Health Surveillance Services Research Articles

A questão ambiental como objeto de atuação da vigilância sanitária: uma análise da inserção das enfermeiras nesse campo

O presente estudo buscou verificar como enfermeiras que atuam na área da Vigilância Sanitária do Município de São Paulo, tratam as questões relativas ao meio ambiente na sua prática cotidiana. A sua realização foi motivada pela urgente necessidade de conservação do meio ambiente, que vem sendo defendida na agenda das políticas nacionais e internacionais. Em julho-agosto de 1999, foram obtidos depoimentos de 8 enfermeiras, os quais foram analisados segundo técnica de análise de discurso. O desenvolvimento do estudo evidenciou que, em geral, as ações realizadas por essas enfermeiras não têm como finalidade a conservação ambiental, restringindo-se a ações de caráter focal e emergencial.

Upper level set scan statistic for detecting arbitrarily shaped hotspots

A declared need is around for geoinformatic surveillance statistical science and software infrastructure for spatial and spatiotemporal hotspot detection. Hotspot means something unusual, anomaly, aberration, outbreak, elevated cluster, critical resource area, etc. The declared need may be for monitoring, etiology, management, or early warning. The responsible factors may be natural, accidental, or intentional. This proof-of-concept paper suggests methods and tools for hotspot detection across geographic regions and across networks. The investigation proposes development of statistical methods and tools that have immediate potential for use in critical societal areas, such as public health and disease surveillance, ecosystem health, water resources and water services, transportation networks, persistent poverty typologies and trajectories, environmental justice, biosurveillance and biosecurity, among others. We introduce, for multidisciplinary use, an innovation of the health-area-popular circle-based spatial and spatiotemporal scan statistic. Our innovation employs the notion of an upper level set, and is accordingly called the upper level set scan statistic, pointing to a sophisticated analytical and computational system as the next generation of the present day popular SaTScan. Success of surveillance rests on potential elevated cluster detection capability. But the clusters can be of any shape, and cannot be captured only by circles. This is likely to give more of false alarms and more of false sense of security. What we need is capability to detect arbitrarily shaped clusters. The proposed upper level set scan statistic innovation is expected to fill this need

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

Impact of the worker food program in Brazil

The worker food program of the Brazilian Ministry of Labor and Employment attempts to ensure adequate nourishment for low-income workers. This study evaluates the nutritional impact of the program, which currently serves approximately 10 million workers. This retrospective dynamic cohort study was carried out with 8,454 workers living in the state of Bahia, Brazil. Health-related data from January 1996 through April 2000 were obtained from computerized medical records from an organization that provides health surveillance services to a large number of companies in the state. The analysis utilized demographic data and nutritional data (weight and also preobesity, that is, a body mass index of 25.00-29.99). Additional information was obtained from the companies through telephone interviews. Being covered by the food program was positively associated with weight gain (age- and sex-adjusted incidence-density ratio = 2.21; 95% confidence interval: 1.78-2.75). No statistically significant association was found between the program and preobesity. The risk of weight gain was higher (P < 0.05) among workers who, at baseline, were of normal weight (body mass index of 18.50-24.99), were preobese, or were from a low socioeconomic background. These results suggest that the worker food program has an unintended negative impact on the nutritional status of workers from a low socioeconomic background. The program's approach, which is limited to dietary recommendations concerning the caloric content of meals, should be revised to better promote the health of the workers participating in the program.

Changes in the role of general practitioners in child health surveillance

Background: Changes in their Contract in 1990 gave general practitioners the opportunity to become more involved in child health surveillance. This study aimed to describe and compare child health surveillance services provided by general practitioners before and after the changes of the 1990 GP contract. Methods: A questionnaire was sent to all general practices within the Nottingham Health Authority area in 1990, and this process was repeated in 1994, ascertaining the services provided for child health surveillance. Outcome measures were: the reported provision of services, keeping of records and facilities for following up non-attenders. Also recorded were the training and qualifications of general practitioners and their attitudes towards child health surveillance. Results: Response rates were 62% in 1990 and 80% in 1994. More practices were involved in the provision of child health surveillance services in 1994, more held a baby clinic and more reported having a recall system for non-attenders. There was little change in the training or qualifications of GPs in child health between 1990 and 1994. In 1994, there was evidence of GPs meeting regularly with Health Visitors. There remained a small number of practices who were not interested in child health surveillance. Conclusion: The 1990 GP contract appears to have increased the provision of child health surveillance services by GPs and improved liaison with Health Visitors in general practice.

Medical concerns in people with severe learning difficulties: report on a vision week and symposium at the Royal College of Physicians and Surgeons of Glasgow, Scotland, 8-12 March 1993.

Over the course of a week, vision clinics were conducted in the wards of Lennox Castle, one of the largest remaining mental handicap institutions in Scotland. Receptions and a seminar encouraged participation by staff and local services. A day Symposium at the Royal College of Physicians and Surgeons in Glasgow presented recent developments in medical care and facilitated discussion on methods of ensuring effective health surveillance, assessment and advisory services.

Exclusion from School and Victim‐blaming

Abstract Over recent years evidence of increasing levels of exclusion from British schools has been provided by individual researchers, teaching associations, local education authorities, the media and the government. Current dominant perceptions tend to focus on the pathological behaviour of individual children (children who ‘behave badly’ in the Government's terms) or the inability of schools to manage such challenging behaviour. Less readily acknowledged are the inherent tensions resulting from processes that permit certain children to be denied access to the compulsory education system and the interaction between exclusion from school and race, gender and class stratification. Exclusion must, therefore, be seen not only in terms of young people's experiences of education and schooling but also as part of the complex relationship between individuals, families, the labour market, health and state support and surveillance services. The paper aims to contribute to increasing awareness of the disadvantage ...

Variation of Growth in Height and Weight of Children II. After Infancy

To provide for early detection of abnormal changes in growth, we propose the monitoring of all children for changes in relative height and relative weight as indirect indicators of growth velocity. To this end we analyzed the growth of 2,156 children, as recorded by the child health surveillance services at ages 2 to 19 years. From their data we constructed growth standards on charts of a novel type, which allow direct reading of relative height (SD score, SDS) and relative weight (percentage deviation of weight from median weight for height and sex, %DW). Variation in height explained most (mean 60%) of the variation in weight, and age did not contribute significantly. Hence, our weight charts are height-based. Next, we defined the variations of changes in (delta) SDS and %DW during the different periods of growth. The group means of changes in each period were zero. Variation in delta SDS is widest at the earliest ages, then decreases until year 9-10 (girls) and 10-11 (boys), and again increases. For delta %DW the picture is similar. We present these variations as diagrams for use in growth screening.