Public good through data linkage: measuring research outputs from the Western Australian Data Linkage System

OBJECTIVE: To measure the 'public good' by retrieving, collating, reviewing and assessing outputs from projects using information supplied from the Western Australian Data Linkage System (WADLS) during 1995-2003. METHODS: Using WADLS project application records, all investigators were contacted and requested to submit research outputs for review. RESULTS: 708 outputs comprising journal articles, reports, presentations, conference proceedings, media, theses and other items were reported. During the review, consequential policy reforms in mental health, crystalline silica exposure guidelines and surgical mortality audit were identified. Consequential clinical practice reforms had occurred in laparoscopic, cholecystectomy and acute coronary care. CONCLUSIONS: Data linkage can make a substantial and quantifiable contribution to population health and policy development.     

Critical race theory as theoretical framework and analysis tool for population health research

In population health research, it is important to consider socioecological perspectives that include cultural attitudes and beliefs which permeate all levels (intrapersonal, interpersonal, institutional/community, and structural/policy). Given the specificity of target populations centered on identity – ethnic and others – it is appropriate and warranted to centralize cultural studies theories into health determinant investigations. Cultural studies, which focus explicitly on identity exploration and impacts, have much to contribute to health research. In accordance with the transdisciplinary nature of population health and bearing in mind the significant role of ethnic identity in health outcomes, it is beneficial to utilize critical race theory (CRT) as a theoretical framework and analysis tool for population health research. This article will: (1) briefly overview a recent mental health study employing CRT, and a commentary that emphasizes how CRT can contribute to the sociology of mental health; and (2) propose ways CRT can be used in psychosocial health research.     

呼吸系统疾病专病队列研究的标准制定与数据共享

目的 慢性阻塞性肺疾病、哮喘、间质性肺疾病和肺血栓栓塞症是重大呼吸系统疾病,严重危害我国居民健康,整合并开展大规模人群队列研究有助于观察疾病的暴露、发病与转归情况。本研究针对我国社区与临床队列资源的多源异构现状,制定呼吸系统疾病专病队列（呼吸专病队列）数据标准,为解决多源异构数据所致共享障碍,以及项目最大程度开展数据交换、整合、共享、储存与利用提供思路与方法。方法 呼吸专病队列数据标准制定思路：①学习、参考国际标准,包括临床数据交换标准协会（CDISC）的CDASH模型,观察性医疗结果合作组织（OMOP）的CDM通用数据模型;②整理、归纳所纳入的4个呼吸专病队列资源,评估各队列资源间的同质性与整合的可能性;③专家讨论,建立呼吸专病队列数据标准。结果 研究纳入的现有呼吸专病队列变量模块同质性较好,基本结构相似,具有数据整合的可行性。参考国际标准,经专家讨论,项目组构建呼吸专病队列的数据标准概念框架,由呼吸专病队列通用数据标准及疾病特异数据标准两部分构成,其中通用数据标准针对各专病队列中均有涉及、能够统一标准的问题或研究变量;特异数据标准则为各疾病特有的问题。经映射匹配,认为该标准与各现有专病队列的变量模块匹配良好,标准可行。结论 数据标准建立后,在回顾性整合现有队列资源的同时,使不同项目以相同的定义和标准开展长期随访,收集核心数据集,为未来开展多中心研究扫除因数据标准不一导致的数据共享障碍,更有利于多源的整合与共享。     

The measurement of bridging social capital in population health research

Social capital is defined as the resources available to individuals and groups through membership in social networks. The definition is consistent with either an individualistic approach or a collective approach. Social capital can be further classified according to bonding versus bridging social capital (e.g. relationships between individuals who are homogeneous or heterogeneous with respect to social class, race/ethnicity, or other attributes). We conducted a systematic review via Pubmed, the ISI web of knowledge and OVID of the studies that examined bridging social capital in public health settings. Our results indicate lack of consistency or uniformity in the operationalization of bridging social capital. We identify some promising approaches to measurement that should be further investigated in future studies.     

城市青少年流动人口主要健康状况及需求调查

目的 通过定量调查和定性访谈,了解城市青少年流动人口健康现状、对门诊服务的需求、寻求和获得健康咨询及服务时遭遇的困难.方法 对我院门诊接诊的青少年流动人口进行问卷调查以及深入访谈,对调查结果及访谈内容进行分析.结果 相对身体健康人群,青少年流动人口更易出现心理健康问题,对门诊服务的需求具有自身的独特性,但不懂得充分利用社会资源获得健康服务.结论 应加强公共卫生服务,加强对青少年流动人口的健康教育及健康促进,为他们提供公平的社会保障和机会.     

Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future

This review summarises nutrition and mental health research in Australia and New Zealand between 1986 and 2006. The method used to identify papers for inclusion was a search of computerised databases: Medline, Cinahl and Meditext 1986–2006, with subsequent bibliographical review. Key search words were nutrition, diet, mental disorder, mental illness, weight, physical health, Australia and New Zealand. Inclusion criteria included: English language, original data in peer reviewed journals, and examination of some component of nutrition in people with a mental illness. The review of thirteen papers found that the evidence base for dietetic practice in mental health has developed through small assessment and interventional research, often with multidisciplinary collaboration. Future research should include quality and outcome measures with intersectoral partnerships. Dietitians are well positioned to lead and participate in mental health research and to implement research findings to improve the nutritional status of this vulnerable group.     

CAPL: a novel association test using case-control and family data and accounting for population stratification

The recent successes of GWAS based on large sample sizes motivate combining independent datasets to obtain larger sample sizes and thereby increase statistical power. Analysis methods that can accommodate different study designs, such as family-based and case-control designs, are of general interest. However, population stratification can cause spurious association for population-based association analyses. For family-based association analysis that infers missing parental genotypes based on the allele frequencies estimated in the entire sample, the parental mating-type probabilities may not be correctly estimated in the presence of population stratification. Therefore, any approach to combining family and case-control data should also properly account for population stratification. Although several methods have been proposed to accommodate family-based and case-control data, all have restrictions. Most of them require sampling a homogeneous population, which may not be a reasonable assumption for data from a large consortium. One of the methods, FamCC, can account for population stratification and uses nuclear families with arbitrary number of siblings but requires parental genotype data, which are often unavailable for late-onset diseases. We extended the family-based test, Association in the Presence of Linkage (APL), to combine family and case-control data (CAPL). CAPL can accommodate case-control data and families with multiple affected siblings and missing parents in the presence of population stratification. We used simulations to demonstrate that CAPL is a valid test either in a homogeneous population or in the presence of population stratification. We also showed that CAPL can have more power than other methods that combine family and case-control data.     

Data linkage for injury surveillance and research in Australia: perils,pitfalls and potential

Objective : To outline some of the key issues for injury‐related data linkage studies in Australia and describe potential applications of data linkage for injury surveillance and research. Methods : Narrative review of data linkage capacity and injury‐related data collection quality in Australia. Results : The establishment of national and state‐based data linkage centres in Australia has been a great leap forward for data linkage capacity for injury research. However, there are still limitations of using data linkage for injury surveillance and research. These are highlighted in the form of key perils and pitfalls, with examples provided. There is still much to be gained for injury research by using data linkage techniques to enhance the information available across the injury continuum, but data quality issues should always be acknowledged. Conclusions : Obtaining authorisation to link injury data collections for national research remains cumbersome. Streamlining of the application process is needed to ensure that injury research is able to be conducted in a timely fashion. Data quality and data linkage rates need to be considered when interpreting research findings. Implications : Streamlining of the application process for research that involves linking data collections would help ensure that research is conducted in a timely fashion.     

Addressing the challenges of cross‐jurisdictional data linkage between a national clinical quality registry and government‐held health data

Objective: To describe the challenges of obtaining state and nationally held data for linkage to a non‐government national clinical registry. Methods: We reviewed processes negotiated to achieve linkage between the Australian Stroke Clinical Registry (AuSCR), the National Death Index, and state held hospital data. Minutes from working group meetings, national workshop meetings, and documented communications with health department staff were reviewed and summarised. Results: Time from first application to receipt of data was more than two years for most state data‐sets. Several challenges were unique to linkages involving identifiable data from a non‐government clinical registry. Concerns about consent, the re‐identification of data, duality of data custodian roles and data ownership were raised. Requirements involved the development of data flow methods, separating roles and multiple governance and ethics approvals. Approval to link death data presented the fewest barriers. Conclusion: To our knowledge, this is the first time in Australia that person‐level data from a clinical quality registry has been linked to hospital and mortality data across multiple Australian jurisdictions. Implications for Public Health: The administrative load of obtaining linked data makes projects such as this burdensome but not impossible. An improved national centralised strategy for data linkage in Australia is urgently needed.     

社区流动人口生殖健康服务面临的问题及对策

随着社会经济发展的进一步加快,至2010年我国流动人口数量将接近1.6亿人,其生殖健康水平直接影响着我国国民素质的整体提高.因此,研究流动人口生殖健康情况对于持续改进我国流动人口生殖健康状况以及提高流动人口生殖健康水平有着重要的意义.本文立足于社区,对流动人口生殖健康服务面临的问题进行了阐述,并就如何推进社区流动人口生殖健康优质服务提出了五方面的对策建议.     

少数民族流动人口的流动特征、社会融合对基本公共卫生服务利用的影响

目的 了解少数民族流动人口的流动特征、社会融合对基本公共卫生服务利用的影响。方法 基于2017年全国流动人口动态监测调查数据,采用两水平logistic回归模型分析少数民族流动人口的流动特征、社会融合与建立居民健康档案、接受健康教育和慢性病健康管理之间的关联性。结果 少数民族流动人口中,36.54% 建立了居民健康档案,以及分别有76.48%和42.49%接受过健康教育和慢性病健康管理。多因素分析结果显示,家庭化流动（OR=1.25;95%CI:1.04~1.49）、跨省流动（OR=1.12;95%CI:1.01~1.25）、流入城市（OR=1.34;95%CI:1.23~1.47）、有社会保障（OR=1.98;95%CI:1.82~2.15）、办理了居住证（OR=1.33;95%CI:1.22~1.46）、有落户意愿（OR=1.13;95%CI:1.02~1.24）以及心理融合（OR=1.07;95%CI:1.05~1.09）与社会参与（OR=1.17;95%CI:1.14~1.21）程度越高,是建档的正向影响因素。而流动城市数在2~3个内相对于1个以内是建档的负向影响因素（OR=0.87;95%CI:0.79~0.95）。有社会保障（OR=1.23;95%CI:1.12~1.35）、居住证（OR=1.45;95%CI:1.32~1.60）及社会参与（OR=1.31;95%CI:1.26~1.37）和心理融合（OR=1.03;95%CI:1.01~1.04）越高,是接受健康教育的正向影响因素,而流动城市数在4个及以上相对于1个以内是接受健康教育的负向影响因素（OR=0.82;95%CI:0.69~0.98）。此外,有居住证（OR=1.54;95%CI:1.07~2.20）和落户意愿（OR=1.66;95%CI:1.11~2.48）对接受慢性病健康管理具有显著的正向效应。 结论 少数民族流动人口对基本公共卫生服务的利用水平总体较低。需要格外关注独自流动、省内流动、流动稳定性较差的人群,促进地区和城乡间基本公共卫生服务的均等化、均衡化发展;通过提高社会融合程度提高基本公共卫生服务的利用水平。     

城市流动人口妇幼保健服务模式探索与研究

目的:通过项目的开展探索完善适合城市流动人口妇幼保健服务模式。方法:在对流动人口孕产妇和儿童保健状况基线调查分析的基础上,研究制定杭州市下城区流动人口妇幼保健管理模式,5年后对相应问题问卷调查并进行对比分析。结果:孕产妇对危险征兆的自我识别和防护明显提高,儿童家长的保健意识明显增强,流动人口孕产妇及儿童的保健服务指标明显提升。结论:杭州市下城区流动人口妇幼保健服务模式取得了较好效果,为政府制定相关政策提供了实践依据。     

整合保健：英国经验对我国社区卫生服务改革的启示

在对英国卫生保健体系进行梳理的基础上,总结了其开展整合保健的做法和经验,尤其是近年来英国卫生服务与社会服务体系进行整合的趋势值得我国借鉴。本文受英国卫生保健体系尤其是初级卫生保健整合做法的启发,针对我国社区卫生服务改革中存在的问题,提出相关的政策建议,包括加强多学科服务团队建设,推动医学模式在社区转变;建立＂守门人＂制度,做实社区首诊和双向转诊;建立部门间的沟通机制,整合卫生服务与社会服务;加大舆论宣传力度,引导居民就医需求等。     

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis

Objective  

The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors.     

Evolution of the Simulated Data Problem

The simulated data problem was designed via an interactive process by the Simulation Problem Organizing Committee and the selected data simulators. Based on discussions at the previous Genetic Analysis Workshop, many of the features of previous simulation problems, such as a complex disease, genome scan, and replication, were retained and in addition, a population genetics model was used to generate the simulated genes. We describe the process that was used to structure the problem and summarize the discussions about many of the scientific issues that were considered. © 2001 Wiley‐Liss, Inc.     

流动人口基本公共卫生服务均等化调查

目的 了解流动人口与当地常住人口基本公共卫生服务不均等的情况.方法 通过现场调研和访谈,抽样调查了浙江省某县的流动人口和常住人口各581人,了解两种人群的基本公共卫生服务在投入、机会.结果 上的不均等情况.结果 流动人口中享受过医疗救助的比例仅占7.8%,低于常住人口的13.4%;有40.9%的流动人口会因为较高的医药费用而不去就医,远远高于常住人口;流动人口妇科检查率为58.7%,低于常住人口(67.7%).结论 应增加公共卫生机构资源配置和财政投入,发展和完善社会医疗保障体系,促进不同人群间基本公共卫生服务的均等化.

Abstract：

Objective To probe into the inequality found in primary public health service available to the migrant population and permanent residents. Methods With on-site interviews, 581 migrant workers and 581 permanent residents in a county in Zhejiang province were surveyed, to learn the inequalities between the two in the expenditure, access and outcomes of the public health service accessible to each. Results only 7. 8% of the migrant population ever had access to medical aid, a ratio far below that of the permanent residents; 40. 9% of the migrant population may turn down medical service beyond their affordability, a ratio far higher; for the migrant population, their ratio of gynecological checkup is 58. 7%, lower than that of the permanent residents (67. 7%). Conclusion Resources and financial allocation to institutions of public health should be enhanced, and social medical and insurance system should be developed and improved, in an effort to encourage the equality of primary public health services accessible to various sectors of the population.     

甘肃省部分地区妇幼卫生年报中孕产妇保健服务指标数据质量研究

目的:了解孕产妇保健服务利用情况,发现妇幼卫生年报中孕产妇保健服务指标数据的质量问题,并解释问题产生的原因。方法:采用多阶段随机抽样方法,抽取甘肃省1个县和1个区共313名在2009年10月1日～2010年9月30日期间有分娩活产史的妇女,对其孕产期保健情况进行问卷调查,采用均数、构成比、率等指标进行统计描述,使用卡方检验作统计推断。结果:孕早期产前检查率城市与农村地区分别为93.0%和94.3%,年报报告结果分别高估了6.0%和5.6%;5次及以上产前检查率城市与农村地区分别为80.3%和78.6%;产后访视率城市与农村地区分别为52.2%和93.7%,年报报告结果分别高估了86.8%和6.2%;孕产妇系统管理率城市与农村地区分别为45.9%和77.4%,年报报告结果分别高估了109.9%和27.0%。结论:妇幼卫生年报报告的孕产妇系统管理率等孕产妇保健服务指标数据存在一定程度的高估。     

外来流动人口社区卫生保健需求初探

通过对武汉市某城区社区卫生服务进行调查,对外来流动人口的构成,卫生保健现状、社区服务需求及利用情况进行一些初步分析及探讨。     

社会融合对流动人口基本公共卫生服务利用的影响分析

目的 通过分析流动人口社会融合及基本公共卫生服务利用的现状,探究社会融合对基本公共卫生服务利用的影响,为改进流动人口基本公共卫生服务利用现状提出建议。 方法 收集2017年全国流动人口卫生计生动态监测数据中流入时间≥6个月的99 494名流动人口的相关数据,对流动人口社会融合及基本公共卫生服务利用现状进行描述性分析,并使用分层logistic回归探究社会融合对基本公共卫生服务利用的影响。结果 在99 494名流动人口中,有36 837人已在流入地建立了健康档案,建档率为37.0%; 75 540人在流入地接受过健康教育,健康教育接受率为75.9%; 社会融合的四个维度中,家庭平均月收入(β= -0.108、-0.085,P<0.001)、家庭平均月支出(β= -0.061、-0.126,P<0.001)、是否有医保(β= 0.349、0.294,P<0.001)、是否在本地参加过工会等组织活动(β= 0.956、0.489,P<0.001)等变量会影响流动人口利用健康档案和健康教育服务。 结论 流动人口的健康档案建立率较低,流动人口健康教育接受情况较好但仍需提升; 流动人口的社会融合情况会影响其利用基本公共卫生服务。