Information Sources

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  • 文章类型: Journal Article
    目的:日本的癌症教育基本计划促进了癌症教育。我们对日本学生进行了反复的横断面调查,以确定随着时间的推移对癌症的态度变化。
    方法:2013年2月在全国范围内对五年级小学生进行了调查。在先前的研究之后,于2019年2月对二年级高中学生进行了重复的横断面调查,因为2019年的二年级高中学生与2013年的五年级学生相对应。自我管理,多项选择问卷询问了人们对癌症的认识及其原因和癌症信息的来源。通过计算每个问题的选择百分比和95%置信区间来进行统计分析。
    结果:检查了2019年和2013年的值之间的差异。2013年收到94所学校(44.1%)的答复,2019年收到114所学校(52.8%)的答复。排除不完整的响应后,2213和3822受访者的有效回复,分别,进行了分析。随着时间的推移,在意识中观察到了理想的变化。年龄的增长与误解的增加以及对癌症原因的期望而不是不期望的看法的下降有关。互联网是高中生常见的信息来源,其次是学校的健康教育。
    结论:学校的癌症教育应旨在消除误解并促进积极,基于证据的信息。改善对癌症筛查的认识可以增加进行筛查的意图。此外,使用社交网站提供癌症信息可以帮助促进初中和高中学生的癌症预防。
    OBJECTIVE: Cancer education has been promoted under the Basic Plan for Cancer Education in Japan. We conducted a repeated cross-sectional survey of Japanese students to determine changes in attitudes regarding cancer over time.
    METHODS: A nationwide survey of fifth-grade elementary students was conducted in February 2013. A repeated cross-sectional survey was conducted following previous studies with second-year high school students in February 2019, as second-year high school students in 2019 corresponded to the generation of fifth-grade students in 2013. The self-administered, multiple-choice questionnaire inquired about the awareness of cancer and its causes and sources of cancer information. Statistical analyses were performed by calculating the percentage of selections and 95% confidence intervals for each question.
    RESULTS: The differences between values in 2019 and 2013 were examined. Responses were received from 94 schools (44.1%) in 2013 and 114 schools (52.8%) in 2019. After excluding incomplete responses, valid responses from 2213 and 3822 respondents, respectively, were analyzed. Desirable changes over time were observed in awareness. Increasing age was associated with a rise in misperceptions and a decline in desirable rather than undesirable perceptions of the causes of cancer. The Internet was a common source of information among high school students, followed by health education at school.
    CONCLUSIONS: Cancer education in schools should aim to counteract misconceptions and promote positive, evidence-based information. Improving perceptions of cancer screening could increase intentions of undergoing screening. Additionally, presenting cancer information using social networking sites could help promote cancer prevention among junior high and high school students.
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  • 文章类型: Journal Article
    由于创伤性脑损伤(TBI)康复的漫长而具有挑战性,患者和护理人员越来越依赖YouTube获取信息。然而,之前没有研究评估过该平台上这些TBI康复视频的质量和可靠性.本研究旨在评估YouTube视频对TBI康复的质量和可靠性。在这项横断面研究中,进行了以“创伤性脑损伤康复”为关键字的YouTube搜索,根据相关性列出了前100个视频。应用排除标准后,共有72个视频被纳入分析.DISCERN,美国医学协会杂志,和全球质量评分用于评估视频的质量和可靠性。视频特征,包括喜欢的数量,不喜欢,持续时间,和上传源,被记录下来。平均DISCERN总分确定为39.56±8.4。此外,《美国医学会杂志》的平均评分为1.93±0.57,全球质量评分为2.6±0.81,DISCERN质量评分为2.55±0.79.分析表明,持续时间较长的视频(P<.001)和较早上传的视频(P=.002)更有可能具有更高的质量。医疗保健专业人员制作的视频比非医疗保健专业人员上传的视频具有更高的DISCERN分数(P=.049)。对YouTube视频进行TBI康复检查表明总体质量中等。研究表明,医疗保健专业人员上传的视频质量更高。为了获得有关TBI康复的可靠信息,还建议优先考虑持续时间较长和上传日期较早的视频。鉴于社交媒体平台在康复教育推广中的重要作用,通过适当措施提高这些视频的质量至关重要。
    Due to the lengthy and challenging nature of traumatic brain injury (TBI) rehabilitation, patients and carers increasingly rely on YouTube for information. However, no previous research has assessed the quality and reliability of these TBI rehabilitation videos on this platform. This study aims to assess the quality and reliability of YouTube videos on TBI rehabilitation. In this cross-sectional study, a YouTube search with the keyword \"traumatic brain injury rehabilitation\" was performed, and the first 100 videos were listed according to relevancy. After applying exclusion criteria, a total of 72 videos were included in the analysis. DISCERN, Journal of the American Medical Association, and Global Quality Score were used to evaluate the quality and reliability of the videos. Video characteristics, including the number of likes, dislikes, duration, and source of upload, were recorded. The mean DISCERN total score was determined to be 39.56 ± 8.4. Additionally, the mean Journal of the American Medical Association score was 1.93 ± 0.57, the Global Quality Score was 2.6 ± 0.81, and the DISCERN quality score was 2.55 ± 0.79. Analysis showed that videos with a longer duration (P < .001) and those uploaded earlier (P = .002) were more likely to be of higher quality. Videos produced by healthcare professionals had higher DISCERN scores (P = .049) than those uploaded by non-healthcare professionals. Examination of YouTube videos on TBI rehabilitation indicates a moderate overall quality. The study revealed that videos uploaded by healthcare professionals have higher quality. For obtaining reliable information on TBI rehabilitation, it is also advisable to prioritize videos with longer durations and earlier upload dates. Given the significant role of social media platforms in educational outreach for rehabilitation, it is crucial to enhance the quality of these videos through appropriate measures.
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  • 文章类型: Journal Article
    与理解对癌症风险和结果的环境影响相关的挑战之一是估计被诊断患有癌症的个体在生命过程中对不利环境条件的潜在暴露。历史上,这部分是由于在癌症诊断前缺乏对癌症患者潜在环境暴露的可靠措施。与癌症相关的时空环境数据和住宅历史信息的新兴来源,再加上新的数据提取和链接技术,提供了将这些数据整合到现有癌症监测数据基础设施中的机会,从而有助于更全面地评估癌症风险和结果。在本文中,我们对可用的环境数据源进行了景观分析,这些数据源可以与国家癌症研究所监测收集的癌症患者的历史居住地址信息相关联,流行病学,和最终结果计划。目的是使研究人员能够使用这些数据来评估癌症开始时,诊断时甚至诊断后的潜在暴露。本文讨论了在各种时空尺度上与数据收集和完整性相关的挑战,以及未来研究的机会和方向。
    One of the challenges associated with understanding environmental impacts on cancer risk and outcomes is estimating potential exposures of individuals diagnosed with cancer to adverse environmental conditions over the life course. Historically, this has been partly due to the lack of reliable measures of cancer patients\' potential environmental exposures before a cancer diagnosis. The emerging sources of cancer-related spatiotemporal environmental data and residential history information, coupled with novel technologies for data extraction and linkage, present an opportunity to integrate these data into the existing cancer surveillance data infrastructure, thereby facilitating more comprehensive assessment of cancer risk and outcomes. In this paper, we performed a landscape analysis of the available environmental data sources that could be linked to historical residential address information of cancer patients\' records collected by the National Cancer Institute\'s Surveillance, Epidemiology, and End Results Program. The objective is to enable researchers to use these data to assess potential exposures at the time of cancer initiation through the time of diagnosis and even after diagnosis. The paper addresses the challenges associated with data collection and completeness at various spatial and temporal scales, as well as opportunities and directions for future research.
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  • 文章类型: Journal Article
    宫颈癌是撒哈拉以南非洲妇女癌症死亡的主要原因。本系统综述旨在确定信息来源及其与宫颈癌知识的关系。识字,筛选,和态度。同行评审的文献于2022年3月2日进行了检索,并于2023年1月24日在四个数据库中进行了更新-CINAHLPlus,Embase,PubMed,和WebofScience。符合条件的研究包括那些经验性的研究,2002年后出版,包括农村妇女,并报告信息来源和偏好。使用混合方法评估工具评估所选文章的质量。数据提取是在Excel电子表格上进行的,并使用叙述性综合来总结33项研究的发现。医护人员是被引用最多的信息来源,其次是大众媒体,社交网络,打印介质,教堂,社区领袖,互联网,和老师。社区领导人是首选,而医护人员是农村妇女中最可靠的来源。宫颈癌知识普遍较低,识字,和筛查吸收,然而,对宫颈癌及其筛查的消极态度的患病率很高;这些结果在农村地区更糟糕。内容分析显示,健康信息来源与宫颈癌素养呈正相关,知识,筛选,积极的筛选态度。撒哈拉以南非洲农村和城市妇女在宫颈癌预防方面存在差异。
    Cervical cancer is the leading cause of cancer deaths among Sub-Saharan African women. This systematic review aimed to identify information sources and their relation to cervical cancer knowledge, literacy, screening, and attitudes. Peer-reviewed literature was searched on 2 March 2022, and updated on 24 January 2023, in four databases-CINAHL Plus, Embase, PubMed, and Web of Science. Eligible studies included those that were empirical, published after 2002, included rural women, and reported on information sources and preferences. The quality of the selected articles was assessed using the Mixed Methods Appraisal Tool. Data extraction was conducted on an Excel spreadsheet, and a narrative synthesis was used to summarize findings from 33 studies. Healthcare workers were the most cited information sources, followed by mass media, social networks, print media, churches, community leaders, the Internet, and teachers. Community leaders were preferred, while healthcare workers were the most credible sources among rural women. There was generally low cervical cancer knowledge, literacy, and screening uptake, yet high prevalence of negative attitudes toward cervical cancer and its screening; these outcomes were worse in rural areas. A content analysis revealed a positive association of health information sources with cervical cancer literacy, knowledge, screening, and positive screening attitudes. Disparities in cervical cancer prevention exist between rural and urban Sub-Saharan African women.
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  • 文章类型: Journal Article
    饮食多样性与老年人的一些健康结果有关。农村地区,然而,通常难以获得影响饮食多样性的健康信息。这项研究旨在通过使用潜在类别分析来确定健康信息源的模式,并评估其与日本农村75岁以上老年人(n=411)的饮食多样性的关系。确定了三种健康信息来源模式:多来源(29.7%),仅限电视(53.5%),和非来源(16.8%)。在多源模式中,越来越多的人使用电视,收音机,和报纸。纯电视模式主要是电视用户,更少的其他来源。非来源模式有许多报告\“没有。“Logistic回归分析显示,与非源模式相比,多源模式对饮食品种有显著的正向影响(比值比:5.434,95%置信区间:1.792-16.472),即使在调整了社会经济因素和身体健康状况之后。这些发现强调了广泛获取健康信息对老年人饮食习惯的积极影响。该研究强调了促进获取各种健康信息来源以增强农村老年人的饮食多样性和整体福祉的重要性。
    Dietary variety is associated with some health outcomes among older adults. Rural areas, however, often have difficulty accessing health information that influences dietary variety. This study aimed to identify patterns of health information sources by using latent class analysis and assess their association with dietary variety among older adults aged ≥ 75 in rural Japan (n = 411). Three patterns of health information sources were identified: multi-sources (29.7%), television-only (53.5%), and non-sources (16.8%). In the multi-sources pattern, more people used television, radio, and newspapers. The television-only pattern had mostly television users, with fewer other sources. The non-sources pattern had many reporting \"none.\" Logistic regression analysis revealed that the multi-sources pattern has a significant positive effect on dietary variety compared with the non-sources pattern (odds ratio: 5.434, 95% confidence interval: 1.792-16.472), even after adjusting for socioeconomic factors and physical health status. These findings underscore the positive impact of broad access to health information on the dietary habits of older individuals. The study highlights the importance of promoting access to diverse health information sources to enhance dietary variety and overall well-being among rural older adults.
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  • 文章类型: Journal Article
    病人-护士口头沟通的复杂性为护理研究提供了宝贵的见解,但是传统的文档方法经常错过这些关键的细节。本研究探讨了语音处理技术在护理研究中的新兴作用,强调病人与护士的口头交流。我们在各种医疗机构进行了案例研究,揭示了电子健康记录在捕捉重要的病人-护士遭遇方面的巨大差距。我们的研究表明,语音处理技术可以有效地弥合这一差距,提高文档准确性,丰富质量护理评估和风险预测数据。该技术在家庭医疗保健中的应用,门诊设置,像痴呆症护理这样的专业领域说明了它的多功能性。它提供了实时决策支持的潜力,改善沟通培训,和加强远程医疗实践。本文提供了将语音处理整合到护理实践中的承诺和挑战的见解,为未来患者护理和医疗保健数据管理的进步铺平了道路。
    The complex nature of verbal patient-nurse communication holds valuable insights for nursing research, but traditional documentation methods often miss these crucial details. This study explores the emerging role of speech processing technology in nursing research, emphasizing patient-nurse verbal communication. We conducted case studies across various healthcare settings, revealing a substantial gap in electronic health records for capturing vital patient-nurse encounters. Our research demonstrates that speech processing technology can effectively bridge this gap, enhancing documentation accuracy and enriching data for quality care assessment and risk prediction. The technology\'s application in home healthcare, outpatient settings, and specialized areas like dementia care illustrates its versatility. It offers the potential for real-time decision support, improved communication training, and enhanced telehealth practices. This paper provides insights into the promises and challenges of integrating speech processing into nursing practice, paving the way for future patient care and healthcare data management advancements.
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  • 文章类型: Journal Article
    2022年,WHO和国际共识分类(ICC)发布了骨髓增生异常肿瘤(MDS)的诊断标准。我们研究了修订后的诊断标准对大量人群中MDS分类的影响。
    我们从cBioPortal检索了一个开源的预先存在的数据集,在这项研究中包括2,454名MDS患者。根据新的2022年WHO和ICC诊断标准对患者进行了重新分类。使用Cox回归进行生存分析以验证新标准并评估危险因素。
    根据世界卫生组织2022年标准,1.4%的患者被重新分类为AML。2022年世卫组织标准提供了比2017年世卫组织标准更好的预后/诊断模型(Akaike信息标准,14,152vs.14,516;一致性指数,0.705vs.0.681)。对于具有低胚细胞计数和SF3B1突变的MDS进行分类,变异等位基因截断率为5%(2022年WHO标准)和不存在RUNX1共突变(2022年ICC标准)与诊断相关.对于具有突变TP53的MDS进行分类,10%的爆炸计数截止值(2022年ICC标准)和多次击中TP53(2022年WHO标准)是≥10%爆炸病例的独立危险因素。
    我们的发现支持世卫组织新标准的完善。我们建议补充使用新的WHO和ICC标准对SF3B1和TP53突变的MDS进行分类,以更好地预测生存。
    UNASSIGNED: In 2022, the WHO and International Consensus Classification (ICC) published diagnostic criteria for myelodysplastic neoplasms (MDSs). We examined the influence of the revised diagnostic criteria on classifying MDSs in a large population.
    UNASSIGNED: We retrieved an open-source pre-existing dataset from cBioPortal and included 2,454 patients with MDS in this study. Patients were reclassified based on the new diagnostic 2022 WHO and ICC criteria. Survival analysis was performed using Cox regression to validate the new criteria and to assess risk factors.
    UNASSIGNED: Based on the 2022 WHO criteria, 1.4% of patients were reclassified as having AML. The 2022 WHO criteria provide a superior prognostic/diagnostic model to the 2017 WHO criteria (Akaike information criterion, 14,152 vs. 14,516; concordance index, 0.705 vs. 0.681). For classifying MDS with low blast counts and SF3B1 mutation, a variant allele frequency cut-off of 5% (2022 WHO criteria) and the absence of RUNX1 co-mutation (2022 ICC criteria) are diagnostically relevant. For classifying MDSs with mutated TP53, a blast count cut-off of 10% (2022 ICC criteria) and multi-hit TP53 (2022 WHO criteria) are independent risk factors in cases with ≥10% blasts.
    UNASSIGNED: Our findings support the refinements of the new WHO criteria. We recommend the complementary use of the new WHO and ICC criteria in classifying SF3B1- and TP53-mutated MDSs for better survival prediction.
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  • 文章类型: Journal Article
    背景:上肢乳腺癌相关淋巴水肿仍然是乳腺癌治疗中最痛苦的并发症之一。YouTube被认为是人口健康和决策的潜在数字资源。然而,获取不充分的信息或错误信息可能会产生不良的影响。这项横断面研究旨在评估可靠性,关于淋巴水肿的YouTube视频的质量和内容,作为讲西班牙语的乳腺癌幸存者的信息来源。
    方法:在2023年1月对YouTube进行了搜索,使用关键词“乳腺癌淋巴水肿”和“乳腺癌淋巴水肿”。\“使用Discern工具评估视频的可靠性和质量,内容,生产来源,喜欢的数量,注释,视图,持续时间,视频功率指数,喜欢比率,在平台上的观看比例和年龄。
    结果:在YouTube上确定的300个西班牙语视频中,根据纳入和排除标准选择35人进行分析。在选定的35个视频中,82.9%(n=29)是由医疗保健或学术专业人员开发的,17.1%(n=9)是由其他人开发的。在专业人员制作的视频中,可靠性(p<0.017)和质量(p<0.03)更高。学术总分(r=0.476;p=0.004),可靠性(r=0.472;p=0.004)和质量(r=0.469;p=0.004)与视频持续时间呈正相关.
    结论:我们的研究结果为教育寻求淋巴水肿信息的乳腺癌幸存者选择医疗保健或学术专业人员制作的视频提供了强有力的理由。在视频发布之前需要进行标准化评估,以确保最终用户从YouTube获得准确和高质量的信息。
    BACKGROUND: Breast cancer-related lymphedema in the upper limb remains one of the most distressful complications of breast cancer treatment. YouTube is considered a potential digital resource for population health and decision making. However, access to inadequate information or misinformation could have undesirable impacts. This cross-sectional study aimed to evaluate the reliability, quality and content of YouTube videos on lymphedema as an information source for Spanish-speaking breast cancer survivors.
    METHODS: A search of YouTube was conducted in January 2023 using the key words \"breast cancer lymphedema\" and \"lymphedema arm breast cancer.\" Reliability and quality of the videos were evaluated using the Discern tool, content, source of production, number of likes, comments, views, duration, Video Power Index, likes ratio, view ratio and age on the platform.
    RESULTS: Amongst the 300 Spanish language videos identified on YouTube, 35 were selected for analysis based on the inclusion and exclusion criteria. Of the 35 selected videos, 82.9% (n = 29) were developed by healthcare or academic professionals and 17.1% (n = 9) by others. Reliability (p < 0.017) and quality (p < 0.03) were higher in the videos made by professionals. The Discern total score (r = 0.476; p = 0.004), reliability (r = 0.472; p = 0.004) and quality (r = 0.469; p = 0.004) were positively correlated with the duration of the videos.
    CONCLUSIONS: Our findings provide a strong rationale for educating breast cancer survivors seeking lymphedema information to select videos made by healthcare or academic professionals. Standardised evaluation prior to video publication is needed to ensure that the end-users receive accurate and quality information from YouTube.
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  • 文章类型: Journal Article
    目的:研究ChatGPT在评估YouTube上最受关注的泌尿系癌症相关视频的医疗内容质量方面的可靠性。
    方法:2024年3月,为每种类型的泌尿外科癌症在YouTube上观看的前20个视频创建了播放列表。ChatGPT和泌尿科专家使用DISCERN-5和全球质量量表(GQS)问卷对视频文本进行了评估。使用Kruskal-Wallis检验比较获得的结果。
    结果:对于前列腺,膀胱,肾,和睾丸癌视频,由人类评估者和ChatGPT给出的中位数(IQR)DISCERN-5评分为(人类:4[1],3[0],3[2],3[1],P=.11;ChatGPT:3[1.75],3[1],3[2],3[0],分别为P=4)和GQS评分为(人类:4[1.75],3[0.75],3.5[2],3.5[1],P=.12;ChatGPT:4[1],3[0.75],3[1],3.5[1],分别为P=.1),得分之间没有显着差异。ChatGPT反应的可重复性被确定为与前列腺癌的25%相似。30%的膀胱癌,30%为肾癌,和35%的睾丸癌(P=0.92)。关于前列腺的视频内容,人类和ChatGPT给出的中位数(IQR)DISCERN-5和GQS得分之间没有统计学上的显着差异,膀胱,肾,和睾丸癌(P>0.05)。
    结论:尽管ChatGPT在评估视频文本的医疗质量方面是成功的,应谨慎评估结果,因为结果的重复性较低.
    OBJECTIVE: To examine the reliability of ChatGPT in evaluating the quality of medical content of the most watched videos related to urological cancers on YouTube.
    METHODS: In March 2024 a playlist was created of the first 20 videos watched on YouTube for each type of urological cancer. The video texts were evaluated by ChatGPT and by a urology specialist using the DISCERN-5 and Global Quality Scale (GQS) questionnaires. The results obtained were compared using the Kruskal-Wallis test.
    RESULTS: For the prostate, bladder, renal, and testicular cancer videos, the median (IQR) DISCERN-5 scores given by the human evaluator and ChatGPT were (Human: 4 [1], 3 [0], 3 [2], 3 [1], P = .11; ChatGPT: 3 [1.75], 3 [1], 3 [2], 3 [0], P = .4, respectively) and the GQS scores were (Human: 4 [1.75], 3 [0.75], 3.5 [2], 3.5 [1], P = .12; ChatGPT: 4 [1], 3 [0.75], 3 [1], 3.5 [1], P = .1, respectively), with no significant difference determined between the scores. The repeatability of the ChatGPT responses was determined to be similar at 25 % for prostate cancer, 30 % for bladder cancer, 30 % for renal cancer, and 35 % for testicular cancer (P = .92). No statistically significant difference was determined between the median (IQR) DISCERN-5 and GQS scores given by humans and ChatGPT for the content of videos about prostate, bladder, renal, and testicular cancer (P > .05).
    CONCLUSIONS: Although ChatGPT is successful in evaluating the medical quality of video texts, the results should be evaluated with caution as the repeatability of the results is low.
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  • 文章类型: Journal Article
    背景:信息来源的多样化和社会结构的变化需要更新公众对姑息治疗的认识。因此,我们澄清了意识的地位和决定因素,信息来源,和信仰,关于日本的姑息治疗。
    方法:这项全国性的横断面调查包括10,000名年龄≥20岁的参与者,他们在2023年通过采用两阶段分层的随机抽样进行招募。我们使用了邮寄的自我管理问卷(INFORM研究2023)。从健康信息国家趋势调查(美国)中选择(部分修改)问卷项目以确保可比性,包括姑息治疗意识,信息来源,和信仰。进行加权逻辑回归以探索意识的决定因素。
    结果:在回答的3452名参与者中(回答率:35.3%),65.2%有姑息治疗意识。加权逻辑回归分析显示,不太可能有任何姑息治疗意识的受访者更年轻,是男性,教育历史有限,家庭收入较低,并且是非互联网用户。其中,性别有明显的关联(女性与女性的调整后赔率比男性:3.20[95%CI:2.66-3.85])。在所有年龄组中,医疗保健专业人员(58.5%)和互联网(30.5%)是最值得信赖的信息来源。年轻的参与者经常在网上收到信息。大多数参与者认为姑息治疗是有益的,尽管82.0%与死亡有关。
    结论:日本人的姑息治疗意识相对较高,大多数人信任来自医疗保健专业人员的信息,而不是互联网。有必要进一步努力解决获得可信赖的姑息治疗信息的障碍。
    BACKGROUND: The diversification of information sources and changes in social structures necessitates updates on the state of public awareness of palliative care. Therefore, we clarified the status and determinants of awareness, information sources, and beliefs, regarding palliative care in Japan.
    METHODS: This nationwide cross-sectional survey included 10 000 participants aged ≥20 years enrolled through random sampling using a two-stage stratification in 2023. We used a mailed self-administered questionnaire (INFORM Study 2023). The questionnaire items were selected (partially modified) from the Health Information National Trends Survey (USA) to ensure comparability, included palliative care awareness, information sources, and beliefs. Weighted logistic regression was conducted to explore the determinants of awareness.
    RESULTS: Of the 3452 participants that responded (response rate: 35.3%), 65.2% had palliative care awareness. The weighted logistic regression analysis revealed that respondents less likely to have any palliative care awareness were younger, were male, had limited education history, had lower household income, and were non-Internet users. Of these, sex had the clear association (adjusted odds ratio for female vs. male: 3.20 [95% CI: 2.66-3.85]). Across all age groups, healthcare professionals (58.5%) and the Internet (30.5%) were the most trusted source of information. Younger participants frequently received information online. Most participants believed that palliative care was beneficial, although 82.0% associated it with death.
    CONCLUSIONS: The Japanese population had a relatively high palliative care awareness, with the majority trusting information from healthcare professionals rather than the Internet. Further efforts are warranted to address barriers to receiving trustworthy palliative care information.
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