Citizens' views on prices of medicines reimbursed by the National Health Service: Findings from Italian online focus groups

INTRODUCTION

Access to medicines is one of the biggest challenges to health systems, affecting society and individuals. This study aims to explore citizens' opinions, perceptions and attitudes on the model of medicines' research and development (R&D) and price setting of medicines reimbursed by the Italian National Health Service.

MATERIALS AND METHODS

We run four online focus groups, analysed through thematic analysis.

INCLUSION CRITERIA

people aged 30-70 years, who had completed at least compulsory schooling (8-10 years), with no specialised knowledge about the subject.

EXCLUSION CRITERIA

healthcare workers, pharmaceutical and device industry employees, researchers and medicine policy board members. We aimed to include a purposive sample of 20 participants, variable in terms of age, educational level and place of residence.

RESULTS

Eleven women and six men participated. The mean age was 53 years (range: 28-73). Most (n = 15) had a university degree or attended secondary schools. Eight had a job, five were not employed, and four were retired. In general, participants supported the role of the public health service. Almost all had limited knowledge of medicines' R&D and price setting. Most asked for transparency on medicine prices and negotiation criteria. Participants considered revenues of pharmaceutical companies disproportionate and most called for containment measures of profits. Most were in favour of a stronger public intervention in R&D and prices' negotiations. Few were sceptical of the public sector's ability to play this role.

DISCUSSION

Medicines' prices were discussed as a health matter. Increasing citizens' awareness of these topics is needed by providing spaces and conditions to participate in the discussion, including different perspectives and interests.

PATIENT OR PUBLIC CONTRIBUTION

Members of BEUC-the European consumer organisation-proposed the project. Altroconsumo, an independent consumer organisation and OCU, a Spanish consumer organisation, participated in developing the project and the main topics to discuss. The Mario Negri Institute and Aplica cooperative-the Spanish methodological team-were involved by BEUC and their national organisations to define the methodology, organisational aspects and contents and conducted the focus groups.

Perceptions of Uncertainty in Medical Care Among Non-medical Professionals and Nurses in Japan: A Cross-Sectional Internet-Based Preliminary Survey

BACKGROUND

Medical care is impacted by uncertainty caused by various factors. The uncertainty that exists in medical care can cause patient distrust and lead to conflict. This study compared the tolerance of uncertainty in medical care between non-medical professionals and nurses.

METHODS

We conducted a cross-sectional Internet-based survey. Participants included 2,100 individuals (600 nurses and 1,500 non-medical professionals; aged ≥ 20 years) from different parts of Japan. Of these, we excluded 70 participants who were classified as non-medical professionals but were registered nurses. Finally, we analyzed data from 2,030 participants (600 nurses and 1,430 non-medical professionals). Three registered nurses and nursing researchers developed an original questionnaire on tolerance of uncertainty in medical care. Data regarding participants' characteristics (age, sex, education level, marital status, having children, population size of the residential area, medical care usage, and occupation) were obtained. We performed a one-way analysis of variance (ANOVA) to compare the data between non-medical professionals and nurses. Additionally, we employed a multiple regression model to investigate factors related to tolerance of uncertainty in medical care scores.

RESULTS

A significant portion of participants (36.7%) were aged 40-50 years (n = 745). Most were women (n = 1,210, 59.6%), and a considerable percentage were medical care users (n = 1,309, 64.5%). Non-medical professionals were less tolerant of uncertainty than nurses, and uncertainty scores were associated with medical care usage, occupation, and population size of the residential area.

CONCLUSIONS

Our findings revealed variations in perceptions of uncertainty in medical care between non-medical professionals and medical care providers. To mitigate conflicts related to medical issues, medical care providers should enhance non-medical professionals' education regarding perceptions of uncertainty in medical care.

Who are the publics engaging in AI?

Given the importance of public engagement in governments' adoption of artificial intelligence systems, artificial intelligence researchers and practitioners spend little time reflecting on who those publics are. Classifying publics affects assumptions and affordances attributed to the publics' ability to contribute to policy or knowledge production. Further complicating definitions are the publics' role in artificial intelligence production and optimization. Our structured analysis of the corpus used a mixed method, where algorithmic generation of search terms allowed us to examine approximately 2500 articles and provided the foundation to conduct an extensive systematic literature review of approximately 100 documents. Results show the multiplicity of ways publics are framed, by examining and revealing the different semantic nuances, affordances, political and expertise lenses, and, finally, a lack of definitions. We conclude that categorizing publics represents an act of power, politics, and truth-seeking in artificial intelligence.

Signalling waiting times to citizens on public oral healthcare providers' websites

Objective: The study aimed to analyse the usefulness of signalling waiting times to citizens on the websites of public primary oral healthcare providers in Finland. Finnish laws require this signalling.Material and methods: We gathered data with two cross-sectional surveys in 2021. One electronic questionnaire was for Finnish-speaking citizens in Southwest Finland. The other was for public primary oral healthcare managers (n = 159). We also gathered data on 15 public primary oral healthcare providers' websites. For the theoretical framework, we combined the agency and signalling theories.Results: Of the citizen respondents (n = 411), 57% knew about the waiting time signalling on the websites. The respondents considered waiting time a high-priority criterion in choosing a dentist, but they rarely searched for information anywhere on the choice of a dentist, wanting to visit the dentist they had earlier visited. The quality of signalled waiting times was low. One out of five managers (response rate 62%) answered that signalled waiting times were based on speculation.Conclusions: Waiting times were signalled to comply with the legislation rather than to inform citizens and to reduce information asymmetry. Further research is needed to acquire information on rethinking waiting time signalling and its desired goals.

Preferences of Patients With Musculoskeletal Disorders Regarding the Timing and Channel of eHealth and Factors Influencing Its Use: Mixed Methods Study

BACKGROUND

Implementation of eHealth is progressing slowly. In-depth insight into patients' preferences and needs regarding eHealth might improve its use.

OBJECTIVE

This study aimed to describe when patients want to use eHealth, how patients want to communicate and receive information digitally, and what factors influence the use of eHealth in clinical practice.

METHODS

A multimethod study was conducted. Two meetings of ~5.5 hours with plenary information sessions and focus groups were held with 22 patients from the rheumatology, orthopedics, and rehabilitation departments of a Dutch hospital specialized in musculoskeletal disorders. Assignments were performed during the focus groups in which qualitative (eg, semistructured interview questions) and quantitative (ie, voting and ranking factors) data were collected.

RESULTS

The way patients want to use eHealth varies between patients and moments of a patient's care pathway. Patients' digital channel preferences depended on the need for interaction with a health care provider (HCP). The interaction need is in turn influenced by the degree to which information or communication is specific to an individual patient and leads to consequences for the patient. The 5 most important factors influencing the use of eHealth were access to medical information (eg, electronic health records), perceived control over disease management, correctness and completeness of information, data security, and access to information or an HCP at any time. The 5 least important factors influencing eHealth use were help with using digital devices, having internet or equipment, digital skills, attitude or emotions toward eHealth, and societal benefits.

CONCLUSIONS

Patients identified opportunities for using eHealth during all moments of their care pathway. However, preferences for eHealth varied between patients and phases in the care pathway. As a consequence, eHealth should be tailored to fit individual patients' preferences but also the need for interaction regarding different topics by offering a variety of digital channels with a gradient of interaction possibilities. Furthermore, digital skills and access to the internet might become less important to focus on in the future. Improving eHealth use by patients may be achieved by providing patients access to correct and safe (medical) information and more control over their care.

Effect of a Park-Based Physical Activity Intervention on Psychological Wellbeing at the Time of COVID-19

Practicing regular physical activity in green spaces has been invocated as a promising strategy for improving wellbeing in urban settings. The aim of the study was to assess the effect of a structured park-based physical activity intervention, the “Moving Parks” project, on citizens’ wellbeing at the time of COVID-19. The intervention was carried out in six public parks in Bologna (Italy) and administered by qualified instructors (from May 2021 to September 2021). The Psychological General Well Being Index short form questionnaire was administered before and after the three months of outdoor activities. A total of 328 participants completed the questionnaire at the beginning and at the end of the project. In September 2021, all psychosocial domains of the questionnaire (anxiety, depressed mood, self-control, positive well-being, vitality energy, and vitality-tiredness) significantly improved in the female sample (p value < 0.01) and only the last two in the male sample (p value < 0.05). The “Moving Parks” project seems to be able to improve citizens’ psychological wellbeing, particularly in women.

Biogeosciences Perspectives on Integrated, Coordinated, Open, Networked (ICON) Science

This article is composed of three independent commentaries about the state of Integrated, Coordinated, Open, Networked (ICON) principles in the American Geophysical Union Biogeosciences section, and discussion on the opportunities and challenges of adopting them. Each commentary focuses on a different topic: (a) Global collaboration, technology transfer, and application (Section 2), (b) Community engagement, community science, education, and stakeholder involvement (Section 3), and (c) Field, experimental, remote sensing, and real-time data research and application (Section 4). We discuss needs and strategies for implementing ICON and outline short- and long-term goals. The inclusion of global data and international community engagement are key to tackling grand challenges in biogeosciences. Although recent technological advances and growing open-access information across the world have enabled global collaborations to some extent, several barriers, ranging from technical to organizational to cultural, have remained in advancing interoperability and tangible scientific progress in biogeosciences. Overcoming these hurdles is necessary to address pressing large-scale research questions and applications in the biogeosciences, where ICON principles are essential. Here, we list several opportunities for ICON, including coordinated experimentation and field observations across global sites, that are ripe for implementation in biogeosciences as a means to scientific advancements and social progress.

Current Consumer Perceptions of Animal Welfare across Different Farming Sectors on the Island of Ireland

Simple Summary

The well-being and welfare of animals on farms is a topic of interest to many people. On the island of Ireland, this issue has received increased attention because of political and governance changes, including Brexit and COVID-19. Policy-makers and industry are considering labelling schemes to inform the food consumer about welfare standards on farms. Focus groups and an online survey were carried out with members of the public on the island of Ireland to explore their awareness, perceptions, and attitudes toward farm animal welfare standards on farms in Ireland and Northern Ireland. Most consumers believed farm animal welfare standards were high, although different farming sectors were rated differently: beef and dairy farms were viewed more positively, and pig and poultry farms were viewed less positively. The living conditions of the animal, size and intensity of the farm, national standards and schemes, and visibility all influenced perceptions of welfare standards. The public also expressed a lack of knowledge and information on the topic. In developing new policies and labelling schemes, it is important to be apprised of the current awareness, attitudes, and perceptions that the public has regarding farm animal welfare standards, as identified in the current paper.

Abstract

There has been increased public interest and concerns in issues such as farm animal welfare (FAW) on the island of Ireland, stoked in part by political and governance changes, such as Brexit and COVID-19. Front-of-pack food labelling represents a primary information channel for many people. In advance of considering formalised food labelling schemes, specifically relating to FAW, it is important to ensure an up-to-date understanding of current consumer perceptions of FAW. With this aim, the current study utilised a mixed methodology. Nine focus group discussions (n = 41) and an online survey (n = 972) with food consumers in Ireland and Northern Ireland explored perceptions of FAW. Results suggest that overall perceptions of FAW are high, and consumers perceive FAW to have improved in the last decade. Quantitative (ANOVA) and qualitative results show variations in perception of FAW between sectors. Results from the focus group discussions identified factors underlying consumers’ perception of FAW: the living conditions of the animal, size and intensity of the farm, national standards and schemes, and visibility. Information insufficiencies and knowledge gaps were identified. The findings are discussed in relation to policy implications for the role of public engagement, front-of-pack welfare labelling, and quality assurance schemes.

[The development of algorithm of preventive consideration of applications of citizen for stomatological polyclinics administrators]

The key priorities of the concept of development of health care in the Russian Federation is the population health support and increasing of availability and quality of medical care. The critical link in chain of interaction between medical organizations and residents is examination of applications of citizen. An appeal of citizen received by state authority, local self-government authority or by the official in accordance with their competence is to be a subject of mandatory proceeding. The service of non-staff chief stomatologist based on the organizational methodical office of Moscow Oblast Stomatological Polyclinic the comprehensive analysis of appeals of citizen appeals regarding provision of medical care in stomatological polyclinics of the Moscow Oblast was carried out. The analysis of summary of tasks demonstrated that in 2020, 107,511 appeals of citizens were received and 1002 tasks were related to stomatological care support that accounts 0.93% of total number of appeals. The results of analysis permitted to elaborate a set of recommendations for administrators of stomatological medical organizations to improve quality of examination of appeals of citizen.

[The financial mechanisms in health care system and medical services]

The article considers financial mechanisms applied in provision of medical services in the Russian health care system. The data concerning the structure of state financing and personal expenses of Russian citizens in health care system is presented. The financial resources in the Russian health care system are formed on the basis of mixed model consisting of personal funds of citizens (private sources of financing) and public funds allocated by budget system to implement the program of state guarantees of free medical care to citizens. Nowadays, the citizens have an opportunity to pay the cost of medical services directly when applying to medical organizations and through medical insurance organization, purchasing voluntary medical insurance policy and visiting medical organizations when insurance case occurred. The key goal of financial policy in concerning health care is the implementation of directions contributing to increase of financial sources in the system of medical services provision, population health support and improving efficiency of financial mechanisms application. The effectiveness of use of financial resources in health care determines the efficiency of impact of financial policy on national economy.

How to Navigate Trainee-Mentor Relationships and Interpersonal Dynamics in the Lab

Relationships with mentors and labmates are defining aspects of a researcher's journey in science. Ideally, these interactions are outstanding opportunities to learn from others and provide the basis for lifelong collaborations. Unfortunately, sometimes interpersonal dynamics in the lab are challenging. Graduate students entering the lab can greatly benefit from advice about navigating the interpersonal aspects of doing science. This article covers essential recommendations for developing a good trainee-mentor relationship and working well with peers in the lab, or being a "good lab citizen." Lab members-especially graduate students-often spend more time with labmates than with their friends and family during their graduate career, making these relationships essential to their well-being. The guidance also covers some advice for handling a tense relationship or problematic work environment. Finally, the advice concludes by discussing how to manage the fear of failure, overcome imposter syndrome, develop self-awareness, and cope with stress. These four issues are fundamental to success in research but are not discussed with graduate students as much as may be necessary. © 2021 Wiley Periodicals LLC.

Analysis of Doctor-Patient Relationship in Post-COVID-19 Period: Perspective Differences Between Citizen and Medical Staff

To evaluate the current views on doctor–patient relationship (DPR) between citizens and medical staff in post-Corona Virus Disease 2019 (COVID-19) period and predict the possible factors of DPR, we distributed questionnaires by a online questionnaire platform--Questionnaire Star (https://www.wjx.cn) to evaluate DPR in post-COVID-19 period. Overall, 312 questionnaires for citizens and 421 questionnaires for medical staff were completed. Citizens felt that service attitude and communication with medical staff, and registering process have been improved. And their trust in doctors has increased by 86.8%. Majority of citizens (66.0%) preferred the tertiary hospitals. If doctor–patient contradictions occurred, 62.9% citizens preferred internal negotiation (with the doctor involved, 44.6%; with hospital management department, 18.3%). There was significant difference of views on the causes of medical violence incidents and the reasons for doctor–patient conflicts in the future between citizens and medical staff. The DPR score of medical staff was lower than citizens at each stage, and even showed a downward tendency in post-COVID-19 period. Furthermore, 20.4% medical staff believed that harmonious DPR would not be maintained, which was distinct from that of the citizens. Combating the COVID-19 provided an important opportunity to improve the DPR. However, unbalanced allocation of high-quality medical resources, gap between the actual treatment efficacy and patient’s expectation, fairness and efficiency issues, financial conflicts, and medical information symmetry were still the influencing factors of DPR.

Automatic Exploitation of YouTube Data: A Study of Videos Published by a French YouTuber During COVID-19 Quarantine in France

The objective of this study was to test the feasibility of automatically extracting and exploiting data from the YouTube platform, with a focus on the videos produced by the French YouTuber HugoDécrypte during COVID-19 quarantine in France. For this, we used the YouTube API, which allows the automatic collection of data and meta-data of videos. We have identified the main topics addressed in the comments of the videos and assessed their polarity. Our results provide insights on topics trends over the course of the quarantine and highlight users sentiment towards on-going events. The method can be expanded to large video sets to automatically analyse high amount of user-produced data.

[Hygiene as a weapon in the fight against SARS-Cov-2. All experts in taking care!]

To combat SARS-Cov-2, hygiene is essential for the safety of caregivers and saves lives. In hospital as well as in everyday social and professional environments, everyone is concerned by hygiene and distancing rules. It is an opportunity for us to reinvent ourselves, protect ourselves and protect the most vulnerable. In hospital, at the heart of the crisis, the action of the infection control team, which includes the infection control nurse, is one of the cornerstones of the fight against COVID-19.

Peer Adoption and Development of Health Innovations by Patients: National Representative Study of 6204 Citizens

Background

There is growing evidence that many patients and caregivers innovate by developing new solutions to cope with their health disorders. Given the easy access to vast internet resources and peers globally, it is increasingly important to understand what may influence user innovation and its adoption in health for improving individual well-being and ensuring their safety, in particular, how interactions with peers and physicians or search behavior, along with sociodemographics, may influence the decision to develop a solution or adopt one developed by a peer.

Objective

The aim of this paper was to study the development and peer-to-peer adoption of user innovations in health care and identify individual-level factors associated with these processes.

Methods

Data were collected via computer-assisted phone survey from a large, random, and representative sample of adult residents in Portugal (N=6204). User innovation questions were added to 1 wave of an ongoing observational, longitudinal, population-based epidemiological study. By asking about individual innovation activity, the sample was split into 3 groups: (1) the developers of health-related solutions for own use (developers), (2) the adopters of solutions developed by other patients or caregivers (peer-to-peer adopters), and (3) the rest of the population. Within the last group, intention to adopt was measured and used as a proxy of future behavior. Regression analysis is used to test the associations.

Results

In the population considered in this paper, an estimated 1.3% (75/6008) reported having developed a solution for own use and 3.3% reported to have adopted a solution developed by peers. The 3 groups (developers, adopters, and remaining population) have distinctive characteristics. Gender plays an important role in the solution development, as women are less likely to develop one (odds ratio [OR] 0.4, 95% CI 0.20-0.81; P<.05). Education is positively associated with the development activity (OR 1.13, 95% CI 1.03-1.24; P<.05) but also with the intentions to adopt a peer-developed solution. Search for health-related information is positively associated with the development, adoption, and the intentions to adopt a solution. Interactions with peers over the internet are rare, but in-person interactions are frequent and have a positive association with the dependent variables in all 3 groups. The results also suggest that trust in doctors represents an important dimension that shapes the attitudes of the population toward peer-developed solutions.

Conclusions

This paper demonstrates the importance of the peer community, doctor-patient relationship, citizen’s search for information on innovation, and individual attitudes toward peer-to-peer adoption in health care. It stresses the need for a reliable Web-based health-related information and the necessity to deeper understand complex relationships between the need to improve health and fulfill the need and the perception of the health care system.

Using Semistructured Surveys to Improve Citizen Science Data for Monitoring Biodiversity

Biodiversity is being lost at an unprecedented rate, and monitoring is crucial for understanding the causal drivers and assessing solutions. Most biodiversity monitoring data are collected by volunteers through citizen science projects, and often crucial information is lacking to account for the inevitable biases that observers introduce during data collection. We contend that citizen science projects intended to support biodiversity monitoring must gather information about the observation process as well as species occurrence. We illustrate this using eBird, a global citizen science project that collects information on bird occurrences as well as vital contextual information on the observation process while maintaining broad participation. Our fundamental argument is that regardless of what species are being monitored, when citizen science projects collect a small set of basic information about how participants make their observations, the scientific value of the data collected will be dramatically improved.

Electronic Health Services in the Patients' Daily Activities - Willingness to Use Health Village Services

Patients and citizens are experienced in Internet use. Earlier studies have suggest that citizens' interest in electronic healthcare services has increased, and there is a need of healthcare professionals to inform patients and their families about this new format and provide them with guidance. The purpose of this study was to find out how patients accept electronic healthcare services and determine their intention to use them based on their opinions of perceived usefulness and perceived ease of use. A survey (N=150) was carried out at a university hospital before electronic services (e-service) were implemented. Participants were motivated to monitor their wellness based on their previous experiences of using electronic services. Patients were confident about the effectiveness of e-service provision.

[Associative commitments]

Volunteering to serve the general interest, that is the profession of faith behind associative commitments. Notably, actions by associations undertaken in favour of organ donation today must, in their content and forms, reconcile tradition and modernity. But they keep their driving principles and values intact.

[Citizen commitment for humanistic values]

Nowadays, as part of the population is seeking meaning, there are reasons to hope that we can live together better in our country. Avoiding resignation and passivity, the purpose of developing humanistic values, those of the Republic, is to build a society that is fairer, more serene and fraternal. A citizen commitment opens up possibilities for this.

Genetics in the 21st Century: Implications for patients, consumers and citizens

The first human genome project, completed in 2003, uncovered the genetic building blocks of humankind. Painstakingly cataloguing the basic constituents of our DNA ('genome sequencing') took ten years, over three billion dollars and was a multinational collaboration. Since then, our ability to sequence genomes has been finessed so much that by 2018 it is possible to explore the 20,000 or so human genes for under £1000, in a matter of days. Such testing offers clues to our past, present and future health, as well as information about how we respond to medications so that truly 'personalised medicine' is now moving closer to a reality. The impact of such a 'genomic era' is likely to have some level of impact on an increasingly large number of us, even if we are not directly using healthcare services ourselves. We explore how advancements in genetics are likely to be experienced by people, as patients, consumers and citizens; and urge policy makers to take stock of the pervasive nature of the technology as well as the human response to it.

Genetics in the 21st Century: Implications for patients, consumers and citizens

The first human genome project, completed in 2003, uncovered the genetic building blocks of humankind. Painstakingly cataloguing the basic constituents of our DNA ('genome sequencing') took ten years, over three billion dollars and was a multinational collaboration. Since then, our ability to sequence genomes has been finessed so much that by 2017 it is possible to explore the 20,000 or so human genes for under £1000, in a matter of days. Such testing offers clues to our past, present and future health, as well as information about how we respond to medications so that truly 'personalised medicine' is now a reality.   The impact of such a 'genomic era' is likely to have some level of impact on all of us, even if we are not directly using healthcare services ourselves. We explore how advancements in genetics are likely to be experienced by people, as patients, consumers and citizens; and urge policy makers to take stock of the pervasive nature of the technology as well as the human response to it.

Shifting dementia discourses from deficit to active citizenship

Within western cultures, portrayals of dementia as 'a living death' are being challenged by people living with the diagnosis. Yet dementia remains one of the most feared conditions. The sociological lens of citizenship provides a conceptual framework for reviewing the role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence. Awareness of cognitive change, and engaging with the diagnostic process, moves people into a transitional, or 'liminal' state of uncertainty. They are no longer able to return to their previous status, but may resist the unwanted status of 'person with dementia'. Drawing on qualitative studies on social participation by people with dementia, we suggest that whether people are able to move beyond the liminal phase depends on acceptance of the diagnosis, social capital, personal and cultural beliefs, the responses of others and comorbidities. Some people publicly embrace a new identity whereas others withdraw, or are withdrawn, from society to live in the shadow of the fourth age. We suggest narratives of deficit fail to reflect the agency people with dementia can enact to shape their social worlds in ways which enable them to establish post-liminal citizen roles. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

Perceptions of Ayurvedic medicine by citizens in Dhaka, Bangladesh

Bangladesh is now facing the public health problems of deficiency of iron and iodine, especially for women. The Ministry of Health and Family Welfare of Bangladesh has implemented strong countermeasures to enhance the health condition of the nation. On the other hand, based on the concept of the Declaration of Alma-Ata, complementary and alternative medicine should be used more vigorously to enhance public health in the world. The usage of complementary and alternative medicine such as ayurvedic medicine (AM) should be increased in Bangladesh. Therefore we conducted the study on perceptions of AM by citizens in Dhaka, Bangladesh in order to promote and enhance the effective usage of AM, including herbal medicines as medical resources, from December 2010 to January 2011. This study showed younger citizens (61.1%) did not get more benefit from AM than elder citizens (48.0%). On the other hand, younger citizens (76.8%) did not get more harm from AM than elder citizens (70.1%). We think that in terms of effectiveness of AM, the younger generation in Dhaka seems to be more skeptical to AM than the elder generation in Dhaka, even though the younger generation are more satisfied with AM than the elder generation. With viewpoint of enhancement of usage of AM in Dhaka, we think that scientifically sound information on AM should be collected rigorously and brought to the citizens vigorously to remove the skeptical feeling of AM from younger citizen in Dhaka. In terms of the effective utilization of limited medical resources, AM should be used appropriately in Bangladesh, Asia and the world.

Imagining the ideal dairy farm

Practices in agriculture can have negative effects on the environment, rural communities, food safety, and animal welfare. Although disagreements are possible about specific issues and potential solutions, it is widely recognized that public input is needed in the development of socially sustainable agriculture systems. The aim of this study was to assess the views of people not affiliated with the dairy industry on what they perceived to be the ideal dairy farm and their associated reasons. Through an online survey, participants were invited to respond to the following open-ended question: "What do you consider to be an ideal dairy farm and why are these characteristics important to you?" Although participants referenced social, economic, and ecological aspects of dairy farming, animal welfare was the primary issue raised. Concern was expressed directly about the quality of life for the animals, and the indirect effect of animal welfare on milk quality. Thus participants appeared to hold an ethic for dairy farming that included concern for the animal, as well as economic, social, and environmental aspects of the dairy system.

Open-access clinical trial registries: the Italian scenario

BACKGROUND

Citizens, patients and their representatives are increasingly insisting on working with health professionals to organize and discuss research protocols. The International Committee of Medical Journal Editors recommended setting up a public clinical trial registry where anyone can find key information about a trial. Around the world, governments have, in fact, now begun to legislate mandatory disclosure of all clinical trials. The aims of the present survey were to assess the availability of clinical trial registries for Italian citizens and to examine the transparency of the data items reported.

METHODS

The availability of open-access clinical trial registries was surveyed on a sample of 182 websites, including research institutes and centers of excellence (IRCCS-teaching hospitals), hospitals and associations. For each registry we downloaded a sample of two trials to assess the correspondence of the data items reported. Results from the Italian and international registries were compared.

RESULTS

Fifteen percent of the sample had an open-access registry of clinical trials. Comparison of the data items available, in terms of completeness and transparency, from institutional and international registries indicated wide variability.

CONCLUSIONS

Italian citizens, patients and their associations have scant access to local registries of clinical trials, and international registries are generally more informative. On the European level, advocacy and lobby actions are needed among citizens and patients to boost the diffusion of open-access clinical trial registries without language barriers, thereby facilitating participation, access to information, and the coordination of clinical research.