mHealth and global mental health: still waiting for the mH2 wedding?

BACKGROUND: Two phenomena have become increasingly visible over the past decade: the significant global burden of disease arising from mental illness and the rapid acceleration of mobile phone usage in poorer countries. Mental ill-health accounts for a significant proportion of global disability-adjusted life years (DALYs) and years lived with disability (YLDs), especially in poorer countries where a number of factors combine to exacerbate issues of undertreatment. Yet poorer countries have also witnessed significant investments in, and dramatic expansions of, mobile coverage and usage over the past decade. DEBATE: The conjunction of high levels of mental illness and high levels of mobile phone usage in poorer countries highlights the potential for "mH(2)" interventions--i.e. mHealth (mobile technology-based) mental health interventions--to tackle global mental health challenges. However, global mental health movements and initiatives have yet to engage fully with this potential, partly because of scepticism towards technological solutions in general and partly because existing mH(2) projects in mental health have often taken place in a fragmented, narrowly-focused, and small-scale manner. We argue for a deeper and more sustained engagement with mobile phone technology in the global mental health context, and outline the possible shape of an integrated mH(2) platform for the diagnosis, treatment, and monitoring of mental health. SUMMARY: Existing and developing mH(2) technologies represent an underutilised resource in global mental health. If development, evaluation, and implementation challenges are overcome, an integrated mH2 platform would make significant contributions to mental healthcare in multiple settings and contexts.

Prices need no preferences: social trends determine decisions in experimental markets for pain relief.

OBJECTIVE: A standard view in health economics is that, although there is no market that determines the "prices" for health states, people can nonetheless associate health states with monetary values (or other scales, such as quality adjusted life year [QALYs] and disability adjusted life year [DALYs]). Such valuations can be used to shape health policy, and a major research challenge is to elicit such values from people; creating experimental "markets" for health states is a theoretically attractive way to address this. We explore the possibility that this framework may be fundamentally flawed-because there may not be any stable values to be revealed. Instead, perhaps people construct ad hoc values, influenced by contextual factors, such as the observed decisions of others. METHOD: The participants bid to buy relief from equally painful electrical shocks to the leg and arm in an experimental health market based on an interactive second-price auction. Thirty subjects were randomly assigned to two experimental conditions where the bids by "others" were manipulated to follow increasing or decreasing price trends for one, but not the other, pain. After the auction, a preference test asked the participants to choose which pain they prefer to experience for a longer duration. RESULTS: Players remained indifferent between the two pain-types throughout the auction. However, their bids were differentially attracted toward what others bid for each pain, with overbidding during decreasing prices and underbidding during increasing prices. CONCLUSION: Health preferences are dissociated from market prices, which are strongly referenced to others' choices. This suggests that the price of health care in a free-market has the capacity to become critically detached from people's underlying preferences.

Assessing effects of site characteristics on remediation secondary life cycle impact with a generalised framework

The 'sustainable remediation' concept has been broadly embraced by industry and governments in recent years in both the US and Europe. However, there is a strong need for more research to enhance its 'practicability'. In an attempt to fill this research gap, this study developed a generalised framework for selecting the most environmentally sustainable remedial technology under various site conditions. Four remediation technologies were evaluated: pump and treat (P&T), enhanced in situ bioremediation (EIB), permeable reactive barrier (PRB), and in situ chemical reduction (ISCR). Within the developed framework and examined site condition ranges, our results indicate that site characteristics have a profound effect on the life cycle impact of various remedial alternatives, thus providing insights and valuable information for determining what is considered the most desired remedy from an environmental sustainability perspective. © 2014 © 2014 University of Newcastle upon Tyne.