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Researchers Use Twitter To Track Diseases And Public Health Issues

A researcher has used social media to track attitudes about vaccination and how they correlate with vaccination rates, in the process creating a novel model to track a variety of disease states.

The study adds to a growing body of evidence that social networking can be used to track diseases and other natural disasters that affect public health. Earlier this year, researchers used Twitter to track rapidly-evolving public sentiment about H1N1 influenza, and found that tweets correlated with actual disease activity. Before that, researchers analyzed how Twitter was used to disseminate information (and misinformation) about flu trends.

In the latest study, published at PLoS Computational Biology, a biology professor at Penn State University compiled 477,768 tweets with vaccination-related phrases from August 2009, when news of a new H1N1 vaccine first was made public, and continued through January 2010.

According to a press release, students rated a sample of about 10% of tweets as positive, negative, neutral or irrelevant. The human-rated tweets were used to program a computer algorithm to analyze the remaining 90% of tweets, leaving 318,379 tweets expressing either positive, negative or neutral sentiments about the H1N1 vaccine. (Tweets found to have nothing to do with H1N1, such as messages about another vaccine entirely, were discarded.)

Of the remaining messages, 255,828 were classified as neutral, 26,667 as negative, and 35,884 as positive. Starting from late August 2009, there was a steady increase in the number of relevant tweets until early November 2009, after which the number dropped back to previous levels.

Negative expressions spiked during the time period when the vaccine was first announced. Later, more-positive sentiments emerged when the vaccine was first shipped across the United States. The researcher also tracked spikes of negative tweets that corresponded to periods of vaccine recall.

Also, the researcher modeled how social media users with either negative or positive sentiments about the H1N1 vaccine followed like-minded people. The public-health message is that if anti-vaccination communities online translate to real-world geographic pockets, it creates a greater risk of local outbreaks.

“By definition, herd immunity only works if unvaccinated, unprotected individuals are distributed sparsely throughout the population, buffered from the disease by vaccinated individuals,” the researcher said. “Unfortunately, the data from Twitter seem to indicate that the buffer of protection cannot be counted on if these clusters exist in real, geographical space.”

Because Twitter users often include a location in their profiles, the researcher could correlate tweets with Centers for Disease Control and Prevention data to determine how vaccination attitudes correlated with estimated vaccination rates. The highest positive-sentiment users were from New England, which had the highest H1N1 vaccination rate.

The method could be used to guide public-health initiatives, the researcher said. Targeted campaigns could be designed according to which region needs more prevention education, as well as predict how many doses of a vaccine will be required in a particular area.

The researcher plans to use his unique social-media analysis to study other diseases, such as obesity, hypertension, and heart disease. It’s already known that obese people are more likely to be associated with one another in real life.

John Snow would have been proud. Recall that he was the first epidemiologist, who in 1854 traced cholera in London back to a single source, a water pump used by the populace. He hypothesized that a single pump was responsible for more than 500 deaths by drawing a map that compared the locations of cholera deaths and the locations of water pumps throughout the city (perhaps making him the first user of Foursquare. Snow had to talk to people directly to gather his data, and would have been amazed at how advances in communication are helping modern scientists track disease.

*This blog post was originally published at ACP Internist*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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