A Physician's Perspective on the Incorporation of Pictograms as a Supplement to Medical Instructions in Chile: A Pilot Study

Introduction and objectivesCurrent models of health care are progressively migrating to more participatory models, where for treatment to achieve results that last over time, there must be effective communication between the patient, his or her caregivers, and health professionals. Although the use of pictograms in the context of medical instructions has been widely studied, in our country, there are no studies about their usefulness, or which set of symbols should be used by the systems. This work aims to present the first step towards the development of platforms that automatically suggest pictograms to supplement medical instructions for primary care settings in Chile.Materials and methodsIn this pilot study, we collected and analyzed the physicians' opinions on the selection of medical instructions that later will automatically be supplemented by the software that is under construction. We designed an expert validation survey using a set of 66 medical instructions with pictograms. This survey provided three rating options for each medical instruction: Not necessary (supplementing the instruction with a pictogram does not carry any value), Useful (supplementing the instruction with a pictogram may help patients to understand and remember the instruction), and Essential (supplementing the instruction with a pictogram is essential). Seventy-one physicians responded to the survey.Results22 out of 66 medical instructions were considered “essential” by >=51% of the experts, and 12 of the 66 were considered to be “useful but not essential” by >=51% of the experts.ConclusionResults of our survey validate the potential use of pictograms as a complement to better comprehension of medical instructions in our country.     

Nutrigenomics-based personalised nutritional advice: in search of a business model?

Nutritional advice has mainly focused on population-level recommendations. Recent developments in nutrition, communication, and marketing sciences have enabled potential deviations from this dominant business model in the direction of personalisation of nutrition advice. Such personalisation efforts can take on many forms, but these have in common that they can only be effective if they are supported by a viable business model. The present paper takes an inventory of approaches to personalised nutrition currently available in the market place as its starting point to arrive at an identification of their underlying business models. This analysis is presented as a unifying framework against which the potential of nutrigenomics-based personalised advice can be assessed. It has uncovered nine archetypical approaches to personalised nutrition advice in terms of their dominant underlying business models. Differentiating features among such business models are the type of information that is used as a basis for personalisation, the definition of the target group, the communication channels that are being adopted, and the partnerships that are built as a part of the business model. Future research should explore the consumer responses to the diversity of “archetypical” business models for personalised nutrition advice as a source of market information on which the delivery of nutrigenomics-based personalised nutrition advice may further build.     

Transparent communication strategy on GMOs: Will it change public opinion?

Innovations are central for the economic growth; however, the use of new technologies needs to be widely accepted in the general public and the society as a whole. Biotechnology in general, and the use of genetic engineering in food production in particular are seen critically by the European public and perceived as "risky", and a transatlantic divide between European and US citizens has been observed. This review investigates the reasons for those differing perceptions and proposes new strategies to communicate the benefits of biotechnology in agriculture to a broader public. When analyzing the dialogue process that has taken place between public, scientists, governmental organizations and industry, questions arise on what has been done differently in Europe, in order to propose new, more successful and efficient communication strategies for the future.     

Requirements on bacterial polyesters as future substitute for conventional plastics for consumer goods

Bacterial polyesters such as polyhydroxybutyrate (PHB) or polyhydroxyalkanoates (PHAs) have to pass the following requirements to be accepted on a large scale: (i) they have to fulfil an urgent market need: (ii) they require that new and efficient composting systems are installed in urban areas; (iii) they have to complete with the present plastics as far as quality and processing performance are concerned; (iv) they have to meet the requirement for the registration as food packages; and (v) they have to meet competitive price limits. (i) Some 30% of the plastics in the municipal waste originates from goods which are less than 1 year in use and tend to be heavily soiled by food and feed residues. This part is difficult and expensive to dispose of. Biodegradable alternatives could replace a large part of it. The waste could be diverted from landfills and incineration to composting sites near the end user. The savings in costs and frustrations are the source of a pressing demand for biopolymers, especially for producing goods which do not demand longevity and which are likely to end up soiled with organic matters. (ii) Composting infrastructures exist in rural areas. In urban areas new systems for collecting and composting ‘garden and kitchen wastes’ are being installed for reducing landfill problems, especially in Austria, Denmark, Germany and the Netherlands. These installations give biopolymers a competitive edge in the disposal discussion. (iii) Bacterial polyesters meet various quality and processing performances. They are water-resistant, and goods made of the polyesters are water-tight. The material can be processed by injection and by blow moulding. However, the esters are not flexible enough for forming films or foils. They also tend to become brittle and to lose their vapour barrier properties. It is expected that these limits will be overcome by improving blend formulations. (iv) Bacterial polyesters are not yet allowed for use as food package material. Since the esters represent a novel product, the procedure for the registration poses serious, but no insoluble problems. They require long and costly tests. There are no indications that bacterial polyesters would not attain the requirements. However, they are not expected to serve as food packages in the near future. (v) The present prices for bacterial polyesters are far too high to be accepted on a large scale by the processing and packaging industry. Costs are high mainly because of the raw material prices and to the small-scale production units. They can be lowered to accepted levels by investing in larger units in countries where inexpensive raw materials are available. Thus they will be able to meet the price limits. Since bacterial polyesters increasingly meet the requirements for the penetration of a mass market and since more and more consumers accept composting as an environmentally sound way of recycling organic materials, the polyesters are expected to penetrate a significant part of the short-lived and contaminated plastic products markets by the turn of the century.     

The relationship between lay and technical views of Escherichia coli O157 risk

Here, we bring together and contrast lay (accessible primarily through social science methodologies) and technical (via risk assessment and epidemiological techniques) views of the risk associated with the Escherichia coli O157 pathogen using two case study areas in the Grampian region of Scotland, and North Wales. Epidemiological risk factors of contact with farm animals, visiting farms or farm fields and having a private water supply were associated with postcode districts of higher than average disease incidence in the human population. However, this was not the case for the epidemiological risk factor of consumption of beef burgers, which was independent of disease incidence in the postcode district of residence. The proportion of the population expressing a high knowledge of E. coli O157 was greatest in high-incidence disease districts compared with low-incidence areas (17% cf. 7%). This supports the hypothesis that in high-disease-incidence areas, residents are regularly exposed to information about the disease through local cases, the media, local social networks, etc. or perhaps that individuals are more likely to be motivated to find out about it. However, no statistically significant difference was found between high- and low-incidence postcode districts in terms of the proportion of the population expressing a high likelihood of personal risk of infection (10% cf. 14%), giving a counterintuitive difference between the technical (epidemiological and quantitative microbiological risk assessment (QMRA)) and the lay assessment of E. coli O157 risk. This suggests that lay evaluations of E. coli O157 risk reflect intuitive and experience-based estimates of the risk rather than probabilistic estimates. A generally strong correspondence was found in terms of the rank order given to potential infection pathways, with environment and foodborne infection routes dominating when comparing public understanding with technical modelling results. Two general conclusions follow from the work. First, that integrative research incorporating both lay and technical views of risk is required in order that informed decisions can be made to handle or treat the risk by the groups concerned (e.g. the public, policy makers/risk managers, etc.). Second, when communicating risk, for example, through education programmes, it is important that this process is two-way with risk managers (e.g. including Food Standards Agency officials and communications team, public health infection control and environmental health officers) both sharing information with the public and stakeholder groups, as well as incorporating public knowledge, values and context (e.g. geographical location) into risk-management decisions.     

Institutionalization of Life-Cycle Thinking in the Everyday Discourse of Market Actors

The widespread popularity of life-cycle assessment (LCA) is difficult to understand from the point of view of instrumental decision making by economic agents. Ehrenfeld has argued, in a 1997 issue of this journal, that it is the world-shaping potential of LCA that is more important than its use as a decision-making tool. The present study attempts to explore the institutionalization of this "LCA world view" among ordinary market actors. This is important because environmental policy relies increasingly on market-based initiatives. Cognitive and normative assumptions in authoritative LCA documents are examined as empirical data and compared with data from focus group interviews concerning products and the environment with "ordinary" manufacturers, retailers, and consumers in Finland. These assumptions are (1) the "cradle-to-grave" approach, (2) the view that all products have an environmental impact and can be improved, (3) the relativity of environmental merit, and (4) the way responsibility for environmental burdens is attributed. Relevant affinities, but also differences, are identified. It is argued that life-cycle thinking is not primarily instrumental, but rather is gaining a degree of intrinsic value. The study attempts to establish a broader institutional context in which the popularity of LCA can be understood. From the point of view of this broader context, some future challenges for the development of LCA and life-cycle thinking are suggested.     

Promoting RRI and active citizenship in an inquiry-based controversial socio-scientific issue: the case of cholesterol regulation with statins

ABSTRACT

Science education is an important dimension of the European Commission’s Responsible Research and Innovation (RRI) objectives; however, RRI is not an explicit focus of biology teaching and few biology teachers have experience in integrating RRI in classroom practice. This study examines the impact of a three 80-minute RRI and active citizenship module on 11th grade biology students, based on the SSIBL pedagogical framework. A representative national sample of 11th grade biology students in Cyprus (n = 398) participated. A pre-post research design examined impact in relation to students’ conceptual understanding regarding cholesterol and its regulation, their understanding of the controversy about cholesterol regulation, awareness of RRI components, feeling of responsibility and willingness to act. Analyses indicated statistically significant gains in conceptual understanding and the understanding of the controversy about cholesterol regulation and awareness of RRI components, as well as in students’ socio-scientific accountability (feeling of responsibility and willingness to act). Conceptual understanding showed increased correlations with Controversy understanding and RRI understanding forming the three of them the cognitive elements of individuals understanding. All of the examined variables are deemed, as of great importance for the design, implementation and evaluation of innovative biology RRI and active citizenship modules.     

Virus-host Interactions during Hepatitis C Virus Entry - Implications for Pathogenesis and Novel Treatment Approaches

Hepatitis C virus (HCV) is a member of the Flaviviridae family and causes acute and chronic hepatitis. Chronic HCV infection may result in severe liver damage including liver cirrhosis and hepatocellular carcinoma. The liver is the primary target organ of HCV, and the hepatocyte is its primary target cell. Attachment of the virus to the cell surface followed by viral entry is the first step in a cascade of interactions between the virus and the target cell that is required for successful entry into the cell and initiation of infection. This step is an important determinant of tissue tropism and pathogenesis; it thus represents a major target for antiviral host cell responses, such as antibody-mediated virus neutralization. Following the development of novel cell culture models for HCV infection our understanding of the HCV entry process and mechanisms of virus neutralization has been markedly advanced. In this review we summarize recent developments in the molecular biology of viral entry and its impact on pathogenesis of HCV infection, development of novel preventive and therapeutic antiviral strategies.