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PubMed2026

Precision medicine in mental health: applications, challenges, and recommendations.

Mental disorders represent a major and growing public health challenge in Europe and worldwide, characterised by marked clinical, biological, and functional heterogeneity, that limits the effectiveness of current diagnostic and therapeutic approaches. In recent years, advances in precision medicine have initiated a paradigm shift in psychiatry, offering new opportunities to improve prevention, prediction, diagnosis, treatment selection, and long-term management by integrating biological, psychological, social, and environmental information.This EPA Guidance Paper provides an overview of the current state of precision medicine in mental health and outlines its potential clinical, scientific, and policy implications. We review key advances in genomics, epigenetics, neuroimaging, transcriptomics, digital technologies, and artificial intelligence, highlighting their relevance across the full clinical pathway, from risk prediction and early detection to treatment personalisation and monitoring. We also examine major barriers to implementation, including limited biomarker validation, insufficient representativeness of research populations, ethical and regulatory challenges, data protection concerns, and inequalities in access across healthcare systems.Based on the available evidence, we propose strategic recommendations to support the responsible and equitable integration of precision approaches into mental health care in Europe. These include strengthening translational research, promoting multidisciplinary collaboration, updating regulatory and ethical frameworks, enhancing professional training, and prioritising mental health within national and European research and health agendas. By addressing these challenges, precision psychiatry has the potential to contribute to more effective, person-centred, and sustainable mental health care, while supporting innovation, reducing stigma, and improving outcomes for patients and society.

Humans↗
PubMed2004

Management systems response to improving immunization coverage in developing countries: a case study from Cambodia.

INTRODUCTION: In contrast to the initial success following the establishment of the National Immunization Program (NIP) in Cambodia in 1986, infant vaccination coverage rates against the six expanded program immunization diseases have not improved since 1995. In response, the NIP of the Ministry of Health has undertaken a series of institutional initiatives to address the problem of static or declining rates of coverage. The aim of this paper is to describe and assess management strategies undertaken by the NIP in Cambodia in support of improved immunization coverage. METHODS: Sources of information used in preparing this report include international literature, national coverage and surveillance data, government policy documentation, information generated by national strategic planning and health centre microplanning processes, a functional analysis of human resources, and data quality audits. RESULTS: The NIP has implemented planning, organizational development and human resource development responses to the problem of low coverage. These have included: integration of the nip strategic and operational plans into the health sector plan; strengthening of needs-based microplanning; establishment of a national monitoring and management support strategy; and the introduction of performance-based agreements between levels of government for improved immunization coverage. CONCLUSIONS: Our analysis of these findings, in particular of the international literature, suggests that NIP's responses have been appropriate, and that the development of NIP management systems and capacity will increase the likelihood for sustained immunization coverage gains within a reform environment of health system decentralization. In 2003, there are early signs that the reform processes undertaken by the NIP have resulted in improved immunization coverage in targeted areas, and this should place the national program in a stronger position to lift immunization coverage in 2004.

Journal Article↗
PubMed2004

Practitioners' attitudes toward the use of treatment progress and outcomes data in child mental health services.

This study focused on practitioners' attitudes toward child mental health services data collection and outcomes measurement in university-based and community-based clinics. It is relevant to the burgeoning field of empirically based mental health therapy management because it examines one potential barrier to psychotherapy and pharmacotherapy strategies (i.e., practitioners' attitudes toward outcomes measurement) that are informed by real-time, clinically relevant data. Two site differences were noted regarding the utility of specific questionnaires and the perceived burden of conducting outcomes measurement. At both sites, practitioners held positive attitudes about outcomes measurement. Compared with psychologists and other child mental health specialists, psychiatrists had less favorable attitudes toward outcomes evaluation. Practitioners who rated outcomes evaluation as more important also perceived less burden associated with such evaluation efforts. Increased understanding of the utility of systematic clinical data collection is more likely to occur in an organizational culture in which treatment progress and outcomes measurement is integral to clinical work.

Adult↗
PubMed1999

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

OBJECTIVE: To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. METHOD: Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. RESULTS: Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. CONCLUSION: The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

Australia↗
PubMed2002

Collaboration--a new IT-service in the next generation of regional health care networks.

During the past 10-15 years, Regional Health Care Networks have been established in many regions throughout the world. Regional Health Care Networks build on well-known techniques, methodologies and appropriate standards. Most of the European Countries have today set up IT strategic plans, with focus on establishment of Regional Health Care Networks. The benefits of having access to all relevant information are tremendous and provide a more cost-effective and coherent health service. By the rapid spread and use of Internet the technology have made it possible to interconnect all kinds of applications. The most experienced regions in Europe have joined a European project PICNIC to develop the Next Generation Regional Health Care Networks to support their new ways of providing health and social care. The previous generation of Regional Health Care Networks, developed in the past 10-15 years, supported the interconnection of applications by transfer of messages. This service will also continue to be one of the most important services in the future health care networks. Messaging is an effective means of integration of isolated high-specialised systems that only needs to exchange data. Tighter coupling may be desirable in some instances to avoid replicating the same functionality in several applications. In other words, certain services can be common and used by a number of applications instead of building that service inside each application. These common services are called middleware services. In PICNIC a new middleware Collaboration IT-service has been identified. This service allows the end users to perform real time clinical Collaboration, with exchange of text, structured data, voice and images.

Cooperative Behavior↗
PubMed1999

Public health nursing in children's protective services.

This article describes the development and integration of a Los Angeles County, Department of Health Services, Public Health Nursing (PHN) program within the local Children's Protective Services (CPS) agency to assist the Children's Social Workers (CSWs) with their legally mandated health case management services. It summarizes the unique health needs of children who enter protective services, and explains why CPS agencies often overwhelmed by an increasing number of cases and diminishing resources, have had difficulty providing necessary health care monitoring and oversight. Program evaluation data detailing PHN services during the first 2 years of program implementation gives valuable insight into their evolving role function within this new practice arena. Issues regarding the integration of disciplines, and the contribution of the PHNs to the CPS agency are discussed.

California↗
PubMed1991

New methods in cross-cultural psychiatry: psychiatric illness in Taiwan and the United States.

OBJECTIVE: Cross-cultural psychiatric research has suffered from many methodological shortcomings. To answer some of these shortcomings, the present study compared rates of psychiatric disorders in Taiwan and the United States by combining data from both countries into a single data set. METHOD: Results from large, community-based surveys in the United States and Taiwan, the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area survey and the Taiwan Psychiatric Epidemiological Project, were combined into a single data set. This integration of the data sets was possible because both surveys used the NIMH Diagnostic Interview Schedule to ascertain cases. The integrated data sets were then analyzed with identical algorithms to generate lifetime prevalence rates of psychiatric disorders according to DSM-III criteria for both the United States and Taiwan. RESULTS: Lifetime prevalence rates of psychiatric illness in Taiwan were generally lower than U.S. rates. The rates of any disorder were 21.56% in Taiwan and 35.55% in the United States (Z = 22.34, p less than 10(-109]. The rates of most specific disorders were lower in Taiwan, and none of the rates was higher in Taiwan. CONCLUSIONS: While a culturally determined response bias may have lowered the rates in Taiwan somewhat, the results appear to be valid. Implications for the future use of structured diagnostic interviews in cross-cultural research are discussed.

Algorithms↗
PubMedDate not supplied

[The Swiss gatekeeper system--a model for improving capacity development and economic effectiveness].

The German as well as the Swiss health care system are facing similar problems. However, in Switzerland different gatekeeper systems to improve the capacity and economic efficiency were successfully tried and tested. The main structures of gatekeeping are the HMO health centres and different GP systems. Central to this idea is the primary care physician functioning as a gatekeeper. He has to control the demands of medical services according to the patient's needs to fulfil integral, comprehensive and economic criteria. Although data processing has not yet been completed yet, first results show clear advantages of the gatekeeper system in respect of the costs and quality of health care compared with the customary Swiss health insurance. Although in Switzerland there are still relatively few persons insured according to the gatekeeper system, it is expected that particularly the family physician systems will expand considerably in the future. Reorganisation and rearrangements of the medical care providers are likely.

Adolescent↗
PubMed1995

Behavior assessment and cross-validation by surrogate measures in drug prevention research.

When used with more orthodox survey or interview techniques, surrogate measures can enhance a study's credibility. Presented is a case report which illustrates the viability of using a surrogate measure to cross-validate self-reports of alcohol consumption by members of a fraternity at a large Midwestern university. As federal authorities continue to scrutinize myriad ways to reduce the nation's health care burden drug abuse research will have an enhanced opportunity to justify its role in that movement. The historical reliance on self-report methods which lack supportive, corroborating evidence of behavior change may jeopardize preventive drug education's opportunity to play a more integral part in influencing health promotion policies.

Alcohol Drinking↗
PubMed2005

Health information systems in humanitarian emergencies.

Health information systems (HIS) in emergencies face a double dilemma: the information necessary to understand and respond to humanitarian crises must be timely and detailed, whereas the circumstances of these crises makes it challenging to collect it. Building on the technical work of the Health Metrics Network on HIS and starting with a systemic definition of HIS in emergencies, this paper reviews the various data-collection platforms in these contexts, looking at their respective contributions to providing what humanitarian actors need to know to target their intervention to where the needs really are. Although reporting or sampling errors are unavoidable, it is important to identify them and acknowledge the limitations inherent in generalizing data that were collected in highly heterogeneous environments. To perform well in emergencies, HIS require integration and participation. In spite of notable efforts to coordinate data collection and dissemination practices among humanitarian agencies, it is noted that coordination on the ground depends on the strengths and presence of a lead agency, often WHO, and on the commitment of humanitarian agencies to investing resources in data production. Poorly integrated HIS generate fragmented, incomplete and often contradictory statistics, a situation that leads to a misuse of numbers with negative consequences on humanitarian interventions. As a means to avoid confusion regarding humanitarian health statistics, this paper stresses the importance of submitting statistics to a rigorous and coordinated auditing process prior to their publication. The audit trail should describe the various steps of the data production chains both technically and operationally, and indicate the limits and assumptions under which each number can be used. Finally emphasis is placed on the ethical obligation for humanitarian agencies to ensure that the necessary safeguards on data are in place to protect the confidentiality of victims and minority groups in politically sensitive contexts.

Altruism↗
PubMed2001

Data sharing and dissemination strategies for fostering competition in health care.

OBJECTIVES: To introduce the concept of common models for data sharing and dissemination, highlight the current operational, technical, and political issues surrounding existing data sharing and dissemination initiatives in a health care market, and suggest an ideal model for future data initiatives. DATA SOURCES/STUDY SETTING: A literature review and case studies of existing data sharing and dissemination initiatives that promote the collection and use of comparative information on provider cost and quality. PRINCIPAL FINDINGS: Three broad types of common models for data sharing and dissemination have evolved over the past decade or so: (1) provider-initiated initiatives developed through collaboration among providers of health care; (2) purchaser-initiated activities driven by a coalition of purchasers; and (3) indirect collaboration-data-sharing initiatives between providers and purchasers with a significant facilitating or regulating role by a third group of stakeholders. The success of a data-sharing and dissemination strategy is determined by how the complex operational, technical, and political issues are addressed. General principles by which a health data initiative might abide include the following: standardized databases as the physical foundation, indicators that reflect the changing market; linkages between and across data sets for comprehensive and complete data; economic value; policy relevance; use of evolving technologies to collect, integrate, and disseminate data; and stakeholder support. CONCLUSIONS: Regulatory solutions alone will not overcome the complex political and technical challenges to data sharing and dissemination. The "ideal" model or process nurturing a market for health care information will incorporate compromise and negotiation to address the issues of data ownership and proprietary concerns, therefore securing the necessary political and financial support of the private sector.

Cooperative Behavior↗
PubMed2005

Integration of physiological and accelerometer data to improve physical activity assessment.

PURPOSE: Accurate measurement of physical activity (PA) is a prerequisite to determine dose-response relationships between activity and health. The combination of HR and accelerometers (ACC) holds promise for improving the accuracy of PA assessment, but it is unclear how currently proposed modeling techniques compare and to what extent different levels of individual calibration (IC) of HR influence monitoring accuracy. METHODS: A total of 10 men and women (25.8 +/- 3.4 yr, 1.70 +/- 0.1 m, 71.7 +/- 11.8 kg, 24.4 +/- 5.0 kg.m-2) were recruited for this study, in which IC of HR to PA energy expenditure (PAEE) during both arm crank and treadmill activity were available. Participants completed 6 h of free-living activity, during which PAEE (obtained with indirect calorimetry), HR, hip ACC, arm ACC, and leg ACC were collected. PAEE was then modeled from two different methods of combining HR and ACC (arm-leg HR+M and branched model), both with IC and group-level calibration (GC) of HR, and also from hip ACC estimates alone. Estimates of PAEE were compared with criterion values for PAEE. RESULTS: Combined estimates of PAEE from the arm-leg HR+M and the branched model were similar when IC was used (R2 = 0.81, SEE = 0.55 METs and R2 = 0.75, SEE = 0.61 METs, respectively). When using GC, all estimates of PAEE had larger error, but the performance of the branched model suffered less than the arm-leg HR+M model (R2 = 0.75, SEE = 0.67 METs and R2 = 0.67, SEE = 0.88 METs, respectively). Both combination modeling techniques were more precise than single-measure hip ACC estimates (R2 = 0.41, SEE = 0.96 METs). CONCLUSION: The combination of HR and ACC improves the accuracy of PAEE estimates and could be applied in large-scale epidemiological studies.

Acceleration↗
PubMedDate not supplied

[Home care for the diabetic within the limits of project--object: pilot project integrated into the health education of the diabetic. Veneto Region].

Twenty one district-nurses working in 13 districts were handed a questionnaire (one questionnaire for each patient), to collect data on nursing interventions and main problems of the 382 diabetic patients cared for. The diabetic patients are a very demanding population with a mean age of 78 years; 314 (82%) have a comorbidity, 272 (71%) severe limits on their physical functioning and 233 (61%) the diabetic foot; 183 patients (47%) are not capable of taking autonomous decisions. The nursing interventions for these patients are both technical (drawing blood samples, diagnostic exams) and educational on how to manage and monitor self-administration of insulin (31 patients, 10%), on self monitoring techniques (116 patients, 30%), on alimentation in general and change in food habits (289 patients, 94.1%). The role of the nurse in promoting patients' independence and in preventing complications is highlighted.

Activities of Daily Living↗
PubMed1998

Do IDSs really benefit from affiliating with managed care plans?

Integrated delivery systems (IDSs) affiliate with HMOs primarily to gain access to patients enrolled in managed care plans. Outright ownership of an HMO offers an IDS additional advantages, including opportunities to create a more seamless care process, improve patient outcomes, draw on the HMOs' experience in reducing costs, and administer health management and delivery at a significantly lower cost than the industry standard. The current trend toward IDS ownership of HMOs suggests that the line between providers and payers is blurring. Some states have encouraged this trend by enacting legislation that allows IDSs to act as insurers. Recent data indicate that IDSs with HMO components tend to be more vertically integrated than those without such components. These data suggest that close alignment with an HMO may be a key element in the effort to achieve vertical integration.

Delivery of Health Care, Integrated↗
PubMed2005

Using GIS-based approaches to support research on neurotoxicants and other children's environmental health threats.

Environmental threats to children's health are complex and multifaceted; consequently, children's environmental health research strives to identify areas of elevated exposure, determine whether particular demographic groups are inequitably exposed, and link exposures to incidence of disease. Many environmental health researchers use geographic information systems (GIS) to ex post display the results of their data collection and analysis. This methodological paper shows some ways by which the ex ante integration of GIS into environmental exposure and epidemiological research can significantly enhance: research design; sampling, recruitment, and retention strategies; data management and analysis; and community translation.

Child↗
PubMed1999

Variation in health care--the roles of the electronic medical record.

Variation in the use of clinical resources, outcomes, costs, access to health care and quality is a well recognized, ever present feature of health care. It is a phenomenon that affects all sectors of the health care delivery process and is important to clinicians, administrators and patients. As a phenomenon variation can be appropriate or inappropriate and the elimination of inappropriate variation is a fundamental principal behind continuous quality improvement in health care. The primary tools for the management of variation exists within the electronic medical record (EMR). The EMR utilizes the existing and evolving information storage technologies (data repositories) and information management tools (applications), to integrate the elements within this long-term data storage. Through this integration the EMR systems are able to provide knowledge representation in differing formats to the decision-makers and this will facilitate more accurate and appropriate decision-making with subsequent improvements in health care delivery.

Costs and Cost Analysis↗
PubMed1997

Statistical and study design issues in assessing the quality and outcomes of care in rheumatic diseases.

As we have pointed out in this article, a health care study should have a well-defined intent that is matched to the study type, population of interest, and outcome. Care must be taken to collect samples in a meaningful way, so that results can be generalized to larger populations. Outcomes must be selected carefully to ensure that they will be sensitive to the types of care being considered, and only a few main outcomes should be selected so as to preserve the level of statistical significance of the research results. Sample sizes should be sufficient to detect an effect of reasonable size, after accounting for attrition in longitudinal studies and rates of occurrence with dichotomous outcomes. If the study purpose is to compare multiple institutions or health care providers, statistical adjustments for case mix will generally be required. Outcome research is an expanding area of development for rheumatology care and for medical care in general. It offers the promise of the use of administrative data bases to answer questions that are important both to arthritis researchers and to consumers of rheumatology care. As with all areas of clinical research, we must maintain appropriate levels of statistical rigor to protect the integrity of the results. Inadequate attention to the design and analysis of data can compromise research results before a study even gets started, and health care research studies have as many potential statistical pitfalls as other types of clinical research.

Epidemiologic Studies↗
PubMed1982

Primary care, private physicians, and public health personnel: a conflict in expectations.

The elimination of categorical grants and their replacement by block grants provides public health departments the opportunity to integrate their services and provide general primary care to the underserved. While some may consider this an opportunity long overdue such a change may generate considerable conflict with private physicians. Questionnaire data from private physicians and health department personnel collected in North Carolina during an experimental program of primary care delivery by health department shows that there is substantial conflict. Private physicians oppose health department involvement in general primary care and in acute ambulatory care for the medically underserved. Physicians expect health departments to focus on preventive services, especially environmental monitoring and communicable disease control. Health department personnel want to expand their efforts beyond these more traditional areas into primary care and are in apparent conflict with private physicians. The community attitudes of a group of physicians within a community as well as the attitudes of a group of public health workers were found to be a major determinant of each individual's attitude toward public health, followed by the individual's age, sex, and years of working in the community.

Adult↗