Assessing Needs of Care in European Nations. ENEPRI Policy Brief No. 14, 28 December 2012

This Policy Brief presents the research questions, main results and policy implications and recommendations of the seven Work Packages that formed the basis of the ANCIEN research project, financed under the 7th EU Research Framework Programme of the European Commission. Carried out over a 44-month period and involving 20 partners from EU member states, the project principally concerns the future of long-term care (LTC) for the elderly in Europe and addresses two questions in particular: How will need, demand, supply and use of LTC develop? How do different systems of LTC perform

Intelligent Advanced User Interfaces for Monitoring Mental Health Wellbeing

It has become pressing to develop objective and automatic measurements integrated in intelligent diagnostic tools for detecting and monitoring depressive states and enabling an increased precision of diagnoses and clinical decision-makings. The challenge is to exploit behavioral and physiological biomarkers and develop Artificial Intelligent (AI) models able to extract information from a complex combination of signals considered key symptoms. The proposed AI models should be able to help clinicians to rapidly formulate accurate diagnoses and suggest personalized intervention plans ranging from coaching activities (exploiting for example serious games), support networks (via chats, or social networks), and alerts to caregivers, doctors, and care control centers, reducing the considerable burden on national health care institutions in terms of medical, and social costs associated to depression cares

GIS and Health: Enhancing Disease Surveillance and Intervention through Spatial Epidemiology

The success of an evidence-based intervention depends on precise and accurate evaluation of available data and information. Here, the use of robust methods for evidence evaluation is important. Epidemiology, in its conventional form, relies on statistics and mathematics to draw inferences on disease dynamics in affected populations. Interestingly, most of the data used tend to have spatial aspects to them. However, most of these statistical and mathematical methods tend to either neglect these spatial aspects or consider them as artefacts, thereby biasing the resultant estimates. Thankfully, spatial methods allow for evidence evaluation and prediction in epidemiologic data while considering their inherent spatial characteristics. This, thus, promises more precise and accurate estimates.This thesis documents and illustrates the contribution spatial methods and spatial thinking makes to epidemiology through studies carried out in two countries with different heath-data quality realities, Uganda and Sweden. To be able to use spatial methods for epidemiology studies, proper spatial data need to be available, which is not the case in Uganda. Consequently, this study had two main aims: (1) It proposed and implemented a novel way of spatially-enabling patient registry systems in settings where the existing infrastructures do not allow for the collection of patient-level spatial details, prerequisites for fine-scale spatial analyses; (2) Where spatial data were available, spatial methods were used to study associative relationships between health outcomes and exposure factors. Spatial econometrics approaches, especially spatially autoregressive regression models were adopted. Also, consistent with location-specific epidemiologic intervention, the advantages of using spatial scan statistics, Geographically Weighted (Poisson) Regression and local entropy maps to distil model parameter estimates into their inherent spatial heterogeneities were illustrated. Our results illustrated that through the use of mobile and web technologies and leveraging on existing spatial data pools, systems that enable recording and storage of geospatially referenced patient records can be created. Also, spatial methods outperformed conventional statistical approaches, giving refined and more accurate parameter estimates. Finally, our study illustrates that the use of local spatial methods can inform policy and intervention better through the identification of areas with elevated disease burden or those areas worth additional scrutiny as illustrated by our study of HIV-TB coinfection areas in Uganda, the areas with high CVD-air pollution associations in Sweden, and areas with consistently high joint mortality burden for CVD and cancer among the Swedish elderly.Overall, the incorporation of spatial approaches and spatial thinking in epidemiology cannot be overemphasized. First, by enabling the capture of fine-scale personal-level spatial data, our study promises more robust analyses and seamless data integration. Secondly, associative analyses using spatial methods showed improved results. Thirdly, identification of the areas with elevated disease burden makes identifying the primary drivers of the observed local patterns more informed and focused. Ultimately, our results inform healthcare policy and strategic intervention as the most affected areas can easily be zoned out. Therefore, by illustrating these benefits, this study contributes to epidemiology, through spatial methods, especially in the aspects of disease surveillance, informing policy, and driving possible effective intervention

Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement

Drawing on leaked texts of potential provisions of the proposed Trans-Pacific Partnership Agreement, this health impact assessment found the potential for negative impacts in the cost of medicines, tobacco control policies, alcohol control policies, and food labeling. Overview The Centre for Health Equity Training Research and Evaluation (CHETRE) has been working with a group of Australian academics and non-government organisations interested in the health of the Australian population to carry out a health impact assessment (HIA) on the Trans-Pacific Partnership Agreement (TPP) negotiations. In the absence of official publicly available drafts of the trade agreement, the health impact assessment drew on leaked texts of potential provisions and formulated policy scenarios based on high priority health policies that could be affected by the TPP. The HIA found the potential for negative impacts in each of the four areas under investigation: the cost of medicines; tobacco control policies; alcohol control policies; and food labeling. In each of these areas, the HIA report traces the relevant proposed provisions through to their likely effects on the policy scenarios onto the likely impact on the health of Australians, focusing particularly on vulnerable groups in the Australian community. The report makes a number of recommendations to DFAT regarding the TPP provisions and to the Australian Government regarding the TPP negotiating process

Methodological Challenges in Estimating Trends and Burden of Cardiovascular Disease in Sub-Saharan Africa

Background. Although 80% of the burden of cardiovascular disease (CVD) is in developing countries, the 2010 global burden of disease (GBD) estimates have been cited to support a premise that sub-Saharan Africa (SSA) is exempt from the CVD epidemic sweeping across developing countries. The widely publicized perspective influences research priorities and resource allocation at a time when secular trends indicate a rapid increase in prevalence of CVD in SSA by 2030. Purpose. To explore methodological challenges in estimating trends and burden of CVD in SSA via appraisal of the current CVD statistics and literature. Methods. This review was guided by the Critical review methodology described by Grant and Booth. The review traces the origins and evolution of GBD metrics and then explores the methodological limitations inherent in the current GBD statistics. Articles were included based on their conceptual contribution to the existing body of knowledge on the burden of CVD in SSA. Results/Conclusion. Cognizant of the methodological challenges discussed, we caution against extrapolation of the global burden of CVD statistics in a way that underrates the actual but uncertain impact of CVD in SSA. We conclude by making a case for optimal but cost-effective surveillance and prevention of CVD in SSA

Doctor of Philosophy

dissertationPublic health surveillance systems are crucial for the timely detection and response to public health threats. Since the terrorist attacks of September 11, 2001, and the release of anthrax in the following month, there has been a heightened interest in public health surveillance. The years immediately following these attacks were met with increased awareness and funding from the federal government which has significantly strengthened the United States surveillance capabilities; however, despite these improvements, there are substantial challenges faced by today's public health surveillance systems. Problems with the current surveillance systems include: a) lack of leveraging unstructured public health data for surveillance purposes; and b) lack of information integration and the ability to leverage resources, applications or other surveillance efforts due to systems being built on a centralized model. This research addresses these problems by focusing on the development and evaluation of new informatics methods to improve the public health surveillance. To address the problems above, we first identified a current public surveillance workflow which is affected by the problems described and has the opportunity for enhancement through current informatics techniques. The 122 Mortality Surveillance for Pneumonia and Influenza was chosen as the primary use case for this dissertation work. The second step involved demonstrating the feasibility of using unstructured public health data, in this case death certificates. For this we created and evaluated a pipeline iv composed of a detection rule and natural language processor, for the coding of death certificates and the identification of pneumonia and influenza cases. The second problem was addressed by presenting the rationale of creating a federated model by leveraging grid technology concepts and tools for the sharing and epidemiological analyses of public health data. As a case study of this approach, a secured virtual organization was created where users are able to access two grid data services, using death certificates from the Utah Department of Health, and two analytical grid services, MetaMap and R. A scientific workflow was created using the published services to replicate the mortality surveillance workflow. To validate these approaches, and provide proofs-of-concepts, a series of real-world scenarios were conducted

Noncommunicable Diseases

Noncommunicable Diseases: A Compendium introduces readers to noncommunicable diseases (NCDs) – what they are, their burden, their determinants and how they can be prevented and controlled. Focusing on cardiovascular disease, diabetes, cancer and chronic respiratory disease and their five shared main risk factors (tobacco use, harmful use of alcohol, unhealthy diet, physical inactivity and air pollution) as defined by the United Nations, this book provides a synopsis of one of the world’s biggest challenges of the 21st century. NCDs prematurely claim the lives of millions of people across the world every year, with untold suffering to hundreds of millions more, trapping many people in poverty and curtailing economic growth and sustainable development. While resources between and within countries largely differ, the key principles of surveillance, prevention and management apply to all countries, as does the need to focus resources on the most cost-effective and affordable interventions and the need for strong political will, sufficient resources, and sustained and broad partnerships. This compendium consists of 59 short and accessible chapters in six sections: (i) describing and measuring the burden and impact of NCDs; (ii) the burden, epidemiology and priority interventions for individual NCDs; (iii) social determinants and risk factors for NCDs and priority interventions; (iv) global policy; (v) cross-cutting issues; and (vi) stakeholder action. Drawing on the expertise of a large and diverse team of internationally renowned policy and academic experts, the book describes the key epidemiologic features of NCDs and evidence-based interventions in a concise manner that will be useful for policymakers across all parts of society, as well as for public health and clinical practitioners

Epidemiological Change and Chronic Disease in Sub-Saharan Africa

Epidemiological Change and Chronic Disease in Sub-Saharan Africa offers new and critical perspectives on the causes and consequences of recent epidemiological changes in sub-Saharan Africa, particularly on the increasing incidence of so-called ‘non-communicable’ and chronic conditions. Historians, social anthropologists, public health experts and social epidemiologists present important insights from a number of African perspectives and locations to present an incisive critique of ‘epidemiological transition’ theory and suggest alternative understandings of the epidemiological change on the continent. Arranged in three parts, ‘Temporalities: Beyond Transition’, ‘Numbers and Categories’ and ‘Local Biologies and Knowledge Systems’, the chapters cover a broad range of subjects and themes, including the trajectory of maternal mortality in East Africa, the African smoking epidemic, the history of sugar consumption in South Africa, causality between infectious and non-communicable diseases in Ghana and Belize, the complex relationships between adult hypertension and paediatric HIV in Botswana, and stories of cancer patients and their families as they pursue treatment and care in Kenya. In all, the volume provides insights drawn from historical perspectives and from the African social and clinical experience to offer new perspectives on the changing epidemiology of sub-Saharan Africa that go beyond theories of ‘transition’. It will be of value to students and researchers in Global Health, Medical Anthropology and Public Health, and to readers with an interest in African Studies