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Epidemiology Group

Medicine, Uruguay

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News Article | May 22, 2017
Site: www.rdmag.com

Through integration with a wearable thermometer, the Thermia online health educational tool developed at Boston Children's Hospital has enabled prediction of seasonal influenza outbreaks in China one month earlier than before, according to a new study in the American Journal of Public Health. "The fact that we were able to predict influenza outbreaks faster than China's national surveillance programs really shows the capacity for everyday, wearable digital health devices to track the spread of disease at the population level," said the study's lead author Yulin Hswen, who is a research fellow in Boston Children's Computational Epidemiology Group and a doctoral candidate at the Harvard T. H. Chan School of Public Health. Although the Boston Children's team has previously demonstrated that social media can be used to track disease, this is the first time that they've shown that outbreaks can be predicted through an integrated wearable device and online tool. "Collectively we are still coming to terms with the data deluge from wearable devices, but it is imperative that we begin to generate value from this data," says the study's senior author Jared Hawkins, PhD, who is director of informatics at Boston Children's Innovation and Digital Health Accelerator (IDHA). "From a public health perspective -- as we have shown with this latest study -- there is enormous potential for tapping this data for research, surveillance and influencing policy." Thermia, a fever educational tool created by the Boston Children's team, works as a standalone digital application or can receive a child's temperature reading directly through the iThermonitor, an FDA-approved, patch-like wearable thermometer that is worn under the arm. This integration is possible under a license agreement between Boston Children's and the iThermonitor's manufacturer, Raiing Medical Inc., which is based in China. In China, the Thermia-empowered iThermonitor has gained popularity among digitally-savvy parents who have purchased the wearable device to monitor their child's temperature. When iThermonitor detects a fever, parents can access Thermia via web or mobile and answer online questions about the child's current symptoms and medical history. Data collected from these interactions is anonymized and analyzed by the Boston Children's team to enable disease tracking. Using this method, the team collected nearly 45,000 data points from China's Thermia users between 2014 and 2016. They discovered that outbreaks of "influenza-like illnesses", which had the hallmark signs of influenza, could be detected digitally in real time. In comparison to the influenza surveillance data collected by the National Health and Family Planning Commission (NHFPC) of the People's Republic of China, the data from iThermonitor and Thermia revealed influenza outbreaks an entire month earlier. "Delays in clinically-reported data and lack of data availability contribute to the challenges of identifying outbreaks rapidly," says John Brownstein, PhD, who is the chief innovation officer at Boston Children's and director of the Computational Epidemiology Lab and the IDHA. "As a result, we have more and more opportunities to use real-time, low-cost digital solutions like Thermia to improve disease surveillance." In China, for example, the National Health and Family Planning Commission normally conducts their influenza surveillance by reporting and confirming cases as children are seen by clinicians at health facilities. But this kind of traditional disease surveillance program is susceptible to lag time before an emerging outbreak is recognized. Factors that contribute to this lag time include patients' proximity and likelihood of traveling to a clinic, the availability of trained clinicians who can identify the signs of influenza and whether or not local laboratory resources are available to confirm cases. In contrast, China has 620 million mobile internet users who can theoretically access the standalone Thermia application from any computer, smartphone or even the Amazon Alexa assistant. "In geographically large and densely populated countries like China, tools like Thermia can provide better on-the-ground disease surveillance than by relying on data that is only captured at the point of treatment in the clinic," says Hswen.


News Article | May 22, 2017
Site: www.rdmag.com

Through integration with a wearable thermometer, the Thermia online health educational tool developed at Boston Children's Hospital has enabled prediction of seasonal influenza outbreaks in China one month earlier than before, according to a new study in the American Journal of Public Health. "The fact that we were able to predict influenza outbreaks faster than China's national surveillance programs really shows the capacity for everyday, wearable digital health devices to track the spread of disease at the population level," said the study's lead author Yulin Hswen, who is a research fellow in Boston Children's Computational Epidemiology Group and a doctoral candidate at the Harvard T. H. Chan School of Public Health. Although the Boston Children's team has previously demonstrated that social media can be used to track disease, this is the first time that they've shown that outbreaks can be predicted through an integrated wearable device and online tool. "Collectively we are still coming to terms with the data deluge from wearable devices, but it is imperative that we begin to generate value from this data," says the study's senior author Jared Hawkins, PhD, who is director of informatics at Boston Children's Innovation and Digital Health Accelerator (IDHA). "From a public health perspective -- as we have shown with this latest study -- there is enormous potential for tapping this data for research, surveillance and influencing policy." Thermia, a fever educational tool created by the Boston Children's team, works as a standalone digital application or can receive a child's temperature reading directly through the iThermonitor, an FDA-approved, patch-like wearable thermometer that is worn under the arm. This integration is possible under a license agreement between Boston Children's and the iThermonitor's manufacturer, Raiing Medical Inc., which is based in China. In China, the Thermia-empowered iThermonitor has gained popularity among digitally-savvy parents who have purchased the wearable device to monitor their child's temperature. When iThermonitor detects a fever, parents can access Thermia via web or mobile and answer online questions about the child's current symptoms and medical history. Data collected from these interactions is anonymized and analyzed by the Boston Children's team to enable disease tracking. Using this method, the team collected nearly 45,000 data points from China's Thermia users between 2014 and 2016. They discovered that outbreaks of "influenza-like illnesses", which had the hallmark signs of influenza, could be detected digitally in real time. In comparison to the influenza surveillance data collected by the National Health and Family Planning Commission (NHFPC) of the People's Republic of China, the data from iThermonitor and Thermia revealed influenza outbreaks an entire month earlier. "Delays in clinically-reported data and lack of data availability contribute to the challenges of identifying outbreaks rapidly," says John Brownstein, PhD, who is the chief innovation officer at Boston Children's and director of the Computational Epidemiology Lab and the IDHA. "As a result, we have more and more opportunities to use real-time, low-cost digital solutions like Thermia to improve disease surveillance." In China, for example, the National Health and Family Planning Commission normally conducts their influenza surveillance by reporting and confirming cases as children are seen by clinicians at health facilities. But this kind of traditional disease surveillance program is susceptible to lag time before an emerging outbreak is recognized. Factors that contribute to this lag time include patients' proximity and likelihood of traveling to a clinic, the availability of trained clinicians who can identify the signs of influenza and whether or not local laboratory resources are available to confirm cases. In contrast, China has 620 million mobile internet users who can theoretically access the standalone Thermia application from any computer, smartphone or even the Amazon Alexa assistant. "In geographically large and densely populated countries like China, tools like Thermia can provide better on-the-ground disease surveillance than by relying on data that is only captured at the point of treatment in the clinic," says Hswen.


News Article | May 19, 2017
Site: www.sciencedaily.com

Through integration with a wearable thermometer, the Thermia online health educational tool developed at Boston Children's Hospital has enabled prediction of seasonal influenza outbreaks in China one month earlier than before, according to a new study in the American Journal of Public Health. "The fact that we were able to predict influenza outbreaks faster than China's national surveillance programs really shows the capacity for everyday, wearable digital health devices to track the spread of disease at the population level," said the study's lead author Yulin Hswen, who is a research fellow in Boston Children's Computational Epidemiology Group and a doctoral candidate at the Harvard T. H. Chan School of Public Health. Although the Boston Children's team has previously demonstrated that social media can be used to track disease, this is the first time that they've shown that outbreaks can be predicted through an integrated wearable device and online tool. "Collectively we are still coming to terms with the data deluge from wearable devices, but it is imperative that we begin to generate value from this data," says the study's senior author Jared Hawkins, PhD, who is director of informatics at Boston Children's Innovation and Digital Health Accelerator (IDHA). "From a public health perspective -- as we have shown with this latest study -- there is enormous potential for tapping this data for research, surveillance and influencing policy." Thermia, a fever educational tool created by the Boston Children's team, works as a standalone digital application or can receive a child's temperature reading directly through the iThermonitor, an FDA-approved, patch-like wearable thermometer that is worn under the arm. This integration is possible under a license agreement between Boston Children's and the iThermonitor's manufacturer, Raiing Medical Inc., which is based in China. In China, the Thermia-empowered iThermonitor has gained popularity among digitally-savvy parents who have purchased the wearable device to monitor their child's temperature. When iThermonitor detects a fever, parents can access Thermia via web or mobile and answer online questions about the child's current symptoms and medical history. Data collected from these interactions is anonymized and analyzed by the Boston Children's team to enable disease tracking. Using this method, the team collected nearly 45,000 data points from China's Thermia users between 2014 and 2016. They discovered that outbreaks of "influenza-like illnesses," which had the hallmark signs of influenza, could be detected digitally in real time. In comparison to the influenza surveillance data collected by the National Health and Family Planning Commission (NHFPC) of the People's Republic of China, the data from iThermonitor and Thermia revealed influenza outbreaks an entire month earlier. "Delays in clinically-reported data and lack of data availability contribute to the challenges of identifying outbreaks rapidly," says John Brownstein, PhD, who is the chief innovation officer at Boston Children's and director of the Computational Epidemiology Lab and the IDHA. "As a result, we have more and more opportunities to use real-time, low-cost digital solutions like Thermia to improve disease surveillance." In China, for example, the National Health and Family Planning Commission normally conducts their influenza surveillance by reporting and confirming cases as children are seen by clinicians at health facilities. But this kind of traditional disease surveillance program is susceptible to lag time before an emerging outbreak is recognized. Factors that contribute to this lag time include patients' proximity and likelihood of traveling to a clinic, the availability of trained clinicians who can identify the signs of influenza and whether or not local laboratory resources are available to confirm cases. In contrast, China has 620 million mobile internet users who can theoretically access the standalone Thermia application from any computer, smartphone or even the Amazon Alexa assistant. "In geographically large and densely populated countries like China, tools like Thermia can provide better on-the-ground disease surveillance than by relying on data that is only captured at the point of treatment in the clinic," says Hswen.


News Article | May 19, 2017
Site: www.eurekalert.org

BOSTON (May 19, 2017) - Through integration with a wearable thermometer, the Thermia online health educational tool developed at Boston Children's Hospital has enabled prediction of seasonal influenza outbreaks in China one month earlier than before, according to a new study in the American Journal of Public Health. "The fact that we were able to predict influenza outbreaks faster than China's national surveillance programs really shows the capacity for everyday, wearable digital health devices to track the spread of disease at the population level," said the study's lead author Yulin Hswen, who is a research fellow in Boston Children's Computational Epidemiology Group and a doctoral candidate at the Harvard T. H. Chan School of Public Health. Although the Boston Children's team has previously demonstrated that social media can be used to track disease, this is the first time that they've shown that outbreaks can be predicted through an integrated wearable device and online tool. "Collectively we are still coming to terms with the data deluge from wearable devices, but it is imperative that we begin to generate value from this data," says the study's senior author Jared Hawkins, PhD, who is director of informatics at Boston Children's Innovation and Digital Health Accelerator (IDHA). "From a public health perspective -- as we have shown with this latest study -- there is enormous potential for tapping this data for research, surveillance and influencing policy." Thermia, a fever educational tool created by the Boston Children's team, works as a standalone digital application or can receive a child's temperature reading directly through the iThermonitor, an FDA-approved, patch-like wearable thermometer that is worn under the arm. This integration is possible under a license agreement between Boston Children's and the iThermonitor's manufacturer, Raiing Medical Inc., which is based in China. In China, the Thermia-empowered iThermonitor has gained popularity among digitally-savvy parents who have purchased the wearable device to monitor their child's temperature. When iThermonitor detects a fever, parents can access Thermia via web or mobile and answer online questions about the child's current symptoms and medical history. Data collected from these interactions is anonymized and analyzed by the Boston Children's team to enable disease tracking. Using this method, the team collected nearly 45,000 data points from China's Thermia users between 2014 and 2016. They discovered that outbreaks of "influenza-like illnesses", which had the hallmark signs of influenza, could be detected digitally in real time. In comparison to the influenza surveillance data collected by the National Health and Family Planning Commission (NHFPC) of the People's Republic of China, the data from iThermonitor and Thermia revealed influenza outbreaks an entire month earlier. "Delays in clinically-reported data and lack of data availability contribute to the challenges of identifying outbreaks rapidly," says John Brownstein, PhD, who is the chief innovation officer at Boston Children's and director of the Computational Epidemiology Lab and the IDHA. "As a result, we have more and more opportunities to use real-time, low-cost digital solutions like Thermia to improve disease surveillance." In China, for example, the National Health and Family Planning Commission normally conducts their influenza surveillance by reporting and confirming cases as children are seen by clinicians at health facilities. But this kind of traditional disease surveillance program is susceptible to lag time before an emerging outbreak is recognized. Factors that contribute to this lag time include patients' proximity and likelihood of traveling to a clinic, the availability of trained clinicians who can identify the signs of influenza and whether or not local laboratory resources are available to confirm cases. In contrast, China has 620 million mobile internet users who can theoretically access the standalone Thermia application from any computer, smartphone or even the Amazon Alexa assistant. "In geographically large and densely populated countries like China, tools like Thermia can provide better on-the-ground disease surveillance than by relying on data that is only captured at the point of treatment in the clinic," says Hswen. Boston Children's Hospital, the primary pediatric teaching affiliate of Harvard Medical School, is home to the world's largest research enterprise based at a pediatric medical center. Its discoveries have benefited both children and adults since 1869. Today, more than 2,630 scientists, including nine members of the National Academy of Sciences, 14 members of the National Academy of Medicine and 11 Howard Hughes Medical Investigators comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's is now a 415-bed comprehensive center for pediatric and adolescent health care. For more, visit our Vector and Thriving blogs and follow us on social media @BostonChildrens, @BCH_Innovation, Facebook and YouTube.


van Schaik G.,Epidemiology Group
Preventive Veterinary Medicine | Year: 2013

At the end of 2007, the first year of what later turned out to be one of the largest Q fever outbreaks in the world with ultimately almost 3500 human patients notified in three years time, dairy goats were suspected to be the possible cause. However, current information on the Q fever prevalence in small ruminants in The Netherlands was lacking.A serological survey, using an indirect ELISA, was carried out in 15,186 sheep and goats in The Netherlands in 2008. In total, 2.4% (95% CI: 2.2-2.7) of the sheep and 7.8% (95% CI: 6.9-8.8) of the goats was seropositive for antibodies against Coxiella burnetii. In 14.5% (95% CI: 12.5-16.5) of the sheep flocks and 17.9% (95% CI: 14.2-21.5) of the goat herds at least one seropositive animal was found. In sheep flocks with at least one seropositive sheep, the within herd seroprevalence was 14.8% (95% CI: 12.6-17.0). In goat herds with at least one seropositive goat, the within herd seroprevalence was 29.0% (95% CI: 24.6-33.3).The seropositive sheep were equally distributed across the country. The seroprevalence in goats in the south-eastern part of The Netherlands, the area where most of the human Q fever cases were notified, was significantly higher than the seroprevalence in goats in the rest of The Netherlands. Dairy sheep and dairy goats had a significantly higher chance of being seropositive than non-dairy sheep and goats. During pregnancy and in the periparturient period, small ruminants tested significantly more often seropositive than in the early- or non-pregnant period.The seroprevalence as well as the true prevalence among small ruminants in The Netherlands were lower than prevalences reported elsewhere. The seroprevalence among sheep was also lower than reported in an earlier Dutch study in 1987. The Q fever seroprevalence was highest in pregnant and periparturient dairy goats in the south-eastern part of The Netherlands, which coincides with the region with the highest human incidence of Q fever. © 2012 Elsevier B.V..


Ronco A.L.,Pereira Rossell Womens Hospital | De Stefani E.,Epidemiology Group | Deneo-Pellegrini H.,Epidemiology Group | Quarneti A.,Pereira Rossell Womens Hospital
Asian Pacific Journal of Cancer Prevention | Year: 2012

Obese postmenopausal women increase their risk of developing breast cancer (BC), in particular if they display an android-type pattern of adiposity, which is also associated to increased risks of diabetes mellitus, hypertension and cardiovascular disease. In order to explore the associations among anthropometry (body mass index, body composition, somatotype), some specific items of medical history (diabetes, hypertension, dislypidemias, hyperuricemia) and the risk of BC in Uruguayan women, a case-control study was carried out between 2004-2009 at our Oncology Unit. 912 women of ages between 23-69 years (367 new BC cases and 545 non hospitalized, age-matched controls with a normal mammography) were interviewed. Twenty body measurements were taken in order to calculate body composition and somatotype. Patients were queried on socio-demographics, reproductive history, family history of cancer, a brief food frequency questionnaire and on personal history of diabetes, dislypidemias, hyperuricemia, hypertension and gallbladder stones. Uni- and multivariate analyses were done, generating odds ratios (ORs) as an expression of relative risks. A personal history of diabetes was positively associated to BC risk (OR=1.64, 95% CI 1.00-2.69), being higher among postmenopausal women (OR=1.92, 95% CI 1.04-3.52). The risks of BC for diabetes in postmenopausal women with overweight combined with dislypidemia (OR=9.33, 95% CI 2.10-41.5) and high fat/muscle ratio (OR=7.81, 95% CI 2.01-30.3) were significantly high. As a conclusion, a personal history of diabetes and overweight was strongly associated to BC. The studied sample had a subset of high-risk of BC featured by postmenopausal overweight and diabetic women, who also had a personal history of hypertension and/or dyslipidemia. The present results could contribute to define new high risk groups and individuals for primary as well as for secondary prevention, since this pattern linked to the metabolic syndrome is usually not considered for BC prevention.


PubMed | Health Improvement Branch Australian Capital Territory Health Directorate, University of Canberra and Epidemiology Group
Type: Journal Article | Journal: BMJ open | Year: 2016

To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs.A cross-sectional analysis of public hospital episode data (2007-2013).Hospitalisations from the ACT, Australia at very small geographic areas.Secondary data on 75290 unique hospital episodes representing 39851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity.Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability.Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers.Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers.Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health.


Rolim D.B.,University of Fortaleza | Vilar D.C.F.L.,Epidemiology Group | De Goes Cavalcanti L.P.,Federal University of Ceará | Freitas L.B.N.,Federal University of Ceará | And 2 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2011

A seroepidemiological investigation was conducted among the population of two municipalities in Northeastern Brazil. Immunoglobulin M (IgM) and IgG antibodies to Burkholderia pseudomallei were positive in 51.27% (161 in 317 samples) and 58.49% (186), respectively. IgM titers were higher in children than in adults. On the contrary, IgG increased progressively with age. We observed a significant association between agricultural occupation and raised IgM titers (P < 0.005) and IgG titers (P < 0.001), and between construction workers and raised IgG titers (P = 0.005). Antibody IgG avidities did not correlate with age. The highest titers of antibodies (1/800) showed the highest antibody avidity indexes (P < 0.01). Most of the serum samples recognized 45-kDa and 200-kDa bands by IgG1 and IgG2 subclasses. Our study showed a high seropositivity among individuals living in endemic regions of the state of Ceara´, and highlights the need for further surveillance close to water courses such as dams and rivers in Northeastern Brazil. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.


PubMed | University of New South Wales, Ingham Institute of Applied Science and Epidemiology Group
Type: | Journal: The Australian & New Zealand journal of obstetrics & gynaecology | Year: 2016

Glycated haemoglobin (HbA1c) is an important tool for assessing glycaemic status in patients with diabetes, but its usefulness in gestational diabetes mellitus (GDM), is unclear.The aim of this study is to evaluate whether HbA1c in women with GDM is valuable in predicting adverse pregnancy outcomes.A retrospective review of women with GDM who had HbA1c measured at diagnosis of GDM (GHb-diag) and at 36 weeks gestation (GHb-36 weeks) was conducted. The association between HbA1c and various pregnancy outcomes was assessed RESULTS: Among 1244 women with GDM in our cohort, both GHb-diag and GHb-36 weeks were independent predictors for large-for-gestation (LGA) babies (OR 1.06, P = 0.005 and OR 1.06, P = 0.002, respectively) and neonatal hypoglycaemia (OR 1.10, P < 0.001 and OR 1.09, P < 0.001, respectively). Women with HbA1c 5.4% (35 mmol/mol) at diagnosis had significantly greater risk for LGA (15.3% vs 8.2%, P < 0.001) and neonatal hypoglycaemia (42.2% vs 23.6%, P < 0.001) than those below this cut-off. The difference between GHb-diag and GHb-36 weeks was small and improvement in HbA1c by 36 weeks was not associated with better pregnancy outcomes.We showed that measurement of HbA1c, either at the time of diagnosis of GDM or toward the end of pregnancy, were both associated with adverse pregnancy outcomes. Women with elevated HbA1c (>5.4% or 35 mmol/mol) at diagnosis of GDM should be monitored closely during pregnancy. However, there is not enough evidence to suggest that repeating HbA1c toward the end of pregnancy will provide additional information in predicting adverse pregnancy outcomes.


The role of meat in squamous cell carcinoma of the esophagus (ESCC) has been considered conflictive. For this reason, we decided to conduct a case-control study on meat consumption and ESCC. Data included 234 newly diagnosed and microscopically examined ESCC and 2,020 controls with conditions not related to tobacco smoking nor alcohol drinking and without changes in their diets. We studied total meat, red meat, beef, lamb, processed meat, poultry, fish, total white meat, liver, fried meat, barbecued meat, boiled meat, heterocyclic amines, nitrosodimethylamine, and benzo[a]pyrene in relation with the risk of ESCC. Red meat, lamb, and boiled meat were directly associated with the risk of ESCC, whereas total white meat, poultry, fish, and liver were mainly protective against this malignancy.

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