Internet use of parents before attending a general pediatric outpatient clinic: does it change their information level and assessment of acute diseases?

BACKGROUND: Before seeing a pediatrician, parents often look online to obtain child health information. We aimed to determine the influence of IUC (internet use regarding the reason for consultation) on their subjective information level, their assessment of acute diseases and the change in this assessment. Secondary objectives were to identify the most commonly used online resources and factors with an influence on IUC. METHODS: This cross-sectional observational study was conducted at a general pediatric outpatient clinic located in Vienna, Austria. An anonymous, voluntary and 14-items-containing questionnaire served to gather all data. A total number of 500 questionnaires were collected. RESULTS: Of the parents attending the outpatient clinic, 21 % use the internet before the appointment (= IUC). Most common online resources utilized for this purpose are websites run by doctors (61.3 %), the outpatient clinic's homepage (56.3 %), Google (40 %), Wikipedia (32.5 %), health advisory services provided by doctors (28.7 %), health portals (21.3 %) and health forums and communities (18.8 %). The information level in terms of the reason for consultation is rated as good by 50.6 %, as average by 46.7 % and as insufficient by 2.7 % (internet users: 42.7 %, 55.3 %, 1.9 %). Acute diseases of the children are estimated to be mild by 58.4 %, to be moderate by 41.1 % and to be severe by 0.5 % (internet users: 54.9 %, 45.1 %, 0 %). After having used any source of information, this assessment is unchanged in 82.8 %, acute diseases are rated as more severe in 13.8 % and as less severe in 3.4 % (internet users: 79.2 %, 16.7 %, 4.2 %). Internet users and non-users do not differ with respect to their information level (p = 0.178), the assessment of acute diseases (p = 0.691) and the change in this assessment (p = 0.999). A higher education level of parents (mothers: p = 0.025, fathers: p = 0.037), a young age of their children (p = 0.012) and acute diseases of their children (p = 0.046) predispose to IUC. CONCLUSIONS: Against the common perception that online health information might fuel panic-mongering, we could not determine a link between IUC and the assessment of acute diseases. The information level of internet users and non-users does not differ either. Further research is needed to clarify causes for high and low IUC.

Monitoring unfractionated heparin in children: a parallel-cohort randomized controlled trial comparing 2 dose protocols.

Monitoring unfractionated heparin (UFH) is crucial to prevent over- or under-anticoagulation. However, the optimal parameters for monitoring UFH in children are not well established. The study objectives were to investigate (1) the relationship between UFH dose and its anticoagulant effect as assessed by anti-Xa, activated partial thromboplastin time (aPTT) and activated clotting time (ACT); (2) other factors influencing UFH effect; (3) the agreement between the assays; and (4) the association between UFH effect and clinical outcome. HEARTCAT was a parallel-cohort randomized controlled trial comparing high-dose (100 U/kg bolus followed by age-based continuous infusion in randomized children) vs low-dose UFH (50 U/kg bolus) during cardiac catheterization in children. Blood samples were drawn before and after UFH administration at 30, 60, and 90 minutes. Four-hundred and two samples of 149 patients were evaluable. Anti-Xa, aPTT, and ACT all showed good discrimination between UFH doses. Regression models demonstrated the following determinants of UFH effect: UFH dose, age, baseline antithrombin (for anti-Xa), and baseline levels of aPTT and ACT, respectively. UFH effects were lower in infants compared with older children, which was more pronounced at low-dose than at high-dose UFH. Agreement between the 3 assays was poor. Most aPTT values were above therapeutic range or beyond measuring limit and thus of limited value for UFH monitoring. No association of UFH dose or effect with clinical outcome could be observed. In conclusion, all assays reflected a significant UFH dose-effect relationship, however, with poor agreement between the respective tests. The age-dependency of UFH effect was confirmed. Notably, the influence of age on UFH effect was dose-dependent.

Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study.

INTRODUCTION: Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. METHODS: This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. RESULTS: Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p < 0.01) display a higher tendency to use the internet for child health information purposes. Mothers and fathers (p = 0.151) as well as parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. DISCUSSION: Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level.

Detection of hypofibrinolysis in stable coronary artery disease using the overall haemostatic potential assay.

INTRODUCTION: Patients with stable coronary artery disease (CAD) are at risk of arterial thrombosis causing myocardial infarction. Detection of global haemostatic markers of hypercoagulability and hypofibrinolysis may be important for risk stratification and individualised treatment. We examined overall haemostatic potential (OHP) and thrombin generation in a group of stable CAD patients. We also sought to investigate associations between fibrinolytic inhibitors and abnormal global fibrinolysis in these patients. MATERIALS AND METHODS: Blood samples were collected from 56 patients defined by coronary anatomy as symptomatically stable CAD. Medications were recorded. Samples were analysed using the global coagulation assays OHP and thrombin generation (calibrated automated thrombogram, CAT), platelet aggregometry measured by Multiplate®, and levels of plasminogen activator inhibitor-1 (PAI-1) antigen measured by ELISA. Results were compared with a reference group of healthy controls. RESULTS: Stable CAD patients displayed increased fibrin and thrombin generation and impaired fibrinolysis (decreased overall fibrinolytic potential, OFP, and increased clot lysis time) compared with healthy controls. No effect of antiplatelet agents or other medications on these parameters was observed using platelet-poor plasma. After multivariate adjustment, OFP of healthy individuals was significantly associated with fibrinogen, but in CAD patients PAI-1 became an important determinant. CONCLUSIONS: Hypercoagulability of plasma is observed in stable CAD, with both increased thrombin generation and reduced fibrinolytic potential making a significant contribution. The OHP assay may provide a simple method of identifying hypercoagulability in individual patients.