Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.

[EX Q]: The St. Louis Post-Dispatch reports that the Missouri Department of Health and Senior Services awarded a no-bid contract to the Missouri Primary Care Association. The agreement will pay the organization $125,000 a year to focus on getting more adolescents to receive at least five vaccines, including influenza, hepatitis A and HPV. Contract talks began before health officials warned last week that a hepatitis A outbreak in the state could grow worse if it spreads to urban areas. Health officials say the state has recorded 414 cases of the virus since September 2017. In previous years, only about 10 cases were reported annually.
[EX A]: State awards contract to boost hepatitis A vaccination rate.

[EX Q]: This is a tricky one. The story does not explicitly address cost, except to call text messaging “a scalable and affordable approach.” For many (or most) patients, the cost of receiving four text messages a week would likely be negligible — covered by an individual’s phone plan or by nominal text rates. However, not everyone owns a mobile phone, a fact that makes access (and cost) a more significant issue. However, the story does deliver on this point. The story discusses both the number of U.S. adults who own mobile phones (90 percent) and the fact that text messages are more accessible than other forms of mobile health communication (such as apps, which require patients to own smartphones or other smart devices). So, while we’d prefer a more in-depth discussion here, we’ll award a Satisfactory rating for the story’s nod in this direction. The story addresses the range of benefits reported in the study, such as reduced cholesterol and blood pressure, but doesn’t quantify that information or offer readers any context. For example, while the story says “patients who had received the text messages had reduced their cholesterol,” the JAMA paper reports that patients who received the text messages had a “mean difference [of] −5 mg/dL” in “LDL-C.” In other words, the information in the paper, while quantified, probably isn’t very useful to many readers outside the health industry. Is “a mean difference of −5 mg/dL in LDL-C” good? Bad? Irrelevant? This is where reporters have an opportunity to shine. If a news story can take those numbers and translate them into language that is accessible to non-experts, it provides a very real service. It would have been great to see that here. As long as people aren’t driving and checking their cell phones, there don’t appear to be any harms associated with receiving well-meaning text messages four times a week, so we’ll mark this one “not applicable.” This is a strong suit. The story not only offers a concise, but good, summary of the study — but it also goes out of its way to address the study’s limitations. For example, the study notes that the study “can’t tell us whether text messaging could eventually lead to fewer subsequent heart attacks among the patients receiving those messages or whether the positive health outcomes would continue past the six-month study window.” Good points, and we’re glad the story includes them. No disease mongering here. The story includes input from an outside expert who was not involved with the research. The story clearly meets our bar here, although it would have been stronger if it had reached out to at least one more independent source — preferably one who hadn’t written an editorial that ran in conjunction with the paper in JAMA. Yes, the editorial was independent and provides some insightful commentary. But it also means we already knew where this source stood on the issue. Finding another reputable expert, who hadn’t already weighed in publicly on the work, would have been great. The focus of the story is not so much on how the text message intervention directly reduced heart disease risk, but on the extent to which it resulted in patients taking steps to reduce their own risk — such as by exercising more, smoking less, making dietary changes, or taking prescription drugs on a regular basis. The story does discuss other “mobile health interventions,” such as smartphone apps — but notes that there don’t appear to be many mobile health projects that rely simply on text messages. The story also looks at how the text messages helped patients pursue lifestyle changes — like exercising more and smoking less — that reduced their risk. It was fairly clear from the story that this was a clinical trial, and that this particular service doesn’t seem to be available to offer customized, encouraging text messages for heart disease patients. From the start, the story frames this research in the context of the much larger “mobile health” field. For example, the story notes that “While there are more than 100,000 health-related apps on the market, the evidence to date is lacking as to whether many of those apps are safe or effective.” Since the story includes quotes from an interview, we can be fairly certain it went beyond the related JAMA news release.
[EX A]: Text Reminders Help People Lower Cholesterol, Blood Pressure

[EX Q]: The story notes that the extensively hydrolyzed formula is more expensive than standard formula; however, the authors should have indicated how much more expensive hydrolyzed formula is compared to regular formula. Monthly cost comparison of two formulas would have been appropriate as this may be a deciding factor for many families who choose not to breastfeed, or who are weaning. We’ve already penalized the story in “evidence” above for not giving the absolute risk reduction, so we won’t do it again here. The story reports on a study which showed about 50% fewer diabetes antibodies in at-risk children who were fed special hydrogized infant formula. But 50% of what? This may or may not translate into fewer cases of childhood diabetes. If there are other side effects or harms associated with using hydrolyzed versus standard formula, they are not described. There are no real “harms” with using formula, either cow’s milk formula or extensively hydrolyzed formula. It appears the latter may be a better choice because there are fewer proteins broken down for digestion. What is missing here for the reader is a clear estimate of the absolute increase in risk of developing these antibodies. For example, if the risk for infants exposed to hydrolyzed is 1% and the risk for standard formula is 2% this may not be worth the cost. Whereas if the risk for those exposed to hydrolyzed is 5% and for those exposed to standard formula is 10% this may be worth it. Both of these represent a 50% increase in risk, but the absolute differences would have substantially different clinical implications The story does not engage in disease mongering. The story carefully explains the results of the study and is conservative about the role a formula may play in the prevention of Type 1 diabetes in susceptible children. it would have been helpful to indicate the prevalence of type 1 diabetes and how much the risk is increased if you have a first degree relative with type 1, which would have provided some perspective on the meaning of the relative increased risk for developing these auto-antibodies if an infant is exposed to standard formula. The story quotes several clinical experts who provide explanation of the results and put these into context with current formula recommendations. Study authors are cited as well as clinical experts who feel the research is noteworthy, but should not change recommendations for a hydrolyzed formula to prevent Type 1 diabetes. Affliations of all sources are listed in the story postscript. There are many options when weaning an infant from breast milk. The story discusses the NEJM study which compared extensively hydrolyzed formula with regular infant formula. While the more expensive hydrolyzed forumula was associated with fewer cases of Type 1 diabetes antibodies in at-risk children, the story notes that there is not definitive evidence that cow’s milk formula will increase the risk of Type 1 Diabetes compared to other types of formular or breast feeding. Various infant formulas are available when weaning infants from breast milk, or when breastfeeding is not an option. The story discusses research that compared regular infant formula with a type of extensively hydrolyzed formula that helps break down proteins during digestion. This formula may not be available to some parents due to greater expense. It is known that breast feeding is preferable to formula, and that it may offer some protection against the development of Type 1 diabetes. Formula is an option, particularly when breast milk is not available, and using formula will not harm an infant. However, formula may somehow trigger the development of autoantibodies as these proteins are broken down for digestion. More research is needed, but this new information from a well-designed double-blinded RCT trial may guide recommendations and parents decisions in choosing a specialized infant formula that does not require breakdown of so many proteins during digestion. There is some thoughtful independent reporting and the story does not appear to rely on a news release.
[EX A]:
Special Infant Formula Might Help Shield Babies from Type 1 Diabetes