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Another factor that has hindered information update was presence of dated information, especially the information about topical ipatropium bromide, which is no longer available in Brazil by the pharmaceutical industry for nasal use, even though it may still be prepared.
Such incorrect data may lead physicians to making incorrect prescriptions to their patients, which can generate questions and uncertainties Table 3. Many sites did not clearly state who the author of the information was.
This fact prevents the user from directly contacting the author to clarify doubts, give suggestions or even point out any misinformation found. In some sites, there was incorrect information published Table 3.
Some mistakes found are, for example, "The cure of allergy lies in environmental control and anti-allergic vaccines" allergic rhinitis may only be controlled and not cured ; "allergens - substances capable of triggering an allergic reaction - such as strong perfumes, cigarette smoke" perfumes and cigarette smoke are irritants and not allergens ; "ozone is a toxic gas responsible for most of the allergic rhinitis episodes" ozone is not an allergen triggering allergic rhinitis ; or "allergic rhinitis, also known as hay fever" only seasonal allergic rhinitis is known as hay fever.
Such mistakes may lead to questioning the credibility of the information and may make people confused. Moreover, the patient that uses the internet to better learn about the disease may disagree with the physician when is based on imprecise information provided by the web Table 3. We could find expressions such as "decongestants, that alleviate nasal congestion.
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These drugs should be used under medical prescription in people with arterial blood hypertension". Such piece of information encourages self-medication in people that access these web sites, especially patients with normal blood pressure, in this case Table 3. Moreover, the communication of treatments not approved by the Medical Federal Council, such as acupuncture, phytotherapy, orthomolecular kits, make the patients search for treatments that are not necessarily effective and may bring financial loss or health complications Table 3.
In a research study with 22 Brazilian sites that addressed the topic of allergic rhinitis, Balbani et al. Thus, one can assume that if more sites are assessed, we may find even further imprecise information. The imprecision of information about health topics in the Internet does not seem to be restricted to the topic of allergic rhinitis and Brazilian sites.
Among the most common inappropriate findings we can include mistakes of definition, such as that allergens are confused with irritating factors. Moreover, some sites presented many grammar mistakes, such as misspelled rhinitis, plus grammar mistakes there was one page with nearly 16 mistakes.
Such mistakes show lack of attention when providing information through the internet and may lead to users questioning the cultural level of the person responsible for the information and the site.
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Privacy was compliant with the expected rules in only In all the other sites that required information from users, there was no clarity concerning storage and safety mechanisms to prevent inappropriate use of data and users were not aware whether they had access to the file where their personal data were stored to cancel or modify the records. Thus, the user would be unsure whether to provide data or not, such as address and taxpayers' number, or they could provide information to be misused by the website.
In addition, the user did not know how to cancel or modify the information, which could be used even against their will. Another item that had many variations among the studied websites was lack of free informed consent. One of the most common findings was registration of users without explaining why.
Upon registering a user, the sites required information such as zip code, address and taxpayers' numbers and did not explain how they would use them, and they could have been used for sending mail without the users' consent or with other purposes that could harm the user who had provided the data.
Another non-compliance was the request of personal information address, taxpayers' number, etc from the users to get answers to questions or suggestions. Honesty was also non-compliant in some sites. Ads of offices or communication of some types of treatment approaches provided in informative texts to the public may lead users to search for the services, without unbiased information for them to come to their own conclusions. In some sites of the pharmaceutical industry, information is provided only about the active principles manufactured by them and not about the drug classsuch as for example desloratadine and not anti-histaminicproviding only a partial and incomplete view to users, especially lay people who do not have access to information about other types of treatments that could be used to fight against allergic rhinitis.
In some pages, we found inappropriate information about the person responsible for the site. When accessing any of the 15 sites that do not identify the person responsible for the information, the users may doubt the veracity of the information and if there are questions or suggestion, they will not know to whom send them some sites offer a contact form, but we do not know who the responsible party is. In some analyzed sites, there were no tools to facilitate the contact with the user, and in some cases it may prevent them from asking questions because the process is very complicated.
We also found compliance concerning transparency of information. These elements include lack of clarity about the purpose of the sites - if they were educational or if they had commercial purposes. Thus, the users cannot know which are the factors that could interfere in the communicated information, to judge the partiality of information conveyed in the web site with commercial purposes directed to sales of products or services.
Other items that hindered the transparency of sites was no presentation of the name of the responsible person, direct or indirect sponsor or supporter of the web sites, which has also hindered the assessment of partial information, which could be influenced according to the sponsorship or person responsible for maintaining or supporting the site.
Among the analyzed Brazilian sites that contained information on allergic rhinitis, most of them were not in compliance with the Manual of Ethical Principles for Medical and Healthcare Sites.
Among the sites that were not in compliance, most of them are directed to lay people and to physicians and healthcare professionals, such as most of the web sites under the societies recognized by AMB, health clinics, hospitals, pharmaceutical companies, and other private medical and non-medical companies and non-profitable institutions and non-identified domains.
It shows that the problems concerning transparency, honesty, quality of information, free informed consent, privacy, medical ethics, responsibility and origin, is not restricted to a specific type of site or a specific type of target audience.
Upon observing such results concerning quality of web sites that provide information about allergic rhinitis, we got concerned about the fact that users may be exposed to incorrect information and take measures based on the information they read, leading to financial losses and health damage.
In addition, we may assume that such problems are not restricted to sites that address allergic rhinitis, but rather to other sites that address health-related topics, such as hypertension, diabetes, asthma, etc.
In view of these problems, we should take measures to control them. Some measurements that could be taken would be the formation of medical and specialist groups in the internet to assess web sites that have health content.
One possible setback is the large number of web sites available on the Brazilian Internet and the constant flow of information available in the web. Another measurement that could be applied would be the creation of portals dedicated exclusively to health issues of interest to the lay people, with previously assessed information to be found by search mechanisms.
These portals could be organized by the Ministry or Secretary of Health, Medical Council or specialty societies, to ensure quality of web sites and information.
We could create web sites with information not only about the lay people, but also about how health care professionals could have access to reliable information about the studied topic, including bibliographical references.
A model of site is rhinitisinfo. The main non-compliances were in decreasing order: It is mandatory that we take measurements to improve the situation, which could be made by the Secretary of Health, medical societies and other entities. A Brief History of the Internet, version 3.
Acessado em 22 de novembro de Acessado em 11 de dezembro de Acessado em 20 de abril de Tratado de Otorrinolaringologia, Sociedade Brasileira de Otorrinolaringologia ; 3: Advice available on the Internet for people with coeliac disease: