Evaluating the Quality, Readability, and Activity of Online Information on Brain Arteriovenous Malformations.

Introduction Brain arteriovenous malformations (AVMs) are vascular deformities created by improper connections between arteries and veins, most commonly in the brain and spinal cord. The management is complex and patient-dependent; further understanding of patient education activities is imperative. Internet access has become more ubiquitous, allowing patients to utilize a large database of medical information online. Using Google Trends (GT) (Google LLC, Mountain View, CA, USA), one can see the public interest in a particular topic over time. Further, when presented with numerous search results, patients may not be able to identify the highest-yielding resources, making objective measures of information quality and readability imperative. Methods A GT analysis was conducted for "hereditary hemorrhagic telangiectasia," "cerebral aneurysm," and "arteriovenous malformation". These relative search volumes (RSV) were compared with the 2017 to 2019 annual USA AVM diagnosis quantity for correlation. These RSVs were also compared with the 2017 to 2019 annual USA deaths due to cerebral hemorrhagic conditions. One search was conducted for "brain arteriovenous malformation". Since most users looking for health information online use only the first page of sources, the quality and readability analyses were limited to the first page of results on Google search. Five quality tools and six readability formulas were used. Results Pearson's correlation coefficients showed positive correlations between USA AVM RSVs and annual AVM deaths per capita from 2017 to 2019 (R2=0.932). The AVM annual diagnosis quantity and AVM RSVs showed a strong positive correlation as well (R2=0.998). Hereditary hemorrhagic telangiectasia and cerebral aneurysms had strong positive correlations between their RSVs and their corresponding annual diagnoses in the 2017 to 2019 time period (R2=0.982, R2=0.709). One-way ANOVA, for USA's 2004 to 2021 AVM RSVs and 2004 to 2019 deaths per capita, displayed no month-specific statistically significant repeating pattern (all p>0.483). The DISCERN tool had four websites that qualified as "poor" and five as "good." The average score for the tool was "good." The Journal of the American Medical Association (JAMA) benchmark scores were very low on average, as four websites achieved zero points. There was a wide variance in the currency, relevance, authority, accuracy, and purpose (CRAAP) scores, indicating an inconsistent level of webpage reliability across results. The patient education materials assessment tool (PEMAT) understandability (86.6%) showed much higher scores than the PEMAT actionability (54.6%). No readability score averaged at or below the American Medical Association (AMA)-recommended sixth-grade reading level. Conclusion These GT correlations may be due to patients and families with new diagnoses researching those same conditions online. The seasonality results reflect that no prior research has detected seasonality for AVM diagnosis or presentation. The quality study showed a wide variance in website ethics, treatment information quality, website/author qualifications, and actionable next steps regarding AVMs. Overall, this study showed that patients are routinely attempting to access information regarding these intracranial conditions, but the information available, specifically regarding AVMs, is not routinely reliable and the reading level required to understand them is too high.

Assessing Patterns in Childhood Obesity Patient Education: A Quality of Online Health Information and Google Trends Analysis.

Background: Childhood obesity (CO) is rapidly increasing in prevalence and developing into a health crisis of developed nations. The condition is associated with increased risk of developing various comorbidities later in life. Current treatment algorithms primarily target family education. Thus, this study aims to understand the quality of information online regarding CO and common comorbidities, determine the readability of online information, and report patterns in public interest over time using Google Trends. Methods: Four validated quality of information tools and 6 readability tools were implemented across 36 websites derived from 4 Google searches. Pearson's correlation coefficient was used to determine the associations between Google Trends' relative search volumes (RSVs) and biennial BMI-based cumulative proportion of CO. Results: Results showed variable information quality among the websites as scores ranged from "fair" to "very poor." Using six readability formulas, no website scored at or below the sixth grade reading level recommended by the American Medical Association. Google Trends' RSVs for the term "Childhood Obesity" were repeatedly increased in the months that fall in the US academic school year (October-November and February-May), and decreased within months in the US vacation periods (December-January and June-September). Search volumes were also negatively correlated with CO and pediatric type 2 diabetes prevalence. Conclusions: In summary, while Google Trends analysis showed that schools may play a role in increasing interest and awareness online, quality of information and readability analysis displayed that the information and its accessibility are far too variable to be reliable.

Google Trends™ and Quality of Information Analyses of Google™ Searches Pertaining to Concussion.

Sports-related concussions occur with high incidence in the United States. Google Trends™ (GT) analyses indicate changes of public interest in a topic over time, and can be correlated with incidence of health events such as concussion. Internet searches represent a primary means of patient education for many health topics, including concussion; however, the quality of medical information yielded by internet searches is variable and frequently of an inappropriate reading level. This study therefore aims to describe GT over time and evaluate the quality and readability of information produced by Google™ searches of the term "concussion." We identified a strong negative correlation from 2009 to 2016 between GT scores and total number of American high school football participants (R 2 = 0.8553) and participants per school (R 2 = 0.9533). Between 2004 and 2020, the monthly GT popularity score were variable (p = 3.193E-08), with September having the greatest scores, correlating with the height of American tackle football season. Applying five validated quality assessment scoring systems at two time points, it was confirmed that different sources yielded varying quality of information. Academic and non-profit healthcare sources demonstrated the highest quality metrics across two time points. There was significant variability of scores among the different scoring systems, however. The majority of searches at both time points yielded information that was rated as "fair" to "poor" in quality. Applying six readability tests, we revealed that only a single commercial website offered information written at or below the American Medical Association- recommended 6th-grade level for healthcare information. In summary, GT data analyses suggest that searches correlate with the American tackle football season and increased between 2009 and 2016, given that public interest in concussion increased and annual participation in football decreased. The quality of information yielded by Google™ searches and readability are inadequate, indicating the need for significant improvement.

Political Campaign Contributions of Surgeons in the United States Throughout the 2020 Election Cycle.

Importance: Political engagement by the physician workforce is necessary to ensure continued representation of their interests in health care legislation. Limited data are available pertaining to the political involvement of US surgeons. Objective: To analyze the magnitude and distribution of political donations made by all US surgeons throughout the 2020 election cycle. Design, Setting, and Participants: Partisan and geographical differences in surgeon contributions by aggregating data (January 1 through December 31, 2020) from the US Federal Election Commission database were analyzed. Contributions were labeled as Republican, Democrat, or independent depending on the committee they were designated to. Main Outcomes and Measures: Differences in contributions to Republicans, Democrats, and independent candidates for all US surgeons and for subgroups. Results: For the 2020 election year, a total of 53 944 donations were made by surgeons in the United States, amounting to $9 223 350.68. Among all surgical specialties, the top 5 highest number of contributions were made from orthopedic surgeons (n = 15 081), ophthalmic surgeons (n = 14 836), neurological surgeons (n = 7481), urologists (n = 4544), and plastic surgeons (n = 4060). Of these donations, 59.46% (n = 32 107) were made to the Republican party ($5 420 326), 30.83% (n = 16 644) were made to the Democratic party ($1 612 775), and 9.71% (n = 5243) were made to nonpartisan (ie, independent) organizations ($2 190 250). Overall, pediatric surgeons reported the lowest mean contribution amount of $59.43, whereas thoracic surgeons reported the highest mean contribution amount of $225.19. Conclusions and Relevance: Health care legislation has an immense impact on how medicine is practiced and utilized. This analysis reveals a high degree of political activity of surgeons across different specialties and geographic regions.

Employing Google Trends to Assess Concussion Search Popularity, Seasonality, and Association With High School Sports Participation.

OBJECTIVE: This investigation employs 2004-2020 Google Trends data to correlate concussion search popularity and high school sports participation while assessing search seasonality and factors associated with search escalation. BACKGROUND: Events linked to concussions, from news to entertainment, altered public perception of concussions and discouraged high-risk activities. Such sentiment likely promoted high school football's 2004-2018 8% decrease in participation, despite simultaneous 8% increase for sports overall. Google Trends (GT) analysis calculates distinct subjects' popularity scores (0-100) by normalizing Google search frequency with other subjects in the same topic. With 35% of patients researching their conditions using Google, tracking concussion popularity scores allows robust analysis of event-driven fluctuation, seasonal variation, and sports impact. DESIGN/METHODS: Worldwide GT analysis was conducted for the disease topic "Concussion" with the categorical filter "Health" from 2004 to 2020. This period's monthly popularity scores with annual averages and annual high school sports participation data were subsequently obtained from Google Trends and the National Federation of State High School Associations, respectively. RESULTS: Concurrence of significant score changes with CTE studies' publication, release of 2015 film Concussion, and the COVID-19 pandemic validates GT's measurement of public interest. From 2006 to 2016, Pearson's correlation coefficients demonstrated strong negative correlation between GT popularity scores for "Concussion" with total number of high school football participants overall (R2 = 0.8553) and participants per school (R2 = 0.9533). Confirming football-related seasonality, one-way ANOVA regression analysis concluded 2004-2020's mean change in month-specific popularity score is not the same (p = 3.193E-08), and months during football season had statistically significant variability (September: p = 4.389E-05) with elevated average z-scores. CONCLUSIONS: Coupled with ANOVA regression and normalized analyses, strong negative correlations between concussion popularity score and high school football participation produce quantitative measures of a long-suspected relationship. Tracking concussion popularity and seasonality with Google Trends provides insight into how, when, and why patients are educating themselves online.

Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States.

In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant (n = 40, 15.6%) or resistant (n = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97-5.26-91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99-27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.