How to Account for Asymmetries in Deliberative Dialogues Comment on "Evaluating Public Participation in a Deliberative Dialogue: A Single Case Study".

In health policy-making, various deliberative mechanisms can be used to engage the members of the public in exploring what might be a reasonable course of action. Scurr et al take power dynamics into consideration to analyse a deliberative dialogue involving stakeholders with diverse points of view. Given such asymmetries at play, the conclusions of deliberations could be biased. Scholars would benefit from guidance on designing and evaluating deliberative processes. This commentary aims to broadly reflect on the possible sources of power and information asymmetries in deliberative dialogues, and to bring the biographical resources approach to deal with such asymmetries.

[COVID-19 on migrants and ethnic minorities]. / COVID-19 en migrantes y minorías étnicas.

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.

Gender Differences in Social Support Received by Informal Caregivers: A Personal Network Analysis Approach.

Social support is an important predictor of the health of a population. Few studies have analyzed the influence of caregivers' personal networks from a gender perspective. The aim of this study was to analyze the composition, structure, and function of informal caregiver support networks and to examine gender differences. It also aimed to explore the association between different network characteristics and self-perceived health among caregivers. We performed a social network analysis study using a convenience sample of 25 female and 25 male caregivers. A descriptive analysis of the caregivers and bivariate analyses for associations with self-perceived health were performed. The structural metrics analyzed were density; degree centrality mean; betweenness centrality mean; and number of cliques, components, and isolates. The variability observed in the structure of the networks was not explained by gender. Some significant differences between men and women were observed for network composition and function. Women received help mainly from women with a similar profile to them. Men's networks were broader and more diverse and they had more help from outside family circles, although these outcomes were not statistically significant. Our results indicate the need to develop strategies that do not reinforce traditional gender roles, but rather encourage a greater sharing of responsibility among all parties.

Information needs and Internet use in urological and breast cancer patients.

AIMS: This study aims to describe the information needs of urological and breast cancer patients and factors related to use of the Internet as a source of health information. METHODOLOGY: A cross-sectional descriptive study was carried out, using individual questionnaire-based interviews held during the oncology appointments of 169 patients with urological cancer and 100 with breast cancer at the Virgen de las Nieves University Hospital in Granada, Spain. The variables studied were use of the Internet as a source of health information, health status, patient's role in the decision-making process, information sources, satisfaction with the health-care system, type of information received, and Internet use. A multivariate logistic regression analysis was carried out. RESULTS: Breast cancer patients are more concerned with long-term results and the effects on their family and personal life. They are also interested in the experiences of other patients and support groups or staff who could help them to cope with their illness. The information needs of patients with urological cancer are linked to short-term alternative treatments, their sex life, keeping healthy, and exercise. More clinical aspects, such as tests and experiments linked to their treatment, are not a frequent information need. The factors linked to use of the Internet as a source of health information are younger age, high level of education, the patient's active role in the decision-making process, and undergoing more aggressive treatment. There is no link between using the Internet as a source of health information and level of satisfaction with the health-care system, or with Internet use in general. CONCLUSION: Patients need additional information about their illness on top of that given to them by health-care staff, and they often use the Internet to find it. The greatest information need is related to the effects of their illness on their day-to-day life. Health-care staff should provide patients with advice about reliable websites and how to search the Internet.

Use of social media by Spanish hospitals: perceptions, difficulties, and success factors.

This exploratory study has two aims: (1) to find out if and how social media (SM) applications are used by hospitals in Spain and (2) to assess hospital managers' perception of these applications in terms of their evaluation of them, reasons for use, success factors, and difficulties encountered during their implementation. A cross-sectional survey has been carried out using Spanish hospitals as the unit of analysis. Geographical differences in the use of SM were found. Social networks are used most often by larger hospitals (30% by medium-size, 28% by large-size). They are also more frequently used by public hospitals (19%, p<0.01) than by private ones. Respondents with a negative perception of SM felt that there is a chance they may be abused by healthcare professionals, whereas those with a positive perception believed that they can be used to improve communication both within and outside the hospital. Reasons for the use of SM include the idea of maximizing exposure of the hospital. The results show that Spanish hospitals are only just beginning to use SM applications and that hospital type can influence their use. The perceptions, reasons for use, success factors, and difficulties encountered during the implementation of SM mean that it is very important for healthcare professionals to use SM correctly and adequately.

Factors related to use of the Internet as a source of health information by urological cancer patients.

AIMS: The aims of this study were to describe the profile of urological cancer patients who look for health information on the Internet and to analyse the factors related to use of the Internet as a source of health information. METHODOLOGY: A cross-sectional descriptive study using individual, semi-structured, questionnaire-based interviews was carried out in oncology clinics in a hospital in Granada (Spain) in a sample group of 169 patients with prostate, bladder and kidney cancer. The dependent variable was use of the Internet as a source of health information. The independent variables were sociodemographic variables, health status, relationship with healthcare services, patient's role in decision-making process, satisfaction with healthcare, Internet use, Internet skills and attitude. Data analyses include descriptive, bivariate and multivariate analyses. RESULTS: Of the patients in the sample group, 72.2 % had prostate cancer, 19.4 % had bladder cancer and 8.3 % had kidney cancer. Only 11.2 % of patients in the group used the Internet as a source of health information. These patients were typically men of an average age of 62 years, who live in urban areas, who have completed secondary or university education, with a high income and who usually share the role of decision maker with their doctor. Patients who use the Internet as a source of health information usually look for support from psychological support groups, have family members who also look for information on the Internet and prefer sources of information other than those provided by the health services. CONCLUSIONS: The study outlines the profile of urological cancer patients who use the Internet as a source of health information. Internet use is related to a patient's attitude towards decision making, level of education and whether or not they look for information from sources other than the health system itself.

Use of the internet as a source of health information by Spanish adolescents.

BACKGROUND: The Internet is a fundamental part of the daily life of adolescents, they consider it as a safe and confidential source of information on health matters. The aims is to describe the experience of Spanish adolescents searching for health information on the Internet. METHODS: A cross-sectional study of 811 school-age adolescents in Granada was carried out. An adapted and piloted questionnaire was used which was controlled by trained personnel. Sociodemographic and health variables were included together with those concerning the conditions governing access to and use of information and communication technologies (ICT). RESULTS: 811 adolescents were surveyed (99.38% response rate), mean age was 17 years old. Of these, 88% used the Internet; 57.5% used it on a daily or weekly basis and 38.7% used it occasionally. Nearly half the sample group (55.7%) stated that they used the Internet to search for health-related information. The main problems reported in the search for e-health were the ignorance of good web pages (54.8%) and the lack of confidence or search skills (23.2%). CONCLUSIONS: In conclusion, it seems plausible to claim that websites designed and managed by health services should have a predominant position among interventions specifically addressed to young people.

Sex differences in the use of the Internet as a source of health information among adolescents.

BACKGROUND: The Internet is a fundamental part of the day-to-day lives of adolescents. Faced with the difficulties of accessing conventional health services, adolescents use the Internet as a confidential and safe means of accessing information about health issues. OBJECTIVES: To describe sex differences in the way in which adolescents search for health information on the Internet. METHODS: Cross-sectional survey with a questionnaire administered by an interviewer. Sociodemographic and health variables and those related to the conditions of access and use of information and communication technologies were gathered (multivariate analysis). RESULTS: About 823 school-age youths were interviewed (21 questionnaires were discarded due to low quality), among whom 54.1% were girls and 46% were boys. The girls had a lower self-assessed level of health than the boys. About 86.5% of the girls used the Internet, compared with 89.9% of the boys (p = 0.155). About 21.7% and 48.3% of the boys used it daily/weekly and occasionally, respectively, compared with 17.9% and 59.1% of the girls who used it daily/weekly and occasionally, respectively. The multivariate analysis shows that girls (odds ratio [OR], 1.709; 95% confidence interval [CI], 1.277-2.287), those in their last year of secondary school (OR, 1.369; 95% CI, 1.025-1.830) and those who had visited the doctor most often the previous year (OR, 1.061; 95% CI, 1.017-1.107), were statistically significantly more likely to search for health information on the Internet. CONCLUSION: Adolescent girls tend to seek more information about health than boys and there are differences in the way in which these girls search for health information on the Internet. The Internet provides adolescents, especially adolescent girls, with an opportunity for relaying health recommendations.

[Accessibility of web sites on health for the elderly]. / Accesibilidad de sitios web sobre salud para mayores.

BACKGROUND: The development and dissemination of the Internet offers new opportunities to meet the needs of older people. To develop this potential, access to the available resources must be guaranteed. Our aims are: (1) To identify web sites in Spanish with information on healthcare for older adults and (2) to assess the accessibility of the web sites selected. INSTRUMENTS AND METHODS: We performed a descriptive study of compliance with accessibility criteria among web sites on healthcare for the elderly. To select the sites with health information aimed at older people, a search method with keywords was used in two of the major Internet search engines. The descriptive study was carried out by using a specially-designed questionnaire. The web sites were independently evaluated by three evaluators. The dimensions studied were visual, motor, cognitive, auditory and global factors. Accessibility A, AA and AAA was evaluated with the TAW test. A descriptive analysis of compliance was carried out and the kappa coefficient was estimated to evaluate the concordance between evaluators (Fleiss' criteria), while the number of errors was calculated according to the TAW criteria. RESULTS: A list of 35 web sites was created. Most of the web sites had a Spanish web hosting provider (74.3%), two sites were from United States (5.7%) and the remainder were from Latin America (Cuba 1, Argentina 2, Mexico 2 and Uruguay 1). A high degree of accessibility was found for the IMSERSO Portal, the Disc@PNET portal, the section on public health protection of the Spanish Ministry of Health web site and the Community of Madrid web site. Fourteen web sites complied with more than 42% of the items evaluated. The dimension with the lowest compliance was cognitive features. When the TAW tool was applied, only the IMSERSO web site fulfilled all the criteria A, AA and AAA. CONCLUSIONS: The present study obtained a accessibility ranking of web sites with information on health for seniors. Accessibility level varied among these web sites.

[Adherence to codes of conduct for biomedical information on the internet in useful websites for pharmacotherapy follow-up]. / Adecuación a los códigos de conducta para información biomédica en internet de sitios web útiles para el seguimiento farmacoterapéutico.

OBJECTIVES: To assess adherence to four codes of conduct in websites providing information useful for pharmacotherapy follow-up. METHODS: We performed a descriptive study of adherence to quality criteria in 19 websites. These sites had been identified in a previous study as being those most frequently used by pharmacists. A descriptive analysis was performed and the kappa coefficient was calculated to evaluate interrater concordance (Fleiss' criteria for evaluation of the kappa index). RESULTS: The most highly rated source of clinical practice guidelines and that which adhered most closely to the 4 codes of conduct was Fisterra. The websites most highly rated in reviews and secondary sources were the Cochrane Library and PubMed. The most highly rated journals were JAMA and the BMJ, followed by Atención Primaria and Medicina Clínica. Among drug information guides, the highest scores were obtained by BOT and Martindale's. The highest rated drug bulletins were the Boletín Terapéutico Andaluz and Butlletí Groc. The most highly rated agency was the World Health Organization. The journals with the lowest scores were Pharmaceutical Care and Seguimiento Farmacoterapéutico followed by the Spanish Internacional Vademecum MediMedia-Medicom. According to Fleiss's criteria, interrater concordance was acceptable for the 4 codes. CONCLUSIONS: The quality of the web sites evaluated varied widely, although most received scores of more than 60 points (out of 100) in the 4 codes of conduct used for evaluation.

[Questionnaire to evaluate health web sites according to European criteria]. / Cuestionario para evaluar sitios web sanitarios según criterios europeos.

OBJECTIVES: To design a questionnaire to evaluate compliance with quality criteria on health web sites and to analyse its reliability. DESIGN: A descriptive study on the reliability of a questionnaire. PARTICIPANTS: Twenty web sites on health topics. SETTING: Internet. MAIN MEASUREMENTS: The questionnaire was based on analysis of content of the criteria of the e-Europe 2002 code of conduct, comparing these with the criteria underlying the AMA, the Summit code and the e-Health Code of Ethics regulations and current directives. The dimensions studied were transparency, absence of conflicts of interest, authorship, data protection, updating, accountability, and accessibility. A preliminary questionnaire was drawn up for a pilot test conducted by 3 researchers for 20 web sites, its reliability was appraised, adjustments were made and the definitive questionnaire was designed. Reliability was evaluated again for 26 web sites evaluated by 3 researchers. To evaluate concordance in the answers of the participants, Cohen's Kappa index with a 95% confidence level was used. RESULTS: All the quality directives of e-Europe 2002, the European regulations and relevant points from other questionnaires were included in the questionnaire designed. Reliability was acceptable (kappa > or = 0.60) for 12 of the 18 quality criteria included. The least concordant aspects of the questionnaire were information update (kappa = 0.310) and accessibility (search for contents and access for persons with disability). CONCLUSIONS: Reliability of the questionnaire designed was acceptable.