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The Internet offers unlimited possibilities for finding health information. However, the user is often faced with the problem of understanding it. Contextualization has a role to play in enhancing the user’s comprehension. We report on a study which addresses this issue, using a theoretical model of communication whose central theme is that of context. A randomized controlled experimental design was chosen, using as a test-bed the website SeniorGezond we had previously developed. The study was composed of a pre-test, the intervention with the website and a post-test. Participants (n=40) were randomly assigned to exposure or no exposure to contextualization with the website. Results show that contextualization increases understanding for non-knowledgeable users. Furthermore, the participant’s cognitive style was found to be a significant factor on understanding. We also found that participants bring their own contexts such as social context and psychological context to support their understanding.

While some researchers have suggested that preferences for attractive faces are the result of a domain-specific beauty detection module, others argue these preferences develop based on averages of stimuli through a domain-general learning mechanism. We tested whether cognitive and perceptual mechanisms sensitive to experience underlie facial preferences by familiarizing participants with human, chimpanzee, or morphed faces (60%-chimp/40%-human). Results indicated that participants familiarized with human-chimp morphs showed greater zygomaticus major activity, a physiological correlate of positive affect (Study 1), and higher explicit attractiveness ratings (Study 2) to faces morphed to some degree with chimpanzees. These results demonstrate that experience shifts attractiveness preferences away from the normative average, and suggest that a domain-general cognitive mechanism better accounts for facial preferences than a domain-specific innate beauty-detector.

websiteextra

A table detailing response rates appears on the STI website.

www.sextransinf.com

Objectives: To examine the factors that influence respondents' willingness to participate in urinary testing for Chlamydia trachomatis in a general population feasibility survey of sexual attitudes and lifestyles.

Methods: 199 sexually experienced, 18–44 year old participants, recruited as part of a larger (n=901) methodological study of sexual attitudes and lifestyles, were invited to provide a urine sample for chlamydial infection testing using ligase chain reaction (LCR) techniques. Analysis of the survey data and in-depth qualitative interviews were undertaken to explore the factors that influenced participants' decisions to participate.

Results: 143/199 (72%) participants agreed to provide a urine sample. The likelihood of providing a urine sample was reduced if other individuals were present in the home at the time of interview (OR 0.42, 95% confidence interval 0.20–0.90, p=0.03). Trust and rapport with the interviewer, understanding the aims of the test, sense of obligation, and perceived importance of the test were identified as additional influencing factors in the in-depth interviews.

Conclusions: Survey respondents' uncertainty or embarrassment at participating in urine testing can be overcome if they are well informed, motivated by the potential health gain, and briefed by trained and confident interviewers.

Key Words: screening; chlamydia; sexually transmitted diseases; survey; sexual behaviour

Background

A discrete choice experiment (DCE) is a preference survey which asks participants to make a choice among product portfolios comparing the key product characteristics by performing several choice tasks. Analyzing DCE data needs to account for within-participant correlation because choices from the same participant are likely to be similar. In this study, we empirically compared some commonly-used statistical methods for analyzing DCE data while accounting for within-participant correlation based on a survey of patient preference for colorectal cancer (CRC) screening tests conducted in Hamilton, Ontario, Canada in 2002.

Methods

A two-stage DCE design was used to investigate the impact of six attributes on participants' preferences for CRC screening test and willingness to undertake the test. We compared six models for clustered binary outcomes (logistic and probit regressions using cluster-robust standard error (SE), random-effects and generalized estimating equation approaches) and three models for clustered nominal outcomes (multinomial logistic and probit regressions with cluster-robust SE and random-effects multinomial logistic model). We also fitted a bivariate probit model with cluster-robust SE treating the choices from two stages as two correlated binary outcomes. The rank of relative importance between attributes and the estimates of β coefficient within attributes were used to assess the model robustness.

Results

In total 468 participants with each completing 10 choices were analyzed. Similar results were reported for the rank of relative importance and β coefficients across models for stage-one data on evaluating participants' preferences for the test. The six attributes ranked from high to low as follows: cost, specificity, process, sensitivity, preparation and pain. However, the results differed across models for stage-two data on evaluating participants' willingness to undertake the tests. Little within-patient correlation (ICC ≈ 0) was found in stage-one data, but substantial within-patient correlation existed (ICC = 0.659) in stage-two data.

Conclusions

When small clustering effect presented in DCE data, results remained robust across statistical models. However, results varied when larger clustering effect presented. Therefore, it is important to assess the robustness of the estimates via sensitivity analysis using different models for analyzing clustered data from DCE studies.

Objective

Internet-delivered interventions can effectively change health risk behaviors and their determinants, but adherence to intervention websites once they are accessed is very low. This study tests whether and how social presence elements can increase website use.

Methods

A website about Hepatitis A, B, and C virus infections was used in a preparatory lab-based eye-tracking study assessing whether social presence elements attract participants' attention, because this is a prerequisite for affecting website use. In the following field study, 482 participants representative of the Dutch population were randomized to either a website with or a website without social presence elements. Participants completed a questionnaire of validated measures regarding user perceptions immediately after exposure to the website. Server registrations were used to assess website use.

Results

Participants in the experimental condition focused on the social presence elements, both in terms of frequency (F(1, 98) = 40.34, p<.001) and duration (F(1, 88) = 39.99, p<.001), but did not differ in website use in comparison with the control condition; neither in terms of the number of pages visited (t(456) = 1.44, p = .15), nor in terms of time on the website (t(456) = 0.01, p = .99).

Conclusions

Adding social presence elements did not affect actual use of an intervention website within a public health context. Possible reasons are limited attention for these elements in comparison with the main text and the utilitarian value of intervention websites.

Objective

To describe how cognitive testing results were used to inform the modification and selection of items for the Consumer Assessment of Health Providers and Systems (CAHPS®) Hospital Survey pilot test instrument.

Data Sources

Cognitive interviews were conducted on 31 subjects in two rounds of testing: in December 2002–January 2003 and in February 2003. In both rounds, interviews were conducted in northern California, southern California, Massachusetts, and North Carolina.

Study Design

A common protocol served as the basis for cognitive testing activities in each round. This protocol was modified to enable testing of the items as interviewer-administered and self-administered items and to allow members of each of three research teams to use their preferred cognitive research tools.

Data Collection/Extraction Methods

Each research team independently summarized, documented, and reported their findings. Item-specific and general issues were noted. The results were reviewed and discussed by senior staff from each research team after each round of testing, to inform the acceptance, modification, or elimination of candidate items.

Principal Findings

Many candidate items required modification because respondents lacked the information required to answer them, respondents failed to understand them consistently, the items were not measuring the constructs they were intended to measure, the items were based on erroneous assumptions about what respondents wanted or experienced during their hospitalization, or the items were asking respondents to make distinctions that were too fine for them to make. Cognitive interviewing enabled the detection of these problems; an understanding of the etiology of the problem informed item revisions. However, for some constructs, the revisions proved to be inadequate. Accordingly, items could not be developed to provide acceptable measures of certain constructs such as shared decision making, coordination of care, and delays in the admissions process.

Conclusions

Cognitive testing is the most direct way of finding out whether respondents understand questions consistently, have the information needed to answer the questions, and can use the response alternatives provided to describe their experiences or their opinions accurately. Many of the candidate questions failed to meet these standards. Cognitive testing only evaluates the way in which respondents understand and answer questions. Although it does not directly assess the validity of the answers, it is a reasonable premise that cognitive problems will seriously compromise validity and reliability.

Background

Despite growing emphasis on public reporting of health care quality data, available data are often ignored.

Objective

To evaluate the usefulness of web-based physician-level data for patients choosing a new primary care physician (PCP).

Design

Patients seeking a new PCP (n = 2225) were invited to view web-based information including PCP credentials, personal characteristics, office location and hours, and patient experience scores. Patient experience scores included validated measures of interpersonal quality, appointment access, care coordination, health promotion, and patient recommendations of the PCP. After viewing the website, participants indicated their preferred PCP and completed a study questionnaire.

Results

Of the invited participants, 17% visited the website (n = 382). Patient experience scores were cited most frequently as important to physician choice (51%). Among these measures, patients’ highest priorities were interpersonal quality (37%) and patient recommendations of the PCP (41%). For patients citing these priorities, the odds of choosing a highly scored physician after viewing the data was nearly 10 times that of choosing such a physician by chance (odds ratio (OR) = 9.52 and 9.71, respectively).

Conclusions

Targeting patients known to be making a health care decision appears to promote the use of performance data. Patients particularly valued data concerning other patients’ experiences and, after viewing the data, made choices well-aligned with their priorities.

Background

On-line provision of information during the transition phase after treatment carries great promise in meeting shortcomings in post-treatment care for breast cancer survivors and their partners. The objectives of this study are to describe the development and process evaluation of a tailored informative website and to assess which characteristics of survivors and partners, participating in the feasibility study, are related to visiting the website.

Methods

The development process included quantitative and qualitative assessments of survivors’ and partners’ care needs and preferences. Participants’ use and evaluation of the website were explored by conducting baseline and post-measurements. During the intervening 10–12 weeks 57 survivors and 28 partners were granted access to the website.

Results

Fifty-seven percent (n=21) of survivors who took part in the post-measurement indicated that they had visited the website. Compared to non-visitors (n=16), they were more likely to have a partner and a higher income, reported higher levels of self-esteem and had completed treatment for a longer period of time. Partners who consulted the on-line information (42%, n=8) were younger and reported lower levels of social support compared to partners who did not visit the website (n=11). Visitors generally evaluated the content and lay-out positively, yet some believed the information was incomplete and impersonal.

Conclusions

The website reached only about half of survivors and partners, yet was mostly well-received. Besides other ways of providing information and support, a website containing clear-cut and tailored information could be a useful tool in post-treatment care provision.

Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression—a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy.

Design Randomised controlled trial.

Setting Internet users in the community, in Canberra, Australia.

Participants 525 individuals with increased depressive symptoms recruited by survey and randomly allocated to a website offering information about depression (n = 166) or a cognitive behaviour therapy website (n = 182), or a control intervention using an attention placebo (n = 178).

Main outcome measures Change in depression, dysfunctional thoughts; knowledge of medical, psychological, and lifestyle treatments; and knowledge of cognitive behaviour therapy.

Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample. For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 (95% confidence interval 0.9 to 5.4). For the “depression literacy” site (BluePages), the reduction was 3.0 (95% confidence interval 0.6 to 5.2). Cognitive behaviour therapy (MoodGYM) reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy. Depression literacy (BluePages) significantly improved participants' understanding of effective evidence based treatments for depression (P < 0.05).

Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression.

It has long been thought that propensities for visual or verbal learning styles influence how children acquire knowledge successfully and how adults reason in everyday life. There is no direct evidence to date, however, linking these cognitive styles to specific neural systems. In the present study, visual and verbal cognitive styles are measured by self-report survey and cognitive abilities are measured by scored tests of visual and verbal skills. Specifically, we administered the Verbalizer-Visualizer Questionnaire (VVQ) and modality-specific subtests of the Wechsler Adult Intelligence Scale (WAIS) to 18 subjects who subsequently participated in a functional magnetic resonance imaging experiment. During the imaging session, participants performed a novel psychological task involving both word-based and picture-based feature matching conditions that was designed to permit the use of either a visual or a verbal processing style during all conditions of the task. Results demonstrated a pattern of activity in modality-specific cortex that distinguished visual from verbal cognitive styles. During the word-based condition, activity in a functionally-defined brain region that responded to viewing pictorial stimuli (fusiform gyrus) correlated with self-reported Visualizer ratings on the VVQ. In contrast, activity in a phonologically-related brain region (supramarginal gyrus) correlated with the Verbalizer dimension of the VVQ during the picture-based condition. Scores from the WAIS subtests did not reliably correlate with brain activity in either of these regions. These findings suggest that modality-specific cortical activity underlies processing in visual and verbal cognitive styles.

Two priming experiments demonstrated exogenous attentional persistence to the fundamental auditory dimensions of frequency (Experiment 1) and time (Experiment 2). In a divided-attention task, participants responded to an independent dimension, the identification of three-tone sequence patterns, for both prime and probe stimuli. The stimuli were specifically designed to parallel the local–global hierarchical letter stimuli of [Navon D. (1977). Forest before trees: The precedence of global features in visual perception. Cognitive Psychology, 9, 353–383] and the task was designed to parallel subsequent work in visual attention using Navon stimuli [Robertson, L. C. (1996). Attentional persistence for features of hierarchical patterns. Journal of Experimental Psychology: General, 125, 227–249; Ward, L. M. (1982). Determinants of attention to local and global features of visual forms. Journal of Experimental Psychology: Human Perception and Performance, 8, 562–581]. The results are discussed in terms of previous work in auditory attention and previous approaches to auditory local–global processing.

Background

Systematic reviews have developed into a powerful method for summarising and synthesising evidence. The rise in systematic reviews creates a methodological opportunity and associated challenges and this is seen in the development of overviews, or reviews of systematic reviews. One of these challenges is how to summarise evidence from systematic reviews of complex interventions for inclusion in an overview. Interventions for communicating with and involving consumers in their care are frequently complex. In this article we outline a method for preparing data integration tables to enable review-level synthesis of the evidence on interventions for communication and participation in health.

Methods and Results

Systematic reviews published by the Cochrane Consumers and Communication Review Group were utilised as the basis from which to develop linked steps for data extraction, evidence assessment and synthesis. The resulting output is called a data integration table. Four steps were undertaken in designing the data integration tables: first, relevant information for a comprehensive picture of the characteristics of the review was identified from each review, extracted and summarised. Second, results for the outcomes of the review were assessed and translated to standardised evidence statements. Third, outcomes and evidence statements were mapped into an outcome taxonomy that we developed, using language specific to the field of interventions for communication and participation. Fourth, the implications of the review were assessed after the mapping step clarified the level of evidence available for each intervention.

Conclusion

The data integration tables represent building blocks for constructing overviews of review-level evidence and for the conduct of meta-synthesis. Individually, each table aims to improve the consistency of reporting on the features and effects of interventions for communication and participation; provides a broad assessment of the strength of evidence derived from different methods of analysis; indicates a degree of certainty with results; and reports outcomes and gaps in the evidence in a consistent and coherent way. In addition, individual tables can serve as a valuable tool for accurate dissemination of large amounts of complex information on communication and participation to professionals as well as to members of the public.

Objectives

To explore the extent to which doctor-rating websites are known and used among a sample of respondents from London. To understand the main predictors of what makes people willing to use doctor-rating websites.

Design

A cross-sectional study.

Setting

The Borough of Hammersmith and Fulham, London, England.

Participants

200 individuals from the borough.

Main outcome measures

The likelihood of being aware of doctor-rating websites and the intention to use doctor-rating websites.

Results

The use and awareness of doctor-rating websites are still quite limited. White British subjects, as well as respondents with higher income are less likely to use doctor-rating websites. Aspects of the doctor–patient relationship also play a key role in explaining intention to use the websites. The doctor has both a ‘complementary’ and ‘substitute’ role with respect to Internet information.

Conclusions

Online rating websites can play a major role in supporting patients’ informed decisions on which healthcare providers to seek advice from, thus potentially fostering patients’ choice in healthcare. Subjects who seek and provide feedback on doctor-ranking websites, though, are unlikely to be representative of the overall patients’ pool. In particular, they tend to over-represent opinions from non-White British, medium–low-income patients who are not satisfied with their choice of the healthcare treatments and the level of information provided by their GP. Accounting for differences in the users’ characteristics is important when interpreting results from doctor-rating sites.

Objective To explore the experiences and perceptions of general practitioners and community nurses in discussing preferences for place of death with terminally ill patients.

Design Qualitative study using semistructured interviews and thematic analysis.

Participants 17 general practitioners and 19 nurses (16 district nurses, three clinical nurse specialists).

Setting 15 general practices participating in the Gold Standards Framework for palliative care from three areas in central England with differing socio-geography. Practices were selected on the basis of size and level of adoption of the standards framework.

Results All interviewees bar one had experience of discussing preferred place of death with terminally ill patients. They reported that preferences for place of death frequently changed over time and were often ill defined or poorly formed in patients’ minds. Preferences were often described as being co-created in discussion with the patient or, conversely, inferred by the health professional without direct questioning or receiving a definitive answer from the patient. This inherent uncertainty challenged the practicability, usefulness, and value of recording a definitive preference. The extent to which the assessment of enabling such preferences can be used as a proxy for the effectiveness of palliative care delivery is also limited by this uncertainty. Generally, interviewees did not find discussing preferred place of death an easy area of practice, unless the patient broached the subject or led the discussions.

Conclusions Further research is needed to enable development of appropriate training and support for primary care professionals. Better understanding of the importance of place of death to patients and their carers is also needed.

Objective

To estimate the effect of online adverts on the probability of finding online cognitive behavioural therapy (CBT) for depression.

Design

Exploratory online cross-sectional study of search experience of people in the UK with depression in 2011. (1) The authors identified the search terms over 6 months entered by users who subsequently clicked on the advert for online help for depression. (2) A panel of volunteers across the UK recorded websites presented by normal Google search for the term ‘depression’. (iii) The authors examined these websites to estimate probabilities of knowledgeable and naive internet users finding online CBT and the improved probability by addition of a Google advert.

Participants

(1) 3868 internet users entering search terms related to depression into Google. (2) Panel, recruited online, of 12 UK participants with an interest in depression.

Main outcome measures

Probability of finding online CBT for depression with/without an advert.

Results

The 3868 users entered 1748 different search terms but the single keyword ‘depression’ resulted in two-thirds of the presentations of, and over half the ‘clicks’ on, the advert. In total, 14 different websites were presented to our panel in the first page of Google results for ‘depression’. Four of the 14 websites had links enabling access to online CBT in three clicks for knowledgeable users. Extending this approach to the 10 most frequent search terms, the authors estimated probabilities of finding online CBT as 0.29 for knowledgeable users and 0.006 for naive users, making it unlikely CBT would be found. Adding adverts that linked directly to online CBT increased the probabilities to 0.31 (knowledgeable) and 0.02 (naive).

Conclusions

In this case, online CBT was not easy to find and online adverts substantially increased the chance for naive users. Others could use this approach to explore additional impact before committing to long-term Google AdWords advertising budgets.

Trial registration

This exploratory case study was a substudy within a cluster randomised trial, registered on http://www.clinicaltrials.gov (reference: NCT01469689). (The trial will be reported subsequently).

Article summary

Article focus

In 2011 in the UK, what is the chance of finding online CBT for depression?

Does online advertising increase that chance?

Key messages

Online CBT for depression is recommended by the National Institute for Health and Clinical Excellence for people with depression, but we did not know how easy it is to find or if online adverts help find it.

People with depression are unlikely to find online CBT by chance: the probabilities of finding online CBT using Google was 0.29 for knowledgeable users and 0.006 for naive users. Adding adverts that linked directly to online CBT increased the probabilities to 0.31 (knowledgeable) and 0.02 (naive).

This method of assessing probability of finding topics should be used before committing to long-term online advertising.

Strengths and limitations of this study

The results are likely to be typical for anyone with depression in the UK in 2011. The approach of identifying typical search terms and simulating knowledgeable and naive user experience, with and without adverts, is generalisable to other conditions and populations.

Search results will change over time.

BACKGROUND

Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US.

OBJECTIVE

To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care.

DESIGN

Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life.

PARTICIPANTS

Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region.

APPROACH

Content analysis of focus group transcripts.

RESULTS

First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were highly educated, and two thirds were either studying or working in a health care field. All but two subjects were Hindu. Several themes emerged that highlighted cultural differences and challenges for this population in the context of end-of-life care: attitudes toward death and suffering; family duty; and preferences for information disclosure and decision making. Participants described cultural challenges due to the evolution of traditional roles, lack of explicit discussion between patients and family members about preferences and care expectations, and a tension between wanting to meet traditional expectations and the challenges in doing so given US social realities.

CONCLUSIONS

Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for information disclosure and decision making.

Objective

To determine whether early adult cognitive ability is a risk factor for depressive symptoms in midlife and how genetic and environmental influences explain the association; to examine cross-sectional relationships between depressive symptoms and specific cognitive abilities at midlife.

Methods

Design

35-year longitudinal and cross-sectional twin study of cognitive aging.

Setting

Large multicenter study in the United States.

Participants

1237 male twins ages 51 to 60.

Measurements

At age 20 and midlife, participants completed the same version of a general cognitive ability test (Armed Forces Qualification Test [AFQT]). Midlife testing included an extensive neurocognitive protocol assessing processing speed, verbal memory, visual-spatial memory, working memory, executive function, and visual-spatial ability. Participants completed the Center for Epidemiologic Studies Depression Scale prior to cognitive testing and provided health and lifestyle information during a medical history interview.

Results

Lower age 20 AFQT scores predicted higher levels of depressive symptoms at age 55 (r=−.16, p<.001). In bivariate twin modeling, 77% of the correlation between early cognitive ability and midlife depressive symptoms was due to shared genetic influences. Controlling for current age, age 20 AFQT, and non-independence of observations, depressive symptoms were associated with worse midlife AFQT scores and poorer performance in all cognitive domains except verbal memory

Conclusion

Results suggest that low cognitive ability is a risk factor for depressive symptoms; this association is partly due to shared genetic influences. Cross-sectional analyses indicate that the association between depressive symptoms and performance is not linked to specific cognitive domains.

Background

How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain.

Objective

The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes.

Methods

Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software.

Results

We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ2 5 = 10.8 (P = .21), comparative fit index = .99, root mean square error of approximation = .052. The model accounted for 66% of the variance in trust and 49% of the variance in readiness to act on the advice.

Conclusions

Adding variables specific to eHealth enhanced the ability of a model of trust to predict trust and readiness to act on advice.

Objective

To investigate whether Danish providers of general health checks present a balanced account of possible benefits and harms on their websites and whether the health checks are evidence-based.

Methods and Design

Cross-sectional study. The search engines Google and Jubii (Danish) were in July and August 2009 used to identify 56 websites using Danish search terms for “health check” and “health examination”. The content of the websites were evaluated using a checklist with 15 officially recommended information items. All tests offered through the websites were registered. The evidence for tests offered through at least 10% of the websites was identified in structured searches using PubMed and The Cochrane Library.

Results

We found 36 different tests on 56 websites offering health checks. Twenty one tests were offered on at least 10% of the websites. Seventeen (81%) of these tests were unsupported by evidence, or there was evidence against them for screening purposes. We found evidence supporting screening using body-mass-index, blood pressure, cholesterol, and faecal occult blood testing. None of the websites mentioned possible risks or harms. The websites presented a median of 1 of the 15 information items; the highest number from any provider was 2.

Conclusions

Information from Danish providers of health checks was sparse and tests were often offered against existing evidence or despite lack of evidence. None of the included websites mentioned potential risks or harms.

Background

Many medical errors occur during the laboratory testing process, including lost test results. Patient inquiry concerning results often represents the final safety net for locating lost results. This qualitative study sought to identify, from a patient perspective, specific preferences and factors that influence the process of communicating normal (negative) laboratory test results to patients.

Methods

We conducted 30-minute guided interviews with 20 adult patients. Patients were recruited from two practice-based research networks in Colorado that were participating in a medical errors study. A semi-structured interview elicited the participant's experience with and preference for laboratory test result notification. Quantitative descriptive statistics were generated for demographic and preference data. Qualitative results were analyzed by a team of experienced qualitative researchers using multiple styles of qualitative analyses, including a template approach and an editing approach.

Results

Ninety percent of participants wanted to be notified of all tests results. Important issues related to notification included privacy, responsive and interactive feedback, convenience, timeliness, and provision of details. Telephone notification was preferred, followed by regular mail. Electronic notification was perceived as uncomfortable because it was not secure. While 65% preferred being notified by a provider, participants acknowledge that this may be impractical; thus, they wanted to be notified by someone knowledgeable enough to answer questions. Participants do not normally discuss their preferences for test result notification with their providers.

Conclusion

Privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety, and are features that may be incorporated into emerging communication channels.

We address two aspects of general interest for the chemical synthesis of colloidal semiconductor nanocrystals: (1) the rational design of the synthesis protocol aiming at the optimization of the reaction parameters in a minimum number of experiments; (2) the transfer of the procedure to the gram scale, while maintaining a low size distribution and maximizing the reaction yield. Concerning the first point, the design-of-experiment (DOE) method has been applied to the synthesis of colloidal CdSe nanocrystals. We demonstrate that 16 experiments, analyzed by means of a Taguchi L16 table, are sufficient to optimize the reaction parameters for controlling the mean size of the nanocrystals in a large range while keeping the size distribution narrow (5-10%). The DOE method strongly reduces the number of experiments necessary for the optimization as compared to trial-and-error approaches. Furthermore, the Taguchi table analysis reveals the degree of influence of each reaction parameter investigated (e.g., the nature and concentration of reagents, the solvent, the reaction temperature) and indicates the interactions between them. On the basis of these results, the synthesis has been scaled up by a factor of 20. Using a 2-L batch reactor combined with a high-throughput peristaltic pump, different-sized samples of CdSe nanocrystals with yields of 2-3 g per synthesis have been produced without sacrificing the narrow size distribution. In a similar setup, the gram-scale synthesis of CdSe/CdS/ZnS core/shell/shell nanocrystals exhibiting a fluorescence quantum yield of 81% and excellent resistance of the photoluminescence in presence of a fluorescent quencher (aromatic thiol) has been achieved.

PACS: 81.20.Ka, 81.07.Bc, 78.67.Bf

The evaluation of tutorial strategies, interface designs, and courseware content is an area of active research in the medical education community. Many of the evaluation techniques that have been developed (e.g., program instrumentation), commonly produce data that are difficult to decipher or to interpret effectively. We have explored the use of decision tables to automatically simplify and categorize data for the composition of user models--descriptions of student's learning styles and preferences. An approach to user modeling that is based on decision tables has numerous advantages compared with traditional manual techniques or methods that rely on rule-based expert systems or neural networks. Decision tables provide a mechanism whereby overwhelming quantities of data can be condensed into an easily interpreted and manipulated form. Compared with conventional rule-based expert systems, decision tables are more amenable to modification. Unlike classification systems based on neural networks, the entries in decision tables are readily available for inspection and manipulation. Decision tables, descriptions of observations of behavior, also provide automatic checks for ambiguity in the tracking data.

Background: Evidence-based patient information (EBPI) is a prerequisite for informed decision-making. However, presentation of EBPI may lead to irrational reactions causing avoidance, minimisation and devaluation of the information.

Objective: To explore whether the theory of cognitive dissonance is applicable to medical decision-making and useful to explain these phenomena.

Setting and participants: 261 volunteers from Hamburg (157 women), ≥50 years old without diagnosis of colorectal cancer.

Design and variables: Within an experiment we simulated information seeking on colorectal cancer screening. Consumers’ attitudes towards screening were surveyed using a rating scale from -5 (participate in no way) to +5 (participate unconditionally) (independent variable). Using a cover story, participants were asked to sort 5 article headlines according to their reading preferences. The headlines simulated the pro to contra variety of contents to be found in print media about colorectal cancer screening. The dependent variable was the sequence of article headlines.

Results: Participants were very much in favour of screening with scores for faecal occult blood test of 4.0 (0.1) and for colonoscopy 3.3 (0.1). According to our hypothesis we found statistically significant positive correlations between the stimuli in favour of screening and attitudes and significant negative correlations between the stimuli against screening and attitudes.

Conclusion: The theory of cognitive dissonance is applicable to medical decision-making. It may explain some phenomena of irrational reactions to evidence-based patient information.

Mating preferences are common in natural populations, and their divergence among populations is considered an important source of reproductive isolation during speciation. Although mechanisms for the divergence of mating preferences have received substantial theoretical treatment, complementary experimental tests are lacking. We conducted a laboratory evolution experiment, using the fruit fly Drosophila serrata, to explore the role of divergent selection between environments in the evolution of female mating preferences. Replicate populations of D. serrata were derived from a common ancestor and propagated in one of three resource environments: two novel environments and the ancestral laboratory environment. Adaptation to both novel environments involved changes in cuticular hydrocarbons, traits that predict mating success in these populations. Furthermore, female mating preferences for these cuticular hydrocarbons also diverged among populations. A component of this divergence occurred among treatment environments, accounting for at least 17.4% of the among-population divergence in linear mating preferences and 17.2% of the among-population divergence in nonlinear mating preferences. The divergence of mating preferences in correlation with environment is consistent with the classic by-product model of speciation in which premating isolation evolves as a side effect of divergent selection adapting populations to their different environments.

Experimentally manipulating the resource environment of Drosophila serrata reveals that mating preferences can evolve, at least in part, as a result of environmentally-based divergent natural selection.

We report an investigation of humans' musical learning ability using a novel musical system. We designed an artificial musical system based on the Bohlen-Pierce scale, a scale very different from Western music. Melodies were composed from chord progressions in the new scale by applying the rules of a finite-state grammar. After exposing participants to sets of melodies, we conducted listening tests to assess learning, including recognition tests, generalization tests, and subjective preference ratings. In Experiment 1, participants were presented with 15 melodies 27 times each. Forced choice results showed that participants were able to recognize previously encountered melodies and generalize their knowledge to new melodies, suggesting internalization of the musical grammar.

Preference ratings showed no differentiation among familiar, new, and ungrammatical melodies. In Experiment 2, participants were given 10 melodies 40 times each. Results showed superior recognition but unsuccessful generalization. Additionally, preference ratings were significantly higher for familiar melodies. Results from the two experiments suggest that humans can internalize the grammatical structure of a new musical system following exposure to a sufficiently large set size of melodies, but musical preference results from repeated exposure to a small number of items. This dissociation between grammar learning and preference will be further discussed.