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At least 217 records · Page 12Linked to original sources

PubMed2006

Action on cycling in primary care trusts: results of a survey of Directors of Public Health.

BACKGROUND: Cycling is a form of physical activity with the potential to make a significant contribution to improving public health; however, participation levels are decreasing. Primary-care trusts (PCTs) are in a position to influence local provision for cycling but the extent of their involvement in policy and practice on cycling is unknown. A survey of Directors of Public Health in PCTs was conducted to establish the level and type of PCT involvement in policies, strategies, programmes and projects on cycling. METHODS: Directors of Public Health on the Faculty of Public Health database were sent an e-mail inviting them to complete an online questionnaire that addressed key issues of PCT involvement with cycling. RESULTS: One hundred and sixty-five responses were received (49% of all PCTs). Thirty-two per cent of respondents said there was someone in the PCT with specific responsibility for cycling. Less than half of PCTs had the basic facilities to encourage staff or visitors to cycle to their premises. Around one in 10 said that cycling was included in their travel plan or local delivery plan, and 49% of respondents said that their physical activity strategy contained reference to cycling. Joint working on the local strategic partnership and community plan was common, with 94% and 82% of PCTs, respectively, saying they had worked with other agencies on these plans. Most PCTs (60%) had worked on the Local Transport Plan. Specific knowledge of cycling policy was low, and demand for additional resources high. CONCLUSION: Cycling does not seem to be high on PCTs' agendas, despite its great potential to improve public health. More could be done to ensure that cycling is given a far greater emphasis within the work of PCTs, notably PCT input into local transport plan development, and production of local physical activity strategies.

Bicycling↗

PubMed2004

Policy analysis in an information-rich environment.

Population-based insurance systems using longitudinal administrative data and record linkage techniques have helped create "information-rich" environments in several sites around the world. The output of five research groups using administrative data (Oxford, Western Australia, and three Canadian centres: Manitoba, Ontario and British Columbia) was analysed from contacts with the research groups and through use of the National Library of Medicine's PubMed and Medical Subject Headings (MeSH) categories. MeSH words "utilization", "economics", "physicians", and "physician practice patterns" more frequently characterized the research by the three Canadian centres than that of the other sites. With core funding for deliverables negotiated with the provincial health ministries, Canadian researchers have been more likely to use linked databases for policy analyses. Manitoba examples highlight the capabilities associated with these information-rich environments. They include the ability to analyse interventions longitudinally; to compare regions, areas and hospitals in defined populations; to combine information on patients and physicians; to add up expenditures for different services within the Canadian health-care system; and to examine population health issues in areas such as education and family services. Well-organized data and the capability for rapid response have been critical for timely policy analysis in Manitoba. A number of successes are mentioned; less successful efforts to influence practice patterns and to modify the internal workings of hospitals are noted. Investments in filling gaps in data collection and in enriching existing data would facilitate additional research. Planning and managing health care for an entire population has benefited greatly from the development of an information-rich environment.

British Columbia↗

PubMed2006

Professional organisation profile: Travel Health Advisory Group, Australia.

The Australian Travel Health Advisory Group was established in 1997 and its membership has been active in several areas, including networking, policy development, research and education in Australia. Information is given on purpose, membership and the various activities of the group.

Advisory Committees↗

PubMed2003

The use of primary/national school absenteeism as a proxy retrospective child health status measure in an environmental pollution investigation.

As a result of community concerns over animal and human ill health centred around a rural town in the Republic of Ireland, a series of epidemiological studies were conducted. The absence of adequate health-information systems forced researchers to investigate alternative methods of assessing child health in the 'at-risk' area. This study aimed to examine annual primary/national school attendance data over a 10 year period as a proxy health status measure. Data from six geographical areas were analysed; one of these six areas was designated the 'high-risk' area on the basis of reports of animal ill health. Significantly higher absenteeism rates were noted in the 'high-risk' area in nine of the 10 years examined. Although caution is urged in the interpretation of these results, this study demonstrates that primary/national school absenteeism data can act as a useful, albeit crude, proxy measure of health status.

Absenteeism↗

PubMed2003

Can patients with osteoporosis, who should benefit from implementation of the national service framework for older people, be identified from general practice computer records? A pilot study that illustrates the variability of computerized medical records and problems with searching them.

Although UK general practice is highly computerized, comprehensive use of these computers is often limited to registration data and the issue of repeat prescriptions. The recording of diagnostic data is patchy. This study examines whether patients with, or at risk of, osteoporosis can be readily identified from general practice computer records. It reports the findings of a pilot study designed to show the variability of recording the diagnosis of osteoporosis and osteopenia, as well as how useful surrogate markers might be to identify these patients. The study also illustrates the difficulties that even skilled practitioners in a primary care research network experience in extracting clinical data from practice information systems. Computer searches were carried out across six practices in a general practice research network in the south-east of England. Two of these practices had previously undertaken research projects in osteoporosis and were consequently expected to have excellent data quality in osteoporosis. These two practices had a combined list size of 27,500 and the remaining practices had a combined practice population of 43,000 patients. The data were found to be variable with over 10-fold differences between practices in the recorded prevalence of osteoporosis diagnosis as well as its surrogate markers-such as fragility fractures, long-term steroid prescription, etc. There was no difference in data quality between the two practices that had conducted osteoporosis research and the rest of the group, other than in the areas of diagnostic recording and prescribing for osteoporosis and recording of fractures. Issues were raised by the practices that struggled to identify patients at risk of osteoporosis about the limitations of Read classification in this disease area. Practices need further assistance if the patients at risk are to be identified. Without urgent action, it will be difficult for practices to identify the patients who are likely to benefit from Standard 6-'Falls' of the National Service Framework for Older People. These findings also have broader implications as UK general practice moves towards the implementation of a quality-based contract.

Aged↗

PubMed2003

GIS based malaria information management system for urban malaria scheme in India.

A GIS based information management system has been developed to help Urban Malaria Control in India. The basic objective is to develop a model to assist planning and implementation of a suitable control measure. The system can help in: (i) identifying high receptive areas in time and space domain; (ii) identifying risk factors for high receptivity; (iii) monitoring and evaluating control measures. To demonstrate this system, information on 33 parameters and malaria cases has been attached to a digitised map of Dindigul, an urban town in Tamil Nadu. Functionalities of the system and its utility are described in this paper. A GIS based information management system ensures that if a localised spurt of the disease occurs, it can be associated rapidly with a likely cause, a specific vector, and a probable human source, so that appropriate preventive action can be taken to arrest any rising trend.

Communicable Disease Control↗

PubMed2002

The cystic fibrosis therapeutics development network (CF TDN): a paradigm of a clinical trials network for genetic and orphan diseases.

Clinical trials have become critical to the advancement of medical science and to the evolution of patient care in medicine. The science of clinical research has advanced from early studies in which treatment was assessed without controls to sophisticated multinational collaborative randomized, double-blind, placebo controlled trials of therapeutic interventions. To facilitate the advancement of clinical research, clinical trials networks have been developed to conduct multicenter studies. This review describes the history of clinical trials, clinical trials networks, and the goals of such networks in the United States. The Cystic Fibrosis Therapeutics Development Network, a network that represents the paradigm for genetic and orphan diseases, is described in detail. This network has been extremely successful in its first 3.5 years of existence conducting 18 different clinical trials in patients with Cystic Fibrosis. Unique aspects of the network include the use of internet applications for study conduct and communication, the development of statistical methodology to enhance the efficiency of clinical trial design, the development of outcome measures specific to Cystic Fibrosis, and the development of infrastructure necessary for expediting protocol development. In the current environment, clinical research faces significant challenges related to ensuring the safe and ethical conduct of clinical research while promoting fast and efficient clinical trials. To succeed and move forward to provide treatments and find cures for diseases, clinical trials networks must continue to evolve. The Cystic Fibrosis Therapeutics Development Network represents a network that has met this challenge and will continue to provide a venue for the safe and efficient conduct of clinical trials in Cystic Fibrosis.

Clinical Trials as Topic↗

PubMed2002

[The BIFAP project: database for pharmaco-epidemiological research in primary care].

OBJECTIVES: To create a data base (BIFAP) with information provided by primary care doctors from the National Health System who use a computer at work, to evaluate its validity as a source of pharmaco-epidemiological information and to use it for the study of the efficacy and safety of medicines. JUSTIFICATION: Some data bases, such as the British GPRD, have shown great efficiency in pharmaco-epidemiological research and in analysis of alarm signals in pharmacovigilance: primary care doctors are in a very good position to obtain clinical information from their patients. It is recommended that the impact of medicines on various populations is evaluated, including of course those medicines most used in Spain. PILOT PHASE: January 2000-end of 2003. 300-500 doctors took part: a) monitoring of certain recommendations on recording; b) dispatch every 2 or 3 months to the Spanish Medicines Agency (AEM) of anonymous information with its origin encrypted (basic demographic details, morbidity, prescriptions, other data of epidemiological relevance), which are analysed by computer to check whether they meet adequate recording standards; c) despatch to the AEM of copies of anonymous clinical reports from small samples of patients (for BIFAP validation studies). FEASIBILITY AND PERSPECTIVES: If BIFAP were viable, a standardised procedure for its use and protocols to support it as a research tool would be put in place.

Clinical Pharmacy Information Systems↗

PubMed2003

Measuring homicide in Russia: a comparison of estimates from the crime and vital statistics reporting systems.

The Russian homicide rate more than tripled between 1988 and 1994 and is now among the highest in the world. This dramatic increase, together with newly available data from a post-Soviet Russian government that is becoming more transparent, has led to a growing number of studies of homicide in Russia. As of yet, however, there has been no systematic evaluation of the homicide reporting systems in the country. This article examines the comparability of the two main sources of homicide estimates in Russia, crime data from the Ministry of the Interior and mortality data from the vital statistics registration system. These estimates are compared annually and by administrative region. Annual estimates from the vital statistics reporting system have reported an average of nearly 40% more homicides than the crime reporting system over the last decade and a half. Regionally, mortality estimates are higher than crime estimates in 66 of 78 regions, and eight of the 12 regions where crime estimates are higher are in areas where previous validation procedures suggest mortality data are suspect. As the regional homicide rate increases, so does the gap between the two estimates. Case definitions of these sources lead us to expect small discrepancies between them, but this does not account for the large differences revealed here. Both systems under-report, for different reasons, and some of the under-enumeration in both systems is purposeful and/or results from a lack of human and monetary resources. Mortality data are probably better for most purposes, especially when comparing Russia to other nations and when estimating causal models. Both systems should be used with caution, however, and the choice between them should depend on the nature of each study.

Crime↗

PubMed2003

Strengthening capacity in developing countries for evidence-based public health: the data for decision-making project.

Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.

Bolivia↗

PubMed2003

Immunization registry accuracy: improvement with progressive clinical application.

BACKGROUND: Healthcare systems have been challenged to ensure the timely administration of immunizations. Immunization registries have been proposed to improve the accuracy and completeness of immunization information and to promote effective practice. METHODS: Comparison of randomly selected samples from two birth cohorts (1993 and 1998) from Denver Health Medical Center. Chart review and immunization registry information for these groups were compared; a composite immunization was recorded and up-to-date (UTD) status established. Registry data were compared with this composite using a sensitivity measure to assess completeness and accuracy. RESULTS: Among 818 children in the 1993 cohort and 1043 children in the 1998 cohort, there were 6386 and 6886 valid immunizations, respectively. The registry recorded 71.4% and 97.7% of these for the 1993 and 1998 cohorts, respectively (p <0.001). The apparent UTD rate, as measured with registry data alone, improved from 37% to 79% between the two time frames (p <0.001). Composite UTD status was 83.1% and 78.9% (1993 vs 1998, respectively). Accurate registry-defined UTD status improved from 44.4% to 100% between the two intervals. CONCLUSIONS: Immunization registry accuracy improved dramatically for recorded immunizations and UTD status. However, after 3 years of registry use, the overall proportion of children who were UTD had not significantly improved. The mere presence of a registry does not ensure more complete vaccination coverage. Other registry-based strategies, including use of the data for reminder, recall, and audit, may further improve immunization coverage.

Child↗

PubMed2003

Child death review. The state of the nation.

BACKGROUND: Child death review (CDR) is a mechanism to more accurately describe the causes and circumstances of death among children. The number of states performing CDR has more than doubled since 1992, but little is known about the characteristics of these programs. The purpose of this study was to describe the current status of CDR in the United States and to document variability in program purpose, scope, organization, and process. METHODS: Investigators administered a written survey to CDR program representatives from 50 states and the District of Columbia (DC), followed by a telephone interview. RESULTS: All 50 states and DC participated; 48 states and DC have an active CDR program. A total of 94% of programs agreed that identifying the cause of and preventing future deaths are important purposes of CDR. Assistance with child maltreatment prosecution was cited as an important purpose by only 13 states (27%). Twenty-two states (45%) review deaths from all causes, while six states (12%) review only deaths due to child maltreatment. CDR legislation exists in 33 states. Fifty-three percent of the CDR programs were implemented since 1996, and 59% report no or inadequate funding. CDR contributes to the death investigation process in seven states (14%), but the majority (59%) of reviews are retrospective, occurring months to years after the child's death. CONCLUSIONS: CDR programs in the United States share commonalities in purpose and scope. Without national leadership, however, the wide variation in organization and process threatens to limit CDR effectiveness.

Adolescent↗

PubMed2003

Application of capture-recapture methodology to estimate the prevalence of dementia in South Carolina.

PURPOSE: The purpose of this study was to estimate the prevalence of dementia in individuals 65 years of age and older in the state of South Carolina using capture-recapture methodology. METHODS: We linked data from the Department of Mental Health admissions, inpatient admissions, and emergency room visits. Separate log-linear models were used to obtain estimates of the underascertainment-corrected prevalence of dementia in twelve age-gender-race subgroups, which were summed to estimate the prevalence of dementia in the total population. RESULTS: We found an overall prevalence of dementia of 14% in South Carolina for persons 65 years of age and older using capture-recapture methodology. This estimate of persons with dementia is 25% higher than the identified cases of dementia in the South Carolina Alzheimer's Disease Registry (10.5%). CONCLUSIONS: Although capture-recapture methods are prone to limitations, they can be used to more accurately estimate the prevalence of dementia in a geographic area.

Aged↗

PubMed2004

Descriptive epidemiology of health problems in Vaslui district, Romania.

PURPOSE: To describe the characteristics of morbidity in one district of Romania and to identify specific priority areas for preventive measures or further research. METHOD: A descriptive retrospective study, cases being identified using routinely collected data on morbidity from a district public health authority. Study population was defined as those resident in Vaslui district, an area characterized by lower socioeconomic development located in the north-eastern region of Romania (Moldova). The main outcome measures were occurrence and prevalence rates of events and patterns of hospital utilization over the study period (1996-2001). RESULTS: The overall occurrence rate was 46,779.1 per 100,000 person-years with a declining trend over the 6-year study period. The highest values were amongst children. The most common causes were respiratory diseases (36.3%) and digestive diseases (31.4%) followed by infectious/parasitic diseases (5.8%), nervous system/sense organs diseases (5.6%) and skin/subcutaneous diseases (5.0%). The point prevalence rate increased steadily from 8.4% in 1996 to 12.5% in 2001, the picture being dominated by anemia in children and cardiovascular diseases (i.e., hypertension, ischemic cardiopathy) in adults. The leading cause for hospitalization remains respiratory diseases followed by cardiovascular and digestive diseases (39.5% of all diagnoses). CONCLUSIONS: The results suggest a number of prevention priorities amongst Vaslui residents such as respiratory diseases especially in children less than 1 year of age and adults over 65 years, chronic cardiovascular diseases in adults or digestive diseases in the whole population. This work can be used as a starting point for other observational studies on health information systems as well as on broader determinants of health within this community.

Adolescent↗

PubMed2002

Data quality and the spatial analysis of disease rates: congenital malformations in New York State.

Spatial analyses of disease rates are increasing as the hardware and software used in disease surveillance and cluster investigations become more accessible and easier to use. The results of these analyses should be interpreted with caution since inconsistencies in health outcome reporting and population estimates may lead to erroneous conclusions. In this report we provide an example, using data on congenital malformations in New York State, to show how under-reporting of malformations by some New York City hospitals can lead to apparent clusters of malformations in other areas of the state where reporting is more complete. We illustrate how spatial analysis techniques can be used to locate under-reporting problems and determine the extent to which the problem exists.

Congenital Abnormalities↗

PubMed2002

The use of a GIS-based malaria information system for malaria research and control in South Africa.

The paper aims to outline the innovative development and application of a Geographical Information System based Malaria Information System for malaria research and control in South Africa. This system is a product of collaboration between the Malaria Control Programmes and the Malaria Research Programme of the Medical Research Council of South Africa. The ability of such a system to process data timeously into a usable format is discussed, as well as its relevance to malaria research, appropriate malaria control measures, tourism, and social and economic development.

Communicable Disease Control↗

PubMed2002

Towards the creation of a health information system for cancer in KwaZulu-Natal, South Africa.

The paper aims to evaluate the potential of Geographical Information Systems (GIS) in the creation of a health information system (HIS) for cancer. A case study describes the spatial distribution of reported cancer in KwaZulu-Natal, South Africa and correlates this with levels of development. The study illustrates the problems of data shortage in a developing country. The mapping of reported cancer reveals a concentration of cancer in the developed metropolitan districts, where the hospitals are located. The study therefore provides a 'geography of accessibility to treatment centres' due to the under-reporting of the disease. Despite incomplete data and under-reporting of the disease, the study illustrates the potential of GIS to add value to a HIS for cancer.

Demography↗

PubMed2003

International distance-learning outreach: the APEC EINet experience.

BACKGROUND: The Emerging Infections Network is a mature electronic network that links Public Health professionals in the Asia Pacific through regular e-mail bulletins and an extensive Web site (http://www.apec.org/infectious). Emerging infections is a new area of study; learning materials help foster education. Our objective is to quantify the response of the network to the introduction of distance-learning materials on the Web site. METHODS: Distance-learning materials, developed by the University of Washington School of Public Health, were field tested and launched on the site. Publicity was carried out prior to the launch of the materials. Access was tracked prospectively using server counts of page downloads. RESULTS: Web access increased substantially during the month after the materials were launched, especially among Asia based computers. The effect was isolated to the distance-learning pages, and not general to the site. CONCLUSIONS: This Web site appears to be responsive to the advertisement and to the materials. Prospective Web-site monitoring proved useful.

Asia↗