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PubMed2000

Gynaecology on the Net: evaluation of the information on hysterectomy contained in health-related web sites.

The popularity of the Internet is expanding rapidly and the number of patients accessing health-related web sites before a clinical consultation is increasing every day. Using popular Internet search engines we retrieved 26 health-related web sites containing patient information on hysterectomy. The web sites underwent a general evaluation on the base of principles of conduct suggested in the literature. The accuracy of the information was then compared with the one provided in the information leaflet produced by the Royal College of Obstetricians and Gynaecologists. There were only a few cases identified of misleading contents and, in general, the information was found to be accurate but rarely comprehensive. Poor adherence to some basic principles of conduct was also noticed.

Journal Article↗

PubMed2006

Assessing the content and quality of information on the treatment of postmenopausal osteoporosis on the World Wide Web.

OBJECTIVE: To evaluate the content and quality of currently available Internet-based information on the treatment of postmenopausal osteoporosis. DESIGN: A sample was obtained comprising the 75 top sites retrieved with the Google search engine using 'treatment of postmenopausal osteoporosis' and then evaluated according to predefined general and specific criteria, content type, language and quality. Using a systematic scoring tool, each site was assessed for factual information provided and site quality. RESULTS: The sites studied were heterogeneous in content and quality. The most frequent type of website corresponded to non-profit organizations (n = 40), followed by commercial sites (n = 19), professional sites (n = 8) and government sites (n = 8). There were no significant differences in the popularity index, medical content score or quality score among the four groups of sites. Twelve websites were papers published in peer-reviewed medical journals. Few sites provided comprehensive medical and complete information on the treatment of postmenopausal osteoporosis oriented towards consumers. The consumer-oriented webpage with the most balanced and complete information was that of the National Osteoporosis Foundation which, at the same time, had the highest popularity index of all the resources studied. CONCLUSION: The content and quality of websites concerning the treatment of postmenopausal osteoporosis are highly varied and sometimes biased. The most frequent high-quality information corresponds to peer-reviewed medical journals. It is necessary to increase the number of resources, with rigorous language that is understandable for consumers, in relation to the treatment of postmenopausal osteoporosis.

Databases, Factual↗

PubMed2002

Closing the digital divide in HIV/AIDS care: development of a theory-based intervention to increase Internet access.

Advances in information technology are revolutionizing medical patient education and the Internet is becoming a major source of information for people with chronic medical conditions, including HIV/AIDS. However, many AIDS patients do not have equal access to the Internet and are therefore at an information disadvantage, particularly minorities, persons of low-income levels and individuals with limited education. This paper describes the development and pilot testing of a workshop-style intervention designed to close the digital divide in AIDS care. Grounded in the Information-Motivation-Behavioral Skills (IMB) model of health behaviour change, we developed an intervention for persons with no prior history of using the Internet. The intervention included instruction in using hardware and search engines, motivational enhancement to increase interest and perceived relevance of the Internet, and skills for critically evaluating and using health information accessed via the Internet. Participants were also introduced to communication and support functions of the Internet including e-mail, newsgroups and chat groups. Pilot testing demonstrated feasibility, acceptability and promise for closing the digital divide in HIV/AIDS care using a relatively brief and intensive theory-based intervention that could be implemented in community settings.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Talking about STD/HIV prevention: a look at communication online.

Little is known about the quality and usability of online health information. This analysis evaluated STD prevention websites' content quality and usability. Thirty-six sites were analyzed to determine their adherence to established sexual health guidelines and their accessibility, usability, credibility and currency. The objective of this study was to determine what communication skills are available to teenagers through STD prevention websites. Only two (6%) addressed safe sex negotiation; seven (19%) addressed basic communication skills; and slightly more than half (53%) addressed at least one sexual decision-making message. Most sites displayed consistent template design and two-thirds had working hyperlinks. But few (19%) of the sites offered a site map, while only one-third (36%) provided an internal search engine. These results indicate that health educators need to include tips on how to negotiate safe sex and improve interactive design features when creating STD websites for teenagers.

Adolescent↗

PubMed2006

The potential for utilizing inter-limb coupling in the rehabilitation of upper limb motor disability due to unilateral brain injury.

PURPOSE: Symmetry tendencies in human movement have generally been regarded as a constraint to upper limb motor performance. However, several recent studies have suggested that this phenomenon might be utilized in the rehabilitation of individuals with motor disability due to unilateral brain injury. In this paper the efficacy of such a rehabilitative approach is explored by reviewing: (i) examples of symmetry tendencies in healthy individuals, (ii) the potential neurophysiological mechanisms responsible for inter-limb coupling, and (iii) recent studies which have directly assessed the effects of inter-limb coupling on individuals with unilateral brain injury. METHOD: A thorough review of current published evidence was conducted utilizing various electronic search engines (Medline, PreMedline, Embase and Cinahl). Studies included those that focused on symmetry tendencies and/or inter-limb coupling in the upper limbs with a particular emphasis placed on studies of individuals with unilateral brain injury. RESULTS: Based on the current literature it seems that motor function of the affected upper limb in individuals with unilateral brain injury can be improved through a rehabilitation approach that incorporates inter-limb coupling. CONCLUSION: This approach should be considered as an adjunct to more common rehabilitation strategies with future research aimed at determining the most effective means of employing this paradigm.

Arm↗

PubMed2000

Partial least squares modeling and genetic algorithm optimization in quantitative structure-activity relationships.

Quantitative structure-activity relationship (QSAR) studies based on chemometric techniques are reviewed. Partial least squares (PLS) is introduced as a novel robust method to replace classical methods such as multiple linear regression (MLR). Advantages of PLS compared to MLR are illustrated with typical applications. Genetic algorithm (GA) is a novel optimization technique which can be used as a search engine in variable selection. A novel hybrid approach comprising GA and PLS for variable selection developed in our group (GAPLS) is described. The more advanced method for comparative molecular field analysis (CoMFA) modeling called GA-based region selection (GARGS) is described as well. Applications of GAPLS and GARGS to QSAR and 3D-QSAR problems are shown with some representative examples. GA can be hybridized with nonlinear modeling methods such as artificial neural networks (ANN) for providing useful tools in chemometric and QSAR.

Algorithms↗

PubMedDate not supplied

STD/HIV prevention for teenagers: a look at the Internet universe.

The objective was to determine how the Internet is used to promote sexual health among adolescents. Six key words were entered into three search engines producing 87,180 results. Three percent (n = 36) were educational Web sites targeted at teenagers and covered a range of sexually transmitted diseases (STDs). These were content analyzed using sexuality education and usability guidelines. All sites addressed some STD information, but only two covered negotiation. Navigability results were mixed; only one third offered a site map. Sexual health educators may need to include more information on how to negotiate safe sex and improve Web navigability for teenagers.

Adolescent↗

PubMedDate not supplied

Communicating health information to an alarmed public facing a threat such as a bioterrorist attack.

Considerable literature exists on the communication of risk to the public through channels such as television, radio, and newspapers. However, little has been written on the communication of risk through less traditional communication forms, such as the Internet. The purpose of this study was to investigate the role of the Internet as an additional source of health information to that provided by the traditional news media in managing the public's response to an emerging health risk such as a bioterrorist attack. Despite some of the Internet's advantages over traditional media, including the depth and speed in which information can be conveyed to different audiences, the Internet was underutilized during fall 2001, when it became important to convey information on the risks of anthrax. A number of developments are required if the health care system is to capitalize on the Internet's potential as a risk communication device. These developments include research into public Internet searching behavior and further development in the role of search engines and government agencies in organizing quality health information.

Anthrax↗

PubMed2003

Evaluation of an Internet-based smoking cessation program: lessons learned from a pilot study.

The potential contribution of the Internet to smoking cessation seems huge, given that a majority of Americans now have both computers and telephones. Despite the proliferation of Web sites offering smoking cessation support, there is little empirical evidence regarding the efficacy of Internet-delivered cessation programs. We developed a cessation Web site and conducted a short-term evaluation of it, examining recruitment approaches, Web site use patterns, alternative retention incentives and re-contact modes, satisfaction, and cessation rate. The intervention included modules on social support and cognitive-behavioral coping skills configured to take advantage of the interactive and multimedia capabilities of the Internet. Cessation and satisfaction data were obtained from a subsample of 370 subjects followed for 3 months. The program was rated as easy to use, and the social support group component was used most frequently. The cessation rate (abstinence for the previous 7 days) at 3 months was 18%, with nonrespondents (n=161) considered smokers. Among a variety of traditional and Internet-based recruitment strategies, the most successful made use of Internet user groups and search engines. Methodological and procedural issues posed in conducting research on the Internet are discussed.

Adaptation, Psychological↗

PubMed2004

Enhanced quality and quantity of retrieval of Critically Appraised Topics using the CAT Crawler.

As healthcare moves towards the implementation of Evidence-Based Medicine (EBM), Critically Appraised Topics (CATs) become useful in helping physicians to make clinical decisions. A number of academic and healthcare organizations have set up web-based CAT libraries. The primary objective of the presented work is to provide a one-stop search and download site that allows access to multiple CAT libraries. A web-based application, namely the CAT Crawler, was developed to serve physicians with an adequate access to available appraised topics on the Internet. Important information is extracted automatically and regularly from CAT websites, and consolidated by checking the uniqueness and availability. The principle of meta-search is incorporated into the implementation of the search engine, which finds relevant topics following keyword input. The retrieved result directs the physician to the original resource page. A full-text article of a particular topic can be converted into a proper format for downloading to Personal Digital Assistant (PDA) devices. In summary, the application provides physicians with a common interface to retrieve relevant CATs on particular clinical topics from multiple resources, and thus speeds up the decision making process.

Algorithms↗

PubMedDate not supplied

Reporting on post-menopausal hormone therapy: an analysis of gynaecologists' web pages.

BACKGROUND: The present study was designed to analyse Web pages of German gynaecologists with regard to postmenopausal hormone therapy (HT). There is a growing body of evidence, that the overall health risks of HT exceed the benefits. Making one's own informed choice has become a central concern for menopausal women. The Internet is an important source of health information, but the quality is often dubious. The study focused on the analysis of basic criteria such as last modification date and quality of the HT information content. The results of the Women's Health Initiative Study (WHI) were used as a benchmark. METHODS: We searched for relevant Web pages by entering a combination of key words (9 x 13 = 117) into the search engine www.google.de. Each Web page was analysed using a standardized questionnaire. The basic criteria and the quality of content on each Web page were separately categorized by two evaluators. Disagreements were resolved by discussion. MAIN FINDINGS: Of the 97 websites identified, basic criteria were not met by the majority. For example, the modification date was displayed by only 23 (23.7%) Web pages. The quality of content of most Web pages regarding HT was inaccurate and incomplete. Whilst only nine (9.3%) took up a balanced position, 66 (68%) recommended HT without any restrictions. In 22 cases the recommendation was indistinct and none of the sites refused HT. With regard to basic criteria, there was no difference between HT-recommending Web pages and sites with balanced position. CONCLUSION: Evidence-based information resulting from the WHI trial was insufficiently represented on gynaecologists' Web pages. Because of the growing number of consumers looking online for health information, the danger of obtaining harmful information has to be minimized. Web pages of gynaecologists do not appear to be recommendable for women because they do not provide recent evidence-based findings about HT.

Estrogen Replacement Therapy↗

PubMed2004

A quality evaluation methodology of health web-pages for non-professionals.

PRIMARY OBJECTIVE: The proposal of an evaluation methodology for determining the quality of healthcare web sites for the dissemination of medical information to non-professionals. METHODS AND PROCEDURES: Three (macro) factors are considered for the quality evaluation: medical contents, accountability of the authors, and usability of the web site. Starting from two results in the literature the problem of whether or not to introduce a weighting function has been investigated. This methodology has been validated on a specialized information content, i.e., sore throats, due to the large interest such a topic enjoys with target users. The World Wide Web was accessed using a meta-search system merging several search engines. A statistical analysis was made to compare the proposed methodology with the obtained ranks of the sample web pages. MAIN OUTCOME AND RESULTS: The statistical analysis confirms that the variables examined (per item and sub factor) show substantially similar ranks and are capable of contributing to the evaluation of the main quality macro factors. A comparison between the aggregation functions in the proposed methodology (non-weighted averages) and the weighting functions, derived from the literature, allowed us to verify the suitability of the method. CONCLUSIONS: The proposed methodology suggests a simple approach which can quickly award an overall quality score for medical web sites oriented to non-professionals.

Attitude to Computers↗

PubMed2006

Health literacy and the World Wide Web: comparing the readability of leading incident cancers on the Internet.

PRIMARY OBJECTIVE: to assess the readability level of Web-based information on leading incident cancers. RESEARCH DESIGN: websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n=33), prostate (n=34), and colorectal (n=33) cancers were included in the final analysis. METHODS: readability was assessed using SMOG, Flesch-Kincaid (F - K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10 - 30 lines of continuous text. Identical text was entered into Microsoft Word 2002 where F - K and FRE scores were determined automatically by the word processor. RESULTS: the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F - K. The mean FRE score was 45.3, a score considered 'difficult'. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs. CONCLUSIONS: findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.

Adult↗

PubMedDate not supplied

Decompression sickness following breath-hold diving.

Despite convincing evidence of a relationship between breath-hold diving and decompression sickness (DCS), the causal connection is only slowly being accepted. Only the more recent textbooks have acknowledged the risks of repetitive breath-hold diving. We compare four groups of breath-hold divers: (1) Japanese and Korean amas and other divers from the Pacific area, (2) instructors at naval training facilities, (3) spear fishers, and (4) free-dive athletes. While the number of amas is likely decreasing, and Scandinavian Navy training facilities recorded only a few accidents, the number of spear fishers suffering accidents is on the rise, in particular during championships or using scooters. Finally, national and international associations (e.g., International Association of Free Drives [IAFD] or Association Internationale pour Le Developpment De L'Apnee [AIDA]) promote free-diving championships including deep diving categories such as constant weight, variable weight, and no limit. A number of free-diving athletes, training for or participating in competitions, are increasingly accident prone as the world record is presently set at a depth of 171 m. This review presents data found after searching Medline and ISI Web of Science and using appropriate Internet search engines (e.g., Google). We report some 90 cases in which DCS occurred after repetitive breath-hold dives. Even today, the risk of suffering from DCS after repetitive breath-hold diving is often not acknowledged. We strongly suggest that breath-hold divers and their advisors and physicians be made aware of the possibility of DCS and of the appropriate therapeutic measures to be taken when DCS is suspected. Because the risk of suffering from DCS increases depending on depth, bottom time, rate of ascent, and duration of surface intervals, some approaches to assess the risks are presented. Regrettably, none of these approaches is widely accepted. We propose therefore the development of easily manageable algorithms for the prevention of those avoidable accidents.

Decompression Sickness↗

PubMed2001

When air is rare: behind the scenes of an asthma web site.

OBJECTIVE: The number of medical Web sites has increased tremendously during the past 5 years. While the quality of the content has also been on the rise, some questions are still open: Where are users referredfrom, how large is the target audience, and how do they behave during their visit? METHODS: The Asthma Information Center is an independent Web site for physicians, patients, and other health care professionals providing information about asthma. Besides mirroring electronic documents of the Global InitiativeforAsthma, numerous interactive pages have been constructed. MAIN OUTCOME MEASURES: Logfiles of the Web server were analyzed for a 5-year interval for numbers of page views, visitors, visits, and external referring sites. RESULTS: The number of visitors has increased since 1995, up to 100,000 page views at the end of the observation interval. In February 2000 approximately 9000 visitors were recorded per month. 3.4 pages were retrieved per visit, which lasted on average 1:57 min. Users are referred primarily by portal sites and only to a lesser extent by search engines. CONCLUSIONS: The audience is large for a specialized medical Web site. Users are usually referred from nonmedical sites. They are seeking fast information, most probably as a second opinion after having consulted their physician.

Asthma↗

PubMed2006

Antimicrobe.org: an online reference for the practicing infectious diseases specialist.

Antimicrobe.org (http://www.antimicrobe.org) is a World Wide Web-based version of the textbook Antimicrobial Therapy and Vaccines, volumes I and II. The Web site currently consists of 3 texts (Microbes, Antimicrobial Agents, and HIV Clinical Manual) and will soon include a fourth, Empiric. The Web site focuses on therapy for infectious diseases, and it covers, in comprehensive detail, a great majority of infections encountered today. The dynamic nature of a Web-based reference allows for information to be frequently updated and enhances a physician's searching capabilities to find answers to very specific clinical questions and the latest available evidence. A Smart Search engine allows users to ask specific questions and to find focused answers, either within the textbook or through PubMed via a guided PubMed references option. The Web site also provides clinical vignettes and minireviews on hot topics in infectious diseases and hyperlinks to other important articles or Web sites. Chapters are written by experts in their field who provide evidence-based information, as well as anecdotal reports about rare infections. Antimicrobe.org would be of great benefit to physicians who treat infections on a routine basis.

Anti-Infective Agents↗

PubMed2002

The 107th Congress' legislative proposals concerning end-of-life care.

PURPOSE: The current health care system cannot reliably meet the needs of patients with eventually fatal chronic illnesses near the end-of-life. Enduring change requires improved public policy, in part because most paid care for serious illness at the end of life now relies on federal programs. This project reviews the legislation proposed in the 107th Congress (2001-2002) related to improving end-of-life care. METHODS: We searched THOMAS, the search engine of the Library of Congress, to identify all bills relating to end-of-life care introduced in either house of the U.S. Congress during the 2001/2002 legislative period. Using explicit criteria intended to find any that received serious attention and incorporating recommendations of political consultants, the initial 563 bills narrowed to 22. We summarize their status as of October 24, 2002. RESULTS: The 22 bills identified dealt with the following topics: demonstration or research projects (9), palliative care or hospice (8), caregivers (7), chronic illness generally (5), care coordination (2), and long-term health care (3). Dementia, graduate medical education, nursing, and pain appeared in 1 bill each. Congress enacted only 1 of the bills. Only 7 bills had more than 10% of either house as sponsors. CONCLUSIONS: While Medicare reform and health care costs are prominent topics among policymakers, Congress is considering essentially no fundamental changes that would remedy the problems associated with health care for the elderly who are seriously ill near the end-of-life. The mismatch between the urgency of policy reform and the lack of vehicles and momentum to achieve reform calls for consensus and leadership from those concerned with hospice and palliative care.

Aged↗

PubMed2006

Diabetes information systems: a rapidly emerging support for diabetes surveillance and care.

BACKGROUND: With the rapid advances in information technology in the last decade, various diabetes information systems have evolved in different parts of the world. Availability of new technologies and information systems for monitoring and treating diabetes is critical to achieving recommended metabolic control, including glycosylated hemoglobin levels. The first step is to develop a registry, including a patient identifier that can link multiple data sources, which can then serve as a springboard to electronic mechanisms for practitioners to gain information on performance and results. OBJECTIVE: The aim is to review the provisions for diabetes surveillance in different parts of the world. This is a systematic review of national and regional information systems for diabetes surveillance. LITERATURE REVIEW: A comprehensive review was undertaken using Medline literature review, internet search using the Google search engine, and e-mail consultation with opinion leaders. TOPICS REVIEW: National/regional-level diabetes surveillance systems in Europe, the United States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art diabetes information systems linking multiple data sources, with extensive audit and feedback capabilities, have also been looked at. RESULTS: National/regional-level audit databases have been tabulated. Diabetes information systems linking multiple data sources have been described. Most of the developed countries have now implemented systems such as diabetes registers and audits for diabetes surveillance in at least some regions, if not nationally. Developing nations are beginning to recognize the need for chronic disease management. CONCLUSIONS: With the advancements in information technology, the diabetes registers have the potential to rise beyond their traditional functions with dynamic data integration, decision support, and data access, as demonstrated by some diabetes information systems. With the rapid pace of development in electronic health records and health information systems, countries that are beginning to build their health information technology infrastructure could benefit from planning and funding along these lines.

Diabetes Mellitus↗