What influences the timing of the introduction of solid food to infants?

The aim of the present study was to assess the factors which may influence the timing of the introduction of solid food to infants. The design was a prospective cohort study by interview and postal questionnaire. Primiparous women (n 541) aged between 16 and 40 years were approached in the Forth Park Maternity Hospital, Fife, Scotland. Of these, 526 women agreed to participate and seventy-eight were used as subjects in the pilot study. At 12 weeks we interviewed 338 women of the study sample. The postal questionnaire was returned by 286 of 448 volunteers. At 12 weeks 133 of 338 mothers said that they had introduced solids. Those that said that they had introduced solids early (<12 weeks) were compared with those who had introduced solids late (>12 weeks) by bivariate and multiple regression analysis. Psychosocial factors influencing the decision were measured with the main outcome measure being the time of introduction of solid food. The early introduction of solids was found to be associated with: the opinions of the infant's maternal grandmother; living in a deprived area; personal disagreement with the advice to wait until the baby was 4 months; lack of encouragement from friends to wait until the baby was 4 months; being in receipt of free samples of manufactured food. Answers to open-ended questions indicated that the early introduction appeared to be influenced by the mothers' perceptions of the baby's needs. Some of the factors influencing a woman's decision to introduce solids are amenable to change, and these could be targeted in educational interventions.     

Who is shaping the food choices of the future?

A conference was held by the British Nutrition Foundation in October 2017 to explore future trends in agriculture, manufacturing and retailing, and the relationship between these trends and food choice. Topics explored by the speakers included sustainability, climate change, Brexit, the ageing population, technological advances in food production, product reformulation, consumer behaviour and public health agendas. This report summarises the conference proceedings.     

What is required to evaluate the impact of pharmaceutical reference pricing?

Objective

To describe empirical studies evaluating the impact of reference pricing (RP) interventions in pharmaceutical markets in order to discuss the requirements for these evaluations.

Methods

Ten studies were included in this review. For each study, the nature of the intervention, the nature of the data available, the nature of the question to be answered and the requirements of the evaluation method were examined through a questionnaire. The most frequently used evaluation method was the conventional before-after estimator, and only three studies used the difference-in-differences method.

Results

Nine studies evaluated a therapeutic RP system and one evaluated a generic RP system. All of the papers reported how the reference price level was established, but only one study directly reported the updating frequency and criteria of the RP system. In four studies, details of simultaneous interventions were not reported. There is no paper providing evidence on overall social welfare impact. Four papers estimated the impact of intervention on the consumer price of drugs covered by the RP system. Only one provided information about the impact on the price of related drugs not covered by the system. Three studies included an outcome variable for the use of health services. The impact of RP intervention on the level of competition in the market for those medicines covered by the system was reported in only three of ten papers.

Discussion/conclusion

Despite the rigorous effort made to evaluate the impact of RP policies in some countries, several limitations may affect both their internal validity (the nature of the data available, statistical problems common to non-experimental data, etc.) and their external validity (heterogeneity in the nature of the intervention).     

What is the responsibility of national government with respect to vaccination?

Given the ethical aspects of vaccination policies and current threats to public trust in vaccination, it is important that governments follow clear criteria for including new vaccines in a national programme. The Health Council of the Netherlands developed such a framework of criteria in 2007, and has been using this as basis for advisory reports about several vaccinations. However, general criteria alone offer insufficient ground and direction for thinking about what the state ought to do. In this paper, we present and defend two basic ethical principles that explain why certain vaccinations are the state's moral-political responsibility, and that may further guide decision-making about the content and character of immunisation programmes. First and foremost, the state is responsible for protecting the basic conditions for public health and societal life. Secondly, states are responsible for promoting and securing equal access to basic health care, which may also include certain vaccinations. We argue how these principles can find reasonable support from a broad variety of ethical and political views, and discuss several implications for vaccination policies.     

Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza?

Over 95% of post‐mortem samples from the 1918 pandemic, which caused 50 to 100 million deaths, showed bacterial infection complications. The introduction of antibiotics in the 1940s has since reduced the risk of bacterial infections, but growing resistance to antibiotics could increase the toll from future influenza pandemics if secondary bacterial infections are as serious as in 1918, or even if they are less severe. We develop a valuation model of the option to withhold wide use of an antibiotic until significant outbreaks such as pandemic influenza or foodborne diseases are identified. Using real options theory, we derive conditions under which withholding wide use is beneficial, and calculate the option value for influenza pandemic scenarios that lead to secondary infections with a resistant Staphylococcus aureus strain. We find that the value of withholding an effective novel oral antibiotic can be positive and significant unless the pandemic is mild and causes few secondary infections with the resistant strain or if most patients can be treated intravenously. Although the option value is sensitive to parameter uncertainty, our results suggest that further analysis on a case‐by‐case basis could guide investment in novel agents as well as strategies on how to use them.     

What is return to work? An investigation into the quantification of return to work

Purpose

To describe and demonstrate issues with return to work (RTW) outcome metrics in common use among clinical researchers and injury compensation organisations. We also aim to describe a framework on which to capture relevant RTW information including current employment status and data on participation and maintenance.

Methods

Structured telephone interviews discussing participant health and vocational status were conducted following compensable transport-related injury. Participants who were working at the time of injury and took time off work because of their injuries (N?=?414) were asked questions relating to their work participation and maintenance, including length of continuous employment, hours worked and duties performed before and after injury. A series of RTW metrics was developed and applied to survey data. Rates of RTW according to each metric were calculated.

Results

Eighty-four per cent of participants had achieved some employment since their injury, and 74% were working at the time of the survey. In contrast, only 58% of participants were working the same hours as prior to their injury and had been doing so for at least 3?months. These data show that different impressions of rehabilitative success can be obtained depending on the criterion used to define RTW suggesting that reliance on a single RTW index (e.g. ??are you currently working???) will not represent important characteristics of employment.

Conclusion

A multi-layered approach to measuring RTW that includes data on reasons for not working, length of continuous employment, hours and duties performed after injury provides greater insight into the vocational status of injured individuals compared to single metrics or outcomes that fail to capture key detail on motives and participation. This information can assist clinicians to more accurately monitor the progress of rehabilitation following injury and compensation schemes to more effectively monitor their performance.     

What constitutes commercial bias compared with the personal opinion of experts?

Introduction: The presence of commercial messages in continuing medical education (CME) is an ongoing cause of concern. This study identifies actions perceived by CME participants to convey commercial bias from CME faculty. METHODS: A questionnaire listing actions associated with CME activities was distributed to 230 randomly selected participants from 7 CME activities designated for AMA PRA Category 1 Credit. The activities were held over an 8-month period. Participants were asked to complete the questionnaire before participating in the live activity. RESULTS: Nine actions identified by over 50% of all respondents were perceived to convey commercial bias. The most critical ones reflecting commercial bias were speaking about only one agent, not providing a balanced presentation of all agents, and faculty relationships with commercial supporters. Ten actions identified by over 50% of the respondents were perceived to convey personal opinion of the faculty. The most prevalent actions were the influence of mentors or teachers, relating general practice habits from the faculty member's own experience, and cultural differences among patient populations. More than half the respondents who indicated they perceived commercial bias in certified activities attributed this perception to an overall impression, instead of 1 or 2 specific actions. DISCUSSION: Actions were identified that conveyed differences between commercial messages and personal opinion. CME providers should define commercial bias for participants, faculty, and planners and provide education about that definition.