Health Information System Research Articles

Utility of learning health systems in radiation oncology.

413 Background: Current health information systems lack a robust framework for longitudinal integration of internal experiences and external evidence into existing workflows. The result is labor intensive, error-prone and fragmented systems plagued with process gaps. Learning health systems (LHS) can be a potential solution to address these gaps. We created and implemented a novel LHS framework in radiation oncology (RO). We hypothesize that this framework can be leveraged to identify and implement opportunities for improvement using a patient-oriented endpoint of time from radiation simulation to treatment start (RSTS). Methods: An RO-LHS was developed through a collaboration between an academic, multi-facility radiation oncology department and an industry partner (Medlever). The end-to-end clinical workflow was embedded into the Medlever platform following an interdisciplinary, iterative analysis with representatives from key teams (clerical, finance and clinical). A novel nomenclature was created to label standardized, customizable templates, which choreograph logic-driven tasks that cover all sub-steps of RSTS. The primary endpoint of RSTS was compared pre- and post-implementation, stratified by key variables, such as facility, staff member, and radiation treatment modality. Results: The iterative workflow analysis identified >700 variables and decision points necessary for >200 cancer and benign conditions routinely managed in RO. >450 treatment protocols were templated.180 logic-driven tasks were created and linked to key parameters, resulting in a choregraphed precision workflow for each patient. Using the first iteration of the build, a total of 512 patients were managed during a 50-day period (03/01/2024-04/20/2024) and were compared to 2875 patients treated prior to implementation. Post-implementation, RSTS was shortened by 36.4% (p<0.001). We identified significant differences in RSTS by radiation modalities (protons vs all others), across facilities, and by providers (p<0.01 for all). Analysis of fractional domain of RSTS, 56% of the time was driven by physician-directed tasks, while 44% was comprised of physics and dosimetry-driven work. Physician-directed tasks had the greatest heterogeneity in time to completion. The biggest variation was noted for the contouring completion task. Significant differences were identified by provider (p<0.001) in nearly each step of the process, including steps not directly tied to physician’s work. Conclusions: Through an inter-disciplinary implementation of the first iteration of a LHS in our RO department, we have significantly shortened RSTS. The implementation and analysis has also enabled us to better understand underlying heterogeneities and identify further opportunities for optimization of RSTS. An LHS framework provides a generalizable solution that could be adapted in other RO clinics.

Associations of Sedentary Behavior with Risks of Cardiovascular Disease Events among Chinese Adults.

Evidence regarding the modification effects of age, sex, ethnicity, socioeconomic status, or weight status on the associations of sedentary behavior (SB) with cardiovascular diseases (CVDs) is limited. Moreover, the mechanisms for the associations also remain unclear. We aimed to investigate the possible influence of these factors on the associations of SB with CVD events and whether the associations are mediated by metabolic phenotypes. This study included 42,619 participants aged 20-74 years, recruited from the Shanghai Suburban Adult Cohort and Biobank study. SB was assessed at baseline and integrated with health information systems to predict future CVD events. Cox proportional hazards models, interaction analyses, restricted cubic splines and causal mediation analyses were used for assessments. Compared to those with ＜3 h/d sedentary time, participants having SB ≥ 5 h/d had significantly higher risks of CVD (HR[95%CI]: 1.27[1.12-1.44]), coronary heart disease (CHD, 1.35[1.14-1.60]), and ischemic stroke (IS, 1.30[1.06-1.60]). The association of CHD was more pronounced in the retired individuals than their counterparts (1.45[1.20-1.76] versus 1.06[0.74-1.52], pinteraction=0.046). When SB was expressed as a continuous variable, a 1 h/d increment in SB was positively associated with risks of CVD (1.03[1.01-1.05]), CHD (1.04[1.01-1.07]), and IS (1.05[1.01-1.08]). High-density lipoprotein cholesterol (HDL-C, proportion mediated: 12.54%, 12.23%, and 11.36%, all p＜0.001), followed by triglyceride (TG, 5.28%, 4.77%, and 4.86%, all p＜0.01) and serum uric acid (SUA, 3.64%, 4.24%, and 2.29%, all p＜0.05) were major mediators through metabolic phenotypes. Higher SB was associated with elevated risks of CVD events. The detrimental effect of SB on CHD risk was more pronounced among retired individuals. Moreover, HDL-C, TG and SUA partially mediated the relationships between SB and CVD events. Our findings may have implications for preventing and controlling CVD associated with SB.

Substance Use Emergency Department Visits Among Youths With Chronic Conditions During COVID-19

Pediatric emergency department (ED) visits for substance use (SU) increased during COVID-19. Better understanding of trends associated with SU ED visits among youths with a chronic medical condition (CMC) is needed to target SU screening, prevention, and intervention efforts in this population. To describe trends in pediatric SU ED visits before and during COVID-19 among youths in the US with and without CMCs and by race and ethnicity. In this cohort study, data were obtained from 47 US children's hospital EDs in the Pediatric Health Information System (PHIS) between March 1, 2018, and March 1, 2022. The cohort included patients aged 10 to 18 years. Data analysis occurred from November 2022 to February 2023. ED visit occurrence before or during the COVID-19 pandemic and with or without the presence of a CMC. CMCs included chronic conditions (CCs) and complex CCs (CCCs). The primary outcome was the number of visits for an SU diagnosis based on diagnostic codes for youths with and without CMCs. Trends were assessed using logistic regression, adjusting for covariates and center effect. The sample included 3 722 553 ED visits from March 1, 2018, to March 1, 2022 (1 932 258 aged 14-18 years [51.9%]; 1 969 718 female [52.9%]; 961 121 Hispanic [25.8%]; 977 097 non-Hispanic Black [26.2%]; 1 473 656 non-Hispanic White [39.6%]). Of all visits, 1 016 913 (27.3%) were youths with CCs and 367 934 (9.9%) were youths with CCCs. Youth SU ED visits increased for all groups during COVID-19. The SU ED visits increased by 23% for youths with CCs (21 357 visits [4.0%] to 23 606 visits [4.9%]), by 26% for youths with CCCs (3594 visits [1.9%] to 4244 visits [2.4%]), and by 50% for youths without CCs (4997 visits [0.4%] to 5607 visits [0.6%]). Furthermore, compared with youths without CCs, youths with CCs had consistently larger odds of SU than the other groups before COVID-19 (adjusted odds ratio, 9.74; 99% CI, 9.35-10.15) and during COVID-19 (adjusted odds ratio, 8.58; 99% CI, 8.25-8.92). The interaction between race and ethnicity and CMCs was significant (P for interaction < .001). The findings of this cohort study suggest that providing SU services to all youths during times of societal crises is critical, but particularly for youths with CMCs who experience higher potential health impacts from SU given their medical concerns.

Healthcare utilization disparities among children with high-risk neuroblastoma treated on Children's Oncology Group clinical trials.

Disparities in relapse and survival from high-risk neuroblastoma (HRNBL) persist among children from historically marginalized groups even in highly standardized clinical trial settings. Research in other cancers has identified differential treatment toxicity as one potential underlying mechanism. Whether racial and ethnic disparities in treatment-associated toxicity exist in HRNBL is poorly understood. This is a retrospective study utilizing a previously assembled merged cohort of children with HRNBL on Children's Oncology Group (COG) post-consolidation immunotherapy trials ANBL0032 and ANBL0931 at Pediatric Health Information System (PHIS) centers from 2005 to 2014. Race and ethnicity were categorized to reflect historically marginalized populations as Hispanic, non-Hispanic Black (NHB), non-Hispanic other (NHO), and non-Hispanic White (NHW). Associations between race-ethnicity and intensive care unit (ICU)-level care utilization as a proxy for treatment-associated toxicity were examined with log binomial regression and summarized as risk ratio (RR) and corresponding 95% confidence interval (CI). The analytic cohort included 370 children. Overall, 88 (23.8%) patients required ICU-level care for a median of 3.0days (interquartile range [IQR]: 1.0-6.5days). Hispanic children had nearly three times the risk of ICU-level care (RR 3.1, 95% CI: 2.1-4.5; fully adjusted RR [aRR] 2.5, 95% CI: 1.6-3.7) compared to NHW children and the highest percentage of children requiring cardiovascular-driven ICU-level care. Children of Hispanic ethnicity with HRNBL receiving clinical trial-delivered therapy were more likely to experience ICU-level care compared to NHW children. These data suggest that further investigation of treatment-related toxicity as a modifiable mechanism underlying outcome disparities is warranted.

Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic

ObjectiveTo evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) due to the COVID-19 pandemic. MethodsWe performed a cross-sectional study using the Pediatric Health Information System. Eligible subjects were children (90 days-18 years) who were discharged from a pediatric ED included in PHIS from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across three study periods: pre-pandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024). ResultsWe included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least one viral respiratory test was performed for 460,826 of 7,311,177 pre-pandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive pre-pandemic slope in viral testing (0.17% encounters/month; 95% confidence interval [CI] 0.17, 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90, 5.07) and positive slope (0.54% encounters/month; 95% CI 0.54, 0.55). The late pandemic period was associated with a negative shift (-17.80%, 95% CI -17.90, -17.70) and positive slope (0.42% encounters/month; 95% CI 0.41, 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200, 5,700) to $33,000/month (95% CI $32,000, $34,000) during the early pandemic. ConclusionRespiratory testing and associated costs increased during the COVID-19 pandemic and were sustained, despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.

Mitigating Risk of Acute Kidney Injury Among Children With Methicillin-resistant Staphylococcus aureus Osteomyelitis.

Children with acute hematogenous osteomyelitis (AHO) from methicillin-resistant Staphylococcus aureus (MRSA) are treated with vancomycin despite the risk of acute kidney injury (AKI). This study evaluates the rate of AKI and resource utilization for children with or without AKI when vancomycin is used in this setting. Children with MRSA AHO treated with vancomycin were retrospectively studied. AKI was assessed by clinical diagnosis and Kidney Disease Improving Global Outcomes (KDIGO) criteria. Cohorts of children with or without AKI were compared for differences in treatment, resource utilization, and outcomes. Multivariate logistic regression analysis assessed factors associated with risk for AKI. Cost analysis was performed using the Pediatric Health Information System and Healthcare Cost and Utilization Project databases. Among 85 children studied, 14 (16.5%) had chart-diagnosed AKI and 24 (28.2%) met KDIGO criteria. Children with AKI had more febrile days and higher thrombosis rates. They had longer vancomycin treatment (8 vs 5d), higher troughs (27.8 vs 17.5mg/L), and prolonged hospitalization (19.9 vs 11.1d). Multivariate analysis found a maximum vancomycin trough level (odds ratio: 1.05, P = 0.003) with a cutoff of 21.7mg/L predicted AKI.Only 2 of 20 (10%) children who had MRSA isolates with a minimum inhibitory concentration of 2 achieved therapeutic vancomycin levels. Pediatric Health Information System data of 3133 children with AHO treated with vancomycin identified 75 (2.4%) with AKI who had significantly longer lengths of stay (13 vs 7d) and higher billed charges ($117K vs $51K) than children without AKI. Chart documentation of AKI (16.5%) grossly underestimated KDIGO-defined occurrence (28.2%). This study showed that vancomycin-associated AKI required substantially greater resource utilization and higher health care costs. Lowering the targeted trough range, shortening the duration of vancomycin therapy, and considering alternative antibiotics when minimum inhibitory concentration ≥2 will reduce the risk and cost of AKI among children with MRSA AHO. Level III-retrospective comparative therapeutic study.

Mortality and comorbidities in a Nationwide cohort of HIV-infected adults: comparison to a matched non-HIV adults' cohort, France, 2006-18.

Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. Using data from the French national health data system, we identified and included 173712 PLWHIV (66.5% men) and 173712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. During the 13 years of follow-up (2006-18), we observed 20018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)]. Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.

Factors influencing health information system acceptance: a cross-sectional study from a low-middle-income country.

The Avicenna unified Health Information System (HIS) was implemented by the Palestinian Ministry of Health in 2010 across government hospitals. Despite its potential, the acceptance of Avicenna HIS by healthcare providers remains unclear after 14 years of application. Understanding the factors that influence healthcare provider acceptance is essential for optimizing the system's success. We investigated factors affecting acceptance of Avicenna HIS among healthcare providers in Palestinian healthcare institutions, focusing on perceived usefulness, ease of use, human factors, technological factors, and organizational support. A cross-sectional study was conducted at the Palestine Medical Complex (PMC) in Ramallah, West Bank, where the Avicenna HIS has been fully implemented since 2010. A systematic random sampling was used to select participants, resulting in 300 completed questionnaires. The study utilized a self-administered questionnaire adapted from a structured tool based on the Technology Acceptance Model (TAM). The questionnaire was validated through expert review and pilot testing, achieving a Cronbach's alpha of 0.86. Each selected healthcare provider was contacted face-to-face, and written informed consent was obtained before administering the questionnaire. A total of 300 questionnaires were completed and returned. The study sample included 178 males (59.3%) and 122 females (40.7%). The majority of participants was aged 20-39 years (270 participants, 90%) and held a bachelor's degree (250 participants, 83.3%). Nurses comprised the largest professional group (153 participants, 51.0%). High levels of perceived usefulness and ease of use were reported, both with mean scores of 4.511 (S.D. = 0.295). Technological factors had a mean score of 4.004 (S.D. = 0.228), while organizational factors scored 2.858 (S.D. = 0.304). Overall acceptance of the HIS was moderately high, with a mean score of 4.218 (S.D. = 0.387). Significant differences in perceived usefulness and ease of use were noted based on gender, age, and experience. This study concludes that both technological and human factors significantly influence the acceptance of HIS among healthcare providers in Palestine. To improve HIS adoption, it is recommended to enhance system functionality, ensure reliable data quality, and provide comprehensive training programs for healthcare providers.

Strategic analysis of Iran's climate resilient health system.

Climate change is a long-term systematic climate variability caused by human activities that alters the composition of the global atmosphere. Health systems should be adaptive and resilient to climate change. Hence, this research aimed to strategically analyze the resilience of Iran's health system to climate change. This study utilized a multiple methods approach. First, in-depth semi-structured interviews were conducted with 32 key climate change and health experts to identify the strengths, weaknesses, opportunities and threats of the Iranian health system's resilience to climate change. Purposeful and snowball sampling techniques were used to ensure maximum diversity among the participants. Then, a questionnaire was developed based on the findings of the first stage and was completed by 33 climate change and health experts. Finally, the strategic position of Iran's health system's resilience to climate change was determined using the internal - external factors matrix. A total of 84 internal factors and 101 external factors were identified that affect the resilience of Iran's health system against climate change. The internal factors were categorized into seven dimensions (i.e., governance and leadership; health financing; health workforce; facilities, equipment and medicines; health information system; health services delivery, and key results). The external factors were categorized into six dimensions (i.e., political, economic, social, technological, environmental, and legal factors). The average score of internal and external factors were 2.47 and 2.12, out of 4 respectively. Iran's health system was found to be in the strategic position of V in terms of resilience to climate change. Therefore, precautionary strategies such as strengthening the climate resilience of healthcare facilities, promoting healthcare facilities' adaptation to climate change, public-private partnership, strengthening the health service delivery system, quality management and cost management, should be implemented to strengthen the resilience of Iran's health system to climate change. Iran's health system is facing significant weaknesses and challenges that have hindered its resilience to climate change. Iran's health system can better prepare and respond to the health impacts of climate change, and safeguarding the health and well-being of its population by addressing these challenges and implementing adaptive and resilience strategies.

Governance by information infrastructures: Origins and evolution of the concept

The term “infrastructure” has evolved to span a wide range of disciplines, reflecting its diverse applications and conceptualizations. This paper argues that information infrastructures (II) represent a distinct and increasingly significant socio-material form, crucial for understanding governance by infrastructure. We examine the origins and evoluIon of II, emphasizing the socio-material differences between II and other technological forms such as systems and online platforms. We highlight particularities of II innovation and implementation process and consider their implications for the politics of technology and governance by infrastructures. Our analysis is grounded on examination of several II in our increasingly digitised information societies, spanning the Internet, social security, platforms, financial infrastructures, energy systems and infrastructures, and health information systems.

Sustaining Current Policies and Introducing New Initiatives: Strategic Five-year Plan for the Government of India

A review of key documents, including political manifestos and reports from NITI Aayog and WHO, outlines healthcare priorities for 2024-2029, aligned with Viksit Bharat 2047 and the UN SDGs. Key actions include expanding Universal Health Coverage through Ayushman Bharat, improving rural healthcare, addressing medical staff shortages, and leveraging digital health, telemedicine, and interoperable records. National missions targeting disease prevention, mental health, and non-communicable diseases aim to promote healthier lifestyles. Strengthening public health preparedness and health information systems, while promoting traditional medicine, is also essential. Expanding maternal and child health programs, increasing access via AB-PMJAY, ensuring quality through NQAS, and driving innovation with R&amp;D funding are vital. Enhanced tobacco control through COTPA, higher taxes, and NTCP campaigns, along with investments in WASH infrastructure through Swachh Bharat and Jal Jeevan Missions, will improve health outcomes. Geriatric care, digitalisation, digital health, mental health, community health workers, and partnerships are critical. Initiatives like healthcare innovation hubs, mobile clinics, and health equity programs will build a resilient, inclusive healthcare system and improve national health.

The use of artificial intelligence, numerical algorithms and expert approach in selected nephrology problems

Background: The integration of AI, numerical algorithms, and expert approaches in nephrology shows promise for enhancing patient care. Traditionally, nephrology relied on clinician expertise, but the growing volume of data requires innovative methods. AI, fueled by vast datasets, can uncover patterns and improve diagnostic accuracy and treatment optimization. Numerical algorithms enable computational modeling of renal physiology and disease progression, aiding in treatment prediction and optimization. Expert systems codify nephrologists' knowledge into decision support tools, aiding in diagnosis and treatment selection. Embracing these technologies can revolutionize nephrological practice, improving patient outcomes.Aim of the study: The aim of the research is to review scientific works on the use of artificial intelligence (AI), numerical algorithms, and expert algorithms in diagnosis, decision support and prediction of selected disease states and issues related to nephrology.Material and methods: The study rigorously retrieved relevant publications from esteemed academic databases, Scopus and PubMed, and screened them based on predefined criteria. Through keyword-based searches, it analyzed the intersection of nephrology and artificial intelligence, offering insights into emerging trends and advancements. This approach facilitated a comprehensive exploration of the integration of artificial intelligence in nephrology research, paving the way for future developments in the field.Results: Artificial intelligence in nephrology and medicine uses various technologies such as machine learning, deep learning and natural language processing to improve diagnosis, treatment and patient care. Analyzes clinical, laboratory, imaging and genetic data to accelerate the identification of kidney diseases. By integrating health information systems and research data, artificial intelligence enables pattern recognition, outcome prediction and treatment optimization, ultimately having the potential to permanently improve patient care.Conclusions: Numerical algorithms, artificial intelligence, and expert algorithms show promise in nephrology, improving patient care and research.

Trends in the Diagnosis of Pediatric Venous Thromboembolism and Arterial Ischemic Stroke during the COVID-19 Pandemic: An Administrative Database Study

To investigate trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic. This retrospective cohort study used the Pediatric Health Information Systems database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. International Classification of Diseases, 10th edition codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use. 1 759 701 unique patients underwent 2 234 135 inpatient admissions. Rate of VTE increased from 84 cases per 10 000 admissions in 2018-2019 to 108 cases per 10 000 admissions in 2020-2021, representing a 28.6% increase (P<.001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95% CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (P<.001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; P<.001) increase in the utilization of pharmacological thromboprophylaxis. This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.

Inter-organizational mobilization in non-hierarchical settings: Bootstrapping information infrastructures for integrated care

In the realm of healthcare digitalization, the advancement of patient-centred care models hinges crucially on the establishment of inter-organizational information infrastructures (IIs): intricate “systems of systems” designed to facilitate efficient data sharing, consolidation, and utilization. However, closed and siloed health information systems often fragment patient data across multiple repositories, resulting in inefficiencies and limitations in inter-organizational access and decision-making at the population level. Bridging these divides demands the integration of loosely coupled information systems within and across organizations. The ongoing evolution of these IIs is intricately shaped by the complex sociotechnical installed base governing their development. It can be difficult to engage potential participants in building and using an II that spans organisational boundaries particularly in contexts marked by diversity of mission, high organizational autonomy and lacking a single authoritative actor. Through a case study in England’s National Health Service, this paper examines the intricate process of mobilizing autonomous organizations to collaborate in developing a shared II for integrated care. In non-hierarchical settings, lacking a clear organizing entity such mobilization requires strategic partnerships and a mix of skills. I introduce the term “collective mobilizer” to represent the collaborative coalition of entities with the capacity to garner sufficient interest among potential constituencies and align visions and resources. By unpicking the role of collective mobilizers, this paper offers insights into the challenges of bootstrapping II development in non-hierarchical contexts and how they may be overcome.

Increased Emergency Department Identification of Young People Experiencing Trafficking During the COVID-19 Pandemic: An Interrupted Time-Series Analysis.

Human trafficking is a public health issue affecting young people across the United States, and trafficked young people frequently present to emergency departments (EDs). The identification of trafficked young people by pediatric EDs during the COVID-19 pandemic is not well understood. We examined trends in the identification of young people with current or lifetime experiences of trafficking in US pediatric EDs before and during the COVID-19 pandemic. We performed an interrupted time-series analysis using the Pediatric Health Information System database, which includes data from 49 US children's hospitals, to determine differences in rates of trafficked young people identified in pediatric EDs before and during the COVID-19 pandemic. We included 910 patients; 255 prepandemic (October 1, 2018, through February 29, 2020) and 655 during the COVID-19 pandemic (March 1, 2020, through February 28, 2023). We found a 1.92-fold increase in the incidence rate of identified trafficked young people at the start of the COVID-19 pandemic in March 2020 (incidence rate ratio = 1.92; 95% CI, 1.47-2.51; P < .001), followed by a decrease over time. The observed increase in identified trafficked young people during the onset of the COVID-19 pandemic should alert pediatric ED providers to the opportunity to identify and provide services for trafficked young people as an important part of improving preparedness for future disease outbreaks. Our observed identification trends do not represent the true incidence of trafficked young people presenting to pediatric EDs during the COVID-19 pandemic. Future work should seek to better understand the true occurrence and the health and service needs of trafficked young people during emergencies.

Socioeconomic Inequalities Worsen the Risk of Death in CKD: A Population-Based Cohort Study in Italy.

Few studies have explored the impact of socioeconomic position on chronic kidney disease (CKD). This study aims to fill this gap using a large Italian cohort of CKD patients. We analyzed a cohort of incident CKD cases from the Lazio regional Health Information System from 1 January 2012 to 31 December 2021. We used the deprivation index (DI), a 5-category census-block indicator that integrates several dimensions of disadvantage. The outcomes were mortality and end-stage kidney disease (ESKD). We characterized the health status of patients in the two years before CKD identification and followed each subject from the index date to the end of follow-up, i.e., the date of the outcome, of emigration, or 31 December 2022, whichever came first. We used Cox proportional hazard models to investigate the association between DI and outcomes (HR, 95% CI). From 2012 to 2021, 127,457 new cases (55.9% men) were diagnosed. The average age was 72.2 (± 13.7) for men and 74.4 (± 14.8) for women. During an average follow-up of 4.3 years (± 3.2), 57,158 patients (45%) died, and 5,994 developed ESKD (5%). The age-adjusted association between DI and mortality was higher in men than in women (p-value interaction = 0.02), HRs for the extreme categories of DI (very high vs. very low) were 1.16, 95% CI 1.12-1.21 for men, and 1.08, 95% CI 1.04-1.13, for women). There was no evidence of association between DI and ESKD. In this population, socioeconomic disadvantage is associated with a higher risk of death but not of ESKD in CKD patients.

Modernizing Public Health Data Systems and Workforce Capacity: The Centers for Disease Control and Prevention's Public Health Informatics Fellowship Program.

The COVID-19 pandemic exposed governmental public health's outdated information technology and insufficient data science and informatics workforce capacity. The Centers for Disease Control and Prevention's Public Health Informatics Fellowship Program (PHIFP) is well positioned to strengthen public health data science and informatics workforce capacity. Established in 1996, PHIFP is a 2-year, full-time, on-the-job training program. PHIFP includes a didactic curriculum, applied learning through informatics projects completed at the assigned host site, short-term technical assistance projects, and a final capstone project. Fellows have learned from and bolstered host site informatics capacity through the development or enhancement of information systems, evaluations, data integration, data visualization, and analysis. Among recent graduates, 54% are employed at Centers for Disease Control and Prevention and 16% are employed at other public health organizations, including local health departments. Fellowships such as PHIFP, which recruit and train promising scientists in public health informatics, are important components of efforts to strengthen public health workforce capacity.

Relationship between paternal excessive weight and neonatal anthropometry in a clinical trial of nutritional counseling for pregnant women with overweight.

Human studies suggest that fathers with obesity influence infant growth and development. This study aimed to evaluate the relationship between paternal body mass index (BMI) and waist circumference (WC) with neonatal anthropometry and adiposity. This study is a cohort nested in a randomized controlled clinical trial of nutritional counseling for pregnant women with overweight. In total, 89 partner-pregnant woman-neonate triads were included. Paternal anthropometric measurements were taken at the time of the interview. Secondary data related to birth were obtained through access to the health information systems. Neonatal skinfold thickness was assessed and the adiposity was estimated using a predictive anthropometric model. Pearson's correlation and adjusted multivariate linear regression models were employed to evaluate the relationship between paternal BMI and WC with neonatal anthropometric measurements and adiposity. In total, 57.0% of the fathers presented a BMI ≥ 25 kg/m² and 14.6% a waist circumference ≥102 cm. The mean ± SD birth weight of the newborns (g) was 3357 ± 538. Paternal BMI and WC were inversely correlated with head circumference at birth [r = -0.31 (p = 0.004), r = -0.23 (p = 0.03), respectively]. Paternal BMI was also inversely correlated with the birth weight standardized by gestational age (z-score) [r = -0.23 (p = 0.03)]. In adjusted multivariate linear regression models, the paternal BMI (kg/m²) was inversely associated with the head circumference at birth (cm) [β = -0.07 (95% CI -0.15; -0.001) p = 0.04]. The data suggest that paternal excessive weight have a negative effect on fetal development, as assessed by anthropometric measurements. The inverse association between paternal BMI and the head circumference at birth was independent of confounders. Future studies with larger sample sizes are necessary to confirm or refute such hypotheses.

Examining the development and utilisation of Community-Based Health Information Systems (CBHIS) in Africa: A Scoping Review

Introduction The community-based health information system (CBHIS) is a vital component of the community health system, as it assesses community-level healthcare service delivery and generates data for community health programme planning, monitoring, and evaluation. CBHIS promotes data-driven decision-making, by identifying priority interventions and programs, guiding resource allocation, and contributing to evidence-based policy development. Objective This scoping review aims to comprehensively examine the use of CBHIS in African countries, focusing on data generation, pathways, utilization of CBHIS data, community accessibility to the data and use of the data to empower communities. Methods We utilised Arksey and O'Malley's scoping review methodology. We searched eight databases: PubMed, EMBASE, HINARI, Cochrane Library, Web of Science, Scopus, Google Scholar, and grey literature databases (Open Grey and OAIster). We synthesized findings using a thematic approach. Results Our review included 55 articles from 27 African countries, primarily in Eastern and Southern Africa, followed by West Africa. Most of the studies were either quantitative (42%) or qualitative (33%). Paper-based systems are primarily used for data collection in most countries, but some have adopted electronic/mobile-based systems or both. The data flow for CBHIS varies by country and the tools used for data collection. CBHIS data informs policies, resource allocation, staffing, community health dialogues, and commodity supplies for community health programmes. Community dialogue is the most common approach for community engagement, empowerment, and sharing of CBHIS data with communities. Community empowerment tends towards health promotion activities and health provider-led approaches. Conclusion CBHIS utilizes both paper-based and electronic-based systems to collect and process data. Nevertheless, most countries rely on paper-based systems. Most of the CBHIS investments have focused on its digitization and enhancing data collection, process, and quality. However, there is a need to shift the emphasis towards enabling data utilisation at the community level and community empowerment.

Outdoor light at night, air pollution and risk of incident type 2 diabetes

BackgroundAir pollution and outdoor light at night (LAN) have been reported to be related to type 2 diabetes (T2D). However, their interaction with risk of T2D remains uncertain. Therefore, our study aimed to explore the relationship between outdoor LAN, air pollution and incident T2D. MethodsOur study included a cohort of 24,147 subjects recruited from 2015 to 2018 in Ningbo, China. Land use regression models were used to evaluate particulate matter with a diameter ≤2.5 μm (PM2.5), ≤10 μm (PM10) and nitrogen dioxide (NO2). Satellite images data with a spatial resolution of 500m was used to estimate outdoor LAN levels. T2D new cases were identified by medical records based on health information system. Cox proportional hazards models were used to estimate Hazard ratios (HRs) and 95% confidence intervals (CIs). Moreover, we investigated the multiplicative and additive interactions between air pollution and outdoor LAN. ResultsDuring 108,908 person-years of follow-up period, 1016 T2D incident cases were identified. The HRs (95% CIs) were 1.22 (1.15, 1.30) for outdoor LAN, 1.20 (1.00, 1.45) for PM2.5, 1.23 (1.11, 1.35) for PM10 and 1.19 (1.04, 1.37) for NO2 in every interquartile range increase, respectively. Furthermore, significant interactions were observed between outdoor LAN and NO2. ConclusionsOur findings indicated that air pollution and outdoor LAN were positively associated with T2D. Moreover, we observed an interaction between outdoor LAN and NO2 suggesting that stronger associations for outdoor LAN and T2D in areas with higher levels of NO2, and for NO2 and T2D in areas with higher levels of outdoor LAN.