Disease detection or public opinion reflection? Content analysis of tweets, other social media, and online newspapers during the measles outbreak in The Netherlands in 2013

BACKGROUND

In May 2013, a measles outbreak began in the Netherlands among Orthodox Protestants who often refuse vaccination for religious reasons.

OBJECTIVE

Our aim was to compare the number of messages expressed on Twitter and other social media during the measles outbreak with the number of online news articles and the number of reported measles cases to answer the question if and when social media reflect public opinion patterns versus disease patterns.

METHODS

We analyzed measles-related tweets, other social media messages, and online newspaper articles over a 7-month period (April 15 to November 11, 2013) with regard to topic and sentiment. Thematic analysis was used to structure and analyze the topics.

RESULTS

There was a stronger correlation between the weekly number of social media messages and the weekly number of online news articles (P<.001 for both tweets and other social media messages) than between the weekly number of social media messages and the weekly number of reported measles cases (P=.003 and P=.048 for tweets and other social media messages, respectively), especially after the summer break. All data sources showed 3 large peaks, possibly triggered by announcements about the measles outbreak by the Dutch National Institute for Public Health and the Environment and statements made by well-known politicians. Most messages informed the public about the measles outbreak (ie, about the number of measles cases) (93/165, 56.4%) followed by messages about preventive measures taken to control the measles spread (47/132, 35.6%). The leading opinion expressed was frustration regarding people who do not vaccinate because of religious reasons (42/88, 48%).

CONCLUSIONS

The monitoring of online (social) media might be useful for improving communication policies aiming to preserve vaccination acceptability among the general public. Data extracted from online (social) media provide insight into the opinions that are at a certain moment salient among the public, which enables public health institutes to respond immediately and appropriately to those public concerns. More research is required to develop an automatic coding system that captures content and user's characteristics that are most relevant to the diseases within the National Immunization Program and related public health events and can inform official responses.

"Pandemic Public Health Paradox": Time Series Analysis of the 2009/10 Influenza A / H1N1 Epidemiology, Media Attention, Risk Perception and Public Reactions in 5 European Countries

In 2009, influenza A H1N1 caused the first pandemic of the 21st century. Although a vaccine against this influenza subtype was offered before or at the onset of the second epidemic wave that caused most of the fatal cases in Europe, vaccination rates for that season were lower than expected. We propose that the contradiction between high risk of infection and low use of available prevention measures represents a pandemic public health paradox. This research aims for a better understanding of this paradox by exploring the time-dependent interplay among changing influenza epidemiology, media attention, pandemic control measures, risk perception and public health behavior among five European countries (Czech Republic, Denmark, Germany, Spain and the UK). Findings suggest that asynchronicity between media curves and epidemiological curves may potentially explain the pandemic public health paradox; media attention for influenza A H1N1 in Europe declined long before the epidemic reached its peak, and public risk perceptions and behaviors may have followed media logic, rather than epidemiological logic.

When god sanctions killing: effect of scriptural violence on aggression

Violent people often claim that God sanctions their actions. In two studies, participants read a violent passage said to come from either the Bible or an ancient scroll. For half the participants, the passage said that God sanctioned the violence. Next, participants competed with an ostensible partner on a task in which the winner could blast the loser with loud noise through headphones (the aggression measure). Study 1 involved Brigham Young University students; 99% believed in God and in the Bible. Study 2 involved Vrije Universiteit-Amsterdam students; 50% believed in God, and 27% believed in the Bible. In Study 1, aggression increased when the passage was from the Bible or mentioned God. In Study 2, aggression increased when the passage mentioned God, especially among participants who believed in God and in the Bible. These results suggest that scriptural violence sanctioned by God can increase aggression, especially in believers.

Too Far to Care? Measuring Public Attention and Fear for Ebola Using Twitter

Background

In 2014, the world was startled by a sudden outbreak of Ebola. Although Ebola infections and deaths occurred almost exclusively in Guinea, Sierra Leone, and Liberia, few potential Western cases, in particular, caused a great stir among the public in Western countries.

Objective

This study builds on the construal level theory to examine the relationship between psychological distance to an epidemic and public attention and sentiment expressed on Twitter. Whereas previous research has shown the potential of social media to assess real-time public opinion and sentiment, generalizable insights that further the theory development lack.

Methods

Epidemiological data (number of Ebola infections and fatalities) and media data (tweet volume and key events reported in the media) were collected for the 2014 Ebola outbreak, and Twitter content from the Netherlands was coded for (1) expressions of fear for self or fear for others and (2) psychological distance of the outbreak to the tweet source. Longitudinal relations were compared using vector error correction model (VECM) methodology.

Results

Analyses based on 4500 tweets revealed that increases in public attention to Ebola co-occurred with severe world events related to the epidemic, but not all severe events evoked fear. As hypothesized, Web-based public attention and expressions of fear responded mainly to the psychological distance of the epidemic. A chi-square test showed a significant positive relation between proximity and fear: χ²₂=103.2 (P<.001). Public attention and fear for self in the Netherlands showed peaks when Ebola became spatially closer by crossing the Mediterranean Sea and Atlantic Ocean. Fear for others was mostly predicted by the social distance to the affected parties.

Conclusions

Spatial and social distance are important predictors of public attention to worldwide crisis such as epidemics. These factors need to be taken into account when communicating about human tragedies.

The influence of priming and pre-existing knowledge of chemotherapy-associated cognitive complaints on the reporting of such complaints in breast cancer patients

OBJECTIVE

Many cancer patients report cognitive changes following chemotherapy. In social psychology, there is ample evidence that psychological and physical complaints can increase with increased accessibility of relevant schemata. The accessibility of related concepts in memory may be facilitated through priming or by pre-existing knowledge, resulting in an increase of reported complaints. We examined whether pre-existing knowledge of chemotherapy-associated cognitive problems and priming the 'chemo-brain' schema increase the reporting of cognitive complaints.

METHODS

Two hundred and sixty-one breast cancer patients were interviewed about cognitive problems and other cancer-related symptoms. Preceding the interview, half of the patients were primed with an introduction letter to the study in which the occurrence of cognitive complaints and its relation with chemotherapy was explicated. The remaining patients received a neutral letter that did not mention this relationship.

RESULTS

Patients with pre-existing knowledge about chemotherapy-associated cognitive problems reported more cognitive complaints (M=3.04) than patients without this knowledge (M=2.21; p<0.001). The priming letter increased the reporting of cognitive complaints only for patients without a history of chemotherapy (p<0.05). All effects were independent of negative affect, age and education level.

CONCLUSION

Our study shows that facilitating the accessibility of concepts related to chemotherapy-associated cognitive complaints directly increases the reporting of such complaints, in particular in patients without firsthand chemotherapy experience. This increase in prevalence of cognitive complaints following a chronically or temporarily accessible 'chemo-brain' schema has relevant implications for clinical practice and for scientific research in this area.

Information about chemotherapy-associated cognitive problems contributes to cognitive problems in cancer patients

OBJECTIVE

Although increasing attention is directed at identifying biological mechanisms underlying cognitive changes observed in cancer patients without central nervous system disease following chemotherapy, psychological factors that can contribute to these cognitive changes are much less studied.

METHODS

In an online experiment, the influence of informing patients about the association between cognitive problems and chemotherapy on self-reported cognitive functioning and neuropsychological test performance was investigated.

RESULTS

Cancer patients treated with chemotherapy (n = 150) reported higher levels of cognitive complaints after receiving such information (M = 21.20) than without such information (M = 18.98; p = 0.032). No difference was found for patients without (a history of) chemotherapy (n = 86; M = 18.85 vs. 20.08; NS). A similar interaction pattern was observed on a word-learning test. Patients treated with chemotherapy recalled fewer words after being informed about the association between cognitive problems and chemotherapy (M = 24.44) than without such information (M = 27.63; p = 0.010). No difference was found for patients not treated with chemotherapy (M = 26.35 vs. 25.38; NS).

CONCLUSION

Patient information may induce a stereotype threat, which affects self-reported cognitive function and neuropsychological test performance in cancer patients for whom this information is relevant.

Emotional coping differences among breast cancer patients from an online support group: a cross-sectional study

Background

Due to mixed findings in research on the effect of online peer-to-peer support on psychological well-being, there is a need for studies explaining why and when online support communities are beneficial for cancer patients.

Objective

Previous studies have typically not taken into account individual coping differences, despite the fact that patients have different strategies to cope with cancer-related emotions. In the current study, it was predicted that the effects of online support group participation would partly depend on patients’ ability to cope with thoughts and emotions regarding the illness.

Methods

For this study, 184 Dutch breast cancer patients filled out a questionnaire assessing activity within a peer-led online support community, coping with emotions and thoughts regarding the illness (cognitive avoidance, emotional processing, and expression) and psychological well-being (depression, breast cancer-related concerns, and emotional well-being). Of these, 163 patients were visiting an online peer-led support community.

Results

Results showed interactions of the intensity of support group participation and coping style on psychological well-being. Specifically, we found an interaction of online activity and emotional expression on depression (beta=–.17, P=.030), a marginally significant interaction of online activity and emotional expression on emotional well-being (beta=.14, P=.089), and an interaction of online activity and cognitive avoidance on breast cancer–related concerns (beta=.15, P=.027). For patients who actively dealt with their emotions and thoughts, active online support group participation was positively related to psychological well-being. For patients high on avoidance of illness-related thoughts or low on emotional expression, active participation was negatively related to measures of well-being.

Conclusions

The current study revealed the role of individual differences in coping in online support group participation. Results suggest that breast cancer patients’ ability to cope with emotions and thoughts regarding the illness influence the relationship between online support group participation and psychological well-being.

Future pandemics and vaccination: Public opinion and attitudes across three European countries

BACKGROUND

Understanding public opinion and attitudes regarding vaccination is crucial for successful outbreak management and effective communication at the European level.

METHODS

We explored national differences by conducting focus group discussions in The Netherlands, Poland and Sweden. Discussions were structured using concepts from behavioural models.

RESULTS

Thematic analysis revealed that participants would base their vaccination decision on trade-offs between perceived benefits and barriers of the vaccine also taking into account the seriousness of the new outbreak. Except for those having chronic diseases, participants expected a low infection risk, resulting in a low willingness to get vaccinated. Information about the health status of cases was considered important since this might change perceived susceptibility. Participants displayed concerns about vaccine safety due to the limited available time to produce and test vaccines in the acute situation of a new pandemic. Swedish participants mentioned their tendency of doing the right thing and following the rules, as well as to get vaccinated because of solidarity with other citizens and social influences. This appeared much less prominent for the Dutch and Polish participants. However, Swedish participants indicated that their negative experiences during the Influenza A/H1N1 2009 pandemic decreases their acceptance of future vaccinations. Polish participants lacked trust in their national (public) health system and government, and were therefore sceptical about the availability and quality of vaccines in Poland.

CONCLUSIONS

Although participants overall expressed similar considerations, important differences between countries stand out, such as previous vaccination experiences, the degree of adherence to social norms, and the degree of trust in health authorities.

Emotional approach coping and the effects of online peer-led support group participation among patients with breast cancer: a longitudinal study

Background

Previous research on the effects of online peer support on psychological well-being of patients with cancer showed mixed findings. There is a need for longitudinal studies explaining if and when online peer-led support groups are beneficial. How patients cope with emotions that come along with the cancer diagnosis might influence effectiveness of online participation. Emotional approach coping is a construct encompassing the intentional use of emotional processing and emotional expression in efforts to manage adverse circumstances.

Objective

In this longitudinal study, we hypothesize that mixed findings in previous research are partly caused by individual differences in coping with emotions, which may moderate the effects of online support group participation on patients’ well-being.

Methods

A total of 133 Dutch patients with breast cancer filled out a baseline (T0) and a follow-up (T1, 6 months later) questionnaire assessing intensity of online participation within the online support community, emotional approach coping (ie, actively processing and expressing emotions), and psychological well-being (depression, emotional well-being, and breast cancer–related concerns). There were 109 patients who visited an online support community at both points in time. Repeated measures ANOVAs assessed change in well-being over time.

Results

Results showed 3-way interactions of time, online intensity of participation, and emotional approach coping on emotional well-being (F_1,89=4.232, P=.04, η²_ρ=.045) and depression (F_1,88=8.167, P=.005, η²_ρ=.085). Online support group participation increased emotional well-being over time for patients who scored low on emotional approach coping at T0, provided that they were highly active online. Patients who were highly active online with a high score on emotional approach coping reported no change in sense of well-being, but showed the highest score on well-being overall. Participating less frequently online was only beneficial for patients who scored high on emotional approach coping, showing an increase in well-being over time. Patients participating less frequently and with a low score on emotional approach coping reported no significant change in well-being over time.

Conclusions

This study extends previous findings on the effects of online peer support in two ways: by testing changes in well-being as a function of intensity of online support group participation and by examining the role of individual differences in emotional coping styles. Findings showed no negative effects of intense support group participation. Participating frequently online was especially helpful for patients who approach their emotions less actively; their emotional well-being increased over time. In contrast, frequent online users who actively approach their emotions experienced no change in well-being, reporting highest levels of well-being overall. For patients who participate less intensively within the support community, coping style seems to outweigh effects of online participation; over time, patients who actively approached emotions experienced an increase in psychological well-being, whereas patients with a low score on emotional approach coping reported no change in depression and emotional well-being.

Broadening the cancer and cognition landscape: the role of self-regulatory challenges

BACKGROUND

The potentially detrimental effects of cancer and related treatments on cognitive functioning have emerged as one of the key foci of cancer survivorship research, but little is known about how psychological variables other than depression influence these relationships. To illustrate the potential of social psychological perspectives, we examine how a self-regulatory analysis and specific self-regulatory challenges of contending with cancer-related expectancies and stereotypes provide conceptual frameworks for understanding some of the potential causes and consequences of cancer-related cognitive deficits.

METHODS

Literatures on cancer-related cognitive deficits, self-regulatory ego depletion, expectancy stereotypes, and their points of convergence are briefly reviewed.

RESULTS

A review and conceptual integration of relevant literatures suggest that coping with cancer can impair self-regulatory capacity. There is an overlap between cognitive deficits associated with self-regulatory challenge and with cancer and its treatment, and restoring self-regulatory resources can attenuate cancer-related cognitive deficits. Examination of specific regulatory challenges of contending with expectancies and stereotypes related to treatment suggests insights that can inform when and among whom cognitive deficits may most likely emerge.

CONCLUSIONS

Integrating social psychological ideas with a substantial knowledge base can illustrate novel research trajectories that can deepen our understanding of cancer-related cognitive deficits and their impact on psychosocial well-being.

Factors associated with hepatitis B vaccination among men who have sex with men: a systematic review of published research

This systematic review identified and synthesised evidence from published research regarding personal and environmental factors associated with hepatitis B virus (HBV) vaccination uptake among gay men and other men who have sex with men (MSM) in low prevalence, high-income countries. A systematic literature search identified 18 eligible papers that addressed factors potentially associated with HBV vaccination uptake among MSM, of which 16 reported research conducted in the US. Studies assessed possible associations between HBV vaccination among MSM and socio-demographic characteristics, behavioural and social-cognitive factors and indicators of health service access. Converging evidence was found for associations between HBV vaccination and younger age, gay self-identification, and not using alcohol and drugs; evidence suggests a lack of association between HBV vaccination and ethnicity. There was converging evidence for associations between HBV vaccination and social-cognitive factors, in particular knowledge, perceived vulnerability and perceived severity regarding HBV infection, and perceived barriers to HBV vaccination. Evidence further supported associations between HBV vaccination and indicators of health service access. While research regarding factors associated with HBV vaccination among MSM remains limited, the identified correlates of HBV vaccination among MSM provide important guidance for the development of health promotion interventions to effectively increase coverage of HBV vaccination among MSM.

Mood as a resource in dealing with health recommendations: how mood affects information processing and acceptance of quit-smoking messages

OBJECTIVE

An experimental study tested the effects of positive and negative mood on the processing and acceptance of health recommendations about smoking in an online experiment. It was hypothesised that positive mood would provide smokers with the resources to systematically process self-relevant health recommendations.

DESIGN

One hundred and twenty-seven participants (smokers and non-smokers) read a message in which a quit smoking programme was recommended. Participants were randomly assigned to one of four conditions: positive versus negative mood, and strong versus weak arguments for the recommended action.

MAIN OUTCOME MEASURES

Systematic message processing was inferred when participants were able to distinguish between high- and low-quality arguments, and by congruence between attitudes and behavioural intentions. Persuasion was measured by participant's attitudes towards smoking and the recommended action, and by their intentions to follow the action recommendation.

RESULTS

As predicted, smokers systematically processed the health message only under positive mood conditions; non-smokers systematically processed the health message only under negative mood conditions. Moreover, smokers' attitudes towards the health message predicted intentions to quit smoking only under positive mood conditions.

CONCLUSION

Findings suggest that positive mood may decrease defensive processing of self-relevant health information.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Predicting life expectancy with a long short-term memory recurrent neural network using electronic medical records

BACKGROUND

Life expectancy is one of the most important factors in end-of-life decision making. Good prognostication for example helps to determine the course of treatment and helps to anticipate the procurement of health care services and facilities, or more broadly: facilitates Advance Care Planning. Advance Care Planning improves the quality of the final phase of life by stimulating doctors to explore the preferences for end-of-life care with their patients, and people close to the patients. Physicians, however, tend to overestimate life expectancy, and miss the window of opportunity to initiate Advance Care Planning. This research tests the potential of using machine learning and natural language processing techniques for predicting life expectancy from electronic medical records.

METHODS

We approached the task of predicting life expectancy as a supervised machine learning task. We trained and tested a long short-term memory recurrent neural network on the medical records of deceased patients. We developed the model with a ten-fold cross-validation procedure, and evaluated its performance on a held-out set of test data. We compared the performance of a model which does not use text features (baseline model) to the performance of a model which uses features extracted from the free texts of the medical records (keyword model), and to doctors' performance on a similar task as described in scientific literature.

RESULTS

Both doctors and the baseline model were correct in 20% of the cases, taking a margin of 33% around the actual life expectancy as the target. The keyword model, in comparison, attained an accuracy of 29% with its prognoses. While doctors overestimated life expectancy in 63% of the incorrect prognoses, which harms anticipation to appropriate end-of-life care, the keyword model overestimated life expectancy in only 31% of the incorrect prognoses.

CONCLUSIONS

Prognostication of life expectancy is difficult for humans. Our research shows that machine learning and natural language processing techniques offer a feasible and promising approach to predicting life expectancy. The research has potential for real-life applications, such as supporting timely recognition of the right moment to start Advance Care Planning.

An experimental study on the effectiveness of disclosing stressful life events and support messages: when cognitive reappraisal support decreases emotional distress, and emotional support is like saying nothing at all

How can we best support others in difficult times? Studies testing the effects of supportive communication revealed mixed findings. The current study focuses on the effects of supportive communication following different disclosure styles, and includes outcome measures to assess emotional well-being. Hypotheses were tested in a 2 (disclosure style: cognitive reappraisal disclosure vs. emotional disclosure) ×3 (support message: cognitive reappraisal response vs. socio-affective response vs. no response) between subjects factorial design. Receiving a cognitive reappraisal response, rather than a socio-affective response or no response, decreased emotional distress in the emotional disclosure group. Support messages showed no effects in the cognitive reappraisal disclosure group. Although socio-affective responses were positively evaluated, cognitive reappraisal responses may be more effective during emotional upheaval because they provide a positive way out of negative emotions.

Changed priorities ahead: Journalists' shifting role perceptions when covering public health crises

Journalistic role perceptions have been extensively studied in general contexts, but little is known as to how roles - or role prioritization - may shift across contexts, and professional characteristics. The aim of this study was gaining an understanding of journalists' changing role perceptions in health crisis coverage, and moreover to examine potential differences between general and specialist reporters. We conducted 22 in-depth interviews with reporters with experience in health crisis reporting in Germany and Finland. Findings suggest that journalists' roles shift when covering health crises (versus non-crises), towards a role as public mobilizers, towards classifying risks and from a watchdog to a more co-operative role. Furthermore, professional characteristics matter in journalists' understanding and performance of their roles. Specialist reporters appear better equipped to deal with the challenges of health crisis coverage, such as balancing remaining critical with co-operation with authorities in their efforts to contain crises. Specialist reporters are also less likely to get swayed by the panic often accompanying health crises than general reporters are.

Fear-Mongering or Fact-Driven? Illuminating the Interplay of Objective Risk and Emotion-Evoking Form in the Response to Epidemic News

This study examined the veracity of the common assumption that news coverage of epidemic outbreaks spawns heightened fears and risk perceptions. An online experiment with 1,324 participants investigated the interplay of the form of news coverage (factual/emotion-laden) and key aspects of actual risk (low/high vulnerability, low/high severity) on audience responses. Participants read one of eight versions of a newspaper article followed by measures on risk perceptions, negative affect, behavioral intentions, and perceived sensationalism. Risk perceptions and fear were primarily driven by objective risk characteristics, whereas emotion-laden news form only increased perceptions of disease severity, not of fear or personal vulnerability.

Analyzing Empowerment Processes Among Cancer Patients in an Online Community: A Text Mining Approach

Background

Peer-to-peer online support groups and the discussion forums in these groups can help patients by providing opportunities for increasing their empowerment. Most previous research on online empowerment and online social support uses qualitative methods or questionnaires to gain insight into the dynamics of online empowerment processes.

Objective

The overall goal of this study was to analyze the presence of the empowerment processes in the online peer-to-peer communication of people affected by cancer, using text mining techniques. Use of these relatively new methods enables us to study social processes such as empowerment on a large scale and with unsolicited data.

Methods

The sample consisted of 5534 messages in 1708 threads, written by 2071 users of a forum for cancer patients and their relatives. We labeled the posts in our sample with 2 types of labels: labels referring to empowerment processes and labels denoting psychological processes. The latter were identified using the Linguistic Inquiry and Word Count (LIWC) method. Both groups of labels were automatically assigned to posts. Automatic labeling of the empowerment processes was done by text classifiers trained on a manually labeled subsample. For the automatic labeling of the LIWC categories, we used the Dutch version of the LIWC consisting of a total of 66 word categories that are assigned to text based on occurrences of words in the text. After the automatic labeling with both types of labels, we investigated (1) the relationship between empowerment processes and the intensity of online participation, (2) the relationship between empowerment processes and the LIWC categories, and (3) the differences between patients with different types of cancer.

Results

The precision of the automatic labeling was 85.6%, which we considered to be sufficient for automatically labeling the complete corpus and doing further analyses on the labeled data. Overall, 62.94% (3482/5532) of the messages contained a narrative, 23.83% (1318/5532) a question, and 27.49% (1521/5532) informational support. Emotional support and references to external sources were less frequent. Users with more posts more often referred to an external source and more often provided informational support and emotional support (Kendall τ>0.2; P<.001) and less often shared narratives (Kendall τ=−0.297; P<.001). A number of LIWC categories are significant predictors for the empowerment processes: words expressing assent (ok and yes) and emotional processes (expressions of feelings) are significant positive predictors for emotional support (P=.002). The differences between patients with different types of cancer are small.

Conclusions

Empowerment processes are associated with the intensity of online use. The relationship between linguistic analyses and empowerment processes indicates that empowerment processes can be identified from the occurrences of specific linguistic cues denoting psychological processes.