Impact of ingredient labeling practices on food allergic consumers.

BACKGROUND: Food allergic consumers depend on ingredient labels for allergen avoidance, and the modality of labeling is changing. OBJECTIVE: To investigate current responses to food labels so that the impact of future label changes can be anticipated. METHODS: Adults who attended Food Allergy & Anaphylaxis Network conferences completed a survey regarding their experiences with food labels for their family's most severely affected food allergic individual (FAI). RESULTS: There were 489 completed surveys (84% participation). Most FAIs were young (41% <4 years of age and 56% 4-18 years of age) and highly atopic (51% had asthma and 69% had atopic dermatitis). Food allergies included the following: peanut, 81%; tree nuts, 53%; milk, 51%; egg, 51%; and soy, 17%. All chocolate products were avoided by 37% of FAIs who were avoiding peanut and 40% who were avoiding tree nuts; 91% of tree nut allergic FAIs avoided all tree nuts. Of FAIs who avoided soy, 41% avoided soybean oil and 38% avoided soy lecithin. Of those who avoided milk, 82% avoided lactose. Allergic reactions were attributed to misunderstanding label terms (16%) and to nonspecific terms (spice, flavor) (22%). Ingredient labels were "always" or "frequently" read before purchase by 99%. Product brand choice was "very much influenced" by the manner of labeling for 86%, and manufacturers were contacted for more information by 86%. CONCLUSIONS: Our results suggest that improved product allergen labeling will reduce allergic reactions and simplify allergy management. However, the new labeling may not indicate the form or source of the allergen, and individuals who do not currently avoid foods with minimal or irrelevant protein content, such as soy oil or soy lecithin, may face additional ambiguity and unnecessary dietary restrictions.     

Errors in interpreting quantities as procedures: the case of pharmaceutical labels

The purpose of this study is to investigate and characterize the errors in cognitive processes deployed in the comprehension of procedural texts found on pharmaceutical labels by subjects of different cultural and educational backgrounds. In this study, participants were asked to read and interpret three pharmaceutical labels related to children's medications of varying complexity: oral rehydration therapy (ORT); over-the-counter cough medicine; and over-the-counter fever medicine. Results indicate that: (1) all groups of participants had considerable difficulty in interpreting the instructions; (2), cultural and educational background appeared to be only weakly related to the accuracy of dosage and administration; and (3) errors of comprehension were related to three features of the texts: situation-representational complexity, inherent quantification complexity, and conformity with intuitive models of therapy based on prior knowledge. The results are discussed in terms of the role of multiple representations (boundary objects) and theories of text comprehension to facilitate the reduction of errors.     

Exploring caregiver understanding of medications immediately after a pediatric primary care visit

Objective

Assess accuracy of caregiver understanding of children's prescribed medications and examine factors associated with accurate recall.

Methods

Cross-sectional, observational study of English- or Spanish-speaking caregivers of primary care patients aged 0–7 years. Child and visit characteristics and caregiver health literacy (Short Test of Health Literacy in Adults) were assessed. Post-visit, caregivers completed questionnaires on medications prescribed. Caregiver and medical record agreement on medication name and administration (dose and frequency) were examined using chi square and logistic regression.

Results

Analyses included 68 caregivers (28% low health literacy); 96% of children had public insurance. Caregivers indicated that the doctor provided clear medication information (100%) and they could follow instructions (98%). 101 medicines were prescribed; 6 were recalled by caregiver only. 71% of medications were accurately named; 37% of administration instructions were accurately recalled. Accurate naming was more often found for patients 3–7 years, without conditions requiring repeat visits, and new medications. Accurate administration responses were associated with having only 1 child at the visit.

Conclusion

Unperceived medication instruction understanding gaps exist at physician visits for caregivers of all literacy levels. Communication and care delivery practices need further evaluation.

Practice implications

Clinicians should be aware of the frequency of caregiver medication misunderstanding.     

Natural health product labels: Is more information always better?

OBJECTIVE: To explore how the information provided on labels as mandated by the new Canadian natural health product (NHP) regulations impacts consumers' perceptions of risks associated with using NHPs. METHODS: Six focus groups were conducted in three locations across Ontario. Consumers were asked to react to two labels for a fictitious product called Saturnflower that represented the "old" standards (label 1) and the new standards (label 2). Groups were audio-taped and transcribed verbatim. Qualitative content analysis was used to identify key themes. RESULTS: The 38 participants criticized label 1 for lacking information about the uses of the product and discussed their frustration at trying to obtain good quality information about NHPs. The lack of risk information on label 1 reinforced their perceptions of NHPs as natural, mild and safe. The majority of participants found label 2 much more informative, but a few were unsettled by the extent of the risk information, questioning if it was necessary. CONCLUSION: The label requirements of the new NHP regulations were generally viewed positively by the consumers who participated in this study. PRACTICE IMPLICATIONS: The additional risk information may generate more NHP-related questions for health care practitioners especially with respect to possible interactions between NHPs and conventional medicines.     

Drug labels: Are they a readable material?

OBJECTIVE: This study aims to evaluate cardiovascular drug labels from the perspective of how readable the text materials are. METHODS: Comparison of drug labels written in accordance with the 1997 Brazilian legislation with those written in accordance with the 2003 Brazilian legislation, with journalistic text and scientific essays using as tool the Flesch Index. RESULTS: The journalistic text had an average Flesch Index of 62.6%; the scientific essays, 23.5%; the drug labels written in accordance with the old legislation, 43.8%; and those written in accordance with the most recent legislation, 47.2%. CONCLUSION: Drug labels are more readable than scientific essays and less readable than journalistic texts; they were classified as difficult to read. PRACTICE IMPLICATIONS: Text readability formulas are an objective measure that may improve the search for better-written communication materials and thereby a greater understanding of drug labels by patients. However, a more detailed validation of an objective measure of text evaluation should be considered by the health authorities of each country, with their own language as basis.     

Interpretation of commercial food ingredient labels by parents of food-allergic children

BACKGROUND: To avoid allergic reactions, food-allergic consumers depend on the ingredient labels of commercial products. Complex ingredient terminology (eg, casein and whey for milk) and label ambiguities (eg, natural flavor and may contain peanut ) might compromise the ability of patients/parents to determine the safety of particular products. OBJECTIVE: The purpose of this investigation was to determine the accuracy of label reading among parents of food-allergic children. METHODS: Parents of children on restricted diets attending our referral center were asked to review a group of 23 food labels taken from widely available commercial products. For each label, each parent/parent pair was asked to indicate whether the product was safe for the allergic child and, if it was not, which foods restricted from the child's diet were in the product. RESULTS: There were 91 participants. Peanut was the most commonly restricted food (82 children), followed by milk, egg, soy, and wheat (60, 45, 27 and 16 children, respectively). Identification of milk and soy was the most problematic: only 4 (7%) of 60 parents correctly identified all 14 labels that indicated milk, and only 6 (22%) of 27 parents correctly identified soy protein in 7 products. Peanut was correctly identified in 5 products by 44 (54%) of the 82 parents restricting peanut. Wheat (10 labels) and egg (7 labels) were correctly identified by most parents (14/16 and 42/45, respectively). Correct label identification was associated with prior instruction by a dietitian. CONCLUSIONS: With current labeling practices, most parents are unable to identify common allergenic food ingredients. These results strongly support the need for improved labeling with plain-English terminology and allergen warnings as well as the need for diligent education of patients about reading labels.     

Knowledge of dietary supplement label information among female supplement users

The use of dietary supplements is a popular form of health behavior, especially among women. Little research has been conducted to determine consumers' comprehension of supplement label information. Therefore, this research evaluated comprehension of supplement label information among women 25-45 years of age who consumed a dietary supplement > or =4 times per week. Participants (n=51) completed a written questionnaire about supplement practices, a 10-item knowledge test, and an individual interview about terms used on supplement labels. Participants answered 70% of the questions correctly on the knowledge test indicating adequate knowledge of dietary sources of nutrients. Knowledge of recommended dosages, dosing instructions, and instructions about inappropriate use of supplements for certain people also was adequate. However, misconceptions regarding the term "natural" on supplement labels, product claims, and testing for product safety existed among participants. Supplement users need additional education about supplement claims and testing for product safety and efficacy to make informed health care choices.     

Significance testing as perverse probabilistic reasoning

Truth claims in the medical literature rely heavily on statistical significance testing. Unfortunately, most physicians misunderstand the underlying probabilistic logic of significance tests and consequently often misinterpret their results. This near-universal misunderstanding is highlighted by means of a simple quiz which we administered to 246 physicians at two major academic hospitals, on which the proportion of incorrect responses exceeded 90%. A solid understanding of the fundamental concepts of probability theory is becoming essential to the rational interpretation of medical information. This essay provides a technically sound review of these concepts that is accessible to a medical audience. We also briefly review the debate in the cognitive sciences regarding physicians' aptitude for probabilistic inference.     

Effect of weight-related labels on corticospinal excitability during observation of grasping: a TMS study

Recent studies of corticospinal excitability during observation of grasping and lifting of objects of different weight have highlighted the role of agent’s kinematics in modulating observer’s motor excitability. Here, we investigate whether explicit weight-related information, provided by written labels on the objects, modulate the excitability of the observer’s motor system and how this modulation is affected when there is a conflict between label and object’s weight. We measured TMS-evoked motor potentials (MEPs) from right hand intrinsic muscles, while subjects were observing an actor lifting objects of different weights, in some trials labeled (heavy/light) in congruent or incongruent way. Results confirmed a weight-related modulation of MEPs based on kinematic cues. Interestingly, any conflict between the labels and the actual weight (i.e., explicit versus implicit information), although never consciously noticed by the observer, deeply affected the mirroring of others’ actions. Our findings stress the automatic involvement of the mirror-neuron system.     

Using pictographs to enhance recall of spoken medical instructions II

The first study in this series [Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio RA. Patient Educ. Couns. 1998;35:83-8] found that recall of spoken medical instructions averaged 14% but that, when pictographs (drawings representing the instructions) accompanied the spoken instructions and were present during recall, 85% of medical instructions were remembered correctly. Those findings suggested that spoken instructions plus pictographs may be a way to give people with low literacy skills access to medical information that is normally available only in written form. However, there were three important limitations to that study: (1) the subjects were literate and perhaps literate people remember pictograph meanings better than people with low literacy skills; (2) only short term recall was tested and, for medical information to be useful clinically, it must be remembered for significant periods of time and (3) a maximum of 50 instructions were shown in pictographs, whereas managing complex illnesses may require remembering several hundred instructions. This study addresses those limitations by investigating 4-week recall of 236 medical instructions accompanied by pictographs by people with low literacy skills. Subjects were 21 adult clients of an inner city job training program who had less than fifth grade reading skills. Results showed 85% mean correct recall of pictograph meanings immediately after training (range from 63 to 99%) and 71% after 4 weeks (range from 33 to 94%). These results indicate that people with low literacy skills can, with the help of pictographs, recall large amounts of medical information for significant periods of time. The impact of pictographs on symptom management and patient quality of life remains to be studied.     

门急诊处方点评与分析

目的 通过点评分析我院门急诊处方用药情况,以提高处方合格率,促进临床合理用药。方法 通过我院HIS系统,临床药师每月随机抽取1 d门急诊处方进行点评与分析。结果 2018年门诊处方为343850张,点评11438张,点评率为3.33%;急诊处方为58344张,点评2053张,点评率为3.52%。门急诊处方总合格率为97.24%,其中门诊处方合格率为97.38%,急诊处方合格率为96.44%。门急诊处方点评中不合理处方共373张,其中门诊300张,急诊73张;门诊不合理处方排前3位为用法用量不合理、诊断与用药不符、选药不合理;急诊不合理处方排前3位为无指征用抗生素、用法用量不合理、选药不合理。结论 应不断加强处方点评力度及行政干预措施,规范医师处方行为,促进合理用药,保障医疗安全。