Trust and Credibility in Web-Based Health Information: A Review and Agenda for Future Research

Background: Online sources are becoming increasingly important in health information seeking, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of online health information from different organisations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and, more specifically how they assess their credibility and trustworthiness. Objectives: This article reviews empirical studies on trust and credibility in the use of online health information. The article seeks to present a profile of the research conducted on trust and credibility in online health information seeking, to identify the factors that impact judgements of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aims to identify the gaps in current knowledge and to propose an agenda for future research. Methods: A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms: online health information, trust, credibility, and their variants, in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of exclusion criteria, this was reduced to a final dataset of 73 articles, which was analysed in full. Results: Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science and computer science, and focussing mostly on the USA and the UK. Documents in the dataset fell into three categories: those using trust or credibility as a dependent variable, those using trust or credibility as an independent variable, and studies of the demographic factors that influence the role of trust or credibility in online health information seeking. There is a consensus that in terms of website design, clear layout and design, interactive features and the authority of the owner have a positive effect on trust or credibility, whilst advertising has a negative effect. With regard to content features, authority of the author, ease of use and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender and perceived health status. Conclusions: There is considerable scope for further research. This includes: increased clarity of the interaction between the variables associated with health information seeking; increased consistency on the measurement of trust and credibility; a greater focus on specific online health information sources; and, enhanced understanding of the impact of demographic variables on trust and credibility judgement

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Educational impact of peer-intervention on the knowledge and attitudes about HIV/AIDS in adolescents in Panama.

BACKGROUND: The purpose of this study was to evaluate the knowledge, attitudes, and practices about HIV/AIDS of high school students in Panama City, Panama and the impact of a peer-to-peer intervention project. METHODS: There were 659 participants in two public and two private schools, one of each got the intervention and the other serving as control. A questionnaire was used as a pretest and post-test to measure the effects of the intervention. The intervention consisted of 12 weekly sessions led by professionally trained peers using four different modalities: theater, group dynamics, videos, and discussions. RESULTS: The difference in the knowledge scores of the questionnaire resulted in an improvement in both the private (ES=0.63) and the public (ES=0.52) schools with the intervention. Another important finding was that the idea of abstinence as disease prevention for high school students rose from 7% to 60% (public school) and from 27% to 62% (private school) in response to an open-ended question. CONCLUSIONS: There were other significant positive findings that demonstrate the efficacy of this peer-to-peer model educating high school students about lowering the risks of contracting HIV/AIDS. This model could also be used to prevent or mitigate other risky behaviors

Efficacy of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine against acute otitis media and nasopharyngeal carriage in Panamanian children – A randomized controlled trial

We previously reported 10-valent pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) efficacy in a double-blind randomized trial (ClinicalTrials.gov: NCT00466947) against various diseases, including acute otitis media (AOM). Here, we provide further analyses. In the Panamanian subset, 7,359 children were randomized (1:1) to receive PHiD-CV or control vaccine at age 2/4/6 and 15–18 months. Of these, 2,000 had nasopharyngeal swabs collected. AOM cases were captured when parents sought medical attention for children with AOM symptoms; surveillance was enhanced approximately 2 y into the study through regular telephone calls or home visits by study personnel, who advised parents to visit the clinic if their child had AOM symptoms. Mean follow-up was 31.4 months. Clinical AOM (C-AOM) cases were assessed by physicians and confirmed by otorhinolaryngologists. Middle ear fluid samples, taken from children with C-AOM after specific informed consent, and nasopharyngeal samples were cultured for pathogen identification. For 7,359 children, 2,574 suspected AOM cases were assessed by a primary healthcare physician; 649 cases were C-AOM cases as per protocol definition. From the 503 MEF samples collected, 158 resulted in a positive culture. In the intent-to-treat cohort (7,214 children), PHiD-CV showed VE against first C-AOM (24.0% [95% CI: 8.7, 36.7]) and bacterial (B-AOM) episodes (48.0% [20.3, 66.1]) in children <24 months, which declined thereafter with age. Pre-booster VE against C-AOM was 30.7% [12.9, 44.9]; post-booster, −6.7% [−36.4, 16.6]. PHiD-CV VE was 17.7% [−6.1, 36.2] against moderate and 32.7% [−20.5, 62.4] against severe C-AOM. VE against vaccine-serotype pneumococcal NPC was 31.2% [5.3, 50.3] 3 months post-booster, and 25.6% [12.7, 36.7] across all visits. NTHi colonization rates were low and no significant reduction was observed. PHiD-CV showed efficacy against C-AOM and B-AOM in children younger than 24 months, and reduced vaccine-serotype NPC

Establishment of a reproducible model of chronic-phase chronic myeloid leukemia in NOD/SCID mice using blood-derived mononuclear or CD34+ cells

An animal model of chronic myeloid leukemia (CML) will help characterize leukemic and normal stem cells and also help evaluate experimental therapies in this disease. We have established a model of CML in the NOD/SCID mouse. Infusion of > or = 4 x 10(7) chronic-phase CML peripheral blood cells results in engraftment levels of > or = 1% in the bone marrow (BM) of 84% of mice. Engraftment of the spleen was seen in 60% of mice with BM engraftment. Intraperitoneal injection of recombinant stem cell factor produced a higher level of leukemic engraftment without increasing Philadelphia-negative engraftment. Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor did not increase the level of leukemic or residual normal engraftment. Assessment of differential engraftment of normal and leukemic cells by fluorescence in situ hybridization analysis with bcr and abl probes showed that a median of 35% (range, 5% to 91%) of engrafted cells present in the murine BM were leukemic. BM engraftment was multilineage with myeloid, B-cell, and T-cell engraftment, whereas T cells were the predominant cell type in the spleen. BM morphology showed evidence of eosinophilia and increased megakaryocytes. We also assessed the ability of selected CD34+ CML blood cells to engraft NOD/SCID mice and showed engraftment with cell doses of 7 to 10 x 10(6) cells. CD34- cells failed to engraft at cell doses of 1.2 to 5 x 10(7). CD34+ cells produced myeloid and B-cell engraftment with high levels of CD34+ cells detected. Thus, normal and leukemic stem cells are present in CD34+ blood cells from CML patients at diagnosis and lead to development of the typical features of CML in murine BM. This model is suitable to evaluate therapy in CML