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PubMed1999

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↗
PubMed1998

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↗
PubMed2004

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↗
PubMed2003

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↗
PubMed2005

The limits of social capital: Durkheim, suicide, and social cohesion.

Recent applications of social capital theories to population health often draw on classic sociological theories for validation of the protective features of social cohesion and social integration. Durkheim's work on suicide has been cited as evidence that modern life disrupts social cohesion and results in a greater risk of morbidity and mortality-including self-destructive behaviors and suicide. We argue that a close reading of Durkheim's evidence supports the opposite conclusion and that the incidence of self-destructive behaviors such as suicide is often greatest among those with high levels of social integration. A reexamination of Durkheim's data on female suicide and suicide in the military suggests that we should be skeptical about recent studies connecting improved population health to social capital.

Female↗
PubMed1995

Fitting the CHIN (community health information network) to the customer: three case studies.

Each of the case studies described above is typical of many health care organizations in the northeastern United States. The reasons each of these three organizations seeks to form or participate in a CHIN varies-from establishing the loyalty of practicing physicians in a community hospital's struggle to survive, through sharing of real-time patient care data in a successful community-wide effort to avoid expensive duplication of services, to driving the transition from a multihospital integrated delivery system to a full-risk accountable health plan. While the need to reduce costs, by taking advantage of economies of scale and prospectively monitoring utilization, is common to all three organizations, selecting the type of CHIN that best fits each scenario, with particular emphasis on aspects of control, is the key success factor.

Community Health Planning↗
PubMed2004

Security infrastructure services for electronic archives and electronic health records.

Communication and co-operation in the domain of healthcare and welfare require a well-defined set of security services based on a Public Key Infrastructure and provided by a Trusted Third Party (TTP). These services describe both status and relation of communicating principals, corresponding keys and attributes, and the access rights to applications and data. Additional services are needed to provide trustworthy information about dynamic issues of communication and co-operation such as time and location of processes, workflow relations, and system behaviour. Legal, social, behavioural and ethical requirements demand securely stored patient information and well-established access tools and tokens. Electronic (and more specifically digital) signatures--as important means for securing the integrity of a message or file--along with certified time stamps or time signatures are especially important for purposes of data storage in electronic archives and electronic health records (EHR). While just mentioning technical storage problems (e.g. lifetime of the storage devices, interoperability of retrieval and presentation software), this paper identifies mechanisms of securing data items, files, messages, sets of archived items or documents, electronic archive structures, and life-long electronic health records. Other workshop contributions will demonstrate related aspects of policies, patient privacy, and privilege management.

Access to Information↗
PubMedDate not supplied

Demystifying values assessment.

The current climate of networking and restructuring among healthcare providers calls for measurable methods to assess an organization's adherence to its fundamental values. In response to that need, the SSM Health Care System (SSMHCS) prepared a guide to assessing values integration. This innovation tool has proven to be adaptable for many uses: it helps organizations examine the compatibility of potential partners' values, as well as their own progress toward integration of their stated mission, values, and philosophy. The guide outlines 10 key areas that serve to focus and define the values assessment: Vision. Serving the poor. Serving the community. Continuous quality improvement. Employment practices. Role of leaders. Stewardship Advocacy. Wellness. Church. The guide includes a discussion of the significance of each of these key areas: the implications of including each area; and key indicators, or standards statements, for assessment. Users' response to the guide has been overwhelmingly positive. This guide should provide valuable systemwide data and identify areas of strength or needed growth.

Community-Institutional Relations↗
PubMedDate not supplied

HIS/RIS/PACS integration: getting to the gold standard.

The technology for acquiring, storing, retrieving, displaying, and distributing images has advanced dramatically in recent years. The push is toward enterprise-wide image management solutions, where digital images from radiology, cardiology, and other "ologies" are seamlessly linked with information from clinical information systems and other databases, and they are accessed seamlessly from a single point of end-user interaction. The "gold standard" of system integration would provide the platform for improved workflow, patient throughput and patient safety, as well as decreased cost. Unfortunately, the gold standard remains elusive in most healthcare environments, even those with new systems. One of the earliest issues that plagued the progress of hospital information system/radiology information systems/picture archiving and communication systems (HIS/RIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM. This barrier was solved by the broker--a software and hardware device that accepts HL7 messages from the RIS then translates, or maps, the data to produce DICOM messages for transmission to the PACS. Technologist workflow requires patient and exam information from the RIS to flow to the modality. The broker provides support for this by taking advantage of the DICOM Modality Worklist (DMWL). Two primary problems are inherent in most brokered configurations. Workflow is driven by paper, and RIS information flows in 1 direction only, which leads to duplicative databases. Overcoming the limitations of HIS/RIS/PACS connectivity requires industry accepted communication protocols/rules. To facilitate this, the Integrating the Health Care Enterprise (IHE) initiative was developed. The goal of IHE is to provide end-users improved access to critical patient and clinical information across all systems within the healthcare delivery network. While the IHE initiative began to facilitate more efficient, predictable, and functional integration between disparate systems, vendors still had technology hurdles to overcome. System integration continues to be significantly hampered, not by technology limitations, but instead by business and political issues. In response to these challenges, several vendors have begun to offer consolidated RIS/PACS solutions and/or HIS/RIS/PACS solutions. Consequently, the prospect of the gold standard appears to be on the horizon. Single vendor consolidated systems are not, however, feasible for deployment in many healthcare organizations, and they are not necessarily the panacea.

Database Management Systems↗
PubMed2004

[Assessing the quality of structures, concepts, and processes in prevention, health promotion, and education. Requirements and solutions].

The effectiveness of health promotion is determined by the foundation of evidence, the targeting of health problems, and the adaptation of interventions to specific social and organizational contexts. Methods for the implementation of these objectives must be able to balance interacting intervention goals, to account for the suitability of interventions for specific target groups and settings, and to integrate complex and divergent data. The core methodology underlying these conditions is peer review assessment. A quality assurance system based on this approach is presented: Two inventories elicit detailed self-descriptions characterizing either actors or activities within health promotion and education. Two assessment instruments instruct experts in reviewing these data according to primary and partial dimensions of quality. Thus, systematically structured and quantifiable quality profiles of organizational units or specific activities are produced. On this basis, comparative indicators for benchmarking purposes can be calculated. Quality profiles containing the strengths and weaknesses of organizations or activities, including indicators, benchmarks, and reviewers' recommendations, are communicated to participating organizations in order to stimulate continuous quality improvement by feedback. Moreover, the system offers a database of comparative indicators for monitoring and optimizing health promotion and education.

Germany↗
PubMed2002

The cost of home-based terminal care for people with AIDS in South Africa.

OBJECTIVES: To describe the costs of establishing and operating a home-based care (HBC) project providing palliative care for people with AIDS (PWA), and to project the full costs to the health care system of extending this care model. DESIGN: Data were collected from seven sites participating in the Hospice Association of South Africa integrated community home-based care (ICHC) model, using site records, interviews with personnel, a continuity of care survey of nursing staff supervising the sites, and time logs kept by community caregivers (CCGs). The seven sites were spread across five provinces, with a mix of rural, peri-urban and urban settings. OUTCOME MEASURES: Set-up (training, equipping and planning) costs per HBC site, HBC operating costs (total and average cost per patient), and average hospital inpatient, hospital outpatient and primary care clinic cost per participating patient. Estimates of scaling up this model of HBC to national roll-out are also provided. RESULTS AND CONCLUSIONS: Providing palliative HBC to PWAs in their last year of life using the ICHC model costs R2 840 per patient per year. Even with this level of HBC input, patients still incurred hospital costs of R2 522 and primary care clinic costs of R1 154 per patient per year. HBC costs are increased in rural areas where a vehicle is required for staff transport. HBC shows considerable potential to deal cost-effectively with growing palliative care needs in the face of the AIDS epidemic, but we need to understand better the true extent to which HBC can substitute for hospitalisation.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Epidemiology in health promotion: a Canadian perspective.

During the second half of this century, Canada has made major organizational advances in providing universal hospital and medical care programs. Although these advances have largely overshadowed public health issues, the focus is now shifting back to public health with an emphasis on health promotion as a guiding philosophy. Epidemiology has played a key role in these developments. However, as we seek to address matters such as "enhancing people's capacity to cope," "healthy public policy," and "self-care," we find ourselves with a limited data base. So it is now necessary for epidemiology to integrate concepts that have their origins in the social and behavioral sciences, and also to deal with new measures of functional and self-assessed health status. A scientific approach to all this is essential, especially in developing and evaluating health promotion initiatives. In addition, national health goals and objectives are needed to help allocate resources rationally and hold health promotion activities accountable for their own performance.

Canada↗
PubMed1997

Expert views on clinical supervision: a study based on interviews.

Clinical supervision is a didactic process of the purpose of human development and maturity. The aim of this study is to analyse views on clinical supervision held by a number of experts, and to reflect on the effects and value of clinical supervision in relation to public health. Data were collected by interviews and analysed in accordance with the grounded theory construction model. The results showed that clinical supervision is an integration process guiding a person from 'novice to expert' by establishing a relationship of trust between supervisor and supervisee. This study indicates that implementation of systematic clinical supervision may positively affect quality of care, and patients' recovery, create improved feeling of confidence in one's work, and prevent burnout among staff. The negative aspects, as reported, were the possibility of high 'opportunity costs', e.g. the time loss for patient care by those participating in organized systematic supervision. On the other hand, clinical supervision contributes towards more efficient use of resources and hence avoids unnecessary costs. However, neither of these aspects were further elaborated on by the experts but clearly indicate an important field for further research.

Attitude of Health Personnel↗
PubMed2003

Intelligent biomedical clothing for personal health and disease management: state of the art and future vision.

Telemedicine has been introduced to overcome distance in order to get prompt access to medical knowledge and appropriate health care. More recently, work in telemedicine has aimed at developing solutions to support the management of chronic diseases such as diabetes, and lung and heart diseases, as well as to provide support for home care services. Telemedicine is also entering the fields of health promotion/prevention disease, life style management, and well-being. The evolution and broadening of telemedicine gives birth to a nomenclature that includes "e-health," "telehealth," and "telecare." The latest developments in microsystems and nanotechnologies as well as in information processing and communication technologies allow miniaturization and non-invasive smart monitoring of physiological and physical data. Ongoing cutting-edge multidisciplinary research in textile fibers, biomedical sensors, and wireless and mobile telecommunications integrated with telemedicine, aims at developing intelligent biomedical clothing (IBC) that could pave the way to support personalized management of health and diseases at the point of need and at any time. In this study, we aim to describe the current status of multidisciplinary research and development of IBC, based on bibliographic research and reports from seminars, workshops, conferences, and working groups. A further aim is to inform the developers, the decision makers, and users in the health and healthcare sector regarding future solutions to support personalized health care and disease management. Both the textile sector and healthcare sector are looking with great interest at the innovative products and applications that could result from the integration of microsystems, nanotechnologies, biomedical sensors, textiles, and mobile telecommunications. For health monitoring, disease prevention and management, rehabilitation, and sport medicine, IBC may offer, in the mid-term future, a unique, wearable non-obtrusive telemedicine platform for individualized services that is readily accessible and of good quality.

Biomedical Technology↗
PubMed2005

Role of health care providers in educational training of patients with diabetes.

Diabetes mellitus is a high prevalence chronic disease, in which several health care providers are involved in the treatment of patients. Multifaceted professional and organizational interventions that facilitate structured and regular review of patients are effective in improving the process of care. Moreover, patient education and enhancement of role of nurses improve clinical outcomes and process of care. As diabetic management requires strict commitment of the patients, their educational therapy is mandatory. Therapeutic Patient Education (TPE) is a continous process, integrated in health care; it is a permanent care process, patient-centred, that must be adapted to the evolution of illness and to the patient's lifestyle; TPE must be structured and organized and it should receive benefits from the appropriate pedagogic means. Since the publication of DCCT data it was clear that intensive insulin therapy had been successfully applied only in centers where a diabetologist, a specialized nurse, a dietician, a psycologist and a motivated patient worked all together, i.e. where there was a "team". The team has to follow a pedagogic, multidisciplinary and patient-centred methodology of care. Well structured integration between health care providers may help to avoid the burn-out syndrome.

Case Management↗
PubMed2005

Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas.

This research considers both spatial and nonspatial factors in examining accessibility to primary healthcare in Illinois. Spatial access emphasizes the importance of geographic barrier between consumer and provider, and nonspatial factors include nongeographic barriers or facilitators such as age, sex, ethnicity, income, social class, education and language ability. The population and socioeconomic data are from the 2000 Census, and the primary care physician data for the same year are provided by the American Medical Association. First, a two-step floating catchment area method implemented in Geographic Information Systems is used to measure spatial accessibility based on travel time. Secondly, the factor analysis method is used to group various sociodemographic variables into three factors: (1) socioeconomic disadvantages, (2) sociocultural barriers and (3) high healthcare needs. Finally, spatial and nonspatial factors are integrated to identify areas with poor access to primary healthcare. The research is intended to develop an integrated approach for defining Health Professional Shortage Areas (HPSA) that may help the US Department of Health and Human Services and state health departments improve HPSA designation.

Catchment Area, Health↗