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PubMed2004

Developing a local comprehensive environment and health tracking system: using what we know to improve health and the environment.

Recent national reports have highlighted the absence of a coordinated local, state, and national environmental health tracking system. Local environmental health agencies are struggling to design and implement data systems that will allow them to evaluate environmental exposures ecological trends, and health outcomes in order to formulate more effective prevention strategies. This paper articulates the need for local environment and health tracking systems, discusses efforts under way around the nation, and describes the initiative being undertaken in one county health department to address this need. It provides information on attributes of indicators to be included in such a system, sources of data, criteria for evaluating the usefulness of indicators, suggestions for involving the community and staff, management strategies for implementing a data system, and recommendations for resolving common barriers to data sharing and use. This information will be useful to agencies that wish to develop their own robust environment and health tracking systems to support the three core functions of public health and the 10 essential public health services.

Community Health Planning↗

PubMed1992

Dermatoses--an occupational hazard in the canning industry.

Despite the recognition that occupational dermatitis is extremely common, few data exist on the prevalence of skin disorders in South African industry. A cross-sectional prevalence study among 686 female workers in a canning factory in the western Cape showed high rates of dermatoses--in particular, chronic paronychia, intertrigo and dermatitis of the hands. A statistically significant association was found between exposure to 'wet work' in the industry and the prevalence of chronic paronychia and intertrigo. Age was also found to be associated with these dermatoses, irrespective of duration of service. The prevalence of dermatitis of the hands was increased among high-exposure workers, but not significantly. Dermatoses are an important occupational hazard in the canning industry, and there is a need for improved preventive measures.

Adolescent↗

PubMed2004

Comparison of methods for evaluation of a medical terminological system.

The importance of terminological systems (TS) to support standardized and structured documentation of medical data is commonly recognized. The usability of TS in real practice strongly depends on the completeness and the correctness of the content of the TS. We here present four different methods that can be applied to evaluate a TS' content. All four methods were applied in a case study. We make a comparison of 1) the results of two methods that focus on the completeness of the content and that differ in the application of the TS that they focus on and 2) the results of an automated and a manual evaluation of the correctness of the content. Finally we summarize the results of all four methods and analyze whether they overlap or complement each other.

Critical Care↗

PubMed2004

JCAHO and CMS to align quality measures: PI efforts will benefit.

Quality measures cover heart attack, heart failure, pneumonia, and surgical infection prevention. Using common metrics, data definitions will strengthen comparative data efforts. Some are concerned that tracking could affect decisions concerning sicker patients.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2004

[Effectiveness and safety of fluticasone propionate in therapy of children suffering from asthma. Part I. Mechanisms of actions and clinical effectiveness of treatment in children with asthma].

The introduction of inhaled corticosteroids (ICS) has been a milestone in asthma therapy. According to current guidelines ICS are the first line drug in chronic anti-inflammatory therapy. The purpose of first part of this publication is to present updated knowledge on mechanisms of anti-inflammatory action as well as some pharmacokinetics and pharmacodynamics data about commonly used ICS, especially fluticasone propionate (FP) and two others: budesonide (BUD), beclomethasone dipropionate (BDP). Some differences between mentioned drugs have been found concerning systemic activity and safety of therapy. Fluticasone propionate is twice as active as the BUD and BDP. First results of therapy are seen 1-2 week after administration. Fluticasone propionate, more lipophilic than other steroids, has also high glucocorticoid receptor affinity and specificity, high topical anti-inflammatory activity and low systemic bioavailability. Systemic availability of FP depends on absorption from respiratory system. Oral bioavailability can be neglected because of almost total inactivation in liver during first pass. Fluticasone propionate has some features of dissociated steroids which means predominance of transrepression over transactivation--beneficial from safety point of view. Clinical efficacy of FP in chronic asthma therapy in children was confirmed in many studies. It significantly reduces the symptoms and exacerbations of asthma. There is a close correlation between FP use and lung function tests. The therapy with FP decreases bronchial hyperreactivity and the use of systemic steroids and rescue medication. The beneficial action of fluticasone propionate in asthma is due its anti-inflammatory properties within the airways (decreasing levels of direct and indirect markers of airways inflammations are observed).

Administration, Inhalation↗

PubMed2006

Leveraging the benefits of Health Information Technology to support healthcare delivery model redesign.

Uninsured and low income underinsured patients create substantial challenges for local healthcare systems, yet their providers are not always included in community-wide implementations of health information technology. To address this deficit, prototypes of the recently proposed National Health Information Network must include providers who care for underserved populations. In 2003, a consortium of providers founded the Waterbury Health Access Program (WHAP) to implement an electronic medical record (EMR) system that would first address the needs of the region's vulnerable underserved patients. It was anticipated that lessons learned would be applicable to other patient populations as well. The WHAP consortium of competing hospitals and outpatient clinics developed a broad-based community-wide initiative to include implementing a common EMR system to share clinical information across all locations. The design includes 11 outpatient clinic locations linked to a common data-sharing tool that is accessible by each clinic, emergency department and community practitioner participating in a local, coordinated charity care program. The collaboration required to support community-wide implementations of health information technology also can be leveraged to facilitate additional quality improvement initiatives.

Ambulatory Care↗

PubMed1991

Isolation of two distinct epithelial cell lines from a single feline mammary carcinoma with different tumorigenic potential in nude mice and expressing different levels of epidermal growth factor receptors.

From a single spontaneous feline mammary carcinoma, two subpopulations of epithelial tumor cells have been isolated. The variant cells were established as cell lines designated K248C and K248P. DNA ploidy analysis showed that the two cell lines represented cell populations already present in the original tumor. Chromosome analysis confirmed the feline origin of K248C and K248P and demonstrated that in addition to unique marker chromosomes characteristic for each cell line, both cell lines had several marker chromosomes in common. These data suggest that the two cell populations arose from a hypothetical single ancestor which diverged during tumor progression. The K248C and K248P cell lines differed from one another with respect to their tumorigenicity in athymic mice and epidermal growth factor (EGF) receptor content. The K248C cells were highly tumorigenic as indicated by a short latency period and high take rate. The K248P cells were poorly tumorigenic. Southern blot analysis revealed that the K248C cells contained an amplified EGF receptor gene that was accompanied by elevated levels of EGF receptor RNA and protein. The K248C cells were growth inhibited in vitro at EGF concentrations that stimulated growth of K248P cells. The amplification of the EGF receptor gene could be detected only in DNA derived from K248C cells at high passage numbers and not in DNA derived from the original tumor and K248C cells at low passage numbers. These data suggest that amplification of the EGF receptor gene occurred during establishment of the K248C cell line.

Animals↗

PubMed1999

Clinical information systems in intensive care.

OBJECTIVE: To review the requirements and functions of clinical information systems for the critical care environment. DATA SOURCES: Peer reviewed studies and articles reported from 1990-1998, identified through MEDLINE search and subsequent article references. SUMMARY OF REVIEW: Clinical information systems (CIS) utilise information technologies to improve and add value to information management, and critical care areas have provided clinical leadership in their development and implementation. Expectations for these systems are high, yet certain basic requirements must be fulfilled. Bedside charting functions of CIS are highly developed and successful. Clinical record keeping has been more challenging, particularly the requirement for electronic storage of a medico-legal record. Decision support ranges in its extent and requires further development. Successful integration with other hospital systems is highly desirable but may be made more difficult by the lack of rigorous technical standards in healthcare computing. The CIS clinical database is fundamental to the quality improvement, research and business reporting functions. The huge amount of data, the lack of common minimal and extensive data sets, and the technical challenges of software development, all combine to make this a resource expensive venture requiring on site customisation. Purchasing and implementing a CIS is costly in human and material resources. CONCLUSION: A high performance CIS is not yet available as an 'off the shelf' product. Close collaboration between the industry and clinicians is important for successful implementation. Clinical awareness of these issues will encourage product development and suitable purchasing strategies.

Journal Article↗

PubMed2006

[Baseline study on a stroke-related cohort in the rural community of Shanghai].

OBJECTIVE: To present data from a baseline investigation on stroke-related cohort population in rural area of Shanghai. METHODS: A cross-sectional study was carried out in a cluster sampling population aged 40 years and over. General information and data on common risk factors in the population were gathered and cerebral vascular hemodynamic indexes were checked. Hemodynamic score was estimated according to single indexes by unified methods. 5335 persons who had met the inclusion criteria were enlisted in the study. Exposure level of risk factors, prevalence of stroke, and hemodynamic indexes were analyzed and distributional characteristics were described. RESULTS: Exposure rate of hypertension, heart disease, diabetes, family history of hypertension, overweight or obesity in males were 31.74%, 6.09%, 1.16%, 3.22%, 17.64%, 29.68% and were 32.76%, 9.22%, 1.55%, 3.84%, 19.22%, 29.44% in female respectively. Standard prevalence of stroke was 1167.3/100000, which in male was significantly higher than that in female (P < 0.05). The change of cerebral vascular hemodynamic indexes was significantly associated with age. Hemodynamic score in 21.3% of the subjects was below 75 points. CONCLUSIONS: Among population of 40 years old and over in rural areas, hypertension was the principal risk factor regarding the rate of stroke. Prevalence of stroke in males was significantly higher than that in females. Abnormal rate of hemodynamic score was about 20% in this population.

Adult↗

PubMedDate not supplied

[Pharmacovigilance of hypolipidemic drugs (fibrates and probucol), from databanks of the French System of Pharmacovigilance].

The methodology of a retrospective study of the side-effects of the most prescribed lipid lowering drugs, essentially fibrates, is described. This study concerns the last 5-years reports to the French System of Pharmacovigilance, centralized in the common data-base located in Lyon. During this period 36,875 reports were recorded, only 409 in which an hypolipidemic drug is stated as "suspect" (according to WHO's definitions) were selected and analyzed. All fibrates were involved, those most frequently implicated being the most widely prescribed (e.g. fenofibrate represents half of the reports).

Databases, Factual↗

PubMed1991

Composing user models through logic analysis.

The evaluation of tutorial strategies, interface designs, and courseware content is an area of active research in the medical education community. Many of the evaluation techniques that have been developed (e.g., program instrumentation), commonly produce data that are difficult to decipher or to interpret effectively. We have explored the use of decision tables to automatically simplify and categorize data for the composition of user models--descriptions of student's learning styles and preferences. An approach to user modeling that is based on decision tables has numerous advantages compared with traditional manual techniques or methods that rely on rule-based expert systems or neural networks. Decision tables provide a mechanism whereby overwhelming quantities of data can be condensed into an easily interpreted and manipulated form. Compared with conventional rule-based expert systems, decision tables are more amenable to modification. Unlike classification systems based on neural networks, the entries in decision tables are readily available for inspection and manipulation. Decision tables, descriptions of observations of behavior, also provide automatic checks for ambiguity in the tracking data.

Decision Making↗

PubMed1991

Adult hereditary fructose intolerance.

Hereditary fructose intolerance was diagnosed in a 69-year-old man on the basis of his medical history and the response to an intravenous fructose tolerance test. Three men of the same age as our patient were used as control subjects. Since the severity may vary and affected individuals self-impose fructose and sucrose restriction, they are essentially symptom free. The diagnosis can only be suspected by taking a careful dietary history. The prevalence of this condition in adults is unknown. It is rare but is likely to be more common than data in the literature would indicate.

Aged↗

PubMed1990

Common methods of analyzing response data in clinical trials.

In evaluating published reports of clinical trials, look for clearly stated objectives; a well-defined patient population; avoidance of systematic selection or allocation of patients in a way that could bias results; an accounting for all enrolled patients; and definitions of the endpoints of interest that are both precise and standard across similar studies. In statistical terms, the outcomes observed in a trial are used to estimate treatment effects or test hypotheses about unknown and inherently unobservable outcomes among all patients with a given disease. Several measures are used to assess a therapy's effectiveness, but the simplest to analyze is the objective response of the disease measured immediately after completion of therapy. The authors describe methods used in the analysis of data, including techniques with versions for data with more than two response categories.

Clinical Trials as Topic↗

PubMed1989

Population genetics of the highly polymorphic locus D16S7 and its use in paternity evaluation.

We have developed a DNA RFLP test to resolve paternity cases in which the accused man is included at a low probability of paternity by conventional testing. The DNA probe p79-2-23 was used to determine the allele frequency distribution for the locus D16S7 in the North American black, Caucasian, and Hispanic racial groups. Approximately 3,500 TaqI-digested DNAs were analyzed from the three populations studied. An apparent continuum of alleles was detected varying in size from 2.9 kb to 8.3 kb. Estimates of the average probability of exclusion were found to be .90 and .79 for the North American black and Caucasian populations, respectively. Gene frequency data for common and rare alleles indicated a potential paternity index ranging from 2 to 450.

Alleles↗

PubMed1989

[Quality of life after surgical interventions--vascular surgery].

Vascular surgery is primarily a reconstructive discipline that contributes appreciably to the patient's quality of life (QL) by improving many organ and system functions. The definition of QL includes a variety of specific and very individual aspects. The postoperative evaluation of QL must be based on the one hand on hard data and common clinical parameters, and, on the other, on the individual feeling of the patient, who compares preoperative sequelae and postoperative functional improvement.

Activities of Daily Living↗

PubMed1989

Occupational adaptation to computerized medical information systems.

This paper explores the effects of computerized medical information systems on the occupational communities of health care professionals in hospitals. Interviews were conducted with informants from the pharmacy and nursing departments at two hospitals currently using medical information systems for communicating physicians' medication orders from the nursing station to the pharmacy. Results showed changes in tasks for both pharmacy and nursing, resulting in increased interdependence between the two departments. This interdependence was accompanied by improved communication and cooperation, providing an opportunity to encourage better working relationships between departments. The use and maintenance of the common computerized data base became a superordinate goal for the two groups, with the computer system itself as the topic of communication.

Adaptation, Psychological↗

PubMed1988

Comparison and partial characterization of the protein profiles and outer membrane antigens of Actinobacillus species isolated from ram lambs with epididymitis.

Three monoclonal antibodies (LG17, LG30, LG33) were used in the indirect fluorescent antibody test, the ELISA, and the immunoelectrotransfer blot technique to identify group-specific and strain-specific epitopes on the outer membranes of Actinobacillus seminis, A actinomycetemcomitans, and 17 field isolates of Actinobacillus spp. The field isolates had been obtained by bacteriologic culture of specimens from ram lambs with epididymitis. Only antibody LG33 consistently had specificity for an outer membrane epitope shared by most of the bacterial isolates tested. Staining of polyacrylamide gels with periodic acid-Schiff reagent, Sudan black B, and Coomassie brilliant blue R250 indicated that target antigens for antibodies LG17 and LG33 contained carbohydrate and lipoprotein components, respectively. The chemical composition of the LG30 target antigen was not determined because of its instability after exposure to sodium dodecyl sulfate. Discontinuous-gradient polyacrylamide gel electrophoresis in sodium dodecyl sulfate and spectrophotometric scans of the gels were used to analyze n-octyl-beta-D-glucopyranoside protein extracts from A seminis, A actinomycetemcomitans, and 13 representative field isolates of Actinobacillus spp. Bacterial isolates could be grouped according to their protein profiles. The first group consisted of A seminis, A actinomycetemcomitans, and 7 field isolates of Actinobacillus spp, all of which shared common protein bands with molecular masses of approximately 94 kilodaltons (kD), 64 kD, 60 kD, 52 kD, 44 kD, and 26 kD. The second group was composed of 6 field isolates, each with unique protein profiles; isolates had relatively few protein bands in common. These data suggested that members of the genus Actinobacillus cultured from ram lambs with epididymitis probably include a number of various strains.

Actinobacillus↗

PubMed1978

Similarities among factors that render macrophages tumoricidal in lymphokine and interferon preparations.

Lymphokine preparations, including supernatants derived from antigen-stimulated Bacillus Calmette-Guérin-immune spleen cell cultures and normal spleen cells incubated with insoluble concanavalin A, were compared with partially purified L-cell interferon for the ability to render resting macrophages nonspecifically tumoricidal in vitro. Significant activation of macrophages by lymphokine preparations occurred at concentrations as low as 0.5 and 0.25% of the assay mixture for antigen-stimulated and concanavalin A-induced lymphokine, respectively. These end point concentrations were each determined to contain 0.3 unit of interferon per ml. Supernatants obtained from unstimulated normal spleen cells, concanavalin A-treated nu/nu spleen cells, or Bacillus Calmette-Guérin-immune spleen cells in the absence of sensitizing antigen did not enhance macrophage tumoricidal function and lacked interferon. Activation by L-cell interferon required at least 1 unit/ml. The macrophage-activating factors contained in lymphokine and interferon preparations were stable at pH 2 and at 56 degrees, but they were destroyed when heated at 80 degrees for 30 min, and were inactivated by trypsin. The data demonstrate common properties for the induction of tumoricidal macrophages by these divese preparations.

Animals↗