Search

Objective: To better understand cancer clinical trials (CCT) information-seeking, a necessary precursor to patient and provider engagement with CCT., Methods: Data from the National Cancer Institute's Cancer Information Service (CIS) were used to examine CCT information-seeking patterns over a 5-year period. Descriptive and logistic regression analyses were conducted to examine characteristics of CIS inquiries and their associations with having a CCT discussion., Results: Between September 2018 - August 2023, 117,016 CIS inquiries originated from cancer survivors, caregivers, health professionals, and the general public; 27.5 % of these inquiries included a CCT discussion (n = 32,160). Among CCT discussions, 35.5 % originated from survivors, 53.5 % from caregivers, 6.1 % from the public, and 4.9 % from health professionals. Inquiries in Spanish had lower odds of a CCT discussion (OR=.26, [.25-.28]), whereas inquiries emanating from the CIS instant messaging (OR=2.29, [2.22-2.37]) and email (OR=1.24, [1.18-1.30]) platforms were associated with higher odds of discussing CCT compared to the telephone. Individuals who were male, younger, insured, and had higher income and education had significantly higher odds of a CCT discussion while those who were non-Hispanic Black and living in rural locales had significantly lower odds., Conclusions: Disparities in CCT information-seeking may contribute to downstream CCT participation., Practice Implications: Quality, language-concordant health information is needed to enable equitable awareness of - and ultimately engagement in - CCT., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

With the rapid development of information technology, the scale of complex networks is increasing, which makes the spread of diseases and rumors harder to control. Identifying the influential nodes effectively and accurately is critical to predict and control the network system pertinently. Some existing influential nodes detection algorithms do not consider the impact of edges, resulting in the algorithm effect deviating from the expected. Some consider the global structure of the network, resulting in high computational complexity. To solve the above problems, based on the information entropy theory, we propose an influential nodes evaluation algorithm based on the entropy and the weight distribution of the edges connecting it to calculate the difference of edge weights and the influence of edge weights on neighbor nodes. We select eight real-world networks to verify the effectiveness and accuracy of the algorithm. We verify the infection size of each node and top-10 nodes according to the ranking results by the SIR model. Otherwise, the Kendall [Formula: see text] coefficient is used to examine the consistency of our algorithm with the SIR model. Based on the above experiments, the performance of the LENC algorithm is verified., (© 2022. The Author(s).)

Background: The internet has made significant contributions towards health education. Analyzing the pattern of online behavior regarding meningitis and vaccinations may be worthwhile. It is hypothesized that the online search patterns in meningitis are correlated with its number of cases and the search patterns of its related vaccines., Methods: This was an infodemiological study that determined the relationship among online search interest in meningitis, its worldwide number of cases and its associated vaccines. Using Google Trends™ Search Volume Indices (SVIs), we evaluated the search queries "meningitis," "pneumococcal vaccine," "BCG vaccine," "meningococcal vaccine" and "influenza vaccine" in January 2021, covering January 2008 to December 2020. Spearman rank correlation was used to determine correlations between these queries., Results: The worldwide search interest in meningitis from 2008 to 2020 showed an average SVI of 46 ± 8.8. The most searched topics were symptoms, vaccines, and infectious agents with SVIs of 100, 52, and 39, respectively. The top three countries with the highest search interest were Ghana, Kazakhstan, and Kenya. There were weak, but statistically significant correlations between meningitis and the BCG (ρ = 0.369, p < 0.001) and meningococcal (ρ = 0.183, p < 0.05) vaccines. There were no statistically significant associations between the number of cases, influenza vaccine, and pneumococcal vaccine., Conclusion: The relationships among the Google SVIs for meningitis and its related vaccines and number of cases data were inconsistent and remained unclear. Future infodemiological studies may expand their scopes to social media, semantics, and big data for more robust conclusions.

Patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) constitute a complex population with different phenotypes based on pathophysiology, comorbidity, sex and age. We aimed to compare the multimorbidity patterns of HF and COPD in men and women using network analysis. Individuals aged 40 years or older on 2015 of the EpiChron Cohort (Aragon, Spain) were stratified by sex and as having COPD (n = 28,608), HF (n = 13,414), or COPD and HF (n = 3952). We constructed one network per group by obtaining age-adjusted phi correlations between comorbidities. For each sex, networks differed between the three study groups; between sexes, similarities were found for the two HF groups. We detected some specific diseases highly connected in all networks (e.g., cardio-metabolic, respiratory diseases, and chronic kidney failure), and some others that were group-specific that would require further study. We identified common clusters (i.e., cardio-metabolic, cardiovascular, cancer, and neuro-psychiatric) and others specific and clinically relevant in COPD patients (e.g., behavioral risk disorders were systematically associated with psychiatric diseases in women and cancer in men). Network analysis represents a powerful tool to analyze, visualize, and compare the multimorbidity patterns of COPD and HF, also facilitated by developing an ad hoc website., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Answering genetics' big data questions often needs an interdisciplinary team whose members freely share their diverse expertise in analysis, statistics, and computation. Sharing requires mutual trust and open acknowledgement of strengths and weaknesses, including those of established geneticists. Only then will newcomers to genetics contribute far beyond their entry-level expectations., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Poison control centers (PCCs) manage millions of information and exposure cases a year. Exposure cases are almost always managed on-site (i.e., at "home") or at a health care facility (HCF). Over the last 10 years, there have been significant changes in the composition of cases managed by PCCs with an overall decrease in total cases but an increase in exposures managed at an HCF. The management and documentation of HCF cases may require more time than cases managed on-site or information cases. Time-work data are needed to accurately gauge the staff resources needed to address these changes. Methods: One poison center with an annual case volume of 74,000 conducted a time-work study of total case management time for a subset of cases: exposures Managed on-site and Managed at an HCF as well as information Drug identification cases. Specialists tracked the time spent communicating, managing, researching, consulting, and documenting. Additionally, the PCC medical records and phone call database were audited to ensure all calls and documented efforts related to a case were included. Results: Cases Managed at an HCF ( n  = 140) took more time (mean 45.8 min, median 29.3 min) than those Managed on-site ( n  = 430; mean 7.4 min, median 5.9 min) or Drug identification case ( n  = 392; mean 2.7 min, median 2.2 min); this difference was significant ( p <.0001). There were 32 cases (23%) Managed at an HCF that required more than 1 h for total management; no Managed On-site or Drug identification cases required more than 33 min. Conclusions: The time required for one PCC to manage cases at an HCF was approximately six times longer than cases that were managed on-site. With PCC case volume and composition changing, previous staffing assumptions may no longer hold true. It would be incorrect to base staffing requirements on case volume alone without scrutiny of case types.

Comorbidity scores to predict mortality are very useful to facilitate decision-making for personalized patient management. This study aim was to assess the contribution of medico-administrative data in addition to French Renal Epidemiology and Information Network (REIN) data to the development of a risk score to predict the 1-year all-cause mortality in patients with End Stage Renal Disease (ESRD), and to compare it with previous scores. Data from a derivation sample (n = 6336 patients who started dialysis in 2015 in France) obtained by linking the REIN and the French National Health Insurance Information System databases were analyzed with multivariate Cox models to select risk factors to establish the score. A randomly chosen validation sample (n = 2716 patients who started dialysis in 2015) was used to validate the score and to compare it with the comorbidity indexes developed by Wright and Charlson. The ability to predict one-year mortality of the score constructed using REIN data linked to the medico-administrative database was not higher than that of the score constructed using only REIN data (i.e., Rennes score). The Rennes score included five comorbidities, albumin, and age. This score (AUC = 0.794, 95%CI: 0.768-0.821) outperformed both the Wright (AUC = 0.631, 95%CI: 0.621-0.639; p < 0.001) and Charlson (AUC = 0.703, 95%CI: 0.689-0.716; p < 0.001) indexes. Data from the REIN registry alone, collected at dialysis start, are sufficient to develop a risk score that can predict the one-year mortality in patients with ESRD. This simple score might help identifying high risk patients and proposing the most adapted care.

Objective: Cancer survivors have various health care needs and are willing to be proactive with their health maintenance. Online information would be a useful resource to guide cancer survivors and their family members. Therefore, identifying the factors that influence Internet searching behaviors among cancer survivors and their family members is a first step toward providing better health care services for cancer care., Methods: We performed focus group interviews that were based on the Theory of Planned Behavior, with thirty-one participants to explore factors related to Internet search behaviors among cancer survivors and their family members., Results: Six themes were identified in the analysis of participant interviews. Attitudes toward searching for health information on the Internet included the themes "Fulfilling unmet needs" and "Confirmation through second opinion." Themes related to social norms included "a required step for sure" and "helping each other." In terms of perceived behavioral control, themes included "difficult to choose because of being 'overwhelmed with information,'" and "complex searching milieu.", Conclusion: It was clear that cancer survivors and their family members had unmet needs for maintaining their health status. They wanted to be informed and actively involved in the decision-making process regarding health management. Consultation and education provided to patients by doctors should not only include information on diet and nutrition but also information on the resulting complications to satisfy their need for reliable health information.

In many real-world networks, the ability to withstand targeted or global attacks; extinctions; or shocks is vital to the survival of the network itself, and of dependent structures such as economies (for financial networks) or even the planet (for ecosystems). Previous attempts to characterise robustness include nestedness of mutualistic networks or exploration of degree distribution. In this work we present a new approach for characterising the stability and robustness of networks with all-positive interactions by studying the distribution of the k-shell of the underlying network. We find that high occupancy of nodes in the inner and outer k-shells and low occupancy in the middle shells of financial and ecological networks (yielding a "U-shape" in a histogram of k-shell occupancy) provide resilience against both local targeted and global attacks. Investigation of this highly-populated core gives insights into the nature of a network (such as sharp transitions in the core composition of the stock market from a mix of industries to domination by one or two in the mid-1990s) and allow predictions of future network stability, e.g., by monitoring populations of "core" species in an ecosystem or noting when stocks in the core-dominant sector begin to move in lock-step, presaging a dramatic move in the market. Moreover, this "U-shape" recalls core-periphery structure, seen in a wide range of networks including opinion and internet networks, suggesting that the "U-shaped" occupancy histogram and its implications for network health may indeed be universal.

Purpose: The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer., Method: This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis., Results: The key themes to emerge from the date were 'living in the here and now' and 'awareness of the Cancer Society'. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society., Conclusions: Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies' services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement., Competing Interests: Declaration of competing interest No conflict of Interest declared., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

HIV medical care providers need a wide range of evidence-based clinical information resources to manage their patients' health. We determined whether providers' choice of information sources for HIV care and treatment are associated with their demographic and medical practice characteristics. Data used for this study were obtained from a probability sample of HIV medical care providers in 13 outpatient HIV facilities in Houston/Harris County, Texas, surveyed between June and September 2009. The mean number of information sources used by HIV medical care providers for HIV care and treatment was 5.83 (95% confidence interval: 4.90-6.75). Antiretroviral therapy guidelines (95.6%), medical journals and textbooks (82.6%), and Internet sources (69.5%) were ranked first, second, and third as sources of clinical information. At least one of the providers' demographic or medical practice characteristics was significantly ( p  ⩽ 0.05) associated with six of the clinical information sources. Integration of these information resources into clinicians' workflow may enhance efficiency of HIV care and treatment and facilitate improved patients' care and health outcomes.

Objective: This study aimed to identify the frequency and goals of Internet usage to access health-related information among primary health care service clients., Methods: The study was conducted in a primary health care centre with a sample of 788 adults. The data were collected through a questionnaire developed by the researchers., Results: The results showed that 81% (n = 640) of the participants used the Internet. All Internet user participants reported that they used the Internet to access health-related information. Of the participants, 67% reported that they used the Internet primarily to obtain information about diseases with 94% reporting that they found the online information reliable and 92% reported that they did not confirm the information they obtained online. The frequency of Internet use to obtain health-related information increased with increase in the level of education of participants. Participants with higher education found the online information to be more reliable and comprehensible. The results showed that while the use of Internet to obtain health-related information was high, the information presented online was not always checked for accuracy., Conclusion: Hence, provision of current and evidence-based information on health-related websites is crucial to preserve community health care., Competing Interests: None

Background: Online healthcare has become an important part of healthcare services. Patients can access unlimited information reflecting a doctor's service quality in online health communities (OHCs). This information can reduce information asymmetry between patients and doctors, and further promote patient decisions. In this study, we focus on the patient's decision to switch from a doctor's online medical service to the same doctor's offline service., Objectives: We classify OHC information into objective information and subjective information. Following this, we investigate how these two types of information influence patient decisions to switch from a doctor's online to offline medical service, and explore the nature of interaction between the two types of influence., Methods: We collected data from a leading OHC in China and constructed a longitudinal dataset to examine our research questions. To control for doctor heterogeneity and common trends across time, we leveraged fixed effects at the doctor level and monthly fixed effects in our models, respectively., Results: Our findings demonstrate a strong relationship between OHC information and patient decisions to switch from a doctor's online to offline medical service. Patients are more likely to switch from online to offline medical services with doctors whose subjective and objective information on their homepages indicate a higher quality (β Subjective  = 0.001, p < 0.001; α Objective  = 0.019, p < 0.002). We also observe that patients prefer doctors who do not exhibit objective information that indicates low-quality service over those who show such information on their homepages, even though the chosen doctor provides a lower-quality service (α Low&#95;Objective  = -0.032, p < 0.006). Further, we find that the influence of subjective information on patient decisions crowds out the influence of objective information., Conclusion: This study investigates the role of subjective and objective information on patient decisions to switch from a doctor's online to offline medical service and the interaction effect between these two types of information. This study provides valuable theoretical and practical implications., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Numerous free and low-cost mobile apps for the care management of kidney disease have become available in recent years. Although these appear to be promising tools, they have not been evaluated comparatively based on standard mobile app metrics, and thus, limited evidence is available regarding their efficacy. This study systematically cataloged and assessed mobile apps designed to assist medication compliance and nutrition tracking that are useful to the chronic kidney disease (CKD) and the end-stage renal disease (ESRD) patients who are on dialysis., Objective: The objective of this study was to comprehensively evaluate mobile apps used for medication compliance and nutrition tracking for possible use by CKD and ESRD patients., Methods: A systematic review framework was applied to the search, screening, and assessment of apps identified and downloaded from the iOS and Android app stores. We selected apps using 13 relevant search terms, narrowed down based on a set of inclusion and exclusion criteria, and then used the Mobile App Rating Scale (MARS), a widely adopted app evaluation tool to assess the effectiveness of apps. The internal consistency and interrater reliability were tested using Cronbach alpha and interclass correlation coefficients (ICCs), respectively., Results: The MARS total score had excellent internal consistency (Cronbach alpha=.90) and a moderate level of interrater reliability (2-way mixed ICC 0.65). Overall, 11 out of the 12 reviewed apps met the minimum acceptable score of 3.0 in MARS rating. The 3 apps with the highest combined scores were My Kidneys, My Health Handbook (MARS=4.68); My Food Coach (MARS=4.48); and National Kidney Foundation Malaysia (MARS=4.20). The study identified 2 general weaknesses in the existing apps: the apps fell short of accommodating advanced interactive features such as providing motivational feedback and promoting family member and caregiver participations in the app utilization., Conclusions: The MARS rating system performed well in the app evaluation. The 3 highest ranked apps scored consistently high across the 5 dimensions specified in MARS. These apps were developed in collaboration with reputable organizations and field experts, demonstrating the importance of expert guidance in developing medical apps., (©Abu Bakkar Siddique, Mary Krebs, Sarai Alvarez, Iris Greenspan, Amit Patel, Julianna Kinsolving, Naoru Koizumi. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.09.2019.)

Background and Objective: The internet provides numerous sources of information about prostate cancer (PCa). The present study investigated internet use among long-term PCa survivors, trust in online PCa-related information, and associated factors., Materials and Methods: Based on the German national research project Familial Prostate Cancer long-term PCa survivors were asked about their internet use in 2017. Associations with sociodemographic (age at survey, children, intimate relationship, education) and disease-related parameters (time since diagnosis, PCa family history, progress) were analyzed using multivariable logistic regression., Results: In all, 4636 long-term PCa survivors were included in the analysis (mean age 76.9 years; standard deviation 6.6 years). Mean follow-up was 14.0 years. Of long-term PCa survivors, 62.1% were using the internet. Among non-users 23.5% expressed strong concerns, among users only 2.8%. Furthermore, 47.2% of internet users sought information about PCa, 18.0% of them indicated difficulties while searching for information. More than half of the users found the online information inappropriate. Lower age, shorter time since diagnosis, progress, and a more frequent internet use were associated with search for information. Only one-third fully trusted online information. Trust in online information was associated with high age, higher educational level, and frequent search for online information. Many survivors stressed that they were primarily trusting their treating urologist., Conclusions: Two-thirds of long-term PCa survivors are using the internet. A significant proportion expressed difficulties finding proper and reliable information. Urologists should be familiar with online resources on PCa in order to offer advice to patients and to recommend adequate information on the internet.

Background: Cancer information services (CISs) are a valuable source of evidence-based information. Previous studies in the field of CISs often investigate only short periods of time. However, there is a need for long-term analyses to identify changes in the use of CISs., Objectives: The purpose of this study was to analyze trends in the inquiries of patients and surrogate seekers to a CIS., Method: We conducted a secondary data analysis of the inquiry records of the German CIS (Krebsinformationsdienst, KID) hosted by the German Cancer Research Center from 1992 until 2016 (N = 545,070). Trends in the number of inquiries were described using the whole sample, while the description of further characteristics is based on a sample (n = 55,046) of patients, their family members, and friends., Results: The inquiries increased in the period examined (1992: 11,344 inquiries; 2016: 34,869 inquiries). Since 2005, a greater share of patients (between 52 and 60%) than surrogate seekers have been contacting the CIS. The mean age of both self-seeking and supported patients increased from under 55 years between 1992 and 2000 up to over 60 years in the year 2016. Breast cancer is at all times the most frequently inquired cancer type (patients: n = 11,319, 39%; surrogate seekers: n = 4173, 17%). Even after the implementation of e‑mail as an additional communication channel, the majority of inquirers still prefer contact by phone (between 80 and 98%)., Conclusions: Changes in the utilization of a CIS over time are discussed against the background of structural changes, such as shifts in prevalence rates, family structures, or media environments.

Background: Childhood cancer affects the whole family and can have a lasting impact on parents of childhood cancer survivors (CCS). We aimed to (1) describe parents' perspective of currently experienced disadvantages and of their support needs during treatment, after treatment, and today; (2) identify characteristics associated with disadvantages and support needs; and (3) describe the use of existing support services., Procedure: In this population-based study, we identified parents of CCS (diagnosed ≤16 years of age, ≥5 years since diagnosis, aged ≥20 years at study) through the Swiss Childhood Cancer Registry (SCCR). Parents completed a questionnaire on perceived disadvantages (e.g., job-related, financial, etc.), support needs (e.g., job-related, financial, etc.), and socio-demographics. Cancer-related characteristics were available from the SCCR. We used multivariable multilevel logistic regression to identify characteristics associated with disadvantages and support needs., Results: An average of 24 years after diagnosis, one-fifth of parents (n = 59/308; 19.2%) reported disadvantages, and 7.1% reported support needs. Many parents had desired more support during (66.9%) or after (34.4%) their child's cancer treatment. Parents whose child experienced late effects (OR = 26.6; 95% CI, 2.9-241.0) or was dependent on parents (OR = 10.6; 95% CI, 2.1-53.7) reported greater current need for more support. Almost half of parents (43.5%) reported having used existing support services., Conclusions: Many parents need more support during and after active treatment of their child's cancer, and some experience support needs and disadvantages long into survivorship. Better promotion of existing services for parental and familial support and setting up new services, where needed, may help parents in the long term., (© 2019 Wiley Periodicals, Inc.)

Background: Parents of children with leukemia should be receiving an extensive amount of information about the care of their child; the aim of this study was to determine the parents’ information needs of children with leukemia. Methods: A cross-sectional study design was used to describe medical, physical, mental and lifestyle information needs among parents of children with leukemia. 209 parents of children diagnosed with leukemia in the west of Iran, during winter 2018, voluntarily participated in individual interviews. Data were analyzed by SPSS version 16 using t-test, One-way ANOVA and bivariate correlations statistical tests at 95% significant level. Results: The mean age of participants was 39.45 years [95% CI: 38.35, 40.55], ranged from 27 to 58 years. Participants achieved 55.6% score of information needs. There was a significant relationship between higher education level (P< 0.001), better economic status (P=0.008) and more family size member (P=0.003) with information needs. Conclusion: Findings suggest that parents of children with leukemia need the information to learn how to take care of their childhood and could be useful for guiding implementers to planning and implement effective programs to promotion information of parents towards children with cancer.

This paper investigates the feasibility, from a user perspective, of integrating a heterogeneous information network mining (HINM) technique into SensePlace3 (SP3), a web-based geovisual analytics environment. The core contribution of this paper is a user study that determines whether an analyst with minimal background can comprehend the network data modeling metaphors employed by the resulting system, whether they can employ said metaphors to explore spatial data, and whether they can interpret the results of such spatial analysis correctly. This study confirms that all of the above is, indeed, possible, and provides empirical evidence about the importance of a hands-on tutorial and a graphical approach to explaining data modeling metaphors in the successful adoption of advanced data mining techniques. Analysis of outcomes of data exploration by the study participants also demonstrates the kinds of insights that a visual interface to HINM can enable. A second contribution is a realistic case study that demonstrates that our HINM approach (made accessible through a visual interface that provides immediate visual feedback for user queries), produces a clear and a positive difference in the outcome of spatial analysis. Although this study does not aim to validate HINM as a data modeling approach (there is considerable evidence for this in existing literature), the results of the case study suggest that HINM holds promise in the (geo)visual analytics domain as well, particularly when integrated into geovisual analytics applications. A third contribution is a user study protocol that is based on and improves upon the current methodological state of the art. This protocol includes a hands-on tutorial and a set of realistic data analysis tasks. Detailed evaluation protocols are rare in geovisual analytics (and in visual analytics more broadly), with most studies reviewed in this paper failing to provide sufficient details for study replication or comparison work., Competing Interests: The authors have declared that no competing interests exist.

This research aims to identify the sources that urban Hui Muslims access to get health information related to cardiovascular diseases (CVD) and how they evaluate the information from different sources. This paper focuses on health information related to cardiovascular diseases among Hui Muslims. The data was gathered by means of an online survey administered on mobile devices. To put the answers given by Hui Muslims into perspective and make a comparison between Hui Muslims and the Han people, we also gathered information from Han-the dominant group in China. The results showed that Chinese Hui Muslims mostly used mediated sources, while Han people mainly used interpersonal sources. Both Hui Muslims and Han people trusted and preferred health information about cardiovascular diseases provided by health organizations, doctors, and healthcare providers. The information given by religious leaders was trusted the least, although Hui Muslims were significantly more positive about religious authority than the Han people. The current results are relevant for Chinese health information promoters and can help them diffuse CVD health information more effectively to urban Hui Muslims.

Cancer education is essential for improving cancer prevention and biobanking knowledge among racial-ethnic minorities, with the goal of increasing diversity and representativeness of biospecimen collections. However, little is known about the communication modalities for optimal delivery of information. We examined feasibility of recruitment and compared communication modalities for delivering cancer prevention and biobanking education to Hispanics. Communication modalities were evaluated using participation rates and change in knowledge, attitudes, self-efficacy, intention, receptivity, and trust. Enrollment in a biobanking registry was a behavioral outcome. Community members in Ponce, Puerto Rico and Tampa, Florida were recruited. Participants (N = 254) were randomized to one of three communication modalities: standard dissemination (mailed materials); enhanced dissemination (mailed materials plus follow-up call); and 'charla' (face-to-face group discussion). Participants completed questionnaires about their knowledge, attitudes, self-efficacy, intentions, receptivity, and trust regarding biobanking and cancer prevention pre- and post-intervention. Knowledge, attitudes, and self-efficacy were improved among all three modalities. Although the greatest increases in knowledge were observed when the information was delivered via charla, the charla had the lowest participation rate. The standard and enhanced dissemination modalities were more feasible for delivering cancer prevention and biobanking education to Hispanics. Lack of differences among the three modalities suggests culturally tailored education may be sufficient to capture the community's intention to participate in biobanking research, regardless of the delivery method for the education. Results from this study contribute to the limited knowledge regarding Hispanics knowledge and intentions for biospecimen collection, and in the future may improve participation in this underrepresented group.

Uncovering modular structure in networks is fundamental for systems in biology, physics, and engineering. Community detection identifies candidate modules as hypotheses, which then need to be validated through experiments, such as mutagenesis in a biological laboratory. Only a few communities can typically be validated, and it is thus important to prioritize which communities to select for downstream experimentation. Here we develop CRANK, a mathematically principled approach for prioritizing network communities. CRANK efficiently evaluates robustness and magnitude of structural features of each community and then combines these features into the community prioritization. CRANK can be used with any community detection method. It needs only information provided by the network structure and does not require any additional metadata or labels. However, when available, CRANK can incorporate domain-specific information to further boost performance. Experiments on many large networks show that CRANK effectively prioritizes communities, yielding a nearly 50-fold improvement in community prioritization.

Several power allocation algorithms for cooperative relay networks are presented in the literature. These contributions assume perfect channel knowledge and capacity achieving codes. However in practice, obtaining the channel state information at a relay or at the destination is an estimation problem and can generally not be error free. The investigation of the power allocation mechanism in a wireless network due to channel imperfections is important because it can severely degrade its performance regarding throughput and bit error rate. In this paper, the impact of imperfect channel state information on the power allocation of an adaptive relay network is investigated. Moreover, a framework including Automatic Repeat reQuest (ARQ) mechanism is provided to make the power allocation mechanism robust against these channel imperfections. For this framework, the end-to-end SNR is calculated considering imperfect channel knowledge using ARQ analytically. The goal is to emphasize the impact of imperfect channel knowledge on the power allocation mechanism. In this paper, the simulation results illustrate the impact of channel uncertainties on the average outage probability, throughput, and consumed sum power for different qualities of channel estimation. It is shown that the presented framework with ARQ is extremely robust against the channel imperfections.

Aim: We aimed to understand how information was delivered to head and neck (H&N) cancer patients and describe the perceptions of the H&N patients concerning information delivery., Methodology: This qualitative investigation was a part of our larger quantitative study that was conducted with H&N cancer patients at two academic hospitals in Montreal. After obtaining the ethical approval, a purposeful sample of participants was recruited from the main study until the content of the information gathered reached saturation. Data were collected by observing the information delivery and interviewing the study participants and Nurse Pivots. All observations and interviews were audiotaped. Data were transcribed verbatim; transcripts were developed, audited, and subjected to a thematic analysis., Results: Eleven H&N patients participated in the study. We found that the doctors were the main source of information at both hospitals; one hospital delivered information systematically to every patient using a multimedia-based information disseminating tool while the second hospital delivered information verbally in an ad hoc manner. Those who received information using the multimedia tool understood what was said to them and were better prepared for the next step, while those who received information verbally did not retain much, were confused, and expressed dissatisfaction., Conclusions: Although the doctors were the main source of information, patients experience difficulties in understanding what was said to them. Comprehensive information together with audiovisuals, when provided to H&N cancer patients based on their needs, seems to improve their understanding of their cancer and prepare them for their treatment.

Background: The aim of the REDSIAM network is to foster communication between users of French medico-administrative databases and to validate and promote analysis methods suitable for the data. Within this network, the working group "Mental and behavioral disorders" took an interest in algorithms to identify adult schizophrenia in the SNIIRAM database and inventoried identification criteria for patients with schizophrenia in these databases., Methods: The methodology was based on interviews with nine experts in schizophrenia concerning the procedures they use to identify patients with schizophrenia disorders in databases. The interviews were based on a questionnaire and conducted by telephone., Results: The synthesis of the interviews showed that the SNIIRAM contains various tables which allow coders to identify patients suffering from schizophrenia: chronic disease status, drugs and hospitalizations. Taken separately, these criteria were not sufficient to recognize patients with schizophrenia, an algorithm should be based on all of them. Apparently, only one-third of people living with schizophrenia benefit from the longstanding disease status. Not all patients are hospitalized, and coding for diagnoses at the hospitalization, notably for short stays in medicine, surgery or obstetrics departments, is not exhaustive. As for treatment with antipsychotics, it is not specific enough as such treatments are also prescribed to patients with bipolar disorders, or even other disorders. It seems appropriate to combine these complementary criteria, while keeping in mind out-patient care (every year 80,000 patients are seen exclusively in an outpatient setting), even if these data are difficult to link with other information. Finally, the experts made three propositions for selection algorithms of patients with schizophrenia., Conclusion: Patients with schizophrenia can be relatively accurately identified using SNIIRAM data. Different combinations of the selected criteria must be used depending on the objectives and they must be related to an appropriate length of time., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: The lack of standardized nomenclature for atopic dermatitis (AD) creates challenges for scientific communication, patient education, and advocacy., Objective: We sought to determine the relative popularity of the terms eczema, AD, and atopic eczema (AE) using global search engine volumes., Methods: A retrospective analysis of average monthly search volumes from 2014 to 2016 of Google, Bing/Yahoo, and Baidu was performed for eczema, AD, and AE in English and 37 other languages. Google Trends was used to determine the relative search popularity of each term from 2006 to 2016 in English and the top foreign languages, German, Turkish, Russian, and Japanese., Results: Overall, eczema accounted for 1.5 million monthly searches (84%) compared with 247 000 searches for AD (14%) and 44 000 searches for AE (2%). For English language, eczema accounted for 93% of searches compared with 6% for AD and 1% for AE. Search popularity for eczema increased from 2006 to 2016 but remained stable for AD and AE., Conclusions: Given the ambiguity of the term eczema, we recommend the universal use of the next most popular term, AD.

Objectives: Health information seeking on behalf of others is an important form of social support by which laypeople provide important sources of information for patients. Based on social network theory, we analyze whether this phenomenon also occurs in offline sources. We also seek to learn more about the type of relationships between information seekers and patients, as research to date indicates that surrogate seeking mostly occurs in close relationships between the seeker and the patient., Methods: Using a large-scale representative survey from the 28 member states of the European Union (N=26,566), our data comprise all respondents who reported seeking health information online or offline (n=18,750; 70.6%)., Results: Within the past year, 61.0% of the online health information seekers and 61.1% of the offline health information seekers had searched on behalf of someone else. Independent of the information channel, surrogate seekers primarily searched for health information for family members (online: 89.8%; offline: 92.8%); they were significantly less likely to search for information on behalf of someone with whom they had weaker ties, such as colleagues (online: 25.1%; offline: 24.4%). In a multilevel generalized linear model, living together with someone was by far the most relevant determinant for surrogate seeking, with differences between countries or Internet activity being less important., Conclusion: These results support the assumptions of social network theory. Implications are discussed, especially with regard to the provision of adequate health information., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Despite the increases in health promotion and educational programs on HIV and AIDS, lack of information and communication on HIV and AIDS for the visually impaired persons continues. The underlying factors that create the information and communication gaps have not been fully explored in Zambia. It is therefore important that, this situational analysis on HIV and AIDS information dissemination to persons with visual impairments at Kang'onga Production Centre in Ndola was conducted. The study commenced in December 2014 to May 2015., Methods: A qualitative case study design was employed. The study used two focus group discussions with males and females. Each group comprised twelve participants. Eight in-depth interviews involving the visually impaired persons and five key informants working with visually impaired persons were conducted. Data was analysed thematically using NVIVO 8 software. Ethical clearance was sought from Excellency in Research Ethics and Science. Reference Number 2014-May-030., Results: It was established that most visually impaired people lacked knowledge on the cause, transmission and treatment of HIV and AIDS resulting in misconceptions. It was revealed that health promoters and people working with the visually impaired did not have specific HIV and AIDS information programs in Zambia. Further, it was discovered that the media, information education communication and health education were channels through which the visually impaired accessed HIV and AIDS information. Discrimination, stigma, lack of employment opportunities, funding and poverty were among the many challenges identified which the visually impaired persons faced in accessing HIV and AIDS information. Integration of the visually impaired in HIV and AIDS programs would increase funding for economic empowerment and health promotions in order to improve communication on HIV and AIDS information. The study showed that, the visually impaired persons in Zambia are not catered for in the dissemination of HIV and AIDS information. Available information is not user-friendly because it is in unreadable formats thereby increasing the potential for misinformation and limitations to their access. This calls for innovations in the communication on HIV and AIDS information health promotion to the target groups.

Background: In the last decades, a reduction in mortality in severely injured patients with an ISS ≥ 16 could be observed. Some authors report a death rate of about 22 %. Moreover, there were some new insights in the last years such as the reduction in mortality by use of whole-body CT and the introduction of the S3 guideline of the German Society of Trauma Surgery "Treatment of Patients with Severe and Multiple Injuries" have supported the evidence-based treatment of severely injured patients. Methods: A retrospective analysis of 2304 patients was performed between 2002 and 2011. The data of the authors' clinic for the trauma registry of the DGU® were used. After applying the inclusion criteria, ISS ≥ 16 and primary transfer from the accident site, 968 patients remained. Results: In the study population, a mean ISS of 29.81 and a mean GCS of 9.42 were found. The average age was 46.04 years. The mortality rate was 28.7 %. A significant difference between decedents and survivors was found at the ISS, GCS, RTS, new ISS, TRISS, RISC, AIS head, AIS skin, RR pre-clinical, pre-clinical heart rate and age. To test whether the lethality was reduced by the increased use of whole-body CT, a division into a group prior to and from 2009 was performed. Results revealed a significant increase in the whole-body CT rate from 56.96 to 71.7 %. The mortality rate declined from 32.3 to 24.5 %. In the same way it was verified whether the S3 guideline had an impact on mortality. Therefore, a division into groups before and from 2011 was conducted. Here, the mortality rate decreased from 30.4 to 18.4 %. In addition, a comparison between 2010 and 2011 was performed. Overall, there were statistically significant differences in the trauma room time, the surgical time, the volume infused, the rate of multiple organ failure and the rate of whole-body CTs performed. Conclusion: In the period from 2002 to 2011 a mortality rate of 28.7 % was found. The higher rate in comparison to published data is most likely explained by the high rate of serious and severe head injuries. The increased use of whole-body CT and the introduction of the S3 guideline led to a significant decrease in mortality in the authors' patient population. This is due particularly to the accelerating of the treatment of severely injured patients, the reduction of the infused volume, shortened surgical phase within the first 24 hours and the increased use of whole-body CT., (Georg Thieme Verlag KG Stuttgart · New York.)

The quest for information is one of the most common activity of human beings. Despite the the impressive progress of search engines, not to miss the needed piece of information could be still very tough, as well as to acquire specific competences and knowledge by shaping and following the proper learning paths. Indeed, the need to find sensible paths in information networks is one of the biggest challenges of our societies and, to effectively address it, it is important to investigate the strategies adopted by human users to cope with the cognitive bottleneck of finding their way in a growing sea of information. Here we focus on the case of Wikipedia and investigate a recently released dataset about users' click on the English Wikipedia, namely the English Wikipedia Clickstream. We perform a semantically charged analysis to uncover the general patterns followed by information seekers in the multi-dimensional space of Wikipedia topics/categories. We discover the existence of well defined strategies in which users tend to start from very general, i.e., semantically broad, pages and progressively narrow down the scope of their navigation, while keeping a growing semantic coherence. This is unlike strategies associated to tasks with predefined search goals, namely the case of the Wikispeedia game. In this case users first move from the 'particular' to the 'universal' before focusing down again to the required target. The clear picture offered here represents a very important stepping stone towards a better design of information networks and recommendation strategies, as well as the construction of radically new learning paths., Competing Interests: The authors have declared that no competing interests exist.

Objective: This mixed-method study assessed 1) survivors' and parents' information needs; and 2) associations between unmet information needs and clinical and socio-demographic characteristics., Methods: Stage 1: CCS and parents of CCS, >5years post-diagnosis completed a questionnaire on information needs, overall health and perceived risk. Predictors for unmet information needs were assessed by multivariable regression. Stage 2: participants were interviewed in-depth on these topics., Results: Questionnaires were completed by 485 participants comprising 322 survivors (mean age: 26.7years, SD=7.9; time since diagnosis: 19.7years, SD=8.8) and 163 parents (child age: 12.9years, SD=2.4; time since diagnosis: 9.7years, SD=2.3), and complemented by 70 interviews. Survivors reported unmet information needs about late effects (57.5%) and parents for fertility issues (62.5%). Survivors had more unmet needs for medical information whereas parents had significantly more regarding sexual issues and lifestyle. Being a parent (p=0.001), dissatisfaction with follow-up care (p=0.003), lower overall health (p=0.014), higher perceived risk of late effects (p<0.001), and greater anxiety/depression (p<0.001) were significantly associated with more unmet needs., Conclusion: Unmet information needs were common for survivors and parents of CCS., Practice Implications: Future efforts towards tailoring information on potential late effects, healthy lifestyles and follow-up care may help to address unmet information needs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Although a wide range of preventive and clinical interventions has targeted cardiovascular risk management (CVRM), outcomes remain suboptimal. Therefore, the question is what additional determinants of CVRM and outcomes can be identified and addressed to optimize CVRM. In this study, we aimed to identify new perspectives for improving healthcare delivery and explored associations between information exchange networks of health care providers and evidence-based CVRM., Methods: This observational study was performed parallel to a randomized clinical trial which aimed to improve professional performance of practice nurses in the Netherlands. Information exchange on medical policy for CVRM ("general information networks") and CVRM for individual patients ("specific information networks") of 180 health professionals in 31 general practices was measured with personalized questionnaires. Medical record audit was performed concerning 1620 patients in these practices to document quality of care delivery and two risk factors (systolic blood pressure (SBP) and LDL cholesterol level). Hypothesized effects of five network characteristics (density, frequency of contact, centrality of CVRM-coordinators, homophily on positive attitudes for treatment target achievement, and presence of an opinion leader for CVRM) constructed on both general and specific information exchange networks were tested and controlled for practice and patient factors using logistic multilevel analyses., Results: Odds for adequate performance were enhanced in practices with an opinion leader for CVRM (OR 2.75, p < .05). Odds for achievement of SBP targets were reduced in practices who had networks with low homophily on positive attitudes for SBP and LDL targets (homophily for SBP targets OR 0.57, p < .05 and OR 0.60, p < .05, homophily for LDL targets OR 0.59, p < .05 and OR 0.61, p < .05 in general and specific information networks, respectively). No effects of network characteristics on cholesterol were found., Conclusions: Delivery of evidence-based CVRM is associated with homophily of clinical attitudes and presence of opinion leaders in primary care teams. These results signal the potential of social networks to be taken into account in further attempts to improve the implementation of evidence-based care for CVRM. Future research is needed to identify and formulate optimal strategies for using opinion leaders to improve CVRM. Future interventions may be more effective if they target a common vision on CVRM within practices.

Objectives: Patients and consumers make many choices that affect their health and their health care. Some of these decisions are informed by evidence, but many are not. A growing body of research indicates that those who are more activated or engaged in their health are more likely to seek out and use information to inform their health decisions. In this paper we review the evidence about patient activation and information seeking, health behaviors, and health outcomes. We also review what is known about how to increase patient activation, and how best to support patients who are at different levels of activation to use information to support their choices., Discussion: Strategies can be tailored to support and information for patients at different levels of activation. These strategies might be implemented in different clinical settings and situations, tailored and targeted approaches for care transitions, health coaching, and in the use of shared-decision-making., Conclusions: Efforts to support informed consumer choices have largely been a 'one size fits all' approach. Understanding consumers, and trying to meet them where they are, is likely to be the focus of the 'next generation' of interventions to support informed consumer choices., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The Internet is a valuable tool that continues to revolutionize many aspects of our lives; however, the ability to disseminate diverse data across populations and nations presents both opportunities and challenges. Online resources are increasingly used in health care, providing wider access to information for patients, researchers, and clinicians. At the turn of the millennium, the National Cancer Institute (NCI) predicted that Internet-based technologies would create a revolution in communication for oncology professionals and patients with cancer. Herein, findings from the NCI's Health Information National Trends Survey are reviewed to give insight into how Internet trends related to oncology patients are evolving. Future trends are discussed, including examples of 'connected health' in oncology; the spread of mobile and ubiquitous access points to Internet-hosted information; the diffusion of devices, sensors, and apps; the spread of personal data sharing; and an evolution in how networks can support person-centred and family-centred care.

Aims: Patients utilize a variety of sources to learn about their condition. This study assessed the association of these resources with patient knowledge, adherence, and physiologic outcomes., Methods: Adults with Type 2 diabetes recruited at an outpatient clinic in Pune, India provided IRB-approved consent and completed surveys measuring diabetes knowledge, self-management, and educational resource utilization. Lab values were obtained from the patient's medical record. Statistical analysis was conducted in SPSS to determine the association between educational resources and outcomes., Results: We enrolled 82 patients with a mean age of 58.3 years. The most commonly used resource was books/pamphlets. The use of television and books/pamphlets as sources of information was significantly associated with greater knowledge and self-management. Use of books and pamphlets and peers with diabetes was associated with lower fasting and postprandial blood glucose. Regression analyses controlling for age, gender, and years with diabetes revealed that use of newspapers and magazines, books and pamphlets, and television were predictors of overall diabetes knowledge and nutrition knowledge. The use of television as a source of information was a predictor of the hours exercised per week., Conclusions: Resources such as books and pamphlets, newspapers and magazines, and television are common ways that people with diabetes learn about their medical conditions. The use of television as a source of information predicted the greatest number of positive outcomes among patients, followed by use of books and pamphlets. These methods should be further explored in order to understand how their benefit may be maximized for patients., (Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (www.google.com), Bing (www.bing.com), and Yahoo (www.yahoo.com). DuckDuckGo (www.duckduckgo.com) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term lateral lumbar interbody fusion, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [Orthopedics. 2016; 39(4):e701-e707.]., (Copyright 2016, SLACK Incorporated.)

Purpose: The purpose of this study is to determine how people diagnosed with cancer who call the Cancer Council Helpline in South Australia differ from carers/family/friends (caregivers) who call., Method: Descriptive, retrospective audit of calls from people who contacted Cancer Council Helpline in South Australia between 16 April 2009 and 16 April 2013 who were diagnosed with cancer (n = 5766) or were the caregivers (n = 5174) of a person with cancer., Results: Caregivers were more likely to be female (p < 0.001); younger in age (p < 0.001); call regarding cancer that was metastasised/widespread/advanced, terminal or at an unknown stage (p < 0.001) and phone requesting general cancer information or emotional support (p < 0.001). This group was more distressed (p < 0.001) but less likely (p = 0.02) to be offered and/or accept referrals to counselling than people diagnosed with cancer who called. Follow-up care was required by 63.5 % of caregivers and 73.1 % of people with cancer according to distress management guidelines; 8.5 and 15.3 %, respectively, accepted referrals to internal services. The most frequently discussed topic for both groups was emotional/psychological concerns. There were no differences in remoteness of residence or call length between groups., Conclusions: Caregivers represented different demographic groups than people diagnosed with cancer who called this helpline. The two groups phoned for different issues, at different stages of disease progression, displayed different levels of distress and, therefore, may benefit from services being tailored to meet their unique needs. These results also demonstrate the capacity of helplines to complement other health services and confirm that callers to cancer helplines exhibit high levels of distress.

This article reports on research into the reasons why clinical staff in an acute hospital may be reluctant to use library services. The research was conducted by Gaynor Thomas at the Prince Philip Hospital in Llanelli in Wales as part of the dissertation she completed for an MSc in Economics. She graduated in July 2014 from Aberystwyth University and has co-written the article with Hugh Preston, her dissertation supervisor. The article summarises the key findings from the interviews undertaken as part of the research process and lists the resulting recommendations. Gaynor also highlights the initiatives which have been put in place with the express aim of removing barriers to use and encouraging clinical staff to make the most of the library which is, she argues, a time-saving resource. AM., (© 2016 Health Libraries Group.)

The aim of this study was to analyze the knowledge structure and report the evolution of hypoxic-ischemic encephalopathy research over the past decade based on co-word analysis. Scientific publications focusing on neonatal hypoxic-ischemic encephalopathy were searched from the Web of Science database (January 2005 to December 2014). The keywords from these articles were extracted, and a knowledge network based on these keywords was built using Ucinet6.212 and NetDraw2.084 software. A total of 1892 papers were included, and 39 high-frequency keywords were defined. "HIE" and "neonate" located at the center of the knowledge network. Etiology and pathogenesis, clinical manifestation, and therapy were researched more widely in the network than other aspects of hypoxic-ischemic encephalopathy. This co-word analysis provides an overview of neonatal hypoxic-ischemic encephalopathy research and suggests that the etiology, clinical manifestation, and therapy of hypoxic-ischemic encephalopathy have become research cores over the past decade., (© The Author(s) 2015.)

Background: Online information resources function dually as important learning tools and sources of the latest evidence-based recommendations for junior medical officers (JMOs). However, little is currently known about how JMOs utilise this information when providing care for their patients. This study aimed to examine the usage and experience of online information resources amongst JMOs in South Australia to ascertain (i) the type of resources accessed, (ii) the frequency, (iii) the intended purpose, and (iv) the perceived reliability., Methods: A survey instrument using multiple choices, five-point Likert scales and free-text comments was developed and distributed through SurveyMonkey to South Australian JMOs between 1 May 2014 and 30 June 2014., Results: Of the 142 surveyed, 100 JMOs (70.4%) used online information resources as their first approach over all other resources available. JMOs overwhelmingly (94.4%, n = 134) used online information resources at least once per day, with the most frequent purpose for use being information regarding prescription medication (82.4%, n = 117, reported 'very frequent' use). JMOs stated online resources were necessary to perform their work and, of the different types of information accessed, they rated peer-reviewed resources as the most reliable., Conclusions: JMOs strongly rely upon online clinical information in their everyday practice. Importantly, provision of these resources assists JMOs in their education and clinical performance.

Single point estimates of human health hazard/toxicity values such as a reference dose (RfD) are generally used in chemical hazard and risk assessment programs for assessing potential risks associated with site- or use-specific exposures. The resulting point estimates are often used by risk managers for regulatory decision-making, including standard setting, determination of emission controls, and mitigation of exposures to chemical substances. Risk managers, as well as stakeholders (interested and affected parties), often have limited information regarding assumptions and uncertainty factors in numerical estimates of both hazards and risks. Further, the use of different approaches for addressing uncertainty, which vary in transparency, can lead to a lack of confidence in the scientific underpinning of regulatory decision-making. The overarching goal of this paper, which was developed from an invited participant workshop, is to offer five approaches for presenting toxicity values in a transparent manner in order to improve the understanding, consideration, and informed use of uncertainty by risk assessors, risk managers, and stakeholders. The five approaches for improving the presentation and communication of uncertainty are described using U.S. Environmental Protection Agency's (EPA's) Integrated Risk Information System (IRIS) as a case study. These approaches will ensure transparency in the documentation, development, and use of toxicity values at EPA, the Agency for Toxic Substances and Disease Registry (ATSDR), and other similar assessment programs in the public and private sector. Further empirical testing will help to inform the approaches that will work best for specific audiences and situations., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Encouraging patients and consumers to use data and other information in choosing health care providers is an important way to enhance patient engagement and improve the quality of care. The growing use of technology, including smart phones and near-ubiquitous Internet access, provides consumers with easy access to websites that collect and report assessments and ratings of providers, primarily physicians and hospitals. In addition to new technology, recent laws and changes in society and the delivery of care are laying the foundation for greater use by consumers of provider performance report cards. Such use could be accelerated if the shortcomings of current report card efforts were addressed. Recommendations include making online report cards easier to use and more understandable, engaging, substantive, and relevant to consumers' health and medical concerns and choices., (Project HOPE—The People-to-People Health Foundation, Inc.)

Online information is a critical resource for evidence-based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice., (© 2014 Wiley Publishing Asia Pty Ltd.)

Scientific evidence on all aspects of smoking amongst youth is very important for designing appropriate interventions to reduce smoking among this vulnerable population. This paper describes current access to antismoking information among school children aged 13 to 15 years in Vietnam in 2014 and examines its potential impact on preventing smoking initiation. The data used in this paper were obtained from the 2014 Global Youth Tobacco Survey (GYTS) in Vietnam. Students were asked questions about their level of awareness of anti-smoking information from various sources in the past 30 days and about lessons in school regarding the dangers of tobacco use during the last 12 months. Those who have never smoked were asked "whether or not they thought about avoiding cigarettes because of health warnings on cigarette packages" and answers were analyzed in combination with data on access to anti-smoking information from other sources. The prevalence of exposure to antismoking campaigns was high among school children in Viet Nam: 55.3% of current smokers reported thoughts of smoking cessation because of health warnings on cigarette packages; 60.5% of never smokers avoided initiating smoking because of the same health warnings. The potential impact of graphic health warnings to prevent school-aged children from smoking initiation would be stronger if there was concurrent access to anti-smoking programs on the dangers of tobacco use in schools. However, school education for tobacco prevention and control has not been as strong as expected. A more comprehensive school curriculum on tobacco prevention and control is recommended to reinforce antismoking messages among school children.

Objectives: This qualitative research aimed to explore how health information sources inform decision-making among Hispanic mothers during their children's first 1000 days of life (conception-age 24 months), and to generate appropriate health information sources and communication strategies for future interventions., Methods: We conducted seven focus groups with 49 Hispanic women who were pregnant or had children <2 years old. Domains included interpersonal and media sources, source trustworthiness, dealing with contradictory information, and how information affects decision-making. We used immersion/crystallization process for analysis., Results: Trusted health information sources included health care providers, female and male family members, BabyCenter.com and other Internet sources, selected social media, and television. Some immigrant women reported preferring the Internet citing less established local support networks. Women highlighted the importance of validating health information through checking multiple sources for consistency and resolving contradictory information. Mothers expressed interest in receiving reliable website links from healthcare professionals and outreach to extended family., Conclusions for Practice: Cultural factors, including immigration status, are important in understanding the use of health information sources and their role in decision-making about pregnancy and child health among Hispanic mothers. Healthcare providers and public health professionals should consider Hispanic mothers health information environment and provide culturally-relevant communication strategies and interventions during this high information-seeking time period.