Provider Recommendation Research Articles

Hospital and White Coat Fears in Children of Parents Working in the Healthcare Field: A Qualitative Study of Parental Experiences

Objectives: This qualitative study investigates the hospital and white coat fears experienced by children of healthcare professionals, focusing on parental insights and experiences. The study explores the prevalence and nature of these fears, the psychological impact on children, and the strategies employed by parents to mitigate their children's anxieties. Materials and Methods: Thirty parents working in various healthcare roles were interviewed using a semi-structured format. Thematic content analysis was used to analyze the data and identify recurring themes and sub-themes related to the children's fears and coping mechanisms. Results: The analysis revealed several key themes, including fear of medical procedures, separation anxiety, fear of medical equipment, the impact of parental roles, and coping mechanisms. Findings indicate that children's exposure to healthcare environments through their parents' professions heightens their awareness and fear of medical situations. Effective parental involvement and clear communication were identified as crucial factors in alleviating these fears. Conclusion: The study emphasizes the need for targeted interventions and supportive environments in healthcare settings to address these anxieties. Practical implications include recommendations for healthcare providers to create child-friendly environments and policies that support parental presence and psychological preparation for children. This comprehensive understanding of children's hospital-related fears can inform better practices and policies in healthcare settings to improve the psychological well-being of children of healthcare workers

The role of technology belief, perceived risk and initial trust in users’ acceptance of urban air mobility: An empirical case in China

Urban Air Mobility (UAM) is poised to revolutionize transportation, necessitating an assessment of public acceptance before broad commercial adoption. This study presents the Urban Air Mobility Acceptance Model (UAM-AM), which draws from the Technology Acceptance Model (TAM) and underscores the crucial role of initial trust, technology belief and perceived risk. The UAM-AM is validated using Structural Equation Modeling (SEM) based on 544 questionnaires for the first time in China. The findings highlight the significant impact of perceived ease of use and perceived usefulness on acceptance, uncovering a complex interplay with the intention to utilize UAM services. Notably, initial trust emerges as a foundational factor, influencing attitudes directly or indirectly through perceived ease of use and perceived usefulness. Moreover, the research identifies technology belief and perceived risk as fundamental drivers of initial trust. Examination of demographic segments reveals a heightened technology belief among individuals with backgrounds in science, indicative of a more favorable attitude towards UAM adoption. In closing, the paper presents recommendations for policymakers, service providers, and eVTOL manufacturers to formulate effective strategies that promote public acceptance during the initial phases of UAM deployment.

Partnerships with primary care providers: Opportunities to prevent eating disorders and mitigate their progression in young people

ABSTRACT Epidemiologic research has identified numerous interpersonal and individual risk factors for and warning signs of emerging eating disorders in adolescents. These findings have informed public health prevention and treatment strategies, including translation of findings to clinical recommendations for primary care providers (PCPs). A next step in this translational work could include a comprehensive approach where PCPs are seen as partners in efforts to improve population health outcomes. PCPs have great potential to implement high-yield interventions that prevent or attenuate the course of adolescent eating disorders. To illustrate this potential, we present a case that highlights missed opportunities for a PCP to prevent, detect, and intervene during a patient’s developing eating disorder. We then relate the case to two emerging research programs that utilize PCP partnerships: one trains PCPs in Strengths-Based Adolescent Healthcare to improve eating disorder prevention; the other adapts Family-Based Treatment for primary care to improve early access to evidence-based treatment. In addition to these promising areas of research, efforts are needed to widen requirements for eating disorder curricula in medical training programs and to address weight stigma in primary care. Together these efforts will help PCPs become effective partners in the prevention and treatment of eating disorders.

Closing the Gap: Foster Parents' Lived Experiences and Recommendations for Interdisciplinary Health-Care Providers.

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents' experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.

Preferences for index-based pasture insurance: a choice experiment in Limpopo Province, South Africa

ABSTRACT South African subsistence livestock farmers rely heavily on traditional mitigation and coping mechanisms to deal with the effects of drought. However, these methods have proven ineffective in managing the full impact of drought. Consequently, policymakers are increasingly interested in promoting Index-based Pasture Insurance (IBPI). This paper aims to assess subsistence livestock farmers' preferences for IBPI. A simple random sampling method was used to select 110 subsistence livestock farmers for data collection. A discrete choice experiment—Conditional Logit and Latent Class models and incentivized lottery games were used to elicit preferences for insurance contracts and loss aversion. The findings indicate that subsistence livestock farmers have a favourable attitude toward IBPI contracts that protect against drought-related pasture degradation. The Conditional Logit model shows that farmers prefer transparent contracts that reimburse with feed and vouchers rather than cash. However, they derive negative marginal utility from basis risk and premium. However, the Latent Class model reveals heterogeneous preferences for IBPI among farmers. Farmers are also loss-averse, but loss aversion did not influence their preference for IBPI. Therefore, the primary recommendation for insurance providers is to consider customizing IBPI attributes to increase adoption among subsistence farmers.

Factors Influencing Herpes Zoster Vaccine Utilization Among Adults Aged 50 and Above Attending Primary Healthcare Center in Saudi Arabia: A Cross-Sectional Study.

Herpes zoster, or shingles, is a significant health concern for older adults caused by the varicella-zoster virus (VZV) reactivation. The availability of effective herpes zoster vaccines offers a crucial preventive measure to reduce the incidence and severity of this condition. However, the uptake of the available vaccine remains suboptimal, especially among adults aged 50 and above. Understanding the factors that influence vaccine utilization is not only essential for developing strategies to improve vaccination rates but also has the potential to significantly reduce the disease burden. This cross-sectional study aimed to identify factors influencing herpes zoster vaccine utilization among adults aged 50 and above attending primary healthcare centerin Saudi Arabia. Data were collected using a validated questionnaire administered to visitors attending Al-Wazarat Primary Healthcare Center in Riyadh. Descriptive and inferential statistics were employed to analyze the data. A total of 403 participants were included in the study, with 73.7% of participants having heard of the disease, yet only 34.2% had received the vaccine. Vaccine uptake was significantly associated with gender, educational level, and healthcare provider recommendations. Common barriers to vaccination included fear of side effects, lack of perceived susceptibility, concerns about vaccine effectiveness, and access to healthcare facilities. Herpes zoster vaccine utilization among older adults in Saudi Arabia is relatively low despite moderate awareness. Enhancing public education through targeted campaigns and strengthening healthcare provider recommendations are crucial to improving vaccine uptake. Addressing specific barriers and misconceptions is essential to reduce the burden of herpes zoster in this population. The need for future research to explore strategies to overcome these challenges and promote higher vaccination rates is urgent and important.

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.

The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

U.S. Selected Practice Recommendations for Contraceptive Use, 2024.

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

Discordant Care and Decision Quality: Patients' Reasons for Not Receiving Their Initial Test of Choice in Colorectal Cancer Screening.

Concordance between a person's values and the test or treatment they ultimately receive is widely considered to be an essential outcome for good decision quality. There is little research, however, on why patients receive "discordant" care. A large, randomized trial of decision aids for colorectal cancer (CRC) screening provided an opportunity to assess why some patients received a different test than the one they preferred at an earlier time point. Of 688 patients who participated in the trial, 43 received a different CRC screening test than the one they selected after viewing a decision aid 6 mo prior. These patients answered 2 brief, open-ended questions about the reasons for this discordance. The research team analyzed their answers using qualitative description. Patient responses reflected 6 major categories: barriers or risks of initially favored test, benefits of alternative test, costs or health insurance coverage, discussion with family or friends, provider factors or recommendation, and health issues. Some of the patients' explanations fit well with the informed concordance approach, which infers poor decision quality from the existence of discordant care, since in these cases it appears that the patient's values and preferences were not adequately respected. Other statements suggest that the patient had an informed rationale for changing their mind about which test to undergo. These cases may reflect high-quality decision making, despite the existence of discordance as measured in the trial. This analysis highlights a major challenge to a popular approach for assessing decision quality, the difficulty of normatively assessing the quality of decision making when apparent discordant care has been provided, and the need to assess patient values and preference over time. Value-choice concordance is an accepted measure for assessing decision quality in decision aid trials, but greater exploration of apparently discordant care challenges key assumptions of this method; this study provides evidence that discordance as typically measured may not always reflect low-quality patient decision making.Researchers evaluating decision aids and assessing decision quality should consider the use of qualitative methods to supplement measures of decision quality and consider assessing patient preferences at multiple time points.

Enhancing healthcare data privacy and security: A comparative study of regulations and best practices in the US and Nigeria

The imperative for robust healthcare data privacy and security is escalating as healthcare systems worldwide are increasingly digitized. This review paper presents a comprehensive comparative analysis of the regulatory frameworks, challenges, and best practices related to healthcare data privacy and security in the United States and Nigeria. By examining the Health Insurance Portability and Accountability Act (HIPAA) in the US and the Nigeria Data Protection Regulation (NDPR) alongside other local regulations, this study highlights the nuances of each country's approach to safeguarding patient data. The analysis extends to the effectiveness of technological solutions like encryption and blockchain, and assesses the role of governance in policy implementation. Case studies from both nations offer insights into successful strategies and underscore the gaps and opportunities for cross-country learning and improvement. The paper concludes with targeted recommendations for policymakers and healthcare providers, aiming to strengthen the security measures and propose areas for further research and development in healthcare data management. This comparative study not only sheds light on current practices but also charts a course for future collaborative efforts to enhance data privacy and security in healthcare on a global scale.

A global perspective on the treatment and maintenance of mature skin using gentle cleansers and moisturizers.

Xerosis is highly prevalent in the population aged over 50 years and substantially impacts quality of life due to the associated stigma, related pruritus, and potential sequelae. We propose that the term mature xerosis be used for subjects over 50 who suffer from age-related xerosis and replace senile xerosis to describe the phenomenon. The etiology of xerosis depends on genetic and environmental factors that affect stratum corneum hydration and skin barrier function. Skincare to restore barrier function is essential in xerosis treatment and is relevant for maintaining and preventing its progression. Many moisturizers and cleansers are available for xerosis; however, they are underutilized by patients with mature xerosis. A panel of eight global dermatologists reviewed the unique aspects of xerosis in mature skin and discussed the specific needs, relevance, and considerations for skincare selection to prevent, treat, and maintain skin with mature xerosis. The panel selected five statements based on evidence from a literature review and the panel's clinical experience to provide clinical considerations and recommendations for dermatologists and other healthcare providers treating patients with mature xerosis. Increased recognition of the burden of xerosis in mature skin is warranted. Gentle cleansers and barrier-restoring ceramide-containing moisturizers are essential to xerosis management, reducing signs and symptoms of xerosis, including associated pruritus.

Discharge against medical advice in rural and remote emergency departments: views of healthcare providers.

The aim of the study was to explore, in one remote hospital, emergency department healthcare providers' experience and perceptions of the factors surrounding a patient's decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence. This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital, Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from 'no influence/little influence' to 'very strong influence'. DAMA management protocol responses were a three-point rating scale from 'rarely/never' to 'always'. Semi-structured interviews were conducted after the survey and explored participants' perceptions in greater detail and current DAMA management protocol. Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled. DAMA is a multifaceted issue, influenced by both personal and hospital system-related factors. Participants agreed that the presence of ILO and/or Aboriginal Health Workers in the emergency department may reduce DAMA occurrences for Indigenous Australians who are disproportionately represented in DAMA rates, particularly in rural and remote regions of Australia.

Patient-Provider Communication and Colorectal Cancer Screening Completion Using Multi-target Stool DNA Testing.

Colorectal cancer (CRC) screening continues to be underutilized in the USA despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Understanding how patient-provider communication influences CRC screening can inform interventions to improve screening completion. We developed a behavioral theory-informed survey to identify patient-provider communication factors associated with multi-target stool DNA (mt-sDNA) screening completion. The survey was administered by RTI International between 03/2022 and 06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021 and 9/2021. Respondents completed an electronic or paper survey. Multivariable logistic regression was used to identify patient-provider communication factors associated with mt-sDNA test completion. A total of 2973 participants completed the survey (response rate, 21.7%) and 81.6% of them (n = 2427) reported having had a conversation with provider about mt-sDNA testing before the test was ordered. Having a conversation with the provider about the test, including discussions about costs, the need for follow-up testing and test instructions were associated with higher odds of test completion and being "very likely" to use the test in the future. Lack of discussion about advantages and disadvantages of available CRC screening options and lack of patient involvement in CRC screening decision-making were associated with reduced odds of test completion and likelihood of future use. Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

ACPM Position Statement: Air Pollution and Environmental Justice

The American Lung Association's “State of the Air” 2023 report reveals almost 36% of Americans live with unhealthy levels of air pollution. Studies link air pollution with acute respiratory symptoms and exacerbation of respiratory and cardiovascular diseases. Differential air pollution exposures between white and non-white communities are significant components of environmental injustices. Even during the COVID-19 lockdown, when the United States experienced significant decreases in polluting activities, these differences persisted. The American College of Preventive Medicine's Science and Translation Committee conducted a nonsystematic literature review to explore initiatives addressing air pollution as a key component of environmental justice, the state of the science regarding health impacts, and evidence supporting mitigations to reduce those impacts. We recommend advocacy for cleaner energy sources and increasing green space; and increasing research, surveillance, and education and training on linkages between air pollutants and health. We recommend preventive medicine physicians raise awareness about increased risks of cardiovascular disease, cancer, asthma, and reduced lung function with air pollution exposure. Preventive medicine physicians may also educate patients and other practitioners about exposures, and how “conventional” disease prevention strategies may have unintended consequences; and influence healthcare leaders to improve efficiency and reduce emissions. We also recommend physicians utilize social determinants of health (SDOH) Z-Codes to capture environmental factors. Private payers should incorporate pollution exposure data into SDOH risk-adjustments for Medicare Advantage programs. Medicaid agencies should develop provider recommendations for pediatric populations, and states should finance in-home interventions for asthma.

To Improve Motivational Barriers to Retention in High Resolution Anoscopy, Patients and Providers Recommend Social and Environmental Changes: A Sequential Explanatory Mixed-Methods Pilot Study in a Federally Qualified Health Center

Loss to follow-up (LTFU) in high-resolution anoscopy (HRA) programs jeopardizes the procedure’s potential to help prevent anal cancer. We explored quality improvement factors to understand how to address this LTFU. Using the transtheoretical COM-B Model (Capability, Opportunity, Motivation, and Behavior) and a sequential explanatory mixed-methods design, we surveyed and interviewed 13 patients who remained engaged in HIV care but who delayed their HRA monitoring or treatment visits in the same community clinic, and 6 HRA clinicians and medical assistants. Analyses involved descriptive statistics and rapid qualitative analysis. Patients were racially, ethnically, and economically representative of the LTFU population, and were generally experienced with HRA (Mean HRA visits = 4.6, SD = 2.8, mdn = 3). Providers were experienced clinicians and medical assistants (Mean years providing HRA = 6.0, SD = 2.2). Analyses revealed two primary, related barriers: (A) motivational barriers such as physical pain, discomfort, embarrassment, and anxiety; which were largely borne from (B) opportunity barriers such as difficulties with scheduling, inconsistent after-care (particularly for pain and discomfort), anxiety-inducing exam rooms and equipment, and internalized and anticipated stigma. Capability barriers, such as limited health literacy about HRA, were less common and, like motivational barriers, linked to opportunity barriers. Participants recommended potential facilitators, including easier scheduling, standardization of pain management and after-care services, and examination room modifications to reduce anxiety. To retain HRA patients in community settings, interventions should address social and physical opportunity barriers that strongly determine motivational and capability barriers. Improving convenience, standardizing pain management, and introducing stigma interventions specific to HRA, could alleviate both motivational and capability barriers.

Too small to care? Developing a model explaining managers' decision to adopt employee stress prevention practices in micro and small enterprises

Employee work stress jeopardizes employee well-being and enterprise performance in micro and small enterprises (MSEs). Although previous studies show that formal stress prevention practices effectively improve employee well-being and, in turn, foster enterprise performance, MSE managers rarely adopt such formal prevention practices. Based on qualitative evidence, we explore the attitudes and perceptions underlying MSE managers' decision to adopt formal stress prevention practices (i.e., their perceived closeness with employees, perceived expertise in stress prevention, attitude toward formal practices, attitude toward external support, attitude toward work stress, and perceived employee buy-in). Moreover, we develop a theoretical model explaining how the extracted attitudes and perceptions influence MSE managers' adoption decisions. Our study contributes to the research on MSE managers' experience with managing work stress and their role as employers. Furthermore, we provide practical recommendations for external providers of formal stress prevention practices on how to engage with MSE managers.

Providers and women’s perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study

BackgroundCervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death.ObjectiveWe explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda.MethodsIn a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis.ResultsThe participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake.ConclusionOpportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.

Significance of Alternative Medicines in Treatment of Chronic Diseases: A Comprehensive Review

The treatment of chronic diseases poses significant challenges to healthcare systems worldwide. While conventional medical approaches have made substantial progress, alternative medicines have gained recognition for their potential to complement or even substitute conventional treatments. This comprehensive review examines the role of alternative medications in chronic disease management, encompassing a wide range of modalities, from herbal remedies and acupuncture to mind-body therapies and chiropractic care. We explore the efficacy and safety of alternative treatments, mechanisms of action, patient perspectives, regulatory and ethical considerations, cost-effectiveness, and the potential for integration with conventional medicine. Drawing upon clinical studies, patient testimonials, and scholarly sources, this review highlights alternative medicine's diverse and evolving landscape, its significance in improving patient outcomes, and the challenges that must be addressed. We offer recommendations for patients, healthcare providers, and policymakers on integrating and responsible use of alternative medicines in chronic disease management.

Why do clinical guidelines for probiotics differ?

Clinical guidelines are recommendations for healthcare providers regarding patients with specific conditions. These guidelines should be based on practice experience and the best available research evidence. However, guidelines developed by various health organisations worldwide often do not agree with each other. This is also true for the current guidelines for the clinical use of probiotics. This article aims to provide examples of conflicting clinical guidelines for probiotics, define reasons for this phenomenon, describe standard tools for improving their quality, and suggest ways to enhance the development and assessment of suitable clinical guidelines for the appropriate clinical use of probiotics in specific conditions.

A survey on popularity bias in recommender systems

AbstractRecommender systems help people find relevant content in a personalized way. One main promise of such systems is that they are able to increase the visibility of items in the long tail, i.e., the lesser-known items in a catalogue. Existing research, however, suggests that in many situations today’s recommendation algorithms instead exhibit a popularity bias, meaning that they often focus on rather popular items in their recommendations. Such a bias may not only lead to the limited value of the recommendations for consumers and providers in the short run, but it may also cause undesired reinforcement effects over time. In this paper, we discuss the potential reasons for popularity bias and review existing approaches to detect, quantify and mitigate popularity bias in recommender systems. Our survey, therefore, includes both an overview of the computational metrics used in the literature as well as a review of the main technical approaches to reduce the bias. Furthermore, we critically discuss today’s literature, where we observe that the research is almost entirely based on computational experiments and on certain assumptions regarding the practical effects of including long-tail items in the recommendations.