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Objective: We investigated the effectiveness of a self-help intervention named PERANTARA, which aims to improve adherence to diagnostic procedures among women with breast cancer (BC) symptoms to reduce the time to a definitive diagnosis. Methods: With a cluster randomized crossover design across four hospitals, PERANTARA and treatment as usual (TAU) or TAU only was provided at successive periods in a randomly determined order. The main outcome was the time between the first medical consultation and the definitive diagnosis. Secondary outcomes were BC knowledge, measured by the Breast Cancer Knowledge Test (BCKT); symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS); quality of life, measured by the World Health Organization Quality of Life-BREF (WHOQOL-BREF); and health status, measured by the EQ-5D-5L. A linear mixed model analysis was conducted to analyse the outcomes. Results: We recruited 132 women with BC symptoms from four hospitals; 67 participants were in the intervention group, and 65 participants were in the control group. PERANTARA reduced the time to definitive diagnosis by 13.3 days (M [SD]: 25.90 [23.20] in the intervention group vs 39.29 [35.10] in the control group; mean difference = −13.26, 95% CI = −24.51 to −2.00, P =.02). No significant difference was found between the groups in BC knowledge, symptoms of anxiety, depression, quality of life, or health status. Conclusions: PERANTARA reduced the time to definitive diagnosis among Indonesian women with BC symptoms. Psychoeducation may be an important addition to regular BC care to prevent undue delays in diagnostic procedures.

Background This study aimed to examine whether fear of cancer recurrence (FCR) was related to two important health behaviours (physical activity and smoking) in a large sample of colorectal cancer patients. Methods Ten thousand nine hundred sixty nine patients, diagnosed in 2010–11, and in remission in 2013, completed the ‘Living with and Beyond Colorectal Cancer’ survey. The survey included purpose‐designed questions on fear of recurrence (‘I have fear about my cancer coming back’), demographics, treatment and health variables. Physical activity (PA) was recorded as number of days per week doing at least 30 min of brisk activity, and smoking status was reported. Results Fifty per cent of respondents reported fear of their cancer returning. More women than men ((Odds Ratio; (OR) 1.58; 95% confidence interval (CI) 1.46, 1.71)) more younger than older patients (OR 2.53; CI 2.33, 2.74) and slightly more patients from deprived areas (OR 1.14, 1.05, 1.23) reported FCR. Independently of demographics and treatment, compared with those meeting the PA guidelines, those who were doing only ‘some’ (OR 1.22; CI 1.11, 1.35) or ‘no’ PA (OR 1.28; CI 1.15, 1.42) reported higher FCR. Compared with non‐smokers, more current smokers reported fear (OR 1.34, CI 1.10, 1.58) and slightly more ex‐smokers (OR 1.11; CI 1.04, 1.21). Conclusions This cross‐sectional study provided novel data showing that colorectal cancer survivors with poorer health behaviours (those with lower activity levels and those who smoked) were more likely to experience FCR. Future research should replicate findings using detailed measures of fear, objective measures of health behaviours and identify directions of associations. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

Our study was aimed at comparing health behavior data collected from a Web-based self-administered questionnaire (Web SAQ) versus a paper-and-pencil self-administered questionnaire and assessing the feasibility of the application.One hundred and ninety (n = 190) pupils (ages 14-16 years) of senior high schools anonymously completed a questionnaire, with demographics and queries about lifestyle, alcohol, and tobacco use. For each class, the adolescents were randomly assigned to complete either the paper version of the questionnaire or the equivalent Web-based one, which used a customized platform developed for the purposes of this survey.Females who filled out the Web SAQ required significantly less time and completed a significantly higher percentage of its items. Although the majority of questions on tobacco and alcohol did not differ significantly across the two administration modes, there were gender-related differences in some sensitive information. Male adolescents on the Web SAQ accounted higher per hour drink consumption (r = 0.27, p = 0.015) and more numerous episodes of inebriety (r = 0.26, p = 0.010), whereas females seemed to state a younger age of alcohol onset (r = 0.33, p = 0.002). Females were more likely to report being monthly smokers on the Web SAQ (odds ratio = 0.37). Adolescents felt significantly less observed and females referred being more independent while compiling the Web SAQ.The findings of the study suggest that differences in reporting of some behavior of adolescents when using a Web SAQ do exist, despite the small-to-medium effect sizes. Exploiting the Web requires further investigation for extensive comprehension of the reasons for such differences.

Objective The study's purpose was to test the generalizability of an individualized information prescription model, which has been previously validated for educating patients about hypertension in emergency department and community health center settings. Study investigators assessed the effects of educational materials targeted to health literacy levels and learning styles on patients' diabetes knowledge in a community clinic setting. Methods From May to August 2012, 160 patients were recruited and randomized into intervention (n = 81) and control (n = 79) groups. Inclusion criteria included 18 years or older, English or Spanish speaker, and a type 2 diabetes diagnosis. Measures included modified versions of the Diabetes Knowledge Test and Subjective Numeracy Scale, along with brief health literacy and learning style assessments. Study team members contacted both groups after 2 and 6 weeks to reassess diabetes knowledge. Results The control group showed no significant change in diabetes knowledge at both follow-ups. In contrast, the mean number of diabetes knowledge questions answered correctly by the intervention group increased significantly after 2 weeks (Δ = 2.66, P = 0.000), which persisted at 6 weeks (Δ = 2.46, P = 0.00). Conclusions This study showed that patients' knowledge about diabetes increased significantly after exposure to educational materials targeted to their health literacy levels and learning style preferences and that the model is transferrable among health conditions.

Background Consumer nutrition environment measures are important to understanding the food environment, which affects individual dietary intake. A nutrition environment measures survey for supermarkets (NEMS-S) has been designed on paper for use in Guatemala. However, a paper survey is not an inconspicuous data collection method. Objective To design, pilot test, and validate the Guatemala NEMS-S in the form of a mobile phone application (mobile app). Methods CommCare, a free and open-source software application, was used to design the NEMS-S for Guatemala in the form of a mobile app. Two raters tested the mobile app in a single Guatemalan supermarket. Both the interrater and the test—retest reliability of the mobile app were determined using percent agreement and Cohen's kappa score and compared with the interrater and test—retest reliability of the paper version. Results Interrater reliability was very high between the paper survey and the mobile app (Cohen's kappa > 0.90). Test—retest reliability ranged from kappa 0.78 to 0.91. Between two certified NEMS-S raters, survey completion time using the mobile app was 5 minutes less than that with the paper form (35 vs. 40 minutes). Conclusions The NEMS-S mobile app provides for more rapid data collection, with equivalent reliability and validity to the NEMS-S paper version, with advantages over a paper-based survey of multiple language capability and concomitant data entry.

Background: Secondary prevention of stroke has been shown to dramatically reduce recurrence and has been described as suboptimal. Objective: To analyse patients’ awareness and knowledge about cerebrovascular risk factors (CVRF) and their influence on CVRF control. Methods: Patients (n = 164) who were attending a stroke outpatient clinic for the first time after hospital discharge (3 months) for a first stroke were asked to answer a short questionnaire including questions on awareness and knowledge of CVRF, visits to a CVRF specialist, number of visits to a general practitioner, adherence to drug treatments, cigarette smoking and cessation. Results: CVRF were spontaneously mentioned as relevant for their stroke by only13% of patients. A specialist was visited by only one-third of the patients and a general practitioner was not visited at all by 27% of the patients since their stroke. Awareness was inversely correlated with older age and good recovery. More than half of the patients had high blood pressure (≥140 mmHg for systolic and ≥90 mmHg for diastolic values) at the time of follow-up. These high values were correlated with poor awareness. Appropriate secondary stroke prevention measures were not received by one-fourth of the patients; this was also correlated with poor awareness. Conclusions: CVRF control is not optimal and is at least partially related to patients’ awareness and knowledge and suboptimal medical follow-up. Older patients and patients with excellent recovery are at particular risk for poor awareness and CVRF control.

Background Self-tests are available to consumers for more than 25 conditions, ranging from infectious diseases to cardiovascular risk factors. Self-tests are defined as in-vitro tests on body materials such as blood, urine, faeces, or saliva that are initiated by consumers to diagnose a particular disorder or risk factor without involving a medical professional. In 2006, 16% of a sample of Dutch Internet users had ever used at least one self-test and 17% intended to use a self-test in the future. The objectives of this study are to determine (1) the frequency of self-test use, (2) the consumers' reasons for using or not using a self-test, (3) the information that is used by self-testers in the different self-test stages and the consumers' interpretation of the quality of this information, (4) the consumers' response to self-test results in terms of their confidence in the result, reassurance by the test result, and follow-up behaviour, (5) the information consumers report to need in the decision making process of using or not using a self-test, and in further management on the basis of the self-test result, and (6) the quality of the currently available consumer information on a selected set of self-tests. Methods Mixed methods study with (1) a cross-sectional study consisting of a two-phase Internet-questionnaire, (2) semi-structured interviews with self-testers and consumers who intend to use a self-test, and (3) the assessment of the quality of consumer information of self-tests. The Health Belief Model and the Theory of Planned Behaviour will serve as the theoretical basis for the questionnaires and the interview topic guides. Conclusions The self-testing area is still in a state of flux and therefore it is expected that self-test use will increase in the future. To the best of our knowledge, this is the first study which combines quantitative and qualitative research to identify consumers' information needs and use concerning self-testing, and the consumers' actual follow-up behaviour based on the self-test result, and simultaneously investigates the quality of the currently available consumer information. The results of this study will be used as an input in developing consumer information on self-testing.

A pilot study was performed to assess the effectiveness of treatment in an opioid dependent population using the Maudsley Addiction Profile (MAP) tool1. The primary outcome of the study was to assess if treatment had an effect on 1. Substance use (quantity and frequency of use), 2. Health risk behaviour (injecting and sharing injecting equipment), 3. Health symptoms (physical and psychological) and 4. Personal /Social functioning (relationships, employment and crime). A secondary outcome was also sought. The study took place in 2007 in an inner city Belfast hospital specialising in the treatment of addiction, over a two month period. Fifteen patients, all opioid dependent and receiving outpatient community treatment, were interviewed at baseline (prior to the commencement of treatment) and at eight weeks follow up. Three patients were lost to follow up. Two patients stopped using altogether. Of the remaining patients, improvements were seen in most areas. There was a decrease in the use of heroin (71.28%), cocaine (99.72%), crack cocaine (100%), cannabis (99.94%) and alcohol (33.17%). There was a reduction in injecting behaviour (60.93%). Improvements were observed in health with a reduction in physical (41.35%) and psychological (35%) symptoms. Overall personal and social functioning improved regarding interactions with family and friends. A reduction in crime was also observed (75%). Opinions and views of staff involved in the study were generally positive. This patient population presents with multiple and complex needs. Effective treatment needs to address these needs and not just drug addiction alone. The Maudsley Addiction Profile tool highlights this.

Objective:To evaluate warm air and paper towel drying for removing bacteria from washed hands.Methods:After hands were washed with non-antibacterial soap, they were dried using warm air with and without ultraviolet light, while being rubbed or held stationary, or paper towels. Each method was performed as a randomized trial using 30 hands.Results:Log colony-forming units (CFU) on palms and fingers increased significantly when hands were dried with warm air while being rubbed for 15 seconds (P < .001), and many bacteria remained at 30 seconds without ultraviolet light (P < .001). Holding hands stationary while drying significantly decreased log CFU on palms, fingers, and fingertips (P < .01 or < .001). Few CFU were detected on palms and fingers dried with ultraviolet light. Although log CFU of palms and fingers did not decrease after drying with three sheets of paper towel, those of fingertips decreased significantly (P < .001). For palms and fingers, log reductions were greater with warm air drying while holding hands stationary, paper towels, and warm air drying while rubbing hands. For fingertips, the log reduction was often greater with paper towels than with warm air.Conclusions:Holding hands stationary and not rubbing them was desirable for removing bacteria. Ultraviolet light reinforced the removal of bacteria during warm air drying. Paper towels were useful for removing bacteria from fingertips but not palms and fingers.