The recent global outbreak of SARS (severe acute respiratory syndrome) provides an opportunity to study the use and impact of public health informatics and population health technology to detect and fight a global epidemic. Population health technology is the umbrella term for technology applications that have a population focus and the potential to improve public health. This includes the Internet, but also other technologies such as wireless devices, mobile phones, smart appliances, or smart homes. In the context of an outbreak or bioterrorism attack, such technologies may help to gather intelligence and detect diseases early, and communicate and exchange information electronically worldwide. Some of the technologies brought forward during the SARS epidemic may have been primarily motivated by marketing efforts, or were more directed towards reassuring people that "something is being done," ie, fighting an "epidemic of fear." To understand "fear epidemiology" is important because early warning systems monitoring data from a large number of people may not be able to discriminate between a biological epidemic and an epidemic of fear. The need for critical evaluation of all of these technologies is stressed. (+info)
Benchmarking information needs and use in the Tennessee public health community.
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OBJECTIVE: The objective is to provide insight to understanding public health officials' needs and promote access to data repositories and communication tools. METHODS: Survey questions were identified by a focus group with members drawn from the fields of librarianship, public health, and informatics. The resulting comprehensive information needs survey, organized in five distinct broad categories, was distributed to 775 Tennessee public health workers from ninety-five counties in 1999 as part of the National Library of Medicine-funded Partners in Information Access contract. RESULTS: The assessment pooled responses from 571 public health workers (73% return rate) representing seventy-two of ninety-five counties (53.4% urban and 46.6% rural) about their information-seeking behaviors, frequency of resources used, computer skills, and level of Internet access. Sixty-four percent of urban and 43% of rural respondents had email access at work and more than 50% of both urban and rural respondents had email at home (N = 289). Approximately 70% of urban and 78% of rural public health officials never or seldom used or needed the Centers for Disease Control (CDC) Website. Frequency data pooled from eleven job categories representing a subgroup of 232 health care professionals showed 72% never or seldom used or needed MEDLINE. Electronic resources used daily or weekly were email, Internet search engines, internal databases and mailing lists, and the Tennessee Department of Health Website. CONCLUSIONS: While, due to the small sample size, data cannot be generalized to the larger population, a clear trend of significant barriers to computer and Internet access can be identified across the public health community. This contributes to an overall limited use of existing electronic resources that inhibits evidence-based practice. (+info)
Leveraging the nation's anti-bioterrorism investments: foundation efforts to ensure a revitalized public health system.
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The emerging potential threats of bioterrorism combined with critical existing epidemics facing the United States call for immediate and urgent attention to the U.S. public health system. The foundation world is helping to answer that call and is sounding the alarm that our health defenses must be able to do "double duty" to protect us from the full spectrum of modern health threats. This Special Report presents a selective sample of recent and ongoing grant activities designed to revitalize and modernize the public health infrastructure, which is vital to protecting the nation's health and ensuring its safety. (+info)
Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance.
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A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems. (+info)
Classification of transmission risk in the national HIV/AIDS surveillance system.
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Risk behavior information is essential for allocating resources and developing effective HIV prevention strategies. Over time, transmission risk information on HIV/AIDS cases has been less likely to be reported to the national surveillance system. The Centers for Disease Control and Prevention (CDC) invited approximately 30 experts in HIV/AIDS and behavioral research from state and local health departments, academia, community-based organizations, and the CDC to participate in a consultation in December 2001 to generate ideas on how best to deal with the lack of risk data. The group was charged with providing recommendations on methods for classifying and reporting risk information and for identifying methods and sources for improving ascertainment of transmission risk behaviors for individuals infected with HIV. This report describes the recommendations and the effects of implementing such recommended procedures on the national HIV/AIDS surveillance database. (+info)
Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system.
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BACKGROUND: Some experimental Medicaid managed care systems have expanded eligibility criteria for chronically ill persons, but these systems' impact on access to care remains unknown. OBJECTIVE: To determine whether initiating a statewide Medicaid managed care system (TennCare) guaranteeing universal access for persons living with HIV or AIDS (PLWHs) increased their enrollment in public sector insurance. DESIGN, SETTING, AND PARTICIPANTS: A retrospective longitudinal descriptive analysis of trends in population characteristics during the study period was performed. The study population included all PLWHs in Tennessee (1992-1997) identified by the State Health Department. These data linked with Medicaid/TennCare enrollment files identified percentages of Tennessee's HIV/AIDS population enrolled in Medicaid (1993) or TennCare (1994-1997) and eligi-bility/demographics changes during program initiation. MAIN OUTCOME MEASURE: Annual percentage of PLWHs enrolled in Medicaid/TennCare. RESULTS: Absolute numbers of PLWHs served by Medicaid/TennCare increased 475% from 1992 (n = 593) to 1997 (n = 2818). Similar increases in Tennessee's overall HIV-positive population occurred. Percentages of PLWHs enrolled in Medicaid/TennCare increased (1993 to 1997): HIV (28% to 34%) and AIDS (32% to 44%). The largest percentage of PLWHs added to the program were uninsured/uninsurable. CONCLUSIONS: Absolute numbers of PLWHs covered by Medicaid/TennCare substantially increased. Percentages of PLWHs covered increased more modestly, partly owing to large increases in overall numbers of HIV-positive Tennesseans during the study period. Increases in coverage were greatest for the AIDS population. Tennessee's broad expansion of eligibility for PLWHs resulted in improved access, but did not result in enrollment of most PLWHs. States contemplating similar Medicaid expansions should not expect all PLWHs to crowd into public sector insurance programs. (+info)
An evaluation of completeness of tuberculosis notification in the United Kingdom.
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BACKGROUND: There has been a resurgence of tuberculosis worldwide, mainly in developing countries but also affecting the United Kingdom (UK), and other Western countries. The control of tuberculosis is dependent on early identification of cases and timely notification to public health departments to ensure appropriate treatment of cases and screening of contacts. Tuberculosis is compulsorily notifiable in the UK, and the doctor making or suspecting the diagnosis is legally responsible for notification. There is evidence of under-reporting of tuberculosis. This has implications for the control of tuberculosis as a disproportionate number of people who become infected are the most vulnerable in society, and are less likely to be identified and notified to the public health system. These include the poor, the homeless, refugees and ethnic minorities. METHOD: This study was a critical literature review on completeness of tuberculosis notification within the UK National Health Service (NHS) context. The review also identified data sources associated with reporting completeness and assessed whether studies corrected for undercount using capture-recapture (CR) methodology. Studies were included if they assessed completeness of tuberculosis notification quantitatively. The outcome measure used was notification completeness expressed between 0% and 100% of a defined denominator, or in numbers not notified where the denominator was unknown. RESULTS: Seven studies that met the inclusion and exclusion criteria were identified through electronic and manual search of published and unpublished literature. One study used CR methodology. Analysis of the seven studies showed that undernotification varied from 7% to 27% in studies that had a denominator; and 38%-49% extra cases were identified in studies which examined specific data sources like pathology reports or prescriptions for anti-tuberculosis drugs. Cases notified were more likely to have positive microbiology than cases not notified which were more likely to have positive histopathology or be surgical in-patients. Collation of prescription data of two or more anti-tuberculosis drugs increases case ascertainment of tuberculosis. CONCLUSION: The reporting of tuberculosis is incomplete in the UK, although notification is a statutory requirement. Undernotification leads to an underestimation of the disease burden and hinders implementation of appropriate prevention and control strategies. The notification system needs to be strengthened to include education and training of all sub-specialities involved in diagnosis and treatment of tuberculosis. (+info)
Creating a coherent set of indicators to monitor health across Europe: the Euro-REVES 2 project.
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The Euro-REVES 2 project, 'Setting up of a coherent set of health expectancies for the European Union', was begun in 1998 under the European Health Monitoring Programme with the aim of selecting a concise set of instruments to simultaneously monitor mortality and the different facets of health. An in-depth analysis of the current health survey instruments in Europe together with a review of past research, found that, although harmonization in instruments appeared to exist superficially, major differences existed. Four instruments have been recommended (where necessary using existing instruments with modifications suggested by the research literature) covering physical and sensory functional limitations, activity restriction, self-perceived health and mental health. Additionally a new global activity limitation indicator (GALI) has been developed. These instruments are firmly anchored to past research and the health concepts behind the indicators and their relevance to policy and guidelines for implementation are explicitly made. The second phase of the project will recommend further instruments, leading to health expectancies that cover all the conceptual framework of population health measurement. This will allow assessment of health inequalities between the European Union countries, an appreciation of the causes and the production of profiles for each country in terms of the various facets of health. (+info)