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During global pandemics, such as coronavirus disease 2019 (COVID-19), crisis communication is indispensable in dispelling fears, uncertainty, and unifying individuals worldwide in a collective fight against health threats. Inadequate crisis communication can bring dire personal and economic consequences. Mounting research shows that seemingly endless newsfeeds related to COVID-19 infection and death rates could considerably increase the risk of mental health problems. Unfortunately, media reports that include infodemics regarding the influence of COVID-19 on mental health may be a source of the adverse psychological effects on individuals. Owing partially to insufficient crisis communication practices, media and news organizations across the globe have played minimal roles in battling COVID-19 infodemics. Common refrains include raging QAnon conspiracies, a false and misleading "Chinese virus" narrative, and the use of disinfectants to "cure" COVID-19. With the potential to deteriorate mental health, infodemics fueled by a kaleidoscopic range of misinformation can be dangerous. Unfortunately, there is a shortage of research on how to improve crisis communication across media and news organization channels. This paper identifies ways that legacy media reports on COVID-19 and how social media-based infodemics can result in mental health concerns. This paper discusses possible crisis communication solutions that media and news organizations can adopt to mitigate the negative influences of COVID-19 related news on mental health. Emphasizing the need for global media entities to forge a fact-based, person-centered, and collaborative response to COVID-19 reporting, this paper encourages media resources to focus on the core issue of how to slow or stop COVID-19 transmission effectively.

The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a "difficult to read" result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [Orthopedics. 2021;44(1):38-42.]., (Copyright 2020, SLACK Incorporated.)

The coronavirus (COVID-19) outbreak poses a substantial threat to public health. Individual efforts to engage in COVID-19 precautionary behaviors are necessary to flatten the pandemic's curve in the waiting period before a vaccine is developed. This study sought to apply the Theory of Motivated Information Management to investigate the relationships among COVID-19 illness uncertainty, information management, and actual precautionary behaviors, both preparatory and preventative. The results of a national opt-in online panel demonstrate that uncertainty discrepancy, anxiety, and information management strategies are key predictors of the adoption of COVID-19 preparation and prevention behaviors. The results further identify diverging associations across age groups with respect to associations between information management and precautionary behaviors. Implications for theory and practice are discussed.

Oropharyngeal squamous cell cancer (OPSCC) is now the most common site of head and neck squamous cell cancer. Despite the focus on treatment deintensification in clinical trials, little is known about the preferences, experiences and needs of patients with OPSCC when deciding between surgery and radiation therapy as primary treatment with curative intent. In this qualitative study, pre-treatment and post-treatment oropharyngeal cancer patients were recruited to take part in one-on-one interviews (n = 11 pre-treatment) and focus group discussions (n = 15 post-treatment) about treatment decision-making. Recordings were transcribed and assessed for emergent themes using framework analysis. From the one-on-one interviews and focus group discussions with OPSCC patients, fourteen themes were identified. Participants expressed alarm at diagnosis, decisional conflict, and a variety of roles in decision-making (physician-controlled, shared, and autonomous). Decisions were driven by the perceived recommendation of the treatment team, a desire for physical (surgical) tumor removal, fear of adverse effects of treatment, and patient-specific values. Although participants felt well-informed by their treating physicians, they identified a need for additional patient-centered information. Participants were critical of the poor quality of information available on the internet, and acknowledged the advantage of hearing the experiences of post-treatment patients. The experiences identified herein may be used to guide patient-centered communication during patient counseling and to inform interventions designed to support patients' needs at diagnosis, ultimately helping to implement high-quality, patient-centered care., (Copyright © 2020. Published by Elsevier Ltd.)

Aim: To investigate knowledge levels concerning COVID-19 in elderly patients with T2DM., Methods: This cross-sectional, quantitative, observational, and descriptive study was undertaken among elderly individuals with T2DM involved in a body balance rehabilitation program that had been suspended due to social isolation. The study participants comprised elderly individuals with T2DM, contactable using fixed or mobile telephones. Data concerning participants' socioeconomic variables and knowledge of COVID-19 were collated, using a Brazil Ministry of Health guidelines checklist. Mann-Whitney and Spearman's correlation tests were used to analyze their responses., Results: Of 30 elderly participants, 76.7% were women and 63.3% were married. The average age was 69.96 ± 4.46 years. The most cited information medium was television (96.6%). Of a possible 24 correct responses on the checklist, the median correct response score was 7.5. No significant relationship was observed between the total checklist score and the variables studied., Conclusion: Elderly participants did not have in-depth knowledge concerning COVID-19, which suggests that their knowledge sources may be deficient or that their capacity to retain information was inadequate.

Objectives/hypothesis: The incidence of human papillomavirus-positive (HPV+) oropharyngeal cancer is rising, but public knowledge about this diagnosis remains low. This study aimed to investigate the quality and readability of online information about HPV+ oropharyngeal cancer., Study Design: Cross-sectional website analysis., Methods: This study conducted a total of 12 web searches across Google, Yahoo, and Bing to identify websites related to HPV+ oropharyngeal cancer. The QUality Evaluation Scoring Tool (QUEST) was used to measure quality based on seven website criteria. The Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) were used to measure readability, with scores estimating the education level a reader would require to understand a piece of text. Readability improves as FRES increases and FKGL decreases., Results: Twenty-seven unique web pages were evaluated. The mean USA reading grade level as measured by FKGL was 10.42 (standard deviation = 1.54). There was an inverse relationship between quality and readability, with a significant positive correlation between QUEST score and FKGL (r = 0.343, P = .040) and a significant negative correlation between QUEST score and FRES (r = -0.537, P = .002)., Conclusions: With a mean USA reading grade level more than four grades above the American Medical Association's recommendation and results indicating that readability suffers as quality improves, these findings suggest that the currently available online information about HPV+ oropharyngeal cancer is insufficient. Improved patient education practices and resources about this diagnosis are needed., Level of Evidence: NA Laryngoscope, 131:87-94, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016., Objective: To examine whether Australia's MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016., Method: Content analysis : Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation : An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified., Results: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use., Conclusion: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR., Implications: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.

Objectives: The aim of this study was to evaluate the quality, readability, and accuracy of Web-based information regarding labiaplasty and to characterize the types of Web sites providing this information., Methods: Investigators used 3 major search engines to query the internet using the search terms labiaplasty, labia reduction, and vaginal rejuvenation. Two validated tools were used to evaluate Web sites: the JAMA benchmark tool and the DISCERN instrument. Three physicians independently reviewed each Web site. Interrater agreement was assessed, and reviewer scores were averaged. Flesch-Kincaid reading ease and Flesch-Kincaid grade level of each site were assessed. Data were analyzed using Stata 14.0 (College Station, TX)., Results: Of the 112 Web sites reviewed, 100 Web sites were from North America, 9 from Europe, 2 from Australia, and 1 from Asia. The median score using the JAMA tool was 1.0 (0.33-4.0), indicating low accountability, whereas the median score using the DISCERN tool was 28 (18.7-77) of 80 with higher scores indicating higher quality. Cohen's weighted κ statistic (0.81) demonstrated near perfect agreement among reviewers for DISCERN scores. The median reading level was 11.9 (6.4-19.5). A majority of the Web sites (92) were for-profit businesses or blogs., Conclusions: The internet enables patients to research sensitive topics and seek answers without worry of social stigma. Online health-related information is a widely used yet poorly studied source of medical information. The majority of Web sites reviewed lack balanced, evidence-based information. Given the wide variation in the quality of information, physicians should guide patients to reputable online resources., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2019 American Urogynecologic Society. All rights reserved.)

Background: Individuals' stress in responding to the current COVID-19 pandemic may be exacerbated by information uncertainty driven by inconsistent, unverified, and conflicting news from various sources. The current study aims to test if information uncertainty during the COVID-19 outbreak was related to acute stress disorder (ASD) over and above other psychosocial stressors., Methods: An anonymous online survey was conducted with 7800 college students throughout China from January 31 through February 11, 2020. Existing scales were modified to measure ASD and six potential stressors including information uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was conducted to assess the unique association of information uncertainty with ASD. To minimize the effect of large sample size and also to get a sense of whether the effects of information uncertainty were similar to people at the center of the epidemic, we repeated the hierarchical regression among 10% of the students who were randomly selected from the entire sample ("10% random sample"; n = 780) and 226 students from Hubei Province where the outbreak started., Results: Information uncertainty was highly prevalent among the respondents (64%). It was significantly associated with ASD beyond other key variables and potential stressors across three samples. In the hierarchical regression among the entire sample, demographic variables accounted for 9.4% of the variance in ASD. The other five stressors added 5.1% of the variance. The information uncertainty (β = .159; p < .001) explained an additional 2.1% of the variance. Likewise, the information uncertainty explained an additional 2.1 and 3.4% of the variance in ASD beyond all other variables among the 10% random sample (β = .165; p < .001) and the Hubei sample (β = .196; p < .01), respectively., Conclusion: Information uncertainty is a unique correlate of psychological stress during the COVID-19 outbreak. Reducing information uncertainty is essential not only for halting virus transmission but also for mitigating negative impacts of the pandemic on people's psychosocial wellbeing. Transparent, timely, and accurate communication can reduce public confusion, fear, and stress. Capacity building in governments, communities, and media outlets to prevent, reduce and manage information uncertainty should be a critical part of the response to an emerging global health crisis such as the COVID-19 pandemic.

The incidence of thyroid cancer continues to increase worldwide. The challenge facing the treatment of thyroid cancers is related to the fact that this disease exhibits a broad range of clinical behaviour from indolent tumour to very aggressive malignancies. Therefore, the public and patient education about thyroid cancer are becoming a crucial step in facing the challenge imposed by this cancer. Currently, social media channels such as YouTube, a video-sharing website on the Internet, play a significant role in public and patient education. Research on the part of YouTube in public education about cancer is on the rise, including a paper on thyroid cancer published recently in the Journal of Cancer Education. However, researchers conducting studies should use tools that are designed to assess videos, not written information or websites. DISCERN instrument and JAMA benchmark tools are not intended to evaluate videos such as those of YouTube. An ideal instrument for assessing YouTube should cover several parameters to identify educationally useful videos, including (i) scientific accuracy of video content, (ii) clarity of the massage given, (iii) authority (creator), (iv) pedagogy and educational basis and (v) technical design, including quality images and good visuals, production style, quality scripts, clear sounds and no noises in the background. While video images help in reinforcing the words and the message, both picture and sound quality are vital in creating a strong mental impression and engaging the audience. This commentary calls for the development of a standardised protocol that can help researchers to enhance their research publications and ensure that adequate and accurate data have been collected and analysed. Such a move will help us in establishing the right literature in this area and will help researchers conducting reviews and meta-analysis on YouTube videos.

Thyroid cancer incidence rates and Internet use are both increasing. Thyroid cancer is common in young patients, who are likely to use the Internet. This study aims to characterize thyroid cancer patient Internet use and search patterns, usability of online resources, and effects on clinical care. From May to December 2017, inclusive, patients with thyroid cancer attending two tertiary cancer centers were invited to complete a survey about Internet use. Thirty-nine of 72 questionnaires were returned (54%). Ninety-seven percent of participants used the Internet, and 87% had looked for thyroid cancer information. The majority (94%) searched on Google. Patients most often looked for information about treatment (94%) and symptom management (76%). Many patients evaluated content quality by comparing several resources (71%), discussing with a physician (56%) or using a credible academic or government site (53%). Online information was somewhat hard to understand for 32%, but 91% found it useful. Over half (60%) of treatment decisions were affected by web resources, and information helped 50% of patients make decisions with their physicians. Respondents highlighted a lack of resources on survivorship and uncommon tumors such as medullary or anaplastic cancer. Physicians should recognize that patients overwhelmingly access online information, which often impacts patients' decision-making. Clinicians can guide thyroid cancer patients through abundant web-based information and assist in interpreting this information. Educators can use this information to guide resource development, tailoring content and design to thyroid cancer patients' needs.

Introduction: Wikipedia is an online encyclopedia read by millions seeking medical information. To provide health professions students with skills to critically assess, edit, and improve Wikipedia's medical content, a skillset aligned with evidence-based medicine (EBM), Wikipedia courses have been integrated into health professions schools' curriculum. This literature review and curricular inventory of Wikipedia educational initiatives provides an overview of current approaches and identifies directions for future initiatives and research., Methods: Five databases were searched for articles describing educational interventions to train health professional students to edit Wikipedia. Course dashboards, maintained by Wiki Education (Wiki Edu), were searched for curricular materials. From these sources, key details were extracted and synthesized, including student and instructor type, course content, educational methods, and student outcomes., Results: Six articles and 27 dashboards reported courses offered between 2015 and 2019. Courses were predominantly offered to medical and nursing students. Instructors delivered content via videos, live lectures, and online interactive modules. Course content included logistics of Wikipedia editing, EBM skills, and health literacy. All courses included assignments requiring students to edit Wikipedia independently or in groups. Limited details on assessment of student learning were available., Discussion: A small but growing number of schools are training health professions education students to improve Wikipedia's medical content. Course details are available on Wiki Edu dashboards and, to a lesser extent, in peer-reviewed publications. While more needs to be done in conducting and sharing assessment of student learning, integrating Wikipedia into health professions education has potential to facilitate learning of EBM and communication skills, improve Wikipedia's online content, and engage students with an autonomous environment while learning. Future considerations should include a thorough assessment of student learning and practices, a final review of student edits to ensure they follow Wikipedia's guidelines and are written in clear language, and improved sharing of teaching resources by instructors.

Evaluate quality and readability of online information for common rheumatologic diseases. Compare rheumatology patients' internet use and preferences to an objective evaluation of internet quality and readability. Five common rheumatologic diseases were searched on the web browser Google using English language. The first twenty websites from each of the five searches were evaluated for internet quality (e.g. content that is current, balanced, has specific aims, and is appropriately cited) using the DISCERN criteria and readability using the Flesch-Kincaid Grade Level (FKGL). The results were contrasted with a survey sent to patients with rheumatic disease. The survey measured patient likeliness to use and trust identified websites. Internet quality was similar (good) for all five diseases searched while readability was poor. There was an inverse relationship between internet quality and readability. Internet quality significantly differed across website sponsor, and readability significantly differed across disease and website sponsor. Common medical website sponsors with the highest combined quality and readability scores were Mayo Clinic and Web MD. Eight hundred and fifty-eight patients were sent a survey, of which 147 (17%) completed. Patients indicated they were most likely to use and trust a Mayo Clinic-sponsored website when compared to other common sponsored websites from our evaluation, followed by the American College of Rheumatology. Although we found good-quality information, all websites evaluated had readability levels above the recommended sixth-grade reading level. The website sponsor with the highest combined readability and quality score was also the most used and trusted by patients. Patients would like more information about credible and trusted websites from their medical providers.

Objective: The spread of misinformation has accompanied the coronavirus pandemic, including topics such as immune boosting to prevent COVID-19. This study explores how immune boosting is portrayed on the internet during the COVID-19 pandemic., Design: Content analysis., Methods: We compiled a dataset of 227 webpages from Google searches in Canada and the USA using the phrase 'boost immunity' AND 'coronavirus' on 1 April 2020. We coded webpages for typology and portrayal of immune boosting and supplements. We recorded mentions of microbiome, whether the webpage was selling or advertising an immune boosting product or service, and suggested strategies for boosting immunity., Results: No significant differences were found between webpages that appeared in the searches in Canada and the USA. The most common types of webpages were from news (40.5%) and commercial (24.7%) websites. The concept of immune boosting was portrayed as beneficial for avoiding COVID-19 in 85.5% of webpages and supplements were portrayed as beneficial in 40% of the webpages, but commercial sites were more likely to have these portrayals. The top immune boosting strategies were vitamin C (34.8%), diet (34.4%), sleep (34.4%), exercise (30.8%) and zinc (26.9%). Less than 10% of the webpages provide any critique of the concept of immune boosting., Conclusions: Pairing evidence-based advice for maintaining one's health (eg, healthy diet, exercise, sleep) with the phrase immune boosting and strategies lacking in evidence may inadvertently help to legitimise the concept, making it a powerful marketing tool. Results demonstrate how the spread of misinformation is complex and often more subtle than blatant fraudulent claims., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Firefighters appear at an increased risk for post-traumatic stress disorder (PTSD). Because of PTSD-related stigma, firefighters may search for information online. The current study evaluated the quality, readability, and completeness of PTSD online resources, and to determine how the online treatment recommendations align with current evidence. Google.ca (Canada) searches were performed using four phrases: 'firefighter PTSD', 'firefighter operational stress', 'PTSD symptoms', and 'PTSD treatment'. The 75 websites identified were assessed using quality criteria for consumer health information (DISCERN), readability and health literacy statistics, content analysis, and a comparison of treatments mentioned to the current best evidence. The average DISCERN score was 43.8 out of 75 (indicating 'fair' quality), with 9 'poor' websites (16-30), 31 'fair' websites (31-45), 26 "good" websites (46-60), and nine excellent websites (61-75). The average grade level required to understand the health-related content was 10.6. The most mentioned content was PTSD symptoms (48/75 websites) and PTSD treatments (60/75 websites). The most frequently mentioned treatments were medications (41/75 websites) and cognitive behavioural therapy (40/75 websites). Cognitive behavioural therapy is supported by strong evidence, but evidence for medications appears inconsistent in current systematic reviews. Online PTSD resources exist for firefighters, but the information is challenging to read and lacks evidence-based treatment recommendations., Competing Interests: The authors declare no conflict of interest.

Purpose Hyperacusis is a disorder characterized by reduced sound tolerance leading to ear pain, emotional distress, and reduced quality of life. Many people with hyperacusis turn to the Internet for information and support from online communities to discuss their condition. The purpose of this study was to assess the content and quality of hyperacusis information presented online. Method The three most used Internet search engines were used to identify relevant websites using the single search term hyperacusis . Fifteen websites were selected for analysis. Details of the purpose, audience, and content of each website were extracted using a bespoke data extraction form. The quality of the information on each website was rated using the validated DISCERN questionnaire. Results There was a wide disparity in the quality and content of hyperacusis information across websites. The website Hyperacusis Focus achieved the highest overall DISCERN score. Hyperacusis Focus and U.K. National Health Service websites were the most comprehensive online resources for health care professionals and patients, respectively. Wikipedia was judged useful for both health care professionals and patients. In general, hyperacusis-related information was accurate. However, no single website provided a complete account of hyperacusis, and some were judged to be selective in the information they provided. Conclusions The Internet provides an important source of information for those who have hyperacusis and those who care for them. Revisions to the websites reviewed here are needed for each to provide a complete account of hyperacusis. Supplemental Material https://doi.org/10.23641/asha.12869717.

Newspapers are a significant source of information to the general public as it reaches quite large numbers. Many readers make an essential health decision based on the information provided by the newspaper. Evidence suggests that quality of health reporting in the newspaper is poor. Most of the health tips in the newspaper may lead to self-medication, which is most dangerous. It is the responsibility of the newspaper to provide health information with scientific evidence and readers to be cautious before making any health-related decision based on newspaper information without consulting experts., Competing Interests: The author declares no competing interests., (Copyright: Pushparaja Shetty et al.)

Objective: To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries., Design: Systematic analysis using the 'Ensuring Quality Information for Patients' (EQIP) Tool (score 0-36), Journal of American Medical Association ( JAMA ) benchmark (score 0-4) and the DISCERN Tool (score 16-80) to analyse websites containing information targeted at the general public., Data Sources: Twelve popular search terms, including 'Coronavirus', 'COVID-19 19', 'Wuhan virus', 'How to treat coronavirus' and 'COVID-19 19 Prevention' were identified by 'Google AdWords' and 'Google Trends'. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information., Eligibility Criteria for Selecting Studies: All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information., Results: Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001)., Conclusion: This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives The objective of this descriptive review was to determine the quality, readability, and suitability of ear and hearing health information and materials for patients and their significant others. Method A literature search was conducted between August 2018 and April 2019 in the databases CINAHL Complete, MEDLINE, and PsychInfo. Inclusion and exclusion criteria were used to shortlist studies. Data regarding quality, suitability, and readability were extracted from the included studies. Data were assessed qualitatively. Results There were 34 studies included in this review. Of those, eight examined quality, 33 assessed readability, and four investigated the suitability of materials. The range of materials assessed included diagnostic reports, patient education materials (PEMs), patient-reported outcome measures, and websites. Quality elements were examined in studies focusing on website information. Findings indicated that most websites were of poor quality. Suitability was examined in studies focusing on PEMs such as hearing aid user guides. Findings indicated that most of the existing materials were not suitable for the intended populations. The reading grade level of information across all four categories was found to be higher than the recommended fifth or sixth reading grade level for health-related materials. Revisions of some diagnostic reports and PEMs showed that improvements are possible. Conclusions This review suggests that ear- and hearing-related materials generally have lower quality and suitability with higher readability (more difficult to read). Development of materials that are suitable, of high quality, and at the appropriate readability levels is required to improve accessibility of ear- and hearing-related materials.

While the internet has democratized and accelerated content creation and sharing, it has also made people more vulnerable to manipulation and misinformation. Also, the received information can be distorted by psychological biases. This is problematic especially in health-related communications which can greatly affect the quality of life of individuals. We assembled and analyzed 364 texts related to nutrition and health from Finnish online sources, such as news, columns and blogs, and asked non-experts to subjectively evaluate the texts. Texts were rated for their trustworthiness, sentiment, logic, information, clarity, and neutrality properties. We then estimated individual biases and consensus ratings that were used in training regression models. Firstly, we found that trustworthiness was significantly correlated to the information, neutrality and logic of the texts. Secondly, individual ratings for information and logic were significantly biased by the age and diet of the raters. Our best regression models explained up to 70% of the total variance of consensus ratings based on the low-level properties of texts, such as semantic embeddings, presence of key-terms and part-of-speech tags, references, quotes and paragraphs. With a novel combination of crowdsourcing, behavioral analysis, natural language processing and predictive modeling, our study contributes to the automated identification of reliable and high-quality online information. While critical evaluation of truthfulness cannot be surrendered to the machine only, our findings provide new insights into automated evaluation of subjective text properties and analysis of morphologically-rich languages in regards to trustworthiness., Competing Interests: No authors have competing interests.

Introduction: Patients are increasingly using internet-based information to inform healthcare utilization and treatment decisions. Our aim was to examine the quality and readability of internet-based information relating to Raynaud's phenomenon (RP) and systemic sclerosis (SSc)., Material and Methods: A systematic review of three commonly used search engines (Google®, Yahoo®, and Bing®) using the terms "Raynaud's phenomenon" and "systemic sclerosis" separately. The first 30 websites per search engine were examined. Quality was assessed using the DISCERN questionnaire and readability by the Flesch-Kincaid Grade Level, SMOG Index, Coleman-Liau index, and Flesch Reading Ease score., Results: Fifty-two studies (30 RP and 22 SSc) were included after duplicates and exclusion criteria were applied. The overall quality of information was low for both SSc and RP (1.99 & 2.21), including in relation to reliability of the literature and information on treatment choices. Readability for RP and SSc was also poor (i.e., the texts were difficult to read) across all of the four methods examined., Conclusion: Overall, RP and SSc internet-based information is of low quality and inadequate readability. The RP and SSc international community should strongly consider developing an information standard for internet-based resources for healthcare users., Key Points: • Patients with SSc and RP are increasingly using internet/online sources of information and support. • RP represents an important opportunity for the early diagnosis of SSc. • The overall quality and readability of internet-based RP and SSc information is poor. • Internet-based RP and SSc information requires improvement to facilitate early diagnosis and inform shared decision-making.

Emergency response to emerging threats with the potential for vertical transmission, such as the 2015 to 2017 response to Zika virus, presents unique clinical challenges that underscore the need for better communication and care coordination between obstetric and pediatric providers to promote optimal health for women and infants. Published guidelines for routine maternal-infant care during the perinatal period, and models for transitions of care in various health care settings are available, but no broad framework has addressed coordinated multidisciplinary care of the maternal-infant dyad during emergency response. We present a novel framework and strategies to improve care coordination and communication during an emergency response. The proposed framework includes (1) identification and collection of critical information to inform care, (2) key health care touchpoints for the maternal-infant dyad, and (3) primary pathways of communication and modes of transfer across touchpoints, as well as practical strategies. This framework and associated strategies can be modified to address the care coordination needs of pregnant women and their infants with possible exposure to other emerging infectious and noninfectious congenital threats that may require long-term, multidisciplinary management. KEY POINTS: · Emerging congential threats present unique coordination challenges for obstetric and pediatric clinicians during emergency response.. · We present a framework to help coodinate care of pregnant women/infants exposed to congenital threats.. · The framework identifies critical information to inform care, health care touchpoints, and communication/information transfer pathways.., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: The development of user-friendly nutrition resources for pregnant women seldom involves end-users. This qualitative study used a citizens' jury approach to determine if our modification of a longstanding, frequently used dietitian-informed diet and diabetes booklet was deemed to be a good healthy eating resource for pregnant women., Design: Midwives recruited thirteen first-time pregnant women not requiring specialist obstetric care or specialist dietetic advice for any reason. Participants were sent a copy of the modified healthy eating in pregnancy booklet prior to 'jury day'. Five women were unable to attend the citizens' jury citing reasons such as early labour. At the jury, five experts presented evidence. Participants adjourned, with an independent facilitator, to 'deliberate' as to whether the resource was suitable or not. The verdict was presented, and subsequent discussion was audio-recorded, transcribed and inductively content analysed., Setting: Southland, New Zealand., Participants: Pregnant women aged 19-35 years (n 8), of whom half had a household income <$NZ30 000., Results: The verdict was 'Yes'; the resource was good. Three themes were derived: communication of health information, resource content and harm reduction in pregnancy. Based on these data, ways to enhance the quality and usability of the booklet were evident., Conclusions: Citizens' juries can be used to obtain an independent assessment by end-users of health resources. Our modified diet and diabetes booklet was considered suitable for providing healthy eating advice to pregnant women. Inclusion of end-users' perspectives is critical for end-user relevant content, comprehension and resource credibility.

Importance: In the modern-day health care environment, it is expected that a large proportion of patients will utilize the Internet to gather health care-related information. However, online sources are often not subjected to adequate quality control measures. Objective: To evaluate the quality of printed online education materials (POEMs) pertaining to elective facial cosmetic surgery. Design, Setting, and Participants: This is a descriptive correlational study. Independent Internet searches for the terms "rhinoplasty," "rhytidectomy," "blepharoplasty," and "browlift" were carried out using the Google search engine. The top 20 web resources for each term were analyzed. Main Outcomes and Measures: All web resources were analyzed for HONcode certification. The DISCERN instrument was then used to determine reliability and specificity of information, whereas readability was assessed using the Flesch Reading Ease (FRE) score and the Flesch-Kincaid Grade Level (FKGL). Results: Of the resulting 80 web resources, 30% ( n  = 24) were HONcode certified. None of the surgical society web resources ( n  = 12) were HONcode certified, and only 42% ( n  = 8) of web resources associated with academic institutions were HONcode certified. Out of a maximum DISCERN score of 80, the mean (standard deviation [SD]) scores were 48 (11) for rhinoplasty, 50 (11) for rhytidectomy, 47 (11) for blepharoplasty, and 45 (10) for browlift. The mean DISCERN scores of the HONcode-certified web resources did not differ significantly from scores of uncertified web resources ( p  = 0.069). There was no significant difference in overall mean DISCERN scores for the different web resource categories. The mean (SD) FRE score was 45.7 (11.9), whereas the mean FKGL score was 10.7 (1.9). HONcode-certified web resources had significantly higher FRE scores ( p  = 0.028) and significantly lower FKGL scores ( p  = 0.0003). Conclusions and Relevance: A significant proportion of POEMs regarding elective cosmetic facial plastic surgery remains uncertified and of inadequate quality. This can negatively impact the informed decision-making process and increase the risk of poor outcomes and lower satisfaction rates.

Background: Pregnant women create their childbirth expectations from their available information. Therefore, they should have access to reliable and quality medical information. However, the literature points a knowledge gap with respect to the sources of information used by them., Objectives: The primary objective was to analyse the most influential and widely used sources of information about childbearing in Spanish pregnant women. The secondary objectives were to assess the quality and usefulness of the information sources, to identify those regarded as deficient by pregnant women and to discover differences in information use related to parity., Design and Methods: A cross-sectional descriptive study was undertaken involving the administration of questionnaires to 40 primiparous and 40 multiparous (taking into account their first and second pregnancy). Social Network Analysis was used, as well as descriptive and inferential statistics for secondary objectives., Results: Midwives were the most widely used (degree 0.988) and influential source of information (degree 0.600). Although the Internet was very much used (degree 0.738), its influence was very limited (degree 0.050). Healthcare professionals provided the most useful and highest quality information. Statistically significant differences have been found between first and second pregnancy of multiparous women in relation to the utilisation of some sources of information., Conclusions: Midwives were identified as the key professionals for informing pregnant women. The most influential sources were always people (this underscoring the importance of the face-to-face contact in the search for information). Although new technologies offered support, were unable to replace the information provided by healthcare professionals., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Although migraine is recognized as one of the most common and disabling diseases in the world, it is nonetheless still underestimated, underdiagnosed, and undertreated. The fact that migraine patients often tend to access the Web to search for headache-related information hinders patient-doctor relationships and one should also bear in mind that, unfortunately, text readability and medical literacy in the overall population may be the reason why patients' understanding of health information is compromised., Aim: We aimed to assess the readability of the home page of the top 10 patient - oriented migraine-related websites and the educational level required to be in a position to broach them., Methods: On April 15, 2018, we conducted a descriptive study on the international version of Google by entering the words "headache" and "migraine." We then analyzed the overall level of readability of texts of the home pages of the top 10 patient-oriented websites, by means of the Simple Measure of Gobbledygook Readability Calculator., Results: Entering "headache" on the home pages of the top 10 patient-oriented websites on Google we found that to understand these particular websites with ease, an average grade level of 12.4 (±1.5 standard deviation, SD) and an average 13.3 years of formal education (±1.7 SD) were required. Similarly, typing "migraine" on Google we found an average grade level of 10.8 (±1.2 SD) and an average of 12.5 years of formal education (±1.9 SD) were required. The most frequently viewed websites all failed to meet the USA National Institutes of Health guidelines, which recommend a range between 6th and 7th grade level readability., Discussion: The present study shows the low readability level resulting from the top 10 patient-oriented headache/migraine websites and the consequent barrier this creates in the dissemination of headache/migraine-related medical information. Although the actual physicians, both primary care physicians and headache specialists are the principal source of understandable headache-related information, only a minority of people consult these professionals. Given the foregoing, the majority of migraine patients is, therefore, unable to obtain adequate comprehensible health information on the Web. Furthermore, the existing gap between migraine-related website content readability and the unmet need for migraine patients to obtain pertinent and correct information might well contribute to the worldwide neglect of migraine as a major public health problem., Conclusion: Physician experts in headache and migraine should actively cooperate in planning informative material to establish what information patients need to know, how they should use it, and how readable that material actually is. Readability ought to be established before the final website publication. Plain language ought to be used and written messages should be supplemented with visual content such as simple drawings. We recommend the setting up of a new dynamic, modern, plain-talking, and efficient approach in communication aimed at catching the public's attention with its readability and thus satisfying a migraine and headache web scenario., (© 2020 American Headache Society.)

Background: Breast cancer incidence is increasing in Vietnam with studies indicating low levels of knowledge and awareness and late presentation. While there is a growing body of literature on challenges faced by women in accessing breast cancer services, and for delivering care, no studies have sought to analyse breast cancer messaging in the Vietnamese popular media. The aim of this study was to investigate and understand the content of messages concerning breast cancer in online Vietnamese newspapers in order to inform future health promotional content., Methods: This study describes a mixed-methods media content analysis that counted and ranked frequencies for media content (article text, themes and images) related to breast cancer in six Vietnamese online news publications over a twelve month period., Results: Media content (n = 129 articles & n = 237 images) sampled showed that although information is largely accurate, there is a marked lack of stories about Vietnamese women's personal experiences. Such stories could help bridge the gap between what information about breast cancer is presented in the Vietnamese media, and what women in Vietnam understand about breast cancer risk factors, symptoms, screening and treatment., Conclusions: Given findings from other studies indicating low levels of knowledge and women with breast cancer experiencing stigma and prejudice, more nuanced and in-depth narrative-focused messaging may be required.

Background: Patients increasingly turn to search engines and online content before, or in place of, talking with a health professional. Low quality health information, which is common on the internet, presents risks to the patient in the form of misinformation and a possibly poorer relationship with their physician. To address this, the DISCERN criteria (developed at University of Oxford) are used to evaluate the quality of online health information. However, patients are unlikely to take the time to apply these criteria to the health websites they visit., Methods: We built an automated implementation of the DISCERN instrument (Brief version) using machine learning models. We compared the performance of a traditional model (Random Forest) with that of a hierarchical encoder attention-based neural network (HEA) model using two language embeddings, BERT and BioBERT., Results: The HEA BERT and BioBERT models achieved average F1-macro scores across all criteria of 0.75 and 0.74, respectively, outperforming the Random Forest model (average F1-macro = 0.69). Overall, the neural network based models achieved 81% and 86% average accuracy at 100% and 80% coverage, respectively, compared to 94% manual rating accuracy. The attention mechanism implemented in the HEA architectures not only provided 'model explainability' by identifying reasonable supporting sentences for the documents fulfilling the Brief DISCERN criteria, but also boosted F1 performance by 0.05 compared to the same architecture without an attention mechanism., Conclusions: Our research suggests that it is feasible to automate online health information quality assessment, which is an important step towards empowering patients to become informed partners in the healthcare process.

Background: High-quality information is essential if clients who request an abortion are to reach informed decisions and feel prepared for the procedure, but little is known concerning the readability of web-based sources containing such material. The aim was to investigate the readability of web-based information about induced abortion., Methods: The search engine Google was used to identify web pages about induced abortion, written in the English language. A total of 240 hits were screened and 236 web pages fulfilled the inclusion criteria. After correcting for duplicate hits, 185 web pages were included. The readability of the text-based content of each web page was determined with Flesch Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook, and Flesch Reading Ease. Data were analyzed with descriptive statistics, Pearson's correlation coefficient and Kruskal-Wallis with Dunn's test as post hoc analysis., Results: Across all grade level measures, a small minority of the web pages had a readability corresponding to elementary school (n < 3, 1%), while the majority had readability corresponding to senior high school or above (n > 153, 65%). The means of the grade level measures ranged between 10.5 and 13.1, and the mean Flesch Reading Ease score was 45.3 (SD 13.6). Only weak correlations (rho < 0.2) were found between the readability measures and search rank in the hit lists. Consistently, web pages affiliated with health care had the least difficult readability and those affiliated with scientific sources had the most difficult readability., Conclusions: Overall, web-based information about induced abortions has difficult readability. Incentives are needed to improve the readability of these texts and ensure that clients encounter understandable information so that they may reach informed decisions and feel adequately prepared when requesting an abortion.

Objective: To determine the quality, content, and readability of patient education materials pertaining to otitis media across several popular online platforms focused on otolaryngology and pediatric primary care education., Methods: Online patient materials related to otitis media and directed toward parents were collected from the American Association for Family Practice (AAFP), ENT-Health section of the American Academy of Otolaryngology-Head and Neck Surgery, Healthychildren.org from the American Academy of Pediatrics, KidsHealth from Nemours, WebMD, and Wikipedia. Materials were analyzed for quality, content, and readability. The DISCERN instrument was used to score quality. A unique content score was generated based on the information provided on each website and on the medical and surgical management of otitis media. Readability scores were calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, and Automated Readability Index., Results: Overall, content was well-balanced. Information from AAFP and Healthychildren.org was focused more on medical management than other sources. The average DISCERN scores showed all sources to be of good quality with minimal shortcomings. The AAFP and KidsHealth websites had some readability scores around the 8th-grade reading level, the National Institute of Health's upper limit recommended for public health information; however, most websites were above this recommended reading level., Conclusion: Patient education materials related to otitis media on academic and certain popular internet sites are good sources to obtain high-quality information on the topic. Patient educational background, prior knowledge and understanding of otitis media, and physician-patient partnership goals should be taken into account when referring patients to online materials.

Objective: Breast cancer is the most common cancer type among women worldwide. Today, health consumers search the Internet to gain health information about many diseases including breast cancer. YouTube™ is the second most commonly used website on the Internet. However, the quality and accuracy of health-related YouTube™ videos are controversial. The objective of this study was to investigate the quality and accuracy of breast cancer-related videos on YouTube™. Material and Methods . "Breast cancer" keyword was entered into YouTube™ search bar, and after excluding advertisement, duplicate, and non-English videos, the first most viewed 50 videos were analyzed. Videos' length, the number of views, comments, likes, and dislikes were recorded. DISCERN and JAMA scores and Video Power Index (VPI) values of the videos were calculated. All videos were evaluated by two independent radiologists experienced on breast cancer. The correlation between the two observers was also analyzed., Results: Of all videos, 14% were uploaded by physicians, 26% by health channels, 20% by patients, 10% by news channels, 2% by herbalists, 2% by blog channels, and 2% by nonprofit activism channels. The mean DISCERN score was calculated as 26.70 ± 10.99 and the mean JAMA score as 2.23 ± 0.97. The mean VPI value, which was calculated to determine the popularity of the videos, was found as 94.10 ± 4.48. A strong statistically significant correlation was found between the two observers in terms of both DISCERN and JAMA scores. There was an excellent agreement between the two observers., Conclusion: The overall quality of the viewed videos was found as poor. Healthcare professionals should be encouraged to upload breast cancer-related videos with accurate information to promote patients for screening and direct them appropriately., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2020 Isil Yurdaisik.)

This study examines how vaccine-related books appear on Amazon, focusing on search and recommendation algorithms. We collected vaccine related books that appeared on the first 10 search result pages by Amazon for seven consecutive days and content coded each book. We also collected Amazon's recommendations for each vaccine book and mapped the network of recommendation among these books. First, we found that the number of vaccine-hesitant books outnumbered vaccine-supportive books two to one. Of these vaccine-hesitant books, 21% were written by physicians and medical experts. Second, although we did not find evidence that their search algorithm systematically favored any particular type of book, the three top ranked books across the seven days were all vaccine-hesitant ones. Lastly, using a network model, we found that books sharing similar views of vaccines were recommended together such that when a user views a vaccine-hesitant book, many other vaccine-hesitant books are further recommended for the user. The three most frequently recommended books were vaccine-hesitant ones. The potential consequences of blindly applying commercial algorithms to a complicated health messages such as vaccines are discussed.

Objective: This convergent mixed methods study examined how information sources influence college students' beliefs and knowledge about vaping. Participants: College students either completed a survey ( n  = 522; January-April, 2016) or were interviewed ( n  = 33; 2015-2016). Methods: College students completed an online survey asking 'where' students had heard about e-cigarette and 'what' they had heard. Responses were quantified and a chi-square analysis was conducted. Additional college student e-cigarette users were interviewed about the credibility of information sources. Thematic analysis was conducted with the coded interviews. Results: There was a significant relationship between information sources for e-cigarettes (social sources, media, advertising, education/research) and the messages they recalled. Friends who vaped and e-cigarette users were the most credible information sources. Confirmation bias and scientific impotence bias characterized assessment of e-cigarette information. Conclusions: Health education specialists working on college campuses should provide accurate information via communication channels most unitized by college students.

Objective: With the rising trend of postponing motherhood, there has been an increasing rate of infertility. Social fertility preservation offers the potential to overcome this age-related infertility, and many women are turning to the Internet to seek medical information. The aim of this study was to evaluate online information on social fertility preservation., Methods: This study used five search terms-"egg freezing," "fertility preservation," "social egg freezing," "social fertility preservation," and "oocyte cryopreservation"-to identify the most popular sites as rated by Google. Accuracy of information and quality of websites were rated on the basis of four categories: Silberg's accountability criteria, Abbott's aesthetic criteria, Flesch-Kincaid readability score, and the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommendations (Canadian Task Force classification III)., Results: Study investigators identified the 21 most used websites. The average Silberg score was 6.57, with 85.7% of websites meeting the criteria for adequate accountability. Only one website (4.8%) did not meet the criteria for appropriate aesthetic appeal. The average Flesch-Kincaid readability score was 11.39, equivalent to a grade 11 reading level, which is significantly higher than the reading level of the general population. A total of 57% of websites contained less than half of the evidence-based recommendations provided in CFAS and SOGC recommendations., Conclusion: Online information on social fertility preservation is easily accessible and aesthetically pleasing, but information is not easily readable and does not reflect evidence-based recommendations. Hence, health care professionals must fill the knowledge gaps and adequately counsel their patients to optimize a woman's chance at a successful pregnancy., (Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

The objective of Nutrimedia is to evaluate, based on the scientific evidence, the veracity of nutrition claims disseminated to the public by the media. In this article, we describe the methodology, characteristics and contents of this web-based resource, as well as its web traffic and media impact since it was launched. Nutrimedia uses a systematic process to evaluate common beliefs, claims from newspapers and advertising identified and selected by its research team, as well as questions from the public. After formulating a structured question for each claim, we conduct a pragmatic search, prioritizing guidelines and/or systematic reviews. We evaluate the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and classify the veracity of each claim into seven categories (true, probably true, possibly true, possibly false, probably false, false, and uncertain). For each evaluation, we develop a scientific report, a plain language summary, a summary of findings table, and, in some cases, a video. From November 2017 to May 2019, we published 30 evaluations (21 were related to foods, six to diets, and three to supplements), most of which were triggered by questions from the public (40%; 12/30). Overall, nearly half of the claims were classified as uncertain (47%; 14/30). Nutrimedia received 47,265 visitors, with a total of 181,360 pages viewed. The project and its results were reported in 84 written media and 386 websites from Spain and 14 other countries, mostly from Latin America. To our knowledge, Nutrimedia is the first web-based resource for the public that evaluates the certainty of evidence and the veracity of nutrition claims using the GRADE approach. The scientific rigor combined with the use of friendly presentation formats are distinctive features of this resource, developed to help the public to make informed choices about nutrition., Competing Interests: The authors have declared that no competing interests exist.

Background: Providing information about prenatal tests is a clinical challenge and the public frequently accesses the Web to read pregnancy-related information. The overarching aim of this study was to investigate the quality of consumer-oriented websites addressing obstetric ultrasound examination in the second trimester of pregnancy., Methods: Swedish websites were identified with Google, using 20 search strings and screening 400 hits (n = 71 included websites). Reliability and information about the examination were assessed with the DISCERN instrument, completeness was assessed according to national guidelines, and readability analyzed with the Readability Index. Popularity was determined with the ALEXA tool and search rank was determined according to Google hit lists., Results: The mean total DISCERN score was 29.7/80 (SD 11.4), with > 50% having low quality for 15 of the 16 questions. The mean completeness score was 6.8/24 (SD 4.5). The Readability Index ranged between 22 and 63, with a mean of 42.7 (SD 6.8), indicating difficult readability. Weak and non-significant correlations were observed between ALEXA/search rank and the investigated quality variables, except for search rank and reliability., Conclusions: The quality of consumer-oriented websites addressing the second trimester ultrasound examination is low. Health professionals need to discuss this with expectant parents considering undergoing the examination. There is a need for efforts that aim to improve the poor quality of online sources in the field of prenatal examinations.

Introduction: Recent research has highlighted disparities in people who perceive as trustworthy sources of e-cigarette health information. Research has yet to examine if trusting a particular source of information is associated with use of e-cigarettes or perceptions of e-cigarette harm. We use a nationally representative survey of American adults to address these gaps in knowledge., Methods: This study used data from the Health Information National Trends Survey (N = 3738). Logistic regression models were used to calculate odds of ever using e-cigarettes and perceived health harm of e-cigarettes. Trust in seven different sources of e-cigarette health information served as the independent variables. Models accounted for confounders., Results: Trusting religious organizations "a lot" as sources of e-cigarette health information was associated with lower odds of ever using e-cigarettes and with lower odds of perceiving e-cigarettes as less harmful than conventional cigarettes. Trusting e-cigarette companies "a lot" as sources of e-cigarette health information was associated with lower odds of viewing e-cigarettes as harmful to health., Conclusion: Trusting health information about e-cigarettes from sources in the medical or public health field was not associated with lower use of e-cigarettes or viewing e-cigarettes as more harmful. Trusting health information from e-cigarette companies yielded perceptions of e-cigarette harm that are consistent with messaging provided by these companies., Implications: As use of e-cigarettes continues to climb, leveraging different modes of health communication will be critical to both discourage e-cigarette use among never-smokers and, potentially, to encourage use of e-cigarettes as an option to achieve smoking cessation or reduce the harm of tobacco products. Our findings suggest that religious organizations may be helpful in communicating anti-e-cigarette messages., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The internet has become an important source of health information for users worldwide. The novel coronavirus caused a pandemic search for information with broad dissemination of false or misleading health information., Objective: The aim of this study was to evaluate the quality and readability of online information about the coronavirus disease (COVID-19), which was a trending topic on the internet, using validated instruments and relating the quality of information to its readability., Methods: The search was based on the term "Wuhan Coronavirus" on the Google website (February 6, 2020). At the search time, the terms "COVID-19" or "SARS-CoV-2" (severe acute respiratory syndrome coronavirus 2) did not exist. Critical analysis was performed on the first 110 hits using the Health on the Net Foundation Code of Conduct (HONcode), the Journal of the American Medical Association (JAMA) benchmark, the DISCERN instrument, and Google ranking., Results: The first 110 websites were critically analyzed, and only 1.8% (n=2) of the websites had the HONcode seal. The JAMA benchmark showed that 39.1% (n=43) of the websites did not have any of the categories required by this tool, and only 10.0% (11/110) of the websites had the four quality criteria required by JAMA. The DISCERN score showed that 70.0% (n=77) of the websites were evaluated as having a low score and none were rated as having a high score., Conclusions: Nonhealth personnel and the scientific community need to be aware about the quality of the information they read and produce, respectively. The Wuhan coronavirus health crisis misinformation was produced by the media, and the misinformation was obtained by users from the internet. The use of the internet has a risk to public health, and, in cases like this, the governments should be developing strategies to regulate health information on the internet without censuring the population. By February 6, 2020, no quality information was available on the internet about COVID-19., (©Jose Yunam Cuan-Baltazar, Maria José Muñoz-Perez, Carolina Robledo-Vega, Maria Fernanda Pérez-Zepeda, Elena Soto-Vega. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 09.04.2020.)

Background: Concern about health misinformation is longstanding, especially on the Internet., Methods: Using agent-based models, we considered the effects of such misinformation on a norovirus outbreak, and some methods for countering the possible impacts of "good" and "bad" health advice. The work explicitly models spread of physical disease and information (both online and offline) as two separate but interacting processes. The models have multiple stochastic elements; repeat model runs were made to identify parameter values that most consistently produced the desired target baseline scenario. Next, parameters were found that most consistently led to a scenario when outbreak severity was clearly made worse by circulating poor quality disease prevention advice. Strategies to counter "fake" health news were tested., Results: Reducing bad advice to 30% of total information or making at least 30% of people fully resistant to believing in and sharing bad health advice were effective thresholds to counteract the negative impacts of bad advice during a norovirus outbreak., Conclusion: How feasible it is to achieve these targets within communication networks (online and offline) should be explored., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)