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PubMed2004

Psychosocial wellbeing and psychiatric care in the European Communities: analysis of macro indicators.

BACKGROUND: This paper reports the findings of an analytical comparison of several macro indicators collected routinely from institutional sources in Europe. METHODS: We carried out a review of macro indicators capable of providing a synthetic description of mental health status and the availability of psychiatric care in European countries. These were collected routinely from sources such as WHO, OECD, EUROSTAT, and IMS. The evaluation of temporal trends in each nation permits subsequent comparisons between countries. RESULTS: In all European countries, a decreased trend of suicides was observed in the period 1980-2000, with the exception of Ireland and (partially) of Spain. In Ireland, the increased trend was particularly strong, with a high risk in young and adult males. Portugal and Greece had respectively the highest and the lowest rates of undetermined causes of death. Most countries that were high consumers of alcohol in the initial period of observation had a rate above the national mean until 1980, after which consumption decreased. Most nations that were low consumers in 1960 had rates below the mean until 1980,when the rates progressively increased. However, a general decrease of alcohol-related deaths was apparent in all countries. Mortality associated with mental disorder increased, most clearly during the mid 1980s. The number of psychiatrists per 100,000 inhabitants ranged from 3.6 in Spain to 17.5 in Finland; of child psychiatrists, from 0.9 in Germany to 5.1 in Portugal. Psychiatric beds ranged from 0.4 per 1,000 inhabitants in Italy and Spain to 1.3 in Ireland. Nine countries showed a trend towards a reduction in psychiatric beds, whilst in a further five countries no change was observed. Rates of long-stay patients varied from 9.5 in the UK to 84 in Belgium, with a generally decreasing trend. The use of outpatient facilities differed markedly between countries, although there was a general increase over time. Official data were scarce in relation to the sale of psychotropic drugs. IMS data indicated increasing consumption in all European countries for antidepressant and antipsychotic medication. CONCLUSIONS: The official data resources available for European countries seem to indicate some discrepancies, probably relating to methods of recording. Better co-ordination in the collection of data about mental health status in the European Union and an improvement of the quality in available services is needed.

Europe↗
PubMed2005

Does testing for prostate-specific antigen contribute to declining prostate cancer mortality? Estimating the broader economic influences on aggregate prostate cancer mortality rates.

Key variables associated with prostate cancer mortality were examined using Canadian province level time-series data over the period 1979-1999 in a multiple regression framework. The key variables driving the prostate cancer mortality rate are per capita income, per capita number of family physicians, rate of prostate cancer incidence, real per capita total health spending, and a time trend. As well, provincial dummy variables show that regional differences exist with higher rates of mortality in eastern Canada. Econometric results show a positive and significant relationship between incidence and mortality, suggesting that the increased amount of prostate-specific antigen (PSA) testing may not have been responsible for mortality declines. However, there is also a downward trend in mortality from prostate cancer when all other factors are controlled for that can be attributed partly to the onset of PSA testing given that the benefits should emerge over time. A 1% increase in incidence is associated with a 0.2% increase in mortality. A 1% increase in real per capita income is associated with a 0.5% increase in mortality when real per capita income is below Canadian dollars 20,054. A 1% increase in the per capita number of family physicians reduces the mortality rate by 0.5%. A 1% increase in real per capita total health expenditures is associated with a 0.7% decline in the mortality rate. Finally, by 1999 there were 4.74 fewer deaths per 100,000 population due to the effect of time after controlling for all other factors--a decrease of approx. 15%.

Aged↗
PubMed2005

Using data to motivate action: the need for high quality, an effective presentation, and an action context for decision-making.

Three common barriers to the effective use of data to inform decisions and motivate action for the planning of cancer control are (1) failure to recognize the availability of high-quality data, (2) not presenting the data in a compelling format, and (3) failing to place the data in a historical and action context. Overcoming these barriers will go a long way toward demonstrating that high-quality data can be used to accomplish the desired outcomes in a Comprehensive Cancer Control (CCC) program. The article identifies existing sources of high-quality data, provides examples of effective presentation, and discusses successes in using data for program planning and implementation. The paper is not meant to provide a comprehensive discussion of using data for decision making, instead providing options to help key CCC stakeholders improve the effectiveness of their decisions as CCC plans are developed and implemented.

Data Collection↗
PubMed2005

Cancer surveillance research: a vital subdiscipline of cancer epidemiology.

Public health surveillance systems relevant to cancer, centered around population-based cancer registration, have produced extensive, high-quality data for evaluating the cancer burden. However, these resources are underutilized by the epidemiology community due, we postulate, to under-appreciation of their scope and of the methods and software for using them. To remedy these misperceptions, this paper defines cancer surveillance research, reviews selected prior contributions, describes current resources, and presents challenges to and recommendations for advancing the field. Cancer surveillance research, in which systematically collected patient and population data are analyzed to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time, has produced not only cancer statistics and etiologic hypotheses but also information for public health education and for cancer prevention and control. Data on cancer patients are now available for all US states and, within SEER, since 1973, and have been enhanced by linkage to other population-based resources. Appropriate statistical methods and sophisticated interactive analytic software are readily available. Yet, publication of papers, funding opportunities, and professional training for cancer surveillance research remain inadequate. Improvement is necessary in these realms to permit cancer surveillance research to realize its potential in resolving the growing cancer burden.

Behavioral Risk Factor Surveillance System↗
PubMed2006

Description of a new all cause mortality surveillance system in Sweden as a warning system using threshold detection algorithms.

A warning system has been set up to detect unusual weekly clusters of deaths by age group and municipality using all-cause Swedish death registry data. The technique for monitoring deaths by age group (<1, 1-24, 25-44, 45-64 and 65 plus) and week uses a compound smoothing technique, which calculates a baseline of expected events from retrospective data. Due to insufficient baseline data for the geographical component of the system a different algorithm, based on the Poisson distribution, was chosen to calculate expected weekly number of deaths per municipality, adjusting for municipalities with inherently higher mortality rates. This system was designed and tested during 2004 and implemented from the beginning of 2005. Threshold settings have been adjusted to provide a realistic number of weekly alerts. An evaluation of the system will be performed prospectively from the beginning of 2005 due to the lack of a gold standard for retrospective performance evaluation.

Adolescent↗
PubMed2006

Evaluated community fire safety interventions in the United States: a review of current literature.

The purpose of the study was to assess the state of fire prevention research, provide an updated synthesis of evaluated fire prevention programs, and discuss the role of fire fighters and data systems in prevention efforts. The review included all evaluations of U.S. based fire prevention interventions published between January 1998 and September 2004 and any earlier articles about U.S. fire prevention interventions not included in two prior review articles. We retrieved information from each identified study including evaluation findings, involvement of fire service personnel and use of existing data systems. We identified twelve articles: seven reported on smoke alarm interventions, three on multi-faceted programs, and two other programs. Five programs involved fire service personnel in the design, implementation, and/or evaluation, and three used existing data systems. Studies reviewed suggest that canvassing and smoke alarm installations are the most effective means of distributing alarms and increasing the functional status of distributed alarms. The functionality of smoke alarms, an issue noted in earlier reviews, remains a problem. Programs involving partnerships with fire departments have indicated success in preventing fires and deaths, improving smoke alarm ownership and functional status, and improving children's fire safety knowledge. Using existing data systems to target and to evaluate interventions was effective. In the years since prior reviews, some improvements in the rigor of evaluation designs have been made, but there is still a need for high quality evaluations that will inform fire injury prevention efforts.

Community-Institutional Relations↗
PubMed2005

Public health data collection and sharing using HIPAA messages.

Public health information has significant value for doctors, public health officials, epidemiological researchers, the general public, and government agencies. Unfortunately, these data are difficult to obtain and are typically collected on as-needed basis and maintained locally. This localized process unavoidably limits the access to important public health data by its users. Moreover, the diversity of data transmission standards and collection techniques make the collected data less usable. This paper proposes a new standardized public health information system based on the HIPAA (Health Insurance Portability and Accountability Act) messages, which are the standard transactions between hospitals and insurance companies. In particular, this paper explores the applicability of HIPAA messages as a data source and transmission standard, and proposes a prototype design of a new system to collect and share public health data using HIPAA messages.

Data Collection↗
PubMed2006

Evaluating a program to build data capacity for core public health functions in local maternal child and adolescent health programs in california.

OBJECTIVES: To improve local Maternal and Child Health programs' capacity to collect and analyze data to support core public health functions, the California Maternal and Child Health Branch (CAMCHB) and the University of California San Francisco Family Health Outcomes project (FHOP) entered into a cooperative agreement. FHOP utilizes a 6-pronged strategy: face-to-face training, telephone technical assistance, on-site consultation, development of automated analytic tools, development of written guidelines, and web dissemination of data and materials. We evaluated the acceptability and effectiveness of these approaches. METHODS: Local Health Jurisdiction (LHJ) staff completed a self-administered questionnaire on use of and satisfaction with FHOP's services. A 34-item assessment tool was used to independently evaluate each 5-year community assessment plan submitted by LHJs to the CAMCHB. Administrative data on the use of FHOP's service was also considered. Correlational analyses were done to determine if use of FHOP services and materials was related to more adequate plans. RESULTS: LHJs with higher overall adequacy scores on their plans had an overall higher level of use of FHOP's products and services. LHJs with higher adequacy scores reported calling FHOP for technical assistance more frequently, using FHOP's book - "Developing an Effective Planning Process: A Guide for Local MCH Programs," and using FHOP's automated tools including EpiBC, an EpiINFO based program for birth certificate analysis, and Microsoft Excel data analysis templates. CONCLUSION: This 6-pronged strategy is well utilized and accepted by local MCH staff and appears to have some degree of association with better quality of local MCH plan documents.

Adolescent↗
PubMed2006

A new method for measuring misclassification of maternal sets in maternally linked birth records: true and false linkage proportions.

OBJECTIVES: Numerous studies have used maternally linked birth records to investigate perinatal outcomes, maternal behaviors, and the quality of vital records birth data. Little attention has been given to assessing errors in the linkages and to understanding how such errors affect estimates derived from the linked data. The author developed a framework for conceptualizing maternal linkage error and measures for quantifying it, and examined the behavior of the new measures in a maternally linked file. METHODS: Linkage errors were conceptualized as misclassification, with the classes being the maternal sets (records classified as representing different births to the same woman). The true linkage proportion, analogous to sensitivity, was used to capture the degree to which all of a woman's births were assigned to a single maternal set; the false linkage proportion, analogous to specificity, was used to capture the degree to which the assigned maternal sets combined births from different women. The behavior of the two proportions was examined by introducing increasing degrees of linkage error into a maternally linked file. RESULTS: Both measures indicated greater misclassification with increasing simulated linkage errors. CONCLUSIONS: The new measures may be a useful tool for assessing the quality of maternally linked data, as well as other types of linked records where the linkages are within a single file. This is a necessary step towards developing methods for addressing misclassification bias in studies of maternally linked records through sensitivity analysis, adjustment, and other means.

Bias↗
PubMed2006

Issues in using state hospital discharge data in injury control research and surveillance.

This study evaluates the quality of injury-related coding in state hospital data and their usefulness to injury researchers. Using 1997 hospital discharge records from 19 states, hospitalized non-fatal injury-related cases were identified by first selecting all cases that met broad criteria for injury, and then dropping cases that appeared incorrectly coded as injuries and cases related to medical care. Based on our criteria, 1,129,980 non-fatal hospitalized cases were identified as probable acute injuries. Three-quarters were coded with a traditional injury diagnosis in the primary diagnosis field, and 90% had a traditional injury diagnosis somewhere in the first six diagnosis fields. Of cases with an injury diagnosis code in the first three diagnosis fields, 88.1% were E coded. E coding completeness varied by state, with some states reporting high rates of E coding by using non-specific E codes. Other challenges included E-coded cases where no injury diagnosis was reported and apparent miscoding of the E code. We conclude that it is possible to combine multiple states' data if researchers are aware of the challenges they may encounter. In order to capture all injury-related cases, it is important to scan secondary diagnosis fields.

Data Collection↗
PubMed2004

Evaluation of a public health Salmonella surveillance system in King County, Washington.

OBJECTIVES: Salmonella infection is the most common cause of foodborne bacterial outbreaks and deaths in the United States. The effectiveness of Salmonella surveillance for detecting outbreaks depends on timeliness of reporting. We evaluated the public health Salmonella surveillance system in King County, Washington, during an outbreak and at baseline. METHODS: We assessed the timeliness of the Salmonella surveillance system in King County using the Public Health-Seattle & King County Laboratory (County PHL) database from 1998 to 1999. We determined median days for key steps involved in the Salmonella identification and reporting process and the percentage of suspected Salmonella isolates confirmed. Time intervals for key steps during a Salmonella outbreak were compared to baseline surveillance. RESULTS: Of the 652 suspected Salmonella isolates sent to the County PHL from 22 clinical laboratories, 617 (94.6%) were confirmed as Salmonella. Salmonella confirmation rates improved from 1998 to 1999, and 41% of the submitting laboratories, contributing 32.4% of the isolates, had 100% confirmation rates for both years. The median total identification time during the outbreak did not differ significantly from baseline (13 days vs 17 days). The time interval for serotyping contributed most to the total identification time. CONCLUSIONS: King County's Salmonella surveillance system requires more than 2 weeks to confirm and report serotype results for Salmonella isolates. Variation in total identification time depends on serotyping time. A more detailed study of other surveillance systems may identify approaches to decrease total identification time.

Disease Outbreaks↗
PubMed2006

Analysis of data-collection methods for an acute stroke care registry.

This study aims to assess and compare the completeness and reliability of data collected by prospective and retrospective methods for the Paul Coverdell National Acute Stroke Registry. The prototypes consisted of eight states that used the same data elements but differed in their collection approach. Three prototypes employed retrospective case ascertainment (n=1218), and five prototypes used prospective or a combination of prospective and retrospective case ascertainment (n=1602). RTI International performed an audit analysis of the eight prototypes. Completeness, exact match, and discrepancy analyses were performed with data elements grouped into 12 categories for this analysis. A sample of 2820 (37.6%) from a total of 7494 records from 91 hospitals was studied. The "in-hospital complications" section had the highest percentage of completeness (99.6%), followed by "demographic data" (97.7%), and "in-hospital diagnostic procedures" (93.4%). The section with the lowest percentage of completeness was "thrombolytic treatment" (53.5%), followed by "reasons for nontreatment with thrombolytics" (57.1%), and "signs and symptoms onset" (63.5%). Across all prototype elements, exact matches with audit data ranged from 62.8% to 95.9%. Documentation of the date/time of stroke onset and of arrival in the emergency department had a high number of discrepancies with audit data, with exact match percentages of 69.7% and 64.5%, respectively. No significant difference was found between retrospective and prospective case ascertainment in completeness or matching with audit data. Combined retrospective and prospective data-collection approaches for different types of data elements may be best in terms of both completeness and accuracy.

Acute Disease↗
PubMed2004

Limitations and potential uses of census-based data on ethnicity in a diverse community.

PURPOSE: Information on ethnicity, socioeconomic status, and social class has value in epidemiologic research and in measurement of the quality of health care but it is difficult to obtain for large populations. This evaluation assessed the potential usefulness of ethnicity data based on address geocoding to the 2000 census. METHODS: We compared ethnicity based on the geocoding data with ethnicity from hospitalization records and birth certificates of a large health maintenance organization. RESULTS: Of 117,209 members with black ethnicity recorded at the time of a hospitalization, the mean percentage of blacks in their geocoded block was only 37%. Among the 62,661 individuals recorded as Asian at the time of a hospitalization, the mean percentage of Asians in their geocoded block was only 24%. Among the 47,328 individuals who lived in a census block that had 50% or more blacks, 81% were recorded as black at the time of a hospitalization. Among the 24,424 individuals who lived in a census block that had 50% or more Asians, 38% were recorded as being Asian at the time of a hospitalization. CONCLUSIONS: In our population, information on ethnicity derived from geocoding at the block level cannot be used to infer the ethnicity of Asian or black individuals.

Adolescent↗
PubMed2004

Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data.

PURPOSE: The ability to identify prevalent cases of diagnosed diabetes is crucial to monitoring preventative care practices and health outcomes among persons with diagnosed diabetes. METHODS: We conducted a comprehensive literature review to assess and summarize the validity of various strategies for identifying individuals with diagnosed diabetes and to examine the factors influencing the validity of these strategies. RESULTS: We found that studies using either administrative data or survey data were both adequately sensitive (i.e., identified the majority of cases of diagnosed diabetes) and highly specific (i.e., did not identify the individuals as having diabetes if they did not). In contrast, studies based on cause-of-death data from death certificates were not sensitive, failing to identify about 60% of decedents with diabetes and in most of these studies, researchers did not report specificity or positive predictive value. CONCLUSIONS: Surveillance is critical for tracking trends in diabetes and targeting diabetes prevention efforts. Several approaches can provide valuable data, although each has limitations. By understanding the limitations of the data, investigators will be able to estimate diabetes prevalence and improve surveillance of diabetes in the population.

Databases, Factual↗
PubMed2005

Data collection for sexually transmitted disease diagnoses: a comparison of self-report, medical record reviews, and state health department reports.

PURPOSE: To compare three methods of data collection on case ascertainment of past chlamydia or gonorrhea diagnoses. METHODS: Data collection for 361 adolescent females between 1998 and 2000 included: 1) face-to-face interviews; 2) computerized and paper medical record reviews; and 3) chlamydia and gonorrhea reports to the state health department. Statistical methods include latent class and composite reference standard analyses. RESULTS: The estimated prevalence of past diagnoses did not differ significantly by data collection method for chlamydia (20.5%, 23.0%, and 19.7% by self-report, medical record reviews, and state health department reports, respectively) or gonorrhea (4.7%, 6.9%, and 5.5%, respectively) during the 2-year study period. The estimated latent class and composite reference standard prevalences for chlamydia were 23.5% and 26.9%, respectively (p=.04 and p < .01 for differences from self-report alone, respectively). For gonorrhea, the estimated latent class and composite reference standard prevalences were 7.8% and 6.9%, respectively (p < .01 for both differences from self-report alone). Kappa scores for self-report compared with the latent class and composite reference standard prevalences ranged from .67 to .80, and the magnitude of under-reporting ranged from 21% to 47%. CONCLUSIONS: The similar case ascertainment from the three sources separately and high reliability of self-report, coupled with its feasibility and low cost, suggest that self-report is a viable data collection method for STD diagnoses. However, using multiple sources may be preferable when time and resources permit given that under-reporting by self-report is likely to occur (particularly for gonorrhea) and that greater case ascertainment can be achieved.

Adolescent↗
PubMed2005

The use of sentinel injury deaths to evaluate the quality of multiple source reporting for occupational injuries.

PURPOSE: This study sought to develop an efficient method for evaluating the validity and completeness of routinely available sources of occupational injury fatality data. METHODS: Deaths due to falls from elevations, machinery, and electrocutions were selected as sentinel injuries likely to have occurred at work. Deaths from these injuries were identified from Maryland vital statistics over 7 years. The work-relatedness of these injuries and sensitivity of reporting were determined from death certificates, medical examiner reports, the National Traumatic Occupational Fatality System (NTOF), the Maryland Occupational Safety and Health Administration (MOSH), and Workers' Compensation (WC) data. RESULTS: A total of 527 deaths were identified for ages 16 and above, of which, 45% were work-related. Identification of work-related deaths varied by source: medical examiner (100%), death certificates (89%), NTOF (68%), MOSH (59%), and WC (44%). Reporting differed by age, cause of injury, year, occupation, and industry. CONCLUSIONS: Examination of work-relatedness for deaths from certain causes is an efficient means of evaluating the quality of occupational injury reporting source data. These sentinel injuries uncovered significant underreporting in sources used by national surveillance systems, resulted in improved NTOF reporting, and suggest the need to make more use of medical examiner data when available.

Accidents, Occupational↗