Background Much research is being carried out using publicly available Twitter data in the field of public health, but the types of research questions that these data are being used to answer and the extent to which these projects require ethical oversight are not clear. Objective This review describes the current state of public health research using Twitter data in terms of methods and research questions, geographic focus, and ethical considerations including obtaining informed consent from Twitter handlers. Methods We implemented a systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of articles published between January 2006 and October 31, 2019, using Twitter data in secondary analyses for public health research, which were found using standardized search criteria on SocINDEX, PsycINFO, and PubMed. Studies were excluded when using Twitter for primary data collection, such as for study recruitment or as part of a dissemination intervention. Results We identified 367 articles that met eligibility criteria. Infectious disease (n=80, 22%) and substance use (n=66, 18%) were the most common topics for these studies, and sentiment mining (n=227, 62%), surveillance (n=224, 61%), and thematic exploration (n=217, 59%) were the most common methodologies employed. Approximately one-third of articles had a global or worldwide geographic focus; another one-third focused on the United States. The majority (n=222, 60%) of articles used a native Twitter application programming interface, and a significant amount of the remainder (n=102, 28%) used a third-party application programming interface. Only one-third (n=119, 32%) of studies sought ethical approval from an institutional review board, while 17% of them (n=62) included identifying information on Twitter users or tweets and 36% of them (n=131) attempted to anonymize identifiers. Most studies (n=272, 79%) included a discussion on the validity of the measures and reliability of coding (70% for interreliability of human coding and 70% for computer algorithm checks), but less attention was paid to the sampling frame, and what underlying population the sample represented. Conclusions Twitter data may be useful in public health research, given its access to publicly available information. However, studies should exercise greater caution in considering the data sources, accession method, and external validity of the sampling frame. Further, an ethical framework is necessary to help guide future research in this area, especially when individual, identifiable Twitter users and tweets are shared and discussed. Trial Registration PROSPERO CRD42020148170; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=148170
BACKGROUND YouTube has become a popular source of healthcare information reaching an estimated 73% of adults in 2019; approximately 35% of adults in the United States have used the internet to self-diagnose a condition. Public health researchers are therefore incorporating YouTube data in their research, with varying methodologies for sampling, defining measures, and handling ethical concerns. OBJECTIVE To understand the types of public health research being implemented with YouTube data and the methodologies and research ethics processes applied to this research. METHODS We implemented a systematic review of articles that were published in peer reviewed journals in English between January 1, 2006 and October 31, 2019 and concerned public health and social media. We extracted data on yearly publication rate, journal impact factor (IF), sampling methods, outcome types, external validity, measures of popularity, presence of user identifying information, IRB review, and informed consent processes. RESULTS This review includes 119 articles from 88 journals. The number of articles published per year increased from two in 2007 to 16 in 2016 and 2017 and then declined to approximately 10 in 2019. Median IF of the journals publishing these studies has remained below 5.0 since 2009. The most common public health topics studied were in the categories of chronic diseases other than cancers (n=28, 23.5%), infectious diseases (n=20, 16.8%), and substance use (n=19, 16.0%). Most studies used content analysis to describe the themes of videos (n=89, 74.8%), while the remainder reported on the quality or utility of videos (n=35, 29.4%), and public opinion or attitudes about video topics (n=31, 26.1%). Few articles scored poorly for quality metrics (n=22, 18.5%). The quality metric most lacking was “validity of measures” (only 6 of 75 studies [8.0%] achieved this metric), followed by “sufficiently rigorous statistical analysis” (14 of 119 studies [11.8%] achieved this metric). The majority (n=82, 68.9%) of articles made no mention of ethical considerations in study design or data collection. Thirty-three (27.7%) contained identifying information about content creators or video commenters. About a quarter of studies sought IRB approval (n=31, 26.1%), but only one sought informed consent from content creators. CONCLUSIONS We found great interest in using YouTube to answer public health questions as indicated by the quantity of articles and the increase in rate of publication over time. However, more careful consideration of study design and thorough validation of outcome measures will strengthen future studies. Debate about the ethics of social media data usage is ongoing. Concrete guidelines on ethical considerations, especially from IRBs, are needed for social media research. CLINICALTRIAL PROSPERO Registration Number CRD42020148170.
Background Staphylococcus aureus is a common cause of healthcare associated infections and is associated with high mortality. Universal S. aureus decolonization reduces methicillin-resistant S. aureus (MRSA) and other bloodstream infections among ICU patients. However, universal decolonization in acute care settings has not shown a similar benefit. We describe a screening and targeted decolonization protocol implemented at an academic hospital across acute and intensive care settings. The goal of this study was to assess the impact of decolonization on rates of S. aureus invasive infections. Methods Adult Medicine, Oncology, Transplant, and ICU patients were screened by nasal swab for S. aureus colonization on admission and change in level of care. Colonized patients received 5 days of chlorhexidine 2% applied to the body and mupirocin for the nares. We compared decolonized patients with patients who received no decolonization. The primary outcome was S. aureus invasive infection from hospital day 5 until discharge, defined by positive cultures from sterile sites. Secondary outcomes included 30-day readmission and 30-day mortality. Results Between 2018-2020, 3,835 (23%) out of 16,467 hospitalized patients screened positive for MSSA (74%) or MRSA (26%). Among colonized patients, median age was 67 years (interquartile range [IQR] 54-79) and median LOS was 6 days (IQR 4-11). Among patients with LOS ≥ 5 days, 977 (37%) received decolonization. There were 122 invasive infections, 56 (46%) occurring in patients who received decolonization. Wound infections were most common (28; 23%), followed by bacteremia (27; 22%). In multivariate regression analysis controlling for confounding factors including comorbidities and length of stay, decolonization was not significantly associated with incident invasive infections (p = 0.395). Conclusion We report on a S. aureus screening and targeted decolonization program; our initial analyses do not demonstrate an association between decolonization and reduced invasive S. aureus infections. Further investigations will examine subsets of high-risk patients and transmission events to assess if specific populations may benefit from this program. Disclosures All Authors: No reported disclosures.
Background:Staphylococcus aureus is a common cause of healthcare associated infections and is associated with high mortality. S. aureus colonization of skin and mucosa contributes to its pathogenesis. Universal S. aureus decolonization reduces methicillin-resistant S. aureus (MRSA) and other bloodstream infections among ICU patients. However, universal decolonization in acute-care settings has not shown a similar benefit. We describe a targeted decolonization protocol implemented at a large academic hospital across acute-care and intensive care settings. We assessed the impact of decolonization on S. aureus–related infections. Methods: Adults admitted in 2018–2019 to the medicine, oncology, transplant, and ICU services were screened for S. aureus colonization using nasal swabs for MRSA/MSSA by culture. Those with S. aureus detected underwent decolonization with 5 days of chlorhexidine 2% baths and mupirocin intranasal ointment. Decolonization was considered complete if given for 5 days. The primary outcome was S. aureus invasive infection from hospital day 3 until discharge, defined by positive clinical cultures from sterile sites. Secondary outcomes included 30-day readmission and 30-day mortality. The control population was patients with negative MRSA/MSSA nasal screening in the same hospital units. Results: In total, 4,465 (23%) of 19,065 screening tests were positive for MSSA (75%) or MRSA (25%). The median age was 69 years (IQR, 56–80), and the median length of stay (LOS) was 6 days (IQR, 4–10). Among patients with LOS ≥3 days, 541 (16%) completed decolonization and 2,161 (64%) received no decolonization. The rate of complete decolonization increased to 35% among those with LOS ≥ 7 days. In total, 802 screened patients developed invasive S. aureus infections. Of 4,437 colonized patients, 536 (12%) had invasive infections, compared with 265 (2.1%) invasive infections in 12,917 noncolonized patients. Among patients with S. aureus colonization, 24% of decolonized patients developed invasive infection and 13% of patients who were not decolonized developed invasive infection. Rates of 30-day readmission and mortality were 28% and 10%, respectively, among fully decolonized patients, versus 20% and 6.6% among those receiving no decolonization. Conclusions: These data provide an assessment of the efficacy of a targeted screening and decolonization program. Although decolonization did not reduce rates of invasive infection or secondary outcomes, further analysis is needed. Patients with longer lengths of stay are more likely to receive full decolonization but are also at higher risk of invasive infection, which may contribute to our unexpected results.Funding: NoneDisclosures: None
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