The Effects of Patient Health Information Seeking in Online Health Communities on Patient Compliance in China: Social Perspective

BACKGROUND

Online health communities (OHCs) can alleviate the uneven distribution and use of medical resources and severe hospital congestion. Patients may seek health information through OHCs before or after visiting physicians, which may affect their cognition, health literacy, decision-making preferences, and health-related behaviors such as compliance. Social factors (social support, social presence, and responsiveness) are closely related to patients' health information-seeking behavior and are significantly considered in OHCs.

OBJECTIVE

This study aimed to explore the effects of patients' health information-seeking behavior (way and effectiveness) on compliance with physicians from the perspectives of patients' perceived social support, social presence, and responsiveness.

METHODS

This study established a research model from the perspective of social information processing by using the social exchange theory. An anonymous questionnaire survey was conducted with several Chinese OHCs to collect data. Partial least squares and structural equation modeling were adopted to test the hypotheses and develop the model.

RESULTS

This study received 403 responses, of which 332 were valid, giving a validity rate of 82.4% (332/403). Among the sample, 78.6% (261/332) of the individuals were aged between 20 and 40 years, 59.3% (197/332) were woman, 69.9% (232/332) lived in urban areas, and 50% (166/332) had at least a bachelor's degree. The reliability, convergent validity, and discriminant validity were acceptable. Both the way and effectiveness of patients seeking health information through OHCs have a positive impact on their compliance through the mediation of their perceived social support, social presence, and responsiveness from OHCs and other users, and patient compliance can be improved by guiding patient health information-seeking behavior in OHCs from a social perspective.

CONCLUSIONS

This study proposes a research model to corroborate that patient health information-seeking behavior (way and effectiveness) in OHCs exerts positive effects on patient compliance with the treatment and physician's advice and provides suggestions for patients, physicians, and OHC service providers in China to help guide patients' health-related behaviors through OHCs to improve patient compliance, patient satisfaction, treatment efficiency, and health outcomes.

Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study

Background

eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs.

Objective

This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory.

Methods

This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses.

Results

The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs.

Conclusions

Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.

Age-related changes in the biophysical and morphological characteristics of mouse cochlear outer hair cells

KEY POINTS

Age-related hearing loss (ARHL) is a very heterogeneous disease, resulting from cellular senescence, genetic predisposition and environmental factors (e.g. noise exposure). Currently, we know very little about age-related changes occurring in the auditory sensory cells, including those associated with the outer hair cells (OHCs). Using different mouse strains, we show that OHCs undergo several morphological and biophysical changes in the ageing cochlea. Ageing OHCs also exhibited the progressive loss of afferent and efferent synapses. We also provide evidence that the size of the mechanoelectrical transducer current is reduced in ageing OHCs, highlighting its possible contribution in cochlear ageing.

ABSTRACT

Outer hair cells (OHCs) are electromotile sensory receptors that provide sound amplification within the mammalian cochlea. Although OHCs appear susceptible to ageing, the progression of the pathophysiological changes in these cells is still poorly understood. By using mouse strains with a different progression of hearing loss (C57BL/6J, C57BL/6NTac, C57BL/6NTacCdh23+ , C3H/HeJ), we have identified morphological, physiological and molecular changes in ageing OHCs (9-12 kHz cochlear region). We show that by 6 months of age, OHCs from all strains underwent a reduction in surface area, which was not a sign of degeneration. Although the ageing OHCs retained a normal basolateral membrane protein profile, they showed a reduction in the size of the K+ current and non-linear capacitance, a readout of prestin-dependent electromotility. Despite these changes, OHCs have a normal Vm and retain the ability to amplify sound, as distortion product otoacoustic emission thresholds were not affected in aged, good-hearing mice (C3H/HeJ, C57BL/6NTacCdh23+ ). The loss of afferent synapses was present in all strains at 15 months. The number of efferent synapses per OHCs, defined as postsynaptic SK2 puncta, was reduced in aged OHCs of all strains apart from C3H mice. Several of the identified changes occurred in aged OHCs from all mouse strains, thus representing a general trait in the pathophysiological progression of age-related hearing loss, possibly aimed at preserving functionality. We have also shown that the mechanoelectrical transduction (MET) current from OHCs of mice harbouring the Cdh23ahl allele is reduced with age, highlighting the possibility that changes in the MET apparatus could play a role in cochlear ageing.

Exploring the Role of Online Health Community Information in Patients' Decisions to Switch from Online to Offline Medical Services

BACKGROUND

Online healthcare has become an important part of healthcare services. Patients can access unlimited information reflecting a doctor's service quality in online health communities (OHCs). This information can reduce information asymmetry between patients and doctors, and further promote patient decisions. In this study, we focus on the patient's decision to switch from a doctor's online medical service to the same doctor's offline service.

OBJECTIVES

We classify OHC information into objective information and subjective information. Following this, we investigate how these two types of information influence patient decisions to switch from a doctor's online to offline medical service, and explore the nature of interaction between the two types of influence.

METHODS

We collected data from a leading OHC in China and constructed a longitudinal dataset to examine our research questions. To control for doctor heterogeneity and common trends across time, we leveraged fixed effects at the doctor level and monthly fixed effects in our models, respectively.

RESULTS

Our findings demonstrate a strong relationship between OHC information and patient decisions to switch from a doctor's online to offline medical service. Patients are more likely to switch from online to offline medical services with doctors whose subjective and objective information on their homepages indicate a higher quality (β_Subjective = 0.001, p < 0.001; α_Objective = 0.019, p < 0.002). We also observe that patients prefer doctors who do not exhibit objective information that indicates low-quality service over those who show such information on their homepages, even though the chosen doctor provides a lower-quality service (α_{Low_Objective} = -0.032, p < 0.006). Further, we find that the influence of subjective information on patient decisions crowds out the influence of objective information.

CONCLUSION

This study investigates the role of subjective and objective information on patient decisions to switch from a doctor's online to offline medical service and the interaction effect between these two types of information. This study provides valuable theoretical and practical implications.

Effects of a complex contaminant mixture on thyroid hormones in breeding hooded seal mothers and their pups

There is a general lack of information on the possible effects of perfluoroalkyl substances (PFASs) on thyroid hormones (THs) in wildlife species. The effects of PFASs, which are known endocrine disruptors, on the TH homeostasis in hooded seals (Cystophora cristata) have yet to be investigated. Previously, correlations were found between plasma thyroid hormone (TH) concentrations in hooded seals, and organohalogen contaminants (OHCs) and hydroxyl (OH)-metabolites. Because animals are exposed to multiple contaminants simultaneously in nature, the effects of the complex contaminant mixtures that they accumulate should be assessed. Herein, we analyse relationships between plasma concentrations of multiple contaminants including protein-associated PFASs, hydroxylated metabolites of polychlorinated biphenyls (OH-PCBs) and lipid soluble OHCs and plasma concentrations of free and total THs, i.e. triiodothyronine (FT3, TT3) and thyroxine (FT4, TT4) in hooded seal mothers and their pups. The perfluoroalkyl carboxylates (PFCAs) were the most important predictors for FT3 concentrations and TT3:FT3 ratios in the mothers. The FT3 levels decreased with increasing PFCA levels, while the TT3:FT3 ratios increased. In the pups, hexachlorocyclohexanes (HCHs) were the most important predictors for TT3:FT3 ratios, increasing with increasing HCHs levels. Additionally, perfluoroalkyl sulfonates (PFSAs) and PFCAs were important predictors for FT4:FT3 ratios in hooded seal pups, and the ratio increased with increasing concentrations. The study suggests that PFASs contribute to thyroid disruption in hooded seals exposed to complex contaminant mixtures that include chlorinated and fluorinated organic compounds.

Hepatic phase I and II biotransformation responses and contaminant exposure in long-finned pilot whales from the Northeastern Atlantic

Faroe Island pilot whales have been documented to have high body burdens of organohalogen contaminants (OHCs), including polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), but low burdens of their respective hydroxylated metabolites (OH-PCBs and OH-PBDEs). The present study investigated the hepatic expression and/or catalytic activities of phase I and II biotransformation enzymes in relation to hepatic concentrations of target OHCs, including OH-PCBs and OH-PBDEs, in long-finned pilot whales (Globicephala melas) from the Northeastern Atlantic. CYP1A, 2B, 2E and 3A protein expressions were identified in juveniles and adult males, but not in adult females. Ethoxyresorufin-O-deethylase (EROD) activity was significantly lower in adult females than in juveniles and adult males. Using multivariate analyses to investigate relationships between biological responses and OHC concentrations, a positive relationship was identified between EROD and OHCs. The activity levels of phase II conjugating enzymes (uridine 5'-diphospho-glucuronosyltransferase [UDPGT], and glutathione S-transferase [GST]) were low. The analyses of mRNA expression did not show correlative relationships with OHC concentrations, but cyp1a and ahr transcripts were positively correlated with EROD activity. We suggest that the low concentrations of OH-PCBs and OH-PBDEs reported in pilot whales is probably due to the identified low phase I biotransformation activities in the species.

Spatial variation in the accumulation of POPs and mercury in bottlenose dolphins of the Lower Florida Keys and the coastal Everglades (South Florida)

The bottlenose dolphin (Tursiops truncatus) is an upper trophic level predator and the most common cetacean species found in nearshore waters of southern Florida, including the Lower Florida Keys (LFK) and the Florida Coastal Everglades (FCE). The objective of this study was to assess contamination levels of total mercury (T-Hg) in skin and persistent organic pollutants (PCBs, PBDEs, DDXs, HCHs, HCB, Σ PCDD/Fs and Σ DL-PCBs) in blubber samples of bottlenose dolphins from LFK (n = 27) and FCE (n = 24). PCBs were the major class of compounds found in bottlenose dolphin blubber and were higher in individuals from LFK (Σ 6 PCBs LFK males: 13,421 ± 7730 ng g^-1 lipids, Σ 6 PCBs LFK females: 9683 ± 19,007 ng g^-1 lipids) than from FCE (Σ 6 PCBs FCE males: 5638 ng g^-1 ± 3627 lipids, Σ 6 PCBs FCE females: 1427 ± 908 ng g^-1 lipids). These levels were lower than previously published data from the southeastern USA. The Σ DL-PCBs were the most prevalent pollutants of dioxin and dioxin like compounds (Σ DL-PCBs LFK: 739 ng g^-1 lipids, Σ DL-PCBs FCE: 183 ng g^-1 lipids) since PCDD/F concentrations were low for both locations (mean 0.1 ng g^-1 lipids for LFK and FCE dolphins). The toxicity equivalences of PCDD/Fs and DL-PCBs expressed as TEQ in LFK and FCE dolphins is mainly expressed by DL-PCBs (81% LFK - 65% FCE). T-Hg concentrations in skin were significantly higher in FCE (FCE median 9314 ng g^-1 dw) compared to LFK dolphins (LFK median 2941 ng g^-1 dw). These concentrations are the highest recorded in bottlenose dolphins in the southeastern USA, and may be explained, at least partially, by the biogeochemistry of the Everglades and mangrove sedimentary habitats that create favourable conditions for the retention of mercury and make it available at high concentrations for aquatic predators.

Organohalogenated contaminants in sediments and bivalves from the Northern Arabian Gulf

Several classes of Organohalogenated contaminants (OHCs) were determined in sediments and bivalves collected from Kuwait coast. The levels and profile of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) and polybrominated diphenyl ethers (PBDEs) were compared in both sediments and bivalves. PCB-153 and -138 were the major contributors towards total OHCs followed by DDT and its metabolites (DDTs). The higher contribution of DDTs (~40%) and BDE-47 (~15%) in bivalves as compared to that in associated sediments indicated high biota-sediment accumulation factors (BSAF). Higher BSAF (values for heavier PCBs, DDTs and PBDEs) also indicated their high accumulation potential from sediment into associated biota at most of the studied locations. Overall, OHCs in sediments and bivalves measured in current study were lower than those reported in the literature worldwide. Most of the sediment concentrations of OHCs (ng/g, dry weight) were in the range of permissible guideline values proposed by Canadian Sediment Quality Guidelines (CSQGs), with few exceptions for DDTs (5 ng/g) and PCBs (22.7 ng/g). Similarly, 10% of bivalve samples contained high levels (ng/g, lipid weight) of PCBs (300) and DDTs (150) and were above the set safety benchmarks. This study establishes baseline for future monitoring programs.

Expression of prestin in OHCs is reduced in Spag6 gene knockout mice

Sperm-associated antigen 6 (Spag6) gene, which encodes an axonemal protein (SPAG6), ubiquitously expresses in tissue and organs containing ciliated cells. The present work was to investigate whether SPAG6 expressed in cochlear hair cells and, if so, to explore the presumable correlations between prestin and SPAG6. The distribution of SPAG6 in organ of Corti and the morphological features of hair cells in basilar membrane were investigated by immunofluorescent staining. The amount of prestin in Spag6 mutant mice was measured by Western blotting and real-time PCR, respectively. Additionally, co-immunoprecipitation tests were performed to confirm the presumed interaction between prestin and SPAG6. We observed that SPAG6 expressed in the cuticular plate in outer hair cells (OHCs) and prestin in the lateral wall of OHCs that located along with SPAG6 at this site. In comparison to Spag6 +/+ mice, Spag6 -/- mice showed apparent morphological abnormity of OHCs and lower intensity of prestin fluorescence. The expression of prestin in Spag6 -/- mice reduced significantly at both protein and mRNA levels. Moreover, co-immunoprecipitation tests demonstrated the interaction between prestin and SPAG6. Taken together, these data indicate that SPAG6 is indispensible for the stability of OHCs by maintaining the normal expression of prestin, which implies that Spag6 gene is essential for mechanosensory function of OHCs.

Lead exposure results in hearing loss and disruption of the cochlear blood-labyrinth barrier and the protective role of iron supplement

This study was designed to investigate the impact of lead (Pb(2+)) on the auditory system and its molecular mechanisms. Pb(AC)2 was administrated to male SD rats aged 21-22 d for 8 weeks at a dose of 300ppm. Male guinea pigs were also administrated with 50mg/kg Pb(AC)2 two times a week for 8 weeks. The auditory nerve-brainstem evoked responses (ABR) was recorded and the morphological changes of the outer hair cells (OHCs) were observed with Phallodin-FITC staining. In addition, the integrity of the blood-labyrinth barrier was observed by TEM and the expression of tight junction proteins (TJPs) in the cochlear stria vascularis was determined by immunofluorescence. Our results showed that Pb(2+) exposure resulted in increased ABR threshold in both rats and guinea pigs. Abnormal shapes and loss of OHCs were found in the cochlear basilar membrane following the Pb(2+) exposure. TEM study showed that the tight junctions between the endothelial cells and the border cells were lost and disrupted. Down-regulation of the occludin, ZO-1 and claudin-5 in the stria vascularis suggested that the increased permeability of the blood-labyrinth barrier may attribute to the Pb(2+)-induced decrease of TJPs' expression. Additionally, Fe(2+) supplement partly reversed the Pb(2+)-induced hearing loss and down-regulation of TJPs. Taken together, these data indicate that the disruption of blood-labyrinth barrier by down-regulating the expression of TJPs plays a role in the Pb(2+)-induced hearing loss, and Fe(2+) supplement protects the auditory system against Pb(2+)-induced toxicity and may have significant clinical implications.

Gentamicin administration on the stapes footplate causes greater hearing loss and vestibulotoxicity than round window administration in guinea pigs

Clinically, gentamicin has been used extensively to treat the debilitating symptoms of Mèniére's disease and is well known for its vestibulotoxic properties. Until recently, it was widely accepted that the round window membrane (RWM) was the primary entry route into the inner ear following intratympanic drug administration. In the current study, gentamicin was delivered to either the RWM or the stapes footplate of guinea pigs (GPs) to assess the associated hearing loss and histopathology associated with each procedure. Vestibulotoxicity of the utricular macula, saccular macula, and crista ampullaris in the posterior semicircular canal were assessed quantitatively with density counts of hair cells, supporting cells, and stereocilia in histological sections. Cochleotoxicity was assessed quantitatively by changes in threshold of auditory brainstem responses (ABR), along with hair cell and spiral ganglion cell counts in the basal and second turns of the cochlea. Animals receiving gentamicin applied to the stapes footplate exhibited markedly higher levels of hearing loss between 8 and 32 kHz, a greater reduction of outer hair cells in the basal turn of the cochlea and fewer normal type I cells in the utricle in the vestibule than those receiving gentamicin on the RWM or saline controls. This suggests that gentamicin more readily enters the ear when applied to the stapes footplate compared with RWM application. These data provide a potential explanation for why gentamicin preferentially ablates vestibular function while preserving hearing following transtympanic administration in humans.