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PubMed2005

End-to-end Encryption for SMS Messages in the Health Care Domain.

The health care domain has a high level of expectation on security and privacy of patient information. The security, privacy, and confidentiality issues are consistent all over the domain. Technical development and increasing use of mobile phones has led us to a situation in which SMS messages are used in the electronic interactions between health care professionals and patients. We will show that it is possible to send, receive and store text messages securely with a mobile phone with no additional hardware required. More importantly we will show that it is possible to obtain a reliable user authentication in systems using text message communication. Programming language Java is used for realization of our goals. This paper describes the general application structure, while details for the technical implementation and encryption methods are described in the referenced articles. We also propose some crucial areas where the implementation of encrypted SMS can solve previous lack of security.

Cell Phone↗
PubMed1993

Stereotype or reality: another look at alcohol and drug use among African American children.

The Center for Substance Abuse Prevention's Division of Communications Programs launched its Urban Youth Public Education Campaign in late 1990 to target African American youth in 14 cities with prevention messages about alcohol and other drugs. During the market research phase of the campaign, the Center sought to determine the extent inner city African American children are impacted by alcohol and other drugs and how widespread the use of these substances is among younger children. Is it rampant and universal, as some press accounts have it, or are the images portrayed by the news media, by popular movies, and by other communication outlets fueling harmful stereotypes? The campaign's market research consisted of in-depth reviews of the literature, of personal communications, conference proceedings, grant and contract reports, monographs, newspaper and magazine articles, and of national survey results, and the analysis of findings from focus groups conducted with 143 African American children living in several urban environments. Although information and conclusions gleaned from the market research revealed a longstanding trend of comparatively lower rates of alcohol and drug use by African American youth, also disclosed was a need for an expanded framework to address the problems of substance abuse within the African American community. An expanded framework acknowledges the dimension of substance use and abuse but also addresses three other dimensions--involvement, exposure, and victimization--that unfold as having major significance for this population of youth who live in urban, high-risk environments.

Adolescent↗
PubMedDate not supplied

Tailored and targeted health communication: strategies for enhancing information relevance.

OBJECTIVE: To discuss tailored messages in the broader context of communication strategies designed to enhance the relevance of health information to a given audience. METHODS: Describe specific mechanisms through which tailored health communication can enhance message relevance and identify situations in which the use of tailoring is most appropriate. RESULTS: Overall, tailored messages appear to stimulate greater cognitive activity than do messages that are not tailored. However, non-tailored messages that happen to be a good fit for a given individual also have similar effects. CONCLUSION: Health communication programs and materials that succeed in making information relevant to their intended audience will be more effective than those that do not. Tailoring is a proven approach to enhancing message relevance, but not the only approach to do so, and under many circumstances may not be the preferred choice.

Behavioral Research↗
PubMed2004

Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions.

OBJECTIVES: We studied school personnel involved in the review of student's immunization status to determine whether personnel training, immunization-related knowledge, attitudes, and beliefs, use of alternative medicine, and sources of vaccine information were associated with the vaccination status of school children. METHODS: Surveys were mailed to a stratified and random sample of 1000 schools in Colorado, Massachusetts, Missouri, and Washington. School personnel reported their training and perceptions of disease susceptibility/severity, vaccine efficacy/safety, key immunization beliefs, use of alternative medicine, confidence in organizations, sources, and credibility of vaccine information, and the rates of vaccine exemptors in their schools. Logistic regression analysis was used to explore associations between personnel factors and beliefs (independent variables) with the likelihood of a child having an exemption (dependent variable). Regression models were adjusted for clustering of children in schools, type of school (public versus private), and state. RESULTS: Surveys were returned by 69.6% of eligible participants. A child attending a school with a respondent who was a nurse was significantly less likely to be have an exemption than a child attending a school with a respondent who was not a nurse (odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.28-0.56). The majority of respondents believed that children (95.6%) and the community (96.1%) benefit when children are vaccinated. Nurses were more likely than nonnurses to hold beliefs supporting the utility and safety of vaccination. Greater perceived disease susceptibility and severity and vaccine efficacy and safety were associated with a decreased likelihood of a child in the school having an exemption. Vaccine misconceptions were relatively common. For example, 19.0% of respondents were concerned that children's immune systems could be weakened by too many immunizations, and this belief was associated with an increased likelihood of a child in the school having an exemption (OR: 1.51; 95% CI: 1.00-2.28). Most respondents had a moderate amount or great deal of confidence in state health departments (91.4%), the Centers for Disease Control and Prevention (CDC) (93.9%), local health departments (88.8%), health care providers (88.5%), the Food and Drug Administration (73.6%), and the health care system (65.2%). Fewer respondents had a moderate amount or great deal of confidence in the media (17.4%). A child attending a school with a respondent who had a moderate amount or great deal of confidence in local and state health departments was less likely to have an exemption (OR: 0.47 and 0.44; 95% CI: 0.27-0.80 and 0.25-0.80, respectively) than a child attending a school with a respondent who did not have a moderate amount or great deal of confidence in local and state health departments. Confidence in other groups was not associated with the likelihood of a child in the school having an exemption. Nearly half (45.5%) of the respondents or their immediate family members had used some form of alternative medicine in the last 5 years. A child attending a school with a respondent who had (or had a family member[s] who) used an alternative medicine practitioner was more likely to have an exemption than a child attending a school with a respondent who had not used an alternative medicine practitioner. There were significant associations between sources used and perception of reliability for vaccine information with the likelihood of a child in the school having an exemption. Use of professional organizations, government resources, vaccine companies, and pharmacists for vaccine information were associated with a decreased likelihood of a child in the school having an exemption. Perceiving health departments and the CDC as a good or excellent source for vaccine information was associated with a decreased likelihood of a child in the school having an exemption. CONCLUSIONS: The training, knowledge, attitudes, and beliefs of school personnel who work with parents on immunrk with parents on immunization issues were associated with the likelihood of a child in the school having an exemption. Although respondents generally believed in vaccinations, misconceptions were common. Many school personnel seem to be unaware of the seriousness of some vaccine-preventable diseases and that unimmunized children are highly susceptible to diseases. These misperceptions were associated with an increased likelihood of a child having an exemption. This study of associations cannot determine causal associations. Nonetheless, the frequency of vaccine misconceptions among school personnel warrants vaccine communication programs for school employees who work with parents on immunization issues. An intervention study could determine whether such programs have an impact on parental decisions to claim exemptions for their children. Personnel without formal health care training who advice parents on immunization issues could be passing on misinformation to parents. Nurses or properly trained health personnel should be the primary school contacts for parents on immunization issues. Health departments and health care providers were used most often by school personnel for vaccine information. Providers, professional organizations, health departments, and the CDC were considered most credible. The CDC may be an underutilized source, given its high credibility; only 58.1% of respondents reported using the CDC for vaccine information. Greater visibility of CDC on vaccine information statements and communication efforts from the CDC directly to school personnel will likely be well received. Respondents who do not consider health departments and the CDC as credible sources were associated with a greater likelihood of a child in their school having an exemption. The CDC may need to consider working with other reliable sources to communicate with these personnel. Studies are needed to understand why some parents choose to forgo vaccination for children who do not have true medical contraindications to vaccines. School personnel trained in vaccine safety may serve as a valuable source of vaccine information for parents. Parents who have misconceptions about vaccines would likely benefit from discussions with health care providers. Additional public-information campaigns regarding misconceptions and the value of vaccination may be needed.

Allied Health Personnel↗
PubMed1994

Global information infrastructure.

The High Performance Computing and Communications Program (HPCC) is a multiagency federal initiative under the leadership of the White House Office of Science and Technology Policy, established by the High Performance Computing Act of 1991. It has been assigned a critical role in supporting the international collaboration essential to science and to health care. Goals of the HPCC are to extend USA leadership in high performance computing and networking technologies; to improve technology transfer for economic competitiveness, education, and national security; and to provide a key part of the foundation for the National Information Infrastructure. The first component of the National Institutes of Health to participate in the HPCC, the National Library of Medicine (NLM), recently issued a solicitation for proposals to address a range of issues, from privacy to 'testbed' networks, 'virtual reality,' and more. These efforts will build upon the NLM's extensive outreach program and other initiatives, including the Unified Medical Language System (UMLS), MEDLARS, and Grateful Med. New Internet search tools are emerging, such as Gopher and 'Knowbots'. Medicine will succeed in developing future intelligent agents to assist in utilizing computer networks. Our ability to serve patients is so often restricted by lack of information and knowledge at the time and place of medical decision-making. The new technologies, properly employed, will also greatly enhance our ability to serve the patient.

Computer Communication Networks↗
PubMedDate not supplied

[Survey about risk perception between citizens resident in a municipal at high risk of environmental crisis].

OBJECTIVE: This paper describes the result of a survey carried out in 2002 about the risk perception of the main risk factors for health and environment in an industrial area at high risk of environmental crisis, in order to contribute to risk communication programs aiming to make the population informed and conscious about industrial risk. DESIGN: The survey was carried out in 2002 through questionnaire to investigate citizens' risk perception SETTING: Municipality of Portoscuso, industrial district located along the South-west coast of Sardinia, and active in the chemical, electrochemical fusion and rolling, thermoelectric fields. PARTICIPANTS: The survey has been carried out, through home interviews, on a representative sample of the population of Portoscuso, consisting of 148 citizens aged between 18 and 70. MAIN OUTCOME MEASURES: The results showed that industrial pollution is considered high by more than 80% of the sample at global and even more at local level showing how this represents an important worrying factor for the local people. CONCLUSION: This is the basis to develop an effective risk communication process, that involves actively all stakeholders (people, experts, industry and local authorities) in risk management.

Adolescent↗
PubMed1995

Maintaining patient satisfaction in a hospital reorganization.

A review of inpatient satisfaction data for MUSC provides both comfort and cause for additional study. Although overall satisfaction rates of 89 and 88 during the period of organizational change indicate stable patient perceptions, one must reflect upon these scores in greater detail. For example, although survey response rates in the 36 percent to 28 percent range appear customary for this type of survey, absolute numbers of discharge responses averaged 496 for the four quarters reported. Some confidence can be taken in the fact that overall survey scores were highly consistent in the 89 to 88 range for the entire reporting period. Moreover, the fact that workforce performance variables such as medication errors and patient occurrence reports did not change indicates that patient care did not deteriorate during this period. Although one could argue that in a time of workforce reduction, employees may work more diligently in order to ensure job security, and that work deterioration may be more apparent over a longer period of observation, this limited view suggests that, at least in the acute phase, work performance was maintained. Future studies should review the relative effectiveness of the specific strategies adopted by MUSC management to ensure high levels of patient care. For example, although MUSC adopted a fairly comprehensive communications effort, it is difficult to discern whether timeliness, variety, or repetition contributed more to the effectiveness of the communications program. Such information could help managers develop focused change implementation strategies. It appears from the inpatient survey data collected by UHC and from the two work performance monitors that MUSC's approach to change management has been able to preserve acceptable levels of patient satisfaction in the face of significant organizational change. Furthermore, these strategies may have been helpful in countering the turbulence caused by large scale change or, at the very least, insulating the care site from potentially negative effects.

Academic Medical Centers↗
PubMed2002

Communication strategies to optimize commitments and investments in iron programming.

There is consensus that a communications component is crucial to the success of iron supplementation and fortification programs. However, in many instances, we have not applied what we know about successful advocacy and program communications to iron programs. Communication must play a larger and more central role in iron programs to overcome several common shortcomings and allow the use of new commitments and investments in iron programming to optimum advantage. One shortcoming is that iron program communication has been driven primarily by the supply side of the supply-demand continuum. That is, technical information has been given without thought for what people want to know or do. To overcome this, the communication component, which should be responsive to the consumer perspective, must be considered at program inception, not enlisted late in the program cycle as a remedy when interventions fail to reach their targets. Another shortcoming is the lack of program focus on behavior. Because the "technology" of iron, a supplement, or fortified or specific local food must be combined with appropriate consumer behavior, it is not enough to promote the technology. The appropriate use of technology must be ensured, and this requires precise and strategically crafted communications. A small number of projects from countries as diverse as Indonesia, Egypt, Nicaragua and Peru offer examples of successful communications efforts and strategies for adaptation by other countries.

Adolescent↗
PubMedDate not supplied

A grand alliance.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Building a medical multimedia database system to integrate clinical information: an application of high-performance computing and communications technology.

The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center.

Abstracting and Indexing↗
PubMed2004

Interactive Web sites for families and physicians of pediatric intensive care unit patients: a preliminary report.

OBJECTIVE: To describe our experience with a Web-based communications program for the patients, families, and referring physicians of patients admitted to our pediatric intensive care unit. DESIGN: Prospective descriptive case series for a 32-month period from April 2000 through January 2003. SETTING: Sixteen-bed multidisciplinary medical-surgical pediatric intensive care unit (PICU). SUBJECTS: Seventy-three of 78 patients admitted to the PICU for > or =3 days and their families participated in the study, along with 26 referring physicians. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We found that 77% (474/619) of surveyed family members and friends thought that the Web page helped them share information, 13% (82/619) were unsure, and only <1% (4/619) thought it did not help them share information. When comparing respondents who thought the Web page helped them share information with those who did not or those who did not know, internet use was significantly associated with thinking that the Web page helped them share information (p =.0007). Seventy-three percent (19/26) of physicians thought that Web page-based communication was easier than present methods to convey patient information, and 62% (16/26) replied that the Web-based communication met their expectation. Fifty-four percent (14/26) of physicians thought they were more likely to refer patients to our PICU because of the Web-based communication; this was significantly associated with physician assessment that the Web-based communication was easier than the present methods of communicating with referring physicians (p =.003). CONCLUSIONS: We conclude that both families and referring physicians find Web-based communications during a child's PICU hospitalization to be very helpful. We suggest that the Web-based PICU communications be developed and studied for both medical and economic impact.

Child↗
PubMed2006

The need for and development of an adaptive Listening and Communication Enhancement (LACE) Program.

Auditory training has long been advocated to enhance communication but has never been time or cost-effective. This article describes the concepts underlying the development of a home-based, interactive adaptive computer program designed to engage the adult hearing-impaired listener in the hearing-aid-fitting process, provide listening strategies, build confidence, and address cognitive changes characteristic of the aging process. An investigation using a between-group, within-subject design with pre- and post-test objective and subjective measures was conducted at five clinical sites. Sixty-five subjects were randomly placed into two groups, one receiving LACE (Listening and Communication Enhancement) immediately following baseline testing and one serving as a control for one month and then receiving training as a crossover group. Results showed statistically significant improvements for the trained subjects on all but one of the outcome measures. Barriers facing the widespread implementation of home-based aural rehabilitation are discussed.

Acoustic Stimulation↗
PubMed2002

Newborn screening program practices in the United States: notification, research, and consent.

OBJECTIVE: To define current practice among US newborn screening programs for notification of results, research, and consenting procedures. METHODS: A telephone survey of all US newborn screening program supervisors. RESULTS: All 51 programs participated. All states reported abnormal results to the infant's physician, and some also reported to the hospital and parents. Cases with abnormal results were tracked to different endpoints but usually (92.1%) at least until a follow-up appointment was made. A total of 66.6% of programs can communicate with programs in other states; 9.8% enable families to suppress reporting of results to the infant's physician. No state has a mechanism for parents to prevent results from entering the medical record. Parents or physicians who request results are often authenticated by providing their name (52.9%). Many programs (45.1%) report only to physicians and require just their name (43.5%), an identification number (17.4%), a letter (26.1%), or a parent's signature (26.1%). A total of 70.6% retain residual blood samples; of these, only 8.3% store them completely devoid of patient identifiers. A total of 49.0% of programs aggregate data for research. In 16.0% of these, the data are publicly available. In 24.0%, researchers obtain approval at their own institution; in 24.0%, researchers obtain approval through the state laboratory Institutional Review Board. In 74.5% of programs, parents are notified but not asked for consent before collection of the sample; 19.6% neither notify parents nor obtain consent before screening. CONCLUSIONS: There is wide variation in practice among the US newborn screening programs. Because the programs collectively manage a comprehensive nationwide genomic databank, careful consideration of how information technology and high-throughput genomic analysis are used will be essential to allow progress in clinical care, public health, and research while protecting individual privacy.

Communicable Disease Control↗
PubMed1999

Telecommunication technology for the management of large scale clinical trials: the Gissi experience.

The Coordinating Centre (CC) of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (GISSI) used telecommunication technology to develop a computerized network system for the data management of the GISSI studies. Through a personal computer (PC), a communication program, a modem and a telephone line, the investigator in each participating centre can connect with a micro-computer at the CC, to recruit/randomize patients and download reports on the progress of the trial. In the first case, the investigator is required to answer a set of predefined questions, and thereby the system automatically checks eligibility criteria and randomly assigns the patient to a treatment arm. In the second case, once the investigator has made a choice from a list of standard reports and the relative query on CC central database, the generation, the formatting and the transfer of the selected report to the PC are executed automatically on line. The main advantages of this system are a reduction in number of mistakes in data completion and in the human and economic resources required, as well as the real time updating of participating centres. The system was successfully adopted in the GISSI-3 trial (200 Coronary Care Units and 19,394 patients enrolled), in the European arm of the CORE trial and it is currently being used in the GISSI-Prevenzione trial.

Algorithms↗
PubMed2007

Variable selection and raking in propensity scoring.

This paper discusses some practical issues in applying propensity scoring in the context of endpoint analysis in a pre-/posttest longitudinal design with an ordinal measure of treatment intensity and a high-dimensional potential covariate space: how many covariates to include in propensity models; how to evaluate the adequacy of tentative propensity models; and how to tailor models to provide hypercontrol on a limited subset of covariates. These issues arose in the evaluation of a health communication program.

Advertising↗
PubMed1999

One size does not fit all: the case for tailoring print materials.

Printed health education materials frequently consist of mass-produced brochures, booklets, or pamphlets designed for a general population audience. Although this one-size-fits-all approach might be appropriate under certain circumstances and even produce small changes at relatively modest costs, it cannot address the unique needs, interests, and concerns of different individuals. With the advent and dissemination of new communication technologies, our ability to collect information from individuals and provide feedback tailored to the specific information collected is not only possible, but practical. The purpose of this article is to: (a) distinguish between tailored print communication and other common communication-based approaches to health education and behavior change; (b) present a theoretical and public health rationale for tailoring health information; and (c) describe the steps involved in creating and delivering tailored print communication programs. Studies suggest computer tailoring is a promising strategy for health education and behavior change. Practitioners and researchers should understand the approach and consider the possibilities it presents for enhancing their work in disease prevention.

Algorithms↗
PubMed2005

Keeping up with evidence a new system for WHO's evidence-based family planning guidance.

The World Health Organization (WHO) is responsible for providing evidence-based family planning guidance for use worldwide. WHO currently has two such guidelines, Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use, which are widely used globally and often incorporated into national family planning standards and guidelines. To ensure that these guidelines remain up-to-date, WHO, in collaboration with the Centers for Disease Control and Prevention and the Information and Knowledge for Optimal Health (INFO) Project at the Johns Hopkins Bloomberg School of Public Health's Center for Communication Programs, has developed the Continuous Identification of Research Evidence (CIRE) system to identify, synthesize, and evaluate new scientific evidence as it becomes available. The CIRE system identifies new evidence that is relevant to current WHO family planning recommendations through ongoing review of the input to the POPulation information onLINE (POPLINE) database. Using the Meta-Analysis of Observational Studies in Epidemiology guidelines and standardized abstract forms, systematic reviews are conducted, peer-reviewed, and sent to WHO for further action. Since the system began in October 2002, 90 relevant new articles have been identified, leading to 43 systematic reviews, which were used during the 2003-2004 revisions of WHO's family planning guidelines. The partnership developed to create and manage the CIRE system has pooled existing resources; scaled up the methodology for evaluating and synthesizing evidence, including a peer-review process; and provided WHO with finger-on-the-pulse capability to ensure that its family planning guidelines remain up-to-date and based on the best available evidence.

Algorithms↗