Communicating health decisions: an analysis of messages posted to online prostate cancer forums

Background  Experiential websites such as message forums and blogs allow Prostate Cancer (PCa) patients to communicate their health decisions to peers. The issues surrounding this form of indirect involvement in public health are little understood. Objective  This paper explores the types of decision-making processes that people are exposed to on PCa online message boards. The kinds of treatment choices patients are making and the reports of their decision-making processes to peers through an online environment are examined in the context of the Heuristic Systematic Model. Method  Messages about treatment decision making were collected from four PCa websites. In total, 137 messages were selected from blogs and online forums and their decision-making processes coded. Results  Men looking online for information about treatment options for PCa are exposed to a range of decision-making processes. Just under half (49.6%) of the messages reported non-systematic decision processes, with deferral to the doctor and proof of cancer removal being the most common. For systematic processing (36.5%), messages most commonly considered treatment outcomes and side-effects. Processes did not vary between the blogs and online forums. Discussion and conclusion  Compared to previous studies far fewer messages reported non-systematic decision processes and only a small number of messages reflected lay beliefs or misbeliefs about PCa treatment. Implications for men and their clinicians of seeking health information online are discussed

Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry:A Cross-sectional Study of Common Conditions in the United States

BACKGROUND: Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties. METHODS AND FINDINGS: We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating “pre-disease”; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications. CONCLUSIONS: For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies. Please see later in the article for the Editors' Summar

Bad news: analysis of the quality of information on influenza prevention returned by Google in English and Italian

Information available to the public influences the approach of the population toward vaccination against influenza compared with other preventative approaches. In this study, we have analyzed the first 200 websites returned by searching Google on two topics (prevention of influenza and influenza vaccine), in English and Italian. For all the four searches above, websites were classified according to their typology (government, commercial, professional, portals, etc.) and for their trustworthiness as defined by the Journal of the American Medical Association (JAMA) score, which assesses whether they provide some basic elements of information quality (IQ): authorship, currency, disclosure, and references. The type of information described was also assessed to add another dimension of IQ. Websites on influenza prevention were classified according to the type of preventative approach mentioned (vaccine, lifestyle, hygiene, complementary medicine, etc.), whether the approaches were in agreement with evidence-based medicine (EBM) or not. Websites on influenza vaccination were classified as pro- or anti-vaccine, or neutral. The great majority of websites described EBM approaches to influenza prevention and had a pro-vaccine orientation. Government websites mainly pointed at EBM preventative approaches and had a pro-vaccine orientation, while there was a higher proportion of commercial websites among those which promote non-EBM approaches. Although the JAMA score was lower in commercial websites, it did not correlate with the preventative approaches suggested or the orientation toward vaccines. For each of the four search engine result pages (SERP), only one website displayed the health-of-the-net (HON) seal. In the SERP on vaccines, journalistic websites were the most abundant category and ranked higher than average in both languages. Analysis using natural language processing showed that journalistic websites were mostly reporting news about two specific topics (different in the two languages). While the ranking by Google favors EBM approaches and, in English, does not promote commercial websites, in both languages it gives a great advantage to news. Thus, the type of news published during the influenza season probably has a key importance in orienting the public opinion due to its high visibility. This raises important questions on the relationships between health IQ, trustworthiness, and newsworthiness

Mendelian randomization study of B-type natriuretic peptide and type 2 diabetes: evidence of causal association from population studies

<p>Background: Genetic and epidemiological evidence suggests an inverse association between B-type natriuretic peptide (BNP) levels in blood and risk of type 2 diabetes (T2D), but the prospective association of BNP with T2D is uncertain, and it is unclear whether the association is confounded.</p> <p>Methods and Findings: We analysed the association between levels of the N-terminal fragment of pro-BNP (NT-pro-BNP) in blood and risk of incident T2D in a prospective case-cohort study and genotyped the variant rs198389 within the BNP locus in three T2D case-control studies. We combined our results with existing data in a meta-analysis of 11 case-control studies. Using a Mendelian randomization approach, we compared the observed association between rs198389 and T2D to that expected from the NT-pro-BNP level to T2D association and the NT-pro-BNP difference per C allele of rs198389. In participants of our case-cohort study who were free of T2D and cardiovascular disease at baseline, we observed a 21% (95% CI 3%-36%) decreased risk of incident T2D per one standard deviation (SD) higher log-transformed NT-pro-BNP levels in analysis adjusted for age, sex, body mass index, systolic blood pressure, smoking, family history of T2D, history of hypertension, and levels of triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The association between rs198389 and T2D observed in case-control studies (odds ratio = 0.94 per C allele, 95% CI 0.91-0.97) was similar to that expected (0.96, 0.93-0.98) based on the pooled estimate for the log-NT-pro-BNP level to T2D association derived from a meta-analysis of our study and published data (hazard ratio = 0.82 per SD, 0.74-0.90) and the difference in NT-pro-BNP levels (0.22 SD, 0.15-0.29) per C allele of rs198389. No significant associations were observed between the rs198389 genotype and potential confounders.</p> <p>Conclusions: Our results provide evidence for a potential causal role of the BNP system in the aetiology of T2D. Further studies are needed to investigate the mechanisms underlying this association and possibilities for preventive interventions.</p&gt

Qualitative Methods for Classifying and Detecting Online Identity Deception

The overall aim of our research is to use qualitative methods to help understand online identity deception. In this position paper, two pilot studies are described. The first was designed to test the feasibility of using content analysis of online discussions to classify the perceptions of the ‘net generation’ regarding different levels of identity deception. Based on the classifications identified, the second follow-up study will use face-to-face focus groups to collect further thoughts on these classifications, and the new data will be presented at this CHI Workshop. It is hoped that the feedback at the Workshop will help to direct further research using qualitative methods to analyse naturally-occurring identity descriptions found on social networking sites. The overall outcome of the research programme is to produce a set of indicators to assist identity deception in online environments

The Latino Age Wave: What Changing Ethnic Demographics Mean for the Future of Aging in the U.S.

Highlights data on aging Latinos/Hispanics, trends in the assets and needs of community-based organizations serving or that could serve older Latinos, and strategies for addressing gaps in supportive policies. Outlines best practices and recommendations

The Value of Online Medication Rating Systems to Older Adults and Their Association with Self-Reported Outcomes

The Internet is a powerful and very popular vehicle for distributing judgment-free health information to patients. Multiple studies have examined the role of online health information as well as physician-rating websites in health care. Studies have examined the value of online drug information for patients and the value of the online drug information for patients. However, no study has examined the usefulness or value of online medication rating websites in facilitating physician-patient communication or participant-reported outcomes. In this study, the value of online medication rating websites to older adults in facilitating communication with their physicians using a newly developed tool was assessed. Additionally, the participant-reported outcomes of quality of life, satisfaction with physician communication, beliefs about medications, and medication adherence plus the relationship between the older adults’ actual ratings of their antihypertensive medications and their self-reported outcomes were examined. Older adults with poor quality of life were more likely to view the online medication rating websites more favorably than participants who enjoy good quality of life. Participants who liked to share health decisions with their physicians were also more likely to have favorable views of the online websites. In addition, older adults with hypertension, who highly rated their antihypertensive medication regimens, were more likely to have good physical quality of life, high satisfaction with physician communication, positive beliefs about medications, and high medication adherence. Older adults with poor quality of life were more likely to be unsatisfied with their antihypertensive medications, have multiple comorbidities, limited health literacy, low satisfaction with their communication with their physicians, take multiple medications, and were more likely to view online medication rating websites favorably compared to their counterparts with good quality of life. Online medication rating websites may play an important role in enhancing physician-patient communication particularly among this segment of the patient population

Disease Prevalence and Health Determinants in Nevada

In this report, we use recent data to describe the health of Nevada and update the previous report (Monnat, 2012) on health outcomes and health determinants in the Silver State. Data for this report are mainly obtained from the County Health Rankings, America’s Health Rankings, and the 2016 Center for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity report. In line with the previous report by Monnat (2012), we reference Nevada’s disease prevalence in relation to the U.S. average and other states, as well as disease distribution among counties in Nevada. We also compaire health indicators in the U.S. with those in other countries, discuss the health determinants and examine their impact on Nevadans’ health. The chapter concludes with the recommendations on strategies to improve health of Nevada residents. Additional resources include the national, state and community public health organizations (Appendix 1) and examples of public health related legislative actions in Nevada (Appendix 2). In the last several decades, there has been growing interest in how modifiable risk factors contribute to disease and mortality rates. Studies point to five key domains as the principal determinants of health: (a) genetic predisposition, (b) social circumstances, (c) environmental conditions, (d) health behaviors, and (e) medical care. It is estimated that as much as 60% of disease risk is attributable to modifiable factors, such as health behaviors, social circumstances, and environmental conditions (McGinnis, Williams-Ruso, & Knickman, 2002). In recent years, health behaviors (e.g. tobacco use, poor diet, and physical inactivity) and social determinants (e.g. poverty, access to health care) have been singled out as contributing to health inequalities (Lewis & Burb-Sharps, 2010; Marmot, 2005). The effect of behavioral and social determinants of health outcomes is evident throughout the U.S and Nevada

An Empirical Validation of the Patient-centered e-Health Framework in Patient-focused Websites

Although the Internet is in its second decade of wide-spread adoption, many patient-centered health websites are still in a phase of early adoption, scrambling to define and defend market segments in a shifting healthcare information landscape. Consequently, healthcare and health information providers are jockeying for position in a dynamic industry trying to serve different patients’ needs. To understand the situation, this article takes the approach of Patient-centered e-Health (PCEH) and makes three contributions. One, we empirically test the PCEH framework on patient-focused websites. Two, given the PCEH framework, we identify five categories of websites that serve different segments of the patient-centered health information market. Three, we analyze the five categories in terms of different features and derive a classification model. This article helps us better understand PCEH websites and guide the future development of online healthcare and health information services