Social Media and Internet‐Based Data in Global Systems for Public Health Surveillance: A Systematic Review

Context: The exchange of health information on the Internet has been heralded as an opportunity to improve public health surveillance. In a field that has traditionally relied on an established system of mandatory and voluntary reporting of known infectious diseases by doctors and laboratories to governmental agencies, innovations in social media and so-called user-generated information could lead to faster recognition of cases of infectious disease. More direct access to such data could enable surveillance epidemiologists to detect potential public health threats such as rare, new diseases or early-level warnings for epidemics. But how useful are data from social media and the Internet, and what is the potential to enhance surveillance? The challenges of using these emerging surveillance systems for infectious disease epidemiology, including the specific resources needed, technical requirements, and acceptability to public health practitioners and policymakers, have wide-reaching implications for public health surveillance in the 21st century.Methods: This article divides public health surveillance into indicator-based surveillance and event-based surveillance and provides an overview of each. We did an exhaustive review of published articles indexed in the databases PubMed, Scopus, and Scirus between 1990 and 2011 covering contemporary event-based systems for infectious disease surveillance.Findings: Our literature review uncovered no event-based surveillance systems currently used in national surveillance programs. While much has been done to develop event-based surveillance, the existing systems have limitations. Accordingly, there is a need for further development of automated technologies that monitor health-related information on the Internet, especially to handle large amounts of data and to prevent information overload. The dissemination to health authorities of new information about health events is not always efficient and could be improved. No comprehensive evaluations show whether event-based surveillance systems have been integrated into actual epidemiological work during real-time health events.Conclusions: The acceptability of data from the Internet and social media as a regular part of public health surveillance programs varies and is related to a circular challenge: the willingness to integrate is rooted in a lack of effectiveness studies, yet such effectiveness can be proved only through a structured evaluation of integrated systems. Issues related to changing technical and social paradigms in both individual perceptions of and interactions with personal health data, as well as social media and other data from the Internet, must be further addressed before such information can be integrated into official surveillance systems.     

Left Ventricular Diastolic Dysfunction in Atrial Fibrillation: Predictors and Relation with Symptom Severity

Left Ventricular Diastolic Dysfunction in Atrial Fibrillation Background: Left ventricular diastolic dysfunction (LVDD) is common in the general population, but its prevalence in atrial fibrillation (AF), predictors for LVDD in AF and the association between LVDD and AF‐related symptom severity has not been well studied. Methods: In 124 consecutive patients (mean age 61 ± 11years, 60% male) with paroxysmal (n = 70) or persistent AF (n = 54) referred for AF catheter ablation, LVDD was evaluated according to current guidelines using transthoracic echocardiography. AF‐related symptom severity was quantified using the European Heart Rhythm Association score. Results: LVDD was present in 46 patients (37%). In uni‐ and multivariable regression analysis, age (OR 1.068 per year, 95% CI 1.023–1.115, P = 0.003) and persistent AF (OR 2.427 vs. paroxysmal AF, 95% CI 1.112–5.3, P = 0.026) were associated with LVDD. LVDD was found in 11% with mild AF symptoms (n = 27) as opposed to 44% in patients with moderate–severe AF symptoms (n = 97, P = 0.002). Thus, the OR for moderate–severe AF symptoms was 6.368 (1.797–22.568, P = 0.004) in the presence of LVDD. Conclusions: LVDD (1) occurs frequently in AF, (2) is associated with advancing age and AF progression and (3) is correlated with symptom severity in AF. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1073‐1077, October 2012)     

Improved Growth Response to GH Treatment in Irradiated Children

ABSTRACT. The growth response to two years of GH treatment was studied in fifteen children after radiotherapy for a cranial tumor. The growth response was compared to that of short children (– 2 SD) and that of children with idiopathic growth hormone deficiency (GHD) of similar ages. All children were treated with hGH 0.1 IU/kg/day s.c; which is a higher dose and frequency than previously reported for irradiated children. On this protocol the growth rate increased 5.0 ± 0.5 cm/y (mean ± SEM) the first year and 3.8 ± 0.7 cm/y the second year compared to the growth rate the year before GH-treatment. Although the net gain in growth was higher than previously reported, the first year growth response was significantly reduced ( p < 0.05) compared to that of GHD-children (7.6 ± 0.5 cm/y) but exceeded ( p < 0.05) that of short children (3.4 ± 0.3 cm/y). The median spontaneous 24 h-GH secretion was 209 mU/I in the short children, 52 mU/I in the irradiated children and 16 mU/1 in the idiopathic GHD children. Thus the growth increment varied inversely to the spontaneous GH secretion observed in the three groups.     

A Longitudinal Study on Growth and Spontaneous Growth Hormone (GH) Secretion in Children with Irradiated Brain Tumors

ABSTRACT. Longitudinal growth was studied in 27 children after radiotherapy for a brain tumor. Growth deviation (1 SD) was found in 56% of the children after 2 years and was most profound in prepubertal children aged between 3 and 8 years at the time of irradiation. In this group growth velocity was markedly reduced and no catch up was seen. In all children studied growth hormone (GH) secretion, measured as the spontaneous secretion over 24 hours, was found to be severely disturbed. Our conclusion is that all children with a growth deviation 1 SD after radiotherapy (40 Gy) to the hypothalamo–hypophyseal region should be considered GH deficient. In such children GH treatment can be initiated without further testing.     

Accuracy at radiography and probing for the diagnosis of proximal caries

In 63 teenagers the proximal surfaces of premolars to be extracted for orthodontic reasons and the adjacent surfaces of neighboring teeth, 598 surfaces in all, were examined radiographically and by probing. Direct inspection after extraction revealed that 51% of the surfaces had incipient carious lesions and 5% lesions with cavities. Of the surfaces with cavities 82.1% were correctly diagnosed radiographically if any radiolucency, regardless of its extent, was used as a diagnostic criterion. However, this yielded a false positive rate of 19.6%. If only radioluccncies extending at least into the inner third of the enamel were called positive the true positive rate was 36.7% and the associated false positive rate 1.6%. At a 5% cavity frequency the predictive positive values were 17% and 53%, respectively. Probing yielded a true positive rate of about 29% and a false positive rate of 1.1% with a predictive positive value of 50-57%. All radiolucencies extending into the dentin were associated with cavities. When the most liberal radiographic criterion was used 37.5% of all carious lesions, whether associated with a cavity or not, were detected and 3.8% of sound surfaces were falsely called carious. The corresponding predictive positive value at the actual rate of incipient lesions and lesions with cavities was 92.6%.     

Pathogenesis of equine herpesvirus‐1 infection in the mouse model

Equine herpesvirus‐1 (EHV‐1) is a major equine pathogen causing respiratory diseases, abortions and severe neurological disorders. The basis of neurological disturbances is, as in other organs, infection of endothelial cells, followed by vasculitis, thrombosis and ischaemic damage of the parenchyma. Here, a murine model was used to explore the mechanism of entry to, and spread within the brain, the cell affinity of the agent and the modulating role of the immune defence, which are all factors governing the pathogenesis of the neurological disease. Because controversial views exist about these mechanisms, we undertook a neuropathological study with intranasally infected adult mice. EHV‐1 entered the brain through the olfactory neuroepithelium and along the olfactory nerves, and spread transsynaptically in rostro‐caudal direction, using olfactory and limbic neuronal networks. Exclusively neurons were infected. The cellular immune reaction exerted a restraining effect on virus dissemination. Following nasal infection, the olfactory route was the major pathway for virus entry and dissemination, involvement of the trigeminal nerve in virus spread seems much less probable. In the adult mouse brain EHV‐1 behaves as a typical neurotropic agent, using, similarly to other herpesviruses, the neuronal networks for dissemination. Vasculitis, the predominant type of lesion in natural infection, and endothelial cell positivity for EHV‐1 were detectable only in the lung. Thus, this agent exhibits in the mouse a dual affinity: it is neurotropic in the brain, and endotheliotropic in visceral organs. Consideration of pathogenetic aspects of equine and experimental murine EHV‐1 infections also helps a better understanding of human herpetic brain disease.     

Initial Clinical Experience with the New Irrigated Tip Magnetic Catheter for Ablation of Scar-Related Sustained Ventricular Tachycardia: A Small Case Series

Background: A remote magnetic navigation system (MNS) has been used with a nonirrigated magnetic catheter for ablation of some supraventricular and ventricular arrhythmias. However, the irrigated tip catheter has not been evaluated.
Objective: To evaluate the feasibility and efficiency of the newly available irrigated tip magnetic catheter for radiofrequency ablation (RF) of electrical storm due to scar-related ventricular tachycardia (VT) in patients with ischemic heart disease.
Methods: Between January and March 2008, a total of 4 consecutive patients (4 men, mean age 67.7 years) with electrical storm who had an implantable cardioverter defibrillator underwent radiofrequency ablation using a remote MNS and the new magnetic irrigated catheter.
Results: Five ablation procedures were performed in study patients. Acute success, defined as noninducibility of any monomorphic VT, was obtained in 3 patients. In 1 patient, a nonclinical VT remained inducible. A monomorphic VT corresponding to clinical VT with the median (range) cycle length of 485 (440–580) ms was induced in all patients. The duration of ablation was 2,273 (985–3087) seconds, with median total procedure and fluoroscopy times of 135 (100–150) minutes and 6.5 (5–9) minutes, respectively. One recurrence occurred 1 week after ablation, which was ablated successfully in the second session. No complication was observed after ablation. During mean follow-up of 4.2 months, all patients were in sinus rhythm, they received no ICD therapy, and no mortality occurred.
Conclusions: Irrigated ablation of scar-related ventricular tachycardia guided by remote MNS is a feasible and effective modality for management of the electrical storm in patients with ischemic cardiomyopathy with minimal radiation exposure.     

Tobacco smoking, an independent determinant for unhealthy diet?: A cross-sectional study of Norwegian workers on platforms in the North Sea

The objective of the study was to examine whether male tobaccosmokers had a more unhealthy diet than non-smokers. Data onsmoking and other variables were collected by questionnaireinterviews and food intake by one 24 h recall. The setting was2 oll platforms. The participants were 310 healthy men workingon 2 platforms in the Norwegian sector of the North Sea. Themean ages were 37 and 39 years for non-smokers and smokers.The prevalence of smoking was 50.3%. Smoking decreased withincreasing level of education, but increased with degree ofurbanization. Smokers consumed less vegetables, fruit and fish,but more meat, soft drinks containing sugar and more coffeethan non-smokers. Smokers had a higher intake of fat and a lowerintake of carbohydrate, vitamins A, D and C and dietary fibre.Smoking was an independent predictor for increasing the consumptionof coffee and high intake of energy, energy from fat and cholesteroland a decreasing consumption of vegetables, fruit, energy fromcarbohydrates, dietary fibre and vitamins A and C. It is concludedthat smokers had a more unhealthy diet than non-smokers.