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3.
J Am Heart Assoc ; 10(19): e020596, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34558301

RESUMO

Background Online platforms are used to manage aspects of our lives including health outside clinical settings. Little is known about the effectiveness of using online platforms to manage hypertension. We assessed effects of tweeting/retweeting cardiovascular health content by individuals with poorly controlled hypertension on systolic blood pressure (SBP) and patient activation. Methods and Results We conducted this 2-arm randomized controlled trial. Eligibility included diagnosis of hypertension; SBP >140 mm Hg; and an existing Twitter account or willingness to create one to follow study Twitter account. Intervention arm was asked to tweet/retweet health content 2×/week using a specific hashtag for study duration (6 months). The main measures include primary outcome change in SBP; secondary outcome point change in Patient Activation Measure (PAM). We remotely recruited and enrolled 611 participants, mean age 52 (SD, 11.7). Mean baseline SBP for the intervention group was 155.8 and for control was 155.6. At 6 months, mean SBP for intervention group was 137.6 and for control was 135.7. Mean change in SBP from baseline to 6 months for the intervention group was -18.5 and for control was -19.8 (P=0.48). Mean PAM at baseline for the intervention group was 70.3 for control was 72.7. At 6 months, mean PAM scores were 71.1 (intervention) and 75.6 (control). Mean change in PAM score for the intervention group was 0.0 and for control was 3.3 (P=0.12). Conclusions Recruiting and engaging patients and collecting outcome measures remotely are feasible using Twitter. Encouraging patients with poorly controlled hypertension to tweet or retweet health content on Twitter did not improve SBP or PAM score at 6 months. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02622256.

5.
Vaccine ; 39(30): 4034-4038, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34140171

RESUMO

The speed at which social media is propagating COVID-19 misinformation and its potential reach and impact is growing, yet little work has focused on the potential applications of these data for informing public health communication about COVID-19 vaccines. We used Twitter to access a random sample of over 78 million vaccine-related tweets posted between December 1, 2020 and February 28, 2021 to describe the geographical and temporal variation in COVID-19 vaccine discourse. Urban suburbs posted about equitable distribution in communities, college towns talked about in-clinic vaccinations near universities, evangelical hubs posted about operation warp speed and thanking God, exurbs posted about the 2020 election, Hispanic centers posted about concerns around food and water, and counties in the ACP African American South posted about issues of trust, hesitancy, and history. The graying America ACP community posted about the federal government's failures; rural middle American counties posted about news press conferences. Topics related to allergic and adverse reactions, misinformation around Bill Gates and China, and issues of trust among Black Americans in the healthcare system were more prevalent in December, topics related to questions about mask wearing, reaching herd immunity and natural infection, and concerns about nursing home residents and workers increased in January, and themes around access to black communities, waiting for appointments, keeping family safe by vaccinating and fighting online misinformation campaigns were more prevalent in February. Twitter discourse around COVID-19 vaccines in the United States varied significantly across different communities and changed over time; these insights could inform targeted messaging and mitigation strategies.


Assuntos
COVID-19 , Mídias Sociais , Vacinas contra COVID-19 , China , Humanos , SARS-CoV-2 , Estados Unidos
6.
J Med Internet Res ; 23(6): e29395, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34106074

RESUMO

BACKGROUND: In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual's health status, ranging from diet and exercise to depression. Uses of digital applications have accelerated during the COVID-19 pandemic where public health organizations have utilized technology to reduce the burden of transmission, ultimately leading to policy discussions about digital health privacy. Though US consumers report feeling concerned about the way their personal data is used, they continue to use digital technologies. OBJECTIVE: This study aimed to understand the extent to which consumers recognize possible health applications of their digital data and identify their most salient concerns around digital health privacy. METHODS: We conducted semistructured interviews with a diverse national sample of US adults from November 2018 to January 2019. Participants were recruited from the Ipsos KnowledgePanel, a nationally representative panel. Participants were asked to reflect on their own use of digital technology, rate various sources of digital information, and consider several hypothetical scenarios with varying sources and health-related applications of personal digital information. RESULTS: The final cohort included a diverse national sample of 45 US consumers. Participants were generally unaware what consumer digital data might reveal about their health. They also revealed limited knowledge of current data collection and aggregation practices. When responding to specific scenarios with health-related applications of data, they had difficulty weighing the benefits and harms but expressed a desire for privacy protection. They saw benefits in using digital data to improve health, but wanted limits to health programs' use of consumer digital data. CONCLUSIONS: Current privacy restrictions on health-related data are premised on the notion that these data are derived only from medical encounters. Given that an increasing amount of health-related data is derived from digital footprints in consumer settings, our findings suggest the need for greater transparency of data collection and uses, and broader health privacy protections.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Informação de Saúde ao Consumidor/estatística & dados numéricos , Coleta de Dados/ética , Conjuntos de Dados como Assunto/provisão & distribuição , Entrevistas como Assunto , Privacidade/psicologia , Pesquisa Qualitativa , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
7.
J Adolesc Health ; 69(2): 234-241, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34167883

RESUMO

PURPOSE: The purpose of this study was to characterize COVID-19 content posted by users and disseminated via TikTok, a social media platform that has become known largely as an entertainment platform for viral video-sharing. We sought to capture how TikTok videos posted during the initial months of the COVID pandemic changed over time as cases accelerated. METHODS: This study is an observational analysis of sequential TikTok videos with #coronavirus from January to March 2020. Videos were independently coded to assess content (e.g., health relatedness, humor, fear, empathy), misinformation, and public sentiment. To assess engagement, we also codified how often videos were shared relative to their content. RESULTS: We coded 750 videos and approximately one in four videos tagged with #coronavirus featured health-related content such as featuring objects such as face masks, hand sanitizer, and other cleaning products. Most videos evoked "humor/parody," whereas 15% and 6% evoked "fear" and "empathy", respectively. TikTok videos posted in March 2020 had the largest number of shares and comments compared with January and February 2020. The proportion of shares and comments for "misleading and incorrect information" featured in videos was lower in March than in January and February 2020. There was no statistical difference between the share and comment counts of videos coded as "incorrect/incomplete" and "correct" over the entire time period. CONCLUSIONS: Analyzing readily available social media platforms, such as TikTok provides real-time insights into public views, frequency and types of misinformation, and norms toward COVID-19. Analyzing TikTok videos has the potential to be used to inform public health messaging and public health mitigation strategies.


Assuntos
COVID-19 , Mídias Sociais , Humanos , Pandemias/prevenção & controle , Saúde Pública , SARS-CoV-2
8.
Psychiatr Serv ; 72(7): 776-783, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34015944

RESUMO

OBJECTIVE: Previous studies indicate that patients' satisfaction with mental health care is correlated with both treatment outcomes and quality of life. The aims of this study were to describe online reviews of mental health treatment facilities, including key themes in review content, and to evaluate the correlation between narrative review themes, facility characteristics, and review ratings. METHODS: United States National Mental Health Services Survey (N-MHSS) facilities were linked to corresponding Yelp pages, created between March 2007 and September 2019. Correlations between review ratings and both machine learning-generated latent Dirichlet allocation topics and N-MHSS-reported facility characteristics were measured by using Spearman's rank-order correlation coefficient. Significance was defined by a Bonferroni-adjusted p<0.001. RESULTS: Of 10,191 unique mental health treatment facilities, 1,383 (13.6%) had relevant Yelp pages with 8,133 corresponding reviews. The number of newly reviewed facilities and the number of new reviews increased throughout the study period. Narrative topics positively correlated with review ratings included caring staff (Spearman's ρ=0.39) and nonpharmacologic treatment (ρ=0.16). Topics negatively correlated with review ratings included rude staff (ρ=-0.14) and safety and abuse (ρ=-0.14). Of 126 N-MHSS survey items, 11 were positively correlated with review rating, including "outpatient mental health facility" (ρ=0.13), and 33 were negatively correlated with review rating, including accepting Medicare (ρ=-0.21). CONCLUSIONS: Narrative topics provide information beyond what is currently collected through the N-MHSS. Topics associated with positive and negative reviews, such as staff attitude toward patients, can guide improvement in patients' satisfaction and engagement with mental health care.


Assuntos
Saúde Mental , Qualidade de Vida , Idoso , Humanos , Medicare , Satisfação do Paciente , Qualidade da Assistência à Saúde , Estados Unidos
9.
J Med Internet Res ; 23(6): e27300, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-33939620

RESUMO

BACKGROUND: As policy makers continue to shape the national and local responses to the COVID-19 pandemic, the information they choose to share and how they frame their content provide key insights into the public and health care systems. OBJECTIVE: We examined the language used by the members of the US House and Senate during the first 10 months of the COVID-19 pandemic and measured content and sentiment based on the tweets that they shared. METHODS: We used Quorum (Quorum Analytics Inc) to access more than 300,000 tweets posted by US legislators from January 1 to October 10, 2020. We used differential language analyses to compare the content and sentiment of tweets posted by legislators based on their party affiliation. RESULTS: We found that health care-related themes in Democratic legislators' tweets focused on racial disparities in care (odds ratio [OR] 2.24, 95% CI 2.22-2.27; P<.001), health care and insurance (OR 1.74, 95% CI 1.7-1.77; P<.001), COVID-19 testing (OR 1.15, 95% CI 1.12-1.19; P<.001), and public health guidelines (OR 1.25, 95% CI 1.22-1.29; P<.001). The dominant themes in the Republican legislators' discourse included vaccine development (OR 1.51, 95% CI 1.47-1.55; P<.001) and hospital resources and equipment (OR 1.22, 95% CI 1.18-1.25). Nonhealth care-related topics associated with a Democratic affiliation included protections for essential workers (OR 1.55, 95% CI 1.52-1.59), the 2020 election and voting (OR 1.31, 95% CI 1.27-1.35), unemployment and housing (OR 1.27, 95% CI 1.24-1.31), crime and racism (OR 1.22, 95% CI 1.18-1.26), public town halls (OR 1.2, 95% CI 1.16-1.23), the Trump Administration (OR 1.22, 95% CI 1.19-1.26), immigration (OR 1.16, 95% CI 1.12-1.19), and the loss of life (OR 1.38, 95% CI 1.35-1.42). The themes associated with the Republican affiliation included China (OR 1.89, 95% CI 1.85-1.92), small business assistance (OR 1.27, 95% CI 1.23-1.3), congressional relief bills (OR 1.23, 95% CI 1.2-1.27), press briefings (OR 1.22, 95% CI 1.19-1.26), and economic recovery (OR 1.2, 95% CI 1.16-1.23). CONCLUSIONS: Divergent language use on social media corresponds to the partisan divide in the first several months of the course of the COVID-19 public health crisis.


Assuntos
COVID-19/epidemiologia , COVID-19/psicologia , Comunicação em Saúde , Mídias Sociais/estatística & dados numéricos , Estudos Transversais , Humanos , Idioma , Pandemias , SARS-CoV-2/isolamento & purificação , Estados Unidos/epidemiologia
10.
Int Rev Psychiatry ; 33(4): 412-423, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33860736

RESUMO

Digital health and technologies are essential to curbing the novel coronavirus 2019 (COVID-19) pandemic especially with shelter-in-place and social distancing orders. Epidemiologists and public health officials are tapping into frequently used technologies like wearables, digital devices, digital and social media data to detect and validate COVID-19 symptoms throughout the pandemic, especially during early stages when symptoms were evolving. In this article, we review how digital technologies and social media platforms can identify and inform our understanding of COVID-19 pandemic surveillance and recovery efforts. We analyze Reddit narrative posts and comments on r/covidlonghaulers to demonstrate how social media can be used to better understand COVID-19 pandemic. Using Reddit data, we highlight long haulers' patient journeys and shed light on potential consequences of their condition. We identified 21 themes, of which the following were significantly associated with valence: COVID-19 Symptoms (r = -0.037), medical advice (r = -0.030), medical system (r = -0.029), bodily processes (r = -0.020), questions (r = 0.024), physical activity (r = 0.033), self-differentials and negations (r = 0.040) and supplements (r = 0.025). Our brief literature review and analysis of r/covidlonghaulers narrative posts demonstrate the value of digital technologies and social media platforms as they act as modern avenues for public health, safety, and well-being.


Assuntos
COVID-19/terapia , Vigilância em Saúde Pública , Recuperação de Função Fisiológica , Mídias Sociais , Telemedicina/tendências , Dispositivos Eletrônicos Vestíveis/provisão & distribuição , Humanos , Distanciamento Físico , Fatores de Tempo
12.
Circulation ; 143(16): e836-e870, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33682423

RESUMO

Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and opioid use disorder affects >2 million Americans. The epidemiology of opioid-associated out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic opioids and linear increases in heroin deaths more than offsetting modest reductions in deaths from prescription opioids. The pathophysiology of polysubstance toxidromes involving opioids, asphyxial death, and prolonged hypoxemia leading to global ischemia (cardiac arrest) differs from that of sudden cardiac arrest. People who use opioids may also develop bacteremia, central nervous system vasculitis and leukoencephalopathy, torsades de pointes, pulmonary vasculopathy, and pulmonary edema. Emergency management of opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of opioid-associated out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas naloxone, an opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest. Opioid education and naloxone distributions programs have been developed to teach people who are likely to encounter a person with opioid poisoning how to administer naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if opioid overdose is suspected, naloxone should also be administered. Secondary prevention, including counseling, opioid overdose education with take-home naloxone, and medication for opioid use disorder, is important to prevent recurrent opioid overdose.

13.
JMIR Cardio ; 5(1): e24473, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33605888

RESUMO

BACKGROUND: Current atherosclerotic cardiovascular disease (ASCVD) predictive models have limitations; thus, efforts are underway to improve the discriminatory power of ASCVD models. OBJECTIVE: We sought to evaluate the discriminatory power of social media posts to predict the 10-year risk for ASCVD as compared to that of pooled cohort risk equations (PCEs). METHODS: We consented patients receiving care in an urban academic emergency department to share access to their Facebook posts and electronic medical records (EMRs). We retrieved Facebook status updates up to 5 years prior to study enrollment for all consenting patients. We identified patients (N=181) without a prior history of coronary heart disease, an ASCVD score in their EMR, and more than 200 words in their Facebook posts. Using Facebook posts from these patients, we applied a machine-learning model to predict 10-year ASCVD risk scores. Using a machine-learning model and a psycholinguistic dictionary, Linguistic Inquiry and Word Count, we evaluated if language from posts alone could predict differences in risk scores and the association of certain words with risk categories, respectively. RESULTS: The machine-learning model predicted the 10-year ASCVD risk scores for the categories <5%, 5%-7.4%, 7.5%-9.9%, and ≥10% with area under the curve (AUC) values of 0.78, 0.57, 0.72, and 0.61, respectively. The machine-learning model distinguished between low risk (<10%) and high risk (>10%) with an AUC of 0.69. Additionally, the machine-learning model predicted the ASCVD risk score with Pearson r=0.26. Using Linguistic Inquiry and Word Count, patients with higher ASCVD scores were more likely to use words associated with sadness (r=0.32). CONCLUSIONS: Language used on social media can provide insights about an individual's ASCVD risk and inform approaches to risk modification.

14.
JMIR Ment Health ; 8(2): e25834, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33635280

RESUMO

BACKGROUND: COVID-19 continues to disrupt global health and well-being. In April-May 2020, we generated a digital, remote interactive tool to provide health and well-being resources and foster connectivity among community members through a text messaging platform. OBJECTIVE: This study aimed to prospectively investigate the ability of a health system-based digital, remote, interactive tool to provide health and well-being resources to local community participants and to foster connectivity among them during the early phases of COVID-19. METHODS: We performed descriptive and nonparametric longitudinal statistical analyses to describe and compare the participants' mood ratings over time and thematic analysis of their responses to text messages to further assess mood. RESULTS: From among 393 individuals seeking care in an urban emergency department in an academic setting, engaged in a two-way text messaging platform, we recorded 287 mood ratings and 368 qualitative responses. We observed no difference in the initial mood rating by week of enrollment [Kruskal-Wallis chi-square H(5)=1.34; P=.93], and the average mood rating did not change for participants taken together [Friedman chi-square Q(3)=0.32; P=.96]. However, of participants providing mood ratings at baseline, mood improved significantly among participants who reported a low mood rating at baseline [n=25, 14.97%; Q(3)=20.68; P<.001] but remained stable among those who reported a high mood rating at baseline [n=142, 85.03%; Q(3)=2.84; P=.42]. Positive mood elaborations most frequently included words related to sentiments of thankfulness and gratitude, mostly for a sense of connection and communication; in contrast, negative mood elaborations most frequently included words related to anxiety. CONCLUSIONS: Our findings suggest the feasibility of engaging individuals in a digital community with an emergency department facilitation. Specifically, for those who opt to engage in a text messaging platform during COVID-19, it is feasible to assess and respond to mood-related queries with vetted health and well-being resources.

15.
Resuscitation ; 159: 117-125, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33400929

RESUMO

BACKGROUND: Among adults with in-hospital cardiac arrest (IHCA), overall survival is lower in black patients compared to white patients. Data regarding racial differences in survival for pediatric IHCA are unknown. METHODS: Using 2000-2017 data from the American Heart Association Get With the Guidelines-Resuscitation® registry, we identified children >24 h and <18 years of age with IHCA due to an initial pulseless rhythm. We used generalized estimation equation to examine the association of black race with survival to hospital discharge, return of spontaneous circulation (ROSC), and favorable neurologic outcome at discharge. RESULTS: Overall, 2940 pediatric patients (898 black, 2042 white) at 224 hospitals with IHCA were included. The mean age was 3.0 years, 57% were male and 16% had an initial shockable rhythm. Age, sex, interventions in place at the time of arrest and cardiac arrest characteristics did not differ significantly by race. The overall survival to discharge was 36.9%, return of spontaneous circulation (ROSC) was 73%, and favorable neurologic survival was 20.8%. Although black race was associated with lower rates of ROSC compared to white patients (69.5% in blacks vs. 74.6% in whites; risk-adjusted OR 0.79, 95% CI 0.67-0.94, P = 0.016), black race was not associated with survival to discharge (34.7% in blacks vs. 37.8% in whites; risk-adjusted OR 0.96, 95% CI 0.80-1.15, P = 0.68) or favorable neurologic outcome (18.7% in blacks vs. 21.8% in whites, risk-adjusted OR 0.98, 95% CI 0.80-1.20, p = 0.85). CONCLUSIONS: In contrast to adults, we did not find evidence for racial differences in survival outcomes following IHCA among children.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Adulto , Afro-Americanos , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu , Feminino , Parada Cardíaca/terapia , Humanos , Masculino , Alta do Paciente , Sistema de Registros , Estados Unidos/epidemiologia
17.
Womens Health (Lond) ; 16: 1745506520949392, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33028170

RESUMO

We sought to evaluate whether there was variability in language used on social media across different time points of pregnancy (before, during, and after pregnancy, as well as by trimester and parity). Consenting patients shared access to their individual Facebook posts and electronic medical records. Random forest models trained on Facebook posts could differentiate first trimester of pregnancy from 3 months before pregnancy (F1 score = .63) and from a random 3-month time period (F1 score = .64). Posts during pregnancy were more likely to include themes about family (ß = .22), food craving (ß = .14), and date/times (ß = .13), while posts 3 months prior to pregnancy included themes about social life (ß = .30), sleep (ß = .31), and curse words (ß = .27), and 3 months post-pregnancy included themes of gratitude (ß = .17), health appointments (ß = .21), and religiosity (ß = .18). Users who were pregnant for the first time were more likely to post about lack of sleep (ß = .15), activities of daily living (ß = .09), and communication (ß = .08) compared with those who were pregnant after having a child who posted about others' birthdays (ß = .16) and life events (.12). A better understanding about social media timelines can provide insight into lifestyle choices that are specific to pregnancy.

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