[Current Status and Development of Drug Information Infrastructure System for the Public in Japan and Overseas].

With the progress of medical treatment, information on drugs, etc. is overflowing on the media and the Internet, and some of them are leading to uncertain information for the purpose of profit, and some of them are wrong information or inaccurate information, and the effect on the patient is regarded as a problem. In Japan, information on public pharmaceuticals for patients and consumers is provided on the Internet, but its utilization is not sufficient. In the Pharmaceuticals and Medical Devices Act, it is stated that "Citizens shall endeavor to use pharmaceuticals, etc., properly and deepen their knowledge and understanding of their efficacy and safety". On the other hand, there is a variety of information available on the Internet, and simply searching does not necessarily lead to reliable information. It is necessary to provide information with a mechanism to ensure that the information is reliable so that it can lead to appropriate medical care. Overseas, medical information infrastructure systems, including highly reliable public pharmaceuticals based on evidence, have been developed. Examples include National Health Service (NHS) in the United Kingdom, MedlinePlus in the United States, and National Prescribing Service (NPS) MedicineWise in Australia. In the era of digital health, it is necessary to discuss issues and prospects for the construction and dissemination of information provision infrastructure that meets the needs of patients and consumers from the perspective of industry, government, academia, and patients.

Disseminating health evidence summaries to increase evidence use in health care.

OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Disseminating health evidence summaries to increase evidence use in health care

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Public Health, Population Health, and Epidemiology Informatics: Recent Research and Trends in the United States.

Objectives: To survey advances in public and population health and epidemiology informatics over the past 18 months. Methods: We conducted a review of English-language research works conducted in the domain of public and population health informatics and published in MEDLINE or Web of Science between January 2015 and June 2016 where information technology or informatics was a primary subject or main component of the study methodology. Selected articles were presented using a thematic analysis based on the 2011 American Medical Informatics Association (AMIA) Public Health Informatics Agenda tracks as a typology. Results: Results are given within the context developed by Dixon et al., (2015) and key themes from the 2011 AMIA Public Health Informatics Agenda. Advances are presented within a socio-technical infrastructure undergirded by a trained, competent public health workforce, systems development to meet the business needs of the practice field, and research that evaluates whether those needs are adequately met. The ability to support and grow the infrastructure depends on financial sustainability. Conclusions: The fields of public health and population health informatics continue to grow, with the most notable developments focused on surveillance, workforce development, and linking to or providing clinical services, which encompassed population health informatics advances. Very few advances addressed the need to improve communication, coordination, and consistency with the field of informatics itself, as identified in the AMIA agenda. This will likely result in the persistence of the silos of public health information systems that currently exist. Future research activities need to aim toward a holistic approach of informatics across the enterprise.

IASM: A System for the Intelligent Active Surveillance of Malaria.

Malaria, a life-threatening infectious disease, spreads rapidly via parasites. Malaria prevention is more effective and efficient than treatment. However, the existing surveillance systems used to prevent malaria are inadequate, especially in areas with limited or no access to medical resources. In this paper, in order to monitor the spreading of malaria, we develop an intelligent surveillance system based on our existing algorithms. First, a visualization function and active surveillance were implemented in order to predict and categorize areas at high risk of infection. Next, socioeconomic and climatological characteristics were applied to the proposed prediction model. Then, the redundancy of the socioeconomic attribute values was reduced using the stepwise regression method to improve the accuracy of the proposed prediction model. The experimental results indicated that the proposed IASM predicted malaria outbreaks more close to the real data and with fewer variables than other models. Furthermore, the proposed model effectively identified areas at high risk of infection.

Public Health Information Systems: Priorities and Practices for Successful Deployments.

A fast paced workshop designed for senior public health decision makers and clinical leaders implementing information systems to support delivery of public health programs. The tutorial will introduce public health information systems and provide best practices for implementing solutions related to immunization, communicable disease case management and outbreak management. Using a combination of formats, the tutorial will: • Highlight key functionality of public health information systems. • Review global crises currently exposing gaps and deficiencies in public health information. • Examine governance, planning, and implementation priorities. • Highlight considerations supporting implementations nationally and in special populations. • Provide real, actionable lessons learned to take away and apply in the real world.

The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

Præventis, the immunisation register of the Netherlands: a tool to evaluate the National Immunisation Programme.

Vaccination coverage is an important performance indicator of any national immunisation programme (NIP). To monitor the vaccination coverage in the Netherlands, an electronic national immunisation register called 'Præventis' was implemented in 2005. Præventis has a link with the population register and can produce letters of invitation for the NIP, register and validate administered vaccinations. The database is used to monitor the vaccination process, produce reminder letters, control the stock of vaccines and provides information used for paying the fees to the different executive organisations involved. Præventis provides a crucial tool for the evaluation of the NIP by producing (sub)national vaccination coverage estimates with high accuracy and allowing additional research: identifying populations at high risk for low coverage based on existing data, conducting specific studies where individuals included in the immunisation register are approached for further research, using vaccination coverage data for the interpretation of (sero)surveillance data, and linking the immunisation register with disease registers to address vaccine safety or vaccine effectiveness. The ability to combine Præventis data with data from other databases or disease registers and the ability to approach individuals with additional research questions offers opportunities to identify areas of priority for improving the Dutch NIP.

Quantitative and qualitative verification of data quality in the childbirth registers of two rural district hospitals in Western Kenya.

OBJECTIVE: to verify the data quality of childbirth registers and explore factors that influence quality at two rural district hospitals in Western Kenya. DESIGN: a retrospective comparative case study for data quality of the 2006 childbirth registers by quantitative and qualitative methods. SETTING: Siaya and Bondo District Hospitals. METHODS: after confirming the physical condition and availability of childbirth registers, the total number of births; number of complete/incomplete data; and number of complete data that were illegible, incorrectly coded, inappropriate and unrecognised were verified quantitatively to evaluate accuracy and completeness. Data categories and instructions were examined qualitatively to assess the relevance, completeness and accuracy of the data. Semi-structured interviews were conducted with key informants to capture their views and factors that influence data quality. FINDINGS: the childbirth registers used by the two hospitals were not developed by the Ministry of Health, and their supply to Bondo was interrupted. Of the 30 data categories in the registers, five for Siaya and 23 for Bondo were more than 20% incomplete. Data for number of antenatal consultations and use of human immunodeficiency virus drugs were at least 50% incomplete for both hospitals. The percentage of illegible, incorrectly coded and inappropriate data was relatively low, and only the place of residence had unrecognised data. Data categories in the registers did not correspond well with those of monthly reports, and inappropriate instructions suggested hidden inaccuracy among apparently valid data. Organisational impediments of the health information system in general, perinatal and intrapartum contexts were identified. KEY CONCLUSIONS: data quality of the childbirth registers was unsatisfactory. Influential factors were primarily organisational and technical, which may have had an adverse effect on midwives' record keeping behaviour. IMPLICATIONS FOR PRACTICE: data quality of the registers can be improved by re-examining technical challenges and organisational impediments at different levels. Midwives' awareness of data quality needs to be increased by sharing the purpose of the childbirth registers. Strong political commitment is also indispensable for putting these findings into action.

Prevalence of smoking and other smoking-related behaviors reported by the Global Youth Tobacco Survey (GYTS) in Thailand.

INTRODUCTION: Thailand ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) on November 8, 2004. The WHO FCTC requires all parties to inform all persons of the health consequences of tobacco consumption and exposure to tobacco smoke. Each party has agreed to develop, implement and evaluate effective tobacco control programs to measure progress in reaching the goals of the WHO FCTC. METHODS: The Global Youth Tobacco Survey (GYTS) was developed to provide data on youth tobacco use to countries for their development of youth-based tobacco control programs. Data in this report can be used as baseline measures for future evaluation of the tobacco control programs implemented by the Ministry of Public Health. RESULTS: Overall, about 1 in 10 Thai students are current smokers, this number including 4 times more boys than girls (17% versus 3.9%). Almost 2 in 10 Thai students start smoking before the age of 10, and almost 7 in 10 students are reported to have been exposed to smoke from others in public places. About 4 in 10 students are reported to have an object with a cigarette brand logo on it. CONCLUSION: The key for Thailand is to implement and enforce the provisions on indirect tobacco advertising, smoking in public places, selling tobacco to youths under 18 years of age, and to use the data from the GYTS to monitor progress toward achieving the goals of the WHO FCTC. When these goals are met, tobacco consumption and exposure in Thailand will have declined substantially.

Prevalence of smoking and other smoking related behaviors reported by the Global Youth Tobacco Survey (GYTS) in four Peruvian cities.

INTRODUCTION: In 2004, Peru ratified the Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and in 2006 passed Law 28705 for tobacco consumption and exposure reduction. The Global Youth Tobacco Survey (GYTS) provides data on youth tobacco use for development of tobacco control programs. Findings from the GYTS conducted in four main cities in Peru in 2000 and 2003 are reported in this paper and can be used to monitor provisions of the WHO FCTC. METHODS: The GYTS is a school-based survey that uses a standardized methodology for sampling, questionnaire construction, field procedures, and data management. In total, 5,332 and 7,824 students aged 13 to 15 years participated in the 2000 and 2003 surveys conducted in Huancayo, Lima, Tarapoto and Trujillo. RESULTS: In both years, Lima had the highest lifetime (54.6% and 59.6%) and current use of tobacco (18.6% and 19.2%) of the four cities. According to gender, boys smoked more than girls and less than 20% of students initiated smoking before the age of 10. Among smokers, more than 60% bought their cigarettes in a store with no restriction for their age, and approximately 12% had ever been offered "free cigarettes". Around 90% of students were in favor of banning smoking in public places. Changes between 2000 and 2003 included an increase in the percentage of smokers who wanted to have a cigarette first thing in the morning in Tarapoto (from 0% to 1.2%) and a decrease in exposure to tobacco at home in Huancayo (from 23.7% to 17.8%) and Trujillo (from 27.8% to 19.8%) CONCLUSION: While few changes in tobacco use among youth have been observed in the GYTS in Peru, the data in this report can be used as baseline measures for future evaluation efforts. At this time, tobacco control efforts in Peru need to focus on enhancing Law 28705 to include enforcement of existing provisions and inclusion of new laws and regulations. Most of these provisions are required of all countries, such as Peru, that have ratified the WHO FCTC.

Evaluation of the use of Global Youth Tobacco Survey (GYTS) data for developing evidence-based tobacco control policies in Turkey.

INTRODUCTION: The tobacco control effort in Turkey has made significant progress in recent years. Turkey initiated its tobacco control effort with the passing of Law 4207 (The Prevention of Harmful Effects of Tobacco Products) in 1996 and ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. It is important to base policy decisions on valid and reliable evidence from population-based, representative studies that are periodically repeated to enable policy makers to monitor the results of their interventions and to appropriately tailor anti-tobacco activities towards future needs. METHODS: The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people and enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. Turkey conducted the GYTS in 2003 and data from this survey can be used as baseline measures for evaluation of the tobacco control programs implemented by the Ministry of Health (MOH) of the Turkish government. RESULTS: The GYTS was conducted in 2003 on a representative sample of students aged 13 to 15 years. It indicated that almost 3 in 10 students in Turkey had ever smoked cigarettes, with significantly higher rates among boys. Current cigarette smoking rates were lower, at 9% for boys and 4% for girls. The prevalence of current use of other tobacco products was about half these figures for each gender. About 80% were exposed to secondhand smoke. Exposure to pro-smoking media messages was not rare. Almost half of the smokers 'usually' bought their tobacco from a store, despite the law prohibiting this. Exposure to teaching against smoking in schools was not universal. CONCLUSION: Findings from the GYTS, with periodic repeats of the survey, can be used to monitor the impact of enforcing various provisions of the present law (No: 4207), the progress made in achieving the goals of the WHO FCTC, and the effectiveness of various preventive interventions against smoking. Such data would inform and help in the development of public health strategy.

Cancer registry policies in the United States and geographic information systems applications in comprehensive cancer control.

OBJECTIVES: Through a long history of cancer policies, public health has a foundation for cancer research and data to use in applying technological advancements for U.S. cancer control efforts. Geographic information systems (GIS) are one technology enabling the visualization of cancer risk patterns associated with incidence, mortality, and accessibility to care. METHODS: U.S. Comprehensive Cancer Control (CCC) program directors were interviewed from 49 of 50 states to assess use and function of GIS tools for mapping data related to cancer control policies and practices. Interviews were coded to obtain frequencies of response associated with content domains mapped using GIS tools and the perceived relative advantages. RESULTS: Significant relationships were found between the mapping of behavioral risk factors, health care services, transportation access, and policy advantages identified by program managers. The mapping of cancer incidence, mortality, and staging, transportation access, and multiple layers of content were found to have significant associations with perceived research advantages. CONCLUSIONS: U.S. CCC program managers recognize several important advantages relating to health policy and research for use of GIS tools in cancer control efforts. The application of GIS in U.S. cancer control efforts is employed unevenly, suggesting the need for innovative policies to support accessibility.

Construction of the Australian Inpatient Export Database (AIED).

OBJECTIVE: To establish a database of exports by Australian acute health care institutions for the period in which exports were first promoted. METHOD: Hospital morbidity data for patients resident overseas (Group A) and Medicare ineligible patients resident in Australia (Group B) were sought for the period 1983-84 to 1995-96 from each state and territory health department. Private hospital permission was obtained for the release of identifiable private hospital data. RESULTS: Data were coalesced into a relational database covering the period 1987-88 to 1995-96. Coding variations between and within jurisdictions over time necessitated the development of a consistent coding mechanism. Group A and Group B patients gave rise to at least 77,568 separations over the period 1987-88 to 1995-96. Of these separations 58,418 (75.3%) should have generated export income and another 10,158 separations (13.1%) were likely to have generated export income. Definite export separations not for dialysis number 52,573, and these form the AIED. CONCLUSION: An Australian database of inpatient exports, the AIED, encompassing public and private hospital data has been established for the period 1987-88 to 1995-96. The problems encountered in the course of this study emphasise the desirability of maintaining an adequately resourced national repository for health statistics.

Use of Western Australian linked hospital morbidity and mortality data to explore theories of compression, expansion and dynamic equilibrium.

Three hypotheses have been advanced to predict changes in population health in countries experiencing low birth and death rates, and increasing expectation of life. Determining which of these best accounts for changing patterns of illness and death is an important step in understanding both the public health and economic impacts of health interventions in an ageing population. The aim of this study was to use the WA Data Linkage System to evaluate the compression, expansion and dynamic equilibrium theories in Western Australia. Changes in life expectancy, average age at first-time hospitalisation and time spent in chronic disabling or activity limiting states were used to evaluate the competing hypotheses. Life expectancy increased by 4.0 and 2.6 years over the 24-year study period in males and females, respectively. However, average time spent with a diagnosed chronic disabling condition increased by 9.2 and 9.4 years in males and females, respectively. These results suggest that an increase in the "medicalisation of more serious morbidity" may be in operation in Australia.

[Study on the evaluation of underreporting and the quality of death cases reporting system, from medical institutions at county level and above, in 2005].

OBJECTIVE: To understand the underreporting on death cases through web-based reporting system from medical institutions at county level and above as well as to evaluate the quality of death cases reporting through the system. METHODS: A large-scale survey was conducted at 130 medical institutions based on stratified random sampling and to evaluate the underreporting and the quality of death cases reporting from medical institutions through data from survey and reporting system. RESULTS: In 2005, the total reporting rates were 78.25% at the county level and 37.93% at the institutes. Comparing with the results of 2004, these rates were going down slightly. The eligibility rate of reporting was 79.62%, increased when comparing with results of 2004. The percentage of obvious coding errors among deaths reported by county level and above medical institutions was 24.68%. A total of 5226 death cases were recorded from medical (outpatient and inpatient) sources. An average underreporting rate of 33.07% was found at the selected medical institutions. Statistical difference of underreporting rate was not found at medical institutions at different levels. CONCLUSION: Since the initiation of the web-based reporting system of death cases at medical institutes from county level and above, the timeliness of data reporting had been increasing remarkably. The system showed irreplaceable advantages. However, there still existed some problems such as the underreporting of death cases,the poor timeliness of reporting, and the poor accuracy of coding. In the meantime, it was noticed that repetitive work existed among medical institutions due to multi-systems, suggesting that it was necessary to establish a national life registration in China.

Semantic interoperability between clinical and public health information systems for improving public health services.

Improving public health services requires comprehensively integrating all services including medical, social, community, and public health ones. Therefore, developing integrated health information services has to start considering business process, rules and information semantics of involved domains. The paper proposes a business and information architecture for the specification of a future-proof national integrated system, concretely the requirements for semantic integration between public health surveillance and clinical information systems. The architecture is a semantically interoperable approach because it describes business process, rules and information semantics based on national policy documents and expressed in a standard language such us the Unified Modeling Language UML. Having the enterprise and information models formalized, semantically interoperable Health IT components/services development is supported.