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Within the healthcare system, patients continue to take on a larger role in managing their health. However, due to the low prevalence of health literacy among the US adult population, many patients are unable to make appropriate medical decisions. The Internet is further contributing to the problem. Patients are looking to the Internet, which can include extremely complex or inaccurate text, when they have questions about their health more often than speaking with their providers. This presents the risk for patients to become confused, misled, or even believe false information about their health. In order for patients to manage their health successfully, they must develop health literacy. This will be possible through advancements in internet technology that will provide the patients with clear, credible health information. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Millions of people world‐wide use websites to help them quit smoking, but effectiveness trials have an average 34% follow‐up data retention rate and an average 9% quit rate. We compared the quit rates of a website using a new behavioral approach called Acceptance and Commitment Therapy (ACT; WebQuit.org) with the current standard of the National Cancer Institute's (NCI) Smokefree.gov website. Design: A two‐arm stratified double‐blind individually randomized trial (n = 1319 for WebQuit; n = 1318 for Smokefree.gov) with 12‐month follow‐up. Setting: United States. Participants: Adults (n = 2637) who currently smoked at least five cigarettes per day were recruited from March 2014 to August 2015. At baseline, participants were mean [standard deviation (SD)] age 46.2 years (13.4), 79% women and 73% white. Interventions: WebQuit.org website (experimental) provided ACT for smoking cessation; Smokefree.gov website (comparison) followed US Clinical Practice Guidelines for smoking cessation. Measurements: The primary outcome was self‐reported 30‐day point prevalence abstinence at 12 months. Findings: The 12‐month follow‐up data retention rate was 88% (2309 of 2637). The 30‐day point prevalence abstinence rates at the 12‐month follow‐up were 24% (278 of 1141) for WebQuit.org and 26% (305 of 1168) for Smokefree.gov [odds ratio (OR) = 0.91; 95% confidence interval (CI) = 0.76, 1.10; P = 0.334] in the a priori complete case analysis. Abstinence rates were 21% (278 of 1319) for WebQuit.org and 23% (305 of 1318) for Smokefree.gov (OR = 0.89 (0.74, 1.07; P = 0.200) when missing cases were imputed as smokers. The Bayes factor comparing the primary abstinence outcome was 0.17, indicating ‘substantial’ evidence of no difference between groups. Conclusions: WebQuit.org and Smokefree.gov had similar 30‐day point prevalence abstinence rates at 12 months that were descriptively higher than those of prior published website‐delivered interventions and telephone counselor‐delivered interventions. [ABSTRACT FROM AUTHOR]

The main aim of study was to identify the primary source of health information seeking among high school students and the characteristics of quality consumer health information from their perspective. A cross sectional descriptive survey was used to conduct the study utilizing a valid questionnaire. The first source of health information seeking for most of the high school student (79%) was the Internet rather than books, journals or family members. Majority of boys (87%) go to the Internet for pathology and definition of diseases, but the girls (82%) usually search for life style, exercise, nutrition, mental health, maturity and then general health information such as physiology, anatomy, and calculations. All of the student recognize content accuracy, and believe that involvements of information specialists in management of websites may guarantee the quality criteria of website. It is concluded that development of a quality consumer health information website is essential to meet the health information needs of students and promotion of health literacy among high school students and adolescents in Iran. [ABSTRACT FROM AUTHOR]

The internet is frequently used by patients for researching information regarding breast cancer. This study aims to assess the quality of these websites using validated tools. The term 'breast cancer' was searched for in 3 search engines. The top 20 results were selected, and duplicates and irrelevant websites were excluded. 26/34 websites were analysed using the DISCERN Plus tool, HONcode and the JAMA benchmarks. 46% of the websites were classed as ‘excellent’ when assessed with the DISCERN tool. The range of DISCERN scores was wide (range: 25–74). Nine websites were found to be HONcode certified. Seven websites complied with all four JAMA benchmarks. This study shows the quality of breast cancer information on the internet is on the whole good; however the range of quality is wide. We recommend healthcare professionals use all 3 tools together to establish which websites are best to advise which websites patients should trust. [ABSTRACT FROM AUTHOR]

The internet is playing an increasingly important part in fueling vaccine related controversies and in generating vaccine hesitant behaviors. English language Antivaccination websites have been thoroughly analyzed, however, little is known of the arguments presented in other languages on the internet. This study presents three types of results: (1) Authors apply a time tested content analysis methodology to describe the information diffused by French language vaccine critical websites in comparison with English speaking websites. The contents of French language vaccine critical websites are very similar to those of English language websites except for the relative absence of moral and religious arguments. (2) Authors evaluate the likelihood that internet users will find those websites through vaccine-related queries on a variety of French-language versions of google. Queries on controversial vaccines generated many more vaccine critical websites than queries on vaccination in general. (3) Authors propose a typology of vaccine critical websites. Authors distinguish between (a) websites that criticize all vaccines (“antivaccine” websites) and websites that criticize only some vaccines (“vaccine-selective” websites), and between (b) websites that focus on vaccines (“vaccine-focused” websites) and those for which vaccines were only a secondary topic of interest (“generalist” websites). The differences in stances by groups and websites affect the likelihood that they will be believed and by whom. This study therefore helps understand the different information landscapes that may contribute to the variety of forms of vaccine hesitancy. Public authorities should have better awareness and understanding of these stances to bring appropriate answers to the different controversies about vaccination. [ABSTRACT FROM AUTHOR]

Abstract: Herbal products are commonly used to treat clinical conditions and are often purchased online without the supervision of a healthcare provider. The use of herbals remains controversial because of widespread exaggerated claims of clinical efficacy and safety. We conducted an online search of 13 common herbals (including black cohosh, echinacea, garlic, ginkgo, ginseng, green tea, kava, saw palmetto, and St John's wort) and reviewed the top 50 Web sites for each using a Google search. We analyzed clinical claims, warnings, and other safety information. A total of 1179 Web sites were examined. Less than 8% of retail sites provided information regarding potential adverse effects, drug interactions, and other safety information; only 10.5% recommended consultation with a healthcare professional. Less than 3% cited scientific literature to accompany their claims. Key safety information is still lacking from many online sources of herbal information. Certain nonretail site types may be more reliable, but physicians and other healthcare professionals should be aware of the variable quality of these sites to help patients make more informed decisions. [Copyright &y& Elsevier]

The main objective of this pilot study was to test the effectiveness of an online, interactive physical activity intervention that also incorporated gaming components. The intervention design included an activity planner, progress monitoring, and gamification components and used SMS text as a secondary delivery channel and feedback to improve engagement in the intervention content. Healthy adults (n = 21) recruited through ads in local newspapers (age 35-73) were randomized to the intervention or the control condition. Both groups reported physical activity using daily report forms in four registration weeks during the three-month study: only the experiment condition received access to the intervention. Analyses showed that the intervention group had significantly more minutes of physical activity inweeks five and nine. We also found a difference in the intensity of exercise inweek five. Although the intervention group reported more minutes of physical activity at higher intensity levels, we were not able to find a significant effect at the end of the study period. In conclusion, this study adds to the research on the effectiveness of using the Internet and SMS text messages for delivering physical activity interventions and supports gamification as a viable intervention tool. [ABSTRACT FROM AUTHOR]

Objective: To evaluate adequacy and adherence to American Society for Reproductive Medicine (ASRM) guidelines of internet information provided by Society for Assisted Reproductive Technology (SART)-affiliated clinics regarding social oocyte cryopreservation (SOC). Design: Systematic evaluation of websites of all SART member fertility clinics. Setting: The internet. Patient(s): None. Intervention(s): All websites offering SOC services were scored using a 0–13 scale, based on 10 questions designed to assess website quality and adherence to the ASRM/SART guidelines. The websites were analyzed independently by two authors. Whenever disagreement occurred, a third investigator determined the score. Main Outcome Measure(s): Scores defined website quality as excellent, ≥9; moderate, 5–8; or poor, ≤4 points. Result(s): Of the 387 clinics registered as SART members, 200 offered oocyte cryopreservation services for either medical or social reasons; 147 of these advertised SOC. The average website scores of those clinics offering SOC was 3.4 ± 2.1 (range, 2–11) points. There was no significant difference in scores between private versus academic clinics or clinics performing more or less than 500 cycles per year. Conclusion(s): The majority of the websites do not follow the SART/ASRM guidelines for SOC, indicating that there is a need to improve the type and quality of information provided on SOC by SART member websites. [ABSTRACT FROM AUTHOR]

Given the growing trend of the Internet as a source of health information, this study evaluated whether direct-to-consumer prescription drug websites for stigmatized illnesses contained stigma-reducing components: onset controllability, offset controllability, and recategorization. The authors examined the contents of the first-level homepages and the second-level pages in 88 stand-alone websites for 15 different stigmatized conditions. Overall, about a third of the websites did not provide a direct link to detailed disease information on the homepage. On the homepages, three stigma-reducing components were rarely offered either through textual or visual cues. On the second level, in terms of textual cues, onset controllability and recategorization were the most prevalent, while offset controllability was relatively less frequent. There were no visual cues on the second level. Results point out the limited and insufficient stigma-reducing components of direct-to-consumer prescription drug websites. [ABSTRACT FROM PUBLISHER]

Abstract: Objectives: Prostate cancer patients, as well as their caregivers and healthcare providers, often search the Internet for information about treatment options. We aimed to assess how accurate and up-to-date information about prostate cancer treatments is on websites owned and managed by health-related organizations that most patients and health care providers would consider to be the most trustworthy, based on the reputations of the site providers. Materials and methods: We reviewed 43 noncommercial and easily found websites that offered extensive information on treatment options for prostate cancer patients. To assess how comprehensive the sites were, we focused on the information they provided on alternative hormonal therapies to commonly prescribed luteinizing hormone-releasing hormone (LHRH) agonists, namely GnRH antagonists and parenteral estradiol. Results: Only 14 of 43 websites presented GnRH antagonists as a therapy option for prostate cancer. Sixteen of these 43 websites presented estrogen as a possible treatment option, but only 1 of the 43 websites contained current information on parenteral estrogen treatments. Less than half of the sites provided time stamps indicating when they were last updated. Furthermore, most sites with time stamps were not in fact up-to-date based on the information posted on the site. Conclusions: Few seemingly reputable Internet sources for medical information provide viewers with the detailed and up-to-date information that they may expect from such sites when searching for alternatives to standard treatment for androgen suppression. Strategies for keeping such websites up-to-date and reliable are discussed. Sites may improve their credibility and usefulness if they (1) present all evidence-based treatment options, (2) regularly update and time stamp their information, (3) acknowledge that their recommendations on treatments may become out-of-date quickly, (4) and direct viewers to information on relevant, active clinical trials. Maintaining high quality sites may ultimately depend on users taking the initiative to inform website owners when their sites are out-of-date. [Copyright &y& Elsevier]

Background: Online Consumer Health websites are a major source of information for patients worldwide. We focus on another modality, online physician advice. We aim to evaluate and compare the freely available online expert physicians’ advice in different countries, its scope and the type of content provided. Setting: Using automated methods for information retrieval and analysis, we compared consumer health portals from the US, Canada, the UK and Israel (WebMD,NetDoctor,AskTheDoctor and BeOK). The evaluated content was generated between 2002 and 2011. Results: We analyzed the different sites, looking at the distribution of questions in the various health topics, answer lengths and content type. Answers could be categorized into longer broad-educational answers versus shorter patient-specific ones, with different physicians having personal preferences as to answer type. The Israeli website BeOK, providing 10 times the number of answers than in the other three health portals, supplied answers that are shorter on average than in the other websites. Response times in these sites may be rapid with 32% of the WebMD answers and 64% of the BeOK answers provided in less than 24 hours. The voluntary contribution model used by BeOK and WebMD enables generation of large numbers of physician expert answers at low cost, providing 50,000 and 3,500 answers per year, respectively. Conclusions: Unlike health information in online databases or advice and support in patient-forums, online physician advice provides qualified specialists’ responses directly relevant to the questions asked. Our analysis showed that high numbers of expert answers could be generated in a timely fashion using a voluntary model. The length of answers varied significantly between the internet sites. Longer answers were associated with educational content while short answers were associated with patient-specific content. Standard site-specific guidelines for expert answers will allow for more desirable content (educational content) or better throughput (patient-specific content). [ABSTRACT FROM AUTHOR]

This study examined writer characteristics and themes written about in a set of 167 spontaneously published stories on a Dutch website for young women with breast cancer. The stories were coded for 6 disease characteristics and 16 themes. Coding results were compared with the characteristics of young women with breast cancer in a hospital cancer register and to the frequency of problems among young breast cancer patients participating in quantitative studies. We found that writer characteristics were diverse. Yet, logistic regression showed that women were more likely to be a writer if they were diagnosed at a younger age (OR 0.82; 95% CI (0.78, 0.85)), underwent a mastectomy (OR 4.63; 95% CI (2.59, 8.26)), or were in the first treatment period (OR 2.83; 95% CI (1.44, 5.58)). All 16 themes were present in the stories, but some themes were addressed less often than their frequency among participants of quantitative studies suggested. The findings indicate that a set of spontaneously published stories might not completely reflect the characteristics and themes of the wider population of young women with breast cancer. Websites with spontaneously published stories should inform readers about this. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Little is known about Internet resources for adolescent patients. This study assessed the quality, readability, and social reach of websites on an illustrative adolescent cancer diagnosis, osteosarcoma. Methods: The top 50 results from four queries in two search engines were screened. Quality and readability were determined using standard DISCERN tool, Flesch Reading Ease and Flesch–Kinkaid Grade. Social reach was gauged by social networking links, global website traffic, and a pilot adolescent-specificity measure. Results: Of 400 websites assessed, 56 (14%) met inclusion criteria. Websites’ mean quality was fair (49.8 on 75-point scale; range 31.0–66.0, poor to excellent); 86% failed readability standards (Grade>8); 75% offered at least one social networking link; and 34% offered site-specific social media. More than 60% received over 50,000 visits in the past month. Only 12.5% included adolescent-specific content. Of the 10 websites ranked highest for quality, only one achieved both readability targets and adolescent-specific content. Conclusions: Although some patient-oriented websites on osteosarcoma are of acceptable quality, most failed readability targets, and few appeared to address adolescents. Practice implications: Better awareness of Internet health resources and social media for adolescents with cancer is needed to address gaps, promote health literacy and facilitate patient–provider communication. [Copyright &y& Elsevier]

Copyright of Gestión Joven is the property of Asociacion Espanola de Contabilidad y Administracion de Empresas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Approximately 90 million American adults have literacy skills that test below a high school reading level. Websites written above this level can pose a challenge for those seeking online information about prostate cancer treatment options. In this study we determine the readability of selected websites using a systematic search process and validated readability formulas. Materials and Methods: We identified the 3 most popular keywords from 513 terms related to prostate cancer treatment options. We then systematically collected 270 websites from the top 3 search engines, and excluded from study those that were nonEnglish, not primarily text, irrelevant and/or duplicated. We used the Flesch-Kincaid grade level and Flesch Reading Ease to determine scores for each site. Results: A total of 62 unique websites were analyzed. Median Flesch-Kincaid grade level was 12.0 (range 8.0 to 12.0) and median Flesch Reading Ease score was 38.1 (range 0.0 to 65.5). Only 3 sites (4.8%) were written below a high school reading level (less than 9.0). Conclusions: Few websites with discussions on prostate cancer treatment options are written below a high school reading level. This is problematic for a third of Americans who seek to further educate themselves using online resources. Clinicians can use this information to guide their patients to appropriate websites. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated the readability, accessibility, usability, and reliability of vascular surgery information on the Internet in the English language. Methods: The Google, Yahoo, and MSN/Bing search engines were searched for “carotid endarterectomy,” “EVAR or endovascular aneurysm repair,” and “varicose veins or varicose veins surgery.” The first 50 Web sites from each search engine for each topic were analyzed. The Flesch Reading Ease Score and Gunning Fog Index were calculated to assess readability. The LIDA tool (Minervation Ltd, Oxford, UK) was used to assess accessibility, usability, and reliability. Results: The Web sites were difficult to read and comprehend. The mean Flesch Reading Ease scores were 53.53 for carotid endarterectomy, 50.53 for endovascular aneurysm repair, and 58.59 for varicose veins. The mean Gunning Fog Index scores were 12.3 for carotid endarterectomy, 12.12 for endovascular aneurysm repair, and 10.69 for varicose veins. The LIDA values for accessibility were good, but the results for usability and reliability were poor. Conclusions: Internet information on vascular surgical conditions and procedures is poorly written and unreliable. We suggest that health professionals should recommend Web sites that are easy to read and contain high-quality surgical information. Medical information on the Internet must be readable, accessible, usable, and reliable. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Patients commonly refer to Internet health-related information. To date, no quantitative comparison of the accuracy and readability of common diagnoses in Pediatric Otolaryngology exist. Study aims: (1) identify the three most frequently referenced Internet sources; (2) compare the content accuracy and (3) ascertain user-friendliness of each site; (4) inform practitioners and patients of the quality of available information. Methods: Twenty-four diagnoses in pediatric otolaryngology were entered in Google and the top five URLs for each were ranked. Articles were accessed for each topic in the three most frequently referenced sites. Standard rubrics were developed to include proprietary scores for content, errors, navigability, and validated metrics of readability. Results: Wikipedia, eMedicine, and NLM/NIH MedlinePlus were the most referenced sources. For content accuracy, eMedicine scored highest (84%; p <0.05) over MedlinePlus (49%) and Wikipedia (46%). The highest incidence of errors and omissions per article was found in Wikipedia (0.98±0.19), twice more than eMedicine (0.42±0.19; p <0.05). Errors were similar between MedlinePlus and both eMedicine and Wikipedia. On ratings for user interface, which incorporated Flesch–Kinkaid Reading Level and Flesch Reading Ease, MedlinePlus was the most user-friendly (4.3±0.29). This was nearly twice that of eMedicine (2.4±0.26) and slightly greater than Wikipedia (3.7±0.3). All differences were significant (p <0.05). There were 7 topics for which articles were not available on MedlinePlus. Conclusions: Knowledge of the quality of available information on the Internet improves pediatric otolaryngologists’ ability to counsel parents. The top web search results for pediatric otolaryngology diagnoses are Wikipedia, MedlinePlus, and eMedicine. Online information varies in quality, with a 46–84% concordance with current textbooks. eMedicine has the most accurate, comprehensive content and fewest errors, but is more challenging to read and navigate. Both Wikipedia and MedlinePlus have lower content accuracy and more errors, however MedlinePlus is simplest of all to read, at a 9th Grade level. [Copyright &y& Elsevier]

This article attempts to review the main research on web sites that promote Eating Disorders (ED), Pro-ana and Pro-mia. It gives the opportunity to reflect on this growing topic that continues to be not well known. Some questions emerge in relation to the sense of belonging to virtual groups, group identity, codes and shared symbols. So, this article is an invitation to start to understand what some authors have called the "Sub-culture Ana" which provides an opportunity to know the way people might possibly suffer from an ED as well as think and feel about their disorder and other aspects of their lives. [ABSTRACT FROM AUTHOR]

Abstract: Studies show internet sourced information often has poor accuracy. However, it is rapidly becoming a major source of patient information. Our aim was to assess accuracy of breast cancer-related information on the internet. The top five breast cancer-related search terms were identified using the commercial program “Wordtracker”. These terms were searched using the search-engine “Google” and the top 100 webpages per topic analysed for applicability and accuracy of information. Overall 500 webpages were analysed. 42% were inapplicable to the question asked. Applicable accuracy rates were variable amongst the five terms: “breast cancer symptoms” 84%, “breast cancer care” 87%, “breast cancer stage” 88%, “breast cancer survival” 91% and “breast cancer signs” 78%. Educational websites were more likely to be accurate(p < 0.001) and interest group administered websites less likely to be accurate(p = 0.018) than other websites. Finding accurate breast cancer information on the internet is difficult due to large numbers of inapplicable unregulated websites preferentially returned via search engines. [Copyright &y& Elsevier]

Abstract: Introduction: The internet is becoming an increasingly popular tool for health seekers. Research on health websites raises ethical debate about the quality of information on the Websites. This work aimed to evaluate Arabic Health Websites from ethical and legal perspectives and evaluate the physician–patient relationship on the web. Methods: This is a descriptive study. A Google and Yahoo search for the term “Arabic Health Websites” in Arabic language was performed and 430 relevant websites were accessed. They were evaluated using a checklist designed by research team based on E-Health Code of Ethics, 2000 to evaluate candor, honesty, quality of information, privacy, informed consent and professionalism in online healthcare. Results: Authors were mentioned in 21.4% of sample and 90% of sites did not mention when the information was last updated. It was noticed that 9.5% of sites mentioned collects data from users and whether data is shared with others or not. The limitations of consultation were mentioned in only 17.7%. The present study revealed that 42.5% of websites assured that healthcare providers obey the laws and regulations governing professional licensing and prescribing. Conclusion: This study revealed poor coverage of most evaluated items. [Copyright &y& Elsevier]

Studies on the effectiveness of information provision for patients with arthritis through the Internet are scarce. This study aimed to describe rheumatoid arthritis (RA) patients' knowledge and information needs before and after launching a website providing information on regional health care services for patients with rheumatic conditions. The intervention consisted of a weekly updated website comprising practical information on regional health care services for patients with arthritis. In addition, patients were offered information leaflets and an information meeting. Before (T1) and 24 months after (T2) the website was launched, a random sample of 400 RA patients filled in a questionnaire regarding knowledge and information need (scores 0-18) about accessibility and contents of 18 regional health care services. Two hundred and fifty-one patients returned the questionnaire (response rate 63%) at T1 and 200 patients (50%) at T2, respectively, with 160 paired observations (112 females (70%), mean age 60.4 years (SD 9.9)). The total score for insufficient knowledge about contents decreased from 9.3 (SD 4.9) to 8.5 (SD 4.8; p = 0.03) and for accessibility from 8.6 (SD 4.7) to 8.4 (SD 4.9; p = 0.59). Total score for information need about contents decreased from 4.2 (SD 4.5) to 1.9 (SD 2.9; p < 0.01) and for accessibility from 3.6 (SD 4.5) to 1.4 (SD 2.4; p < 0.01) (paired t-tests). After the administration of a website comprising practical health care information, RA patients' information need and to a lesser extent their perception of having insufficient knowledge on relevant regional health care services decreased significantly. The results of this descriptive study suggest that the use of the Internet to inform patients may be effective, although controlled studies are required to evaluate and optimize web-delivered information. [ABSTRACT FROM AUTHOR]

Objectives To analyze content and quality of headache, abdominal pain, and dysmenorrhoea websites, and to thematically analyze online pain forums. Methods Websites offering support, advice, or information regarding pain were explored. Websites were analyzed quantitatively using the Health-Related Website Evaluation Form and the DISCERN scale. Websites containing forum functions were thematically analysed assessing how the Internet is used for support and advice. Results 63 websites were included. Few websites scored in the upper quartiles of scores on the measures. 7 websites contained supportive posts, pertaining only to dysmenorrhoea. The ways users cope and the coping judgements of other forum users are presented thematically. 3 themes emerged: (1) passively engaged postings, (2) actively engaged postings, and (3) reactively engaged postings. Conclusions Internet pain resources are of low quality and questionable value in providing help to adolescents. Future research should explore how to improve quality. [ABSTRACT FROM AUTHOR]

The article discusses a study which determined what teaching general practitioners (TGPs) think about francophone Internet sites dedicated to chronic low back pain (CLBP). The study enrolled 112 TGPs in the Southern region and then used an assessment scale to evaluate 7 web sites about CLBP in semicontrolled conditions. It concluded that French TGPs believe that CLBP sites should focus on nonmedical, practical advice.

Objectives. The objective of this study is to evaluate the information quality about pregnancy symptoms in Spanish available in the internet. Materials and methods. This is an analytic, cross-sectional study. In order to evaluate the selected websites, we used a methodology previously validated by Curró et al. The websites were selected from Google, MSN.com and yahoo.com. The quality evaluation included three components: medical contents, accountability and usability of the website. The medical content was compared with the data available in the national guidelines for Comprehensive Sexual and Reproductive Health, from the Peruvian Ministry of Health. Results. Ninety nine websites in Spanish were evaluated. from them, 26.3% had medium adherence to the gold standard document. In 37.4% the websites were of low quality. A total of 24.2% were blogs, they were associated (as a protrective factor) to sites of poor quality (OR: 0.1, 95% CI: 0.02 to 0.5). Conclusions. The majority of websites in Spanish related to pregnancy symptoms have low quality. These findings indicate the need to properly educate patients and general public, and a critical evaluation of the information quality found at the Internet as well. [ABSTRACT FROM AUTHOR]

Abstract: Parents and teachers of children with autism spectrum disorders (ASD) are often presented with a confusing array of intervention options that vary considerably in their level of research support. Logical sources of information and guidance are the web sites of national autism associations. This research examined the quality of the information that is available on the web sites of national autism associations with regard to educational and therapy interventions. Rankings derived from current research evidence on interventions were compared with those available on web sites to determine whether or not this information was consistent with current research evidence and the stated aims of the organisations. Overall, these sites provided limited guidance for parents and teachers with regard to the selection of research-based interventions. Several options to improve the information available are discussed. [Copyright &y& Elsevier]

Abstract: Purpose: The purpose of this qualitative study was to improve understanding of family caregivers’ use of Web-based intervention support by integrating three theoretical models. The study applied the Anderson''s model of health service utilization, Venkatesh''s theory of technology acceptance, and Chatman''s and Wilson''s information behavior theories. Methods: This qualitative study is part of a larger study. An interpretive grounded theory approach was used to conduct in-depth interviews with Chinese caregivers of family members with dementia. The caregivers received Internet-based information support and personalized e-mail intervention. A purposive sample of fourteen caregivers was selected to participate in the interviews. Constant comparison, analytic memoing, case analysis, and concept mapping were used to conduct theoretical triangulation analysis. Results: Three main factors influenced the use of the intervention: (a) caregiver needs, which are influenced by personal capacity, social support available, and caregiving belief; (b) information communication technology (ICT) factors, including accessibility barriers and perceived efforts to use the technology; and (c) style of using the technology, such as preference for using e-mail or the customized Website. The personal capacity of caregivers was influenced by many factors, including computer and language proficiency, health service knowledge, caregiving competence and competing roles and responsibilities. Social support available for caregivers included available computer, language or caregiving support and health service knowledge. Caregiving belief included traditional belief of giving care, and health belief of the illness. New caregivers needed a different kind of support intervention compared with experienced caregivers. Caregivers with different amounts of experience tended to have different learning styles, with new caregivers preferring interactive intervention and more experienced caregivers preferring more reflective learning. Conclusions: This study reinforced the findings of the larger quantitative study that it is important to address both care-giving needs and technology factors in Internet-based intervention. The quantitative study found that less competent caregivers with more positive attitudes towards technology tended to use the intervention more frequently. In this qualitative research, the findings revealed that caregiver needs, ICT factors, and style of use explained the pattern of intervention use. This new conceptualization has integrated information acceptance, health service utilization, and information behavior theories. More studies will be needed to confirm if the proposed concept can explain or predict the usage behavior in other Web-based interventions. [Copyright &y& Elsevier]

Background: The aim of this study was to assess, at the European level and using digital technology, the inter-pathologist reproducibility of the ISHLT 2004 system and to compare it with the 1990 system We also assessed the reproducibility of the morphologic criteria for diagnosis of antibody-mediated rejection detailed in the 2004 grading system. Methods: The hematoxylin–eosin-stained sections of 20 sets of endomyocardial biopsies were pre-selected and graded by two pathologists (A.A. and M.B.) and digitized using a telepathology digital pathology system (Aperio ImageScope System; for details refer to http://aperio.com/). Their diagnoses were considered the index diagnoses, which covered all grades of acute cellular rejection (ACR), early ischemic lesions, Quilty lesions, late ischemic lesions and (in the 2005 system) antibody-mediated rejection (AMR). Eighteen pathologists from 16 heart transplant centers in 7 European countries participated in the study. Inter-observer reproducibility was assessed using Fleiss''s kappa and Krippendorff''s alpha statistics. Results: The combined kappa value of all grades diagnosed by all 18 pathologists was 0.31 for the 1990 grading system and 0.39 for the 2005 grading system, with alpha statistics at 0.57 and 0.55, respectively. Kappa values by grade for 1990/2005, respectively, were: 0 = 0.52/0.51; 1A/1R = 0.24/0.36; 1B = 0.15; 2 = 0.13; 3A/2R = 0.29/0.29; 3B/3R = 0.13/0.23; and 4 = 0.18. For the 2 cases of AMR, 6 of 18 pathologists correctly suspected AMR on the hematoxylin–eosin slides, whereas, in each of 17 of the 18 AMR-negative cases a small percentage of pathologists (range 5% to 33%) overinterpreted the findings as suggestive for AMR. Conclusions: Reproducibility studies of cardiac biopsies by pathologists in different centers at the international level were feasible using digitized slides rather than conventional histology glass slides. There was a small improvement in interobserver agreement between pathologists of different European centers when moving from the 1990 ISHLT classification to the “new” 2005 ISHLT classification. Morphologic suspicion of AMR in the 2004 system on hematoxylin–eosin-stained slides only was poor, highlighting the need for better standardization of morphologic criteria for AMR. Ongoing educational programs are needed to ensure standardization of diagnosis of both acute cellular and antibody-mediated rejection. [Copyright &y& Elsevier]

ABSTRACT Because of the limitation of time and resources, health professionals are often not able to provide support for consumers via personal communication. Consumers are increasingly active in managing their own health. E-word-of-mouth (eWOM), or consumer-generated content, on health social networking sites (SNSs) provides a new opportunity for health communication tailored to consumers' personal needs. Using netnography, a well structured internet-based ethonography, we analyze discussion threads posted to an obesity support group on a popular health SNS based in the US. We classify e-group members as support seekers and providers. Our results identify two major features of eWOM on health SNSs that facilitate tailored health communication. First, eWOM on health SNSs provides the types of support (informational and emotional) that help support seekers actively cope with heath-related problems and strains. Second, eWOM on health SNSs contains massages rich with personal experiences of support providers that offer solutions for problems that support seekers face in everyday situations. As support seekers participate in SNSs, their opportunity for learning means that they can become 'information elite', evolving from support seekers to support providers. We discuss important implications for policymakers and marketers for learning from and participating in eWOM on health SNSs. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Although the percentage of Romanians who use the Internet to find health information is 16% and the proportion of Romanians looking for health information on the web has tripled from 2006 to 2009, no atempt has been made so far to assess the quality of information in the Romanian medical webscape. Aim: The present study aimed to evaluate some general characteristics of the Romanian health related web sites. Methods: We investigated a sample of 317 medical sites randomly selected from the largest Romanian web directory. Two of the authors collected independently data about the number of unique visitors/month, medical specialty, site ownership, main purpose of the site and target audience. Disagreements were identified and a final common decision was taken by the evaluators through consensus. Results: Our results sugest that the Romanian medical webscape represents a relatively small portion of the Romanian webscape. In terms of number of sites we found that the most prominent categories were the complementary and alternative medicine sites and multi-specialty sites ranking first and second respectively. With more then 80% of the total traffic recorded by the medical websites, multispecialty sites clearly dominate the virtual health space. A very small number of medical websites have a real potential to influence health information seeking Internet users, since almost 90% of the medical web sites draw an insignificant number of visitors. Conclusions: The results of our study might be representative beyond its statistical population to the general Romanian webscape but this has yet to be verified. [ABSTRACT FROM AUTHOR]

Abstract: Background: A number of websites on the Internet promote health-enhancing behaviors among people with spinal cord injury (SCI). However, the information available is of unknown accuracy and quality. Objective: To examine the accuracy, quality, and targeting strategies used in online physical activity (PA) information aimed at people with SCI. Methods: A purposive sample of 30 frequently accessed websites for individuals with SCI that included PA information was examined. Websites were evaluated based on their descriptive characteristics, level of accuracy in relation to newly defined PA recommendations for people with SCI, technical and theoretical quality (i.e., use of behavioral theories) characteristics, and targeting strategies to promote PA among people with SCI. Descriptive statistics were utilized to illustrate the results of the evaluation. Results: PA information was easily accessible, as rated by the number of clicks required to access information. Only 6 websites (20%) provided specific PA recommendations and these websites exhibited low accuracy. Technically, websites were of high quality with a mean score of 4.1 of a possible 6 points. In contrast, websites had a low level of theoretical quality, with 23 of the 30 websites (77%) scoring below 9 of a possible 14 points (i.e., 64% of a perfect score) for theoretical content. A majority of websites evaluated did not use cognitive (e.g., self-efficacy, self-talk, and perceived social norms) and behavioral (e.g., self-monitoring, motivational readiness, and realistic goal-setting) strategies in their messages. A majority (80%) of the evaluated websites customized information for persons with different injury levels and completeness. Less than half of the websites evaluated tailored PA information toward people at different stages of their injury rehabilitation (37%) or for their caregivers (30%). Conclusion: Accuracy and theoretical quality of PA information presented to people with SCI on the Internet may not be optimal. Websites should be improved to incorporate accepted PA recommendations and behavioral theory to better deliver health messages about PA. [Copyright &y& Elsevier]

Abstract: To promote a healthy lifestyle, a web-based health self-checkup system was developed, by which users can monitor their healthy lifestyle through daily checkups and make changes based on the prescription provided. The system consists of five components: (a) daily checkup key physiological parameters related to the metabolic syndrome, such as body weight, body fat, blood pressure and blood glucose level, (b) lifestyle questionnaires, including smoking, drinking, sleeping, entertainment, exercise and eating, (c) data analysis and interpretation, (d) report and behavior modification prescription, and (e) web-based health diary and mentor service. The development and key elements of the system are described in detail. [ABSTRACT FROM AUTHOR]

Background: The assumption behind the presented work is that the information people search for on the internet reflects the disease status in society. By having access to this source of information, epidemiologists can get a valuable complement to the traditional surveillance and potentially get new and timely epidemiological insights. For this purpose, the Swedish Institute for Infectious Disease Control collaborates with a medical web site in Sweden. Methods: We built an application consisting of two conceptual parts. One part allows for trends, based on user specified requests, to be extracted from anonymous web query data from a Swedish medical web site. The second conceptual part permits tailored analyses of particular diseases, where more complex statistical methods are applied to the data. To evaluate the epidemiological relevance of the output, we compared Google search data and search data from the medical web site. Results: In the paper, we give concrete examples of the output from the web query-based system. We also present results from the comparison between data from the search engine Google and search data from the national medical web site. Conclusions: The application is in regular use at the Swedish Institute for Infectious Disease Control. A system based on web queries is flexible in that it can be adapted to any disease; we get information on other individuals than those who seek medical care; and the data do not suffer from reporting delays. Although Google data are based on a substantially larger search volume, search patterns obtained from the medical web site may still convey more information from an epidemiological perspective. Furthermore we can see advantages with having full access to the raw data. [ABSTRACT FROM AUTHOR]

Often, internet can bring a sense of anxiety rather than information and understanding to the patient. Our aim was to assess the quality of information available for patients on the management of polycystic ovarian syndrome (PCOS) on the internet. Five search engines were searched using phrases ‘PCOS and ‘patient information’. Various parameters of quality that were assessed were source, currency and editorial review process (for credibility) and hierarchy and accuracy of evidence (for content of the websites). Fifteen relevant websites were located, none of which complied with all the criteria for quality. Complete information on PCOS was not provided by any of the website to women according to the quality criteria. With 1,000 of websites launched everyday, it is difficult for patients to determine which website is trustworthy and valid. Patients need to be watchful about quality of the information on medical conditions in the internet. [ABSTRACT FROM AUTHOR]

We established a medical education website to deliver real-time, clinical case-based education to sites in Somaliland from the UK. The website was based on a web 2.0 social networking concept in order to recreate, as nearly as possible, the clinical bedside teaching experience. A survey showed that medical students in Somaliland had sufficient computer access to exploit the website. Teaching began in December 2008 and the teaching programme has developed into a regular weekly teaching session involving up to seven different student groups in Somaliland at different locations. As well as north-south teaching, the website has been employed to support a study module in London. Small groups of UK-based medical students have been partnered with intern tutors in Somaliland. Forty UK students have taken part in this teaching, which is now in its second year. Feedback from those involved has demonstrated that a collaboration in which both north-south and south-north teaching occurs can strengthen partnerships in which both parties contribute and benefit. [ABSTRACT FROM AUTHOR]

As more people use the internet to access health information, nurses need to become skilled in systematically reviewing websites so that they can guide patients to the most appropriate sites. The 5Cs website evaluation tool provides a structured guide to such evaluation, giving tips and suggesting key considerations. The 5 Cs are the key areas that need to be addressed in a comprehensive evaluation -- credibility, currency, content, construction and clarity. [ABSTRACT FROM AUTHOR]

Many HIV-positive persons use the Internet to address at least some of their needs for HIV-specific information and support. The aim of this multimethod study was to understand how a diverse sample of persons who were recently diagnosed with HIV (PRDH) used the Internet after an HIV diagnosis and their perceptions of online HIV-related information and resources. HIV-positive persons ( N = 63) who had been diagnosed since the year 2000 were recruited primarily through HIV-related websites and HIV medical clinics. One third of participants (33%, n = 21) were gay or bisexual men, 25% ( n = 16) were heterosexual men, 32% ( n = 20) were heterosexual women, and 10% ( n = 6) were transgender women (male to female). Semistructured interviews and brief postinterview surveys were used to collect qualitative and quantitative data. Qualitative findings suggested that the most appealing websites to PRDH included those that: (1) provided usable information on topics of immediate concern; (2) used accessible formats that were easy to navigate; (3) were perceived as trustworthy, and (4) provided access to diverse perspectives of persons living with HIV/AIDS. Topics that PRDH found most useful included various medical treatment-related issues, tools for coping with depression and fear, and learning how others cope with HIV. Incorporating the perspectives of HIV-positive persons into the design and content of HIV-related websites is important to enhance their appeal for this diverse and growing population. [ABSTRACT FROM AUTHOR]

AbstractHeart failure (HF) results in high hospitalization rates and healthcare costs. Telemonitoring of HF has been shown to result in improved outcomes but usually involves the use of expensive equipment. A more feasible alternative may be the use of a Web site. The purpose of this study is to investigate the use of a Web site designed for HF telemonitoring. Patients newly referred to a heart function clinic were screened for eligibility. Twenty participants were recruited and entered their weight and symptoms onto the Web site for 6 months. A nurse monitored the Web site for changes in participant health status and telephoned the participants as necessary. Self-care, quality of life, 6-minute walk test, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) were assessed. Interviews were conducted to assess intervention uptake. Seventeen participants completed the study. A significant change was observed on the maintenance subscale of the Self-Care of Heart Failure Index (p = 0.039). There was a trend toward improvement on the confidence subscale of the Self-Care of Heart Failure Index (p = 0.069), Minnesota Living With Heart Failure®Questionnaire (p = 0.337), 6-minute walk test (p = 0.124), and NT-proBNP (p = 0.210). Participants and nurses demonstrated a favorable uptake of the Web site. A Web site that facilitates the telemonitoring of patients with HF was favorably accepted and its use in this pilot study was associated with improved self-care skills. However, further investigation is warranted in a larger study population. [ABSTRACT FROM AUTHOR]

Background: Medicines Regulatory Authorities (MRAs), among other core regulatory functions, play a vital role in stimulating the rational use of medicines by providing regulatory information of good quality to all stakeholders. Little research has attempted to report on existence and maintenance of MRA websites at global level, as well as the types of information made publicly available. Objectives: To identify functioning MRA websites on a global level, to update a study carried out in 2001 on the development of the quality and types of information of 51 websites, and to identify model components within existing websites. Methods: The Internet was searched and WHO Medicines Regional Advisers and WHO medicines country advisers (National Professional Officers) were contacted in order to identify MRA websites. The 51 websites assessed in 2001 were assessed again, using the same criteria for the quality and types of information as in 2001. Results: The number of MRA websites identified has risen from 53 to 116. Most criteria, such as frequency of updates, pharmacovigilance information and regulatory guidance for applicants for medicines marketing authorization (registration) have improved substantially. However, navigability of websites has weakened. Conclusion: Quantitative growth of the number of MRA websites is impressive. The quality of information provided on the 51 assessed websites has improved. Exemplary website components are proposed to help MRAs to improve transparency by developing and maintaining high-quality websites. [ABSTRACT FROM AUTHOR]

Abstract: A significant number of Active Pharmaceutical Ingredients (APIs) have been identified in the environment and in surface waters. Data on the environmental hazards associated with these substances are emerging but are still scarce. We have compiled publicly available ecotoxicity data for APIs into a database called WikiPharma. The use of the database is free of charge. It can be accessed and updated continuously as a “wiki”. The aim of WikiPharma is to provide an easily accessible, comprehensive and up-to-date overview of effects caused by pharmaceuticals on non-target organisms. The database currently contains basic information, i.e. substance name, ATC code(s) and pharmaceutical group(s), for 831 APIs representing 35 different drug classes. Effect data have been identified and included for 116 of these substances. These ecotoxicity test data have been extracted from 156 different sources. The development of a comprehensive database on ecological hazard of APIs can facilitate identification of data gaps and promote environmental risk assessment of these substances. The database is available at www.wikipharma.org. [Copyright &y& Elsevier]

The article presents a study which evaluates the readability of spine-related web-based educational materials in the U.S. It notes that 121 sample documents are gathered from agencies including North American Spine Society (NASS), American Association of Neurological Surgeons (AANS), and American Academy of Orthopaedic Surgeons (AAOS) for analysis. Results of the study revealed that only 2.5 percent of the articles were readable for patients and the general public in the United States.

Background Teledermatology utilizes telecommunication technologies for the exchange of dermatologic information across distances. In 2000, we developed the Virtual Grand Rounds in Dermatology (VGRD) as a free, user-friendly platform for dermatologists to present complex dermatologic cases to the international community for clinical feedback, consultation, and continuing education. Methods VGRD was designed using simple graphics to facilitate access in remote and developing geographic regions. Members present their case according to a recommended template and are encouraged to provide clinical and histopathologic photographs. Viewers’ comments are posted on the site within 24–48 h following receipt. Results VGRD's low-cost store-and-forward system allows easy accessibility to expertise for colleagues around the world. VGRD currently comprises a community of 344 clinicians across all dermatologic subspecialties, and links users to cases as well as a recent interactive addition for more urgent feedback: VGRD Blog. The Maine Virtual Skin Clinic is another sister site developed as an educational tool for physicians and residents in primary care. VGRD can be found at . Conclusions With its easy-to-use platform for teleconsultation services, VGRD has the potential to enhance clinical outcomes and education. In the next few years, we hope to continue to expand VGRD, including launching a comprehensive search engine in VGRD to provide users with a “one-stop resource.” With the growth of teledermatology, we will combine web consultations with web-based education into a single resource for dermatologists interested in new possibilities in clinical practice, patient care, and continuing education. [ABSTRACT FROM AUTHOR]

Objective: To examine information on preimplantation genetic diagnosis (PGD) presented on IVF clinic websites.Design: We systematically sampled every third IVF clinic on the 2004 Centers for Disease Control provider list.Setting: The Internet.Patient(s): None.Intervention(s): None.Main Outcome Measure(s): Benefits, risks, and other types of information mentioned regarding PGD.Result(s): Of 135 sites examined, 88.1% had websites, and 70% mentioned PGD, of which 27% were university- or hospital-based and 63% were private clinics. Sites mentioning PGD listed uses and benefits of PGD far more than the risks involved. Of these sites, 76% described testing for single-gene diseases, but fewer mentioned risks of missing target diagnoses (35%) or risks for loss of embryo (18%), and 14% described PGD as new or controversial. Private clinics were more likely than other programs to be on either the East or West Coast, list certain PGD risks (e.g., diagnostic error), note that PGD was new or controversial, reference source of PGD information, provide accuracy rates of genetic testing of embryos, and offer gender selection for social reasons.Conclusion(s): Most IVF clinics advertise PGD online, but the scope and quality of information about it varies widely, emphasizing benefits while minimizing risks. Clinics and patients may benefit from more thorough and consistent presentation of PGD, drawing on available evidence to best provide a realistic portrayal of PGD. [ABSTRACT FROM AUTHOR]

Purpose: The Internet has become a widely used resource for patients and families to obtain medical information but the quality of information available is highly variable. We sought to determine if Web pages addressing common and uncommon pediatric urology topics differ in terms of quality or characteristics. Materials and Methods: We performed an Internet search using 5 common conditions (vesicoureteral reflux, hypospadias, prenatal hydronephrosis, cryptorchidism, enuresis) and 5 uncommon conditions (exstrophy, prune belly, posterior urethral valves, Wilms tumor, ureterocele). We recorded total hits, presence of sponsored links, page owner and author type, last update, content quality, readability, accreditation and advertising. Content quality was graded on a 5-point scale for accuracy and completeness of natural history, diagnosis and treatment. Results: We evaluated 100 sites on 10 topics. Common topics had more hits (980,000 vs 194,000) and were more likely to have sponsored advertisements (40% vs 0%) than uncommon topics. No difference was seen between topics in time from last update, owner/author type, financial disclosure, accreditation or advertising. Median quality grade was 4.0. Common topics had higher quality grades for disease natural history and diagnosis. Reading grade level was high and was similar between the groups. Conclusions: Web sites devoted to common pediatric urology topics have higher quality information for disease diagnosis and natural history. Otherwise, the quality of pediatric urology information on the Internet is high for common and uncommon topics. A high reading level is required to use these resources. [Copyright &y& Elsevier]

Abstract: The Immunization Information Resource Web site is provided as a public service by the Chiropractic Health Care Section of the American Public Health Association. The site compiles annotated bibliographies of citations from the scientific literature, as well as other authoritative peer-reviewed information sources on this topic. Our intent was to create a resource of information for health care professionals that is current, accurate, objective, evidence based, and as user-friendly as possible. This article describes the Internet-based Immunization Information Resource Web site developed and sponsored by the Chiropractic Health Care Section of the American Public Health Association and discusses current issues and future challenges for sustaining and further advancing such evidence-based initiatives for the chiropractic profession. [Copyright &y& Elsevier]

Abstract: Objective: This study describes the extent to which chiropractors with Web sites practicing in Canada advertise health products for sale and considers this practice in the context of chiropractic codes of ethics and conduct. Methods: Chiropractic Web sites in Canada were identified using a public online business directory (Canada 411). The Web sites were searched, and an inventory of the health products for sale was taken. The influences of type of practice and province of practice on the sale of health product were assessed. Textual comments about health product marketing were summarized. National and provincial codes of ethics were reviewed, and the content on health product advertising was summarized. Results: Two hundred eighty-seven Web sites were reviewed. Just more than half of the Web sites contained information on health products for sale (n = 158, 54%). Orthotics were advertised most often (n = 136 practices, 47%), followed by vitamins/nutritional supplements (n = 53, 18%), pillows and supports (n = 40, 14%), and exercise/rehabilitation products (n = 20, 7%). Chiropractors in solo or group chiropractic practices were less likely to advertise health products than those in multidisciplinary practice (P < .001), whereas chiropractors in BC were less likely to advertise nutritional supplements (P < .01). Provincial codes of ethics and conduct varied in their guidelines regarding health product sales. Conclusions: Variations in codes of ethics and in the proportions of practitioners advertising health products for sales across the country suggest that opinions may be divided on the acceptability of health product sales. Such practices raise questions and considerations for the chiropractic profession. [Copyright &y& Elsevier]