Smartphone applications in paediatric radiology: availability and authority.

BACKGROUND: With the widespread ownership of smartphones, many health care professionals question the degree to which medically related smartphone applications are reliable. OBJECTIVES: To assess the variety of smartphone applications relating to paediatric radiology and the presence of health care professional involvement in their development. As a secondary objective, we explore whether there are gaps within the paediatric radiology app market. MATERIALS AND METHODS: The most popular smartphone marketplaces (Apple iTunes App Store, Blackberry Mobile Market, Google Play Android Market, Nokia Ovi, Samsung and Microsoft Windows Marketplace) were searched for terms relating to paediatric radiology. Cost, review ratings, number of downloads, health care involvement and target audience were recorded. RESULTS: Nine paediatric radiology applications were found in the Apple iTunes App Store and nine in the Google Play Android Market. The target audiences for all applications were health care professionals. None were available for patients or their caregivers. All applications were reported to have medical expertise in their development. CONCLUSION: All paediatric radiology applications were developed with the aid of a health care professional. Due to the small number available online, there is a potential gap in the marketplace for further applications in this field, possibly aimed at patients and their families.

Financial versus health motivation to quit smoking: a randomized field study.

OBJECTIVE: Smoking is the most preventable cause of death, thus justifying efforts to effectively motivate quitting. We compared the effectiveness of financial versus health messages to motivate smoking cessation. Low-income individuals disproportionately smoke and, given their greater income constraints, we hypothesized that making financial costs of smoking more salient would encourage more smokers to try quitting. Further, we predicted that financial messages would be stronger in financial settings where pecuniary constraints are most salient. METHODS: We conducted a field study in low-income areas of New Haven, Connecticut using brochures with separate health vs. financial messages to motivate smoking cessation. Displays were rotated among community settings-check-cashing, health clinics, and grocery stores. We randomized brochure displays with gain-framed cessation messages across locations. RESULTS: Our predictions were confirmed. Financial messages attracted significantly more attention than health messages, especially in financial settings. CONCLUSIONS: These findings suggest that greater emphasis on the financial gains to quitting and use of financial settings to provide cessation messages may be more effective in motivating quitting. Importantly, use of financial settings could open new, non-medical venues for encouraging cessation. Encouraging quitting could improve health, enhance spending power of low-income smokers, and reduce health disparities in both health and purchasing power.

Pilot Evaluation of an In-Store Nutrition Label Education Program.

PURPOSE: To describe and provide recommendations for the implementation of an evaluation for an already existing, in-store Nutrition Label Education Program (NLEP). METHODS: We describe the development and implementation of an evaluation consisting of a pre- and postsurvey and one month follow-up. The evaluation was designed to assess satisfaction with the NLEP as well as changes in participant nutrition label knowledge, confidence in using nutrition labels, and actual changes in nutrition label use. RESULTS: Nineteen participants took part in the pilot evaluation. The evaluation was successful in demonstrating high levels of satisfaction with the NLEP as well as positive changes in participant confidence and some increased knowledge in using nutrition labels. However, only 3 people participated in the follow-up, limiting the ability to assess behaviour change. CONCLUSIONS: Ideally, NLEPs should include ongoing evaluation that extends beyond just assessing participant satisfaction. Recommendations are provided for conducting such evaluations, including the importance of incorporating the evaluation into the program itself, using existing questionnaires when possible, and employing pre- and postsurveys as well as follow-up interviews to assess change.

Consumer e-health solutions: the cure for Baumol's disease?

Baumol's disease is the fact that costs in persistently labour-intensive sectors such as healthcare do not drop, despite increased use of technology. The idea of consumer e-health solutions is seductive, because it provides one option for treating Baumol's disease. However, barriers to the implementation of these solutions exist, and the successful treatment of Baumol's disease with consumer e-health solutions rests on more than their removal. In this introduction, the editor-in-chief adds to the conversation four shifts that are critical to reaping the benefits of consumer e-health solutions: moving the focus from privacy to protection; from mere access to the use of information in decision-making; from the patient-provider dyad to one that includes a full formal and informal care team; and from structural solutions in healthcare to ones designed around the goals we have for our health system.

The impact of commercial health datasets on medical research and health-care algorithms.

As the health-care industry emerges into a new era of digital health driven by cloud data storage, distributed computing, and machine learning, health-care data have become a premium commodity with value for private and public entities. Current frameworks of health data collection and distribution, whether from industry, academia, or government institutions, are imperfect and do not allow researchers to leverage the full potential of downstream analytical efforts. In this Health Policy paper, we review the current landscape of commercial health data vendors, with special emphasis on the sources of their data, challenges associated with data reproducibility and generalisability, and ethical considerations for data vending. We argue for sustainable approaches to curating open-source health data to enable global populations to be included in the biomedical research community. However, to fully implement these approaches, key stakeholders should come together to make health-care datasets increasingly accessible, inclusive, and representative, while balancing the privacy and rights of individuals whose data are being collected.

Public's preferences for health science popularization short videos in China: a discrete choice experiment.

Background: Health science popularization short video disseminates health information to the public in an understandable way about health information. Objective: To investigate the preferences of Chinese residents for health science popularization short videos and provide suggestions for optimizing the production of short videos. Methods: An online survey of Chinese people was conducted using a self-administered questionnaire, and a discrete choice experiment (DCE) was used to explore the public's preferences for health science popularization short videos. Results: A total of 618 respondents were included, of which 306 (45.51%) were male and 312 (50.49%) were female, 271 (43.85%) were aged 18-25, 239 (38.67%) were aged 26-60, and 108 (17.48%) were aged 60 and above. Whether the video is charged or not (46.891%) and the account subject (28.806%) were both considered important. The results of the DCE revealed that the participants considered video free of charge as the most significant attribute of health science popularization short videos (OR 3.433, 95% CI 3.243-3.633). Overall, participants preferred and were more willing to pay for health science popularization short videos with a hospital account subject (OR 1.192, 95% CI 1.116-1.274), with the form of graphic narration (OR 1.062, 95% CI 1.003-1.126), free of charge (OR 3.433, 95% CI 3.243-3.633), with the content that satisfies their needs (very much needed: OR 1.253, 95% CI 95% CI 1.197-1.311; generally needed: OR 1.078, 95% CI 1.029-1.129), with platform certification (OR 1.041, 95% CI 1.011-1.073), without commercial advertisements (OR 1.048, 95% CI 1.018-1.080), with simple-to-understand content (OR 1.071, 95% CI 1.040-1.104), and with video content that evokes fear or dread of illness in the viewer (OR 1.046, 95% CI 1.015-1.078). Conclusion: Participants favor free health popularization short videos, which are hospital accounts, with content that is illustrated, understandable, meets their needs, and can serve as a warning. In the future, the production of health popularization short videos should focus on improving the diversity and relevance of video content, making it as easy to understand to achieve good science popularization effects.

Consumer preferences for maize products in urban Kenya.

BACKGROUND: New maize varieties have been biofortified with provitamin A, mainly a-carotene, which renders the grain yellow or orange. Unfortunately, many African consumers prefer white maize. The maize consumption patterns in Africa are, however, not known. OBJECTIVE: To determine which maize products African consumers prefer to purchase and which maize preparations they prefer to eat. METHODS: A survey of 600 consumers was conducted in Nairobi, Kenya, at three types of maize outlets: posho mills (small hammer mills), kiosks, and supermarkets. RESULTS: Clients of posho mills had lower incomes and less education than those of kiosks and supermarkets. The preferred maize product of the posho-mill clients was artisanal maize meal; the preferred product of the others was industrial maize meal. Maize is the preferred staple for lunch and dinner, eaten as a stiff porridge (ugali), followed by boiled maize and beans (githeri), regardless of socioeconomic background. For breakfast, only half the consumers prefer maize, mostly as a soft porridge (uji). This proportion is higher in low-income groups. Consumers show a strong preference for white maize over yellow, mostly for its organoleptic characteristics, and show less interest in biofortified maize. CONCLUSIONS: Maize is the major food staple in Nairobi, mostly eaten in a few distinct preparations. For biofortified yellow maize to be accepted, a strong public awareness campaign to inform consumers is needed, based on a sensory evaluation and the mass media, in particular on radio in the local language.

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services.

OBJECTIVE: To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. METHODS: Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. RESULTS: Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. CONCLUSION: The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities.

Consumer awareness and strategies among families with high-deductible health plans.

OBJECTIVE: High-deductible health plans (HDHPs) are a new and controversial approach to increasing the share of health care costs paid by patients. Our study had the following aims: (1) to describe the experiences of families with HDHPs who had incurred high out-of-pocket costs and (2) to identify areas where clinicians could support more effective health care decisions by such families. METHODS: We conducted four focus groups with adults whose families had HDHPs in a New England-based health plan and had experienced high or unexpected out-of-pocket health care costs during the past 12 months. Transcripts of audio recordings were independently coded by three investigators using modified grounded theory techniques. RESULTS: The 21 focus group participants had a good general understanding of how their HDHP worked, but reported confusion about specific processes due to the plans' complexity. They described heightened awareness of health care costs, and identified important barriers to their ability to control costs. These included needing to seek care for urgent problems without having the time to assess potential costs; having mistaken expectations about what services the HDHP covered; and being reluctant to discuss costs with doctors. They attempted to control costs by delaying or avoiding visits to doctors, but felt they had little control over costs once a clinical encounter had begun. CONCLUSIONS: Patients with HDHPs reported heightened sensitivity to health care costs, and described important barriers to their ability to make effective choices. Helping such patients make optimal decisions will likely require systems-level changes that involve clinicians and health insurers.

Does price transparency legislation allow the uninsured to shop for care?

BACKGROUND: The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer. OBJECTIVE: To assess the response rate of California hospitals to a patient price request and to compare the price estimates received to Medicare reimbursement. DESIGN: We sent letters to California acute-care hospitals from a fictional uninsured patient requesting an estimate for one of three common elective procedures: a laparoscopic cholecystectomy, a hysterectomy, or routine screening colonoscopy. PARTICIPANTS: Three hundred and fifty-three hospitals in California. MEASUREMENTS: Hospital response rates, difference between price estimates received, and Medicare reimbursement for equivalent procedures. RESULTS: Only 28% (98/353) of hospitals responded and their response varied in content. Of the 98 responses, 15 (15%) did not provide a quote and instead asked for more information such as the billing code, 55 (56%) provided a price estimate for hospital services only, 10 (10%) included both physician and hospital services, and 18 (18%) did not specify what was covered. The median discounted price estimate was higher than Medicare reimbursement rates for all procedures: hysterectomy ($17,403 vs. $5,569; p<0.001), cholecystectomy ($14,014 vs. $7,196; p<0.001) and colonoscopy ($2,017 vs. $216; p<0.001). CONCLUSIONS: Current California legislation fails to meet its objective of enabling uninsured patients to compare prices for hospital-based health care services.

Analysis of the question-answer service of the Emma Children's Hospital information centre.

The information centre of the Emma Children's Hospital AMC (EKZ AMC) is a specialised information centre where paediatric patients and persons involved with the patient can ask questions about all aspects of disease and its social implications. The aim of the study was to evaluate the question-answer service of this information centre in order to determine the role of a specialised information centre in an academic children's hospital, identify the appropriate resources for the service and potential positive effects. For this purpose, a case management system was developed in MS ACCESS. The characteristics of the requester and the question, the time it took to answer questions, the information sources used and the extent to which we were able to answer the questions were registered. The costs of the service were determined. We analysed all questions that were asked in the year 2007. Fourteen hundred thirty-four questions were asked. Most questions were asked by parents (23.3%), healthcare workers (other than nurses; 16.5%) and nurses (15.3%). The scope of the most frequently asked questions include disease (20.2%) and treatment (13.0%). Information on paper was the main information source used. Most questions could be solved within 15 min. Twelve percent to 28% of total working hours are used for the question-answer service. Total costs including staff salary are rather large. In conclusions, taking over the task of providing additional medical information and by providing readily available, good quality information that healthcare professionals can use to inform their patients will lead to less time investment of these more expensive staff members. A specialised information service can anticipate on the information need of parents and persons involved with the paediatric patient. It improves information by providing with relatively simple resources that has the potential to improve patient and parent satisfaction, coping and medical results. A specialised information centre is therefore a valuable and affordable asset to an academic children's hospital.

The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial.

BACKGROUND: The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave. METHODS: The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping. RESULTS: The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found. CONCLUSIONS: In this study, the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies' perspective and, therefore, this study does not provide a financial reason for implementing this intervention. However, with a relatively small investment, the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement. TRIAL REGISTRATION NUMBER: NTR1117.

Direct-to-consumer advertising: Australian pharmacists' experiences with non-prescription medicines.

OBJECTIVE: Direct-to-consumer advertising (DTCA) of over-the-counter or prescribed medicines is a highly controversial issue relating to public health care. Advocates highlight the advantages of DTCA in terms of patient awareness and autonomy. Opponents voice concerns about safety and patients' best interests. The views of physicians and consumers about DTCA have been widely investigated. There has been little research, however, in relation to pharmacists' experiences with DTCA and the impact of DTCA on pharmacy practice. The aim of this study was therefore to explore pharmacists' perceptions of DTCA in Australia and its impact on pharmacy practice. METHODS: A semi-structured in-depth interview was conducted with a purposive convenience sample of retail pharmacists in Sydney, Australia. Interviews were recorded, transcribed ad verbatim and continued until data saturation. Emerging themes were extracted and analysed according to the grounded theory approach. KEY FINDINGS: Pharmacists participating in this study reported concern about potential harm to patient health and well-being as a result of the influence of DTCA. DTCA was seen to impede pharmacists in the discharge of their fundamental ethical responsibilities, leading to a strong sense of disempowerment. Pharmacists' gate-keeping role was challenged by DTCA encouraging consumers to self-medicate and inducing a range of drug-seeking behaviours. Although pharmacists acknowledged that DTCA may have a role in promoting patient autonomy, in practice DTCA compromised their role in safeguarding consumers from inappropriate use of medicines. CONCLUSIONS: This study highlighted that the impact of DTCA is not restricted to prescription medicines, but extended also to over-the-counter, pharmacist-only and other pharmacy-related products. Pharmacists perceived that DTCA disempowered them, compromising their role in safeguarding the community from inappropriate medicine use.

A curious jumble: the Canadian approach to online consumer health information.

As part of a larger e-health strategy, Canadian governments have invested millions in online health information services for the lay public. These services are intended to reduce demands on the primary health care system by encouraging greater individual responsibility for health and are often promoted using the language of personal empowerment. In this paper, we describe how lay searchers generally look for online health information and discuss the disempowering challenges they are likely to face in (a) locating Canadian government-sponsored health information sites and (b) finding useful information on these sites to address everyday health concerns. We conclude with several recommendations for policy changes.

HIV/AIDS information by African companies: an empirical analysis.

This article investigates the extent of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Disclosures (HIV/AIDSD) in online annual reports by 200 listed companies from 10 African countries for the year ending 2006. Descriptive statistics reveal a very low level of overall HIV/AIDSD practices with a mean of 6 per cent disclosure, with half (100 out of 200) of the African companies making no disclosures at all. Logistic regression analysis reveals that company size and country are highly significant predictors of any disclosure of HIV/AIDS in annual reports. Profitability is also statistically significantly associated with the extent of disclosure.

Schizophrenia, drug companies and the internet.

To investigate differences in the content of websites funded, and not funded, by drug companies, the top 50 websites about 'schizophrenia' in Google and Yahoo were analysed in relation to five variables: three scales relating to causes, treatments and violence, and two categorical variables about the condition being extremely severe and about linking coming off medication to violence. Fifty eight percent of the websites analysed received funding from drug companies. Drug company funded websites were significantly more likely to espouse bio-genetic rather than psycho-social causal explanations, to emphasise medication rather than psycho-social treatments, to portray 'schizophrenia' as a debilitating, devastating and long-term illness, and to link violence to coming off medication. They were neither more nor less likely to describe 'schizophrenics' as violent. These results suggest that the documented influence of the pharmaceutical industry over research, professional organisations, teaching institutions, clinical practice and regulatory bodies may now extend to public promotion, via the internet, of perspectives conducive to maximisation of sales.

Economics of reducing Campylobacter at different levels within the Belgian poultry meat chain.

Campylobacter infections pose a serious public health problem in Belgium. Poultry meat is most likely responsible for 40% of human campylobacteriosis cases in Belgium. On a yearly basis, consumption of poultry meat causes at least 22,000 campylobacteriosis cases, with a cost of illness of Euro 10.9 million. Several intervention measures have been proposed in literature, aiming to reduce the contamination of poultry meat and thus lead to significant reductions of human campylobacteriosis cases. This study aimed to evaluate the cost-benefit ratio, i.e., the ratio of reduced costs of illness on intervention costs of various intervention measures. These measures were selected by representatives from the poultry meat sector and experts in the field of poultry science. The selection comprised measures at the farm level (phage therapy), at the processing plant (spraying of carcasses with lactic acid or electrolyzed oxidizing water, crust freezing, or irradiation), and at the consumer level (improving kitchen hygiene and application of home freezing). Among these measures, the decontamination of carcasses with electrolyzed oxidizing water applied in the processing plant was the most efficient (17.66), followed by the use of lactic acid (4.06). In addition, phage therapy generated a positive cost-benefit ratio (2.54). Irradiation indicated the highest efficacy, but its cost-benefit ratio was rather low (0.31). There seems to be less gain by trying to improve food handling in the kitchen. The cost to reach consumers is large, while only a very limited fraction of the consumers is willing to change its behavior. The outcome of this study poses valuable information for future risk-management decisions in Belgium.