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As integrated healthcare delivery systems stake their claims for the future, it is rapidly becoming the health information manager's duty to integrate and manage healthcare data. Read on for a general outlook on the changes surrounding integration activities, from new trends to integration's impact on the profession.
Prevalence of suicide with pesticides in the State of Mato Grosso do Sul, Brazil, was evaluated based on data from the Integrated State Center for Toxicological Surveillance under the State Health Department and reported from January 1992 to December 2002. Population and crop production data were collected from the Brazilian Institute of Geography and Statistics, and suicide data were obtained from the State Health Department. During the period studied, 1,355 cases of pesticide poisoning were reported, including 506 suicide attempts, resulting in 139 deaths. The regions of Campo Grande and Dourados had the highest prevalence of suicide attempts, with Dourados having the most deaths. Dourados also had a high prevalence of suicide attempts overall, with an increasing trend in the previous 10 years. The results indicated that Dourados is a critical region in the State in terms of intentional ingestion of pesticides, showing the need for an epidemiological investigation to better evaluate and quantify these events among the rural population.
The potential prognostic use of lysosomal reactions to environmental pollutants is explored in relation to predicting animal health in marine mussels, based on diagnostic biomarker data. Cellular lysosomes are already known to accumulate many metals and organic xenobiotics and the lysosomal accumulation of the carcinogenic polycyclic aromatic hydrocarbon 3-methylcholanthrene (3-MC) is demonstrated here in the hepatopancreatic digestive cells and ovarian oocytes of the blue mussel. Lysosomal membrane integrity or stability appears to be a generic indicator of cellular well-being in eukaryotes; and in bivalve molluscs it is correlated with total oxygen and nitrogen radical scavenging capacity (TOSC), protein synthesis, scope for growth and larval viability; and inversely correlated with DNA damage (micronuclei), as well as lysosomal swelling (volume density), lipidosis and lipofuscinosis, which are all characteristic of failed or incomplete autophagy. Integration of multiple biomarker data is achieved using multivariate statistics and then mapped onto "health status space" by using lysosomal membrane stability as a measure of cellular well-being. This is viewed as a crucial step towards the derivation of explanatory frameworks for prediction of pollutant impact on animal health; and has facilitated the development of a conceptual mechanistic model linking lysosomal damage and autophagic dysfunction with injury to cells, tissues and the whole animal. This model has also complemented the creation and use of a cell-based bioenergetic computational model of molluscan hepatopancreatic cells that simulates lysosomal and cellular reactions to pollutants. More speculatively, the use of coupled empirical measurements of biomarker reactions and modelling is proposed as a practical approach to the development of an operational toolbox for predicting the health of the environment.
The development of air pollution standards ideally involves the integration of data from the disciplines of epidemiology, controlled clinical studies, and animal toxicology. Epidemiological studies show statistical associations between health outcomes and exposure; they cannot establish a definite cause-effect relationship. The utility of toxicological studies is to establish this relationship. Recently, there was simultaneous promulgation of a new National Ambient Air Quality Standard (NAAQS) for particulate matter < 2.5 microns in aerodynamic diameter (PM2.5) and a revised NAAQS for ozone (O3). The O3 NAAQS was based, in part, on a sound foundation of toxicological data from controlled exposure studies in humans and animals. It also relied on epidemiological studies of hospital admissions for respiratory diseases. Such studies also served as important bases for the new PM2.5 NAAQS. However, the most influential bases for the PM NAAQS were the numerous and generally consistent epidemiological studies that associated exposure with premature mortality in susceptible subpopulations and the inability of numerous hypothesized confounding factors to negate the associations. Using ozone and PM as examples, this paper discusses the scientific basis for NAAQS promulgations in situations in which the underlying database differed greatly in the extent of toxicological support.
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Structured reporting (SR) was recently added to the Digital Imaging and Communications in Medicine (DICOM) standard to provide an efficient mechanism for the generation, distribution, and management of clinical reports. The main advantage of SR is the ability to link clinical documents with the referenced images for simultaneous retrieval and display. A generic SR toolkit that covers the different clinical reports used in today's healthcare enterprises was developed for picture archiving and communication system (PACS) workstations. The modules of the SR toolkit collaborate to automatically construct the DICOM SR files from the free-text input presented in hypertext markup language (HTML) by using the associated SR trees. The DICOM toolkit is reused for SR encoding and DICOM services. A setup module was required for creating both the standard and private SR templates used in different healthcare specialties. The SR manager transparently converts between the different SR document presentations, that is, DICOM SR files and HTML documents, to provide the end users with an easy-to-use toolkit. To evaluate and demonstrate the effectiveness of the SR toolkit in a pragmatic setting, the toolkit was integrated into PACS workstations.
SITIE is a workstation devoted to epidemiological data selection, analysis, and representation. Epidemiological data are collected using the French Communicable Diseases computer Network and stored in an Oracle database. Disease selection and spatial and temporal representations can be done using a user friendly graphic interface. SITIE automatically generates SQL requests to the Oracle database, extracts the data, processes it according to the user's choice, and represents the data. SITIE is built upon the AVS graphic package and allows the creation of new applications using previously developed modules linked together to form a network. SITIE can be viewed as a tool box for epidemiological data representations. Three example applications are detailed in order to make clear the way a new application can be built using SITIE. The reusability of modules is exemplified by a compound application.
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The development of clinical toxicology over the past 50 years has been extensive. This article illustrates ways in which the clinical toxicology unit in Edinburgh has used a combination of public health data, poisons information data, and clinical data to inform policy and aid clinical management of patients with poisoning. Integration of public health systems with poisons information and clinical treatment services is an important tool for the future development of clinical toxicology.
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We have explored how age at first intoxication with alcohol relates to mental health, social integration and adjustment to the adult role. The data stem from a longitudinal representative study of 2000 Norwegians. The sample was assessed at ages 19-22, 21-24 and 25-28. Among females, only early intoxication was related to young adult symptoms of poor mental health. A U-shaped association between intoxication debut and psychological problems was revealed among males, implying that both early and late beginners had more such problems than those who had followed the mainstream. These associations persisted without change over time. However, males who remained abstainers in adulthood were psychologically healthy, but they showed indications of a delayed entry into the adult role. Male late beginners were also somewhat reluctant to adopt adult role-behaviors. Thus, getting drunk for the first time in mid-adolescence seems to be an ingredient in the normal developmental process in young males.
AIM: This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). BACKGROUND: The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. METHOD: Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. FINDINGS: As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. CONCLUSION: Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services.
The two-stage sociological survey of public opinion has become an integral and, as the whole course of work showed, important part of the introduction of new economic mechanism into public health with a view of its optimization. However, it should be stressed that such a survey of public opinion is only one part of our complex programme. It seems to us that the most prospective survey appears to be the study of psychological aspects of management under new economic conditions. We are convinced that the knowledge of "human factor" and proper decision-making process under transition to the new economic methods of management would enable our followers to avoid many difficulties we have met with.
BACKGROUND: The first school for children with intellectual disability (ID) was opened in Tel Aviv in 1929; the first boarding school for children with ID was established in Jerusalem in 1931; and the first center for assessment of children with ID established in Tel Aviv in 1936. With the establishment of the State of Israel in 1948, there was a total of four residential care centers providing services for 150 children with ID. OBJECTIVE: This paper will describe the history and development of the public health work with persons with intellectual disability from the birth of the State of Israel in 1948 until today, with a focus on medical and nursing care and ideas for future work with this population. DATA SOURCES: Studies and documents from the Office of the Medical Director, Division for Mental Retardation of the Ministry of Social Affairs in Israel. DATA EXTRACTION: The Division for Mental Retardation is in contact with approximately 23,000 persons of all ages. Residential care is provided to about 6,000 persons in 54 institutions countrywide. In addition, 2,000 persons receive residential care in hostels or protected apartments within the community. More than 50 other settings provide vocational and educational services to 15,000 persons--day-care kindergartens, day-treatment centers, sheltered workshops, or integrated care within the community. DATA SYNTHESIS: Data on the health profile, morbidity, and mortality of the residents in residential care centers are used to illustrate the medical and nursing work with this population. CONCLUSIONS: We recommend that the direction in Israel should be a combination of both community and institutional care for the population of persons with ID. We recommend the establishment of a subspecialty for physicians and nurses in intellectual disability and the establishment of a Health Division within the Ministry of Social Affairs to facilitate better service, education, and research.
As providers of health care face the multiple challenges of today's health care environment, many believe that integrated delivery systems promise the structure needed to provide high-quality, cost-efficient care. They make structural and process changes with the expectation that those changes will improve system performance. But few systems actually measure progress in creating an integrated system. This article describes one health care system's strategy for introducing organizational measures to create an integrated system scorecard and focuses on the development, results, and use of the staff survey. The survey provides reliable indicators of system integration. Linking the survey results with network performance measures, in turn, provides managers with tools for judging whether system integration is associated with improved system performance.
The incidence and prevalence of chronic degenerative disease in America's elderly population are important determinants of the need for long-term care health services. Though a wide range of data on disease incidence and prevalence is available from a variety of different health studies, a Congressional Budget Office study (1977) concluded that data limitations are a major factor in the lack of precise national long-term care cost estimates. In this paper, we present a modeling strategy to make better use of existing data by using biomedically motivated actuarial models to integrate multiple data sources into a comprehensive model of population health dynamics. The development of a specific model for application to a disease of interest involves three distinct phases. First, biomedical evidence and data are used to specify a cohort model of chronic disease morbidity and mortality. Second, the model is fitted to cohort mortality data with estimates of its parameters being derived by maximum likelihood procedures. Third, the morbidity distribution in the national population is generated from the parameter estimates. The model is used to examine lung cancer morbidity and mortality patterns for U. S. white and non-white males in 1977. A review of these patterns suggests that, based on current concepts of lung cancer incidence and natural history, over 2 percent of white males in the United States have lung cancer at some stage of development, though most of this prevalence is pre-clinical.
The ecological approach to the disease facilitates the understanding of the reasons for the multiplicity of causal factors and the finding of those on which the preventive measures will be easily and successfully directed. That is the reason why integration of space data for getting insight into the existing condition from ecological point of view is necessary. The ecological need to sum up the work of the water research and to estimate the future water quality trends by observing the relevant parameters as influential ecological factors for the health of the population resulted in relation data base VODE. Besides it integrates the data group of waters data and from the ecological standpoint is suitable for the several years study of trends of existing water supply system condition with special survey of the results of the water quality analyses in view of the recognition of the actual pollutions that are significant for the health problems of population, group and individuals. One gets informations by putting questions and than plans necessary interventions, what is the new significant contribution in the approach to the analytical and monitoring techniques, i.e., application of informatical techniques in water pollution control.