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.

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.

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.

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.

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.

Quantitation of metastatic tumor burden from human colon tumor xenografts using radiolabelled monoclonal antibody 17-A fragments.

In realistic models of human tumor xenograft metastasis, the metastatic foci arise in perivascular sites and rarely grow to sizes which are easily quantifiable by visual inspection. As an alternative approach, we have used monoclonal antibody (MAb) 17-1A F(ab')2 fragments labelled with radioiodine (125I) to study the differential accumulation of label in xenografts and metastatic tumor sites as well as in noninvolved tissues of NIH Swiss nude mice receiving HT-29 human colon tumor cells. Images of the whole-body distribution and sites of localization were determined using a pinhole-collimated Angergamma camera. Radioactivity was determined in tissue samples using a well scintillation system, and pharmacokinetics were assessed during the initial 72 h after injection of antibody fragments. The half-life of 125I-F(ab')2 fragments in the blood, 8.6 h, was similar in nontumor-bearing control and tumor-bearing mice. The half-life in subcutaneous tumor xenografts was 30.1 h. The tumor xenograft to tissue activity ratios per unit weight (radiolocalization indices) at 72 h were: blood 90, lung 65, pancreas 50, muscle 35, spleen 20, liver and mesenteric lymph node 10. All subcutaneous xenografts were successfully imaged, and images of 5 of 9 mice (55%) appeared to demonstrate the presence of metastatic tumor by differential and focal accumulation of MAb fragments after 48 or 72 h in the lung (2 cases) or abdominal cavity (3 cases). Necropsy and subsequent histological and biodistribution studies confirmed the presence of metastatic tumor in these sites and identified tumor in several additional sites. The smallest volume of metastatic tissue in liver or lung determined at necropsy which appeared to have been detected by imaging was about 20 mm3. Generally, for mice with metastatic tumors, the radioactivity per unit weight of metastatic tumor-bearing organs compared to tumor-free organs was 2- to 7-fold greater. The results indicate that a radiolocalization index of > or = 2 is generally necessary for metastatic tumor detection by imaging although this is influenced by the extent of anatomical location of the tumor. It was possible to predict the tissue distribution of the fragments from the planar image for the amounts of radioactivity (approximately 1 mCi/kg body weight) employed in this study. These results demonstrate the utility of this approach to quantitate the metastatic burden arising from human colon tumor xenografts in this experimental model.

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.

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.

Single coronary artery with the right coronary artery arising from the first septal perforator.

A 50-year-old woman with chest pain and an exercise thallium-201 scintigram positive for focal ischemia was found on coronary arteriography to have a heretofore unreported variant of single left coronary artery with the right coronary artery originating as a branch from the first septal perforator. Proximally, the aberrant vessel coursed through the ventricular septum at the level of the right ventricular outflow tract. A conus artery was absent and this is a possible basis for the focal basal ventricular ischemia and the patient's symptoms.

Clinical signs of normal plasma volume expansion during pregnancy.

A majority of cases of pregnancy complications are associated with a relative maternal hypovolemia. The records of 200 pregnant women who had had plasma volume determinations were reviewed in hopes of finding indicators of relative maternal hypovolemia other than the pregnancy complication itself. The signs of relative hypovolemia in pregnant women include those of decreased uterine growth, absence of a maternal systolic flow murmur, and absence of significant dependent ankle edema. Laboratory tests indicative of maternal hypovolemia include failure to develop a decline in maternal hematocrit, serum blood urea nitrogen/creatinine ratio greater than 15, a decreased creatinine clearance, abnormal platelet function, elevated serum glutamic oxaloacetic transaminase, ultrasonic evidence of oligohydramnios and/or decreased maternal heart size, and absence of hypervolemia on chest x-ray film. These findings and tests are only relative indicators of maternal hypovolemia, and it is suggested that, for an accurate defining of pregnant women who are at risk, the actual plasma volume determination has to be performed frequently in the pregnant population.

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.

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.

Effect of alcohol ingestion on regional cerebral blood flow.

Regional distribution of cerebral blood flow was assessed in 10 normal social drinkers following consumption of .75 g/kg alcohol and in a control session without alcohol. Alcohol increased blood flow in the gray matter in all brain areas except the left anterior area. The results are discussed in terms of the effect of alcohol on regional cerebral activation.

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.

Evaluation and testing of in vitro labeled technetium Tc-99m red blood cells in two animal models for neonatal RBC volume determinations.

The present study was designed to evaluate the red blood cell (RBC) radiolabeling technique utilizing the short half-lived radionuclide technetium-99m and to compare the results with the well-recognized standard chromium-51 method. The procedure was evaluated in a canine and a newborn lamb model utilizing dual radionuclide labeling and counting techniques. With the express purpose of providing a significant radiation dose reduction, the procedure presented was adapted for utilization in a neonatal patient population. Statistical analysis of the data revealed that there was no significant difference in the radiolabeling efficiency for the two methods (Cr-51, 86.6%; Tc-99m, 92.4%). Assessment of the in vitro stability for technetium-99m RBCs showed that less than a 4% loss of radiolabel from the RBC was seen in a 4-hr time span in the canine model (15 min, 90.5%; 2 hr, 88.9%; 4 hr, 86.6%) when compared to the 15 min equilibrium sample. Evaluation of newborn lamb RBC volumes showed that the technetium-99m RBC volume did not significantly differ from the chromium-51 labeling technique (Cr-51, 24.0 ml/kg; Tc-99m, 23.2 ml/kg). Summarization of the whole-body radiation dose showed that greater than a 30-fold reduction in absorbed dose was achieved in the newborn (Cr-51, 30.0 mrad; Tc-99m, 0.9 mrad). The modified procedure presented for the radiolabeling of the RBC with the short half-lived radionuclide technetium-99m provides a technique comparable to the utilized standard chromium-51 RBC method, yet with a large reduction in absorbed radiation dose. This procedure is presented as a superior technique for the determination of pediatric RBC volumes.

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).