Health-related services use and the onset of functional disability: 10 year follow-up study

This study aimed to examine the effect of health-related service use on the development of functional disability in an older adult Taiwanese cohort. The sample population consisted of 871 participants without Instrumental Activities of Daily Living (IADL) disabilities, 1061 participants without Activities of Daily Living (ADL) disabilities and 817 participants without IADL and ADL disabilities at baseline. The onset of IADL and ADL disabilities were estimated as the follow-up survey year that these functional disabilities were first noted, or the follow-up survey year that the participant was noted as having died. A Cox proportional hazards model, with time-dependent covariates, was used to analyze the association between the time of onset of the functional disabilities and the health-related service use, after controlling for age, gender, education, marital status and time varying chronic disease status. This study found that an increase in the number of services used by the participants resulted in fewer IADL and ADL disabilities. Furthermore, participants who attended recreational programs, regular health examinations, and who received the information assistance and meal preparation were significantly less likely to develop disabilities. Participants who used one or more services were 55–77% less likely to be IADL disabled, and were 54–81% less likely to be ADL disabled, and were also 59–89% less likely to develop IADL and ADL disabilities as compared to those who used none. In the present study therefore, as the number of health services used increased the likelihood of developing a functional disability decreased.     

Medical information on the internet

Objective

To assess medical information provided in a medically oriented Internet discussion group, in terms of the professional status of the individuals providing information, the consistency of the information with standard medical practice, and the nature of the evidence cited in support of specific claims or recommendations.

Design

Standardized review of 1,658 consecutive messages on a particular online discussion group during a 5-month period.

Setting

An online discussion group for sufferers of painful hand and arm conditions.

Subjects

All participants in this discussion group during the study period.

Measurements and main results

Professional training of those offering medical information, consistency of the advice and recommendations offered with conventional medical practice, and nature of evidence cited in support of medical claims were determined. Of all messages, 55.9% (927) addressed a medical topic. Of these, 79% (732) provided medical information, of which 89.3% (654) were authored by persons without professional medical training, and 5.1% (37) were authored by trained health professionals. Approximately one third of the medical information provided was classified as unconventional. Personal experience was the basis of information provided in 61% of the nonprofessionals’ messages and 13.5% of the professionals’ messages, while no source was given as the basis of information provided in 29.8% of the nonprofessionals’ messages and 67.6% of the professionals’ messages. A published source was cited in 9.2% of the nonprofessionals’ and 18.9% of the professionals’ messages.

Conclusions

These findings suggest that medical information available on Internet discussion groups may come from nonprofessionals and may be unconventional, based on limited evidence, and/or inappropriate.     

Digestive disease resources on the internet

The aim of this study is to help digestive disease professionals fully utilize the resources available on the Internet for patient care, education, and research. The following search resources were employed to locate websites: general search engines--Lycos, Metacrawler, Webcrawler, and Yahoo!; medical search engines--HealthWeb, MedMatrix, MedWeb, and MedWebPlus; website links; and publications. The inclusion of web sites was based on their content. Each site was evaluated with respect to its authorship, attribution, currency, and disclosure. All digestive disease professional organizations and academic centers that met the above criteria were included. Only nutrition sites with relevance to digestive diseases were included. A variety of very useful web sites related to digestive diseases exist on the Internet, and their numbers are growing. Many of these sites have valuable information that can be used to improve patient care, promote medical education, and facilitate research. Digestive disease professionals should adopt the Internet and address the many issues raised by this technology.     

最佳证据网上资源介绍

循证医学是针对具体的临床问题,全面搜集有关的研究证据,严格评价所获得的研究证据的质量,将整合得到的最佳研究证据应用于指导具体临床实践并对应用效果进行追踪再评估[1-2].因此,证据及其质量是循证医学实践的关键,而最佳证据的获得实质上就是对现有的、最好的各种文献资源、数据资源和事实资源进行检索利用.     

最佳证据网上资源介绍

循证医学是针对具体的临床问题,全面搜集有关的研究证据,严格评价所获得的研究证据的质量,将整合得到的最佳研究证据应用于指导具体临床实践并对应用效果进行追踪再评估¨引。因此,证据及其质量是循证医学实践的关键,而最佳证据的获得实质上就是对现有的、最好的各种文献资源、数据资源和事实资源进行检索利用。