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DragonflyNewsletter of the NN/LM PNR
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CDCynergy is a program for public health professionals that guides them through 52 steps of a communication intervention and offers context-sensitive published information at every step. The Centers for Disease Control and Prevention (CDC) has developed the program in order to improve the reliance of public health workers on the best theories and practices, augmented with evidence-based information. Core documents--public policies, classic theories, standard methodologies--are all included, as are hundreds of examples of communication interventions. Multimedia is used extensively to offer video explanations by experts in the field and public service messages for both radio and TV. The program also links to documents and examples on the web.
In order to train public health professionals to use CDCynergy, CDC has contracted with the Society of Public Health Educators (SOPHE) to provide trainers. Nancy Press, RML Consumer Health Coordinator, was chosen by the Pacific Northwest Regional Chapter of SOPHE to represent the chapter at a train-the-trainer session at CDC in February and then to be the trainer for the Pacific Northwest on behalf of SOPHE.
Nancy was the only librarian at the train-the-trainer session. Most of the other 24 participants were public health department workers, private public health consultants, and university public health faculty planning to use CDCynergy as their course curriculum.
CDC is developing 16 different variants of CDCynergy. Currently available are versions highlighting interventions in Micronutrients, Diabetes, Immunization, and Cardiovascular Health. CDCynergy will also be put up on the web within the next year. Dr. Galen Cole of CDC, who led the development of the CDCynergy, is interested in collaborating with the National Library of Medicine and with librarians in development and implementation of future versions of CDCynergy.
Dragonfly, Winter, 2002
-- Volume 33, Number 1
(posted on PNRNews April 1, 2002)
Find out if a web site is easy-to-read...using software you probably already have.
Ability to read makes a difference in health care. One study "revealed that those who read at the lowest grade levels (grades 0-2) had average annual health care costs of $12,974 compared with $2969 for the overall population studied." (Health Literacy, Report of the Council on Scientific Affairs Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association, JAMA Vol. 281 No. 6, February 10, 1999, 552-7.)
A long-term way of addressing this problem is to improve the literacy level of the population but, right now, we need to ensure that people can get plenty of easy-to-read materials. In the RML we are often asked to recommend Web materials that are easy-to-read. How do we find out? We asked a noted health educator and have been following her advice ever since.
1. Copy the text of the web page or pages. A sample will do; if a discussion of diabetes is spread over 4 or 5 different pages, just copy one.
2. Paste the text into a blank MS Word document.
3. In Word, under "Tools" choose "Options." Click on the "Spelling and Grammar" tab. Make sure that there is a check in the box next to "Show readability statistics." Click "ok."
4. Now, under "Tools" choose "Spelling and Grammar." Click "Ignore" as many times as you have to in order to get past those spelling change screens. The last screen you will get has a section entitled "Readability." Passive sentences are harder to understand, so the readability information includes a passive sentence tally. Then, note the "Flesch Reading Ease" score and the "Flesch-Kincaid Grade Level."
For one particular project a community asked me to find web sites that were no higher than 6th grade reading level, so I used this test and eliminated any links to sites that came in at above 6.0 on the Flesch-Kincaid Grade Level scale. Your institution may choose a different grade level depending on the community it serves.
You won't be able to use this method with .pdf files or with graphic files, but it works well for text files.
Dragonfly, Winter, 2002
-- Volume 33, Number 1
(posted on PNRNews February 7, 2002)
Our problem: How to teach effective use of PubMed?
Our strategy: Use interesting examples to illustrate the mechanics of how the system searches for material and displays the results.
Creating original examples that are both instructive as well as interesting is often the most difficult part of preparing for a class on PubMed.
As the teacher, you can take advantage of putting the cart in front of the horse: Find an interesting article, and to then tailor a search strategy to find that citation.
One of the best ways to do this is to keep an eye on national Internet news sites (such as CNN and MSNBC, which often rely on AP and Reuters sources) for stories announcing medical breakthroughs or scientific discoveries.
For example, scanning the Web on the morning of January 11, 2002, provided the following headlines that suggested possible PubMed search examples:
Protein Controls Severe Pain
Low-salt, Low-meat Diet can Prevent Kidney Stones
Both of these news items discuss the imminent publication of research in a major journal. These news items provide you with the name of the researchers and the journals in which their respective works will be published. Using this information, I could construct citation-oriented searches on penninger j [au] AND cell [ta] to retrieve the Protein-Pain article and borghi l [au] AND n engl j med [ta] to retrieve the Salt-Meat-Kidney Stone article.
Care must be used if you use this type of citation-focused search. The timing of the news announcement quite often precedes the acquisition and inclusion of the original article within PubMed. Check to be sure that the article is actually in PubMed before you do the search before an audience. Nothing is more embarrassing than to sell an audience on a search strategy only to have it pull up no hits. On the morning of January 11, 2002, neither of the searches listed above retrieved the desired citations. If you are patient, you�ll find within a few days that these citations have been added to PubMed. At this point they are fair game for serving as a search example, so long as you do not try to retrieve them using any of the fields that are only available after the record has been fully indexed.
Health-related Internet news stories do much more than simply herald the publication of new research. Recent events will often cause news sources to revisit issues that have been the subject of previous research. This type of article often leads to a controversial or surprising topic that is quite suitable to serve as the subject of an effective PubMed search example.
CDC Renews Sprout Warning
The article reaffirms the risk of developing food poisoning from eating uncooked alfalfa and bean sprouts. This easily translates to the simple query food poisoning AND sprouts and retrieves 25 hits. Taking the example one step further, you can substitute sprout* for sprouts to demonstrate how truncation picks up six additional records when compared to the original search.
Experts Debate Accutane Link to Suicide
On January 5th, 2002, a small plane was flown into a Tampa, FL, high-rise. The 15-year-old pilot was taking the drug Accutane to treat his acne. There have been questions in the past about a possible association between the use of Accutane and suicidal behavior. This story can be translated using the MeSH browser. The resulting PubMed search strategy of Isotretinoin/adverse effects[MESH] AND suicide[MESH] would retrieve a total of 11 hits.
Today�s medical and scientific breakthroughs serve as the inspiration for future research. Each day provides a fresh supply of potential examples for the database instructor. The four examples above were derived from a single morning of skimming the newswires. If you use current news items to serve as the subjects for your search examples, you�ll have no trouble capturing and holding the attention of your audience at your next presentation.
Dragonfly, Winter, 2002 --
Vol.33, Number 1
(posted on PNRNews January 25, 2002)
Drexie Malone is collaborating with the Pacific Northwest Regional Medical Library by investigating how well its new Web look is accessible to all.
Web page access for the disabled is a timely subject for almost any library, whether hospital, public, or academic. The number of Americans with disabilities who can benefit from access to the World Wide Web (WWW) is significant. Approximately 10% of the American population has vision, auditory, mobility, or cognitive disabilities that jeopardize their WWW access (1). Recent government regulations require federal Web sites to meet accessibility standards.
Many libraries have successfully responded to the increased demand for computer and Internet access for the majority of their users. People with disabilities, however, have seen their information access actually diminish. Features such as the graphical user interface (GUI), images, and animation have improved use of the Web for most people. At the same time, these innovations have made it harder for people who have disabilities. Text-based Web pages, which were originally the only format on the WWW, opened a whole world of information to people with vision problems. But adaptive technology devices used by the visually impaired - screen readers, for example - do not 'read' images; they read only text. In addition, screen readers do not interpret animation or tables and columns.
Web innovations can also be confusing or useless to those who have other kinds of disabilities. A person who is deaf will miss the presentation of a video clip that is not accompanied by closed-captioned text. Animation with sound and streaming video are also obstacles for people with auditory impairments. Reduced mobility (from an accident, repetitive stress injury, or permanent physical limitations) requires an alternative to the mouse to navigate Web pages. Such alternative technology includes keyboard navigation instead of a mouse, mouth sticks, head pointers, eyegaze-operated keyboards, and infrared devices.
People with learning disabilities may not understand all of the information presented on a busy, disorganized Web page. Unless the format is simplified and repeated, those with cognitive impairment will not benefit from the dense information presented on Web pages.
Regulations
Amendments to the Rehabilitation Act of 1973, made in 1998, took effect in June 2001 (2). The changes to Section 508 of this Act require electronic and information technology used by the federal government to be accessible to people with disabilities. Enforcement is to be implemented by suits against the government when users believe they have been denied equal access. Section 508 rules do not apply to private companies, but disability advocates hope the private sector will follow in opening up the WWW for disabled users.
Older legislation exists to support technology access for the disabled. The Americans With Disabilities Act of 1990 requires that appropriate aids and services be furnished to insure effective communication to individuals with disabilities (3,4). The Assistive Technology Act of 1998 requires that states receiving funding under the Act be subject to Section 508.
Solutions
The most prominent organization supporting accessibility is the World Wide Web Consortium (W3C), which promotes the Web Accessibility Initiative (WAI) on its Web site (http://www.w3.org/TR/WCAG10/) (5). The WAI guidelines cover 14 points, from text and language structure to making program elements like applets compatible with assistive technologies. Many Web page accessibility solutions use the W3C guidelines for direction. Guidelines can be extensive, or as simple as these, which were distilled by Dan Comden, consultant and manager of the Adaptive Technology Lab at the University of Washington (UW) (6):
If Web page designers do nothing more than follow these three basic guidelines, they will meet 90% of the needs of the disabled for Web page access. The Adaptive Technology Lab is associated with the DO-IT (Disabilities, Opportunities, Internetworking, and Technology) program at the UW, promoting "the use of electronic and information technology to maximize the independence, productivity, and participation of people with disabilities." (http://www.washington.edu/doit/)
Testing
In addition to implementing these guidelines, it is useful to test Web sites after the format has been implemented. One may test electronically by using a tool to check for Web page compatibility. "Bobby tested and approved" is the logo of an electronic tool, named Bobby, produced by the Center for Applied and Special Technology (CAST) (http://www.cast.org/bobby/ ) (7). The tool checks if Web pages meet the WAI guidelines. Pages must pass all priority 1, the lowest of 3 priorities, checkpoints for approval. One may submit the page Universal Resource Locator (URL) to the site and the results are presented online. Approved sites may display the Bobby-approved icon; the display is optional and not enforced.
Other sites provide Web access testing, including but not limited to, Pennsylvania's Initiative on Assistive Technology (PAIT), the TRACE center, and the Adaptive Technology Resource Centre (ATRC) (8). The WAVE 2.01 Web page accessibility check, produced by PAIT, also uses the WAI guidelines, checking for alternative text, reading order, structural tags, and keyboard shortcuts. The ATRC and the TRACE center have produced a Web accessibility verifier, called A-Prompt (9). This access tool will make repairs to correct HTML problems it detects, following WAI guidelines. The tool is downloaded to the user's computer. No test can perform a completely automatic check and cannot tell you if the page is truly accessible. The tool will check if images and links are labeled but cannot tell if the text is meaningful or useful. The Web architect must exercise judgment to conclude the page is accessible.
Finally, electronic testing of a Web site can be accomplished by reviewing the pages through a text-based browser, like Lynx, to experience how a person without vision would interpret the site. Such a browser is navigated with keyboard controls so the navigation design can be assessed. Another easy, inexpensive test is to shut off the graphics in the browser and see how the page looks to a screen-reader.
A second type of Web site analysis is usability testing. Web page usability can be defined simply as whether or not a page is easy to use. Usability refers to an "interface that is workable and intuitive from a user's point of view" (10). Qualitative information is collected when users are given a series of tasks to complete and their explanations are recorded. Jakob Nielsen, one of the best-known Web site usability experts, states that most Web site problems can be detected with as few as 5 to 15 subjects, generally 5 people per test (11). Another maxim is that 8 participants will identify 80% of the problems users might have with the system (12). Usability testing is a method whose time has come. The technique can be relatively brief, inexpensive, and effective. Testing replaces opinions with user-centered data.
The guiding principle of Web page accessibility for the disabled is that when changes are made to improve access for people with disabilities, all users benefit. With attention to clarity, consistency, and content of Web pages, information is more available to everyone.
Reference List
Dragonfly, Winter 2002
-- Volume 33, Number 1
(posted on PNRNews January 8, 2002)
Oregon Health & Science University and the AHEC of Southwest Oregon have begun new outreach projects, with funding from the Pacific Northwest RML. Target audiences for health information outreach continue to expand, and these members will be working with partners in exciting new areas.
OHSU will use its resource library subcontract funding to support "Finding It on the Internet: Health Access for Elders." Using a web page designed by elders and persons from the OHSU Division of Medical Informatics and Outcomes Research, OHSU Library, and the OHSU Center for Healthy Aging, elders will be able to find information on health, illness, end of life issues, and other health-related topics of interest. The site will contain links to established websites as well as original content written by nursing faculty at OHSU. It will also contain information on local organizations that work with elders. As part of its planning and evaluation component, the project will provide data comparing what participants say is useful site design with generally accepted best practice for usability. This research should be useful to others developing websites for seniors. Dolores Judkins is the project director.
Brendan Ashby and colleagues at the Southwest Oregon Area Health Education Center are creating Cyber Health Camp to provide high school youth and educators with a regional health career and medical issues information repository. A web-based interactive application will allow students from disadvantaged backgrounds to develop Internet skills and to access information on health careers, rural health opportunities, a health calendar of events and programs, university and college health-related programs, scholarships, and regional health institutions. The Cyber Camp program is the culmination of multiple collaborative activities including partners from high schools, universities, hospitals and other community based organizations.
Summaries of current, as well as recently completed projects are available on the RML Funding Opportunities page at http://nnlm.gov/pnr/funding/oldproj.html
Dragonfly, Winter, 2002 --
Vol.33, Number 1
(posted on PNRNews January 7, 2002)
Produced by the NN/LM PNR
Maryanne Blake, Editor
Michael Boer, Publication Manager
This publication is funded in whole with Federal funds from the National Library of Medicine, National Institutes of Health, under Contract No. N01-LM-1-3516.
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