Verify health information on Twitter before using it in daily practice

Advances in medicine have added greatly to the therapeutic armamentarium of the doctor. There are several options that a doctor can choose from unlike the yesteryears. Similar is the case with diagnostic options. In this age of evidence-based medicine, doctors need to stay updated with current advances in medicine in general including their specialties in order to make the best decision for their patients. Traditionally, it used to be print medical journals, which may yet be the source of information for many doctors. But, the internet and the advent of social media, especially Twitter, have changed the way we communicate today. The reach of social media is phenomenal.

Healthcare professionals use Twitter not only to connect with their colleagues, but also as a quick resource to access new information and events, often ‘real time’ i.e. as they are happening, particularly when time is of the essence.

While better connectivity has contributed immensely to the practice of medicine by disseminating knowledge, on the flip side of it, sifting out the valid from the invalid on the internet is no simple task.

There is no denying that Twitter can gain you the latest information in the form of a practice changing update, breaking news, conference updates or what are the most currently discussed ‘trending’ topics. You can also be a part of the ‘Twitter discussions’. But it is important to examine the credibility of the tweet, whether the content posted is evidence-based or is a personal opinion. The information in the permitted 140-280 characters usually may be the interpretation of that particular Twitter account holder. Always go the main article and try to verify the source. Review the information for yourself, before you decide to use it in your daily practice.

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

                                                     

26% doctors suffer from severe mobile phone-induced anxiety: Excessive use of mobile phone can be injurious to your health

While people are concerned about cancer, which still remains a controversial issue, there are other future health problems caused by use of mobile phones especially smart phones. Prolonged use of mobile phone can cause neck pain, dry eyes, computer vision syndrome, anxiety (ringxiety), phobias (nomophobia) and insomnia.

Addressing a press conference on the occasion of World Environment Day, Padma Shri & Dr. BC Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India; Dr. Narendra Saini  Secretary General Indian Medical Association; Dr. Sanjay Gupta, Senior Orthopedic Surgeon at Moolchand Medcity; Dr. J Nagpal Sr. Psychiatrist and Padma Shri Awardee and Dr. A K Grover Sr Eye Specialist Ganga Ram Hospital said that in India, the hazards of radiation are much more than in the West because of active and passive mobile phone radiations and also because of combined use of other radiations such as from computers, microwaves and frequent x-ray done by doctors.

Fifty crore people in the world use mobile phones. These phones release low power radio frequency waves, which transmit radio frequency radiations from 500-800 mGH through the antenna placed near the head.

Heart Care Foundation of India conducted a survey, which included 25 nurses of one hospital, 25 office staff of one public company, 25 media desk executives of one electronic TV media house and 87 family physicians from all across Delhi. The observations were as follows:

 Use of Smart phones

• 80 % office staff, 80% nurses, 80% media desk executives and 41% family physicians are on Face book. Amongst family physicians, 26% used it for less than 15 minutes; 7% 15-30 minutes; 9% between 30-60 minutes; 2% between 60-90 minutes and 5% more than 120 minutes. 25% family physicians connected to Face book from their phones.Ten percent office staff, 20% nurses and 60% media house desk executives and 31% family physicians used smart phones. Amongst family physicians, 11.5% spent < 30 minutes on their smart phone daily; 7% 30-60 minutes; 3% 60-90 minutes; 2% 90-120 minutes; 4% 120-240 minutes and 9% > 240 minutes.
• 20 % office staff, 30% nurses, 70% media desk executives and 25% family physicians have a Twitter account. Among family physicians, only 50% used it regularly and 25% used it daily. Of the daily users, 90% used it for less than 5 minutes.   
• Only 7% family physicians blogged.
• Thirty-six percent family physicians retrieved emails from their phone.

 Smart phone addiction, a new disease

• On an average, nurses recharged their phone battery twice in a day; media desk executives and doctors did it three times in a day.
• Sixty-one percent doctors find someone to call as soon as they leave their office or as soon as their flight lands.
• Seventy percent family physicians keep their cell phone with them constantly. Even at home they keep it in their pocket or right next to them.
• 43% of them fiddle with their cell phone whenever they have downtime (even when they are not on the phone or they only have a very few minutes to kill).
• 33% of them always feel anxious about their cell phone, especially when they are unable to use it (meeting, plane, class, church)
• 28% of them are uncomfortable and fidgety when they are not using their cell phone.
• 7% family physicians feel the need to talk on the phone almost all the time.
• Sixty-three percent of family physicians sleep with their cell phone under the pillow or on a night stand right next to the bed.  This number is 20-50% for nurses, office staff and media desk executives.

Nomophobia

Sixty percent of youth aged 20-30 years fear losing their mobile phone, called nomophobia; 43% of family physicians suffer from nomophobia.

Cell phone anxiety

• 43% family physicians experienced high levels of anxiety, stress, or insecurity, whenever they were without their cell phone.
• 50% of the mobile phone users experienced ringxiety.
• 25% family physicians sometimes believed their phone was ringing, but when they answered it or listened longer they found that it wasn't ringing at all (phantom ringing).
• 15% family physicians reported feeling stressed when they received their cell phone bill and then experienced shock once they actually saw the amount.
• 22% family physicians reported being unable to resist special offers on the latest cell phone models.

Severity of anxiety

·  The mean social media addiction score (calculation based on 17 dependence questions) for doctors was 5.5. (Any score of more than 8 requires social media curfew and social media holidays along with counseling). 

·   Only 6% family physicians reported feeling no anxiety at all.

·   Mild anxiety (score < 4) was present in 43% family physicians (average score 3)

·  Moderate anxiety (score 5-7) was present in 25% of family physicians (average score 6).

·   26% family physicians had a score of > 8 indicating presence of social media addiction (average score 10).

·   The mean social media addiction score (calculation based on 17 dependence questions) was 6.3 for office staff, 9 for desk executives and 8 for nurses.

Mobile phone as a cause of conflict

• 26% family physicians had been teased because they had their cell phone even while working out or doing some other activity.
• 48% doctors said that their personal cell phone use had increased significantly.
• Face book was the cause of conflict in 20 % of situations for a family conflict (second to TV).
• 23% family physicians experienced problems at work because of their cell phone use.
• 18% family physicians had had problems with family or friends because of the cell phone use.

 Mobile phone as a cause of disturbed sleep

·         On an average, office staff spent 20 minutes, nurses 30 minutes and media house desk executives 60 minutes surfing on their smart phones on the bed.

·         26% family physicians were disturbed by a smart phone alert in the night; 7% reported getting disturbed daily (average 3 times).

·         Only 40% doctors and 30% of nurses, hospital staff and media executives would stop using their mobile phones 30 minutes before sleep.

·         50% mobile phone users woke up in the night because of smart phone alerts.

·         40% people had disturbed sleep pattern because of smart phone use.

Mobile phone use while driving

Using or talking on a mobile phone while driving is more dangerous than driving under the influence of alcohol. Using mobile phone while driving reduces reaction time by 30% compared to people under the influence of alcohol and 50% compared to persons without alcohol. The reaction time under the influence of mobile phone is half a second longer. This amounts to a car traveling with a speed of 70 miles /hour to cover a distance of 46 feet before stopping.

36% doctors said that they receive emergency calls on mobile when they are driving. When they stop and answer, 20% of the calls are marketing calls enough to get frustrated and 30% of the calls are emergency calls from their patients.

Mobile phone as a cause of day time distraction

·         32% family physicians reported being distracted by a smart phone alert during a meeting.

·     30% of non doctors said that they got distracted in a meeting because of an SMS or email alert.

Mobile phone breaks and holidays

 Only 48% family physicians took cell phone breaks while at work.

Use of mobile phone in the Operation Theatre

In a US survey of cardiopulmonary bypass technicians published in the journal Perfusion, 50% used a smart phone during surgery, 43% in a cardiac OT, 50% talked on cell phone and 50% texted on their phones. In cardiac OT, 20% perfusionists accessed emails, 15% used internet and 3% checked or posted on social networking sites during surgery.

A similar survey conducted by Heart Care Foundation of India in one of the corporate hospital in Delhi found:

• Ninety percent of nurses and 50% of OT technicians also reported taking calls during the surgery.
• Ten percent doctors, 20% nurses and 50% technicians would check their messages (SMS) even during surgery.
• No doctor or nurse tweeted during the surgery, but 50% of the technicians who have a Twitter account said that they do use Twitter and tweet during the surgery.
• None of the doctors, nurses or technicians used their emails or accessed their Face book accounts during surgery.
• Doctors do talk and attend to their mobile phones while surgery is going on and communicate through a nurse or a junior who works as a bridge between the surgeon and the caller.

The reason given for picking up the phone was to rule out emergency calls, but the reason for use of SMS or Twitter was boredom.

Computer vision syndrome

Computer vision syndrome is a temporary condition resulting from focusing the eyes on a computer display for protracted and uninterrupted periods of time.

Some symptoms are headaches, blurred vision, neck pain, redness in the eyes, fatigue, eye strain, dry eyes, irritated eyes, double vision, vertigo/dizziness, polyopia and difficulty refocusing the eyes. These symptoms can be further aggravated by improper lighting conditions (glare or bright overhead lighting) or air moving past the eyes (overhead vents, direct air from a fan).

Computer vision syndrome affects some 90% of the people who spend three hours or more a day at a computer.

BlackBerry thumb

Overuse of the thumb to operate a mobile device may lead to BlackBerry thumb.

BlackBerry thumb is a neologism that refers to a form of repetitive strain injury caused by the frequent use of the thumbs to press buttons on PDAs, smartphones, or other mobile devices.

It is also called wiiitis, nintendinitis, playstation thumb or cellphone thumb.

Thumb lacks the dexterity that the other four fingers have. This is especially common in those who use these devices for such activities at high speeds comparable to that of touch typing.

Symptoms of BlackBerry thumb include aching and throbbing pain in the thumb or sometimes other fingers and in the wrist.

 Other diseases

• Wii Knees, Touch-Screen Finger, Text Neck, and the dreaded Smartphone Saggy Face, Phantom Vibration Syndrome.
• Wii knees; Tenderness or soreness in the knees from excessive use of the Nintendo Wii Fit. Similar in nature to tennis elbow.
• Saggy face (saggy jowls, double chins and "marionette lines" often develop from the angles at which people use their trendy new mobile devices. Leaning your head to hold your mobile phone in between your face and shoulder is believed to cause facial skin and muscle to lose its elasticity more quickly than normal).

HCFI and IMA suggestions to prevent and treat mobile phone addictions

• Face book holidays: One should take a full one week face book holiday if one is suspected to have social media addiction.
• Electronic curfew:  Everybody should have 30 minutes of electronic curfew before they sleep. (Electronic curfew means not using mobile phones and other mobile devices for 30 minutes before sleep).
• Use mobile only when mobile.
• Limit mobile talk time to less than 2 hours a day
• Once the battery is discharged, call it a day for mobile use.
• Follow the formula of "20-20-20" to prevent dry eyes: Every 20 mins, focus the eyes on an object 20 feet (6 meters) away for 20 seconds or close the eyes for 20 seconds, at least every half hour.
• To prevent computer vision syndrome, spend less than 3 hours on a computer.
• Using other fingers to press buttons on handheld device can prevent BlackBerry thumb.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 54572 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”