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PubMed2005

Public health data collection and sharing using HIPAA messages.

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

Data Collection↗
PubMed2006

Comparison of the traits of physically active and inactive women.

PURPOSE: To explore the determinants of physical activity for working women and to compare traits of active with inactive women. DATA SOURCES: Original research articles, books, government reports, and self-report survey data from 373 university employees who attended an employer-sponsored health screening. CONCLUSIONS: Active women had lower body mass indexes and more beneficial high-density lipoprotein cholesterol when compared to inactive women. They were more likely to have a past history of sustained physical activity. Significant psychosocial determinants to physical activity included time constraints, confidence in finding an activity that can be enjoyed in bad weather, and not being too tired at the end of the day to engage in physical activity. IMPLICATIONS FOR PRACTICE: Nurse practitioners are in key positions to help women increase their levels of physical activity. Knowing the traits of active women can help busy clinicians focus interventions that address those traits, leading to greater efficiency and effectiveness.

Adolescent↗
PubMed2006

One year of smokefree bars and restaurants in New Zealand: impacts and responses.

BACKGROUND: New Zealand introduced a smokefree bars and restaurants policy in December 2004. We reviewed the data available at December 2005 on the main public health, societal and political impacts and responses within New Zealand to the new law. METHODS: Data were collected from publicly available survey reports, and from government departments and interviews. This included data on smoking in bars, attitudes to smokefree bars, bar patronage, socially cued smoking, and perceived rights to smokefree workplaces. RESULTS: The proportion of surveyed bars with smoking occurring decreased from 95% to 3% during July 2004-April 2005. Between 2004 and 2005, public support for smokefree bars rose from 56% to 69%. In the same period, support for the rights of bar workers to have smokefree workplaces rose from 81% to 91%. During the first ten months of the smokefree bars policy, there were only 196 complaints to officials about smoking in the over 9900 licensed premises. The proportion of smokers who reported that they smoked more than normal at bars, nightclubs, casinos and cafés halved between 2004 and 2005 (from 58% to 29%). Seasonally adjusted sales in bars and clubs changed little (0.6% increase) between the first three quarters of 2004 and of 2005, while café and restaurant sales increased by 9.3% in the same period. Both changes continued existing trends. Compared to the same period in 2004, average employment during the first three quarters of 2005 was up 24% for 'pubs, taverns and bars', up 9% for cafés/restaurants, and down 8% for clubs (though employment in 'pubs, taverns and bars' may have been affected by unusually high patronage around a major sports-series). The proportion of bar managers who approved of smokefree bars increased from 44% to 60% between November 2004 and May 2005. Bar managers also reported increased agreement with the rights of bar workers and patrons to smokefree environments. The main reported concerns of the national and regional Hospitality Associations, in 2005, were the perceived negative effects on rural and traditional pubs. CONCLUSION: As in other jurisdictions, the introduction of smokefree bars in New Zealand has had positive overall health protection, economic and social effects; in contrast to the predictions of opponents.

Commerce↗
PubMed1995

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners; payment of fees--HRSA. Final rule.

This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank) authorizing the reporting and release of information concerning: Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule removes restrictions on allowed methods of payment for Data Bank fees.

Dentists↗
PubMed1967

The National Standard Reference Data system.

The National Standard Reference Data System is a government-wide effort to give to the technical community of the United States optimum access to the quantitative data of physical science, critically evaluated and compiled for convenience. This program was established in 1963 through action of the President's Office of science and Technology and the Federal Council for Science and Technology, acting upon the recommendation of the Council's Committee on Scientific and Technical Information. The National Bureau of Standards has been assigned responsibility for administering the effort. The general object of the system is to coordinate and integrate existing activities in data evaluation and compilation into a systematic comprehensive program, supplementing and expanding technical coverage when necessary, establishing and maintaining standard for the output of the participating groups, and providing mechanisms for dissemination of the output as required. The NSRDS is a decentralized operation of nationwide scope, with central coordination by the Bureau; it comprises a complex of data centers and other activities carried on in government agencies, academic institutions, and nongovernmental laboratories. The independent operational status of existing data projects is maintained and encouraged. Data centers that are components of NSRDS produce compilations of critically evaluated data, critical reviews of the state of quantitative knowledge in specialized areas, and computations of useful functions derived from standard reference data.

Electronic Data Processing↗
PubMed2000

A survey of surgical audit in Australia: whither clinical governance?

A postal survey was undertaken to determine the extent of surgical audit in Australian public hospitals in the context of clinical governance. Participants were 88 surgical units from 74 Australian public hospitals in 1998 with more than 70 beds. The main outcome measures were performance of audit, methods used, frequency, documentation and perceived adequacy of resources and comparison of performance with Royal Australasian College of Surgeons requirements for re-certification. The main findings were that most units performed audit, but over two-thirds declared that they had insufficient resources to conduct audit according to College requirements, while a substantial proportion did not comply with other published guidelines for the conduct of audit meetings. The conclusion from this survey is that surgical audit will be unable to play its part in quality initiatives inherent in the clinical governance concept unless appropriately resourced.

Australia↗
PubMed1997

Perceptions of Species Abundance, Distribution, and Diversity:Lessons from Four Decades of Sampling on a Government-Managed Reserve

/ We examined data relative to species abundance, distribution, anddiversity patterns of reptiles and amphibians to determine how perceptionschange over time and with level of sampling effort. Location data werecompiled on more than one million individual captures or observations of 98species during a 44-year study period on the US Department of Energy's(DOE) Savannah River Site National Environmental Research Park (SRS-NERP) inSouth Carolina. We suggest that perceptions of herpetofaunal speciesdiversity are strongly dependent on level of effort and that land managementdecisions based on short-term data bases for some faunal groups could resultin serious errors in environmental management. We provide evidence thatacquiring information on biodiversity distribution patterns is compatiblewith multiyear spatially extensive research programs and also provide aperspective of what might be achieved if long-term, coordinated researchefforts were instituted nationwide.To conduct biotic surveys on government-managed lands, we recommend revisionsin the methods used by government agencies to acquire and report biodiversitydata. We suggest that government and industry employees engaged inbiodiversity survey efforts develop proficiency in field identification forone or more major taxonomic groups and be encouraged to measure the status ofpopulations quantitatively with consistent and reliable methodologies. Wealso suggest that widespread academic cooperation in the dissemination ofinformation on regional patterns of biodiversity could result byestablishment of a peer-reviewed, scientifically rigorous journal concernedwith status and trends of the biota of the United States. KEY WORDS: Abundance; Amphibian; Biodiversity; Distribution; Landmanagement; Reptile

Journal Article↗
PubMed2003

Legal and assistance aspects of Alzheimer's disease: analysis of 100 cases.

Caring for patients with disabling cognitive diseases, such as Alzheimer's disease (AD) and other progressive dementias, has a number of legal and social welfare implications. The two main problems to be discussed with patients and caregivers are the need for a legal guardian and requests for government financial support, both of which depend on the patient's progressive loss of autonomy and increasing need for assistance. In order to study the presence of these two support measures, we considered 100 AD patients (56 women and 44 men) divided in four groups on the basis of the stage of the disease: mild (25), moderate (34) and severe (32), or death (9). We investigated the number of caregivers for each patient (and their relationship with the patient), the presence of a legal guardian, and whether government financial support had been obtained. The number of caregivers increased for each patient as the disease advanced (54% with moderate and 67% with severe disease had > or =1 caregiver), but only 11% of the patients had a guardian. The caregivers were most likely to be family members (70% were spouses, 45% offspring). Only 23% of the patients with moderate and 62% with severe disease received government financial support. Our data concerning the care of incompetent people (as AD patients progressively become) in juridical (guardianship/trusteeship/proxy/power of attorney) and social terms (government financial support) show that such aspects are not sufficiently taken into account until the patients reach a severe disease or have died.

Aged↗
PubMedDate not supplied

Adolescent pregnancy and childbearing: levels and trends in developed countries.

CONTEXT: Adolescent pregnancy occurs in all societies, but the level of teenage pregnancy and childbearing varies from country to country. A cross-country analysis of birth and abortion measures is valuable for understanding trends, for identifying countries that are exceptional and for seeing where further in-depth studies are needed to understand observed patterns. METHODS: Birth, abortion and population data were obtained from various sources, such as national vital statistics reports, official statistics, published national and international sources, and government statistical offices. Trend data on adolescent birthrates were compiled for 46 countries over the period 1970-1995. Abortion rates for a recent year were available for 33 of the 46 countries, and data on trends in abortion rates could be gathered for 25 of the 46 countries. RESULTS: The level of adolescent pregnancy varies by a factor of almost 10 across the developed countries, from a very low rate in the Netherlands (12 pregnancies per 1,000 adolescents per year) to an extremely high rate in the Russian Federation (more than 100 per 1,000). Japan and most western European countries have very low or low pregnancy rates (under 40 per 1,000); moderate rates (40-69 per 1,000) occur in Australia, Canada, New Zealand and a number of European countries. A group of five countries--Belarus, Bulgaria, Romania, the Russian Federation and the United States--have pregnancy rates of 70 or more per 1,000. The adolescent birthrate has declined in the majority of industrialized countries over the past 25 years, and in some cases has been more than halved. Similarly, pregnancy rates in 12 of the 18 countries with accurate abortion reporting showed declines. Decreases in the adolescent abortion rate, however, were less prevalent. CONCLUSIONS: The trend toward lower adolescent birthrates and pregnancy rates over the past 25 years is widespread and is occurring across the industrialized world, suggesting that the reasons for this general trend are broader than factors limited to any one country: increased importance of education, increased motivation of young people to achieve higher levels of education and training, and greater centrality of goals other than motherhood and family formation for young women.

Abortion, Legal↗
PubMed2006

Data sharing and intellectual property in a genomic epidemiology network: policies for large-scale research collaboration.

Genomic epidemiology is a field of research that seeks to improve the prevention and management of common diseases through an understanding of their molecular origins. It involves studying thousands of individuals, often from different populations, with exacting techniques. The scale and complexity of such research has required the formation of research consortia. Members of these consortia need to agree on policies for managing shared resources and handling genetic data. Here we consider data-sharing and intellectual property policies for an international research consortium working on the genomic epidemiology of malaria. We outline specific guidelines governing how samples and data are transferred among its members; how results are released into the public domain; when to seek protection for intellectual property; and how intellectual property should be managed. We outline some pragmatic solutions founded on the basic principles of promoting innovation and access.

Access to Information↗
PubMed2006

The role of private drug vendors as malaria treatment providers in selected malaria endemic areas of Sri Lanka.

BACKGROUND AND OBJECTIVES: The involvement of private drug vendors in malaria treatment is particularly high in developing countries and understanding their practices and knowledge about antimalarials and malaria treatment will aid in devising strategies to increase the correct use of antimalarials and improve adherence to the government's malaria drug policy. Results of a study on the knowledge and practices of the private drug vendors conducted in seven districts in Sri Lanka, mostly in malarious areas are presented. METHODS: Data on awareness of government's malaria drug policy, practice of issuing antimalarials, knowledge about malaria and antimalarial drugs were collected from the drug vendors using pre-tested questionnaire in vernacular language. Data were statistically analysed using Stata 8.2. Chi-square test was carried out for individual explanatory variables and a logistic regression model was applied taking all response variables as binary outcome. RESULTS: Vendors' knowledge on antimalarials was poor with 58% of the vendors being unaware of the government malaria drug policy in the country. Also, the advice provided to customers buying antimalarials was limited. However, the majority of the private vendors emphasised that they were aware of the importance of case confirmation before treatment as stressed in the national policy. Although, the vendors did not have a high awareness of national drug policies they were only found selling chloroquine and primaquine as recommended by the Ministry of Health. INTERPRETATION AND CONCLUSION: In recent years Sri Lanka, as a whole, has experienced very little malaria. The reduction in demand for antimalarials due to low incidence levels may have influenced the knowledge and awareness on antimalarials and government drug policies. However, since low levels of malaria do not guarantee that epidemics will not occur, attempts to educate private drug vendors as a part of an organised control programmes are of major importance.

Antimalarials↗
PubMed1992

Dietary pesticide risk assessment.

In this review, the process of dietary pesticide risk assessment has been presented and three major components of the process--estimation of pesticide residue levels, estimation of food consumption patterns, and characterization of risk based on a comparison of exposure estimates with toxicological criteria--have been identified. Each component of the process is subject to considerable uncertainty that may compromise the accuracy of the final risk assessment. In estimating pesticide residue levels, common practices range from highly theoretical models assuming that all residues are present at a predetermined level (typically at the tolerance level) to the use of market basket survey data obtained at the time the food is ready for consumption. Intermediate techniques include using actual monitoring data (usually obtained from government residue enforcement programs) and/or making corrections to estimates on the basis of actual pesticide use. Additional corrections may be used to incorporate data on the effects of post-harvest practices such as processing, washing, cooking, peeling, and transportation that have often been shown to dramatically reduce residue levels, although occasional increases in residue levels and/or formation of toxicologically significant breakdown products may also result from post-harvest practices. Food consumption estimates are typically derived from national surveys of consumer food consumption behavior and are also subject to considerable uncertainty. Food consumption estimates are often disaggregated into distinct population subgroups based on age, gender, geographic region, and ethnicity, although the accuracy of estimates for particular subgroups is commonly questioned on the basis of the adequacy of sample size. At the present time, data from the 1977-78 Nationwide Food Consumption Survey are still being used, and the incorporation of more recent data from the 1987-88 Nationwide Food Consumption Survey is being delayed due to major flaws in the study. On occasion, other food consumption surveys may be used, although they are typically much smaller in scope than the 1977-78 and 1987-88 studies and are considered less reliable. The multiplication of residue level estimates by food consumption estimates yields an estimate of human pesticide exposure. Commonly, the theoretical maximum residue contribution (TMRC) is calculated that represents the maximum "legal" exposure to pesticides. Calculation of the TMRC involves the assumptions that all pesticides legally allowed on a particular commodity will always be applied, that all residues are present at the tolerance levels, and that there are no post-harvest effects on residue levels. Often the TMRC is used as a sorting tool by the EPA in its preliminary assessment of dietary risks to pesticides.(ABSTRACT TRUNCATED AT 400 WORDS)

Diet↗
PubMed1976

24. The Illinois automated long-term care system--three years of experience.

The lack of a comprehensive long-term care information system, common to most state governments, led the State of Illinois to develop and operate a flexible system responsive to a multipilicity of needs. Two hierarchically structured, interfacing data bases on facilities and patients were designed, providing a foundation to which numerous programs related to long-term care can be added as modules or subsystems. Apart from technical and practical difficulties normally encountered in the development of automated systems, the Illinois long-term care data bases have been found to be a viable means of managing large volumes of data, and of providing management information to state agencies that regulate long-term care facilities or utilize their services for state-aided clients. New approaches have been made to match patient needs with available beds, to predict staffing patterns and operating costs, and to test a quality-of-care evaluation system in a regulatory environment.

Costs and Cost Analysis↗