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PubMed2003

Integrating GIS components with knowledge discovery technology for environmental health decision support.

This paper presents a new category of decision-support tools that builds on today's Geographic Information Systems (GIS) and On-Line Analytical Processing (OLAP) technologies to facilitate Geographic Knowledge Discovery (GKD). This new category, named Spatial OLAP (SOLAP), has been an R&D topic for about 5 years in a few university labs and is now being implemented by early adopters in different fields, including public health where it provides numerous advantages. In this paper, we present an example of a SOLAP application in the field of environmental health: the ICEM-SE project. After having presented this example, we describe the design of this system and explain how it provides fast and easy access to the detailed and aggregated data that are needed for GKD and decision-making in public health. The SOLAP concept is also described and a comparison is made with traditional GIS applications.

Artificial Intelligence↗

PubMed1998

Computerised controllers for safety critical medical applications.

A novel design for a computer control system to be employed in safety critical applications, as found in medical environments, is presented. It features a low complexity, fault detecting hardware architecturally supporting a strictly cyclic operating mode, as known from programmable logic controllers, and a specification level, graphical programming technique based on the interconnection of application oriented standard software function modules. By design, there is no semantic gap between the programming and machine execution levels. Thus enabling the safety licensing of application software by an extremely simple but rigorous method, the software verification problem is satisfactorily solved for a large application area, where failures may cause hazards to, or even loss of, human safety and lives.

Computer Systems↗

PubMed2004

The public health usefulness of the exercise recreation and sport survey (ERASS) surveillance system.

BACKGROUND: There is a public health need to monitor habitual participation in physical activity (PA). This report evaluates the usefulness of routine sport and recreation sector collected 'Exercise Recreation and Sport Survey (ERASS)' data from a public health perspective. METHODS: The ERASS telephone surveys collected information about participation in any PA undertaken for exercise, recreation or sport and the frequency of participation during the previous 12 months from a random sample of 3,400 Australians (aged > or = 15) each quarter. Activities were categorised as Health Enhancing Physical Activities (HEPA) if the activity was of sufficient intensity (METs > or = 3.5). 'Sufficiently active' people reported HEPA > or = 5 days/week and the sedentary group reported HEPA < 0.5 day/week. The total person-days of PA were calculated and main PA types that contributed to HEPA were highlighted. RESULTS: In 2001, walking accounted for 58% of all HEPA person-days. For females walking (66%), swimming (5.7%) and gym (4.7%) combined accounted for 75% of HEPA days while for males, walking (50%), cycling (8.1%), football (6.2%), jegging (5.6%) and swimming (4.5%) were main contributors. The mean days walked was 2.20 days/week (95% CI; 2.16-2.25) while all other HEPA combined totalled 1.56 days/week (95% CI; 1.52-1.60). Over 12-month period 15.8% of Australians were defined as sedentary and 31% were 'sufficiently active' including 16.8% who reported frequent walking (> or = 5 days/week). CONCLUSION: ERASS could supplement informational gaps in current PA surveillance. It provides estimates of long-term PA behavioural habits and informs policy makers about the types of activities that contribute to population health.

Adolescent↗

PubMed2006

Translating patient safety legislation into health care practice.

BACKGROUND: An independent state agency, the Authority is charged with taking steps to reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety. PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM (PA-PSRS): The Authority implemented PA-PSRS, a mandatory reporting and analysis system for both adverse events and near-misses, among 450 hospitals, birthing centers, and ambulatory surgical facilities. Pennsylvania is the only state to require the reporting of both adverse events and near-misses. THE PATIENT SAFETY ADVISORY: The Patient Safety Advisory is a quarterly publication containing articles about trends in reports submitted to PA-PSRS. The peer-reviewed articles include analysis of and lessons learned from PA-PSRS reports and evidence-based risk reduction strategies based on research in the clinical literature. To complement and reinforce the effectiveness of certain Advisory articles, the Authority has introduced electronic, educational tool kits on its Web site that can be downloaded. They include posters, draft policies, audio-slide presentations for staff training, and other materials related to clinical implementation of patient safety interventions and protocols. SUMMARY AND CONCLUSION: In just over two years, the Authority has developed a program that turns reports into actionable items through the analysis and research of adverse events and near-misses.

Awards and Prizes↗

PubMed2006

Hepatitis A surveillance in England--how many cases are not reported and does it really matter?

Underreporting of hepatitis A infection in England may be high and a number of outbreaks have occurred undetected by routine surveillance. We evaluated surveillance of hepatitis A cases by employing capture-recapture analysis on data from two distinct outbreaks of hepatitis A. The overall reporting of cases of hepatitis A was 81.7% (95% CI 55.3-95) in the first outbreak in North East England and reporting through Lab Base was 65.7% (95% CI 42.8-76.4). In the second outbreak in the East Midlands the overall reporting of hepatitis A cases was 27.8% (95% CI 19-38.7) and through Lab Base 16.6% (95% CI 11.4-23.1). Underreporting of hepatitis A cases is high. Public health interventions exist to prevent and control outbreaks of hepatitis A. The lack of reliable data on incidence and prevalence hampers effective public health management of this disease.

Disease Notification↗

PubMedDate not supplied

Rapid epidemiological assessment of health status in displaced populations--an evolution toward standardized minimum, essential data sets.

Rapid epidemiological assessment (REA) has evolved over the past 30 years into an essential tool of disaster management. Small area survey and sampling methods are the major application. While REA is protocol driven, needs assessment of displaced populations remains highly non-standardized. The United Nations and other international organizations continue to call for the development of standardized instruments for post-disaster needs assessment. This study examines REA protocols from leading agencies in humanitarian health assistance across an evaluation criteria of best-practice attributes. Analysis of inconsistencies and deficits leads to the derivation of a Minimum Essential Data Set (MEDS) proposed for use by relief agencies in post-disaster REA of health status in displaced populations. This data set lends itself to initial assessment, ongoing monitoring, and evaluation of relief efforts. It is expected that the task of rapid epidemiological assessment, and more generally, the professional practice of post-disaster health coordination, will be enhanced by development, acceptance, and use of standardized Minimum Essential Data Sets (MEDS).

Benchmarking↗

PubMed2002

Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States.

OBJECTIVES: Ectopic pregnancy is a common condition with significant health consequences; complications are a major cause of maternal mortality in the United States. Accurate ascertainment of the number of ectopic pregnancies occurring in the United States has been dramatically affected by changing medical practices, causing estimates based on hospital data to be falsely low. This study was performed to identify nationally representative data on ectopic pregnancies and determine overlap of these data, to calculate the annual weighted number of ectopic pregnancies and confidence intervals for these estimates, and to determine barriers to estimation of ectopic pregnancy incidence. METHODS: To assess whether a national estimate of the incidence of ectopic pregnancy could be calculated, we analyzed 1992-99 data from the six nationally representative data sets that include information on ectopic pregnancy. We examined relevant data in each data set and assessed whether any combination of data sets could be used to estimate ectopic pregnancy incidence. We calculated weighted estimates and 95% confidence intervals for hospitalizations, outpatient surgeries, outpatient medical procedures, and physician visits for and self-reports of ectopic pregnancy. RESULTS: Small sample sizes severely limited calculation of estimates of ectopic pregnancy. Data needed for assessing multiple counting was not available consistently. The likelihood of multiple counting of cases was substantial when data set counts were combined. CONCLUSIONS: A reliable incidence rate for ectopic pregnancy in the United States could not be estimated from existing nationally representative data sources. Major advances in diagnosis and treatment of ectopic pregnancy have affected surveillance in two ways: inpatient hospital treatment of ectopic pregnancy has decreased, and multiple health care visits for a single ectopic pregnancy have increased. Alternate means of surveillance are needed to improve understanding of risk factors and trends for ectopic pregnancy, and we recommend examination of the databases of public and private insurance systems and managed care systems. Similar alternate means of surveillance may be needed for other health conditions with comparable changes in management of care.

Adolescent↗

PubMed2002

Evaluation of maternal death surveillance: a community process.

The Mississippi State Department of Health found that the Centers for Disease Control and Prevention guidelines for evaluating surveillance systems could be used as a community approach in changing a maternal mortality surveillance system. This experience caused us to think more broadly about maternal mortality, challenge the guideline process, and ultimately embark on a new surveillance system. System changes included ensuring dissemination of findings, increasing number and type of stakeholders, including nonmedical factors, heightening awareness of maternal mortality, promoting timely reviews, reviewing our regulatory authority, adding field staff notification about maternal deaths, expanding the definition of maternal death, and combining surveillance systems-all of which leads to improved maternal mortality surveillance in Mississippi.

Adolescent↗

PubMed2002

Safe motherhood in the United States: challenges for surveillance.

OBJECTIVES: Maternal mortality ratios in the United States are higher than those of many other industrialized nations. Moreover, these ratios have not changed in the past 20 years, and large racial disparities persist in measures of both maternal mortality and morbidity. In an affluent developed country, maternal deaths should serve as rare sentinel events, highlighting opportunities for prevention and reduction of morbidities. However, existing surveillance efforts are poorly developed, and pregnancy-related deaths and illnesses tend to be underreported. To formulate recommendations for improved surveillance, the authors reviewed existing data on maternal health. METHODS: This review examines the scope and quality of existing information and the strengths and limitations of definitions of maternal mortality and morbidity used in data collection and reporting. RESULTS: This review suggests numerous gaps in surveillance of U.S. maternal health. Psychological as well as physical morbidity, and the presence and adequacy of appropriate treatment, should be ascertained. Quality of pregnancy-related care at the clinical and community levels, and the impact on mortality and morbidity, must be assessed. Collection of morbidity data outside of health care delivery sites is also essential. Trade-offs between nationally representative and other less comprehensive data sources, such as sentinel clinics, large healthcare organizations, and public healthcare financing systems, should be considered. CONCLUSION: Maternal health remains an important frontier for U.S. public health surveillance efforts. Improved surveillance offers opportunities for reducing pregnancy-related mortality and gaining a better understanding of the relationship between maternal morbidity and mortality.

Databases, Factual↗

PubMed2003

Aggregate Health Status: a benchmark index for community health.

A qualitative review of population health assessment models used throughout the United States and Canada indicate both individual and community-level domains of health. Individual-level domains of health include health habits, education, public safety, environment, social, government, culture, and mobility. Community-level domains include the same general health domains but aggregated to the community level Aggregate Health Status (AHS). In the development of the AHS portion of our model, the dependent variable was the general health question from the Medical Outcomes Study. The remainder of the survey was partitioned into mutually exclusive individual measure subsets. A linear combination of these global variables then produces a single estimate relating the multiple domains of the broader determinants of health to health status. This global variable uniquely discriminates between the five categories of general health. This model serves as a framework and benchmark indicator that (1) provides a summary indicator of the overall health status of the population, (2) is broadly representative of populations rather than individuals, (3) is a population perspective rather than a provider perspective, and (4) emphasizes outcomes versus inputs and processes.

Benchmarking↗

PubMed2003

Eliminating missing race/ethnicity data from a sexually transmitted disease case registry.

Data regarding race and ethnicity are usually requested when conducting public health surveillance. However, such data are frequently not included in case reports by providers. This report describes efforts to reduce the extent of missing race and/or ethnicity data in reports of sexually transmitted diseases in Massachusetts. A list of cases reported to the Department of Public Health between March 1 and May 31 1999 lacking race and/or ethnicity data was generated. A student intern tried contacting the providers with a request for complete information. Of the 2,954 cases of syphilis, gonorrhea, and chlamydia infection reported during the study period, 34.8% (1,028 cases) lacked race/ethnicity data. Despite an average of 2.27 calls and 1.5 transfers per call, data was successfully added to only 143 cases, increasing the percent of reported cases with complete data from 65.2% to 70.0%. The telephone calls, while inefficient for collecting this data, had some advantages. For example, they offered opportunities for communication between the STD Division and providers regarding other provider needs or services that the Division might meet. Consideration can also be given to using surnmame lists, ethnic marketing lists, birth records, and matching the case's address with census block data to infer race and/or ethnicity.

Data Collection↗

PubMed2003

Utilization of public mental health services by children with serious emotional disturbances.

The Integrated Database (IDB) was created to provide a broad picture of the use of state-funded mental health (MH) and substance abuse (SA) services. Assembled separately for three states (Delaware, Oklahoma, and Washington), the IDB links client-level and service-level data maintained by the state MH, SA, and Medicaid agencies. This study used the IDB to examine public MH services for children with serious emotional disturbances (SED) in 1996. Children with SED represented 9% to 22% of all children with MH service use. Between one half and two thirds of children with SED received psychotropic medication; 20% to 40% had a MH inpatient or residential stay. Medicaid was the primary funder of MH services for children with SED; only 2% to 12% of children with SED received services solely through the state MH agency.

Adolescent↗

PubMed2003

Effect of interpregnancy interval on infant low birth weight: a retrospective cohort study using the Michigan Maternally Linked Birth Database.

OBJECTIVE: To examine the relationship between interpregnancy interval and low birth weight (LBW), using the retrospective cohort design. METHODS: We used the maternally linked Michigan livebirth data documented between 1989 and 2000 to evaluate LBW in relation to interpregnancy (i.e., delivery-to-conception) interval, overall and at levels of other reproductive risk factors. We fit separate logistic regression models for pairs of first-second, second-third, third-fourth, and fourth-fifth births to control for confounding. RESULTS: Of the 565,911 infants identified, 5.5% had LBW. Univariate and stratified analyses showed that the risk for LBW was lowest when the interpregnancy interval was 18-23 months, and increased with shorter or longer intervals. This J-shaped relationship persisted after controlling for all risk factors simultaneously. For example, among the first-second birth pairs, the adjusted odds ratios (AORs) for LBW associated with interpregnancy intervals <6, 24-59, 60-95, and 96-136 months were 1.4 (95% confidence interval [CI] = 1.3-1.5), 1.5 (95% CI = 1.3-1.6), 1.1 (95% CI = 1.0-1.1) and 1.5 (95% CI = 1.3-1.8), respectively, compared with an interval of 18-23 months. Among the second-third birth pairs, the AORs were 1.5 (95% CI = 1.3-1.6), 1.3 (95% CI = 1.2-1.4), 1.1 (95% CI = 1.0-1.1), and 1.6 (95% CI = 1.3-2.0), respectively. Among the third-fourth birth pairs, the AORs were 1.2 (95% CI = 1.1-1.4), 1.3 (95% CI = 1.1-1.5), 1.0 (95% CI = 0.9-1.1), and 1.4 (95% CI = 1.0-2.0), respectively. Among the fourth-fifth birth pairs, the AORs were 1.3 (95% CI = 1.1-1.6), 1.2 (95% CI = 0.9-1.5), 1.1 (95% CI = 1.0-1.4), and 1.3 (95% CI = 0.8-2.3), respectively. The population attributable risk associated with interpregnancy intervals shorter than 18 months or longer than 23 months was 9.4%. CONCLUSION: These data suggest that spacing pregnancies appropriately could be used as a strategy for preventing LBW.

Adolescent↗

PubMed2003

Validation of birth certificate data in New York State.

Vital statistics birth certificate data are an important source of information for researchers, policy makers, and state officials to evaluate the quality of care delivered to pregnant women. The purpose of this study was to assess the validity of data elements being reported by the hospitals on the birth certificate record when compared to the medical record. This study used a random sample of birth certificates from two upstate and two downstate counties, in New York State, comprising a total of 100 records per county. The review assessed data elements from seven major categories: prenatal care, maternal medical risk factors, risk factors related to pregnancy, lifestyle risk factors, method of delivery, complications of labor and delivery, and infant information. Sensitivity, specificity, the positive predictive value and the negative predictive value assessed level of agreement between the birth certificate and the medical record. Overall, the birth certificate data reflected high specificity, because most conditions are rare. The sensitivity of the data was more varied, ranging from 0 to 100%, reflecting that if a rare condition was present it often was not documented on the birth certificate. Many of the data elements are reported accurately. However, caution should be used for data elements that are poorly reported.

Birth Certificates↗

PubMed2004

Utilization of public mental health services by adults with serious mental illness.

Public mental health (MH) services were examined for non-elderly adults with serious mental illness (SMI) using a database combining information from Medicaid, MH, and substance abuse agencies in three states. These data show that between 23% and 39% of those with SMI received MH services only through Medicaid. Relative use of community versus state hospitals for delivery of psychiatric inpatient care varied across the three states. However, state hospitals accounted for a large proportion of total inpatient days, due to high mean annual days of care. In two states, Medicaid paid for fewer psychiatric inpatient days than expected.

Adult↗

PubMed2004

A new method for classifying patterns of prenatal care utilization using cluster analysis.

OBJECTIVES: The objectives of this study were: to 1) define patterns of prenatal care utilization using cluster analysis, 2) describe two alternative cluster solutions and compare these groupings to the Adequacy of Prenatal Care Utilization Index (APNCU), 3) compare the cluster solutions and the APNCU with respect to maternal age and prematurity, and 4) discuss advantages and disadvantages of using cluster analysis to study prenatal care. METHODS: The study sample included 3544 women in the 1988 National Maternal and Infant Health Survey for whom complete prenatal care visit data were available. Clustering was carried out in two stages, first employing nearest centroid sorting (the k means method), a nonhierarchical approach, and then using Ward's Minimum Variance Method, a hierarchical clustering technique. RESULTS: Patterns of prenatal care defined by cluster analysis varied by timing of the first visit, total number of visits, and the rate of accumulation of visits, but this variation was different compared to that seen for the APNCU. While the cluster solutions and the APNCU identified a similar normative pattern of care, other patterns identified were quite different. In particular, the six-cluster solution differentiated among women who entered care at similar times, but accumulated visits at differing rates and experienced differing rates of preterm delivery. CONCLUSION: Cluster analysis is a new tool for studying prenatal care. Further studies are needed to refine the method and test whether the alternative perspective it provides will lead to new findings concerning the relationship of prenatal care and birth outcomes.

Birth Certificates↗

PubMed2004

[Basics of Bavarian health assessment reporting].

Management information systems which support a demand-oriented, integrative and comprehensive decision-making in health care policy are of pre-eminent importance for the health care system. Present health care legislation in Bavaria underlines the importance of health reporting as a tool for periodical assessment of the situation and starting-point for decision-making in health care. Demands made on the Bavarian health report stem from both European and national levels and also from the regional structure within the state. It is intended that the health reporting should reach the local level. Single reports cannot cover all relevant aspects. Therefore, health reporting in Bavaria has a modular structure. There is a need for integrated, flexibly useful information. Following an evidence-based approach, health information may be subject to critical assessment. This approach enables decision makers to assess the grade of certainty of recommendations. Health reporting in Bavaria aims at following the people through time. The intelligent use of new media will have to play a key role.

Delivery of Health Care↗

PubMedDate not supplied

A compilation of chiropractic and complementary/alternative medicine (CAM) data from public-use national surveys: report on a health-services research resource for the chiropractic and CAM scientific community.

BACKGROUND: Federally funded national surveys are routinely conducted to provide reliable, valid, and relevant data on health and health care, and these "public-use" survey data are typically made available for further study by the wider scientific community. The full potential for using such data to examine the delivery, utilization, organization, and costs of chiropractic or complementary/alternative (CAM) health care remains largely untapped. OBJECTIVE: To report on a project that identifies and indexes public-use survey databases that contain explicit reference to chiropractic and CAM health care, and compiles that information into a web-based resource for the scientific community. METHODS: Review of database source collections. RESULTS: The utility and efficiency of secondary analyses as a cost-effective research strategy are well appreciated within the larger health-services research community, creating many possible opportunities for productive cooperative research endeavors across scientific disciplines. CONCLUSION: The Chiropractic and Complementary/Alternative Compilation User's Manual is available for free download at http://w3.palmer.edu/carber/manualhome.asp, or by following the links at the Palmer Center for Chiropractic Research homepage.

Chiropractic↗