HMOs and health services research: the penalty of taking the lead.
Explore the source record for details and available documents.
Consumer Behavior↗
SEARCH · Search PubMed
Results for “Health data integration”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Occupational health care for the 21st century: from health at work to workers' health.
A survey of relevant national and international legislation and recommendations on occupational health (OH) organization revealed two fundamental approaches to OH: 1) the historically older labor approach, essentially seeing OH care as an obligation of the employer derived from the labor contract, and 2) an emerging health approach, including all workers and all aspects of health, A draft decree on OH in Flanders seeks to integrate the two approaches. It extends the scope of OH to all workers (not only employees), introduces holistic health surveillance, rejects the incapacity concept, provides for strong integration of health and workplace surveillance, and stresses ethics. Workers' satisfaction is seen as the first criterion in quality control. Systematic data collection and analysis, and when necessary, scientific research are recommended. Additional resources for OH services should be provided by stakeholders other than employers.
Accidents, Occupational↗
National environmental public health tracking program: bridging the information gap.
In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program's academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.
Centers for Disease Control and Prevention, U.S.↗
Hospitals in the year 2000: a scenario.
Hospitals came into the twentieth century as creations of local, usually altruistic, interests and wrestled with accelerating change throughout the decades. Their success brought third-party financing, employee health plans, and government guarantees for charity care. Success seemed to breed success, and they raced ahead with capital investment in bricks, mortar, and high technology, only to find themselves in increasing trouble as 1990 approached. Writing from the precarious perch of the year 2000, the author views the worsening hospital situation and raises questions about the contradictions of federal interventions, the efforts to create "systems," the plight of small hospitals, and the love-hate role of medical staffs. Offered for consideration is a scenario of a health care crisis in the early 1990s comparable to the savings and loan crisis of 1988. However, this time the federal intervention is not simply in dollars, but, instead, brings on a "health for all" program with national financing and decentralized "district health" management. As in other nations of the world, hospitals become an integral part of the commitment to attack the root causes of ill health.
Data Collection↗
Legal issues: office management practices.
Student health records, whether paper or electronic, are restricted and protected to a greater degree than are educational records. Some school health office software is designed to provide greater data protection than is possible in paper records. However, unless basic district and health office practices are established to prevent access to or corruption of electronic health data, technological safeguards will be useless. This article describes school and health office policies and practices that are necessary for the integrity, confidentiality, and security of student health information.
Child↗
Integrated index of occupational exposure to cadmium as a predictor of kidney dysfunction.
In a study carried out in an alkaline battery factory, the study group consisted of 141 factory workers exposed to cadmium, while 206 workers in the textile industry constituted the control group. Cadmium in blood (Cd-B), cadmium in urine (Cd-U) as well as beta 2-microglobulin and retinol-binding protein (RBP) in urine were determined. Exposure to cadmium in the factory was high. In 1988, Cd-B concentrations in different departments averaged 11.2-29.9 micrograms/l. To evaluate the admissible period of occupational exposure to cadmium, an integrated exposure index [Cd-B (micrograms/l) x years of exposure] is proposed. According to the dose-response relationship, an increase in low molecular weight protein excretion in urine can be expected in 10% of subjects at an integrated exposure index of about 300 micrograms/l x years of exposure. The data obtained confirmed the validity of the recommended health-based limits for occupational exposure of 10 micrograms/l and 10 micrograms/g creatinine for Cd-B and Cd-U respectively.
Adult↗
Defining needs-based urban health planning areas is feasible and desirable: a population-based approach in Toronto, Ontario.
Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.
Catchment Area, Health↗
How accurate is information that patients contribute to their Electronic Health Record?
Increased patient interaction with medical records and the advent of personal health records (PHRs) may increase patients' ability to contribute valid information to their Electronic Medical Record (EHR) medical record. Patient input through a secure connection, whether it be a patient portal or PHR, will integrate many aspects of a patient's health and may help lessen the information gap between patients and providers. Patient reported data should be considered a viable method of enhancing documentation but will not likely be as complete and accurate as more comprehensive data-exchange between providers.
Ambulatory Care↗
Integration of Web-based and PC-based clinical research databases.
UNLABELLED: We have created a Web-based repository or data library of information about measurement instruments used in studies of multi-factorial geriatric health conditions (the Geriatrics Research Instrument Library - GRIL) based upon existing features of two separate clinical study data management systems. GRIL allows browsing, searching, and selecting measurement instruments based upon criteria such as keywords and areas of applicability. Measurement instruments selected can be printed and/or included in an automatically generated standalone microcomputer database application, which can be downloaded by investigators for use in data collection and data management. METHODS: Integration of database applications requires the creation of a common semantic model, and mapping from each system to this model. Various database schema conflicts at the table and attribute level must be identified and resolved prior to integration. Using a conflict taxonomy and a mapping schema facilitates this process. RESULTS: Critical conflicts at the table level that required resolution included name and relationship differences. CONCLUSIONS: A major benefit of integration efforts is the sharing of features and cross-fertilization of applications created for similar purposes in different operating environments. Integration of applications mandates some degree of metadata model unification.
Aged↗
Exploring the role of complementary and alternative medicine in public health practice and training.
OBJECTIVES: Consumer use of complementary and alternative medicine (CAM) in the United States continues to expand. Although conventional medicine has responded actively, the response from public health has been far less pronounced. To examine the potential for integrating CAM into public health contexts, an exploratory survey was conducted. DESIGN: A 19-item, self-administered survey instrument was used to collect participant data. SETTINGS/LOCATION: Participants were surveyed at the 2003 American Public Health Association (APHA) annual meeting while attending CAM-related talks sponsored by the Alternative and Complementary Health Practices Special Interest Group (ACHP SPIG). SUBJECTS: A convenience sample of 153 individuals was surveyed, which was predominantly female (81%) and Caucasian (68%), with an average age of 42 years. OUTCOME MEASURES: The survey instrument included items about participant and client demographics, participant use of CAM (personal and professional), perceived client interest in CAM, and several attitude measures. RESULTS: The majority of participants (64%) were currently employed as public health professionals working in a wide variety of settings with highly diverse populations. Personal use of CAM was high (66% using four or more modalities). The majority also reported integrating CAM into work settings. There was a significant relationship between personal and professional use of CAM. Participants overwhelmingly agreed that more professional training in this area was needed. CONCLUSIONS: This exploratory study provides insight into the potential role of CAM as an important resource in public health settings. Additional funding and research in this area is urgently needed.
Adult↗
Web-based health care agents; the case of reminders and todos, too (R2Do2).
This paper describes efforts to develop and field an agent-based, healthcare middleware framework that securely connects practice rule sets to patient records to anticipate health todo items and to remind and alert users about these items over the web. Reminders and todos, too (R2Do2) is an example of merging data- and document-centric architectures, and of integrating agents into patient-provider collaboration environments. A test of this capability verifies that R2Do2 is progressing toward its two goals: (1) an open standards framework for middleware in the healthcare field; and (2) an implementation of the 'principle of optimality' to derive the best possible health plans for each user. This paper concludes with lessons learned to date.
Artificial Intelligence↗
Clinical training in complementary therapies for the 21st century.
Over the past 6 years an innovative portfolio of degree courses in complementary therapies has been developed at the University of Westminster. In 1996, when the first three courses of the BSc Scheme were validated, the high-quality clinical experience needed to consolidate the academic and practical skills was planned. The opening of the unique multidisciplinary Polyclinic in 1998 marked the beginning of an exciting clinical training and research dimension to the University's complementary therapies provision. The Polyclinic represents a unique opportunity for integrated medicine, not only with other healthcare professionals but also between complementary therapies. The rationale for the creation of the Polyclinic is discussed. The development of the integrated medicine theme of the Complementary Therapies Scheme and its consolidation within the clinical experience for the students is described. The further enrichment of the students' clinical experience with placements in other healthcare settings is also described. The development of the clinical provision is discussed including clinical governance, the management structures, and influence of nursing and midwifery, introduction of supervision for the clinic tutors, data collection and plans for the future.
Complementary Therapies↗
IT-based diagnostic instrumentation systems for personalized healthcare services.
This paper describes recent research and development activities on the diagnostic instruments for personalized healthcare services in Seoul National University. Utilizing the state-of-the-art information technologies (IT), various diagnostic medical instruments have been integrated into a personal wearable device and a home telehealthcare system. We developed a wrist-worn integrated health monitoring device (WIHMD) which performs the measurements of non-invasive blood pressure (NIBP), pulse oximetry (SpO2), electrocardiogram (ECG), respiration rate, heart rate, and body surface temperature and the detection of falls to determine the onset of emergency situation. The WIHMD also analyzes the acquired bio-signals and transmits the resultant data to a healthcare service center through a commercial cellular phone. Two different kinds of IT-based blood glucometer have been developed using a cellular phone and PDA(personal digital assistant) as a main unit. A blood glucometer was also integrated within a wrist pressure measurement module which is interfaced with a cellular phone via Telecommunications Technology Association (TTA) standard in order to provide users with easiness in measuring and handling two important health parameters. Non-intrusive bio-signal measurement systems were developed for the ease of home use. One can measure his ECG on a bed while he is sleeping; measure his ECG, body temperature, bodyfat ratio and weight on a toilet seat; measure his ECG on a chair; and estimate the degree of activity by motion analysis using a camera. Another integrated diagnostic system for home telehealthcare services has been developed to include a 12 channels ECG, a pressure meter for NIBP, a blood glucometer, a bodyfat meter and a spirometer. It is an expert system to analyze the measured health data and based on the diagnostic result, the system provides an appropriate medical consultation. The measured data can be either stored on the system or transmitted to the central server through the internet. We have installed the developed systems on a model house for the performance evaluation and confirmed the possibility of the system as an effective tool for the personalized healthcare services.
Accidental Falls↗
Integrating remote sensing approach with pollution monitoring tools for aquatic ecosystem risk assessment and management: a case study of Lake Victoria (Uganda).
Aquatic ecosystems around the world, lake, estuaries and coastal areas are increasingly impacted by anthropogenic pollutants through different sources such as agricultural, industrial and urban discharges, atmospheric deposition and terrestrial drainage. Lake Victoria is the second largest lake in the world and the largest tropical lake. Bordered by Tanzania, Uganda, and Kenya, it provides a livelihood for millions of Africans in the region. However, the lake is under threat from eutrophication, a huge decline in the number of native fish species caused by several factors including loss of biodiversity, over fishing and pollution has been recently documented. Increasing usage of pesticides and insecticides in the adjacent agricultural areas as well as mercury contamination from processing of gold ore on the southern shores are currently considered among the most emergent phenomena of chemical contamination in the lake. By the application of globally consistent and comprehensive geospatial data-sets based on remote sensing integrated with information on heavy metals accumulation and insecticides exposure in native and alien fish populations, the present study aims at assessing the environmental risk associated to the contamination of the Lake Victoria water body on fish health, land cover distribution, biodiversity and the agricultural area surrounding the lake. By the elaboration of Landsat 7 TM data of November 2002 and Landsat 7 TM 1986 we have calculated the agriculture area which borders the Lake Victoria bay, which is an upland plain. The resulting enhanced nutrient loading to the soil is subsequently transported to the lake by rain or as dry fall. The data has been inserted in a Geographical information System (ARCGIS) to be upgraded and consulted. Heavy metals in fish fillets showed concentrations rather low except for mercury being higher than others as already described in previous investigations. In the same tissue, cholinesterases activity (ChE) as an indicator of insecticides exposure showed significant differences among fish species in both activity and sensitivity of selected inhibitor insecticides. This integrated approach aims at identifying and quantifying selected aquatic environmental issues which integrated with monitoring techniques such as contaminant concentrations and biological responses to insecticides exposure in fish populations will provide a scientific basis for aquatic zones management and assist in policy formulations at the national and international levels.
Animals↗
Air pollution exposure monitoring and estimating. Part I. Integrated air quality monitoring system.
This paper presents an integrated exposure monitoring system, based on an expansion of existing air quality monitoring systems using dispersion modelling. The system allows: (1) identifying geographical areas whose inhabitants are most exposed to ambient pollution; (2) identifying how many people in an area are exposed to concentrations of pollution exceeding air quality guidelines; (3) describing the exposure of population subgroups (e.g. children); (4) planning pollution abatement measures and quantifying their effects; (5) establishing risk assessment and management programs, and (6) investigating the short- and long-term effects of both pollutants and pollution sources on public health. The effect of pollution is rarely very large and in order to discover it, exposure estimation must provide data that reflects both spatial and temporal variations. Estimates of pollution exposure are obtained using an integrated approach that combines results of measurements from monitoring programs with dispersion calculations. These values can serve as estimates for individual short-term or long-term exposure. The grouped data allows the expression of ambient pollution concentrations as the spatial distribution of estimates such as the mean or 98th percentile of such compounds as SO2, O3, NO2, PM10 and PM2.5. This integrated approach has been combined into a single software package, AirQUIS.
Air Movements↗
The importance of developing an informatics framework for mental health.
Though mental health services are important in human terms, and account for a tenth of health expenditure, they are not well served in informatics developments. There are no specific mental health components in the European Union's health telematics programmes, and there is similar under-representation in national programmes. Yet telematics has much to offer mental health services and their management, and can address directly current service anxieties. Telematics concepts which could benefit mental health include integrated, multi-disciplinary records, real-time multi-site record access, and structured programmes to plan, schedule, and monitor care delivery. The power of information systems to sort data, and to represent them graphically, can sift like data items from complex records, and can present them in displays which highlight their significance. Above all, quality of care can be enhanced by monitoring, and by improved outcome measurement. However, a planned programme of research and development is needed, to relate and adjust current health informatics techniques to the special attributes of mental health. The World Health Organisation has identified the potential of such a programme, but greater vision and commitment is needed at policy level if mental health services and patients are to receive the benefits from health informatics which are available to the physically ill.
Abstracting and Indexing↗
Virtual food components: functional food effects expressed as food components.
BACKGROUND: The ability to communicate food benefits is essential for the successful development of functional foods and their role in improving public health. However, the functional efficacy of foods often cannot be represented by food composition. The concept of virtual food components (VFCs)-food data that express health-related effects, properties or functions of foods in the format of food components-is therefore proposed. OBJECTIVE: To develop protocols for designing VFC data sets that communicate functional efficacies of foods to end users, in order to facilitate evidence-based food choice, and allow data management systems to provide a more complete description of nutritional effects of foods than has been possible with values for actual food components alone. METHOD: A framework within which to develop VFCs was constructed, linking food choice to health end points. It involves scientific validation, generation of relative indices, their translation into a meaningful language based on equivalents to known and understood reference foods, followed by data consolidation and ecological validation. Criteria used to evaluate VFCs were importance, independence, validity, accuracy, robustness, sensitivity, linearity/additivity, relevance, comprehensiveness, acquirability, completeness, meaningfulness, acceptability and safety. The developmental framework and evaluative criteria were applied to glycaemic glucose equivalents (GGE), a VFC representing postprandial glycaemia, and to wheat bran equivalents for faecal bulk (WBE(fb)), a VFC representing faecal bulking efficacy. RESULTS: VFCs were used to identify foods according to health-related effects that cannot be accurately predicted from food composition data, and were used in a nutrition management system to concurrently show nutrient intake and physiological effects in the same units. The proposed evaluative criteria identified points requiring further research, and showed that lack of integrity-tested VFC data is an immediate challenge. CONCLUSION: VFCs are a means of communicating relative functional efficacy of foods as a continuous variable, and provide end users with a more accurate and complete view of the health effects of foods than can be provided by health claims or food composition data alone.
Databases, Factual↗
TLC-Asthma: an integrated information system for patient-centered monitoring, case management, and point-of-care decision support.
A great deal of successful work has been done in the area of EMR development, implementation, and evaluation. Less work has been done in the area of automated systems for patients. Efforts to link data at multiple levels - the patient, the case manager, and the clinician have been rudimentary to-date. In this paper we present a model information system that integrates patient health information across multiple domains to support the monitoring and care of children with persistent asthma. The system has been developed for use in a multi-specialty group practice and includes three primary components: 1) a patient-centered telephone-linked communication system; 2) a web-based alert reporting and nurse case-management system; and 3) EMR-based provider communication to support clinical decision making at the point-of-care. The system offers a model for a new level of connectivity for health information that supports customized monitoring, IT-enabled nurse case-managers, and the delivery of longitudinal data to clinicians to support the care of children with persistent asthma. Systems like the one described are well-suited, perhaps essential, technologies for the care of children and adults with chronic conditions such as asthma.
Adolescent↗