Personas in online health communities

Many researchers and practitioners use online health communities (OHCs) to influence health behavior and provide patients with social support. One of the biggest challenges in this approach, however, is the rate of attrition. OHCs face similar problems as other social media platforms where user migration happens unless tailored content and appropriate socialization is supported. To provide tailored support for each OHC user, we developed personas in OHCs illustrating users’ needs and requirements in OHC use. To develop OHC personas, we first interviewed 16 OHC users and administrators to qualitatively understand varying user needs in OHC. Based on their responses, we developed an online survey to systematically investigate OHC personas. We received 184 survey responses from OHC users, which informed their values and their OHC use patterns. We performed open coding analysis with the interview data and cluster analysis with the survey data and consolidated the analyses of the two datasets. Four personas emerged—Caretakers, Opportunists, Scientists, and Adventurers. The results inform users’ interaction behavior and attitude patterns with OHCs. We discuss implications for how these personas inform OHCs in delivering personalized informational and emotional support.     

Families’ control preference for participation in patient care in adult intensive care

ObjectiveUnderstand families’ preferences and observed participation in patient care in an adult ICU.Research methodologyThe mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients.SettingTwo public hospital intensive care units in Australia.Main outcome measures1) Families’ preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit.ResultsAlmost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%).ConclusionDifferences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.     

Get it right,make it easy,see it all: Viewpoints of autistic individuals and parents of autistic individuals about the autism diagnostic process in Australia

BackgroundThe clinical process for being evaluated for an autism diagnosis is often time consuming and stressful for individuals and their caregivers. While experience of and satisfaction with the diagnostic process has been reviewed in the literature, few studies have directly investigated the viewpoints of individuals diagnosed with autism and caregivers of autistic individuals about what is important in the autism diagnostic process.MethodA Q methodological design was employed to capture the subjective viewpoints about the diagnostic process of individuals on the autism spectrum and caregivers of autistic individuals. Thirty-eight participants responded to a set of 66 statements representing different aspects of the autism diagnostic process.ResultsThe analysis identified three significant viewpoints: Get it Right, Make it Easy, and See it All. Participants reflected upon the importance of a comprehensive diagnostic assessment process, ease of diagnostic processes, and a holistic approach to autism diagnosis for autistic individuals and caregivers of autistic individuals.ConclusionsThe findings provide a consumer perspective that encourages reform of the current process for diagnosing autism in Australia, and an insight into what consumers are wanting from diagnostic services. This information is useful for policy-makers and service providers to create a more supportive and client-centred diagnostic process at all levels of service delivery.     

The response to nutritional labels: Evidence from a quasi-experiment

This paper evaluates a UK policy that aimed to improve dietary information provision by introducing nutrition labelling on retailers’ store-brand products. Exploiting the differential timing of the introduction of Front-of-Pack nutrition labels as a quasi-experiment, our findings suggest that labelling led to a reduction in the quantity purchased of labelled store-brand foods, and an improvement in their nutritional composition. More specifically, we find that households reduced the total monthly calories from labelled store-brand foods by 588 kcal, saturated fats by 14 g, sugars by 7 g, and sodium by 0.8 mg.     

Opioid consumption in patients undergoing Roux-en-Y bariatric surgery compared with population controls with and without obesity

BackgroundPatients with obesity are prescribed more opioids than the general population.ObjectivesTo compare opioid consumption in patients with obesity who underwent Roux-en-Y bariatric surgery (RYGB) with population controls with and without obesity, not undergoing bariatric surgery, and to identify characteristics associated with opioid use.SettingThis study included all patients with a principal diagnosis of obesity, aged 18–72 years, with a RYGB surgical code in the Swedish Patient Register between 2007 and 2013.MethodsRYGB patients (n = 23,898) were age- and sex-matched with 1 control patient with obesity (n = 23,898) and 2 population controls without obesity (n = 46,064). Participants were classified as nonconsumers and consumers based on their opioid dispensations during the 12 months before baseline. Opioid consumption was assessed for 24 months.ResultsNonconsumers. Within 24 months, a significantly higher proportion of RYGB patients (16.6%) started using opioids compared with the controls with obesity (14.3%, P < .0001) and population controls (5.4%, P < .0001). RYGB patients and controls with obesity had higher median daily intake of opioid morphine equivalent (MEQ) (2.8 mg/d) than population controls (2.5 mg/d, P < .0001). Consumers. Within 24 months, the proportion of RYGB patients and controls with obesity that was using opioids were similar (53.1% and 53.4%), but higher compared to population controls (38.0%, P < .0001). The median daily opioid MEQ was higher among RYGB patients than in population controls (10.5 versus 7.8 mg/d, P < .0001). RYGB patients, overall, had higher incidence of bowel surgery and cholecystectomy compared with controls with obesity and population controls, leading to prolonged opioid use in this group. Opioid consumption in general was associated with chronic pain and psychiatric disorder, which were more common in patients with obesity than in the population controls.ConclusionRYGB surgery increased the risk of prolonged opioid use in patients with obesity who were nonconsumers before surgery but had no effect on overall opioid use among prior consumers. RYGB-associated complications requiring surgery influenced opioid use for both nonconsumers and consumers. Regular reassessments of pain mechanisms and specific treatment owing to type of pain could prevent unnecessary opioid use in this patient group.     

From incremental to fundamental substitution in chemical alternatives assessment

Several chemicals in consumer products are subject to binding or voluntary phase-out agreements that are based on international treaties such as the Stockholm Convention on Persistent Organic Pollutants or on regulatory frameworks such as the European Union's Registration, Evaluation, Authorization and Restriction of Chemicals (REACH). To facilitate a phase-out process, alternatives assessment is commonly applied as an emerging approach to identifying chemicals (or materials, processes, and behavior changes) serving as substitutes. Polybrominated diphenyl ethers (PBDEs), long-chain poly- and perfluorinated alkyl substances (PFASs), and polychlorinated biphenyls (PCBs) are well-known cases of chemicals where substitution processes can be studied. Currently, there are various challenges in assessing, evaluating and effectively introducing chemical alternatives. These challenges are mainly related to similarity in chemical structures and, hence, similar hazard profiles between phase-out and substitute chemicals, leading to a rather incremental than fundamental substitution. A hampered phase-out process, the lack of implementing Green Chemistry principles in chemicals design, and lack of Sustainable Chemistry aspects in industrial processes design constitute additional challenges. We illustrate the various challenges in the process of phasing out and successfully substituting hazardous chemicals in consumer products and provide guiding principles for addressing these challenges. We propose an integrated approach of all stakeholders involved toward more fundamental and function-based substitution by greener and more sustainable alternatives. Our recommendations finally constitute a starting point for identifying further research needs and for improving current alternatives assessment practice.     

The male menopause: lifestyle and sexuality

The existence of a variety of disturbing symptoms, sometimes loosely described as 'the male menopause', has received wide confirmation in both professional and lay literature over the last few years. Whilst there is no conclusive empirical evidence that the majority of men undergo a hormonal 'change of life' equivalent to that found in women, it has become clear that a significant number do experience psychological and social difficulties at some point in middle age. It has also become clear that in certain respects, these negative experiences resemble those typically associated with a traumatic menopause in middle-aged women. Amongst the various symptoms reported, one is of particular interest: the recurring expression of male sexual anxiety and/or dissatisfaction with sex-life. This paper draws upon a comparative analysis of professional and lay publications concerning the male menopause and menopause, which appeared in the U.K. and U.S.A. between approx. 1930-1983, to locate this expression of sexual anxiety in the context of a changing conception of middle age in the western world. The main focus is on the influence of contemporary models of sexualised lifestyle on sexual expectations and relations between the sexes during mid-life. Attention is also paid to the possible future implications of changing images of middle age for the diagnosis and treatment of the male menopause/climacteric or mid-life crisis.     

Risk assessment and management of new and existing chemicals

An evaluation was made of the recently developed risk assessment methodologies for new and existing chemicals in the European Communities. The evaluation also included the methodologies to prioritize chemicals and procedures for risk management, i.e., the (draft) guidance document for the development of strategies for risk reduction. The way in which chemicals are prioritized is accepted with only very few comments. Clear progress has been made in the development and harmonization of risk assessment methodologies and the application of estimation methodologies. Nevertheless, improvements are necessary for the estimation of consumer and occupational exposure, the derivation, use and transparency of assessment factors for chemicals and classes of chemicals based on the mode of toxic action, environmental exposure models and their validation and relation with monitoring data. As far as risk management is concerned it was recommended to improve the integration of the myriad of directives and regulations, to clarify definitions, to provide clear guidance on the determination and weighing of advantages and implications of risk reduction measures and to develop tools, including voluntary agreements, to speed up the slow chemical-by-chemical approach.