How well does the Internet answer patients’ questions about inflammatory bowel disease?

BACKGROUND

The Internet is an increasingly important source of health information.

OBJECTIVE

To assess how well common websites answered patients’ questions regarding inflammatory bowel disease (IBD).

METHODS

Thirty websites were identified and evaluated. Based on a previous survey of patient information needs, a comprehensive question list was developed in the three following areas: medical information (seven items), medical treatment (six items) and self-management (eight items). The websites were evaluated for the amount of information they provided to answer each question using two standard measures of information quality – the DISCERN and the Ensuring Quality Information for Patients scales.

RESULTS

Four particularly strong websites, scoring highest (on a scale from 1 to 5) in terms of IBD information, were the Crohn’s and Colitis Foundation of America (mean information score 4.3), About.com (4.2), HealthCentral (3.8) and WebMD (3.8). These websites also scored well on the DISCERN and the Ensuring Quality Information for Patients quality scales. Most websites provided at least adequate information on common symptoms, complications, treatments and what is known (or not known) about the causes of IBD. However, many web-sites did not provide adequate information about prognosis, possible side effects of treatment and risks of developing cancer. Information regarding self-management was covered to a very limited extent.

CONCLUSION

Websites could be strengthened by providing more of the information patients deem to be important, and by more clearly identifying sources of information and the date the information was updated. Most websites would benefit from more attention given to reducing the reading level and improving the organization of material.     

Dissemination of 'patient-oriented evidence that matters' on the Internet: the case of Type 2 diabetes treatment.

AIMS: To evaluate the dissemination of patient-oriented evidence that matters (POEMs) derived from the UK Prospective Diabetes Study (UKPDS) through health information websites. METHODS: Google and Altavista search engines were used to generate a list of websites about Type 2 diabetes treatments. We evaluated a random sample of 50 websites from each list, plus the first 10 websites displayed on each search engine looking for the presence of POEMs about diabetes treatment derived from the UKPDS. Websites were also ranked using the DISCERN instrument. RESULTS: The final sample consisted of 66 websites. The most frequently stated item was that tight blood pressure decreased complications and/or mortality (55.5%). The effects of metformin on morbidity and/or mortality in overweight patients and the greater effect of control of blood pressure rather than blood glucose control on complications were stated in 18.2 and 16.7% of cases, whereas the lack of effect of tight blood glucose control on premature mortality and of insulin or sulphonylureas on aggregate micro- or macrovascular outcomes in overweight patients were stated in one case each (1.5%). The lack of effect of tight blood glucose control on quality of life was not stated in any website. POEMs were more frequently present in websites rated high with the DISCERN instrument, websites with the Health-on-the-Net seal and non-commercial websites. CONCLUSIONS: The dissemination of POEMs through the Internet is poor. If patients are to be involved in decision-making processes, efforts should be made to update the Internet contents to meet this challenge.     

The association between educational resource utilization and knowledge/self-management among patients with Type 2 Diabetes in Pune,India

AimsPatients utilize a variety of sources to learn about their condition. This study assessed the association of these resources with patient knowledge, adherence, and physiologic outcomes.MethodsAdults with Type 2 diabetes recruited at an outpatient clinic in Pune, India provided IRB-approved consent and completed surveys measuring diabetes knowledge, self-management, and educational resource utilization. Lab values were obtained from the patient’s medical record. Statistical analysis was conducted in SPSS to determine the association between educational resources and outcomes.ResultsWe enrolled 82 patients with a mean age of 58.3 years. The most commonly used resource was books/pamphlets. The use of television and books/pamphlets as sources of information was significantly associated with greater knowledge and self-management. Use of books and pamphlets and peers with diabetes was associated with lower fasting and postprandial blood glucose.Regression analyses controlling for age, gender, and years with diabetes revealed that use of newspapers and magazines, books and pamphlets, and television were predictors of overall diabetes knowledge and nutrition knowledge. The use of television as a source of information was a predictor of the hours exercised per week.ConclusionsResources such as books and pamphlets, newspapers and magazines, and television are common ways that people with diabetes learn about their medical conditions. The use of television as a source of information predicted the greatest number of positive outcomes among patients, followed by use of books and pamphlets. These methods should be further explored in order to understand how their benefit may be maximized for patients.     

Quality of Internet-based information on gastrointestinal diseases

BACKGROUND:

The Internet is becoming an increasingly common source of health information for patients.

OBJECTIVE:

To examine the quality of gastrointestinal disease- and symptom-related Internet sites that might be searched by patients.

METHODS:

A total of 120 websites were evaluated from July to November 2009 using the DISCERN instrument to determine the quality of content of health and treatment information.

RESULTS:

There was substantial variability in the quality of Internet resources regarding gastrointestinal diseases and their symptoms. Information-based and institutional websites were rated highest. Resources related to celiac disease, colon cancer and abdominal pain scored the highest.

CONCLUSIONS:

Overall, the quality of web-based resources was variable. Because patient education is important in the management of gastroenterological diseases, the increasing use of the Internet poses new opportunities and challenges for physicians.     

Parental confusion may result when primary health care professionals show heterogeneity in their knowledge,attitudes, and perceptions regarding infant nutrition,food allergy,and atopic dermatitis

Introduction and objectives

Whether the guidelines on infant nutrition, food allergy and atopic dermatitis confer real health benefits in practice at the population level has not been deeply studied. We aimed here to characterize the knowledge, attitudes, and perceptions regarding these issues among primary health care professionals. In addition, we surveyed available parent-reported information sources and the incidence of food-related symptoms, dietary restrictions, food allergy, and atopic dermatitis among one-year-old children in the general population.

Accessibility, nature and quality of health information on the Internet: a survey on osteoarthritis

OBJECTIVES: This study aims to determine the quality and validity of information available on the Internet about osteoarthritis and to investigate the best way of sourcing this information. METHODS: Keywords relevant to osteoarthritis were searched across 15 search engines representing medical, general and meta-search engines. Search engine efficiency was defined as the percentage of unique and relevant websites from all websites returned by each search engine. The quality of relevant information was appraised using the DISCERN tool and the concordance of the information offered by the website with the available evidence about osteoarthritis determined. RESULTS: A total of 3443 websites were retrieved, of which 344 were identified as unique and providing information relevant to osteoarthritis. The overall quality of website information was poor. There was no significant difference between types of search engine in sourcing relevant information; however, the information retrieved from medical search engines was of a higher quality. Fewer than a third of the websites identified as offering relevant information cited evidence to support their recommendations. CONCLUSIONS: Although the overall quality of website information about osteoarthritis was poor, medical search engines may provide consumers with the opportunity to source high-quality health information on the Internet. In the era of evidence-based medicine, one of the main obstacles to the Internet reaching its potential as a medical resource is the failure of websites to incorporate and attribute evidence-based information.     

Interleukin-18 is associated with the severity of atopic dermatitis

BackgroundInterleukin (IL)-18 acts as both a Th1 and Th2 cytokine, but its association with allergic diseases remains unclear. The aim of the present study was to measured plasma IL-18 and serum IgE levels in atopic children to evaluate how IL-18 is associated with allergic diseases.MethodsThe plasma IL-18 and serum IgE levels in 51 atopic children, 28 healthy control children and 14 healthy control adults were measured by enzyme-linked immunosorbent assay (ELISA). The 5' end of the IL-18 gene of 48 atopic children and 20 healthy control children was sequenced.ResultsThe plasma IL-18 level was significantly elevated in children with bronchial asthma and/or atopic dermatitis. Plasma IL-18 levels in the moderate or severe atopic dermatitis group were significantly higher than those in either the control group or the mild atopic dermatitis group. There was a positive correlation between plasma IL-18 and serum IgE levels. Three allelic combinations of polymorphisms in the IL-18 gene promoter region were observed. There was no significant difference in the plasma IL-18 levels between groups carrying these genotypes. However, bronchial asthma patients had significantly higher frequencies of the − 137 G/G genotype than did control children.ConclusionsThe plasma IL-18 level was elevated, particularly in patients with atopic dermatitis. As the clinical severity of atopic dermatitis increased, the plasma IL-18 level also tended to increase. These findings suggest that IL-18 may be associated with the severity of atopic dermatitis.     

The reliability and validity of the Turkish version of Fullerton Advanced Balance (FAB-T) scale

PurposeThe aim of this study was to evaluate the reliability and validity of the Turkish version of the FAB(FAB-T) scale in the older Turkish adults.MethodsThe reliability and validity of the scale was tested on 200 community-dwelling older adults. FAB-T scale was scored by different physiotherapists on different days to evaluate inter-rater and intrarater reliability. The Berg Balance Scale (BBS) was used for the evaluation of convergent validity, and the content validity of the FAB-T scale was investigated.ResultsThe FAB-T scale showed very high inter- and intra-rater reliability. For inter-rater agreement, on the individual test items and total score ICC values were 0.92 (95 %CI; 0.90–0.94) and 0.96 (95% CI; 0.95–0.97) respectively. The intra-rater agreement, on the individual test items and total score ICC values were 0.93 (95 %CI; 0.91– 0.95) and 0.96 (95% CI; 0.95– 0.97) respectively. There was a good agreement between the FAB-T and BBS scales. A high correlation was found between the BBS and FAB-T scales [rho = 0.70 (%95 CI; 0.62–0.76)] indicating good convergent validity. Considering the content validity of the FAB-T scale, no floor (floor score: 0%) or ceiling (ceiling score: 6.5%) effect was detected.Conclusion: The FAB-T scale was successfully translated from the original English version (FAB) and demonstrated strong psychometric features. It was found that the FAB-T scale has very high inter-rater and intra-rater reliability. Considering the convergent validity, the scale has high correlation with the BBS. The FAB-T has no floor and ceiling effect.     

Evaluation of phagocytes in atopic dermatitis

BackgroundPatients with atopic dermatitis frequently present recurrent infections by pyogenic bacteria or by intracellular microorganisms, suggesting an immune disorder.ObjectiveLaboratorial investigation of phagocyte activity and chemotactic response by neutrophilic polymorphonuclear and mononuclear phagocytes in the peripheral blood of patients with atopic dermatitis from moderate to severe.MethodsThrough a transversal study, patients with atopic dermatitis from moderate to severe were selected. The neutrophilic and mononuclear phagocytes were separated and the phagocytic ingestion of zymosan particles was analysed, in addition to migration distance to the bacterial lipopolysaccharide chemotactic factor, comparing the results to the values obtained from healthy individuals within the same age group.ResultsNineteen patients were selected, 11 female and 8 male. The mean age was 6.47 years (±4.65). Among the 19 patients studied, 14 (73.68%) presented a reduction in the neutrophilic and mononuclear phagocyte activity, with two (1.53%) patients presenting a reduction in the activity of both phagocytes.ConclusionOur results demonstrated a reduction in chemotactic response and phagocytic activity by neutrophilic and/or mononuclear phagocytes in the majority of patients with atopic dermatitis from moderate to severe. Our results were coherent with the clinical data concerning the higher incidence of infections by pyogenic bacteria and fungi in patients with atopic dermatitis, which are microorganisms that require defence by the phagocytes researched in the present study.     

Growing Awareness of the Importance of Health Literacy in Individuals with COPD

Abstract

Good communication will impact clinical practice by assisting patients in understanding health information as well as medical recommendations. Health literacy is important for communication between healthcare professionals and patients with Chronic Obstructive Lung Disease (COPD). In this article we review the concepts, definitions and measurement tools used to evaluate health literacy and recommend ways in which this information may be integrated into clinical practice. Increased awareness of health literacy will assist clinicians to improve patients’ knowledge of their disease and adherence to healthcare recommendations.     

Quality assessment of patient information on the management of gallstone disease in the internet – A systematic analysis using the modified ensuring quality information for patients tool

IntroductionThe internet has become a fundamental source of medical information for patients, however, little is known about the quality of patient information regarding the management of gallstone disease (GD).MethodsA systematic review of information on GD in the internet was performed. The top 100 websites for every different search term and search engine were assessed using the validated EQIP tool (Score 0–36).ResultsA total of 2000 websites were identified and 212 (11%) were eligible for analysis. The overall median EQIP score of all websites was 15 (IQR 13–18). Of all websites, 63% originated from North America however, these represented the lowest median EQIP score of 15. Only 41% of the websites differentiated between clinical presentations and 19% provided emergency information. Only 3% of the websites reported complication rates, ranging from 3 to 36%.ConclusionThis is a comprehensive assessment of online patient information on GD using the EQIP tool. The assessment of the quality of websites concerning GD by the EQIP tool indicates that the majority of sites were of low-quality information. There is an immediate need for better informative and educational websites regarding GD that are compatible with international quality standards.     

Prevalence of allergic diseases in a sample of Taif citizens assessed by an original Arabic questionnaire (phase I) A pioneer study in Saudi Arabia

BackgroundIn recent decades, the prevalence of allergic diseases has markedly increased worldwide; however, there are still many cases which remain undiagnosed. Epidemiological studies have the potential to elucidate the prevalence and risk factors for these diseases.ObjectivesThis study aimed at evaluating the capability of a new original non-translated questionnaire in Arabic language to determine the prevalence and severity of these diseases in a sample from Taif citizens. Thus, it could provide a framework as an initial step towards accomplishing the first national questionnaire-based survey study determining the actual prevalence of various allergic diseases in Saudi Arabia.MethodsA detailed seven-section questionnaire including 143 closed questions covering almost all of the usual and unusual symptoms of various allergic diseases, in Arabic language, was handed out to 1050 subjects, from whom 877 (83.52%) questionnaires were completed; however, 23 questionnaires were discarded as they were not accurately filled in. Thus, 854 (81.33%) were enrolled in this study.ResultsUrticaria, allergic rhinitis with or without other co-morbidities, and atopic dermatitis were the most prevalent allergic morbidities, however, other allergic diseases could be diagnosed by the aid of the questionnaire. Likelihood ratio-evidenced agreement between diagnosis reached by the questionnaire and that reached by doctor occurred in 50 sample cases (p < 0.0001).ConclusionsThe questionnaire proved its capability in aiding the diagnosis of various allergic morbidities. It evidenced a high prevalence of allergic diseases in Taif city. This is an important health issue which requires strategic application of primary health care facilities to achieve adequate control.     

Can care of elderly be measured? A method for estimating the individual care of recipients in community health care

Background

Almost every country in the Western world has great difficulties allocating enough financial resources to meet the needs in the care of the increasing elderly population. The main problem is common to all countries and concerns the efforts to meet elderly persons' needs on an individual level while still maintaining society's responsibility for distributing justice. The aim of this study is to elaborate an instrument for measuring the quality of individual care and staff's working time in order to allocate public resources fairly. The present study gives an account of a new classification system named TiC (Time in Care), indicating how it can be used most effectively and also investigating the validity and reliability of the system.

Methods

All recipients in 13 sheltered homes for elderly care (n = 505) in a Swedish municipality were surveyed regarding the care they needed, in dimensions of General Care, Medical Care, Cognitive Dysfunction and Rehabilitation, and the time required. Construct validity was assessed by means of factor analysis. The inter-rater agreement of two raters concerning 79 recipients was measured using weighted Kappa. The stability of the instrument and its sensitivity to change were investigated through test-retest reliability measurements, conducted once a month during a six-month period. The content validity of the instrument was also assessed.

Results

Factor analysis resulted in a reduction of the number of items from 25 to 16 in three dimensions: General Care, Medical Care and Cognitive Dysfunction. The Kappa analysis showed satisfactory to excellent inter-rater agreement. The care need scores were basically stable but showed sensitivity to change in health status.

Conclusion

The instrument was found to be useful and reliable for assessing individual needs in community health care.     

Prevalence of asthma and other allergic diseases in children born after in vitro fertilisation

BackgroundChildren born after in vitro fertilisation (IVF) are under greater risk of development of some health problems than those children born after spontaneous conception. Yet it is not exactly known what the prevalence of asthma and other allergic diseases among these children is.Aims of the studyTo investigate the prevalence of asthma, allergic rhinitis and atopic dermatitis in children born after IVF, and controls born after spontaneous pregnancy using questionnaires of International Study of Asthma and Allergies in Children (ISAAC).MethodsWe recruited 158 children (mean age: 4.60 ± 2.14 years) born after IVF pregnancies and 102 children (mean age: 5.27 ± 2.8 years) as control group to investigate the prevalences of asthma, atopic dermatitis and allergic rhinitis. The questions in the questionnaire were asked to the parents by telephone or face to face.ResultsWheezing ever has been reported in 19 % of the children born after IVF and in 17.6 % of the control group (p > 0.05). No significant differences were found between groups, in terms of use of any anti-asthma drugs, physician diagnosed asthma and admission to emergency room with wheezing (p > 0.05). In addition, prevalence of allergic rhinitis and atopic dermatitis were also comparable between two groups (p > 0.05).ConclusionsPrevalences of asthma, allergic rhinitis and atopic dermatitis are similar in children born after IVF and children born after spontaneous conception.     

Prevalence of and risk factors for the development of atopic dermatitis in schoolchildren aged 12–14 in northwest Croatia

BackgroundAtopic dermatitis is a common allergic disorder. A multifactorial background for atopic dermatitis has been suggested, with genetic as well as environmental factors influencing disease development. Our aim was to estimate the prevalence rate and associated factors for atopic dermatitis in northern Croatia using the methods of the internationally standardised ISAAC protocol.MethodsThe study was undertaken among 12–14-year-old schoolchildren. Data were collected using standardised ISAAC written questionnaire Phase One and some selected questions from the ISAAC supplementary questionnaire completed by parents.ResultsA total of 2887 children participated in the study. Estimated lifetime (ever) prevalence rate of atopic dermatitis symptoms was 7.55% and estimated 12-month prevalence rate was 5.75%. The factors found to be associated to the symptoms of atopic dermatitis ever were: positive family atopy, female gender, sleeping on feather pillow and contact with pets after age of seven, and to the symptoms in the past 12 months were: positive family atopy, female gender, sleeping on feather pillow, parasite infestation, and contact with pets in the first year of life.ConclusionsThe results of our study show that northern Croatia is a region with moderate prevalence rates of atopic dermatitis. Following risk factors were family atopy, female gender and sleeping on feather pillow. Because of controversial results of previous studies conducted on the same topic further investigations should be made.     

Interpretation of graphic data by patients in a general medicine clinic

Objective:To assess how patients use graphic data to decide on preferences between alternative treatments. Design:Cross-sectional survey of patients, physicians, and medical students. The physicians and medical students served as a control group with which to compare the patients’ responses. Setting:A university-based Department of Veterans Affairs Medical Center. Participants:152 patients seen in a general medicine clinic, 57 medical students, and 11 physicians. Measurements and results:Subjects were given a survival graph showing the patient outcomes for two different unidentified treatments for an unidentified serious disease. They were asked to indicate which treatment they preferred and which portion(s) of the curves most influenced their preference. A large majority of both patients and health professionals preferred the treatment that had worse short-term and better long-term survival. Eleven percent of patients and 51% of health professionals identified mid-curve data (points other than the curve endpoints) as most influencing their preferences. Conclusions:A graphic survival curve appears to provide enough information to assess patient preferences between two alternative treatments. Patients appeared to differ from physicians and medical students in their interpretation of the curves. Received from the Department of Veterans Affairs Medical Center, Oregon Health Sciences University, Portland, Oregon.     

Plasma adrenomedullin levels in children with asthma: Any relation with atopic dermatitis?

BackgroundAsthma is a chronic, inflammatory disease of the airway, and adrenomedullin (ADM) may have some effects against bronchoconstriction. However, the role(s) of ADM in asthmatic children have not been evaluated yet. The aims of this study were to determine if there are any changes in plasma ADM levels during acute asthma attack, and to search for any association between allergen sensitivity and ADM level in asthmatic children.MethodsTwenty-seven children with acute asthma attack, ranging in age from 5 to 15 years were investigated and compared with 20 controls. Plasma ADM levels (ng/mL) were measured by ELISA method.ResultsNo significant difference was found in ADM levels between the controls and patients in either the acute attack or remission period. Plasma ADM levels were significantly higher in the acute attack (p = 0.043) compared to the remission period in patients who were considered as having a “severe attack” according to GINA (Global Initiative for Asthma) classification. There were statistically significant correlations between the patients’ AlaTOP and Food Panel 7 levels and plasma ADM levels in the acute attack period (p = 0.010, p = 0.001, respectively). The ADM levels in patients with a history of atopic dermatitis were significantly higher in the acute attack period compared to those without a history of atopic dermatitis (p = 0.007).ConclusionWe speculate that ADM may have a role in children with atopic dermatitis, and may also have a role in the immuno-inflammatory process of asthma.     

Do people self-reporting information about chronic respiratory disease have corroborative evidence in their general practice medical records? A study of intermethod reliability.

AIMS: To use intermethod reliability to compare self-reported data about chronic respiratory disease and health service utilisation with data contained in general practice medical records. METHODS: Self-reported postal questionnaire information from a small cohort of an age-sex stratified sample of 2318 patients was compared with information contained in their medical records. The agreement between the two sources of information was assessed. RESULTS: The case notes of 115/135 individuals from eight general practices were examined. For self-reported chest injury or operation (kappa, kappa=-0.03), or chronic bronchitis (kappa=0.10), agreement was poor. Agreement for self-reported pleurisy (kappa=0.32), hay fever or rhinitis (kappa=0.40), or eczema or dermatitis (kappa=0.30) was fair; for chronic obstructive pulmonary disease (COPD) or emphysema (kappa=0.56), or heart trouble (kappa=0.54), agreement was moderate; for asthma (kappa=0.78) or pneumonia (kappa=0.62), agreement was good; and for pulmonary tuberculosis (kappa=0.88), agreement was very good. The strength of agreement for information about health service utilisation for respiratory problems ranged from moderate to very good and was good for smoking status. CONCLUSIONS: Although based on small numbers, our results suggest good or very good agreement between self-reported data and general practice medical records for the absence or presence of some respiratory conditions and some types of respiratory-related health care utilisation. Depending on the research question being examined self-reported information may be appropriate.     

Omalizumab beyond asthma

IntroductionOmalizumab has been demonstrated to be a successful therapy in the management of asthma through reduction of patient's symptoms and use of inhaled corticosteroids. The effect of omalizumab is achieved by immunoglobulin E (IgE) blockage and other secondary mechanisms resulting from this blockage. Because other diseases have an important IgE mediation in their physiopathology, the question arises as to if omalizumab would be useful in the treatment of other IgE-mediated diseases.ObjectiveWe present an overview of the experimental studies and clinical reports evaluating the use of omalizumab in diseases different to asthma including atopic dermatitis, urticaria, eosinophilic gastrointestinal disorders, idiopathic anaphylaxis, latex allergy, hymenoptera venom allergy, and other IgE diseases.MethodsWe reviewed the literature using PUBMED, EMBASE, and LILACS for publications which used omalizumab in the treatment of patients with allergic diseases or any other diseases. Complete articles published in English, Spanish or Portuguese were included.ConclusionThere is not enough evidence to support the regular use of omalizumab in IgE diseases other than asthma. However, some experimental and clinical investigations indicate that omalizumab could be a therapeutic option in several allergic diseases like atopic dermatitis, urticaria, and eosinophilic gastrointestinal disorders. More control studies are needed in each IgE disease to evaluate the efficacy and safety of omalizumab in IgE mediated diseases.