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Health Data (health + data)
Selected AbstractsQuantifying the Effects of Mask Metadata Disclosure and Multiple Releases on the Confidentiality of Geographically Masked Health DataGEOGRAPHICAL ANALYSIS, Issue 1 2008Dale L. Zimmerman The availability of individual-level health data presents opportunities for monitoring the distribution and spread of emergent, acute, and chronic conditions, as well as challenges with respect to maintaining the anonymity of persons with health conditions. Particularly when such data are mapped as point locations, concerns arise regarding the ease with which individual identities may be determined by linking geographic coordinates to digital street networks, then determining residential addresses and, finally, names of occupants at specific addresses. The utility of such data sets must therefore be balanced against the requirements of protecting the confidentiality of individuals whose identities might be revealed through the availability of precise and accurate locational data. Recent literature has pointed toward geographic masking as a means for striking an appropriate balance between data utility and confidentiality. However, questions remain as to whether certain characteristics of the mask (mask metadata) should be disclosed to data users and whether two or more distinct masked versions of the data can be released without breaching confidentiality. In this article, we address these questions by quantifying the extent to which the disclosure of mask metadata and the release of multiple masked versions may affect confidentiality, with a view toward providing guidance to custodians of health data sets. The masks considered include perturbation, areal aggregation, and their combination. Confidentiality is measured by the areas of confidence regions for individuals' locations, which are derived under the probability models governing the masks, conditioned on the disclosed mask metadata. [source] Applying the Concept of Positive Deviance to Public Health Data: A Tool for Reducing Health DisparitiesPUBLIC HEALTH NURSING, Issue 6 2007Lorraine O. Walker ABSTRACT The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in low-resource communities, has been effective in community mobilization and programming to improve health outcomes. We present a protocol for extending the concept to analysis of existing public health data. The protocol includes assessing whether PD fits the situation, identifying positive deviants, and identifying behaviors associated with positive deviants' healthy outcomes. Analyzing existing datasets from a PD perspective may aid public health nurses in efforts to reduce health disparities. The effectiveness of our protocol will be clarified in future research. [source] Geocoding Health Data: The Use of Geographic Codes in Cancer Prevention and Control, Research and Practice edited by Gerard Rushton, Marc P. Armstrong, Josephine Gittler, Barry R. Greene, Claire E. Pavlik, Michele M. West and Dale L. ZimmermanTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 4 2008LU WANG No abstract is available for this article. [source] Gender differences in genetic and environmental influences on gambling: results from a sample of twins from the National Longitudinal Study of Adolescent HealthADDICTION, Issue 3 2010Kevin M. Beaver ABSTRACT Aims To examine the extent to which genetic factors and shared and non-shared environmental factors are implicated in the development of gambling behaviors and to examine whether there are gender differences in the genetic and environmental contributors to gambling behaviors. Design A genetically informative analysis was performed by using DeFries,Fulker (DF) analysis. Setting Analysis of secondary data drawn from the National Longitudinal Study of Adolescent Health (Add Health). Participants A total of 324 monozygotic (MZ) twins and 278 same-sex dizygotic (DZ) twins were included in the analysis. Of these twins, there were 150 male MZ twins, 144 male DZ twins, 174 female MZ twins and 134 female DZ twins. Measurements Gambling behavior was measured through eight self-reported questions that tapped a range of items designed to measure problems related to gambling. Self-reported measures of self-control and delinquent involvement were also included to examine the degree to which these factors covaried with gambling behavior. Findings The results of the DF analysis indicated that when male and female twin pairs were analyzed simultaneously, genetic factors explained approximately 70% of the variance in gambling and non-shared environmental factors explained the remaining variance. When gender-specific models were calculated, substantial gender differences emerged. For males, genetic factors explained approximately 85% of the variance in gambling, with the non-shared environment accounting for the remaining variance. For females, genetic factors explained none of the variance in gambling behaviors, while the shared environment explained 45% of the variance and the non-shared environment explained 55% of the variance. Conclusions Analysis of twins from the Add Health data suggests that there are significant gender differences in the genetic and environmental underpinnings to gambling behaviors. [source] Substance use disorder among older adults in the United States in 2020ADDICTION, Issue 1 2009Beth Han ABSTRACT Aims This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. Design Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002,06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. Setting Non-institutionalized US residences. Participants Representative sample of the US civilian, non-institutionalized population. Measurements Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Findings Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002,06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. Conclusions Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder. [source] The influence of news events on health after disaster: A longitudinal study in general practiceJOURNAL OF TRAUMATIC STRESS, Issue 6 2009Petra M.H. ten Veen This study investigates the influence of local and international news events on utilization of health services resources and health complaints as presented by victims of a fireworks depot disaster. It was hypothesized that victims (N = 2,854) will show more utilization and health complaints to their general practitioner (GP) in the week after 11 local news reports of events relating to the specific index trauma and 6 unrelated disasters reported in international print news, than the week before. Health data of victims and matched controls were extracted from electronic medical records, covering 4-years postdisaster. Especially local news events concerning the cause of the disaster were associated in both victims and controls with an increase of GP utilization and health complaints, including medically unexplained physical symptoms, chronic diseases, and psychological problems. No difference between victims and controls were found. [source] A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal healthACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010W. Warburton Warburton W, Hertzman C, Oberlander TF. A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health. Objective:, To determine whether risk for adverse neonatal outcomes are reduced by stopping SSRI use before the end of pregnancy. Method:, Using population health data, maternal health and prenatal SSRI prescriptions were linked to neonatal birth records (N = 119 547) (1998,2001). Neonates SSRI-exposed in the last 14 days (L14) of gestation were compared with infants who had gestational exposure, but not during the last 14 days (NL14). Propensity score matching was used to control for potential confounders (total exposure, maternal health characteristics). Results:, Increased risk for neonatal respiratory distress was present where L14 exposure occurred compared with risk where exposure stopped before L14. However, controlling for potential maternal and neonatal confounders, differences disappeared. Conclusion:, Controlling for maternal illness severity, reducing exposure to SSRI's at the end of pregnancy had no significant clinical effect on improving neonatal health. These findings raise the possibility that some adverse neonatal outcomes may not be an acute pharmacological condition such as toxicity or withdrawal. [source] Evaluation of reduced rank semiparametric models to assess excess of risk in cluster analysisENVIRONMETRICS, Issue 4 2009Marco Geraci Abstract The existence of multiple environmental hazards is obviously a threat to human health and, from a statistical point of view, the modeling and the detection of disease clusters potentially related to those hazards offer challenging tasks. In this paper, we consider low rank thin plate spline (TPS) models within a semiparametric approach to focused clustering for small area health data. Both the distance from a putative source and a general, unspecified clustering process are modeled in the same fashion and they are entered log-additively in mixed Poisson-Normal models. Some issues related to the identification of the random effects arising from this approach are investigated. Under different simulated scenarios, we evaluate the proposed models using conditional Akaike's weights and tests for variance components, providing a comprehensive model selection methodology easy to implement. We examine observations of lung cancer deaths taken in Ohio between 1987 and 1988. These data were analyzed on several occasions to investigate the risk associated with a putative source in Hamilton county. In our analysis, we found a strong south-eastward spatial trend which is confounded with a significant radial distance effect decreasing between 0 and 150 km from the point source. Copyright © 2008 John Wiley & Sons, Ltd. [source] Modelling the effects of air pollution on health using Bayesian dynamic generalised linear modelsENVIRONMETRICS, Issue 8 2008Duncan Lee Abstract The relationship between short-term exposure to air pollution and mortality or morbidity has been the subject of much recent research, in which the standard method of analysis uses Poisson linear or additive models. In this paper, we use a Bayesian dynamic generalised linear model (DGLM) to estimate this relationship, which allows the standard linear or additive model to be extended in two ways: (i) the long-term trend and temporal correlation present in the health data can be modelled by an autoregressive process rather than a smooth function of calendar time; (ii) the effects of air pollution are allowed to evolve over time. The efficacy of these two extensions are investigated by applying a series of dynamic and non-dynamic models to air pollution and mortality data from Greater London. A Bayesian approach is taken throughout, and a Markov chain monte carlo simulation algorithm is presented for inference. An alternative likelihood based analysis is also presented, in order to allow a direct comparison with the only previous analysis of air pollution and health data using a DGLM. Copyright © 2008 John Wiley & Sons, Ltd. [source] Evaluation of Bayesian models for focused clustering in health dataENVIRONMETRICS, Issue 8 2007Bo Ma Abstract This paper examines the ability of Bayesian hierarchical models to recover evidence of disease risk excess around a fixed location. This location can be a putative source of health hazard, such as an incinerator, mobile phone mast or dump site. While Bayesian models are convenient to use for modeling, it is useful to consider how well these models perform in the true risk scenarios. In what follows, we evaluate the ability of these models to recover the true risk under simulation. It is surprising that the resulting posterior parameters estimates are heavily biased. Using the credible intervals for distance decline parameter to assess ,coverage or power' of detecting distance effect, the ,power' decreases with increasing correlation in the background population effect. The inclusion of correlated heterogeneity in models does affect the ability of the models to detect the stronger distance decline scenarios. The uncorrelated heterogeneity seems little affect this ability however. Copyright © 2007 John Wiley & Sons, Ltd. [source] Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern BrazilADDICTION, Issue 6 2003Raúl A. Mendoza-Sassi ABSTRACT Aims To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT). Design Cross-sectional study. Setting A town in southern Brazil. Participants A representative sample of 1260 people aged 15 and over. Measurements Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Findings Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class (P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61,13.16) compared with women. A linear trend was found (P = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91,5.58) and ex-smokers (OR 1.30; CI 0.56,2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35,4.56) of presenting a positive test. Conclusions The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies. [source] Measuring health polarization with self-assessed health dataHEALTH ECONOMICS, Issue 9 2007Benedicte ApoueyArticle first published online: 20 AUG 200 Abstract This paper proposes an axiomatic foundation for new measures of polarization that can be applied to ordinal distributions such as self-assessed health (SAH) data. This is an improvement over the existing measures of polarization that can be used only for cardinal variables. The new measures of polarization avoid one difficulty that the related measures for evaluating health inequalities face. Indeed, inequality measures are mean based, and since only cardinal variables have a mean, SAH has to be cardinalized to compute a mean, which can then be used to calculate an inequality measure. In contrast, the new polarization measures are median based and hence do not require to impose cardinal scaling on the categories. After deriving the properties of these new polarization measures, we provide an empirical illustration using data from the British Household Panel Survey that demonstrates that SAH polarization is also a relevant question on empirical grounds, and that the polarization measures are adequate to evaluate polarization phenomena whereas inequality measures are not adequate in these cases. Copyright © 2007 John Wiley & Sons, Ltd. [source] Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocolJOURNAL OF ADVANCED NURSING, Issue 8 2010Eva Abad-Corpa abad-corpa e., meseguer-liza c., martínez-corbalán j.t., zárate-riscal l., caravaca-hernández a., paredes-sidrach de cardona a., carrillo-alcaraz a., delgado-hito p. & cabrero-garcía j. (2010) Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol. Journal of Advanced Nursing,66(8), 1845,1851. Abstract Title.,Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol. Aim., To generate changes in nursing practice introducing an evidence-based clinical practice (EBCP) model through a participatory process. To evaluate the effectiveness of the changes in terms of nurse-sensitive outcome (NSO). Background., For international nursing science, it is necessary to explore the reasons for supporting EBCP and evaluate the real repercussions and effectiveness. Methods., A mixed methods study with a sequential transformative design will be conducted in the bone marrow transplant unit of a tertiary-level Spanish hospital, in two time periods >12 months (date of approval of the protocol: 2006). To evaluate the effectiveness of the intervention, we will use a prospective quasi-experimental design with two non-equivalent and non-concurrent groups. NSO and patient health data will be collected: (a) impact of psycho-social adjustment; (b) patient satisfaction; (c) symptom control; (d) adverse effects. All patients admitted during the period of time will be included, and all staff working on the unit during a participatory action research (PAR). The PAR design will be adopted from a constructivist paradigm perspective, following Checkland's "Soft Systems" theoretical model. Qualitative techniques will be used: 2-hour group meetings with nursing professionals, to be recorded and transcribed. Field diaries (participants and researchers) will be drawn up and data analysis will be carried out by content analysis. Discussion., PAR is a rigorous research method for introducing changes into practice to improve NSO. [source] Stability analysis of an additive spline model for respiratory health data by using knot removalJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES C (APPLIED STATISTICS), Issue 5 2009Harald Binder Summary., In many settings with possibly non-linear influence of covariates, such as in the present application with children's respiratory health data, generalized additive models are an attractive choice. Although techniques for fitting these have been extensively investigated, there are fewer results on stability of replication, i.e. stability of fitted model components with respect to perturbations in the data. Nevertheless, this aspect is essential for judging how useful the present model is for understanding predictors of lung function. We therefore investigate existing tools for stability analysis based on bootstrap samples, such as quantities for variability and bias, for our application. Furthermore, as the focus is on models based on B -splines, knot removal techniques are available. These can help to provide more insight into the stability of local features that are fitted in bootstrap samples. We analyse the bootstrap result matrix via log-linear models. Specifically, the relationship with respect to local features between the influence functions of potential lung function predictors is investigated. [source] A Bayesian hierarchical distributed lag model for estimating the time course of risk of hospitalization associated with particulate matter air pollutionJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES C (APPLIED STATISTICS), Issue 1 2009Roger D. Peng Summary., Time series studies have provided strong evidence of an association between increased levels of ambient air pollution and increased hospitalizations, typically at a single lag of 0, 1 or 2 days after an air pollution episode. Two important scientific objectives are to understand better how the risk of hospitalization that is associated with a given day's air pollution increase is distributed over multiple days in the future and to estimate the cumulative short-term health effect of an air pollution episode over the same multiday period. We propose a Bayesian hierarchical distributed lag model that integrates information from national health and air pollution databases with prior beliefs of the time course of risk of hospitalization after an air pollution episode. This model is applied to air pollution and health data on 6.3 million enrollees of the US Medicare system living in 94 counties covering the years 1999,2002. We obtain estimates of the distributed lag functions relating fine particulate matter pollution to hospitalizations for both ischaemic heart disease and acute exacerbation of chronic obstructive pulmonary disease, and we use our model to explore regional variation in the health risks across the USA. [source] Home range and habitat selection of pampas deerJOURNAL OF ZOOLOGY, Issue 1 2008A. R. Vila Abstract The southernmost subspecies of pampas deer Ozotocerus bezoarticus celer is an endemic and endangered cervid of the Argentine Pampas. The aim of our study was to describe the habitat use of this deer on the coast of Samborombón Bay. Twelve adult pampas deer (seven female and five male) were radiotracked and their home-range sizes and habitat selection studied from 1995 to 2001. The mean home-range size was 898±181 ha, and the core area was concentrated in 22% of their range. The home-range size of males was three times larger than that of females (1422 vs. 523 ha). Deer home ranges overlapped extensively. No sex differences were found regarding habitat selection. Celtis tala forests and Spartina densiflora grasslands were used more than expected by their availability, while wetlands, coastal grasslands and Salicornia ambigua beaches were avoided. Their habitat selection was affected by cattle presence, suggesting avoidance: they tended to use areas free of cattle, and their home ranges were larger when cattle were absent. An action plan for this endangered population of pampas deer should include initiatives involving private landowners in pampas deer conservation, the use of fire and cattle grazing management tools to improve deer habitat, and studies to provide biological and health data related to pampas deer coexistence with cattle. [source] Dental health status of liver transplant candidatesLIVER TRANSPLANTATION, Issue 2 2007James Guggenheimer A prerequisite dental evaluation is usually recommended for potential organ transplant candidates. This is based on the premise that untreated dental disease may pose a risk for infection and sepsis, although there is no evidence that this has occurred in organ transplant candidates or recipients. The purpose of this study was to assess the prevalence of dental disease and oral health behaviors in a sample of liver transplant candidates (LTCs). Oral examinations were conducted on 300 LTCs for the presence of gingivitis, dental plaque, dental caries, periodontal disease, edentulism, and xerostomia. The prevalence of these conditions was compared with oral health data from national health surveys and examined for possible associations with most recent dental visit, smoking, and type of liver disease. Significant risk factors for plaque-related gingivitis included intervals of more than 1 yr since the last dental visit (P = 0.004), smoking (P = 0.03), and diuretic therapy (P = 0.005). Dental caries and periodontal disease were also significantly associated with intervals of more than 1 yr since the last dental visit (P = 0.004). LTCs with viral hepatitis or alcoholic cirrhosis had the highest smoking rate (78.8%). Higher rates of edentulism occurred among older LTCs who were less likely to have had a recent dental evaluation (mean 88 months). In conclusion, intervals of more than 1 yr since the last dental visit, smoking, and diuretic therapy appear to be the most significant determinants of dental disease and the need for a pretransplantation dental screening evaluation in LTCs. Edentulous patients should have periodic examinations for oral cancer. Liver Transpl 13:280,286, 2007. © 2007 AASLD. [source] Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's diseasePHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2010Joseph E. Amuah PhD Abstract Purpose To estimate the risk (and determinants) of discontinuing cholinesterase inhibitors (ChEIs) in a population-based sample of Alzheimer's disease (AD) patients. Methods This is a retrospective cohort study based on linked de-identified administrative health data from the province of Saskatchewan, Canada. The cohort included all AD patients receiving a ChEI prescription during the first year of provincial coverage (2000,2001). Persistence was defined as no gap of 60+ days between depletion and subsequent refill of a ChEI prescription. Kaplan-Meier analysis was used to estimate the risk of discontinuation over 40 months. Cox regression with time-varying covariates was used to assess risk factors for ChEI discontinuation. Results The sample included 1080 patients (64% female, average age 80,±,7 years). Baseline mean (SD) Mini-Mental State Examination (MMSE) and Functional Activities Questionnaire (FAQ) scores were 20.8 (4.4) and 17.5 (7.7), respectively. Over 40 months, 84% discontinued therapy. The 1-year risk of discontinuation was 66.4% (95%CI 63.5,69.3%). Discontinuation was significantly more likely for females (adjusted HR 1.34, 95%CI 1.16,1.55) and among those with lower MMSE scores (2.52, 2.01,3.17 if <15), not receiving social assistance (1.25, 1.07,1.45), and paying at least 65% of total prescription costs (1.51, 1.30,1.74). It was significantly less likely for patients with frequent physician visits (0.78, 0.66,0.93, for 7,19 vs. <7 visits), higher Chronic Disease Scores (0.74, 0.61,0.89, for 7+ vs. <4), and FAQ scores of 9+ (0.82, 0.69,0.99). Conclusion The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors. Copyright © 2010 John Wiley & Sons, Ltd. [source] Life course weight gain and C-reactive protein levels in young adults: Findings from a Brazilian birth cohort,AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 2 2009Aydin Nazmi Rapid weight gain in childhood is associated with increased risk of chronic diseases in adults. C-reactive protein (CRP) is a mediator of atherosclerosis and chronically elevated levels predict cardiovascular outcomes. The effects of life course weight gain on CRP levels are not clear. The 1982 Pelotas (Brazil) birth cohort study (n = 5,914) has prospectively collected weight and health data at several follow-ups since birth. The most recent was in 2004,05, when 77.4% of the cohort was traced and CRP levels were measured in 89% of those interviewed (n = 3827). Geometric mean (SE) C-reactive protein levels were 0.89 mg/l (0.03) and 1.66 mg/l (0.04) in men and women, respectively. In analyses adjusted for confounding variables, weight gain in infancy showed a weak negative association among males, but from the second year onwards, weight gain was positively associated with CRP levels. In females, weight gain was associated with higher CRP at every period tested. The strongest associations were observed in the most recent (18,23 years) period; CRP ratios (95% CI) per z score increase in weight gain were 1.78 (1.57,2.00) and 1.52 (1.30,1.78) for men and women, respectively. Males who were stunted at 2 years and centrally obese at 23 years had the highest CRP levels (P = 0.002 for interaction). In summary, rapid weight gain throughout life predicted higher CRP levels. Public health efforts need to tackle chronic under-nutrition in infancy, together with rapid weight gain in later childhood and adolescence, especially in countries undergoing the nutritional transition. Am. J. Hum. Biol. 2009. © 2008 Wiley-Liss, Inc. [source] Applying the Concept of Positive Deviance to Public Health Data: A Tool for Reducing Health DisparitiesPUBLIC HEALTH NURSING, Issue 6 2007Lorraine O. Walker ABSTRACT The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in low-resource communities, has been effective in community mobilization and programming to improve health outcomes. We present a protocol for extending the concept to analysis of existing public health data. The protocol includes assessing whether PD fits the situation, identifying positive deviants, and identifying behaviors associated with positive deviants' healthy outcomes. Analyzing existing datasets from a PD perspective may aid public health nurses in efforts to reduce health disparities. The effectiveness of our protocol will be clarified in future research. [source] Geographic Information Systems: A New Tool for Environmental Health AssessmentsPUBLIC HEALTH NURSING, Issue 5 2006Mona Choi ABSTRACT Objectives: (1) To develop tools for health care professionals and communities to assess environmental exposures and (2) to evaluate the utility of integrating patient-reported environmental health information with geographic information systems (GIS) mapping of environmental data in a pilot study. Methods: A survey was used to collect self-reported environmental exposure and health data from a convenience sample of people at an urban community health center (N=101). Environmental exposure and census information were obtained from federal agencies. Analysis was performed using descriptive statistics and GIS. Results: Frequent environmental health risk factors were reported, such as older housing (93%) and household smoking (78%). Health problems including asthma (54%) and lead poisoning (14%) were reported. Odds ratios indicated a statistically significant relationship between mold/mildew and reporting asthma. GIS was found to be a useful tool in displaying environmental risk factors and potentially associated health effects. Conclusions: Given the important role that environmental health risks can play in public health, it is critical that community/public health nurses begin to integrate environmental health assessment skills into their professional practices. Simple community surveys can be an effective means to raise awareness about environmental health risk factors and utilizing GIS can further enhance the accessibility of the combined exposure and health information. [source] Privacy protection, health care and quality controlQUALITY ASSURANCE JOURNAL, Issue 3 2002Rudolf Bruppacher Abstract In the past three decades, patient rights on the one hand, and health care and research activities in health services on the other hand, have experienced unprecedented development. Requirements of privacy protection, particularly the restrictions on ,secondary analysis' of health data, have become a problem in an increasingly complex health care environment and have become a hindrance to research. Legal regulations have developed differently in different countries. Recent attempts, such as the European Community directive on privacy protection promise effective harmonization, at least for developed countries. However, many questions regarding their interpretation remain and they are discussed in this article. Copyright © 2002 John Wiley & Sons, Ltd. [source] A retrospective analysis of VIOXX in Australia: using clinical trial data and linked administrative health data to predict patient groups at risk of an adverse drug eventAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010Margaret T. Whitstock No abstract is available for this article. [source] Some Simple Tests for Spatial Effects Around Putative Sources of Health RiskBIOMETRICAL JOURNAL, Issue 4 2007Andrew B. Lawson Abstract The need for tests dealing with different features of small area health data is less important with the increase in computation speed of computers and the access to MCMC methods. However there are many situations where exploratory testing could be useful and where MCMC methods are not readily useable or available. In this paper, a number of simple tests are derived for the logistic model for case events. This model assumes that a control disease is available and that the events have a binary label relating to case or control state. The tests are derived from likelihood considerations and Monte Carlo critical regions are examined. A simulated evaluation of the tests is presented in terms of Monte Carlo power. A data example is considered. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Hierarchical and Joint Site-Edge Methods for Medicare Hospice Service Region Boundary AnalysisBIOMETRICS, Issue 2 2010Haijun Ma Summary Hospice service offers a convenient and ethically preferable health-care option for terminally ill patients. However, this option is unavailable to patients in remote areas not served by any hospice system. In this article, we seek to determine the service areas of two particular cancer hospice systems in northeastern Minnesota based only on death counts abstracted from Medicare billing records. The problem is one of spatial boundary analysis, a field that appears statistically underdeveloped for irregular areal (lattice) data, even though most publicly available human health data are of this type. In this article, we suggest a variety of hierarchical models for areal boundary analysis that hierarchically or jointly parameterize,both,the areas and the edge segments. This leads to conceptually appealing solutions for our data that remain computationally feasible. While our approaches parallel similar developments in statistical image restoration using Markov random fields, important differences arise due to the irregular nature of our lattices, the sparseness and high variability of our data, the existence of important covariate information, and most importantly, our desire for full posterior inference on the boundary. Our results successfully delineate service areas for our two Minnesota hospice systems that sometimes conflict with the hospices' self-reported service areas. We also obtain boundaries for the spatial residuals from our fits, separating regions that differ for reasons yet unaccounted for by our model. [source] Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 yearsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2006K Spilsbury Objective, To investigate incidence trends and demographic, social and health factors associated with the rate of hysterectomy and morbidity outcomes in Western Australia and compare these with international studies. Design, Population-based retrospective cohort study. Setting, All hospitals in Western Australia where hysterectomies were performed from 1981 to 2003. Population, All women aged 20 years or older who underwent a hysterectomy. Methods, Statistical analysis of record-linked administrative health data. Main outcome measures, Rates, rate ratios and odds ratios for incidence measures and length of stay in hospital and odds ratios for morbidity measures. Results, The age-standardised rate of hysterectomy adjusted for the underlying prevalence of hysterectomy decreased 23% from 6.6 per 1000 woman-years (95% CI 6.4,6.9) in 1981 to 4.8 per 1000 woman-years (95% CI 4.6,4.9) in 2003. Lifetime risk of hysterectomy was estimated as 35%. In 2003, 40% of hysterectomies were abdominal. The rate of hysterectomy to treat menstrual disorders fell from 4 per 1000 woman-years in 1981 to 1 per 1000 woman-years in 1993 and has since stabilised. Low socio-economic status, having only public health insurance, nonindigenous status and living in rural or remote areas were associated with increased risk of having a hysterectomy for menstrual disorders. Indigenous women had higher rates of hysterectomy to treat gynaecological cancers compared with nonindigenous women, particularly in rural areas. The odds of a serious complication were 20% lower for vaginal hysterectomies compared with abdominal procedures. Conclusion, Western Australia has one of the highest hysterectomy rates in the world, although proportionally, significantly fewer abdominal hysterectomies are performed than in most countries. [source] Development of a questionnaire to collect public health data for school entrants in London: Child Health Assessment at School Entry (CHASE) projectCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2005S. Edmunds Abstract Background, To develop a multiprofessional consensus about the relative contributions of the components of children's health and well-being and to develop a questionnaire that can be used to assess these in London's children. Methods, Semi-structured interviews with health, education and social services professionals were used to identify areas to include in the questionnaire. These ideas were used as the basis for a wider Delphi consultation, with 79 experts in the area of child health. Round 1 of the Delphi asked panellists to rate 54 items as to whether they should be included in the questionnaire or not. Responses were divided into four categories: item to be included measurement method agreed, item to be included measurement method not agreed, no consensus, or excluded. In round 2, consensus was sought for the categories where there was none following round 1. Results, Themes identified by the interviews were: economic factors, ethnicity, environment, nutrition, hygiene and physical activity, growth, suffers from chronic/serious illness, development, disability and learning, accidents and hospital attendances, self-regulation, psychological well-being, significant life events. After Delphi round 1, items included, where quality measurement method was agreed, were: deprivation index (from postcode), child's ethnicity, temporary accommodation, care status, registered with general practitioner, dental visits, height, weight, special educational needs status, baseline educational assessment result, immunization status, visual and hearing function. Following round 2, items relating to chronic illness, mental health, physical functioning, general health, self-esteem, family cohesion and accident status were agreed for inclusion with a measurement method also agreed. The questionnaire was acceptable to parents. Conclusion, The validity, reliability and feasibility of this questionnaire must now be examined. This data set, if collected across London, would substantially increase the public health data available and allow trends in health to be monitored. [source] Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, CanadaCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 6 2009Herenia P. Lawrence Abstract,,, Objectives:, To investigate (i) oral health inequalities between off-reserve Aboriginal and non-Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten-aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off-reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005. Methods:, Cross-sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3- to 5-year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District's Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16,20 First Nations communities. Results:, When compared with non-Aboriginal children aged 3,5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off-reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child's age and sex, school's risk level and clustered-correlated data. The mean dmft of on-reserve Aboriginal 4-year olds in 2005 was 11.2 and 5.9 for their off-reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2-, 3- and 4-year-old Aboriginal children in the SLZ were: 9.1 (8.3,9.9), 12.4 (11.8,13.1), 13.1 (12.1,14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2,7.1), 8.9 (8.2,9.6), 11.2 (10.5,11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively). Conclusions:, Significant disparities in caries experience exist between off-reserve Aboriginal and non-Aboriginal children living in the same locales and between Aboriginal children living on- and off-reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5-year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non-Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities. [source] | ||||||||||||||||||||||