Understanding preferences for receiving health communications and information about clinical trials: a cross-sectional study among US adults.

OBJECTIVE: Effective health communication is critical for understanding and acting on health information. This cross-sectional study explored participants' understanding of their health condition, their preferences for receiving health communications, and their interest in receiving clinical trial results across several therapeutic areas. METHODS: The study recruited participants via social media, email newsletters, and advocacy organizations. An online screener captured demographic information (health conditions, age, race/ethnicity, gender, and education). Eligible participants were emailed an online survey assessing preferred sources and formats for receiving health information, interest in learning about topics related to the results of clinical trials, and health literacy levels. RESULTS: In total, 449 participants (median age, 35 years [range, 18-76]; White, 53%; higher education, 65%; mean (range) health literacy score, 1.9 [0.4-3.0]) from 45 US states completed the survey representing 12 disease indications (bipolar, blood and solid tumor cancers, irritable bowel syndrome, inflammatory bowel disease, major depressive disorder, migraine, Parkinson's, psoriasis/atopic dermatitis, retinal vein occlusion/macular degeneration, rheumatoid arthritis, and spasticity). Healthcare providers were the preferred source of health information (59%), followed by Internet searches (11%). Least preferred sources were social media (5%), friends/family (3%), and email newsletters (2%). Participants preferred multiple formats and ranked reading materials online as most preferred (33%), along with videos (28%) and infographics (27%). Printed materials (14%) and audio podcasts (9%) were the least preferred formats. A majority of the participants reported that the health information they found was hard to understand (57%) and confusing (62%). Most participants (85%) were somewhat/very interested in learning about clinical trial results, with the highest interest in short summaries of safety (78%) and efficacy (74%) results. CONCLUSION: Effective health communication may be achieved via multiple formats shared directly by healthcare providers.

Researchers wanted to learn how people preferred to receive health-related communications, including information about the results of clinical trials. They surveyed 449 people from 45 US states with 12 different health conditions. The survey questions asked people about their preferred sources and ways of getting health information. It also asked about their interest in learning about clinical trials related to their health condition. The results showed that most people preferred to get health information from their healthcare providers (59%). The Internet was the second most popular choice (11%) for getting health information. People did not like getting health information from social media, friends or family, or email newsletters as much. When it came to how health information was shared, people liked reading materials online (33%), watching videos (28%), and looking at infographics (27%). They did not like printed materials and audio podcasts as much. Most people (85%) were interested in learning about the results of clinical trials in short summaries. They wanted to know about the safety (78%) and how well the treatments worked (74%) in the short summaries. In conclusion, people liked getting health information from healthcare providers like doctors, nurses, and others in different formats. Sharing information in different formats through healthcare providers may improve communication for patients with different health conditions.

How Health Literacy Can Enhance the Design and Conduct of Clinical Trials from Consent to Conclusion.

Health literacy research and interventions have provided multiple tools to improve communication between professionals and patients in clinical contexts for many years. Despite the reality that many patients participate in clinical trials in conjunction with standard medical care, only recently have efforts extended to address and improve the health literacy of both clinical trial researchers and participants. To date, the primary focus of health literacy activities in clinical trials has centered on communicating trial results to trial participants. This report describes the opportunities and strategies necessary to layer health literacy activities across the clinical trial process from consent to conclusion.

HealthLit4Kids study protocol; crossing boundaries for positive health literacy outcomes.

BACKGROUND: Health attitudes and behaviours formed during childhood greatly influence adult health patterns. This paper describes the research and development protocol for a school-based health literacy program. The program, entitled HealthLit4Kids, provides teachers with the resources and supports them to explore the concept of health literacy within their school community, through classroom activities and family and community engagement. METHODS: HealthLit4Kids is a sequential mixed methods design involving convenience sampling and pre and post intervention measures from multiple sources. Data sources include individual teacher health literacy knowledge, skills and experience; health literacy responsiveness of the school environment (HeLLO Tas); focus groups (parents and teachers); teacher reflections; workshop data and evaluations; and children's health literacy artefacts and descriptions. The HealthLit4Kids protocol draws explicitly on the eight Ophelia principles: outcomes focused, equity driven, co-designed, needs-diagnostic, driven by local wisdom, sustainable, responsive, systematically applied. By influencing on two levels: (1) whole school community; and (2) individual classroom, the HealthLit4Kids program ensures a holistic approach to health literacy, raised awareness of its importance and provides a deeper exploration of health literacy in the school environment. The school-wide health literacy assessment and resultant action plan generates the annual health literacy targets for each participating school. DISCUSSION: Health promotion cannot be meaningfully achieved in isolation from health literacy. Whilst health promotion activities are common in the school environment, health literacy is not a familiar concept. HealthLit4Kids recognizes that a one-size fits all approach seldom works to address health literacy. Long-term health outcomes are reliant on embedded, locally owned and co-designed programs which respond to local health and health literacy needs.

Depurated fish as an alternative reference for field-based biomarker monitoring.

The whole of the Swan-Canning Estuary, in the south-west of Australia, is impacted by human activity, and the selection of a local reference site to assess the impact of environmental contamination on the health of biota is not possible. To determine whether fish depurated under laboratory conditions could be used as an alternative to a reference site; adult black bream (Acanthopagrus butcheri) were collected from the estuary and maintained in clean water (S24) for 3 months. A suite of biomarkers of fish health were assessed, and the results were compared with field-captured black bream from three sites within the estuary (Ascot, Claisebrook, and Riverton). Comparisons of a subset of biomarkers were also made between hatchery-bred juvenile fish and the depurated fish. Biomarker levels were up to 3.8 times higher in field captured fish compared with depurated fish, while DNA integrity was lower. EROD activity was comparable in the hatchery-bred black bream to the depurated fish while s-SDH levels were two times higher in the hatchery fish. From the results obtained, field-captured black bream depurated for 3 months are suitable to determine reference/baseline levels for biomarker of health studies in estuarine environments.

Academic dishonesty and unprofessional behavior.

PURPOSE: To investigate differences in radiologic science student and faculty perceptions of academic dishonesty and unprofessional behavior. METHODS: Radiologic science faculty and students were questioned about their perceptions of academic dishonesty and unprofessional behavior using ethical scenarios in an electronic survey format. RESULTS: Significant differences occurred between faculty and student values regarding the seriousness of cheating and unprofessional behaviors. Faculty viewed cheating and unprofessional behaviors as more serious than students. Faculty and student self-reports of cheating behavior demonstrated no significant differences; however, significant differences existed in self-reported incidences of unprofessional behavior. CONCLUSION: Faculty and students differed in their values and participation related to cheating and unprofessional behaviors. Efforts should be directed toward bridging the gap between faculty and student perceptions.

Freshwater shrimp (Palaemonetes australis) as a potential bioindicator of crustacean health.

Palaemonetes australis is a euryhaline shrimp found in southwestern Australian estuaries. To determine if P. australis is a suitable bioindicator species for monitoring the health of estuarine biota, they were exposed to measured concentrations of the polycyclic aromatic hydrocarbon, benzo[a]pyrene (B[a]P) at 0.01, 0.1, or 1 ppm for 14 days under laboratory conditions. At the end of exposure the shrimp were sacrificed for biomarker [ethoxycoumarin O-deethylase (ECOD), 8-oxo-dG concentration, and sorbitol dehydrogenase (SDH) activity] analyses. Gender did not appear to influence biomarker responses of the shrimp in this study. ECOD activity was induced in the treatment groups in a linear fashion from three (0.01 ppm) times to 12 (1 ppm) times the negative controls. 8-oxo-dG concentration was reduced three times in treatment groups below the controls suggesting impaired DNA repair pathways. There was no increase in SDH, signifying hepatopancreatic cell damage had not occurred in any treatment group. The response of P. australis to B[a]P exposure indicates that this crustacean is suitable bioindicator species for both laboratory studies and field monitoring. A combination of ECOD and SDH activities and 8-oxo-dG concentration represent a suitable suite of biomarkers for environmental monitoring of the sublethal effects of organic pollution to crustaceans from an estuarine environment.

The value of stress protein 70 as an environmental biomarker of fish health under field conditions.

Hsp70 protein in three tissue types (gill, liver, and muscle) from black bream (Acanthopagrus butcheri) collected in a highly variable estuarine environment was investigated to determine which tissue provides better intersite discrimination. The usefulness of hsp70 expression to identify anthropogenic stress under field conditions was evaluated. Intersite differences were detected in hsp70 levels in gill and white muscle of black bream while liver showed no spatial difference. There was high interfish variability in hsp70 levels in each tissue group. A post hoc power analysis of the datasets for each tissue found that in black bream, white muscle provided the best discriminatory power to elucidate spatial variability. Only 11 fish per site are required to identify significant intersite differences in white muscle whereas for gill and liver tissues 14 and 21 fish per site, respectively, would be required. Because of high intertissue and interindividual variability, field measurement of hsp70 should be complemented by evidence of changes in other biomarkers of fish health.

Hepatic metabolism of contaminants in the terapontid fish, yellowtail trumpeter (Amniataba caudavittata Richardson).

The yellowtail trumpeter (Amniataba caudavittata) is an estuarine-dependent omnivorous fish found in the Swan-Canning Estuary, Western Australia. Thirty five fish were injected with either the polycyclic aromatic hydrocarbon, benzo[a]pyrene (B[a]P), the synthetic flavenoid beta-naphthoflavone (BNF), or used as controls. The fish were then sampled at 3 and 7 days postinjection. Induction of the enzyme ethoxyresorufin O-deethylase (EROD) activity was nonsignificant while ethoxycoumarin O-deethylase (ECOD) activity induction differed amongst treatments. A high interindividual variability in the EROD activity was observed. The measurement of sorbitol dehydrogenase in the serum (s-SDH) was elevated (BNF 2.2 times and B[a]P 3.2 times the control fish) demonstrating that liver cell damage had occurred. Increases in biliary metabolites of both B[a]P-type and pyrene-type (19 times and 3.4 times the controls respectively) indicated that detoxification of pyrene-type compounds had taken place. Fish of the Terapontidae family, such as the yellowtail trumpeter, were found to be suitable for biomonitoring the health of the Swan-Canning Estuary. A combination of ECOD activity, s-SDH, and the measurement of biliary metabolites represents a suitable suite of biomarkers for environmental monitoring of the sublethal effects of PAH pollution in these fish.

Endocrine disruption in male mosquitofish (Gambusia holbrooki) inhabiting wetlands in Western Australia.

The use of gonopodial indices as potential indicators of endocrine disruption in the mosquitofish Gambusia holbrooki inhabiting south west Australian wetlands was investigated. A minimum of 50 mature males was collected from each of five water-bodies in the Swan Coastal Plain, Western Australia, in order to measure morphological features related to reproduction. A set of morphological measurements were used to derive the following indices: gonopodium length/standard body length, pre-anal length/standard body length, the index of elongation and the percentage of male fish with hooks on the distal end of the gonopodium. Indices of male mosquitofish collected from Jack Finney Lake, located in the Curtin University campus, suggest the presence of endocrine disrupting chemicals (EDCs) in this water-body, while those from Lake Kulinup suggest this is a site of concern. Indices of male fish from the Wagerup wetland, Lake Monger and Loch McNess indicate that fish inhabiting these wetlands are not affected by EDCs. This preliminary study suggests that EDCs may be present in a number of wetlands of the Swan Coastal Plain. Further study using EDC specific markers such as vitellogenin induction in male mosquitofish is required to confirm whether EDCs are present in these water-bodies.

Interseasonal variability in biomarkers of exposure in fish inhabiting a southwestern Australian estuary.

The Swan-Canning Estuary, in southwestern Australia, undergoes distinct seasonal changes, with freshwater discharge predominant in the winter (wet) season and low flow with high salinity predominant in the dry summer season. To investigate seasonal variability in biomarkers of exposure in fish, black bream (Acanthopagrus butcheri) were collected from seven sites in the Swan-Canning Estuary in winter 2000 and in summer 2001. No interseasonal or intersite differences in serum sorbitol dehydrogenase concentration were found, indicating the measured mixed-function oxygenase (MFO) enzymes were not influenced by liver damage. The ethoxyresorufin-O-deethlyase (EROD) activity of the postspawning females was higher in summer than in winter but was significantly lower than that in males in both seasons, suggesting estradiol suppression in females. Sexual differences in ethoxycoumarin-O-deethylase (ECOD) activity were not evident in either season. Both EROD and ECOD activities and polycyclic aromatic hydrocarbons (PAH) biliary metabolites had significantly different patterns of induction between seasons. The ratio of naphthalene-type to benzo(a)pyrene-type biliary metabolites was significantly higher in summer, indicating the sources of petroleum hydrocarbons were petrogenic compared to in winter, when the source was a mixture of pyrogenic and petrogenic PAHs. There was no upstream or downstream gradient of response in any biomarker in either season, demonstrating that there were multiple sources of contaminant input into the estuary. Although winter biomarker levels were triggered by the discharge runoff from major roads and drains, summer biomarker levels appear to have been related to recreational boating use on the estuary.

Metabolic enzyme activities in black bream (Acanthopagrus butcheri) from the Swan-Canning Estuary, Western Australia.

The Swan-Canning estuary, in southwestern Australia, is subject to frequent algal blooms and associated periods of hypoxia due to high levels of nutrients in stormwater runoff and sewage spills. Fish in which cellular respiration is impaired due to chronic exposure to non-nutrient pollutants in the water will have a reduced ability to survive these periods of high stress. In order to investigate if metabolic respiration in black bream (Acanthopagrus butcheri) was altered, fish were collected from five sites in the Swan-Canning estuary in summer 2001, summer 2002 and winter 2002. Aerobic and anaerobic capacities were estimated by measuring the enzymes cytochrome C oxidase (CCO) and lactate dehydrogenase (LDH). Neither seasonal or annual trends, nor upstream or downstream gradients were observed in either biomarker. The fish collected from the Barrack Street site, which is close to the Perth Central Business District, were heavily challenged in their aerobic capacity in the summer months compared to the other sites. In addition, the fish at Barrack Street displayed an altered anaerobic capacity. It is likely that the impaired metabolic capacity of the fish at Barrack Street reduces the fishes' ability to survive the frequent algal blooms within the estuary.

Interannual variability in fish biomarkers in a contaminated temperate urban estuary.

During the past decade the Swan-Canning estuary, Western Australia, has shown signs of stress which has been attributed to high nutrient inputs. There is little information on the effect of nonnutrient contaminants on biota inhabiting the estuary. A suite of biomarkers was measured on black bream (Acanthopagrus butcheri) to determine whether annual variations in fish biomarkers exist in the wet (winter) and dry (summer) seasons. Serum sorbitol dehydrogenase showed no significant differences between years, indicating that measured mixed-function oxygenase (MFO) enzyme activities were not affected by annual variations in hepatic tissue damage. Ethoxyresorufin-O-deethylase activity was lower in female black bream than in male fish while ethoxycoumarin-O-deethylase activity was not influenced by gender. Biomarker levels measured at various sites confirm that major roads and drains are significant contributors of MFO-inducing chemicals into the Swan-Canning estuary. No consistent upstream or downstream gradient in biomarker response was identified. The ratio of naphthalene-type to benzo(a)pyrene-type biliary metabolites was linked to runoff from urban areas into the estuary. There was high annual variability in all biomarkers in both seasons, suggesting that biannual monitoring is required to evaluate the effect of contaminants on the biota in the estuary.

Exaggerated postprandial lipaemia and lower post-heparin lipoprotein lipase activity in middle-aged men.

An exaggerated postprandial lipaemic response is thought to play a central role in the development of an atherogenic lipoprotein phenotype, a recognized lipid risk factor for coronary heart disease. A small number of limited studies have compared postprandial lipaemia in subjects of varying age, but have not investigated mechanisms underlying age-associated changes in postprandial lipaemia. In order to test the hypothesis that impaired lipaemia in older subjects is associated with loss of insulin sensitivity, the present study compared the postprandial lipaemic and hormone responses for 9 h following a standard mixed meal in normolipidaemic healthy young and middle-aged men. Lipoprotein lipase (LPL) and hepatic lipase (HL) activities were determined in post-heparin plasma 9 h postprandially and on another occasion under fasting conditions. Postprandial plasma glucose (P<0.02), retinyl ester (indirect marker for chylomicron particles; P<0.005) and triacylglycerol (TAG)-rich lipoprotein (density<1.006 g/ml fraction of plasma) TAG (P<0.05) and retinyl ester (P<0.005) responses were higher in middle-aged men, whereas plasma insulin responses were lower in this group (P<0.001). Fasting and 9 h postprandial LPL and HL activities were also significantly lower in the middle-aged men compared with the young men (P<0.006). In conclusion, the higher incremental postprandial TAG response in middle-aged men than young men was attributed to the accumulation of dietary-derived TAG-rich lipoproteins (density<1.006 g/ml fraction of plasma) and occurred in the absence of marked differences in fasting TAG levels between the two groups. Fasting and postprandial LPL and HL activities were markedly lower in middle-aged men, but lack of statistical associations between measures of insulin response and post-heparin lipase activities, as well as between insulin and measures of postprandial lipaemia, suggest that this lower activity cannot be attributed to lack of sensitivity of lipases to activation by insulin. Alternatively, post-heparin lipase activities may not be good markers for the insulin-sensitive component of lipase that is activated postprandially.