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Mortality surveillance systems can have limitations, including reporting delays, incomplete reporting, missing data, and insufficient detail on important risk or sociodemographic factors that can impact the accuracy of estimates of current trends, disease severity, and related disparities across subpopulations. The Centers for Disease Control and Prevention used multiple data systems during the COVID-19 emergency response—line-level case‒death surveillance, aggregate death surveillance, and the National Vital Statistics System—to collectively provide more comprehensive and timely information on COVID-19‒associated mortality necessary for informed decisions. This article will review in detail the line-level, aggregate, and National Vital Statistics System surveillance systems and the purpose and use of each. This retrospective review of the hybrid surveillance systems strategy may serve as an example for adaptive informational approaches needed over the course of future public health emergencies. (Am J Public Health. 2024;114(10):1071–1080. https://doi.org/10.2105/AJPH.2024.307743) [ABSTRACT FROM AUTHOR]

Policy PointsPublic reporting is associated with both mitigating and exacerbating inequities in high‐quality home health agency use for marginalized groups.Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does.Targeted federal, state, and local interventions should focus on raising awareness about the five‐star quality ratings among marginalized populations for whom inequities have been exacerbated. Context: Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high‐quality, long‐term care for older adults. The objective of this study is to evaluate the impact of the home health five‐star ratings on changes in high‐quality home health agency use by race, ethnicity, income status, and place‐based factors. Methods: We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high‐quality home health agencies between July 2014 and June 2017. To estimate the impact of the home health five‐star rating introduction on the use of high‐quality home health agencies, we use a longitudinal observational pretest–posttest design. Findings: After the introduction of the home health five‐star ratings in 2016, we found that adjusted rates of high‐quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. Additionally, we found that the disparity in high‐quality home health agency use between low‐income and higher‐income home health patients was exacerbated after the introduction of the five‐star quality ratings. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high‐quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high‐quality home health agency use. Other neighborhoods experience a nonsignificant change in high‐quality home health agency use. Conclusions: Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low‐income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Targeted interventions should focus on raising awareness around the five‐star ratings. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) ablation is performed worldwide. To attract patients, hospitals frequently have webpages that tout the success of the procedure. The information disseminated to the public via these webpages has not been systematically reviewed. Our objective was to assess accuracy of information delivered to the public on hospital websites in regard to atrial AF ablation. Methods: From July 2019 to January 2020, we performed a Google search for all US hospitals registered with Medicare to see if they had a webpage describing AF ablation. Resulting hospital webpages were abstracted for data on AF ablation success rates and risks. Success rates over 86%, the highest success rate in the medical literature, were deemed exaggerated. Results: Among 4805 hospitals, 487 had webpages describing AF ablation and 33 discussed success rates of AF ablation. Twelve percentage reported exaggerated success rates, 3% referred to ablation as a cure, and 2.8% referred to ablation as a tool to eliminate AF. Less than 10% of webpages describing AF ablation noted the potential need for a second ablation to achieve the stated success rate and merely 16% mentioned risks of the procedure. One percentage of webpages directly suggested AF ablation could reduce risk of stroke while others indirectly suggested it by discussing cessation of anticoagulation. Two webpages mentioned reduced mortality. Conclusion: US hospital webpages rarely discuss AF ablation. When discussed, there were concerning unsubstantiated claims regarding mortality, stroke prevention, and need for medical therapy. This could lead to some patients undergoing AF ablation based on faulty understanding. [ABSTRACT FROM AUTHOR]

Remote health monitoring can help prevent disease at the earlier stages. The Internet of Things (IoT) concepts have recently advanced, enabling omnipresent monitoring. Easily accessible biomarkers for neurodegenerative disorders, namely, Alzheimer's disease (AD) are needed urgently to assist the diagnoses at its early stages. Due to the severe situations, these systems demand high-quality qualities including availability and accuracy. Deep learning algorithms are promising in such health applications when a large amount of data is available. These solutions are ideal for a distributed blockchain-based IoT system. A good Internet connection is critical to the speed of these system responses. Due to their limited processing capabilities, smart gateway devices cannot implement deep learning algorithms. In this paper, we investigate the use of blockchain-based deep neural networks for higher speed and delivery of healthcare data in a healthcare management system. The study exhibits a real-time health monitoring for classification and assesses the response time and accuracy. The deep learning model classifies the brain diseases as benign or malignant. The study takes into account three different classes to predict the brain disease as benign or malignant that includes AD, mild cognitive impairment, and normal cognitive level. The study involves a series of processing where most of the data are utilized for training these classifiers and ensemble model with a metaclassifier classifying the resultant class. The simulation is conducted to test the efficacy of the model over that of the OASIS-3 dataset, which is a longitudinal neuroimaging, cognitive, clinical, and biomarker dataset for normal aging and AD, and it is further trained and tested on the UDS dataset from ADNI. The results show that the proposed method accurately (98%) responds to the query with high speed retrieval of classified results with an increased training accuracy of 0.539 and testing accuracy of 0.559. [ABSTRACT FROM AUTHOR]

Public reporting of hospitals' performance data is a growing trend. This transparency may improve patient choices, competition, and service quality. This study aims to provide recommendations to improve hospitals' transparency in Iran. A qualitative study designed with 18 semi-structured interviews. Recommendations were categorized into five main themes, including passing a comprehensive law on transparency to create political commitment, educating people and healthcare providers to create the culture, developing a simple and efficient structure to foster transparency, and monitoring and evaluating transparency. The most important issue is political commitment. If it exists, the rest of the obstacles can be solved. [ABSTRACT FROM AUTHOR]

Aim: To describe nursing‐sensitive indicators measured in Catalonia. Background: In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. Methods: Trends study of nursing‐sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long‐term care centres. Results: Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. Conclusions: Among all indicators measured in primary care, hospital and long‐term care, only 14 analysed are nursing‐sensitive; no nursing‐sensitive indicators regarding mental health are measured. Implications for Nursing Management: Research focused on development of nursing‐sensitive indicators offers an opportunity to measure and benchmark nurses' quality of care and their contribution in achieving populations' health improvement and health care system sustainability. [ABSTRACT FROM AUTHOR]

Background. Free access to information as a public right has become a critical issue in healthcare. Some health systems disclose information about hospitals’ performance to influence patients’ choices. However, there is little transparency in Iran. Objectives. As a basic step to improve the transparency of hospitals’ performance in Iran, this study was designed to explore the perceived barriers to transparency. Material and methods. This qualitative study was conducted through eighteen face-to-face interviews with macro-, meso- and micro- -level experts of the health system with different academic orientations. The data was analyzed using a thematic analysis method. Results. Five main themes were identified, including inadequate regular hospital performance data available to the government; lack of transparency culture among health system authorities; concerns about the transparency of hospitals’ poor performance; absence of rule of law and immaturity of the country’s health system governance, which weakens democracy. Therefore, the decision-making system mostly supports special groups rather than the public. Conclusions. These barriers have become more prominent due to the existence of the conflict of interests among authorities and the power of pressure groups. Therefore, interviewees suggested that the necessary infrastructures be created prior to promoting transparency. Among the most important prerequisites is managing the conflict of interest in the health system to have decisions favor public interests. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze factors related to patient safety incidents by analyzing '2018 patient safety report data' for Korea, and to prepare a plan for preventing patient safety incidents. Methods: Analysis was done for 2018 patient safety report data published in 2019. In 2018, 9,250 patient safety incidents were reported, and for this study data (3,757) from hospitals with more than 500 beds were analyzed. SPSS 25.0 was used for the crosstabulation analysis and multinominal logistic regression. Results: There were no factors affecting the sentinel event. The main factors of adverse events were age, patient room, treatment room, day duty of nurses, falls, transfusions, and medication. Conclusion: In order to prevent patient safety incidents, elderly patients should receive verbal and nonverbal communication that will help them understand the complexity of the disease. Finding ways to reduce nurse overtime and reduce human error by computerizing patient monitoring systems, fall prevention activities, and patient safety regulations and procedures are necessary. [ABSTRACT FROM AUTHOR]

An editorial is presented on reporting in vitro fertilization (IVF) outcomes. Topics include requiring assisted reproductive technology (ART) due to infertility; ART being the treatment in which gametes or embryos are handled outside of the body and predominantly involves IVF; and variables affecting outcome include ovarian reserve, cause and duration of infertility, number of previous failed IVF cycles, and number and stage of embryos transferred.

Background: Patient reported outcomes (PROs) provide information on a patient's health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting. Methods: We developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identification of existing tools, (b) identification of user requirements and designing steps for selection and implementation of PROs and PROMs, (c) discussing a prototype of the framework during a national workshop, (d) developing a web version, (e) pre-testing of the framework. A total of 40 users with different perspectives (clinicians, patient representatives, quality managers, purchasers, researchers) have been consulted. Results: The final framework is presented as the PROM-cycle that consists of eight steps in four phases: (1) goal setting, (2) selecting PROs and PROMs, (3) developing and testing of quality indicator(s), (4) implementing and evaluating the PROM(s) and indicator(s). Users emphasized that the first step is the key element in which the why, for whom and setting of the PROM has to be defined. This information is decisive for the following steps. For each step the PROM-cycle provides guidance and tools, with instruments, checklists, methods, handbooks, and standards supporting the process. Conclusion: We developed a framework to support the selection and implementation of PROs and PROMs. Each step provides guidance and tools to support the process. The PROM-cycle and its tools are publicly available and can be used by clinicians, quality managers, patient representatives and other experts involved in using PROMS. Through periodic evaluation and updates, tools will be added for national and international use of the PROM-cycle. [ABSTRACT FROM AUTHOR]

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Copyright of Dynamis is the property of Dynamis - Facultad de Medicina de la Universidad de Granada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article informs that National Public Radio and ProPublica launched the Lost Mothers series, and a turning point in the national conversation for maternal mortality which created frustration and concern for those national organizations and hospitals who had been sounding the alarm of maternal mortality for years prior to this catalyst. It also informs that National Perinatal Information Center (NPIC) is driven by data, and empower the shared purpose of improving patient care.

This is a research-in-progress article that aims to explore the extent emergent formats for public health sector as new projects for EMR systems are launched and negotiated locally. The article adopts institutional theory and the concept of institutional logics to explore ICTs projects in Dubai's public health organizations. To set the scene for this study, the article traces temporal developments and trends of health ICT projects, through an institutional analysis of associated discourses, over the course of almost a decade. The article identifies three institutional influences during consecutive periods of time that shaped how ICT projects are depicted and approached. The aim is to explore how these new formats for health projects are enacted by healthcare workers and their implications for public health organizations. [ABSTRACT FROM AUTHOR]

The National Collaborating Centres for Public Health (NCCPH) collaborated on the development of an action framework for integrating equity into population health status reporting. This framework integrates the research literature with on-the-ground experience collected using a unique collaborative learning approach with public health practitioners from across Canada. This article introduces the Action Framework, describes the learning process, and then situates population health status reporting (PHSR) in the current work of the public health sector. This is followed by a discussion of the nature of evidence related to the social determinants of health as a key aspect of deciding what and how to report. Finally, the connection is made between data and implementation by exploring the concept of actionable information and detailing the Action Framework for equity-integrated population health status reporting. The article concludes with a discussion of the importance of putting knowledge mobilization at the core of the PHSR process and makes suggestions for next steps. The purpose of the article is to encourage practitioners to use, discuss, and ultimately strengthen the framework. [ABSTRACT FROM AUTHOR]

The article discusses the failure of the ethnic data collectors to record the complexity of mental public health crisis in the U.S. It focus particularly on the lack of data for the Asian American and Native Hawaiian & Pacific Islander (NHPI) communities. It mentions the increase in major depressive disorders among some Asian Americans.

Regulators consider randomized controlled trials (RCTs) as the gold standard for evaluating the safety and effectiveness of medications, but their costs, duration, and limited generalizability have caused some to look for alternatives. Real world evidence based on data collected outside of RCTs, such as registries and longitudinal healthcare databases, can sometimes substitute for RCTs, but concerns about validity have limited their impact. Greater reliance on such real world data (RWD) in regulatory decision making requires understanding why some studies fail while others succeed in producing results similar to RCTs. Key questions when considering whether RWD analyses can substitute for RCTs for regulatory decision making are WHEN one can study drug effects without randomization and HOW to implement a valid RWD analysis if one has decided to pursue that option. The WHEN is primarily driven by externalities not controlled by investigators, whereas the HOW is focused on avoiding known mistakes in RWD analyses. [ABSTRACT FROM AUTHOR]

The author offers insights on the clinical population medicine (CPM) practice which integrates clinical care strategies and approaches to population health. Topics discussed include the perceived benefits of CPM to individuals and the whole community, the use of patient and population health data by health care institutions in the promotion of disease prevention and community health services, and the publication of various studies which involve population health assessment.

Despite benefits to sharing data among public health programs, confidentiality laws are often presumed to obstruct collaboration or data sharing. We present anoverviewof theuseandrelease of confidential, personally identifiable information as consistent with public health interests and identify opportunities to align data-sharing procedures with use andreleaseprovisions in statelaws to improve program outcomes. In August 2013, Centers for Disease Control and Prevention staff and legal researchers from the National Nurse-Led Care Consortium conducted a review of state laws regulating state and local health departments in 50 states and the District of Columbia. Nearly all states and the District of Columbia employ provisions for the generaluse and release of personally identifiable information without patient consent; disease-specific use or release provisions vary by state. Absence of lawregardinguse and release provisions was noted. Health departments should assess existing state laws to determine whether the use or release of personally identifiable information is permitted. Absence of direction should not prevent data sharing but prompt an analysis of existing provisions in confidentiality laws. [ABSTRACT FROM AUTHOR]

Background: Rates of Bordetella pertussis have been increasing in Alberta, Canada despite vaccination programs. Waning immunity from existing acellular component vaccines may be contributing to this. Vaccine effectiveness can be estimated using a variety of data sources including diagnostic codes from physician billing claims, public health records, reportable disease and laboratory databases. We sought to determine if diagnostic codes from billing claims (administrative data) are adequately sensitive and specific to identify pertussis cases among patients who had undergone disease-specific laboratory testing.Methods: Data were extracted for 2004-2014 from a public health communicable disease database that contained data on patients under investigation for B. pertussis (both those who had laboratory tests and those who were epidemiologically linked to laboratory-confirmed cases) in Alberta, Canada. These were deterministically linked using a unique lifetime person identifier to the provincial billing claims database, which contains International Classification of Disease version 9 (ICD-9) diagnostic codes for physician visits. We examined visits within 90 days of laboratory testing. ICD-9 codes 033 (whooping cough), 033.0 (Bordetella pertussis), 033.1 (B. parapertussis), 033.8 (whooping cough, other specified organism), and 033.9 (whooping cough, other unspecified organism) in any of the three diagnostic fields for a claim were classified as being pertussis-specific codes. We calculated sensitivity, specificity, positive (PPV) and negative (NPV) predictive values.Results: We identified 22,883 unique patients under investigation for B. pertussis. Of these, 22,095 underwent laboratory testing. Among those who had a laboratory test, 2360 tested positive for pertussis. The sensitivity of a pertussis-specific ICD-9 code for identifying a laboratory-confirmed case was 38.6%, specificity was 76.9%, PPV was 16.0%, and NPV was 91.6%.Conclusion: ICD-9 codes from physician billing claims data have low sensitivity and moderate specificity to identify laboratory-confirmed pertussis among persons tested for pertussis. [ABSTRACT FROM AUTHOR]

To systematically improve population health in the United States, community health records (CHRs) must be defined, developed, and implemented. Like electronic and personal health records, CHRs have both unique and overlapping information. CHRs contain data about communities, including the social, physical, and lifestyle determinants of health. These records will serve to complement electronic and personal health records to provide a more complete view of population health, allowing stakeholders to target community health and quality-of-life interventions in a data-driven and evidence-based manner, establishing the basis from which organizations can develop a systematic approach to improving community health. This commentary calls on the United States to conduct a set of consensus activities to define and implement CHRs. [ABSTRACT FROM AUTHOR]

Background: Outcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres-a possible source of bias. Population-based studies decrease survivor bias and provide additional insight into this high-mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia.Methods: All cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex- and region-specific incidence rates were calculated, and characteristics associated with 1-year survival were assessed.Results: We identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1-year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1).Conclusions: The incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia. [ABSTRACT FROM AUTHOR]

Syndromic surveillance, the collection of symptom data from individuals prior to or in the absence of diagnosis, is used throughout the developed world to provide rapid indications of outbreaks and unusual patterns of disease. However, the low cost of syndromic surveillance also makes it highly attractive for the developing world. We present a case study of electronic participatory syndromic surveillance, using participant-mobile phones in a rural region of Western Uganda, which has a high infectious disease burden, and frequent local and regional outbreaks. Our platform uses text messages to encode a suite of symptoms, their associated durations, and household disease burden, and we explore the ability of participants to correctly encode their symptoms, with an average of 75.2% of symptom reports correctly formatted between the second and 11th reporting timeslots. Concomitantly we identify divisions between participants able to rapidly adjust to this unusually participatory style of data collection, and those few for whom the study proved more challenging. We then perform analyses of the resulting syndromic time series, examining the clustering of symptoms by time and household to identify patterns such as a tendency towards the within-household sharing of respiratory illness. [ABSTRACT FROM AUTHOR]

Romanian healthcare confronts with several issues remained still unsolved. One of the main issues is bureaucracy. In our country bureaucracy finds a place in almost every public sector, especially in healthcare. Doctors have to complete daily papers over papers, to hand them to the National Insurance House and then, in the rest of the time, to practice their job. Unfortunately, the time for medicine is limited because of the several situations that must be completed monthly. Our paper tries to analyze the main problem, along with its root causes, in order to propose viable solutions that could be adopted so our healthcare system could be among the other European healthcare systems. [ABSTRACT FROM AUTHOR]

The article discusses the role of data analysis and technological innovations in public health care. It notes that big data and their background algorithms have taken over the decision making role previously performed by humans. It adds that public health should consider preserving the individual's rights and privileges without extending the usage of data to other areas like military and criminal activities.

Context: Disease registries enable priority setting and batching of clinical tasks, such as reaching out to patients who have missed a routine laboratory test. Building disease registries requires collaboration among professionals in medicine, population science, and information technology. Specialty care addresses many complex, uncommon conditions, and these conditions are diverse. The cost to build and maintain traditional registries for many diverse, complex, low-frequency conditions is prohibitive. Objective: To develop and to test the Specialty Miniregistries platform, a collaborative interface designed to streamline the medical specialist's contributions to the science and management of population health. Design: We used accessible technology to develop a platform that would generate miniregistries (small, routinely updated datasets) for surveillance, to identify patients who were missing expected utilization, and to influence clinicians and others to change practices to improve care. The platform was composed of staff, technology, and structured collaborations, organized into a workflow. The platform was tested in five medical specialty departments. Main Outcome Measure: Proof of concept. Results: The platform enabled medical specialists to rapidly and effectively communicate clinical questions, knowledge of disease, clinical workflows, and improvement opportunities. Their knowledge was used to build and to deploy the miniregistries. Each miniregistry required 1 to 2 hours of collaboration by a medical specialist. Turnaround was 1 to 14 days. Conclusions: The Specialty Miniregistries platform is useful for low-volume questions that often occur in specialty care, and it requires low levels of investment. The efficient organization of information workers to support accountable care is an emerging question. [ABSTRACT FROM AUTHOR]

Background: The diagnosis coding and medical procedure are methods of treatment that helps patients to organize and classify information correctly. Coding is a related factor with the quality to provide the data of illnesses and injuries. Aim: To examine rate of the coding accuracy of hospital patients of Imam Khomeini in Ahvaz (Iran) during spring 2010. Material and methods: In this cross-sectional study that was performed in 2010, society of investigation was 5062 records of patients admitted to the surgical ward of Imam Khomeini Hospital in Ahvaz from which 260 records were selected incidentally and orderly. Instrument of data collection was a checklist developed by the researchers based on library resources and the accuracy was confirmed in the narrative checklist used by expert faculty in this. After the data were collected, they analyzed using Excel software. Results: The most accurate coding was related to other procedures (92.61%) and least accurate coding was related to the major diagnosis (84.91%) and the lowest completeness of the encoding was related to other diagnosis regarding 66.88%. Conclusion: The results showed that the accuracy of diagnosis coding and procedure was optimal, but the level of completeness of diagnosis coding was too low regarding to hospital training. [ABSTRACT FROM AUTHOR]

From a Westerner's perspective of the place of people with a disability in Asian society, there are similarities and differences between the two societies. A major problem for the Asian countries is their lack of reliable disability prevalence data. The stigmatization of people with a disability remains an international problem and is not confined to Asian cultures. It is argued that the environmental contexts of a culture need to be explored before making generalisations about a culture's attitudes towards people experiencing a disability. Differences between social policies toward disadvantaged groups are explored with reference to economic rationalist policies, utilitarian individualism, materialism, and the potential moral challenges presented by new genetic discoveries. The rise of globalisation and its potential impact upon traditional Asian cultures is explored. The concluding analysis examines developments in disability legislation, support services and the development of a local disability research capacity. [ABSTRACT FROM AUTHOR]

The death certificate is mandated by civil law and serves as a medical-scientific document useful for biostatistics and epidemiological research. For a variety of reasons, death certificates can be misclassified. We reviewed data from self-inflicted deaths collected over an 8-year period by the Forensic Institute of the University Sacro Cuore of Rome ( Italy). Four hundred and thirty-five of 2904 were classified as self-inflicted deaths (15%). The comparison with death certificates processed by the local public health authority ( ASL) and by the Italian National Census Bureau ( Istat) and with the judicial investigation results available in the Italian Penal Court archive shows some discrepancies. One-hundred and twenty-four of 435 deaths were not considered to be self-inflicted but due to a crime (29% overrecording suicide) with a higher reduction for women, suggesting that it is easier to confuse a murder for suicide in female cases. Any discrepancies between the mortality and crime data are discussed in details. [ABSTRACT FROM AUTHOR]

We developed an electronic Health Information Management System (HIMS) for Public Health Midwives (PHMs) in Sri Lanka. We conducted a needs analysis amongst 16 PHMs, which found that they spent most of their time managing health records. The HIMS was designed so that it could accept data from the PHMs, and generate reports which could be used by the PHMs themselves as well as by their supervisors. The HIMS was trialled by a group of 16 PHMs in a remote area of the Ratnapura district of Sri Lanka. Mini-laptops with the software were distributed to the PHMs and they were given the necessary training. They started entering historical data from the registers into the system by themselves. Nearly 10,000 public health records were generated in the first three months. In a subsequent survey, the PHMs all gave positive answers indicating that they were happy with the pilot system, they would like to continue using it to enhance their service and they wanted to see it expanded across the whole of Ratnapura district. The system seems to be a practical solution for the field activities of PHMs in Sri Lanka. [ABSTRACT FROM AUTHOR]

Background: As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. Methods: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. Results: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity. Conclusion: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e-PCR systems has been challenging for many. Emerging strategies from EMS agencies and others that have successfully implemented EHRs may be useful in expanding e-PCR system use and facilitating this transition for other EMS agencies. [ABSTRACT FROM AUTHOR]

Background: The burden of cancer affects all countries; while high-income countries have the capacity and resources to establish comprehensive cancer control programs, low and middle-income countries have limited resources to develop such programs. This paper examines factors associated with the development of cancer registries in four provinces in Turkey. It looks at the progress made by these registries, the challenges they faced, and the lessons learned. Other countries with similar resources can benefit from the lessons identified in this case study. Methods: A mix of qualitative case study methods including key informant interviews, document review and questionnaires was used. Results: This case study showed that surveillance systems that accurately report current cancer-related data are essential components of a country's comprehensive cancer control program. At the initial stages, Turkey established one cancer registry with international support, which was used as a model for other registries. The Ministry of Health recognized the value of the registry data and its contribution to the country's cancer control program and is supporting sustainability of these registries as a result. Conclusions: This study demonstrates how Turkey was able to use resources from multiple sources to enhance its population based cancer registry system in four provinces. With renewed international interest in non-communicable diseases and cancer following the 2011 UN high-level meeting on NCDs, low- and middle- income countries can benefit from Turkey's experience. Other countries can utilize lessons learned from Turkey as they address cancer burden and establish their own registries. [ABSTRACT FROM AUTHOR]

The Japanese Gastric Cancer Association (JGCA) started a new nationwide gastric cancer registry in 2008. Approximately 50 data items, including surgical procedures, pathological diagnoses, and survival outcomes, for 12004 patients with primary gastric cancer treated in 2001 were collected retrospectively from 187 participating hospitals. Data were entered into the JGCA database according to the JGCA Classification of gastric carcinoma, 13th edition and the International Union Against Cancer (UICC) TNM Classification of malignant tumors, 5th edition by using an electronic data collecting system. Finally, data of 11261 patients with gastric resection were analyzed. The 5-year follow-up rate was 83.5%. The direct death rate was 0.6%. TNM 5-year survival rates (5YSRs)/JGCA 5YSRs were 91.8/91.9% for stage IA, 84.6/85.1% for stage IB, 70.5/73.1% for stage II, 46.6/51.0% for stage IIIA, 29.9/33.4% for stage IIIB, and 16.6/15.8% for stage IV. The proportion of patients more than 80 years old was 7.0%, and their 5YSR was 48.7%. Compared to the JGCA archived data, though the follow-up rate needs to be improved, these data suggest that the postoperative results of patients with primary gastric carcinoma have improved in those with advanced disease and in the aged population in Japan. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate a hospital-based injury recording system on hip fracture registration in elderly persons aged + 65 years from 1994 through 2008, and to examine the agreement between the number of validated fractures and the number of fractures reported to the Norwegian Patient Registry using three different sources: (1) Medical records, (2) Patient administrative system and (3) The hospital's hip fracture record to the Norwegian Patient Registry from 2002 through 2008. The injury recording system included 582 hip fracture events and 535 (92%) were confirmed through the medical records. Reasons for non-verification were different coding failures. Searching the patient administrative system using ICD codes identified 16 hip fractures not included in the fracture registry between 2002 through 2008. The total number was the same as the number of hip fractures reported to the Norwegian Patient Registry using ICD codes alone for identification. The conclusion is that on well-defined diagnosis like hip fractures, local fracture registries may obtain a high degree of reliability if different sources are available for quality control. Well-functioning patient administrative systems may be used to study numbers of hip fractures. [ABSTRACT FROM AUTHOR]

By the sixteenth century, it was widely accepted that plague, whatever its true nature, was a contagious disease. The Venetian state ordered Venetian travellers and its representatives abroad to report any news about the mal contagioso to the government. Fragmentary survivals in the records of the Sanita and other sources allow an understanding of what it was that they thought was causing the disease and what Venetians thought could be done. It is a commonplace that traditional ideas about medicine and religion were increasingly discarded as more and more accurate records of the periodicity of disease became available. Vhttp://bkstrm.epnet.com:8080/ai/images/save.gifenice's attempts allow us to measure the change. [ABSTRACT FROM AUTHOR]

The article details a study which examined the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL), which provide demographic information on patients with group 1 pulmonary arterial hypertension (PAH) in the U.S. REVEAL showed 2,967 patients with PAH who were diagnosed between March 2006 and September 2007. It noted that patients with PAH are older than those registered in the National Institutes of Health (NIH) registry.

Despite widespread use of communicable disease surveillance data to inform public health intervention and control measures, the reporting completeness of the notifiable disease surveillance system remains incompletely assessed. Therefore, we conducted a comprehensive study of reporting completeness with an analysis of 53 diseases reported by 8 health care systems across North Carolina, USA, during 1995-1997 and 2000-2006. All patients who were assigned an International Classification of Diseases, 9th Revision, Clinical Modification, diagnosis code for a state-required reportable communicable disease were matched to surveillance records. We used logistic regression techniques to estimate reporting completeness by disease, year, and health care system. The completeness of reporting varied among the health care systems from 2% to 30% and improved over time. Disease-specific reporting completeness proportions ranged from 0% to 82%, but were generally low even for diseases with great public health importance and opportunity for interventions. [ABSTRACT FROM AUTHOR]

AIMS of AMIS Plus To learn from each other, to understand the transfer, use and practicability of knowledge gained from randomised trials and to generate input for subsequent prospective and randomised studies. Furthermore, to determine how adherence to guideline-based treatments in the 'real world⇔tm) works. Funding AMIS Plus is an industry-sponsored project but the supporting institutions do not play any part in the design of the registry, data collection, analysis or interpretation. Quality-of-care interventions AMIS Plus data enable doctors to identify deficits in medical care, implement the necessary changes in diagnostics and therapeutic procedures and document their impact on clinical outcome in patients with acute coronary syndrome (ACS). Setting From 106 hospitals treating ACS in Switzerland, 76 hospitals temporarily or continuously enrolled patients in AMIS Plus. Years: 1997. Population Patients are included on the basis of their final diagnosis. Current number of cases: 33,040. Start points ST elevation myocardial infarction, non-ST elevation myocardial infarction and since 2000, unstable angina. Baseline data 230 variables are collected including demographics, medical history, cardiovascular risk factors, acute symptoms, time of symptom onset, first medical contact, time of admission and start of thrombolysis or balloon, out of hospital management, clinical presentation, early in-hospital management, reperfusion treatment, hospital course, diagnostic tests used or planned, hospital length of stay, discharge medication, destination and at 1 year, outcome, rehospitalisation, intervention, working time and quality of daily life. Data capture Data are provided through an internet- or paper-based questionnaire completed by the treating doctor or a trained study nurse. Data quality The data are centralised at the AMIS Plus Data Center, checked for plausibility and consistency and crosschecked when queries arise. Incomplete questionnaires are returned to the enrolment centres for completion. One-third of the variables are obligatory. End point and linkages to other data In-hospital outcome, 3-months and 1-year follow-up outcome. No linkages exist at present. Access to data Available for research with the approval of the AMIS Plus Steering Committee. Participating hospitals use the data for benchmarking and their own quality control. [ABSTRACT FROM AUTHOR]

The article offers information on the significance of clinically useful electronic health records (EHR) in reducing medical errors and promoting efficiency and improved quality of medical care. It discusses the shortcomings of 1990s electronic system and electronic version of the paper record in meeting clinical needs where the current system was reported to be clinically failed due to its slow work flow. It mentions the usage of clinical document architecture (CDA) or clinical continuity of care records (CCR), unique patient identifier (UPI), and tools are available to support clinical decision-making and promote adherence to clinically recommended therapies. It also mentions the computer decision support (CDS) system for beta blocker and angiotensin converting enzyme (ACE)-inhibitor use.

Background: BioSense is the US national automated biosurveillance system. Data regarding chief complaints and diagnoses are automatically pre-processed into 11 broader syndromes (e.g., respiratory) and 78 narrower subsyndromes (e.g., asthma). The objectives of this report are to present the types of illness and injury that can be studied using these data and the frequency of visits for the syndromes and sub-syndromes in the various data types; this information will facilitate use of the system and comparison with other systems. Methods: For each major data source, we summarized information on the facilities, timeliness, patient demographics, and rates of visits for each syndrome and sub-syndrome. Results: In 2008, the primary data sources were the 333 US Department of Defense, 770 US Veterans Affairs, and 532 civilian hospital emergency department facilities. Median times from patient visit to record receipt at CDC were 2.2 days, 2.0 days, and 4 hours for these sources respectively. Among sub-syndromes, we summarize mean 2008 visit rates in 45 infectious disease categories, 11 injury categories, 7 chronic disease categories, and 15 other categories. Conclusions: We present a systematic summary of data that is automatically available to public health departments for monitoring and responding to emergencies. [ABSTRACT FROM AUTHOR]

Background: Current public concern over the spread of infectious diseases has underscored the importance of health surveillance systems for the speedy detection of disease outbreaks. Several international report-based monitoring systems have been developed, including GPHIN, Argus, HealthMap, and BioCaster. A vital feature of these report-based systems is the geo-temporal encoding of outbreak-related textual data. Until now, automated systems have tended to use an ad-hoc strategy for processing geo-temporal information, normally involving the detection of locations that match pre-determined criteria, and the use of document publication dates as a proxy for disease event dates. Although these strategies appear to be effective enough for reporting events at the country and province levels, they may be less effective at discovering geo-temporal information at more detailed levels of granularity. In order to improve the capabilities of current Web-based health surveillance systems, we introduce the design for a novel scheme called spatiotemporal zoning. Method: The proposed scheme classifies news articles into zones according to the spatiotemporal characteristics of their content. In order to study the reliability of the annotation scheme, we analyzed the inter-annotator agreements on a group of human annotators for over 1000 reported events. Qualitative and quantitative evaluation is made on the results including the kappa and percentage agreement. Results: The reliability evaluation of our scheme yielded very promising inter-annotator agreement, more than a 0.9 kappa and a 0.9 percentage agreement for event type annotation and temporal attributes annotation, respectively, with a slight degradation for the spatial attribute. However, for events indicating an outbreak situation, the annotators usually had inter-annotator agreements with the lowest granularity location. Conclusions: We developed and evaluated a novel spatiotemporal zoning annotation scheme. The results of the scheme evaluation indicate that our annotated corpus and the proposed annotation scheme are reliable and could be effectively used for developing an automatic system. Given the current advances in natural language processing techniques, including the availability of language resources and tools, we believe that a reliable automatic spatiotemporal zoning system can be achieved. In the next stage of this work, we plan to develop an automatic zoning system and evaluate its usability within an operational health surveillance system. [ABSTRACT FROM AUTHOR]

Objective To document and verify the number of cases of severe acute respiratory syndrome (SARS) during the 2002–2003 epidemic in mainland China. Method All existing Chinese SARS data sources were integrated in one final database. This involved removing non-probable and duplicate cases, adding cases at the final stage of the outbreak, and collecting missing information. Results The resulting database contains a total of 5327 probable SARS cases, of whom 343 died, giving a case fatality ratio (CFR) of 6.4%. While the total number of cases happens to be equal to the original official reports, there are 5 cases overall which did not result in death. When compared with Hong Kong Special Administrative Region of China, China Taiwan, and Singapore, the SARS epidemic in mainland China resulted in a considerably lower CFR, involved relatively younger cases and included fewer health care workers. Conclusions To optimise future data collection during large-scale outbreaks of emerging or re-emerging infectious disease, China must further improve the infectious diseases reporting system, enhance collaboration between all levels of disease control, health departments, hospitals and institutes nationally and globally, and train specialized staff working at county centres of disease control. [ABSTRACT FROM AUTHOR]

Peripheral T-cell lymphomas (PTCL) represent a small subgroup of non-Hodgkin lymphomas historically difficult to diagnose. We conducted a comprehensive assessment of 3287 PTCL cases diagnosed from 1992 to 2005 in 13 Surveillance, Epidemiology and End Results registries. Incidence trends, age-adjusted incidence rates and relative survival rates were compared across the study period, and by sex, race and age groups. From 1992 to 2005, PTCL incidence increased by 280%. Age-adjusted incidence rates were higher in males (Male/Female incidence rate ratio (IRR) 1.8) and in Blacks (Black/White IRR 1.2). Asian predominance was pronounced for extranodal NK/T-cell lymphoma, nasal type. Whites had higher 5-year survival than other racial groups for most histologic subtypes; however, the differences were not statistically significant. The variance in incidence rates and outcomes across PTCL subtypes support the pursuit of ongoing research to identify the etiology, pathophysiology, treatment patterns and differences in treatment response for PTCL subsets. [ABSTRACT FROM AUTHOR]

Several charts are presented that show health statistics in the U.S. as of September 5, 2008 including the percentage of adults who used complementary and alternative medicine, provisional cases of infrequently reported notifiable diseases for the week ending August 30, 2008, and provisional cases of selected notifiable diseases for weeks ending August 30, 2008 and September 1, 2007.

Objectives. We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports. Methods. We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional). Results. Optimal performance in consistently connecting callers with an action officer in 30 minutes or less was achieved by 31% of participating health departments. Reaching a live person upon dialing, regardless of who that person was, was the strongest predictor of optimal performance both in being connected with an action officer and in consistency of connection times. Conclusions. Health departments can achieve optimal performance in consistently connecting a caller with an action officer in 30 minutes or less and may improve performance by using a telephone-based disease surveillance system in which the phone is answered by a live person at all times. (Am J Public Health. 2008;98:1706-1711. doi:10.2105/AJPH.2007.114710) [ABSTRACT FROM AUTHOR]