Other questions concerned the window period The use of this service shows in our experience a growth pattern typical of demand niches which are not covered by other types of services [ 17 ]. The mean age and predominance of the male sex is in accordance with other studies made in different countries [ 18 ]. The year difference in median age between Spanish and Latin American users is surprising. As our method did not allow for registering this variable in a consistent way, it could be that only younger users felt it important to specify their age. This could be explained by a high number of doubts arising from young people after some sort of risky sexual relationship.
For a Spain-based Web site, the high number of users from Latin America is surprising and reflects the enormous reach of the Internet. The reason is probably multiple: information is more limited and access to social and health services is more restricted in Latin America than in Europe.
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Also, looking at the few questions originating in other European countries, the sharing of a common language Spanish in this case is another reason for the high usage in Latin America. Messages supporting the Web site were attached to questions, reflecting the constant growth of the site. Many of the messages were critical of the absence of similar initiatives or they praised different aspects our Web site, such as its seriousness, free access, quality, or the scientific content of the answers.
Most of the questions were directly related to HIV infection, with hepatitis clearly behind in interest.
The high media exposure of AIDS compared with hepatitis is probably the main reason for this imbalance. Also, higher levels of information about hepatitis or the wrong impression that it is less serious than HIV could be behind these differences. The gap in the number of questions for the two diseases is more marked in Latin America where AIDS was clearly the main concern. The highest numbers of queries are sent just after the weekend, a fact most probably related with an increase in risky sexual practices during the weekend.
The types of questions received suggest a low information level about AIDS among our users. A considerable number of graphics and special documents were available on our Web site, illustrating and discussing many aspects present in the written questions. However, it seems that users prefer the question—answer model rather than ready-made information. It could be that a different profile exists for users on the Web who are not asking for direct advice. This latter group would have a higher level of education and be more knowledgeable about the disease and thus more capable of searching for and finding information directly.
Concerning hepatitis, in most of the cases it was the patient who was consulting about the risk of infecting household contacts. Most of the questions about hepatitis came from Spain, a fact that can be attributed to a lower level of awareness of this disease in Latin America. Compared with AIDS, we registered a higher percentage of questions about healthy living, treatment efficacy, and toxic effects for the different types of hepatitis.
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The level of information was higher than for HIV infection, especially in the questions coming from Latin America. A considerable number of repeated questions were follow-ups of previous e-mail by the same sender. The mean time elapsed between question reception and answer posting was generally fewer than seven days, but it seems that this delay was considered excessive by some of our users.
The Internet is perceived by users as a speedy, almost instantaneous means of communication, and an effort should be made to shorten these time lapses when interacting with them [ 5 , 6 ]. We opted for e-mailing personal replies to these people to avoid a reiterative section. Our e-mailed replies contained different types of standardised text as well as links to pertinent previous answers posted in the section.
The main limitation of our study is the absence of some important information such as educational level or socioeconomic status to better describe our users. Basic data such as age and country of origin was missing in some of the queries. We consciously decided not to use a proper questionnaire, in favour of confidentiality, easy access, and swift communication of standard e-mail.
Although improbable, the profile of our users could be somewhat different from the one we describe. Also absent from our study are other important data such as expectations of the users, how the information given was used, and how the community as a whole might be using the information on the Web site. All this data was unfortunately out of our initial scope and should be obtained by specific questionnaires different from the simple circuit of e-mail and posting of answers that we used.
Looking at our results, it seems obvious that there is a great demand for this type of consultation service in the general population. In our opinion, factors such as anonymity, no fee charged, and immediacy of the answers are important keys for success. Perhaps one of the most interesting results of our study is that a general media information site, such as a newspaper on the Internet, turns out to be a good vehicle for delivering health information and advice.
The media site delivered high Internet traffic, with a mean of four million accesses and , single users per month. Sponsorship by the pharmaceutical industry can be a good working model if standards for independence are strictly followed. Users are sensitive to conflicts of interest in the healthcare industry. The Internet seems to be a practical source for a second opinion: it reduces cost, there is no waiting list, and the quality of the answer is guaranteed by a certified expert in the field [ 19 ] chosen by a well-known sponsor, such as the newspaper in this case.
This experiment with two infectious entities, AIDS and hepatitis, both having an important impact on public health, revealed the Internet as an especially useful tool for disease awareness and prevention as well as for health education of patients and the public. Finally, this particular type of Internet health service offers the possibility of easy identification of patient needs and concerns in the general population. This knowledge can be important to health planners wanting to improve health policies and interventions.
Its placement as a specialised site inside a health section that is part of a general information and news Web site appears to be a good model for this type of service, offering great accessibility to and exposure of the information. In view of its high demand and the increasing number of supportive messages received, our experience has been tremendously satisfactory. After two years, the Web site is well-established and its traffic continues to grow. Future investigations should employ a simple Web-based anonymous questionnaire including some questions about how the information given is used.
This data will give a more comprehensive description of users and could be a very useful tool for tailoring content to their needs. Author contributions. RB and JEL designed the study. RB and JEL analyzed the data. JEL enrolled patients. MS helped to maintain a swift communication between the Web users and the medical expert. PLoS Med 3 7 : e DOI: Funding: The authors received no specific funding for this study. National Center for Biotechnology Information , U. PLoS Med. Published online Jul 4. Tom Ferguson, Academic Editor. Author information Article notes Copyright and License information Disclaimer.
E-mail: se. Received Aug 16; Accepted Mar This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. This article has been cited by other articles in PMC. Abstract Background Advice from a medical expert on concerns and queries expressed anonymously through the Internet by patients and later posted on the Web, offers a new type of patient—doctor relationship.
Editors' Summary Background.
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Why Was This Study Done? What Did the Researchers Do and Find? What Do These Findings Mean? Additional Information. Introduction AIDS can be considered the first media disease. Aim of the Study The aim of this study was to perform a descriptive analysis of questions about AIDS and hepatitis made to an infectious disease expert sent through the Internet to a consumer-oriented website in the Spanish language.
Open in a separate window. Figure 1. Figure 2. Figure 3. Example of an Answered Question on the Web Translation of Question and Answer: Question on oral sex and the risk of infection: Dear Doctor Losa, although there are numerous questions addressing the risk of AIDS transmission through oral sex, I have not been able to find any referring to this risk when oral sex is given by a man to a woman. Answer to the female questioner: The risk for either receptive or active oral sex is very similar in men and women. Results A total of questions were received from December until November with a marked linear growth pattern Figure 1.
Figure 4. Table 2 Types of Questions. Acknowledgments Author contributions. Hepatitis C virus and human immunodeficiency virus coinfection in Spain. J Infect.
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What is e-health? J Med Internet Res. Email consultations in health care: 2—Acceptability and safe application. Email consultations in health care: 1—Scope and effectiveness. The first generation of e-patients. Health information on the Internet: Patient empowerment or patient deceit? Indian J Med Sci. Using Internet survey among cancer patients. Patient experiences and attitudes about access to a patient electronic healthcare record and linked Web messaging. J Am Med Inform Assoc. Trust and sources of health information: The impact of the Internet and its implications for health care providers: Findings from the first Health Information National Trends Survey.
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Hepatitis C information on the World Wide Web. Clin Infect Dis. Health Psychol. Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor service. Patient Educ Couns. About this product Product Information In this first book to bring both establishment and dissenting views of the AIDS crisis into one volume, Gary Null unravels the halftruths that many argue have marred the study of this disease from the start.
In clear, jargon-free prose, the book offers an unbiased, unflinching discussion of all sides of each issue. Null explores a new type of health care, grounded in patients' own choices and dispositions, that poses a challenge to the top-down, expert-controlled medical systems favored by the establishment. Drawing from Null's many years of study of alternative, traditional, and orthodox medicine as well as from interviews with many long-term survivors, the book dissects the claims of the AZT and drug-cocktail approach to treating AIDS and offers a trilogy of treatment strategies based on wide views of how to enhance the immune system and improve overall functioning.
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