Implementation of advanced radiotherapy technology to improve clinical outcomes in rural NSW.

PROBLEM: Availability of advanced radiotherapy technology to treat cancer is limited in regional Australia. At Central West Cancer Care Centre, the utilisation rate of intensity-modulated radiotherapy and volumetric modulated arc therapy was significantly lower compared to other NSW public health services. Stereotactic ablative body radiotherapy treatment was not available at Central West Cancer Care Centre. DESIGN: To increase the intensity-modulated radiotherapy/volumetric modulated arc therapy utilisation rate and to make stereotactic ablative body radiotherapy treatment available through quality improvement projects with multi-disciplinary collaboration. SETTING: Central West Cancer Care Centre is part of Western NSW Local health District. Central West Cancer Care Centre has two linear accelerators for delivering intensity-modulated radiotherapy, volumetric modulated arc therapy and stereotactic ablative body radiotherapy treatments, and a computed tomography simulator with 4D computed tomography capability. KEY MEASURES FOR IMPROVEMENT: Intensity-modulated radiotherapy/volumetric modulated arc therapy utilisation rate increases to > 65% Stereotactic ablative body radiotherapy available to Central West Cancer Care Centre patients STRATEGY FOR CHANGE: A multi-disciplinary active of team radiation oncologists, medical physics specialists and radiation therapists developed an implementation plan for each treatment technique. EFFECT OF CHANGE: There was a significant increase in use of advanced techniques. The impact on patients included the following: Fewer side effects and improved control of disease as the advanced techniques directed the dose to the tumour and reduced the radiation dose to organ at risk. Treatment completed sooner than conventional radiotherapy, as the required dose required fewer trips to the hospital. Rural and remote patients were not required to travel to a metropolitan centre to have stereotactic ablative body radiotherapy treatment. LESSONS LEARNT: Strong commitment from a trained team and a collaborative approach is important for the implementation of advanced technology in regional centres.

Zika Virus on YouTube: An Analysis of English-language Video Content by Source.

OBJECTIVES: The purpose of this study was to describe the source, length, number of views, and content of the most widely viewed Zika virus (ZIKV)-related YouTube videos. We hypothesized that ZIKV-related videos uploaded by different sources contained different content. METHODS: The 100 most viewed English ZIKV-related videos were manually coded and analyzed statistically. RESULTS: Among the 100 videos, there were 43 consumer-generated videos, 38 Internet-based news videos, 15 TV-based news videos, and 4 professional videos. Internet news sources captured over two-thirds of the total of 8 894 505 views. Compared with consumer-generated videos, Internet-based news videos were more likely to mention the impact of ZIKV on babies (odds ratio [OR], 6.25; 95% confidence interval [CI], 1.64 to 23.76), the number of cases in Latin America (OR, 5.63; 95% CI, 1.47 to 21.52); and ZIKV in Africa (OR, 2.56; 95% CI, 1.04 to 6.31). Compared with consumer-generated videos, TV-based news videos were more likely to express anxiety or fear of catching ZIKV (OR, 6.67; 95% CI, 1.36 to 32.70); to highlight fear of ZIKV among members of the public (OR, 7.45; 95% CI, 1.20 to 46.16); and to discuss avoiding pregnancy (OR, 3.88; 95% CI, 1.13 to 13.25). CONCLUSIONS: Public health agencies should establish a larger presence on YouTube to reach more people with evidence-based information about ZIKV.

Characteristics of medication advertisements found in US women's fashion magazines.

Background: Although prescriptions are dispensed at discretion of medical professionals, many pharmaceutical companies use direct-to-consumer (DTC) advertising to increase sales. Over-the-counter (OTC) medications are similarly marketed. Methods: We examined the content of advertisements in 38 issues of 9 popular US women's fashion magazines. We evaluated target audience, health condition, product availability, message appeal, target to females, and mention of potential side effects and benefits. Results: Sixty total medication advertisements were identified, 58.3% (95% CI: 45.8, 70.8) for prescription products. In magazines targeted to non-Hispanic Whites, >65% of advertisements were for OTC medications whereas 80% (95% CI: 66.7, 94.5) of advertisements found in Black/Latina magazines were for prescription medications. The rational appeal was used most commonly in non-Hispanic White magazines (75.9%; 95% CI: 60.3, 91.5). Emotional appeal was featured more often in prescription advertisements magazines (60.0; 95% CI:43.8, 76.2) compared to OTC (8.0; 95% CI: -2.6, 18.6). Conclusion: Although emotional appeal may be effective for selling medication to women, it often does not completely inform consumers of potential risks.

English language YouTube videos as a source of lead poisoning-related information: a cross-sectional study.

Exposure to lead is detrimental to children's development. YouTube is a form of social media through which people may learn about lead poisoning. The aim of this cross-sectional study was to analyze the variation in lead poisoning-related YouTube contents between different video sources. The 100 most viewed lead poisoning-related videos were manually coded, among which, 50 were consumer-generated, 19 were created by health care professionals, and 31 were news. The 100 videos had a total of more than 8.9 million views, with news videos accounting for 63% of those views. The odds of mentioning what lead poisoning is, how to remove lead, and specifically mentioning the danger in ages 1-5 because of rapid growth among videos created by health care professionals were 7.28 times (Odds ratio, OR = 7.28, 95% CI, 2.09, 25.37, p = 0.002); 6.83 times (OR = 6.83, 95% CI, 2.05, 22.75, p = 0.002) and 9.14 times (OR = 9.14, CI, 2.05, 40.70, p = 0.004) that of consumer-generated videos, respectively. In this study, professional videos had more accurate information regarding lead but their videos were less likely to be viewed compared to consumer-generated videos and news videos. If professional videos about lead poisoning can attract more viewers, more people would be better informed and could possibly influence policy agendas, thereby helping communities being affected by lead exposure.

Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria.

BACKGROUND AND OBJECTIVES: Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The objective of this study is to review the contribution of TBAs in the birthing process in Nigeria, and to examine barriers and opportunities for utilizing TBAs in improving maternal and child health outcomes in Nigeria. METHODS: A literature review of two major electronic databases was conducted using the PRISMA framework to identify English language studies conducted between 2006 and 2016. Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria. RESULTS: The value of TBAs has not been fully examined as few studies have aimed to examine its potential role in reducing maternal mortality with proper training. Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Specific areas of training for TBAs that were identified and recommended in review including: recognizing delivery complications, community support for TBA practices through policy, evaluation of TBA training programs and increasing collaboration between healthcare facilities and TBAs. Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities.

An Analysis of Electronic Cigarette and Cigarette Advertising in US Women's Magazines.

BACKGROUND: Traditional cigarette advertising has existed in the US for over 200 years. Studies suggest that advertising has an impact on the initiation and maintenance of smoking behaviors. In recent years, electronic cigarettes (e-cigarettes) emerged on the market as an alternative to the traditional tobacco cigarette. The purpose of this study was to describe advertisements in popular US magazines marketed to women for cigarettes and e-cigarettes. METHODS: This study involved analyzing 99 issues of 14 popular US magazines marketed to women. RESULTS: Compared to advertisements for traditional cigarettes, advertisements for e-cigarettes were more often found in magazines geared toward the 31-40-year-old audience (76.5% vs. 53.1%, P = 0.011) whereas traditional cigarette advertisements were nearly equally distributed among women 31-40 and ≥40 years. More than three-quarters of the e-cigarette advertisements presented in magazines aimed at the higher median income households compared to a balanced distribution by income for traditional cigarettes (P = 0.033). CONCLUSIONS: Future studies should focus on specific marketing tactics used to promote e-cigarette use as this product increases in popularity, especially among young women smokers.

An Analysis of Technology-Related Distracted Biking Behaviors and Helmet Use Among Cyclists in New York City.

Bicycling is becoming an increasingly utilized mode of transportation in New York City. Technology-related distracted bicycling and helmet use are behaviors that can impact bike safety. The aims of this study were twofold: (1) to determine rates and types of technology-related distracted behaviors among bicyclists in the borough of Manhattan in New York City; and (2) to assess the rate of bicycle helmet use among these cyclists. Bicyclists in five popular riding areas in Manhattan were observed for a total of 50 h using a digital video camera during summer months in 2014. Videos were coded and enumerated for the total number and gender of cyclists, type of bicycle, number wearing headphones/earbuds and/or using a mobile phone, and whether the cyclist was wearing a helmet. Almost 25,000 cyclists were observed across the five selected locations (n = 24,861). Riders were almost four times more likely not to wear a helmet on rental bikes as compared with non-rentals (Citi Bike(®) OR 3.8; 95% CI 2.5, 5.9: other rental OR 3.8; 95% CI 3.0, 4.9). Significantly increased odds of not wearing a helmet were observed for females relative to males (OR 1.4; 95% CI 1.1, 1.8) across varied times and locations. Overall, rates of technology-related distraction were low, with headphone use being most prevalent. Males were more likely to wear headphones/earbuds (OR 2.0; 95% CI 1.4, 2.9), as were cyclists on Citi Bikes relative to other rental bikes (OR 2.2; 95% CI 1.3, 3.6). Findings from this study contribute to the growing literature on distracted biking and helmet use among bike share program riders and other cyclists and can inform policymakers and program planners aiming to improve bicycle safety in urban settings.

Coverage of the Ebola Virus Disease Epidemic on YouTube.

OBJECTIVE: The recent Ebola virus disease (EVD) outbreak in 2014-2015 has been the largest and longest lasting to date. Media coverage about the outbreak has been extensive, but there are large gaps in our understanding of the ways in which widely accessed social media sites are used during times of public health crisis. The purpose of this study was to analyze widely viewed videos about EVD on the YouTube video-sharing site. METHODS: We coded the source, content, and characteristics of the 100 most widely viewed videos about EVD on YouTube. RESULTS: The videos included in the sample were viewed more than 73 million times. The death toll in West Africa was mentioned in nearly one-third of the videos. Over one-third of the videos mentioned how EVD was generally transmitted. There was little mention of treatment and no mention of the need for US funding of disaster preparedness; coordination between local, state, and federal governments; or beds ready for containment. No significant differences in the number of views were identified between video sources with the exception of a significantly higher number of views for "consumer videos" compared with "commercial television videos." CONCLUSIONS: With 1 billion unique users a month, YouTube has potential for both enhancing education and spreading misinformation.

An Advertisement and Article Analysis of Skin Products and Topics in Popular Women's Magazines: Implications for Skin Cancer Prevention.

BACKGROUND: In the United States, skin cancer is the most commonly diagnosed cancer, with an estimated 5 million people treated per year and annual medical treatment expenditures that exceed 8 billion dollars. The purpose of this study was two-fold: 1) to enumerate the number of advertisements for skin products with and without Sun Protection Factor (SPF) and to further analyze the specific advertisements for sunblock to determine if models, when present, depict sun safe behaviors and 2) to enumerate the number of articles related to the skin for content. Both aims include an assessment for differences in age and in magazines targeting a Black or Latina population. METHODS: The sample for this cross sectional study was comprised of 99 issues of 14 popular United States magazines marketed to women, four of which market to a Black or Latina audience. RESULTS: There were 6,142 advertisements, of which 1,215 (19.8%, 95% CI: 18.8-20.8%) were related to skin products. Among the skin product advertisements, 1,145 (93.8%, 95% CI: 93.9-96.3%) depicted skin products without SPF. The majority of skin articles (91.2%, 95% CI: 91.7-100.0%), skin product advertisements (89.9%, 95% CI: 88.2-91.6%), and sunblock advertisements featuring models (were found in magazines aimed at the older (>24 yr) audience. CONCLUSION: Future research on this topic could focus on the extent to which images in these magazines translate into risky health behaviors, such as sun seeking, or excessive other harmful effects of UV radiation.

Prevalence of infant formula advertisements in parenting magazines over a 5-year span.

UNLABELLED: Marketing of infant formula contributes to a decreased likelihood to breastfeed. This study established the prevalence of infant formula advertisements in two popular US parenting magazines and explored trends in infant formula advertisement prevalence from 2007 to 2012. METHODS: Advertisements were analyzed using a comprehensive coding schematic. RESULTS: We established a high proportion of 0.43 advertisements per page of content in both magazines and observed a significant increase in infant formula advertisement prevalence beginning in 2009. CONCLUSIONS: Infant formula companies use aggressive marketing in parenting magazines. Nurses who are well-trained in breastfeeding best practices can offer new mothers evidence-based information on the benefits of breastfeeding.

Advertising of toothpaste in parenting magazines.

We assessed advertisements for children's toothpaste in two widely read US parenting magazines. Data on the number and type of toothpaste advertisements in two parenting magazines were collected from 116 magazine issues between 2007 and 2011. The number of children's toothpaste advertisements per year and across magazines was computed. The amount of toothpaste presented in each advertisement was categorized. We noted whether the toothpaste advertisement stated that the toothpaste was fluoridated. We identified a total of 117 children's toothpaste advertisements in these magazines and confirmed that the majority of the magazine issues contained at least one toothpaste advertisement. Of the 31 advertisements that depicted a picture of a toothbrush with toothpaste, all but one (96.8 %) depicted a full swirl of toothpaste covering the entire toothbrush head, which is well over the recommended amount. The pictures on the advertisements show an excessive amount of toothpaste on the brush, which directly conflicts with the instructions on many toothpastes and dentist recommendations. Those advertisements with photographs that depict a toothbrush with a full brush head of toothpaste are showing over four times the recommended amount for children.

A comparison of the nutritional quality of food products advertised in grocery store circulars of high- versus low-income New York City zip codes.

Grocery stores can be an important resource for health and nutrition with the variety and economic value of foods offered. Weekly circulars are a means of promoting foods at a sale price. To date, little is known about the extent that nutritious foods are advertised and prominently placed in circulars. This study's aim was to compare the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). Circulars from grocery stores in the five highest and five lowest median household income NYC zip codes were analyzed. Nutrition information for food products was collected over a two-month period with a total of 805 products coded. The study found no significant difference between the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). In both groups, almost two-thirds of the products advertised were processed, one-quarter were high in carbohydrates, and few to no products were low-sodium, high-fiber, or reduced-, low- or zero fat. Through innovative partnerships with health professionals, grocery stores are increasingly implementing in-store and online health promotion strategies. Weekly circulars can be used as a means to regularly advertise and prominently place more healthful and seasonal foods at an affordable price, particularly for populations at higher risk for nutrition-related chronic disease.

Food advertisements in two popular U.S. parenting magazines: results of a five-year analysis.

Obesity rates among American youth have prompted an examination of food advertisements geared towards children. Research indicates children's high exposure to these advertisements and their influence on food preferences. Less is known about the presence of these advertisements in parenting magazines. This study's objective was to examine prevalence of food advertisements in popular parenting magazines and identify products by USDA food category. We analyzed 116 issues of two popular U.S. parenting magazines across five years. All food and beverage advertisements for USDA Food Category were coded. Breakfast cereals were coded for nutritional quality. The coding took place at varied libraries in New Jersey, in the United States. A total of 19,879 food and beverage products were analyzed. One-third of advertisements (32.5%) were for baked goods, snacks, and sweets -- products generally low in nutrient density. Two-thirds of the breakfast cereals were low in nutritional quality (64.6%). Beverages comprised 11% of the advertisements, fruit juices the highest proportion. Less than 3% of advertisements were for fruits and vegetables combined. No significant food product trends were evident across the five-year period. Food advertisements identified in parenting magazines were generally low in nutritional value. Additional research is necessary to determine the influence of food advertisements on parents' purchasing habits.