Family, health, and adolescence

The present research examined the correlations between types of family relationships and adolescents' beliefs about their own health. "Healthy" adolescents (N=765) completed both the Multidimensional Health Locus of Control questionnaire and Olson's scale assessing family cohesion and adaptability. They were compared to a group of 358 adolescents diagnosed with mental disorders. Cohesion in the family of origin was a significant factor in the adolescents' feeling of control over their own health as well as in the level of power they attributed to other people. Among these adolescents, adaptability of the family of origin was positively correlated with stronger feelings of control over one's own health and with lower levels of belief in chance. Family relations were significant in the adolescents' acquisition of feelings of control over their own health.     

Content analysis of physical examination templates in electronic health records using SNOMED CT

ObjectivesMost electronic health record (EHR) systems are built on proprietary information models and terminology, which makes achieving semantic interoperability a challenge. Solving interoperability problems requires well-defined standards. In contrast, the need to support clinical work practice requires a local customization of EHR systems. Consequently, contrasting goals may be evident in EHR template design because customization means that local EHR organizations can define their own templates, whereas standardization implies consensus at some level. To explore the complexity of balancing these two goals, this study analyzes the differences and similarities between templates in use today.MethodsA similarity analysis was developed on the basis of SNOMED CT. The analysis was performed on four physical examination templates from Denmark and Sweden. The semantic relationships in SNOMED CT were used to quantify similarities and differences. Moreover, the analysis used these identified similarities to investigate the common content of a physical examination template.ResultsThe analysis showed that there were both similarities and differences in physical examination templates, and the size of the templates varied from 18 to 49 fields. In the SNOMED CT analysis, exact matches and terminology similarities were represented in all template pairs. The number of exact matches ranged from 7 to 24. Moreover, the number of unrelated fields differed a lot from 1/18 to 22/35. Cross-country comparisons tended to have more unrelated content than within-country comparisons. On the basis of identified similarities, it was possible to define the common content of a physical examination. Nevertheless, a complete view on the physical examination required the inclusion of both exact matches and terminology similarities.ConclusionsThis study revealed that a core set of items representing the physical examination templates can be generated when the analysis takes into account not only exact matches but also terminology similarities. This core set of items could be a starting point for standardization and semantic interoperability. However, both unmatched terms and terminology matched terms pose a challenge for standardization. Future work will include using local templates as a point of departure in standardization to see if local requirements can be maintained in a standardized framework.     

Forty years of SNOMED: a literature review

Background

Over a period of 40 years, SNOMED has developed from a pathology-specific nomenclature (SNOP) into a logic-based health care terminology. In spite of its long existence and continuous evolvement, it is yet unknown to what extent SNOMED is used in clinical practice, and what benefits were achieved. The aim of this paper is to investigate this by providing an overview of published studies in which a version of SNOMED was studied or applied.

Methods

This paper analyzes the use of SNOMED over time, as reflected in scientific publications, by means of Medline literature search in PubMed. The search included papers from 1966 until June 2006. For each selected paper the following characteristics were classified: version, medical domain, coding moment (during or after the care process), usage, and type of evaluation (e.g., does SNOMED work, does SNOMED help).

Results

250 papers were included in this research. The number of annual publications has increased, as has the number of domains in which SNOMED is being used. Theoretical studies mainly concern comparison of SNOMED to other terminological systems and SNOMED as an illustration of a terminological systems' theory. Few studies are available on the usage of SNOMED in clinical practice, largely involving coding information and retrieval/aggregation based on SNOMED codes.

Conclusion

The clinical application of SNOMED is broadening beyond pathology. The majority of studies concern proving the value of SNOMED in theory. Fewer studies are available on the usage of SNOMED in clinical practice. Literature gives no indication of the use of SNOMED for direct care purposes such as decision support.

     

Public health interventions: reaching Latino adolescents via short message service and social media

Background

Adolescents are substantial users of short message service (SMS) and social media. The public health community now has more opportunities to reach this population with positive youth development and health messages through these media. Latinos are a growing and youthful population with significant health risks and needs. This population may benefit from SMS and social media health interventions.

Objective

To examine (1) SMS and social media utilization and behavior among Latino youth, and (2) how SMS and social media can be effectively used as a component of public health interventions focused on decreasing sexual risk taking among Latino youth.

Methods

A mixed-methods approach, using both quantitative survey data and qualitative interview data, was used to provide a robust understanding of SMS and social media use and behavior for public health interventions. We recruited 428 ninth and tenth grade, self-identifying Latino adolescents to participate in a quantitative survey. Additionally, we conducted five key informant interviews with staff and 15 youth.

Results

We found that 90.8% (355/391) of respondents had access to a mobile phone either through having their own or through borrowing or sharing one. Of those who had access to a mobile phone, 94.1% (334/355) used SMS, with 41.1% (113/275) sending and receiving more than 100 text messages per day. Of 395 respondents, 384 (97.2%) had at least one social media account, and the mean number of accounts was 3.0 (range 0–8). A total of 75.8% (291/384) of adolescents logged in to their account daily. Of those with a social media account, 89.1% (342/384) had a Facebook account. Youth who took the survey in English were significantly more likely than those who took it in Spanish to have access to a mobile phone (χ² ₁ = 5.3; 93.3% vs 86.3%; P = .02); to be high-volume texters (χ² ₂ = 16.8; 49.4% vs 25.3%; P < .001); to use the Internet daily (χ² ₁ = 5.0; 76.6% vs 66.0%; P = .03); to have a Facebook account (χ² ₁ = 9.9; 90.9% vs 79.7%; P = .002); and to have a greater mean number of social media accounts (t ₃₈₇ = 7.9; 3.41 vs 2.07; P < .001).

Conclusions

SMS and social media are pervasive among Latino youth. Program staff and youth perceive these as credible and essential methods of communication in the context of public health programs. Public health interventions must continue to innovate and maximize new ways to reach young people to reinforce public health messages and education.     

A computer generated patient carried health check card

A computerized record system has been programmed so a patient's important medical information can be printed out and given to the patient in the form of a `health check card'. One aim was to enable patients to take more responsibility for their own preventive care. Following the issue of cards to 331 patients in 126 families, there was an increase in the uptake of cervical cytology screening, blood pressure recordings and tetanus immunization. Replies to a questionnaire enclosed with the card were received from 161 patients (in 86 of the families): most found the cards acceptable and believed they would be useful.     

Inviting infrequent attenders to attend for a health check: costs and benefits.

A total of 114 patients who had not attended their general practitioner in the previous three years were identified by searching a sample of 1488 records (12.8% of the practice list). An invitation for a health check was sent, in keeping with the requirements of the new general practitioner contract. Seventeen out of 94 patients invited (18%) attended. Surgery staff spent 28 hours and the practice doctors spent 15 hours on arranging and carrying out the investigation. The group responding to the invitation were in general healthy; the only new finding of remediable disease was mild hypertension in one man. The smoking rate and alcohol consumption rate were low. Of 13 patients who needed tetanus immunization, five refused it and five failed to return. All three women who were overdue for a cervical smear failed to return to have it done. It is concluded that screening infrequent attenders is not an efficient use of medical time.     

Professionals with delivery skills: backbone of the health system and key to reaching the maternal health Millennium Development Goal

The attainment of the fifth Millennium Development Goal requires adequate national reserves of skilled birth attendants. Nurses, midwives, and their equivalents form the frontline of the formal health system are a critical element of global efforts to reduce ill-health and poverty in the poorest areas of the world. Planning and policies supporting these cadres of workers must be placed high on the development agenda and championed by key international and national players. This article first sets forth an argument for the equity and efficiency of nurses, midwives, and their equivalents as the cadre largely responsible for maternal health. Second, it traces the root causes of neglect of this critical cadre, including a vacuum in political will in the context of poverty, lack of protections for frontline workers, the historical political position of the field of midwifery, lack of a pipeline of secondary school graduates, and gender inequity. Investment in the largely female cadre that cares for the majority of the world’s poorer women has simply not been a high enough priority. Key policy recommendations include harnessing political will and adequate metrics, protection of frontline workers’ safety and livelihoods, ensuring an adequate pipeline with a focus on girls’ education and donor support for training and professional organizations. The fifth and final policy recommendation is a call for unified international support of rapid scale-up of cadres of delivery care workers.     

Determining correspondences between high-frequency MedDRA concepts and SNOMED: a case study

Background  

The Systematic Nomenclature of Medicine Clinical Terms (SNOMED CT) is being advocated as the foundation for encoding clinical documentation. While the electronic medical record is likely to play a critical role in pharmacovigilance - the detection of adverse events due to medications - classification and reporting of Adverse Events is currently based on the Medical Dictionary of Regulatory Activities (MedDRA). Complete and high-quality MedDRA-to-SNOMED CT mappings can therefore facilitate pharmacovigilance.     

Associations between attachment representations and health behaviors in late adolescence

In this study, we tested the associations among attachment ratings and health behaviors by relationship status. For individuals in relationships, attachment security was associated positively with health promotion and quality sleep and negatively with risk behaviors; fearfulness was associated positively with risk behaviors. With the exception of sleep behaviors, associations with security and fearfulness were reversed for single participants. Associations between dismissingness and quality of sleep support the proposal that individuals who deny or dismiss their attachment needs may experience physical symptoms of distress that affect their health. Future work exploring the benefits of security when coping with illness or lifestyle change is discussed.     

Unemployment, drug use, and health in late adolescence

In order to study the health correlates of unemployment, young urban South Australians, of average age 19.6 years and with 10.5% unemployed, were asked to rate their health and report number of doctor visits of the preceding month. Information about financial state, work satisfaction, and drug use was also collected. The satisfied employed rated their health somewhat more favourably than did either the dissatisfied employed or the unemployed, but changes in work situation over the next year were not related to changes in health. Alcohol use differed according to work situation for females but not males; cigarette-smoking, which did not vary with work situation, was associated with poorer health.     

Improving cardiovascular disease risk communication in the UK national health service health check programme

ObjectiveTo develop and test training to improve practitioners’ confidence and perceived understanding when communicating cardiovascular disease (CVD) risk using novel tools and metrics.MethodsA CVD risk communication training workshop was developed through interviews with patients and practitioners delivering Health Checks, a literature review, NICE guidance and the UK Health Check competency framework. It was pilot-tested with practitioners delivering Health Checks in the UK. Perceived practitioner understanding and confidence were measured before and up to 10 weeks after the workshop, and changes were compared with those in a control group (who received no intervention). Perceived impact was also explored through semi-structured interviews.ResultsSixty-two practitioners (34 intervention, 28 control) took part. Perceived practitioner understanding (p = .030) and perceived patient understanding (p = .007) improved significantly for those delivering Health Checks in the training group compared with controls. Practitioner confidence also improved significantly more in practitioners who attended the training (p = .001). Findings were supported by interviews with a sub-sample of practitioners (n = 13).ConclusionThe training workshop improved practitioners’ confidence and perceived understanding of CVD risk in Health Checks.Practice ImplicationsThe training is an important step to improving practitioner understanding of CVD risk in Health Checks and should be implemented on a wider scale.     

Patients with cardiomyopathy screened by an annual health check]

We identified 12 new cases of hypertrophic cardiomyopathy (HCM) and 3 new cases of dilated cardiomyopathy (DCM with echocardiography) in 72980 (aged 18-85 years, 43.1 +/- 14.1) industrial workers during an annual health check from April to October in 1996. Two of 3 patients with DCM were males, 21 and 25 years of age. No patients had symptoms. ST-T abnormalities by electrocardiography were found in 87% (13/15) of patients with cardiomyopathy and left ventricular hypertrophy (LVH) in 53% (8/15). Our findings suggest that echocardiography is important in mass screening for early detection of asymptomatic cardiomyopathy in middle-aged as well as young patients with ST-T abnormalities.     

Contrasting lexical similarity and formal definitions in SNOMED CT: Consistency and implications

ObjectiveTo quantify the presence of and evaluate an approach for detection of inconsistencies in the formal definitions of SNOMED CT (SCT) concepts utilizing a lexical method.Material and methodUtilizing SCT’s Procedure hierarchy, we algorithmically formulated similarity sets: groups of concepts with similar lexical structure of their fully specified name. We formulated five random samples, each with 50 similarity sets, based on the same parameter: number of parents, attributes, groups, all the former as well as a randomly selected control sample. All samples’ sets were reviewed for types of formal definition inconsistencies: hierarchical, attribute assignment, attribute target values, groups, and definitional.ResultsFor the Procedure hierarchy, 2111 similarity sets were formulated, covering 18.1% of eligible concepts. The evaluation revealed that 38 (Control) to 70% (Different relationships) of similarity sets within the samples exhibited significant inconsistencies. The rate of inconsistencies for the sample with different relationships was highly significant compared to Control, as well as the number of attribute assignment and hierarchical inconsistencies within their respective samples.Discussion and conclusionWhile, at this time of the HITECH initiative, the formal definitions of SCT are only a minor consideration, in the grand scheme of sophisticated, meaningful use of captured clinical data, they are essential. However, significant portion of the concepts in the most semantically complex hierarchy of SCT, the Procedure hierarchy, are modeled inconsistently in a manner that affects their computability. Lexical methods can efficiently identify such inconsistencies and possibly allow for their algorithmic resolution.     

Trajectories of sleep problems in childhood: associations with mental health in adolescence

Study ObjectivesWe examined initial levels (intercepts) of sleep–wake problems in childhood and changes in sleep–wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems.MethodsParticipants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep–wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep–wake problems were assessed.ResultsLatent growth curve modeling revealed that children with higher levels of sleep–wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep–wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep–wake problems in adolescence. The slope of sleep–wake problems from ages 9 to 11 did not predict age 18 mental health.ConclusionsYouth who had higher sleep–wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep–wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.     

Invitation to attend a health check in a general practice setting: comparison of attenders and non-attenders

A sample of 1570 men and women aged 20-45 years registered with an inner-city Cardiff practice were offered the opportunity by their general practitioner to have a health check at the surgery. The demographic characteristics, attitudes, beliefs and preventive health behaviour and past contact with the practice were compared for a sample of 259 non-attenders and 216 attenders. The results showed that attenders were generally better educated, better motivated to look after their health, had fewer ties and commitments, performed more healthapproved practices, had had more recent contact with their own practice and accepted the legitimacy of a general practitioner's interest in his patients' lifestyle. Offering cohorts of patients additional screening services is unlikely to be efficient or effective since it is the low-risk people already known to the doctor who are most likely to attend. The onus lies on primary health care to provide services in a way which permits appropriate screening of the high-risk groups as they attend for other reasons.     

The computer health check — the first 100 patients

While waiting to see the doctor, patients used a computerized interview to answer questions about their health. An analysis of the first 100 interviews is presented in this paper. The results indicate that patients liked the system and the doctors found it useful.     

Semantic similarity-based alignment between clinical archetypes and SNOMED CT: an application to observations

PurposeOne of the main challenges of eHealth is semantic interoperability of health systems. But, this will only be possible if the capture, representation and access of patient data is standardized. Clinical data models, such as OpenEHR Archetypes, define data structures that are agreed by experts to ensure the accuracy of health information. In addition, they provide an option to normalize clinical data by means of binding terms used in the model definition to standard medical vocabularies. Nevertheless, the effort needed to establish the association between archetype terms and standard terminology concepts is considerable. Therefore, the purpose of this study is to provide an automated approach to bind OpenEHR archetypes terms to the external terminology SNOMED CT, with the capability to do it at a semantic level.MethodsThis research uses lexical techniques and external terminological tools in combination with context-based techniques, which use information about structural and semantic proximity to identify similarities between terms and so, to find alignments between them. The proposed approach exploits both the structural context of archetypes and the terminology context, in which concepts are logically defined through the relationships (hierarchical and definitional) to other concepts.ResultsA set of 25 OBSERVATION archetypes with 477 bound terms was used to test the method. Of these, 342 terms (74.6%) were linked with 96.1% precision, 71.7% recall and 1.23 SNOMED CT concepts on average for each mapping. It has been detected that about one third of the archetype clinical information is grouped logically. Context-based techniques take advantage of this to increase the recall and to validate a 30.4% of the bindings produced by lexical techniques.ConclusionsThis research shows that it is possible to automatically map archetype terms to a standard terminology with a high precision and recall, with the help of appropriate contextual and semantic information of both models. Moreover, the semantic-based methods provide a means of validating and disambiguating the resulting bindings. Therefore, this work is a step forward to reduce the human participation in the mapping process.