocol. Data were analyzed using descriptive statistics. RESULTS: There were 207,545 EMS encounters during the study period, including 31,885 transports for acute trauma-related illness. Prehospital providers provided spine-assessment forms for 2,220 patient encounters. Providers reported a decision to immobilize 1,301 (59%) patients. For these immobilized patients, spine protocol findings included 416 (32%) patients deemed as unreliable, 358 (28%) with distracting injury, 80 (6%) with an abnormal neurologic examination, and 709 (54%) with spine pain or tenderness. Linkage of EMS and hospital data revealed seven acute spine fracture patients among the 2,220 reported encounters, all of whom were immobilized by EMS providers. CONCLUSIONS: Use of this prehospital spine-assessment protocol resulted in an EMS provider decision not to immobilize approximately 40% of EMS trauma patients. Few spine fracture patients were encountered during the investigational period, though all were immobilized.