Scale-free networks are rare.

Real-world networks are often claimed to be scale free, meaning that the fraction of nodes with degree k follows a power law k-α, a pattern with broad implications for the structure and dynamics of complex systems. However, the universality of scale-free networks remains controversial. Here, we organize different definitions of scale-free networks and construct a severe test of their empirical prevalence using state-of-the-art statistical tools applied to nearly 1000 social, biological, technological, transportation, and information networks. Across these networks, we find robust evidence that strongly scale-free structure is empirically rare, while for most networks, log-normal distributions fit the data as well or better than power laws. Furthermore, social networks are at best weakly scale free, while a handful of technological and biological networks appear strongly scale free. These findings highlight the structural diversity of real-world networks and the need for new theoretical explanations of these non-scale-free patterns.

Practicing what they preach: health behaviors of those who provide health advice to extensive social networks.

As a way of identifying a conduit to disseminate health information, this study aims to explore health behaviors and attitudes of a unique group of extensively socially-networked individuals who regularly are asked for their health advice. Respondents from a population-based consumer opinion panel (n = 2,639) were categorized as "extensively socially-networked" (75+ friends and acquaintances, and almost daily giving friends advice on general issues) vs. "non-networked." The networked respondents were further divided into "health-networked" (regularly asked for health advice) versus "only-socially-networked" groups (asked for general advice, not health). Chi-square analyses, ANOVA tests, and multivariate regressions controlling for sociodemographic variables compared health behaviors and attitudes between groups. Results indicated that health-networked individuals reported more positive health behaviors (e.g., fruit and vegetable consumption) and attitudes than only-socially-networked and non-networked individuals. Future research is warranted to elucidate how providing health advice to a large network contributes to the positive health of health-networked individuals. Exploratory analyses revealed that doctors and health/fitness magazines were main sources of health and nutrition information for health-networked respondents. Through their advice and word-of-mouth, health-networked individuals have the potential to influence the health information of large groups of people and, therefore, may serve as valuable change agents to disseminate health and nutrition information.

Incidental health information use on the Internet.

This study investigates the correlates of incidental or nonpurposive health information use on the Internet. Through a secondary analysis of the Health Information National Trends Survey II data, this study reveals that incidental health information use on the Internet is positively associated with overall Internet use, active health information seeking on the Internet, and incidental health information use from traditional media. Thus, this study extends the notion of media complementarity to incidental media usage in a health communication context. This study also reveals that adults who have been diagnosed with cancer are more likely to have incidental health information use from traditional media but not the Internet. More important, this study suggests that incidental health information use on the Internet is positively associated with health knowledge. The findings have important implications for health information campaigns on the Internet.

Public reporting in health care: how do consumers use quality-of-care information? A systematic review.

BACKGROUND: One of the underlying goals of public reporting is to encourage the consumer to select health care providers or health plans that offer comparatively better quality-of-care. OBJECTIVE: To review the weight consumers give to quality-of-care information in the process of choice, to summarize the effect of presentation formats, and to examine the impact of quality information on consumers' choice behavior. The evidence is organized in a theoretical consumer choice model. DATA SOURCES: English language literature was searched in PubMed, the Cochrane Clinical Trial, and the EPOC Databases (January 1990-January 2008). STUDY SELECTION: Study selection was limited to randomized controlled trails, controlled before-after trials or interrupted time series. Included interventions focused on choice behavior of consumers in health care settings. Outcome measures referred to one of the steps in a consumer choice model. The quality of the study design was rated, and studies with low quality ratings were excluded. RESULTS: All 14 included studies examine quality information, usually CAHPS, with respect to its impact on the consumer's choice of health plans. Easy-to-read presentation formats and explanatory messages improve knowledge about and attitude towards the use of quality information; however, the weight given to quality information depends on other features, including free provider choice and costs. In real-world settings, having seen quality information is a strong determinant for choosing higher quality-rated health plans. CONCLUSIONS: This review contributes to an understanding of consumer choice behavior in health care settings. The small number of included studies limits the strength of our conclusions.

Energy, climate, food and health.

On June 3-5, 2008, international organizations and heads of state met in Rome to discuss the critical situation in global food supplies and prices during the World Food Crisis Summit. The intent of this column is to provide approaches to identifying the complex issues that impact public health, public safety, and nutrition on a global basis. The Web sites selected provide a background for the complex issues involved (energy, climate and environment, agriculture, and politics) and reveal controversial and competing agendas with many far-reaching implications.

Categorization of services for seeking information in biomedical literature: a typology for improvement of practice.

Biomedical researchers have to efficiently explore the scientific literature, keeping the focus on their research. This goal can only be achieved if the available means for accessing the literature meet the researchers' retrieval needs and if they understand how the tools filter the perpetually increasing number of documents. We have examined existing web-based services for information retrieval in order to give users guidance to improve their everyday practice of literature analysis. We propose two dimensions along which the services may be categorized: categories of input and output formats; and categories of behavioural usage. The categorization would be helpful for biologists to understand the differences in the input and output formats and the tasks they fulfil in information-retrieval activities. Also, they may inspire future bioinformaticians to further innovative development in this field.

Research use and support needs, and research activity in social care: a cross-sectional survey in two councils with social services responsibilities in the UK.

The purpose of this study was to investigate the level of research activity, research use, research interests and research skills in the social care workforce in two UK councils with social service responsibilities (CSSRs). A cross-sectional survey was conducted of the social care workforce in two CSSRs (n = 1512) in 2005. The sample was identified in partnership with the councils, and included employees with professional qualifications (social workers and occupational therapists); staff who have a role to assess, plan and monitor care; service managers; commissioners of services; and those involved with social care policy, information management and training. The survey achieved a response rate of 24% (n = 368). The Internet was reported as an effective source of research information; conversely, research-based guidelines were reported to have a low impact on practice. Significant differences were found in research use, by work location, and postgraduate training. Most respondents saw research as useful for practice (69%), and wanted to collaborate in research (68%), but only 11% were planning to do research within the next 12 months. Having a master's degree was associated with a greater desire to lead or collaborate in research. A range of research training needs, and the preferred modes of delivery were identified. Support to increase research activity includes protected time and mentorship. The study concludes that a range of mechanisms to make research available for the social care workforce needs to be in place to support evidence-informed practice. Continual professional development to a postgraduate level supports the use and production of evidence in the social care workforce, and promotes the development of a research culture. The term research is used to include service user consultations, needs assessment and service evaluation. The findings highlight a relatively large body of the social care workforce willing to collaborate and conduct research. Councils and research support systems need to be developed to utilise this relatively untapped potential.

How do general practitioners assess the criteria for due care for euthanasia in concrete cases?

OBJECTIVE: In the Netherlands the law states that physicians are allowed to grant a request for euthanasia or physician-assisted suicide (EAS) if specific criteria for due care are met. This study investigated which sources physicians use to determine whether three of these criteria (unbearable and hopeless suffering, and no realistic alternatives for treatment) are met. METHODS: The data were collected for the project Support and Consultation on Euthanasia in the Netherlands. General practitioners (GPs) received a written questionnaire concerning the most recent request for EAS that they had received. Of the 3614 (60%) GPs who returned the questionnaire, 1681 described the most recent request for EAS. RESULTS: The study shows that physicians used different types of sources, and more than one source, to determine whether the criteria were met. More sources were used when the criteria were met or when a request resulted in EAS. The determination of every criterion required a different approach, but for all criteria discussions with colleagues were important. CONCLUSIONS: Using less sources when a criterion is not met could possibly lead to less extensive consideration of the criteria, and therefore to assessing too easily that the request does not meet the criteria for due care.

Perceptions of traditional information sources and use of the world wide web to seek health information: findings from the health information national trends survey.

As medical information becomes increasingly available and individuals take a more active role in managing their personal health, it is essential for scholars to better understand the general public's information-seeking behavior. The study reported here explores the use of the World Wide Web to seek health information in a contemporary information-media environment. Drawing from uses and gratifications theory and the comprehensive model of health information seeking, perceptions of traditional information sources (e.g., mass media, one's health care provider, etc.) are posited to predict use of the Web to seek health information and perceptions of information acquired from searches. Data from the Health Information National Trends Survey (HINTS; N = 3982) were analyzed to test study hypotheses. Trust in information-oriented media, entertainment-oriented media, and one's health care provider all predicted Web use behavior and perceptions. The implications of the findings for research on information seeking and the role of the Web in patient empowerment are discussed.

Assessing the content and quality of information on the treatment of postmenopausal osteoporosis on the World Wide Web.

OBJECTIVE: To evaluate the content and quality of currently available Internet-based information on the treatment of postmenopausal osteoporosis. DESIGN: A sample was obtained comprising the 75 top sites retrieved with the Google search engine using 'treatment of postmenopausal osteoporosis' and then evaluated according to predefined general and specific criteria, content type, language and quality. Using a systematic scoring tool, each site was assessed for factual information provided and site quality. RESULTS: The sites studied were heterogeneous in content and quality. The most frequent type of website corresponded to non-profit organizations (n = 40), followed by commercial sites (n = 19), professional sites (n = 8) and government sites (n = 8). There were no significant differences in the popularity index, medical content score or quality score among the four groups of sites. Twelve websites were papers published in peer-reviewed medical journals. Few sites provided comprehensive medical and complete information on the treatment of postmenopausal osteoporosis oriented towards consumers. The consumer-oriented webpage with the most balanced and complete information was that of the National Osteoporosis Foundation which, at the same time, had the highest popularity index of all the resources studied. CONCLUSION: The content and quality of websites concerning the treatment of postmenopausal osteoporosis are highly varied and sometimes biased. The most frequent high-quality information corresponds to peer-reviewed medical journals. It is necessary to increase the number of resources, with rigorous language that is understandable for consumers, in relation to the treatment of postmenopausal osteoporosis.

Sources of health information among Vietnamese American men.

Vietnamese American men face multiple health disparities compared to white men. Our study objective was to determine the sources of health information used by Vietnamese men in the United States. A population-based, in-person survey was conducted among Vietnamese men in Seattle during 2002. Our survey was completed by 509 Vietnamese men (79% response rate). The most commonly reported sources of health information included Vietnamese newspapers/magazines (73%), Vietnamese and English language television (64% and 67%, respectively), Vietnamese radio (51%), and friends and family members (51% and 63%, respectively). We found that sources of health information varied significantly among sociodemographic subgroups of the Vietnamese male population. Sources of health information among Vietnamese American men differ considerably from other racial/ethnic groups. Research findings should be used to guide the development of health education interventions for Vietnamese men and subgroups within the Vietnamese male population.

Knowledge in the Palm of your hands: PDAs in the clinical setting.

OBJECTIVE: To explore the impact of hand-held computers on patient care by identifying: (i) how often clinical staff accessed resources on hand-held computers to inform their clinical decision making; (ii) Which hand-held resources were thought to be most useful in the clinical setting; (iii) the barriers to using hand-held resources to support patient care. DESIGN: A descriptive study comparing aspects of Personal Digital Assistant (PDA) resource use in two phases, between August 2002 and December 2003. There was variability in the way that resources were accessed between the two studies. SETTING: University Hospitals of Leicester NHS Trust, an acute teaching hospital, and one primary care practice. PARTICIPANTS: A purposive sample of 14 clinical and librarian staff participated in phase one and 14 in phase two of the study. Participants consisted of consultants, nurses, pharmacist, junior doctors, clinical librarians, and a general practitioner. MAIN OUTCOME MEASURES: Baseline Data Questionnaire to identify the participants' level of knowledge and use of hand-helds on entering the study. End-of-phase questionnaire with self-reported measures of use of the hand-held and PDA resources during the study. RESULTS: All of the participants used hand-helds in their clinical setting to support evidence-based practice and education, but with varying frequency. More staff reported using the hand-held to answer specific patient questions in phase two than phase one of the study. UK resources were preferred to American resources. The 'plug-in and go' method using Secure Digital (SD) cards was preferred to downloading resources from the Internet. CONCLUSIONS: Hand-held technology is emerging as an effective clinical tool to aid evidence-based practice and support the educational needs of clinical staff. The hand-held can provide a critical mass of information that is relevant, quickly accessible and in a coherent format: delivering clinical information at the point of need with a resulting benefit to patient safety.

Severe acute respiratory syndrome (SARS): knowledge, attitudes, practices and sources of information among physicians answering a SARS fever hotline service.

In June 2003, Taiwan introduced a severe acute respiratory syndrome (SARS) telephone hotline service to provide concerned callers with rapid access to information, advice and appropriate referral where necessary. This paper reports an evaluation of the knowledge, attitude, practices and sources of information relating to SARS among physicians who staffed the SARS fever hotline service. A retrospective survey was conducted using a self-administered postal questionnaire. Participants were physicians who staffed a SARS hotline during the SARS epidemic in Taipei, Taiwan from June 1 to 10, 2003. A response rate of 83% was obtained. All respondents knew the causative agent of SARS, and knowledge regarding SARS features and preventive practices was good. However, only 54% of respondents knew the incubation period of SARS. Hospital guidelines and news media were the major information sources. In responding to two case scenarios most physicians were likely to triage callers at high risk of SARS appropriately, but not callers at low risk. Less than half of all respondents answered both scenarios correctly. The results obtained suggest that knowledge of SARS was generally good although obtained from both medical and non-medical sources. Specific knowledge was however lacking in certain areas and this affected the ability to appropriately triage callers. Standardized education and assessment of prior knowledge of SARS could improve the ability of physicians to triage callers in future outbreaks.

Information resource preferences by general pediatricians in office settings: a qualitative study.

BACKGROUND: Information needs and resource preferences of office-based general pediatricians have not been well characterized. METHODS: Data collected from a sample of twenty office-based urban/suburban general pediatricians consisted of: (a) a demographic survey about participants' practice and computer use, (b) semi-structured interviews on their use of different types of information resources and (c) semi-structured interviews on perceptions of information needs and resource preferences in response to clinical vignettes representing cases in Genetics and Infectious Diseases. Content analysis of interviews provided participants' perceived use of resources and their perceived questions and preferred resources in response to vignettes. RESULTS: Participants' average time in practice was 15.4 years (2-28 years). All had in-office online access. Participants identified specialist/generalist colleagues, general/specialty pediatric texts, drug formularies, federal government/professional organization Websites and medical portals (when available) as preferred information sources. They did not identify decision-making texts, evidence-based reviews, journal abstracts, medical librarians or consumer health information for routine office use.In response to clinical vignettes in Genetics and Infectious Diseases, participants identified Question Types about patient-specific (diagnosis, history and findings) and general medical (diagnostic, therapeutic and referral guidelines) information. They identified specialists and specialty textbooks, history and physical examination, colleagues and general pediatric textbooks, and federal and professional organizational Websites as information sources. Participants with access to portals identified them as information resources in lieu of texts. For Genetics vignettes, participants identified questions about prenatal history, disease etiology and treatment guidelines. For Genetics vignettes, they identified patient history, specialists, general pediatric texts, Web search engines and colleagues as information sources. For Infectious Diseases (ID) vignettes, participants identified questions about patients' clinical status at presentation and questions about disease classification, diagnosis/therapy/referral guidelines and sources of patient education. For ID vignettes, they identified history, laboratory results, colleagues, specialists and personal experience as information sources. CONCLUSION: Content analysis of office-based general pediatricians' responses to clinical vignettes provided a qualitative description of their perceptions of information needs and preferences for information resource for cases in Genetics and Infectious Diseases. This approach may provide complementary information for discovering practitioner's information needs and resource preferences in different contexts.

Meeting the public's cancer information needs: characteristics of callers to the National Cancer Information Center of the American Cancer Society.

BACKGROUND: In this study, we describe the characteristics of the callers of the American Cancer Society's National Cancer Information Center (NCIC), why they called, how they learned about NCIC, and their satisfaction. METHODS: A random sample of callers (N = 19,487) completed a telephone survey. RESULTS: The majority were female, White, 45 to 74 years old, had incomes greater than 35,001 dollars, and were college educated. They learned about the NCIC through TV advertisements and requested information about specific cancers, local programs, or making donations. CONCLUSIONS: These findings validate the usefulness of the NCIC and are helpful in identifying and targeting persons who do not routinely use this service.

Endometriosis: internet resources.

Endometriosis is a puzzling disease characterized by pelvic pain, infertility, allergies, fatigue, and bowel problems. It is a non-lethal medical condition that disables only women and frustrates physicians who are frequently limited in their treatment success. Recently endometriosis has been linked with endocrine, environmental, genetic, and immune factors. The public health impact of endometriosis is significant in terms of suffering, lost income, infertility, stress on families, and medical costs. Resources for endometriosis on the Internet include search engines, medical sources, advocacy sources, U.S. government sources, personal Web sites, public library databases, and social science sources.

The information requirements of people with cancer: where to go after the "patient information leaflet"?

Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.

Guide of internet sites for the study of cardiology.

OBJECTIVE: To increase the offer of didactic resources for medical students, physicians, and health care professionals, stimulating the use of the Internet for academic purposes or cardiological updating. METHOD: Electronic addresses with academic content in the areas of anatomy, biophysics, physiology, semiology, electrocardiography, and image diagnosis were researched and selected. The selection criteria included the following: relevance of the content, neatness of presentation, and richness of animation resources. The sites obtained were classified in regard to their contents and academic level. RESULTS: The sites obtained were as follows: 5 sites of anatomy and anatomical pathology, one of biophysics, 3 of physiology, 8 of semiology, 7 of image diagnosis, and 2 of electrocardiography. The sites were also organized according to academic level to provide an alternative access. The set of addresses resulted in a simplified and hierarchic guide of contents for the study of cardiac morphology and image diagnosis in cardiology. CONCLUSION: The resulting list of sites is an example of the potential of the Internet as a learning instrument to be used in association with other conventional pedagogical methods.

Prospective evaluation of an internet-linked handheld computer critical care knowledge access system.

INTRODUCTION: Critical care physicians may benefit from immediate access to medical reference material. We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit (ICU) to multiple community-based ICUs. METHODS: Four community hospital ICUs with 17 physicians participated in this prospective interventional study. Following training in the use of an internet-linked, updateable handheld computer knowledge access system, the physicians used the handheld devices in their clinical environment for a 12-month intervention period. Feasibility of the system was evaluated by tracking use of the handheld computer and by conducting surveys and focus group discussions. Before and after the intervention period, participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed, as well as the speed and quality of their decision making. Participants generated admission orders during each scenario, which were scored by blinded evaluators. RESULTS: Ten physicians (59%) used the system regularly, predominantly for nonmedical applications (median 32.8/month, interquartile range [IQR] 28.3-126.8), with medical software accessed less often (median 9/month, IQR 3.7-13.7). Eight out of 13 physicians (62%) who completed the final scenarios chose to use the handheld computer for information access. The median time to access information on the handheld handheld computer was 19 s (IQR 15-40 s). This group exhibited a significant improvement in admission order score as compared with those who used other resources (P = 0.018). Benefits and barriers to use of this technology were identified. CONCLUSION: An updateable handheld computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making. However, during the study, acceptance of the system was variable. Improved training and new technology may overcome some of the barriers we identified.