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PubMed2025

Advancing translational exposomics: bridging genome, exposome and personalized medicine.

Understanding the interplay between genetic predisposition and environmental and lifestyle exposures is essential for advancing precision medicine and public health. The exposome, defined as the sum of all environmental exposures an individual encounters throughout their lifetime, complements genomic data by elucidating how external and internal exposure factors influence health outcomes. This treatise highlights the emerging discipline of translational exposomics that integrates exposomics and genomics, offering a comprehensive approach to decipher the complex relationships between environmental and lifestyle exposures, genetic variability, and disease phenotypes. We highlight cutting-edge methodologies, including multi-omics technologies, exposome-wide association studies (EWAS), physiology-based biokinetic modeling, and advanced bioinformatics approaches. These tools enable precise characterization of both the external and the internal exposome, facilitating the identification of biomarkers, exposure-response relationships, and disease prediction and mechanisms. We also consider the importance of addressing socio-economic, demographic, and gender disparities in environmental health research. We emphasize how exposome data can contextualize genomic variation and enhance causal inference, especially in studies of vulnerable populations and complex diseases. By showcasing concrete examples and proposing integrative platforms for translational exposomics, this work underscores the critical need to bridge genomics and exposomics to enable precision prevention, risk stratification, and public health decision-making. This integrative approach offers a new paradigm for understanding health and disease beyond genetics alone.

Humans↗
PubMed2006

The evolution of integrated chronic disease prevention in Alberta, Canada.

BACKGROUND: Recognition of the common risk factors for leading chronic diseases in Canada has contributed to the development of integrated chronic disease prevention and health promotion approaches. The Alberta Heart Health Project studied the capacity of health organizations in Alberta, Canada, to engage in heart health promotion. This article describes how the Alberta Heart Health Project acted on emerging research findings describing the preliminary stages of integrated chronic disease prevention in Alberta to provide leadership to encourage provincial chronic disease prevention efforts. CONTEXT: Political support for integrated chronic disease prevention was evident at the provincial and federal levels in Canada. As a result of organizational restructuring, loss of key health promotion champions, and decreased funding allocations, Alberta's regional health authorities sought increased efficiency in their chronic disease prevention efforts. METHODS: Descriptive data were derived from a brief questionnaire on regional health authorities' chronic disease prevention priorities and activities, an inventory of regional health authority health promotion programs and services, content analysis of key regional health authority documents, and focus groups with regional health authority staff, management, and policymakers. CONSEQUENCES: In 2002, the Alberta Heart Health Project data revealed that many regional health authorities were beginning to engage in integrated chronic disease prevention. However, little collaboration occurred across the health organizations; provincial leadership to facilitate collaboration and networking for integrated chronic disease prevention was needed. INTERPRETATION: Results supported the growing momentum for provincial leadership to enhance collaboration for integrated chronic disease prevention, which contributed to the development of the Alberta Healthy Living Network. The government's assistance is also needed to support the intersectoral collaborations essential for integrated chronic disease prevention.

Alberta↗
PubMed2006

HEARTFAID: A knowledge based platform of services for supporting medical-clinical management of heart failure within elderly population.

HEARTFAID is a research and development project aimed at devising, developing and validating an innovative knowledge based platform of services, able to improve early diagnosis and to make more effective the medical-clinical management of heart diseases within elderly population. Chronic Heart Failure is one of the most remarkable health problems for prevalence and morbidity, especially in the developed western countries, with a strong impact in terms of social and economic effects. All these aspects are typically emphasized within the elderly population, with very frequent hospital admissions and a significant increase of medical costs. Recent studies and experiences have demonstrated that accurate heart failure management programs, based on a suitable integration of inpatient and outpatient clinical procedures, might prevent and reduce hospital admissions, improving clinical status and reducing costs. HEARTFAID aims at defining efficient and effective health care delivery organization and management models for the "optimal" management of the care in the field of cardiovascular diseases. The HEARTFAID innovative computerized system will improve the processes of diagnosis, prognosis and therapy provision, providing the following services: * electronic health record for easy and ubiquitous access to heterogeneous patients data;* integrated services for healthcare professionals, including patient telemonitoring, signal and image processing, alert and alarm system;* clinical decision support in the heart failure domain, based on pattern recognition in historical data, knowledge discovery analysis and inferences on patients' clinical data.The formalization of the pre-existing clinical knowledge and the discovery of new elicited knowledge represent the core of the HEARTFAID platform.

Aged↗
PubMed1994

Future directions for comprehensive public health surveillance and health information systems in the United States.

The authors describe a comprehensive system for public health surveillance for the United States based on a network of data systems ranging from population surveys and physician-based records to electronically linked laboratory and administrative data. They also discuss traditional uses of surveillance data, legal and ethical issues associated with using data from any surveillance system (particularly the tension between individual privacy and the public right to a healthful environment), and factors impeding the development of a comprehensive system. Just as provisional data on notifiable diseases are critical in protecting communities from disease, data from other information systems should be applied to prevention practice with the same urgency. The major barriers to a successful comprehensive, nationwide, integrated public health surveillance and information system are a lack of appreciation for the value of high-quality provisional surveillance data and a weak societal commitment to public health.

Confidentiality↗
PubMed2006

Factors affecting detoxification readmission: analysis of public sector data from three states.

The objective of this study was to understand the rate of detoxification readmissions and the factors associated with readmission within a public sector population. The study sample was drawn from an integrated database that includes Medicaid and state mental health and substance abuse agency data from three states (Delaware, Oklahoma, and Washington) for 1996-1998. Clients with at least one state agency-sponsored detoxification event in 1996 or 1997 were included in the study. Twenty-seven percent of the sample was readmitted for detoxification within 1 year of their index detoxification. Clients who received two or more substance-abuse-related services within 30 days of their index detoxification were less likely to be readmitted and had a longer time until their second detoxification admission. Detoxification readmission is common in the public sector. Engaging patients in treatment following detoxification may reduce readmission rates and time to readmission.

Adult↗
PubMed1999

The effects of managed care on physician and clinical integration in hospitals.

OBJECTIVE: To empirically estimate the effects that managed care has had on physician and clinical integration in urban hospitals. DATA SOURCES: The 1993 Hospital-Physician Relationship Survey conducted for the Prospective Payment Assessment Commission, augmented with data from a variety of secondary sources. The entire 1,495 responding hospitals were used to construct measures of integration; 591 responding hospitals in urban areas were used for the managed care analysis. STUDY DESIGN: Factor analysis was used to reduce 23 integration variables into 5 physician and 3 clinical integration factors. Two-stage least-squares regression techniques were used to estimate the effects of endogenous managed care. Models were estimated for all urban hospitals and for hospital subsets based upon ownership, multi-hospital system status, and teaching. PRINCIPAL FINDINGS: Other things equal, physician involvement in hospital management and governance increased with managed care involvement; to a lesser degree, the use of physician organization arrangements and other joint ventures also increased. Practice management and support services were lower in hospitals with high managed care activity. Larger hospitals, investor owned, system, and non-teaching hospitals had larger managed care revenues. Managed care revenues were lower in more concentrated hospital markets. CONCLUSIONS: The relationship between managed care and physician and clinical integration is relatively modest. Much of the realignment under managed care has been limited to certain types of efforts. Those efforts can best be described as foundation-building rather than comprehensive or fundamental.

Data Collection↗
PubMed2026

The SARS-CoV-2 Integrated Genomic Epidemiology Database (IGED): Linking viral genomes with patient-level metadata to advance statewide genomic surveillance in California.

In July 2021, the California Code of Regulations Title 17 required all laboratories performing SARS‑CoV‑2 whole genome sequencing (WGS) to report their sequencing results to the California Department of Public Health (CDPH). These viral genomic data and patient metadata were compiled into the Integrated Genomic Epidemiology Database (IGED). Linking anonymized viral sequences with patient‑level information enabled monitoring of infectiousness, pathogenicity, transmission dynamics, evolution, and vaccine evasion among emerging SARS‑CoV‑2 lineages. Laboratories performing SARS-CoV-2 WGS transmitted sequencing results to CDPH through Electronic Laboratory Reporting (ELR) and non-ELR pathways. CDPH applied uniform reporting requirements but allowed flexibility in specific data formats to accommodate diverse data systems. To preserve data quality and interoperability across heterogeneous sources, CDPH implemented standardization, validation, and deduplication protocols. Snowflake, a cloud‑based data storage and analytics platform, and Posit Connect, a cloud deployment and automation platform, supported the management, processing, and integration of data within the IGED. The IGED established links between SARS‑CoV‑2 WGS data and epidemiologic metadata for 801,418 sequences, representing 81.7% of all sequences reported in California. Lineages reported to the IGED showed strong concordance with lineage proportions in GISAID. Sequences reported to the IGED had average turnaround times longer than one month, and the majority of sequencing was performed in Southern California and Los Angeles. The IGED enhanced genomic surveillance through predictive modeling and monitoring concerning evolutionary trends such as recombination and saltations in persistent infections. Development of the IGED highlighted the need for standardized data requirements, sustained funding for sequencing, incentives for data submission, and interdisciplinary collaboration to build an effective genomic surveillance system. This framework for linking genomic and epidemiologic data has not only generated critical insights for SARS‑CoV‑2 but also provided the foundation for CDPH and other public health organizations to develop similar IGED‑like systems for other priority pathogens as genomic surveillance expands.

Journal Article↗
PubMed2002

Lessons in integration--operations research in an Indian leprosy NGO.

Since the Alma Ata Declaration in 1978, health systems supporting the treatment and control of infectious diseases like leprosy and tuberculosis have been encouraged to 'integrate' into the primary health care structure within countries. Now, more than 20 years later, countries are still grappling with the concept of integration and looking for ways to achieve it. This study reports findings from a leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a leprosy non-governmental organization (NGO), between 1996 and 2000 in Koraput district, Orissa. The project addressed the issue of integration on two levels. On the one hand LEPRA used the context of the project to explore ways in which to integrate TB services into their existing leprosy control structure. On the other hand, lessons from the pilot study were intended to help the organization find ways of linking with the government health care structure. Following a 'qualitative approach', this operations research project assessed the perceptions of communities and providers about leprosy and tuberculosis services. Providers across the spectrum of this plural healthcare system were asked to provide comment on developing stronger networks with each other, with NGOs and with government, while patients and communities were asked to describe the resources available to them and the constraints they face in accessing health care in general, and for leprosy and TB in particular. LEPRA staff from top management to the outreach workers were also approached for their views. Patients and communities noted that physical access to treatment was a major constraint, while the existence of local providers and family support structures facilitated health and health care. Providers expressed a willingness to collaborate (with LEPRA and the government), but lacked training, adequate staff support and the appropriate equipment/technical resources. Also lacking were adequate information campaigns to inform the public about these diseases and their treatment. This information has provided LEPRA with an understanding of how they might best fill gaps in the existing system and therefore assist in the process of integrating services in their own organization and through the primary health care structure. To achieve this aim, LEPRA will increasingly become involved in developing relationships and partnerships with government in the delivery of training and services and in infrastructure development.

Data Collection↗
PubMed2005

The Population Health Approach: health GIS as a bridge from theory to practice.

BACKGROUND: The Population Health Approach, proposed by Health Canada, is the articulation of a long advocated model of human health. This approach strives to ensure that the health system is appropriately oriented to improve health status by applying evidence based practices across the continuum from health determinants to service interventions. Although conceptually appealing, it has been difficult to implement widely in the existing program-based health care system. The Population Health Surveillance Unit (PHSU) of the Vancouver Island Health Authority (VIHA) has developed a health geographical information system (HGIS), where GIS is used as both platform for information integration and as an analytical tool supporting comprehensive data analysis. With the assistance of the HGIS, the theory of the population health approach can be transformed into a practical, stepwise process supporting health services and program planning. RESULTS: Three important components of a health service planning and evaluation framework grounded in population health theory are described in this article. In particular, a stepwise methodological process to enable the incorporation of the principles of a population health into practical applications is presented; the technical functionality to integrate multiple sources of information, with different levels and scales is discussed; and sources of information about the health of the population at the appropriate level to populate this frame are proposed. An application of the methodology in the planning of health services for a high needs neighbourhood is presented as an illustrative example. CONCLUSION: The population health approach incorporates the consideration of health determinants and the context within which the health conditions arise in communities. The complexity of these relationships requires the application of innovative methodologies such as Health GIS to frame the issues practically. A population health based foundation for the planning and evaluation of health services can now move from theory to practice.

Journal Article↗
PubMed2005

Information subsystem of the SO4/Cl ratio as database for studying its influence on human health.

General lack of surface waters in the Dalmatian region on one hand (Croatia) and a large profusion and complexity of underground waters circulation, on the other hand, are typical phenomena of Dalmatian Karst region. Underground waters in Dalmatia belong to rift water similar to surface waters considering its hydrochemical and hygienic characteristics. Health care institutions and water authorities have become particularly interested in observing and monitoring water as well as preserving its quality. A relational database has been developed for carrying out chemical analyses expressed by the SO4/Cl ratio since it is necessary to organize and integrate a large number of analytical and ecological health-data. The database can serve as a methodological platform for the study of environmental factors influencing human health. The prototype database consists of data obtained by investigations, which have been conducted by the Water Examination Department of the Public Health Institute of Split Dalmatian County (Croatia) and University of Split Medical School. The database currently contains more than 3000 data.

Chlorides↗
PubMed2005

Information subsystem of total hardness (Ca + Mg) as a database for studying its influence on human health.

Dalmatia (Southern Croatia) belongs to the Dinaric karst region. The permeability of karst soil allows a great quantity of dissolved organic and toxic matter rendering it hygienically unsafe. The hinterland of the Dinaric karst region is relatively scarcely populated since the largest agglomeration of population and industry is in the coastal zones. Hence, most of the surface flow have preserved their natural characteristics. The water supply authorities and health care institutions are especially interested in observing and monitoring water quality. A relational database has been developed for carrying out chemical analyses expressed by total hardness (Ca + Mg) since it is necessary to organize and integrate a large number of analytical and ecological health-data. The database can serve as a methodological platform for the study of environmental factors influencing human health. The prototype database consists of data obtained by investigations which have been conducted by the Water Examination Department of the Public Health Institute, Split-Dalmatian County (Croatia) and the University of Split Medical School. The database currently contains more than 3000 data.

Calcium↗
PubMed1995

Enhancing coverage and sustainability of vaccination programs: an explanatory framework with special reference to India.

The article addresses the question in what form and under what conditions vaccination programs can be expected to continue once the 'take off' period is over. This matter is of great importance because of the need to continuously vaccinate new cohorts of children with a high degree of coverage and in an appropriate manner. Using data from India, where vaccination programs are integrated in regular health care delivery, an explanatory framework is presented which, first, analyses the vaccination program in terms of different levels, organizational cultures and inner-level linkages and, second, addresses the relation between the program and its socio-cultural context. The analysis provides starting points for changes that could enhance coverage and sustainability. Such changes include alterations in program design and adjustments in the views of different categories of program staff. The article discusses strategies directed at achieving such changes.

Child↗
PubMed1997

Designing evaluations for a women's health education program.

Explicitly incorporating women's health into the medical school curriculum is a relatively new process for educators. Moreover, until recently, no standard definition of women's health had been developed. Because there are no specific evaluation designs for women's health programs, evaluators must adapt existing evaluation concepts to fit the needs of the program. Evaluation is a broad concept that includes assessments of knowledge, skills, and attitudes to reach decisions about program improvements. The purpose of this article is to describe methods of evaluating women's health programs, including how to tailor basic evaluation concepts to the program. Several areas of women's health programming are discussed as background to creating the innovative design for this new program evaluation. An example of an evaluation design for a totally integrated women's health curriculum is presented, including some preliminary data and a discussion of strategies for overcoming obstacles to initiating women's health evaluations.

Curriculum↗
PubMedDate not supplied

Does Dixon's Integrative Environmental Health Model inform an understanding of rural parents' perceptions of local environmental health risks?

A qualitative study of parents' perceptions of local environmental health risks was conducted to assess the fit between concepts from Dixon's Integrative Environmental Health Model (DIEH model) and field-generated data. This research was part of a prospective study addressing environmental exposures of rural low-income children. Home visit data from 11 parents were analyzed (1) thematically and (2) according to DIEH concepts. These complementary analyses allowed the researchers to examine perceptions that were congruent with or diverged from the DIEH model. Findings revealed that participants were concerned about children's exposure to pathogenic molds and cigarette smoke and felt uninformed about risks and prevention strategies. Barriers to preventive actions included families' lack of time and a disinterest in brochures. Participants reported being "stuck" in substandard housing by poverty and family demands. They expressed concern about risks, but were unsure "what to worry about." Results provided the researchers with confidence that the DIEH model aligned with participants' cognitive constructions of risk. As a result, the DIEH model was incorporated into the conceptualization for the clinical trial phase of the study. This type of check between a theoretical approach and field data can be a helpful intermediate step for researchers involved in multiyear studies.

Adult↗
PubMed1992

Factors affecting the future need for dental manpower in Canada and Quebec.

During the past decade, dental faculties in North America have reduced class sizes due to a perceived oversupply of dentists. Several schools have been closed outright, and others have been threatened with closure. These actions may have a negative impact on the future supply of dentists. The current beliefs with regards to the oversupply of dentists have inadequately accounted for the dramatic demographic and epidemiologic changes that are occurring in North America. Major changes in population distribution and disease trends point to an increased need for adult dental services in the future. Therefore, models for dental manpower needs should integrate these data to avoid a potential shortage of dental health care personnel in the future.

Adolescent↗
PubMed2003

A dynamic Web application within an n-tier architecture: a Multi-Source Information System for end-stage renal disease.

A Multi-Source Information System (MSIS) has been designed for the Renal Epidemiology and Information Network (REIN) dedicated to End-Stage Renal Disease. Interoperability has been considered at 4 levels: semantics, network, formats and contents. An n-tier architecture has been chosen at the network level. It is made out of a universal client, a dynamic Web server connected to a production database and to a data warehouse. The MSIS is patient-oriented, based on a regional organization. Its implementation in the context of a regional experimentation is presented with insights on the design and underlying technologies. The n-tier architecture is a robust model and flexible enough to aggregate multiple information sources and integrate modular developments. The data warehouse is dedicated to support health care decision-making.

Data Display↗
PubMed1993

Projections of hypertension-related renal disease in middle-aged residents of the United States.

OBJECTIVE: To establish nationwide projections for hypertension-related renal disease among middle-aged residents of the United States and compare disease burden in demographic subgroups. DESIGN: Integrated analysis of data from the US Census, the National Health and Nutrition Examination Survey of 1976 through 1980 (NHANES II), the 1971 through 1975 NHANES I Epidemiologic Follow-up Study, the Hypertension Detection and Follow-up Program trial, and the US Renal Data System. POPULATION: African-American and white residents of the United States, aged 30 to 69 years. MAIN OUTCOME MEASURES: Incidence rates and counts of hypertension, hypertension-related hypercreatinemia, and hypertension-related end-stage renal disease (ESRD). RESULTS: Each year, approximately 1.8 million middle-aged Americans develop hypertension, 140,000 develop hypertension-related hypercreatinemia, and 5300 develop hypertension-related ESRD. African Americans are at increased risk for hypertension (relative risk [RR], 1.6; population-attributable risk [PAR], 5%), hypercreatinemia if hypertensive (RR, 2.4; PAR, 18%), ESRD if hypertensive with hypercreatinemia (RR, 2.7; PAR, 32%), and hypertension-related ESRD overall (RR, 8.0; PAR, 44%). Compared with women, men are at increased risk for hypertension (RR, 1.3; PAR, 13%) and hypertension-related ESRD (RR, 1.6; PAR, 23%). Most cases of hypercreatinemia in hypertensives (73%) occur among those with mild hypertension. CONCLUSIONS: Progression to ESRD is rare in persons with hypertension-related renal disease, and factors other than blood pressure probably play an important role. A large proportion of hypertension-related renal disease cases occur among population subgroups considered to be at low risk. Interventions that favorably influence factors associated with the progression of hypertension-related renal disease in African Americans, in men, and in persons with mild hypertension, hold the greatest potential for reducing the population burden of hypertension-related ESRD.

Adult↗