News & Analysis Medical News & Perspectives.........p117
Lab, Field, & Clinic...........................p120
News From the CDC ........................p122
Agencies Use Social Media to Track Foodborne Illness
Implantable Spinal Cord Stimulator Allows Voluntary Movement in Individuals With Lower-Extremity Paralysis
Syphilis Rates Increase, Especially Among Men
Driven by Prescription Drug Abuse, Heroin Use Increases Among Suburban and Rural Whites news@JAMA: From JAMA’s Daily News Site
HPV Vaccine for Oral Cancer? Reducing Preventable Deaths
Capitol Health Call ...........................p121 Governors Urged to Expand Medicaid
Adults With Disabilities Need Physical Activity, Too
Penalty for Lacking Health Coverage Burwell Confirmed as as DHHS Secretary Reforming the VA
Medical News & Perspectives
Agencies Use Social Media to Track Foodborne Illness Bridget M. Kuehn, MSJ
M
ost cases of foodborne illness are never reported to public health authorities. But that doesn’t mean those afflicted suffer in silence. Many people turn to social media to complain and even identify food purveyors they believe are responsible. To tap into this rich source of information, city public health departments have begun mining the tweets and online reviews of those possibly sickened by food. The City of Chicago Department of Public Health was the first to test the potential of social media in identifying foodborne outbreaks. The department partnered with civicminded local technologists and the Smart Chicago Collaborative, a nonprofit organization that uses technology to improve the lives of Chicagoans,todevelopanapplicationtomonitor Twitter for possible food poisoning references. A similar project is under way in New York, where the New York City Department of HealthandMentalHygieneisworkingwithColumbiaUniversitytechnologistsandthereview websiteYelptocombrestaurantpatrons’comments for signs of a budding outbreak.
Twitter by people in Chicago. The app scans the data and provides the health department with potential leads. Staff members review the leads and send messages to individuals with likely food poisoning, encouraging them to report their illness to the department using an online form. TheFoodborneChicagoapphasclassified morethan2900messagesonTwitteroverthe past year as likely related to foodborne illness,
according to Choucair. After reviewing these, staff followed up on 330 that fit certain criteria. Of the people they contacted, 87% (288) filed a report about their illness. The past year has been a learning process for the department and those developing the app. Choucair explained that some tweet authors have been “caught off guard” by receiving a tweet from the department. The technologyhasalsorequiredsometweaks.For
twitter.com/foodbornechi
A Civic Project DespitetheavailabilityofChicago’s311cityservices hotline, which fields calls on everything from potholes to food poisoning, many cases of foodborne illness go unreported, explained Bechara Choucair, MD, commissioner of the Chicago Department of Public Health. “People may not know, or they may not want to,” Choucair said. “We are being more proactive about collecting reports.” The Smart Chicago Collaborative and local web developers built the application using machine learning to identify potential cases of food poisoning mentioned on
Public health departments in Chicago and New York are using social media tools such as Twitter and Yelp as sources of consumer comments that might help identify outbreaks of foodborne illness.
jama.com
JAMA July 9, 2014 Volume 312, Number 2
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/30/2015
117
News & Analysis
example, initially the app might flag a tweet by a professor giving a talk about foodborne illness. The algorithms have since been improved to better identify real complaints. “We are getting better by the day,” Choucair said.
Bad Reviews AnactualoutbreakledtoNewYork’spilotproject testing whether Yelp reviews might signal threatstofoodsafety.Publichealthofficialsinvestigating a 2011 outbreak of gastrointestinal illnesses among a restaurant’s patrons found that some who didn’t file an official complaint reported their experience on Yelp. Sharon Balter, MD, medical epidemiologist at New York’s public health department, explained that a staff member used her own Yelp account to contact individuals who posted about their experiences at the restaurant under investigation. A few agreed to talk with investigators. Balter and her colleagues then enlisted Yelp and Luis Gravano, PhD, of Columbia University’s computer science department, and
his students for a pilot study to identify outbreaks prospectively based on Yelp reviews. From July 2012 to March 31, 2013, the software program created for the pilot screened 294 000 Yelp reviews (Harrison C et al. MMWR Morb Mortal Wkly Rep. 2014; 63[20]:441-445). It cited 893 as requiring evaluation by health department staff. About half were found to be consistent with food poisoning and occurred within a month of the review’s posting or didn’t specify a date (requiring further investigation). Only about 3% of these staff-flagged reviews had been reported through traditional means. Staff further investigated 129 claims and conducted phone interviews with 27 people who posted illness-related reviews. The interviews enabled staff to identify 3 unreported outbreaks that caused 16 illnesses. Investigations of the restaurants linked to the outbreaks found numerous violations of safe food-handling practices. Balter said the results suggest that Yelp surveillance may identify small outbreaks of foodborne illness that traditional surveil-
lance techniques miss. “It’s a way of reaching people who don’t know to call the health department,” she said, noting that individuals posting online are likely different from those who call the department to report illnesses. In fact, her colleagues have used Yelp messages to contact individuals who posted about illnesses that were not recent enough to be included in the pilot to let them know they can report their concerns to the department. One downside of Yelp outreach is that some users infrequently check their Yelp messages. Others may have chosen not to reply. Chicago and New York have been sharing their experiences and trying to learn from each other, said Choucair. Balter said New York is working with Gravano and his students to use Twitter for surveillance. Choucair noted that the computer code for the Foodborne Chicago app is now available on GitHub, an open source repository that allows other public health departments or civic-minded technologists to access computer code and improve on it.
Driven by Prescription Drug Abuse, Heroin Use Increases Among Suburban and Rural Whites Bridget M. Kuehn, MSJ
118
ing from abuse of prescription opioids is driving a resurgence in heroin use, the latest study provides evidence of major shifts in the demographics of heroin users. Using survey data from a national sample of 2797 pa-
tients entering substance abuse treatment, the researchers found that although individuals who began using heroin in the 1960s were mostly young men in their mid-teens whose first opioid drug was heroin, more re-
Heroin use appears to be increasing among nonurban whites who previously abused prescription opioids.
JAMA July 9, 2014 Volume 312, Number 2
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/30/2015
jama.com
Medicimage/www.sciencesource.com
T
he face of heroin use in the United States is changing dramatically. A study published in JAMA Psychiatry in late May found that compared with previous generations of heroin users, newer initiates are more likely to be older, to be white, to live in nonurban areas, and to have previously abused prescription painkillers (Cicero TJ et al. JAMA Psychiatry. doi:10.1001 /jamapsychiatry.2014.366[published online May 28, 2014]). Anecdotal reports from law enforcement and substance abuse treatment professionals have long suggested that many individuals who become addicted to prescription painkillers eventually move on to heroin when it becomes too difficult or expensive to access prescription opioids. Recent data from the Substance Abuse and Mental Health Services Administration support this anecdotal evidence (Kuehn BM. JAMA. 2013;310[14]:1433-1434). In addition to providing additional data suggesting that opioid dependence result-
Lab, Field, & Clinic...........................p120
News From the CDC ........................p122
Agencies Use Social Media to Track Foodborne Illness
Implantable Spinal Cord Stimulator Allows Voluntary Movement in Individuals With Lower-Extremity Paralysis
Syphilis Rates Increase, Especially Among Men
Driven by Prescription Drug Abuse, Heroin Use Increases Among Suburban and Rural Whites news@JAMA: From JAMA’s Daily News Site
HPV Vaccine for Oral Cancer? Reducing Preventable Deaths
Capitol Health Call ...........................p121 Governors Urged to Expand Medicaid
Adults With Disabilities Need Physical Activity, Too
Penalty for Lacking Health Coverage Burwell Confirmed as as DHHS Secretary Reforming the VA
Medical News & Perspectives
Agencies Use Social Media to Track Foodborne Illness Bridget M. Kuehn, MSJ
M
ost cases of foodborne illness are never reported to public health authorities. But that doesn’t mean those afflicted suffer in silence. Many people turn to social media to complain and even identify food purveyors they believe are responsible. To tap into this rich source of information, city public health departments have begun mining the tweets and online reviews of those possibly sickened by food. The City of Chicago Department of Public Health was the first to test the potential of social media in identifying foodborne outbreaks. The department partnered with civicminded local technologists and the Smart Chicago Collaborative, a nonprofit organization that uses technology to improve the lives of Chicagoans,todevelopanapplicationtomonitor Twitter for possible food poisoning references. A similar project is under way in New York, where the New York City Department of HealthandMentalHygieneisworkingwithColumbiaUniversitytechnologistsandthereview websiteYelptocombrestaurantpatrons’comments for signs of a budding outbreak.
Twitter by people in Chicago. The app scans the data and provides the health department with potential leads. Staff members review the leads and send messages to individuals with likely food poisoning, encouraging them to report their illness to the department using an online form. TheFoodborneChicagoapphasclassified morethan2900messagesonTwitteroverthe past year as likely related to foodborne illness,
according to Choucair. After reviewing these, staff followed up on 330 that fit certain criteria. Of the people they contacted, 87% (288) filed a report about their illness. The past year has been a learning process for the department and those developing the app. Choucair explained that some tweet authors have been “caught off guard” by receiving a tweet from the department. The technologyhasalsorequiredsometweaks.For
twitter.com/foodbornechi
A Civic Project DespitetheavailabilityofChicago’s311cityservices hotline, which fields calls on everything from potholes to food poisoning, many cases of foodborne illness go unreported, explained Bechara Choucair, MD, commissioner of the Chicago Department of Public Health. “People may not know, or they may not want to,” Choucair said. “We are being more proactive about collecting reports.” The Smart Chicago Collaborative and local web developers built the application using machine learning to identify potential cases of food poisoning mentioned on
Public health departments in Chicago and New York are using social media tools such as Twitter and Yelp as sources of consumer comments that might help identify outbreaks of foodborne illness.
jama.com
JAMA July 9, 2014 Volume 312, Number 2
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/30/2015
117
News & Analysis
example, initially the app might flag a tweet by a professor giving a talk about foodborne illness. The algorithms have since been improved to better identify real complaints. “We are getting better by the day,” Choucair said.
Bad Reviews AnactualoutbreakledtoNewYork’spilotproject testing whether Yelp reviews might signal threatstofoodsafety.Publichealthofficialsinvestigating a 2011 outbreak of gastrointestinal illnesses among a restaurant’s patrons found that some who didn’t file an official complaint reported their experience on Yelp. Sharon Balter, MD, medical epidemiologist at New York’s public health department, explained that a staff member used her own Yelp account to contact individuals who posted about their experiences at the restaurant under investigation. A few agreed to talk with investigators. Balter and her colleagues then enlisted Yelp and Luis Gravano, PhD, of Columbia University’s computer science department, and
his students for a pilot study to identify outbreaks prospectively based on Yelp reviews. From July 2012 to March 31, 2013, the software program created for the pilot screened 294 000 Yelp reviews (Harrison C et al. MMWR Morb Mortal Wkly Rep. 2014; 63[20]:441-445). It cited 893 as requiring evaluation by health department staff. About half were found to be consistent with food poisoning and occurred within a month of the review’s posting or didn’t specify a date (requiring further investigation). Only about 3% of these staff-flagged reviews had been reported through traditional means. Staff further investigated 129 claims and conducted phone interviews with 27 people who posted illness-related reviews. The interviews enabled staff to identify 3 unreported outbreaks that caused 16 illnesses. Investigations of the restaurants linked to the outbreaks found numerous violations of safe food-handling practices. Balter said the results suggest that Yelp surveillance may identify small outbreaks of foodborne illness that traditional surveil-
lance techniques miss. “It’s a way of reaching people who don’t know to call the health department,” she said, noting that individuals posting online are likely different from those who call the department to report illnesses. In fact, her colleagues have used Yelp messages to contact individuals who posted about illnesses that were not recent enough to be included in the pilot to let them know they can report their concerns to the department. One downside of Yelp outreach is that some users infrequently check their Yelp messages. Others may have chosen not to reply. Chicago and New York have been sharing their experiences and trying to learn from each other, said Choucair. Balter said New York is working with Gravano and his students to use Twitter for surveillance. Choucair noted that the computer code for the Foodborne Chicago app is now available on GitHub, an open source repository that allows other public health departments or civic-minded technologists to access computer code and improve on it.
Driven by Prescription Drug Abuse, Heroin Use Increases Among Suburban and Rural Whites Bridget M. Kuehn, MSJ
118
ing from abuse of prescription opioids is driving a resurgence in heroin use, the latest study provides evidence of major shifts in the demographics of heroin users. Using survey data from a national sample of 2797 pa-
tients entering substance abuse treatment, the researchers found that although individuals who began using heroin in the 1960s were mostly young men in their mid-teens whose first opioid drug was heroin, more re-
Heroin use appears to be increasing among nonurban whites who previously abused prescription opioids.
JAMA July 9, 2014 Volume 312, Number 2
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/30/2015
jama.com
Medicimage/www.sciencesource.com
T
he face of heroin use in the United States is changing dramatically. A study published in JAMA Psychiatry in late May found that compared with previous generations of heroin users, newer initiates are more likely to be older, to be white, to live in nonurban areas, and to have previously abused prescription painkillers (Cicero TJ et al. JAMA Psychiatry. doi:10.1001 /jamapsychiatry.2014.366[published online May 28, 2014]). Anecdotal reports from law enforcement and substance abuse treatment professionals have long suggested that many individuals who become addicted to prescription painkillers eventually move on to heroin when it becomes too difficult or expensive to access prescription opioids. Recent data from the Substance Abuse and Mental Health Services Administration support this anecdotal evidence (Kuehn BM. JAMA. 2013;310[14]:1433-1434). In addition to providing additional data suggesting that opioid dependence result-
