Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study.

INTRODUCTION: Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. METHODS: We retrospectively analyzed data collected from the free Android app "Anesthesiologist" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). RESULTS: Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. CONCLUSION: The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.

Global nurse/midwife workforce and reproductive health through social ecology lens.

OBJECTIVE: To explore how community social ecology factors may be associated with country registered nurse/registered midwife (RN/RM) workforce supply and reproductive health globally. DESIGN: A cross-sectional design using a social ecology framework was employed. SAMPLE: Data were retrieved from publicly available websites for 107 countries. MEASUREMENTS: Dependent variables included RN/RM density, maternal mortality ratios (MMR), and adolescent birth rates (ABR). Independent variables included gender inequality, region, country income classification, education, gross domestic product per capita, government expenditure of spending on education and health, life expectancy, percent of female seats in legislature, and labor force participation factors. RESULTS: The best fit multivariable model of RN/RM density showed that after adjustment for region, country income and the GII, the percent of females with some secondary education explained most of variation in RN/RM density. The best fit models of MMR and ABR showed that gender inequality explained most of the variation. Other factors in the models were the percent of female seats in legislatures, region, country income class, and mean years of schooling. CONCLUSIONS: Employing a social ecology model can useful in RN/RM workforce planning and development as countries seek multisectoral strategies for increasing the RN/RM supply and improving reproductive health outcomes.

What's the story? An analysis of children's books about atopic dermatitis.

BACKGROUND/OBJECTIVES: Atopic dermatitis is an inflammatory skin condition with significant disease burden. Bibliotherapy, the use of storybooks to understand an illness, has been proven effective in several pediatric disorders but has not been studied in dermatologic disease. The purpose of this study was to assess the availability of storybooks about atopic dermatitis and analyze them based on adherence to American Academy of Dermatology guidelines for the treatment of atopic dermatitis, readability, author qualifications, cost, and availability. METHODS: Selection criteria included that the books were primarily about atopic dermatitis, were illustrated, cost less than $25, and were written in English. Storybooks were identified using an Internet search of the Google, Amazon, and Barnes & Noble websites. Flesch-Kincaid Grade Level was used to calculate reading level. RESULTS: Twenty-three storybooks were identified. The mean cost of the storybooks was $8.2 ± 7.0. Authors included mothers, professional authors, and medical professionals. Mean reading grade level was 4.1 ± 1.5. Of American Academy of Dermatology-recommended treatments, most storybooks mentioned moisturizers or bathing. Fewer than half discussed moisturizing after bathing, topical corticosteroids, wet wrap therapy, oral antihistamines, antimicrobials, systemic agents, or phototherapy. None mentioned topical calcineurin inhibitors or bleach baths. CONCLUSION: Storybooks about atopic dermatitis are available. Of those reviewed, none covered all the American Academy of Dermatology treatment guidelines. Studies have shown that bibliotherapy can be useful for education and behavioral modification for pediatric diseases, and future studies are needed to examine whether comprehensive, accurate storybooks about atopic dermatitis improve clinical outcomes or improve the quality of life of individuals with atopic dermatitis and their caregivers.

Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States.

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Estimating the cost of delivering direct nutrition interventions at scale: national and subnational level insights from India.

India's national nutrition and health programmes are largely designed to provide evidence-based nutrition-specific interventions, but intervention coverage is low due to a combination of implementation challenges, capacity and financing gaps. Global cost estimates for nutrition are available but national and subnational costs are not. We estimated national and subnational costs of delivering recommended nutrition-specific interventions using the Scaling Up Nutrition (SUN) costing approach. We compared costs of delivering the SUN interventions at 100% scale with those of nationally recommended interventions. Target populations (TP) for interventions were estimated using national population and nutrition data. Unit costs (UC) were derived from programmatic data. The cost of delivering an intervention at 100% coverage was calculated as (UC*projected TP). Cost estimates varied; estimates for SUN interventions were lower than estimates for nationally recommended interventions because of differences in choice of intervention, target group or unit cost. US$5.9bn/year are required to deliver a set of nationally recommended nutrition interventions at scale in India, while US$4.2bn are required for the SUN interventions. Cash transfers (49%) and food supplements (40%) contribute most to costs of nationally recommended interventions, while food supplements to prevent and treat malnutrition contribute most to the SUN costs. We conclude that although such costing is useful to generate broad estimates, there is an urgent need for further costing studies on the true unit costs of the delivery of nutrition-specific interventions in different local contexts to be able to project accurate national and subnational budgets for nutrition in India.

An economy of scales: A selective review of obesity's economic causes, consequences, and solutions.

This paper reviews the economic research on obesity, covering topics such as the measurement of, and trends in, obesity, the economic causes of obesity (e.g. the monetary price and time cost of food, food assistance programs, income, education, macroeconomic conditions, and peer effects), and the economic consequences of obesity (e.g. lower wages, a lower probability of employment, and higher medical care costs). It also examines the extent to which obesity imposes negative externalities, and economic interventions that could potentially internalize such externalities, such as food taxes, subsidies for school-based physical activity programs, and financial rewards for weight loss. It discusses other economic rationales for government intervention with respect to obesity, such as imperfect information, time inconsistent preferences, and irrational behavior. It concludes by proposing a research agenda for the field. Overall, the evidence suggests that there is no single dominant economic cause of obesity; a wide variety of factors may contribute a modest amount to the risk. There is consistent evidence regarding the economic consequences of obesity, which are lower wages and higher medical care costs that impose negative externalities through health insurance. Studies of economic approaches to preventing obesity, such as menu labeling, taxes on energy-dense foods, and financial rewards for weight loss find only modest effects on weight and thus a range of policies may be necessary to have a substantial effect on the prevalence of obesity.

Online education about herbs and dietary supplements: margin or mission?

BACKGROUND: Online education is increasingly used to train health professionals, but little is known about how variations in cost affect use of elective training. We assessed whether offering registration for free increased the number of modules consumed in both absolute terms (# modules consumed per person, pp) and relative terms (# modules consumed per # modules registered). METHODS: We analyzed results of the 'natural experiment' on learner's use of the OSU Center for Integrative Health and Wellness online elective curriculum, Introduction Herbs and Dietary Supplements Across the Lifespan, in which costs varied based on monthly discounts for students, faculty, staff, alumni, and members of selected professional associations. RESULTS: Over 7 months there were a total of 905 registrants for 8553 modules. Most (847/905, 94%) registered for free; they completed 1505 (18%) of 8344 modules for which they registered. Fewer (58/905, 6%) people paid for registration; they completed a significantly higher percentage 90/209 (43%, P < 0.001) of modules for which they registered; those who paid full, non-discount rates had the highest completion rates (62%, P < 0.001). Free and paid registrants completed about the same average number of modules per person, pp, (1.8 pp free vs.1.6 pp paid). CONCLUSION: Although it may not contribute to financial margins, offering free online elective training addresses the institutional mission of increasing the number health professionals trained and the number of modules consumed compared with charging for training. Additional research is needed to determine the impact of pricing on educational outcomes and ultimately on patient care.

Health education for microcredit clients in Peru: a randomized controlled trial.

BACKGROUND: Poverty, lack of female empowerment, and lack of education are major risk factors for childhood illness worldwide. Microcredit programs, by offering small loans to poor individuals, attempt to address the first two of these risk factors, poverty and gender disparity. They provide clients, usually women, with a means to invest in their businesses and support their families. This study investigates the health effects of also addressing the remaining risk factor, lack of knowledge about important health issues, through randomization of members of a microcredit organization to receive a health education module based on the World Health Organization's Integrated Management of Childhood Illness (IMCI) community intervention. METHODS: Baseline data were collected in February 2007 from clients of a microcredit organization in Pucallpa, Peru (n = 1,855) and their children (n = 598). Loan groups, consisting of 15 to 20 clients, were then randomly assigned to receive a health education intervention involving eight monthly 30-minute sessions given by the organization's loan officers at monthly loan group meetings. In February 2008, follow-up data were collected, and included assessments of sociodemographic information, knowledge of child health issues, and child health status (including child height, weight, and blood hemoglobin levels). To explore the effects of treatment (i.e., participation in the health education sessions) on the key outcome variables, multivariate regressions were implemented using ordinary least squares. RESULTS: Individuals in the IMCI treatment arm demonstrated more knowledge about a variety of issues related to child health, but there were no changes in anthropometric measures or reported child health status. CONCLUSIONS: Microcredit clients randomized to an IMCI educational intervention showed greater knowledge about child health, but no differences in child health outcomes compared to controls. These results imply that the intervention did not have sufficient intensity to change behavior, or that microcredit organizations may not be an appropriate setting for the administration of child health educational interventions of this type. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, NCT01047033.

Using students' weekly diaries to evaluate positive youth development programs: the case of Project P.A.T.H.S. in Hong Kong.

Six schools participating in the Full Implementation Phase of Project P.A.T.H.S. (Secondary 1 Level) were randomly selected and invited to join this research study. After completion of the Tier 1 Program, 216 Secondary 1 (Grade 7) students in the participating schools were randomly invited to write a reflective journal in the form of a weekly diary to reveal their perceptions and feelings regarding the Tier 1 Program and the related benefits. Results of the qualitative data analyses showed that most of the respondents: (a) had positive views of the program, (b) had positive views of the instructors, and (c) stated that they had acquired competencies at societal, familial, interpersonal, and personal levels after joining the program. The present qualitative findings based on students' weekly diaries provide additional support for the effectiveness of the Tier 1 Program of Project P.A.T.H.S. in Hong Kong.

Broadcasting behavior change: a comparison of the effectiveness of paid and unpaid media to increase folic acid awareness, knowledge, and consumption among Hispanic women of childbearing age.

Awareness about folic acid's effectiveness in reducing the risk of certain birth defects has increased among women in the United States; however, few Hispanic women are consuming enough folic acid daily. A 1998 survey conducted by the Gallup Organization for the National March of Dimes Birth Defects Foundation found that English-speaking Hispanic women had lower folic acid awareness (53% vs. 72%) and lower daily consumption (29% vs. 33%) than non-Hispanic White women. In 1999, the Centers for Disease Control and Prevention (CDC) conducted baseline surveys with Spanish-speaking Hispanic women in selected U.S. markets to measure folic acid awareness, knowledge, and consumption. A Spanish-language public service announcement (PSA) volunteer campaign and a paid Spanish-language media and community education campaign were conducted in 2000 and 2002, respectively. Comparisons of postcampaign surveys indicate that the paid media campaign was significantly more effective than the PSA campaign in increasing folic acid awareness, knowledge, and consumption among Spanish-speaking Hispanic women.

EFNEP: a nutrition education program that demonstrates cost-benefit.

OBJECTIVE: Data on the economic value of nutrition education programs, such as the Expanded Food and Nutrition Education Program (EFNEP), can help decision makers choose among alternative programs based on costs and benefits. A cost-benefit analysis of EFNEP was conducted to determine if participants' savings in food expenditures exceeded program implementation costs. DESIGN/SUBJECTS: Costs were collected over 6 months using expenditure reports and other records. Benefits were determined using prospective data from 371 women enrolled in EFNEP who completed a 24-hour food recall and behavior survey, and recorded the amount of money spent monthly on food at program entry and exit. Two treatment groups received nutrition education and one group did not receive education. One treatment group estimated food expenditures from recall and the other collected register receipts or recorded expenditures. Control group subjects reported expenditures from recall. Net present value (NPV) was calculated using mean EFNEP cost per participant subtracted from the mean change in family food expenditures per participant over a 5-year period at three discount rates. STATISTICAL ANALYSES: Analysis was designed to compare food expenditures among the two experimental groups and control group and food and nutrient intakes and survey scores between the combined experimental group and control group. RESULTS: The average EFNEP program cost perparticipant was $388, and graduating participants reported that family food expenditures decreased on average by $10 to $20 per month or $124 to $234 over a year. When benefits were projected to last 5 years, the NPV was $147 to $696 depending on the method of food expenditure estimation and the discount rate. At the same time individuals reduced food expenditures, they increased intakes of iron, vitamin C, vitamin B-6, and fiber. They added less salt when cooking and read nutrition labels more often. They also reported not running out of food at the end of the month as often. APPLICATIONS/CONCLUSIONS: Findings from this research showed that EFNEP is cost-beneficial. The magnitude of the savings in food expenditures is sensitive to the method of food expenditure reporting and assumptions about how long participants will retain the behaviors they learn.

Farmacoeconomia: conceitos e aspectos operacionais / Pharmacoeconomy: concepts and operational aspects

Farmacoeconomia é a aplicação da economia ao estudo dos medicamentos, visando à otimização do uso de recursos financeiros sem que ocorra prejuizo na qualidade do tratamento. Seu estudo pode envolver aspectos "macro", aplicando técnicas de epidemiologia, bem como estudo de grupo de especialistas, em que são tomadas decisões por consenso, após avaliação de risco/benefício/custo de equivalentes terapêuticos. Na área "micro" da farmacoeconomia, a atenção visa apenas a um ou poucos medicamentos, focalizando uma doença ou um sintoma, e utiliza técnicas e termos derivados da economia, como avaliação custo-benefício, custo-efetividade, custo-utilidade e minimização de custos com o uso de medicamentos...

Evaluation of the hepatitis B prevention education programme in Poland.

Evaluation of the hepatitis B prevention education programme was performed as a survey including all the coordinators in 25 regions (211 coordinators; half the country). The success of the programme was defined by an objective measure (the ratio of vaccinated children to the total number of children in a region) and a subjective measure (the need to introduce changes in current procedures). The best information was felt to be provided on the subjective area, with financial aspects raising the most doubts. There was a high level of participation in local training by school nurses, but insufficient participation by paediatric nurses and paediatricians. In one-third of the regions schools fulfilled the tasks set them, but in 19% of the regions only a few schools did. Information about vaccination was given in most public children's clinics in 65% of the regions, but there was no activity in 6% of the regions. Recruitment of sponsorship was successful, with only 12% of parents paying the full cost of vaccination. The most important factors contributing to the success of the education programme were the health education and the epidemiology departments of state sanitary inspection, the schools' medical services and paediatric services. The greatest perceived need for change in procedures was in the area of cooperation with local authorities. Only 56% of those surveyed felt the director of the local sanitary station participated to a significant extent, though the programme is very dependent on such participation. Overall, 12% of the regions achieved a ratio of 20 or more between vaccinated and non-vaccinated children, with another 52% reaching a ratio of 5-19.9. The perceived need for changes in cooperation with the Health Service was smaller in regions in which the ratio of vaccinated children was higher. The survey showed a connection between the results of the education programme and the incidence of hepatitis B virus infection.

The costs and effectiveness of three vitamin A interventions in Guatemala.

The purpose of the study presented in this paper was to estimate, using secondary sources of data, the cost and effectiveness of three programs to combat vitamin A deficiency in Guatemala-the national sugar fortification program, a targeted capsules distribution program and the promotion of home food production combined with nutrition education and to draw conclusions concerning priorities for Guatemala. Data on the costs and coverage were collected from implementing agencies in Guatemala. Coverage data were converted into a common set of impact indicators. Sensitivity analyses were conducted on variables whose precise value was uncertain. Potential impacts of improvements in program performance operations were also explored. The analysis found the cost per high-risk person achieving adequate vitamin A to be US $0.98 for fortification, US $1.68-1.86 for capsule distribution and US $3.10-4.16 for food production/education. Fortification is the most efficient option if vitamin A levels in sugar are maintained at reasonable levels. Where fortified sugar is not consumed and vitamin A deficiency is highly prevalent, small-scale, targeted, complementary interventions such as capsules and food production education may be appropriate for sustained broader impacts.

Impact of nutrition education and mega-dose vitamin A supplementation on the health of children in Nepal.

The impact on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality of two alternative approaches-nutrition education and mega-dose capsule distribution (6-12-month-olds: 100,000 IU; 1-5-year-olds: 200,000 IU)-in communities in Nepal are compared. Approximately 40,000 children from 75 locations in seven districts in two ecological settings (lowland and hills) took part in the study and were randomly allocated to intervention cohorts or a control group. At 24 months after the implementation of the project the reduction of risk for xerophthalmia was greater among children whose mothers were able to identify vitamin-A-rich foods (relative risk (RR) = 0.25; 95% confidence interval (CI) = 0.10-0.62) than among the children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at 2 years was reduced for both the nutrition education (RR = 0.64; 95% Cl = 0.48-0.86) and capsule distribution (RR = 0.57; 95% CI = 0.42-0.77) cohorts. The nutrition education programme was, however, more expensive to deliver than the capsule distribution programme. High rates of participation for children in the supplementation programme were achieved quickly. The nutrition education messages also spread rapidly throughout the study population (regardless of intervention cohort assignment). Practices, however, were slower to change. In communities where maternal literacy was low and channels of communication were limited the capsule distribution programme appeared to be more economical. However, there are economies of scale for nationwide education programmes that do not exist for capsule distribution programmes. Although nutrition education provides economies of scale and the promise of long-term sustainability, a comprehensive national programme requires both dietary supplementation and nutrition education components.

PIP: The effectiveness of two approaches to vitamin A deficiency prevention--nutrition education and mega-dose capsule distribution--was compared in a 3-year study involving almost 40,000 children 6 months to 10 years of age from seven ecologically diverse districts in Nepal. The nutrition education program promoted increased intake of vitamin A-rich foods during the dry season, serving wild greens, and primary health care service utilization. At baseline, 44.9% of the study villages did not have any cases of Bitot's spots; by the third year, 65.5% were free of this sign of vitamin A deficiency. 85% of community risk variation was explained by agricultural patterns, market food availability, household income, maternal literacy, sanitation, and the village's average nutritional status. At 12 months, capsule distribution had reduced the risk of new Bitot's spots by 55% (relative risk (RR), 0.45; 95% confidence interval (CI), 0.33-0.60); however, its impact had declined by 24 months and was non-significant at 36 months. At 24 months, the reduction of risk for xerophthalmia was greatest among children whose mothers were able to identify vitamin A-rich foods (RR, 0.25; 95% CI, 0.10-0.62) and were literate (RR, 0.06; 95% CI, 0.01-0.42). By 24 months, child mortality risk had declined in both the nutrition education (RR, 0.64; 95% CI, 0.48-0.86) and capsule distribution (RR, 0.57; 95% CI, 0.42-0.77) groups. Although the effects of both programs were similar, the capsule program achieved higher coverage rates at a lower cost while the educational intervention provided economies of scale and potential for long-term sustainability. Most feasible would be a comprehensive national program that included both these components as well as maternal literacy training.

The AIDS prevention magic show: avoiding the tragic with magic.

Teenagers are a crucial target group for interventions concerning acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV). Experimenting with their burgeoning sexuality and increased ability to obtain drugs, they are prime candidates for AIDS prevention and education strategies. The intervention described in this paper is a 30-minute magic show, presented by Cyrus (or Iris) the Virus, a sinister but entertaining character portrayed by any health educator willing to spend a few hours learning the magic tricks. The tricks explain why sharing needles and choosing sexual partners based on appearance alone can result in AIDS. Cyrus also uses magic to communicate the ways that AIDS is not transmitted, how to refuse sex, and how to use condoms correctly. The show, as well as increasing the audience's knowledge about HIV, attempts to induce behavioral change by increasing participants' perceived self-efficacy--a predictor of healthful behavior. Still in its pilot phase, the show has been seen by 281 students ages 10-15 years. Viewers rate the show highly, and preliminary analysis suggests that perceived self-efficacy has been significantly improved.

Combining health education, risk-rated insurance and employee rebates into an integrated health care cost management strategy.

Health education, risk rating and employee rebates can be combined into a comprehensive health promotion program within a benefits plan, reflecting health promotion in its truest sense.