Prevalence of increased intraocular pressure and optic disk cupping: multicenter glaucoma screening in Israel during the 2009 and 2010 World Glaucoma Weeks

BACKGROUND

Early detection of glaucoma enables early initiation of treatment. Screening populations at risk is likely to help achieve this goal.

OBJECTIVES

To increase public awareness regarding early detection of glaucoma, and estimate the prevalence of increased intraocular pressure (IOP) and optic disk cupping in the screened population.

METHODS

A public awareness campaign was carried out in Israel during the 2009 and 2010 World Glaucoma Week, culminating each year in a one-day, free-of-charge screening of individuals in 13 outreach public locations. Screening was performed by 45 ophthalmologists and included a brief medical history, slit-lamp exam with measurement of intraocular pressure (IOP), and evaluation of cup/disk ratio.

RESULTS

A total of 2560 individuals were screened; the mean age was 59 +/- 13 years. IOP > or = 21 mmHg was found in 4.8%, and 12.3% had cupping > or = 0.5. IOP > or = 21 mmHg together with cupping > or = 0.5 were present in 1.4% and this rate increased with age: 3.7% of cases in the age group > or = 70 years compared to 1% and 0.6% in the age groups 50-69 and < 50 years, respectively (P < 0.001). Likewise, the prevalence of cupping > or = 0.7 and of IOP > or = 24 mmHg increased significantly with age. The prevalence of IOP > or = 21 mmHg increased in cases with a family history of glaucoma in first-degree relatives (10.5% compared to 3.9%, P < 0.001). The prevalence of IOP > or = 21 mmHg was also increased in diabetic patients (8.3% vs. 4.3% in non-diabetics, P = 0.002). Further ophthalmologic evaluation was recommended to 13% of the screened individuals.

CONCLUSIONS

Outreach screening for glaucoma is a valuable tool for detecting glaucoma, pre-perimetric glaucoma, or ocular hypertension in a meaningful number of previously undiagnosed cases. Yet, cost-effectiveness issues should also be considered. The yield of such screening increases with age and seems to be most advantageous in cases with diabetes or a family history of glaucoma.

What sources do adolescents turn to for information about their health concerns?

BACKGROUND

Adolescents are developmentally normatively interested in information about sexuality and other health-related issues. In the absence of available health programming, identifying the sources of information that youth are currently accessing will help adolescent health researchers understand where youth 'are,' thereby informing where and how future interventions can be targeted. This is particularly important in resource-limited settings, such as Iran, where funding for public health programming is scant. This study aimed to examine primary and preferred sources of adolescents' health information queries and identify health topics in which they are most interested.

METHODS

In 2011, a random sample of 915 adolescents, aged 14-18 years, completed anonymous, self-administered questionnaires.

RESULTS

Mothers (51.11%) and same-sex friends (40.11%) were both the primary as well as the preferred source of health information for adolescents. More than one in three adolescents identified media information sources, including books (39.6%) and the Internet (37.9%), as their primary and preferred sources. The most common topic adolescents sought information about was sexuality issues. Younger adolescents preferred receiving information from parents, whereas older adolescents preferred friends as sources for information [X2=9.3, p=0.009]. No age differences were noted in using media sources (p>0.05).

CONCLUSIONS

These findings indicate future interventions should integrate some if not all of these sources [both people (mothers, same-sex friends) and media (books, the Internet)] to deliver evidenced-based health information.

Presenting efficacy information in direct-to-consumer prescription drug advertisements

OBJECTIVE

We evaluated whether presenting prescription drug efficacy information in direct-to-consumer (DTC) advertising helps individuals accurately report a drug's benefits and, if so, which numerical format is most helpful.

METHODS

We conducted a randomized, controlled study of individuals diagnosed with high cholesterol (n=2807) who viewed fictitious prescription drug print or television ads containing either no drug efficacy information or efficacy information in one of five numerical formats. We measured drug efficacy recall, drug perceptions and attitudes, behavioral intentions, and drug risk recall.

RESULTS

Individuals who viewed absolute frequency and/or percentage information more accurately reported drug efficacy than participants who viewed no efficacy information. Participants who viewed relative frequency information generally reported drug efficacy less accurately than participants who viewed other numerical formats.

CONCLUSION

Adding efficacy information to DTC ads-both in print and on television-may potentially increase an individual's knowledge of a drug's efficacy, which may improve patient-provider communication and promote more informed decisions.

PRACTICE IMPLICATIONS

Providing quantitative efficacy information in a combination of formats (e.g., absolute frequency and percent) may help patients remember information and make decisions about prescription drugs.

An evaluation of diet and physical activity messaging in African American churches

The use of faith-based organizations as sites to deliver diet and physical activity interventions is increasing. Methods to assess the messaging environment within churches are limited. Our research aimed to develop and test an objective assessment methodology to characterize health messages, particularly those related to diet and physical activity, within a sample of African American churches. Written messages (bulletins, brochures, magazines) were systematically collected over 1 year and analyzed with a coding scheme that had high interrater reliability (average κ = .77). Within all health messages (n = 1109), diet and physical activity messages were prevalent (47% and 32%, respectively). Consistent with prior qualitative research, messages related to meals and to providing food to people in need were frequently found (54% and 25% of diet messages, respectively). Contrary to past research, sports and physical activity as praise (e.g., praise dancing) were the most prevalent physical activity messages (36% and 31% of physical activity messages, respectively). Bulletins, flyers, and brochures were the media in which diet and physical activity messages were most frequently found (14%, 33%, and 24%, respectively), and the church was the most frequent source (41%). Only diet and physical activity messages focused on disease prevention were more likely to originate from national health organizations than from the church (26% vs. 16%). Churches varied in the topics, media types, and sources of health messages, an important factor to consider when planning and implementing health promotion research. Future research should determine whether the enhancement of church messaging environments can produce behavioral change.

Accessing sexual health information online: use, motivations and consequences for youth with different sexual orientations

We examine reasons why youth of different sexual orientations look for sexual health information online, and what, if anything, they do with it. The Teen Health and Technology study involved online surveys of 5542 Internet users, ages 13 through 18 in the United States. Searching for sexual health information online was reported frequently and varied significantly by sexual orientation: from 19% of heterosexual youth to 78% of gay/lesbian/queer youth. The most common reasons youth look for sexual health information is for privacy and curiosity. Sexual minority youth are more likely than heterosexual youth to report that they looked for information online because they did not have anyone to ask. Once youth have the information, no differences by sexual orientation were noted as to what they did with it. Instead, seeking out the information for privacy-related reasons and having no one to ask were related to taking some action on the information received. Findings indicate that online information is most valuable to those youth who lack alternatives. Care needs to be taken to help ensure that the sexual health information online is accurate and includes topics specific to sexual minority youth.

A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol

INTRODUCTION

Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk. In this project, we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice. Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Islander and non-indigenous adults, recruited through primary care, at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care.

METHODS AND ANALYSIS

Randomised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk. The trial will be augmented by formal economic and process evaluations to assess acceptability, equity and cost-effectiveness of the intervention. The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management. The programme is electronically integrated with the primary care provider's software and will include interactive smart phone and Internet platforms. The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline-recommended blood pressure (BP) and cholesterol targets. Secondary outcomes include change in mean BP and fasting cholesterol levels, proportion meeting BP and cholesterol targets separately, self-efficacy, health literacy, self-reported point prevalence abstinence in smoking, body mass index and waist circumference, self-reported physical activity and self-reported medication adherence.

ETHICS AND DISSEMINATION

Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences

CLINICAL TRIALS REGISTRATION NUMBER

ACTRN12613000715774.

Vision and challenges of a cartographic representation of expert medical centres for rare diseases

In Germany, many highly specialized facilities for the diagnosis and treatment of rare diseases exist. However it is quite difficult for patients to find the required specialists because of the fact that information on the internet is scattered and of variable quality. The German Federal Ministry of Health initiated several activities to address this issue. This paper describes the project se-atlas which aims at presenting the medical care options for people with rare diseases on an interactive map and in a list format. Potential users of this resource will be patients and their relatives, doctors, non-medical personnel and the general public. Most information derived from the data sets is already listed in ORPHANET. The project's primary goals are to steadily increase the data set and to ensure its quality. This paper presents the goals and measures taken in this project. It gives an overview of the challenges implementing such a new service and the visions behind.

A critical review of consumer health devices for stress self-management

A number of consumer health devices have been advertised as effective means to manage individual stress. However, objective evidence of their efficacy is not readily available. We present a critical analysis of evidence related to efficacy of stress management devices based on comprehensive literature review and information provided by the vendors. The analysis was conducted along four dimensions: metrics, theoretical frameworks, evaluation, and FDA clearance. The review resulted in identification of critical issues including limited information on operational characteristics, controversial theoretical underpinnings, and lack of systematic evaluation. Efficacy of these consumer devices has yet to be established.

Increasing information accessibility for patients in obstetrics-gynecology domain

It is important for the patient to have access to personal medical information in order to manage information for increased quality of medical care and life. The paper presents a module added to an Obstetrics-Gynaecology Department information system (OGD IS) supporting patient empowerment. The patient is accessing the system easily using laptops or mobile devices. The application accessed by the patient is web-based, implemented in Visual Studio. NET, using ASP.NET pages and C# language, and the application is published in the Windows Azure cloud. The solution is user friendly using familiar devices and is ubiquitous using the cloud solution. A module for translating medical terms in colloquial ones is integrated in the system. For certain situations the patient will get information related to life style influencing health status as how and what to eat or what type of exercise it is recommended.

A "Smart" m-health Application for Travelers: The Public's Opinion

This paper describes an empirical study which evaluates the Greek population perceptions on a "Smart" m-health application for Travelers, their attitude towards use, and their intention to use it. Based on TAM, IDT and other research works, a theoretical model was empirically constructed and then validated. The sample was 313 individuals, who most of them travel frequently and using Smartphone. Data analysis was performed using partial least squares path modeling. Results highlight the very strong significant effect of perceived usefulness, relative advantage and compatibility as well as, the significant effect of perceived ease of use to attitude towards using a "Smart" m-health application for Travelers. The study findings reveal also a strong significant effect of attitude towards use to behavioral intention to use showing the need for such m-health applications.

Fall-related Information seeking behavior of seniors on the web

Falls form a major health problem for older persons, and increasingly strain the healthcare system. The Internet is a potentially useful platform for empowering seniors. The aim of this study was therefore to investigate the information-seeking behavior about falls among elderly Internet users. A web-based survey was distributed among all members of an association of elderly people (&gt; 60 years old). Fallers and non-fallers, seniors with and without experience with information seeking and the willingness of elderly for undertaking self-assessment tests on the Internet versus solely receiving information about falls were compared. In general, there was much stated interest in receiving information about conditions and medications that increase the risk of falls and information on safety in the house. Around half of the 62 respondents did not feel that they are well-informed about falls. Searching for fall-related information was not significantly associated with having falls in the previous 12 months (OR 2.11, CI: 0.55-8.16). The majority expressed higher interest in receiving fall-related information than undertaking a self-assessment test. However, only a small proportion had searched for this information already.

Providing multilingual access to health-related content

Finding health-related content is not an easy task. People have to know what to search for, which medical terms to use, and where to find accurate information. This task becomes even harder when people such as immigrants wish to find information in their country of residence and do not speak the national language very well. In this paper, we present a new health information system that allows users to search for health information using natural language queries composed of multiple languages. We present the technical details of the system and outline the results of a preliminary user study to demonstrate the usability of the system.

[Television and Internet as sources of women knowledge of tobacco smoking, alcohol consumption and energy drinks impact on health]

INTRODUCTION

Accessibility of the Internet allows obtaining information on different areas of life, including the impact of smoking, alcohol consumption and energy drinks on health. Environmental exposure to tobacco smoke and active smoking are a serious risk for women's health, especially for women in reproductive age and children at any time in their lives. Alcohol is a risk factor for the development of general diseases, and consumed by pregnant women has a toxic effect on the body of women and a child in the prenatal period. Due to the increased consumption of energy drinks containing among others nervous system stimulants and carbohydrates, their consumption should be a conscious choice of the consumers. Knowledge of the health risks resulting from the lifestyle can be a decisive factor for the implementation of health behaviour. The aim of the study was to determine the sources from which men and women acquire information concerning the effects of cigarette smoking, alcohol consumption and energy drinks on health. The respondents interest in the above mentioned subjects was also evaluated.

MATERIAL AND METHODS

The survey study was carried out in a group of 160 persons (114 women and 46 men), aged 19-60 years, randomly selected from the patients presenting to the Department of Conservative Dentistry with Endodontics of the Medical University of Lublin. An author's questionnaire was prepared for this research. The data were analyzed statistically with the use of Pearson's X2 test. Statistically significant test values were those with p<0.05.

RESULTS

The internet was a source of information about the impact of smoking cigarettes on health for 52.63% women and 56.52% men, about the alcohol effect on health for 57.02% women and 45.65% men, while about energy drinks for 61.40 % of women and 47.83% men. Differences between sex of the respondents and indicated source of information were not statistically significant. Obtaining information from television programmes on the impact of smoking on health reported 70.18% of women and 63.04% of men, about alcohol consumption - 66.67% women and 58.70% men respectively. There was no statistically significant correlation between sex of the respondents and obtaining information concerning cigarette smoking and alcohol consumption. Women showed significantly more frequently TV programmes as a source of information about energy drinks (61.40%) compared to males (43.48%) (X2 = 4.28, p <0.05). Interest in the subject of the impact of smoking, alcohol consumption and energy drinks on health was not dependent on sex of the respondents.

CONCLUSIONS

Most women acquire knowledge about the effects of cigarette smoking, alcohol consumption and energy drinks on health from TV programmes, although the internet is an increasingly important source of information in this respect.

An open-source, mobile-friendly search engine for public medical knowledge

The World Wide Web has become an important source of information for medical practitioners. To complement the capabilities of currently available web search engines we developed FindMeEvidence, an open-source, mobile-friendly medical search engine. In a preliminary evaluation, the quality of results from FindMeEvidence proved to be competitive with those from TRIP Database, an established, closed-source search engine for evidence-based medicine.

Expert insights on the design and implementation of interactive patient websites for people with chronic pain

Chronic pain is a burden on an individual, social and economic level. Growing published research outlines various innovative online solutions aimed at addressing this issue, including interactive patient websites. This paper presents expert insights regarding an existing interactive chronic pain website, 'ONESELF', operating in Switzerland. Based on their experience, members of the research team involved in the 'ONESELF' project were asked to reflect about what they understood to be key considerations salient to designing and implementing such interventions. Thematic analysis uncovered five main themes that these experts used to interpret what worked, when and why in 'ONESELF' design and implementation: health literacy, Internet literacy, access to healthcare, adherence and attrition, and health outcomes. These findings may serves as a base to assist Australian health researchers and practitioners working toward developing effective interactive patient websites for people with chronic pain.