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PubMed2026

Smartphone Apps for Preventing Adolescent Health Problems Among Health Care Professionals: Systematic Search and Quality Assessment.

BACKGROUND: Health care professionals must consider multiple dimensions of prevention when consulting with adolescents. Identifying risky behaviors early in adolescence is crucial for reducing both morbidity and mortality. General practitioners are increasingly eager to incorporate digital tools for prevention into their consultations with adolescents; however, the relevance and clinical validity of these digital tools are not always established or well-known. Consequently, primary care professionals require guidance and support in selecting relevant mobile health (mHealth) tools. OBJECTIVE: The aim of this study is to identify relevant and useful digital apps to help primary care professionals detect at-risk adolescents across all recommended areas of prevention: orthopedics, mental health, substance abuse, risk behaviors, sexual health, vaccinations, social relationships, and nutrition. METHODS: A systematic review of smartphone apps, with an analysis of content quality, was carried out by 4 researchers using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. The App Store and Google Play Store platforms were surveyed. The inclusion criteria were as follows: free of charge, date of last update, availability in French or English, relevance of the preventive approach to adolescents, and scientific validation. Four health care professionals assessed the apps: 2 selected the apps relevant to health care professionals, then 3 analyzed these apps using the French version of the Mobile App Rating Scale (MARS-F). Intraclass correlation coefficient, model (2,1) (2-way random effects, absolute agreement, single measures); standard error of measurement; and mean absolute error were also calculated. RESULTS: A total of 976 apps were identified, 49 of which had disappeared from the platforms prior to analysis. Nine apps were retained. Seven (0.72%) were included after evaluation using the MARS-F: 2 on mental health and 5 on sexual health (including 3 on contraception only). The mean MARS-F interrater score ranged from 2.5/5 to 3.8/5. The global MARS-F score demonstrated a pooled SD of 0.60 and an intraclass correlation coefficient (2,1) of 0.0003, resulting in a calculated standard error of measurement of 0.60. The average discrepancy between raters was a mean absolute error of 0.53. CONCLUSIONS: No similar studies have been identified in the literature that specifically focus on mobile apps designed to support health care professionals in delivering preventive care to adolescents. Of the 8 areas of prevention identified as relevant for adolescents, only 3 are addressed by the apps validated through our methodology (5 focus on sexual health). Consequently, current apps are insufficient to support health care professionals in their overall preventive work with adolescents. Such a review should be conducted systematically prior to the development of any new tool to prevent duplication and channel creative efforts toward truly innovative digital solutions. Furthermore, a thorough analysis of relevant, recommended websites is essential, as these resources complement the use of mobile apps designed for health care professionals.

Humans↗
PubMed2000

Digital radiographic image archival, retrieval, and management.

Data in the health care environment can encompass a wide range of contents, each representing one aspect of health care delivery. Examples of such a diverse and yet related content are diagnostic images, laboratory results, patient history, hospital administration, and insurance and payer coverage. The focus of this article is the handling of diagnostic imaging in general and radiographic imaging in particular, therefore fundamental concepts and issues are presented and discussed.

Computer Security↗
PubMed2003

Digital imaging: a promising tool for mushroom identification.

Mushroom poisoning is a diagnostic and treatment dilemma for health care professionals. Decisions regarding treatment following ingestions are usually made without a firm identification of the fungus and tend to be more aggressive than necessary. The identification of mushrooms is beyond the scope of health care professionals, and a mycologist is essential to make an accurate identification. Telemedicine and digital imaging is an emerging technology that can assist in mushroom identification and facilitate patient care. The efficacy of using digital images sent over the Internet was tested in a pilot project. This article describes three cases in which digital images and verbal descriptions assisted in mushroom identification. When the actual specimen was sent to a mycologist, a definitive identification was obtained and compared with the presumptive identification. Digital images alone do not permit definitive identification; however, they often contain sufficient information to help the clinician rule out the possibility of a severely toxic species. Data accumulated to date indicate that digital imaging can be an important tool in the diagnosis and treatment of mushroom ingestion, and possibly other biologicals such as plants, insects, and reptiles.

Adult↗
PubMed1992

Emergency department applications of digital dictation and natural language processing.

The emergency physician has a number of challenges that must be addressed in providing high quality emergency health care delivery. One of these is the need to develop accurate documentation of the patient's health status and the patient's response to treatment in the ED. Digital dictation when combined with natural language processing is an evolving technology that is very user-friendly, fast, flexible, and cost-effective. Together, they can potentially improve risk management, reimbursement, and ultimately patient care. All the specialties of medicine are facing tremendous challenges of quality in the coming decade. In the past, an ED would wait for an incident or maloccurrence to happen. The director would analyze the cause, educate the staff, and write a new policy. Quality assurance meant searching for deviance and promoting compliance. The approach of "quality as a process of continuous improvement" suggests that the old ways don't work. We must have access to the detailed information about our clinical practice in order to assess outcomes, evaluate procedures, and undergo any meaningful change. It is said, "We cannot change what we cannot measure". Certainly tens of thousands of handwritten illegible ED reports represent an effective barrier to any substantive insight into our clinical process, and that constitutes an absolute barrier to any effective change. Digital dictation represents one gateway into the electronic record. Combined with NLP and appropriate information management, this technology holds tremendous potential for growth and provides for quality in the coming decade.

Efficiency↗
PubMed2003

The Danish National Health Informatics Strategy.

The central vision for the future information systems in the Danish health care sector is one of a generally accepted, common information model enabling comprehensive digital reuse of shared clinical data. A generic 'Basic-EHR-structure' has been developed for this purpose by the National Board of Health from a through analysis of the production of clinical information. The strategy contributes to the achievement of the national political goals for the health care sector and describes four important steps to be made by the health care IT systems in order to reach full interoperability and digital reusability of clinical information. Some important initiatives of the strategy are a national terminology server, coordinated implementation of EHRs, and the Public Health Information Portal.

Denmark↗
PubMedDate not supplied

Prostate cancer screening between low-income African-American and Caucasian men.

OBJECTIVE: African-Americans (AA) are more likely than Caucasians (CA) to be diagnosed with advanced prostate cancer, perhaps due to delayed detection. We investigated racial differences in prostate cancer screening according to age and socioeconomic and demographic indices in a large and predominantly low-income population. METHODS: In-person interviews were conducted with 12,552 men, 84% AA, recruited during 2002 through 2004 from 25 community health centers in the southern United States. Prostate specific antigen test (PSA) and digital rectal examination (DRE) histories, and socioeconomic and demographic indices (i.e., education, household income, health insurance, and marital status) were determined. Odds ratios (OR) from logistic regression summarized the screening and race association as a function of age, while controlling for socioeconomic status (SES). RESULTS: Racial differences in screening prevalence varied with age. Of men older than 65 years, CA were significantly more likely to report a PSA test (OR = 1.4) or DRE (OR = 1.5) within the past 12 months. However, these disparities were reduced with control for SES (PSA: OR =1.2; DRE: OR = 1.3, P > 0.05). In contrast, at ages younger than 65, CA were equally or less likely to have received a recent PSA test or DRE, particularly at ages 45-49 years (PSA: OR = 0.7; DRE: OR = 0.9), with little change after SES adjustment. CONCLUSIONS: Consistent with several screening recommendations, younger AA men, especially those younger than age 50, are more likely than CA to have had a recent PSA test or DRE, independent of SES. Of men older than age 65, less frequent use of screening among AA than CA seems partly attributable to SES and factors other than race.

Adult↗
PubMed2002

Trends in cigar smoking and perceptions of health risks among Massachusetts adults.

OBJECTIVE: To track trends in cigar smoking and assess perceptions of cigar related health risks among Massachusetts adults. DESIGN: A random digit dial telephone survey conducted in 1993 and a subsequent monthly random digit dial survey conducted March 1995 to June 2000. PARTICIPANTS: 4733 adults who completed the 1993 survey and 14 868 adults who completed the monthly survey between 1995 and 2000. MAIN OUTCOME MEASURES: Trends in current and experimental cigar use and perceptions of health risks. RESULTS: Current cigar usage increased significantly among men aged 18-34 years between 1993 (5.8%) and 1997-98 (18.2%), but began to decrease in 1999-2000 (13.5%). Young men were much more likely than older men or women of any age to have experimented with cigars in the year before interview, but this trend appears to have decreased slightly since 1998. Young male cigar smokers were increasingly those who never smoked cigarettes. Former cigarette smokers were not smoking cigars in greater numbers. Cigar smokers were roughly three times as likely as those who do not smoke cigars to believe cigars are a safer alternative to cigarettes, and that perception did not appear to change much over time. CONCLUSION: Cigar usage increased dramatically among young men in Massachusetts in conjunction with national increases in sales and marketing of cigars, but now appears to be decreasing.

Adolescent↗
PubMed1992

Changes in mammography use: economic, need, and service factors.

OBJECTIVES: The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. METHODS: Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. RESULTS: Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. CONCLUSIONS: Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.

Aged↗
PubMed2003

Design and operation of the National Survey of Children with Special Health Care Needs, 2001.

OBJECTIVES: This report presents the development, plan, and operation of the National Survey of Children with Special Health Care Needs (CSHCN), a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. This survey was designed to produce national and State-specific prevalence estimates of CSHCN, describe the types of services that they need and use, and assess aspects of the system of care for CSHCN. This study included two additional modules to provide health care coverage estimates for all children and to collect data on the reasons that low-income uninsured children lack health care coverage. Primary funding for this survey was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. METHODS: A random-digit-dial sample of households with children under 18 years of age was selected from each of the 50 States and the District of Columbia. Depending on the health care needs of the children in each household, a detailed interview was conducted for one randomly selected child with special needs and a brief health insurance interview was conducted for one randomly selected child without special needs. The respondent was the parent or guardian who knew the most about the child's health and health care. RESULTS: A total of 196,888 household screening interviews were completed from October 2000 to April 2002. This resulted in 38,866 completed special-needs interviews and 176,296 completed health insurance interviews for children without special needs. The weighted overall response rate for special-needs interviews was 61.0%.

Adolescent↗
PubMed2004

Characteristics of people aged 45 years or older with heart disease by frequent mental distress status, 2001.

BACKGROUND: Depression commonly occurs after nonfatal cardiac events and is associated with adverse health outcomes. METHODS: In 2001, the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized adults, administered cardiovascular health questions to 19 states and DC. Among those aged > or = 45 years, we examined the association of frequent mental distress (FMD) (> or = 14 self-reported mentally unhealthy days in the past 30 days) with modifiable adverse behaviors (smoking, physical inactivity, and obesity) and health care coverage. RESULTS: The prevalence of FMD among adults with heart disease was 14.8%. Age-adjusted odds ratios indicated that adults with heart disease and FMD were more likely to smoke, to be physically inactive, to be obese, and to be without health care coverage than persons without FMD. Although frequent mental distress was associated with only one adverse health behavior (physical inactivity) after fully adjusting when these health behaviors were considered separately, we observed a twofold increased likelihood for the presence of multiple adverse health behaviors among those with FMD as compared to those without FMD. CONCLUSIONS: Medical counseling on lifestyle changes after cardiac events is accepted as a key part of rehabilitation; however, the mental well-being of patients may also need to be monitored, as it may be a mediating factor in achieving healthy lifestyle goals.

Aged↗
PubMed2005

Use of a wireless local area network in an orthodontic clinic.

Radiographic images and other patient records, including medical histories, demographics, and health insurance information, can now be stored digitally and accessed via patient management programs. However, digital image acquisition and diagnosis and treatment planning are independent tasks, and each is time consuming, especially when performed at different computer workstations. Networking or linking the computers in an office enhances access to imaging and treatment planning tools. Access can be further enhanced if the entire network is wireless. Thanks to wireless technology, stand-alone, desk-bound personal computers have been replaced with mobile, hand-held devices that can communicate with each other and the rest of the world via the Internet. As with any emerging technology, some issues should be kept in mind when adapting to the wireless environment. Foremost is network security. Second is the choice of mobile hardware devices that are used by the orthodontist, office staff, and patients. This article details the standards and choices in wireless technology that can be implemented in an orthodontic clinic and suggests how to select suitable mobile hardware for accessing or adding data to a preexisting network. The network security protocols discussed comply with HIPAA regulations and boost the efficiency of a modern orthodontic clinic.

Cell Phone↗
PubMed2004

Comparison of methods for identifying a population-based sample of Filipina women for a health survey.

This paper describes and compares 2 random-digit dialing (RDD) methods that have been used to select minority subjects for population-based research. These methods encompass the census-based method, which draws its primary sampling units from census tracts with a high proportion of minority persons, and the registry-based method, which derives its primary sampling units from a population-based cancer registry. Our study targeted Filipinos living in 10 Northern California counties, where they constitute 4% of the total population. Eligible participants (Filipina women, at least aged 20, who spoke 1 of 4 interview languages) were asked to complete a short telephone interview. Both the census and registry methods located Filipino households with comparable efficiency and with a higher yield than would be expected in a non-targeted population survey, such as the Mitofsky-Waksberg RDD method. No systematic pattern of responses was evident that would indicate that either method sampled women who were systematically less acculturated or less likely to use cancer screening tests. Although both methods offer substantial gains in efficiency, their utility is limited by generating samples that tend to over-represent high-density areas. The degree to which these methods are considered viable depends on further refinement to limit, or eliminate, their inherent selection biases without sacrificing their increased efficiency to locate minority populations.

Adult↗
PubMed2004

The role of sport-fish consumption advisories in mercury risk communication: a 1998-1999 12-state survey of women age 18-45.

BACKGROUND: In 2002, in the United States, 48 states issued advisories for sport-fish consumers that included 39 chemical contaminants. The most commonly identified chemical was methyl mercury, which is linked to reproductive and developmental effects. Advisories to reduce consumption of contaminated fish have been issued by states since the early 1970s. Advisories are being integrated to include both sport and commercial fish. METHODS: As part of a comprehensive risk-communication project, from December 1998 through August 1999 the Wisconsin Division of Public Health and the State of Maine Bureau of Health conducted a 12-state random-digit-dial telephone survey of 3015 women of childbearing age (ages 18-45). The goal was to assess the prevalence of fish consumption, understanding of mercury toxicity, and awareness of state sport-fish consumption advisories for mercury. We gathered information concerning respondents' demographic characteristics, understanding of mercury toxicity, fish consumption during the preceding 12 months, and sport-fish consumption advisory awareness. RESULTS: The overall survey completion rate was 57% with a Council of American Survey Research Organizations (CASRO)-calculated response rate of 50%. Completion rates varied from 37% in New Jersey to 73% in Minnesota. Fish consumption during the previous 12 months was reported by 87% of respondents (range by state of 82-90%). Nearly 10% of women reported consuming two or more fish-meals per week over the prior 12 months. Twenty-nine percent reported sport-fish consumption during the same time period, with a greater state-to-state variability (14-43%). Most women (71%) were aware of mercury's toxicity to a developing child (87% among those aware of an advisory and 67% among those unaware of an advisory). However, awareness of state advisories was only 20%, ranging by state from 8% to 32%. Women who were older, had more than a high school education, and had a household member with a fishing license were the most informed about mercury and fish-consumption advisories. CONCLUSIONS: Most women of childbearing age consume commercial fish and a substantial number also consume sport-caught fish. Despite this potential exposure to dietary mercury, most are unfamiliar with their state's mercury fish-consumption advisory. Most women were aware of the most toxic effects of mercury but less informed about mercury and its relationship to types of fish and fish characteristics. Minorities, women over age 30, family incomes above 25,000 US dollars, and those with some collage education were more likely to be consuming two or more fish-meals per week. Until source control and environmental remediation efforts can reduce the environmental burden of mercury below levels of concern, combined sport and commercial fish consumption advisories will remain the primary means of reducing human exposure to methylmercury. Assuring and assessing the effectiveness of such advisories is paramount. Our survey documents that current efforts to inform vulnerable populations are far from optimal.

Adolescent↗
PubMed1999

[Benign prostatic hyperplasia--dos the frequency of operations depend on insurance status?].

In this epidemiologic study, conducted in a representative age-stratified cohort of the town of Zurich, 1221 men aged 65, 70, 75, 80 and 85 years (accidentally at least 200 men in each of the five age groups) returned the correctly completed questionnaire containing standardized questions on those symptoms, which can be caused by BPH, also on digital rectal examination of the prostate gland, done by urologist or family doctor, and therefore, if the BPH has been diagnosed and, for that reason, if surgical or nonsurgical treatment. Calculating the age-specific prevalence of BPH and the prostate symptom score (international PSS), this study evaluates the relation between prostatectomy (results of surgery) and the health-insurance status. The logistic regression as multivariate analysis, the effects of age and professional education adjusted in the first step, reveals that the insurance status does not reflect the indication for surgery. The means of PSS are very low in men, BPH being never diagnosed, moderate in men with prostatectomy and higher in men with diagnosed BPH but without need for surgery, highest in men with subjective and objective indication for surgical intervention: the means of PSS by insurance status are in each of these four groups homogeneous. On the other hand, persons with only basic health-insurance seem much more to omit the digital examination of the prostate gland. Nevertheless, the complaints or symptoms caused by BPH, as stated by the patients in a quantitative manner of increasing severity, take care that the patient himself, not waiting too long, decides to visit a doctor. The quality of life, examined by classes of PSS, depends clearly from the persisting symptoms; the insurance status cannot show statistically any evident influence.

Age Factors↗
PubMed2002

Communication in science.

Science must have a common language. For centuries, Latin language carried out this job, but the progress in computer technology and internet world through the last 20 years, began to produce a new language with the new century; the computer language. The information masses, which need data language standardization, are the followings; Digital libraries and medical education systems, Consumer health informatics, Medical education systems, World Wide Web Applications, Database systems, Medical language processing, Automatic indexing systems, Image processing units, Telemedicine, New Generation Internet (NGI).

Communication↗
PubMed2000

Can radiologic images be incorporated into the electronic patient record?

As radiology makes advances toward filmlessness, all of medicine is headed, just as rapidly, toward paperless transmission of patient information. While there are obvious advantages to this electronic approach, and several standards to conform to for the transmission of textual (Health Level 7 [HL-7]) and image (Digital Imaging and Communications in Medicine [DICOM]) data, it is the integration of these two data sets that is clinically essential and yet poorly defined. This report defines an approach for, and the successful implementation of, the integration of radiologic image data with textual data contained within the electronic patient record (EPR) through the use of standard internet protocols. Incorporation of medical images in the EPR has proven to be critical to the successful deployment of picture archiving and communications systems (PACS) and the reduction of film consumption at Massachusetts General Hospital (MGH). Since the installation of the first internet-based Image Data Repository (IDR) at MGH in 1995, the system has adequately served to meet the needs of clinical requests by both radiology-only browser users and users of the EPR. It has drastically reduced the need for film and provided concurrent display of images and text throughout the institution and beyond.

Computer Systems↗
PubMed1998

The role of digital imaging and communications in medicine in an evolving healthcare computing environment: the model is the message.

The decision to use Digital Imaging and Communications in Medicine (DICOM), Health Level 7 (HL7), a common object broker such as the Common Object Request Brokering Architecture (CORBA) or ActiveX (Microsoft Corp, Redmond, WA) or any other protocol for the transfer of DICOM data depends on the requirements of a particular implementation. The selection of protocol is independent of the information model. Our goal as message standards developers is to design a data interchange infrastructure that will faithfully convey the computer-based patient record and make it available to authorized health care providers when and where it is needed for patient care. DICOM accurately and expressively represents the clinically significant properties of images and the semantics of image-related information. The DICOM data model is small and well-defined. The model can be expressed in Standard Generalized Markup Language (SGML) or Object Management Group Interface Definition Language or other common syntax-and can be implemented using any reliable communications protocol. Therefore our opinion is that the DICOM semantic data model should serve as the basis for a logically equivalent set of specifications in HL7, CORBA, ActiveX, and SGML for the interchange of biomedical images and image-related information.

Computer Communication Networks↗
PubMed1992

Evaluation of PACS-induced organizational change.

Filmless digital imaging with a PACS will affect health care institutions by changing the handling of clinically relevant information, altering needed staffing levels, and possibly affecting both the quality and cost of care. Economic evaluation of PACS compares the costs and/or benefits of PACS with those of all other relevant alternatives. Other evaluations may focus on narrower research questions. This paper discusses methodological considerations in economic evaluation, methods of time measurement, and the methods and results of several applied assessments of PACS effects on the medical imaging department or the hospital.

Cost-Benefit Analysis↗