Delivering healthcare information via the internet: cardiac patients' access, usage, perceptions of usefulness, and web site content preferences.

OBJECTIVES: To assess patients' usage of the Internet as a source of personal healthcare information and patients' perceptions of usefulness and content preferences of more locally focused online health-related material. MATERIALS AND METHODS: A paper-based survey was undertaken by a convenience sample of cardiac outpatients. Age, gender, Internet access, Internet usage, perception of usefulness of online information, predicted intention to use a local cardiology Web site if available, and preferred components to be included were recorded. Univariate and bivariate statistics were used. RESULTS: Two hundred thirty-seven patients responded (62.1% males). One hundred seventy-six (74.3%) used the Internet, with 126 (63%) using it daily. For patients who did not have direct access to the Internet, 26 (50%) had a family member to do this on their behalf. Thus, the majority of patients (202 [85%]) had access to the Internet at home or someone who could access it on their behalf. Internet usage declined with age (Kendall's tau_b=0.321, p<0.001). There was no difference in use with gender (p=0.235). There was considerable interest expressed in a locally delivered Web-based information service. CONCLUSIONS: Online healthcare information services have the potential to reach the vast majority of cardiac patients either directly or through family support. The most elderly patients are less likely to use these services. Despite apparent satisfaction with existing online resources, there appears to be an unmet need for more information and considerable support for a locally based cardiac patient Web resource to deliver this. These findings may help guide future patient information Web site redesign.

Maternal smoking during pregnancy specifically reduces human fetal desert hedgehog gene expression during testis development.

CONTEXT: Maternal cigarette smoking during gestation increases cryptorchidism and hypospadias and reduces testis size and fertility in sons by unknown mechanisms. OBJECTIVE: The objective of the study was to determine whether maternal smoking is linked with changes in male human fetal endocrinology, testis gene expression, and liver concentrations of cigarette smoke chemicals. DESIGN: This was an observational study of the male fetus, comparing pregnancies during which the mothers either did or did not smoke. SETTING: The study was conducted at the universities of Aberdeen, Glasgow, and Nottingham and Macaulay Institute (Aberdeen). PATIENTS/PARTICIPANTS: Testes, blood, and livers were collected from 69 morphologically normal human male fetuses of women undergoing elective termination of normal second-trimester pregnancies. MAIN OUTCOME MEASURES: Testosterone, human chorionic gonadotropin, LH, and cotinine; expression of 30 reproductive/developmental genes; liver concentrations of 16 polycyclic aromatic hydrocarbons; and Leydig, Sertoli. and germ cell numbers were determined. RESULTS: There were no significant differences in fetal size, testis weight, cell numbers, seminiferous tubule diameter, or circulating LH and testosterone. Fetuses from smoking mothers had smoking range cotinine levels and liver concentrations of polycyclic aromatic hydrocarbons that were significant predictors of maternal smoking (P < 0.001). Only the Sertoli cell-specific gene, desert hedgehog (DHH), was significantly altered by maternal smoking (reduced 1.8-fold, P = 0.013). CONCLUSIONS: The consequences of reduced DHH signaling in men and mice are consistent with epidemiology for effects of gestational maternal smoking on sons. Given the absence of other observed effects of maternal smoking, we concluded that reduced DHH is part of a mechanism linking maternal gestational smoking with impaired reproductive development in male offspring.