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Primary prevention of malignant melanoma in a Swedish urban preschool sector.

Malignant melanoma is the most rapidly increasing tumor in Sweden. Sunburns in childhood are considered a major risk factor. In the spring of 1989, a health education program was therefore initiated in Stockholm County in cooperation with the local preschool authorities in the area. Lectures on malignant melanoma, hazards of sunburns in childhood, and the importance of sun awareness were arranged for the nursery school matrons in the preschool sector. Thirty-five of 42 authorities (83%) wanted a lecture for their nursery school matrons, whereas 17% of the authorities wanted to spread information on their own. Of 1,991 nursery schools, 1,783 (90%) took part in the information program. These, the Stockholm nonparticipants, and the rest of the country received written information from the Federation of Swedish Municipalities by initiative of the Department of Cancer Prevention. A questionnaire distributed to 574 randomly selected nursery schools in Stockholm county and to 100 in a reference area outside Stockholm showed that sun awareness was reported high in both places. Face-to-face information disseminated by an established organization was more effective in increasing sun awareness in the preschool sector than mailed information alone. In the areas where lectures were given, the message of sun awareness practice was passed on to nursery school staff and parents twice as effectively as in the reference area (p less than 0.01).

Child Day Care Centers↗

Overview and characteristics of some occupational exposures and health risks on offshore oil and gas installations.

This review considers the nature, and recognition and control, of health risks in the offshore oil and gas industry from the occupational hygiene point of view. Particular attention is given to the changes in the nature of exposure and control of inhalation risks from substances hazardous to health in the UK sector, but other risks (e.g. dermatitis, noise and vibration) are also considered. The amount of published information on exposure to these hazards in the sector, or indeed on long-term health outcomes of working offshore, is limited. The approach taken to occupational health and hygiene in the sector has to be set in the context of the challenge of working in a remote and hostile environment where attention to safety and the need for emergency response to acute, rather than chronic, medical events are vital. However, changes in attitudes towards occupational health in the sector, legislation, the impact of environmental protection requirements and technology have all contributed to increasing the attention given to assessment and control of chemical and physical hazards. The health risks and benefits associated with the abandonment of installations, the application of new technologies, recovery of oil from ever deeper waters, lower staffing levels, environmental changes, the ageing workforce and the recognition of exposure patterns needing further attention/control (sequential multiple exposures, smaller workforce, peak/short-term exposures, etc.) are other current and future occupational hygiene challenges.

Air Pollutants, Occupational↗

Private sector support of nursing research.

Members of the American Nurses' Association Council of Nurse Researchers were surveyed for information about their nursing research funding activity within the private sector: their submission of proposals to private organizations, the outcomes, and effective funding strategies. Results indicated that 51% of applications submitted to private organizations and 78% of intramural applications were funded. However, 65% of proposals funded by private organizations and 59% of intramurally supported projects were for $3,000 or less. A variety of strategies led to private sector support of successful nursing research proposals. These included making direct, personal contact with funding agencies, matching proposals with the needs and interests of the funding agency, networking with other professionals to obtain funding information, and submitting well-written proposals consistent with agency guidelines.

Financing, Organized↗

[Epidemiological surveillance of homicides and suicides. A report on the Cali workshop].

Underregistration of homicides and suicides is a problem that exists in most of the countries of the region, owing to the variety of ways these causes are coded and analyzed, insufficient funding for information management, and lack of trained personnel, of coordinated data collection, and of a non-centralized system for issuing reports. The health sector plays an important role in recording information about violent acts, but the information collected and evaluated by the health services is usually limited to the sex and age of the victim, the nature of the injuries, and, occasionally, the type of weapon or means of aggression. The morbidity and mortality statistics compiled by the services do not reflect the true magnitude of the epidemiologic problem of violence because of, among other reasons, underreporting in emergency rooms and outpatient clinics. In addition, victims--for example, those who experience violence within their families--often do not seek services at health institutions.

Accidents, Traffic↗

Overview of good epidemiologic practices.

The results of epidemiologic research are increasingly being used by those who establish health policy in the private and public sector. To increase the contribution such information might make to the decision-making process, a number of organizations have made recommendations for improvements in epidemiologic practices. ERIC, the Epidemiology Resource Information Center, a pilot project of the Chemical Manufacturers Association, has developed "Guidelines for Good Epidemiology Practices." This document provides recommendations regarding organization and personnel; facilities, resource commitment, and contractors; protocol; review and approval procedures; study conduct; communication of study results; archiving of study materials and data; and quality assurance. Although intended for use by those in the private sector who conduct environmental and industrial epidemiology, it should have utility for the entire profession.

Chemical Industry↗

Integrated assessment of environment and health: America's children and the environment.

The significance of the environment for health is increasingly being recognized. There is a need for systematic approaches to assessment of environmental factors most relevant to health, health outcomes most influenced by the environment, and the relationships between them, as well as for approaches to representing the results of such assessments in policy deliberations. As a step in the development of such methods, we used findings and data from the environmental protection and public health sectors to develop a set of measures representing topics relevant to children's environmental health. We used a definition of the environment that emphasized contaminants and a process that involved both analytic and deliberative elements. The steps in this process were to a) develop a conceptual framework to depict relationships between environment and health with relevant types of data and information, b) select topic areas of significance for children, c) identify best available data sources and devise measures, d) assess possible surrogate data sources and measures when needed, e) design and implement metrics for computation of measures using specified data elements, f) select graphical representations of measures, g) identify related measures, and h) identify data gaps. Representatives of policy and stakeholder audiences participated in this process. The measures are presented in three groups that reflect contaminants in the environment, contaminants in human tissues, and diseases and disorders. The measures present scientifically based representations of data understandable to stakeholders and policy makers that integrate key information from the health and environment sectors in a consistent format.

Biomarkers↗

Hospitals and the competitive edge: how educated boards make a difference.

Hospital leaders face challenges from many different arenas--business, finance, and patient care. One resource often overlooked as a strategic asset is the hospital board of directors. Too often hospital boards erroneously assume or are forced into the roles of either micro-management or crisis management. Board education, which focuses on pertinent healthcare market information and strategic decision making, can help board members' understanding of their roles. As part of its overall plan, hospital leadership should ensure that its board members understand the market environment and its effect upon the hospital's strategic directions, options, and priorities. This article focuses on the structure and type of information that board members need to know to better guide the hospital leadership through the decision-making process and to fulfill their obligations to the institution they serve.

Decision Making, Organizational↗

Development of a security vulnerability assessment process for the RAMCAP chemical sector.

The Department of Homeland Security (DHS), Directorate of Information Analysis & Infrastructure Protection (IAIP), Protective Services Division (PSD), contracted the American Society of Mechanical Engineers Innovative Technologies Institute, LLC (ASME ITI, LLC) to develop guidance on Risk Analysis and Management for Critical Asset Protection (RAMCAP). AcuTech Consulting Group (AcuTech) has been contracted by ASME ITI, LLC, to provide assistance by facilitating the development of sector-specific guidance on vulnerability analysis and management for critical asset protection for the chemical manufacturing, petroleum refining, and liquefied natural gas (LNG) sectors. This activity involves two key tasks for these three sectors: Development of a screening to supplement DHS understanding of the assets that are important to protect against terrorist attack and to prioritize the activities. Development of a standard security vulnerability analysis (SVA) framework for the analysis of consequences, vulnerabilities, and threats. This project involves the cooperative effort of numerous leading industrial companies, industry trade associations, professional societies, and security and safety consultants representative of those sectors. Since RAMCAP is a voluntary program for ongoing risk management for homeland security, sector coordinating councils are being asked to assist in communicating the goals of the program and in encouraging participation. The RAMCAP project will have a profound and positive impact on all sectors as it is fully developed, rolled-out and implemented. It will help define the facilities and operations of national and regional interest for the threat of terrorism, define standardized methods for analyzing consequences, vulnerabilities, and threats, and describe best security practices of the industry. This paper will describe the results of the security vulnerability analysis process that was developed and field tested for the chemical manufacturing sector. This method was developed through the cooperation of the many organizations and the individuals involved from the chemical sector RAMCAP development activities. The RAMCAP SVA method is intended to provide a common basis for making vulnerability assessments and risk-based decisions for homeland security. Mr. Moore serves as the coordinator for the chemical manufacturing, petroleum refining, and LNG sectors for the RAMCAP project and Dr. Jones is the chief technology officer for ASME-ITI, LLC for RAMCAP.

Chemical Industry↗

Long-term care information systems: an overview of the selection process.

Under the current Medicare Prospective Payment System method and the ever-changing managed care environment, the long-term care information system is vital to providing quality care and to surviving in business. system selection process should be an interdisciplinary effort involving all necessary stakeholders for the proposed system. The system selection process can be modeled following the Systems Developmental Life Cycle: identifying problems, opportunities, and objectives; determining information requirements; analyzing system needs; designing the recommended system; and developing and documenting software.

Attitude of Health Personnel↗

Data warehousing in molecular biology.

In the business and healthcare sectors data warehousing has provided effective solutions for information usage and knowledge discovery from databases. However, data warehousing applications in the biological research and development (R&D) sector are lagging far behind. The fuzziness and complexity of biological data represent a major challenge in data warehousing for molecular biology. By combining experiences in other domains with our findings from building a model database, we have defined the requirements for data warehousing in molecular biology.

Computational Biology↗

Multi-sectoral health promotion and public health: the role of evidence.

BACKGROUND: Evidence-informed health promotion and public health is an emerging and ever-changing theme in research and practice. A collaborative approach to gathering and applying evidence is crucial to implementing effective multi-sectoral health promotion and public health interventions for improved population outcomes. This paper presents an argument for the development of multi-sector evidence and discusses both facilitators and challenges to this process. METHODS: Sector-specific contacts familiar with decision-making processes were selected from referrals gained through academic, government and non-government networks and interviewed (in-person or via telephone) as part of a small scale study to scope the use of evidence within non-health sectors where decisions are likely to impact on public health. RESULTS: The views gathered are preliminary, and this analysis would benefit from more extensive consultation. Nonetheless, information gathered from the interviews and literature search provide valuable insights into evidence-related decision-making paradigms which demonstrate similarities with, and differences from, those found in the health sector. CONCLUSIONS: Decisions in health promotion and public may benefit from consideration of the ways in which disciplines and sectors can work together to inform policy and practice.

Cooperative Behavior↗

Genomics in the public domain: strategy and policy.

The public domain has been conspicuous in media accounts of public and private sector initiatives to complete the sequence of the human genome. The issue of whether the human genome will be freely available to the public or privately held as a proprietary resource has captured the attention of the scientific, trade and popular press, the financial markets, and even heads of state. Although some media commentary has framed the issue as a conflict between ethics and greed, strategic considerations go a long way towards explaining the timing and quality of information disclosures on both sides of the public-private divide.

DNA↗

Monitoring of national drug policies--regional comparison between Bulgaria, Romania, Macedonia, Bosnia Herzegovina.

After the profound economic and political changes most of the East European countries started market-oriented reforms. During the last 10 years rapid development of the private pharmaceutical sector and a slow privatisation process was observed. The balance between the private and public sector became very important for achieving NDP goals. The goal of this study is to evaluate the availability and development of the NDP structures in East European countries--Bulgaria (BG). Romania (Rom), Macedonia (Mac), Bosnia Herzegovina (BiH). For the assessment of the availability of NDP structures a questionnaire focused on seven main NDP components was used. These components are: legislation and regulations; essential drug selection and drug registration; drug allocation in the health budget/public sector financing policy; public sector procurement procedures; public sector distribution and logistics; price policy; information and continuing education on drug use. According to the survey the most developed NDP structures are drug legislation and regulations (incl. quality control), drug registration and drug distribution. We can assume that the people have access to different drugs of appropriate quality and in time. The systems for public drug financing, procurement and price policy are under developing or not efficient enough. The financial availability of drugs is difficult. There is a lack of objective drug information and postgraduate education is not oriented on the ED. It means that there is no guarantee for rational drug prescription and usage of drugs on the markets.

Bosnia and Herzegovina↗

Data analysis needs for health sector reform.

This paper addresses the role of information in health policy reform. It recognizes that reform can be based on data, but that there are other influences on health policy. The steps involved in making policy, including problem identification, comparison of solutions, policy adoption, implementation, and amendment, all require information. When information is unavailable for any of these steps, the policy process sometimes proceeds without it. The policy makers must make difficult choices regarding the potential benefit of comprehensive information to the policy outcome versus the potential drawbacks, in terms of time and cost, of seeking the missing information. Different areas where data are needed within health policy are enumerated, as are sources of health policy data, and examples of strategies are given. Finally, three case studies are presented, highlighting the use of information in policy making. The National Epidemiology Board in Thailand commissioned studies by experts on relevant policy topics. It had a substantial impact on changing policies in the areas of AIDS control, iodine deficiency, essential drugs and vaccination. The attempt at decentralizing health administration to the province level in Papua New Guinea is the second example presented. At the time of the evaluation, this effort had not yet attained its objectives of improving the health of the people, nor had it reduced costs or lessened inequity among regions. If this reform had been tested in a pilot project, its problems may have been discovered at an earlier stage of implementation when they would have been easier to correct. The final case concerns the UNICEF child survival interventions during the 1980s. These interventions were chosen based on cost-effectiveness analysis and were successfully implemented. The use of cost-effectiveness analysis in prioritizing interventions is one example of the way in which information can improve policy and health outcomes.

Data Collection↗

Icelandic. Decision of the Supreme Court on the protection of privacy with regard to the processing of Health Sector Databases. Attorney at Law vs The State of Iceland.

Mr. R appealed for a decision by the Court to overturn the refusal of the Medical Director of Health to her request that health information in medical records pertaining to herdeceased father should not be entered into the Health Sector Database. Furthermore, she called for recognition of her right to prohibit the transfer of such information into a database. Article 8 of Act No 139/1998 on a Health Sector Database provides for the right of patients to refuse permission, by notification to the Medical Director of Health, for information concerning them to be entered into the Health Sector Database. The Court concluded that R could not exercise this right acting as a substitute of her deceased father, but it was recognised that she might, on the basis of her right to protection of privacy, have an interest in preventing the transfer of health data concerning her father into the database, as information could be inferred from such data relating to the hereditary characteristics of her father which might also apply to herself. It was revealed in the course of proceedings that extensive information concerning people's health is entered into medical records, e.g. medical treatment, life-style and social conditions, employment and family circumstances, together with a detailed identification of the person that the information concerns. It was recognised as unequivocal that the provisions of Paragraph 1 of Article 71 of the Constitution applied to such information and guaranteed to every person the right to protection of privacy in this respect. The Court concluded that the opinion of the District Court, which, inter alia, was based on the opinion of an assessor, to the effect that so-called one-way encryption could be carried out in such a secure manner that it would be virtually impossible to read the encrypted data, had not been refuted. It was noted, however, that Act No. 139/1998 provides no details as to what information from medical records is required to be encrypted in this manner prior to transfer into the database or whether certain information contained in the medical records will not be transferred into the database. The documents of the case indicate that only the identity number of the patient would be encrypted in the database, and that names, both those of the patient and his relatives, as well as the precise address, would be omitted. It is obvious that information on these items is not the only information appearing in the medical records which could, in certain cases, unequivocally identify the person concerned. Act No. 139/1998 also provides for authorisation to the licensee to process information from the medical records transferred into the database. The Act stipulates that certain specified public entities must approve procedures and process methods and monitor all queries and processing of information in the database. However, there is no clear definition of what type of queries will be directed to the database or in what form the replies to such queries will appear. The Court concluded that even though individual provisions of Act No 139/1998 repeatedly stipulate that health information in the Health Sector Database should be non-personally identifiable, it is far from adequately ensured under statutory law that this stated objective will be achieved. In light of the obligations imposed on the legislature by Paragraph 1 of Article 71 of the Constitution, the Court concluded that various forms of monitoring of the creation and, operation of the database are no substitute in this respect without foundation in definite statutory norms. In light of these circumstances, and taking into account the principles of Icelandic law concerning the confidentiality and protection of privacy, the Court concluded that the right of R in this matter must be recognised, and her court claims, therefore, upheld.

Databases, Factual↗

Cooperation of fuzzy segmentation operators for correction aliasing phenomenon in 3D color Doppler imaging.

The study described in this paper concerns natural object modeling in the context of uncertain, imprecise and inconsistent representation. We propose a fuzzy system which offers a global modeling of object properties such as color, shape, velocity, etc. This modeling makes a transition from a low level reasoning (pixel level), which implies a local precise but uncertain representation, to a high level reasoning (region level), inducing a certain assignment. So, we use fuzzy structured partitions characterizing these properties. At this level. each property will have its own global modeling. Then, these different models are merged for decision making. Our approach was tested with several applications. In particular, we show here its performance in the area of blood flow analysis from 3D color Doppler images in order to quantify and study the development of this flow. We present methods that detect and correct aliasing phenomenon, i.e. inconsistent information. At first, the flow space is partitioned into fuzzy sectors where each sector is defined by a center, an angle and a direction. In parallel, the velocity information carried by the pixels is classified into fuzzy classes. Then, by combining these two partitions, we obtain the velocity distribution into sectors. Moreover, for each found path (from the first sector to the last one), we locate and correct inconsistent velocities by applying global rules. After extracting some meaningful sector features, the fuzzy modeling, applied to the aliasing correction, makes it possible to simplify and synthesize the blood flow direction.

Blood Flow Velocity↗

Keeping nurses at work: a duration analysis.

A shortage of nurses is currently a problem in several countries, and an important question is therefore how one can increase the supply of nursing labour. In this paper, we focus on the issue of nurses leaving the public health sector by utilising a unique data set containing information on both the supply and demand side of the market. To describe the exit rate from the health sector we apply a semi-parametric hazard rate model. In the estimations, we correct for unobserved heterogeneity by both a parametric (Gamma) and a non-parametric approach. We find that both wages and working conditions have an impact on nurses' decision to quit. Furthermore, failing to correct for the fact that nurses' income partly consists of compensation for inconvenient working hours results in a considerable downward bias of the wage effect.

Adult↗