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PubMed2004

Second-generation HIV surveillance: better data for decision-making.

This paper seeks to outline the key elements of the expanded surveillance efforts recommended by the second-generation HIV surveillance approach. Second-generation systems focus on improving and expanding existing surveillance methods and combine them in ways that have the greatest explanatory power. The main elements of this approach include: considering biological surveillance - HIV, AIDS, sexually transmitted infections (STIs) - and behavioural surveillance as integral components, targeting surveillance efforts at segments of the population where most new infections are concentrated - which might differ depending on the stage and type of the epidemic - and providing the rationale for the optimal use of data generated for monitoring the HIV epidemic and evaluating national AIDS control programmes. The paper emphasizes improvements in existing surveillance methodologies and discusses in detail crucial issues such as the validity of HIV prevalence data measured in pregnant women and linking HIV surveillance and behavioural data collection. In addition, a strategic partnership between second-generation surveillance and AIDS programme evaluation is proposed that stresses the complementary roles of these data collection activities in determining the effectiveness of prevention and care programmes and explaining the epidemiological trend data collected by sentinel serosurveillance systems. In conclusion, second-generation HIV surveillance systems provide a comprehensive, cost-effective and appropriate response to the information needs of AIDS control programmes. The implementation of such systems, including a better use of the data generated by the system, will ensure that national programmes are in the best possible position to respond to the challenges of the epidemic.

Behavioral Risk Factor Surveillance System↗
PubMed2003

Establishment of a database of diagnosed HCV-infected persons in Scotland.

To provide a comprehensive understanding of the epidemiology of hepatitis C virus (HCV) infection in Scotland, a database of all persons known to have been infected with HCV in Scotland was established. Non-identifying data, held on the computers and requests forms in Scotland's principal and confirmatory HCV testing laboratories, were entered onto a National Database at the Scottish Centre for Infection and Environmental Health. As at December 2001, records from 13,519 persons in Scotland known to have been infected with HCV had been entered on to the database (one in 378 of Scotland's population). Of the 13,519, 69% were male and 90% of the 9,092 for whom risk factor information was available had injected drugs; 37% were from Greater Glasgow. Fifty-six per cent of the 13,519 were diagnosed between 1998 and 2001; 1,727 (23%) of the new diagnoses from 1998 to 2001 were aged under 25 years. The data provide an insight into the epidemiology of HCV infection in Scotland. They support other data, which indicate that the current major risk factor for HCV in the country is injecting drug use.

Adolescent↗
PubMed2004

Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City.

Hip fractures are a major cause of death and disability among the elderly. Although previous studies have shown hip fracture rates to be highest among Whites, and lowest among Blacks, less is known about how these differences are affected by gender and age. We determined the hip fracture hospitalization rates for non-Hispanic Whites, Blacks, Hispanics, and Asians in New York City from 1988 to 2002 using Statewide Planning and Resource Cooperative System data from the New York state Department of Health. We found that hip fracture hospitalization rates for those aged 50 and older were higher for women than men, with a risk ratio of 1.75 (95% confidence interval [CI] 1.73-1.77). Annual age-adjusted hip fracture hospitalization rates among White, Black, Hispanic, and Asian women were 459, 137, 143, and 174 per 100,000, respectively. The corresponding rates for men were 230, 109, 87, and 104, respectively. For both genders, and all race/ethnicity groups, the rates increased sharply with age. Although overall, women had higher rates compared to men, these differences varied by race and age. For Whites and Asians, women had higher rates for all age groups older than 50 years. For Hispanics aged 50-59, men had a higher rate than did women, but this gender relationship reversed after age 60. For Blacks, however, men had higher rates than women until age 70, after which women had higher rates. These results demonstrate that race/ethnicity, as well as age and gender, influence the incidence of hip fractures. Moreover, Asians, with their low bone mass, showed no increased hip fractures, compared to non-Hispanic Blacks and Hispanics. Further study is needed to explain this paradox.

Black or African American↗
PubMed2004

This surveillance system goes beyond bioterrorism.

Florida hospitals are benefiting in practical ways from a system originally designed to detect bioterrorism attacks. The system is proving useful in alerting emergency staff to naturally occurring infections early enough to take proactive action. The system is available to any interested ED. EDs can use the system to identify common maladies such as influenza in time to prepare for a community outbreak. Any ED in a large populated area may find the system useful.

Bioterrorism↗
PubMedDate not supplied

Deaths due to road traffic crashed in Hyderabad city in India: need for strengthening surveillance.

BACKGROUND: Road traffic crashes are an important cause of death and disability in India. Reliable and accurate data are necessary to plan strategies to reduce death and disability due to road traffic crashes. We assessed the utility of the available data on deaths due to road traffic crashes for road crash surveillance for a major metropolitan city of southern India. METHODS: We analysed the Department of Police database on deaths due to road traffic crashes for 2002 in Hyderabad, southern India and collected data from a leading newspaper for the same information using a standardized format. RESULTS: A total of 3039 cases of road traffic crashes were recorded in the police database for 2002, including 400 cases (13.2%) in which 411 people were killed. In the same year, 316 cases of road traffic crashes resulting in 353 deaths were reported in the newspaper. The majority of those who died due to these crashes were males. Seventy per cent of those killed were between 16 and 49 years of age. Pedestrians and riders of two-wheelers were the most vulnerable. Collision with a vehicle caused 86.4% of all crashes and 60% of the victims died before reaching a hospital. The available data were not comprehensive enough to provide a thorough basis for planning intervention strategies to reduce fatalities due to road crashes. CONCLUSION: Despite the gaps in reporting of fatalities in road traffic crashes in these data sources, they provide insights into the magnitude and nature of deaths resulting from such crashes in Hyderabad. The available data have limitations and there is a need for strengthening the road traffic crash surveillance system to have reliable, accurate and adequate data on road traffic crashes and the resulting fatalities and injuries. These could then form the basis for planning effective intervention strategies to improve road safety.

Accidents, Traffic↗
PubMed2004

Surveillance of sexually transmitted infections in the West Midlands using anonymised individual patient datasets from genitourinary medicine clinics.

Sexually transmitted infections (STIs) declined in the UK during the 1980s and early 1990s but have increased substantially since 1995. Within the overall increase there are important differences in the epidemiology of these infections. The current, aggregate system of STI data collection in the UK provides limited demographic information and is unable to fully explain these differences. More useful information can be obtained using an enhanced surveillance system that collects disaggregate, anonymised, individual patient data including ethnic group and truncated postcode of residence. Such a system has been set up in the West Midlands NHS region. The methodology of the project is described here along with the findings to date. These findings confirm that the burden of STIs disproportionately affects young persons, men who have sex with men, black ethnic minority groups and those living in urban areas. Identifying the groups at greatest risk in this way enables interventions to be more usefully targeted.

Adolescent↗
PubMed2004

Inflammatory bowel disease--hospitalization.

OBJECTIVES: This analysis examines trends in hospitalization for Crohn's disease and ulcerative colitis, the two main forms of inflammatory bowel disease (IBD). DATA SOURCES: Data are from the Hospital Morbidity Database for 1983/84 to 2000/01, and from the Health Person-Oriented Information Database for 1994/95 to 2000/01. ANALYTICAL TECHNIQUES: Sex- and age-specific rates were calculated for separations attributed to Crohn's disease and ulcerative colitis. Rates and hospital days were also calculated for hospitalizations in which IBD was among the first five diagnostic codes on a patient's discharge abstract. The frequency of rehospitalization was examined. MAIN RESULTS: From the early 1980s to the mid-1990s, annual rates of hospitalization for Crohn's disease and ulcerative colitis rose slightly, but have since levelled off. Hospitalization rates for both conditions are highest among people in their twenties. The average length of stay for patients with either disease fell from about 2 weeks in 1983/84 to 9 or 10 days in 2000/01. More than a quarter of patients hospitalized for Crohn's disease and over 20% of those with ulcerative colitis were readmitted within the same year.

Adolescent↗
PubMed2004

National and regional health information infrastructures: making use of information technology to promote access to evidence.

The vision for national and regional health information infrastructures (HII) includes provision of a framework that is supportive of access and integration of health information with the goal of improving the health and safety of individuals, public health systems, and nations. Internationally, prominent examples of national and regional HIIs exist that provide a means for achievement of this goal. However, to fully realize benefits, an explicit mechanism is needed for linking national and regional HIIs with existing knowledge, automated processes and evaluation of the ability of HIIs to meet the information needs of primary recipients. Using the United States' Na-tion Health Information Infrastructure (NHII) as an example, the authors describe expansion of the conceptual framework to explicitly acknowledge the role of access to evidence at the overlap between the three dimensions of the NHII to create an "evidence-based" link between interrelated components. The role of national measures in setting e-communication goals and evaluating the evolving infrastructure in meeting informational needs of users is discussed. Additionally, automated knowledge management tools such as practice guidelines are presented as a means by which access to critical information is delivered to users, in a format that is appropriate for their health literacy level and that provides adequate support for informed decision making.

Decision Support Techniques↗
PubMed2004

Analysis of Web access logs for surveillance of influenza.

The purpose of this study was to determine whether the level of influenza in a population correlates with the number of times that internet users access information about influenza on health-related Web sites. We obtained Web access logs from the Healthlink Web site. Web access logs contain information about the user and the information the user accessed, and are maintained electronically by most Web sites, including Healthlink. We developed weekly counts of the number of accesses of selected influenza-related articles on the Healthlink Web site and measured their correlation with traditional influenza surveillance data from the Centers for Disease Control and Prevention (CDC) using the cross-correlation function (CCF). We defined timeliness as the time lag at which the correlation was a maximum. There was a moderately strong correlation between the frequency of influenza-related article accesses and the CDC's traditional surveillance data, but the results on timeliness were inconclusive. With improvements in methods for performing spatial analysis of the data and the continuing increase in Web searching behavior among Americans, Web article access has the potential to become a useful data source for public health early warning systems.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

Collection and integration of clinical data for surveillance.

OBJECTIVE: The syndromic surveillance project at Public Health-Seattle & King County incorporates several data sources, including emergency department and primary care visit data collected and normalized through an automated mechanism. We describe significant changes made in this "second generation" of our system to improve data quality while complying with privacy and state public health reporting regulations. METHODS/RESULTS: The system uses de-identified visit and patient numbers to assure data accuracy, while shielding patient identity. Presently, we have 124,000 basic visit records (used to generate stratified denominators), and 29,000 surveillance records, from four emergency departments and a primary care clinic network. The system is capable of producing syndrome-clustered data sets for analysis. DISCUSSION: We have incorporated data collection techniques such as automated querying, report parsing, and HL7 electronic data interchange. We are expanding the system to include greater population coverage, and developing an understanding how to implement data collections more rapidly at individual hospital sites, as well as how best to prepare the data for analysis.

Bioterrorism↗
PubMedDate not supplied

From stool to statistics: reporting of acute gastrointestinal illnesses in Canada.

BACKGROUND: Limitations associated with the under-reporting of enteric illnesses have long been recognized but the extent and variation of this under-reporting in Canada has not been examined. Given the public health value of surveillance data, a closer examination of under-reporting of enteric illnesses in Canada was warranted. METHODS: Paper-based surveys were administered (a) to all laboratories in Canada licensed to process stool specimens and (b) to all local public health authorities in two provinces. RESULTS: Of the laboratories surveyed, 67% (n=274) conducted on-site testing of stool specimens for enteric bacteria, 31% (n=126) for parasites and 10% (n=42) for viruses. In the year 2000, these laboratories processed 459,982 stool specimens, of which 5%, 15%, 8% and 19% were positive for enteric bacteria (excluding C. difficile), C. difficile, parasites and viruses, respectively. Variations in laboratory testing and health authority reporting protocols and policies were identified. Of the laboratory-confirmed cases of AGI reported to local public health authorities, 5% (n=846) were not reported to provincial counterparts. CONCLUSION: A significant proportion of AGI cases submitting stool specimens are not captured in Canada's passive surveillance system due to unknown etiology. A much smaller proportion of laboratory-confirmed cases reported to local public health authorities are not captured at the provincial or national level. Given that the number of laboratory-confirmed AGI cases represents such a small fraction of all community cases, strategies to compensate for under-reporting and efforts directed at harmonizing laboratory and local public health authority policies and practices would be welcomed.

Acute Disease↗
PubMed2004

Shorter hospital stays for breast cancer.

OBJECTIVES: This article examines trends in and factors influencing the length of stay for female breast cancer patients who were hospitalized between 1981 and 2000. DATA SOURCES: The hospital data are from the Hospital Morbidity Database and the Health Person-oriented Information Database, both maintained by Statistics Canada. Data on new cases of breast cancer are from the Canadian Cancer Registry and the National Cancer Incidence Reporting System. ANALYTICAL TECHNIQUES: Descriptive analyses present length of stayfor all hospital admissions with a primary diagnosis of breast cancer, by four-year period and by the patient's age, cancer stage, comorbid conditions and surgical procedures. Logistic regression is used to examine associations between these factors and length of stay. MAIN RESULTS: Since the early 1980s, the average length of stay in hospital for female breast cancer has fallen from 15.1 to 4.5 days. Declines occurred regardless of age group, cancer stage, procedure and comorbid conditions. Average stays first began to fall for less serious cases, but were eventually apparent for even the most serious.

Adult↗