The Italian information system on occupational exposure to carcinogens (SIREP): structure, contents and future perspectives

OBJECTIVES: The Italian information system for recording occupational exposures to carcinogens (SIREP) was set up in 1996 as a result of the implementation of European directives concerning the improvement of workplace safety and health. The aim of this study is to describe the characteristics of this information system designed and developed for monitoring exposure risk at workplace. The main results about exposed workers in Italy are also presented. Moreover, we discuss the choices adopted when setting up the structure and the issues encountered in recording data and introduce future developments of the system. METHODS: The design of the information system made use of the structured analysis technique, and it is based on a relational database. Particular attention has been addressed to the system security to prevent non-authorized accesses and to guarantee data integrity. The core information of the database is in accordance with recommendations of the European work group on the measurements of the exposures in the workplace. Results are reported by economic sector, carcinogenic agent, job task and exposure level. RESULTS: The professional exposures of approximately 36,547 employees from 2778 firms were reported to the SIREP database in the period 1996-2005. The three prevalent exposures-hardwood dust, benzene and polycyclic aromatic hydrocarbons-account for >25% of the exposed workers. The main economic activity involved is wood industry and furniture manufacture, while the most frequently observed job is chemical-processing plant operator of petrochemical plants. At the end of 2005, >100,000 different exposure histories were recorded and the number of exposed workers accounts for approximately 0.2% of the Italian workforce. CONCLUSIONS: The SIREP database has been set up in order to assess, control and reduce the carcinogen risk in the workplace. It may be useful as part of a surveillance and monitoring system to determine the need for intervention strategies and to assess their effectiveness.     

A Web-based Electronic Health Record System for National Surveillance

Objective

This showcase aims to demonstrate the viability of Practice Fusion’s web-based electronic health record system for national surveillance. Practice Fusion also wishes to provide aggregate data to public health departments for surveillance for free. This showcase also hopes to engage those potential partners around uses of the company’s research database.

Introduction

Practice Fusion is a web-based electronic health record system with over 150,000 medical professional users treating over 50 million patients. The company focuses on small, ambulatory practices and is predominately comprised of practices in the field of primary care. The user base makes it an ideal system for public health surveillance. The Research Division has undertaken pilot projects to demonstrate the viability of using the data for surveillance for acute diseases, like influenza-like illness, chronic diseases, like diabetes, and risk factors, like hypertension.

Methods

Surveillance systems based on electronic health records have clear advantages over case based reporting, but the majority of those systems are limited to the small geographical area affiliated with the hospital or health plan associated with the project. Practice Fusion has coverage in all 50 states and runs on a single, multi-tenant database making comparisons across those states and the localities within them immediately feasible. The company wishes to engage the organizations represented at ISDS in order to advance public health surveillance using the research database. It is very difficult to obtain electronic health record data currently, but with the appropriate data use agreement Practice Fusion believes that it is a moral imperative to use its aggregate data for surveillance. The Research Division has developed methods for the surveillance of influenza-like illness with its system and comparisons to the CDC have proven its viability.

Conclusions

By comparing trends and levels of influenza-like illness generated from Practice Fusion’s research database to Google Flu Trends and the gold standard estimates produced by the CDC, web-based electronic health record systems have proved to be a viable foundation for syndromic surveillance. The implementation of the system also shows that case definitions for surveillance need not be overly simplistic if they do not require cases to be submitted from physicians, but rather can be programmed to be identified through automated algorithms.     

Update from CDC’s Public Health Surveillance & Informatics Program Office (PHSIPO)

Objective

To provide updates on current activities and future directions for the National Notifiable Diseases Surveillance System (NNDSS), BioSense 2.0, and the Behavioral Risk Factor Surveillance System (BRFSS) and on the role of PHSIPO as the “home” at CDC for addressing cross-cutting issues in surveillance and informatics practice.

Introduction

The practice of public health surveillance is evolving as electronic health records (EHRs) and automated laboratory information systems are increasing adopted, as new approaches for health information exchange are employed, and as new health information standards affect the entire cascade of surveillance information flow. These trends have been accelerated by the Federal program to promote the Meaningful Use of electronic health records, which includes explicit population health objectives. The growing use of Internet “cloud” technology provides new opportunities for improving information sharing and for reducing surveillance costs. Potential benefits include not only faster and more complete surveillance but also new opportunities for providing population health information back to clinicians.For public health surveys, new Internet-based sampling and survey methods hold the promise of complementing existing telephone-based surveys, which have been plagued by declining response rates despite the addition of cell-phone sampling. While new technologies hold promise for improving surveillance practice, there are multiple challenges, including constraints on public health budgets and the workforce. This panel will explore how PHSIPO is addressing these opportunities and challenges.

Methods

Panelists will provide updates on 1) PHSIPO’s role in engaging health departments, the organizations that represent them, and CDC programs in shaping national policies for implementing the Meaningful Use program, 2) how the BioSense 2.0 program is supporting growth in syndromic surveillance capacity, including its partnership with ISDS in developing standards for syndromic surveillance as part of Meaningful Use, 3) improvements that are underway in strengthening the NNDSS, including efforts to improve CDC’s support for health department disease reporting systems and to develop a “shared services” approach that could provide a platform for streamlining the exchange of information between health departments and CDC, 4) pilot development of Internet-based panels of survey volunteers to supplement existing telephone-based sampling in the BRFSS and of approaches to extend BRFSS survey information through consent-based linkage of survey responses to selected measures recorded in respondents’ EHRs.

Results

Potential questions or discussion points that might arise include: What can or should be done to assure that the population health objectives of Meaningful Use are fulfilled? What are the lessons learned to date in leveraging investments in the Meaningful Use of EHRs to improve disease reporting and syndromic surveillance systems? What are the next steps in developing BioSense 2.0 to assure that it leads to strengthened surveillance capacity at both state/local and regional/national levels? How can insights from the BioSense redesign be applied to improve case reporting and other surveillance capacities? What is CDC doing to address states’ concerns about the growing number of CDC surveillance systems? How will national discussions about the future of public health affect the future surveillance practice? What can be done to assure the ongoing representativeness of population health surveys? Is it feasible to link BRFSS responses to information obtained from EHRs? How can data from surveillance become part of the real-time evidence base for clinical decision making?

Conclusions

The intended outcome of the panel is to foster a conversation between the panelists and the audience, to inform the audience about recent developments in PHSIPO, to obtain insights from the audience about innovations and ideas arising from their experience, and to generate new ideas for approaches to meeting the needs of public health for surveillance information.     

We Can Have It All: Improved Surveillance Outcomes and Decreased Personnel Costs Associated With Electronic Reportable Disease Surveillance,North Carolina, 2010

Objectives. We assessed the timeliness, accuracy, and cost of a new electronic disease surveillance system at the local health department level. We describe practices associated with lower cost and better surveillance timeliness and accuracy.Methods. Interviews conducted May through August 2010 with local health department (LHD) staff at a simple random sample of 30 of 100 North Carolina counties provided information on surveillance practices and costs; we used surveillance system data to calculate timeliness and accuracy. We identified LHDs with best timeliness and accuracy and used these categories to compare surveillance practices and costs.Results. Local health departments in the top tertiles for surveillance timeliness and accuracy had a lower cost per case reported than LHDs with lower timeliness and accuracy ($71 and $124 per case reported, respectively; P = .03). Best surveillance practices fell into 2 domains: efficient use of the electronic surveillance system and use of surveillance data for local evaluation and program management.Conclusions. Timely and accurate surveillance can be achieved in the setting of restricted funding experienced by many LHDs. Adopting best surveillance practices may improve both efficiency and public health outcomes.Communicable disease reporting is central to public health surveillance, providing data to detect outbreaks and to describe disease trends.1 Over the past 10 years, communicable disease surveillance has transitioned from traditional paper-based disease reports to electronic reporting.2 All states have converted parts or all of their disease reporting to electronic systems, and most states now use an electronic system to enter and transmit case information at local and state public health agencies.3The transition to electronic reporting has resulted in corresponding modifications to surveillance practice, including changes in who enters and accesses communicable disease case data and how these data are entered at local and state health department levels.4–6 These and other changes have been described at the state level,3,7,8 but less information is available describing changes at the local level. Furthermore, there is little documented information on the cost or cost-effectiveness of electronic communicable disease surveillance systems at any level. Because funds for local public health are scarce and must be prioritized on the basis of costs and benefits, information about the costs of electronic disease surveillance is needed.In 2008, North Carolina implemented the North Carolina Electronic Disease Surveillance System (NC EDSS). The goal of this study was to describe the resources dedicated to communicable disease surveillance with NC EDSS at the local health department (LHD) level. We examined the cases reported before and after NC EDSS implementation and calculated personnel costs associated with communicable disease reporting with the NC EDSS system. Finally, we assigned LHDs composite scores on the basis of accuracy and timeliness of case reports, and compared costs and surveillance practices for LHDs with better and worse timeliness and accuracy.     

Occupational toxicology and the control of exposure to pharmaceutical agents at work

BACKGROUND: The pharmaceutical industry employs >350 000 people worldwide in operations including research and development (R&D), manufacturing, sales and marketing. Workers employed in R&D and manufacturing sectors are potentially exposed to drug substances in the workplace that are designed to modify physiology and also to chemical precursors that are potentially hazardous to health. Pharmaceutical workers are at risk from adverse health effects, including occupational asthma, pharmacological effects, adverse reproductive outcomes and dermatitis. AIM: This study aimed to describe the approaches taken by pharmaceutical companies for identifying and communicating potential adverse health effects that may result from workplace exposures and in setting 'in-house' exposure control limits and to highlight the challenges in controlling workplace exposures to increasingly potent compounds. METHOD: The literature was reviewed by searching the Medline and HSELine databases. RESULTS: The findings are presented in five sections, covering: test methods and approaches to occupational toxicology; hazard communication; approaches to setting health-based occupational exposure limits for pharmaceutically active agents; recent approaches to risk control; and occupational hygiene and exposure controls. CONCLUSION: Significant efforts have been directed at predicting and evaluating potential occupational health hazards in the pharmaceutical industry. The pharmaceutical industry has provided leadership in controlling exposure to hazardous substances. Much of this work has been driven by a real need to control occupational exposures to substances that can have profound adverse health effects in exposed employees and that are becoming increasingly more potent.     

Occupational Health and Safety in Aquaculture: Insights on Brazilian Public Policies

Aquaculture has many occupational hazards, including those that are physical, chemical, biological, ergonomic, and mechanical. The risks in aquaculture are inherent, as this activity requires particular practices. The objective of the present study was to show the risks associated with the aquaculture sector and present a critical overview on the Brazilian public policies concerning aquaculture occupational health. Methods include online research involved web searches and electronic databases including Pubmed, Google Scholar, Scielo and government databases. We conducted a careful revision of Brazilian labor laws related to occupational health and safety, rural workers, and aquaculture. The results and conclusion support the idea that aquaculture requires specific and well-established industry programs and policies, especially in developing countries. Aquaculture still lacks scientific research, strategies, laws, and public policies to boost the sector with regard to occupational health and safety. The establishment of a safe workplace in aquaculture in developing countries remains a challenge for all involved in employer-employee relationships.     

The financial and nonfinancial costs of implementing electronic health records in primary care practices

The incentives in the American Recovery and Reinvestment Act to expand the "meaningful use" of electronic health record systems have many health care professionals searching for information about the cost and staff resources that such systems require. We report the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in north Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year. We also estimate that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that "end users"-physicians, other clinical staff, and nonclinical staff-needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters.     

May we support your decision?

Expert systems to support medical decision-making have so far achieved few successes. Current technical developments, however, may overcome some of the limitations. Although there are several theoretical currents in medical artificial intelligence, there are signs of them converging. Meanwhile, decision support systems, which set themselves more modest goals than replicating or improving on clinicians' expertise, have come into routine use in places where an adequate electronic patient record exists. They may also be finding a wider role, assisting in the implementation of clinical practice guidelines. There is, however, still much uncertainty about the kinds of decision support that doctors and other health care professionals are likely to want or accept.     

Environmental surveillance in health in Brazil's Unified Health System

The incorporation of environmental surveillance in the field of public health policies is a relatively recent demand in Brazil. One of the major challenges in environmental health surveillance is defining its object and the specificity of its practice. The expanded concept of exposure, treated as a set of complex relations between a society and the environment, and not as a personal attribute, is central to the definition of indicators and should guide the practice of environmental surveillance in the health sector. Among the difficulties encountered in applying this concept within the Brazilian Health System, is the need to restructure health surveillance activities and to form multidisciplinary teams capable of dialoguing with other sectors. Furthermore, information systems capable of aiding in health situation analysis and decision making must be constructed. Taking this into consideration, a review of the object and concepts of environmental health surveillance was undertaken and the challenges with respect to its implementation in the Brazilian Health System were identified.     

Surveillance in environmental public health: issues, systems, and sources.

This article describes environmental public health surveillance and proposes a framework to enhance its practice in the United States. Special issues for surveillance in environmental public health are examined, and examples of existing systems useful for environmental public health practice are provided. Current and projected surveillance needs, as well as potential sources of data, are examined. The proposed framework for conducting environmental public health surveillance involves data from three points in the process by which an agent in the environment produces an adverse outcome in a host: hazards, exposures, and outcomes. Environmental health practitioners should build on efforts in other fields (e.g., infectious diseases and occupational health) to establish priorities in the surveillance of health conditions associated with exposure to environmental toxicants. For specific surveillance programs, existing data systems, as well as data gaps, should be identified. Coordinated surveillance systems can facilitate public health efforts to prevent and control disease, injury, and disability related to the interaction between people and their environment.     

上海市1953年至2000年矽尘工种接触矩阵分析

[目的]根据上海市工作场所危害因素监测资料库中矽尘监测资料,尝试建立上海市1953年至2000年矽尘工种接触矩阵（JEM）。介绍JEM方法,以供探讨。[方法]运用EXCEL,ACCESS和STATA软件对矽尘监测资料作整理、分析、回归和推算。该资料库中有1953年至2000年矽尘的监测数据65561个。由工业卫生专家根据理论与其实践的认识评定行业及工种的强度级别;求取以不同年代（时段）、行业级别和工种级别三者分类交叉归并后的113个浓度均值;再求得对数实测浓度均值（应变量）与时段、行业级别和工种级别（自变量）之间的回归方程式,在时段上加用哑变量修饰使回归式更好地拟合各时段的波动变化,从回归式推算缺失值填补空格项。结合数据,讨论工种接触矩阵的意义、用途、方法和前景。[结果]建立了上海市1953年至2000年矽尘浓度9个时段、4个行业级别和4个工种级别的144个数据矩阵。工作场所的矽尘在48年内从高出工作标准数倍下降至接近或达到卫生标准,提示了职业卫生工作的重大成就,但曲线的波动也反映出相应的浓度问题。[结论]以上海市工作场所矽尘监测资料为基础,经统计分析建立了相应的工种接触矩阵,为职业卫生监测、职业病诊断、职业流行病学研究和劳动能力判断等方面的接触评定提供了数据基础。     

Implementation of a Multimodal Mobile System for Point-of-Sale Surveillance: Lessons Learned From Case Studies in Washington,DC, and New York City

Background

In tobacco control and other fields, point-of-sale surveillance of the retail environment is critical for understanding industry marketing of products and informing public health practice. Innovations in mobile technology can improve existing, paper-based surveillance methods, yet few studies describe in detail how to operationalize the use of technology in public health surveillance.

Objective

The aims of this paper are to share implementation strategies and lessons learned from 2 tobacco, point-of-sale surveillance projects to inform and prepare public health researchers and practitioners to implement new mobile technologies in retail point-of-sale surveillance systems.

Methods

From 2011 to 2013, 2 point-of-sale surveillance pilot projects were conducted in Washington, DC, and New York, New York, to capture information about the tobacco retail environment and test the feasibility of a multimodal mobile data collection system, which included capabilities for audio or video recording data, electronic photographs, electronic location data, and a centralized back-end server and dashboard. We established a preimplementation field testing process for both projects, which involved a series of rapid and iterative tests to inform decisions and establish protocols around key components of the project.

Results

Important components of field testing included choosing a mobile phone that met project criteria, establishing an efficient workflow and accessible user interfaces for each component of the system, training and providing technical support to fieldworkers, and developing processes to integrate data from multiple sources into back-end systems that can be utilized in real-time.

Conclusions

A well-planned implementation process is critical for successful use and performance of multimodal mobile surveillance systems. Guidelines for implementation include (1) the need to establish and allow time for an iterative testing framework for resolving technical and logistical challenges; (2) developing a streamlined workflow and user-friendly interfaces for data collection; (3) allowing for ongoing communication, feedback, and technology-related skill-building among all staff; and (4) supporting infrastructure for back-end data systems. Although mobile technologies are evolving rapidly, lessons learned from these case studies are essential for ensuring that the many benefits of new mobile systems for rapid point-of-sale surveillance are fully realized.     

Design and operation of state and local infectious disease surveillance systems.

Since 2001, increased attention has been focused on improving acute infectious disease surveillance systems. This article describes options for their design and operation. Systems designed primarily to detect individual cases of reportable diseases may differ from those designed to detect outbreaks or support design or evaluation of control programs. Timeliness, sensitivity, and predictive value of surveillance systems cannot all be maximized at the same time. Core activities of surveillance systems include collection, analysis, and dissemination of information about health events under surveillance. Doing these well requires attention to the mechanics of surveillance, such as making the health department accessible at all times to receive reports and provide consultation, and maintaining current directories of persons for dissemination of surveillance data, alerts, and recommendations. Rapid access to electronic representations of health events (eg, laboratory reports, patient records, or health care claims) provides great opportunities for more timely and complete surveillance. Some important information (eg, exposures, contacts) will still need to be collected directly from affected persons. One productive strategy is to collect core demographic and onset data on all cases and detailed clinical, exposure, and outcome data on a subset.     

The development of a prototype database for the voluntary reporting of occupational exposure data on chemicals

A prototype occupational exposure database was developed as part of a study to retrospectively collect chemical exposure data from U.K. industry. The data dictionary for the database was constructed using existing recommendations on core data elements developed by working groups from the ACGIH and the European Union. The study also made use of existing job and workplace coding schemes. The practicalities of gathering the data by voluntary donation, its storage in a database, and the transfer of suitably anonymised data to the U.K. Health and Safety Executive's National Exposure Database system were investigated and assessed. Prior to the development, several existing exposure database systems were evaluated for their suitability to store the data from the study. Though of high quality, these were found to be insufficiently flexible for the diversity of datasets encountered and so the prototype exposure database was constructed using a leading database development package. The database was successfully used to gather data and forward it in a suitable format to the U.K. Health and Safety Executive. The published recommendations on occupational exposure databases and the associated coding schemes provided a very useful foundation for designing and implementing the prototype database. However, as data collection proceeded it became clear that the existing recommendations often were poorly understood and misinterpreted, or at least interpreted differently, by different database designers, data collectors, and other users of occupational exposure data. It is suggested that several items in the ACGIH and European Union core recommendations are ambiguous and need to be clarified. Once agreed, the improved database design criteria need to be widely promoted to foster a common understanding and to encourage their use by all those involved in collecting occupational exposure data. Beyond this, recommendations for exposure databases should be augmented to facilitate easy exchange of data between organizations.     

Development of a National Occupational Exposure Survey and Database associated with NIOSH hazard surveillance initiatives

NIOSH pioneered hazard surveillance in the workplace by designing and conducting the 1972 to 1974 National Occupational Hazard Survey (NOHS), the 1981 to 1983 National Occupational Exposure Survey (NOES), and the 1984 to 1989 National Occupational Health Survey of Mining (NOHSM). The databases developed from these three on-site surveys represent unique resources for associating potential chemical, physical and biological agents with industries and occupational groups. The data have been a primary source of information for NIOSH, regulatory agencies, health professionals, researchers, and labor organizations in establishing priorities for prevention strategies that include medical and engineering interventions, development of occupational standards, and the identification of research needs. Recognizing that the data from these surveys are becoming dated, a multidisciplinary team comprising members from various NIOSH research divisions was established to develop a hazard surveillance strategy for the Institute, including options for a national hazard surveillance survey and database. The proposed new hazard survey builds on lessons learned from the previous surveys, seeks opportunities to incorporate existing data from other sources, expands the scope of industries and hazards, and takes advantage of advances in data gathering, processing and dissemination technology. This article presents current considerations and recommendations for a new hazard survey and database.     

Biological monitoring: concepts and applications in public health

This study provides an overview of the theoretical discussion on potential uses for biological monitoring of exposure to chemical substances as related to human health, considering different concepts: definitions, uses, and limitations of internal dose and biological effect indicators and their availability for the substances to be quantified; knowledge of reference values, action levels, and limits based on health and negotiated patterns in biological monitoring interpretation and perspectives; and ethical and social problems in practice and within different preventive practices and their use in public health. Biological monitoring is the result of an exposure situation with conclusions based on scientific and consensus values, rules, and legislation. Biological monitoring as a continuous process and related to actually observed cases has helped establish technological exposure reference values and consensus levels as indicators for improving the environment and the workplace. As a step in the decision-making process in risk analysis, biological monitoring needs to be critically assessed as to its ethical aspects in light of the end use of results and values, which are references for application of this methodology.     

Occupational health services in non-industrial settings in the US: a review

The provision of occupational health services at sites other than the workplace has undergone considerable expansion in recent years in the United States. These alternate sources of occupational health services include hospital-based clinics, free-standing clinics, corporate health programs, urgent care centers, group practices, and health maintenance organizations. These additional sources of occupational health care hold the promise of making a significant contribution toward reducing the still considerable burden of occupational illness and injury in the US. However, serious problems relating to the nature, quantity, and quality of care provided in these settings remain. This paper reviews the literature on occupational health services in these non-industrial settings and explores their potential promise and problems.     

Syndromic Surveillance from a Local Perspective – A Review of the Literature

Objective

Review of the origins and evolution of the field of syndromic surveillance. Compare the goals and objectives of public health surveillance and syndromic surveillance in particular. Assess the science and practice of syndromic surveillance in the context of public health and national security priorities. Evaluate syndromic surveillance in practice, using case studies from the perspective of a local public health department.

Introduction

Public health disease surveillance is defined as the ongoing systematic collection, analysis and interpretation of health data for use in the planning, implementation and evaluation of public health, with the overarching goal of providing information to government and the public to improve public health actions and guidance [1,2]. Since the 1950s, the goals and objectives of disease surveillance have remained consistent [1]. However, the systems and processes have changed dramatically due to advances in information and communication technology, and the availability of electronic health data [2,3]. At the intersection of public health, national security and health information technology emerged the practice of syndromic surveillance [3].

Methods

To better understand the current state of the field, a review of the literature on syndromic surveillance was conducted: topics and keywords searched through PubMed and Google Scholar included biosurveillance, bioterrorism detection, computerized surveillance, electronic disease surveillance, situational awareness and syndromic surveillance, covering the areas of practice, research, preparedness and policy. This literature was compared with literature on traditional epidemiologic and public health surveillance. Definitions, objectives, methods and evaluation findings presented in the literature were assessed with a focus on their relevance from a local perspective, particularly as related to syndromic surveillance systems and methods used by the New York City Department of Health and Mental Hygiene in the areas of development, implementation, evaluation, public health practice and epidemiological research.

Results

A decade ago, the objective of syndromic surveillance was focused on outbreak and bioterrorism early-event detection (EED). While there have been clear recommendations for evaluation of syndromic surveillance systems and methods, the original detection paradigm for syndromic surveillance has not been adequately evaluated in practice, nor tested by real world events (ie, the systems have largely not ‘detected’ events of public health concern). In the absence of rigorous evaluation, the rationale and objectives for syndromic surveillance have broadened from outbreak and bioterrorism EED, to include all causes and hazards, and to encompass all data and analyses needed to achieve “situational awareness”, not simply detection. To evaluate current practices and provide meaningful guidance for local syndromic surveillance efforts, it is important to understand the emergence of the field in the broader context of public health disease surveillance. And it is important to recognize how the original stated objectives of EED have shifted in relation to actual evaluation, recommendation, standardization and implementation of syndromic systems at the local level.

Conclusions

Since 2001, the field of syndromic surveillance has rapidly expanded, following the dual requirements of national security and public health practice. The original objective of early outbreak or bioterrorism event detection remains a core objective of syndromic surveillance, and systems need to be rigorously evaluated through comparison of consistent methods and metrics, and public health outcomes. The broadened mandate for all-cause situation awareness needs to be focused into measureable public health surveillance outcomes and objectives that are consistent with established public health surveillance objectives and relevant to the local practice of public health [2].     

GIS在公共卫生领域的应用现状与发展趋势

从公共卫生的疾病监测与预防、环境健康研究、卫生服务与利用、公共卫生突发事件等4个方面,概述了近年来国内外应用GIS的现状,分析了当前GIS技术的不足,对GIS在该领域的发展趋势进行了展望。指出随着GIS进一步提高其空间数据分析能力,广泛地集成其他技术,GIS在公共卫生领域有着巨大的应用潜力。