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PubMed2006

Social capital and health: civic engagement, community size, and recall of health messages.

OBJECTIVES: We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. METHODS: With 1980-1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. RESULTS: A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. CONCLUSIONS: Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes.

Adult↗
PubMed1998

Substance use among nurses: differences between specialties.

OBJECTIVES: Valid data on factors that increase a health care worker's likelihood of substance use are integral in ensuring professional standards and quality health care for consumers. This study explored the association between nursing specialty and past-year substance use. METHODS: In an anonymous mailed survey, a balanced stratified sample of registered nurses (n = 4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking. RESULTS: Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.5, 8.2); oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR = 2.4; 95% CI = 1.6, 3.8). No specialty differences appeared for prescription-type drug use. CONCLUSIONS: Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by specialty, preventive initiatives should consider inter-disciplinary approaches to substance use education.

Adult↗
PubMed2004

U.S. Department of Veterans Affairs Enterprise Reference Terminology strategic overview.

The Veterans Health Affairs (VHA) branch of the Department of Veterans Affairs has undertaken an Enterprise Reference Terminology (ERT). VHA, arguably the largest integrated healthcare provider in the United States, has completely computerized virtually all clinical transactions, including physician orders and documentation. The VA is now integrating its clinical records across hundreds of sites of care by means of a Health Data Repository (HDR) project. ERT has been designed to provide a terminology development environment, terminology services, and maintenance services for the clinical and business content in HDR and other VHA applications. Drug, laboratory observations, and clinical document title files have been developed, and the ERT will encompass all HDR domains by 2008. Commercial tools are used to host the VHA's ERT terminology development and server environments. We will select and adopt both open-source and licensable terminology systems to provide ERT content, as well as reuse existing VA-specific terminology content.

Hospital Information Systems↗
PubMed1993

[Health promotion. Planning process of health promotion programs for individuals with arthritis].

Based on the health conception viewed from the literature on nursing and by the clients, health is defined as a living experience, or as a perception of wellness in this study. That is, it is the perceived wellness that the individual obtains by wholistically integrating all dimensions of health where ever the individual stands in the health continuum. Thus health exists independently, regardless of illness or disability, because the individual is able to perceive the wellness within limitations imposed to him/her. Also, based on the health conception defined in this study and the literature review on health promotion, health promotion is defined as the process of enhancing the perception of wellness (i.e., living experience), where ever the individual stands in the health continuum. Therefore, health promotive care represents the process of making client help himself to improve health experience/perception of wellness by selecting and/or integrating the individual or social health parameters (determinants) based on his reality. After analyzing the data which is provided from the related literature and the results from the descriptive/exploratory research on this group of clients, and then applying those analysis results to the PRECEDE model, planning process for health promotion program is established. However, as planning process is only based on data from literature in the first stage, it will be modified appropriately according to the assessment feedback from the direct participation of client in the following study. Based on the planning model refined through this assessment process, health promotion program is to be developed, implemented and evaluated. Planning process of health promotion for clients with arthritis is begun from the assessment of health outcome as the first phase. It is analyzed from this study that clients with arthritis indicates lower quality of life/satisfaction than the other groups from the several research findings indicate. In the second phase, according to the analysis results in the first phase, clients' health problems (perceived seriousness about illness, uncertainty in illness, helplessness, difficulty of movement), which affect the low quality of life, are identified and then program objective for each problem is demonstrated. As an objective for the perceived seriousness about illness, relief of the mistrust on the general effects of treatment for illness is determined through appropriate data analysis. And clients' accumulation of accurate knowledge on the nature of illness is determined as an objective, for reducing uncertainty in the illness. Also enhancement of distraction ability and self-efficacy perception is defined as objectives for reducing physical, psychological and social helplessness.(ABSTRACT TRUNCATED AT 400 WORDS)

Arthritis↗
PubMed2000

Technology architecture guidelines for a health care system.

Although the demand for use of information technology within the healthcare industry is intensifying, relatively little has been written about guidelines to optimize IT investments. A technology architecture is a set of guidelines for technology integration within an enterprise. The architecture is a critical tool in the effort to control information technology (IT) operating costs by constraining the number of technologies supported. A well-designed architecture is also an important aid to integrating disparate applications, data stores and networks. The authors led the development of a thorough, carefully designed technology architecture for a large and rapidly growing health care system. The purpose and design criteria are described, as well as the process for gaining consensus and disseminating the architecture. In addition, the processes for using, maintaining, and handling exceptions are described. The technology architecture is extremely valuable to health care organizations both in controlling costs and promoting integration.

Computer Systems↗
PubMed1999

A model for integrated home care of frail older patients: the Silver Network project. SILVERNET-HC Study Group.

Home care programs for the treatment of frail elderly have been developed in many countries around the world. In the Silver Network project all services are provided in an integrated fashion by one "single entry" center, differently from the traditional fee-for-service or not integrated systems. The delivery of health and social services for frail elderly individuals are integrated and coordinated by a case manager who uses a "second generation" assessment instrument, the Minimum Data Set for Home Care (MDS-HC). We describe the principal clinical and functional characteristics of nearly 1300 patients admitted between 1997 and 1998 to such an integrated home care program in eleven Italian Health Agencies. The database, derived from the serial MDS-HC assessments of each patient, provides a unique opportunity to delineate the different criteria for eligibility for home care, and compare the selected populations of the participating Health Agencies.

Aged↗
PubMed2001

Human exposure to endocrine disrupters: carcinogenic risk assessment.

Human exposure to endocrine disrupters (EDs) is widespread and is considered to pose a growing threat to human health. Recent advances in molecular and genetic research and better understanding of mechanisms of blastic cell transformation have led to efforts to improve cancer risk assessment for populations exposed to this family of xenobiotics. In risk assessment, low dose extrapolation of cancer incidence data from both experimental animals and epidemiology studies has been largely based on models assuming linear correlation at low doses, despite existence of evidence showing otherwise. Another weakness of ED risk assessment is poor exposure data in ecological studies. Those are frequently rough estimates derived from contaminated items of local food basket surveys. Polyhalogenated hydrocarbons are treated as examples. There is growing sense of urgency to develop a biologically based dose response model of cancer risk, integrating emerging data from molecular biology and epidemiology to provide more realistic data for risk assessors, public, public health managers and environmental issues administrators.

Carcinogens, Environmental↗
PubMed1999

Reengineering outcomes management: an integrated approach to managing data, systems, and processes.

The integration of outcomes management into organizational reengineering projects is often overlooked or marginalized in proportion to the entire project. Incorporation of an integrated outcomes management program strengthens the overall quality of reengineering projects and enhances their sustainability. This article presents a case study in which data, systems, and processes were reengineered to form an effective Outcomes Management program as a component of the organization's overall project. The authors describe eight steps to develop and monitor an integrated outcomes management program. An example of an integrated report format is included.

Attitude of Health Personnel↗
PubMed2005

How the national healthcare quality and disparities reports can catalyze quality improvement.

BACKGROUND: The purpose of the National Reports on Healthcare Quality and Disparities is to enhance awareness of quality and health care disparities, track progress, understand variations, and catalyze improvements in health care. OBJECTIVES: The objective of this paper is to propose a model that will facilitate a user's progression from knowledge to action and to show how the reports, its data warehouse, associated products, and Agency for Healthcare Research and Quality resources are integrated and focused on a comprehensive campaign to improve health care quality. DESIGN: The design of the paper is to present a conceptual model and to show how implementation strategies for the reports fit the model. FINDINGS: The authors propose a quality improvement supply chain model to help elucidate the links of the process, corresponding developmental stages that potential users need to master and progress through, and "just-in-time" supply chain inputs at each of the corresponding stages, and populate the model with examples. CONCLUSION: The traditional ways of disseminating knowledge derived from science through reports and conferences are inadequate to the humbling need for vast improvements in the US health care system. Our model suggests the need for a wide variety of information, packaged in a diverse ways, and delivered just in time and on demand. It encourages the alignment of decision makers and researchers, along with information intermediaries and innovation brokers, to make the information production cycle more efficient and effective. Future iterations of the reports will improve relevance, meaning, and distribution of information to facilitate its uptake by potential users.

Adolescent↗
PubMed1993

Medical imaging databases. A National Institutes of Health workshop.

Development and implementation of a medical imaging database in a PACS-type environment that integrates all the patient data will impact directly on the quality of patient care. In addition, access to the wealth of information that is simply not accessible through the current technology, will contribute to improved disease detection and improved patient treatment, as well as produce significant new medical knowledge. Research and implementations must proceed in interdisciplinary environments which successfully combine the expertise and knowledge from the medical community with that of the database and computer science disciplines.

Database Management Systems↗
PubMed2005

The sexual and reproductive health of young people in the Arab countries and Iran.

This article reviews the sexual and reproductive health situation of young people aged 10-24 in the Arab states and Iran, based on published and unpublished literature and interviews with 51 key informants working mostly in NGOs and international agencies in the region. There are few national government programmes addressing young people's sexual and reproductive health, with the exceptions of Tunisia and Iran, and a lack of population-based data to guide such programmes. Although the strong emphasis on the integrity and strength of the family unit has a protective effect, young people lack access to information. Education curricula that include these topics are rare and where they do exist, relevant sections are frequently skipped over by teachers, who are unprepared. Health service providers neither recognise the needs of this age group nor make young people welcome, particularly those who are unmarried. Increased education and employment mean the age at marriage is rising, but unprotected forms of marriage are also reported. Taboos surrounding discussion of sexuality remain a key constraint, and data on unwanted pregnancy and abortion, violence against women, and STIs/HIV/AIDS are limited. Building on NGO models and existing efforts, there is a need for the development of national programmes to support the well-being of young people in this region.

Adolescent↗
PubMedDate not supplied

What does Medicare pay for? Disentangling the flow of funds to health care providers.

Many Medicare policies pertain to only part of an expenditure category for which there are publicly available data. Integrating three types of data sources, this DataWatch disaggregates Medicare spending by type of provider. It also disaggregates payments to hospital outpatient departments by type of service. The results reveal a number of patterns obscured by more aggregate figures. For instance, although Medicare pays for most skilled nursing facility (SNF) services through Part A, Part B paid SNFs almost a billion dollars for rehabilitation services in fiscal year 1996. The recipients were not eligible for Part A SNF benefits but were residents of nursing homes.

Fee-for-Service Plans↗
PubMed1994

HERMES: a health care workstation integration architecture.

An architecture is described that facilitates integration of existing databases and applications without modifying them. By means of this architecture, data from different sources dispersed in a network can be combined and directly used in existing applications or applications that have been developed specially for integration. This feature of combining data from different sources into one workstation is viewed as the enabling technology on which computer-based patient records can be built. The abstraction of computer-, network- and application-specific details is completely dealt with by the integration architecture. This integration architecture has been developed with extendibility and flexibility in mind, and allows for a growth-path towards application of the open system paradigm in medicine.

Computer Communication Networks↗
PubMed1991

Integrating medical images into hospital information systems.

The effective delivery of health care has become increasingly dependent on a wide range of medical data that includes a variety of images. Manual and computer-based medical records ordinarily do not contain image data, leaving the physician to deal with a fragmented patient record widely scattered throughout the hospital. The Department of Veterans Affairs is currently installing a prototype hospital information system workstation network to demonstrate the feasibility of providing image management and communications functionality as an integral part of an existing hospital information system. The core of this system is a data base management system adapted to handle images as a new data type. A general model for this network-based integration is discussed and various alternative architectures are examined.

Database Management Systems↗
PubMedDate not supplied

Assessment of the integration of the ecological approach in health promotion programs.

PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Canada↗
PubMed1998

Health Care Fraud and Abuse Data Collection Program: reporting of final adverse actions--extension of comment period--OIG, HHS. Notice of proposed rulemaking; extension of comment period.

On October 30, 1998, we published a notice of proposed rulemaking designed to set forth the policy and procedures for implementing the new Healthcare Integrity and Protection Data Banks (HIPDB), in accordance with the statutory requirements of section 1128E of the Social Security Act, as added by section 221(a) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (63 FR 58341). We are extending the comment period at the request of several organizations.

Data Collection↗
PubMed2026

Re-emerging Marburg virus disease in Africa: spillover ecology, geographic expansion, and surveillance vulnerabilities.

Marburg virus disease (MVD) is re-emerging across Africa as a high-consequence zoonosis shaped by expanding ecological suitability, repeated spillover, and uneven surveillance capacity. This review synthesizes current evidence on the ecological, epidemiological, and operational determinants of contemporary Marburg virus (MARV) emergence. We conceptualize MVD as an ecological-emergence system produced by interactions among reservoir-host biology, environmental change, human exposure, health-system readiness, and mobility, rather than as a series of isolated outbreaks. Recent detections in multiple African regions indicate wider enzootic circulation than previously recognized and support repeated, reservoir-associated introductions from distributed ecological foci. Spillover risk is heightened where mining, land-use change, agricultural encroachment, settlement growth, climate-sensitive habitat disruption, and population movement increase contact with Egyptian rousette bats (Rousettus aegyptiacus) and contaminated roost environments. Following primary spillover, diagnostic delays, fragmented surveillance, limited laboratory decentralization, healthcare-associated transmission, and mobility-linked exposure can enable outbreak amplification and delayed recognition. Serological findings further suggest possible "shadow epidemiology," with unrecognized or mild MARV infections occurring outside confirmed outbreak chains. Critical preparedness gaps persist in ecological risk mapping, longitudinal reservoir surveillance, decentralized molecular diagnostics, genomic sequencing, data integration, and cross-border early warning. Future preparedness should move beyond reactive containment toward integrated One Health approach combining predictive ecological surveillance, rapid community-level detection, real-time genomics, infection prevention, risk communication, and regional coordination to identify spillover early and prevent human transmission.

Animals↗