Do differences in reported expenditures between household scanner data and expenditure surveys matter in health policy research?

Household scanner data are increasingly used to inform health policy such as sugar‐sweetened beverage taxes. This article examines whether differences in the level of reported expenditures between IRI Consumer Network scanner panel and the Consumer Expenditure Survey (CES) lead to important differences in demand elasticities and policy simulation outcomes. Using each dataset, we estimated a structural consumer demand system with seven food groups and a numéraire good. To compare the two datasets on a level playing field, we went to great lengths to ensure that the explanatory variables in the two demand models were comparably constructed. Results indicate that scanner data households are not consistently more price responsive than the general population and underreported Consumer Network expenditures do not seem to result in systematic differences in price elasticities. The income elasticities are uniformly lower in Consumer Network than in CES for higher income households because of the positive association between income and the degree of underreporting. This, however, has limited effects on uncompensated price elasticities and policy simulations because food budget shares are small for higher income households. Overall, these findings support continued use of household scanner data in health policy research related to effects of price (dis)incentives.     

Pharmacists' perceptions of a live continuing education program comparing distance learning versus local learning

BackgroundConstraints in geography and time require cost efficiencies in professional development for pharmacists. Distance learning, with its growing availability and lower intrinsic costs, will likely become more prevalent.ObjectiveThe objective of this nonexperimental, postintervention study was to examine the perceptions of pharmacists attending a continuing education program. One group participated in the live presentation, whereas the second group joined via a simultaneous webcast.MethodsAfter the presentation, both groups were surveyed with identical questions concerning their perceptions of their learning environment, course content, and utility to their work. Comparisons across group responses to the summated scales were conducted through the use of Kruskal-Wallis tests.ResultsAnalysis of the data showed that both the distance and local groups were demographically similar and that both groups were satisfied with the presentation method, audio and visual quality, and both felt that they would be able to apply what they learned in their practice. However, the local group was significantly more satisfied with the learning experience.ConclusionsDistance learning does provide a viable and more flexible method for pharmacy professional development, but does not yet replace the traditional learning environment in all facets of learner preference.     

Hazard assessment of selenium and other trace elements in wild larval razorback sucker from the Green River, Utah

Contaminant investigations of the Green River in northeastern Utah have documented selenium contamination at sites receiving irrigation drainage. The Green River provides critical habitat for four endangered fishes including the largest extant riverine population of endangered razorback sucker. Although 2175 larval razorback suckers were collected from the river between 1992 and 1996, very few juveniles have been captured within recent decades. Selenium concentrations were measured in larval razorback suckers collected from five sites in the Green River (Cliff Creek, Stewart Lake Drain, Sportsman's Drain, Greasewood Corral, and Old Charlie Wash) to assess the potential for adverse effects on recruitment of larvae to the juvenile stage and the adult population. Larvae from all sites contained mean selenium concentrations ranging from 4.3 to 5.8 microg/g. These values were at or above the proposed toxic threshold of 4 microg/g for adverse biological effects in fish, which was derived from several laboratory and field studies with a wide range of fish species. At two sites, Cliff Creek and Stewart Lake Drain, selenium concentrations in larvae increased over time as fish grew, whereas selenium concentrations decreased as fish grew at Sportsman's Drain. Evaluation of a 279-larvae composite analyzed for 61 elements demonstrated that selenium and, to a lesser extent, vanadium were elevated to concentrations reported to be toxic to a wide range of fish species. Elevated selenium concentrations in larval razorback suckers from the five sites suggest that selenium contamination may be widespread in the Green River, and that survival and recruitment of larvae to the juvenile stage may be limited due to adverse biological effects. Selenium contamination may be adversely affecting the reproductive success and recruitment of endangered razorback sucker.     

Multimorbidity's research challenges and priorities from a clinical perspective: The case of ‘Mr Curran’

Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. Effective approaches are needed to manage such complex patients in primary care. This paper describes the results of a scoping exercise, including a two-day workshop with 17 professionals from six countries, experienced in general practice and primary care research as well as epidemiology, clinical pharmacology, gerontology and methodology. This was followed by a consensus process investigating the challenges and core questions for multimorbidity research in primary care from a clinical perspective and presents examples of the best research practice. Current approaches in measuring and clustering multimorbidity inform policy-makers and researchers, but research is needed to provide support in clinical decision making. Multimorbidity presents a complexity of conditions leading to individual patient's needs and demanding complex processes in clinical decision making. The identification of patterns presupposes the development of strategies on how to manage multimorbidity and polypharmacy. Interventions have to be complex and multifaceted, and their evaluation poses numerous methodological challenges in study design, outcome measurement and analysis. Overall, it can be seen that complexity is a main underlying theme. Moreover, flexible study designs, outcome parameters and evaluation strategies are needed to account for this complexity.     

Identification and Assessment of Public Health Surveillance Gaps under the IHR (2005)

Objective

To conceive and develop a model to identify gaps in public health surveillance performance and provide a toolset to assess interventions, cost, and return on investment (ROI).

Introduction

Under the revised International Health Regulations (IHR [2005]) one of the eight core capacities is public health surveillance. In May 2012, despite a concerted effort by the global community, the World Health Organization (WHO) reported out that a significant number of member states would not achieve targeted capacity in the IHR (2005) surveillance core capacity.Currently, there is no model to identify and measure these gaps in surveillance performance. Likewise, there is no toolset to assess interventions by cost and estimate the ROI.We developed a new conceptual framework that: (1) described the work practices to achieve effective and efficient public health surveillance; (2) could identify impediments or gaps in performance; and (3) will assist program managers in decision making.

Methods

Published articles and grey-literature reports, manuals and logic model examples were gathered through a literature review of PubMed, Web of Science, Google Scholar, and other databases. Logic models were conceived by categorizing discrete surveillance inputs, activities, outputs, and outcomes. Indicators were selected from authoritative sources or developed and then mapped to the logic model elements. These indicators will be weighted using the principle component analysis (PCA), a method for enhanced precision of statistical analysis. Finally, on the front end of the tool, indicators will graphically measure the surveillance gap expressed through the tool’s architecture and provide information using an integrated cost-impact analysis.

Results

We developed five public health surveillance logic models: for IHR (2005) compliance; event-based; indicator-based; syndromic; and predictive surveillance domains. The IHR (2005) domain focused on national-level functionality, and the others described the complexities of their specific surveillance work practices. Indicators were then mapped and linked to all logic model elements.

Conclusions

This new framework, intended for self-administration at the national and subnational levels, measured public health surveillance gaps in performance and provided cost and ROI information by intervention. The logic model framework and PCA methodology are tools that both describe work processes and define appropriate variables used for evaluation. However, both require real-world data. We recommend pilot testing and validation of this new framework. Once piloted, the framework could be adapted for the other IHR (2005) core capacities.     

Evaluation of the survival of bacterial contaminants in an inhalable insulin powder.

Survival and growth of three model test bacterial species (Pseudomonas fluorescens, Staphylococcus epidermidis and Bacillus subtilis), present in the air and/or in the human respiratory tract, were tested in inhalable insulin-lactose powder under optimal relative humidity and temperature conditions (RH = 96% and optimal growth temperature for each bacterium of 26-37 degrees C) as well as representative indoor conditions (RH = 43% and T = 20 degrees C). The bacteria survived from 12 h to 7 days depending on the bacterial species and the test condition. P. fluorescens vegetative cells had the lowest and B. subtilis spores the highest survival rate. It was found that insulin-lactose powder does not support bacterial growth and that higher bacterial survival rate was found under representative indoor conditions. Selected experiments were performed with B. subtilis by adding sterile saliva into insulin-lactose powder to represent a typical condition for inhaler use. Furthermore, two other powders were tested with B. subtilis: one representing an inert powder without any nutrients (glass beads) and the other representing a powder with optimal nutrients (tryptic soy broth powder). The data indicate that the survival rate of B. subtilis did not change after the saliva was added and that the survival in insulin-lactose powder was similar to that in inert powder but lower than in powder with optimal nutrients. These results suggest that bacterial growth on residual powder in the inhaler under patient use conditions is unlikely and therefore the concern for patient safety is remote.     

长鞭红景天化学成分的研究

长鞭红景天化学成分的研究彭江南，葛永潮，李晓晖（军事医学科学院放射医学研究所，北京１００８５０）红景天是滋补强壮药物，目前正引起人们极大的兴趣，现已有一些产品上市。我们曾对数种红景天的化学成分进行过研究［１～４］。长鞭红景天（Ｒｈｏｄｉｏｌａｆａｓｔ...     

Effect of a Nutrient Rich Foods consumer education program: results from the nutrition advice study

BackgroundThe Nutrient Rich Foods (NRF) approach to eating uses the NRF Index, a nutrient profiling metric to help consumers choose foods that contain more vitamins, minerals, and other nutrients per kilocalorie. Research is needed to test the efficacy of dietary guidance using nutrient profiling systems to rank foods.ObjectiveTo examine whether nutrition education and supporting materials would increase understanding of the NRF approach and improve food shopping, meal planning, consumption of nutrient-rich foods, and diet quality.DesignUnbalanced randomized controlled trial conducted in February to May 2009 with participants assigned to NRF education group (n=128) or control group receiving standard nutrition education (n=61).Participants/settingAdult primary food shoppers and preparers with at least one child in the household aged 3 to 17 years.InterventionGroup education session and support tools (pocket guide, shopping list, refrigerator magnet, weekly e-mail messages, and biweekly mailings).Main outcome measuresSurveys of knowledge, attitudes, and behaviors and two 24-hour telephone dietary recalls at baseline and after an 8-week intervention period.Statistical analysesExamined time-by-treatment interactions in outcome measures.ResultsCompared to controls, NRF participants increased meal planning (+24.2% vs ?4.9%; P<0.01), ability to identify nutrient-rich foods (+60.2% vs +24.6%; P<0.001), and use of shopping lists (+14.1% vs +3.3%; nonsignificant trend), and consumed more vegetables and fruits (P<0.05). NRF participants improved overall diet quality as shown by their scores on the Healthy Eating Index (P=0.04) and NRF scale scores (nonsignificant trend). Significant improvements were observed in Healthy Eating Index component scores for total fruit; whole fruit; whole grains; saturated fat; and energy from solid fats, alcohol, and added sugars.ConclusionsFindings of this study showed that a consumer education program increased participants' use of the NRF approach and improved diet quality. Larger and longer-term studies are needed to confirm the findings and better understand processes of change.     

Synthesized MR images: comparison with acquired images

Synthesized and directly acquired spin-echo images were compared in order to assess the validity of magnetic resonance (MR) image synthesis as a method enabling retrospective formation of images by interactive manipulation of scan parameters. Synthetic images subjectively compared favorably in both accuracy and precision with acquired images when formed for the same values of echo (TE) and repetition times (TR) and for interpolated and extrapolated values of both TE and TR. Plots of synthetic and acquired signals within the same pixel sectors quantitatively showed comparable values for several regions of interest in the brain. Percent error and noise-normalized differences between acquired and synthetic images were tested as a quantitative measure of accuracy. Percent error was consistently less than 5% for brain parenchyma, and synthetic signals were accurate to within four times the noise level at acquisition. The apparent signal-to-noise ratio of synthetic images was comparable, superior, or inferior to similar acquired images, depending on the values of TE and TR. Total acquisition time required for synthetic formation of images for arbitrary values of TE and TR was equivalent to that of a single direct acquisition with a TR of 2,500 msec.