Création d'un algorithme d'identification d'expériences vécues par des patients ou leurs proches à partir de messages issus des réseaux sociaux : un cas d'usage sur le COVID long

Introduction

La pandémie de COVID-19 a entrainé une masse d'informations sur les réseaux sociaux et forums provenant de multiples acteurs : gouvernements, journalistes ou encore citoyens. Parmi ces messages, de nombreux patients se sont saisis de ces outils pour partager leurs symptômes et se regrouper en communauté, comme c'est le cas des patients atteints de COVID long avec le hashtag #aprèsJ20. Un algorithme de traitement automatique du langage naturel capable d'identifier les messages constituant des expériences de santé vécues par des patients ou des proches permettrait d'exploiter ces données de vie réelle dans un objectif de santé publique.

Méthodes

A partir de différentes sources, 12 430 messages issus de forums et réseaux sociaux (Twitter, Facebook) ont été extraits sur différentes pathologies : cancer (sans précision d'une localisation), diabète, maladie de Fabry, COVID-19, sevrage tabagique. Ces messages ont été manuellement analysées et codifiées en trois catégories selon la nature de l'internaute : patient/aidant ou proche/répondant. Sur la base de ce « gold standard », un modèle de « machine learning » a été créé et entrainé, couplé avec des champs lexicaux marqueurs d'expériences vécues (par exemple, la présence d'un récit à la première personne ou du champ lexical de la famille). Deux modèles Xgboost ont été choisis permettant de déterminer en premier lieu si l'internaute est un proche de malade ou non, puis dans un second temps, si c'est un patient ou non. Pour être validé, ce modèle a été appliqué sur des messages spécifiques au COVID long. Une sélection aléatoire de ces messages couplée à une annotation par trois annotateurs a permis de mesurer les performances du modèle.

Résultats

Après application de l'algorithme d'identification d'expériences vécues par des patients ou des proches, 700 messages ont été revus et annotés sur le COVID long. Les catégories patients et aidants ont été regroupées en raison des nombreux cas de formes familiales de COVID long rapportés sur les réseaux sociaux. Les performances du modèle ont permis de mesurer une sensibilité de 96 %, une spécificité de 76 %, une « accuracy » à 87 % et une précision de 84 %.

Conclusion

Un algorithme identifiant les expériences vécues par des patients ou des proches au sein des messages issus des réseaux sociaux facilite leur utilisation comme données de vie réelle. Les bonnes performances de l'algorithme, notamment sur les formes longues de COVID-19, permettent un suivi prospectif de ces patients dans un objectif de santé publique. Une future version du modèle devra intégrer la possibilité d'identifier au sein d'un même message la présence d'expériences à la fois de patients et de proches, notamment en cas de formes familiales (”mon fils et moi avons un covid long ”).

Déclaration de liens d'intérêts

Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy

Background

During the Covid-19 pandemic fake news has been circulating impacting on the general population’s opinion about a vaccine against the SARS-CoV-2. Health literacy measures the capacity of navigating health information.

Methods

We used data from a prospective national online cohort of 1647 participants. Descriptive statistics, Chi2 and ANOVA independence tests and two multivariable multinomial regression models were performed. Interactions between each variable were tested.

Results

Detection of fake news and health literacy scores were associated with intention to get vaccinated against SARS-CoV-2 (p < 0.01). The risk of being “anti-vaccination” or “hesitant”, rather than “pro-vaccination”, was higher among individuals reporting bad detection of fake news, respectively OR = 1.93 (95%CI = [1.30;2.87]) and OR = 1.80 (95%CI = [1.29;2.52]). The risk of being in “hesitant”, rather than “pro-vaccination” was higher among individuals having a bad health literacy score (OR = 1.44; 95%CI = [1.04;2.00]). No interaction was found between detection of fake news and health literacy.

Conclusions

To promote acceptance of a vaccine against SARS-CoV-2, it is recommended to increase individuals’ ability to detect fake news and health literacy through education and communication programs.

Spatio-temporal patterns of orchids flowering in Cameroonian rainforests

We characterized the flowering patterns of 45 epiphytic orchid species occurring in Cameroonian rainforests to explore the environmental and evolutionary forces driving their phenology. We used a dataset of 3470 flowering events recorded over a period of 11 years in the Yaoundé living collection (82% of the flowering events) and from in situ observations (18% of the flowering events) to (i) describe flowering frequency and timing and synchronization among taxa; (ii) test flowering patterns for phylogenetic relatedness at the generic level; and (iii) investigate the spatial patterns of phenology. An annual flowering pattern prevailed among the species selected for this study. The species-rich African genera Angraecum and Polystachya are characterized by subannual and annual frequency patterns, respectively. However, in terms of flowering time, no phylogenetic signal was detected for the four most diverse genera (Ancistrorhynchus, Angraecum, Bulbophyllum, and Polystachya). Results suggest also an important role of photoperiod and precipitation as climatic triggers of flowering patterns. Moreover, 16% of the taxa cultivated ex situ, mostly Polystachya, showed significant differences in flowering time between individuals originating from distinct climatic regions, pointing toward the existence of phenological ecotypes. Phenological plasticity, suggested by the lack of synchronized flowering in spatially disjunct populations of Polystachya, could explain the widespread radiation of this genus throughout tropical Africa. Our study highlights the need to take the spatial pattern of flowering time into account when interpreting phylogeographic patterns in central African rainforests.

[Incidence of rotavirus gastroenteritis among children under 5 years consulting a paediatrician or a general practitioner in France]

BACKGROUND

Rotavirus (RV) is the main infectious agent of severe acute gastroenteritis (AGE) in infants and children under 5 years. Given the recent availability of new vaccines, it is important to accurately assess the incidence of rotavirus gastroenteritis (GERV) and their medical and epidemiological consequences.

METHODS

This work is the French part of study program called SPRIK, a multicenter, prospective, observational study conducted from October 2005 to May 2007 to estimate the annual incidence of GERV within children under 5 years visiting a general practitioner or pediatrician. It presents data collected by 41 general practitioners and 36 paediatricians located throughout the French metropolitan territory. A stool sample was taken for every child. Rotavirus presence was sought by the physician using a rapid immunochromatographic test. French results are presented in this article.

RESULTS

A total of 1648 GEA episodes corresponding to 1463 eligible patients were included in the study mainly from December to May (peak in February-March). The incidence rate of GERV leading to consultations in general practice was 1357 cases per 100,000 patient-years (PY) (1.36%), with a 95% confidence interval of [1345-1368]. The peak incidence occurs before 2 years. GERV accounted for 21% of all GEA cases seen by paediatricians and general practitioners. Patients with GERV were younger (14.1 ± 10.8 versus 18.4 ± 13.9 months for other GEA, P<0.0001) and had more severe clinical symptoms: presence of fever (32.6% versus 20.0%, P<0.0001), behavioural symptoms (45.6% versus 20.8%, P<0.0001) and dehydration (48.7% versus 21.2%, P<0.0001). GERV episodes were considered severe in 79.7% of cases, using the Vesikari scale. More than 86% patients received oral rehydration during the episode and 13 patients (5.8%) were hospitalized. Nearly 80% GERV episodes were considered severe using the Vesikari scale. Main genotypes were G1P[8] rotavirus (44%) and G9P[8] rotavirus (35%) types.

CONCLUSION

The incidence rate reported in this study is close to results of previous studies done in Europe. The frequency and severity relative to GERV support vaccination in very young children to reduce the burden associated with this pathology.

[Management of patients with benign prostatic hyperplasia by urologists: the DUO study]

The DUO study intended to define the factors determining diagnostic and treatment strategies for benign prostatic hyperplasia (BPH) management.

METHODS

This longitudinal, observational study was conducted in France (June 2004 to March 2005), with a representative sample of private and hospital urologists.

RESULTS

1027 BPH patients were included by 202 urologists and 856 were followed-up 6 months later. Mean I-PSS was 14.9 (+/- 6.7) at inclusion and 10.5 (+/- 6.7) at the follow up visit. At inclusion, pharmacologic treatment was prescribed to 84% of the patients, surgery to 13% and no treatment to 3%. Factors in favour of surgery (versus drugs) were BPH severity (OR = 2.5 if IPSS = 20), patients' choice (OR = 2.5), quality of life improvement (OR = 2.2), post-void residual (OR = 2.1) and dribbling (OR = 1.6). Patients' age and prostatic volume have no impact on this choice. Factors in favour of a combination of an alpha-blocker plus an 5alpha-reductase inhibitor (versus an alpha-blocker) were prostate volume (OR = 7.8), patient's age (OR-3.0 if age = 74) and post-void residual (OR = 2.3) and those in favour of a 5alpha reductase inhibitor (versus an alpha-blocker) were prostate volume (OR = 7.6), PSA results (OR = 5.8), patients' age (OR = 5.4 if > 74 years, OR = 2.1 if > 68 years).

CONCLUSION

Medical or surgical treatment of BPH results in IPSS improvement at 6 months. Patients' age and prostatic volume favour 5alpha-reductase inhibitor initiation and have no impact on surgical treatment decision. Surgery is performed in severe BPH or when patients expecting a quality of life improvement do that choice.

Malformations corticales et épilepsie : apport de l’IRM

Malformations of cortical development are increasingly recognized as important causes of epilepsy, developmental delay and other neurological disorders. Our purpose is to present the relevance of the MRI in these pathologies with the clinical, genetic and therapeutic aspects. This classification is based on the three fundamental events of cortical formation: proliferation of neurons and glie in the periventricular zone, migration of postmitotic neurons to the periphery, subsequent cortical organization. MR analysis evaluates particularly the cortical thickness, sulcal and cortical morphology, gray-white matter junction, and looks for gray matter in abnormal location. These data coupled with the familial history, the seizure characteristics and genetic findings should allow an appropriate classification of the lesions. MR imaging allows the detection and classification of cortical malformations. MR imaging findings are primordial to consider surgery when the epilepsy becomes refractory to the anti-epileptic drugs. An adequate classification of these malformations should help to provide to the family an appropriate counseling both in terms of genetics and outcome.

[The role of aortic morphology in the occurrence of hypertension in patients undergoing surgery for coarctation of the aorta before the age of 1 year]

OBJECTIVE

Hypertension on effort can be observed following surgical treatment of coarctation of the aorta even if the operation has been performed early and has been judged to be satisfactory. The pathophysiology of this hypertension has not been completely elucidated. The aim of our study was to look for a residual morphological anomaly of the aortic arch which might be responsible.

METHODS

This was a retrospective study of patients aged over 10 years who had undergone surgery for coarctation of the aorta before the age of 1 year, consecutively between 1979 and 1993, and free from re-coarctation clinically or with Doppler. All of them had a blood pressure effort test on a cycling machine, echocardiography and an MRI of the thoracic aorta.

RESULTS

61 patients were included. Their median age was 15 years, 59% were male, 15% were hypertensive at rest and 56% on effort. With univariate analysis, only the average blood pressure (p=0.03) and the resting pulse pressure (p=0.001) were associated with hypertension on effort. With multivariate analysis the only factors that correlated independently with maximum arterial pressure on effort were the height of the patient (p=0.02) and the pulse pressure (p<0.0001). The surgical technique and the age at intervention were not associated with hypertension on effort (p=0.96 and 0.69 respectively). The diameter of the horizontal aorta and the aorta at the site of repair, measured on MRI, added to the diameter of the descending aorta at the diaphragm were not lower in patients with hypertension on effort (p=0.77 and 0.38). There were proportionally more Roman type aortic arches than Gothic types in patients with hypertension on effort, but this difference was not significant (p=0.18).

CONCLUSION

In our study, the patients with hypertension on effort following correction of coarctation of the aorta did not display any residual obstruction at the level of the aortic cross on MRI. However, they had a resting pulse pressure that was significantly higher than the non hypertensive patients, reflecting an increase in the aortic wall rigidity.

Mesure des diamètres aortiques dans le suivi IRM des coarctations

OBJECTIVE

During aortic coarctation follow-up, accurate diameter measurements using MRI are required. The purpose of this study was to compare the reproducibility of aortic measurements on axial and sagittal views using black blood (Fast-Spin-Echo) and three-dimensional Gadolinium-enhanced MR angiography.

SUBJECTS AND METHODS

We studied 34 patients who underwent evaluation after surgical treatment in the first year of life. The aortic measurements were made at six thoracic levels. We calculated the mean difference between the two sequences, and used Bland and Altman method and the comparison to zero.

RESULTS

With black blood, either on axial or sagittal views, aortic measurements were in agreement. Between two sequences, we considered as acceptable a mean difference of 0,5 mm with limits of agreement of +/- 3 mm. Difficulties were found for proximal ascending aorta measurements on all sequences. Using MR angiography, the highest agreement at the site of repair was on sagittal view, while the highest agreement at other sites was on axial views.

CONCLUSION

Black blood sequence provides a better reproducibility for aortic measurements than native slices of MR angiography.