A digital divide in direct market farmers' online sales and marketing: Early pandemic evidence from California

The use of the internet for sales and marketing has been on an upward trend in the past decade. The early stages of the COVID-19 pandemic prompted an increase in direct market farmers' use of online sales and marketing. This paper analyzes California direct market farmers' use of online sales and marketing technologies during the first ten months of the pandemic to understand (1) how their use interacted with farmers' sales and profitability and (2) which direct market farmers were more likely to use them. Research on farmers' access to online sales and marketing technologies is important since consumers increasingly use the internet to buy or find information about products. The findings are based on 364 responses to an online survey administered in January–April 2021 and 13 follow-up interviews conducted in September 2021–August 2022. We used quantitative and qualitative analyses to answer the following questions: (1) How did the use of online sales and marketing technologies interact with direct market farmers' gross income and profitability between March–December 2020? (2) What barriers did direct market farmers face in accessing online sales and marketing technologies? And (3) What farm and farmer characteristics were most associated with using online sales and marketing technologies in 2020? Our findings show that, between March–December 2020, direct market farmers who had an online presence or added online sales after March 2020 were more likely to increase their sales and profitability than farmers who did not use online sales and marketing at all. However, farmers who used online sales at the start of 2020 and continued using it as a market channel were likely to increase their sales but not profitability. We argue that (1) using online sales and marketing technologies likely helped direct market farmers access markets during the pandemic, (2) there are barriers to accessing these technologies, and online sales may not be the right fit for all direct market farms, (3) many farmers need training and reliable internet to be able to navigate online technologies, and (4) more research is needed to understand how direct market farmers experience and navigate the trend toward market digitalization, and how this is related to already-existing inequalities among direct market farmers.

Some key aspects of telemedicine development to support human illness: a systematic review

The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.

Regenerative therapies for erectile dysfunction: the influence of direct-to-consumer marketing on patient interest.

Background: Despite a lack of evidence, a number of "regenerative" therapies have become popularized treatments for erectile dysfunction (ED). Platelet-rich plasma (PRP) injections and shockwave therapy have received significant attention through direct-to-consumer marketing and are advertised as viable alternatives to guideline-backed therapies. Additionally, focused low-intensity shock wave therapy (LiSWT) has become conflated with acoustic or radial wave therapy (rWT), although their mechanism of wave generation and tissue penetration is distinct. GAINSWave, a marketing platform for acoustic wave therapy, has also pervaded the marketplace. We aim to evaluate the relative impact of direct-to-consumer marketing of shockwave therapy and PRP by analyzing the quantity of Google internet search queries for selected regenerative and guideline-backed non-regenerative therapies for ED. Methods: National Google Search trends in the United States (www.google.com/trends) were analyzed to characterize interest in different forms of therapy for ED. Search trends for PRP, LiSWT (and various iterations), intracavernosal injections (ICI), intraurethral injections (IU), vacuum erectile device (VED), and GAINSWave were analyzed. Monthly search data were compiled over multiple years, ending at 2/28/2020, just before the COVID-19 pandemic and state of emergency in the United States. Macro-level changes in public interest were quantified using yearly averages. Results: Patterns in Google Search interest in PRP and LiSWT increased respectively by 3-fold and 275-fold over the decade, representing a larger share of Google Searches by 2020. Trends in Google Search interest in selected types of shockwave therapy for ED also show that queries for GAINSWave commanded public interest, increasing by 219-fold from 2016 to 2020. Conclusions: Regenerative therapies for ED have produced interest surpassing other adjunct guideline-backed therapies, despite receiving the designation of "experimental" or "investigational" therapies. The establishment of GAINSWave also constitutes an inflection point for the whole shockwave market: searches for shockwave therapy increased by 782% between 2016 and 2020. Direct-to-consumer marketing of PRP and shockwave therapy has upturned the customary role of physicians in counseling patients about evidence-based therapies for ED. This increase in public interest in GAINSWave emphasizes its success as a marketing platform. The urological community should consider strategies to address misinformation, such as search-engine optimization, social media, and educational outreach.

Innovations in infectious disease testing: Leveraging COVID-19 pandemic technologies for the future.

Innovations in infectious disease testing have improved our abilities to detect and understand the microbial world. The 2019 novel coronavirus infectious disease (COVID-19) pandemic introduced new innovations including non-prescription "over the counter" infectious disease tests, mass spectrometry-based detection of COVID-19 host response, and the implementation of artificial intelligence (AI) and machine learning (ML) to identify individuals infected by the severe acute respiratory syndrome - coronavirus - 2 (SARS-CoV-2). As the world recovers from the COVID-19 pandemic; these innovative solutions will give rise to a new era of infectious disease tests extending beyond the detection of SARS-CoV-2. To this end, the purpose of this review is to summarize current trends in infectious disease testing and discuss innovative applications specifically in the areas of POC testing, MS, molecular diagnostics, sample types, and AI/ML.

Direct-to-consumer laboratory testing (DTCT): challenges and implications for specialists in laboratory medicine.

In vitro diagnostics (IVD) testing is a powerful tool for medical diagnosis, and patients' safety is guaranteed by a complex system of personnel qualification of the specialist in laboratory medicine, of process control, and legal restrictions in healthcare, most of them under national regulation. Direct-to-consumer laboratory testing (DTCT) is testing ordered by the consumer and performed either by the consumer at home or analysis of self-collected samples in a laboratory. However, since DTCT are not always subject to effective competent authority oversight, DTCT may pose risks to lay persons using and relying on it for healthcare decision-making. Laboratory medicine specialists should be very cautious when new DTCTs are introduced. As qualified professionals, they should feel obliged to warn and educate patients and the public about the risks of inappropriate and harmful DTCT.

Direct-to-Consumer Academic Telemedicine.

Over the past 2 years, telemedicine has skyrocketed as COVID-19 propelled innovation and implementation at unparalleled rates. Within the UC Davis academic health system, a new paradigm for telemedicine emerged: direct-to-consumer telemedicine. The video-based telemedicine program has become the largest of its kind in California and is staffed by 80 providers (MDs, APPs) across five clinical departments/groups (primary care practice group, family and community medicine department, emergency medicine department, the nursing department, and the physical medicine and rehabilitation department). September 2021 marked the 1-year anniversary of a journey that has opened access, improved coordination, and become a workforce engine for our evolving virtual health infrastructure.

Direct-to-consumer testing - benefits for consumers, people with disease and public health.

Direct-to-consumer (DTC) tests can be defined as any in-vitro diagnostic (IVD) test or, more broadly, any medical test using an IVD or medical device, that is marketed directly to consumers without involvement of a health care provider (HCP). Examples are pregnancy tests, alcohol breath tests, blood pressure measurements (medical device), coagulation tests (INR), self-monitoring of blood glucose, continuous glucose monitoring (medical device), HIV tests, HPV tests, SARS-CoV-2 antigen tests, or genetic tests. DTC tests fulfil various customer needs such as making rapid decisions (e.g. glucose monitoring for insulin dosing, SARS-CoV-2 antigen test, hormone test identifying fertile days, alcohol test), monitoring chronic conditions between consultations (e.g. diabetes, lipidaemia, hypertension), saving time and reducing consultations (e.g. INR, SARS-CoV-2 antigen test, blood pressure monitoring), screening for disease when no symptoms are present (e.g. occult blood, cholesterol, triglycerides, SARS-CoV2 antigen test), or maintaining privacy (e.g. pregnancy test, HIV test, HPV test, certain genetic tests). Further, DTC tests can reduce cost and expand access to care in countries with limited resources and can support healthcare systems in extraordinary circumstances such as a pandemic. Valid concerns about DTC testing need to be described, addressed and resolved with the help of authorities and regulators in collaboration with HCP and should not detract from the advantages DTC tests can provide. HCP should play a more prominent role in educating the public through mass media and social media on the proper use of DTC tests and help to pinpoint problem areas.

Urgent Care Through Telehealth.

Urgent care as a distinct clinical care entity began in the 1970s to treat low-acuity conditions. Virtual urgent care (VUC) can be provided by the primary care physician (PCP) or home health system of the patient, and many commercial direct-to-consumer (DTC) companies have emerged to provide this service. Quality of care continues to be evaluated, but some studies suggest that DTC providers prescribe antibiotics at a higher rate than PCPs. VUC has been proposed to improve equity and access to care, but early evidence is mixed. New utilization owing to convenience may lead to overall higher health care costs.

Daily Rapid Antigen Exit Testing to Tailor University COVID-19 Isolation Policy.

We evaluated daily rapid antigen test (RAT) data from 323 COVID-19-positive university students in Connecticut, USA, during an Omicron-dominant period. Day 5 positivity was 47% for twice-weekly screeners and 26%-28% for less-frequent screeners, approximately halving each subsequent day. Testing negative >10 days before diagnosis (event time ratio (ETR) 0.85 [95% CI 0.75-0.96]) and prior infection >90 days (ETR 0.50 [95% CI 0.33-0.76]) were significantly associated with shorter RAT positivity duration. Symptoms before or at diagnosis (ETR 1.13 [95% CI 1.02-1.25]) and receipt of 3 vaccine doses (ETR 1.20 [95% CI 1.04-1.39]) were significantly associated with prolonged positivity. Exit RATs enabled 53%-74% of students to leave isolation early when they began isolation at the time of the first positive test, but 15%-22% remained positive beyond the recommended isolation period. Factors associated with RAT positivity duration should be further explored to determine relationships with infection duration.

Universal Coronavirus Testing to Control the Pandemic: Ethical Issues and Dilemmas

Every country had to make several difficult decisions in the initial phase of the Coronavirus (COVID-19) pandemic to allocate resources for COVID testing. Decisions on who should be tested for COVID-19 testing are extremely vital for pandemic preparedness. In this article, we highlight the need for prioritization of testing resources including direct-to-consumer testing methods, ethical dilemmas involved in obligatory testing, and testing of refugees and immigrants.

Misleading Advertising of Health-Related Products in Ecuador during the COVID-19 Pandemic.

Background Media coverage of the COVID-19 pandemic increased tuning ratings during this time. The aim of this study was to identify misleading advertising of health-related products on Ecuadorian television during the COVID-19 pandemic. Methods Television channels were monitored for 111 h in the months of June and October 2020. Verbal, nonverbal and context content were analyzed from each advertising spot according to ethical standards for the promotion of products for human health Results A total of 667 spots were analyzed. Most, 90%, involved misleading advertising of health-related products. Products for gastrointestinal conditions were the most publicized (17.8%) during the period analyzed. Newscasts most often advertised products intended to improve sexual potency (22.9%) and to a lesser degree those intended to prevent and treat respiratory problems (1.8%); this relationship was reversed when compared to general programming (p < 0.05). Conclusions Most of the health-related products advertised on Ecuadorian television are advertised misleadingly, with news programs having the highest number of such advertisements per hour of programming.

Farm resilience during the COVID-19 pandemic: The case of California direct market farmers.

CONTEXT: The COVID-19 pandemic caused significant shocks to U.S. food systems at multiple scales. While disturbances to long-distance supply chains received substantial attention in national media, local supply chains experienced mixed impacts. As broad closures of schools, restaurants, and other businesses sourcing from local farmers removed key marketing channels for many direct market farmers, consumer interest in Community Supported Agriculture (CSA), farmers markets, and on-farm and online direct farm sales increased. OBJECTIVE: In this paper, we examine the resilience and vulnerability of farmers during the March 2020 through December 2020 period of the COVID-19 pandemic. We focus on California farmers and ranchers engaged in direct market sales. METHODS: Through a widely disseminated survey, we collected responses from 364 farmers and used these data to answer the following questions about direct market farmers in California: 1) What were direct market farmers' experiences of the pandemic from March 2020 through December 2020? 2) Which factors (e.g., relationships, institutions, market channels) did farmers report enhanced their resilience during the pandemic? 3) Which individual and operational factors were significantly associated with resilience during the pandemic? And finally, 4) how do the farmer-reported factors compare to the statistically significant factors associated with resilience? We created three dependent variables-ability to respond to the pandemic, concern about pandemic impacts, and change in profitability-to operationalize several aspects of resilience and examine their association with individual and operational characteristics through a series of ordered logistic regression models. RESULTS AND CONCLUSIONS: Across both the quantitative models and the farmer reported factors, we found that farmers who increased their use of online sales and marketing during the first year of the pandemic, had larger-scale farms, and had more on-farm crop and livestock diversity were more resilient to the shocks of the pandemic. We also found that greater use of non-direct-to-consumer market channels was associated with less resilience. The characteristics of the farming operations played a relatively larger role in predicting resilience compared to the individual characteristics of the farmers surveyed. SIGNIFICANCE: This study gives a detailed picture of how California direct market farmers fared during the pandemic and the characteristics associated with greater resilience. As short and long-term disruptions become increasingly common in agriculture, policies and programs can leverage support to direct market farmers, particularly direct-to-consumer farmers, as a strategy to strengthen farmer resilience.

Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients.

Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This "perspective" paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations' access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the "solution to everything". In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial "Direct-To-Consumer" services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to "capabilities" supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing "public health value" through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups.

Examining the perceived transparency of DTC genetic testing company communication and its impact on consumer trust, attitude and behavioral intentions

Purpose>This study examines perceived transparency of direct-to-consumer (DTC) genetic testing communication and measures its impact on consumers' trust, attitudes, and the intention to recommend the test to others.Design/methodology/approach>An online survey of US–based adults (over 18 years of age) (N = 271) was administered by the online panel company Qualtrics Panels. The sample consisted of participants who have taken a DTC genetic test previously because only existing consumers could provide insight into companies' transparency about the entire genetic testing process (including the communication before, during, and after) as they experienced it. Participants were asked questions that measured intention to recommend DTC genetic tests to others, trust, attitude toward the DTC testing, and perceptions of transparency of the DTC companies' communication.Findings>Results indicated that consumers who perceive DTC genetic testing companies to be transparent in their communication tend to trust the genetic testing process more, have more positive attitudes toward DTC genetic tests, and are more likely to recommend the tests to others.Research limitations/implications>This study integrates corporate communication and science communication through the theoretical framework of transparency. It empirically demonstrates that message transparency is key to increasing the publics' trust, attitude and behavioral intentions toward companies that involve sensitive health information or online privacy.Originality/value>This paper answers previous calls to explore the organizational approach of science communication in the context of the under-examined companies in the science and health sectors, specifically the DTC genetic testing industry.

A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada)

The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information;(2) professional and organizational issues;(3) quality of services and patient satisfaction;(4) cost, remuneration, and funding;(5) technology and infrastructure;(6) the emergence of private telehealth platforms in a public HSSS;(7) digital divide and equity;and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges. © Copyright © 2021 Alami, Lehoux, Attieh, Fortin, Fleet, Niang, Offredo, Rouquet, Ag Ahmed and Ly.

Rapid expansion of direct-to-consumer telemental health during the COVID-19 pandemic: A case series

Background: The coronavirus disease 2019 (COVID-19) pandemic brought many challenges to patient care delivery. The need for social distancing and relaxing of federal and state telemental health regulations paved the way for widespread adoption of direct-to-consumer (DTC) ambulatory mental health video visits. Methods: We present cases that demonstrate the use of video visits across 6 clinical areas, each serving a unique population of patients, in a large behavioral health system. The benefits and limitations of this modality are illustrated in children, adults, and older adults with mood disorders, anxiety disorders, intellectual disability, substance use disorders, neurocognitive disorders, and schizophrenia. Results: Although telephone visits were acceptable and necessary to serve some patients, there are many advantages to video visits in providing best patient care. Education and support for telemental health-delivered to both patients and clinicians-is critical to the success of the DTC model. Conclusions: DTC telemental health is a widespread clinical tool used during the COVID-19 pandemic. Because this model has many strengths and advantages compared with traditional telemental health delivered in a clinic, regulators and insurers should be open to its continued use post-pandemic when clinically appropriate. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Advertising in Location-Based Games: An Exploration in Pokémon GO

Location-based advertising (LBA), such as billboards and signage, has long been a direct-to-consumer advertising staple. As locative media such as Location-Based Games (LBG) begins to rise in prominence, digital LDA becomes increasingly appealing. In this paper, we explore the impacts of LBA on small businesses in the LBG Pokémon GO, a lacuna in the literature. We gather participant experience through a collection of 35 semi-structured interviews with businesses leveraging Niantic's sponsored location LBA. These testimonies indicate (1) participant businesses found LBG advertising to be satisfactory, (2) LBG advertising improves brand recognizability for local commerce, and (3) local community is an important factor for success in LBG advertising. These findings indicate future patterns for integrating local businesses into LBG like Pokémon GO, suggesting potential for LBG advertising to assist local businesses. © 2022 ACM.

Online seminars as an information source for direct-to-consumer stem cell therapy.

Aim: To attend stem cell (SC) seminars hosted by US-based direct-to-consumer SC businesses either in person or via online 'webinars' to determine accuracy and regulatory oversight of the advertised SC therapies. Methods: The therapeutic claims, costs, risks, scientific evidence in support of a therapy and any regulatory oversight were collated using pre-established checklists. Participation consisted of one live attendance of a seminar, and following COVID-19 restrictions, review of seven recorded presentations available on the internet from SC businesses. Results & conclusion: None of the SC therapies advertised by direct-to-consumer clinics reviewed were supported by proper clinical evidence nor substantiated by peer reviewed literature.

Impact of COVID-19 on Pennsylvania farm revenue: Looking back at the 2020 season

Initial forecasts predicted severe financial losses for small and midsized farmers as the COVID-19 pandemic disrupted usual market channels nationwide. Early reports both confirmed and challenged these fears, as some farmers could not find new markets while others established or expanded their direct-to-consumer sales to replace their lost outlets. To understand the impact of the pandemic on Pennsylvania farmers across the entire 2020 growing season, Chatham University and Pasa Sustainable Agriculture(1) surveyed farmers and performed interviews with a subset of these farmers. The anonymous survey was distributed by Pennsylvania-based farm organizations to their constituents, predominantly through email. Just under half the farmers (42%) reported a loss of revenue, while over half (58%) reported either no change or an increase in revenue in 2020. The scale of these changes varied greatly. We also found that vegetable farmers fared slightly better than livestock/eggs/dairy farmers;those with a higher pre-COVID revenue did better than those with a lower pre-COVID revenue;and farms that were able to increase direct-to-consumer sales maintained or increased their total revenues. Participation in state and federal relief programs varied and appeared to have no significant effect on farmers' final 2020 revenue. Farmers' responses to the open-ended survey questions demonstrated that the weather, a lack of infrastructure to support small and midsized producers, and consumers' lack of support for a regional food system were major challenges before COVID. Without meaningful policy changes, these challenges will persist beyond the pandemic's resolution.

Novel methods for an interesting time: Exploring U.S. local food systems' impacts and initiatives to respond to COVID.

The COVID-19 pandemic and associated public health and social distancing mandates caused unprecedented shifts and disruptions for local and regional food systems (LRFS). The pandemic also brought new and heightened attention to the structure and resiliency of US food systems, and LRFS appeared to be positioned to significantly increase the scope and scale of their market reach as a result. Researchers from three universities collaborated with staff from the U.S. Department of Agriculture's Agricultural Marketing Service to recruit leaders from sixteen key coalitions within the U.S. LRFS sector to frame an adaptive, community-driven set of applied research activities to understand important themes, learn from effective responses and gain insights into how local and regional supply chains may change post-pandemic. In this paper, we summarise urgent and emergent strategies and innovations from LRFS captured in a fall 2020 consumer survey, with additional insights on how the survey was framed and interpreted, considering synthesis of collaborative discussions and project team interactions. We conclude the article with a set of research, policy and technical assistance priorities that were identified and validated by this LRFS network.