United Kingdom national media representations of medications used in dementia: a systematic content analysis

Introduction

Newspapers contribute to public understanding and perceptions of health-related issues (1,2). Examination of news media reporting to elucidate how the public conceptualise and understand medicines use in dementia has been limited to date.

Aim

To investigate communication to the public about medications used in dementia via newspaper articles.

Methods

A systematic content analysis explored communication in the 10 highest circulated UK newspapers about medications used in dementia, over a 10-year period from 2010 to 2019. LexisNexis UK was searched using terms relating to medications and treatment in dementia (both for dementia and for other co-morbid conditions), and articles relating to medicines use in dementia were identified for inclusion. A standardised coding frame was developed, piloted, and used to code all included articles across three domains: structure (bibliographic details); content (information within each article); and judgement and rating (subjective variable related to information presented, and scored from 0-10). Where an article was linked to a scientific journal article, this was retrieved, and the content cross-checked. A second researcher independently coded a random sample (10%) of articles. Level of intercoder agreement was determined by calculation of Cohen’s kappa value.

Results

One hundred articles satisfied the inclusion criteria. The newspapers which most frequently contained relevant articles were: the Daily Mail (n = 33) and the Daily Express (n = 30), followed by the Daily Mirror (n = 12), the Guardian (n = 11), the Mail on Sunday (n = 5), the Sunday Express (n = 3), the i (n = 3), the Metro (n = 1), the Daily Star (n = 1) and the People (n = 1). The largest numbers of articles were published in 2011 and 2012 (n=18) and the smallest number in 2019 (n = 4), with no apparent trend observed over the study period. Main article themes were: benefits and effectiveness, risk and harm, lack of diagnosis, and funding and potential future drug developments. Starting therapy early and continuing in later stages of dementia were reported to maintain function and independence and slow decline. Antipsychotics, sedatives and opioid analgesics were considered to worsen symptoms and increase risk of death. Lack of dementia diagnosis resulted in inability to obtain dementia medication when people needed and would benefit from it. Lack of funding was highlighted as a barrier to research. Most articles were written from a clinical perspective (n=82). Half had a negative slant, 46% had a positive slant and 4% were neutral. Almost half were judged to be excellent quality (45%), 35% were considered average and 20% were judged as poor quality. Cohen’s kappa values ranged from 0.63 to 1.00, indicating satisfactory agreement between coders.

Conclusion

There remains scope for improvement in quality of mass media communication regarding medications used in dementia.

Strengths of this study include the systematic approach employed in content analysis, while limitations include exclusion of the Sun, the Times and the Telegraph due to lack of availability of circulation figures, and exclusion of media sources other than newspapers.

References

(1) Akintola O, Lavis JN, Hoskins, R. Print media coverage of primary healthcare and related research evidence in South Africa. Health Res Policy Syst. 2015;13:68.

(2) Stanford FC, Tauqeer Z, Kyle TK. Media and its influence on obesity. Curr Obes Rep. 2018; 7(2):186–92.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Nutrient database improvement project: the influence of USDA quality and yield grade on the separable components and proximate composition of raw and cooked retail cuts from the beef chuck

This study was designed to provide updated information on the separable components, cooking yields, and proximate composition of retail cuts from the beef chuck. Additionally, the impact the United States Department of Agriculture (USDA) Quality and Yield Grade may have on such factors was investigated. Ultimately, these data will be used in the USDA - Nutrient Data Laboratory's (NDL) National Nutrient Database for Standard Reference (SR). To represent the current United States beef supply, seventy-two carcasses were selected from six regions of the country based on USDA Yield Grade, USDA Quality Grade, gender, and genetic type. Whole beef chuck primals from selected carcasses were shipped to three university laboratories for subsequent retail cut fabrication, raw and cooked cut dissection, and proximate analyses. The incorporation of these data into the SR will improve dietary education, product labeling, and other applications both domestically and abroad, thus emphasizing the importance of accurate and relevant beef nutrient data.

A team approach: implementing a model of care for preventing osteoporosis related fractures

The implementation of a multidisciplinary team-based model of care has led to significant increases in identification of patients with osteoporosis who are at risk of refracture, together with improved treatment uptake and ongoing management.

INTRODUCTION

Osteoporosis-related fractures and consequent hospital admissions are largely preventable; however, little attention has been paid to how to achieve this, in particular, through improved models of care. Presentation to emergency departments (ED) with minimal trauma fracture (MTF) provides opportunity for patients at risk to be identified, referred and managed through a systematic process ensuring prompt intervention and continuing follow-up. This study is aimed to design and implement a care model for people over 50 years of age, presenting to ED with an MTF.

METHOD

Established a multidisciplinary fracture prevention team to identify and capture at-risk patients for referral and management. Clinical data revealed the extent of lost opportunities. An electronic flagging system and data acquisition tool were developed and piloted. Established a referral pathway to detect, manage and follow-up patients, coordinated by a fracture prevention nurse.

RESULTS

Increased awareness of osteoporosis as a cause of MTF, better identification of at-risk patients across departments and services and development of a flagging and referral protocol has resulted in 100% capture of at-risk patients presented to ED. As a result there has been a significant increase in patients attending the fracture prevention clinic (FPC) (p < 0.001) from 11% in 2007 to 29% in 2008 and a significantly reduced time between fracture and when patients are seen in the FPC (p < 0.001).

CONCLUSION

A multipronged systematic team approach to identifying and capturing patients with a high risk of refracture and a dedicated nurse coordinator role has created efficiencies in the detection and management of osteoporosis.

Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants

OBJECTIVE

The aim of this study is to characterize baseline regional oxygen saturations (rSO(2)) in stable preterm infants during the first weeks of life.

STUDY DESIGN

Cerebral, renal and abdominal rSO(2) were continuously monitored from the time of birth to 21 days in twelve preterm infants of 29-34 weeks gestation. Regional saturations were evaluated for trends over time, variability and differences between gestational ages (GAs) and reported pediatric values.

RESULT

Both cerebral (66-83%) and renal (64-87%) rSO(2) baselines were within the range of reported neonatal values but consistently decreased over the first weeks of life (P<0.01). The baseline abdominal rSO(2) was 32-66% and increased with GA (P=0.05). The rSO(2) variability was lowest for cerebral measurements and highest at the abdomen. Abdominal rSO(2) variability decreased over time (P≤0.05).

CONCLUSION

Daily baseline rSO(2) in preterm infants changes over the first weeks of life, especially at the abdomen. Evolution in baseline rSO2 over time may indicate regional developmental maturation of physiological oxygen balance.

Euseiusfinlandicus (Acari: Phytoseiidae) as a potential biocontrol agent against Tetranychus urticae (Acari: Tetranychidae): life history and feeding habits on three different types of food

Life history and reproductive parameters of the generalist predatory mite Euseius (Amblyseius) finlandicus (Oudemans) were studied in the laboratory at 25 +/- 1 degrees C, with a 16L:8D photoperiod and 60 +/- 15% RH, to investigate its response to different food sources: an eriophyid mite Aceria sp., tulip pollen Tulipa gesnerana L., and two-spotted spider mite Tetranychus urticae Koch. Total developmental time of the immature stages was the shortest on eriophyid mites, followed by pollen, and then spider mites. Fecundity was highest on pollen (43.69 eggs; 1.63 eggs/female/day), then eriophyid mites (39.73 eggs; 1.37 eggs/female/day) and lowest on spider mites (18.16 eggs; 0.80 eggs/female/day). Intrinsic rate of increase (Rm), net reproductive rate (Ro) and finite rate of increase (lambda) followed the same pattern [pollen (0.168, 27.96 and 1.183, respectively), eriophyid mites (0.153, 20.81 and 1.167), spider mites (0.110, 9.44 and 1.119)]. Mean generation time (days) was the shortest on pollen (19.90), followed by eriophyid mites (20.02), and then spider mites (20.59). Average spider mite larvae consumed by E. finlandicus during immature stages were 9.18 for males and 11.85 for females. Adult E. finlandicus females consumed an average of 166.38 spider mite protonymphs during adult stage compared to an average of 66.55 by males. The number of prey protonymphs consumed per day by females was highest in the oviposition period, lower in the pre-oviposition period and the lowest in the post-oviposition period. The eriophyid mite as a prey recorded the shortest developmental time, while pollen as food recorded the highest oviposition rate in E. finlandicus. The potential of this predator as a biocontrol agent against T. urticae is discussed.

Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial

Conservative therapies for equinus in cerebral palsy may help to postpone calf surgery in younger children. This study reports a prospective randomised trial of intramuscular botulinum toxin A (BtA) as an alternative to serial casting in 20 children with a dynamic component to calf equinus. Outcome was assessed in the short term to show the effect of one treatment cycle. Assessments were by clinical examination, video gait analysis, and three-dimensional gait analysis. BtA was of efficacy similar to that of serial casting. Tone reduction in the BtA group allowed a more prolonged improvement in passive dorsiflexion, which may allow more opportunity for increase in muscle length. Gait analysis showed an improved mean ankle kinematic pattern in a subsection of both groups, which was maintained at 12 weeks in the BtA group, whereas the cast group relapsed. There were fewer side effects in the BtA group. Median time to reintervention was similar.

Evidence that plant varieties respond differently to NO2 pollution as indicated by resistance to insect herbivores

The effects of NO(2) pollution on the performance of aphids feeding on different bean varieties were investigated by fumigation experiments. The susceptibility of the different genotypes dramatically changed as the concentration of atmospheric pollutant was increased. The direction of change was not constant between varieties. Our data suggest that resistance or susceptibility of a plant variety to insect herbivory can be significantly altered when subjected to pollutant stress, thus indicating that it may be difficult to predict the susceptibility of host plants in a polluted atmosphere.

Understanding the Medicare Fee Schedule and its impact on physicians under the final rule

On January 1, 1992, the Medicare program unveiled a new method for paying physicians known as the Medicare Fee Schedule (MFS). The new fee schedule is a complex system of administrative pricing based on the resource inputs used in producing physician services. The MFS consists of three parts: 1) a Relative Value Scale, which assigns to each medical service a value relative to all other services; 2) a conversion factor, which converts the relative values into dollars; and 3) a geographic adjustment factor, which adjusts payments based on geographic differences in the cost of producing physician services. In this article, the following are addressed: how the relative values were determined; how the geographic adjustment factor was constructed; and how the conversion factor was calculated. In addition, balance billing limits and the Medicare Volume Performance Standards (MVPS) are described. Computer simulations of the impact of the MFS on payments to physicians are presented. The authors found that the MFS will 1) redistribute payments away from surgeons, radiologists, and other procedure-based specialties toward the primary care specialties; 2) redistribute payments away from urban areas toward rural areas; and 3) redistribute payments away from invasive procedures and diagnostic tests toward evaluation and management services. The authors conclude with a discussion of the future refinements of the MFS, its applicability to other payers, and whether it will accomplish its intended purposes.

Air pollution and agricultural aphid pests. II chamber filtration experiments

The responses of four major aphid pest species feeding on three major crops were studied in a series of experimental chambers on the roof of Imperial College in South Kensington, London. The experimental chambers were continually circulated with air which had been subjected to a variety of filtration treatments. In the first series of experiments there were three chambers subject to ambient air, charcoal-filtered air, and charcoal plus 'Purafil'-filtered air; in the subsequent experiments there were four chambers, a charcoal plus 'Purafil' plus charcoal treatment being added. These treatments provided a range of concentrations and mixtures of the ambient gases present at the site. The growth rate of aphids was measured both during filtration and post-filtration, the plants being exposed from sowing for either 42 or 84 days. In all cases there were significant effects on aphid performance which seemed to be most strongly linked to absolute and relative NO concentrations. The pattern of responses by the aphids accorded extremely well with those observed in closed-chamber fumigation experiments with stimulation of performance in relatively polluted air in all cases except Acyrthosiphon pisum (Harris) feeding on Vicia faba L. where the opposite effect was recorded.