How can we monitor the impact of national health information systems? Results from a scoping review.

BACKGROUND: National health information (HI) systems provide data on population health, the determinants of health and health system performance within countries. The evaluation of these systems has traditionally focused on statistical practices and procedures, and not on data use or reuse for policy and practice. This limits the capacity to assess the impact of HI systems on healthcare provision, management and policy-making. On the other hand, the field of Knowledge Translation (KT) has developed frameworks to guide evidence into practice. METHODS: A scoping review of the KT literature to identify the essential mechanisms and determinants of KT that could help monitor the impact of HI systems. RESULTS: We examined 79 publications and we identified over 100 different KT frameworks but none of these were focused on HI systems per se. There were specific recommendations on disseminating evidence to stakeholders at the institutional and organizational level, and on sustaining the use of evidence in practice and the broader community setting. CONCLUSIONS: We developed a new model, the HI-Impact framework, in which four domains are essential for mapping the impact of national HI systems: (i) HI Evidence Quality, (ii) HI System Responsiveness, (iii) Stakeholder Engagement and (iv) Knowledge Integration. A comprehensive impact assessment of HI systems requires addressing the use of HI in public health decision-making, health service delivery and in other sectors which might have not been considered previously. Monitoring Stakeholder Engagement and Knowledge Integration certifies that the use of HI in all policies is an explicit point of assessment.

Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response.

BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.

Changes in Na+/K+-ATPase activity, unsaturated fatty acids and metallothioneins in gills of the shore crab Carcinus aestuarii after dilute seawater acclimation.

We have assessed the activity of Na(+)/K(+)-ATPase, cAMP, free fatty acids (FFA) and metallothionein (MT) in the posterior gills of the brackish water shore crab Carcinus aestuarii during acclimation to 10 ppt dilute seawater (DSW). Following 3-18 days acclimation in DSW specific activity of Na(+)/K(+)-ATPase in native gill homogenates and partially purified membrane vesicles was progressively increased, from 1.7- to 3.9-fold. After short-term acclimation of crabs in DSW with added sucrose to make media isosmotic with the haemolymph the specific Na(+)/K(+)-ATPase activity in homogenates was not increased, relative to SW enzyme activity. Moreover, hyposmotic conditions led to depletion of cAMP in gills. In partially purified membrane vesicles isolated from posterior gills, fatty acids with compositions 16:0, 18:0, 18:1, 20:4 and 20:5 dominated in both SW- and DSW-acclimated Carcinus. During a year in which the metabolic activity of crabs was increased, the arachidonic/linoleic acids ratio (ARA/LA) for DSW-acclimated crabs was markedly increased relative to that in SW. Increased Na(+)+K(+)-ATPase activity under hyposmotic stress may be modulated at least partially by the changed proportion of fatty acids in the purified membranes of posterior gills. Long-term acclimation of shore crabs to DSW resulted in a 2.6-fold increase in cytosolic metallothionein (MT) content in posterior gills over those in SW crabs. Assuming an antioxidant role of MT associated with intracellular zinc partitioning, the observed MT induction in posterior gills may be considered an adaptive response of C. aestuarii to hyposmotic stress.

Dielectric relaxation of DNA aqueous solutions.

We report on a detailed characterization of complex dielectric response of Na-DNA aqueous solutions by means of low-frequency dielectric spectroscopy (40 Hz-110 MHz). Results reveal two broad relaxation modes of strength 20

Evaluation of the Mytilus galloprovincialis Lam. digestive gland metallothionein as a biomarker in a long-term field study: seasonal and spatial variability.

A study was made of seasonal and spatial variability of metallothionein (MT) concentrations, determined spectrophotometrically in the soluble fraction of the digestive gland of mussels Mytilus galloprovincialis, collected between 1999 and 2001 from several coastal and estuarine locations along the central Eastern Adriatic coast (Croatia). The seasonal influence on the MT and metal concentrations (higher values in winter-spring season, than in summer-autumn season) is more pronounced than the local site-specific influence. Furthermore, within each season a significant site-specific dependence on the MT and trace metal variations can be detected. An inverse relationship of mussel condition index (CI) and temperature with MT and trace metals levels indicates the influence of food abundance and mussel annual reproductive cycle. Substantially higher concentrations of both MT and Cd were recorded in mussels inhabiting estuarine locations, possibly indicating a markedly higher Cd bioavailability at these locations. The positive correlations obtained between MT and Cd in all seasons except autumn support an argument for application of digestive gland MT as a biomarker of Cd exposure, providing evidence for assessing the most appropriate season for mussel sampling.

Interferon treatment of uterine cervical carcinoma: 20 years of follow-up.

Twenty-seven randomized patients with biopsy proven carcinoma of the uterine cervix were treated with human natural leucocytic interferon (HNLI) and followed up, while 30 randomized patients were followed up in the control group and were not treated with HNLI. International Federation of Gynecology and Obstetrics (FIGO) classification of HNLI-treated patients was IA: 8, IB: 9, IIA and IIB: 10. FIGO classification of control non-treated patients was IA: 9, IB: 10, IIA and IIB: 12. HNLI was applied locally at 2x10(6) U daily in pessaries for 21 days before surgery. Survival analysis of the HNLI-treated patients after 240 months of observation showed that 20 patients (74.07%) out of 27 survived, and in the control group 14 patients (46.67%) out of 30 survived. Statistical difference between the HNLI-treated group and control group of patients is significant P<0.05.

Has psoriasis its own characteristic trichogram?

The aim of this study was to determine if there were characteristic trichogram changes in scalp psoriasis in patients without clinically evident effluvium or alopecia. A total of 45 patients (17 men and 28 women, aged from 15 to 73 years) with clinically and histologically confirmed psoriasis vulgaris with scalp involvement were included. The control group consisted of 60 volunteers (23 males and 37 females aged from 15 to 74 years) with no scalp involvement. Our results from the psoriatic group showed highly increased proportions of dysplastic hair roots. Median proportion was 50% with 95% confidence interval (CI) for median 30-60%, whereas telogen hair ratio was slightly increased-median proportion was 16% with 95% CI for median 15-20%. Within the psoriasis patients' group no statistically significant correlations were found between the proportion of dysplastic hairs and the patients' age, sex, and the intensity and duration of disease. According to the results of this study, the dysplastic hairs in scalp psoriasis are statistically significant much more frequently compared with the control group. Thus, the increased proportion of dysplastic hairs in scalp psoriasis without effluvium or alopecia might be its characteristic trichogram sign.

Haloperidol-stomach lesions attenuation by pentadecapeptide BPC 157, omeprazole, bromocriptine, but not atropine, lansoprazole, pantoprazole, ranitidine, cimetidine and misoprostol in mice.

The focus was on haloperidol (central dopamine antagonist)-stomach lesion, a longly described suitable counterpart of dopamine blocker cysteamine-duodenal lesion. In this, the contribution of blockade of central/peripheral dopamine receptors and prostaglandins synthesis, along with influence of antiulcer agents was evaluated in mice. Male NMRI Hannnover mice were sacrificed 24 h after haloperidol (25 mg/kg b.w. i.p., given alone or with saline (haloperidol+saline) (i) or in combination (ii,iii)). Supporting central dopamine predominance for haloperidol stomach lesion induction, co-administration of peripheral dopamine receptor antagonist domperidone (5 mg/kg i.p.) (haloperidol+ domperidone) (ii), or prostaglandin synthesis inhibitor indomethacin (10 mg/kg s.c.) (haloperidol+ indomethacin) (iii) did not aggravate this lesion. (i) In haloperidol+saline challenged mice the lesions were inhibited by co-administration (/kg i.p.) of a gastric pentadecapeptide BPC 157, GlyGluProProProGlyLysProAlaAspAspAlaGlyLeuVal, M.W. 1419 (10 microg, 10 ng, 10 pg, but not 1 pg, 100 fg, 10 fg), bromocriptine (10 mg), omeprazole (10 mg, 100 mg, but not 1 mg). Atropine (10, 100, 200 mg), pirenzepine (10, 100, 200 mg), misoprostol (10, 100, 200 microg), pantoprazole (1, 10, 100 mg), lansoprazole (0.1, 1, 10 mg), cimetidine (10, 100, 200 mg) and ranitidine (10, 100, 200 mg) were not effective. (ii) Dopamine peripheral blockade influence: in haloperidol+domperidone mice, previously effective bromocriptine, pentadecapeptide BPC 157 (10 microg) or omeprazole (10 mg) did not attenuate stomach lesions. (iii) Prostaglandins synthesis blockade effect: in haloperidol+indomethacin mice, previously effective agents, bromocriptine or omeprazole were not active, while BPC 157 effect was only lessened.

Further contribution in the densitometric study of the labyrinthic capsule with special reference to the bottom of the internal auditory meatus.

The quantity of minerals in the labyrinthic capsule of the basal coil and of the separating wall facing the internal auditory meatus in different life periods was determined by the densitometric method. The quantity of minerals is reduced in the labyrinthic capsule and in the separating wall in spite of the bone apposition and increasing thickness of the separating wall.

Video-densitometric quantitation of fluorescence quenching on totally irradiated thin-layer chromatographic plates.

The influence of the instrumental settings of a video-imaging system on the quality of captured images was studied. The performance of the Camag video documentation system was evaluated by measurements of fluorescence quenching of a model compound (the pesticide atrazine) in the UV spectral region. The effects of different camera settings (aperture and number of accumulated frames) on background response, baseline noise, and sensitivity and reproducibility of detection were studied for different commercial thin-layer chromatographic (TLC) and high-performance TLC (HPTLC) plates. The results showed that as the number of frames, in other words, the image brightness and background response, increased, the sensitivity also increased, reaching a maximum at settings that gave an image of moderate luminosity. Additional frame accumulation caused a decrease in sensitivity. A similar pattern was observed by measuring the limit of detection (LOD). If the f-stop number (aperture) was too large, the image was too bright, and if the aperture was too small, the image was too dark. Both of these extremes resulted in a higher LOD. However, good sensitivity does not necessarily mean a low detection limit because of the high baseline noise at the same capturing conditions. Evaluation of dark or moderately luminous video images gave more repeatable results than did evaluation of very bright images. With HPTLC silica gel plates, the relative standard deviation ranged from 1.8 to 2.5% for settings that resulted in moderately bright images, and from 5 to 8% for settings that resulted in bright images.

Distribution of structural and trace elements in human temporal bone.

This study was undertaken to evaluate a systematic analysis of mineral and trace elements of individual functionally determined parts of adult temporal bone. Marked differences were observed in basic structural elements (Ca, P, Mg, and Zn) among different bone regions. The more so, molar Ca/P ratio was significantly different in various regions, being highest in the hammer and vestibular regions. Taxonomic analysis revealed specific differences in the mineral ratio between the two petrous bone regions believed to develop from various embryonal bases. According to results, the observed differences in mineral trace element composition of particular regions of human temporal bone might be explained by their developmental specificities and functional adaptation.

Rapid detection of respiratory syncytial virus in clinical specimens.

Results of the direct immunofluorescence (IF) test in 152 clinical specimens (throat swabs) were compared with those of respiratory syncytial virus (RSV) isolation. The prevalence of RSV infections in the upper and lower respiratory tract was high especially in infants until 12 months of age. The average RSV isolation rate was 18.42%, whereas the virus antigen detection was positive in 19.74% of cases. The agreement between virus isolation and direct IF was 92.1%, the sensitivity of IF being 82.14% and its specificity 94.35%.

Analysis of data as information: quality assurance approach.

Describes a prototype module for data analysis of the healthcare delivery system. It consists of three main parts: data/variable selection; algorithms for the analysis of quantitative and qualitative changes in the system; and interpretation and explanation of the results. Such a module designed for primary health care has been installed on a PC in the health manager's office. Data enter the information system through the standard DBMS procedures, followed by calculating a number of different indicators and the time series, as the ordered sequences of indicators, according to demands of the manager. The last procedure is "the change analysis" with estimation of unexpected differences between and within some units, e.g. health-care teams, as well as some unexpected variabilities and trends. As an example, presents and discusses the diagnostic pattern of neurotic cases, referral patterns and preventive behaviour of GP's teams as well.

Possibilities of See5 software in forecasting of life expectancy not achieving.

Results of application of See5 to epidemiological domain were presented. The aim of this paper is to find out if See5 can be used for forecasting whether life expectancy will be achieved or not. The basis for forecasting are data-attributes, predictors (anthropological data, living habits, laboratory data, blood pressure measured in years 1970/71, and the status of examinee--class (alive or dead) in 1990. Data were split at random into 10 blocks with approximately the same number of cases and the same distribution of classes. Results were given in the form of decision trees and rulesets, and tested through crossvalidation. The most interesting question--what are prediction-candidates for not achieving life expectancy estimated in the year of examination--did not give a satisfactory result: the accuracy of classification was about 70%. However, a very interesting fact is that each rule consists of at least one candidate predictor, usually considered as risk factor (e.g. high diastolic blood pressure and animal fat consumption).

The influence of the dentition on the shape of the mandible.

In the course of life the mandible undergoes substantial morphological and dimensional changes. The changes concerning mandibular angle, relation between the length of the mandibular corpus and ramus as well as roughness in the place of insertion of masseteric and pterygoid muscles do not depend upon age or sex but (apodictical) exclusively upon the dentition. In the complete dentition all masticatory muscles take part in chewing and grinding. The function of the temporal and masseter muscle is (reduced) weakened in partial or complete loss of teeth. The most evident morphological change of the lower jaw consists of an apparent elongation of its corpus resulting in a characteristic senile appearance. Measurements have been performed on 114 macerated mandibles of individuals ranging from 4 months to 68 years of age. The following measures have been taken: number of teeth in the lower jaw, angle between the corpus and ramus of mandible, length of the mandibular corpus, height of the mandibular ramus and angle of the mandibular incisure. The angle between the mandibular corpus and ramus is significantly lower in mandibles with 11 and more teeth (p < 0.001). The length of the mandible is significantly larger (p < 0.02) in mandibles with less than 11 teeth. The mandibular ramus is significantly higher in mandibles with more teeth (p < 0.01). There were no significant differences in the angle of the mandibular incisure within the groups (p > 0.05). The discriminant analysis reveals that 62.3% of the variability of mandibles is dependent upon the number of teeth. The rest of proportional variability of 37.7% is probably due to new circumstances and adjustment of the mandible in the period from tooth extraction.

Genealogical structuring of a population.

The study observed population of 484 generation restrictive genealogies collected in four Croatian regions during 1970/71 within "The study of fat and carbohydrate metabolism indicators correlated with the occurrence of diabetes in animal fat and oil consuming population groups". The genealogies were collected on two islands (Brac and Hvar) and in two continental regions (Sinjska Krajina and Srijem). Genealogy Structure Index (GSI) was defined as quantitative indicator of genealogy structure. GSI was continuos variable which, by its extreme, describes vertical and horizontal type of genealogy structure, independently of the way genealogies were collected. Genealogy structure of surveyed population was described on the basis of participation of different genealogy types. Populations of the island Hvar and Brac showed to have horizontal genealogy type, continental population of Sinjska Krajina showed to have mixed type and continental population of Srijem showed to have vertical type of genealogy structure.

The Croatian Health Survey--SF-36: I. General quality of life assessment.

The objective of the Croatian Health Survey was the assessment of population health related quality of life in the transitional environment of Croatia. Health status measures incorporate dimensions such as physical, psychological, and social functioning, role performance and perception of wellbeing. In order to assess health status, "The medical outcome study 36-item short-form health survey (SF-36) model" was used. A total sample of 5048 inhabitants (1983 males and 3065 females), 18 years and over, represents approximately 1% of the general population of Croatia. Mean scores were as follows: physical functioning (PF) 69.94, role-physical (RP) 63.01, bodily pain (BP) 64.51, general health (GH) 53.40, vitality (VT) 51.85, social functioning (SF) 72.96, role-emotional (RE) 72.42, mental health (MH) 61.71 and health transition (HT) 44.79. Results of the SF-36 health survey in Croatia are very much like the results in other European countries with indication that general quality of life is lower in Croatia.

Gender related differences of low level exposure to occupational irritants--a three-year follow-up of chemical industry workers.

The authors followed changes in the ventilatory function in a group of 102 chemical workers over a three year period to evaluate gender related differences on respiratory effects of low concentrations of occupational irritants. Measurements were performed annually and the results of ventilatory test were compared to predicted normal values. Lung function was measured by recording maximum expiratory flow-volume (MEFV) curves. Baseline data show ventilatory function impairments of the obstructive-restrictive type, as measured by the Tiffeneau index and FEV1. After one and two years of exposure, impairment in flow rates at low lung volumes became prominent. Analysis of lung function in three years of the study suggests obstructive impairments mostly in the larger airways accompanied by a restrictive component. The ventilatory flow at low lung volumes was characterized by obstruction, but not by restrictive findings. Women appear to be more sensitive than men to the irritant effects of these exposures as measured by flow rates at low lung volumes--the smaller airways (FEF50% = 82.7 +/- 23.6 in women and FEF50% = 92.1 +/- 32.1 in men; p = 0.017), while men experienced greater changes than women to irritant effects on their ventilatory capacity--the large airways (FVC = 99.6 +/- 10.6 in men and FVC = 106.74 +/- 9.8 in women; p = 0.001). The additive effect of smoking to environmental irritation is demonstrated by the proportionately lower lung capacity in smokers. Overall, the effect of these pollutants in women is more synergistic than additive.

The Croatian health survey--patient's satisfaction with medical service in primary health care in Croatia.

The aim of the study was to investigate patient satisfaction with nurses and general practice organization in Croatia. A total of 2,252 patients 18 years of age and over from 47 randomly selected general practices were included in the study. 72.1% of patients were satisfied with nurses and general practice organization. Older and less educated patients were generally more satisfied. Patients were more pleased with nurses' behavior (81.9%) than with practice organization (62.3%). Factor analysis revealed two underlying discriminates of patient satisfaction--"positive attitude towards the nurse" and "inaccessibility of practice". The former discriminate emphasized a great potential of nursing, which should be taken into consideration in the transformation of health care system in Croatia.

Surname as 'cancer risk' in extreme isolates: example from the island of Lastovo, Croatia.

The aim of this study was to analyze whether there are surnames which appear more frequently among the ancestors of cancer cases in a small isolate, in comparison to the ancestral surnames of the healthy controls, using the classic case-control design. The chosen setting was the island of Lastovo, Croatia, located more than 100 kilometers from the nearest coastal region. The period of study was 1970-1995, during which a total of 76 cancer cases were recorded in a population of approximately 800. The comparison of surname frequencies was performed in current and in five ancestral generations. The leading hypothesis was that, if inbreeding and common ancestry contributed to the development of the disease, then those phenomena should be reflected in increasing frequency of some surnames among ancestors, identifying the 'hidden' consanguinity, or 'following' cancer-promoting genes on the Y-chromosome. The results imply that there are surnames representing a classic "risk" for cancer, but also those "protecting" from its development, which all underscores the importance of founder effect and genetic predisposition to the disease in a small, reproductively isolated population. All of the results become more evident and increasingly significant when analyzed in more distant ancestral generations.