Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Community Networks”

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.

At least 1,531 records · Page 85Linked to original sources
PubMed2005

[Dynamics of interdisciplinary around a health care network: simultaneous programme design and evaluation planning].

This article reports on the evaluation experience of a multiple sclerosis care network in the Midi-Pyrénées region (MIPSEP). It shows how an evaluation team composed of public health doctors and sociologists progressively and naturally evolved from having a purely external observation role towards having a collaborative role actively working with the network's members and partners. A qualitative method was chosen for the data collection through interviews with the network's actors, and the frameworks for reference were constituted from official texts which defined the networks and their missions. Coming from a curative and healing culture, the network's actors were concerned primarily about how to organise themselves in order to better respond to the needs expressed by the patients. The various professional backgrounds and cultures, faced with different perspectives from innovation and confronted with the related difficulties, participated in a collective expertise exercise and collaborated in the construction process. This example supports an open, qualitative, evolutionary evaluation approach which is done in close proximity to the field and work on the ground. The study is timely given the current explosion of debate on evaluation methods. With a great deal of exchange and reflection on suitable tools and indicators as well as the respective roles of researchers, care givers and decision-makers, the results of this study advocate to favour multidisciplinary approaches, including opening up this process to funders and planning authorities rather than over-theorising about it, which only serves to enclose and paralyse a process that, on the contrary, should aim to be more inclusive. This could be a useful way to decompartmentalise and break down existing barriers within the health system.

Community Networks↗
PubMed1996

Data quality of the Drug Abuse Warning Network.

The purpose of this article was to assess the quality of data collected by the Drug Abuse Warning Network (DAWN), which reports drug abuse emergency department visits. The results of quality assurance studies at 36 sites were reviewed and interpreted. Data collection procedures are not consistent among hospitals and, along with personnel, regularly change within a hospital. Trained investigators reabstracted DAWN report forms at 24 sites and determined that only 57.4% of the cases that met DAWN case definition criteria had been reported; one of five cases had been reported at one site. The technique used in 11 (47.8%) of 23 hospitals to screen for potential DAWN cases detected only 36% of the cases found when all medical charts are examined. The investigators found discrepancies between reported and actual cases in 81.3% of the report forms reabstracted, with an average of 2.3 errors per form. Information as to the drug(s) involved was incorrect in 36.3% of the forms. Due to underreporting of drug abuse emergency department visits and poor quality data in DAWN report forms, DAWN estimates of drug activity must be viewed with caution. Furthermore, estimation of trends is risky, due to differences between emergency departments as to reporting systems and changes over time.

Community Networks↗
PubMed2001

Disability as a function of social networks and support in elderly African Americans and Whites: the Duke EPESE 1986--1992.

OBJECTIVES: We examined the association of structural and functional aspects of social relationships with change in disability, and the degree to which race modifies these associations. METHODS: Data are from a population-based sample of 4,136 African Americans and Whites aged > or = 65 living in North CAROLINA: Disability data were collected during seven consecutive yearly interviews and summarized in two outcome measures. Measures of social relationships included five measures representing network size, extent of social interaction, and specific type of relationships, as well as instrumental and emotional support. Weighted proportional odds models were fitted to model disability as a function of baseline social network and support variables, and the interaction of each variable with follow-up time. RESULTS: Network size and social interaction showed significant negative associations with disability risks, which did not vary by race, or as a function of time. Social interaction with friends was associated with a reduced risk for disability, but social interaction with children or relatives was not related to disability. Instrumental support was associated with a significantly increased disability risk, with a greater adverse effect among Whites than African AMERICANS: Emotional support was not associated with disability, but a protective effect for ADL disability was found after controlling for its intercorrelation with instrumental support. DISCUSSION: The findings provide further evidence for the role of social relationships in the disablement process, although not all types of social relationships may be equally beneficial. Furthermore, these associations may be more complex than simple causal effects. There were few racial differences in the association of social relationships with disability, with the possible exception of instrumental support, which may allude to possible sociocultural differences in the experience of instrumental support exchanges.

Activities of Daily Living↗
PubMed1997

Coordinating rural divisions: the workforce window.

Divisions of General Practice have been established to alleviate the professional isolation which general practitioners face by being excluded from involvement in other parts of the health care system. Divisions facilitate the development of local communication networks and cooperative activities which improve the integration of general practice with other elements of the health system. Coordination of communication is one of the strengths of divisions at the local level and Rural Divisions Co-ordinating Units at the State level. This strength is being effectively utilised to target general practice workface issues. Given the significant proportion of general practitioners in the medical workforce, particularly in rural and remote areas, this has implications for broader medical workforce issues. Australia faces a maldistribution in its general practitioner workforce, with an excess supply in urban areas and a significant shortfall in rural and remote areas. Since 1995-96, the General Practice Rural Incentives Program, which targets the recruitment and retention of rural doctors, has devolved funding to the Rural Divisions Co-ordination Units to coordinate the statewide provision of practical assistance to rural general practitioners, through their divisions, in relation to continuing medical education and the provision of locums. There is potential to build on the success of these initiatives and also to work with urban divisions through the state-based organisational structures which are currently being developed.

Australia↗
PubMed2006

Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands.

OBJECTIVE: To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. DESIGN: Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record. SETTING: Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004. RESULTS: We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%). CONCLUSIONS: For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

Community Networks↗
PubMed2001

Japanese experience of telemedicine in oncology.

We started telemedicine projects from 1990 with a telepathology system within Tsukiji Campus of National Cancer Center. In 1994, we connected Tsukiji Campus and Kashiwa Campus by 6 Mbps optical fiber leased line using IP protocol for data transmission, for teleconference, telepathology, and teleradiology projects. We also started connection of regional cancer centers and are now forming a cancer center network of 14 cancer centers. We are at present organizing 130 teleconferences per year with an attendance of more than 16000 people as summary. We have also used a high-resolution image transferring system, such as SHD (2000 pixelsx2000 pixels resolution) system on one side, and an economical telemedicine system using JAVA and a WWW browser (NCC_image) on the other side. We think that providing information is another field of telemedicine. We began the experimental gopher and WWW service in 1993. We are now providing official up-to-date cancer information for patients and healthcare professionals. We are getting more than 400000 hits per month. We are also providing a teleconference video session which is held every week on the Internet using a Real Video system with synchronized slide presentation on the WWW browser. We are also organizing a Cancer Image Reference Database System including DICOM images with viewer software. This paper is a summary of the telemedicine projects performed at the National Cancer Center.

Community Networks↗
PubMed2004

Substance abuse and behavioral correlates of sexual assault among South African adolescents.

OBJECTIVE: The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality. METHOD: Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence. RESULTS: The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00-3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34-5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10-3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12-1.86), suicidal dialogue (OR = 2.48, CI = 1.19-5.19), and suicidal attempts (OR = 3.2, CI = 1.65-6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant. CONCLUSION: This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem.

Adolescent↗
PubMedDate not supplied

Multicenter epidemiologic and health services research on therapeutics in the HMO Research Network Center for Education and Research on Therapeutics.

Research and education programs in therapeutics that combine the data, organizational capabilities, and expertise of several managed care organizations working in concert can serve an important role when a single organization is not large enough to address a question of interest, when diversity in populations or delivery systems is required, and when it is necessary to establish consistency of results in different settings. Nine members of the HMO Research Network, a consortium of health maintenance organizations (HMOs) that perform public domain research, have formed a Center for Education and Research on Therapeutics (CERT), sponsored by the Agency for Healthcare Research and Quality, to conduct multicenter research in therapeutics. The CERT uses a distributed organizational model with shared leadership, in which data reside at the originating organization until they are needed to support a specific study. Extraction of data from the host computer systems, and some manipulation of data, is typically accomplished through computer programs that are developed centrally, then modified for use at each site. For complex studies, pooled analysis files are created by a coordinating center, and then analysed by investigators throughout the HMOs. It is also possible to contact HMO members when necessary. This multicenter environment has several benefits, addressing: (1) a wide array of questions about the safety and effectiveness of therapeutics, (2) the impact of efforts to change clinicians' and patients' behavior, and (3) pharmacoeconomic and pharmacogenetic questions.

Community Networks↗
PubMedDate not supplied

Co-operative health information networks in Europe: experiences from Greece and Scotland.

BACKGROUND: Internet technology is transforming the general approach to communication and dissemination of information in the field of healthcare. However, it is also creating problems in terms of finding information, and knowing what credibility to place on the information found. The chaotic nature of the World Wide Web (WWW) and the simplistic approach adopted by search engines can make the task of finding relevant information difficult, and the user can waste considerable amounts of time on the process. Even when information is found, there is no general quality assurance process that can guarantee the credibility of the resulting information. OBJECTIVE: The aim of this research was to develop an approach for establishing co-operative health information networks (CHINs) with different focuses, which can be used in different parts of Europe. The resulting CHINs would provide organised healthcare information and support comprehensive and integrated sets of healthcare telematic services for a broad range of users. Such developments would reduce the difficulties of finding information and knowing what credibility to ascribe to it. METHODS: A common approach has been developed based on drawing together contributions from the major healthcare service providers in the region. Standard structures are recommended so that information is presented in a uniform way. Appropriate mechanisms ensure adequate security and a level of quality assurance for the end user. RESULTS: Since 1996, CHINs have been developed in six European countries as part of a European Union (EU) project. This paper presents the overall approach adopted, and the achievements in two different regions of Europe (Greece and Scotland). Although the circumstances in these two regions are very different, in both cases the resulting CHIN has proved successful. CONCLUSIONS: CHINs offer a solution to the difficulty of finding relevant health information on the Internet and guaranteeing its credibility. They can be used in different ways in different regions, and have major benefits for both information providers and end users.

Community Networks↗
PubMed2006

SEAM--improving the quality of palliative care in regional Toowoomba, Australia: lessons learned.

INTRODUCTION: The proliferation of professional palliative care services in recent years has increased access for people with palliative care needs; however, gaps in services continue to exist, particularly in rural and remote areas of Australia. In order to address one gap in rural health service delivery, the Support, Education, Assessment, and Monitoring (SEAM) Service for regional and rural people in Toowoomba, Queensland, Australia, was introduced. This new model of service delivery aimed to provide palliative services to patients and their families who live in the regional city of Toowoomba and its rural catchment area. It also aimed to facilitate education, support and networking among health-care professionals, particularly general practitioners and nurses employed in general practice (practice nurses). METHOD: The evaluation involved twenty face-to-face interviews with a variety of health professionals who had contact with the SEAM service from June 2003 to June 2004. Qualitative data analysis of the transcribed interviews provided the basis for the evaluation. The emergent themes regarding the SEAM service included: satisfaction and benefit of the SEAM service; knowledge of and contact with the SEAM service; the SEAM role; and expansion of the role. RESULTS: The data indicate that the majority of health professionals who had contact with the SEAM service were satisfied with the service and found it to be of benefit to them and their clients. Participants commented on the extensive networking and support work established by the SEAM nurse with other health service providers. Difficulties experienced with the SEAM service included poor utilisation by GPs and, therefore, clients in need of palliative support. This was predominately due to lack of knowledge of the service as well as limited understanding of the SEAM nurse role. CONCLUSION: The SEAM service has resulted in increased links between health professionals providing palliative care to rural clients. The most successful strategy was the use of multidisciplinary case conferencing which not only built links among health professionals caring for individual clients, but also resulted in improved care for those clients. As a result of better integration and communication, palliative care services to rural people have been improved. However, with regard to the delivery of direct patient care, or in the support of GPs for the management of palliative care patients, it was apparent that the service did not meet its objectives. The lack of use by GPs and patients appears to be related to a lack of awareness of the existence of the service. A positive outcome of this poor utilisation is, however, that the model has allowed the identification of factors that work as barriers to GPs and client/family utilisation of rural palliative care services.

Community Networks↗
PubMed2005

[European surveillance of tuberculosis: description of the network and recent results].

A network for the surveillance of tuberculosis covering the WHO European Region was set up in 1996. It aims to improve the contribution of surveillance to TB control, promoting standardised methods to compare countries. Standardized individual or aggregate data on notified TB cases is provided annually from national surveillance institutions. In the enlarged European Union (EU), overall TB notification rates decreased in recent years (14/100 000 in 2002), but leveled off in some countries including France and the United Kingdom, partly due to increasing numbers of patients from high TB incidence areas (30% in 2002). Multidrug resistance (MDR) was much more frequent in the Baltic States (21% in 2002) than in other countries (1.7%; range: 0-3.7%). Treatment of new pulmonary TB cases notified in 2001 was completed within 12 months in 74% of cases, ongoing in 3%, interrupted due to death in 7%, and interrupted for other reasons or unknown in 15%. In the Balkans and Turkey, notification rates ranged between 20 and 62 per 100 000 in 2002, and decreasing or stable except for Romania (153 in 2002). In the East (former Soviet Union), TB surveillance data, although incomplete, shows an increasing incidence (97/100 000 in 2002), high prevalence of primary MDR (14% in Kazakhstan), and frequent treatment failures (10% in new cases). At the time of EU enlargement, European TB surveillance covering the whole WHO European Region should continue, with support of TB control in the East as a regional priority.

Community Networks↗
PubMed2005

Hospital networks for the treatment of acute myocardial infarction.

Patients with ST-elevation myocardial infarction (STEMI) may have a survival benefit, as well as a reduced occurrence of reinfarction and stroke, if treated with primary percutaneous coronary intervention (PCI) instead of fibrinolysis. Furthermore, there are no other reperfusion options for patients with absolute contraindications to fibrinolysis or after failed fibrinolysis or in shock. Unfortunately, primary PCI programs require a relatively high number of experienced interventional cardiologists as well as other specialized personnel to guarantee a 24-hour call schedule together with a high level of skill. Since these conditions may be achieved only in a minority of hospitals with high volumes of interventional procedures, most of the patients with STEMI will be admitted to hospitals without a primary PCI program. The implementation of hospital networks based on a Hub-and-Spoke model is the only way to allow the choice of a reperfusion treatment on the basis of clinical needs and not only on the basis of the hospital characteristics. In Italy this process should be driven by regional authorities that have to establish the distribution of Hub centers, in close cooperation with cardiologists and physicians involved in emergency departments and 118 Service. Several key points, such as the collaboration between cardiologists and emergency physicians, common diagnostic and therapeutic protocols, prehospital diagnosis and treatment, transportation difficulties, overflow of the patients in the Hub centers, public campaigns for the use of the 118 Service and registries for all patients with STEMI, should be adequately addressed and implemented. In hospitals with well established primary PCI programs, all patients with STEMI should receive a mechanical reperfusion. The selection of patients with STEMI who might benefit most from mechanical reperfusion even after transfer, should be made considering the patient's risk profile, the time interval from symptom onset and the time interval to a primary PCI: in late comers (> 3 hours of symptom onset) and in the elderly, primary PCI should be the treatment of choice, but in early comers and younger patients, if an excessive time delay is necessary to perform a primary PCI, fibrinolysis might be a good initial option. In the latter, a systematic immediate transfer of high-risk patients to a primary PCI center for facilitated or rescue PCI should be considered.

Angioplasty, Balloon, Coronary↗
PubMed2004

Public health surveillance and incidence of adulthood Guillain-Barré syndrome in Spain, 1998-1999: the view from a sentinel network of neurologists.

Temporal variation in Guillain-Barré syndrome (GBS) warrants monitoring in certain situations. This study sought to describe a public-health-based GBS surveillance service in Spain and conduct pilot surveillance in the period 1998-1999. Neurologists from 11 hospitals countrywide, serving a population of 3.9 million, reported all patients, ages 20 years or over, admitted to hospital with suspected GBS. Cases that did not belong to the designated hospital catchment area or failed to fulfill diagnostic criteria after follow- up were excluded. Reported monthly incidence was compared against predicted incidence obtained from retrospective data (1985-1997) using a reported method based on 97.5% percentile values. Alarm thresholds for 2000 onwards were obtained by applying the same method to the updated 1985-1999 series. During the 2-year period, 98 GBS cases were reported, yielding an overall age-adjusted incidence of 1.26 per 100 000 population, with a breakdown by sex of 1.83 for males and 0.76 for females. Monthly incidence remained below or was similar to the corresponding threshold limit value. Seasonality with highest incidence in winter was more pronounced in the elderly. Preceding events, mainly respiratory infections, were identified in 71% of patients. Pilot two-year GBS surveillance in Spain resulted neither in alarm nor in preventive measures. Adult GBS incidence in Spain might be monitored by a surveillance system set up at short notice when a possible threat is perceived. A monthly incidence of over 3 per 100 000 person-years in the population aged 20 years or older would exceed threshold values.

Adult↗
PubMed1996

Home health visits using a cable television network: user satisfaction.

There are about 1.5 million home patients who receive home health care (nurses visiting patients in their homes) in the US each year. In a significant proportion of these visits, hands-on care is not needed. Rather, the nurse needs to verify compliance with medication regimes, assess mental or emotional status, or check blood sugar levels, blood pressure and the like. Many of these activities might be handled by a nursing visit using interactive video to the patient's home, saving the nurse's time wasted in driving, finding parking, etc. A system for delivering home health care using interactive video has been piloted in the state of Kansas. Using the local cable television infrastructure for audio and video transmission, this system permits a nurse to see patients in their homes for a fraction of the cost of an on-site visit. This new method of delivering home health care is being evaluated with an ongoing study of utilization and user satisfaction. We conducted a prospective survey administered to home health nurses (n = 2) and homebound patients (n = 3) using a cable TV-mediated interactive video system, to assess utilization and user satisfaction with televideo-mediated home health care visits. One hundred and eighty-one patient questionnaires and 193 nurses questionnaires were completed. The average length of a visit was 15 minutes (range 1-91). All mean scores tabulated for the questions indicated strong nurse and patient satisfaction with the system. Participating nurses and clients were satisfied with the televideo encounters. The mean score for all questions was better than neutral. Recognizing that this was a pilot study, hampered by small numbers and subject to the inherent biases of a single institution study, the results support further investigation and implementation of this modality for home health care.

Aged↗
PubMed2005

[Prevalence and management of heart failure in France: national study among general practitioners of the Sentinelles network].

BACKGROUND: Epidemiological data on heart failure's epidemiology in France are scarce and mostly hospital based. The present study's objective is to estimate the prevalence of heart failure (HF) and its management, in subjects aged 60 years and older seen by the French general practitioners (GP). METHODS: A standardised questionnaire was mailed to 900 GPs of the Sentinelles network, requiring answers for any patient aged 60 years and more, seen on a randomly assigned single day of year 2002. National census and health insurance data were used to estimate prevalence. RESULTS: 434 GPs answered, reporting data for 1797 patients aged 60 years and more. The 214 patients with HF, aged 79 years on average, had been seen by a cardiologist in 95% of cases. Results of an echocardiography was available for 58% of HF patients. Compared to non-HF patients, patients with HF were significantly more dependent, more frequently requiring home visit of the GP and more frequently hospitalised (p < 0.001, age adjusted). All the 42% HF patients with a reported left ventricle ejection fraction lower than 40% were treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor inhibitor. The prevalence of HF among patients aged 60 years and older was estimated at 11.9% in general practice (95% confidence interval: 10.5-13.5), and at 2.19% (1.9-2.5) in the general population. The prevalence increased with age, over 20% in persons aged 80 years and more. CONCLUSION: HF in patients aged 60 years and more seen in general practice in France is characterised by a high prevalence and medical consumption in terms of required number of hospitalisation and GP's home visit. For the GP, the diagnosis of HF relies on the cardiologist more than on an echocardiography. The therapeutic management seems to fit the actual recommendations.

Aged↗
PubMed2003

Component-based mediation services for the integration of medical applications.

Allowing exchange of information and cooperation among network-wide distributed and heterogeneous applications is a major need of current health-care information systems. The European project SynEx aims at developing an integration platform for both new and legacy applications on each partner's site. We developed, in this project, mediation services based on the generic and reusable software components that facilitate the construction of an integration platform and ease the communication and the meaningful transformation among distributed and heterogeneous applications. The main component of the mediation services is named Pilot, which serves as an intelligent broker. It uses a multi-agents service model allowing the integration platform to be multi-servers. It transforms a client request into a valid high level service on the platform. Each service is broken up into several elementary steps by the Pilot. For each step, the Pilot uses an agent to realize the operation configured by the step. At runtime, the Pilot synchronizes the execution of different steps. To ease the communication and the interaction with the heterogeneous systems, an agent can integrate a Mediator. The Mediators are the communication and interpretation tools within the mediation services. We have developed a generic model that can be specialized for creating specific mediators for the different use cases. The mediator model uses two interfaces to connect the mediator with two systems that need to communicate. Each interface deals with the three aspects through three managers (the Communication Manager, the Syntax Manager and the Semantic Manager). Some ready-to-use specializations are developed for some well defined cases which can reduce the development effort. Once a manager is specialized, it can be used in different combinations with other managers to resolve different problems. The meaningful transformation is ensured on a semantic level in each mediator through the Semantic Model component. This last component allows the mapping among different vocabularies used by different systems through a shared ontology which allows the mapping process to focus on the meaning of the transformed information. We have used XML in different components of the mediation services as the interchange format and the description format. This has enhanced the flexibility of the components. The component based approach allows the generic components to be reused in different contexts and also allows the mediations services to be open to integrate other available technologies thus largely reduce the development efforts.

Artificial Intelligence↗
PubMed2005

A preliminary evaluation of a health monitoring programme in Hungary.

BACKGROUND: In 1998 a joint initiative of the Hungarian School of Public Health and the National Public Health Service created a network of sentinel stations based in primary care facilities in four Hungarian counties. The aim was to establish a system that will provide valid data on morbidity of selected diseases in Hungary. METHODS: Based on standardized protocols, the participating centres have continuously reported data on the prevalence of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and some malignant diseases, as well as supplying denominator data. The four counties represent both eastern and western parts of Hungary, reflecting the known geographical disparities in health. Each county office enrolled general practitioners maintaining representation in terms of both geography and distribution of settlement size. RESULTS: A total of 73 general practitioners agreed to participate, providing care for 15.6% (138,088 people) of the population in the counties. The population registered with the practices were representative in terms of age and sex of both the participating counties and the entire country. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in each county but varies considerably, with higher levels in the western counties, especially among older age groups of both sexes. CONCLUSIONS: The establishment of sentinel stations to collect morbidity data is feasible and sustainable in Hungarian primary care. The data that have been generated provide a valid and comprehensive picture of important aspects of the Hungarian population's health, with important implications for health policy and health service planning. In regions where low prevalence rates of diseases and high mortality rates simultaneously exist special attention is required to explore the background of this caveat. KEY POINTS: Till the end of 1998 no program operated in Hungary engaged with non-communicable disease morbidity data collection, except some hospital-based registries, which failed to produce reliable information. The establishment of sentinel stations to collect morbidity data is feasible and sustainable in Hungarian primary care, the valid morbidity data can be built into the decision making process in health service planning. Regular training, quality control and feedback are important contributors to the success of the program. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in each county but varies considerably, with higher levels in the western counties, especially among older age groups of both sexes. More research needed to determine the possible contribution of unknown morbidity and health service utilisation to the different prevalence values in the two parts of Hungary.

Adolescent↗
PubMed1995

ComputerLink: the impact of a computer network on Alzheimer's caregivers' decision-making confidence and skill.

1. INTRODUCTION. Decision-making demands faced by homebound caregivers of persons with Alzheimer's Disease (AD) are numerous and complex. Although caregivers frequently know what to do in caring for the person with AD, they lack confidence in their decisions [1]. The challenge of caregiving decisions may be compounded by the lack of resources to aid in decision-making or affirm decisions made. Because many caregivers are homebound, they are unable to avail themselves of traditional health and social services. ComputerLink, computer network, was designed to address the needs of these homebound caregivers. 2. DESCRIPTION. The ComputerLink consisted of a set of specialized programs and utilities residing within a public computer network. The three main features of the ComputerLink, which may provide aid to caregivers in decision making, include: the electronic encyclopedia (EE); a communications utility composed of a question and answer bulletin board (Q&A) and public (Forum) and private mail services; and a decision support module (DSM). The EE contained illness-specific information to support decision-making. The Forum and private mail provided caregivers with a means to interact with peers and professionals about their caregiving decisions. Q&A provided the opportunity to ask questions about caregiving and receive feedback from professionals and peers. The DSM could be accessed to gain information about decision-making or to actually work through a decision problem. The DSM was built on a multi-attribute utility model which employed English-language questions to guide users through a decision analysis. The analysis strategy was designed to help the user focus on the values and trade-offs that occur during difficult choices. The impact of ComputerLink on decision confidence and skill was evaluated as part of a larger randomized experiment. 102 AD caregivers were recruited: 51 caregivers in the control group and 47 in the experimental group completed the 12-month study. The mean age of the caregivers was 60 years. Thirty-three percent were male and 28 percent were Black. The groups did not differ in demographic characteristics. The ComputerLink interface was menu-driven and the system was available 24 hours. ComputerLink use was captured through a passive monitoring system. AD caregivers accessed ComputerLink a total of 3,875 times, with a mean access per individual of 83 (range: 3 - 590). The mean length of an encounter was 13 minutes; subjects typically accessed two or more functions during this time. The decision support model was accessed 91 times. The communication functions were most frequently used (3,724 Forum accesses and 1,888 private mail); the information utility was accessed 518 times. 3. RESULTS. Decision confidence was objectively measured using a modification of the Saunders and Courtney confidence-in-decision making instrument. Caregivers who had access to ComputerLink experienced greater confidence in decision-making than caregivers in the control group (t = 2.73, p < .01). Access to ComputerLink did not alter decision skill as measured by the number of alternative solutions generated for two self-identified decisions problems (t = .18, p < .05). Decision-making confidence correlated positively with ComputerLink accesses (r = .32, p = < .02) and with length of time spent on ComputerLink (r = .30, p = < .02). 56% of the AD caregivers reported that use of ComputerLink increased both their confidence and skill in decision making, though only 38 percent reported using the DSM to make a decision. 4. DISCUSSION. Access to ComputerLink increased decision-making confidence, but not decision-making skill in AD caregivers. The impact of ComputerLink on decision confidence, and not skill, may be related to the differential use of the utilities. (abstract truncated)

Alzheimer Disease↗