Major infection events over 5 years: how is media coverage influencing online information needs of health care professionals and the public?

BACKGROUND: The last decade witnessed turbulent events in public health. Emerging infections, increase of antimicrobial resistance, deliberately released threats and ongoing battles with common illnesses were amplified by the spread of disease through increased international travel. The Internet has dramatically changed the availability of information about outbreaks; however, little research has been done in comparing the online behavior of public and professionals around the same events and the effect of media coverage of outbreaks on information needs. OBJECTIVE: To investigate professional and public online information needs around major infection outbreaks and correlate these with media coverage. Questions include (1) How do health care professionals' online needs for public health and infection control information differ from those of the public?, (2) Does dramatic media coverage of outbreaks contribute to the information needs among the public?, and (3) How do incidents of diseases and major policy events relate to the information needs of professionals? METHODS: We used three longitudinal time-based datasets from mid-2006 until end of 2010: (1) a unique record of professional online behavior on UK infection portals: National electronic Library of Infection and National Resource of Infection Control (NeLI/NRIC), (2) equivalent public online information needs (Google Trends), and (3) relevant media coverage (LexisNexis). Analysis of NeLI/NRIC logs identified the highest interest around six major infectious diseases: Clostridium difficile (C difficile)/Methicillin-resistant Staphylococcus aureus (MRSA), tuberculosis, meningitis, norovirus, and influenza. After pre-processing, the datasets were analyzed and triangulated with each other. RESULTS: Public information needs were more static, following the actual disease occurrence less than those of professionals, whose needs increase with public health events (eg, MRSA/C difficile) and the release of major national policies or important documents. Media coverage of events resulted in major public interest (eg, the 2007/2008 UK outbreak of C difficile/MRSA). An exception was norovirus, showing a seasonal pattern for both public and professionals, which matched the periodic disease occurrence. Meningitis was a clear example of a disease with heightened media coverage tending to focus on individual and celebrity cases. Influenza was a major concern during the 2009 H1N1 outbreak creating massive public interest in line with the spring and autumn peaks in cases; although in autumn 2009, there was no corresponding increase in media coverage. Online resources play an increasing role in fulfilling professionals' and public information needs. CONCLUSIONS: Significant factors related to a surge of professional interest around a disease were typically key publications and major policy changes. Public interests seem more static and correlate with media influence but to a lesser extent than expected. The only exception was norovirus, exhibiting online public and professional interest correlating with seasonal occurrences of the disease. Public health agencies with responsibility for risk communication of public health events, in particular during outbreaks and emergencies, need to collaborate with media in order to ensure the coverage is high quality and evidence-based, while professionals' information needs remain mainly fulfilled by online open access to key resources.

Validity of International Health Regulations in reporting emerging infectious diseases.

Understanding which emerging infectious diseases are of international public health concern is vital. The International Health Regulations include a decision instrument to help countries determine which public health events are of international concern and require reporting to the World Health Organization (WHO) on the basis of seriousness, unusualness, international spread and trade, or need for travel restrictions. This study examined the validity of the International Health Regulations decision instrument in reporting emerging infectious disease to WHO by calculating its sensitivity, specificity, and positive predictive value. It found a sensitivity of 95.6%, a specificity of 38%, and a positive predictive value of 35.5%. These findings are acceptable if the notification volume to WHO remains low. Validity could be improved by setting more prescriptive criteria of seriousness and unusualness and training persons responsible for notification. However, the criteria should be balanced with the need for the instrument to adapt to future unknown threats.

Evaluating the online activity of users of the e-Bug web site.

Web server log analysis is being increasingly used to evaluate the user behaviour on healthcare resource web sites due to the detailed record of activity that they contain. This study aimed to use this information to evaluate the e-Bug web site, a healthcare resource that provides a range of educational resources about microbes, hand and respiratory hygiene, and antibiotics. This evaluation was conducted by analysing the web server logs of the e-Bug web site for the period January 2008 to November 2009, using a proprietary application named Sawmill. The e-Bug web site has had >900,000 page views generated from >88,000 users, with an increase in May 2009 during the swine flu epidemic and a further increase in September 2009 following the official launch of e-Bug. The majority of visitors were from the UK, but visits were recorded from 190 different countries. Word(®) document resources were downloaded >169,000 times, with the most popular being a swine flu factsheet. PowerPoint(®) document resources were downloaded >36,000 times, with the most popular relating to the 'chain of infection'. The majority of visitor referrals originated from search engines, with the most popular referral keywords being variations on the e-Bug name. The most common non-search engine referrals were from other healthcare resources and agencies. Use of the site has increased markedly since the official launch of e-Bug, with average page views of >200,000 per month, from a range of countries, illustrating the international demand for a teaching resource for microbes, hygiene and antibiotics.

Computer games to teach hygiene: an evaluation of the e-Bug junior game.

Handwashing, respiratory hygiene and antibiotic resistance remain major public health concerns. In order to facilitate an effective outcome when teaching the basic principles of hand and respiratory hygiene, educational interventions should first target school children. As computer games are ubiquitous in most children's lives, e-Bug developed computer games targeted at teaching children handwashing, respiratory hygiene and antibiotic resistance. The games were designed for two target audiences: junior school children (9-12 year olds); and senior school children (13-15 year olds). Between May and August 2009, the finalized junior game underwent an evaluation in three UK schools (in Glasgow, Gloucester and London), involving 62 children in the schools and ∼ 1700 players accessing the junior game online. The e-Bug junior game consists of a number of levels of play, each of which promotes a set of learning outcomes (LOs). These LOs, complementary to those in the e-Bug packs, are expressed through the game mechanics (the rules of the game) rather than through story or dialogue. Although the junior game's evaluation demonstrated a statistically significant change in the knowledge for only a small number of given LOs, because many children had the required knowledge already before playing the game, this is e-Bug's first statistical study on the junior game and the first comprehensive evaluation of its kind. Future work includes a re-examination of the quiz-style questionnaires utilized in this study and an exploration of the potential knowledge change acquired strictly through engagement.

What are school children in Europe being taught about hygiene and antibiotic use?

e-Bug is a pan-European antibiotic and hygiene teaching resource that aims to reinforce awareness in school children of microbes, prudent antibiotic use, hygiene and the transmission of infection. Prior to the production of the resource, it was essential to examine the educational structure across each partner country and assess what school children were being taught on these topics. A questionnaire was devised for distribution to each European partner (Belgium, Czech Republic, Denmark, England, France, Greece, Italy, Poland, Portugal and Spain), exploring their educational structure and examining educational resources or campaigns currently available. From the data collected it was evident that the majority of European schools have structured hand hygiene practices in place from a young age. The curricula in all countries cover the topic of human health and hygiene, but limited information is provided on antibiotics and their prudent use. School educational resources that link to the national curriculum and implement National Advice to the Public campaigns in the classroom are limited. The Microbes en question mobile health education campaign in France is an example of a successful children's education campaign and an innovative programme. Evaluation of the impact of school education on attitude and change of behaviour is also limited throughout many European countries. Not enough is currently being done across Europe to educate school children on the importance of appropriate antibiotic use and antibiotic resistance. The data from this research were used to develop e-Bug, a European Union-funded antibiotic and hygiene teaching resource.

Developing e-Bug web games to teach microbiology.

As a complement to the e-Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as well as to educate. A set of agreed learning outcomes (LOs) were provided by the scientific partners of the e-Bug Project and the games were developed using user-centred design techniques (the needs, wants and limitations of the potential game players were assessed at each stage of the design process). The e-Bug games were designed for two age groups: Junior (9-12 year olds); and Senior (13-15 year olds). A study using focus groups was done to gain an understanding as to the types of games enjoyed by the target users. According to the preliminary study, the Junior Game was developed as a platform game and the Senior Game was developed as a story-based detective game. The Junior Game consists of five levels, each associated with a set of LOs. Similarly, the Senior Game consists of four missions, each comprising five stages using problem-based learning techniques and LOs. In this paper, the process of development for each game is described in detail and an illustration is provided of how each game level or mission addresses the target LOs. Development of the games used feedback acquired from children in four schools across the UK (Glasgow, London and two in Gloucester). The children were selected according to their willingness to participate. European Partners of the e-Bug Project also provided further support, translation and requests for modifications. The knowledge gained of LOs and further evaluation of the games is continuing, and preliminary results are in press. The final versions of the games, translated into 11 European languages, are available online via www.e-bug.eu.

Evaluation of e-Bug, an educational pack, teaching about prudent antibiotic use and hygiene, in the Czech Republic, France and England.

OBJECTIVES: e-Bug, a junior and senior school educational programme to decrease the spread of infection and unnecessary antibiotic use, was developed and consisted of eight sections providing information on the spread, treatment and prevention of infection as well as basic information on microbes, both useful and harmful. Each section comprised teacher background information, lesson plans and an interactive student activity, and extension activities were also available for more able students. This study aimed to evaluate the effectiveness of the e-Bug pack in improving children's knowledge in these key areas, when used within the National Curriculum in England, France and the Czech Republic. METHODS: Junior (9-11 years) and senior (12-15 years) school classes were divided into either control or intervention groups for evaluation of the resource. Students were required to complete identical knowledge questionnaires at three timepoints (before, immediately after and 6 weeks after teaching), to assess knowledge change and retention. Teaching, using the e-Bug pack, was given by junior and senior school teachers. RESULTS: The junior e-Bug teaching pack demonstrated a significant improvement in student's knowledge in all sections and there was no significant decrease in student knowledge observed after a 6 week period. Knowledge improvement with the senior e-Bug pack varied between regions, although consistent improvement was observed for Gloucestershire (England) and Ostrava (Czech Republic). CONCLUSIONS: Although a success, modifications are required in both packs to further improve student knowledge and make the packs more appealing.

eBug--teaching children hygiene principles using educational games.

Technology enhanced education has been recently established as a new approach for all stages of education. However, among these new IT media it is computer games playing the central role in delivering education in particular to children and teenagers, however, real world sound evaluation is often given little attention. The EU funded e-Bug project developed web games aimed at children to teach basic principles of prudent antibiotics use, hand and respiratory hygiene and aims to reinforces an awareness of microbes, hand and respiratory hygiene among junior and senior school children in 10 countries in Europe. An educational pack implemented in schools across Europe is complemented by Internet web games for two age groups teaching a set of learning objectives (LOs) using a fast and interactive platform game design for junior children and investigate detective games based on PBL principles for senior children. In this paper, we present the design of e-Bug junior and senior games and evaluation results.

Social deprivation and hospital admission for respiratory infection: an ecological study.

STUDY OBJECTIVE: To examine the relationship between social deprivation and risk of hospital admission for respiratory infection. METHODS AND SUBJECTS: Ecological study using hospital episode statistics and population census data. Cases were residents of the West Midlands Health Region admitted to hospital with a diagnosis of respiratory infection, acute respiratory infection, pneumonia or influenza over a 5-year period. Postcodes of cases were used to assign Townsend deprivation scores; these were then ranked and divided into five deprivation categories. Poisson regression analysis was used to estimate the magnitude of effect for associations between deprivation category and hospital admission by age and admitting diagnosis. MAIN RESULTS: There were 136755 admissions for respiratory infection, equivalent to an annual admission rate of 27.1 per 1000 population (95% CI = 26.9-27.2). Deprivation was associated with increased admission rates for all respiratory infection (P < 0.0001) and affected all age-groups. The greatest effect was in the 0-4 years age-group with admission rates 91% higher in the most deprived children compared to the least deprived. Hospital admissions for acute respiratory infection and pneumonia were both significantly associated with deprivation (P < 0.0001). CONCLUSIONS: Respiratory infection is associated with social inequalities in all age-groups, particularly in children. Prevention of respiratory infection could make an important contribution to reducing health inequalities.

Detection and response to a meningococcal disease outbreak following a youth football tournament with teams from four European countries.

An outbreak of meningococcal disease, caused by Neisseria meningitidis, occurred following an international youth football tournament in the summer of 1997, affecting individuals from four European countries. This paper describes the outbreak, focusing on international co-operation in detection, investigation, control and follow-up, identifying weaknesses and exploring opportunities for improved co-operation. Data came from interviews, reports and related documents. The detection and management of the outbreak in each country is analysed. Eleven cases were linked to this outbreak and serotyped as C:2a:P1.5. Control measures varied in each country, reflecting different national guidelines. The outbreak illustrated deficiencies in management of international outbreaks but also demonstrated benefits of international co-operation.

LASIK complications and the Internet: is the public being misled?

BACKGROUND: LASIK (Laser in Situ Keratomileusis) is a very popular combined surgical and laser procedure, which is used to correct myopia (shortsightedness) and hyperopia (farsightedness). There is concern that the public is being misled regarding the safety of the procedure. OBJECTIVES: To assess the quality and quantity of the information on complications on LASIK Web sites. METHOD: Serial analysis and evaluation of the authorship, content, and technical quality of the information on the complications of LASIK on 21 Web sites. RESULTS: Of the 21 LASIK Web sites visited, 17 were commercial. Of the 21 Web sites, 5 (24%) had no information on complications. Of the 16 sites that had information on complications the author of the information was clearly identified in 5 (31%), the content was only referenced in 2 (12.5%), and evidence of the information having been updated was only seen in 2 (12.5%). The quantity of information is generally minimal and the information itself is generally difficult to understand and locate. CONCLUSION: The quality and quantity of the information on the Web on the complications of LASIK are poor. More work is required to encourage clear, accurate, up-to-date, clearly authored, and well-referenced, balanced ophthalmic information.

Changing public attitudes to antibiotic prescribing: can the internet help?

INTRODUCTION: Antimicrobial resistance is a global problem with serious implications for modern medicine. Education of the public is essential for reducing patient pressure on GPs and subsequent inappropriate prescribing. Evaluation of educational interventions is necessary to assess their impact on public knowledge and attitudes. The aim of this study was to evaluate the effect of a health information website, part of the National electronic Library of Infection, on user knowledge and attitudes. METHOD: Questionnaires testing user knowledge and attitudes before and after using the website. RESULTS: There were significant improvements in knowledge about the use of antibiotics and antibiotic resistance. Expectations that antibiotics should be prescribed were significantly reduced after using the website. Health professionals showed a significantly greater knowledge about antibiotics and were less likely to expect antibiotics to be prescribed for acute otitis media than non-health professionals before using the website. There was no significant difference between the knowledge of these groups after using the website, but non-health professionals continued to have higher expectations of antibiotics being prescribed than health professionals. CONCLUSIONS: Health information websites can play a significant role in influencing public knowledge and attitudes. Further research is needed to investigate how people learn from these interventions and to determine their long-term impact on public attitudes and subsequent behaviour.

Responding to the challenge of communicable disease in Europe.

In the 1960s and 1970s, communicable disease seemed a minor threat, but since then the emergence of new infections and the reemergence of old diseases has provoked a renewed focus on European communicable disease surveillance and control. A "network approach" among European countries has been successful in detecting some international outbreaks, but management and funding aspects remain unresolved. Surveillance outside the European Union has faced new challenges as a result of economic and political change following the collapse of communism. Subsequently, innovative international surveillance schemes are currently being implemented in the countries of Central and Eastern Europe and the former Soviet Union. The challenge for surveillance in Europe is to ensure that it has the capacity to meet both the needs of today and the diseases of the future.

Antibiotic guidance on the web: an opportunity for open review.

The report The Path of Least Resistance recommended that local antibiotic prescribing information should be based on national guidelines produced under the aegis of the National Institute for Clinical Excellence (NICE). During the period when NICE guidelines on the management of infectious disease are being developed, interim guidelines are needed in primary care. Draft antibiotic guidance developed by Primary Care Groups and the Public Health Laboratory Service was posted on the PHLS website for consultation. An explanatory letter containing the website address was sent to all regional prescribing leads, asking them to draw it to the attention of all those involved in the development of antibiotic guidance. As a result of the numerous comments received from around the UK in the 18 months after posting on the website, 125 substantial changes were made and grading of evidence was added. The electronic production of guidance greatly facilitated the open review process and consequent modifications and reduced printing costs.

Public health, epidemiology and war

delivery of humanitarian aid in wartime is difficult. However it is essential that aid is provided in the most effective manner possible, targeted on those most in need whilist minimizing waste. Furthermore the delivery of aid should be sensitive to the future needs of the communities in conflict. This requires information on the needs of the vulnerable population. There is litle experience of collecting data on the impacts of war on a civilian population. The war in Bosnia disrupted surveillance of communicable disease. The local authorities were assisted by the World Health Organization in re-establishing survillance. The data generated was valuable in planning interventions to munimise the possibility of major outbreaks of infection, reduce the impact of infectious disease and in guiding the humanitarian aid effort. The experience described suggests that public health surveillance of the civilian population in wartime is possible and useful. Besides the need for planning, the public health doctor in wartime has a role as an advocate for those suffering; this funtion can be carried aut much more effectively if is based on objective data collection rather than hearsay (AU)