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At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Using geographic information systems to assess risk for elevated blood lead levels in children.

OBJECTIVES: Targeted screening for childhood lead poisoning depends on assessment of risk factors including housing age. Using a geographic information system (GIS), we aim to determine high-risk regions in Charleston County, South Carolina, to assist public health officials in developing targeted lead-screening. METHODS: Properties built before 1978 were geocoded (assigned latitude and longitude coordinates) from tax assessor data. Addresses of Charleston County children who have been screened for lead poisoning were also geocoded. Locations of all housing, lead poisoning cases, and negative screens were created as separate map layers. Prevalence ratios of lead poisoning cases were calculated, as were relative risks for each category of housing. RESULTS: Maps of Charleston County were produced showing the location of old housing, where screening took place, and where cases were found. One thousand forty-four cases were identified. Twenty percent of children living in pre-1950 homes had elevated blood lead levels (EBLL). Children living in pre-1950 housing were 3.9 times more likely to have an EBLL than children living in post-1977 housing. There was no difference in risk of living in a 1950-1977 home vs. a post-1977 home. A large number of cases were also found in an area of newer houses, but near a potential point source. Eighty-two percent of all screens were from children in post-1977 homes. CONCLUSIONS: Children living in pre-1950 housing were at higher risk for lead poisoning. GIS is useful in identifying areas of risk and unexpected clustering from potential point sources and may be useful for public health officials in developing targeted screening programs.

Child↗
PubMedDate not supplied

Classification of transmission risk in the national HIV/AIDS surveillance system.

Risk behavior information is essential for allocating resources and developing effective HIV prevention strategies. Over time, transmission risk information on HIV/AIDS cases has been less likely to be reported to the national surveillance system. The Centers for Disease Control and Prevention (CDC) invited approximately 30 experts in HIV/AIDS and behavioral research from state and local health departments, academia, community-based organizations, and the CDC to participate in a consultation in December 2001 to generate ideas on how best to deal with the lack of risk data. The group was charged with providing recommendations on methods for classifying and reporting risk information and for identifying methods and sources for improving ascertainment of transmission risk behaviors for individuals infected with HIV. This report describes the recommendations and the effects of implementing such recommended procedures on the national HIV/AIDS surveillance database.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Mortality rates for common respiratory diseases in an English population 1979-1998: artefact and substantive trends.

We analysed a mortality database in which all causes of death on each death certificate were coded, as well as underlying cause, to study trends from 1979 to 1998. Multiple-cause-coded death rates for pneumonia and acute bronchitis fell steadily and consistently. There were complementary rises and falls in death rates for individual chronic obstructive pulmonary diseases (COPD)--chronic bronchitis, emphysema, chronic obstructive airways disease--attributable to changes in clinical terminology. Judged by underlying cause, death rates for COPD were lower than those for lung cancer; but, judged by all mentions, death rates for COPD were appreciably higher than for lung cancer. Death rates for COPD, like lung cancer, fell over time in women under 65 years of age and in men; and increased in older women. For all respiratory diseases studied, except lung cancer, the underlying cause of death alone considerably underestimated the extent of their certification on death certificates.

Age Distribution↗
PubMed2004

Artefact or reality? Increases in persons notified to the Regional Drug Misuse Database in the South West of England, 1996-2001.

The incidence of new persons and repeat attenders presenting for treatment for problem drug misuse in the South West of England more than doubled from 1996-1997 to 2000-2001. During this time there was an increase in the number and severity of chronic cases, both in terms of the prevalence of heroin and crack-cocaine use and in the frequency of injecting and sharing injecting equipment. Growth in the availability of treatment, changes in notification practice and sub-regional variation make it difficult to be confident about real rates of increase, or age, gender and substance misuse changes, but the size of these changes mean they are unlikely to be purely artefactal.

Adult↗
PubMed2004

How representative is the population covered by the RCGP spotter practice scheme? Using Geographical Information Systems to assess.

BACKGROUND: The Royal College of General Practitioners Weekly Returns Service (WRS) is a network of sentinel general practices providing weekly data on illnesses diagnosed in general practice across England and Wales. The WRS contributes to the surveillance of infectious disease, most notably influenza. We use Geographical Information Systems (GIS) techniques to establish whether the practice populations of the current WRS are representative of the general population. METHODS: This study compares the practice population with the general population using the Department of the Environment, Transport and Regions (DETR) Indices of Deprivation 2000 scores for English wards. RESULTS: Comparisons at the national level reveal that the WRS population is less deprived than the general population. At a supra-regional level the WRS practice population shows the same North-South differences as the national population, but the proportions of patients in the more deprived and least deprived wards are more exaggerated in the WRS population. A supplementary analysis reveals that the WRS has no patients in the most deprived wards of London. CONCLUSION: The differences have implications for the future recruitment of practices to the WRS. Previous studies have demonstrated the effect of socio-economic deprivation on GP consultation rates. To ensure that the consultation rates reported by the WRS will better reflect consulting patterns in the general population the WRS will need to recruit practices with patients in the most deprived areas of the South and less deprived areas in the North of England. This study demonstrates the value of GIS in the establishment of surveillance systems.

Communicable Diseases↗
PubMed2004

Quality of age data in patients from developing countries.

BACKGROUND: Age misreporting is common in demographic studies but the prevalence and magnitude of age misreporting in clinical cohorts is unknown. We analysed single-year age distribution and terminal digit preference in cancer patients from developing countries. METHOD: Age distribution was analysed by plotting a single-year age of 3874 cancer patients from 72 different countries, mainly from the Indian subcontinent and the Middle East, who resided in the UAE at the time of cancer diagnosis. Preference for age ending with digits '0' and '5' was evaluated using Whipple's index (WI), which has value 100 in cohorts without preference. Preference for all 10 terminal digits was expressed as the difference between the found and expected frequencies using Myers blended method and was graphed. RESULTS: Age data quality was low in cancer patients from the Indian subcontinent (WI = 177) and Middle Eastern countries (WI = 113-204). Females of all nationalities supplied better quality of age data (lower WI) than males. Preference for age ending with digits '0' and '5' was found in all populations except the UAE male citizens who did not show preference for terminal digit '0'. CONCLUSION: Age data quality in this cohort of patients from developing countries was low. Preference for age ending with numbers '0' and '5' is common. In studies conducted in developing countries, age data quality should be analysed as it may bias results and weaken the power of the study.

Age Distribution↗
PubMed2004

Completeness of ascertainment by cancer registries: putting bounds on the number of missing cases.

BACKGROUND: When comparing cancer incidence or mortality rates between different regions, it is important to know how complete the registration data are on which these figures are based. A number of ways of estimating completeness have been proposed, but it is often difficult to say how precise these estimates are. We describe a computer program developed to produce measures of precision for estimates of completeness obtained by one such method, the flow method. METHODS: The program works by resampling the required data sets, and repeatedly calculating completeness estimates until convergence of the standard errors occurs. It was tested on colorectal tumours from a single health district, and empirical confidence limits for 1 and 5 year completeness were compared with those obtained by applying various normalizing transformations and a beta distribution. The method was then applied to tumours of the head and neck, breast and lung and the results compared with those from a capture-mark-recapture exercise carried out 4 years previously. RESULTS: The sampling distribution was close to normal for 1 year completeness, but much less so for 5 year completeness, as assessed by quantile plots. Approximation by a beta distribution was better than by normalizing transformation. Although there were differences between the results produced by the flow method and capture-recapture, the flow method is more reproducible and easier to apply. CONCLUSION: It is now possible to estimate confidence limits for the results of the flow method, and thus determine whether comparative results between registries are likely to be affected by sampling error.

Bias↗
PubMed2004

What has happened to antimicrobial usage in primary care in the United Kingdom since the SMAC report? - description of trends in antimicrobial usage using the General Practice Research Database.

BACKGROUND: The aim of the study was to assess antibiotic prescribing within the United Kingdom for three of the Standing Medical Advisory Committee recommendations 'four things which could be done'. METHODS: We conducted a retrospective survey of morbidity and antibiotic prescribing data between 1993 and 2001 using the national General Practice Research Database. Antibiotic prescribing was linked to diagnoses of cough/cold and sore throat; length of antibiotic course for uncomplicated cystitis. RESULTS: The rate of antibiotic prescribing for cough/cold declined between 1993 (43.7 per 1000 patient years at risk) and 1999 (23.5 per 1000 patient years at risk) and has since increased slightly (to 30.5 per 1000 patient years at risk in 2001). Antibiotic prescribing for sore throat declined between 1995 (80.6 per 1000 patient years at risk) and 1999 and has since remained static (42.1 per 1000 patient years at risk in 2001). Trimethoprim was the most commonly used antibiotic for episodes of uncomplicated cystitis and the prescription of 3 day (or less) courses has increased from 16.4 per cent in 1998 to 41.5 per cent in 2001. CONCLUSIONS: For the SMAC recommendation to limit prescribing for uncomplicated cystitis to 3 days in otherwise fit women there has been demonstrable impact since the publication of the SMAC report. For two recommendations (no prescribing of antibiotics for simple coughs and colds; no prescribing of antibiotics for viral sore throats) the impact has been less clear against the background of a general reduction in antimicrobial prescribing.

Adolescent↗
PubMed2004

Alcohol as a certified cause of death in a 'middle England' population 1979-1999: database study.

The Alcohol Harm Reduction Strategy for England, recently published, highlights current concerns about alcohol consumption in this country. We used a database to examine trends in mortality for all deaths certified as effects of alcohol from 1979-1999, including mentions as well as underlying cause, in a relatively prosperous population in southern England. Mortality, certified as direct effects of alcohol, tripled during the 21 years of study; and mortality rates based on mentions were about double those based on underlying cause. The increase in recent years in mortality based on mentions was considerably greater than that based on underlying cause. Data on age, sex and occupational social class show that people whose alcohol intake kills them are from a broad cross-section of society.

Adolescent↗
PubMed2004

Regional surveillance of accident and emergency department attendances: experiences from the West Midlands.

Information is collected on every patient that attends accident and emergency (A and E). However, there is currently no central collection of these data. In 1999 it was decided to collect data on all A and E attendances in the West Midlands region. All 21 hospitals with 24 h A and E departments were asked to submit data to the Surveillance Centre at the University of Birmingham. To date, 19 hospitals have submitted data but the formats vary leading to a substantial amount of data processing. There are several limitations to the data set, for example a lack of information on the reasons for attendance. Despite this, routinely collected A and E data have great potential for surveillance and the data have been used in original research and to guide local policy. The West Midlands system is the largest source of A and E data in the United Kingdom. This information is of use to a wide range of organizations.

Data Collection↗
PubMed2006

Computer technology and the childhood immunization programme: an investigation of low uptake rates in Coventry Primary Care Trust.

BACKGROUND: The childhood vaccination programme in Coventry Primary Care Trust (PCT) has resulted in consistently low uptake rates for a number of years. After an evaluation of operational processes, an examination of the data systems was performed. METHODS: The under-reporting of vaccinations performed and methodology issues were investigated using data collected by the Child Health Information Department (CHID) and the Finance Department. RESULTS: Data held by the Finance Department result in an uptake rate of between 0.79 and 1.92% higher than those held by the CHID. Locally, the Southwest Child Health (SWIFT) system, the programme used to calculate uptake rates by many of the PCTs across the country, excludes those children residing outside the boundary but registered within it. Coventry PCT's Cover of Vaccination Evaluated Rapidly (COVER) statistics are based on a subgroup of the responsible population. CONCLUSIONS: The computer technology currently utilized by the NHS provides inaccurate statistics for the COVER programme. Systematic under-reporting to the CHID results in moderately lowered uptake rates. A programming anomaly in the SWIFT system has resulted in the collection of data based on a subgroup of the responsible population. This undermines the validity of the statistics collected and renders comparability of data between different PCTs, particularly those using different systems, difficult.

Ambulatory Care Information Systems↗
PubMed2006

Developing a national primary care-based early warning system for health protection--a surveillance tool for the future? Analysis of routinely collected data.

The increasing threat of infections with pandemic potential such as influenza has focussed attention on the information needed to inform those managing a pandemic. The Health Protection Agency, Nottingham University and EMIS have developed a new national health protection surveillance system using QRESEARCH, an established primary care-derived database, to provide timely and local information on trends in community illness and prescribing. This article describes the first year of the surveillance project. Data on consultations and prescribing were extracted from routinely generated computerized consultation records between November 2004 and December 2005. Weekly consultation and prescribing rates for a range of conditions including influenza-like illness and prescription of anti-viral drugs for influenza and vomiting were developed as 'key indicators'. These indicators were presented in a weekly bulletin showing data to strategic health authority level for use by those working in public health. The particular value of this scheme is the ability to produce timely data on illness to local level and to link prescribing to morbidity. The data were used 'real time' to reassure about lack of illness following the Buncefield Fuel Depot incident. This scheme is being further developed to provide daily local influenza-related information needed in an influenza pandemic.

Ambulatory Care Information Systems↗
PubMed2004

Overcoming the hurdles to providing urban health care in the 21st century.

The delivery of health care services to urban populations in the United States is a system of rapidly increasing complexity. With the emergence of superspecialized physicians, a scientific approach to disease management has received great emphasis. Those providing health care at the population level may also apply this evidence-based approach. Analysis of the process of health care delivery in its entirety is complicated, confusing, and may be fraught with bias. In this article, a powerful instrument for providing a scientific approach to urban health care health policy development is introduced. This tool allows for analysis and assessment of hurdles to health care delivery to urban populations by dividing the process into elements of "administration," "provision," and "utilization" (APU). This APU triangle model, while intuitive, also allows a more definitive analysis by parts than would be possible to make of the whole. Using this model, the authors explore some of the hurdles faced by each element as well as some potential solutions. Although this model is presented in the context of urban hurdles to health care, it is equally applicable to rural environments or other service-delivery systems. In conclusion, this article discusses the emergence of the role of the public health department as the facilitator and manager between sectors of the community not traditionally connected in a collaborative health care model. Thus, the urban public health department coordinates efforts to surmount the hurdles and provides the venue for analysis, development, and employment of successful strategies.

Cities↗
PubMed2004

Montefiore Medical Center in The Bronx, New York: improving health in an urban community.

The author calls on academic medical centers that serve urban communities to go beyond the traditional mission of patient care, teaching, and research by accepting responsibility to build community-based care systems that are capable of improving the health of underserved populations within their reach. The experience of Montefiore Medical Center in the Bronx, New York, is presented to illustrate the nature, scope, and complexity of the undertaking that is required. Eight initiatives are described: expanding the primary care network, creating The Children's Hospital at Montefiore and the Child Health Network, responding to the needs of other high-risk populations, integrating the network with health information technology, using care-management systems to improve quality, reinforcing ethical allocation of resources, building teaching and research into the network, and preserving community vitality. The author believes that the current health care environment offers opportunities that may help to stimulate change in the direction of community-based systems. Managed care provides financial incentives to academic centers that are willing to accept risk and responsibly manage the care of a defined community, and advanced information technologies can support them in that endeavor. The author concludes that for academic medical centers with the proper systems in place, accepting responsibility for the community is not only the right thing to do, it is the strategic thing to do.

Academic Medical Centers↗
PubMedDate not supplied

eHealth technology and Internet resources: barriers for vulnerable populations.

Disparities in accessing health information exist for various vulnerable populations. Reviewing access issues for those seeking and/or needing health information suggests that there are many factors that may inhibit access. These include a wide diversity in the education, background, and needs of those seeking information, and the distribution of information among many disciplines and information sources. The most needy among this group may require extensive, multispecialty healthcare and may have particular problems with access, treatment adherence, and working within the healthcare system.

Access to Information↗
PubMed2004

Using Medicare data to estimate the number of cases missed by a cancer registry: a 3-source capture-recapture model.

BACKGROUND: Cancer surveillance is essential for assessing patterns of cancer occurrence. State cancer registries do not capture all available cases potentially biasing results. Secondary data may be useful in identifying new cases and estimating the number of cases missed. OBJECTIVE: We sought to create 2 distinct data sources from Medicare claims to use in combination with registry data as 3 sources for a capture-recapture analysis to estimate the capture rate and bias in capture of a statewide cancer registry. METHODS: Data from the Virginia cancer registry (Registry) were merged with Medicare inpatient (Part A) as well as Medicare outpatient and physician claims (Part B) to provide 3 sources to estimate missing cases. A 3-source loglinear model was used to estimate the number of missing cancer cases for breast, lung, colorectal, and prostate cancer. Models included main effects and interactions. Additional analysis looked at the effect of demographic and comorbidity variables. RESULTS: Loglinear models demonstrated mostly positive dependence between the 3 sources, implying that 2-source models would underestimate missing cases and overestimate capture rates. Using capture-recapture estimates of total number of cancer cases as the denominator, capture rates for Registry ranged from 59% (colorectal) to 74% (lung). When the aggregate of cases found by either Medicare or Registry were used the capture rates ranged from 74% (prostate) to 89% (breast). Further analysis indicated that capture rates differed by demographic characteristics. CONCLUSION: We conclude that Medicare claims are useful to supplement a Registry, estimate the number of missing cases, and assess bias in capture.

Aged↗