Social Media as a Tool in Medicine - Digital Social Networks and Health

• Social Media as a Tool in Medicine

Digital Social Networks and Health

1. R. Craig Lefebvre, PhD; 
2. Alexandra S. Bornkessel, MA

+Author Affiliations

1. From RTI International, Research Triangle Park, NC (R.C.L., A.S.B.); and University of South Florida College of Public Health, Tampa (R.C.L.).

1. Correspondence to R. Craig Lefebvre, PhD, RTI International, 47 S Palm Ave, Suite 208, Sarasota, FL 34236. E-mail clefebvre@rti.org

Key Words:

• cardiovascular disease prevention
• digital health
• obesity
• patient-centered care
• patient education
• self-management
• social media
• social networks

Introduction

This article documents the emergence of social media, and specifically social network sites (SNS) and their impact on health information–seeking and health-related behaviors. We review surveys of user behavior on SNS to document how health information is being transformed into a social health experience rather than an individual or clinical endeavor. We then turn to the research evidence for how SNS may influence health behaviors. Although there is a substantial literature that provides support for the role of social variables in the genesis and management of health and disease, there is little scientific grounding for how to leverage these variables to improve health in either online or offline milieus. We conclude with recommendations for practice to optimize the use of social media and its contribution to improved health outcomes, and pose a series of questions that may guide the development of a research agenda in this area.

The technological innovations of blogs, podcasts, interactive media, and SNS have enabled many people to create, post, and share their own messages and content by using a variety of digital social communication tools and platforms. People and organizations can now quickly create and deliver content through more interactive Web sites and online communities where, for example, people with medical conditions can seek, give, and receive advice from other patients and healthcare providers.^1,2 New communication technologies and the emergence of what has been dubbed Web 2.0 are providing the opportunity for health professionals and patients alike to engage with 1 another, …

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Review

A compendium of causative agents of occupational asthma

Xaver Baur

• Correspondence: Xaver Baur xaver.baur@charite.de

Journal of Occupational Medicine and Toxicology 2013, 8:15 doi:10.1186/1745-6673-8-15

Published: 24 May 2013

Abstract (provisional)

Objective

The objective is to provide an evidence-based compendium of allergenic and irritant agents that are known to cause occupational asthma in order to improve diagnostics and disease management.

Methods

Two previously published reviews from our group utilized database searches to identify studies which were then rated according to the Scottish Intercollegiate Guideline Network (SIGN) grading system. The evidence level for each causative agent or worksite was graded using the Royal College of General Practitioners (RCGP) three-star system.

Results

Approximately 3,000 relevant papers were identified, which covered 372 different causes of allergic and 184 different causes of irritant occupational asthma. The highest level achieved using the SIGN grading system was 2++, indicating a high quality study with a very low risk of confounding or bias and a high probability of a causal relationship. Using the modified RCGP three-star grading system, the strongest evidence of association with an individual agent or worksite ('***') was found for exposure to laboratory animals. Associations with moderate evidence level ('**') were obtained for a) the allergenic agents or worksites: alpha-amylase from Aspergillus oryzae, various enzymes from Bacillus subtilis, papain, bakeries , western red cedar, latex, psyllium, storage mites, rat, carmine, egg proteins, Atlantic salmon, fishmeal, Norway lobster, prawn, snow crab, seafood, trout and turbot, reactive dyes, b) the irritant agents or worksites: benzene-1,2,4-tricarboxylic acid, 1,2- anhydride [trimellitic anhydride], chlorine, cobalt, cement, environmental tobacco smoke, grain, welding fumes, construction work, swine confinement, World Trade Center disaster 2001, and c) agents or worksites causing allergic as well as irritant occupational asthma, included farming, poultry confinement, various isocyanates and platinum salts. A low evidence level (RCGP) was obtained for 84 agents or worksites (42 from each group), providing a total of 141 conditions with a low, moderate or strong evidence level.

Conclusion

This work comprises the largest compendium and evaluation of agents and worksites causing allergic or irritant occupational asthma from the literature assessed in an evidence-based manner.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Best strategies to implement clinical pathways in an emergency department setting. Study protocol in asthma and gastroenteriris.

Study protocol

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

Mona Jabbour, Janet Curran, Shannon D Scott, Astrid Guttman, Thomas Rotter, Francine M Ducharme, M Diane Lougheed, M Louise McNaughton-Filion, Amanda Newton, Mark Shafir, Alison Paprica, Terry Klassen, Monica Taljaard,Jeremy Grimshaw and David W Johnson

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Implementation Science 2013, 8:55 doi:10.1186/1748-5908-8-55

Published: 22 May 2013

Abstract (provisional)

Background

The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for `point of care? management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. Design/methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma?the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis?the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits.

Discussion

This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. Trial registration ClinicalTrials.gov: NCT01815710

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Multifactorial intervention for children with asthma and overweight

Study protocol

Multifactorial intervention for children with asthma and overweight (Mikado): study design of a randomised controlled trial

Maartje Willeboordse, Kim D van de Kant, Maroeska N de Laat, Onno C van Schayck, Sandra Mulkens and Edward Dompeling

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BMC Public Health 2013, 13:494 doi:10.1186/1471-2458-13-494

Published: 21 May 2013

Abstract (provisional)

Background

In children, the prevalence's of both obesity and asthma are disconcertingly high. Asthmatic children with obesity are characterised by less asthma control and a high need for asthma medication. As the obese asthmatic child is becoming more common in the clinical setting and the disease burden of the asthma-obesity phenotype is high, there is an increasing need for effective treatment in these children. In adults, weight reduction resulted in improved lung function, better asthma control and less need for asthma medication. In children this is hardly studied. The Mikado study aims to evaluate the effectiveness of a long term multifactorial weight reduction intervention, on asthma characteristics in children with asthma and a high body weight.

Methods

The Mikado study is a two-armed, randomised controlled trial. In total, 104 participants will be recruited via online questionnaires, pulmonary paediatricians, the youth department of the Municipal Health Services and cohorts of existing studies. All participants will be aged 6--16 years, will have current asthma, a Body Mass Index in the overweight or obesity range, and no serious comorbidities (such as diabetes, heart diseases). Participants in the intervention arm will receive a multifactorial intervention of 18 months consisting of sessions concerning sports, parental involvement, individual counselling and lifestyle advices including dietary advices and cognitive behavioural therapy. The control group will receive usual care. The primary outcome variables will include Forced Expiratory Volume in one second and Body Mass Index - Standard Deviation Score. Secondary outcomes will include other lung function parameters (including dynamic and static lung function parameters), asthma control, asthma-specific quality of life, use of asthma medication and markers of systemic inflammation and airway inflammation.

Discussion

In this randomised controlled trial we will study the potential of a multifactorial weight reduction intervention to improve asthma-related outcome measures in asthmatic children with overweight. Moreover, it will provide information about the underlying mechanisms in the relationship between asthma and a high body weight in children. These findings can contribute to optimal management programs and better clinical guidelines for children with asthma and overweight.

Trial registration: Clinicaltrial.gov NCT00998413

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

OPEN ACCESS PEER-REVIEWED

RESEARCH ARTICLE

Eosinophils Promote Epithelial to Mesenchymal Transition of Bronchial Epithelial Cells

• Atsushi Yasukawa equal contributor,
 
• Koa Hosoki equal contributor,
 
• Masaaki Toda,
 
• Yasushi Miyake,
 
• Yuki Matsushima,
 
• Takahiro Matsumoto,
 
• Daniel Boveda-Ruiz,
• Paloma Gil-Bernabe,
 
• Mizuho Nagao,
 
• Mayumi Sugimoto,
 
• Yukiko Hiraguchi,
 
• Reiko Tokuda,
 
• Masahiro Naito,
•  [ ... ],
 
• Esteban C. Gabazza 

Abstract

Eosinophilic inflammation and remodeling of the airways including subepithelial fibrosis and myofibroblast hyperplasia are characteristic pathological findings of bronchial asthma. Epithelial to mesenchymal transition (EMT) plays a critical role in airway remodelling. In this study, we hypothesized that infiltrating eosinophils promote airway remodelling in bronchial asthma. To demonstrate this hypothesis we evaluated the effect of eosinophils on EMT by in vitro and in vivo studies. EMT was assessed in mice that received intra-tracheal instillation of mouse bone marrow derived eosinophils and in human bronchial epithelial cells co-cultured with eosinophils freshly purified from healthy individuals or with eosinophilic leukemia cell lines. Intra-tracheal instillation of eosinophils was associated with enhanced bronchial inflammation and fibrosis and increased lung concentration of growth factors. Mice instilled with eosinophils pre-treated with transforming growth factor(TGF)-β1 siRNA had decreased bronchial wall fibrosis compared to controls. EMT was induced in bronchial epithelial cells co-cultured with human eosinophils and it was associated with increased expression of TGF-β1 and Smad3 phosphorylation in the bronchial epithelial cells. Treatment with anti-TGF-β1 antibody blocked EMT in bronchial epithelial cells. Eosinophils induced EMT in bronchial epithelial cells, suggesting their contribution to the pathogenesis of airway remodelling.

• Abstract
• Introduction
• Results
• Discussion
• Materials and Methods
• Supporting Information
• Author Contributions
• References

Citation: Yasukawa A, Hosoki K, Toda M, Miyake Y, Matsushima Y, et al. (2013) Eosinophils Promote Epithelial to Mesenchymal Transition of Bronchial Epithelial Cells. PLoS ONE 8(5): e64281. doi:10.1371/journal.pone.0064281

Editor: Hong Wei Chu, National Jewish Health, United States of America

Received: November 9, 2012; Accepted: April 12, 2013; Published: May 21, 2013

Copyright: © 2013 Yasukawa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This research was supported by a Grant-in-aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

• NIHPA Author Manuscripts
• PMC3654689

J Allergy Clin Immunol Pract. Author manuscript; available in PMC 2013 May 15.

Published in final edited form as:

J Allergy Clin Immunol Pract. 2013 March; 1(2): 137–141.

doi:  10.1016/j.jaip.2012.07.002

PMCID: PMC3654689

NIHMSID: NIHMS425019

Climate Change and Our Environment: The Effect on Respiratory and Allergic Disease

Charles S. Barnes, PhD,a Neil E. Alexis, Jonathan A. Bernstein, John R. Cohn, Jeffrey G. Demain, Elliott Horner,Estelle Levetin, Andre Nel, and Wanda Phipatanakul

Author information ► Copyright and License information ►

Abstract

Climate change is a constant and ongoing process. It is postulated that human activities have reached a point at which we are producing global climate change. This article provides suggestions to help the allergist/environmental physician integrate recommendations about improvements in outdoor and indoor air quality and the likely response to predicted alterations in the earth’s environment into their patient’s treatment plan. Many changes that affect respiratory disease are anticipated. Examples of responses to climate change include energy reduction retrofits in homes that could potentially affect exposure to allergens and irritants, more hot sunny days that increase ozone-related difficulties, and rises in sea level or altered rainfall patterns that increase exposure to damp indoor environments. Climate changes can also affect ecosystems, manifested as the appearance of stinging and biting arthropods in new areas. Higher ambient carbon dioxide concentrations, warmer temperatures, and changes in floristic zones could potentially increase exposure to ragweed and other outdoor allergens, whereas green practices such as composting can increase allergen and irritant exposure. Finally, increased energy costs may result in urban crowding and human source pollution, leading to changes in patterns of infectious respiratory illnesses. Improved governmental controls on airborne pollutants could lead to cleaner air and reduced respiratory diseases but will meet strong opposition because of their effect on business productivity. The allergy community must therefore adapt, as physician and research scientists always have, by anticipating the needs of patients and by adopting practices and research methods to meet changing environmental conditions.

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