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Divi N, Mantero J, Libel M, Leal Neto O, Schultheiss M, Sewalk K, Brownstein J, Smolinski M. Using EpiCore to Enable Rapid Verification of Potential Health Threats: Illustrated Use Cases and Summary Statistics. JMIR Public Health Surveill 2024; 10:e52093. [PMID: 38488832 PMCID: PMC10980988 DOI: 10.2196/52093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/26/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The proliferation of digital disease-detection systems has led to an increase in earlier warning signals, which subsequently have resulted in swifter responses to emerging threats. Such highly sensitive systems can also produce weak signals needing additional information for action. The delays in the response to a genuine health threat are often due to the time it takes to verify a health event. It was the delay in outbreak verification that was the main impetus for creating EpiCore. OBJECTIVE This paper describes the potential of crowdsourcing information through EpiCore, a network of voluntary human, animal, and environmental health professionals supporting the verification of early warning signals of potential outbreaks and informing risk assessments by monitoring ongoing threats. METHODS This paper uses summary statistics to assess whether EpiCore is meeting its goal to accelerate the time to verification of identified potential health events for epidemic and pandemic intelligence purposes from around the world. Data from the EpiCore platform from January 2018 to December 2022 were analyzed to capture request for information response rates and verification rates. Illustrated use cases are provided to describe how EpiCore members provide information to facilitate the verification of early warning signals of potential outbreaks and for the monitoring and risk assessment of ongoing threats through EpiCore and its utilities. RESULTS Since its launch in 2016, EpiCore network membership grew to over 3300 individuals during the first 2 years, consisting of professionals in human, animal, and environmental health, spanning 161 countries. The overall EpiCore response rate to requests for information increased by year between 2018 and 2022 from 65.4% to 68.8% with an initial response typically received within 24 hours (in 2022, 94% of responded requests received a first contribution within 24 h). Five illustrated use cases highlight the various uses of EpiCore. CONCLUSIONS As the global demand for data to facilitate disease prevention and control continues to grow, it will be crucial for traditional and nontraditional methods of disease surveillance to work together to ensure health threats are captured earlier. EpiCore is an innovative approach that can support health authorities in decision-making when used complementarily with official early detection and verification systems. EpiCore can shorten the time to verification by confirming early detection signals, informing risk-assessment activities, and monitoring ongoing events.
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Affiliation(s)
- Nomita Divi
- Ending Pandemics, San Francisco, CA, United States
| | - Jaś Mantero
- Ending Pandemics, San Francisco, CA, United States
| | - Marlo Libel
- Ending Pandemics, San Francisco, CA, United States
| | - Onicio Leal Neto
- Ending Pandemics, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Kara Sewalk
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
| | - John Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
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Gertz A, Rader B, Sewalk K, Varrelman TJ, Smolinski M, Brownstein JS. Decreased Seasonal Influenza Rates Detected in a Crowdsourced Influenza-Like Illness Surveillance System During the COVID-19 Pandemic: Prospective Cohort Study. JMIR Public Health Surveill 2023; 9:e40216. [PMID: 38153782 PMCID: PMC10784978 DOI: 10.2196/40216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/24/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Seasonal respiratory viruses had lower incidence during their 2019-2020 and 2020-2021 seasons, which overlapped with the COVID-19 pandemic. The widespread implementation of precautionary measures to prevent transmission of SARS-CoV-2 has been seen to also mitigate transmission of seasonal influenza. The COVID-19 pandemic also led to changes in care seeking and access. Participatory surveillance systems have historically captured mild illnesses that are often missed by surveillance systems that rely on encounters with a health care provider for detection. OBJECTIVE This study aimed to assess if a crowdsourced syndromic surveillance system capable of detecting mild influenza-like illness (ILI) also captured the globally observed decrease in ILI in the 2019-2020 and 2020-2021 influenza seasons, concurrent with the COVID-19 pandemic. METHODS Flu Near You (FNY) is a web-based participatory syndromic surveillance system that allows participants in the United States to report their health information using a brief weekly survey. Reminder emails are sent to registered FNY participants to report on their symptoms and the symptoms of household members. Guest participants may also report. ILI was defined as fever and sore throat or fever and cough. ILI rates were determined as the number of ILI reports over the total number of reports and assessed for the 2016-2017, 2017-2018, 2018-2019, 2019-2020, and 2020-2021 influenza seasons. Baseline season (2016-2017, 2017-2018, and 2018-2019) rates were compared to the 2019-2020 and 2020-2021 influenza seasons. Self-reported influenza diagnosis and vaccination status were captured and assessed as the total number of reported events over the total number of reports submitted. CIs for all proportions were calculated via a 1-sample test of proportions. RESULTS ILI was detected in 3.8% (32,239/848,878) of participants in the baseline seasons (2016-2019), 2.58% (7418/287,909) in the 2019-2020 season, and 0.27% (546/201,079) in the 2020-2021 season. Both influenza seasons that overlapped with the COVID-19 pandemic had lower ILI rates than the baseline seasons. ILI decline was observed during the months with widespread implementation of COVID-19 precautions, starting in February 2020. Self-reported influenza diagnoses decreased from early 2020 through the influenza season. Self-reported influenza positivity among ILI cases varied over the observed time period. Self-reported influenza vaccination rates in FNY were high across all observed seasons. CONCLUSIONS A decrease in ILI was detected in the crowdsourced FNY surveillance system during the 2019-2020 and 2020-2021 influenza seasons, mirroring trends observed in other influenza surveillance systems. Specifically, the months within seasons that overlapped with widespread pandemic precautions showed decreases in ILI and confirmed influenza. Concerns persist regarding respiratory pathogens re-emerging with changes to COVID-19 guidelines. Traditional surveillance is subject to changes in health care behaviors. Systems like FNY are uniquely situated to detect disease across disease severity and care seeking, providing key insights during public health emergencies.
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Affiliation(s)
- Autumn Gertz
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
| | - Benjamin Rader
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Kara Sewalk
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
| | - Tanner J Varrelman
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
| | | | - John S Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Suy Lan C, Sok S, Chheang K, Lan DM, Soung V, Divi N, Ly S, Smolinski M. Cambodia national health hotline - Participatory surveillance for early detection and response to disease outbreaks. Lancet Reg Health West Pac 2022; 29:100584. [PMID: 36605884 PMCID: PMC9808424 DOI: 10.1016/j.lanwpc.2022.100584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Channé Suy Lan
- InSTEDD iLab Southeast Asia, Phnom Penh, Cambodia
- Corresponding author.
| | - Samnang Sok
- Communicable Disease Control Department, Ministry of Health, Cambodia
| | | | | | | | | | - Sovann Ly
- Communicable Disease Control Department, Ministry of Health, Cambodia
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McNeil C, Verlander S, Divi N, Smolinski M. Straight from the source: Landscape of Participatory Surveillance Systems across the One Health Spectrum (Preprint). JMIR Public Health Surveill 2022; 8:e38551. [PMID: 35930345 PMCID: PMC9391976 DOI: 10.2196/38551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Nomita Divi
- Ending Pandemics, San Francisco, CA, United States
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Divi N, Smolinski M. EpiHacks, a Process for Technologists and Health Experts to Cocreate Optimal Solutions for Disease Prevention and Control: User-Centered Design Approach. J Med Internet Res 2021; 23:e34286. [PMID: 34807832 PMCID: PMC8717129 DOI: 10.2196/34286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Technology-based innovations that are created collaboratively by local technology specialists and health experts can optimize the addressing of priority needs for disease prevention and control. An EpiHack is a distinct, collaborative approach to developing solutions that combines the science of epidemiology with the format of a hackathon. Since 2013, a total of 12 EpiHacks have collectively brought together over 500 technology and health professionals from 29 countries. Objective We aimed to define the EpiHack process and summarize the impacts of the technology-based innovations that have been created through this approach. Methods The key components and timeline of an EpiHack were described in detail. The focus areas, outputs, and impacts of the twelve EpiHacks that were conducted between 2013 and 2021 were summarized. Results EpiHack solutions have served to improve surveillance for influenza, dengue, and mass gatherings, as well as laboratory sample tracking and One Health surveillance, in rural and urban communities. Several EpiHack tools were scaled during the COVID-19 pandemic to support local governments in conducting active surveillance. All tools were designed to be open source to allow for easy replication and adaptation by other governments or parties. Conclusions EpiHacks provide an efficient, flexible, and replicable new approach to generating relevant and timely innovations that are locally developed and owned, are scalable, and are sustainable.
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Affiliation(s)
- Nomita Divi
- Ending Pandemics, San Francisco, CA, United States
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6
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Pitzonka L, Cutler M, Bu Y, Blanco A, Fumero E, Torra A, Smolinski M. 465 Tirbanibulin, a novel anti-proliferative and pro-apoptotic agent for the treatment of actinic keratosis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Leal Neto O, Cruz O, Albuquerque J, Nacarato de Sousa M, Smolinski M, Pessoa Cesse EÂ, Libel M, Vieira de Souza W. Participatory Surveillance Based on Crowdsourcing During the Rio 2016 Olympic Games Using the Guardians of Health Platform: Descriptive Study. JMIR Public Health Surveill 2020; 6:e16119. [PMID: 32254042 PMCID: PMC7175192 DOI: 10.2196/16119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background With the evolution of digital media, areas such as public health are adding new platforms to complement traditional systems of epidemiological surveillance. Participatory surveillance and digital epidemiology have become innovative tools for the construction of epidemiological landscapes with citizens’ participation, improving traditional sources of information. Strategies such as these promote the timely detection of warning signs for outbreaks and epidemics in the region. Objective This study aims to describe the participatory surveillance platform Guardians of Health, which was used in a project conducted during the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil, and officially used by the Brazilian Ministry of Health for the monitoring of outbreaks and epidemics. Methods This is a descriptive study carried out using secondary data from Guardians of Health available in a public digital repository. Based on syndromic signals, the information subsidy for decision making by policy makers and health managers becomes more dynamic and assertive. This type of information source can be used as an early route to understand the epidemiological scenario. Results The main result of this research was demonstrating the use of the participatory surveillance platform as an additional source of information for the epidemiological surveillance performed in Brazil during a mass gathering. The platform Guardians of Health had 7848 users who generated 12,746 reports about their health status. Among these reports, the following were identified: 161 users with diarrheal syndrome, 68 users with respiratory syndrome, and 145 users with rash syndrome. Conclusions It is hoped that epidemiological surveillance professionals, researchers, managers, and workers become aware of, and allow themselves to use, new tools that improve information management for decision making and knowledge production. This way, we may follow the path for a more intelligent, efficient, and pragmatic disease control system.
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Affiliation(s)
- Onicio Leal Neto
- University of Zurich, Zurich, Switzerland.,Epitrack, Recife, Brazil
| | - Oswaldo Cruz
- Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jones Albuquerque
- Epitrack, Recife, Brazil.,Immunopathology Lab Keizo Asami, Recife, Brazil
| | | | | | | | - Marlo Libel
- Ending Pandemics, San Francisco, CA, United States
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Crawley A, Paolotti D, Dalton C, Brownstein J, Smolinski M. Global flu view: a platform to connect crowdsourced disease surveillance around the world. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Leal Neto O, Dimech GS, Libel M, de Souza WV, Cesse E, Smolinski M, Oliveira W, Albuquerque J. Saúde na Copa: The World's First Application of Participatory Surveillance for a Mass Gathering at FIFA World Cup 2014, Brazil. JMIR Public Health Surveill 2017; 3:e26. [PMID: 28473308 PMCID: PMC5438444 DOI: 10.2196/publichealth.7313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/23/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background The 2005 International Health Regulations (IHRs) established parameters for event assessments and notifications that may constitute public health emergencies of international concern. These requirements and parameters opened up space for the use of nonofficial mechanisms (such as websites, blogs, and social networks) and technological improvements of communication that can streamline the detection, monitoring, and response to health problems, and thus reduce damage caused by these problems. Specifically, the revised IHR created space for participatory surveillance to function, in addition to the traditional surveillance mechanisms of detection, monitoring, and response. Participatory surveillance is based on crowdsourcing methods that collect information from society and then return the collective knowledge gained from that information back to society. The spread of digital social networks and wiki-style knowledge platforms has created a very favorable environment for this model of production and social control of information. Objective The aim of this study was to describe the use of a participatory surveillance app, Healthy Cup, for the early detection of acute disease outbreaks during the Fédération Internationale de Football Association (FIFA) World Cup 2014. Our focus was on three specific syndromes (respiratory, diarrheal, and rash) related to six diseases that were considered important in a mass gathering context (influenza, measles, rubella, cholera, acute diarrhea, and dengue fever). Methods From May 12 to July 13, 2014, users from anywhere in the world were able to download the Healthy Cup app and record their health condition, reporting whether they were good, very good, ill, or very ill. For users that reported being ill or very ill, a screen with a list of 10 symptoms was displayed. Participatory surveillance allows for the real-time identification of aggregates of symptoms that indicate possible cases of infectious diseases. Results From May 12 through July 13, 2014, there were 9434 downloads of the Healthy Cup app and 7155 (75.84%) registered users. Among the registered users, 4706 (4706/7155, 65.77%) were active users who posted a total of 47,879 times during the study period. The maximum number of users that signed up in one day occurred on May 30, 2014, the day that the app was officially launched by the Minister of Health during a press conference. During this event, the Minister of Health announced the special government program Health in the World Cup on national television media. On that date, 3633 logins were recorded, which accounted for more than half of all sign-ups across the entire duration of the study (50.78%, 3633/7155). Conclusions Participatory surveillance through community engagement is an innovative way to conduct epidemiological surveillance. Compared to traditional epidemiological surveillance, advantages include lower costs of data acquisition, timeliness of information collected and shared, platform scalability, and capacity for integration between the population being served and public health services.
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Affiliation(s)
- Onicio Leal Neto
- EpitrackRecifeBrazil.,SingularityU Recife ChapterRecifeBrazil.,Aggeu Magalhães Research CenterDepartament of Health CollectiveRecifeBrazil
| | | | - Marlo Libel
- Skoll Global Threats FundPandemics TeamSan Francisco, CAUnited States
| | | | - Eduarda Cesse
- Aggeu Magalhães Research CenterDepartament of Public HealthRecifeBrazil
| | - Mark Smolinski
- Skoll Global Threats FundPandemics TeamSan Francisco, CAUnited States
| | - Wanderson Oliveira
- Brazil's Ministry of HealthGeneral Coordination of Public Health Emergencies ResponseBrasiliaBrazil
| | - Jones Albuquerque
- EpitrackRecifeBrazil.,Federal Rural University of PernambucoInformatics DepartamentRecifeBrazil
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10
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Baltrusaitis K, Santillana M, Crawley AW, Chunara R, Smolinski M, Brownstein JS. Determinants of Participants' Follow-Up and Characterization of Representativeness in Flu Near You, A Participatory Disease Surveillance System. JMIR Public Health Surveill 2017; 3:e18. [PMID: 28389417 PMCID: PMC5400887 DOI: 10.2196/publichealth.7304] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/03/2017] [Accepted: 03/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background Flu Near You (FNY) is an Internet-based participatory surveillance system in the United States and Canada that allows volunteers to report influenza-like symptoms using a brief weekly symptom report. Objective Our objective was to evaluate the representativeness of the FNY population compared with the general population of the United States, explore the demographic and behavioral characteristics associated with FNY’s high-participation users, and summarize results from a user survey of a cohort of FNY participants. Methods We compared (1) the representativeness of sex and age groups of FNY participants during the 2014-2015 flu season versus the general US population and (2) the distribution of Human Development Index (HDI) scores of FNY participants versus that of the general US population. We analyzed associations between demographic and behavioral factors and the level of participant follow-up (ie, high vs low). Finally, descriptive statistics of responses from FNY’s 2015 and 2016 end-of-season user surveys were calculated. Results During the 2014-2015 influenza season, 47,234 unique participants had at least one FNY symptom report that was either self-reported (users) or submitted on their behalf (household members). The proportion of female FNY participants was significantly higher than that of the general US population (n=28,906, 61.2% vs 51.1%, P<.001). Although each age group was represented in the FNY population, the age distribution was significantly different from that of the US population (P<.001). Compared with the US population, FNY had a greater proportion of individuals with HDI >5.0, signaling that the FNY user distribution was more affluent and educated than the US population baseline. We found that high-participation use (ie, higher participation in follow-up symptom reports) was associated with sex (females were 25% less likely than men to be high-participation users), higher HDI, not reporting an influenza-like illness at the first symptom report, older age, and reporting for household members (all differences between high- and low-participation users P<.001). Approximately 10% of FNY users completed an additional survey at the end of the flu season that assessed detailed user characteristics (3217/33,324 in 2015; 4850/44,313 in 2016). Of these users, most identified as being either retired or employed in the health, education, and social services sectors and indicated that they achieved a bachelor’s degree or higher. Conclusions The representativeness of the FNY population and characteristics of its high-participation users are consistent with what has been observed in other Internet-based influenza surveillance systems. With targeted recruitment of underrepresented populations, FNY may improve as a complementary system to timely tracking of flu activity, especially in populations that do not seek medical attention and in areas with poor official surveillance data.
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Affiliation(s)
- Kristin Baltrusaitis
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Mauricio Santillana
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard School of Engineering and Applied Sciences, Cambridge, MA, United States
| | - Adam W Crawley
- Skoll Global Threats Fund, San Francisco, CA, United States
| | - Rumi Chunara
- The Global Institute of Public Health, New York University, New York, NY, United States.,Computer Science & Engineering, New York University, New York, NY, United States
| | - Mark Smolinski
- Skoll Global Threats Fund, San Francisco, CA, United States
| | - John S Brownstein
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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12
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Chunara R, Aman S, Smolinski M, Brownstein JS. Flu Near You: An Online Self-reported Influenza Surveillance System in the USA. Online J Public Health Inform 2013. [PMCID: PMC3692780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective Introduction Methods Results Conclusions
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Affiliation(s)
- Rumi Chunara
- Harvard Medical School, Boston, MA, USA;,Boston Children’s Hospital, Boston, MA, USA;,Rumi Chunara, E-mail:
| | - Susan Aman
- Boston Children’s Hospital, Boston, MA, USA
| | | | - John S. Brownstein
- Harvard Medical School, Boston, MA, USA;,Boston Children’s Hospital, Boston, MA, USA
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Coyne JC, Schwenk TL, Smolinski M. Recognizing depression: a comparison of family physician ratings, self-report, and interview measures. J Am Board Fam Pract 1991. [PMID: 1927587 DOI: 10.3122/jabfm.4.4.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Major depressive disorder is the most common diagnosis encountered in family practice, yet family physicians are relatively unlikely to make the diagnosis. This study compared physician ratings of depression with scores from the Center for Epidemiological Studies-Depression (CES-D) questionnaire and with telephone interview diagnoses of depression using the 3rd revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for major depressive disorder in a population of 266 patients in community-based family practices. Additional assessments were made of health status, stress, social support, prescribed psychotropic medication, and counseling. The prevalence of positive questionnaire scores in this population was 22.6 percent, and the prevalence of major depressive disorder (based on telephone interview) was 8 percent. Physician ratings of depression were relatively inaccurate when compared with either CES-D scores or telephone interview diagnoses. Optimum specificity (80 percent) and sensitivity (50 percent) with telephone interview diagnoses were achieved when physicians rated the patient as having any depression versus having no depression. Physician ratings of depression were correlated with their assessment of patient stress, social support, and physical health but not with more objective measures of these variables. When compared with telephone interview diagnosis, the sensitivity and specificity of the CES-D scores were relatively poor, suggesting that the CES-D is not useful as a screening tool for unselected populations. Finally, we found that family physicians base their assessments of depression more on distress than on depressive symptoms. Certain physician myths, barriers, and biases may exist that preclude the effective diagnosis of depression.
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Affiliation(s)
- J C Coyne
- Department of Family Practice, University of Michigan Medical Center, Ann Arbor 48109-0708
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Dăncescu P, Smolinski M, Tintăreanu J. Studies on the prevalence and the intensity of the infection with soil-transmitted helminths in Romania. Arch Roum Pathol Exp Microbiol 1971; 30:413-25. [PMID: 5150504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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15
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Duca M, Duca E, Bernescu E, Alexandrescu M, Buiuc D, Moroşanu V, Teodorovici G, Ivan A, Năstase A, Smolinski M, Straton C, Luca V. [Virological and seroepidemiological studies of the circulation of arboviruses of group B in Rumanian territory]. Rev Med Chir Soc Med Nat Iasi 1970; 74:381-9. [PMID: 5447566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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16
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Lupaşco G, Bossie A, Bona C, Ioanid L, Smolinski M, Negulici E, Cristesco A. [Value of immunofluorescence reaction in detection of P. malariae infections and the dynamics of antibody titers during infection and after radical treatment]. Arch Roum Pathol Exp Microbiol 1969; 28:157-66. [PMID: 5408303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lupascu G, Bossie-Agavriloaei A, Ioanid L, Bona C, Smolinski M, Negulici E, Florescu C. [Serological evolution of infection by Plasmodium malariae: variations of fluorescent antibody titre after radical treatment]. Bull World Health Organ 1969; 40:312-9. [PMID: 4897339 PMCID: PMC2554614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Duca M, Duca E, Moroşanu V, Buiuc D, Smolinski M, Voiculescu A. [Antibodies against Arbovurus B in humans and domestic animals in southwestern Rumania]. Rev Med Chir Soc Med Nat Iasi 1968; 72:677-82. [PMID: 5693774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Lupaşco G, Dăncesco P, Tînţăreanu J, Smolinski M. [Studies on the epidemiology of strongyloidosis in Rumania]. Arch Roum Pathol Exp Microbiol 1967; 26:551-6. [PMID: 5591580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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20
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Hacig A, Solomon P, Ianco L, Smolinski M. [Value of various standardized antigens of Trichinella spiralis evaluated by the intradermoreaction test]. Arch Roum Pathol Exp Microbiol 1967; 26:273-8. [PMID: 5589817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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21
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Lupascu G, Bossie-Agavriloaei A, Bona C, Ioanid L, Smolinski M. [The value of the immunofluorescent reaction in the detection of asymptomatic parasitemia due to Plasmodium malariae]. Bull World Health Organ 1967; 36:485-90. [PMID: 4864306 PMCID: PMC2476311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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22
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Lupaşcu G, Tinţăreanu J, Solomon P, Smolinski M. [Aspects concerning the organization of control of teniasis (Taenia solium)]. Microbiol Parazitol Epidemiol (Bucur) 1966; 11:257-263. [PMID: 5967208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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23
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Dranga A, Marinov R, Smolinski M. [Epidemiology of diphyllobothriasis in the Danube delta]. Rev Med Chir Soc Med Nat Iasi 1966; 70:153-6. [PMID: 5936603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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24
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Lupaşcu G, Panaitescu D, Smolinski M. [Criteria and methods of preventing and combating helminthiasis]. Microbiol Parazitol Epidemiol (Bucur) 1965; 10:533-50. [PMID: 5863230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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25
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Lupaşcu G, Hacig A, Tintăreanu J, Solomon P, Smolinski M. [Diagnostic methods in trichinellosis. Value of immunobiological diagnosis in the study of apparent foci in the Rumanian People's Republic]. Microbiol Parazitol Epidemiol (Bucur) 1965; 10:233-44. [PMID: 5845684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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26
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Ciucă M, Lupaşco G, Bossie-Agavriloaei A, Smolinski M, Işfan T, Atanasiu M, Constantinesco G, Scarlat M, Gima I, Luscalu A, Voicoulesco A, Voicoulesco P. [The evolution of endemic malaria in the Vedea and Teleorman river basins within the framework of the program of eradication. Efficiency of the epidemiological surveillance]. Arch Roum Pathol Exp Microbiol 1964; 23:555-72. [PMID: 5830280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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