Using conceptual work products of health care to design health IT.

This paper introduces a new, model-based design method for interactive health information technology (IT) systems. This method extends workflow models with models of conceptual work products. When the health care work being modeled is substantially cognitive, tacit, and complex in nature, graphical workflow models can become too complex to be useful to designers. Conceptual models complement and simplify workflows by providing an explicit specification for the information product they must produce. We illustrate how conceptual work products can be modeled using standard software modeling language, which allows them to provide fundamental requirements for what the workflow must accomplish and the information that a new system should provide. Developers can use these specifications to envision how health IT could enable an effective cognitive strategy as a workflow with precise information requirements. We illustrate the new method with a study conducted in an outpatient multiple sclerosis (MS) clinic. This study shows specifically how the different phases of the method can be carried out, how the method allows for iteration across phases, and how the method generated a health IT design for case management of MS that is efficient and easy to use.

Applying the XForms Standard to Public Health Case Reporting and Alerting.

Notifiable condition reporting and alerting are two important public health functions. Today, a variety of methods are used to transfer these types of information. The increasing use of electronic health record systems by healthcare providers makes new types of electronic communication possible. We used the XForms standard and nationally recognized technical profiles to demonstrate the communication of both notifiable condition reports and patient-tailored public health alerts. This demonstration of bi-directional communication took placein a prototypical health information exchange environment. We successfully transferred information between provider electronic health record systems and public health systems for notifiable condition reporting. Patient-specific alerts were successfully sent from public health to provider systems. In this paper we discuss the benefits of XForms, including the use of XML, advanced form controls, form initialization and reduction in scripting. We also review implementation challenges, the maturity of the technology and its suitability for use in public health.

Ecological model of disaster management.

The ecological model of disaster management provides a framework to guide occupational health nurses who are developing disaster management programs.This ecological model assumes that disaster planning, preparedness, response, and recovery occur at various levels of the organization. These nested, increasingly complex organizational levels include individual and family, workplace, community, state, tribal, federal, and global levels. The ecological model hypothesizes that these levels interact and these dynamic interactions determine disaster planning, preparedness, response, and recovery outcomes. In addition to the features of the hazard or disaster, it is also assumed that parallel disaster planning, preparedness, and response elements, logistical challenges, and flexibility, sustainability, and rehabilitation elements occur at each level of the ecological model. Finally, the model assumes that evaluation of response and recovery efforts should inform future planning and preparedness efforts.

Integrating open-source technologies to build low-cost information systems for improved access to public health data.

Effective public health practice relies on the availability of public health data sources and assessment tools to convey information to investigators, practitioners, policy makers, and the general public. Emerging communication technologies on the Internet can deliver all components of the "who, what, when, and where" quartet more quickly than ever with a potentially higher level of quality and assurance, using new analysis and visualization tools. Open-source software provides the opportunity to build low-cost information systems allowing health departments with modest resources access to modern data analysis and visualization tools. In this paper, we integrate open-source technologies and public health data to create a web information system which is accessible to a wide audience through the Internet. Our web application, "EpiVue," was tested using two public health datasets from the Washington State Cancer Registry and Washington State Center for Health Statistics. A third dataset shows the extensibility and scalability of EpiVue in displaying gender-based longevity statistics over a twenty-year interval for 3,143 United States counties. In addition to providing an integrated visualization framework, EpiVue's highly interactive web environment empowers users by allowing them to upload their own geospatial public health data in either comma-separated text files or MS Excel spreadsheet files and visualize the geospatial datasets with Google Maps.

Is agricultural activity linked to the incidence of human West Nile virus?

BACKGROUND: West Nile virus (WNV) has spread throughout the contiguous United States. During the 2002-2003 period, there were 14,023 laboratory-confirmed human cases of WNV in 45 states and 541 associated deaths. Factors that affect case distribution are poorly understood. This study assessed the relationship of environmental factors and agricultural activity with the presence of human WNV cases. METHODS: County-level data were collected that included 2002 and 2003 WNV surveillance data, temperature, dairy revenue, precipitation, total irrigated acres, and total crop revenue. Logistic regression models were used to determine which risk factors were significantly associated with WNV human cases. RESULTS: Significant independent predictors for counties with human WNV cases were population (odds ratio [OR]=1.20, p<0.0001); higher average daily temperature in April through October (OR=1.19 for each additional degree Fahrenheit, p<0.0001); and total crop sales (OR=1.14 (p<0.001). The ORs for these predictors increased in an analysis of counties with ten or more cases. CONCLUSIONS: Higher temperature and farming activity may be strongly associated with the incidence of human WNV infection. Larger studies of more agricultural centers are warranted to determine which environmental factors increase the risk of human infection and how these infections can be prevented.

Evaluation of the Washington State National Pharmaceutical Stockpile dispensing exercise, part II--dispensary site worker findings.

On January 24, 2002, the Washington State Department of Health, in collaboration with local and federal agencies, conducted an exercise of the Centers for Disease Control and Prevention's National Pharmaceutical Stockpile dispensing portion of the Washington State plan. This exercise included predrill planning, training, and the orchestration of services of more than 40 dispensary site workers. These workers provided education and post-exposure prophylaxis for over 230 patient volunteers in the aftermath of a simulated exposure to B. anthracis. This article discusses findings of a postdrill questionnaire completed by 90% of these dispensary site workers who provided triage, education, dispensary, security and other services during this exercise. In general, this dispensing drill promoted confidence in the worker participants and provided an opportunity for these participants to coordinate their activities. This mock bioterrorist preparedness exercise allowed worker participants and observers to review and evaluate the Washington State plan for dispensing the National Pharmaceutical Stockpile. This article is apparently the first published account of dispensary site workers' subjective impressions and quantitative analysis of their postdrill opinions following a simulated bioterrorist post-exposure chemoprophylaxis dispensing exercise.

Evaluation of the Washington State National Pharmaceutical Stockpile dispensing exercise: Part I--Patient volunteer findings.

The Centers for Disease Control and Prevention's National Pharmaceutical Stockpile (NPS) program is designed to ensure the availability of life-saving antibiotics, other medical supplies, and equipment and their prompt delivery to the site of a disaster, including a possible bioterrorist incident, anywhere in the United States. On January 24, 2002, the Washington State Department of Health conducted an exercise, simulating a mass exposure to Bacillis anthracis, to test the NPS dispensing portion of the Washington State plan. This drill included the recruitment, education, and postexposure prophylaxis of over 230 volunteer patients. This article describes and discusses findings from an exit survey completed by these patient volunteers.

Development and evaluation of public health informatics at University of Washington.

Public Health Informatics (PHI) education began at the University of Washington (UW) with a Summer Institute in 1995. The Biomedical and Health Informatics graduate program, which is housed in the School of Medicine, is an interdisciplinary, multi-school program. It demonstrates the UW's cooperative efforts in advancing informatics, encompassing the schools of public health, medicine, nursing, dentistry, pharmacy, information and graduate schools in computer science. This article provides an overview of the developmental milestones related to activities in PHI and describes the evaluation strategy and assessment plan for PHI training at the UW (http://phig.washington.edu).

Comparación de la seguridad y eficacia de los dispositivos intrauterinos colocados por médicos y personal de enfermería en el Brasil / Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil

Con el objeto de determinar si en el Brasil miembros adiestrados del personal de enfermería podían prestar servicios de inserción de dispositivos intrauterinos (DIU) con el mismo grado de seguridad y eficacia que los médicos, se llevó a cabo un estudio experimental en la clínica principal del Centro de Investigaciones de Atención Integrada a la Mujer y al Niño en Rio de Janeiro. De noviembre de 1984 a abril de 1986, 1711 mujeres que acudieron a la clínica para la inserción de un DIU fueron asignadas aleatoriamente a uno de sus 11 médicos o 13 miembros del personal de enfermería para la inserción de una T de cobre 200. Todos los médicos y miembros del personal de enfermería que prestaron esos servicios habían asistido al curso normal de formación clínica en planificación familiar en el Centro. De las 860 inserciones intentadas por los médicos y por el personal de enfermería, 1,3 y 3,3 porciento, respectivamente, fueron un fracaso, diferencia que resultó muy significativa en términos estadísticos (P0,01). Debido, principalmente, al tamaño pequeño del cuello uterino y a la falta de dilatación, las multíparas tuvieron una tasa de fracaso en la inserción de 8 porciento, cifra relativamente alta en comparación, con la observada en primíparas (1,0 porciento). Se observó una tasa global de complicaciones durante la inserción de 1,8 porciento y entre las complicaciones se observaron diaforesis, vómitos, síncope, laceración cervical y un caso de perforación uterina...(AU)

Comparación de la seguridad y eficacia de los dispositivos intrauterinos colocados por médicos y personal de enfermería en el Brasil / Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil

Con el objeto de determinar si en el Brasil miembros adiestrados del personal de enfermería podían prestar servicios de inserción de dispositivos intrauterinos (DIU) con el mismo grado de seguridad y eficacia que los médicos, se llevó a cabo un estudio experimental en la clínica principal del Centro de Investigaciones de Atención Integrada a la Mujer y al Niño en Rio de Janeiro. De noviembre de 1984 a abril de 1986, 1711 mujeres que acudieron a la clínica para la inserción de un DIU fueron asignadas aleatoriamente a uno de sus 11 médicos o 13 miembros del personal de enfermería para la inserción de una T de cobre 200. Todos los médicos y miembros del personal de enfermería que prestaron esos servicios habían asistido al curso normal de formación clínica en planificación familiar en el Centro. De las 860 inserciones intentadas por los médicos y por el personal de enfermería, 1,3 y 3,3 porciento, respectivamente, fueron un fracaso, diferencia que resultó muy significativa en términos estadísticos (P0,01). Debido, principalmente, al tamaño pequeño del cuello uterino y a la falta de dilatación, las multíparas tuvieron una tasa de fracaso en la inserción de 8 porciento, cifra relativamente alta en comparación, con la observada en primíparas (1,0 porciento). Se observó una tasa global de complicaciones durante la inserción de 1,8 porciento y entre las complicaciones se observaron diaforesis, vómitos, síncope, laceración cervical y un caso de perforación uterina...(AU)

Se publica en inglés en el Bull. PAHO. Vol. 29(3):206-15, 1995

Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil

This article will also be published in Spanish in the BOSP. Vol. 120(2):87-97, 1996

Screening practices for cervical and breast cancer in Costa Rica

Cervical cancer and breast cancer are leading causes of cancer-related morbidity and mortality in Costa Rica. This reports results of an evaluation of cervical and breast cancer screening practices among Costa Rican women 25 to 58 years old that was based on a nationwide 1984-1985 survey. The evaluation showed that while Pap smears were widely used to screen for cervical cancer, many women did not have their first cervical smear or gynecologic examination until age 30, and that cervical cancer screening was less common among certain high-risk groups, including women with multiple sexual partners and those with high parity. Less than half the women surveyed reported having had a breast examination by a health care provider. Utilization of both cervical cancer and breast cancer screening examinations could be increased by targeting inadequately screened high-risk women through the existing health care system

Screening practices for cervical and breast cancer in Costa Rica

Cervical cancer and breast cancer are leading causes of cancer-related morbidity and mortality in Costa Rica. This reports results of an evaluation of cervical and breast cancer screening practices among Costa Rican women 25 to 58 years old that was based on a nationwide 1984-1985 survey. The evaluation showed that while Pap smears were widely used to screen for cervical cancer, many women did not have their first cervical smear or gynecologic examination until age 30, and that cervical cancer screening was less common among certain high-risk groups, including women with multiple sexual partners and those with high parity. Less than half the women surveyed reported having had a breast examination by a health care provider. Utilization of both cervical cancer and breast cancer screening examinations could be increased by targeting inadequately screened high-risk women through the existing health care system

Estudios de detección selectiva del cáncer de cérvix y del cáncer de mama en Costa Rica / Screening practices for cervical and breast cancer in Costa Rica

Screening practices for cervical and breast cancer in Costa Rica

Prevalencia de enfermedades de transmisión sexual en las mujeres de Costa Rica / Prevelency of sexually transmitted diseases in CostaRican woman

Pocos estudios han descrito la epidemiología de las infecciones por enfermedades de transmisión sexual (ETS) basándose en muestras serológicas representativas de la población en general y no solo en grupos selectos de pacientes. Ello se debe a la dificultad para obtener serologías en muestras representativas de la población y a la falta de información sobre el historial médico y sexual de los pacientes para quienes existen estudios serológicos. Por otra parte, es solo en años recientes que se ha desarrollado una prueba serológica lo suficientemente específica para diferenciar los anticuerpos a los tipos 1 y 2 del virus del Herpes simplex (VHS) (1) lo que ha hecho posible estimar con precisión la prevalencia de la infección con el VHS de tipo 2 (VHS-2): una de las más importantes ETS. El presente artículo se base en las pruebas serológicas y la información de una muestra nacionalmente representativa de las mujeres de Costa Rica. Describe la prevalencia de anticuerpos al virus del Herpes simplex tipos 1 y 2, sífilis, chlamydia, virus de inmunodefiencia humana (HIV-1) y virus linfotrópico de células humanas-T (HTLV-1) según características demográficas, médicas y sexuales. El artículo también muestra la distribución regional de la prevalencia de anticuerpos a esto agentes

Estudios de detección selectiva del cáncer de cérvix y del cáncer de mama en Costa Rica / Screening practices for cervical and breast cancer in Costa Rica

Screening practices for cervical and breast cancer in Costa Rica

Se publica en inglés en: Bull. Pan Am. Health Org. 24(4)

Servicios de salud maternoinfantil y vacunación en Panamá y Guatemala / Maternal and child health services and vaccination in Panamá and Guatemala

En Guatemañla y Panamá se efectuaron en 1983-1984 y 1984-1985, respectivamente, dos encuestas mediante entrevistas, diseñadas para evaluar la medida en que se utilizan los servicios de salud maternoinfantil. En la encuesta panameña se obtuvieron entrevistas completas de 8 240 mujeres de 15 a 49 años de edad, mientras que en la encuesta guatemalteca se realizaron entrevistas completas a 3 670 mujeres de 15 a 44 años de edad. Estas entrevistas se realizaron principalmente para estimar la prevalencia del uso de la contracepción y para proveer datos basados en la población sobre el uso de servicios de salud maternoinfantil, entre ellos los de vacunación a todos los niveles, con objeto de medir el impacto del programa en cada país. Para los propósitos de este análisis, la muestra de la encuesta en ambos países se limitó a mujeres de 15 a 44 años de edad que estuvieran casadas en el momento de la entrevista y que hubieran dado a luz un hijo vivo dentro de los cinco años anteriores. En Panamá, un porcentaje mucho mayor que en Guatemala de mujeres casadas de 15 a 44 años informaron que utilizaban los servicios de salud maternoinfantil. En ambos países, un porcentaje relativamente alto de mujeres que residían en las zonas urbanas dijeron que hacían uso de estos servicios, mientras que las mujeres indígenas de ambos países informaron que hacían un uso relativamente escaso de ellos. Además, se encontraron asociaciones entre la utilización de dichos servicios y el grado de escolaridad de la madre, su ocupación, paridad y el lugar donde tuvo a su último hijo. Asimismo, era más probable que emplearan métodos contraceptivos las mujeres que usaban los tres tipos de servicios de salud maternoinantil que las mujeres que habían dicho que utilizaban solo alguno o ninguno de ellos. En lo que se refiere al grado de cobertura de la vacunación de niños pequeños en Panamá y Guatemala, los datos de la encuesta señalaron que el grado de vacunación era relativamente mayor en Panamá...