Showing papers in "The Journal of medical research in 2018"

The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings

Abstract: Background: Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. Objective: The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. Methods: We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as “America’s Top Doctors” through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. Results: Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed “Top Doctor” versus those who were not. Conclusions: The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization.

Weight Stigma Goes Viral on the Internet: Systematic Assessment of YouTube Comments Attacking Overweight Men and Women.

Abstract: Background: Anonymous verbal attacks against overweight individuals on social media are common and widespread. These comments often use negative, misogynist, or derogatory words, which stigmatize the targeted individuals with obesity. These verbal attacks may cause depression in overweight individuals, which could subsequently promote unhealthy eating behavior (ie, binge eating) and further weight gain. To develop an intervention policy and strategies that tackle the anonymous, Web-based verbal attacks, a thorough understanding of the comments is necessary. Objective: This study aimed to examine how anonymous users verbally attack or defend overweight individuals in terms of 3 themes: (1) topic of verbal attack (ie, what aspects of overweight individuals are verbally attacked), (2) gender of commenters and targeted overweight individuals, and (3) intensity of derogation depending on the targeted gender (ie, the number of swear words used within comments). Methods: This study analyzed the content of YouTube comments that discuss overweight individuals or groups from 2 viral videos, titled “Fat Girl Tinder Date” and “Fat Guy Tinder Date.” The twin videos provide an avenue through which to analyze discussions of obesity as they organically occurred in a contemporary setting. We randomly sampled and analyzed 320 comments based on a coding instrument developed for this study. Results: First, there were twice as many comments verbally attacking overweight individuals (n=174) than comments defending them (n=89). Second, overweight women are attacked for their capacities (eg, laziness, maturity; 14/51, 28%), whereas overweight men are attacked for their heterosocial skills (eg, rudeness, annoyance; 24/29, 83%). Third, the majority of commenters who attacked overweight women are male (42/52, 81%). Fourth, attacking comments generated toward overweight women included more swear words (mean 0.44, SD 0.77) than those targeting men (mean 0.23, SD 0.48). Conclusions: Our data elucidate a worrying situation of frequent disinhibited aggressive messages against overweight individuals online. Importantly, the patterns of verbal aggression differ depending on the gender of the targeted overweight individuals. Thus, gender-tailored intervention strategies that specifically tackle Internet users’ verbal aggression against overweight individuals need to be developed. [Interact J Med Res 2018;7(1):e6]

Representation of Tinnitus in the US Newspaper Media and in Facebook Pages: Cross-Sectional Analysis of Secondary Data

Abstract: Background: When people with health conditions begin to manage their health issues, one important issue that emerges is the question as to what exactly do they do with the information that they have obtained through various sources (eg, news media, social media, health professionals, friends, and family). The information they gather helps form their opinions and, to some degree, influences their attitudes toward managing their condition. Objective: This study aimed to understand how tinnitus is represented in the US newspaper media and in Facebook pages (ie, social media) using text pattern analysis. Methods: This was a cross-sectional study based upon secondary analyses of publicly available data. The 2 datasets (ie, text corpuses) analyzed in this study were generated from US newspaper media during 1980-2017 (downloaded from the database US Major Dailies by ProQuest) and Facebook pages during 2010-2016. The text corpuses were analyzed using the Iramuteq software using cluster analysis and chi-square tests. Results: The newspaper dataset had 432 articles. The cluster analysis resulted in 5 clusters, which were named as follows: (1) brain stimulation (26.2%), (2) symptoms (13.5%), (3) coping (19.8%), (4) social support (24.2%), and (5) treatment innovation (16.4%). A time series analysis of clusters indicated a change in the pattern of information presented in newspaper media during 1980-2017 (eg, more emphasis on cluster 5, focusing on treatment inventions). The Facebook dataset had 1569 texts. The cluster analysis resulted in 7 clusters, which were named as: (1) diagnosis (21.9%), (2) cause (4.1%), (3) research and development (13.6%), (4) social support (18.8%), (5) challenges (11.1%), (6) symptoms (21.4%), and (7) coping (9.2%). A time series analysis of clusters indicated no change in information presented in Facebook pages on tinnitus during 2011-2016. Conclusions: The study highlights the specific aspects about tinnitus that the US newspaper media and Facebook pages focus on, as well as how these aspects change over time. These findings can help health care providers better understand the presuppositions that tinnitus patients may have. More importantly, the findings can help public health experts and health communication experts in tailoring health information about tinnitus to promote self-management, as well as assisting in appropriate choices of treatment for those living with tinnitus.

The Patient Perspective on the Impact of Tenosynovial Giant Cell Tumors on Daily Living: Crowdsourcing Study on Physical Function and Quality of Life.

Abstract: Background: Tenosynovial giant cell tumor (TGCT) is a rare, benign lesion affecting the synovial lining of joints, bursae, and tendon sheaths. It is generally characterized as a locally aggressive and often recurring tumor. A distinction is made between localized- and diffuse-type. The impact of TGCT on daily living is currently ill-described. Objective: The aim of this crowdsourcing study was to evaluate the impact of TGCT on physical function, daily activities, societal participation (work, sports, and hobbies), and overall quality of life from a patient perspective. The secondary aim was to define risk factors for deteriorated outcome in TGCT. Methods: Members of the largest known TGCT Facebook community, PVNS is Pants!!, were invited to an e-survey, partially consisting of validated questionnaires, for 6 months. To confirm disease presence and TGCT-type, patients were requested to share histological or radiological proof of TGCT. Unpaired t tests and chi-square tests were used to compare groups with and without proof and to define risk factors for deteriorated outcome. Results: Three hundred thirty-seven questionnaires, originating from 30 countries, were completed. Median age at diagnosis was 33 (interquartile range [IQR]=25-42) years, majority was female (79.8% [269/337]), diffuse TGCT (70.3% [237/337]), and affected lower extremities (knee 70.9% [239/337] and hip 9.5% [32/337]). In 299 lower-extremity TGCT patients (32.4% [97/299]) with disease confirmation, recurrence rate was 36% and 69.5% in localized and diffuse type, respectively. For both types, pain and swelling decreased after treatment; in contrast, stiffness and range of motion worsened. Patients were limited in their employment (localized 13% [8/61]; diffuse 11.0% [21/191]) and sport-activities (localized 58% [40/69]; diffuse 63.9% [147/230]). Compared with general US population, all patients showed lower Patient-Reported Outcomes Measurements Information System-Physical Function (PROMIS-PF), Short Form-12 (SF-12), and EuroQoL 5 Dimensions 5 Levels (EQ5D-5L) scores, considered clinically relevant, according to estimated minimal important difference (MID). Diffuse versus localized type scored almost 0.5 standard deviation lower for PROMIS-PF (P<.001) and demonstrated a utility score of 5% lower for EQ-5D-5L (P=.03). In localized TGCT, recurrent disease and ≥2 surgeries negatively influenced scores of Visual Analog Scale (VAS)-pain/stiffness, SF-12, and EQ-5D-5L (P<.05). In diffuse type, recurrence resulted in lower score for VAS, PROMIS-PF, SF-12, and EQ-5D-5L (P<.05). In both types, patients with treatment ≤1year had significantly lower SF-12. Conclusions: TGCT has a major impact on daily living in a relatively young and working population. Patients with diffuse type, recurrent disease, and ≥2 surgeries represent lowest functional and quality of life outcomes. Physicians should be aware that TGCT patients frequently continue to experience declined health-related quality of life and physical function and often remain limited in daily life, even after treatment(s). [Interact J Med Res 2018;7(1):e4]

Clinical Study of Ectopic Pregnancy in a Rural Setup: A Two Year Survey

Abstract: Aims and Objective: To study the risk factors, symptomatology and sites of ectopic pregnancy. Materials and Methods: The study was conducted over a 2 year period from August 2011 to August 2013 in Department of OBG at Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka. The parameters studied were age and parity distribution, symptoms at presentation, associated risk factors and site of ectopic pregnancy. Results: There were 25 cases of ectopic pregnancy of the total 2542 deliveries accounting to 1%. Most patients were multiparous belonging to the age group of 20 – 30 years. The most common symptom was pain abdomen followed by bleeding per vagina and history of amenorrhea. 32 % of the patients came in shock. Risk factors were associated in 60% of cases, the most common being a history of tubal surgery. Ampullary part of the tube was the most frequent site accounting for 44% of cases. All the patients were managed by surgical intervention. Conclusion: Ectopic pregnancy is a nightmare for the obstetrician. Early diagnosis and early referral are the key to successful management. It is better to over diagnose an ectopic pregnancy especially in a rural setup. The dictum should be to ‘THINK ECTOPIC’ in a woman in reproductive age group with pain abdomen or bleeding PV or when she comes in shock irrespective of tubal ligation.

Usage, Acceptability, and Effectiveness of an Activity Tracker in a Randomized Trial of a Workplace Sitting Intervention: Mixed-Methods Evaluation.

Abstract: Background: Wearable activity trackers are now a common feature of workplace wellness programs; however, their ability to impact sitting time (the behavior in which most of the desk-based workday is spent) is relatively unknown. This study evaluated the LUMOback, an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in desk-based office workers. Objective: Study objectives were to explore: (1) office workers’ self-directed LUMOback use, (2) individual-level characteristics associated with LUMOback use, (3) the impact of LUMOback use on activity and sitting behaviors, and (4) office workers’ perceived LUMOback acceptability. Methods: Exploratory analyses were conducted within the activity tracker intervention group (n=66) of a 2-arm cluster-randomized trial (n=153) with follow-up at 3 and 12 months. The intervention, delivered from within the workplace, consisted of organizational support strategies (eg, manager support, emails) to stand up, sit less, and move more, plus the provision of a LUMOback activity tracker. The LUMOback, worn belted around the waist, provides real-time sitting feedback through a mobile app. LUMOback usage data (n=62), Web-based questionnaires (n=33), activPAL-assessed sitting, prolonged (≥30 min bouts) and nonprolonged (<30 min bouts) sitting, standing and stepping time (7-day, 24 h/day protocol; n=40), and telephone interviews (n=27) were used to evaluate study aims. LUMOback usage data were downloaded and described. Associations between user characteristics and LUMOback usage (in the first 3 months) were analyzed using zero-inflated negative binomial models. Associations between LUMOback usage and 3-month activity outcomes were analyzed using mixed models, correcting for cluster. LUMOback acceptability was explored using 3-month questionnaire data and thematic analysis of telephone interviews (conducted 6 to 10 months post intervention commencement). Results: Tracker uptake was modest (43/61, 70%), and among users, usage over the first 3 months was low (1-48 days, median 8). Usage was greatest among team leaders and those with low self-perceived scores for job control and supervisor relationships. Greater tracker use (≥5 days vs <5 days) was significantly associated only with changes in prolonged unbroken sitting (−50.7 min/16 h; 95% CI −94.0 to −7.3; P=.02) during all waking hours, and changes in nonprolonged sitting (+32.5 min/10 h; 95% CI 5.0 to 59.9; P=.02) during work hours. Participants found the LUMOback easy to use but only somewhat comfortable. Qualitatively, participants valued the real-time app feedback. Nonuptake was attributed to being busy and setup issues. Low usage was attributed to discomfort wearing the LUMOback. Conclusions: The LUMOback—although able to reduce prolonged sitting time—was only used to a limited extent, and its low usage may provide a partial explanation for the limited behavior changes that occurred. Discomfort limited the feasibility of the LUMOback for ongoing use. Such findings yield insight into how to improve upon implementing activity trackers in workplace settings. [Interact J Med Res 2018;7(1):e5]

3D Printing and its Future in Medical World

Abstract: Since the time of its inception, 3D printing has not only fascinated the researchers but also health professionals. Though the process is exciting, it involves meticulous coordination and selection process to achieve a desirable product. This review article discusses about the history of evolution of 3 D printers, their current application and future trends. Emphasis has also been laid to recognize the best suitable product and ways to prevent its misuse.

Extrahepatic Autoimmune Diseases are Prevalent in Autoimmune Hepatitis Patients and Their First-Degree Relatives: Survey Study

Abstract: Background: Concurrent autoimmune illnesses contribute to increased medical burden and reduced quality of life in patients with autoimmune hepatitis (AIH). The frequency of coexisting autoimmune conditions among North American patients with AIH and their families remains incomplete. Challenges associated with disease capture in the electronic medical record, high study costs, and geographic spread of patients are formidable barriers to understanding the extent of concurrent autoimmune conditions in these groups. Objective: This objective of this study was to examine the frequency of extrahepatic autoimmune diseases (EHAD) among AIH cases and healthy controls as well as their first-degree relatives using social networking sites (SNS). Methods: We developed a 53-question survey detailing the history of autoimmune diseases. A survey link was posted at routine intervals within specific Web-based cohorts on SNS. Healthy controls, without self-reported autoimmune liver disease, were recruited from Amazon’s Mechanical Turk. Continuous variables were summarized using medians and P values obtained with the Wilcoxon rank-sum test. Categorical variables were compared using the chi-square test. Results: Compared with controls (n=1162), cases (n=306) were more likely to be older (median age: 49 vs 33 years), female (284/306, 92.81% vs 955/1162, 82.18%), and have an EHAD (128/306, 41.83% vs 218/1162, 18.76%; P=.001). The most frequent EHADs among cases were thyroid disease (49/306, 16.01% ), Sjogren syndrome (27/306, 8.82%), Raynaud phenomenon (23/306, 7.52%), and psoriasis (22/306, 7.19%). Overall, 55.88% (171/306) of cases and 35.71% (1601/4484) of controls reported at least 1 first-degree relative (FDR) with a history of EHAD (P=.001). Cases had a significantly higher risk of EHAD than controls after the adjustment for age, sex, race, and body mass index: odds ratio 2.46 (95% CI 1.8-3.3); P=.001. Conclusions: Patients with AIH report higher prevalence of coexistent EHAD than healthy controls, and their FDRs are also more likely to have autoimmune disorders.

Characterizing Websites That Provide Information About Complementary and Integrative Health: Systematic Search and Evaluation of Five Domains.

Abstract: Background: In recent years, there has been an increase in the utilization of complementary and integrative health (CIH) care, and an increase in information-seeking behavior focused on CIH. Thus, understanding the quality of CIH information that is available on the internet is imperative. Although there have been a limited number of studies evaluating the quality of websites providing information about specific CIH-related topics, a broad evaluation of CIH websites has not been conducted. Objective: This study was designed to fill that gap. We set out to assess website quality in 5 CIH domains: (1) acupuncture, (2) homeopathy, (3) massage, (4) reiki, and (5) yoga. This study aimed to 1) characterize the websites by type and quality; 2) evaluate website characteristics which may affect readers’ perceptions, specifically message content, structural features, and presentation style, and 3) investigate the extent to which harms, benefits and purposes of use are stated on websites. Methods: This study employed a systematic search strategy to identify websites in each of the target domains to be evaluated. The websites were then classified by type, and a set of checklists focusing on quality, message content, structural features, and presentation style was used to evaluate the websites. Lastly, we performed content analysis to identify harms, benefits, and perceived purposes of use. Results: There were similarities across domains regarding their overall quality and their message content. Across all domains, a high proportion of websites received strong scores in terms of ownership, currency, interactivity and navigability. Scores were more variable concerning authorship, balanced presentation of information and the use of sources of information. However, there were differences regarding their structural features and presentation style. Acupuncture and reiki sites tended to include more external links, and yoga, fewer. There was variation across domains in the extent to which the websites contained domain-specific terminology. Websites tended to provide an extensive list of potential benefits, while reporting of harms was scarce. Conclusions: This is the first study to perform a multidimensional assessment of websites in multiple CIH domains. This review showed that while there are similarities among websites of different CIH domains, there are also differences. The diverse distribution of website types suggests that, regardless of CIH domain, the public encounters information through many different types of media, and it would be useful to consider how the presentation of this content may differ depending on the medium. The characteristics for which variability exist are areas that warrant greater attention from researchers, policy makers, clinicians and patients. There is also a need to better understand how individuals may interact with CIH websites, and to develop tools to assist people to interpret the CIH-related information that they encounter.

Characteristics of Adults' Use of Facebook and the Potential Impact on Health Behavior: Secondary Data Analysis.

Abstract: Background: Social influences are a primary factor in the adoption of health behaviors. Social media platforms, such as Facebook, disseminate information, raise awareness, and provide motivation and support for positive health behaviors. Facebook has evolved rapidly and is now a part of many individuals' daily routine. The high degree of individual engagement and low attrition rate of this platform necessitate consideration for a potentially positive impact on health behavior. Objective: The aim of this paper is to investigate the use of Facebook by adults. Knowledge is limited to the unique characteristics of Facebook users, including time spent on Facebook by adults of various age groups. Characteristics of Facebook users are important to understand to direct efforts to engage adults in future health behavior interventions. Methods: Institutional Review Board approval was obtained for this secondary analysis of existing de-identified survey data collected for the Pew Research Center. The sample included adults age 18-65 years and above. Binomial logistic regression was performed for the model of age group and Facebook use, controlling for other demographics. A multinomial logistic regression model was used for the variable of time spent on Facebook. Based on the regression models, we computed and reported the marginal effects on Facebook use and time spent of adults age groups, including age groups 18-29, 30-49, 50-64, and 65 and over. We discuss these findings in the context of the implications for promoting positive health behaviors. Results: The demographics of the final sample (N=730) included adults age 18-65 years and above (mean 48.2 yrs, SD 18.3 yrs). The majority of the participants were female (372/730, 50.9%), white (591/730, 80.9%) and non-Hispanic (671/730, 91.9%). Bivariate analysis indicated that Facebook users and nonusers differed significantly by age group (χ2=76.71, P<.001) and sex (χ2=9.04, P=.003). Among subjects aged 50 and above, the predicted probability was 66% for spending the same amount of time, 10% with increased time, and 24% with decreased time. Conclusions: The key findings of this study were Facebook use among midlife and older adults was more likely to stay the same over time, compared to the other age groups. Interestingly, the young adult age group 18-29 years was more likely to decrease their time on Facebook over time. Specifically, younger females were most likely to decrease time spent on Facebook. In general, male participants were most likely to spend the same amount of time on Facebook. These findings have implications for future health intervention research, and ultimately, for translation to the clinic setting to improve health outcomes.

Engaging a Community for Rare Genetic Disease: Best Practices and Education From Individual Crowdfunding Campaigns

Abstract: Background: Genetic sequencing is critically important to diagnostic health care efforts in the United States today, yet it is still inaccessible to many. Meanwhile, the internet and social networking have made crowdfunding a realistic avenue for individuals and groups hoping to fund medical and research causes, including patients in need of whole exome genetic sequencing (WES). Objective: Amplify Hope is an educational program designed to investigate what factors affect the success of medical crowdfunding campaigns. We conducted a needs assessment, a series of 25 interviews concerning crowdfunding, and provided training on best practices identified through our assessment for 11 individuals hoping to run their medical crowdfunding campaigns to raise money for patients to access trio WES to identify the mutated proteins that caused their apparent inherited disease. Methods: The crowdfunding education was given in a 30-day training period with resources such as webinars, fact sheets and a crowdfunding training guide emailed to each participant. All campaigns were launched on the same date and were given 30 days to raise the same goal amount of US $5000. Reviewing the 4 crowdfunding campaigns that raised the goal amount within the 30-day period, we sought to identify features that made the 4 crowdfunding campaigns successful. In addition, we sought to assess which factors the resulting 75 donors report as influencing their decision to donate to a campaign. Finally, we investigated whether crowdfunding campaigns for exome sequencing had an impact on increasing applicant’s and donors’ knowledge of genomics. Results: Of the 86 study inquiries, 11 participants submitted the required forms and launched their crowdfunding campaigns. A total of 4 of the 11 campaigns raised their goal amounts within 30 days. Conclusions: We found that social media played an important role in all campaigns. Specifically, a strong social media network, an active outreach process to networks, as well as engagement within the study all correlated with a higher success rate. Amplify Hope donors were more likely to support projects that were near their fundraising goals, and they found video far more effective for learning about genomics than any other medium. [Interact J Med Res 2018;7(1):e3]

Is Mean Platelet Volume to Platelet ratio a promising indicator of diabetic regulation in type 2 diabetes mellitus

Abstract: Aims: Type 2 diabetes mellitus (T2DM) is associated with great disease burden since it has high prevalence, morbidity and mortality rates. Platelets (PLT) are directly or indirectly involve in the processes of chronic complications in T2DM. Beside serving as a marker of platelet activation, mean platelet volume (MPV) is also considered as an inflammatory indice. A MPV to PLT ratio (MPR) is introduced as a novel inflammatory predictor and a marker of worse outcome, recently. We aimed to study MPR levels of type 2 diabetic patients in present report. Methods: Subjects older than 18 years old and with type 2 diabetes mellitus treated in outpatient internal medicine clinics of our university hospital during June 2017 to December 2017 were included. Medical data of the patients obtained from computerized database of the institution analyzed retrospectively. General characteristics and laboratory parameters of the participants, were compared to those in healthy controls. Results: We found significantly increased MPR in diabetic subjects compared to healthy volunteers (p=0.02). Moreover, MPR and fasting blood glucose (r=0.264, p<0.001), and MPR and HbA1c (r=0.234, p=0.003) were significantly and positively correlated (r=0.234, p=0.003). Conclusion: We suggest that, elevated MPR in otherwise healthy subject should courage physicians for prompt evaluation for type 2 DM. Correlations between MPR and fasting plasma glucose and HbA1c need validation with further studies with larger population.

Convergence on the Constraints and Challenges in the Awareness, Prevention, Treatment and CONTROL OF TYPE 2 DIABETES and Diabetes-Related Conditions

Abstract: The global epidemiology of type 2 diabetes over time regarding the biologic, cultural, demographic, therapeutic regimen and lifestyle changes are factors which have been described with particular focus on the aetiology, complications, natural history and risks pertaining to the disorder. Expansive data depict that type 2 diabetes incidence and prevalence increase rapidly to the detriment of pecuniary measures in health services and society. Recent decades have been encumbered with tumultuous and contentious polemics marked with conflicts in research findings and budget cuts in the awareness, prevention, treatment and control of the constraints and challenges regarding diabetes and related conditions, especially in LIMCs. Our health systems are faced with adverse policy expansiveness to unavoidable or threatened accelerating global needs in health and development as well as a realizable paradigm of performing more with less. Strategies in the prevention, treatment and control of type 2 diabetes and diabetes-related conditions aim to mitigate the risk of the development of diabetes and

Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study.

Abstract: Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID). Objective: We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality. Methods: We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care. Results: The baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service. Conclusions: With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion.

A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments.

Abstract: Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes. [Interact J Med Res 2018;7(1):e2]

Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons

Abstract: Background: The publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence. Objective: The aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons. Methods: A Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. Results: The response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001). Conclusions: According to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals.

Calorie Estimation From Pictures of Food: Crowdsourcing Study.

Abstract: Background: Software designed to accurately estimate food calories from still images could help users and health professionals identify dietary patterns and food choices associated with health and health risks more effectively. However, calorie estimation from images is difficult, and no publicly available software can do so accurately while minimizing the burden associated with data collection and analysis. Objective: The aim of this study was to determine the accuracy of crowdsourced annotations of calorie content in food images and to identify and quantify sources of bias and noise as a function of respondent characteristics and food qualities (eg, energy density). Methods: We invited adult social media users to provide calorie estimates for 20 food images (for which ground truth calorie data were known) using a custom-built webpage that administers an online quiz. The images were selected to provide a range of food types and energy density. Participants optionally provided age range, gender, and their height and weight. In addition, 5 nutrition experts provided annotations for the same data to form a basis of comparison. We examined estimated accuracy on the basis of expertise, demographic data, and food qualities using linear mixed-effects models with participant and image index as random variables. We also analyzed the advantage of aggregating nonexpert estimates. Results: A total of 2028 respondents agreed to participate in the study (males: 770/2028, 37.97%, mean body mass index: 27.5 kg/m2). Average accuracy was 5 out of 20 correct guesses, where “correct” was defined as a number within 20% of the ground truth. Even a small crowd of 10 individuals achieved an accuracy of 7, exceeding the average individual and expert annotator’s accuracy of 5. Women were more accurate than men (P<.001), and younger people were more accurate than older people (P<.001). The calorie content of energy-dense foods was overestimated (P=.02). Participants performed worse when images contained reference objects, such as credit cards, for scale (P=.01). Conclusions: Our findings provide new information about how calories are estimated from food images, which can inform the design of related software and analyses.

A Literature Review of Healthcare Professionals’ Attitudes towards Patients with Mental Illness

Abstract: Background: The purpose of this review of literature is to examine the problem of stigma and discrimination in the provision of mental health care. The author will review the literature available from research and assessments in relation to this topic as well as the problems faced in research and proposed solutions to this phenomenon. Topics requiring further research into bettering the situation of both the patient and the health care service provider will be highlighted. Objective: To inventory and organize the peer-reviewed literature related to attitudes of health professionals towards the mentally ill and to identify shifts in research focus from risk evaluation to intervention and reduction. To consider research directions with clear applications for improved care and care outcomes. Methods: A comprehensive review of the peer-reviewed literature was conducted to retrieve empirical studies that addressed attitudes of health professionals towards the mentally ill. A matrix was created to determine the capacity, quality, and characteristics of 47 research studies conducted between 1996 and 2014, all pertaining to attitudes of health professionals towards patients with mental illness. Results: A synthesis of these empirical studies revealed an emerging literature related to attitudes of healthcare professionals towards the mentally ill and the consequences of limited information focusing on patients’ perspectives. Conclusions: Amid growing trends in numerous countries of healthcare professionals’ negative attitudes towards the mentally ill, the need for further research is clear. Researchers must fill gaps in literature concerning appropriate strategies and techniques to minimize negative attitudes among healthcare providers.

Quality of Web Information About Palliative Care on Websites from the United States and Japan: Comparative Evaluation Study.

Abstract: Background: Patients and their families are able to obtain information about palliative care from websites easily nowadays. However, there are concerns on the accuracy of information on the Web and how up to date it is. Objective: The objective of this study was to elucidate problematic points of medical information about palliative care obtained from websites, and to compare the quality of the information between Japanese and US websites. Methods: We searched Google Japan and Google USA for websites relating to palliative care. We then evaluated the top 50 websites from each search using the DISCERN and LIDA instruments. Results: We found that Japanese websites were given a lower evaluation of reliability than US websites. In 3 LIDA instrument subcategories—engagability (P<.001), currency (P=.001), and content production procedure (P<.001)—US websites scored significantly higher and had large effect sizes. Conclusions: Our results suggest that Japanese websites have problems with the frequency with which they are updated, their update procedures and policies, and the scrutiny process the evidence must undergo. Additionally, there was a weak association between search ranking and reliability, and simultaneously we found that reliability could not be assessed by search ranking alone. [Interact J Med Res 2018;7(1):e7]

Trustworthiness, Readability, and Suitability of Web-Based Information for Stroke Prevention and Self-Management for Korean Americans: Critical Evaluation.

Abstract: Background: Websites are common sources of health information to stroke survivors and caregivers for continual management of stroke and its long-term sequelae. The presence of risk factors and mortality rates related to stroke are high in Korean Americans. A vast majority of this group are active Web users and rely on the Web-based information due to lack of insurance and, thus, limited access to long-term stroke care. Thus, it is critical to evaluate existing stroke websites for their trustworthiness, readability, and suitability. Objective: The objective of our study was to provide a systematic evaluation of stroke-related websites regarding (1) trustworthiness, (2) readability, and (3) suitability for stroke prevention and self-management for Korean Americans. Methods: We selected a total of 156 websites using search terms “stroke,” “CVA,” “중풍 (jungpung),” and “뇌졸증 (noejoljung)” on Google and Yahoo. After eliminating duplicates and irrelevant websites (n=116), we evaluated a total of 42 websites (15 in English and 27 in Korean) using the National Library of Medicine’s health website’s evaluation tool for trustworthiness; Simple Measure of Gobbledygook for readability; and Suitability Assessment of Materials for suitability. All three instruments used the 3-point Likert scale: superior (=2), adequate (=1), or not suitable (=0). Results: Of the 42 websites evaluated, we rated 62% (26/42) websites as “adequate” or above for trustworthiness. The information on 48% (20/42) websites had not been updated for more than a year, which indicates poor currency; 33% (14/42) websites failed to provide the publisher and contact information, which yields poor authority; 50% (21/42) websites did not cite sources of health information, which indicates lack of accuracy. Only 2 websites met the recommended readability (5th grade or lower reading level). The suitability was also suboptimal; only 1 website was rated as “superior”; 60% (25/42) websites were “adequate,” and 38% (16/42) were “not suitable.” Most websites were limited in graphical directions, interactive motivations for desired healthy behaviors, and multiple language translations. Conclusions: The existing stroke-related websites in either English or Korean are trustworthy and suitable, yet precise citation of evidence-based information will improve trustworthiness. The contents requiring high reading level may set a barrier to the utilization of Web-based health information for Korean Americans with a lower level of education. In addition, supplementing graphical examples, interaction features, and culturally relevant information in multiple languages are the areas for improvement in suitability. The improved features can reduce the reading burden of stroke patients or caregivers and build their confidence when applying the information for stroke management in daily living. These strategies are especially crucial to Korean Americans, who inevitably seek Web-based information to fill the gap between their demand and access to health care for a long-term self-management after a stroke.

Detection of Medically Important Parasites in Fruits and Vegetables Collected from Local Markets in Dire Dawa, Eastern Ethiopia

Abstract: Background: Consumption of fruits and vegetables are highly beneficial for maintenance of health and prevention of diseases. On the other hand, they can act as potential sources for the spread of various infectious parasitic diseases. Detection of medically important parasites in fruits and vegetables is paramount in the prevention and control of parasitic diseases. Objective: The objective of this study was to determine the prevalence & determinants of medically important parasites in fruits & vegetables collected from local markets in Dire Dawa City, Eastern Ethiopia. Methods: A cross-sectional study involving standardized parasitological techniques and structured questionnaire was used to collect the data from September 14 to October 29, 2015. Eight types of fruits and vegetables (lettuce, cabbage, carrot, tomato, green pepper, banana, orange, and spinach) were collected from nine conveniently selected local markets in Dire Dawa City. Equal numbers of samples (47 each, totally 376 samples) were randomly collected from the selected markets retail fruits and vegetables. The collected data were entered and analyzed using SPSS version 20. Descriptive statistics, bivariate and multivariate logistic regressions were used in the analysis.

Evaluation of Consciousness Energy Healing Treated Pyridoxine (Vitamin B6)

Abstract: The aim of the research work to evaluate the impact of the Consciousness Energy Treatment on the physicochemical and thermal properties of pyridoxine using the modern analytical technique. The sample was divided into control and treated part. Only the treated sample was received the Trivedi Effect-Consciousness Energy Treatment remotely by a renowned Biofield Energy Healer, Dahryn Trivedi. The particle sizes were significantly decreased by 17% (d10), 6.2% (d50), 0.54% (d90), and 0.3% {D(4,3)}; thus, the specific surface area was significantly increased by 13.72% in the treated pyridoxine compared with the control sample. The PXRD peak intensities and crystallite sizes were significantly altered ranging from -40.45% to 154.76% and -57% to 51.33%, respectively; however, the average crystallite size was decreased by 6.52% in the treated sample compared with the control sample. The heat requires to melt (fusion) the treated pyridoxine was increased by 3.82% compared with the control sample. The total weight loss was significantly decreased by 5.14%; however, the residue amount was significantly increased by 8.34% in the treated sample compared with the control sample.

Cytotoxicity of selected medicinal plants extracts using the brine shrimp lethality assay from Samburu county, Kenya

Abstract: Aim of the study: This test was carried out to assess the cytotoxicity bioassay of selected medicinal plants from Samburu County, Kenya. Materials and Methods: Selected medicinal plants namely Clerodendrum myricoides, (Hoecst) Vatke Carissa eduli (Forsk) vahl, Acassia tortilis (Fossk) Hayne Myrsine africana L., Rhamnus staddo A. Rich, Rhamnus prinoides L, herit, Psiadia arabica Jabb and Spach and Sansevierria enhribergii Bach were subjected to the Brineshrimp Lethality Test. Three dilutions of the aqueous, methanol/water (70/30) v/v and chloroform extracts were used five (5) tubes per dilution. Ten naupli were introduced per tube and mortality evaluated after 24hrs. Mortality data was analysed using the probit method of Finney Computor Programme. The programme uses the number of dose level, the number of brine shrimp for every concentration, percent mortality for every concentration and dose level to calculate lethal concentration (LC50) and its 95 % confidence interval. Results: All the aqueous extracts had an LC50 equal to or higher than 1000μg/ml which is considered non cytotoxic. The extracts showing a low LC50 (< 1000) are likely candidates for cytotoxic or anticancer drugs and can be investigated further. The extracts showing a high LC50 (> 1000) can be used as non cytotoxic drugs and hence further investigations would be necessary. Conclusion: The bioactivity results in this study validates the use of the plants as herbal remedies by Samburu Traditional healers.

Polynuclear neutrophil variation and oxidative stress in Type 2 Diabetics

Abstract: Context: Chronic hyperglycemia and inflammation in type 2 diabetics may be correlated with oxidative stress, which is the basis of microand macro-angiopathic complications. The evolution of this inflammation resulted in the accumulation of neutrophils at the inflammatory site, the latter are in the basal state in a state of constant preactivation for the production of O2. Objectives: This study aimed to determine the quantitative and morphological variation of neutrophils; and to identify the level of correlation between neutrophil levels and oxidative stress in type 2 diabetics in Lubumbashi. Material and methods: Spectrophotometric and microscopic methods were used to evaluate glycemia and neutrophils in the samples. Results: The study included 27 confirmed type 2 diabetics, including 52% of women. Their average age was 56.33 ± 11.79 years old. An increase in neutrophil count and a deviation of the Arneth curve were observed in 37.03% and 71.14%, respectively, of diabetic subjects. Conclusion: This study showed an increase in neutrophils in type 2 diabetics. This may be related to an indirect activation of the immune system in these subjects.

Seroprevalence of dengue virus among children with febrile illness in Nnewi, Nigeria

Abstract: Background: Dengue fever is regarded as the most important arboviral disease worldwide. Aims and Objectives: This study was designed to investigate the prevalence of denque virus seropositivity among children with febrile illness at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. Study Design: A cross sectional study consisting of 96 subjects was performed. The subjects were recruited using the systematic sampling technique. Ethical approval was obtained from the Ethics committee of Nnamdi Azikiwe University Teaching Hospital Nnewi and informed consent was sought from study participants. Setting: This study was conducted at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State Nigeria. Materials and Methods: The demographic data and dietary pattern of the subjects was obtained using well structured questionnaire. Dengue Virus IgM was analysed using ELISA techniques. Malaria parasitaemia was determined using microscopy techniques while Haematological parameters were evaluated using haematology auto analyser (PE-6800 fully auto haematology analyser Procan). Statistics: Statistical analysis was performed using the Statistical package for social sciences (SPSS) version 24. Results: The results showed a prevalence of 77.1% Dengue Virus seropositivity among children with febrile illness in the study population with a greater prevalence found among the males (54.1%) than female (45.9%) subjects. The dengue virus seropositive participants had significantly greater IgM levels compared with the seronegative participants (2.02 ± 0.76 vs 0.84 ± 0.28; p < 0.001). Children who had dengue virus had significantly greater WBC (p = 0.017), esinophil (p<0.001), but lower RBC (<0.001), Hb (p = 0.001) and basophil (p = 0.001) compared with dengue virus negative children. The result showed a strong positive association between anemia and dengue viral status (χ, 6.31; p = 0.012) with dengue virus seropositive partcipants at greater risk (OR, 3.52; p = 0.015) of developing anemia compared to those who had no dengue virus. More so, the incidence of anemia was higher in those who had malaria and dengue virus co-infection (86.8%) compared with those who had no malaria and were Dengue virus negative (7.5%) and those who presented with malaria but had no Dengue virus (5.7%). Furthermore, the result indicates a significant association (p = 0.005) between dengue virus seropositivity and malaria co-infection with anemia. Conclusion: Our report has revealed that dengue virus is an emerging cause of fever among the study population. This calls for urgent attention and large scale research to confirm the circulating strains of the dengue virus

Indicators of Malnutrition in Under 5 Pakistani Children: A DHS Data Secondary Analysis

Abstract: Objective: To assess the rates of stunting, wasting and underweight in under 5 Pakistani children and identify their associated indicators. Methodology: Data was retrieved from DHS program website for sub-analysis. The outcome variables were constructed according to WHO standards for malnutrition indicators. The three study outcomes of stunting, wasting and underweight were defined on the basis of -2 SD levels of the standard corresponding Z-scores for age of children. STATA 10.0 software was used for measurements of final dataset of 3071 children. Results: High prevalence of stunting, wasting and underweight (45.1%, 10.4% and 26.7% respectively) was identified in this study. Maternal and fathers secondary or above education, health facility delivery, cesarean section and rich SES children have less odds of becoming stunted. Whereas children of older mothers, child age above 2 years, small birth size, 5 or above birth order, rural residence with no toilet facility had greater odds to develop stunting. Similar characteristics of children with underweight were identified; however, very few indicators for wasting were identified. Conclusion: A very high number of under 5 Pakistani children are malnourished. Health budget should be increased and new facilities for educating and counseling patients are required to prevent malnutrition.

Basic Life Support Knowledge Among a Nonmedical Population in Jeddah, Saudi Arabia: Cross-Sectional Study

Abstract: Background: Providing basic life support (BLS) at the site of an accident is crucial to increase the survival rates of the injured people. It is especially relevant when health care is far away. Objective: The aim of our study is to assess the BLS knowledge level of the Saudi Arabian population and identify influencing factors associated with level of knowledge about BLS. Methods: Our study is a cross-sectional descriptive study, which was conducted using a self-administered online questionnaire derived from the BLS practice test. The Saudi population was the target population. The questionnaire was divided into two parts: one contained demographic data and the second part contained questions to test the population’s perception about how to perform BLS techniques properly. The data were collected between July and August 2017. Statistically significant differences were defined as those with a P value <.05, and a score of five or more was considered a passing score on the second part. We used SPSS version 21 for data analysis. Results: Our study included 301 participants. Our participants’ BLS online exam scores ranged from 0 to 10, with a mean of 4.1 (SD 1.7). Only 39.2% (118/301) of the participants passed the test. The percentage of bachelor’s degree or higher holders constituted 60.1% (181/301) of the study population. In addition, higher income was significantly associated with higher scores on the test (P=.04). Conclusions: This study demonstrated that the theoretical knowledge level of BLS among the general population in Jeddah was below average. There is a critical need to increase the public’s exposure to BLS education through raising awareness campaigns and government-funded training programs that aim to curb the incidence of out-of-hospital cardiac arrest mortalities in the Saudi community.