The quality of pediatric orthopaedic information on the internet.

BACKGROUND: Many patients use the Internet for health information. However, there are few guarantees to the reliability and accuracy of this information. This study examined the quality and content of the Internet Web pages for 10 common pediatric orthopaedic diagnoses. METHODS: We identified 10 common diagnoses in pediatric orthopaedics: brachial plexus injury, cerebral palsy, clubfoot, developmental dysplasia of the hip, leg length discrepancy, osteochondroma, polydactyly, scoliosis, spina bifida, and syndactyly. We used 2 of the most popular search engines to identify the top 10 Web sites for each disease. We evaluated the Web sites utilizing both the quality-based Health On the Net (HON) Foundation criteria and our own content-based grading sheets. The custom grading sheets focused on essential information about disease summary, pathogenesis, diagnosis, treatment, and prognosis. RESULTS: Three orthopaedic surgeons graded 98 academic, commercial, nonprofit, and physicians' Web sites for 10 diseases. Academic Web sites scored the highest in content (mean, 60.8% ± 15.5%), whereas commercial Web sites scored the lowest (mean, 46.7% ± 22.2%). Among the diagnoses, osteochondroma Web sites had the highest content scores (mean, 75.8% ± 11.8%), whereas polydactyly Web sites had the lowest content scores (mean, 39.3% ± 15.7%). In contrast, Web sites about developmental dysplasia of the hip had the highest HON scores (65.0 ± 11.1), whereas those about brachial plexus birth palsy scored the lowest (42.6% ± 16.9%). Among the content subgroups, scores were generally higher for disease summary and diagnostics and lower for prognosis. CONCLUSIONS: The Internet Web sites reviewed demonstrated a wide range of content and information. We found that nonprofit and academic Web sites were the most reliable sources, whereas commercial and, surprisingly, physician-run Web sites were the least reliable. We advise physicians to talk to their patients about the information they get on the Internet and how it dictates their expectations. We hope this study, combined with further understanding of how our patients use this information, can help improve the Internet content. CLINICAL RELEVANCE: Physicians should know that their patients may be receiving misleading information from the Internet and be able to discuss this with their patients.

Peroxisome proliferator-activated receptor agonists inhibit inflammatory edema and hyperalgesia.

Previous studies have produced conflicting data on the contribution of the peroxisome proliferator-activated receptors (PPARs) to the inflammatory process. This study investigated the effects of several PPARalpha and PPARgamma subtype-specific agonists on the inflammation and hyperalgesia produced by intraplantar carrageenan injection in unanesthetized male Sprague-Dawley rats. Intraperitoneal administration of PPARalpha agonists reduced edema in parallel to their potencies determined in vitro. Perfluorooctanoic acid (PFOA) inhibited carrageenan-induced edema in a dose-dependent manner, and also reduced thermal hypersensitivity. Furthermore, PFOA produced much more robust effects when administered 0.5-24 hrs before carrageenan, as compared to when it was administered 1.5 hrs after carrageenan. Intraperitoneal administration of similar doses of the PPARgamma agonist rosiglitazone, but not the less potent agonist, troglitazone, reduced edema when administered before but not after carrageenan. We conclude that systemic administration of potent PPARalpha and PPARgamma agonists exert anti-hyperalgesic and/or antiinflammatory actions in vivo, possibly by interfering with the initiation of inflammation.