bluuebunny/crossref_metadata_2025 huggingface dataset:
GÜÇ MOTİVASYONUNUN İŞ SEVGİSİNE ETKİSİNDE GERİBİLDİRİM ARAMA DAVRANIŞININ DÜZENLEYİCİ ROLÜ
Authors: ASLAN Sevil , ANTALYALI Ömer Lütfi
Published: July 2018

Bu çalışmanın amacı, güç motivasonuyla iş sevgisi
ilişkisinde geribildirim arama motivasyonlarının düzenleyici rolünün
araştırılmasıdır. Alanda yapılan çalışmalarda, çalışanların iş sevgisinin
birçok etmenin yanında temel motivasyon kaynakları ve geribildirim arama
motivasyonlarıyla ilişkili olduğu görülmüştür. İşyerinde var olan performansla
ilgili bilgilere erişimi sağlayan geribildirim arama, belirsizliklerin
azalmasında etkili olduğundan iş sevgisiyle oldukça ilişkilidir. Bunun yanında,
bireyin etkin olma isteğini niteleyen güç ihtiyacının karşılanması sonucunda iş
sevgisinin pozitif yönde etkilendiği bilinmektedir. Buradan hareketle bu çalışmada,
bireylerin güç motivasyonlarının iş sevgisine etkisi ve geribildirim arama
motivasyonlarının bu ilişkideki rolüne odaklanılmıştır. Bu amaçla çalışma, özel
hastanelerde çalışan 219 hemşireye ulaşılarak gerçekleştirilmiştir.
Katılımcıların temel motivasyon kaynakları, iş sevgileri ve geribildirim arama
davranışlarını ölçmek amacıyla 3 farklı ölçekten oluşan anket kullanılmıştır.
Anket sonucunda elde edilen veriler SPSS ve AMOS programlarıyla analiz edilerek
değerlendirmeye tabi tutulmuştur. Analiz sonucunda hemşirelerin geribildirime
kayıtsızlık düzeyinin, güç motivasyonunun iş sevgisine etkisinde düzenleyici
rolü olduğu saptanmıştır. Buna göre bireyin geribildirime kayıtsızlık düzeyi
arttıkça güç ihtiyacının iş sevgisine etkisinin artış gösterdiği tespit
edilmiştir. Buna karşın geribildirime defansif yaklaşma düzeylerinin, güç
motivasyonunun iş sevgisine etkisinde herhangi bir etkisinin olmadığı
görülmüştür.
Current Highlights About the Safety of Inorganic Nanomaterials in Healthcare
Authors: Perioli Luana , Pagano Cinzia , Ceccarini Maria Rachele
Published: July 2018

:

In recent years inorganic materials are largely present in products intended for
health care. Literature gives many examples of inorganic materials used in many healthcare
products, mainly in pharmaceutical field.

:

Silver, zinc oxide, titanium oxide, iron oxide, gold, mesoporous silica, hydrotalcite-like compound
and nanoclays are the most common inorganic materials used in nanosized form for
different applications in the health field. Generally, these materials are employed to realize
formulations for systemic use, often with the aim to perform a specific targeting to the pathological
site. The nanometric dimensions are often preferred to obtain the cellular internalization
when the target is localized in the intracellular space.

:

Some materials are frequently used in topical formulations as rheological agents, adsorbents,
mattifying agents, physical sunscreen (e.g. zinc oxide, titanium dioxide), and others.

:

Recent studies highlighted that the use of nanosized inorganic materials can represent a risk
for health. The very small dimension (nanometric) until a few years ago represented a fundamental
requirement; however, it is currently held responsible for the inorganic material toxicity.
This aspect is very important to be considered as actually numerous inorganic materials
can be found in many products available in the market, often dedicated to infants and children.
These materials are used without taking into account their dimensional properties with
increased risk for the user/patient.

:

This review deals with a deep analysis of current researches documenting the toxicity of
nanometric inorganic materials especially those largely used in products available in the market.
Improving the Efficacy of Anticancer Drugs via Encapsulation and Acoustic Release
Authors: Ahmed Salma E. , Awad Nahid , Paul Vinod , Moussa Hesham G. , Husseini Ghaleb A.
Published: July 2018

Conventional chemotherapeutics lack the specificity and controllability, thus may poison
healthy cells while attempting to kill cancerous ones. Newly developed nano-drug delivery systems have
shown promise in delivering anti-tumor agents with enhanced stability, durability and overall performance;
especially when used along with targeting and triggering techniques. This work traces back the
history of chemotherapy, addressing the main challenges that have encouraged the medical researchers
to seek a sanctuary in nanotechnological-based drug delivery systems that are grafted with appropriate
targeting techniques and drug release mechanisms. A special focus will be directed to acoustically triggered
liposomes encapsulating doxorubicin.
Random Global and Local Optimal Search Algorithm Based Subset Generation for Diagnosis of Cancer
Authors: Meenachi Loganathan , Ramakrishnan Srinivasan
Published: July 2018

Background:

Data mining algorithms are extensively used to classify the data, in which
prediction of disease using minimal computation time plays a vital role.

Objective:

The aim of this paper is to develop the classification model from reduced features and
instances.

Methods:

In this paper we proposed four search algorithms for feature selection the first algorithm
is Random Global Optimal (RGO) search algorithm for searching the continuous, global optimal
subset of features from the random population. The second is Global and Local Optimal (GLO)
search algorithm for searching the global and local optimal subset of features from population. The
third one is Random Local Optimal (RLO) search algorithm for generating random, local optimal
subset of features from the random population. Finally the Random Global and Optimal (RGLO)
search algorithm for searching the continuous, global and local optimal subset of features from the
random population. RGLO search algorithm combines the properties of first three stated algorithm.
The subsets of features generated from the proposed four search algorithms are evaluated using the
consistency based subset evaluation measure. Instance based learning algorithm is applied to the
resulting feature dataset to reduce the instances that are redundant or irrelevant for classification.
The model developed using naïve Bayesian classifier from the reduced features and instances is
validated with the tenfold cross validation.

Results:

Classification accuracy based on RGLO search algorithm using naïve Bayesian classifier
is 94.82% for Breast, 97.4% for DLBCL, 98.83% for SRBCT and 98.89% for Leukemia datasets.

Conclusion:

The RGLO search based reduced features results in the high prediction rate with less
computational time when compared with the complete dataset and other proposed subset generation
algorithm.
Understanding Process Variables and their Interactions for Maximizing Production of Artemisinin Derivative Artemether (Anti-Malarial Drug) Through Cunninghamella echinulata var elegans at 5 L Bioreactor Level
Authors: Dubey Kashyap Kumar , Kumar Punit
Published: July 2018

Background:

Malaria is one of the life threatening diseases which is caused by Plasmodium
sp. of protozoa and uses Anopheles mosquitos as vector. Plasmodium vivax and Plasmodium falciparum
are common form of malaria parasite. Artemisinin is reported for its antimalarial activities and Artemether
which is a methyl ether derivative of Artemisinin, has been found effective against P. falciparum.

Methods:

In the present study, bioconversion of Artemisinin into Artemether was carried out experimentally
and the statistical tools like experimental factorial design and Response Surface Methodology
were used to find optimal conditions (concentration of Artemisinin, age of inoculum, temperature & pH)
using Cunninghamella echinulata var. elegans. Experimental conditions for maximum product recovery
from culture broth were also optimized using various polar and non-polar solvents for extraction. Artemether
purity was analyzed by reverse-phase HPLC. Experimental data was fitted in a quadratic model
and effect of various parameters was analyzed.

Results:

It was found that bioconversion of Artemisinin into Artemether is growth associated process. It
was observed that molasses used as carbon source supported production of Artemether to 3.4g/L. The
biomass and oxygen are key element affecting of bioconversion of Artemisinin into Artemether such as
higher dissolved oxygen reduced the Artemether bioconversion. The highest bioconversion of Artemisinin
into Artemether was obtained at temperature 25.5oC, 5g/L concentration of Artemisinin, at age of
inoculum of 44.5 h and at pH 6.0. Model suggested the highest bioconversion of Artemisinin into Artemether
was 54% at shake flask level which was near about experimental finding. An optimal condition
for bioconversion was also analyzed and 64% bioconversion was obtained in 5L bioreactor.

Conclusion:

The outcomes of the study provided optimum conditions for bioconversion of Artemisinin
into Artemether.
Amyotrophic Lateral Sclerosis and Oxidative Stress: A Double-Blind Therapeutic Trial After Curcumin Supplementation
Authors: Chico Lucia , Ienco Elena Caldarazzo , Bisordi Costanza , Lo Gerfo Annalisa , Petrozzi Lucia , Petrucci Antonio , Mancuso Michelangelo , Siciliano Gabriele
Published: July 2018

Objective: To investigate the efficacy of curcumin oral supplementation (600 mg/day, Brainoil),
a natural antioxidant compound, in Amyotrophic Lateral Sclerosis (ALS).

Methods:

Patients were randomized into two groups: Group A received placebo for 3 months, then
Brainoil for the following 3 months, Group B took Brainoil for 6 months. The evaluations were conducted
at basal (T0), after 3 months of double blinded Brainoil or placebo treatment (T1), and after the
3 month open-label phase (T2). Clinical evaluations and oxidative stress biomarkers, including oxidative
protein products (AOPPs), ferric reducing ability (FRAP), total thiols (T-SH) and lactate, were
evaluated, compared to a control group, during an incremental forearm exercise test.

Results:

Over the entire study Group B showed a stable score of the ALS-FRS-r which decreased in
Group A (p<0.01), in parallel with a reduction of AOPPs (p<0.01) which was not detected into Group
A. Also FRAP exercise values remained stable in Group B, while in Group A they were reduced without
treatment at T1 (0.05
T0 exercise lactate was lower compared to Group A (p<0.01). Compared to controls, the
whole ALS population showed a greater oxidative stress (p<0.001), those treated with curcumin
(Group B) exhibiting decreased exercise AOPPs at T2 with values approaching those of controls.

Conclusion:

Although further studies are needed to confirm these data, treatment with curcumin
shows encouraging results indicating a slight slowdown in disease progression, improving aerobic metabolism
and oxidative damage, this also contributing to deepen knowledge into the pathogenic
mechanisms of ALS.
Serum Tryptophan, Tryptophan Catabolites and Brain-derived Neurotrophic Factor in Subgroups of Youngsters with Autism Spectrum Disorders
Authors: Ormstad Heidi , Bryn Vesna , Verkerk Robert , Skjeldal Ola H. , Halvorsen Bente , Saugstad Ola Didrik , Isaksen Jorn , Maes Michael
Published: July 2018

Background:

There is evidence that changes in neuro-immune responses coupled with dysfunctions
in serotonin metabolism underpin the pathophysiology of autism spectrum disorders (ASD).

Objective:

This study aimed to delineate whether ASD subgroups or characteristics show aberrations
in tryptophan and brain-derived neurotrophic factor (BDNF) metabolism.

Methods:

65 individuals with ASD (diagnosed according to ICD criteria) and 30 healthy control patients
were included. Measured were serum levels of tryptophan, kynurenine (KYN), kynurenic acid (KA), quinolinic
acid (QA), BDNF and PRO-BDNF and total blood 5-HT and 5-OH-tryptophan (5-HTP).

Results:

Elevated BDNF levels and lower tryptophan and KA levels were characteristics of both
childhood autism and intellectual disability disorder, whilst elevated tryptophan and lower 5-HT synthesis
were hallmarks of Asperger syndrome. A pathological MRI was associated with elevated tryptophan
and lowered KA. Abnormal EEG results and dysmorphology were both associated with an elevated
BDNF/ PRO-BDNF ratio. Any brain pathology and gastro-intestinal symptoms were accompanied
by lowered KA.

Conclusions:

Increased BDNF production and changes in the metabolism of tryptophan are associated
with many ASD characteristics, showing particularly strong associations with childhood autism and
Intellectual and Developmental Disabilities. Peripheral BDNF and tryptophan metabolism appear to
take part in the pathophysiology of autism spectrum disorders and their phenotypes.
Rethinking Data Sharing at the Dawn of a Health Data Economy: A Viewpoint (Preprint)
Authors: Tang Chunlei , Plasek Joseph M , Bates David W.
Published: July 2018

UNSTRUCTURED

A health data economy has begun to form, but its rise has been tempered by the profound lack of sharing of both data and data products such as models, intermediate results, and annotated training corpora, and this severely limits the potential for triggering economic cluster effects. Economic cluster effects represent a means to elicit benefit from economies of scale from internal data innovations and are beneficial because they may mitigate challenges from external sources. Within institutions, data product sharing is needed to spark data entrepreneurship and data innovation, and cross-institutional sharing is also critical, especially for rare conditions.
Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study (Preprint)
Authors: Portz Jennifer Dickman , Bayliss Elizabeth A , Bull Sheana , Boxer Rebecca S , Bekelman David B , Gleason Kathy , Czaja Sara
Published: July 2018

BACKGROUND

Patient portals offer modern digital tools for older adults with multiple chronic conditions (MCC) to engage in their health management. However, there are barriers to portal adoption among older adults. Understanding portal user interface and user experience (UI and UX) preferences of older adults with MCC may improve the accessibility, acceptability, and adoption of patient portals.

OBJECTIVE

The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UI and UX, intent to use, and use behaviors among older patients with MCC.

METHODS

We carried out a qualitative descriptive study of Kaiser Permanente Colorado’s established patient portal, My Health Manager. Older patients (N=24; mean 78.41 (SD 5.4) years) with MCC participated in focus groups. Stratified random sampling was used to maximize age and experience with the portal among participants. The semistructured focus groups used a combination of discussion and think-aloud strategies. A total of 2 coders led the theoretically driven analysis based on the TAM to determine themes related to use behavior, portal usefulness and ease of use, and intent to use.

RESULTS

Portal users commonly used email, pharmacy, and lab results sections of the portal. Although, generally, the portal was seen to be easy to use, simple, and quick, challenges related to log-ins, UI design (color and font), and specific features were identified. Such challenges inhibited participants’ intent to use the portal entirely or specific features. Participants indicated that the portal improved patient-provider communication, saved time and money, and provided relevant health information. Participants intended to use features that were beneficial to their health management and easy to use.

CONCLUSIONS

Older adults are interested in using patient portals and are already taking advantage of the features available to them. We have the opportunity to better engage older adults in portal use but need to pay close attention to key considerations promoting usefulness and ease of use.
Internet Sex discourse and porn viewing by Arab adolescents: The overt and the covert and its impact on their sexual education and behavior (Preprint)
Authors: Gesser-Edelsburg Anat , Abed Elhadi Munawar
Published: July 2018

BACKGROUND

Due to the religious proscription, it was found that Arab youths acquire information and view pornography secretly. The internet exposes them to contents that contradict religious and cultural taboos. There are few studies about viewing habits of sexual contents among Arab adolescents and about the way they discuss sexuality.

OBJECTIVE

to characterize the barriers and difficulties that prevent sexual discourse in Arab society and enable pornography viewing, according to the perceptions of adolescents and mothers.

METHODS

phenomological qualitative research methods, in-depth interviews with 40 participants. 20 Arab adolescents, sampled by two age groups: 14-16 and 16-18. In addition, 20 mothers of adolescents from both sexes were interviewed.

RESULTS

The findings indicate that mothers “turn a blind eye” to porn viewing and sexual activity by boys, versus a sweeping prohibition and denial of such behavior by girls. The boys reported viewing porn routinely, whereas girls denied doing so, but admitted that their girlfriends watched porn. The study also found that the boys have guilt feelings during and after the viewing as a result of the clash between modernity and traditional values.

CONCLUSIONS

It is necessary to find a way to encourage a significant sexual discourse to prevent the violent consequences of its absence in Arab society. A controlled, transparent and critical sexual discourse could help youth make more informed decisions concerning the search for sexual contents, porn viewing and sexual behavior.
Geographic Representativeness of a Web-Based Smoking Cessation Intervention: Reach Equity Analysis (Preprint)
Authors: Amato Michael S , Graham Amanda L
Published: July 2018

BACKGROUND

Cigarette smoking is the leading cause of preventable death and disease in the United States. Smoking prevalence is higher in rural areas than in metropolitan areas, due partly to differences in access to cessation treatment. With internet use at 89% of all US adults, digital approaches could increase use of cessation treatment and reduce smoking.

OBJECTIVE

We investigated the extent to which smokers from rural areas use a digital cessation resource. We compared the geographic distribution of registered users of a free Web-based smoking cessation program with the geographic distribution of US smokers.

METHODS

We mapped user-provided ZIP codes to Rural-Urban Continuum Codes. A total of 59,050 of 118,574 users (49.80%) provided valid ZIP codes from 2013 to 2017. We used US National Survey of Drug Use and Health data from 2013 to 2017 to compare the geographic distribution of our sample of Web-based cessation users with the geographic distribution of US smokers. Reach ratios and 95% confidence intervals quantified the extent to which rural smokers’ representation in the sample was proportionate to their representation in the national smoking population. Reach ratios less than 1 indicate underrepresentation.

RESULTS

Smokers from rural areas were significantly underrepresented in 2013 (reach ratio 0.89, 95% CI 0.87-0.91) and 2014 (reach ratio 0.89, 95% CI 0.86-0.92), proportionally represented in 2015 (reach ratio 1.08, 95% CI 1.02-1.14) and 2016 (reach ratio 1.03, 95% CI 0.94-1.14), and proportionally overrepresented in 2017 (reach ratio 1.16, 95% CI 1.12-1.21). Smokers from Large Metro areas were proportionally represented in 2013 and 2014 but underrepresented in 2015 (reach ratio 0.97, 95% CI 0.94-1.00), 2016 (reach ratio 0.89, 95% CI 0.85-0.94), and 2017 (reach ratio 0.89, 95% CI 0.86-0.91).

CONCLUSIONS

Results suggest that smokers from rural areas are more than proportionally reached by a long-standing digital cessation intervention. The underrepresentation of smokers from Large Metro areas warrants further study.
eHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association (Preprint)
Authors: Britt Rebecca Katherine , Collins William Bart , Wilson Kari , Linnemeier Georgiann , Englebert Andrew Mark
Published: July 2018

BACKGROUND

The eHealth Literacy Scale (eHEALS) has been widely adopted by researchers to understand how eHealth literacy can be put into context. eHealth researchers need to know how to promote positive health behavior changes across college students, given the importance of the Internet to acquire and use health information. The American College Health Association identified a set of key health issues that affect college students today. By understanding how eHEALS might be related to college students’ maintenance of their health and their use of online health resources, researchers will be provided with a better understanding of eHealth literacy and its pragmatic implications for health campaigns and future interventions.

OBJECTIVE

The goal of the study was to examine what eHEALS reveals about college student health behaviors identified by the American College Health Association. To understand college student current health maintenance and their intentions to maintain their health and use online resources, the theory of planned behavior was used as the theoretical framework for the study.

METHODS

Data were collected via a survey of 422 college students that included the eHEALS measure and questions about health issues based on the recommendations of the American College Health Association. These questions asked about college student current health, subsequent use of online health resources, and their intention to maintain their health and make use of such resources in the future.

RESULTS

eHEALS was positively and significantly associated with all 8 areas of health issues identified by the American College Health Association for college student current maintenance of health and use of online health resources and for future intention of health maintenance and use of online resources. Key issues that emerged with eHealth literacy were maintaining safe sex practices and seeking out related information, seeking out information on an exercise regime, information on vaccinations, and maintaining a balanced diet.

CONCLUSIONS

These results suggest several areas that may be targeted for future health campaigns toward college students. In addition, eHEALS was found to be a useful instrument for college students in the United States. Lastly, these results point to a need to deliver targeted information to college students, particularly since eHEALS captures literacy based on positively phrased items.
Investigating a Message Tailoring Strategy to Improve Efficacy of Activity Promotion Interventions: A Study Protocol (Preprint)
Authors: Sadat Rezai Leila , Burns Catherine Marie
Published: July 2018

BACKGROUND

There have been challenges in designing effective behaviour-change interventions, including those that promote physical activity. One of the key reasons is that many of those systems do not account for individuals’ characteristics and their psychological differences, which affect their approach toward adopting target behaviour. For decades, tailoring has been used as a common technique to effectively communicate health-related information to persuade people to follow a healthier living. However, its use in the design of persuasive technologies has not been adequately investigated.

OBJECTIVE

The objective of this research is to explore the effects of tailoring when it is grounded in Higgins’ regulatory focus theory.

METHODS

A combination of cross-sectional and longitudinal studies has been proposed to examine how individuals’ intention to become more physically active would be affected by receiving health messages that may or may not match their self-regulatory orientation. The research would also subjectively, as well as objectively, measures the changes in individuals’ physical activity level.

RESULTS

The anticipated completion date for the consequent studies is December 2016.

CONCLUSIONS

In this article, the importance of refining message-framing research questions and a stepwise approach to develop an efficient experimental design to examine a new tailoring strategy is discussed. A set of small studies is proposed that would inform the best approach to design the principal experiment. The findings of principal experiment will provide a deeper insight into the relationship between regulatory-focus theory, persuasive message construction, and individuals’ physical activity behaviour.
What Drives Young Vietnamese to Use Mobile Health Innovations? Implications for Health Communication and Behavioral Interventions (Preprint)
Authors: Tran Bach Xuan , Zhang Melvyn WB , Le Huong Thi , Nguyen Hinh Duc , Nguyen Long Hoang , Nguyen Quyen Le Thi , Tran Tho Dinh , Latkin Carl A , Ho Roger CM
Published: July 2018

BACKGROUND

Mobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents.

OBJECTIVE

This study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth.

METHODS

An online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders.

RESULTS

Among 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps.

CONCLUSIONS

This study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management.
The Use of Avatar Counseling for HIV/AIDS Health Education: The Examination of Self-Identity in Avatar Preferences (Preprint)
Authors: Canidate Shantrel , Hart Mark
Published: July 2018

BACKGROUND

The number of adults using the Internet to obtain health information is on the rise. An estimated 66% of the adults reportedly use the Internet to obtain health information related to a specific disease (ie, human immunodeficiency virus and acquired immunodeficiency syndrome, HIV/AIDS). Previous research has demonstrated that health information seekers use the Internet to seek answers to stigma-laden questions from health avatars.

OBJECTIVE

The objective of this study was to identify patterns in the choice of avatar among health information seekers (patients or public health workers) using the Internet to obtain HIV/AIDS information and to describe the demographic characteristics (age, gender, and ethnicity) of health information seekers to determine whether they preferred an avatar that was similar to their own gender and ethnicity.

METHODS

The Rural South Public Health Training Center (RSPHTC) partnered with the New York State Department of Health to create the HIV/AIDS Avatar project. The avatar project was created to serve as an educational resource for public health workers by providing relevant and accurate information about HIV/AIDS. First, the user was instructed to choose one of the 8 avatars that voiced responses to 100 common questions and answers about HIV/AIDS. Next, the website gave users the option to complete a brief 3-question demographic survey. Finally, the demographic characteristics of each user were compared with the chosen avatar to determine whether they preferred an avatar that was similar to their own gender and ethnicity.

RESULTS

The avatar project website was loaded with 800 videos that included the answers to the top 100 questions about HIV/AIDS voiced by 8 avatars. A total of 1119 Web-based health information seekers completed the demographic survey upon accessing the website. Of these, 55.14% (617/1119) users were female. A total of 49.96% (559/1119) users were aged between 30 and 49 years. The ethnicity of the user and the avatar was found to have the strongest connection. All the users choose the female avatar matching their own ethnicity, followed by the male avatar. Additionally, the white female avatar was chosen the most by all users regardless of the age group or gender.

CONCLUSIONS

Web-based health information seekers using the Internet to access medical research information may feel more comfortable receiving the answers to HIV stigma-laden questions from avatars, rather than receiving information directly from a health care provider. Additionally, providers seeking to utilize avatars to deliver interventions in health care settings may benefit from offering individuals choices in how they receive health information. Having the ability to choose whom you seek information from may lead to an increase in knowledge and awareness and could motivate HIV-positive individuals to seek care.
How, When and Why People Seek Health Information Online: Qualitative Study in Hong Kong (Preprint)
Authors: Chu Joanna TW , Wang Man Ping , Shen Chen , Viswanath Kasisomayajula , Lam Tai Hing , Chan Sophia Siu Chee
Published: July 2018

BACKGROUND

The Internet has become an established source for health information. The number of individuals using the Internet to search for health information, ranging from healthy lifestyle advice to treatment and diseases, continues to grow. Scholars have emphasized the need to give greater voice and influence to health consumers. Hong Kong, being one of the most technologically advanced and connected cities in the world, has one of the highest Internet penetration rates in the world. Given the dearth of research in an Asian context, Hong Kong is an excellent platform to study individuals’ perceptions (eg, benefits and limitations on seeking health information online and how the information is used) on health information seeking.

OBJECTIVE

The aim of this paper was to study individuals’ perceptions on health information seeking and to document their Internet information–seeking behaviors.

METHODS

Five focus groups (n=49) were conducted from November 2015 to January 2016 with individuals across different age groups (18 years or above). Focus group contents were audiotaped, transcribed, and analyzed using thematic analysis techniques.

RESULTS

Older (55+ years) and less educated respondents were less likely to use the Internet to search for health information. Among individuals who obtained health information via the Internet, regardless of the severity of the health issue, the Internet was always the first source for information. Limited doctor consultation time and barriers to accessing professional health services were the main reasons for using the Internet. Convenience and coverage were regarded as the main advantages, whereas credibility and trustworthiness of health information were noted as limitations. The use of Web-based health information varied among individuals; hence, the implications on the doctor-patient relationship were mixed.

CONCLUSIONS

The prevalent and increasing use of the Internet for health information seeking suggests the need for health care professionals to understand how it can be optimally utilized to improve health outcomes. Strategies for communicating and disseminating credible health information in a form that users can understand and use are essential. Due to the rapid technological and related behavioral changes, online health information seeking and its effects need to be closely monitored.
An E-Learning Module to Improve Nongenetic Health Professionals� Assessment of Colorectal Cancer Genetic Risk: Feasibility Study (Preprint)
Authors: Douma Kirsten Freya Lea , Aalfs Cora M , Dekker Evelien , Tanis Pieter J , Smets Ellen M
Published: July 2018

BACKGROUND

Nongenetic health providers may lack the relevant knowledge, experience, and communication skills to adequately detect familial colorectal cancer (CRC), despite a positive attitude toward the assessment of history of cancer in a family. Specific training may enable them to more optimally refer patients to genetic counseling.

OBJECTIVE

The aim of this study was to develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge, and comprehension of communication skills, and to assess the feasibility of the e-learning module for continued medical education of these specialists.

METHODS

A focus group helped to inform the development of a training framework. The e-learning module was then developed, followed by a feasibility test among a group of surgeons-in-training (3rd- and 4th-year residents) and then among gastroenterologists, using pre- and posttest questionnaires.

RESULTS

A total of 124 surgeons-in-training and 14 gastroenterologists participated. The e-learning was positively received (7.5 on a scale of 1 to 10). Between pre- and posttest, attitude increased significantly on 6 out of the 10 items. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49% to 72% correct at pretest to 67% to 87% correct at posttest.

CONCLUSIONS

This study shows the feasibility of a problem-based e-learning module to help surgeons-in-training and gastroenterologists in recognizing a hereditary predisposition in patients with CRC. The e-learning led to improvements in attitude toward the assessment of cancer family history, knowledge on criteria for referral to genetic counseling for CRC, and comprehension of communication skills.
Effectiveness of Two Web-Based Interventions for Chronic Cancer-Related Fatigue Compared to an Active Control Condition: Results of the �Fitter na kanker� Randomized Controlled Trial (Preprint)
Authors: Bruggeman-Everts Fieke Z. , Wolvers Marije D. J. , van de Schoot Rens , Vollenbroek-Hutten Miriam M. R. , Van der Lee Marije L.
Published: July 2018

BACKGROUND

Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients.

OBJECTIVE

The current paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition.

METHODS

Severely fatigued cancer survivors were recruited via online and offline channels, and self-registered on an open-access website. After eligibility checks, 167 participants were randomized via an embedded automated randomization function into: (1) physiotherapist-guided Ambulant Activity Feedback (AAF) therapy encompassing the use of an accelerometer (n=62); (2) psychologist-guided Web-based mindfulness-based cognitive therapy (eMBCT; n=55); or (3) an unguided active control condition receiving psycho-educational emails (n=50). All interventions lasted nine weeks. Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale (primary outcome) six times from baseline (T0b) to six months (T2). Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule (secondary outcome). Treatment dropout was investigated.

RESULTS

Multiple group latent growth curve analysis, corrected for individual time between assessments, showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group. The analyses were checked by a researcher who was blind to allocation. Clinically relevant changes in fatigue severity were observed in 66% (41/62) of patients in AAF, 49% (27/55) of patients in eMBCT, and 12% (6/50) of patients in psycho-education. Dropout was 18% (11/62) in AAF, mainly due to technical problems and poor usability of the accelerometer, and 38% (21/55) in eMBCT, mainly due to the perceived high intensity of the program.

CONCLUSIONS

Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails.

CLINICALTRIAL

Trialregister.nl NTR3483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3483 (Archived by WebCite at http://www.webcitation.org/6NWZqon3o)
Healthier Together: Using an Internet-Based Communication Campaign and Improvement Science to Build Engagement in a Learning Network (Preprint)
Authors: Opipari-Arrigan Lisa , Seid Michael , Margolis Peter A.
Published: July 2018

BACKGROUND

Network-based Learning Health Systems that facilitate patient, clinician and researcher collaboration are emerging as a means to improve health and the healthcare system. The first step to engaging in a network is becoming aware that one exists.

OBJECTIVE

Our objective was to determine whether an Internet-based communication campaign within a network focused on improving outcomes for children and adolescents with inflammatory bowel disease could be used as a strategy for engaging a broad base of stakeholders – patients, families, clinicians and researchers – in a peer-produced learning network.

METHODS

We developed an Internet-based communication campaign targeting all stakeholder groups (patients, families, clinicians, researchers) in the ImproveCareNow (ICN) Network. Using existing network communication channels and 56 ICN clinical care centers as distribution nodes, we aimed to collect 1,000 expressions of support for collaborative healthcare and ICN over 9 weeks. Participants were stakeholder groups (patients, families, clinicians, researchers) in the ICN Network. Outreach took place via social media, email, blogs, e-newsletters, list-serves, webinars, and ICN clinics. Individuals were asked to post an expression of support on the HealthierTogether.org microsite. We used quality improvement methods to evaluate outreach channels and strategies and guide subsequent outreach interventions. The main outcome and measures were the number of microsite visits, number of posted expressions of support, and microsite visit-to-posted expression conversion rate were tracked daily via run and controls charts to determine impact.

RESULTS

Over the course of 9 weeks, the microsite received 5,496 visits from 2,183 unique visitors and collected over 1,000 expressions of support for collaborative healthcare, including written statements, photos, and videos. Expressions came from all stakeholder groups, including patients/families/friends (48%), clinicians (30%), researchers (5%), and interested others (17%). Submissions included stories of the importance of collaboration in improving health and healthcare. Frequent, repeated prompting, direct requests from known individuals, and increasing urgency were related to increased postings.

CONCLUSIONS

An Internet-based communication campaign using network communication channels and care centers can be an effective means of motivating awareness and simple participation in contributing to improvement in care and outcomes.
Self-Guided Web-Based Interventions: Scoping Review on User Needs and the Potential of Embodied Conversational Agents to Address Them (Preprint)
Authors: Scholten Mark R , Kelders Saskia M , Van Gemert-Pijnen Julia EWC
Published: July 2018

BACKGROUND

Web-based mental health interventions have evolved from innovative prototypes to evidence-based and clinically applied solutions for mental diseases such as depression and anxiety. Open-access, self-guided types of these solutions hold the promise of reaching and treating a large population at a reasonable cost. However, a considerable factor that currently hinders the effectiveness of these self-guided Web-based interventions is the high level of nonadherence. The absence of a human caregiver apparently has a negative effect on user adherence. It is unknown to what extent this human support can be handed over to the technology of the intervention to mitigate this negative effect.

OBJECTIVE

The first objective of this paper was to explore what is known in literature about what support a user needs to stay motivated and engaged in an electronic health (eHealth) intervention that requires repeated use. The second objective was to explore the current potential of embodied conversational agents (ECAs) to provide this support.

METHODS

This study reviews and interprets the available literature on (1) support within eHealth interventions that require repeated use and (2) the potential of ECAs by means of a scoping review. The rationale for choosing a scoping review is that the subject is broad, diverse, and largely unexplored. Themes for (1) and (2) were proposed based on grounded theory and mapped on each other to find relationships.

RESULTS

The results of the first part of this study suggest the presence of user needs that largely remain implicit and unaddressed. These support needs can be categorized as task-related support and emotion-related support. The results of the second part of this study suggest that ECAs are capable of engaging and motivating users of information technology applications in the domains of learning and behavioral change. Longitudinal studies must be conducted to determine under what circumstances ECAs can create and maintain a productive user relationship. Mapping the user needs on the ECAs’ capabilities suggests that different kinds of ECAs may provide different solutions for improving the adherence levels.

CONCLUSIONS

Autonomous ECAs that do not respond to a user’s expressed emotion in real time but take on empathic roles may be sufficient to motivate users to some extent. It is unclear whether those types of ECAs are competent enough and create sufficient believability among users to address the user’s deeper needs for support and empathy. Responsive ECAs may offer a better solution. However, at present, most of these ECAs have difficulties to assess a user’s emotional state in real time during an open dialogue. By conducting future research with relationship theory–based ECAs, the added value of ECAs toward user needs can be better understood.
Promoting Secondary Analysis of Electronic Medical Records in China: Summary of the PLAGH-MIT Critical Data Conference and Health Datathon (Preprint)
Authors: Li Peiyao , Xie Chen , Pollard Tom , Johnson Alistair Edward William , Cao Desen , Kang Hongjun , Liang Hong , Zhang Yuezhou , Liu Xiaoli , Fan Yong , Zhang Yuan , Xue Wanguo , Xie Lixin , Celi Leo Anthony , Zhang Zhengbo
Published: July 2018

UNSTRUCTURED

Electronic health records (EHRs) have been widely adopted among modern hospitals to collect and track clinical data. Secondary analysis of EHRs could complement the traditional randomized control trial (RCT) research model. However, most researchers in China lack either the technical expertise or the resources needed to utilize EHRs as a resource. In addition, a climate of cross-disciplinary collaboration to gain insights from EHRs, a crucial component of a learning healthcare system, is not prevalent. To address these issues, members from the Massachusetts Institute of Technology (MIT) and the People’s Liberation Army General Hospital (PLAGH) organized the first clinical data conference and health datathon in China, which provided a platform for clinicians, statisticians, and data scientists to team up and address information gaps in the intensive care unit (ICU).
A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study (Preprint)
Authors: Paxton Raheem J , Hajek Richard , Newcomb Patricia , Dobhal Megha , Borra Sujana , Taylor Wendell C , Parra-Medina Deborah , Chang Shine , Courneya Kerry S , Block Gladys , Block Torin , Jones Lovell A
Published: July 2018

BACKGROUND

Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population.

OBJECTIVE

The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, “A Lifestyle Intervention Via Email (ALIVE),” delivered to a sample of racial and ethnic minority breast cancer survivors.

METHODS

Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program’s 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study.

RESULTS

Upon completion, 44 of 71 survivors completed the study. Our “intention-to-treat” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (−304 vs. −59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (−2.3 g/day) and trans fat (−0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails.

CONCLUSIONS

ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform.

CLINICALTRIAL

ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh)