Flu, Twitter, and the Future of Public Health Surveillance

Saw a really cool article about public health and social media. Actually, it was about flu and Twitter, titled, "Scientists Use Twitter to Track Flu Epidemics, How to Stay Healthy This Flu Season."

The take-away from this article isn't that scientists used Twitter to track flu. Although, o.k, that's important. The really important development is that scientists developed an algorithm to track public health activity via social media.

First, this thought: Realtime surveillance has been the dream of many public health authorities and researchers. Various models have developed to track diseases, primarily by tracking data submitted by hospital ERs. The University of Pittsburgh has an example of this with the RODDS Laboratory. (If you don't want to click the link, RODDS stands for Real-time Outbreak and Disease Surveillance System).

Second, this thought: I've been told that a true realtime surveillance system would be very difficult to establish in the U.S. in the absence of a single payer health insurance system. In other words, in countries where there is a single payer system, e.g. the government, all patient data are collected and aggregated by a central database system. Theoretically, such a single point of data entry allows realtime surveillance.

But, this article points to a wonderfully efficient, even elegant, way to do an end run around enormously expensive database systems that would have to be woven through the enormously tangled HIPAA regulations and the rules, regulations, and private market interests of the healthcare providers and the healthcare insurers.

To track the flu, scientists--lead biologist was Marcel Salanthe from Penn State U.--analyzed 70,000 Tweets about flu. The Tweet data were analyzed with CDC data on vaccinations. The authors observed patterns that showed crossover between flu outbreaks and vaccinations.

And how did they do this? They developed the algorithm. That's the beauty of their work. An algorithm like this can be used to surveil any number of public health threats. Quoting from "What Twitter Knows About Flu," quoting Salanthe, "You can observe how people feel about certain things in a real-world context....On Twitter, people talk about things that matter to them in a completely normal context."

No worries about confidentiality, no delving into private insurers' proprietary data, no laws and regulations to comply with--these data are voluntarily provided by people on Twitter, the world's most realtime forum.

Table Saw Safety

Here's a public health issue near and dear to my heart. Table saws. And, I have to admit, it has been a little too close to my heart, literally. And it goes like this:

I am home alone with the kids. They're getting along fabulously, so I decide to try to get a couple small projects done that have been hanging around the "shop" for too long. I cobbled together a step stool for my older daughter and a couple wooden trays for my wife.

Everything's going great and I'm moving along, full steam ahead. I'm like one of those extreme makeover guys. In fact, I'm impressed with how fast I'm working and how well it's going.

Now, as a rule, I ALWAYS unplug the tablesaw when I'm adjusting it.

ALWAYS. Except tonight. And I'm fully cognizant, aware, that I'm not bothering to unplug.

My younger daughter, who was about four years old at the time, wanders in during a lull. I'm absentmindedly talking to her. I'm measuring the distance from the blade to the fence. And I hear the most terrifying words in any language:

"Daddy? What's this?"

The tablesaw screams to life, the wind created by the blade rushes underneath the palm of my left hand, she bolts, I shout "OH MY GOD!" and yank the cord out of the wall.

To our credit, neither of us cried.

I made a huge, huge mistake in not unplugging the machine before I started to work around it. But I gotta tell ya--I don't want one of the new saws considered by the Consumer Product Safety Commission earlier this month.

If you're a woodworker you've seen the videos:


On the other hand (is that a pun?) I'm a shoestring woodworker. Adding the extra expense of the SawStop to a table saw for me certainly would make it safer. I'd not even own one.

Concussions in young athletes

Saw an article that got my attention, being that I'm the dad to a few young athletes. "Athlete concussions eyed," an AP article published October 6, 2011 mentions PA House Bill 200, which if passed would be:

"An Act establishing standards for managing concussions and traumatic brain injuries to student athletes; assigning duties to the Department of Health and the Department of Education; and imposing penalties."

The sponsor, Rep. Tim Briggs, is quoted as saying "Over the years, the mentality of head injuries in sports wsa to shake it of and get back in the game..." And I think most people who've been involved with sports know exactly what he's talking about. Like a neighbor, whose sixth grade son was dinged in a football game and the coach put him back in. "You'd better check him," a friend told his mom, "He's not o.k." And his mom did, and she pulled him off the field, and the coach was angry and her son was angry and she did the right thing. It was his third concussion in three years of 'little kid' football.

What I don't understand is why it takes legislation to put the brakes on this attitude. There was something of a controversy a few months ago when a local high school girl lacrosse player sustained a seriously damaging concussion--and the coaching establishment closed ranks to say that girls lacrosse players don't wear helmets because helmets aren't a part of the game, and properly coached players don't need helmets.

The rational boggles the mind. Good coaching won't deflect an errant ball the way a helmet will.

So legislation like HB200 (the PA Senate has a similiar bill in SB200), which puts the responsibility on the coaches, apparently IS necessary.

Stroke Treatment in Pennsylvania

A few years ago I worked on a report on stroke prevention, treatment, and rehabilitation. It was a good report, and had the input and endorsement of some of the top stroke doctors in Pennsylvania (probably in the country). Here's the report, Brain Defense: A Stroke Prevention and Treatment Strategy for Pennsylvania.

Just saw today that PA House Bill 1400, which was introduced earlier this month, addresses strokes:

"Establishing a Statewide stroke system of care by recognizing primary stroke centers and directing the creation of emergency medical services training and transport protocols."

I'd kind of like to think that the sponsors took a look at our report. Or at least that Health committee staff did.

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