Using automated medical records for rapid identification of illness syndromes (syndromic surveillance): the example of lower respiratory infection

BACKGROUND: Gaps in disease surveillance capacity, particularly for emerging infections and bioterrorist attack, highlight a need for efficient, real time identification of diseases. METHODS: We studied automated records from 1996 through 1999 of approximately 250,000 health plan members in greater Boston. RESULTS: We identified 152,435 lower respiratory infection illness visits, comprising 106,670 episodes during 1,143,208 person-years. Three diagnoses, cough (ICD9CM 786.2), pneumonia not otherwise specified (ICD9CM 486) and acute bronchitis (ICD9CM 466.0) accounted for 91% of these visits, with expected age and sex distributions. Variation of weekly occurrences corresponded closely to national pneumonia and influenza mortality data. There was substantial variation in geographic location of the cases. CONCLUSION: This information complements existing surveillance programs by assessing the large majority of episodes of illness for which no etiologic agents are identified. Additional advantages include: a) sensitivity, uniformity and efficiency, since detection of events does not depend on clinicians' to actively report diagnoses, b) timeliness, the data are available within a day of the clinical event; and c) ease of integration into automated surveillance systems. These features facilitate early detection of conditions of public health importance, including regularly occurring events like seasonal respiratory illness, as well as unusual occurrences, such as a bioterrorist attack that first manifests as respiratory symptoms. These methods should also be applicable to other infectious and non-infectious conditions. Knowledge of disease patterns in real time may also help clinicians to manage patients, and assist health plan administrators in allocating resources efficiently

Managing an Online Survey about Influenza Vaccination in Primary Healthcare Workers

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2¿1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders

Knowledge of and attitudes to influenza vaccination in healthy primary healthcare workers in Spain, 2011-2012

Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011– 2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72–6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83–3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56–3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine

National immunization strategies targeting migrants in six European countries

Over the last three years an unprecedented flow of migrants arrived in Europe. There is evidence that vaccine preventable diseases have caused outbreaks in migrant holding centres. These outbreaks can be favored by a combination of factors including low immunization coverage, bad conditions that migrants face during their exhausting journey and overcrowding within holding facilities. In 2017, we conducted an online survey in Croatia, Greece, Italy, Malta, Portugal and Slovenia to explore the national immunization strategies targeting irregular migrants, refugees and asylum seekers. All countries stated that a national regulation supporting vaccination offer to migrants is available. Croatia, Italy, Portugal and Slovenia offer to migrant children and adolescents all vaccinations included in the National Immunization Plan; Greece and Malta offer only certain vaccinations, including those against diphtheria-tetanus-pertussis, poliomyelitis and measles-mumps-rubella. Croatia, Italy, Malta and Portugal also extend the vaccination offer to adults. All countries deliver vaccinations in holding centres and/or community health services, no one delivers vaccinations at entry site. Operating procedures that guarantee the migrants' access to vaccination at the community level are available only in Portugal. Data on administered vaccines is available at the national level in four countries: individual data in Malta and Croatia, aggregated data in Greece and Portugal. Data on vaccination uptake among migrants is available at national level only in Malta. Concluding, although diversified, strategies for migrant vaccination are in place in all the surveyed countries and generally in line with WHO and ECDC indications. Development of procedures to keep track of migrants' immunization data across countries, development of strategies to facilitate and monitor migrants' access to vaccinations at the community level and collection of data on vaccination uptake among migrants should be promoted to meet existing gaps. The study was conducted in the framework of the CARE (''Common Approach for REfugees and other migrants' health") project (717217/CARE) that received funding from the EU health Programme (2014–2020). info:eu-repo/semantics/publishedVersio

Development of risk models for the prediction of new or worsening acute kidney injury on or during hospital admission: a cohort and nested study

Background: Acute kidney injury (AKI) is a common clinical problem with significant morbidity and mortality. All hospitalised patients are at risk. AKI is often preventable and reversible; however, the 2009 National Confidential Enquiry into Patient Outcome and Death highlighted systematic failings of identification and management, and recommended risk assessment of all emergency admissions. Objectives: To develop three predictive models to stratify the risk of (1) AKI on arrival in hospital; (2) developing AKI during admission; and (3) worsening AKI if already present; and also to (4) develop a clinical algorithm for patients admitted to hospital and explore effective methods of delivery of this information at the point of care. Study design: Quantitative methodology (1) to formulate predictive risk models and (2) to validate the models in both our population and a second population. Qualitative methodology to plan clinical decision support system (CDSS) development and effective integration into clinical care. Data analysis: Quantitative – both traditional and Bayesian regression methods were used. Traditional methods were performed using ordinal logistic regression with univariable analyses to inform the development of multivariable analyses. Backwards selection was used to retain only statistically significant variables in the final models. The models were validated using actual and predicted probabilities, an area under the receiver operating characteristic (AUROC) curve analysis and the Hosmer–Lemeshow test. Qualitative – content analysis was employed

Evidence of an accelerating increase in prevalence of diagnosed Type 2 diabetes in British men, 1978-2005

Background The prevalence of Type 2 diabetes is increasing worldwide; predictions suggest that the disease will reach epidemic proportions this century. This study aims to estimate the extent of the increase in prevalence of diagnosed Type 2 diabetes in British men between 1978 and 2005. Methods A representative cohort of 7722 British men aged 40-59 years at entry in 1978-1980 were selected from general practices in 24 British towns. Seven sequential questionnaire surveys were carried out between 1978 and 2005, recording recall of a doctor diagnosis of diabetes at each time point. Logistic regression models with generalized estimating equations were fitted to provide age-adjusted estimates of the calendar year increases in odds of Type 2 diabetes, both overall and for consecutive periods, each of approximately 5 years. Results The crude prevalence of Type 2 diabetes increased from 1.2% in 1978-1980 to 12.1% in 2005. The age-adjusted average annual increase in Type 2 diabetes prevalence for the 27-year study period was 7.0% [95% confidence interval (CI) 5.4%, 8.6%]. However, the age-adjusted annual rate of increase increased over time, from 4.3% (95% CI 0.4%, 8.2%) between 1979 and 1984 to 11.8% (95% CI 8.4%, 15.4%) between 2003 and 2005; P (trend) = 0.01. The highest annual increases occurred in subjects with higher mean body mass index levels and in towns in Scotland. Conclusions The prevalence of Type 2 diabetes has risen substantially in Britain during the last three decades; the recent rate of increase has been almost three times greater than that in the early 1980s

Immunization Offer Targeting Migrants: Policies and Practices in Italy

The unprecedented flow of migrants over the last three years places Italy in front of new issues regarding medical care from the rescue phase up to the integration into the national health services, including preventive actions. We used online questionnaires to investigate the Italian national and regional policies for immunization offer targeting asylum seekers, refugees, irregular migrants and unaccompanied minors. Another questionnaire was used to assess how these policies are translated into practice in migrant reception centres and community health services. Questionnaires were filled out at the national level, in 14 out of 21 Regions/Autonomous Provinces, and in 36 community health services and 28 migrant reception centres. Almost all responders stated that all vaccinations included in the National Immunization Plan are offered to migrant children and adolescents. The situation concerning adults is fragmented, with most of the Regions and local centres offering more vaccines than the national offer—which include polio, tetanus and measles–mumps-rubella. Data on immunized immigrants is archived at the regional/local level with different methods and not available at the national level. Further efforts to ensure consistency in vaccine provision and adequate mechanisms of exchanging data are needed to guarantee a complete vaccination offer and avoid unnecessary health actions, including unnecessary re-vaccination