An evaluation of the contents and quality of menopause information on the World Wide Web

OBJECTIVE: To evaluate the content and quality of currently available World Wide Web based information about menopause. DESIGN: A sample of the 100 top sites obtained with the search engine Google for the key word "menopause" was evaluated according to predefined general and specific criteria, content type, language, and quality. The Internet popularity was established by the number of links to each website. Using a systematic scoring tool each site was assessed on factual information provided and quality of site. RESULTS: The websites studied were heterogeneous in content and quality. The most frequent type of website has commercial content with low quality, biased or useless information. Few sites provided comprehensive medical information about menopause. The scientific societies not always provided complete information about the possible adverse events related with hormone replacement therapy. The results of the Women's Health Initiative (WHI) and the Million Women (MW) studies are discussed by very few websites. Internet popularity did not correlate with measures of quality such as display of authorship, attribution or references, currency of information, and disclosure. CONCLUSION: The content and quality of the websites concerning menopause are widely varied and sometimes biased to commercial goals. The dominant medical information is of low quality and do not comply with general quality scores although the most informative sites have comprehensive content about the menopause including the recent results of the WHI and MW studies.     

The impact of information technology on histopathology

Pathology is one of the most computer intensive areas of medicine and as a result diagnostic pathologists in histopathology have often been at the cutting edge of computer literacy. The majority of laboratories use laboratory information systems to issue and store pathology reports. Many of these systems provide the diagnostician with the ability to retrieve reports and cases using coding systems such as SNOMED, but more advanced computer facilities that might assist the pathologist in the diagnosis or interpretation of a case are often lacking. In recent years advances in computer technology have begun to have a much wider impact on the practice of medicine and newer technologies are beginning to find their way into the reporting room. In this review, I cover some of the recent and emerging advances in IT that have the potential to revolutionize the practice of diagnostic histopathology in the next 5 years. The major area of telepathology has been a subject of several recent reviews and will not be covered here.     

Enquiring minds want to know: topics requested by users of a children's health information website

OBJECTIVE: To investigate health information needs of users of a health information website for children and young people. METHODS: A prospective analysis was conducted of unsolicited information requests to the Children First for Health (www.childrenfirst.nhs.uk) website, an NHS-run health and hospital online information resource for children, young people and families. All specific and general enquiries were recorded prospectively and coded according to health topic, age of the enquirer and web pages accessed. RESULTS: There were 2865 (62%) general health information and 924 (21%) specific enquiries received over an 18-month period (6.3 enquiries per day). More general enquiries were received about adolescent (64%) than children's (36%) health issues. The most common topics were psychosocial issues, hospital and health services, and normal growth and development. Only 1% of requests for information related to smoking, alcohol and drugs. CONCLUSION: Children and adolescents are active users of the Internet for health information. The results of this study highlight the health topics that are of greatest interest to children and young people. PRACTICE IMPLICATIONS: The findings provide objective data on health information topics of interest to UK children and young people and can be used to guide development of health information aimed at UK youth.     

Efficacy on menopausal neurovegetative symptoms and some plasma lipids blood levels of an herbal product containing isoflavones and other plant extracts

OBJECTIVES: To assess the efficacy of a product containing isoflavones and other plant extracts (BIO) on whole menopausal symptomatology and plasma lipids profile. METHODS: Multicentre, randomized, double blind, placebo controlled clinical investigation on 125 menopausal women randomly assigned to two groups treated for 6 months with placebo or one tablet daily of an herbal product containing 72 mg/dose of isoflavones of different plants origin and other plant extracts (BIO). Primary end-point: Kupperman Menopause Index (KI) variations; secondary end-point: activity on plasma lipids profile and clinical global impression (CGI) on efficacy and tolerability by investigators and patients. The usual parametric test (paired Student t test) was performed to evaluate the significance. In case of non-applicability of parametric tests, the non-parametric Mann-Whitney U test was used. The differences where considered significant at p<0.05 level. RESULTS: At the end of treatment in both groups KI showed a significant decrease (p<0.001). However, in the BIO group the KI reduction was significantly higher (p=0.0265) than in the placebo group after 4 and 6 months of treatment. In the BIO treated patients the LDL cholesterol showed a borderline but not significant reduction compared to placebo (p=0.0608) and triglyceride (TG) a significant (p=0.0151) decrease compared to placebo. The investigator's and patient's CGI on BIO group where superior as compared to placebo. Clinical tolerability was good in booth groups. CONCLUSION: On the basis of positive effects on KI and lipids profile as well as of good clinical tolerability, BIO can be considered one of the possible alternative therapy for conventional HRT.     

Web evaluation at the US National Institutes of Health: use of the American Customer Satisfaction Index online customer survey

Background

The National Institutes of Health (NIH), US Department of Health and Human Services (HHS), realized the need to better understand its Web users in order to help assure that websites are user friendly and well designed for effective information dissemination. A trans-NIH group proposed a trans-NIH project to implement an online customer survey, known as the American Customer Satisfaction Index (ACSI) survey, on a large number of NIH websites—the first “enterprise-wide” ACSI application, and probably the largest enterprise Web evaluation of any kind, in the US government. The proposal was funded by the NIH Evaluation Set-Aside Program for two years at a cost of US $1.5 million (US $1.275 million for survey licenses for 60 websites at US $18,000 per website; US $225,000 for a project evaluation contractor).

Objective

The overall project objectives were to assess the value added to the participating NIH websites of using the ACSI online survey, identify any NIH-wide benefits (and limitations) of the ACSI, ascertain any new understanding about the NIH Web presence based on ACSI survey results, and evaluate the effectiveness of a trans-NIH approach to Web evaluation. This was not an experimental study and was not intended to evaluate the ACSI survey methodology, per se, or the impacts of its use on customer satisfaction with NIH websites.

Methods

The evaluation methodology included baseline pre-project websites profiles; before and after email surveys of participating website teams; interviews with a representative cross-section of website staff; observations of debriefing meetings with website teams; observations at quarterly trans-NIH Web staff meetings and biweekly trans-NIH leadership team meetings; and review and analysis of secondary data.

Results

Of the original 60 NIH websites signed up, 55 implemented the ACSI survey, 42 generated sufficient data for formal reporting of survey results for their sites, and 51 completed the final project survey. A broad cross-section of websites participated, and a majority reported significant benefits and new knowledge gained from the ACSI survey results. NIH websites as a group scored consistently higher on overall customer satisfaction relative to US government-wide and private sector benchmarks.

Conclusions

Overall, the enterprise-wide experiment was successful. On the level of individual websites, the project confirmed the value of online customer surveys as a Web evaluation method. The evaluation results indicated that successful use of the ACSI, whether site-by-site or enterprise-wide, depends in large part on strong staff and management support and adequate funding and time for the use of such evaluative methods. In the age of Web-based e-government, a broad commitment to Web evaluation may well be needed. This commitment would help assure that the potential of the Web and other information technologies to improve customer and citizen satisfaction is fully realized.     

Automatic detecting indicators for quality of health information on the Web

OBJECTIVES: To automatically evaluate the quality of health information on the Internet, we presents a method for detecting indicators for quality of health information. METHODS: An automatic indicator detection tool (AIDT) was developed in the following steps: (1) 18 initial technical criteria were chosen; (2) multiple measurable indicators were defined for each criterion; (3) these measurable indicators on the Web pages were automatically detected by a computer program; (4) the detectable indicators were selected for each criterion based on detection accuracy and occurrence frequency, and detecting criteria on Web pages; (5) AIDT was developed based on the detectable indicators and criteria. The efficiency of detection tool was measured by recall and precision of detecting criteria. The performance of AIDT was tested using three data sets. RESULTS: AIDT with validated detectable indicators can reach 93% recall and 98% precision on these data sets. AIDT can automatically and correctly detect measurable criteria on Web pages. CONCLUSIONS: Automatic detecting indictors for quality of health information is feasible and effective. Using an automatic detecting tool is a promising method for identifying quality criteria of health information, and eventually it can be used to develop instruments for evaluating the quality of health Websites.     

Differences in health related quality of life in a sample of Spanish menopausal women with and without obesity

OBJECTIVE: To investigate whether body mass index, abdominal obesity or fat distribution in postmenopausal women influence their quality of Life. METHODS: A cross-sectional study was carried out on 250 postmenopausal women (age: 50-64 years), with intact uterus and ovaries, sexually active, and non-hormone therapy users. Various anthropometric measurements were considered and a specific health-related quality of life (HR-QoL) instrument, the Cervantes scale, was performed. RESULTS: Thirty-three women were not included as they refused to participate in the study, had chronic disease such as hypertension, diabetes type 2, depression or did not answer all the scale items, so 217 patients were evaluated. According with BMI values, 34% of women were obese, 46.1% were in overweight, 19.8% were in normal weight and there were not underweight women. Any consistent relation was found between BMI and global values of HR-QoL, but obese women were diagnosed with "high level of problems" in the "psychical domain" and in the "sexuality domain". This difference in "sexuality domain" was also appreciated in women with abdominal obesity. Fat or lean mass was not correlated with HR-QoL. CONCLUSION: In our study, obesity did not affect the global HR-QoL in Spanish postmenopausal women, but could have an influence on the psychical and sexual domains. Others anthropometric measurements are not associated with changes in HR-QoL. Additional research with HR-QoL specific and validated instruments and with a longitudinal design seems necessary to confirm our results.     

Healthcare seeking and treatment for menopausal symptoms in the United States

OBJECTIVES: A population-based study was used to describe healthcare seeking behavior for menopausal symptoms and treatment among women 40-65 years old in the United States. METHODS: Participants were recruited into the Menopause Epidemiology Study from the KnowledgePanel(SM), which is selected by random digit dialing and probability sampling from the US population. From this source, 6201 women 40-65 years old were contacted and 4402 women participated. From the 3135 peri- and postmenopausal women, detailed information was obtained on menopausal symptoms, healthcare seeking, medication usage, and symptom relief from the medication. RESULTS: Many women (60%) reported seeking health care for their menopausal symptoms. More than half of these women sought health care in the past 12 months. Vasomotor symptoms were the most frequently reported menopause symptoms across all races/ethnicities, and the most common symptoms discussed with a health care professional. One-third of the women (34%) used only hormone therapies, 12% used complementary and/or alternative medicines, and 16% used both for treatment of menopausal symptoms. CONCLUSIONS: This study has shown that a large number of women consult healthcare providers for menopausal symptoms, indicating these symptoms are bothersome. Yet, in the United States, there is considerable variation in the symptomatology, healthcare seeking, and use of therapies for menopausal symptoms across cultures. To alleviate these symptoms women have tried alternative treatments as well as hormone therapies, yet many women did not get complete relief of specific symptoms.     

Acceptance and use of health information technology by community-dwelling elders

ObjectivesWith the worldwide population growing in age, information technology may help meet important needs to prepare and support patients and families for aging. We sought to explore the use and acceptance of information technology for health among the elderly by reviewing the existing literature.MethodsReview of literature using PubMed and Google Scholar, references from relevant papers, and consultation with experts.ResultsElderly people approach the Internet and health information technology differently than younger people, but have growing rates of adoption. Assistive technology, such as sensors or home monitors, may help ‘aging in place’, but these have not been thoroughly evaluated. Elders face many barriers in using technology for healthcare decision-making, including issues with familiarity, willingness to ask for help, trust of the technology, privacy, and design challenges.ConclusionsBarriers must be addressed for these tools to be available to this growing population. Design, education, research, and policy all play roles in addressing these barriers to acceptance and use.     

For what purpose and reasons do doctors use the Internet: a systematic review

OBJECTIVES: To determine doctors' reasons for using the Internet, and the factors that influence their usage. DATA SOURCES: A systematic review of 38 studies, from 1994 to 2004, describing surveys of doctors' Internet usage. RESULTS: All of the studies were in the developed world, primarily in North America. Approximately 60-70% of doctors have access to the Internet, but in several studies access is more than 90%. Access is steadily increasing. Most Internet activity focuses on email and searching in journals and databases, but there is a very wide range of activities. Professional email with colleagues and patients is low, but increasing. The major factors discouraging usage are time, workload and cost, while too much information, liability issues and lack of skills also feature as discouraging factors. Factors encouraging use are unclear, but overall patient satisfaction and belief in improved service delivery, time saving and demand from patients are factors. There is a trend that males use the Internet more than females, young more than old, and specialists more than generalists, but these differences are not across the board, and show variations between studies. CONCLUSION: In spite of the limitations, it is clear that doctors are highly connected to the Internet, and their professional usage is increasing. Factors encouraging and discouraging usage are more complex than simple connectivity. Usage differences between demographic groups do exist, but are equalising. More and consistent research is required in this area.     

The risk of using the Internet as reference resource: a comparative study

OBJECTIVE: We sought to examine the frequency and the specific problems encountered in accessing Internet references in two leading medical journals during the last 3 years. METHODS: Two investigators independently reviewed all publications in the issues of the New England Journal of Medicine and The Lancet during October 2005 to March 2006, November 2004 to January 2005, and November 2003 to January 2004. We calculated the total number of references and the subset referred to an Internet source of each article. Then, we visited the electronic sources to identify the Internet references and noted the problems of accessibility, if any. When we failed to directly access the reference in the electronic address provided by the authors, we visited the referred website; if this was also inadequate, we performed Google searches to retrieve the missing reference(s). RESULTS: 465/18,850 (2.5%) and 952/24,630 (3.9%) of the reviewed references in the New England Journal of Medicine and The Lancet, respectively, referred to Internet sources; from these we could not access 68/465 (14.6%) and 170/952 (17.9%) in the two journals, respectively. There were increasing proportions of lost Internet references as they age. Searching into the website referred by the authors of the reviewed articles could not provide the missing information in a considerable proportion (62.2%). However, the use of an Internet search engine (Google) helped us to identify references in other websites, reducing the proportion of missing Internet references to 17/465 (3.7%) and 17/952 (1.8%) for the two journals, respectively. CONCLUSIONS: The response "page not found" was commonly encountered when we tried to access Internet references in publications of leading medical journals during the last 3 years. A considerable proportion of missing references was identified with the use of Google search engine. Authors of scientific articles should be aware of the problem of missing Internet references and until well-established Internet archiving solutions are in use, they should choose carefully their Internet references from reliable websites whenever it is impossible to avoid using them.     

The treatment of menopausal symptoms by traditional East Asian medicines: Review and perspectives

This article provides an overview and critical evaluation of the management of menopausal symptoms by traditional East Asian medicines (TEAMs). For this purpose we utilise an interdisciplinary perspective that draws on social history, medical anthropology, and clinical research. Our goal is threefold. First, we examine the research literature regarding evidence for the effectiveness of TEAMs in the management of menopausal symptoms. The failure of all studies reviewed to address the problematic articulation between tradition and modernity in the case of menopausal syndrome leads us to examine more closely how this connection has been constructed. In the second part of this review we explain how during the late 20th century various TEAMs currents such as traditional Chinese medicine (TCM), Japanese Kampō, and Korean medicine, explored different responses to a biomedically defined disorder, namely menopause, that was until then not discussed in these traditions. Third, based on the findings of the previous sections we make a number of recommendations as to how research in this field might be improved. We argue that while robust evidence for the efficacy of TEAMs in treating menopausal symptoms is currently lacking, existing studies provide sufficient evidence to warrant further research. A new interdisciplinary research framework that takes account of the actual realities of TEAMs practice will be required however for meaningful answers regarding the two most urgent problems in the field to emerge. These are, first the issue of actual treatment effects, and second the more general problem of how TEAMs might be integrated into personalised health care.     

Patients' use of the Internet for pain-related medical information

Objective

Patients increasingly use the Internet for medical information. For doctor–patient communication it is important to gain insight into the use and impact of medical Internet searches of patients. This study aims to evaluate patients’ use of the Internet for information about their pain problem.

Methods

A self-administered survey on pain-related Internet use was sent to 200 new patients attending a university pain center. The response rate was 61%.

Results

Half of all respondents used the Internet for medical information and a smaller percentage (39%) searched for specific information about pain. Patients found information on the Internet to be of good quality and quite easy to find and understand. In general, Respondents did not learn anything new. The on-line medical information confirmed what they already knew. Less than half of the respondents discussed information from the Internet with their physician.

Conclusion

Half of all patients used the Internet for medical information. Patients are reasonably certain that the information is accurate and reliable, while this may not always be the case.

Practice implications

Physicians should inquire about patients’ use of various sources of information (such as the Internet) and offer to clarify any questions or concerns that arise from that use.     

Relationship between health service use and health information technology use among older adults: analysis of the US National Health Interview Survey

Background

Older adults are the most frequent and heaviest users of health services in the United States; however, previous research on older adults’ use of health information technology (HIT) has not examined the possible association of HIT use among older adults with their use of health services.

Objective

This study examined the relationship between US older adults’ use of health services and their use of the Internet for health-related activities, controlling for socioeconomic characteristics and aging-related limitations in sensory and cognitive function. It also examined gender differences in the pattern of association between the types of health services used and HIT use.

Methods

The data for this study were drawn from the 2009 US National Health Interview Survey (NHIS), which was the first nationally representative household survey to collect data on HIT (Internet) use. First, the rates of lifetime and 12-month HIT use among sample adults (n = 27,731) by age group (18-29 to 85 and over) were analyzed. Second, bivariate analysis of sociodemographic characteristics, health status, and health service use by HIT use status among those aged 65 or older (n = 5294) was conducted. Finally, multivariate binary logistic regression analysis was used to test the study hypotheses with 12-month HIT use as the dependent variable and 12-month health service uses among the age group 65 or older as possible correlates.

Results

The rates of HIT use were significantly lower among the age groups 65 or older compared with the younger age groups, although the age group 55 to 64 was not different from those younger. The rates of HIT use decreased from 32.2% in the age group 65 to 74 to 14.5% in the age group 75 to 84 and 4.9% in the 85 and older age group. For both genders, having seen or talked to a general practitioner increased the odds of HIT use. However, having seen or talked to a medical specialist, eye doctor, or physical therapist/occupational therapist (PT/OT) were significantly associated with HIT use only for older women, while having seen or talked to a mental health professional only marginally increased the odds of HIT use only for older men. Having visited or talked to a chiropractor and having had overnight hospitalization, surgery, and/or homecare services were not associated with the odds of HIT use for either gender.

Conclusions

Older-adult users of general health services were more likely to use HIT than nonusers of general health services, while older-adult users of specialized health services were not different from nonusers of specialized health services in their odds of HIT use. The findings have implications for narrowing the age-related and socioeconomic status-related gaps in HIT use. The access gaps among racial/ethnic minority older adults and poorly educated and/or low-income older adults are especially striking and call for concerted efforts to facilitate Internet access and HIT use among these disadvantaged older adults.     

Determinants of Internet use as a preferred source of information on personal health

Objective

To understand the personal, social and cultural factors likely to explain recourse to the Internet as a preferred source of personal health information.

Design

A cross-sectional survey was conducted among a population of 2923 Internet users visiting a firmly established website that offers information on personal health. Multiple regression analysis was performed to identify the determinants of site use.

Measurement

The analysis template comprised four classes of determinants likely to explain Internet use: beliefs, intentions, user satisfaction and socio-demographic characteristics. Seven-point Likert scales were used. An analysis of the psychometric qualities of the variables provided compelling evidence of the construct's validity and reliability. A confirmatory factor analysis confirmed the correspondence with the factors predicted by the theoretical model.

Findings

The regression analysis explained 35% of the variance in Internet use. Use was directly associated with five factors: perceived usefulness, importance given to written media in searches for health information, concern for personal health, importance given to the opinions of physicians and other health professionals, and the trust placed in the information available on the site itself.

Conclusion

This study confirms the importance of the credibility of information on the frequency of Internet use as a preferred source of information on personal health. It also shows the potentially influential role of the Internet in the development of personal knowledge of health issues.     

Effects Of Internet-Based Tailored Advice on the Use of Cholesterol-Lowering Interventions: A Randomized Controlled Trial

Background

Elevated low-density lipoprotein (LDL) cholesterol is a leading risk factor for cardiovascular disease. Despite the availability of proven interventions to lower LDL cholesterol, their use remains subobtimal. Many websites provide interactive, tailored advice on cardiovascular risk in an attempt to help bridge this evidence-practice gap, yet there is little evidence that provision of such a tool is effective in changing practice.

Objectives

The objective was to define the effects on use of cholesterol-lowering interventions of a consumer-targeted tailored advice website.

Methods

This was a prospective, double-blind, randomized controlled trial open to any adult Australian with access to the Internet. A total of 2099 participants were randomized. Of these, 45% were male, the mean age of all participants was 56, and 1385 (66%) self-reported hypercholesterolemia. Follow-up information was obtained for 1945 (93%). Participants completed a brief online questionnaire. Individuals assigned to intervention received immediate, fully automated, personally tailored advice (based on current guidelines) regarding the need for commencement of statin therapy, increased statin therapy in those already on treatment, and nondrug intervention strategies. Control group participants were directed to static Web pages providing general information about cholesterol management.

Results

The primary outcome was the proportion of participants that commenced or increased use of prescribed cholesterol-lowering therapy. Of the total 2099 randomized participants, 304 (14%) met eligibility criteria for cholesterol-lowering therapy but were not prescribed treatment, and 254 (12%) were prescribed treatment but were not achieving the recommended target level. Treatment was commenced or increased in 64 (6.0%) of the 1062 intervention group participants and 79 (7.6%) of the 1037 control group participants (% difference = -1.6%, 95% confidence interval [CI] -3.75 to 0.57, P = .15). No differences were found between the randomized groups for the secondary outcomes of “discussed treatment with a health professional” (% difference = -3.8%, 95% confidence interval [CI] -8.16 to 0.19, P = .08), “had their cholesterol checked” (% difference = -1.5%, 95% CI -5.79 to 2.71, P = .48), “had their blood pressure checked” (% difference = 1.4%, 95% CI -2.55 to 5.34, P = .49) or made a lifestyle change (P values between .49 and .96).

Conclusions

Despite providing specific carefully tailored advice, this website had no detectable effect on cholesterol management strategies. This finding raises considerable uncertainty about the value of Internet-based tools providing tailored advice directly to consumers.

Trial Registration

{"type":"clinical-trial","attrs":{"text":"NCT00220974","term_id":"NCT00220974"}}NCT00220974; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00220974","term_id":"NCT00220974"}}NCT00220974 (Archived by WebCite at http://www.webcitation.org/5sdq63rrY)     

Consciousness about climacteric and menopausal symptoms affects the mental health of middle-aged women

Consciousness about climacteric and menopausal symptoms in relationship to menopausal stage and mental health was investigated. Midlife women (N = 407, 40-60 years old) were asked about their menstrual status, consciousness of climacteric and menopausal symptoms, self-esteem and depression. Based on their menstrual status, 222 participants were divided into three groups (pre-menopause, peri-menopause, and post-menopause). The main results are as follows. Women who were pre-menopausal had a negative consciousness about menopause, which contributed negatively to their self-esteem. Women who were perimenopausal or post-menopausal had more symptoms, which contributed negatively to their mental health. These results indicate that middle-aged women should be provided with interventions focusing on their menopausal status.