Readability of Consumer Health Information on the Internet: A Comparison of U.S. Government–Funded and Commercially Funded Websites

The Internet has become an extremely prevalent means of communicating health information to consumers. Guidelines for selecting reliable health information websites give preference to U.S. government sites over commercially funded sites. However, these websites are not useful to consumers unless they are able to read and understand them. The authors’ objective was to compare the readability of Internet health information intended for consumers found on U.S. government–funded websites versus that found on commercially funded websites. Consumer health websites were identified through a systematic Internet search. Webpages for 10 common health topics were extracted from each website. Readability of webpages was determined by 3 validated measures: Flesch Reading Ease, Flesch-Kincaid Reading Level, and SMOG Formula. Mean readability of government-funded and commercially funded websites was compared using the Mann-Whitney U test. Commercially funded websites were significantly more difficult to read as measured by Flesch Reading Ease (49.7 vs. 55.6 for government-funded sites, p = .002) and Flesch-Kincaid Reading Level (10.1 vs. 9.3, p = .012). There was no significant difference according to SMOG Formula (12.8 vs. 13.2, p = .150). The overall readability of Internet health information intended for consumers was poor. Efforts should be made to ensure that health information communicated via the Internet is easy for consumers to read and understand.     

An Exploratory Study of Older Adults' Comprehension of Printed Cancer Information: Is Readability a Key Factor?

Printed cancer information often is written at or beyond high school reading levels, despite lower average literacy abilities of the public. The objectives of this exploratory study were twofold: (1) to evaluate older adults' comprehension of breast (BC), prostate (PC), and colorectal (CC) cancer information; and (2) to determine if comprehension of BC, PC, and CC information varies according to text readability. Comprehension of printed cancer resources was evaluated with 44 community-dwelling older adults using the Cloze procedure and recall questions. Participants' comprehension scores were compared with Simple Measure of Gobbledegook (SMOG) readability scores (<grade 13 vs. grade 13+). Overall, older adults had satisfactory comprehension of cancer information as measured by Cloze (.86 ± .01) and recall (.71 ± .02). For CC information written at grade 13, however, a significant negative correlation between readability and Cloze comprehension was found (r _s  = ?.44, SE = .17, p = .019), indicating poorer participant comprehension at higher readability levels. Comprehension of BC or PC information did not vary by readability level. Though readability plays a role in older adults' understanding of cancer information, cancer type and content are also important factors that influence comprehension. Use of plain language is recommended for CC resources.     

Housing and health—Current issues and implications for research and programs

This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs. The views expressed in this article are those of the authors and do not necessarily reflect official policies of the US Centers for Disease Control and Prevention or the US Department of Housing and Urban Development.     

and biology

有一个富翁,带了许多金银财宝,到很远的地方去寻找快乐。但他走过了千山万水,到过了无数的地方,却始终没有找到快乐。一天,正当他沮丧地坐在山道旁休息时,见一位农夫背着一大捆柴草快乐地唱着山歌从山上下来,富翁急忙上前向农夫问道:“我是个令人羡慕的富翁,为什么却总是找不到     

Brominated Indoles and Phenols in Marine Sediment and Water Extracts from the North and Baltic Seas–Concentrations and Effects

This work presents results from analytical as well as ecotoxicologic investigations of sediment and water samples from the North and Baltic Seas. A bioassay-directed procedure was used to investigate cause–effect relationships between observed effects in acute laboratory bioassays (luminescent bacteria assay with Vibrio fischeri and embryo test with Danio rerio) and analyte concentrations in extracted samples. Brominated phenols and indoles—including 4-bromophenol; 2,4-dibromophenol; 4- and 6-bromoindole; 3,4-, 4,6-, and 3,6-dibromoindole; and tribrominated compounds—were identified in partly remarkable concentrations (up to 40,000 ng g⁻¹ total organic carbon TOC for 4-bromophenol) in North Sea sediment samples and water samples (913 ng L⁻¹ 3,6-dibromoindole) from the German Bight. The toxicity of some of the identified brominated substances was low, with median effect concentration levels (EC₅₀) ranging from 0.08 to 21.7 mg/L for V. fischeri and 4.3 to 46.3 mg/L for D. rerio. Comparison of the concentrations of analytes with ECs showed a toxicity contribution of brominated phenols and indoles to overall toxicity of the fraction. In the case of one water sample from the German Bight, brominated phenols and indoles accounted for the observed toxicity. Brominated phenols and indoles, which are assumed to be of biogenic origin, have rarely been discussed so far in the context of ecotoxicologic effects in marine ecosystems.     

Comparing objective and subjective status: Gender and space (and environmental justice?)

The environmental justice literature has described differential health effects of environmental toxins and pollutants on people of different socio-economic status (SES) that may not always reflect differing levels of exposure. We offer four questions or contentions that together may contribute to understanding this conundrum and then present an empirical exploration of one of these questions: Does the relationship between SES and self-perceived status vary in space? Utilizing data from an original questionnaire survey of randomly selected adults conducted in twenty-five communities in British Columbia, Canada, a supplementary data set containing demographic and socio-economic characteristics of the communities themselves, and multilevel modelling techniques, this article describes relationships between objective and subjective measures of social status, by gender and in space. Our analysis contributes to the development of innovative environmental justice models by bringing some spatial sensitivity to interrelationships among these aspects of status.     

Burns and Nutrition

In adults, burns of 40％ total body surface areas(TBSA)or greater were virtually unsurvivable but a few decades ago.Now, more than half of the adult patients with a 70％ TBSA burn survive. In children, the size of the survivable injury has increased so much that it is now possible to save a child with burns exceeding 95％ TBSA full thickness.The decrease in mortality and morbidity related to major thermal burn injuries noted in the past decade is primarily due to improvements in four major areas.     

Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships?

PurposeAdolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors.MethodsBy following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender.ResultsMen and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners.ConclusionsAdolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.     

δ-Carbolines and their ring-opened analogs: synthesis and evaluation against fungal and bacterial opportunistic pathogens

Previous studies have indicated that the δ-carboline (2) ring system derived from the natural product cryptolepine (1) may represent a pharmacophore for anti-infective activity. This paper describes the design and synthesis of a small library of substituted δ-carbolines and the evaluation of the anti-fungal and anti-bacterial activities. An evaluation of the anti-bacterial activity of a previously reported library of ring-opened analogs was also conducted to provide an opportunity to test the hypothesis that both group of compounds may have the same biological target. Results indicate that against a selected group of fungal pathogens, substituted δ-carbolinium analogs displayed higher potency and several fold lower cytotoxicity than cryptolepine the parent natural product. Both the δ-carbolinium compounds and their ring-opened analogs, exhibited equally high anti-bacterial activity against the selected pathogens and especially against the gram positive bacteria evaluated.     

Interplay Between Self-Efficacy and Perceived Availability at Home and in the School Neighborhood on Adolescents’ Fruit and Vegetable Intake and Energy-Dense,Low-Nutrient Food and Sugary Drink Consumption

Objective

The current study aimed to examine the interplay between self-efficacy and perceived availabilities of fruits and vegetables (F&V) and energy-dense, low-nutrient foods and sugary drinks (EDLNF&SD) at home and in the school neighborhoods on adolescents’ eating behaviors.

The doctor and the literary text — potentials and pitfalls

Expectations are growing that literature may contribute to clinical skills. Narrative medicine is a quickly expanding area of research. However, many people remain sceptical to the idea of literature having a capacity to “save the life of medicine”. It is therefore urgent to scrutinize both the arguments in favour of and those against the potential of literature for increasing medical understanding. This article attempts to do this. It does in fact support the assertion that literature is important, but it stresses precisely its character of potential. There is no simple connection between acquaintance with literary texts and understanding of the different aspects of medical work. Much more need to be known about the conditions which allow the experiences residing in texts to be transformed into lived personal knowledge. This revised version was published online in July 2006 with corrections to the Cover Date.     

Health technology assessment use and dissemination by patient and consumer groups: why and how?

OBJECTIVES: Although increasing effort is being devoted to developing strategies to increase knowledge transfer and the uptake of health technology assessment (HTA) by various stakeholders, very little is known about the utilization and dissemination of HTA findings by patient and consumer organizations. The goal of this study is to understand how and why patient and consumer organizations use HTA findings within their organizations, and what factors influence how and when they communicate their findings to members or other organizations. METHODS: We examined the use and dissemination of four controversial HTA reports by sixteen patient and consumer organizations in Ontario and Quebec. We gathered data from semistructured interviews conducted between December 2006 and April 2007. RESULTS: Although HTA findings are often used by the patient and consumer organizations, key differences were observed in exactly how the four HTA reports were used. Three types of use (instrumental, conceptual, and symbolic) are reported and illustrated. We highlight the importance of the organization's mission and knowledge base in explaining the types of use observed. CONCLUSIONS: We contend that the use and dissemination of HTA reports by specific groups could help in widening the debate around controversial health technologies. The implications and opportunities for HTA agencies relate to the following: (i) identification of "lay" organizations that could help in disseminating results; (ii) acknowledgement of a "lay" audience for HTA findings; (iii) strategic inclusion of advocacy groups during the assessment process for highly controversial technologies; and (iv) contribution of these organizations to the push efforts of knowledge transfer.     

Insurance expansions and hospital utilization: Relabeling and reabling?

The 2010 Patient Protection & Affordable Care Act (ACA) significantly expanded access to private and public health insurance for low-income individuals through income-based subsidies and income-based eligibility expansions, respectively. In this paper, we use the universe of hospitals from 2009 to 2015 to characterize how these expansions affected the financing of hospital visits, along with price, utilization, and potential spillovers in the quality of care. The insurance coverage expansions generated a shift in the composition of payers and a modest increase in the utilization of hospital outpatient services. While concerns have been raised that these shifts in utilization could cause negative spillovers to the already insured population (e.g., Medicare enrollees), we find no significant change in the quality of care experienced by those already insured. The primary result of both federally funded insurance expansions was to increase the profits generated and prices charged by the hospitals providing such services.     

Gender and Binegativity: Men’s and Women’s Attitudes Toward Male and Female Bisexuals

This study assessed the influence of gender on attitudes about bisexuals. A total of 164 heterosexual female and 89 heterosexual male undergraduates completed the Biphobia Scale (Mulick & Wright, 2002), rewritten to refer to bisexual men and bisexual women and thus re-named the Gender-Specific Binegativity Scale. A mixed-design ANOVA revealed an interaction between rater’s sex and target’s sex: women equally accepted bisexual men and bisexual women, but men were less accepting of bisexual men than bisexual women. A mediation analysis indicated the relationship between rater’s sex and greater acceptance of bisexual women was partially explained by eroticization of female same-sex sexuality. Finally, participants also responded to two open-ended items, which provided additional information about the content of binegativity: participants described male bisexuals negatively, as gender-nonconforming, and labeled them “really gay,” whereas participants described female bisexuals positively, as sexy, and labeled them “really heterosexual.” These findings suggest multiple underlying beliefs about bisexuals that contribute to binegativity, particularly against bisexual men. Results also confirm the importance of considering gender (of both the target and the rater) when assessing sexual prejudice.