Improving access to COVID-19 information by ensuring the readability of government websites.

ISSUE ADDRESSED: This study evaluated the readability of web pages from two public-facing Victorian government websites that were responsible for communicating key health messages relating to the COVID-19 pandemic in 2020. METHODS: Webpages were downloaded and filtered to identify relevant materials (English language materials containing HTML files that referred to COVID-19). The files were converted to text files and two Python packages, SpaCy and TextStat were used to obtain the data presented here. In addition to running two well-established readability tests, SMOG Index (Simple Measure of Gobbledygook) and Flesch Reading Ease formula, we also calculated the figures for sentence length and word length, which drive the readability measures and allow a disaggregated view of the data. Type token ratio measures were conducted as a reflection of the breadth of vocabulary used in the web pages. RESULTS: Derived measures of text complexity were higher than recommended levels of text complexity for health promotion materials, which are generally set at senior primary school levels. This did not vary depending on the intended audience (public or professional). A senior secondary reading level was required for effective engagement with the text published on both sites. CONCLUSIONS: Improving the readability of materials on key government websites where information about COVID-19 is being communicated to the public, represents a low cost and potentially effective means of improving public understanding of the pandemic and the steps individuals need to take to protect themselves and the community. SO WHAT?: Given the challenges widely identified in ensuring compliance with protective behaviours, confidence in seeking vaccination and increasing distrust of government, it would be strategic to improve public communication to ensure health messages are simple and readily understood. SUMMARY: The complexity and readability of text contained in web pages during 2020 from two Victorian government departments were evaluated. Communication regarding the restrictions and the management of risks associated with COVID-19 was the main focus of these 367 individual web pages from the Department of Health and Human Services (DHHS) and the Department of Education and Training (DET). Results indicated that across both sites and on both readability measures used, an education level equivalent to senior secondary school would be required to readily understand the contents.

Usage of Behavior Guidance Techniques Differs by Provider and Practice Characteristics.

PURPOSE: The purpose of this study was to determine provider and practice characteristics influencing usage of behavior guidance techniques (BGTs). METHODS: A 24-item survey was emailed to 4,117 active AAPD members to identify factors influencing pediatric dentists' use of BGTs. RESULTS: A total of 1,081 surveys were returned, for a 26 percent response rate. The mean age of respondents was 44.7 years old, with recent graduates comprising the largest group (30.5 percent). Usage of voice control, nitrous oxide, sedation, and general anesthesia (GA) differed significantly, according to experience. Respondents with at least 30 years of experience reported changes in usage. Tell-show-do, nitrous oxide, oral sedation, and passive restraint were significantly more frequent among female respondents. Parental absence, oral sedation, and GA were significantly more frequent in respondents serving low income populations. Parental absence, pharmacologic techniques, and restraint were significantly different in frequencies among the different geographic regions. CONCLUSIONS: Usage of behavior guidance techniques has changed over the past three decades, with more recent graduates and experienced practitioners now emphasizing pharmacologic techniques. More assertive behavior guidance techniques are used more frequently by experienced providers and those in practices in the southwest or serving lower income populations. Pharmacologic techniques are used at a higher prevalence by recent graduates and providers who are female or serving lower income populations.

Is early joint attention associated with school-age pragmatic language?

In order to evaluate evidence for the social-cognitive theory of joint attention, we examined relations between initiation of and response to joint attention at 12 and 18 months of age and pragmatic and structural language approximately 6 years later among children with and without autism spectrum disorder. Initiation of joint attention at 18 months was associated with structural, but not pragmatic, language for children with and without autism spectrum disorder. School-age children with autism exhibited difficulties with structural and pragmatic language relative to non-autistic siblings of children with autism and low-risk controls. No evidence of the broader autism phenotype was observed. These findings do not support the social-cognitive theory of joint attention.

Early developmental trajectories associated with ASD in infants with tuberous sclerosis complex.

OBJECTIVE: We performed a longitudinal cohort study of infants with tuberous sclerosis complex (TSC), with the overarching goal of defining early clinical, behavioral, and biological markers of autism spectrum disorder (ASD) in this high-risk population. METHODS: Infants with TSC and typically developing controls were recruited as early as 3 months of age and followed longitudinally until 36 months of age. Data gathered at each time point included detailed seizure history, developmental testing using the Mullen Scales of Early Learning, and social-communication assessments using the Autism Observation Scale for Infants. At 18 to 36 months, a diagnostic evaluation for ASD was performed using the Autism Diagnostic Observation Schedule. RESULTS: Infants with TSC demonstrated delays confined to nonverbal abilities, particularly in the visual domain, which then generalized to more global delays by age 9 months. Twenty-two of 40 infants with TSC were diagnosed with ASD. Both 12-month cognitive ability and developmental trajectories over the second and third years of life differentiated the groups. By 12 months of age, the ASD group demonstrated significantly greater cognitive delays and a significant decline in nonverbal IQ from 12 to 36 months. CONCLUSIONS: This prospective study characterizes early developmental markers of ASD in infants with TSC. The early delay in visual reception and fine motor ability in the TSC group as a whole, coupled with the decline in nonverbal ability in infants diagnosed with ASD, suggests a domain-specific pathway to ASD that can inform more targeted interventions for these high-risk infants.

Effects of intranasal oxytocin on social anxiety in males with fragile X syndrome.

Fragile X syndrome (FXS) is a rare inherited genetic disorder causing severe intellectual disability and autistic-like symptoms. Individuals with FXS, males in particular, often exhibit extreme eye gaze avoidance and hyperarousal when they encounter stressful social situations. We investigated whether oxytocin (OT), a hormone with prosocial and anxiolytic effects, could alleviate symptoms of social anxiety in this population. A randomized double-blind placebo-controlled single-dose trial was performed with intranasal administration of placebo, 24 IU OT and 48 IU OT. Measures of eye gaze frequency, heart rate, respiratory sinus arrhythmia (RSA), heart rate variability (HRV) and salivary cortisol were obtained during a structured social challenge conducted 50 min following OT administration. Ten low-functioning males with FXS (aged 13-28 years) traveled to Stanford for the initial visit: 8 completed the study. Eye gaze frequency improved significantly in response to the 24 IU OT dose and salivary cortisol levels decreased significantly in response to the 48 IU OT dose. There was no effect of OT on heart rate, RSA or HRV although individual plots of the heart rate data suggested that OT increased heart rate in some participants and decreased heart rate in others. These findings suggest that intranasal administration of OT may ameliorate some symptoms of social anxiety in patients with FXS. Further double-blind placebo-controlled studies of OT, conducted in combination with behavioral treatment programs, may be warranted.

A comparison of the analgesic efficacy of medium-frequency alternating current and TENS.

OBJECTIVE: To compare the analgesic efficacy of burst-modulated medium-frequency alternating current (BMAC) and transcutaneous electrical nerve stimulation (TENS) using an experimental cold pain model. DESIGN: Within-group crossover study. SETTING: A university research laboratory. PARTICIPANTS: Twenty healthy subjects. INTERVENTIONS: BMAC (4-kHz AC applied in 4-millisecond bursts at 50Hz) and TENS (125-microsecond phase duration applied at a frequency of 50Hz) administered to each participant on separate occasions. MAIN OUTCOME MEASURE: Time to cold pain threshold. RESULTS: The mean time to cold pain threshold with the BMAC intervention was no different than with TENS. Statistical analysis showed that both interventions elevated the cold pain threshold significantly [BMAC: increase=15.2seconds, 97.5% confidence interval (CI) 3.1 to 27.2, P=0.01; TENS: increase=15.4seconds, 97.5%CI 2.5 to 28.4, P=0.02], and the difference between interventions was not simply insignificant but the intervention effects were 'significantly the same' (mean difference=0.3seconds, 95%CI -15.3 to 15.9, P=0.97). CONCLUSIONS: BMAC is as effective as TENS in increasing cold pain thresholds in healthy subjects. Since BMAC has been shown to be more comfortable than TENS in previous studies and is likely to be better accepted and tolerated by patients, clinical investigation is warranted.