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PubMed2003

A building an education infrastructure for allied health.

This article discusses the emerging education information infrastructure. It uses a five-part framework (aggregating, organizing, using, tool building, and policy making) to describe this infrastructure, then uses the same framework to argue for a tightly coupled education information infrastructure specifically for allied health. This tightly coupled education resource would allow educators, allied health professionals, and the general public to gain improved access to education resources on the Internet through metadata and digital reference services. Specific benefits of the building effort are discussed.

Allied Health Occupations↗
PubMed1995

Digital optical archiving of medical records in hospital information systems--a practical approach towards the computer-based patient record?

The large number of inpatients and outpatients in university hospitals leads to high costs of medical documentation and to an increasing number of medical documents. Due to legal regulations, these medical records have to be stored for 30 years. This implies spatial, organizational, and economical problems. At present, conventional archiving in hospitals often does not satisfy the need to make medical records available for health-care professionals in a systematic and timely manner. From 1989 to 1993 a pilot study on "digital optical archiving of medical records" was carried out at Heidelberg University Hospital. The study has shown the feasibility of digital optical archiving in hospital s if done under certain conditions. In 1995, Heidelberg University Hospital adopted a procedure for "digital optical archiving of medical records". The digital optical archive will first be filled with the medical records of the department of neurosurgery and the endoscopic and echographic images and reports of the department of internal medicine. It is to be expected that this procedure will gradually lead to an integrated functionality on health-care professional workstations, to a hospital-wide use of an electronic patient record, and to media-independent document management systems. The paper focuses on the potentials of digital optical archiving as an integral part of hospital information systems, and on the requirements for the systematic managements of hospital information systems with respect to digital optical archives.

Archives↗
PubMed1995

The relationship of health professional shortage areas to health status. Implications for health manpower policy.

OBJECTIVE: To compare the health status of adult residents of health professional shortage areas (HPSAs) with adult residents of non-HPSAs. DESIGN: A random-digit dialing telephone survey. Respondents were subsequently classified by their county of residence as residing in an HPSA or non-HPSA. PARTICIPANTS: A sample of 470 adults (18 years or older) living in Kentucky. MAIN OUTCOME MEASURES: Health status was measured by the Medical Outcomes Study 20-Item Short-Form Health Survey's six subscales. RESULTS: Controlling for demographic variables in the multiple regression analysis, there were significant differences between HPSAs and non-HPSAs for the social, mental health, and pain subscales. An interaction between age and HPSAs in relation to health status was observed for the physical, social, mental health, health perception, and pain subscales. After stratification by age (18 to 44 years, 45 to 64 years, or 65 years or older), HPSA-designated areas were associated with poorer health status in all but the youngest age strata. Elders in HPSAs had the poorest health status. CONCLUSIONS: Health professional shortage areas are associated with poorer health status in the older segments of the adult population. Future policy may need to focus on increasing access not only to primary care services but also to specific types of services that may promote better health status of elderly residents of HPSAs.

Adult↗
PubMed1996

Alcohol consumption among the elderly in a general population, Erie County, New York.

OBJECTIVES: Relatively few studies of drinking among the elderly have been completed despite the growing proportional representation of the elderly in the US population. This study sought to estimate the prevalence of and to observe whether active or health-oriented lifestyles are associated with heavy drinking among the elderly. METHODS: Random-digit dialing telephone interviews were conducted with 2325 Erie County, New York, general population residents aged 60 years or older. RESULTS: The prevalence of heavy drinking was 6%. Adjusted analyses showed positive associations between heavy drinking and being male, having suburban residency, and currently using cigarettes. Negative relationships were observed between heavy drinking and socioeconomic status, rural residency, and degree of health orientation. Age and level of active lifestyle were not significant contributors to the model. CONCLUSIONS: Of the studied variables, health orientation offers the greatest opportunity to address heavy drinking among the elderly.

Aged↗
PubMed1996

Effects of instruction on the knowledge, attitudes and beliefs of dental students towards digital radiography.

OBJECTIVE: To investigate the effects of a course of instruction in intraoral digital radiology on the knowledge, attitudes and beliefs of dental students. METHODS: A questionnaire was administered to dental students at two institutions with (UL) and without (MCG) formal instruction in digital dental radiology, investigating their understanding of the principles of digital radiography, their attitudes to its use in the near future, and on the timing and suitability of the topic in the undergraduate dental curriculum. Differences in the responses between preclinical and clinical students at the two institutions were statistically assessed. RESULTS: The overall response rate was 66% (277) with rates of 52% (103) at MCG and 76% (174) at UL. UL students knew significantly more about digital radiography but they also had some significant misconceptions and differed in their perception of its future role. Most students (93%) believed that digital radiography should be included in the curriculum or offered as an elective course. CONCLUSIONS: Dental students want digital radiology to be introduced into the dental radiology curriculum, regardless of whether it is examined or not. The teaching methods and content of such a course need careful consideration.

Attitude of Health Personnel↗
PubMed1996

Health care spending in 1994: slowest in decades.

Falling medical prices and slowing growth in private health insurance premiums diverted the spotlight from large-scale reform of the health care system in 1994. In aggregate, growth in health expenditures dropped to its lowest rate in more than thirty years. Even at this low rate, health spending grew faster than gross domestic product (GDP), but the economy easily absorbed these modest increases. In this picture of moderation, there was one disconcerting note: Medicare spending continued to increase at double-digit rates. Although Medicare's more rapid spending growth seems out of sync with the current modest health spending growth trends in the private sector, closer examination of factors accounting for growth in 1994 suggests that some difference is warranted.

Cost Control↗
PubMed2006

Factors associated with physical activity in Canadian adults with diabetes.

INTRODUCTION: The purpose of this study was to identify key demographic and health factors associated with physical activity (PA) participation in adults with type 1 or type 2 diabetes. METHODS: Participants were adults > or = 18 yr of age living in the province of Alberta, Canada who were previously diagnosed with type 1 (N = 697) or type 2 (N = 1614) diabetes. Individuals were recruited from the Canadian Diabetes Association (Alberta) registry and through a random digit-dialing protocol. Multiple and logistic regression models were employed to identify demographic and health factors related to PA levels, of which many to date have not been examined in this population. Analyses were conducted separately for type 1 and type 2 groups. RESULTS: Of those with type 1 and type 2 diabetes, 63.7 and 71.9%, respectively, were not achieving recommended PA levels. For those with type 1, higher PA levels were associated with a younger age, being single, higher income, lower level of perceived disability, and not smoking. For the type 2 group, a younger age, male gender, higher education, higher income, lower body mass index, and lower level of perceived disability were associated with higher PA levels. CONCLUSIONS: Many of our results for both diabetes types are consistent with findings from other limited research in this domain. Contrary to previous research, however, a significant negative relationship was reported between body mass index and PA for the type 2 group. In addition, perceived disability was negatively associated with PA, which, to date, has not been reported in the literature with type 2 individuals. Research and practice related to physical activity promotion for this population should take into account specific demographic and health factors associated with PA.

Alberta↗
PubMed1996

Information, consciousness, and health.

A 16-year empirical assessment of anomalous human/machine interactions provides strong evidence that consciousness can add information to otherwise random digital strings. A parallel program of remote perception studies establishes the inverse process: the anomalous acquisition of information about distant physical targets. Remarkably, neither of these extraordinary capabilities shows any dependence on either the distance or the time separating the participant from the target. The relevance of these consciousness abilities to human health follows from recognition that physiology entails myriad subtle information processes, all of which involve some degree of randomicity in their normal functions, and thus may be similarly influenced by conscious volition.

Consciousness↗
PubMedDate not supplied

Exposures and their determinants in radiographic film processing.

Radiographers process X-ray films using developer and fixer solutions that contain chemicals known to cause or exacerbate asthma. In a study in British Columbia, Canada, radiographers' personal exposures to glutaraldehyde (a constituent of the developer chemistry), acetic acid (a constituent of the fixer chemistry), and sulfur dioxide (a byproduct of sulfites, present in both developer and fixer solutions) were measured. Average full-shift exposures to glutaraldehyde, acetic acid, and sulfur dioxide were 0.0009 mg/m3, 0.09 mg/m3, and 0.08 mg/m3, respectively, all more than one order of magnitude lower than current occupational exposure limits. Local exhaust ventilation of the processing machines and use of silver recovery units lowered exposures, whereas the number of films processed per machine and the time spent near the machines increased exposures. Personnel in clinic facilities had higher exposures than those in hospitals. Private clinics were less likely to have local exhaust ventilation and silver recovery units. Their radiographers spent more time in the processor areas and processed more films per machine. Although exposures were low compared with exposure standards, there are good reasons to continue practices to minimize or eliminate exposures: glutaraldehyde and hydroquinone (present in the developer) are sensitizers; the levels at which health effects occur are not yet clearly established, but appear to be lower than current standards; and health effects resulting from the mixture of chemicals are not understood. Developments in digital imaging technology are making available options that do not involve wet-processing of photographic film and therefore could eliminate the use of developer and fixer chemicals altogether.

Acetic Acid↗
PubMedDate not supplied

Syndromic surveillance: hospital emergency department participation during the Kentucky Derby Festival.

INTRODUCTION: Electronic syndromic surveillance may have value in detecting emerging pathogens or a biological weapons release. Hospitals that have an agile process to evaluate chief complaints of patients seeking emergency care may be able to more quickly identify subtle changes in the community's health. An easily adaptable prototype system was developed to monitor emergency department patient visits during the Kentucky Derby Festival in Louisville, Kentucky, from April 16-May 14, 2002. Use of the system was continued during the same festival periods in 2003 and 2004. METHOD: Twelve area hospitals in Louisville, Kentucky, participated in a prospective analysis of the chief symptoms of patients who sought care in the emergency department during the Kentucky Derby Festival during 2002. Six hospitals were classified as computer record groups (CRG) and used their existing computerized record capabilities. The other 6 hospitals used a personal digital assistant (PDA) with customized software (PDA group). Data were evaluated by the health department epidemiologist using SaTScan, a modified version of a cancer cluster detection program, to look for clusters of cases above baseline over time and by Zip code. RESULTS: All 12 hospitals were able to collect and provide data elements during the study period. The 6 CRG hospitals were able to perform daily data transmission; however, 3 CRG hospitals were unable to interpret their data because it was transmitted in pure text format. In contrast, data from all 6 PDA group hospitals were interpretable. Real-time data analysis was compared with post-event data, and it was found that the real-time evaluation correctly identified no unusual disease activity during the study period. CONCLUSIONS: The 12 hospitals participating in this study demonstrated that community-wide surveillance using computerized data was possible and that the 6 study hospitals using a PDA could quickly interpret emergency department patients' chief complaints. The emergency department chief complaints group could serve as a disease sentinel for the community.

Bioterrorism↗
PubMed2006

Does sampling using random digit dialling really cost more than sampling from telephone directories: debunking the myths.

BACKGROUND: Computer assisted telephone interviewing (CATI) is widely used for health surveys. The advantages of CATI over face-to-face interviewing are timeliness and cost reduction to achieve the same sample size and geographical coverage. Two major CATI sampling procedures are used: sampling directly from the electronic white pages (EWP) telephone directory and list assisted random digit dialling (LA-RDD) sampling. EWP sampling covers telephone numbers of households listed in the printed white pages. LA-RDD sampling has a better coverage of households than EWP sampling but is considered to be more expensive due to interviewers dialling more out-of-scope numbers. METHODS: This study compared an EWP sample and a LA-RDD sample from the New South Wales Population Health Survey in 2003 on demographic profiles, health estimates, coefficients of variation in weights, design effects on estimates, and cost effectiveness, on the basis of achieving the same level of precision of estimates. RESULTS: The LA-RDD sample better represented the population than the EWP sample, with a coefficient of variation of weights of 1.03 for LA-RDD compared with 1.21 for EWP, and average design effects of 2.00 for LA-RDD compared with 2.38 for EWP. Also, a LA-RDD sample can save up to 14.2% in cost compared to an EWP sample to achieve the same precision for health estimates. CONCLUSION: A LA-RDD sample better represents the population, which potentially leads to reduced bias in health estimates, and rather than costing more than EWP actually costs less.

Adolescent↗
PubMed2003

Ambient intelligence in health care.

Ambient Intelligence (AmI) is a new paradigm in information technology, in which people are empowered through a digital environment that is aware of their presence and context, and is sensitive, adaptive, and responsive to their needs, habits, gestures and emotions. The most ambitious expression of AmI is Intelligent Mixed Reality (IMR), an evolution of traditional virtual reality environments. Using IMR, it is possible to integrate computer interfaces into the real environment, so that the user can interact with other individuals and with the environment itself in the most natural and intuitive way. How does the emergence of the AmI paradigm influence the future of health care? Using a scenario-based approach, this paper outlines the possible role of AmI in health care by focusing on both its technological and relational nature. In this sense, clinicians and health care providers that want to exploit AmI potential need a significant attention to technology, ergonomics, project management, human factors and organizational changes in the structure of the relevant health service.

Electronics↗
PubMed2002

Evidence for healing of periodontal defects 5 years after conventional and regenerative therapy: digital subtraction and bone level measurements.

OBJECTIVE: The aim of the present study was to compare radiographic assessment of bony fill by digital subtraction analyses (DSA) after periodontal surgery of infrabony and furcation defects with bone level measurements. METHODS: For 19 patients with 19 infrabony lesions and 20 degree II furcation defects, five defects were treated conventionally and 34 defects were treated by regenerative periodontal surgery. At baseline and 60 +/- 3 months after surgery, clinical measurements (GI, PPD, PAL-V, PAL-H, PlI) and standardized radiographs were obtained. Furthermore, intrasurgically after reflection of a mucoperiosteal flap and 60 months after surgery after local anesthesia without flap reflection, the distance from the cementoenamel junction (CEJ) to bottom of the bony defect (BD) was measured vertically (PBL-V) and, in furcation defects, horizontally (PBL-H). Pre- and postsurgical radiographs were analyzed by digital subtraction. Bone level gain and DSA results were compared by simple regression analysis. RESULTS: Surgical treatment revealed significant PPD reduction (- 3.45 +/- 1.56 mm; P < 0.001), PAL-V gain (2.84 +/- 1.36 mm; P < 0.001), and PBL-V gain (1.68 +/- 1.20 mm; P < 0.001) in infrabony defects, as well as PPD reduction (- 1.68 +/- 1.73 mm; P = 0.001) and PAL-H gain [1.43 +/- 1.70 mm (P = 0.001)] in furcation defects after 5 years. A correlation could be found in furcation defects between PBL-H gain and DSA (R2 = 0.34, P = 0.003), whereas the study failed to demonstrate a consistent correlation between PBL-V and DSA in infrabony defects (R2 = 0.12, P = 0.149). CONCLUSIONS: DSA correlates significantly with PBL-H measurements in furcation defects. Thus, either method is a sufficient tool to evaluate bony fill within furcation defects. On the other hand, DSA did not correlate significantly with PBL-V measurements in infrabony defects. This discrepant contribution of DSA in the evaluation of these two types of defects may be explained by the fact that DSA primarily evaluates change in a buccolingual direction.

Adult↗
PubMed2006

The relation of social isolation, loneliness, and social support to disease outcomes among the elderly.

OBJECTIVE: This study examined relations between social isolation, loneliness, and social support to health outcomes in a sample of New Mexico seniors. METHOD: We used random-digit dialing to obtain a random sample of 755 southern New Mexico seniors. Participants answered questions pertaining to demographics, social isolation and loneliness, social support, and disease diagnosis including diabetes, hypertension, heart disease, liver disease, arthritis, emphysema, tuberculosis, kidney disease, cancer, asthma, and stroke. The sample allowed for comparison of Caucasian and Hispanic participants. RESULTS: Correlational and logistic analyses indicated that belongingness support related most consistently to health outcomes. Ethnic subgroup analysis revealed similarities and differences in the pattern of associations among the predictor and outcome variables. DISCUSSION: The results demonstrate the importance of social variables for predicting disease outcomes in the elderly and across ethnic groups.

Aged↗
PubMed2001

Organ doses and subjective image quality of indirect digital panoramic radiography.

OBJECTIVES: To determine if slight variations in exposure will affect diagnostic image quality and absorbed radiation doses for digital and analogue panoramic radiography. METHODS: Thermoluminescent dosimeters were placed in the thyroid gland, eyes, submandibular glands, parotid glands and skin of two human cadaver heads. Three different exposure settings were used: 70 kV, 120 mAs; 77 kV, 75 mAs; and 81 kV, 60 mAs. Subjective image quality was assessed using a phantom head. Storage phosphor (SP) images were printed on film and both analogue and SP images were assessed for their subjective image quality on a five-point rating scale. The results were statistically analysed using logistic regression analysis and chi(2) tests. RESULTS: Highest organ doses were measured for the submandibular glands, followed by the parotid glands. Salivary gland doses tended to be higher at lower kV settings. Image quality was not statistically different for the different exposure settings. Imaging technique did not seem to influence diagnostic image quality, except for the periapical status of upper premolars where SP was better. The main reason for any differences appeared to be interobserver variation. CONCLUSIONS: Analogue and SP panoramic radiography performed equally well for subjective diagnostic image quality. No significant differences could be found at the exposure settings used in this study. Radiation doses were highest for the salivary glands, especially at lower kV settings.

Eye↗
PubMed2005

Radiographic alveolar bone change as an outcome measure for therapies that inhibit bone loss or foster bone gain.

Periodontal clinical trials rely on signs of gingival inflammation, periodontal probing methods, and intra-oral radiographic methods to measure outcomes of therapies that inhibit bone loss or foster bone gain. A single radiograph can provide information on the accumulation of past disease, and sequential radiographs can determine regeneration or progression of periodontal destruction. However, the precision achieved with a radiograph is associated with the actual exposure of the film and the subsequent analysis. A film exposed using standardized geometry and standardized processing has many advantages over non-standardized conventional film. If the patient population for a study is a small, selective group, or if one needs to identify the smallest amount of bone loss in the shortest time, standardized films may be used. Conversely, in a large-scale trial, the use of standardized films may prove to be impractical. Since the advent of personal computer-based image-processing workstations, digital-image analysis has also become a practical tool for clinical trials. Digital subtraction radiography is a highly precise and accurate technique for assessing bony changes associated with periodontal disease. Therefore, advanced digital-imaging systems may be more cost-effective in a clinical trial because the level of precision will have an effect on study length and sample size.

Alveolar Bone Loss↗
PubMed1997

The microprocessor and medicine.

Technology continues to accelerate at an amazing pace. Where have we been, where are we going, and what do these technology enhancements mean to the health care industry? We are entering the era of the personal computer becoming the window to the multimedia digital world of cyberspace. Microprocessors will continue to improve from one generation to the next to make cyberspace as realistic as possible-and with their improving capabilities will come myriad applications for health care services, either not cost-effective, or not even contemplated, until now. As a leader of an organization, one who approves substantial budgets for information technology, you must ask yourself what new products and services these startling technological advances will create. How will they change health and medical care?

Computer Communication Networks↗
PubMed2002

The impact of anthrax attacks on the American public.

CONTEXT: Incidents involving anthrax (Bacillus anthracis) through the mail in 4 metropolitan areas have raised concerns about the public's response nationally and locally. OBJECTIVE: To examine public response to these incidents and what it reveals about the demand placed on health professionals and public health officials nationally, in affected areas, and by affected people. DESIGN: Random-digit-dialed telephone surveys of samples of households nationally and in 3 specific metropolitan areas where cases of anthrax were reported: the District of Columbia; Trenton/Princeton, New Jersey; and Boca Raton, Florida. OUTCOME MEASURE: Respondents were asked a series of questions measuring their level of concern and their behavior in response to threats of anthrax and potential bioterrorist acts. RESULTS: The lives of a large share of people were affected in 3 metropolitan areas where anthrax incidents occurred. Residents of those 3 areas and people there who were affected by the incidents expressed a higher level of concern and took more precautions handling their mail. However, these incidents did not lead to great demands on the health system. CONCLUSIONS: The incidents of anthrax created anxieties, especially in areas where incidents occurred. There was some increased demand on the health system, but the demands were not large-scale. In the event of a major outbreak of disease, most Americans will rely heavily on their own physician for advice. Both national and local systems of population-based information gathering about the public's response to bioterrorist attacks are needed.

Adult↗