Online health information-seeking behaviours for low back pain in the United Kingdom: analysis of data from Google trends and the Global Burden of Disease Study, 2004-2019.

BACKGROUND: Low back pain (LBP) is a leading cause of global disability. Timely health-seeking is crucial for early diagnosis and management of pathologies. Despite increases in internet usage, there is sparse literature regarding online health information-seeking behaviours (OHISBs) for LBP and how they correlate with the LBP disease burden in the UK. METHODS: To examine OHISB trends, we conducted Prais-Winsten analyses on monthly search volume data from Google Trends in the UK between 1 January 2004 and 1 December 2019. Cross-correlation analyses assessed the relationship between annual LBP search volume and LBP morbidity and mortality data from the Global Burden of Disease study (2004-2019). RESULTS: From 2004 to 2019, the trend in LBP search volume was curvilinear (ß=1.27, t=5.00, p<0.001), with a slope change around the end of 2006. There was a negative linear trend (ß=-0.25, t35=-1.52, p<0.14) from 2004 to 2006 and a positive linear trend (ß=0.67, t108=9.17, p<0.001) from 2007 to 2019. Cross-correlations revealed positive associations between search volume and disease burden indicators for LBP such as prevalence and incidence at lags 4 and 5. CONCLUSIONS: A rising trend in OHISBs for LBP was noted between 2004 and 2019. This trend positively correlates with incidence, prevalence and burden measures. These findings emphasise the importance of high-quality online resources to increase awareness around LBP, facilitating early diagnosis and management.

Impact of Sickle Cell Awareness Day on online health information seeking in Africa using Google Trends.

The United Nations Council Assembly recognized sickle cell disease (SCD) as a global public health problem due to its increasing burden, particularly in sub-Saharan Africa. To raise awareness, a resolution was adopted, designating June 19th as SCD awareness day. However, the impact of this awareness day on online health information seeking behaviour (OHISB) in African countries is not well understood, especially in Nigeria, Ghana and Uganda where SCD prevalence is high. To assess the impact, the study used Google Trends data as a measure of OHISB for SCD. The analysis covered the 60 days before the awareness day, the awareness day itself, and the 60 days afterward. Time series analysis was conducted using joinpoint regression to identify significant changes in OHISB trends. The results indicated that the impact of the Sickle Cell Awareness Day on OHISB varied across African countries and did not consistently inspire significant changes in information seeking behaviour. This suggests the need for more targeted awareness campaigns to improve public knowledge of SCD in Africa. It also highlights the importance of revising the current awareness day or creating alternative health awareness initiatives that adopt a long-term approach and address the specific health needs of the African population. Furthermore, due to limitations in using Google Trends data in some African countries with insufficient data, future research should explore other sources of internet data or conduct surveys to gain a more comprehensive understanding of the impact of the Sickle Cell Awareness Day on OHISB in Africa.

Knowledge, attitudes, and practice of female genital mutilation and cutting: an observational cross-sectional study in English primary care (FGM/C Study).

BACKGROUND: Female genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practised. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C. AIM: To explore the knowledge, attitudes, and practice of primary care GPs and practice nurses (PNs) regarding FGM/C. DESIGN & SETTING: An observational cross-sectional study with GPs and PNs working in primary care in the West Midlands, UK. METHOD: An online survey was circulated to GPs and PNs between September 2019 and December 2019. RESULTS: A total of 137 survey responses were received. Study participants were predominantly female (81.8%) and GPs (59.9%), with a mean age of 47.3 years (standard deviation [SD] 9.1). The survey found 19.7% of responders reported seeing >1 patient with FGM/C in the past 12 months. It also found 91.3% of responders had received some form of FGM/C training; however, the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C. CONCLUSION: The results have suggested varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that patients with FGM/C typically present in primary care, it is important that clinicians can provide appropriate support underpinned by up-to-date training.

Examining the Trends in Online Health Information-Seeking Behavior About Chronic Obstructive Pulmonary Disease in Singapore: Analysis of Data From Google Trends and the Global Burden of Disease Study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, and timely health care seeking is imperative for its prevention, early detection, and management. While online health information-seeking behavior (OHISB) is increasingly popular due to widespread internet connectivity, little is known about how OHISB for COPD has changed in comparison with the COPD disease burden, particularly at a country-specific level. OBJECTIVE: This study aimed to examine the trends in OHISB for COPD and how that compared with the estimates of COPD disease burden in Singapore, a highly wired country with a steadily increasing COPD disease burden. METHODS: To examine the trends in OHISB for COPD, we performed Prais-Winsten regression analyses on monthly search volume data for COPD from January 2004 to June 2020 downloaded from Google Trends. We then conducted cross-correlational analyses to examine the relationship between annualized search volume on COPD topics and estimates of COPD morbidity and mortality reported in the Global Burden of Disease study from 2004 to 2017. RESULTS: From 2004 to 2020, the trend in COPD search volume was curvilinear (ß=1.69, t194=6.64, P<.001), with a slope change around the end of 2006. There was a negative linear trend (ß=-0.53, t33=-3.57, P=.001) from 2004 to 2006 and a positive linear trend (ß=0.51, t159=7.43, P<.001) from 2007 to 2020. Cross-correlation analyses revealed positive associations between COPD search volume and COPD disease burden indicators: positive correlations between search volume and prevalence, incidence, years living with disability (YLD) at lag 0, and positive correlations between search volume and prevalence, YLD at lag 1. CONCLUSIONS: Google search volume on COPD increased from 2007 to 2020; this trend correlated with the upward trajectory of several COPD morbidity estimates, suggesting increasing engagement in OHISB for COPD in Singapore. These findings underscore the importance of making high-quality, web-based information accessible to the public, particularly COPD patients and their carers.

Using Google Trends to assess the impact of Global Public Health Days on online health information-seeking behaviour in Arabian Peninsula.

BACKGROUND: Global Public Health Days (GPHD) are public health interventions which serve to improve public awareness of specific health conditions. Google Trends is a publicly available tool that allows the user to view the popularity of a searched keyword during a specified time period and across a predetermined region. Our objective was to use Google Trends to assess the impact of four GPHD (World Heart Day, World Mental Health Day, World Diabetes Day and World Hypertension Day) on online health information-seeking behaviour (OHISB), 4 weeks before and a week after the GPHD, across six countries of the Arabian Peninsula (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates). METHODS: Relative Search Volume (RSV) was extracted for the aforementioned countries from 28 days before the GPHD and 7 days afterwards. Statistical analysis, undertaken using joinpoint regression software, showed that GPHD have significant changes for Saudi Arabia (Diabetes, Mental Health and Heart day) and UAE (Mental Health day) but were short-lived with a fall in RSV of up to 80% after peak interest. CONCLUSION: GPHD appears to be effective in some countries while further research is needed to investigate the reason of its limitations.

Playing in the UEFA Europa League Does Not Adversely Affect English Premier League or La Liga Performance.

PURPOSE: This article presents data challenging the widely held but untested view that concurrently playing mid-week Union of European Football Associations (UEFA) Europa League matches adversely affects domestic league performance. METHOD: Over 16 seasons we compared next-season domestic league performance of the two highest finishing UEFA Europa League qualifying clubs with the two highest finishing non-qualifiers in England and Spain. RESULTS: Clubs concurrently playing UEFA Europa League football showed significantly superior domestic league performance including wins, losses, goals, goal difference and points tally. The number of European matches played was not related to domestic league performance. CONCLUSIONS: The absence of prior rigorous analysis including appropriate comparison data has led to the proliferation of a widespread confirmatory bias, defined as the tendency to seek out evidence that backs one's hunches and to ignore evidence that contradicts them. Based on our evidence, football professionals, journalists, pundits, and fans should consider the UEFA Europa League competition more favorably.

Feasibility of a randomized single-blind crossover trial to assess the effects of the second-generation slow-release dopamine agonists pramipexole and ropinirole on cued recall memory in idiopathic mild or moderate Parkinson's disease without cognitive impairment.

BACKGROUND: The aim was to assess the feasibility of a single-centre, single-blind, randomized, crossover design to explore the effects of two slow-release dopamine agonists, ropinirole and pramipexole, on cued recall in Parkinson's disease. As the design required a switch from the prescribed agonist (pramipexole-to-ropinirole, or ropinirole-to-pramipexole), the primary objectives were to (a) examine the efficacy of processes and procedures used to manage symptoms during the washout period and (b) to use cued recall estimates to inform a power calculation for a definitive trial. Secondary objectives were to assess consent and missing data rates, acceptability of clinical support for the OFF sessions, experience of the OFF sessions and of agonist switching, barriers-to-participation for patients and informal caregivers. METHODS: Patients were randomized in a 1:1 ratio to two treatment arms and stabilized on each agonist for 6 weeks. The arms differed only in the sequence in which the agonists were administered. Cued recall was assessed ON medication and, following a washout period resulting in 93.75% agonist elimination, OFF medication. RESULTS: A total of 220 patients were screened: 145 were excluded and 75 invitations to participate were sent to eligible patients. Fifty-three patients declined, 22 consented and 16 completed the study. There were no serious adverse events, and rates of non-serious adverse events were equivalent between the agonists. Using the largest standard deviation (SD) of the ON-OFF difference cued recall score (inflated by ~25% to give a conservative estimate of the SD in a definitive trial) and assuming an effect of at least 10% of the observed range of OFF medication cued recall scores for either agonist to be clinically important, a main trial requires a sample size of just under 150 patients. The consent and missing data rates were 29 and 27% respectively. The washout period and the preparation for the OFF sessions were acceptable, and the sessions were manageable. The experience of switching was also manageable. Barriers to participation included concerns about disease stability, side effects, research process, carer workload and accessibility of the information sheet. CONCLUSIONS: This study presented challenges to recruitment both in design and execution, and while it was a major aim of the study to assess this, evaluation of these challenges provided the opportunity to explore how they could be overcome for future studies. TRIAL REGISTRATION: EudraCT 2012-000801-64.

Evidence of an amnesia-like cued-recall memory impairment in nondementing idiopathic Parkinson's disease.

Medicated, non-dementing mild-to-moderate Parkinson's disease (PD) patients usually show recall/recollection impairments but have only occasionally shown familiarity impairments. We aimed to assess two explanations of this pattern of impairment. Recollection typically improves when effortful planning of encoding and retrieval processing is engaged. This depends on prefrontally-dependent executive processes, which are often disrupted in PD. Relative to an unguided encoding and retrieval of words condition (C1), giving suitable guidance at encoding alone (C2) or at encoding and retrieval (C3) should, if executive processes are disrupted, improve PD recollection more than control recollection and perhaps raise it to normal levels. Familiarity, being a relatively automatic kind of memory, whether impaired or intact, should be unaffected by guidance. According to the second explanation, PD deficits are amnesia-like and caused by medial temporal lobe dysfunction and although poorer recollection, which is caused by hippocampal disruption, may be improved by guidance, it should not improve more than control recollection. Familiarity impairment will also occur if the perirhinal cortex is disrupted, but will be unimproved by guidance. Without guidance, recollection/recall was impaired in thirty PD patients relative to twenty-two healthy controls and remained relatively equally impaired when full guidance was provided (C1 vs C3), both groups improving to broadly the same extent. Although impaired, and markedly less so than recollection, familiarity was not improved by guidance in both groups. The patients showed elevated rates of subclinical depressive symptoms, which weakly correlated with recall/recollection in all three conditions. PD executive function was also deficient and correlated with unguided/C1 recollection only. Our results are consistent with a major cause of the patients' recall/recollection impairments being hippocampal disruption, probably exacerbated by subclinical depressive symptoms. However, the results do not exclude a lesser prefrontal cortex contribution because patient executive functions were impaired and correlated solely with unguided overall recollection.

Second-generation dopamine agonists and recollection impairments in Parkinson's disease.

A selective deficit in the recollection of episodic details is frequently reported in Parkinson's disease (PD). Previous explanations implicate dopamine dysregulation in prefrontal structures on which strategic memory processes rely. However, neuroimaging advancements suggest dopaminergic dysregulation of hippocampally dependent memory processes. Accordingly, dopamine agonists, which target D3 receptors in the hippocampus, may impair hippocampal functioning, causing a more pronounced recollection decline. Recognition memory (RM), familiarity, and recollection were examined in 21 patients with mild-to-moderate PD (Hoehn and Yahr mean: 2.67). Patients were subdivided into two subgroups according to dopamine agonist (pramipexole [PPX] or ropinirole [RPR]), and completed matched versions of an RM test in a medicated and unmedicated condition (termed ON and OFF, respectively). Ten demographically matched healthy volunteers (HVs) also completed both RM tasks in two separate sessions. The PD group (PPX and RPR subgroups combined) showed impairments in RM and recollection, but spared familiarity. When subdivided by dopamine agonist, the PPX subgroup's ON-medication recollection performance was significantly lower than that of both the HVs and RPR subgroup. There was no evidence of decline in OFF-medication recollection or familiarity in either the PPX or RPR subgroups. Recollection in both PD subgroups correlated positively with a composite measure of recall, but not prefrontally dependent measures of cognitive control. These findings suggest that mild-to-moderate PD patients may show relatively preserved recollection and familiarity, but that recollection is selectively disrupted by PPX, but not RPR and that this effect may depend on disrupted hippocampal function rather than impaired pre-frontally dependent executive functions.