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Deiner MS, Honcharov V, Li J, Mackey TK, Porco TC, Sarkar U. Large Language Models Can Enable Inductive Thematic Analysis of a Social Media Corpus in a Single Prompt: Human Validation Study. JMIR INFODEMIOLOGY 2024; 4:e59641. [PMID: 39207842 PMCID: PMC11393503 DOI: 10.2196/59641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/04/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Manually analyzing public health-related content from social media provides valuable insights into the beliefs, attitudes, and behaviors of individuals, shedding light on trends and patterns that can inform public understanding, policy decisions, targeted interventions, and communication strategies. Unfortunately, the time and effort needed from well-trained human subject matter experts makes extensive manual social media listening unfeasible. Generative large language models (LLMs) can potentially summarize and interpret large amounts of text, but it is unclear to what extent LLMs can glean subtle health-related meanings in large sets of social media posts and reasonably report health-related themes. OBJECTIVE We aimed to assess the feasibility of using LLMs for topic model selection or inductive thematic analysis of large contents of social media posts by attempting to answer the following question: Can LLMs conduct topic model selection and inductive thematic analysis as effectively as humans did in a prior manual study, or at least reasonably, as judged by subject matter experts? METHODS We asked the same research question and used the same set of social media content for both the LLM selection of relevant topics and the LLM analysis of themes as was conducted manually in a published study about vaccine rhetoric. We used the results from that study as background for this LLM experiment by comparing the results from the prior manual human analyses with the analyses from 3 LLMs: GPT4-32K, Claude-instant-100K, and Claude-2-100K. We also assessed if multiple LLMs had equivalent ability and assessed the consistency of repeated analysis from each LLM. RESULTS The LLMs generally gave high rankings to the topics chosen previously by humans as most relevant. We reject a null hypothesis (P<.001, overall comparison) and conclude that these LLMs are more likely to include the human-rated top 5 content areas in their top rankings than would occur by chance. Regarding theme identification, LLMs identified several themes similar to those identified by humans, with very low hallucination rates. Variability occurred between LLMs and between test runs of an individual LLM. Despite not consistently matching the human-generated themes, subject matter experts found themes generated by the LLMs were still reasonable and relevant. CONCLUSIONS LLMs can effectively and efficiently process large social media-based health-related data sets. LLMs can extract themes from such data that human subject matter experts deem reasonable. However, we were unable to show that the LLMs we tested can replicate the depth of analysis from human subject matter experts by consistently extracting the same themes from the same data. There is vast potential, once better validated, for automated LLM-based real-time social listening for common and rare health conditions, informing public health understanding of the public's interests and concerns and determining the public's ideas to address them.
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Affiliation(s)
- Michael S Deiner
- Department of Ophthalmology and Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
| | - Vlad Honcharov
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jiawei Li
- S-3 Research, LLC, San Diego, CA, United States
| | - Tim K Mackey
- S-3 Research, LLC, San Diego, CA, United States
- Global Health Program, Department of Anthropology, University of California San Diego, La Jolla, CA, United States
| | - Travis C Porco
- Departments of Ophthalmology, Epidemiology and Biostatistics, Global Health Sciences, and Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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2
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Deiner MS, Deiner NA, Hristidis V, McLeod SD, Doan T, Lietman TM, Porco TC. Use of Large Language Models to Assess the Likelihood of Epidemics From the Content of Tweets: Infodemiology Study. J Med Internet Res 2024; 26:e49139. [PMID: 38427404 PMCID: PMC10943433 DOI: 10.2196/49139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/20/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Previous work suggests that Google searches could be useful in identifying conjunctivitis epidemics. Content-based assessment of social media content may provide additional value in serving as early indicators of conjunctivitis and other systemic infectious diseases. OBJECTIVE We investigated whether large language models, specifically GPT-3.5 and GPT-4 (OpenAI), can provide probabilistic assessments of whether social media posts about conjunctivitis could indicate a regional outbreak. METHODS A total of 12,194 conjunctivitis-related tweets were obtained using a targeted Boolean search in multiple languages from India, Guam (United States), Martinique (France), the Philippines, American Samoa (United States), Fiji, Costa Rica, Haiti, and the Bahamas, covering the time frame from January 1, 2012, to March 13, 2023. By providing these tweets via prompts to GPT-3.5 and GPT-4, we obtained probabilistic assessments that were validated by 2 human raters. We then calculated Pearson correlations of these time series with tweet volume and the occurrence of known outbreaks in these 9 locations, with time series bootstrap used to compute CIs. RESULTS Probabilistic assessments derived from GPT-3.5 showed correlations of 0.60 (95% CI 0.47-0.70) and 0.53 (95% CI 0.40-0.65) with the 2 human raters, with higher results for GPT-4. The weekly averages of GPT-3.5 probabilities showed substantial correlations with weekly tweet volume for 44% (4/9) of the countries, with correlations ranging from 0.10 (95% CI 0.0-0.29) to 0.53 (95% CI 0.39-0.89), with larger correlations for GPT-4. More modest correlations were found for correlation with known epidemics, with substantial correlation only in American Samoa (0.40, 95% CI 0.16-0.81). CONCLUSIONS These findings suggest that GPT prompting can efficiently assess the content of social media posts and indicate possible disease outbreaks to a degree of accuracy comparable to that of humans. Furthermore, we found that automated content analysis of tweets is related to tweet volume for conjunctivitis-related posts in some locations and to the occurrence of actual epidemics. Future work may improve the sensitivity and specificity of these methods for disease outbreak detection.
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Affiliation(s)
- Michael S Deiner
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
| | - Natalie A Deiner
- College of Letters and Science, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Vagelis Hristidis
- Department of Computer Science and Engineering, University of California, Riverside, Riverside, CA, United States
| | - Stephen D McLeod
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- American Academy of Ophthalmology, San Francisco, CA, United States
| | - Thuy Doan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas M Lietman
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Travis C Porco
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Yakobashvili D, Zhu A, Aftab OM, Steidl T, Mahajan J, Khouri AS. Ophthalmology residency programs on social media. Int Ophthalmol 2023; 43:4815-4819. [PMID: 37845579 DOI: 10.1007/s10792-023-02883-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE With the transition from away rotations and in-person interviews during the COVID-19 pandemic came a search for alternative methods to represent and promote residency programs. We investigated utilization of social media by ophthalmology residency programs in response to the pandemic. METHODS Social media accounts of accredited ophthalmology residency programs were found through a manual search on Facebook, Instagram, and Twitter. Each program's geographical region (Northeast, Midwest, South, or West) was identified, and year of account creation (2009-2021) was noted. An exponential regression model was used to model total number of social media accounts over time. Comparisons of total number of social media accounts before/after the pandemic and by region, stratified by social media platform, were evaluated through chi-square analysis. RESULTS Of 125 ophthalmology residency programs, 63% (n = 79) had at least one account on a social platform. 142 acc. Instagram held the most accounts (45%, n = 64), followed by Facebook (29%, n = 41) and Twitter (26%, n = 37). From 2009 to 2021, there has been an exponential increase in social media accounts (R2 = 0.962). 45% (n = 65) of all accounts were created after March 2020. Instagram increased the most, with 45 ophthalmology residency accounts created after the pandemic as compared to 19 created prior (p < 0.001). The number of social media accounts did not vary by region. CONCLUSIONS Based on current trends, the presence of ophthalmology residency programs on social media will likely continue expanding, with major social platforms becoming a vaster source of information for ophthalmology residency applicants.
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Affiliation(s)
- Daniela Yakobashvili
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 185 W S Orange Ave, 90 Bergen Street, Suite 6100, Newark, NJ, 07103, USA
| | - Aretha Zhu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 185 W S Orange Ave, 90 Bergen Street, Suite 6100, Newark, NJ, 07103, USA
| | - Owais M Aftab
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 185 W S Orange Ave, 90 Bergen Street, Suite 6100, Newark, NJ, 07103, USA
| | - Tyler Steidl
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 185 W S Orange Ave, 90 Bergen Street, Suite 6100, Newark, NJ, 07103, USA
| | - Jasmine Mahajan
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 185 W S Orange Ave, 90 Bergen Street, Suite 6100, Newark, NJ, 07103, USA
| | - Albert S Khouri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 185 W S Orange Ave, 90 Bergen Street, Suite 6100, Newark, NJ, 07103, USA.
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Pradeep T, Ravipati A, Melachuri S, Fu R. More than just a stye: identifying seasonal patterns using google trends, and a review of infodemiological literature in ophthalmology. Orbit 2023; 42:130-137. [PMID: 35240907 DOI: 10.1080/01676830.2022.2040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We aim to evaluate the utility of internet search query data in ophthalmology by: (1) Evaluating trends in searches for styes in the United States and worldwide, and (2) Performing a review of literature of infodemiological data in ophthalmology. METHODS Google Trends search data for "stye" was analyzed from January 2004 to January 2020 in the United States and worldwide. Spearman's correlation coefficient and sinusoidal modeling were performed to assess the significance and seasonality of trends. Review of literature included searches for "ophthalmology Google trends," "ophthalmology twitter trends," "ophthalmology infodemiology," "eye google trends," and "social media ophthalmology." RESULTS Searches for styes were cyclical in the United States and globally with a steady increase from 2004 to 2020 (sum-of-squares F-test for sinusoidal model: p < .0001, r2 = 0.96). Peak search volume index (SVI) months were 7.9 months in the United States and 6.8 months worldwide. U.S. temperature and SVI for stye were correlated in the United States at the state, divisional, and country-wide levels (p < .005; p < .005; p < .01 respectively). Seven articles met our literature review inclusion criteria. CONCLUSIONS We present a novel finding of seasonality with global and U.S. searches for stye, and association of searches with temperature in the United States. Within ophthalmology, infodemiological literature has been used to track trends and identify seasonal disease patterns, perform disease surveillance, improve resource optimization by identifying regional hotspots, tailor marketing, and monitor institutional reputation. Future research into this domain may help identify further trends, improve prevention efforts, and reduce medical costs.
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Affiliation(s)
- Tejus Pradeep
- Department of Ophthalmology, University of Pennsylvania Scheie Eye Institute, Philadelphia, Pennsylvania, USA
| | - Advaitaa Ravipati
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samyuktha Melachuri
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Maitra C, Rowley J. Using a social media based intervention to enhance eye health awareness of members of a deprived community in India. INFORMATION DEVELOPMENT 2022. [DOI: 10.1177/02666669211013450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Deprived communities in India experience a range of health challenges as the result of a mixture of lack of access to information technologies, and difficulties in accessing health information and provision. This article reports on an intervention centred on the use of the social media platform, WhatsApp, in order to promote eye health communication. The case study based research was conducted in the village of Chowbaga, close to Kolkata, in West Bengal, with women participants who had low levels of education and high levels of unemployment. The women were invited to participate in a WhatsApp intervention that comprised five educational sessions. Participants were recruited through the local school that their children attended. Shortly after the conclusion of the intervention, focus groups were conducted with the participants in order to develop an understanding of participants views of the beneficial characteristics of such a social media based intervention, and, more specifically, the benefits of WhatsApp in increasing awareness of eye problems within their community. This research demonstrates and summarises the benefits of WhatsApp as a communications medium for deprived communities, as well as its potential for increasing awareness of eye problems. In particular, participants were of the view that future access to WhatsApp and other mobile-based platforms empowered them to take better care of their own and their family’s health.
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Deiner MS, Kaur G, McLeod SD, Schallhorn JM, Chodosh J, Hwang DH, Lietman TM, Porco TC. A Google Trends Approach to Identify Distinct Diurnal and Day-of-Week Web-Based Search Patterns Related to Conjunctivitis and Other Common Eye Conditions: Infodemiology Study. J Med Internet Res 2022; 24:e27310. [PMID: 35537041 PMCID: PMC9297131 DOI: 10.2196/27310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/18/2021] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies suggest diurnal patterns of occurrence of some eye conditions. Leveraging new information sources such as web-based search data to learn more about such patterns could improve the understanding of patients' eye-related conditions and well-being, better inform timing of clinical and remote eye care, and improve precision when targeting web-based public health campaigns toward underserved populations. OBJECTIVE To investigate our hypothesis that the public is likely to consistently search about different ophthalmologic conditions at different hours of the day or days of week, we conducted an observational study using search data for terms related to ophthalmologic conditions such as conjunctivitis. We assessed whether search volumes reflected diurnal or day-of-week patterns and if those patterns were distinct from each other. METHODS We designed a study to analyze and compare hourly search data for eye-related and control search terms, using time series regression models with trend and periodicity terms to remove outliers and then estimate diurnal effects. We planned a Google Trends setting, extracting data from 10 US states for the entire year of 2018. The exposure was internet search, and the participants were populations who searched through Google's search engine using our chosen study terms. Our main outcome measures included cyclical hourly and day-of-week web-based search patterns. For statistical analyses, we considered P<.001 to be statistically significant. RESULTS Distinct diurnal (P<.001 for all search terms) and day-of-week search patterns for eye-related terms were observed but with differing peak time periods and cyclic strengths. Some diurnal patterns represented those reported from prior clinical studies. Of the eye-related terms, "pink eye" showed the largest diurnal amplitude-to-mean ratios. Stronger signal was restricted to and peaked in mornings, and amplitude was higher on weekdays. By contrast, "dry eyes" had a higher amplitude diurnal pattern on weekends, with stronger signal occurring over a broader evening-to-morning period and peaking in early morning. CONCLUSIONS The frequency of web-based searches for various eye conditions can show cyclic patterns according to time of the day or week. Further studies to understand the reasons for these variations may help supplement the current clinical understanding of ophthalmologic symptom presentation and improve the timeliness of patient messaging and care interventions.
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Affiliation(s)
- Michael S Deiner
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
| | - Gurbani Kaur
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Stephen D McLeod
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
| | - Julie M Schallhorn
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
| | - James Chodosh
- Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Daniel H Hwang
- Stanford University, San Mateo, CA, United States
- The Nueva School, San Mateo, CA, United States
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Travis C Porco
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
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Nguyen AAK, Tsui E, Smith JR. Social media and ophthalmology: A review. Clin Exp Ophthalmol 2022; 50:449-458. [DOI: 10.1111/ceo.14091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/24/2022] [Accepted: 05/01/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Andrew A. K. Nguyen
- Flinders University College of Medicine and Public Health Flinders University Adelaide South Australia Australia
| | - Edmund Tsui
- UCLA Stein Eye Institute University of California Los Angeles California USA
| | - Justine R. Smith
- Flinders University College of Medicine and Public Health Flinders University Adelaide South Australia Australia
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Dara M, Habibi A, Azarpira N, Dianatpour M, Nejabat M, Khosravi A, Tanideh N. Novel RNA extraction method from human tears. MOLECULAR BIOLOGY RESEARCH COMMUNICATIONS 2022; 11:167-172. [PMID: 36777000 PMCID: PMC9905750 DOI: 10.22099/mbrc.2022.45266.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Human tears can be used as a noninvasive source of genetic materials and biomarkers in the prognosis and diagnosis of ocular and non-ocular diseases. The present protocol is a novel direct RNA extraction method from tears. This study aims to provide a suitable method for direct extraction of RNA from tears with high quality and quantity. In this study, we develop a TRIzol base protocol for direct RNA extraction from human tears. quality and quantity of extracted RNA measured by calculation of 260/280 UV absorption ratio using Nanodrop and real-time PCR. RNA was extracted with this modified method and a purified (260/280 UV absorption ratio between 1.8 to 2 and a high yield of total RNA, on average 95 μg, from tears was extracted. In conclusion, we developed an easy and suitable method for direct extraction of total RNA from tears with high quality and quantity.
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Affiliation(s)
- Mahintaj Dara
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author: Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Tel: +98 71 36122241; Fax: +98 71 36122240; E.mail:
| | - Azam Habibi
- Department of tissue engineering and cell therapy, School of Advanced Technology in Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Dianatpour
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Nejabat
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Khosravi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Tanideh
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Deiner MS, Seitzman GD, Kaur G, McLeod SD, Chodosh J, Lietman TM, Porco TC. Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study. JMIR INFODEMIOLOGY 2022; 2:e31732. [PMID: 35320981 PMCID: PMC8931841 DOI: 10.2196/31732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 12/20/2022]
Abstract
Background In a prior study at the start of the pandemic, we reported reduced numbers of Google searches for the term “conjunctivitis” in the United States in March and April 2020 compared with prior years. As one explanation, we conjectured that reduced information-seeking may have resulted from social distancing reducing contagious conjunctivitis cases. Here, after 1 year of continued implementation of social distancing, we asked if there have been persistent reductions in searches for “conjunctivitis,” and similarly for other communicable disease terms, compared to control terms. Objective The aim of this study was to determine if reduction in searches in the United States for terms related to conjunctivitis and other common communicable diseases occurred in the spring-winter season of the COVID-19 pandemic, and to compare this outcome to searches for terms representing noncommunicable conditions, COVID-19, and to seasonality. Methods Weekly relative search frequency volume data from Google Trends for 68 search terms in English for the United States were obtained for the weeks of March 2011 through February 2021. Terms were classified a priori as 16 terms related to COVID-19, 29 terms representing communicable conditions, and 23 terms representing control noncommunicable conditions. To reduce bias, all analyses were performed while masked to term names, classifications, and locations. To test for the significance of changes during the pandemic, we detrended and compared postpandemic values to those expected based on prepandemic trends, per season, computing one- and two-sided P values. We then compared these P values between term groups using Wilcoxon rank-sum and Fisher exact tests to assess if non-COVID-19 terms representing communicable diseases were more likely to show significant reductions in searches in 2020-2021 than terms not representing such diseases. We also assessed any relationship between a term’s seasonality and a reduced search trend for the term in 2020-2021 seasons. P values were subjected to false discovery rate correction prior to reporting. Data were then unmasked. Results Terms representing conjunctivitis and other communicable conditions showed a sustained reduced search trend in the first 4 seasons of the 2020-2021 COVID-19 pandemic compared to prior years. In comparison, the search for noncommunicable condition terms was significantly less reduced (Wilcoxon and Fisher exact tests, P<.001; summer, autumn, winter). A significant correlation was also found between reduced search for a term in 2020-2021 and seasonality of that term (Theil-Sen, P<.001; summer, autumn, winter). Searches for COVID-19–related conditions were significantly elevated compared to those in prior years, and searches for influenza-related terms were significantly lower than those for prior years in winter 2020-2021 (P<.001). Conclusions We demonstrate the low-cost and unbiased use of online search data to study how a wide range of conditions may be affected by large-scale interventions or events such as social distancing during the COVID-19 pandemic. Our findings support emerging clinical evidence implicating social distancing and the COVID-19 pandemic in the reduction of communicable disease and on ocular conditions.
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Affiliation(s)
- Michael S Deiner
- Francis I Proctor Foundation University of California San Francisco San Francisco, CA United States.,Department of Ophthalmology University of California San Francisco San Francisco, CA United States
| | - Gerami D Seitzman
- Francis I Proctor Foundation University of California San Francisco San Francisco, CA United States.,Department of Ophthalmology University of California San Francisco San Francisco, CA United States
| | - Gurbani Kaur
- School of Medicine University of California San Francisco San Francisco, CA United States
| | - Stephen D McLeod
- Francis I Proctor Foundation University of California San Francisco San Francisco, CA United States.,Department of Ophthalmology University of California San Francisco San Francisco, CA United States
| | - James Chodosh
- Department of Ophthalmology Massachusetts Eye and Ear Harvard Medical School Boston, MA United States
| | - Thomas M Lietman
- Francis I Proctor Foundation University of California San Francisco San Francisco, CA United States.,Department of Ophthalmology University of California San Francisco San Francisco, CA United States.,Department of Epidemiology and Biostatistics Global Health Sciences University of California San Francisco San Francisco, CA United States
| | - Travis C Porco
- Francis I Proctor Foundation University of California San Francisco San Francisco, CA United States.,Department of Ophthalmology University of California San Francisco San Francisco, CA United States.,Department of Epidemiology and Biostatistics Global Health Sciences University of California San Francisco San Francisco, CA United States
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Lavista Ferres JM, Meirick T, Lomazow W, Lee CS, Lee AY, Lee MD. Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis. JAMA Ophthalmol 2021; 140:43-49. [PMID: 34792555 DOI: 10.1001/jamaophthalmol.2021.4852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Infectious conjunctivitis is highly transmissible and a public health concern. While mitigation strategies have been successful on a local level, population-wide decreases in spread are rare. Objective To evaluate whether internet search interest and emergency department visits for infectious conjunctivitis were associated with public health interventions adopted during the COVID-19 pandemic. Design, Setting, and Participants Internet search data from the US and emergency department data from a single academic center in the US were used in this study. Publicly available smartphone mobility data were temporally aligned to quantify social distancing. Internet search term trends for nonallergic conjunctivitis, corneal abrasions, and posterior vitreous detachments were obtained. Additionally, all patients who presented to a single emergency department from February 2015 to February 2021 were included in a review. Physician notes for emergency department visits at a single academic center with the same diagnoses were extracted. Causal inference was performed using a bayesian structural time-series model. Data were compared from before and after April 2020, when the US Centers for Disease Control and Prevention recommended members of the public wear masks, stay at least 6 feet from others who did not reside in the same home, avoid crowds, and quarantine if experiencing flulike symptoms or exposure to persons with COVID-19 symptoms. Exposures Symptoms of or interest in conjunctivitis in the context of the COVID-19 pandemic. Main Outcome and Measures The hypothesis was that there would be a decrease in internet search interest and emergency department visits for infectious conjunctivitis after the adaptation of public health measures targeted to curb COVID-19. Results A total of 1156 emergency department encounters with a diagnosis of conjunctivitis were noted from January 2015 to February 2021. Emergency department encounters for nonallergic conjunctivitis decreased by 37.3% (95% CI, -12.9% to -60.6%; P < .001). In contrast, encounters for corneal abrasion (1.1% [95% CI, -29.3% to 29.1%]; P = .47) and posterior vitreous detachments (7.9% [95% CI, -46.9% to 66.6%]; P = .39) remained stable after adjusting for total emergency department encounters. Search interest in conjunctivitis decreased by 34.2% (95% CI, -30.6% to -37.6%; P < .001) after widespread implementation of public health interventions to mitigate COVID-19. Conclusions and Relevance Public health interventions, such as social distancing, increased emphasis on hygiene, and travel restrictions during the COVID-19 pandemic, were associated with decreased search interest in nonallergic conjunctivitis and conjunctivitis-associated emergency department encounters. Mobility data may provide novel metrics of social distancing. These data provide evidence of a sustained population-wide decrease in infectious conjunctivitis.
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Affiliation(s)
| | - Thomas Meirick
- Department of Ophthalmology, University of Washington, Seattle
| | - Whitney Lomazow
- Department of Ophthalmology, University of Washington, Seattle
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle
| | - Michele D Lee
- Department of Ophthalmology, University of Washington, Seattle
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Abstract
PURPOSE OF REVIEW With social media use continuing to increase in popularity, ophthalmologists use social media daily for interactions with patients, colleagues, and the academic community. RECENT FINDINGS The potential reach of social media is overwhelmingly encouraging, but academic organizations have much work to do in order to compete for viewership on social media platforms, and users need to remain vigilant of easily spread misinformation. Individual ophthalmology practices can tailor their social media presence to attract and educate patients. Using hashtags to supplement the experience of academic conferences has boosted engagement both of attendees and other interested parties. As an effective indicator of the popularity of different subjects in medicine, new studies are leveraging social media for epidemiological models. Finally, social media is emerging as a powerful tool for patient advocacy in ophthalmology. SUMMARY The accessibility of social media uniquely positions it to educate patients, disseminate public eye health initiatives, and increase the reach of individual physicians. It is also able to enhance the academic experience of conferences, connecting new research colleagues, and is becoming the subject of epidemiologic studies itself. Whether using social media for patient education, research, clinical practice, or patient advocacy, ophthalmologists will find social media an increasingly important workplace contributor.
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Affiliation(s)
| | - Simon S M Fung
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Edmund Tsui
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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12
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Maitra C, Rowley J. Delivering eye health education to deprived communities in India through a social media-based innovation. Health Info Libr J 2021; 38:139-142. [PMID: 34192405 DOI: 10.1111/hir.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
In this article, Chandrani Maitra, with her supervisor, Prof. Jennifer Rowley, reports on her PhD research conducted at Manchester Metropolitan University. This research aimed to develop understanding of the benefits of, and the challenges associated with the use of social media to disseminate eye health information in deprived communities in India. Such communities typically have a low level of access to health information, as the result of poor literacy, poverty, lack of women's empowerment, cultural practices, society dynamics, and medical malpractice. This study used an intervention based on the social media platform, WhatsApp, to educate a group of women volunteers so that they were able to contribute to the management of the eye health of their family, friends, and neighbours. Interviews were conducted with deprived community members (DCMs), community healthcare advocates (CHAs) and, healthcare professionals (HCPs). The DCMs reported a number of benefits associated with their participation in the eye health intervention. CHAs and HCPs agreed that an extended roll out of the intervention had potential to deliver benefits, but expressed concerns that some of the ongoing social challenges facing deprived communities might act as barriers to progress. F.J.
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Affiliation(s)
| | - Jenny Rowley
- Manchester Metropolitan University, Manchester, UK
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13
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Kammrath Betancor P, Tizek L, Zink A, Reinhard T, Böhringer D. Estimating the Incidence of Conjunctivitis by Comparing the Frequency of Google Search Terms With Clinical Data: Retrospective Study. JMIR Public Health Surveill 2021; 7:e22645. [PMID: 33656450 PMCID: PMC7970297 DOI: 10.2196/22645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 01/30/2021] [Indexed: 01/13/2023] Open
Abstract
Background Infectious conjunctivitis is contagious and may lead to an outbreak. Prevention systems can help to avoid an outbreak. Objective We aimed to evaluate if Google search data on conjunctivitis and associated terms can be used to estimate the incidence and if the data can provide an estimation for outbreaks. Methods We obtained Google search data over 4 years for the German term for conjunctivitis (“Bindehautentzündung”) and 714 associated terms in 12 selected German cities and Germany as a whole using the Google AdWords Keyword Planner. The search volume from Freiburg was correlated with clinical data from the Freiburg emergency practice (Eye Center University of Freiburg). Results The search volume for the German term for conjunctivitis in Germany as a whole and in the 12 German cities showed a highly uniform seasonal pattern. Cross-correlation between the temporal search frequencies in Germany as a whole and the 12 selected cities was high without any lag. Cross-correlation of the search volume in Freiburg with the frequency of conjunctivitis (International Statistical Classification of Diseases and Related Health Problems [ICD] code group “H10.-”) from the centralized ophthalmologic emergency practice in Freiburg revealed a considerable temporal association, with the emergency practice lagging behind the frequency. Additionally, Pearson correlation between the count of patients per month and the count of searches per month in Freiburg was statistically significant (P=.04). Conclusions We observed a close correlation between the Google search volume for the signs and symptoms of conjunctivitis and the frequency of patients with a congruent diagnosis in the Freiburg region. Regional deviations from the nationwide average search volume may therefore indicate a regional outbreak of infectious conjunctivitis.
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Affiliation(s)
| | - Linda Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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14
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Oser SM, Oser TK. Qualitative Content Analysis of Type 1 Diabetes Caregiver Blogs and Correlations With Caregiver Challenges and Successes. J Patient Exp 2021; 7:957-963. [PMID: 33457528 PMCID: PMC7786671 DOI: 10.1177/2374373520975726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Social media increasingly reflects patient experience, especially for self-managed conditions. We examined family experience with type 1 diabetes (T1D) through qualitative analysis of blogs written by caregivers of children with T1D, survey derived from that analysis, and survey administration among T1D caregivers. Analysis of 140 blog posts and 663 associated comments identified 77 topics, which were categorized into self-management, emotional, challenges, and successes. By subcategory analysis, self-management challenges were strongly correlated between blog content and survey responses (R = .838, P = .005), and emotional challenges were moderately correlated (R = .415, P = .02). Emotional successes were not significantly correlated (R = .161, P = .511), and self-management successes were too few to analyze. The range of topics and the correlations between blog expressions and survey responses highlight the potential of blog analysis to gain insight into the challenges facing families living with T1D.
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Affiliation(s)
- Sean M Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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15
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Al-khersan H, Lazzarini TA, Fan KC, Patel NA, Tran AQ, Tooley AA, Lee WW, Alfonso E, Sridhar J. Social media in ophthalmology: An analysis of use in the professional sphere. Health Informatics J 2020; 26:2967-2975. [DOI: 10.1177/1460458220954610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To characterize how ophthalmologists are using social media in their practice. A survey regarding ophthalmologists’ personal and professional use of social media was distributed online through a university alumni listserv. Data collection occurred over 4 weeks from January to February 2020. In total, 808 ophthalmologists opened the survey email, and 160 responded (19.8%). Of 160 respondents, 115 (71.9%) participated in social media for personal use. Professional use of social media was noted by 63 (39.4%) respondents. Age >40 years old correlated with less personal ( X2 = 5.06, p = 0.025) but not professional use ( p = 0.065). Private practice was associated with more use of social media professionally compared to those in an academic or Veteran’s Affairs hospital ( X2 = 6.58, p = 0.037). A majority of respondents (58.7%) were neutral regarding the effect of social media on their practice. The present survey showed that nearly 40% of respondents are involved in social media in a professional context. Private practice correlated with increased use of social media professionally, but providers were most commonly neutral regarding the impact of social media on their practice. This finding suggests further avenues of research including how providers using social media professionally are defining and assessing successful use.
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Affiliation(s)
| | | | | | | | | | - Andrea A Tooley
- Manhattan Eye Ear Throat Hospital, Northwell University, USA
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16
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Al-khersan H, Tanenbaum R, Lazzarini TA, Patel NA, Sridhar J. A Characterization of Ophthalmology Residency Program Social Media Presence and Activity. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2020. [DOI: 10.1055/s-0040-1714682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective To determine the presence and activity of ophthalmology departments associated with residency programs on social media platforms and the use of these social media platforms by residency applicants.
Design Cross-sectional online assessment of ophthalmology training program departments' presence and activity on Facebook, Twitter, and Instagram.
Participants A total of 120 accredited ophthalmology residency training programs and 498 ophthalmology residency applicants.
Methods Each department was evaluated by (1) searching for social media links on the department's Web site, (2) searching for the department on Facebook, Twitter, and Instagram, and (3) searching on Google. A simultaneous survey was conducted to assess social media platform use of 2019 to 2020 ophthalmology residency application cycle candidates.
Main Outcomes The presence of ophthalmology departments on Facebook, Twitter, and Instagram, as well as the total number of followers and posts during January 2020.
Results Of 120 programs evaluated, 45 programs (37.5%) had a Facebook page, 29 (24.3%) were on Twitter, and 22 (18.3%) had an Instagram page. Among top 20 Doximity-ranked ophthalmology programs, 80% had at least one social media page on Facebook, Twitter, or Instagram compared with 33% among the remainder of programs (chi-square test = 15.2, p < 0.001). Top 20 programs also had more followers compared with others on Facebook (4,363 vs. 696, respectively, p < 0.0001) and Twitter (3,673 vs. 355, respectively, p = 0.007) but not on Instagram (1,156 vs. 1,687, respectively, p = 0.71). Among 498 residency applicants to Bascom Palmer Eye Institute from the 2019 to 2020 cycle, 159 (31.9%) responded to a survey regarding their use of social media during the application process. In total, 54 (34%) responded that they used social media to evaluate residency programs.
Conclusion Departments of top 20 ophthalmology residency had both a greater presence and following on social media compared with other departments. While Facebook was the most used platform by ophthalmology departments, applicants most commonly used Instagram. As applicants come to use these social media resources more frequently, ophthalmology residency programs may increasingly benefit from maintaining an active social media page.
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Affiliation(s)
- Hasenin Al-khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rebecca Tanenbaum
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Thomas A. Lazzarini
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nimesh A. Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
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17
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Tsui E, Rao RC. Navigating Social Media in #Ophthalmology. Ophthalmology 2019; 126:779-782. [DOI: 10.1016/j.ophtha.2019.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/27/2022] Open
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18
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Google Searches and Detection of Conjunctivitis Epidemics Worldwide. Ophthalmology 2019; 126:1219-1229. [PMID: 30981915 DOI: 10.1016/j.ophtha.2019.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Epidemic and seasonal infectious conjunctivitis outbreaks can impact education, workforce, and economy adversely. Yet conjunctivitis typically is not a reportable disease, potentially delaying mitigating intervention. Our study objective was to determine if conjunctivitis epidemics could be identified using Google Trends search data. DESIGN Search data for conjunctivitis-related and control search terms from 5 years and countries worldwide were obtained. Country and term were masked. Temporal scan statistics were applied to identify candidate epidemics. Candidates then were assessed for geotemporal concordance with an a priori defined collection of known reported conjunctivitis outbreaks, as a measure of sensitivity. PARTICIPANTS Populations by country that searched Google's search engine using our study terms. MAIN OUTCOME MEASURES Percent of known conjunctivitis outbreaks also found in the same country and period by our candidate epidemics, identified from conjunctivitis-related searches. RESULTS We identified 135 candidate conjunctivitis epidemic periods from 77 countries. Compared with our a priori defined collection of known reported outbreaks, candidate conjunctivitis epidemics identified 18 of 26 (69% sensitivity) of the reported country-wide or island nationwide outbreaks, or both; 9 of 20 (45% sensitivity) of the reported region or district-wide outbreaks, or both; but far fewer nosocomial and reported smaller outbreaks. Similar overall and individual sensitivity, as well as specificity, were found on a country-level basis. We also found that 83% of our candidate epidemics had start dates before (of those, 20% were more than 12 weeks before) their concurrent reported outbreak's report issuance date. Permutation tests provided evidence that on average, conjunctivitis candidate epidemics occurred geotemporally closer to outbreak reports than chance alone suggests (P < 0.001) unlike control term candidates (P = 0.40). CONCLUSIONS Conjunctivitis outbreaks can be detected using temporal scan analysis of Google search data alone, with more than 80% detected before an outbreak report's issuance date, some as early as the reported outbreak's start date. Future approaches using data from smaller regions, social media, and more search terms may improve sensitivity further and cross-validate detected candidates, allowing identification of candidate conjunctivitis epidemics from Internet search data potentially to complementarily benefit traditional reporting and detection systems to improve epidemic awareness.
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Sié A, Diarra A, Millogo O, Zongo A, Lebas E, Bärnighausen T, Chodosh J, Porco TC, Deiner MS, Lietman TM, Keenan JD, Oldenburg CE. Seasonal and Temporal Trends in Childhood Conjunctivitis in Burkina Faso. Am J Trop Med Hyg 2018; 99:229-232. [PMID: 29761759 DOI: 10.4269/ajtmh.17-0642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute conjunctivitis follows a seasonal pattern. Although its clinical course is typically self-limited, conjunctivitis epidemics incur a substantial economic burden because of missed school and work days. This study investigated seasonal and temporal trends of childhood conjunctivitis in the entire country of Burkina Faso from 2013 to 2016, using routine monthly surveillance from 2,444 government health facilities. A total of 783,314 cases were reported over the 4-year period. Conjunctivitis followed a seasonal pattern throughout the country, with a peak in April. A nationwide conjunctivitis outbreak with a peak in September 2016 was noted (P < 0.001), with an excess number of cases first detected in June 2016. Nationwide passive surveillance was able to detect an epidemic 3 months before its peak, which may aide in allocation of resources for containment and mitigation of transmission in future outbreaks.
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Affiliation(s)
- Ali Sié
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | | | - Augustin Zongo
- National Health Information System, Ministry of Health, Ouagadougou, Burkina Faso
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Heidelberg Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - James Chodosh
- Cornea and Refractive Surgery, Massachusetts Eye and Ear Hospital, Boston, Massachusetts
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Michael S Deiner
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Thomas M Lietman
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Jeremy D Keenan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Catherine E Oldenburg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
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