BACKGROUND: Hashimoto thyroiditis (HT) is an autoimmune thyroid disease and the leading cause of hypothyroidism in areas with sufficient iodine intake. The quality-of-life impact and financial burden of hypothyroidism and HT highlight the need for additional research investigating the disease etiology with the aim of revealing potential modifiable risk factors.
OBJECTIVE: Implementation of measures against such risk factors, once identified, has the potential to lessen the financial burden while also improving the quality of life of many individuals. Therefore, we aimed to examine the potential seasonality of HT in Europe using the Google Trends data to explore whether there is a seasonal characteristic of Google searches regarding HT, examine the potential impact of the countries\' geographic location on the potential seasonality, and identify potential modifiable risk factors for HT, thereby inspiring future research on the topic.
METHODS: Monthly Google Trends data on the search topic \"Hashimoto thyroiditis\" were retrieved in a 17-year time frame from January 2004 to December 2020 for 36 European countries. A cosinor model analysis was conducted to evaluate potential seasonality. Simple linear regression was used to estimate the potential effect of latitude and longitude on seasonal amplitude and phase of the model outputs.
RESULTS: Of 36 included European countries, significant seasonality was observed in 30 (83%) countries. Most phase peaks occurred in spring (14/30, 46.7%) and winter (8/30, 26.7%). A statistically significant effect was observed regarding the effect of geographical latitude on cosinor model amplitude (y = -3.23 + 0.13 x; R2=0.29; P=.002). Seasonal increases in HT search volume may therefore be a consequence of an increased incidence or higher disease activity. It is particularly interesting that in most countries, a seasonal peak occurred in spring and winter months; when viewed in the context of the statistically significant impact of geographical latitude on seasonality amplitude, this may indicate the potential role of vitamin D levels in the seasonality of HT.
CONCLUSIONS: Significant seasonality of HT Google Trends search volume was observed in our study, with seasonal peaks in most countries occurring in spring and winter and with a significant impact of latitude on seasonality amplitude. Further studies on the topic of seasonality in HT and factors impacting it are required.

BACKGROUND: Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement.
OBJECTIVE: The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic.
METHODS: Google Trends data were retrieved using the search topics \"telemedicine\" or \"e-health\" to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms \"telemedicine\" or \"eHealth\" (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks.
RESULTS: Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=-22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic.
CONCLUSIONS: Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives.

BACKGROUND: Given that signage, messaging, and advertisements (ads) are the gateway to many interventions in suicide prevention, it is important that we understand what type of messaging works best for whom.
OBJECTIVE: We investigated whether explicitly mentioning suicide increases engagement using internet ads by investigating engagement with campaigns with different categories of keywords searched, which may reflect different cognitive states.
METHODS: We ran a 2-arm study Australia-wide, with or without ads featuring explicit suicide wording. We analyzed whether there were differences in engagement for campaigns with explicit and nonexplicit ads for low-risk (distressed but not explicitly suicidal), high-risk (explicitly suicidal), and help-seeking for suicide keywords.
RESULTS: Our analyses revealed that having explicit wording has opposite effects, depending on the search terms used: explicit wording reduced the engagement rate for individuals searching for low-risk keywords but increased engagement for those using high-risk keywords.
CONCLUSIONS: The findings suggest that individuals who are aware of their suicidality respond better to campaigns that explicitly use the word \"suicide.\" We found that individuals who search for low-risk keywords also respond to explicit ads, suggesting that some individuals who are experiencing suicidality search for low-risk keywords.

UNASSIGNED: Irritable bowel syndrome (IBS) is a chronic GI disorder that affects people all over the world. Patients frequently look for information about their ailments online. Despite being widely and easily accessible, online information\'s quality and readability are under doubt. In this investigation, we assessed the effectiveness and usability of IBS Arabic websites found on significant search engines.
UNASSIGNED: IBS-related search terms in Arabic were entered into two search engines (Google and YouTube), and the first 30 websites per word from Google, and the first 20 websites per word from YouTube were assessed for eligibility. Eligible Google websites were assessed for quality and readability, while YouTube websites were assessed for quality. Quality was assessed using the DISCERN score and the JAMA Benchmark. Readability was assessed using the automatic Arabic readability index (AARI). Associations between quality, readability, types of websites (medical/nonmedical), and video length were analyzed.
UNASSIGNED: For Google: A total of 48 websites were evaluated, mean DISCERN score was 40.4 (SD = 10.28) indicating fair quality. The mean JAMA score was 1.6 (SD = 0.69), with the readability being worse the higher the quality. Medical websites had higher quality scores than nonmedical ones. For YouTube: A total of 34 YouTube videos were evaluated, mean DISCERN score was 34.7 (SD = 7.35), indicating poor quality. The mean JAMA score was 1.4 (SD = 0.72). Medical websites had higher quality scores than nonmedical ones. There was no association between the quality of the videos and their length.
UNASSIGNED: The majority of websites were of low to fair quality and required a high degree of readability. As a result, we advise (1) healthcare practitioners to offer helpful websites to their patients, and (2) the development of IBS-related websites under the guidance of experts, with the involvement of patients.

BACKGROUND: Previous studies have indicated that users\' health information-seeking behavior can serve as a reflection of current health issues within a community. This study aimed to investigate the online information-seeking behavior of Iranian web users on Google about Henoch-Schönlein purpura (HSP).
METHODS: Google Trends (GTr) was utilized to collect big data from the internet searches conducted by Iranian web users. A focus group discussion was employed to identify users\' selected keywords when searching for HSP. Additionally, keywords related to the disease\'s symptoms were selected based on recent clinical studies. All keywords were queried in GTr from January 1, 2012 to October 30, 2022. The outputs were saved in an Excel format and analyzed using SPSS.
RESULTS: The highest and lowest search rates of HSP were recorded in winter and summer, respectively. There was a significant positive correlation between HSP search rates and the terms \"joint pain\" (P = 0.007), \"vomiting\" (P = 0.032), \"hands and feet swelling\" (P = 0.041) and \"seizure\" (P < 0.001).
CONCLUSIONS: The findings were in accordance with clinical facts about HSP, such as its seasonal pattern and accompanying symptoms. It appears that the information-seeking behavior of Iranian users regarding HSP can provide valuable insights into the outbreak of this disease in Iran.

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BACKGROUND: A clinical diagnostic support system (CDSS) can support medical students and physicians in providing evidence-based care. In this study, we investigate diagnostic accuracy based on the history of present illness between groups of medical students using a CDSS, Google, and neither (control). Further, the degree of diagnostic accuracy of medical students using a CDSS is compared with that of residents using neither a CDSS nor Google.
METHODS: This study is a randomized educational trial. The participants comprised 64 medical students and 13 residents who rotated in the Department of General Medicine at Chiba University Hospital from May to December 2020. The medical students were randomly divided into the CDSS group (n = 22), Google group (n = 22), and control group (n = 20). Participants were asked to provide the three most likely diagnoses for 20 cases, mainly a history of a present illness (10 common and 10 emergent diseases). Each correct diagnosis was awarded 1 point (maximum 20 points). The mean scores of the three medical student groups were compared using a one-way analysis of variance. Furthermore, the mean scores of the CDSS, Google, and residents\' (without CDSS or Google) groups were compared.
RESULTS: The mean scores of the CDSS (12.0 ± 1.3) and Google (11.9 ± 1.1) groups were significantly higher than those of the control group (9.5 ± 1.7; p = 0.02 and p = 0.03, respectively). The residents\' group\'s mean score (14.7 ± 1.4) was higher than the mean scores of the CDSS and Google groups (p = 0.01). Regarding common disease cases, the mean scores were 7.4 ± 0.7, 7.1 ± 0.7, and 8.2 ± 0.7 for the CDSS, Google, and residents\' groups, respectively. There were no significant differences in mean scores (p = 0.1).
CONCLUSIONS: Medical students who used the CDSS and Google were able to list differential diagnoses more accurately than those using neither. Furthermore, they could make the same level of differential diagnoses as residents in the context of common diseases.
BACKGROUND: This study was retrospectively registered with the University Hospital Medical Information Network Clinical Trials Registry on 24/12/2020 (unique trial number: UMIN000042831).

Introduction Affecting more than 30 million adults annually, osteoarthritis (OA) is the most common joint disorder in the United States. A variety of management options for knee OA exists, including physical therapy, weight loss, intra-articular corticosteroid injections, and total joint arthroplasty. With many treatments available, patients often utilize the internet to educate themselves about their condition and management options. The purpose of this study was to evaluate the quality, transparency, and readability of online information for the treatment of knee OA. Methods The search terms \"knee,\" \"arthritis,\" and \"treatment\" were entered into an incognito mode Google browser. Websites were classified by type (commercial, academic, nonacademic medical practice, government/patient advocacy, and other) and graded on content quality, transparency, and readability using the following scores, respectively: modified DISCERN, Journal of American Medical Association (JAMA) Benchmark, and Flesch-Kincaid (FK) grade level. Results Of the 95 websites evaluated, commercial (mean, 38.2) and academic (37.3) sites had the highest total DISCERN scores, which were significantly greater than nonacademic medical practice (31.8) and government/patient advocacy sites (33.4) (p≤0.035). Nonacademic medical practice sites had the lowest mean total DISCERN (31.8) and JAMA (1.47) scores and the highest FK grade level readability (9.5). There was a significant positive correlation between mean total DISCERN and JAMA scores (r=0.46, p<0.001). Conclusion The mean overall quality of websites regarding the treatment of OA was good as evidenced by greater modified DISCERN scores. However, website quality ranged from poor to excellent, indicating that some websites are still missing key information patients may find useful when assessing treatment options online.

The increasing number of people who use drugs (PWUDs) can be attributed to the rising online sales of drugs and other related substances. Information on drugs and drug markets has also become easily accessible in web-search engines and social media. Aside from providing direct care, nurses have essential roles in preventing substance use disorder. These roles include health education, liaison, and researcher. Thus, nurses must examine and utilize the Internet, where information and transactions related to these substances are increasing.
This study utilized an infodemiological design in exploring the worldwide information utilization for substance use disorder. Data were gathered from Google Trends and Wikimedia Pageview. The data included relative search volumes (RSV), top and rising related queries and topics, and Wikipedia page views between 2004 and 2022. After describing the data, autoregressive integrated mean averaging (ARIMA) models were used to predict future utilization of online information from Google and Wikipedia.
Google trends ranked 37 countries based on the search volumes for substance use disorder. Ethiopia, Finland, the United States, Kenya, and Canada have the highest RSVs, while the lowest-ranked country is Turkey, followed by Mexico, Spain, Japan, and Indonesia. Google searches for substance use disorder-related information increased by more than 900% between 2004 and 2022. In addition, Wikipedia page views for substance use disorder-related information increased by almost 200% between 2015 and 2022. Based on the ARIMA models, RSVs and page views are predicted to increase by about 150% and 120% by December 2025. Top and rising search-related topics and queries revealed that the public increasingly utilized online information to understand specific substances and the possible mental health comorbidities related to substance use disorders. Their recent concerns revolved around diagnostics, specific substances, and specific disorders.
The Internet can be of paradoxical use in substance use disorder. It has been previously reported to be increasingly used in drug trades, contributing to the increasing prevalence of substance use disorder. Likewise, the present study\'s findings revealed that it is increasingly utilized for substance use disorder-related information. Thus, nurses and other healthcare professionals should ensure that online information regarding substance use disorders is accurate and up-to-date.
Nurse informaticists can form and lead Internet- and social-media-based health teams that perform national infodemiological investigations to assess online information. In doing so, they can inform, expand, and contextualize ehealth substance use education and strengthen the accessibility and delivery of substance use healthcare. In addition, public health nurses can collaborate to engage patients and communities in identifying harmful substance use disorder information online and creating culturally-appropriate messages that will correct misinformation and improve ehealth literacy, specifically in substance use disorder.

UNASSIGNED: the coronavirus pandemic and associated lockdowns restricted movement with non-essential hospital trips discouraged to prevent spread of the virus. Disruption of medical services can lead to increased seeking of medical advice and symptom management online. With COVID-19 known to worsen existing cardiovascular disease or precipitate a new one, we sought to explore online search trends of the Nigerian public regarding cardiac events before and during the COVID-19 pandemic.
UNASSIGNED: using Google Trends™, relative search volume for the terms \'cardiac arrest\', \'heart attack\', and \'heart arrest\' were analyzed for the periods 27th February to 30th September in 2019 and 2020 respectively. Descriptive statistics, Mann-Whitney U test for relative search volume, search terms comparison in both years and Kendall´s correlation coefficient for examining relationships between time frames and search terms were used.
UNASSIGNED: searches for terms \'heart attack\' (p<0.001) and \'heart arrest\' (p=0.01) were higher in 2020 compared to 2019, with a correlation between searches for \'cardiac arrest\' and \'heart arrest\' (p<0.001) and between \'heart attack\' and \'heart arrest\' (p=0.01). There was a strong positive correlation between search for \'heart attack\' in 2019 and 2020 (tau b=0.35, p<0.001); and a moderate positive correlation for \'heart arrest\' (tau b=0.13, p=0.01).
UNASSIGNED: increased online activity relating to cardiac arrest was recorded during the early months of the pandemic when compared to the year prior. Notable increases in search activity aligned with the timing of heart-related illnesses and deaths of Nigerian celebrities during the pandemic. Further understanding of health-related online search activity in Nigeria could inform the development of health promotion interventions and support health-related information seeking for cardiovascular diseases.