Category Archives: Technology
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
University of Maryland Study Shows Need for Improved Communication by Dental Professionals
New research from the University of Maryland School of Public Health found that a majority of dentists and dental hygienists are not regularly using recommended communication techniques with their patients that can contribute to improved oral health literacy and prevention of oral disease. The researchers, who published their findings in the Journal of Dental Hygiene, surveyed 540 Maryland dental hygienists to determine the frequency of the use of 18 recommended communication techniques to effectively communicate science-based information to patients. Only one basic technique—use of simple language—was used by more than 90 percent of dental offices, according to survey responders. The survey also found that dental professionals who had taken a communication course in a non-dental educational setting were more likely to regularly use varying types of communication techniques. Read more on health literacy.
Study: Online Medical Searches Not a Good Idea for People Who Struggle With Uncertainty, Anxiety
People who struggle with uncertainty and anxiety might want to stay away from online health information searches, according to a new study in the journal Cyberpsychology, Behavior and Social Networking. The study, which included 512 healthy men and women with a mean age of about 33, analyzed how online searchers affected their anxiety, as well as their reactions to statements such as "I always want to know what the future has in store for me" and "I spend most of my time worrying about my health." "If I'm someone who doesn't like uncertainty, I may become more anxious, search further, monitor my body more, go to the doctor more frequently—and the more you search, the more you consider the possibilities," said Thomas Fergus, an assistant professor of psychology and neuroscience at Baylor University. "If I see a site about traumatic brain injuries and have difficulties tolerating uncertainty, I might be more likely to worry that's the cause of the bump on my head." These persistent worries can increase the likelihood of worrying about potential medical bills, disability and job loss, which in turn can lead to even more online searches, doctors visits, unnecessary medical tests and stress. Read more about technology.
Study: TV Drug Ads Are Often Misleading
A study on the veracity of television drug ads by researchers at Dartmouth and the University of Wisconsin-Madison found that six out of 10 claims could potentially mislead a viewer. The study was published in the Journal of General Internal Medicine. The researchers found misleading claims among television ads for both prescription and nonprescription drugs, and that some of the ads omitted or exaggerated information. The researchers studied the 6:30 to 7 p.m. portion of nightly news broadcast, which often contains drug ads, and reviewed 168 different drug advertisements that aired between 2008 and 2010. Trained researchers classified the ads as truthful, potentially misleading or false. The researchers found only one in ten claims were false, while six in ten were misleading and included errors such as leaving out important information, exaggerating information, providing opinions or making meaningless associations with lifestyles. Read more on prescription drugs.
Even Healthy Weight Adults with High Body Fat at Increased Risk of Heart Disease
Even older adults with healthy body weights can be at increased risk of cardiovascular diseases if they have high percentages of body fat, according to a new study The American Journal of Cardiology. "Just because someone has a normal BMI does not necessarily mean they are metabolically normal," said lead researcher Dr. John Batsis, a geriatrician at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. The study found that women with excess body fat (above 35 percent) were 57 percent more likely to die from heart-related causes within 11 years than were women with healthy body fat levels. Javier Salvador, MD, an endocrinologist at the University Clinic of Navarra in Pamplona, Spain, who was not involved in the study, said the findings demonstrate the limits of body mass index (BMI), which measures weight in relation to height. Read more on heart health.
‘Image Discrepancies’ of Job Roles Can Hurt Job Satisfaction, Performance and Pay
The lack of client understanding of the actual job roles of nurse practitioners and other professionals can negatively impact job satisfaction, performance and pay, according to a recent study in the Academy of Management Journal. "If people don't understand what you do, they tend to devalue what you do," study co-author Michael Pratt, a professor of management and organization at Boston College. "They don't understand why you're making all this money—'Why should I pay you all this money?' is a common question these professionals keep hearing." The study looked at “image discrepancies” in four professions—nurse practitioners, architects, litigation attorneys and certified public accountants—finding a noticeable and negative lack of understanding by clients for each. For example, many patients don’t realize that nurse practitioners can examine patients and prescribe medicine, and instead insist on seeing a doctor. "I assumed professionals would actually get over it, that there would be frustration, it would be an interpersonal problem, and that would be the extent of it," Pratt said. "I didn't think it would have such a big impact on how they did their job, how it affected their pay and how they performed. I was surprised at the depth of how this affected job performance. It's not simply annoying -- it has real impact.” Read more on mental health.
CDC Emphasizing Electronic Laboratory Reporting to Improve Public Health’s Response to Disease Outbreaks
The U.S. Centers for Disease Control and Prevention’s (CDC) emphasis on the widespread adoption of electronic laboratory reporting (ELR) has helped improve public health’s response to dangerous infections, according to data from CDC’s Morbidity and Mortality Weekly Report (MMWR). ELRs enable labs to report disease outbreak information quickly and in a usable format. The number of labs that utilize ELRs has more than doubled since 2005, and CDC has helped fund their increased use since 2010 in 57 state, local and territorial health departments. Current estimates are that about 62 percent of lab reports were received electronically. “Electronic laboratory reporting can give health officials better, more timely and complete information on emerging infections and outbreaks than they have ever received before,” said Robert Pinner, MD, associate director for surveillance, programs and informatics in CDC’s National Center for Emerging and Zoonotic Diseases. “Implementing these systems is a complex task that requires substantial investment, but ELR will provide health departments the tools they need to quickly identify and respond to disease threats and monitor disease trends now and in the future.” Read more on technology.
After years of deliberation, the U.S. Food and Drug Administration (FDA) has issued final guidance on the regulation of smartphone medical devices. In a nutshell, generally speaking any device used in diagnosis or treatment can’t be marketed until it’s approved by the FDA; other apps—such as calorie counters, or pedometers built into a phone—don’t need the FDA’s nod. The FDA’s criteria is how much risk an app poses for a consumer. The agency says it “intends to focus its regulatory oversight on a subset of mobile medical apps that present a greater risk to patients if they do not work as intended.”
Specifically, the FDA will focus its oversight on mobile medical apps that:
- Are intended to be used as an accessory to a regulated medical device—for example, an application that allows a health care professional to make a specific diagnosis by viewing a medical image from a picture archiving and communication system (PACS) on a smartphone or a mobile tablet.
- Transform a mobile platform into a regulated medical device—for example, an application that turns a smartphone into an electrocardiography (ECG) machine to detect abnormal heart rhythms or determine whether a patient is experiencing a heart attack.
“We have worked hard to strike the right balance, reviewing only the mobile apps that has the potential to harm consumers if they do not function properly,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “Our mobile medical app policy provides app developers with the clarity needed to support the continued development of these important products.”
While the final guidelines were only just released, FDA has cleared 100 mobile medical apps for marketing in the last few years, and 40 of those were just in the last two years.
Synim Rivers, an FDA spokesman, answered questions for NewPublicHealth about the final guidance on mobile medical apps.
Public health institutions across the country are joining the 10.5 million users on the virtual pinboard website, Pinterest, to share important health information and images. Topics such as women’s health, healthy living, emergency preparedness and public health history are a few of the boards on the CDCgov page. Harvard School of Public Health focuses more on healthy eating, recommended readings and inspirational quotes. Users are able to categorize topics and pictures anyway they want, allowing every institute’s page to be unique.
Users of the online scrapbook view content, “re-pin” photos to their pages, add comments to images and “like” user’s content. Pages encourage users to leave comments on the images that they like most or would like to see more of. Pinterest is the third-fastest growing social network, with 80 percent of users being women and 50 percent mothers, according to TechCrunch. The site is another way for public health professionals to stay at the center of the public health conversation and interact with their key audience on the most recent public health issues. The dissemination of information continues to grow as more people participate in the sorting, collecting and sharing of public health information.
Take a look at some of the other public health institutions that are joining Pinterest: American Public Health Association (APHA), Ohio State's College of Public Health and Association of Public Health Laboratories (APHL).
Confusing ‘Sell-by’ and ‘Best-before’ Labeling Leads to Billions of Pounds of Wasted Food
Inconsistent “sell-by” and “best-before” dates on package labels lead Americans to needlessly discard billions of pounds of food every year, according to a new study by Harvard Law School and the Natural Resources Defense Council. The labels are meant to inform retailers about a food product’s peak freshness. "The labeling system is aimed at helping consumers understand freshness, but it fails—they think it's about safety. And (consumers) are wasting money and wasting food because of this misunderstanding," said co-author Emily Broad Lieb, who led the report from the Harvard Law School's Food Law and Policy Clinic. The study recommends that “sell-by” dates be reconfigured so as to be invisible to consumers, that a uniform label system is created and that technology-based “smart labels” be used more often. "Under the current patchwork of state and federal laws, consumers are left in the lurch, forced to decipher the differences between 'sell-by' and 'best if used by,' and too often food is either thrown out prematurely, or families wind up consuming dangerous or spoiled food," said Congresswoman Nita Lowey (D-NY), in a release. Read more on food safety.
Study: Hospitals that Perform the Most Surgeries Also Have Lowest Readmission Rates
A new study from the New England Journal of Medicine indicates that the higher quality of care during a surgical procedure, the lower the likelihood of the patient being readmitted for additional surgery. It also found that hospitals that performed the most procedures also, on average, delivered a higher quality of care. In a review of about 480,000 patients discharged from more than 3,000 U.S. hospitals, the researchers found that one in seven were readmitted within 30 days, with the hospitals that did the most procedures having both the lowest readmission rates and the lowest death rates. Hospitals with the most surgeries had readmission rates of about 12.7 percent, compared to 16.8 percent for hospitals with the fewest procedures. "If hospitals performing very few surgeries do not have the volume required to create highly reliable care systems despite their best quality-improvement efforts, perhaps they should not be performing them," said Don Goldmann, MD, chief medical and scientific officer of the Institute for Healthcare Improvement in Boston, who was not involved in the study. "This is a provocative suggestion and deserves careful consideration before being implemented." Read more on access to health care.
HHS ‘Meaningful Consent’ Website to Help Providers, Patients Understands EHR Sharing
As electronic health records (EHRs) become more common, a new website from the U.S. Department of Health and Human Services (HHS) will help health care providers and patients determine exactly how they want their electronic patient health information shared. Meaningful Consent will address issues such as the laws and policies related to the health information exchange (HIE). It also includes strategies and tools for providers, certain health information organizations and other implementers of health information technology. The site also provides background, lessons learned, videos and customizable tools from the HHS Office of the National Coordinator for Health Information Technology’s eConsent pilot project, which tested the use of tablet computers to provide patients with better information on EHRs. Read more on technology.
EHRs Linked to Lower Rates of Hospitalization
The use of electronic health records (EHRs) is linked to lower rates of hospitalization, according to a new study in the Journal of the American Medical Association. Researchers tracked approximately 170,000 people treated for diabetes between 2005 and 2008, finding that changing from paper records to EHRs was associated with a decrease in hospitalizations of between 5 and 6 percent. There was no link to a change in the number of overall doctors’ office visits. The U.S. government has committed about $30 billion for the widespread implementation of EHRs. Rainu Kaushal, MD, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York, who was not involved in the study, said while the study shows that investment in EHRs is important, it is also just one piece of what needs to be done to improve overall care. "An EHR is a critical infrastructural tool to change the way in which healthcare is delivered, but it is one of a set of tools that needs to be employed," she said. "It's when you start getting those pieces together…that you really start finding some significant changes in utilization." Read more on technology.
FDA Proposes Stronger Safety Labels of Opioids
In response to the growing public health problem of opioid-related overdose and death, the U.S. Food and Drug Administration (FDA) is calling for stronger safety labeling for long-acting and extended-release opioids. New labeling will emphasize both the dangers of abuse and possible death—there were 16,651 in 2010, according to FDA—and the risk for women who are pregnant. "The FDA is invoking its authority to require safety labeling changes and postmarket studies to combat the misuse, abuse, addiction, overdose and death from these potent drugs that have harmed too many patients and devastated too many families and communities," said FDA Commissioner Margaret Hamburg in a release. “Today’s action demonstrates the FDA’s resolve to reduce the serious risks of long-acting and extended release opioids while still seeking to preserve appropriate access for those patients who rely on these medications to manage their pain.” Read more on prescription drugs.
IOM: Nation Faces Looming ‘Cancer Crisis’
An aging population, rising health care costs, the complexity of care and other issues are leading the United States toward a future cancer crisis, according to a new report from the Institute of Medicine (IOM). Current estimates predict as many as 2.3 million new cancer diagnoses per year by 2030, with the total cost of cancer care expected to climb to $173 billion by 2020. The report concluded that what’s needed is a shift toward patient-centered, evidence-focused care. "Most clinicians caring for cancer patients are trying to provide optimal care, but they're finding it increasingly difficult because of a range of barriers," said Patricia Ganz, chairwoman of the committee that wrote the report and a professor at the School of Medicine and School of Public Health at the University of California, Los Angeles. "As a nation, we need to chart a new course for cancer care. Changes are needed across the board, from how we communicate with patients to how we translate research into practice to how we coordinate care and measure its quality." Read more on cancer.
New York City is currently developing a pilot public health program known as NYC Macroscope — the first domestic effort to aggregate electronic health record (EHR) data into a surveillance tool to inform public health decisions. The population health surveillance system will compile electronic health records from primary care practices to help city health officials monitor—and respond to—the real-time prevalence of conditions that impact public health. The project is the result of a partnership between the New York City Health Department and the CUNY School of Public Health, with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, and additional support from the de Beaumont Foundation, Robin Hood and the New York State Health Foundation.
NewPublicHealth spoke with Carolyn Greene, MD, Deputy Commissioner of the NYC Department of Health and Mental Hygiene’s Division of Epidemiology, about the plans and goals for the program.
NewPublicHealth: Tell us about NYC Macroscope and how it will work.
Carolyn Greene: NYC Macroscope is going to be New York City’s first electronic health record surveillance system. We have a program here at the health department called Primary Care Information Project (PCIP), and it’s one of the nation’s largest distributed electronic health record networks. PCIP began in 2005. It concentrated on primary care practices in high need areas where the Health Department really wanted to encourage providers to use electronic health records. The program has been extremely successful and they’ve completed many different activities to improve the quality of clinical care.
But in recent years, we’ve been asking the question: Can we use electronic health records for more than just patient care? Can we, in fact, use electronic health records to monitor the health of the population? Here at the Health Department, we have many different ways to conduct population health surveillance. We have surveys that we conduct by telephone, we have disease registries that we host, and we have our vital statistics registry on deaths and births. All these data are very important. But they are costly, resource-intensive and they often have a time lag from when the data are collected to when we can actually find the results from the data, so the advantages of an electronic health record surveillance system are many.
One advantage is that the architecture is already there. If you already have the electronic health records in place, you don’t have to find additional resources to collect the data because you’re already collecting the data through the EHR architecture. Other advantages are that potentially you can collect data in real time and potentially at low cost.
NPH: Do you see any potential disadvantages?
Greene: I think the first one is we always have to ask how representative the data will be in terms of representing the population as a whole. First of all, electronic health records only collect data on people who are in care and, because sicker patients go to the doctor more frequently, there’s a greater likelihood that we may be picking up more information on sicker patients. So we have questions about how representative are the data.
Conflicts of Interest in Determination of Food Additive Safety
Who determines whether a food additive is safe? Often it’s people with ties to the food additive industry, according to a new conflict-of-interest study from The Pew Charitable Trusts in the journal JAMA Internal Medicine. From 1997 to 2012, about 20 percent of safety determinations submitted to the U.S. Food and Drug Administration were authored by employees of food additive manufacturers, and 13 percent were authored by someone working a consultant selected by the manufacturer. Researchers also found that the expert panels tasked with conducting most of the safety assessments rely on many of the same experts over and over again. "There's a cadre of 10 people that serve on almost all of these expert panels," said study author Thomas Neltner, director of Pew's food additives project. "Three-quarters of the panels contained at least one of these people. One person served on 44 percent of the panels, which tells us there's not only conflicts of interest, but there's a very small group of people making these decisions." Michael Jacobson, executive director of the Center for Science in the Public Interest, sees these results as a clear problem that needs to be addressed. "These committees give a very superficial, one-sided review," he said. "They want to please the sponsor, and then maybe they will get more business because they've proven themselves trustworthy, but it's no way to run a food safety review process." Read more on food safety.
CDC: 1 in 8 Preschoolers Obese, Raising their Risk for Adult Obesity
About one in eight—or 12 percent—of preschoolers are obese. However, after decades spent watching that number climb, nineteen states and territories are seeing drops in obesity among low-income preschoolers, according to the latest Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). Overweight and obese children are five times more likely to grow up to be obese adults, so early intervention by state and local health officials is critical. The report provides a number of ways they can help, including the creation of partnerships with community members to make community changes that promote healthy eating and active living, as well as making it easier for families with children to buy healthy, affordable foods and beverages in their neighborhoods. Read more on obesity.
Hospitals’ Exchange of Electronic Health Records Climbed 41 Percent from 2008 to 2012
Health information exchange (HIE) between hospitals and providers outside their organizations climbed 41 percent from 2008 to 2012, with six in 10 hospitals exchanging electronic health records (EHR) in 2012, according to a new study in the journal Health Affairs. The researchers say this illustrates how EHRs have become complementary tools that improve health care quality and safety. “We know that the exchange of health information is integral to the ongoing efforts to transform the nation’s health care system and we will continue to see that grow as more hospitals and other providers adopt and use health IT to improve patient health and care,” said Farzad Mostashari, MD, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. “Our new research is crystal clear: health information exchange is happening and it is growing. But we still have a long road ahead toward universal interoperability.” Read more on technology.