The goal was to evaluate the content, quality, and readability of the information available about clear aligner treatment on the Internet. The search terms “aligner,” “clear aligner,” and “Invisalign” (Align Technology, Tempe, AZ, USA) were analyzed in three search engines (Google [Google LLC, Mountain View, CA, USA], Bing [Microsoft, Redmond, WA, USA], and Yahoo [Yahoo, Sunnyvale, CA, USA]). The first 50 websites for each keyword in each search engine were screened. Duplicate websites, advertisements, links to scientific articles, videos, and other irrelevant websites were excluded. The quality of the remaining websites was analyzed using the DISCERN and Journal of American Medical Association (JAMA) benchmark instruments together with the Health on the Net code (HONcode, Health On the Net Foundation, Geneva, Switzerland). The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Statistical analyses were performed by one-way analysis of variance, Kruskal–Wallis and Fischer’s exact tests, with p   0.05). Overall, the quality of web-based information about clear aligners was poor and the readability of the data was insufficient. Websites presenting high-quality data with better readability are needed for potential aligner patients.

/pdf/information-on-the-internet-about-clear-aligner-treatment-an-2oirjbofpz.pdf

Information on the Internet about clear aligner treatment-an assessment of content, quality, and readability

To the Editor: The cohort study of cardiovascular outcomes and antihypertensive drug treatment by Dr Wassertheil-Smoller and colleagues used data from the Women’s Health Initiative Observational Study. We have a number of concerns that we believe limit drawing conclusions from this study. First, relative to the study sample size, the number of incident events was small and therefore the study may not have had adequate power to detect the end points in each subgroup (Tables 4 and 5 in the original article). For example, among women receiving a calcium channel blocker (CCB) plus an angiotensin-converting enzyme (ACE) inhibitor, only 8 cardiovascular deaths were reported. The P values for the overall comparison of therapies only reached borderline statistical significance for cardiovascular mortality, the outcome with the lowest annualized rates. Second, the confidence intervals reported for the hazard ratios in Tables 5 and 7 in the original article have not been adjusted for multiple comparisons, increasing the likelihood of a chance finding. Finally, the authors report the participants’ use of antihypertensive medications at baseline and in year 3 of follow-up, but did not account for changes in antihypertensive medications that likely occurred over time.

Bruce Psaty

Papers

Cardiovascular Outcomes and Antihypertensive Drug Treatment in Older Women—Reply