SIM Quarterly [In brief, ISSUE 2]

Researching primary care physicians on the Internet: 1997 was published by Isis Research in April 1997. Taking the form of a telephone survey, the study was designed to evaluate the potential of the Internet as a method for conducting market surveys upon doctors. The study population consisted of 100 'nationally representative' primary care physicians in France, Germany, Italy, Spain, the UK, and the USA.

The writers suggest that if it can be established that doctors using the Internet are not significantly different from those who are not, then market research using e-mail contacts could be considered representative in the US, where 48% of primary care physicians have ever personally used the Internet (nearly half, versus 5-8% in the European countries). Further studies are planned in order to evaluate whether using the Internet to conduct surveys is likely to introduce bias.

The survey also found that most American physicians usually access the Internet from home (72% versus 34% accessing it from work), and 77% of this home use is at least partly medically-related (MEDLINE being the most popular site). No detailed analysis of usage patterns in Europe is supplied owing to an inadequate sample population size; even the population of US users is only 46 persons.

The small sample sizes, and the lack of methodological details or mention of response rates make it difficult to draw valid conclusions. Two versions of the questionnaire were also used - one in the US, and another in Europe - but the results from both were combined for analysis. Much of the data must be regarded as anecdotal. The writers have attempted to extrapolate Internet usage rates in the sample population to national populations of doctors, although the minimum and maximum estimates vary widely e.g. there may be anywhere between 1 390 to 5 780 of the UK's 37 000 general practitioners on the Internet.

The report is available for Ł395 from Isis Research UK Ltd., The Boathouse, Putney, London SW15 1HL.

Bruce McKenzie MB, ChB
GP Registrar
Chesterfield, UK

Healthcare information on Internet accessible via public kiosks in Brazil

Source: Jornal de Ciencia (JC E-Mail) [Science Daily], Rio de Janeiro, 31 July 1997 [in Portuguese].

Ruth Cardoso, Brazil's First Lady, inaugurated kiosks for public access to the Internet in Rio de Janeiro on August 1 1997. A telephone card provides access to all sorts of information of interest to the public, such as the caller's identity documents, employment cards, passports, education, employment, citizens' rights - and health services.

A prototype of the equipment, developed by the Research and Development Centre of Telebras (the Brazilian telecommunications company) was presented. It is expected that the kiosks will be installed in covered areas such as shopping malls and banks.

The first screen gives access to the Web site of the 'Citizens' Agency', which will index a database managed by Comunidade Solidaria. Use of the kiosk is free or charged, according to the type of service requested.

Jack Woodall PhD
Director, ProMED-mail
New York, USA

Official reaction to disease reporting on the Internet

On 17 June 1997 the media, quoting 'diplomatic sources', reported on the Internet that there was an outbreak of dengue fever in Santiago de Cuba (eastern Cuba), with possibly 'thousands' of cases - but that official sources denied it.

That same day CubaPress, an independent Cuban news service, quoted Dr Dessy Mendoza (President of the Independent Medical College of Santiago de Cuba) on its Web site, as saying that 10 000 people in the area had already suffered from the dengue outbreak, and 30 had died, including a child aged 7 years.

On 18 June the World Health Organization posted a notice on its e-mail bulletin and on its disease outbreaks Web site saying that Cuba had officially reported an outbreak of dengue fever in that locality, with 826 cases and 3 deaths. No report was placed on the Cuban Government Web site. This is the first report of dengue in Cuba since an island-wide epidemic in 1981, when 350 000 cases and 158 deaths occurred.

In later editions, CubaPress reported that Dr Mendoza had been arrested, supposedly for unauthorised reporting of the extent of the epidemic, that his house had been searched and papers removed, and that he was being detained and charged with unlawful association and meeting, and 'enemy propaganda'. He was still under detention weeks later.

In another Latin American country two years earlier, the official reaction to reporting an epidemic had a different outcome. In September 1995 the Director General of Health for Venezuela sent out a message in Spanish on the Internet which read as follows (translated):

Concerning the information on Venezuelan equine encephalitis, the level of misinformation and alarm on the Internet is worrisome. We wish to advise that the epidemic focus is in 4 municipalities of Zulia state and that there is a cordon sanitaire which includes mass vaccination of horses and air spraying. In addition, adequate medical aid is guaranteed to those affected. By this same means detailed information on the number of cases by locality and measures for epidemic control will be provided.

However, it soon transpired that the concern expressed on the Internet had been well-founded, that the outbreak was much larger and was not being adequately combatted, and the Director General was relieved of his duties.

Jack Woodall PhD
Director, ProMED-mail
New York, USA

Disease prevention mediated by Internet

In SIM Quarterly Issue 1 there is a special report on the ProMED-mail list, which reports outbreaks of emerging diseases worldwide.

That paper tells the story of a Swiss tourist who did not get a yellow fever immunization before visiting the Amazon, and paid for that mistake with his life. There is a sequel to the story. The report of the case on ProMED-mail was seen by subscribers at the Pan American Health Organization, who advised their office in Brazil that if a yellow fever-infected tourist had passed through Manaus, it was likely that infected Brazilians were also going there and, as the city was known to harbour the yellow fever mosquito, a public health hazard existed. In fact a second case occurred in August in an unvaccinated American tourist who visited the same jungle area, fell ill, and returned home via Manaus to die. The health authorities in Manaus responded by vaccinating the entire city, thus avoiding a possible epidemic.

Since that paper was written, ProMED-mail has been involved in another public health intervention. In early 1997 an epidemic of Lassa fever was reported from Sierra Leone. In May, as a result of the deteriorating situation there, troops from the USA and other countries were sent out to protect the lives of their nationals. Lassa fever is a serious viral hemorrhagic disease with a high mortality rate for which there is no vaccine, and the only effective treatment is the antiviral drug ribavirin, which is in short supply in the West. Another ProMED-mail moderator had been following the reports of the Lassa outbreak on the list and became concerned about the lack of ribavirin. He e-mailed many people and eventually found Dr David Duffy of the University of Alaska, who sent a message to the commanding officer of the carrier group en route to Freetown to evacuate U.S. citizens. As a result, a supply of ribavirin was obtained in time to treat any military or civilian personnel who might have contracted Lassa fever while in the country. Fortunately, no cases occurred.

Jack Woodall PhD
Director, ProMED-mail
New York, USA

Society for the Internet in Medicine

Comments to: simq@cybertas.demon.co.uk

Copyright Š 1997 Society for the Internet in Medicine. All rights reserved.
Date: September 21, 1997
Document URL: http://www.cybertas.demon.co.uk/simq/issue2/brief.html