Citizens' Access to Online Health Information - An International Survey of IMIA Member Countries.

Citizens' access to their online health information is pivotal. Therefore, this study examines citizens' access to their online health information across countries and healthcare settings. The study is based on a survey design targeting the 98 IMIA representatives of the national societies. Results indicate that Test results and Medications are the two types of online information that citizens in most cases have access to. Ten countries provide citizens access to all the different types of information included in the study. That relatively few countries provide citizens access to all the included types of online health information underscores the importance of continuous emphasis on accessibility and research within this field.

Equity in digital healthcare - the case of Denmark.

As digital healthcare services are expanding in use and purpose in a Danish context so are the functionalities embedded in these, constituting citizens' access to healthcare services and personal health data. In Denmark, the impact of inequalities in digital healthcare remains largely unexplored, making it crucial to pay close attention to this aspect as the digital transformation of the sector progresses. According to the Danish Health Act (2019), the Danish healthcare system is required to ensure easy and equal access to healthcare, high-quality treatment, coherent patient pathways, freedom of choice, easy access to information, transparency, and short waiting times for every citizen. These are focal law-based requirements influenced by the digitalisation of healthcare. Hence, based on insights from a highly digitalised country, in this case, Denmark, this paper aims to initiate a discussion on inequities in digital healthcare, address current challenges, and consider future directions by elaborating on conceptual, ethical, evidence-informed, and methodological issues linked to inequities in digital healthcare. Specifically, this paper discusses why inequities in digital healthcare in a Danish context need increased attention, how health equity is embedded in Danish legislation and how it can be approached from an ethical perspective. The central focus revolves around the essential principles of empowerment, emancipation, and equity, which are being highlighted to emphasise that the digitalisation of healthcare should actively work towards preventing and avoiding the perpetuation of healthcare inequalities. The paper concludes by discussing future directions for ensuring a more sustainable, robust, and equitable digital healthcare system.

Long-term Recovery After Colorectal Cancer Surgery Among the Old: A Qualitative Study.

BACKGROUND: Colorectal cancer is the third most frequently diagnosed cancer worldwide, disproportionally affecting older people. With modern treatment, older people are surviving cancer treatment and recovery. However, only a limited number of studies on the older person's experience of recovery exist. Knowledge of the experience of recovery among people 80 years or older is essential to optimize recovery and follow-up care. OBJECTIVE: The aim of this study was to explore the experiences of persons 80 years or older during recovery up to 2 years after curative colorectal cancer surgery. METHODS: This exploratory inductive qualitative study was conducted through 18 individual in-depth interviews between July 2020 and June 2021. Content analysis was used to analyze the data. RESULTS: The main theme identified was Recovery among the old is a complex process. It indicated that older people operated on for colorectal cancer may have intricate health challenges that affect recovery in addition to their cancer and treatment. The main theme is built upon the subthemes Individual factors affect colorectal cancer recovery and External support systems facilitate and impede colorectal recovery. CONCLUSION: Important resources for recovery among old patients included their own coping ability and support from social networks and healthcare services. The identified barriers to recovery included other health problems and issues with healthcare services delivery. IMPLICATIONS FOR PRACTICE: It is essential for healthcare personnel in contact with older patients to be aware of factors that influence their recovery to identify and preserve the older person's resources and implement health-promoting initiatives to optimize recovery when needed.

Exploring variables affecting sense of coherence and social support in recovery after colorectal cancer surgery among the oldest old.

OBJECTIVE: To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. METHODS: This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. RESULTS: Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. CONCLUSION: The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery.

A Fully Conjugated Planar Heterocyclic [9]Circulene.

Fully aromatic [n]circulenes have only been known to encompass up to eight aromatic rings (n = 8), with no reports of endeavors in the synthesis of higher-order analogues (n > 8). Herein we present the first [9]circulene, formally a diazatrioxa[9]circulene, along with a tetrahydro-diazatetraoxa[10]circulene. The key transformation, for construction of the macrocyclic framework, is a simple high-yielding dimerizing condensation between 3,6-dihydroxycarbazole and glyoxal. Single crystal X-ray analysis reveals the [9]circulene to be perfectly planar and containing elongated benzene rings, which is induced by strain to accommodate planarity. Alternating bond lengths in the solid state indicate contribution from a [9]radialene resonance structure in the [9]circulene π-system. The central nonaromatic rings of both circulenes have paratropic ring currents, as evident by nucleus independent chemical shift (NICS) and anisotropy of the induced current density (ACID) calculations, which can be attributed to induced paratropicity from the surrounding aromatic rings.

Allosteric Cooperativity and Template-Directed Synthesis with Stacked Ligands in Porphyrin Nanorings.

The link between allosteric cooperativity and template-directed synthesis has been investigated by studying complexes in which two oligopyridine ligands bind inside a zinc porphyrin nanoring in a stacked arrangement. The binding of a 6-porphyrin nanoring to two tridentate ligands (with s-triazine or benzene cores) occurs with high negative allosteric cooperativity (α ≈ 10-3-10-4). Formation constants for 1:1 and 1:2 complexes were determined by UV-vis-NIR denaturation titration, using pyridine as a competing ligand, and cooperativity factors were confirmed by NMR spectroscopy. The rate constants for formation of the 1:1 and 1:2 complexes are approximately equal, and the negative cooperativity can be attributed to faster dissociation of the 1:2 complex. These tridentate ligands are not effective templates for directing the synthesis of the 6-porphyrin nanoring, in keeping with their negative cooperativity of binding. In contrast, the binding of a 12-porphyrin nanoring to two hexadentate ligands occurs with high positive allosteric cooperativity (α > 40), and the ligand is an effective Vernier template for directing the synthesis of the 12-porphyrin nanoring. This stacked Vernier template approach creates the product in an open circular conformation, which is advantageous for preparing macrocycles that do not easily adopt a figure-of-eight geometry.

Anti-Aromatic versus Induced Paratropicity: Synthesis and Interrogation of a Dihydro-diazatrioxa[9]circulene with a Proton Placed Directly above the Central Ring.

We present a high-yielding intramolecular oxidative coupling within a diazadioxa[10]helicene to give a dihydro-diazatrioxa[9]circulene. This is the first [n]circulene containing more than eight ortho-annulated rings (n>8). The single-crystal X-ray structure reveals a tight columnar packing, with a proton from a pendant naphthalene moiety centred directly above the central nine-membered ring. This distinct environment induces a significant magnetic deshielding effect on that particular proton as determined by 1 H NMR spectroscopy. The origin of the deshielding effect was investigated computationally in terms of the NICS values. It is established that the deshielding effect originates from an induced paratropic ring current from the seven aromatic rings of the [9]circulene structure, and is not due to the nine-membered ring being antiaromatic. UV/Vis spectroscopy reveals more efficient conjugation in the prepared diazatrioxa[9]circulene compared to the parent helical azaoxa[10]helicenes, and DFT calculations, including energy levels, confirm the experimental observations.

Symmetric, Unsymmetrical, and Asymmetric [7]-, [10]-, and [13]Helicenes.

Fully aromatic helicenes with more than one pitch-length are illustrious synthetic targets with potential applications in advanced optical devices and nano-electronics. The task of extending the length of fully conjugated helicenes past one pitch length is challenging. Now, the synthesis of a series of azaoxa[7]-, [10]-, and [13]helicenes is described. The synthesis is based on iterative oxidative furan formation between 3,6-dihydroxycarbazoles and/or 2-naphthols. The flexibility of the presented method allows the convenient and scalable synthesis of symmetric, unsymmetrical, and asymmetric homo-chiral structures. The [13]helicenes can be synthetically functionalized both at the termini and the periphery. The full range of helicenes were characterized using NMR and optical spectroscopy (UV/Vis, fluorescence, and CD) along with single-crystal X-ray crystallography. The enantiomers of the [13]helicenes are the longest optically pure helicenes isolated to date.

Entropy/Enthalpy Compensation in Anion Binding: Biotin[6]uril and Biotin-l-sulfoxide[6]uril Reveal Strong Solvent Dependency.

Binding of anions using macrocyclic structures with a nonpolar interior using the CH···anion interaction as the recognition motif has gained popularity in the past few years, and such receptors often rely on a subtle interplay between enthalpic and entropic factors. For these types of receptors solvation of both the anion and the binding pocket of the macrocyclic host play important roles in the overall energetic picture of the binding event. Systematic chemical modifications of synthetic receptors that are able to bind anions in a variety of solvents is an important tool to gain understanding of the factors that determine the supramolecular chemistry of anions. Here we present the chiral macrocyclic structure biotin-l-sulfoxide[6]uril as a host molecule that binds anions in both water and in organic solvents. Biotin-l-sulfoxide[6]uril is prepared in a highly diastereoselective one-pot synthesis from the macrocycle biotin[6]uril. We compare the binding properties with that of biotin[6]uril, also studied in acetonitrile and in aqueous buffer at neutral pH. The biotin-l-sulfoxide[6]uril generally exhibits stronger recognition of anions in acetonitrile, but weaker binding in water as compared to the biotin[6]uril macrocycle. We have studied the binding events using a combination of NMR spectroscopy, isothermal titration calorimetry (ITC), and computational methods.

The patient experience with treatment and self-management (PETS) questionnaire: translation and cultural adaption of the Norwegian version.

BACKGROUND: Noncommunicable diseases represents long term medical conditions, which often puts the patients under enormous demands when following treatment, exposing them to experiencing treatment burden. The Patient Experience with Treatment and Self-Management (PETS) questionnaire was developed as a patient-reported measure to identify treatment burden of chronic illness, using modern measurement theory and tested in a variety of settings. Developed in English, this set of measures had not been previously translated into Norwegian. The objective of this study was to develop a Norwegian version of the PETS and to pretest the translated measures through a cognitive debriefing methodology. METHODS: A rigorous translation approach was applied, guided by Functional Assessment of Chronic Illness Therapy methodology. Bilingual teams from Norway and the United States reviewed the translation to develop a provisional version, which was evaluated for test content validity with cognitive interviews by probing 12 native Norwegian patients with noncommunicable diseases. The interviews applied both concurrent and retrospective verbal probing techniques, guided by a question route. Audio-recorded interviews were transcribed verbatim and analysed using systematic text condensation. RESULTS: Assessment of translatability identified the need for cultural adaptation on several core words, balanced with the need to keep close to the original literal meaning. Seven patients with colorectal cancer and five patients with heart failure participated in cognitive testing of the Norwegian version of the PETS. The analytical process of the cognitive interviews identified two emergent main themes, 'comprehension and readability' and 'relevance of the PETS', with seven corresponding subthemes. Most items, response options and instructions were well understood by the patients. Revisions were made concerning cultural relevance. CONCLUSIONS: PETS items were semantically equivalent to the original. The patients with colorectal cancer and heart failure were able to comprehend the PETS and found it to express their experience with treatment burden in chronic illness. Future work will focus on psychometric construct validation and reliability testing of the PETS.

Benzylic Thio and Seleno Newman-Kwart Rearrangements.

The thermally induced OBn → SBn and OBn → SeBn migration reactions facilitate the rearrangement of O-benzyl thio- and selenocarbamates [BnOC(═X)NMe2] (X = S or Se) into their corresponding S-benzyl thio- and Se-benzyl selenocarbamates [BnXC(═O)NMe2] (X = S or Se). A series of substituted O-benzyl thio- and selenocarbamates were synthesized and rearranged in good yields of 33-88%. The reaction rates are higher for substrates with electron-donating groups in the 2 or 4 position of the aromatic ring, but the rearrangement also proceeds with electron-withdrawing substituents. The rearrangement follows first-order reaction kinetics and proceeds via a tight ion pair intermediate consisting of the benzylic carbocation and the thio- or selenocarbamate moiety. Computational studies support these findings.