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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]

Managing residential care facilities (RCFs) includes the ability to manage adverse events while maintaining a human rights-based approach to care and support. Literature investigating rights-based approaches in RCFs is scarce; therefore, an investigation of the current approach in RCFs will inform improvements. This study sought to identify whether RCFs in Ireland upheld a rights-based approach during the course of adverse events by analyzing notifications of adverse events from 2021 taken from the Database of Statutory Notifications from Social Care in Ireland. Data analysis was conducted independently by two researchers. Notifications of adverse events were coded according to whether the human rights principles of fairness, respect, equality, dignity, and autonomy were upheld or violated during the adverse event and its subsequent management. There was some evidence of violations, including staff violations during adverse events and their management, as well as residents violating fellow residents' autonomy, respect, and dignity in notifications of "serious injury" and "allegations of abuse." However, overall, good practice was identified, with residents' human rights upheld by staff. Our findings indicate that a rights-based approach to care and support is being upheld during adverse events and their management, which may indicate that such an approach to care and support has been adopted [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]

Hospital quality has been measured and made publicly available for decades in the US and for more than a decade in Germany, as part of an effort to help those countries achieve quality improvement. The German hospital market presents a unique opportunity to examine the relationship between public reporting and quality improvement in the absence of performance-linked payment incentives in a high-income country. We considered quality indicators from several important categories of health services provided in hospitals (hip, knee, obstetrics, neonatology, heart, neck artery surgery, pressure ulcers, and pneumonia), using structured hospital quality reports from the period 2012-19. Our findings support the idea that public reporting provides a quality benchmark and prevents the provision of very low quality health care services, suggesting that imposing financial punishment on low performers is not necessary and may hinder quality improvement and aggravate health disparities. Although hospitals' intrinsic motivation and market forces play roles in improving quality, they are not sufficient to maintain the quality of high-performing hospitals. Therefore, in addition to rewarding high-performing institutions, aligning quality incentives with the intrinsic professional values of clinical care may be useful in achieving quality improvement. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to determine the impact of the strengthening or relaxation of face covering mandates on the subsequent national case incidence of coronavirus disease 2019 (COVID-19) in Europe as the full vaccination rate was increasing. Methods: European countries in which case incidence increased for 3 consecutive weeks were monitored and analyzed using COVID-19 incidence data shared by the World Health Organization (WHO). The epidemic trend of COVID-19 in Europe was compared with that of countries elsewhere in the world based on WHO weekly epidemiological reports from June 20 to October 30, 2021. In addition, this study provided insight into the impact of government mask mandates on COVID-19 incidence in Europe by measuring the index scores of those facial covering policies before and after mandate relaxation or strengthening. The effects of the vaccination rate and the speed of vaccination on COVID-19 incidence were also analyzed. Results: The incidence of COVID-19 after the relaxation of face covering mandates was significantly higher than before relaxation. However, no significant difference was observed in vaccination rate between countries with increased and decreased incidence. Instead, rapid vaccination delayed the resurgence in incidence. Conclusion: The findings suggest that face covering policies in conjunction with rapid vaccination efforts are essential to help mitigate the spread of COVID-19. [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]

Public reporting is a policy to improve quality and increase data transparency. The objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. Panel data analysis. About 146 nursing homes with complete quarterly data in New Jersey between January 1, 2012, and December 31, 2019. Using data from the State of New Jersey Department of Health and Nursing Home Compare, staff-to-resident ratios were trended for registered nurses, licensed practical nurses, and certified nursing assistants by shift and over time. Panel data analysis was used to test the association between the ratios and the ratings. Compared to 2012, staffing ratios improved slightly for licensed practical nurses but not for registered nurses or certified nursing assistants in 2019 (P <.001). The number of residents assigned doubled at night for all personnel. During the day and evening shifts, registered nurse staffing was significantly associated with the Nursing Home Compare staffing rating (P <.01) but not the overall rating. Decreasing the number of residents assigned to a registered nurse in NHs results in an increase in staffing ratings. Mandatory public reporting holds nursing homes accountable for quality outcomes but does not improve staffing ratios. Quality resident care is the cumulative result of multiple measures inclusive of staffing; therefore, administrators should continue to focus on improving quality in NHs, which may improve staffing ratios across shifts. [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]

Mandated social distancing has been applied globally to reduce the spread of coronavirus disease 2019 (COVID-19). However, the beneficial effects of this community-based intervention have not been proven or quantified for the COVID-19 pandemic. This is a regional population-level observational study. Using publicly available data, we examined the effect of timing of mandated social distancing on the rate of COVID-19 cases in 119 geographic regions, derived from 41 states within the United States and 78 other countries. The highest number of new COVID-19 cases per day recorded within a geographic unit was the primary outcome. The total number of COVID-19 cases in regions where case numbers had reached the tail end of the outbreak was an exploratory outcome. We found that the highest number of new COVID-19 cases per day per million persons was significantly associated with the total number of COVID-19 cases per million persons on the day before mandated social distancing (β = 0.66, P < 0.0001). These findings suggest that if mandated social distancing is not initiated until the number of existing COVID-19 cases has doubled, the eventual peak would result in 58% more COVID-19 cases per day. Subgroup analysis on those regions where the highest number of new COVID-19 cases per day has peaked showed increase in β values to 0.85 (P < 0.0001). The total number of cases during the outbreak in a region was strongly predicted by the total number of COVID-19 cases on the day before mandated social distancing (β = 0.97, P < 0.0001). Initiating mandated social distancing when the numbers of COVID-19 cases are low within a region significantly reduces the number of new daily COVID-19 cases and perhaps also reduces the total number of cases in the region. • The number of coronavirus disease 2019 (COVID-19) cases at the time of mandated social distancing in a region is a strong predictor of peak daily new cases. • Early mandated social distancing significantly reduces the number of daily new COVID-19 cases in the region. • Early mandated social distancing also likely significantly reduces the total number of COVID-19 cases in the region. [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]

Objective: To assess the quality when filling out a health follow-up instrument for children in a town in northeastern Brazil. Method: It is a cross-sectional study involving 204 children who received care at 16 family health units. This study analyzes how they filled out the child's health card (CS) and the Child's Health Record (CSI), the differences between both and the associated factors. Results: the filling out was unsatisfactory in 37.2% of the CS and 50.5% of the CSI. Regarding the CSIs, the correct filling out was observed less often in the following cases: supply of iron supplements (0%), development checkups (1.1%), prenatal care (9.9%), feeding after stopping the breastfeeding (17.6%), and growth curves (0%-27.5%). There was a lower percentage of correct filling out for the CSIs regarding the baby's name, type of labor and weight indication in the graph. Newborns from married mothers (p = 0.045) and female babies (p = 0.017) showed lower probability of inappropriate filling out of both CSs and CSIs, respectively. Conclusion: The instrument for health surveillance in children is being underused. [ABSTRACT FROM AUTHOR]

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Aim: The global priority for strengthening the health system is the need to improve health information systems. The effectiveness of medical institutions work depends on the statistical data processing quality and speed, which makes the use of information systems in health care currently relevant. Experimental: 1233 respondents took part in the sociological survey, including 352 health professionals working with AIS (Automated Information System "Polyclinic"), " Attached Population Register" (APR), Electronic Dispensary Patient Register (EDPR). Result and Discussion: 70.4% responded - "significantly improved" to the question about improving the organization of medical care in health care facilities after the introduction of information systems. And, also we have studied the "Electronic Dispensary Patient Register (EDPR)" portal, where 881 patients (18-63 years old) with arterial hypertension are on dispensary registration. Conclusion: Results of sociological surveys on health informatization have shown that information systems in health-care facilitate access to information, save time for medical personnel, improve management of work processes and improve the efficiency of medical institutions. [ABSTRACT FROM AUTHOR]

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]

Objectives Malignant mesothelioma (MM) is a rare and aggressive cancer mostly caused by asbestos exposure, and for which the diagnosis is difficult. This study aimed to assess the completeness and correctness of MM registration using 3 independent national databases: the Belgian Cancer Registry (BCR), the population-based mortality statistics (certificates of death, COD), and the Belgian Mesothelioma Registry (BMR). Methods The study cohort included all MM reported to the BCR and diagnosed between 2004 and 2012 (n = 2292), all patients reviewed by the pathology commission of the BMR (2004–2012; n = 2019), and COD data for all Belgian citizens (2004–2013). Available data were compared in terms of registered cases, histological diagnosis, performed immunohistochemical (IHC) tests, and IHC test results. Results Comparison of BCR with BMR registrations showed 94.8% concordant cases. The proportion of MM diagnoses originally reported to BCR with unspecified MM morphology was reduced from 25.8% to less than 1%. Results from IHC tests were available for 95.3% of concordant MM cases. Different IHC patterns could be distinguished by MM histology. MM cases registered at BCR for which COD mentioned an MM as underlying cause of death represented 76.4% of deceased cases. MM long-term survivors (survival >3 years; 10.9%) were characterised by distinct clinical and biological characteristics. Conclusions A comparison of independent Belgian MM registration databases elucidated under-registration and misclassification and revealed possible reasons for observed discordances. Combining all the available information resulted in enhanced completeness and correctness of MM registration in Belgium and allowed for the identification and characterisation of MM long-term survivors. [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.

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]

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]

We studied the relationship between the time of day bacteriology reports were available in the electronic medical record (Epic, Verona, WI) and subsequent length of stay (LOS) following the last report before discharge. All patients ≥18 years admitted to the UF Health Shands Hospital between 1/1/2014–2/29/2016 were included. We calculated the mean LOS following the report for each half-hour time period between 6 AM and 1 PM (N = 14, 95.6% of all results) and tested the relationship to subsequent LOS. For patients whose total LOS was ≤168 hours (N = 13,830) there was a highly significant positive linear relationship between the report time and LOS following the last report (r = 0.8813, P = 0.00001556). For those patients with total LOS > 168 h, there was no clear relationship between report time in the morning and LOS after the last bacteriology report. The relationship between bacteriology report time in the morning and use of this information by physicians in discharge decision-making is likely to be complex and multi-factorial, but for those patients with a total hospital LOS ≤168 h, there is a strong relationship between an earlier report and earlier patient discharge. [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.

Discusses the ability to display physiological medical records that can be projected on a Screen.Presents the history of this equipment, beginning with Carl Ludwig. Ludwig (1816?1895), was the first to bring forward a scripture from the heart?the arterial blood pressure record?in 1847, by means of the kymograph [2]. The instrument soon spread throughout the world, becoming a must in any self-respected physiology laboratory, both as a teaching and research tool, persisting well into the mid-20th century. Discusses the development of this technology and reports on applications for its use. [ABSTRACT FROM AUTHOR]

Background Many public health laboratories adopting the U.S. HIV laboratory testing algorithm do not have a nucleic acid test (NAT), which is needed when the third- or fourth-generation HIV screening immunoassay is reactive and the antibody-based supplemental test is non-reactive or indeterminate. Objectives Among public health laboratories utilizing public health referral laboratories for NAT conducted as part of the algorithm, we evaluated the percentage of screening immunoassays needing NAT, the number of specimens not meeting APTIMA (NAT) specifications, time to APTIMA result, the proportion of acute infections (i.e., reactive APTIMA) among total infections, and screening immunoassay specificity. Study design From August 2012 to April 2013, 22 laboratories enrolled to receive free APTIMA (NAT) at New York or Florida public health referral laboratories. Data were analyzed for testing conducted until June 2013. Results Submitting laboratories conducted a median of 4778 screening immunoassays; 0–1.3% (median 0.2%) needed NAT. Of 140 specimens received, 9 (6.4%) did not meet NAT specifications. The median time from specimen collection to reporting the 11 reactive NAT results was ten days, including six days from receipt in the submitting laboratory to shipment to the referral laboratory. Acute infections ranged from 0 to 12.5% (median 0%) of total infections. Third- and fourth-generation immunoassays met package insert specificity values. Conclusions Public health referral laboratories provide a feasible option for conducting NAT. Reducing the time from specimen collection to submission of specimens for NAT is an important step toward maximizing the public health impact of identifying acute infections. [ABSTRACT FROM AUTHOR]