Internet resources and web pages for pediatric surgeons

The Internet, the largest network of connected computers, provides immediate, dynamic, and downloadable information. By re-architecturing the work place and becoming familiar with Internet resources, pediatric surgeons have anticipated the informatics capabilities of this computer-based technology creating a new vision of work and organization in such areas as patient care, teaching, and research. This review aims to highlight how Internet navigational technology can be a useful educational resource in pediatric surgery, examines web pages of interest, and defines ideas of network communication. Basic Internet resources are electronic mail, discussion groups, file transfer, and the Worldwide Web (WWW). Electronic mailing is the most useful resource extending the avenue of learning to an international audience through news or list-servers groups. Pediatric Surgery List Server, the most popular discussion group, is a constant forum for exchange of ideas, difficult cases, consensus on management, and development of our specialty. The WWW provides an all-in-one medium of text, image, sound, and video. Associations, departments, educational sites, organizations, peer-reviewed scientific journals and Medline database web pages of prime interest to pediatric surgeons have been developing at an amazing pace. Future developments of technological advance nurturing our specialty will consist of online journals, telemedicine, international chatting, computer-based training for surgical education, and centralization of cyberspace information into database search sites.     

Health information seeking by parents in the Internet age

Aim:   Studies have shown increasing Internet use for health information. We aimed to broadly examine parents' utilisation of information sources for their children's health, their trust in them and to define the role of the Internet for children's health information
Methods:   Interview of a convenience sample of parents of patients presenting to a tertiary paediatric emergency department (ED) (Royal Children's Hospital, Melbourne, Australia) in 2006/2007.
Results:   A total of 360 parents completed the interview. Parents had used on average five sources of health information for their children in the previous 6 months. In the previous 6 months and immediately prior to the ED visit, general practitioners were consulted for health information by 87% and 39%, chemists by 44% and 2%, the Internet by 43% and 6% and telephone advice health lines by 30% and 10%, respectively. Of these sources, parents 'greatly trusted' Royal Children's Hospital ED doctors and nurses 82% ( n  = 112) their regular general practitioners in 73% ( n  = 303), chemists in 45% ( n  = 160), telephone advice health lines (Nurse-On-Call) in 42% ( n  = 90) and the Internet in general in 10% ( n  = 112). Overall, 52% had sought health information for their children on the Internet. Only 20% knew and 11% had ever used the regional children's hospital web site ( http://www.rch.org.au/kidsinfo ), but 97% of the Internet users reported they would trust this information.
Conclusion:   While using numerous different sources, parents in this study mostly use and trust traditional sources of health information. Scores of respondents use the Internet to seek health information for their children and would value easier access to Internet sources that they trust.     

How reliable is the Internet for caregivers on their decision to vaccinate their child against influenza? Results from googling in two languages

We have chosen Google, which is the most widely used search engine, to simulate a parent's experience in trying to find an answer on whether to have her/his child vaccinated against influenza. In doing this, we aimed to find out the chances that a parent with usual Internet searching tendencies may encounter right, wrong, and irrelevant answers in her/his search in the world wide web. We searched the Internet for an answer to the question “Should I make my child vaccinated against influenza?” by using the keywords “influenza”, “vaccine”, and “children” in two languages (English and Turkish). The “correct” answer was at least one clear statement meaning that annual influenza vaccination is recommended for all children (aged 6 months–18 years). Thirty-two of the 112 websites and 45 of the 103 websites had the correct answer, whereas 24 and 46 websites contained incorrect information in English and Turkish searches, respectively. Only non-relevant information was found in 56 English and 12 Turkish websites. When the first page of search results were taken into account, correctness and incorrectness were observed in six and four English and four and six in Turkish websites, respectively. Our findings call for the urgent need to check public-oriented healthcare information on the Internet for accuracy, completeness, and consistency. We have arrived at a conclusion that the information on the Internet cannot and should not be a substitute for routine care by primary care physicians.     

Utility of the Randomization Test and Importance of Nonstatis-tical Inference in Experimental Teratology

The implausibility of random sampling assumption in experimental teratology is pointed out. It is emphasized that nonstatistical inference remains a standard scientific approach, in spite of widespread use of many statistical tests. The randomization test can be introduced to experimental teratologjsts as an alternative to conventional statistical procedures for nonrandom sampling data. A program list for the randomization test written in BASIC for microcompter is given.     

The use of the Internet for children's health and the environment

The Internet can provide a wealth of information related to the effects of environmental exposures on children's health. This article provides guidance on searching the Internet for pertinent information and discusses how to evaluate such information. It also provides an extensive list of environmental-health-related websites hosted by governmental and nongovernmental agencies, and other organizations.     

Can paediatricians benefit from the Internet?

It is likely that many paediatricians will find the Internet useful. The main benefits are probably the ease and speed of communication and immediate access to a few databases such as MEDLINE. It is also practical to integrate the import, processing, storage, and export of data into one's own computer. It is also possible that the Internet in all its forms will become an integrated part of our daily paediatric practice as a result of the increased usage of the Internet by patients, parents, and paediatricians.     

Internet and computer access and use for health information in an underserved community.

BACKGROUND: The "digital divide" is the gap between those with access to information tools such as the Internet and those without access. The gap has been described by income, education, age, and race. Little information exists on computer and Internet access and use for health information by parents, particularly among populations of low income and low education level. OBJECTIVE: To describe computer and Internet access and use, including health information retrieval, among low-income, urban, African American caregivers (parents). DESIGN: Cross-sectional survey administered in pediatric waiting rooms of urban community-based health centers in a low-income area. PARTICIPANTS: Caregivers of pediatric outpatients. MAIN OUTCOME MEASURES: Access to computers, Internet access, and use of Internet for health information. RESULTS: In 2003, among 260 African Americans who completed surveys, 58% had a computer and 41% had home Internet access. Fifty-two percent had used the Internet for finding health information. Ninety-three percent agreed or strongly agreed that there is useful health information on the Internet. Ninety-two percent agreed or strongly agreed that they would want to talk with a medical professional about health information on the Internet. Sixty-five percent of respondents had no additional schooling after high school. Annual household income was 相似文献   

The cause and prevention of human birth defects: What have we learned in the past 50 years?

ABSTRACT This review article dealig with the subject of “The Cause and Prevention of Human Birth Defects” was prepared in celebration of the 40th anniversary of the Japanese Teratology Society. It begins with recollections of some of the important contributions of Japanese scientists in the fields of teratology and embryology and a summary of the many scientific and medical accomplishments of the past 50 years in the fields of teratology, genetics, developmental biology, epidemiology and genetics. The review includes a summary of the drugs, chemicals and physical agents that have been documented to result in congenital malformations and reproductive effects when pregnant women are exposed during pregnancy. The principles of teratology were also summarized and emphasize that 1) no teratogenic agent can be described qualitatively as a teratogen, since a teratogenic exposure must include not only the agent, but also the dose and the time in pregnancy when the exposure occurs. 2) Even agents that have been demonstrated to result in malformatins cannot produce every type of malformation. 3) Known teratogens can be presumptively identified by the spectrum of malformations they produce. 4) It is easier to exclude an agent as a cause of birth defects than to definitively conclude that it was responsible for birth defects. 5) When evaluating the risk of exposures, the dose is a crucial component in determining the risk. 6) Teratogenic agents follow a toxicological dose response curve. This means that each teratogen has a threshold dose, below which, there is no risk of teratogenensis, no matter when in pregnancy the exposure occurred. 7) The evaluation of a child with congenital malformations connot be adequately performed unless it is approached with the same scholarship and detail, as is any other complicated medical problem. 8) Each physician must recognize the consequences of providing erroneous reproductive risks to pregnant women exposed to drugs and chemicals during pregnancy or alleging that a child's malformations are due to an environmental agent without performing a complete and scholarly evaluation.     

Communication and collaboration technologies

This is the third in a series of columns exploring health information technology (HIT) in the neonatal intensive care unit (NICU). The first column provided background information on the implementation of information technology throughout the health care delivery system, as well as the requisite informatics competencies needed for nurses to fully engage in the digital era of health care. The second column focused on information and resources to master basic computer competencies described by the TIGER initiative (Technology Informatics Guiding Education Reform) as learning about computers, computer networks, and the transfer of data.1 This column will provide additional information related to basic computer competencies, focusing on communication and collaboration technologies. Computers and the Internet have transformed the way we communicate and collaborate. Electronic communication is the ability to exchange information through the use of computer equipment and software.2 Broadly defined, any technology that facilitates linking one or more individuals together is a collaborative tool. Collaboration using technology encompasses an extensive range of applications that enable groups of individuals to work together including e-mail, instant messaging (IM ), and several web applications collectively referred to as Web 2.0 technologies. The term Web 2.0 refers to web applications where users interact and collaborate with each other in a collective exchange of ideas generating content in a virtual community. Examples of Web 2.0 technologies include social networking sites, blogs, wikis, video sharing sites, and mashups. Many organizations are developing collaborative strategies and tools for employees to connect and interact using web-based social media technologies.3.     

Internet poses multiple risks to children and adolescents

Computers and Internet usage, whether by children at home or at public places such as schools and libraries, are here to stay. Tremendous benefits in terms of educational opportunities, communication, and recreation can be expected. With all the benefits that such information technology provides, however, there is an element of risk that should not inhibit its use but must be attended to and managed. The methods child sexual offenders use to pursue their criminal interests will continue to evolve as technology evolves. The first and most important line of defense calls for parents and other caregivers to remain directly responsible for the safety of the children in their care. Parents, teachers, healthcare providers, and other caregivers need to learn continually about the Internet and remain aware of how best to protect children who use the computer and the Internet. Law enforcement agencies must also continue to prepare for advances in computer technology, to better anticipate the behavior of child sexual offenders, and to investigate and prosecute offenders. All law enforcement, medical, and social services personnel who have contact with children on a regular basis must continue to educate children and their parents or guardians about the dangers posed by the Internet. After a child is victimized, law enforcement, medical, and social services personnel also must remain cognizant that the victim's computer may contain evidence that may help identify and prosecute the offender. In short, all those charged with the protection of children and the prosecution of child sexual offenders must continue to adapt to our ever-evolving computer technology.     

Survey of Internet web sites on circumcision

Information on circumcision is available on the Internet, which is available for parents to review. The purpose of this study is to sample and summarize the Internet's informational content on circumcision. One hundred web sites were identified using the Google search engine on February 15, 2003. The informational content of each site was reviewed and tabulated. Seventy-three of the 100 web sites were appropriate for review. Ten agreed with recommending circumcision, 4 agreed under limited circumstances, 37 recommended against circumcision, and 4 recommended against circumcision under limited circumstances. Eighteen did not take a stance for or against. Thirteen agreed that circumcision reduces the risk of urinary tract infection, and 16 disagreed with this. Fifteen agreed that circumcision reduces the risk of penile cancer and 14 disagreed with this. Fifty-one percent of web sites surveyed were against circumcision, 14% of the web sites surveyed recommended circumcision, and 25% of surveyed web sites had no opinion.     

Functional Damage in the Developing Brain Induced by Maternal Environmental Agents: Ethanol, Tobacco and Low-Copper Level

To evaluate tests for behavioral teratology in animals, brain dysfunction caused by maternal environmental agents is compared both epidemiologically and experimentally. Ethanol: The features of CNS involvement in human FAS (fetal alcohol syndrome) and FAE (fetal alcohol effects) are developmental delay and intellectual impairment. One of the most vulnerable structures in the rat fetus exposed to ethanol in utero is the synaptic formation in the hippocampus. What test for brain dysfunctions, such as deficits in learning, inhibition and attention, is there? Tobacco: Thirty-three percent of human FTS (fetal tobacco syndrome) cases have CNS involvement, which is characterized by developmental delay, and behavioral problems such as a short attention span and hyperactivity. As to the concomitant effects of ethanol and tobacco on human offspring, CNS involvement appeared to be most specific for alcohol exposure, but was also observed slightly with smoking without drinking. How can the effects of concomitant substances be discriminated in an animal test? Low-copper level in brain: Related to the development of their offspring, abnormal movements in brindled mutant mouse heterozygotes are observed. These findings may be influenced by both copper and oxygen radical metabolism. The teratogenic effects of triethylene tetramine dihydrochloride, a chelating drug for copper on the fetal mouse brain are noted both grossly and microscopically. How can the abnormal CNS development in relation to a certain biochemical mechanism be detected by means of an animal test? In conclusion, to examine behavioral teratology in animals, specificity and accuracy should be considered in comparison with in humans.     

Use of the Internet by parents of paediatric patients

AIM: We aimed to determine the rate of Internet use for obtaining medical information by health-care patients at a tertiary paediatric hospital, whether the Internet may influence patients' attitudes to health-care services and health-care providers and whether patients would prefer the assistance of a professional informatics officer. METHODS: An anonymous questionnaire randomly distributed to 450 subjects at Sydney Children's Hospital, Sydney, Australia. RESULTS: A total of 294 (65%) questionnaires were returned. Overall Internet use for medical information was 64% (189/294). Most (97%; 183/189) respondents reported 'wanting to know more' as the reason they sought information on the Internet. Eighty-eight per cent (167/189) of respondents reported that they trust their doctor more than the Internet. Twenty-one per cent (39/189) had presented their doctor with information about which he/she was unaware and 18% (34/189) had altered a health-care decision because of information found on the Internet. The Internet had influenced questions asked of doctors in 83% (156/189). Eighty-six per cent (252/294) of all respondents were in favour of professional assistance to obtain medical information. CONCLUSION: A large number of patients use the Internet to find information that influences their attitudes to health care. The services of a medical informatics professional would likely benefit both patients and doctors.     

HEADSS up: Adolescents and the Internet

INTRODUCTION

The Internet contains a tremendous amount of unregulated information. Internet use gives adolescents access to a wide variety of information and communication devices, and may be associated with certain risks.

OBJECTIVE

To provide health care professionals with information on adolescent Internet use and its associated risks.

DISCUSSION

Ninety-four per cent of Canadian youth surveyed nationwide in 2005 reported having Internet access in their homes. Parents and health care providers need to educate themselves on issues of Internet safety. The divergent means by which adolescents are using the Internet and the inherent risks associated with unsupervised and uneducated use are addressed. Parents and teenagers are provided with tips for safe Internet use, and health care providers are offered sample questions pertaining to adolescent Internet use.

SUMMARY

A large proportion of adolescents use the Internet daily. Studies examining the risks of online exposure in this age group are evolving. Awareness of the range of applications and information available online will facilitate counselling on appropriate Internet use.     

The role of the pediatrician in preventing congenital malformations

? The development of new knowledge and new diagnostic techniques and technology as well as the sophistication of epidemiology studies and maturation of the fields of clinical genetics and clinical teratology have revolutionized the field of reproductive and developmental biology.? Advances have enabled physicians and scientists to determine the causes of developmental abnormalities and, therefore, discover methods of prevention. The process of evaluation is based on the knowledge base developed over the past 50 years.? Although genetic abnormalities are responsible for a significant proportion of reproductive and developmental deleterious effects, a larger proportion of these effects are due to unknown causes.? Environmental causes are less frequent, although many of the environmental effects as well as many of the genetic effects can be prevented through genetic counseling and preconceptual planning. Effective treatment and amelioration of developmental effects also have improved.? More than 50 environmental drugs, chemicals, maternal diseases, infections, nutritional abnormalities, and physical agents can affect reproduction deleteriously and result in CMs.Theoretically, all these causes are preventable.? Throughout the developing world, the addition of folic acid and iodine could prevent tens of thousands of birth defects and developmental abnormalities.? In the United States, the opportunity for prevention can be introduced at the population level and by addressing individual patients’ clinical problems.? If a mother of a malformed infant had some type of exposure during pregnancy, such as a diagnostic radiologic examination or medication, the consulting physician should not support or suggest the possibility of a causal relationship before performing a complete evaluation. If a pregnant woman who has not yet delivered had some type of exposure during pregnancy, the consulting physician should not support or suggest the possibility that the fetus is at increased risk before performing a complete evaluation. ? Every patient deserves a complete, scholarly evaluation that uses the basic principles of teratology and risk analysis.     

Acoustic Startle Response in the Study of Developmental Toxicity

Acoustic startle response (ASR) is a defensive reflex that occurs shortly after presentation of a brief intense acoustic stimulus. It consists of a sudden contraction of facial and skeletal muscle. ASR in rodents is a gross vibration-like movement of the body that is easy to elicit, record, and analyze quantitatively. It can also be used as a reliable and sensitive measure of physiological mechanism of developmental toxicity. The basic neural mechanisms of ASR have been elucidated. The cochlear nucleus and the reticular nucleus of pons are essential to the induction and regulation of ASR amplitude. Fear or anxiety augments ASR (fear potentiation) and functionally involves amygdala. A brief presentation of a weak acoustic stimulus shortly before the presentation of a startling stimulus suppresses ASR (prepulse inhibition). Prepulse inhibition is thought to be regulated by the dopaminergic mesolimbic system. Taken together, these phenomena suggest the use of ASR as a means of modeling anxiety/fear and the sensorymotor abnormalities that may present themselves in a condition such as schizophrenia. In this review, the fundamental behavioral and neural features of ASR are described and major findings in connection with the toxicology of ASR are reviewed. Finally, the significance of ASR in the study of developmental toxicology including behavioral teratology is discussed. Key words : acoustic startle response, fear potentiation, prepulse inhibition, developmental toxicology, behavioral teratology     

Creating and curating a pediatric radiology digital library to make the Internet a useful reference tool for the radiologist

Background. To practice pediatric radiology optimally, radiologists need convenient access to organized and authoritative pediatric radiology information. The Internet has the potential for offering such convenient access, but the majority of information on it is poorly organized and of questionable authority. Objective. The goal of this project was to create and curate a pediatric radiology digital library that will make the Internet a useful reference tool for the radiologist at the point-of-care. Materials and Methods. A pediatric radiology digital library containing organized and authoritative pediatric radiology information from the Internet was created and has three components : (1) PediatricRadiology.com (http://pediatricradiology.com) – a catalog of pediatric radiology Web sites; (2) The MetaTextbook of Pediatric Radiology (http://www.vh.org/Providers/TeachingFiles/MetatextbookPedRad/MetaTBPedRad.html) – a catalog of pediatric radiology teaching file cases on the Internet; and (3) Paediapedia (http://www.vh.org/Providers/TeachingFiles/PAP/PAPHome.html) – an imaging encyclopedia of pediatric disease. The pediatric radiology digital library is curated regularly. Results. Over 7 months, 223,689 pages of information were read and 26,972 images were viewed in the pediatric radiology digital library by 69,866 individual users, with 20 % of the users from outside the United States. Conclusion. Creating a pediatric radiology digital library that identifies and organizes authoritative pediatric radiology information and makes it conveniently available can allow radiologists to use the Internet productively as a reference tool. Received: 9 March 1998 Accepted: 4 June 1998     

Application of the mouse exo utero development system in the study of developmental biology and teratology

The mouse exo utero development system is useful for analyzing the roles of molecules or interactions between tissues in the histogenesis of organs after the mid-gestational period. In the article presented here, we review the mouse exo utero development system and its specific modifications depending on different purposes as well as its advantages over and limitations compared to other systems in the study of developmental biology and teratology.