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PubMed1993

Effects of non-response on estimates derived from an oral health survey of older adults.

A major source of bias in health surveys is non-response on the part of those selected to take part in a study. In a survey of the oral health of older adults in Ontario, Canada, we used an initial telephone survey based on random digit dialing with a personal interview and clinical examination follow-up. The telephone survey was completed by 3033 individuals (78.0%) of those sampled. The follow-up was completed by only 907 (30.0%) of these subjects. Nevertheless, there were no major differences in the characteristics of those completing the telephone survey and those subsequently participating in the follow-up. Non-response bias analysis indicated that differences between crude and adjusted estimates of the prevalence of oral conditions were small and the effect of non-response on estimates of the relationship between socioeconomic status and oral health in this population were also small. These results indicate that response rates lower than those conventionally regarded as acceptable do not necessarily compromise the results of epidemiological studies.

Aged↗
PubMed2006

Web GIS in practice IV: publishing your health maps and connecting to remote WMS sources using the Open Source UMN MapServer and DM Solutions MapLab.

Open Source Web GIS software systems have reached a stage of maturity, sophistication, robustness and stability, and usability and user friendliness rivalling that of commercial, proprietary GIS and Web GIS server products. The Open Source Web GIS community is also actively embracing OGC (Open Geospatial Consortium) standards, including WMS (Web Map Service). WMS enables the creation of Web maps that have layers coming from multiple different remote servers/sources. In this article we present one easy to implement Web GIS server solution that is based on the Open Source University of Minnesota (UMN) MapServer. By following the accompanying step-by-step tutorial instructions, interested readers running mainstream Microsoft(R) Windows machines and with no prior technical experience in Web GIS or Internet map servers will be able to publish their own health maps on the Web and add to those maps additional layers retrieved from remote WMS servers. The 'digital Asia' and 2004 Indian Ocean tsunami experiences in using free Open Source Web GIS software are also briefly described.

Geographic Information Systems↗
PubMed2001

Effect of health messages about "Light" and "Ultra Light" cigarettes on beliefs and quitting intent.

OBJECTIVE: To test the impact of three health messages focusing on vent holes, sensory effects of Light and Ultra Light cigarettes, or health consequences of smoking, respectively, on beliefs and quitting intentions. DESIGN: In the course of a random digit dialed telephone survey, subjects were randomised to hear one of three messages. To test the effects of the messages, beliefs and quitting intentions were assessed both pre- and post-message. PARTICIPANTS: Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES: Beliefs were summarised on three dimensions: Safety (reduced health risk), Delivery (lower tar and nicotine delivery), and Sensation (less harsh). Quitting interest was captured by the "quit index", an aggregate measure of quitting interest and intent. RESULTS: The message focusing on smokers' sensory perceptions of Light and Ultra Light cigarettes resulted in the most positive change in beliefs about safety, delivery, and intent to quit, and was particularly effective among those who believed that these cigarettes were less harsh. The effect was most pronounced among young adults, and among smokers of Light and Ultra Light brands who most endorsed their sensory benefits. CONCLUSIONS: Addressing smokers' sensory experience that Light and Ultra Light cigarettes feel less harsh may be a promising strategy for changing their misconceptions about these cigarettes and enhancing their interest in quitting. Media counter-advertising on Lights and Ultra Lights, focusing on sensory aspects of these cigarettes, may be an important part of tobacco control efforts.

Adult↗
PubMed2002

Are rural residents and Hispanics less satisfied with medical care? Evidence from the Permian Basin.

Few population-based studies of consumers' perceptions of health care quality have included both rural residents and Hispanics. Using data collected through a random-digit telephone survey of households in the Permian Basin region of west Texas, an area with a relatively high percentage of Mexican Americans, we tested for rural/urban and ethnic differences in satisfaction with medical care. The study had several limitations, but the findings suggest that rural residents of this region rate the quality of their medical care overall more negatively than do their urban counterparts. No ethnic differences were found when controlling for demographic, social, economic, and health-status characteristics. Other factors, including part-time employment, a lack of continuous health insurance coverage, and poor health status appear to have a stronger, negative relationship with satisfaction. The collection and reporting of more specific measures of interpersonal and technical quality would further enable policy-makers, managers, and clinicians to better serve their patient populations.

Adult↗
PubMed2026

The European Health Data Space and the Secondary Use of Sensitive Health Data.

INTRODUCTION: The European Health Data Space (EHDS) is one of the European Union's most ambitious data-governance projects. It aims to create a common framework through which electronic health data can be accessed and reused across Member States for care, research, innovation, policy, and public-interest purposes. Its practical viability depends not only on digital infrastructure, but also on legal, ethical, and organisational harmonisation, particularly for genetic and genomic data. METHODS: This paper examines the EHDS with emphasis on the secondary use of health data. It reviews the EHDS institutional architecture, discusses Finland's Findata as a national model for structured access, and analyses challenges for data holders and data donors, including interoperability, governance burdens, privacy protection, residual re-identification risk, and genomic-data sensitivity. RESULTS: A cross-border cancer-genomics case study shows that the EHDS can streamline data discovery and the routing of access requests, but does not by itself eliminate legal fragmentation, heterogeneous ethics review, and consent-related barriers. DISCUSSION: Effective implementation will require harmonisation beyond infrastructure, including clearer consent standards, more consistent ethics procedures, interoperable metadata, and proportionate safeguards for genomic data.

Electronic Health Records↗
PubMed1992

PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects.

Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

Computer User Training↗
PubMed2006

Use of personal digital assistant devices in order to access, consult and apply a corpus of clinical guidelines and decision-based support documentation like the Italian SPREAD Guidelines on stroke disease.

During the past few years, personal digital assistants (PDAs) have become widespread commodities, like computers and mobile phones. Many health-care providers, particularly physicians, routinely use PDAs in their everyday work. Accessing guidelines and clinical decision-based support tools, such as the downloadable version of the Italian SPREAD Guidelines represents one of the most important and common clinical applications. The current experience suggests that the need for best evidence models at the time of decision making is strong and that portable accessibility is critical: including just-in-time information systems that allow physicians to retrieve the best evidence at the point of care, and a standardized electronic health record (EHR) easily integrating into daily practice and is affordable to most family physicians.

Computers, Handheld↗
PubMed2006

Using digital videos displayed on personal digital assistants (PDAs) to enhance patient education in clinical settings.

OBJECTIVES: To evaluate the effects of using an audiovisual animation (i.e., digital video) displayed on a personal digital assistant (PDA) for patient education in a clinical setting. METHODS: Quasi-experimental study of a prospective technology intervention conducted in an outpatient infectious diseases clinic at an academic medical center. Subjects responded to questions immediately before, immediately after, and 4-6 weeks after watching a digital video on a PDA. Outcome measures include participant knowledge of disease, knowledge of medications, and knowledge of adherence behaviors; attitudes toward the video and PDA; self-reported adherence; and practicality of the intervention. RESULTS: Fifty-one English-speaking adults who were initiating or taking medications for the treatment of HIV/AIDS participated in the study. At visit one, statistically significant improvements in knowledge of disease (p<0.005; paired t-test), knowledge of medications (p<0.005; paired t-test), and knowledge of adherence behaviors (p<0.05; ANOVA) were measured after participants watched the PDA-based video. At visit two (4-6 weeks later), statistically significant improvements in self-reported adherence to the medication regimens (p<0.005; paired t-test) were reported. Participants liked the PDA-based video and indicated that it was an appropriate medium for learning, regardless of their baseline literacy skills. The video education process was estimated to take 25 min of participant time and was viewed in both private and semi-private locations. CONCLUSIONS: Technology-assisted education using a digital video delivered via PDA is a convenient and potentially powerful way to deliver health messages. The intervention was implemented efficiently with participants of a variety of ages and educational levels, and in a range of locations within clinical environments. Additional study of this methodology is warranted.

Adult↗
PubMed2002

Distribution of serum prostate-specific antigen in healthy Korean men: influence of ethnicity.

OBJECTIVES: To evaluate the normal distribution of serum prostate-specific antigen (PSA) levels in healthy Korean men. The subjects included men younger than 40 years of age, because information on serum PSA levels in younger men is scarce. METHODS: Between January 1997 and December 1998, the serum PSA levels of the subjects who visited our hospital for a routine health checkup were determined. All men who were older than 50 years with abnormal digital rectal examination findings and/or an abnormal serum PSA level (greater than 4.0 ng/mL) underwent transrectal ultrasound-guided sextant biopsy. Two men who were found to have cancer were excluded from the analysis. The detection rate of prostate cancer for men with abnormal digital rectal examination findings and/or an abnormal serum PSA level was 2.0% for men 50 to 59 years old; 0.0% for men 60 to 69 years old; and 11.1% for men 70 to 79 years old. A total of 8297 men (aged 20 to 79 years) were included in the study. RESULTS: The median serum PSA level (5th to 95th percentile range) was 0.90 ng/mL (0.33 to 2.25) for men 20 to 29 years old; 0.89 ng/mL (0.30 to 2.35) for men 30 to 39 years old; 0.89 ng/mL (0.30 to 2.36) for men 40 to 49 years old; 0.96 ng/mL (0.32 to 2.96) for men 50 to 59 years old; 1.22 ng/mL (0.33 to 3.78) for men 60 to 69 years old; and 1.25 ng/mL (0.30 to 7.49) for men 70 to 79 years old. The median and 95th percentile serum PSA levels of Korean men younger than 50 years were higher, but those for men 50 years old or older were lower than in other races. In our study cohort, the serum PSA level weakly correlated with age (r = 0.088, P <0.001). The serum PSA level weakly correlated with age in men 50 years old or older (r = 0.116, P <0.001) but in men younger than 50 years, it did not correlate (r = 0.000, P = 0.987). CONCLUSIONS: These results suggest that the distribution and cutoff value of the serum PSA level in Korean men differ from those in other races. In addition, our findings raise the question of whether lowering the PSA cutoff may enhance the detection of cancer in this population with low prostate cancer rates.

Age Distribution↗
PubMed2001

A national survey of stress reactions after the September 11, 2001, terrorist attacks.

BACKGROUND: People who are not present at a traumatic event may also experience stress reactions. We assessed the immediate mental health effects of the terrorist attacks on September 11, 2001. METHODS: Using random-digit dialing three to five days after September 11, we interviewed a nationally representative sample of 569 U.S. adults about their reactions to the terrorist attacks and their perceptions of their children's reactions. RESULTS: Forty-four percent of the adults reported one or more substantial stress symptoms; 91 percent had one or more symptoms to at least some degree. Respondents throughout the country reported stress syndromes. They coped by talking with others (98 percent), turning to religion (90 percent), participating in group activities (60 percent), and making donations (36 percent). Eighty-five percent of parents reported that they or other adults in the household had talked to their children about the attacks for an hour or more; 34 percent restricted their children's television viewing. Thirty-five percent of children had one or more stress symptoms, and 47 percent were worried about their own safety or the safety of loved ones. CONCLUSIONS: After the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. Even clinicians who practice in regions that are far from the recent attacks should be prepared to assist people with trauma-related symptoms of stress.

Adaptation, Psychological↗
PubMed2005

Use and Impact of eHealth System by Low-income Women With Breast Cancer.

This article is the second of a two-part series reporting on a population-based study intended to use an eHealth system to examine the feasibility of reaching underserved women with breast cancer (Gustafson, McTavish et al., Reducing the digital divide for low-income women with breast cancer, 2004; Madison Center for Health Systems Research and Analysis, University of Wisconsin; Comprehensive Health Enhancement Support System [CHESS]) and determine how they use the system and what impact it had on them. Participants included women recently diagnosed with breast cancer whose income was at or below 250% of poverty level and were living in rural Wisconsin (n = 144; all Caucasian) or Detroit (n = 85; all African American). Because this was a population-based study all 229 participants received CHESS. A comparison group of patients (n = 51) with similar demographics was drawn from a separate recently completed randomized clinical trial. Use rates (e.g., frequency and length of use as well as type of use) as well as impact on several dimensions of quality of life and participation in health care are reported. Low-income subjects in this study logged on and spent more time on CHESS than more affluent women in a previous study. Urban African Americans used information and analysis services more and communication services less than rural Caucasians. When all low-income women from this study are combined and compared with a low-income control group from another study, the CHESS group was superior to that control group in 4 of 8 outcome variables at both statistically and practically significant levels (social support, negative emotions, participation in health care, and information competence). When African Americans and Caucasians are separated the control group's sample size becomes 30 and 21 thus reducing power. Statistical significance is retained, however, in all four outcomes for Caucasians and in two of four for African Americans. Practical significance is retained for all four outcomes. We conclude that an eHealth system like CHESS will be used extensively and have a positive impact on low-income women with breast cancer.

Breast Neoplasms↗
PubMed1996

Case-control study of endogenous steroid hormones and endometrial cancer.

BACKGROUND: It has been suggested that identified risk factors for endometrial cancer operate through a single etiologic pathway, i.e., exposure to relatively high levels of unopposed estrogen (estrogen in the absence of progestins). Only a few studies, however, have addressed this issue directly. PURPOSE: We assessed the risk of developing endometrial cancer among both premenopausal and postmenopausal women in relation to the circulating levels of steroid hormones and sex hormone-binding globulin (SHBG). The independent effect of hormones was assessed after adjustment for other known risk factors. METHODS: The data used in the analysis are from a case-control study conducted in five geographic regions in the United States. Incident cases were newly diagnosed during the period from June 1, 1987, through May 15, 1990. The case patients, aged 20-74 years, were matched to control subjects by age, race, and geographic region. The community control subjects were obtained by random-digit-dialing procedures (for subjects 20-64 years old) and from files of the Health Care Financing Administration (for subjects > or = 65 years old). Additional control subjects who were having a hysterectomy performed for benign conditions were obtained from the participating centers. Women reporting use of exogenous estrogens or oral contraceptives within 6 months of interview were excluded, resulting in 68 case patients and 107 control subjects among premenopausal women and 208 case patients and 209 control subjects among postmenopausal women. The hormone analyses were performed on blood samples obtained from case patients or from hysterectomy control subjects before surgery. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by use of an unconditional logistic regression analysis after we controlled for matching variables and potential confounders. All P values were two-sided. RESULTS: High circulating levels of androstenedione were associated with 3.6-fold and 2.8-fold increased risks among premenopausal and postmenopausal women, respectively, after adjustment for other factors (P for trend = .01 and < .001, respectively). Risks related to other hormone fractions varied by menopausal status. Among postmenopausal women, a reduced risk was associated with high SHBG levels and persisted after adjustment was made for obesity and other factors (OR = 0.51; 95% CI = 0.27-0.95). High estrone levels were associated with increased risk (OR = 3.8; 95% CI = 2.2-6.6), although adjustment for other risk factors (particularly body mass index) diminished the effect (OR = 2.2; 95% CI = 1.2-4.4). Albumin-bound estradiol (E2), a marker of the bioavailable fraction, also remained an important risk factor after adjustment was made for other factors (OR = 2.0; 95% CI = 1.0-3.9). In contrast, high concentrations of total, free, and albumin-bound E2 were unrelated to increased risk in premenopausal women. In both premenopausal and postmenopausal groups, risks associated with obesity and fat distribution were not affected by adjustment for hormones. CONCLUSION: High endogenous levels of unopposed estrogen are related to increased risk of endometrial cancer, but their independence from other risk factors is inconsistent with being a common underlying biologic pathway through which all risk factors for endometrial cancer operate. IMPLICATIONS: Further research should focus on alternative endocrinologic mechanisms for risk associated with obesity and body fat distribution and for the biologic relevance of the increased risk associated with androstenedione in both premenopausal and postmenopausal disease.

Adult↗
PubMed2005

Influence of strategic direction for NHS Scotland knowledge services on indexing policy for the NHS Scotland e-library.

OBJECTIVES: Indexing policy for the NHS Scotland e-Library needs to maximize future inter-operability with other significant health- and social-care-related resources. The strategic drive towards integration and partnership working means that the indexing system has to be widely acceptable to the full range of disciplines within the integrated health-care family. METHODS: Indexes identified by various means and then shortlisted using predefined criteria. RESULTS: Three subject indexes have been chosen--Medical Subject Headings (MeSH), CareData and the Government Category List (GCL), plus mapping between natural language and MeSH terms. This decision was a reasonable compromise between the strategy-driven aim of seamless access for all 'partners in care', and practical constraints of time/manpower. Other authority files (e.g. geographical area, language) are also standards based, and customised to reflect the information needs of an increasingly integrated health-care system. CONCLUSIONS: No single index could provide the scope required to meet the widening range of NHS information need. The influence of high-level strategic aims and objectives have extended their reach to influence indexing policy for the e-Library. Our indexing policy will continue to evolve and contribute to a knowledge management infrastructure capable of supporting current and future NHS Scotland information needs and strategy. Layperson terminology was identified as a gap; additional measures to address this gap are highlighted.

Abstracting and Indexing↗
PubMed2004

Unsupervised firearm handling by California adolescents.

OBJECTIVE: Relatively little is known about the behavior of adolescents around firearms. The present investigation was undertaken to estimate the proportion of community-residing adolescents who report that they have ever handled a gun without adult knowledge or supervision. METHODS: A random digit dial interview was conducted with 5801 California adolescents as part of the California Health Interview Survey. Respondents were asked whether they have ever held a gun and whether they have ever done so without adult knowledge or supervision. Study design and population weights were applied to these data. In addition, adolescents' reports about the most recent unsupervised handling incident were coded to ascertain what they were doing with the gun as well as with whom and where the incident occurred. RESULTS: One third (33%) of California adolescents report that they have handled a firearm; 5% report that they have done so without adult knowledge or supervision. Half (49%) of all unsupervised handling involved shooting and only 11% occurred in the respondent's home. Several demographic variables (being male, African American, living in a rural area) and risk behaviors (smoking, drinking, being the victim of a gun related threat), as well as having a gun in the home and parents not knowing the adolescent's whereabouts in the afternoon were each associated with unsupervised gun handling. CONCLUSIONS: Unsupervised gun handling is associated with other health risk behaviors. Unsupervised gun handling typically involves shooting the gun and usually occurs with friends, away from the home.

Accidents, Home↗
PubMed2000

The clinical significance of the digital patient record.

BACKGROUND: Computer technology has revolutionized the way the world does business, allowing us to work faster, smarter and more efficiently than ever before. Computers first made their way into the dental office in the late 1960s as an accounts receivable device. Today, we can digitize anything and recall it in the operatory with the patient. CLINICAL IMPLICATIONS: This article discusses new trends in the digital patient record and the benefits this technology provides to the dental team in terms of improved data collection and recording. It also discusses the benefits a digital patient record provides to patients, as well as how to communicate patients' oral health needs using these electronic tools.

Communication↗
PubMed1987

Some problems in the analysis of hospital in-patients morbidity statistics--on the usefulness of rank distribution of morbidity.

Though the application of the hospital morbidity is very limited due mainly to the biasing aspect of the data, some important uses can be made by formulating a norm of hospital disease pattern in investigating the deviation of a hospital's patients morbidity or in time-series analysis of such morbidity. A most feasible way of establishing a representative norm of inpatients morbidity from the hospital statistics is to use the modal rank distribution of disease categories according to the magnitude of its relative proportion. The level of classification recommendable for this purpose is the three-digits code disease categories listed in International Classification of Disease (the latest edition), World Health Organization. The distribution of disease in the ordered ranks demonstrated a high degree of consistency in both intra and inter hospital comparison with rank correlation reaching the level of as high as 0.99.

Health Surveys↗
PubMed1999

Plantar dermatoglyphic features of the Urhobos of southern Nigeria.

OBJECTIVE: To establish the dermatoglyphic features of the Urhobos of southern Nigeria. DESIGN: Cross sectional study of randomly selected Urhobo subjects. SETTING: Department of Anatomy, College of Health Sciences, University of Port Harcourt, Port Harcourt, southern Nigeria. MAIN OUTCOME: Plantar and digital pattern types were determined and Dankmeijer's (DI) and pattern intensity (PII) indices were calculated. RESULTS: Males showed greater pattern types than females except in loops and whorls of the digits, where females showed greater numbers than males. The pattern intensity index was higher in females than in males. What appears characteristic to this group however, was the presence of few whorl distribution in the small toe in female subjects which was absent in male subjects. CONCLUSION: This study thus provide normal dermatoglyphic features for the Urhobos of Southern Nigeria and also highlighted possible distinguishing dermtoglyphic difference between the Ibos and Urhobos of Southern Nigeria.

Adolescent↗
PubMedDate not supplied

Paving the way for electronic medical records.

This article explores the reasons why electronic medical records have not become widely deployed in the health care industry. Y2K moved to center stage and fears of computer meltdowns became the single greatest obstacle to overcome before considering new technology possibilities. Almost every other information technology initiative in health care was delayed or suspended, while the issues of compatibility with four-digit dates were examined. Finding systems and devices that weren't Y2K compliant and replacing or working around their deficiencies left precious few resources available for other tasks. Another issue is standardization. The potential and promise of electronic records can only be realized if a standard way to describe clinical information can be agreed upon and implemented in practice situations. Clients have been reluctant to purchase electronic records while vendors are offering nonstandard solutions. Obstacles and benefits to implementing EMR systems are outlined. Despite some of the barriers to implementing EMRs, the future is bright for their widespread deployment.

Attitude to Computers↗