Twitch potentia induced by two different modalities of neuromuscular electrical stimulation: implications for motor unit recruitment.

INTRODUCTION: We tested the hypothesis that twitch potentiation would be greater following conventional (CONV) neuromuscular electrical stimulation (50-µs pulse width and 25-Hz frequency) compared with wide-pulse high-frequency (WPHF) neuromuscular electrical stimulation (1-ms, 100-Hz) and voluntary (VOL) contractions, because of specificities in motor unit recruitment (random in CONV vs. random and orderly in WPHF vs. orderly in VOL). METHODS: A single twitch was evoked by means of tibial nerve stimulation before and 2 s after CONV, WPHF, and VOL conditioning contractions of the plantar flexors (intensity: 10% maximal voluntary contraction; duration: 10 s) in 13 young healthy subjects. RESULTS: Peak twitch increased (P<0.05) after CONV (+4.5±4.0%) and WPHF (+3.3±5.9%), with no difference between the 2 modalities, whereas no changes were observed after VOL (+0.8±2.6%). CONCLUSIONS: Our results demonstrate that presumed differences in motor unit recruitment between WPHF and CONV do not seem to influence twitch potentiation results.

The EPAGE internet guideline as a decision support tool for determining the appropriateness of colonoscopy

RÉSUMÉ Contexte : Peu d'études ont examiné la façon dont les médecins appréhendent les guidelines, et encore moins celle dont ils perçoivent de tels guidelines disponibles sur Internet. Cette étude évalue l'acceptation par les médecins d'un guideline électronique portant sur l'adéquation de la colonoscopie. Méthode : Des gastroentérologues participant à une étude observationnelle internationale ont consulté un guideline électronique pour une série consécutive de patients adressés pour une colonoscopie. Le guideline a été élaboré par le Panel Européen sur l'Adéquation de l'Endoscopie Gastro-intestinale (EPAGE en version anglaise), utilisant une méthode validée (RAND). Les opinions des médecins sur le guideline, sur le site Internet et sur les perspectives d'utilisation ont été recueillies au moyen de questionnaires. Résultats : 289 patients ont été inclus dans l'étude. Le temps moyen pour consulter le site Internet a été de 1.8 min et 86% des médecins l'ont considéré comme simple à utiliser. Les recommandations ont été facilement localisées pour 82% des patients et les médecins étaient d'accord avec l'adéquation de la colonoscopie dans 86% des cas. Selon les critères EPAGE, la colonoscopie était appropriée, incertaine et inappropriée, respectivement chez 59, 28 et 13% des patients. Conclusions : Le guideline EPAGE a été considéré comme acceptable et simple à utiliser. L'utilisation, l'utilité et la pertinence du site Internet a été jugée comme acceptable. Son utilisation effective dépendra cependant de la levée de certains obstacles au niveau organisationnel et culturel.

Male sexuality-related concerns: what use of the internet?

Purpose: Although young males encounter sexually-related concerns, they are mostly absent from specialized services. Our objective is to assess whether the internet is used by boys to find answers to these types of problems and questions. Methods: In the context of a qualitative study assessing young males' barriers to access sexual and reproductive health facilities, we conducted two focus groups gathering 12 boys aged 17-20. Discussions were triggered through the presentation of four vignettes corresponding to questions posted by 17-20 year old boys and girls on an information website for adolescents (www.ciao.ch), concerning various sexual dysfunction situations. In order to avoid having to talk about their own experience, participants were asked what they would do in those cases. Results: In general, the internet was mentioned quite thoroughly as a means of searching for information through research engines and a place to address professionals for advice.Within the hierarchy of consultation possibilities, the internet was given the first place as a way to deal with these types of problems presenting many advantages: (1) the internet enables to maintain intimacy; (2) it is anonymous (use of a pseudo); (3) it avoids having to confront someone face-to-face with personal problems which can be embarrassing and challenging for one's pride; (4) it is free; and (5) it is accessible at all times. In other words, participants value the internet as a positive tool to avoid many barriers which prevent offline consultations to take place. Most participants consider the internet at least as a first step in trying to solve a problem; for instance, by better defining the seriousness of a problem and judging if it is worth consulting a doctor. However, despite the positive qualities of the internet, they do put forward the importance of having specialists answering questions, trustworthiness, and being followed-up by the same person. Participants suggested that a strategy to break down barriers for boys to consult in face-to-face settings is to have a consultation on the internet as a first step which could then guide the person to an in-person consultation if necessary. Conclusions: The internet as a means of obtaining information or consulting received high marks overall. Although the internet cannot replace an in-person consultation, the screen and the keyboard have the advantage of not involving a face-to-face encounter and raise the possibility of discussing sexual problems anonymously and in private. The internet tools together with other new technologies should continue to develop in a secure manner as a space providing prevention messages and to become an easy access door to sexual and reproductive health services for young men, which can then guide youths to appropriate resource persons. Sources of support: This study was supported by the Maurice Chalumeau Foundation, Switzerland.

Discriminant validity and test-retest reliability of a self-administered Internet-based questionnaire testing doctors' knowledge in evidence-based medicine.

Aims and objectives  This study aimed to determine the discriminant validity and the test-retest reliability of a questionnaire testing the impact of evidence-based medicine (EBM) training on doctors' knowledge and skills. Methods  Questionnaires were sent electronically to all doctors working as residents and chief residents in two French speaking hospital networks in Switzerland. Participants completed the questionnaire twice, within a 4-week interval. The discriminant validity was examined in comparing doctors' performance according to their reported EBM previous training. Proportion of agreement between both sessions of the questionnaire, Cohen's kappa and 'uniform kappa' determined its test-retest reliability. Results  The participation rate was 9.8%/7.1% to first/second session. Performance increased according to the level of doctors' previous training in EBM. The observed proportion of agreement between both sessions was over 70% for 14/19 questions, and the 'uniform kappa' was superior to 0.60 for 15/19 questions. Conclusion  The discriminant validity and test-retest reliability of the questionnaire were satisfying. The low participation rate did not prevent the study from achieving its aims.

Les adolescents, Internet et les nouvelles technologies: un nouveau pays des merveilles ? [Adolescents, Internet and new technologies: a new wonderland?]

Cet article passe en revue les côtés positifs et les risques liés à l'utilisation des nouvelles technologies. Parmi les aspects positifs, figurent l'accès rapide à des informations à caractère éducatif, la possibilité d'échanges à caractère social ou intellectuel, et l'ouverture à des renseignements dans le domaine de la santé, des drogues ou de la sexualité. Les menaces sont liées à l'inexpérience et à la difficulté à juger de la validité des informations, ou du risque que les jeunes prennent en diffusant des informations sur le web. La dépendance à internet et le risque de violence sont probablement surestimés. Un monitorage ouvert et interactif de la part des parents constitue une bonne prévention. L'investigation du rapport que chaque jeune patient entretient avec ces outils fait partie intégrante de tout bilan de santé. [Abstract] This reviews the use of new technologies with its benefits and pitfalls. Among the positive aspects are instant access to educational information, the possibility to connect with mates and to develop social exchanges, as well as an access to preventive contents in the field of health, substances or sexuality. The risks are linked with inexperience and the adolescent's inability to assess the validity of information collected on Internet, as well as a lack of insights of the consequences of launching information or images on the web. The menace of addiction or of violence induced by intemet is probably overestimated by many adults but should be taken into account. Parents should monitor their adolescents' activity in an open and interactive way. Moreover, any adolescent medical check-up should touch on the use of new technologies.

Implementation and evaluation of an internet health site for adolescents in Switzerland.

Ciao is a website specifically designed for young people and focuses mainly on health issues. This report presents the process of setting up the site and a first evaluation undertaken by using two self-administered questionnaires administered via the website itself. It suggests that it is possible to provide young people with authoritative health information and to facilitate their access to counseling and health care facilities by having young people use such a website.

A U-shaped association between intensity of Internet use and adolescent health.

OBJECTIVE: To examine the relationship between different Internet-use intensities and adolescent mental and somatic health. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of adolescents aged 16 to 20 years in post-mandatory school. From a self-administered anonymous questionnaire, 3906 adolescent boys and 3305 girls were categorized into 4 groups according to their intensity of Internet use: heavy Internet users (HIUs; >2 hours/day), regular Internet users (RIUs; several days per week and <= 2 hours/day), occasional users (<= 1 hour/week), and non-Internet users (NIUs; no use in the previous month). Health factors examined were perceived health, depression, overweight, headaches and back pain, and insufficient sleep. RESULTS: In controlled multivariate analysis, using RIUs as a reference, HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep. Male NIUs and female NIUs and occasional users also were found at increased risk of higher depressive scores. Back-pain complaints were found predominantly among male NIUs. CONCLUSIONS: Our study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. In addition, HIUs were confirmed at increased risk for somatic health problems. Thus, health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Also, they should consider regular Internet use as a normative behavior without major health consequence. Pediatrics 2011;127:e330-e335