Infodemiology and infoveillance: framework for contagious exanthematous diseases, of childhood in Italy.

BACKGROUND: Contagious exanthematous diseases are becoming a major public health problem. The purpose of this study was to evaluate the potential epidemiological trend of four infectious exanthematous diseases in Italy through the searches on the internet. METHODS: We used the following Italian search term: 'Sesta malattia' (Sixth Disease, in English), 'Eritema Infettivo' (also knows 'Quinta malattia' in Italian; Fifth Disease in English), 'Quarta malattia' (Fourth Disease in English) and 'Scarlattina' (Scarlet fever in English). We overlapped Google Trends and Wikipedia data to perform a linear regression and correlation analysis. Statistical analyses were performed using the Spearman's rank correlation coefficient (rho). The study period is between July 2015 and December 2022. RESULTS: The diseases considered have a seasonal trend and the search peaks between GT and Wikipedia overlap. A temporal correlation was observed between GT and Wikipedia search trends. Google Trends Internet search data showed strong correlation with Wikipedia with a rho statistically significant for Fifth disease (rho = 0.78), Fourth disease (rho = 0.76) and Scarlet-fever (rho = 0.77), moderate correlation for Sixth disease (rho = 0.32). CONCLUSIONS: Infectious disease searches using Google and Wikipedia can be useful for public health surveillance and help policy makers implement prevention and information programs for the population, in addition to the fact that increases in searches could represent an early warning in the detection of outbreaks.

Digital epidemiology and infodemiology of hand-foot-mouth disease (HFMD) in Italy. Disease trend assessment via Google and Wikipedia.

BACKGROUND AND AIM: The study aimed to evaluate the epidemiological trend of hand, foot and mouth disease (HFMD) in Italy using data on Internet search volume. METHODS: A cross-sectional study design was used. Data on Internet searches were obtained from Google Trends (GT) and Wikipedia. We used the following Italian search term: "Malattia mano-piede-bocca" (Hand-foot-mouth disease, in English). A monthly time-frame was extracted, partly overlapping, from July 2015 to December 2022. GT and Wikipedia were overlapped to perform a linear regression and correlation analyses. Statistical analyses were performed using the Spearman's rank correlation coefficient (rho). A linear regression analysis was performed considering Wikipedia and GT. RESULTS: Search peaks for both Wikipedia and GT occurred in the months November-December during the autumn-winter season and in June during the spring-summer season, except for the period from June 2020 to June 2021, probably due to the restrictions of the COVID19 pandemic. A temporal correlation was observed between GT and Wikipedia search trends. CONCLUSIONS: This is the first study in Italy that attempts to clarify the epidemiology of HFMD. Google search and Wikipedia can be valuable for public health surveillance; however, to date, digital epidemiology cannot replace the traditional surveillance system.

Impact on online research on celebrities' uncommon diseases: the curious case of Justin Bieber and Ramsay Hunt syndrome.

Aim: We investigated how to use Internet user searches to gauge the impact of a celebrity illness on global public interest. Methods: The study design is cross-sectional. Data on Internet searches were obtained from Google Trends (GT) for the period between 2017-2022 using the search words "Ramsay Hunt syndrome" (RHS), "Ramsay Hunt syndrome type 2," "Herpes zoster," and "Justin Bieber." The frequency of specific page views for "Ramsay Hunt syndrome," "Ramsay Hunt syndrome type 1," Ramsay Hunt syndrome type 2," Ramsay Hunt syndrome type 3," "Herpes zoster," and "Justin Bieber" were collected via a Wikipedia analysis tool that shows the number of times a specific page is viewed. Statistical analyses were performed using the Pearson (r) and Spearman's rank correlation coefficient (rho). Results: GT data, in 2022, show a strong correlation for Justin Bieber and RHS or RHS type 2 (r = 0.75); similarly, Wikipedia data show a strong correlation for Justin Bieber and the others explored terms (r > 0.75). Furthermore, the correlation was strong between GT and Wikipedia for RHS (rho = 0.89) and RHS type 2 (rho = 0.88). Conclusions: The peak search times for the GT and Wikipedia pages were during the same period. Useful new tools and analyses of Internet traffic data may be effective in assessing the impact of announced celebrity uncommon illnesses on global public interest.

Past and Future Influenza Vaccine Uptake Motivation: A Cross-Sectional Analysis among Italian Health Sciences Students.

Despite its effectiveness in the prevention of seasonal flu, influenza vaccination uptake remains low, even among healthcare workers (HCWs), despite their occupational risk. The aim of this study was to explore the association between main reasons for accepting or refusing influenza vaccination and the decision to receive the vaccination during both previous and following year among health sciences students. A multi-center, cross-sectional study was performed using a validated online questionnaire. Data were analyzed by performing univariable and multivariable logistic analysis. Data from over 3000 participants showed that avoiding the spread of infection to family members and the general population (aOR: 43.55), as well as to patients (aOR: 16.56) were the main reasons associated with the highest probability of taking the influenza vaccination the following year. On the contrary, not considering influenza as a severe disease was the reason associated with the lowest probability for past (aOR: 0.17) and future vaccination (aOR: 0.01). Therefore, the importance of vaccination to protect others should always be the core of vaccination campaigns for health sciences students, together with tools to increase their awareness of the severity of this disease.

Using Google Trends and Wikipedia to Investigate the Global Public's Interest in the Pancreatic Cancer Diagnosis of a Celebrity.

A cross-sectional study was designed to assess the impact of a celebrity's announcement of having been diagnosed with pancreatic cancer on the volume of cancer-related research on the Internet. Global searches were carried out on Google Trends (GT) for the period from 1 January 2004 to 20 November 2022 (since data prior to 2004 were not available) using the search words Tumore del Pancreas (pancreatic cancer), Tumore neuroendocrino (neuroendocrine tumor), and Fedez (the name of a popular Italian rapper). The frequency of specific page views for Fedez, Tumore del pancreas, and Tumore neuroendocrino was collected via Wikipedia Trends data. Statistical analyses were carried out using the Pearson correlation coefficient (r). The GT data revealed a strong correlation (r = 0.83) while the Wikipedia Trends data indicated a moderate correlation (r = 0.37) for Tumore neuroendocrino and Tumore del pancreas. The search peaks for the GT and Wikipedia pages occur during the same time period. An association was found between the celebrity's announcement of his pancreatic cancer diagnosis and the volume of pancreatic-cancer-related online searches. Our findings demonstrate that media events and media coverage of health-related news can raise people's curiosity and desire for health information.

Urban density and COVID-19: understanding the US experience.

This paper revisits the debate around the link between population density and the severity of COVID-19 spread in the USA. We do so by conducting an empirical analysis based on graphical evidence, regression analysis and instrumental variable strategies borrowed from the agglomeration literature. Studying the period between the start of the epidemic and the beginning of the vaccination campaign at the end of 2020, we find that the cross-sectional relationship between density and COVID-19 deaths changed as the year evolved. Initially, denser counties experienced more COVID-19 deaths. Yet, by December, the relationship between COVID deaths and urban density was completely flat. This is consistent with evidence indicating density affected the timing of the outbreak-with denser locations more likely to have an early outbreak-yet had no influence on time-adjusted COVID-19 cases and deaths. Using data from Google, Facebook, the US Census and other sources, we investigate potential mechanisms behind these findings.

Infodemiology of RSV in Italy (2017-2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age?

The aim of this study was to evaluate whether or not online queries for Respiratory Syncytial Virus (RSV) retrieved by means of Google Trends™ and the Italian Wikipedia analysis program mirror the occurrence of influenza-like illnesses (ILI), as reported by the Italian Influenza Surveillance network (InfluNet). Estimated rates for ILI in the general population and in the age groups 0−4 years and 5−14 years were obtained for the influenza seasons 2017−2018 to 2020−2021. Similarly, a weekly fraction of online searches was retrieved for a series of terms associated with Respiratory Syncytial Virus. Next, trends for daily visualization of Italian Wikipedia Pages for Human Respiratory Syncytial Virus, Pneumonia, Bronchiolitis, Influenza, and Respiratory Failure were similarly retrieved. The correlation of all search terms with ILI was analyzed by means of Spearman's rank correlation analysis. Among search terms associated with the clinical diagnosis of Respiratory Syncytial Virus infections, the occurrence of ILI was highly correlated only with Bronchiolitis in the age group 0−4 years (ß 0.210, p = 0.028), while more generic search terms, such as Bronchitis, fever, influenza, and Pneumonia, were identified as effective predictors of ILI, in general and by age groups. In a regression analysis modeled with ILIs as the outcome variable, daily visualizations for the Wikipedia pages on Bronchiolitis were identified as negative predictors for ILI in general (ß = −0.152, p = 0.032), ILI in age group 0−4 years (ß = −0.264, p = 0.001) and 5−14 years (ß = −0.202, p = 0.006), while Influenza was characterized as a positive effector for ILIs in the age group 5−14 years (ß = 0.245, p = 0.001). Interestingly, not only were the search terms extensively correlated with one another, but all of them were also characterized by autocorrelation through a Durbin-Watson test (all estimates DW < 2.0) In summary, our study identified a complicated pattern of data visualization as no clear association between rates of ILI in pediatric age group 0−4 and 5 to 14 years was actually found. Finally, our data stress that the infodemiology option may be quite problematic for assessing the time trend of RSV infections in Italy until more appropriate reporting will be made available, by sharing estimates of Lower Respiratory Tract Infections, and through a more accurate characterization of younger age groups.

Do Degree Programs Affect Health Profession Students' Attitudes and Opinions Toward Vaccinations? An Italian Multicenter Study.

Background: Healthcare workers' attitudes toward vaccination have been widely described in the literature, but a restricted amount of studies assessed healthcare students' knowledge, attitudes, and opinions on this issue. This study aimed to estimate the influence of a degree course on knowledge and immunization behavior among healthcare students and to compare medical students with students from other health profession degree programs to identify possible differences. Methods: A multicenter, cross-sectional study was performed in 2018 in 14 Italian Universities (3,131 students were interviewed). A validated questionnaire was used to assess knowledge, attitudes, and opinions toward vaccinations, with a specific focus on influenza vaccine and attitudes toward mandatory vaccination policies. Statistical software STATA® 14 was used. Results: Significant differences were recorded between medical students and other healthcare students. The intention to get vaccinated against influenza during the next season and having been vaccinated in the previous season was higher in the medical group (p < 0.001). In the group of students of other health professions, we registered a lower probability of identifying themselves as a high-risk group for contracting infectious diseases as a consequence of their profession and health status (aOR 0.49; CI95%: 0.40-0.60) and an increased likelihood of defining their level of knowledge on vaccine-preventable diseases and related vaccinations as "insufficient/sufficient/fair" (aOR 1.31; CI95%: 1.11-1.56). Conclusions: Results show several differences between medical students and students of other health professions when it comes to vaccination knowledge, attitudes, and perceptions, as well as a general low tendency to be vaccinated against influenza.

Altered Food Behavior and Cancer: A Systematic Review of the Literature.

There is evidence of an association between cancer and certain types of altered eating behaviors, including orthorexia, food cravings, and food addiction. Given the growing interest in the topic throughout the scientific community we conducted a systematic review to summarize current evidence on the development of altered food behavior, including food addiction and cancer. The Cochrane Collaboration and the Meta-analysis Of Observational Studies in Epidemiology guidelines were followed to perform this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the process and results. The structured literature search was conducted on 19 April 2022, on PubMed/Medline and Scopus, combining free-text terms and medical subject headings. A total of seven articles were included once the selection process was completed. Food craving has been associated with different types of cancer in adults and young patients, as well as with orthorexia; conversely, compulsive eating has only been explored in patients with prolactinoma treated with dopamine agonists. This systematic review explored a new area of research that warrants further investigation. More research is required to better understand the relationship between cancer and food behavior.

Risk Factors for Addictive Behaviors: A General Overview.

Many people around the world have behaviors that are recognized as addictive behaviors, usually not causing significant health consequences except in a few cases, which consist typically of a low percentage of people who may develop addictive behavioral disorders that may be associated with functional impairment and distress [...].

Knowledge and attitudes towards Zika virus: an Italian nation-wide cross-sectional study.

BACKGROUND: Zika virus (ZIKV) is an arthropod-borne virus transmitted through infected mosquitos. The aim of this Italian nation-wide study was to evaluate general population's knowledge and attitudes towards ZIKV, its transmission, and travel-related preventive measures. METHODS: This cross-sectional study was conducted between July and August 2017, through a validated questionnaire. Predictors of knowledge were analysed through multivariate regression. RESULTS: Among 1119 respondents, 20% and 71% knew etiological agent and transmission route of ZIKV infection, respectively. Approximately 43% ignored the preventive measures to be taken after returning from endemic areas. At multivariate analysis, predictors of poor knowledge were age, living in Central or South Italy and Islands, being poorly educated, having never heard of or attended a travel clinic. CONCLUSIONS: This study captures an overall poor knowledge of Zika among general public. This research highlights the need of designing and implementing measures to improve travellers' awareness and protection against ZIKV.

Infodemiology of flu: Google trends-based analysis of Italians' digital behavior and a focus on SARS-CoV-2, Italy.

INTRODUCTION: The aim of the current study was to assess if the frequency of internet searches for influenza are aligned with Italian National Institute of Health (ISS) cases and deaths. Also, we evaluate the distribution over time and the correlation between search volume of flu and flu symptoms with reported new cases of SARS-CoV-2. MATERIALS AND METHODS: The reported cases and deaths of flu and the reported cases of SARS-CoV-2 were selected from the reports of ISS, the data have been aggregated by week. The search volume provided by Google Trends (GT) has a relative nature and is calculated as a percentage of query related to a specific term in connection with a determined place and time-frame. RESULTS: The strongest correlation between GT search and influenza cases was found at a lag of +1 week particularly for the period 2015-2019. A strong correlation was also found at a lag of +1 week between influenza death and GT search. About the correlation between GT search and SARS-CoV-2 new cases the strongest correlation was found at a lag of +3 weeks for the term flu. CONCLUSION: In the last years research in health care has used GT data to explore public interest in various fields of medicine. Caution should be used when interpreting the findings of digital surveillance.

Dietary Fiber Intake and Risk of Pancreatic Cancer: Systematic Review and Meta-Analysis of Observational Studies.

The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population's awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.

Wikipedia, Google Trends and Diet: Assessment of Temporal Trends in the Internet Users' Searches in Italy before and during COVID-19 Pandemic.

We obtained data from Google Trends and Wikipedia in order to assess whether an analysis of Internet searches could provide information on the Internet users' behaviour/interest in diets. Differences in seasonality, year and before/during COVID-19 pandemic were assessed. From Wikipedia, we extracted the number of times a page is viewed by users, aggregated on monthly and seasonal bases. We also used Google Trends to evaluate the frequency of the users' web searches. The Mediterranean diet was the most frequently (33.9%), followed by the pescatarian diet (9.0%). Statistically, significant seasonal differences were found for the Mediterranean, vegetarian, Atkins, Scarsdale, and zone diets and pescetarianism. The most commonly searched diet and consequent diet-related queries on Google resulted to be: Dukan diet, Dukan and weight loss. Ketogenic, FODMAP and intermittent fasting diets were statistically more frequently searched during the pandemic compared with before. Our data show a different trend of searches based on the seasonality, year and the pandemic. These data could be useful for scientists, practitioners and policy makers because they can inform educational campaigns via the Internet, especially in periods when the population is more receptive.

Knowledge, attitudes and practices towards COVID-19 among nursing students of the University of Palermo: results from an online survey.

INTRODUCTION: The aim of the study was to evaluate the knowledge, attitude and practices towards SARS-CoV-2 among nursing students of University of Palermo during the rapid rise period of the COVID-19 pandemic. MATERIALS AND METHODS: This is cross-sectional study. A survey was provided to all nursing students and consisted of two parts: demographics and Knowledge, Attitude and Practices (KAP) survey. A multivariate linear regression model was used and adjusted Odds Ratios (aOR) are presented. RESULTS: 575 students were interviewed, and their mean age was 22.29 ± 4.2. The overall score indicates good knowledge (p=0.046) and good practices among the four courses of study (p=0.038). Multivariate linear regression showed that Attitude score (b = -0.29; p = 0.024) and Knowledge score (b = 0.10; p = 0.026) adjusted for age, gender, year of study, perceived economic status, perceived health status were significantly associated with Practice score. CONCLUSION: Our results suggest that proper health education is useful for encouraging optimistic attitudes and maintaining safe practices among future category of nurses.

The effects of COVID-19 pandemic on the trend of measles and influenza in Europe.

Letter to Editor.

What can internet users' behaviours reveal about the mental health impacts of the COVID-19 pandemic? A systematic review.

OBJECTIVES: At the end of 2019, an acute infectious pneumonia (coronavirus disease 2019 [COVID-19]) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, and subsequently spread around the world starting a pandemic. Globally, to date, there have been >118 million confirmed cases, including >2 million deaths. In this context, it has been shown that the psychological impact of the pandemic is important and that it can be associated with an increase in internet searches related to fear, anxiety, depression, as well as protective behaviours, health knowledge and even maladaptive behaviours. STUDY DESIGN: This is a systematic review. METHODS: This review aims to collect, analyse and synthesise available evidence on novel data streams for surveillance purposes and/or their potential for capturing the public reaction to epidemic outbreaks, particularly focusing on mental health effects and emotions. RESULTS: At the end of the screening process, 19 articles were included in this systematic review. Our results show that the COVID-19 pandemic had a great impact on internet searches for mental health of entire populations, which manifests itself in a significant increase of depressed, anxious and stressed internet users' emotions. CONCLUSIONS: Novel data streams can support public health experts and policymakers in establishing priorities and setting up long-term strategies to mitigate symptoms and tackle mental health disorders.

Reasons behind flu vaccine acceptance and suggested interventions to promote flu vaccination acceptance among healthcare workers.

The flu vaccination rate is still too low, both among healthcare providers (HCPs) and among health sciences university students. This study aims to assess the reasons of past and future flu vaccination acceptance among health sciences university students, and second, to identify what interventions would be helpful to foster acceptance of the flu vaccination among HCPs. A multicentre cross-sectional study was performed, using a validated questionnaire administered to health sciences students enrolled in 14 Italian universities. A multivariable logistic regression model was used. A total of 3131 questionnaires were collected. The statement that mandatory vaccination is required to increase adhesions to vaccinations (adjusted odds ratio [aOR] = 1.57; 95% confidence interval [CI] = 1.25-1.97), being in favour of this obligation (aOR = 7.91; 95% CI = 2.50-25.02) and considering themselves as people at risk of infection (aOR = 1.96; 95% CI = 1.46-2.64), are associated with having received the vaccination in the past flu season; on the other hand, planning to be vaccinated for the next season to avoid infecting patients is protective (aOR = 0.51; 95% CI = 0.38-0.70). This study shows which beliefs are associated with having joined the previous vaccination campaign in a large sample of HCPs. The acceptance of vaccination is an outcome behaviour resulting from a complex decision-making process. In order to implement coverage of the influenza vaccination in HCPs, it is necessary to implement awareness campaigns and provide specific information for this category of workers.

Correlation between flu and Wikipedia's pages visualization.

INTRODUCTION: This study aimed to assess if the frequency of the Italian general public searches for influenza, using the Wikipedia web-page, are aligned with Istituto Superiore di Sanità (ISS) influenza cases. MATERIALS AND METHODS: The reported cases of flu were selected from October 2015 to May 2019. Wikipedia Trends was used to assess how many times a specific page was read by users; data were extracted as daily data and aggregated on a weekly basis. The following data were extracted: number of weekly views by users from the October 2015 to May 2019 of the pages: Influenza, Febbre and Tosse (Flu, Fever and Cough, in English). Cross-correlation results are obtained as product-moment correlations between the two times series. RESULTS: Regarding the database with weekly data, temporal correlation was observed between the bulletin of ISS and Wikipedia search trends. The strongest correlation was at a lag of 0 for number of cases and Flu (r=0.7571), Fever and Cough (r=0.7501). The strongest correlation was at a lag of -1 for Fever and Cough (r=0.7501). The strongest correlation was at a lag of 1 for number of cases and Flu (r=0.7559), Fever and Cough (r=0.7501). CONCLUSIONS: A possible future application for programming and management interventions of Public Health is proposed.

Insight the data: Wikipedia's researches and real cases of arboviruses in Italy.

OBJECTIVES: The primary aim of this study was to evaluate the temporal correlation between Wikitrends and conventional surveillance data generated for Chikungunya, Dengue, Zika, and West Nile Virus infection reported by bulletin of Italian National Institute of Health (Istituto Superiore di Sanità in italian, ISS). STUDY DESIGN: A cross-sectional study design was used. METHODS: The reported cases of Dengue and Chikungunya were selected from July 2015 to December 2019. For West Nile Virus, the bulletins are issued in the period June-November (6 months) of the years 2015-2019, and for Zika virus, the data reported in the ISS bulletin start from January 2016. From Wikipedia Trends, we extracted the number of monthly views by users from the July 2015 to December 2019 of the pages Chikungunya, Dengue, Zika virus, and West Nile Virus. RESULTS: A correlation was observed between the bulletin of ISS and Wikipedia Wikitrends, the correlation was strong for Chikungunya and West Nile Virus (r = 0.9605; r = 0.9556, respectively), and highly statistically significant with P-values <0.001. The correlation was moderate for Dengue and Zika virus (r = 0.6053; r = 0.5888, respectively), but highly statistically significant with P-values <0.001. CONCLUSIONS: Classical surveillance system should be integrated with the tools of digital epidemiology that have potential role in public health for the dynamic information and provide near real-time indicators of the spread of infectious disease.