Are Patient-Centered Care, Healthcare Consumerism, and Trust in Physicians Compatible?: Positioning Analysis of the Patient-Provider Relationship.

Patient-centered care and healthcare consumerism are dominant models of the patient-provider relationship. Positioning theory was applied to examine consumers' and physicians' positions on patient-centered care and healthcare consumerism, along with their attitudes toward direct-to-consumer healthcare service advertising and trust in the medical profession. Surveys were conducted with a convenience sample of consumers and physicians respectively. Patient-centered care was the only theoretical construct that both consumers and physicians unequivocally embraced. Both groups were either ambivalent or skeptical of the other three concepts. Between the two groups, physicians exhibited a stronger endorsement of patient-centered care and more negative attitudes toward advertising than consumers. When the relationships among the theoretical constructs were examined, a negative correlation between patient-centered care and consumerism was found among consumers. Also, patient-centered care and trust were negatively correlated in both groups. Implications of these findings are discussed for strategic communication, consumer and physician education, and future research.

Analysis of Direct-To-Consumer Healthcare Service Advertisements on Television: An Application of the Patient Expectation Framework.

Direct-to-consumer advertisements for healthcare services constitute a rare channel of public communication where consumers see and hear directly from their local providers and healthcare organizations. Although spending on these advertisements has increased drastically during the past decades, research on their content and effects remains rare. To fill this gap, we analyzed primetime television advertisements for healthcare services directly targeting consumers. The advertisements were collected from the two largest media markets in Nevada for one month. In total, 795 advertisements were identified, and 106 of them were non-duplicates. Analysis revealed that the advertisements focused on patients' good health outcomes by showing them smiling, going out and about, having fun with others, and enjoying rigorous physical activities. On the other hand, the advertisements focused less on the providers. Although the advertisements often showed providers in clinical settings, basic information about their professional degrees was often missing. Mentions of providers' other qualifications and professional experiences were even scarcer. Also, a substantial number of advertisements failed to show providers interacting with patients. Additional analysis of patient and provider characteristics revealed under-representation of racial or ethnic minority and older adult patients. Representation of women and minorities as providers was even more uncommon. We discussed the implications of these findings from the perspective of patient expectation and made suggestions to help providers improve their direct-to-consumer advertisements.

Marijuana Message Channels, Health Knowledge, Law Knowledge, and Confidence in Knowledge as Risk and Protective Factors of Marijuana Use among College Students.

Marijuana use among U.S. college students is the highest since the mid-1980s. Because knowledge about marijuana and confidence in the knowledge are related to changing marijuana laws and marijuana-related messages ubiquitous in college students' information environment, we examined their relationships with use. The Structural Equation Modeling method was used to analyze the relationships using survey responses from 249 college students in an adult-use marijuana legal state. Marijuana health knowledge was related to less use, and law knowledge was related to more use. Both relationships were mediated by perceived risk. Confidence in knowledge was related to more use directly as well as indirectly via lower peer disapproval and lower perceived risk. Among various marijuana message channels, peers were the most influential, contributing to lower health knowledge and higher confidence in knowledge.

Competencies for Health Communication Specialists: Survey of Health Communication Educators and Practitioners.

For more than two decades, health communication educators and practitioners have been working toward establishing a competency model to guide health communication education. This article reports the results of a survey to identify competencies for health communication specialists with master's degrees. To prepare the survey, a working group drafted a competency list through reviewing the literature and soliciting feedback from attendees at a professional society meeting, resulting in lists of items reflecting 18 knowledge domains, 11 skill sets, and 14 application bundles labeled "abilities." The survey asked participants to rate the 43 items in terms of their importance and provide their opinions about the preparation of health communication specialists. The survey was disseminated online through professional associations and completed by 142 participants (74 educators and 68 practitioners). Nearly all of the 43 items were rated "somewhat important" or higher. The lists were reduced to 10 knowledge domains, three skill sets, and five abilities through factor analyses. Replication of the findings and triangulation with studies employing different research methods will help advance this line of inquiry.

US direct-to-consumer medical service advertisements fail to provide adequate information on quality and cost of care.

BACKGROUND: In the 1970s, the Federal Trade Commission declared that allowing medical providers to advertise directly to consumers would be "providing the public with truthful information about the price, quality or other aspects of their service." However, our understanding of the advertising content is highly limited. OBJECTIVE: To assess whether direct-to-consumer medical service advertisements provide relevant information on access, quality and cost of care, a content analysis was conducted. METHOD: Television and online advertisements for medical services directly targeting consumers were collected in two major urban centres in Nevada, USA, identifying 313 television advertisements and 200 non-duplicate online advertisements. RESULTS: Both television and online advertisements reliably conveyed information about the services provided and how to make an appointment. At the same time, less than half of the advertisements featured insurance information and hours of operation and less than a quarter of them contained information regarding the quality and price of care. The claims of quality were substantiated in even fewer advertisements. The scarcity of quality and cost information was more severe in television advertisements. CONCLUSION: There is little evidence that medical service advertising, in its current form, would contribute to lower prices or improved quality of care by providing valuable information to consumers.

U.S. College Students' Marijuana Information Sources, Confidence in Knowledge, and Objective Knowledge.

In recent years, marijuana use on U.S. college campuses reached the highest point while the perceptions of risk and social disapproval registered the lowest since the early 1980s. However, little attention has been paid to the sources of the marijuana-related messages and their relationships with marijuana knowledge and confidence in knowledge, proximate protective/risk factors. To fill this gap, a convenience sample of students (N = 249) on a campus located in a U.S. recreational marijuana legal state were surveyed to identify their marijuana information sources and explore the relationships among the sources, confidence in marijuana knowledge, and objective knowledge. Peers/media were the most important sources and they were used more than other sources. Use of peers/media sources was related to lower health knowledge and higher confidence in knowledge. Although students named parents and education/science sources as important, these were less frequently used than siblings, the sources they named as the least important. This study advanced our understanding of the various sources of marijuana information used by U.S. college students and the relationships between the information sources and confidence in knowledge and objective knowledge, two emerging risk/protective factors in the era of marijuana deregulation.

Targeted Downregulation of kdm4a Ameliorates Tau-engendered Defects in Drosophila melanogaster.

BACKGROUND: Tauopathies, a class of neurodegenerative diseases that includes Alzheimer's disease (AD), are characterized by the deposition of neurofibrillary tangles composed of hyperphosphorylated tau protein in the human brain. As abnormal alterations in histone acetylation and methylation show a cause and effect relationship with AD, we investigated the role of several Jumonji domain-containing histone demethylase (JHDM) genes, which have yet to be studied in AD pathology. METHODS: To examine alterations of several JHDM genes in AD pathology, we performed bioinformatics analyses of JHDM gene expression profiles in brain tissue samples from deceased AD patients. Furthermore, to investigate the possible relationship between alterations in JHDM gene expression profiles and AD pathology in vivo, we examined whether tissue-specific downregulation of JHDM Drosophila homologs (kdm) can affect tauR406W-induced neurotoxicity using transgenic flies containing the UAS-Gal4 binary system. RESULTS: The expression levels of JHDM1A, JHDM2A/2B, and JHDM3A/3B were significantly higher in postmortem brain tissue from patients with AD than from non-demented controls, whereas JHDM1B mRNA levels were downregulated in the brains of patients with AD. Using transgenic flies, we revealed that knockdown of kdm2 (homolog to human JHDM1), kdm3 (homolog to human JHDM2), kdm4a (homolog to human JHDM3A), or kdm4b (homolog to human JHDM3B) genes in the eye ameliorated the tauR406W-engendered defects, resulting in less severe phenotypes. However, kdm4a knockdown in the central nervous system uniquely ameliorated tauR406W-induced locomotion defects by restoring heterochromatin. CONCLUSION: Our results suggest that downregulation of kdm4a expression may be a potential therapeutic target in AD.

Inhibition of neddylation facilitates cell migration through enhanced phosphorylation of caveolin-1 in PC3 and U373MG cells.

BACKGROUND: Protein neddylation is a post-translational modification by a covalent conjugation with the neural precursor cell expressed, developmentally downregulated 8 (NEDD8). Although this process has been reported to participate in diverse cellular signaling, little is known about its role in cancer cell migration. Given a recent proteomics report showing that NEDD8 is downregulated in prostate cancer tissues versus normal prostate tissues, we tested the possibility that neddylation plays a role in cancer evolution, and then tried to identify target proteins of the neddylation. METHODS: The neddylation process was inhibited by transfecting cancer cells with NEDD8-targeting siRNAs or by treating the cells with a NAE1 inhibitor MLN4924. Cell migration was evaluated by an in vitro wound-healing assay and a Transwell migration assay. His/NEDD8-conjugated proteins were pulled down with nickel-affinity beads under a denaturing condition, and identified by Western blotting. All data were processed using the Microsoft Excel program and analyzed statistically by two-sided, unpaired Student's t-test. RESULTS: Caveolin-1, which plays a critical role in cell migration, was identified to be conjugated with NEDD8. When the neddylation was inhibited, the phosphorylation of caveolin-1 at Tyr14 was augmented in PC3 and U373MG cells, thereby leading to increased cell migration. Such consequences by neddylation inhibition were abolished in the presence of a Src family kinase inhibitor PP2. CONCLUSIONS: NEDD8 seems to inhibit the Src-mediated phosphorylation of caveolin-1 by modifying the structure of caveolin-1 protein, which blocks the migration of cancer cells. Although the neddylation process is currently regarded as an emerging target for cancer therapy, our results suggest the possibility that the inhibition of neddylation could facilitate cancer invasion or metastasis at least in some types of cancers.

Content, Exposure, and Effects of Public Discourses about Marijuana: A Systematic Review.

This review presents a comprehensive picture of research studies about marijuana-related content in news, social media, and advertisements. Studies that examined the extent of people's exposure to the messages and its effects were also included. A total of 27 peer-reviewed journal articles and one thesis were located, of which 16 analyzed the content, four contained information about people's exposure to the messages, and ten examined the effects. Over time, news coverage shifted from negative to slightly positive toward marijuana use. Social media and advertisements were overwhelmingly favorable toward marijuana use and legalization by claiming social, romantic, and health benefits of marijuana use while completely downplaying risks. A majority of social media accounts were also run by advocacy groups and industry interests, rather than individuals who were simply sharing opinions or experiences. Furthermore, absence of health authorities among the highly popular social media accounts about marijuana was notable. The news, social media, and advertising messages about marijuana were widely used by the members of public, which in turn generated some demonstrable effects on the audience's marijuana-related perceptions and behaviors. The public and policymakers need to become aware of this information environment for potential marijuana users and take more proactive measures to protect vulnerable populations.

Professionalism and Commercialism on Cosmetic Surgeons' Websites.

This study analyzed the homepages of 250 cosmetic surgeons' websites by focusing on the representation of cosmetic surgery providers, cosmetic surgery recipients, and cosmetic surgery practice itself. Based on a literature review, some common elements of the webpages were preidentified as the indicators of professionalism or commercialism. Subsequently, each homepage was scrutinized for their presence and salience. Overall, cosmetic surgeons' websites were high in professionalism and low in commercialism in their representation of the service providers. In depicting the recipients, the websites were moderate in both professionalism and commercialism. The representation of practice was low in professionalism and moderate in commercialism. Implications of these findings for doctors, regulators, and consumer advocates are discussed and directions for future research are proposed.

Extended Monopole antenna Array with individual Shield (EMAS) coil: An improved monopole antenna design for brain imaging at 7 tesla MRI.

PURPOSE: To propose a new Extended Monopole antenna Array with individual Shields (EMAS) coil that improves the B1 field coverage and uniformity along the z-direction. METHODS: To increase the spatial coverage of Monopole antenna Array (MA) coil, each monopole antenna was shielded and extended in length. Performance of this new coil, which is referred to as EMAS coil, was compared with the original MA coil and an Extended Monopole antenna Array coil with no shield (EMA). For comparison, flip angle, signal-to-noise ratio (SNR), and receive sensitivity maps were measured at multiple regions of interest (ROIs) in the brain. RESULTS: The EMAS coil demonstrated substantially larger flip angle and receive sensitivity than the MA and EMA coils in the inferior aspect of the brain. In the brainstem ROI, for example, the flip angle in the EMAS coil was increased by 45.5% (or 60.0%) and the receive sensitivity was increased by 26.9% (or 14.9%), resulting in an SNR gain of 84.8% (or 76.3%) when compared with the MA coil (or EMA). CONCLUSION: The EMAS coil provided 25.7% (or 24.4%) more uniform B1+ field distribution compared with the MA (or EMA) coil in sagittal. The EMAS coil successfully extended the imaging volume in lower part of the brain. Magn Reson Med 75:2566-2572, 2016. © 2015 Wiley Periodicals, Inc.

Jumonji histone demethylases as emerging therapeutic targets.

The methylation status of lysine residues in histones determines the transcription of surrounding genes by modulating the chromatin architecture. Jumonji domain-containing histone-lysine demethylases (Jmj-KDMs) remove the methyl moiety from lysine residues in histones by utilizing Fe(2+) and α-ketoglutarate. Since genetic alterations in Jmj-KDMs occur in various human cancers, the roles of Jmj-KDMs in cancer development and progression have been investigated, but still controversial. The KDM7 subfamily, which belongs to the Jmj-KDM family, is an emerging class of transcriptional coactivators because its members erase the repressive marks H3K9me2/1, H3K27me2/1, and H4K20 me1. Recently, KDM7C (alternatively named PHF2) was discovered as a new KDM7 member and identified to play a tumor-suppressive role through the reinforcement of p53-driven growth arrest and apoptosis. In this article, we generally reviewed the roles of Jmj-KDMs in human cancers and more discussed the molecular functions and the clinical significances of KDM7C.

Differential expression of cancer-associated fibroblast-related proteins according to molecular subtype and stromal histology in breast cancer.

The purpose of this study aimed to investigate the clinicopathologic characteristics of breast cancer according to its cancer-associated fibroblast (CAF) phenotype. Immunohistochemistry staining of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER-2), Ki-67, podoplanin, prolyl 4-hydroxylase, fibroblast activation protein alpha (FAPα), S100A4, platelet-derived growth factor receptor alpha (PDGFRα), PDGFRß, and chondroitin sulfate proteoglycan (NG2) was performed on tissue microarray consisting of 642 breast cancer cases. Samples were categorized into luminal A, luminal B, HER-2, or triple-negative breast cancer (TNBC) according to immunohistochemical results, whereas tumor stroma was classified into desmoplastic, sclerotic, normal-like, or inflammatory type based on histological findings. Expression of CAF-related proteins in the stroma differed depending on breast cancer molecular subtypes. All CAF-related protein expression was high (p < 0.05) in HER-2 type, whereas in luminal A, the expression of FAPα, PDGFα, PDGFß, and NG2 was low, and in TNBC, the expression of podoplanin, prolyl 4-hydroxylase, and S100A4 was low. In the stromal component, CAF-related protein expression differed according to stromal phenotype (p < 0.001). The desmoplastic type showed high expression of podoplanin, prolyl 4-hydroxylase, S100A4, PDGFRα, and PDGFRß, whereas the sclerotic type exhibited low expression of FAPα, PDGFα, PDGFß, and NG2. The inflammatory type had high expression of FAPα and NG2 with low podoplanin, while normal-like type showed low expression of prolyl 4-hydroxylase and S100A4. Our results suggested that differential CAF-related protein expression depended on the molecular subtypes and stromal histologic features of breast cancer, indicating that in the future, this system could potentially use these markers for prognosis prediction and targeted therapy of breast cancer.

"Let's Get This Party Started!": An Analysis of Health Risk Behavior on MTV Reality Television Shows.

Past research has examined portrayals of risk behavior in various media, including television, advertising, and film. To address an underexplored area, this study analyzed drinking, smoking, and sexual activities in MTV reality programming popular among adolescent viewers from 2004 to 2011. Cast members' demographic attributes were also examined in relation to their risk behaviors. Results demonstrated that drinking and casual sexual behaviors were pervasive among cast members. Smoking and more intense sexual behaviors were also present, but to a smaller degree. Men and young adult cast members were more likely to engage in risk behaviors than women and teenage cast members. Also, ethnic/racial minority characters were shown drinking more often than were White cast members. Interpretations of these findings are discussed based in social cognitive theory and the concept of super peers. Implications for future research are provided.

Hox proteins coordinate peripodial decapentaplegic expression to direct adult head morphogenesis in Drosophila.

The Drosophila BMP, decapentaplegic (dpp), controls morphogenesis of the ventral adult head through expression limited to the lateral peripodial epithelium of the eye-antennal disc by a 3.5 kb enhancer in the 5' end of the gene. We recovered a 15 bp deletion mutation within this enhancer that identified a homeotic (Hox) response element that is a direct target of labial and the homeotic cofactors homothorax and extradenticle. Expression of labial and homothorax are required for dpp expression in the peripodial epithelium, while the Hox gene Deformed represses labial in this location, thus limiting its expression and indirectly that of dpp to the lateral side of the disc. The expression of these homeodomain genes is in turn regulated by the dpp pathway, as dpp signalling is required for labial expression but represses homothorax. This Hox-BMP regulatory network is limited to the peripodial epithelium of the eye-antennal disc, yet is crucial to the morphogenesis of the head, which fate maps suggest arises primarily from the disc proper, not the peripodial epithelium. Thus Hox/BMP interactions in the peripodial epithelium of the eye-antennal disc contribute inductively to the shape of the external form of the adult Drosophila head.

Super-resolution track-density imaging of thalamic substructures: comparison with high-resolution anatomical magnetic resonance imaging at 7.0T.

The thalamus is one of the most important brain structures, with strong connections between subcortical and cortical areas of the brain. Most of the incoming information to the cortex passes through the thalamus. Accurate identification of substructures of the thalamus is therefore of great importance for the understanding of human brain connectivity. Direct visualization of thalamic substructures, however, is not easily achieved with currently available magnetic resonance imaging (MRI), including ultra-high field MRI such as 7.0T, mainly due to the limited contrast between the relevant structures. Recently, improvements in ultra-high field 7.0T MRI have opened the possibility of observing thalamic substructures by well-adjusted high-resolution T1 -weighted imaging. Moreover, the recently developed super-resolution track-density imaging (TDI) technique, based on results from whole-brain fiber-tracking, produces images with sub-millimeter resolution. These two methods enable us to show markedly improved anatomical detail of the substructures of the thalamus, including their detailed locations and directionality. In this study, we demonstrate the role of TDI for the visualization of the substructures of the thalamic nuclei, and relate these images to T1-weighted imaging at 7.0T MRI.

Seven-Tesla magnetic resonance images of the substantia nigra in Parkinson disease.

OBJECTIVE: To investigate anatomical changes in the substantia nigra (SN) of Parkinson disease (PD) patients with age-matched controls by using ultra-high field magnetic resonance imaging (MRI). METHODS: We performed 7T MRI in 10 PD and 10 age-matched control subjects. Magnetic resonance images of the SN were obtained from a 3-dimensional (3D) T(2)*-weighted gradient echo sequence. Region of interest-based 3D shape analysis was performed to quantitatively compare images from the 2 groups. RESULTS: The boundary between the SN and crus cerebri was not smooth in PD subjects. Undulation in the lateral surface of the SN appeared more intense in the side contralateral to that with the more severe symptoms, and more prominent at the rostral level of the SN than at the intermediate or caudal levels. In addition to the lateral surface, there was a striking difference in the dorsomedial aspects of the SN between PD and control subjects. In control subjects, a brighter signal region was observed along the dorsomedial surface of the lateral portion of SN, whereas in PD subjects, this region was observed as a dark region containing a hypointense signal in T(2)*-weighted images. The measurement of SN volumes, normalized to the intracranial volumes, showed higher values in PD subjects than in control subjects. INTERPRETATION: This study demonstrates that 3D 7T MRI can definitively visualize anatomical alterations occurring in the SN of PD subjects. Further pathological studies are required to elucidate the nature of these anatomical alterations.

Social media intervention for promoting breastfeeding among WIC participants.

Social media have emerged as a promising communication channel for promoting breastfeeding among a new generation of mothers. Yet, there is no published study reporting the effects of a large-scale social media intervention on key breastfeeding-related perceptions, attitudes, and behaviors. As a component of its breastfeeding promotion campaign, the Women, Infants, and Children (WIC) program implemented a 12-month intervention using Facebook and Instagram and subsequently evaluated the outcomes by surveying WIC-participating women (N = 832) twice, immediately before and after the intervention. Based on their level of exposure to the intervention messages, the women were retrospectively classified into two groups, resulting in a two-group (no-low exposure vs. medium-high exposure) quasi-experiment. Women in the medium-high exposure group, in comparison with women in the no-low exposure group, exhibited higher campaign awareness (p < .001), visits to the campaign website (p < .001), and engagement with the website content (p < .001). They also reported more positive breastfeeding attitudes (M = 17.26 vs. M = 16.51, p < .05), self-efficacy (M = 54.48 vs. M = 49.94, p < .01), and social support (M = 27.37 vs. M = 25.11, p < .001). But they did not differ from women in the no-low exposure group in breastfeeding initiation (p > .05) and duration (p > .05). In conclusion, a social media-based intervention resulted in more positive breastfeeding attitudes, higher self-efficacy, and higher perceived social support. Future studies need to investigate the optimal level of intervention message dosage that prompts significant behavioral changes.

Gender differences in the risk and protective factors of marijuana use among U.S. College students.

Gender differences in the risk and protective factors of marijuana use among college students were explored by analyzing online survey responses from 464 undergraduates. Women perceived higher risk and used marijuana less than men, with no gender difference in peer disapproval. In addition, women had higher objective knowledge regarding the health effects of marijuana, although they exhibited lower confidence in their knowledge. In subsequent regression analyses, health knowledge, confidence in knowledge, perceived risk, and peer disapproval predicted women's marijuana use, whereas only confidence in knowledge and perceived risk predicted men's use. These findings can help devise effective intervention strategies.

Patient-Centered Care and Healthcare Consumerism in Online Healthcare Service Advertisements: A Positioning Analysis.

Patient-centered care and healthcare consumerism are the two most dominant ideas about the relationship between patients and providers in the United States. To identify providers' positions between the two perspectives, we analyzed the content of direct-to-consumer healthcare service advertisements. The advertisements were collected in the state of Nevada (N = 323) and their landing pages were analyzed for provider attributes, patient experience features, and terms referring to patients and providers. The results showed that the advertisements fully embraced the notion of patient-centeredness by commonly claiming patient-centered care and frequently using the term "patient." The advertisements also contained multiple indicators of healthcare consumerism, although they avoided using the terms "consumer/customer/client" closely associated with consumerism. Contrary to the prominence of patient experience features, provider attributes were not common. An additional analysis of inter-specialty differences in advertising features confirmed the strong consumerism position of cosmetic surgery providers. Application of the healthcare service advertising analytic scheme developed for this study could help providers and healthcare administrators recognize how their advertising messages may reflect their values.