JMIR Publications

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  Surveillance Systems

  Jun 15, 2018

  A Surveillance Infrastructure for Malaria Analytics: Provisioning Data Access and Preservation of Interoperability

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  Authors List:

  • Mohammad Sadnan Al Manir  
  • Jon Haël Brenas  
  • Christopher JO Baker  
  • Arash Shaban-Nejad  

  Abstract:

  Background: According to the World Health Organization, malaria surveillance is weakest in countries and regions with the highest malaria burden. A core obstacle is that the data required to perform malaria surveillance are fragmented in multiple data silos distributed across geographic regions. Furthermore, consistent integrated malaria data sources are few, and a low degree of interoperability exists between them. As a result, it is difficult to identify disease trends and to plan for effective interventions. Objective: We propose the Semantics, Interoperability, and Evolution for Malaria Analytics (SIEMA) platform for use in malaria surveillance based on semantic data federation. Using this approach, it is possible to access distributed data, extend and preserve interoperability between multiple dynamic distributed malaria sources, and facilitate detection of system changes that can interrupt mission-critical global surveillance activities. Methods: We used Semantic Automated Discovery and Integration (SADI) Semantic Web Services to enable data access and improve interoperability, and the graphical user interface-enabled semantic query engine HYDRA to implement the target queries typical of malaria programs. We implemented a custom algorithm to detect changes to community-developed terminologies, data sources, and services that are core to SIEMA. This algorithm reports to a dashboard. Valet SADI is used to mitigate the impact of changes by rebuilding affected services. Results: We developed a prototype surveillance and change management platform from a combination of third-party tools, community-developed terminologies, and custom algorithms. We illustrated a methodology and core infrastructure to facilitate interoperable access to distributed data sources using SADI Semantic Web services. This degree of access makes it possible to implement complex queries needed by our user community with minimal technical skill. We implemented a dashboard that reports on terminology changes that can render the services inactive, jeopardizing system interoperability. Using this information, end users can control and reactively rebuild services to preserve interoperability and minimize service downtime. Conclusions: We introduce a framework suitable for use in malaria surveillance that supports the creation of flexible surveillance queries across distributed data resources. The platform provides interoperable access to target data sources, is domain agnostic, and with updates to core terminological resources is readily transferable to other surveillance activities. A dashboard enables users to review changes to the infrastructure and invoke system updates. The platform significantly extends the range of functionalities offered by malaria information systems, beyond the state-of-the-art.

  • JMIR Public Health Surveill 2018;4(2):e10218

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  Infoveillance, Infodemiology and...

  Jun 6, 2018

  Identifying Methods for Monitoring Foodborne Illness: Review of Existing Public Health Surveillance Techniques

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  Authors List:

  • Rachel A Oldroyd  
  • Michelle A Morris  
  • Mark Birkin  

  Abstract:

  Background: Traditional methods of monitoring foodborne illness are associated with problems of untimeliness and underreporting. In recent years, alternative data sources such as social media data have been used to monitor the incidence of disease in the population (infodemiology and infoveillance). These data sources prove timelier than traditional general practitioner data, they can help to fill the gaps in the reporting process, and they often include additional metadata that is useful for supplementary research. Objective: The aim of the study was to identify and formally analyze research papers using consumer-generated data, such as social media data or restaurant reviews, to quantify a disease or public health ailment. Studies of this nature are scarce within the food safety domain, therefore identification and understanding of transferrable methods in other health-related fields are of particular interest. Methods: Structured scoping methods were used to identify and analyze primary research papers using consumer-generated data for disease or public health surveillance. The title, abstract, and keyword fields of 5 databases were searched using predetermined search terms. A total of 5239 papers matched the search criteria, of which 145 were taken to full-text review—62 papers were deemed relevant and were subjected to data characterization and thematic analysis. Results: The majority of studies (40/62, 65%) focused on the surveillance of influenza-like illness. Only 10 studies (16%) used consumer-generated data to monitor outbreaks of foodborne illness. Twitter data (58/62, 94%) and Yelp reviews (3/62, 5%) were the most commonly used data sources. Studies reporting high correlations against baseline statistics used advanced statistical and computational approaches to calculate the incidence of disease. These include classification and regression approaches, clustering approaches, and lexicon-based approaches. Although they are computationally intensive due to the requirement of training data, studies using classification approaches reported the best performance. Conclusions: By analyzing studies in digital epidemiology, computer science, and public health, this paper has identified and analyzed methods of disease monitoring that can be transferred to foodborne disease surveillance. These methods fall into 4 main categories: basic approach, classification and regression, clustering approaches, and lexicon-based approaches. Although studies using a basic approach to calculate disease incidence generally report good performance against baseline measures, they are sensitive to chatter generated by media reports. More computationally advanced approaches are required to filter spurious messages and protect predictive systems against false alarms. Research using consumer-generated data for monitoring influenza-like illness is expansive; however, research regarding the use of restaurant reviews and social media data in the context of food safety is limited. Considering the advantages reported in this review, methods using consumer-generated data for foodborne disease surveillance warrant further investment.

  • JMIR Public Health Surveill 2018;4(2):e57

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  Mass Media/Social Media Communication...

  Jun 5, 2018

  Junk Food Marketing on Instagram: Content Analysis

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  Authors List:

  • Amy Jo Vassallo  
  • Bridget Kelly  
  • Lelin Zhang  
  • Zhiyong Wang  
  • Sarah Young  
  • Becky Freeman  

  Abstract:

  Background: Omnipresent marketing of processed foods is a key driver of dietary choices and brand loyalty. Market data indicate a shift in food marketing expenditures to digital media, including social media. These platforms have greater potential to influence young people, given their unique peer-to-peer transmission and youths’ susceptibility to social pressures. Objective: The aim of this study was to investigate the frequency of images and videos posted by the most popular, energy-dense, nutrient-poor food and beverage brands on Instagram and the marketing strategies used in these images, including any healthy choice claims. Methods: A content analysis of 15 accounts was conducted, using 12 months of Instagram posts from March 15, 2015, to March 15, 2016. A pre-established hierarchical coding guide was used to identify the primary marketing strategy of each post. Results: Each brand used 6 to 11 different marketing strategies in their Instagram accounts; however, they often adhered to an overall theme such as athleticism or relatable consumers. There was a high level of branding, although not necessarily product information on all accounts, and there were very few health claims. Conclusions: Brands are using social media platforms such as Instagram to market their products to a growing number of consumers, using a high frequency of targeted and curated posts that manipulate consumer emotions rather than present information about their products. Policy action is needed that better reflects the current media environment. Public health bodies also need to engage with emerging media platforms and develop compelling social counter-marketing campaigns.

  • JMIR Public Health Surveill 2018;4(2):e54

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  Instruments and Questionnaires for...

  May 30, 2018

  Accurately Inferring Compliance to Five Major Food Guidelines Through Simplified Surveys: Applying Data Mining to the UK National Diet and Nutrition Survey

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  Authors List:

  • Nicholas Rosso  
  • Philippe Giabbanelli  

  Abstract:

  Background: National surveys in public health nutrition commonly record the weight of every food consumed by an individual. However, if the goal is to identify whether individuals are in compliance with the 5 main national nutritional guidelines (sodium, saturated fats, sugars, fruit and vegetables, and fats), much less information may be needed. A previous study showed that tracking only 2.89% of all foods (113/3911) was sufficient to accurately identify compliance. Further reducing the data needs could lower participation burden, thus decreasing the costs for monitoring national compliance with key guidelines. Objective: This study aimed to assess whether national public health nutrition surveys can be further simplified by only recording whether a food was consumed, rather than having to weigh it. Methods: Our dataset came from a generalized sample of inhabitants in the United Kingdom, more specifically from the National Diet and Nutrition Survey 2008-2012. After simplifying food consumptions to a binary value (1 if an individual consumed a food and 0 otherwise), we built and optimized decision trees to find whether the foods could accurately predict compliance with the major 5 nutritional guidelines. Results: When using decision trees of a similar size to previous studies (ie, involving as many foods), we were able to correctly infer compliance for the 5 guidelines with an average accuracy of 80.1%. This is an average increase of 2.5 percentage points over a previous study, showing that further simplifying the surveys can actually yield more robust estimates. When we allowed the new decision trees to use slightly more foods than in previous studies, we were able to optimize the performance with an average increase of 3.1 percentage points. Conclusions: Although one may expect a further simplification of surveys to decrease accuracy, our study found that public health dietary surveys can be simplified (from accurately weighing items to simply checking whether they were consumed) while improving accuracy. One possibility is that the simplification reduced noise and made it easier for patterns to emerge. Using simplified surveys will allow to monitor public health nutrition in a more cost-effective manner and possibly decrease the number of errors as participation burden is reduced.

  • JMIR Public Health Surveill 2018;4(2):e56

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  Infoveillance, Infodemiology and...

  May 28, 2018

  New Tobacco and Tobacco-Related Products: Early Detection of Product Development, Marketing Strategies, and Consumer Interest

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  Authors List:

  • Yvonne CM Staal  
  • Suzanne van de Nobelen  
  • Anne Havermans  
  • Reinskje Talhout  

  Abstract:

  Background: A wide variety of new tobacco and tobacco-related products have emerged on the market in recent years. Objective: To understand their potential implications for public health and to guide tobacco control efforts, we have used an infoveillance approach to identify new tobacco and tobacco-related products. Methods: Our search for tobacco(-related) products consists of several tailored search profiles using combinations of keywords such as “e-cigarette” and “new” to extract information from almost 9000 preselected sources such as websites of online shops, tobacco manufacturers, and news sites. Results: Developments in e-cigarette design characteristics show a trend toward customization by possibilities to adjust temperature and airflow, and by the large variety of flavors of e-liquids. Additionally, more e-cigarettes are equipped with personalized accessories, such as mobile phones, applications, and Bluetooth. Waterpipe products follow the trend toward electronic vaping. Various heat-not-burn products were reintroduced to the market. Conclusions: Our search for tobacco(-related) products was specific and timely, though advances in product development require ongoing optimization of the search strategy. Our results show a trend toward products resembling tobacco cigarettes vaporizers that can be adapted to the consumers’ needs. Our search for tobacco(-related) products could aid in the assessment of the likelihood of new products to gain market share, as a possible health risk or as an indicator for the need on independent and reliable information of the product to the general public.

  • JMIR Public Health Surveill 2018;4(2):e55

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  Theme Issue 2017: Improving Global...

  May 22, 2018

  Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review

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  Authors List:

  • Sharon Stucker Weir  
  • Stefan D Baral  
  • Jessie K Edwards  
  • Sabrina Zadrozny  
  • James Hargreaves  
  • Jinkou Zhao  
  • Keith Sabin  

  Abstract:

  Background: Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately. Objective: The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs. Methods: To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched. Results: There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations. Conclusions: Current reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized.

  • JMIR Public Health Surveill 2018;4(2):e28

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  Letter to the Editor

  May 15, 2018

  Overcoming Barriers to HIV Prevention and Healthcare Among Sub-Saharan African Migrants in Spain

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  Authors List:

  • Miriam Navarro  
  • Bárbara Navaza  
  • Anne Guionnet  
  • Rogelio López-Vélez  

  Abstract:

  • JMIR Public Health Surveill 2018;4(2):e10478

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  Pharmacovigilance

  May 9, 2018

  Causality Patterns for Detecting Adverse Drug Reactions From Social Media: Text Mining Approach

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  Authors List:

  • Danushka Bollegala  
  • Simon Maskell  
  • Richard Sloane  
  • Joanna Hajne  
  • Munir Pirmohamed  

  Abstract:

  Background: Detecting adverse drug reactions (ADRs) is an important task that has direct implications for the use of that drug. If we can detect previously unknown ADRs as quickly as possible, then this information can be provided to the regulators, pharmaceutical companies, and health care organizations, thereby potentially reducing drug-related morbidity and saving lives of many patients. A promising approach for detecting ADRs is to use social media platforms such as Twitter and Facebook. A high level of correlation between a drug name and an event may be an indication of a potential adverse reaction associated with that drug. Although numerous association measures have been proposed by the signal detection community for identifying ADRs, these measures are limited in that they detect correlations but often ignore causality. Objective: This study aimed to propose a causality measure that can detect an adverse reaction that is caused by a drug rather than merely being a correlated signal. Methods: To the best of our knowledge, this was the first causality-sensitive approach for detecting ADRs from social media. Specifically, the relationship between a drug and an event was represented using a set of automatically extracted lexical patterns. We then learned the weights for the extracted lexical patterns that indicate their reliability for expressing an adverse reaction of a given drug. Results: Our proposed method obtains an ADR detection accuracy of 74% on a large-scale manually annotated dataset of tweets, covering a standard set of drugs and adverse reactions. Conclusions: By using lexical patterns, we can accurately detect the causality between drugs and adverse reaction–related events.

  • JMIR Public Health Surveill 2018;4(2):e51

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  Behavioural Surveillance for Public...

  May 4, 2018

  The Acceptability and Feasibility of Implementing a Bio-Behavioral Enhanced Surveillance Tool for Sexually Transmitted Infections in England: Mixed-Methods...

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  Authors List:

  • Sonali Wayal  
  • David Reid  
  • Paula B Blomquist  
  • Peter Weatherburn  
  • Catherine H Mercer  
  • Gwenda Hughes  

  Abstract:

  Background: Sexually transmitted infection (STI) surveillance is vital for tracking the scale and pattern of epidemics; however, it often lacks data on the underlying drivers of STIs. Objective: This study aimed to assess the acceptability and feasibility of implementing a bio-behavioral enhanced surveillance tool, comprising a self-administered Web-based survey among sexual health clinic attendees, as well as linking this to their electronic health records (EHR) held in England’s national STI surveillance system. Methods: Staff from 19 purposively selected sexual health clinics across England and men who have sex with men and black Caribbeans, because of high STI burden among these groups, were interviewed to assess the acceptability of the proposed bio-behavioral enhanced surveillance tool. Subsequently, sexual health clinic staff invited all attendees to complete a Web-based survey on drivers of STI risk using a study tablet or participants’ own digital device. They recorded the number of attendees invited and participants’ clinic numbers, which were used to link survey data to the EHR. Participants’ online consent was obtained, separately for survey participation and linkage. In postimplementation phase, sexual health clinic staff were reinterviewed to assess the feasibility of implementing the bio-behavioral enhanced surveillance tool. Acceptability and feasibility of implementing the bio-behavioral enhanced surveillance tool were assessed by analyzing these qualitative and quantitative data. Results: Prior to implementation of the bio-behavioral enhanced surveillance tool, sexual health clinic staff and attendees emphasized the importance of free internet/Wi-Fi access, confidentiality, and anonymity for increasing the acceptability of the bio-behavioral enhanced surveillance tool among attendees. Implementation of the bio-behavioral enhanced surveillance tool across sexual health clinics varied considerably and was influenced by sexual health clinics’ culture of prioritization of research and innovation and availability of resources for implementing the surveys. Of the 7367 attendees invited, 85.28% (6283) agreed to participate. Of these, 72.97% (4585/6283) consented to participate in the survey, and 70.62% (4437/6283) were eligible and completed it. Of these, 91.19% (4046/4437) consented to EHR linkage, which did not differ by age or gender but was higher among gay/bisexual men than heterosexual men (95.50%, 722/756 vs 88.31%, 1073/1215; P<.003) and lower among black Caribbeans than white participants (87.25%, 568/651 vs 93.89%, 2181/2323; P<.002). Linkage was achieved for 88.88% (3596/4046) of consenting participants. Conclusions: Implementing a bio-behavioral enhanced surveillance tool in sexual health clinics was feasible and acceptable to staff and groups at STI risk; however, ensuring participants’ confidentiality and anonymity and availability of resources is vital. Bio-behavioral enhanced surveillance tools could enable timely collection of detailed behavioral data for effective commissioning of sexual health services.

  • JMIR Public Health Surveill 2018;4(2):e52

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  HIV/AIDS/STI Prevention and Care

  May 4, 2018

  Trends in HIV Terminology: Text Mining and Data Visualization Assessment of International AIDS Conference Abstracts Over 25 Years

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  Authors List:

  • Nicole Dancy-Scott  
  • Gale A Dutcher  
  • Alla Keselman  
  • Colette Hochstein  
  • Christina Copty  
  • Diane Ben-Senia  
  • Sampada Rajan  
  • Maria Guadalupe Asencio  
  • Jason Jongwon Choi  

  Abstract:

  Background: The language encompassing health conditions can also influence behaviors that affect health outcomes. Few published quantitative studies have been conducted that evaluate HIV-related terminology changes over time. To expand this research, this study included an analysis of a dataset of abstracts presented at the International AIDS Conference (IAC) from 1989 to 2014. These abstracts reflect the global response to HIV over 25 years. Two powerful methodologies were used to evaluate the dataset: text mining to convert the unstructured information into structured data for analysis and data visualization to represent the data visually to assess trends. Objective: The purpose of this project was to evaluate the evolving use of HIV-related language in abstracts presented at the IAC from 1989 to 2014. Methods: Over 80,000 abstracts were obtained from the International AIDS Society and imported into a Microsoft SQL Server database for data processing and text mining analyses. A text mining module within the KNIME Analytics Platform, an open source software, was then used to mine the partially processed data to create a terminology corpus of key HIV terms. Subject matter experts grouped the terms into categories. Tableau, a data visualization software, was used to visualize the frequency metrics associated with the terms as line graphs and word clouds. The visualized dashboards were reviewed to discern changes in terminology use across IAC years. Results: The major findings identify trends in HIV-related terminology over 25 years. The term “AIDS epidemic” was dominantly used from 1989 to 1991 and then declined in use. In contrast, use of the term “HIV epidemic” increased through 2014. Beginning in the mid-1990s, the term “treatment experienced” appeared with increasing frequency in the abstracts. Use of terms identifying individuals as “carriers or victims” of HIV rarely appeared after 2008. Use of the terms “HIV positive” and “HIV infected” peaked in the early-1990s and then declined in use. The terms “men who have sex with men” and “MSM” were rarely used until 1994; subsequently, use of these terms increased through 2014. The term “sex worker” steadily increased in frequency throughout conference years, whereas the term “prostitute” decreased over time. Conclusions: The results of this study highlight changes in HIV terminology use over 25 years, including the addition, disappearance, and changing use of terms that reflect advances in HIV research and medical practice and destigmatization of the disease. Coupled with findings from related quantitative research, HIV-related terminology recommendations based on results of this study are included. Adoption of these recommendations will further efforts to use less stigmatizing language and facilitate effective communication between health professionals and people affected by HIV.

  • JMIR Public Health Surveill 2018;4(2):e50

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  HIV/AIDS/STI Prevention and Care

  May 3, 2018

  Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study

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  Authors List:

  • Shruta Rawat  
  • J Michael Wilkerson  
  • Sylvia M Lawler  
  • Pallav Patankar  
  • BR Simon Rosser  
  • Kanjani Shukla  
  • Seyram Butame  
  • Maria L Ekstrand  

  Abstract:

  Background: As Internet and mobile phone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras (transgender women), hesitant to access traditional health care systems. Objective: The purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be useful in targeting the prevention of HIV acquisition and to increase the quality of life among persons living with HIV/AIDS. Methods: Data from 4 focus groups with MSM and interviews with 4 hijras, 10 health service providers, and 8 mHealth developers were thematically analyzed. Results: Once the need for an mHealth intervention was confirmed, comments about features were organized into 3 themes: content, interface, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Interface subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geolocation to link to just-in-time services; and using telemedicine to increase access to health service providers and community services. The 5 retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps. Conclusions: These findings may help inform mHealth development in India.

  • JMIR Public Health Surveill 2018;4(2):e46

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  Public Health Informatics

  May 3, 2018

  Improving Visualization of Female Breast Cancer Survival Estimates: Analysis Using Interactive Mapping Reports

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  Authors List:

  • Awatef Ahmed Ben Ramadan  
  • Jeannette Jackson-Thompson  
  • Chester Lee Schmaltz  

  Abstract:

  Background: The Missouri Cancer Registry collects population-based cancer incidence data on Missouri residents diagnosed with reportable malignant neoplasms. The Missouri Cancer Registry wanted to produce data that would be of interest to lawmakers as well as public health officials at the legislative district level on breast cancer, the most common non-skin cancer among females. Objective: The aim was to measure and interactively visualize survival data of female breast cancer cases in the Missouri Cancer Registry. Methods: Female breast cancer data were linked to Missouri death records and the Social Security Death Index. Unlinked female breast cancer cases were crossmatched to the National Death Index. Female breast cancer cases in subcounty senate districts were geocoded using TIGER/Line shapefiles to identify their district. A database was created and analyzed in SEER*Stat. Senatorial district maps were created using US Census Bureau’s cartographic boundary files. The results were loaded with the cartographic data into InstantAtlas software to produce interactive mapping reports. Results: Female breast cancer survival profiles of 5-year cause-specific survival percentages and 95% confidence intervals, displayed in tables and interactive maps, were created for all 34 senatorial districts. The maps visualized survival data by age, race, stage, and grade at diagnosis for the period from 2004 through 2010. Conclusions: Linking cancer registry data to the National Death Index database improved accuracy of female breast cancer survival data in Missouri and this could positively impact cancer research and policy. The created survival mapping report could be very informative and usable by public health professionals, policy makers, at-risk women, and the public.

  • JMIR Public Health Surveill 2018;4(2):e42

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