HealthWise

You Can Track Flu Online With Google

A collaboration between Google and the U.S. Centers for Disease Control and Prevention in Atlanta has yielded an online tool that may help people know about flu outbreaks even more quickly than existing surveillance methods.

A new site, Google Flu Trends, takes a novel approach to tracking flu outbreaks using search engine queries. The new tool, called Google Flu Trends, will monitor search trends to see abnormally large numbers of searches for the flu and related terms. It will then publish a map of affected areas in its new service.

Google says its new system will be able to detect influenza outbreaks up to two weeks faster than the traditional surveillance systems in use.

"As with any communicable disease, early detection is key for health professionals to react quickly," said Jeremy Ginsberg, the lead engineer who developed the new site.

"With online search queries, what we see is millions of people who are interested in searching online for information about health. And with winter approaching, more people will be curious about flu, because we are entering the flu season."

A paper accompanying the launch of the site was accepted by the journal Nature, with the editor in chief, Philip Campbell, praising the "exceptional public health implications of this paper." The journal is allowing the paper to be discussed with the public before it is published. But while researchers in the field call the new system interesting and novel, they are not ready to get behind the new site yet.

"I think the way to tell, obviously, is to compare it with actual surveillance data, which they should be able to pick up locally," said Stephen Morse, an epidemiologist at Columbia University's Mailman School of Public Health. "Whether searching for the flu is meaningful or not can only be compared with another gold standard method."

Morse said the system is open to a few problems.

"I think the approach sounds like a reasonable one, but I can think of several reasons why people might want to search for information on the flu," he said.

For example, Morse noted, as a flu researcher, he searches for flu information constantly, despite not being ill. More prevalent problems could accompany an increase in flu-related search terms because of a media report about the flu or, at this point, the threat of avian influenza.

Others have similar concerns.

"It's certainly intriguing and outside-of-the-box," said Dr. Lisa Jackson, an infectious disease specialist with the Group Health Center for Health Studies in Seattle. "The difficulty is that the term, flu, is not just used for influenza. A lot of people think of flu as a gastrointestinal issue."

She cited the rhinovirus, which causes stomach flu, along with the norovirus and rhinovirus, which cause the common cold -- which many mistake for flu -- as possible confounders of Google's new system.

"I think a big problem is that the term, flu, is used for lots of different things, so right away you have an issue with that," Jackson said. "I'm not sure how well [Google Flu Trends] will translate into helping us identify areas of influenza activity."

In response to concerns like this, Ginsberg said that in researching the new site, the data that is gathered from search engine queries is compared against past search trends and physician data. In the past, the trends in searching for flu have lined up well with actual outbreaks.

"What we have done is actually looked at four or five years of all of the data collected by the CDC's network of physicians. ... We compared that to the aggregated search queries on the flu over the past five years. We realized that the correlation tends to be very, very tight."

It remains unclear, however, how the information will be affected by the possibility of manipulation on the Internet by people hoping to alter results. Still, while they wait to see the results of the new system, researchers say that unconventional methods like this have had some success in the past.

Jackson cited an outbreak of diarrhea several years ago in Milwaukee that was caused by a faulty septic system. She noted that the outbreak was caught because pharmacists in the area noticed that the diarrhea drug Imodium and toilet paper were flying off the shelves.

Morse noted that another Web site with a similar concept to Google Flu Trends, called Who is Sick? asks sick individuals to describe their symptoms. They can then observe if others in their area have similar illnesses. Morse also indicated that better surveillance is certainly needed for figuring out where outbreaks of flu occur.

"Determining when a flu outbreak begins is difficult because there's a tendency not to report it," he said.

"Flu is underreported. People don't tend to go to hospitals or physicians unless they think they are very sick. What you're seeing, usually, when you actually get reports of flu outbreak, is those who are sick enough."

Morse said novel methods that observe human behavior to make predictions about disease outbreaks greatly aid the fight against influenza.

Overweight Kids Found to Have Arteries of 45-Year-Olds

Obese children as young as 10 had the arteries of 45-year-olds and other heart abnormalities that greatly raise their risk of heart disease, say doctors who used ultrasound tests to take a peek inside.

"As the old saying goes, you're as old as your arteries are," said Dr. Geetha Raghuveer of Children's Hospital in Kansas City, who led one of the studies. "This is a wake-up call."

The studies were reported Tuesday at an American Heart Association conference. About a third of American children are overweight and one-fifth are obese. Many parents think that "baby fat" will melt away as kids get older. But research increasingly shows that fat kids become fat adults, with higher risks for many health problems.

"Obesity is not benign in children and adolescents," said Dr. Robert Eckel, a former heart association president and cardiologist at the University of Colorado-Denver. It is why the American Academy of Pediatrics recently recommended cholesterol-lowering drugs for some kids, he noted.

Raghuveer wanted to see if early signs of damage could be documented. She and colleagues used painless ultrasound tests to measure the thickness of the wall of a major neck artery in 70 children, ages 10 to 16. Almost all had abnormal cholesterol and many were obese.

No one knows how thick a 10-year-old's artery should be, since they're not regularly checked for signs of heart disease, so researchers used tables for 45-year-olds, who often do get such exams. The kids' "vascular age" was about 30 years older than their actual age, she found.

A separate study tied childhood obesity to abnormal enlargement of the left atrium, one of the chambers of the heart. Enlargement is a known risk factor for heart disease, stroke and heart rhythm problems.

Julian Ayer, a researcher at Royal Prince Alfred Hospital Sydney Australia, did ultrasound exams on 991 seemingly healthy children ages 5 to 15. He saw a clear link between rising weight and size of the left atrium.

A third study by Dr. Walter Abhayaratna of Australian National University in Canberra, Australia, also used ultrasound tests and found impairment in the heart's ability to relax between beats in children who were overweight or obese. The study involved the first 150 children participating in a larger community-based study. Earlier research he helped conduct found more rigid arteries in such children - a possible sign of plaque deposits starting to form.

"Even at this young age of 10, you can have children who have got arterial stiffness who are comparable to 30- and 40-year-olds," he said.

Dr. Michael Schloss, a New York University heart disease prevention specialist, said the evidence shows obesity is more than a cosmetic issue for children.

"If you've seen what's on the menu for most school lunches, these findings are no surprise," he said. "The time has come to seriously deal with the issue of childhood obesity and physical inactivity on a governmental and parental level."

Exercise May Not Help Heart Patients

Exercise can do a lot of good for most people, but it apparently isn't much help to those with heart failure, the fastest-growing heart problem in the United States. The study - the largest ever of exercise in patients whose hearts don't pump enough blood - left many doctors disappointed. Results were reported Tuesday at an American Heart Association conference. Although there were some encouraging trends and clear benefits for certain people, exercise failed to deliver on the main goal - keeping people out of the hospital and improving their survival rates.

"It's a shame," said Dr. Harlan Krumholz, a quality-of-care researcher at Yale University who had no role in the study. "Exercise is not that magic elixir that we had hoped," at least for these patients.

About 5 million Americans have heart failure. It kills more than 300,000 of them and accounts for a million hospitalizations each year. Those numbers are expected to grow as the nation's population gets older. The condition occurs when the heart muscle weakens over time and can no longer pump effectively. Fluid can back up into the lungs, leaving people gurgling and gasping for breath as they struggle to climb stairs or walk around the block.

Exercise has long been known to help prevent the clogged arteries that develop in heart disease and to help heart attack patients recover. But smaller, previous studies have made conflicting findings about whether it helps heart failure patients or even is safe for them. Doctors had hoped that exercise would prove as effective as drugs for these patients, sparing them the cost and potential side effects.

The study involved 2,231 people with moderate heart failure in the United States, Canada and Europe. It was led by Dr. Christopher O'Connor at Duke University. All of the patients were getting optimal medical care, with more than 90 percent on an ideal mix of medicines. Those who needed them also had implanted heart devices to maintain good rhythm. They were randomly placed in two groups - one given usual care and the other usual care plus an exercise training program. Exercisers were given 36 supervised training sessions lasting half an hour three times a week. After 18 such sessions, they were given a treadmill or an exercise bike to use at home, for five 40-minute sessions each week.

Three months into the study, only half were exercising at least three times a week for 40 minutes. After one year, only one-fourth were exercising five times a week.

The fact so few stuck with the exercise program made it difficult to show a positive result, O'Connor said. There were 796 deaths or hospitalizations among those getting usual care and 759 in the exercise group -- a statistical draw. However, after doctors adjusted for factors like how long people were able to tolerate exercise, how badly damaged their hearts were and rates of depression, they did find a modest but significant benefit for exercise.

"It's disappointing," said Dr. Robert Eckel, a former heart association president and an exercise specialist at the University of Colorado at Denver. "You cannot make strong conclusions about subgroups."

Insurers now do not pay for exercise training for people with heart failure, and "this study is not going to help" convince them to start, Eckel said.

"We all would have liked to see a huge benefit to exercise," said Dr. Lawton Cooper, medical officer at the National Heart, Lung and Blood Institute, which paid for the study.

Still, for most people, "it is worth your while," Cooper said. "We know there are all kinds of benefits of exercise." Among them: quality-of-life improvements, said Dr. Ann Bolger, a heart failure specialist at the University of California in San Francisco.

"Just the fact that it's safe is a huge deal," she said. "Patients want to be in control and to be active," and this shows them they can.

One study participant - Lise Coleman, 44, of Fayetteville, N.C. -- said exercise dramatically improved her life.

"When I first started in the program, I was a pitiful thing. By the time I finished -- you know how they time you when you walk around the track -- I was the fastest walker," she said.

Doctors in the study gave her an exercise bike, which she still rides sometimes more than once a day. Her husband also bought her a treadmill, and she bought an elliptical trainer.

"I love it. When you have heart failure, your mind wants to do more than your body is able," she said. "I can do more than I used to."

MICHELLE

Google, U.S. Centers for Disease Control, Children's Hospital - Kansas City, MO; American Academy of Pediatrics, Yale University, New York University, Duke University, Australian National University, Royal Prince Alfred Hospital.