Follow-up care after a health fair screening in three Houston neighborhoods in 2008

Background. Each year thousands of people participate in mass health screenings for diabetes and hypertension, but little is known about whether or not those who receive higher than normal screening results obtain the recommended follow-up medical care, or what barriers they perceive to doing so. ^ Methods. Study participants were recruited from attendees at three health fairs in low-income neighborhoods in Houston, Texas Potential participants had higher than normal blood pressure (> 90/140 mgHg) or blood glucose readings (100 mm/dL fasting or 140 mm/dL random). Study participants were called at one, two, and three months and asked if they had obtained follow-up medical care; those who had not yet obtained follow-up care were asked to identify barriers. Using a modified Aday-Andersen model of health service access, the independent variables were individual and community characteristics and self-perceived need. The dependent variable was obtaining follow-up care, with barriers to care a secondary outcome. ^ Results. Eighty-two study participants completed the initial questionnaire and 59 participants completed the study protocol. Forty-eight participants (59% under an intent to treat analysis, 81% of those completing the study protocol) obtained follow-up care. Those who completed the initial questionnaire and who reported a regular source of care were significantly more likely to obtain follow-up care. For those who completed the study protocol the relationship between having a regular source of care and obtaining follow-up care approached but did not reach significance. For those who completed the initial questionnaire, self-described health status, when examined as a binary variable (good, very good, excellent, or poor, fair, not sure) was associated with obtaining follow-up care for those who rated their health as poor, fair, or not sure. While the group who completed the study protocol did not reach statistical significance, the same relationship between self-described health status of poor, fair, or not sure and obtaining follow-up care was present. The participants who completed the study protocol and described their blood pressure as OK or a little high were statistically more likely to get follow-up care than those who described it as high or very high. All those on oral medications for hypertension (12/12) and diabetes (4/4) who were told to obtain follow-up care did so; however, the small sample size allows this correlation to be of statistical significance only for those treating hypertension. ^ The variables significantly associated with obtaining follow-up care were having a regular source of care, self-described health status of poor, fair, or not sure, self-described blood pressure of OK or a little high, and taking medication for blood pressure. ^ At the follow-up telephone calls, 34 participants identified barriers to care; cost was a significant barrier reported by 16 participants, and 10 reported that they didn’t have time because they were working long hours after Hurricane Ike. ^ The study included the offer of access assistance: information about nearby safety-net providers, a visit to or information from the Health Information Center at their Neighborhood Center location, or information from Project Safety Net (a searchable web site for safety net providers). Access assistance was offered at the health fairs and then again at follow-up telephone calls to those who had not yet obtained follow-up care. Of the 48 participants who reported obtaining follow-up care, 26 said they had made use of the access assistance to do so. The use of access assistance was associated with being Hispanic, not having health insurance or a regular source of care, and speaking Spanish. It was also associated with being worried about blood glucose. ^ Conclusion. Access assistance, as a community enabling characteristic, may be useful in aiding low-income people in obtaining medical care. ^

Revisiting health literacy and its impact on patient-physician communication

Objective. To review professional literature on health literacy and its impact on patient-physician communication, to describe significant literature on this issue, and to summarize implications of the findings from this literature. Design. Update of a review of literature. Data sources: MEDLINE. Review Methods. Articles dealing with the impact of health literacy on patient-physician communication were selected. The articles addressed at least one of four criteria on the subject: prevalence of the problem; effect of health literacy on patient-physician communication; association of health literacy to health outcomes; and interventions to enhance communication with patients exhibiting limited health literacy. Results. Approximately 623 articles were selected for review; 87 were fully reviewed and found to be relevant to the issue; and 25 articles were cited. Conclusion. Limited health literacy is extremely widespread throughout the U.S., particularly among specific populations. Providers must be aware that patients often process health care decision making differently from their own familiar procedures and that by taking the steps to make medical language and health information simpler and the time to confirm patient understanding, health outcomes of limited health literacy populations will improve. ^

Information sources influencing urban Mexican-American women's cancer screening participation

Breast and cervical cancer, though less common in Mexican-American than in Anglo women, are more likely to go undetected in Mexican-American women, leaving them more vulnerable to advanced disease and death. Although highly effective screening tests--the Pap smear and the mammogram--can detect these cancers early, many Mexican-American women do not regularly undergo these preventive screening tests.^ To explore the differential influence of encouraging sources of health information, this investigation examined the relationship between encouragement from a "peer"--husband or partner, child or children, other family members, or close friends--and a "health professional"--a doctor, a nurse, or another health professional--on Mexican-American women's cancer screening intentions and behaviors. Furthermore, this research explored whether the sources' influence on cancer screening intentions and behaviors differed depending on level of acculturation.^ One thousand seven hundred eleven surveys of Mexican-American women were analyzed to identify the source that most effectively encourages these women to participate in cancer screening. The data provided evidence that health professionals strongly influenced this population's cancer screening intentions and behaviors. Evidence for peer influence was also found; however, it was usually weaker, and, in some cases, negligible. Peer encouragement was related to Pap test behaviors and mammogram intentions, but not to Pap test intentions or mammogram behaviors. Consistently, women reported greater intentions and screening behaviors when encouraged from a health professional than from a peer. Acculturation was not found to be a modifying variable related to the relationship between sources of information and Pap test or mammogram intentions and behaviors.^ Because health professionals were identified as strongly influencing both intentions and behaviors for Pap tests and mammograms, further efforts should be undertaken to urge them to encourage their clients to obtain cancer screening. Failure to provide this encouragement leads to missed opportunities. Enlisting support from peers also may help to increase cancer screening participation in urban Mexican-American women; however, the consistently greater intentions and behaviors related to a health professional's encouragement indicated the greater power of the latter. ^

The relationship between hospital financial performance and information technology integration strategy selection

In light of the new healthcare regulations, hospitals are increasingly reevaluating their IT integration strategies to meet expanded healthcare information exchange requirements. Nevertheless, hospital executives do not have all the information they need to differentiate between the available strategies and recognize what may better fit their organizational needs. ^ In the interest of providing the desired information, this study explored the relationships between hospital financial performance, integration strategy selection, and strategy change. The integration strategies examined – applied as binary logistic regression dependent variables and in the order from most to least integrated – were Single-Vendor (SV), Best-of-Suite (BoS), and Best-of-Breed (BoB). In addition, the financial measurements adopted as independent variables for the models were two administrative labor efficiency and six industry standard financial ratios designed to provide a broad proxy of hospital financial performance. Furthermore, descriptive statistical analyses were carried out to evaluate recent trends in hospital integration strategy change. Overall six research questions were proposed for this study. ^ The first research question sought to answer if financial performance was related to the selection of integration strategies. The next questions, however, explored whether hospitals were more likely to change strategies or remain the same when there was no external stimulus to change, and if they did change, they would prefer strategies closer to the existing ones. These were followed by a question that inquired if financial performance was also related to strategy change. Nevertheless, rounding up the questions, the last two probed if the new Health Information Technology for Economic and Clinical Health (HITECH) Act had any impact on the frequency and direction of strategy change. ^ The results confirmed that financial performance is related to both IT integration strategy selection and strategy change, while concurred with prior studies that suggested hospital and environmental characteristics are associated factors as well. Specifically this study noted that the most integrated SV strategy is related to increased administrative labor efficiency and the hybrid BoS strategy is associated with improved financial health (based on operating margin and equity financing ratios). On the other hand, no financial indicators were found to be related to the least integrated BoB strategy, except for short-term liquidity (current ratio) when involving strategy change. ^ Ultimately, this study concluded that when making IT integration strategy decisions hospitals closely follow the resource dependence view of minimizing uncertainty. As each integration strategy may favor certain organizational characteristics, hospitals traditionally preferred not to make strategy changes and when they did, they selected strategies that were more closely related to the existing ones. However, as new regulations further heighten revenue uncertainty while require increased information integration, moving forward, as evidence already suggests a growing trend of organizations shifting towards more integrated strategies, hospitals may be more limited in their strategy selection choices.^

Image Retrieval: The MIRACLE Approach

ImageCLEF is a pilot experiment run at CLEF 2003 for cross language image retrieval using textual captions related to image contents. In this paper, we describe the participation of the MIRACLE research team (Multilingual Information RetrievAl at CLEF), detailing the different experiments and discussing their preliminary results.

CDAPubMed: a browser extension to retrieve EHR-based biomedical literature

Over the last few decades, the ever-increasing output of scientific publications has led to new challenges to keep up to date with the literature. In the biomedical area, this growth has introduced new requirements for professionals, e.g., physicians, who have to locate the exact papers that they need for their clinical and research work amongst a huge number of publications. Against this backdrop, novel information retrieval methods are even more necessary. While web search engines are widespread in many areas, facilitating access to all kinds of information, additional tools are required to automatically link information retrieved from these engines to specific biomedical applications. In the case of clinical environments, this also means considering aspects such as patient data security and confidentiality or structured contents, e.g., electronic health records (EHRs). In this scenario, we have developed a new tool to facilitate query building to retrieve scientific literature related to EHRs. Results: We have developed CDAPubMed, an open-source web browser extension to integrate EHR features in biomedical literature retrieval approaches. Clinical users can use CDAPubMed to: (i) load patient clinical documents, i.e., EHRs based on the Health Level 7-Clinical Document Architecture Standard (HL7-CDA), (ii) identify relevant terms for scientific literature search in these documents, i.e., Medical Subject Headings (MeSH), automatically driven by the CDAPubMed configuration, which advanced users can optimize to adapt to each specific situation, and (iii) generate and launch literature search queries to a major search engine, i.e., PubMed, to retrieve citations related to the EHR under examination. Conclusions: CDAPubMed is a platform-independent tool designed to facilitate literature searching using keywords contained in specific EHRs. CDAPubMed is visually integrated, as an extension of a widespread web browser, within the standard PubMed interface. It has been tested on a public dataset of HL7-CDA documents, returning significantly fewer citations since queries are focused on characteristics identified within the EHR. For instance, compared with more than 200,000 citations retrieved by breast neoplasm, fewer than ten citations were retrieved when ten patient features were added using CDAPubMed. This is an open source tool that can be freely used for non-profit purposes and integrated with other existing systems.

Sistema de recomendación semántico para la movilidad en el entorno AFRICA BUILD Portal

La Gestión de Recursos Humanos a través de Internet es un problema latente y presente actualmente en cualquier sitio web dedicado a la búsqueda de empleo. Este problema también está presente en AFRICA BUILD Portal. AFRICA BUILD Portal es una emergente red socio-profesional nacida con el ánimo de crear comunidades virtuales que fomenten la educación e investigación en el área de la salud en países africanos. Uno de los métodos para fomentar la educación e investigación es mediante la movilidad de estudiantes e investigadores entre instituciones, apareciendo así, el citado problema de la gestión de recursos humanos. Por tanto, este trabajo se centra en solventar el problema de la gestión de recursos humanos en el entorno específico de AFRICA BUILD Portal. Para solventar este problema, el objetivo es desarrollar un sistema de recomendación que ayude en la gestión de recursos humanos en lo que concierne a la selección de las mejores ofertas y demandas de movilidad. Caracterizando al sistema de recomendación como un sistema semántico el cual ofrecerá las recomendaciones basándose en las reglas y restricciones impuestas por el dominio. La aproximación propuesta se basa en seguir el enfoque de los sistemas de Matchmaking semánticos. Siguiendo este enfoque, por un lado, se ha empleado un razonador de lógica descriptiva que ofrece inferencias útiles en el cálculo de las recomendaciones y por otro lado, herramientas de procesamiento de lenguaje natural para dar soporte al proceso de recomendación. Finalmente para la integración del sistema de recomendación con AFRICA BUILD Portal se han empleado diversas tecnologías web. Los resultados del sistema basados en la comparación de recomendaciones creadas por el sistema y por usuarios reales han mostrado un funcionamiento y rendimiento aceptable. Empleando medidas de evaluación de sistemas de recuperación de información se ha obtenido una precisión media del sistema de un 52%, cifra satisfactoria tratándose de un sistema semántico. Pudiendo concluir que con la solución implementada se ha construido un sistema estable y modular posibilitando: por un lado, una fácil evolución que debería ir encaminada a lograr un rendimiento mayor, incrementando su precisión y por otro lado, dejando abiertas nuevas vías de crecimiento orientadas a la explotación del potencial de AFRICA BUILD Portal mediante la Web 3.0. ---ABSTRACT---The Human Resource Management through Internet is currently a latent problem shown in any employment website. This problem has also appeared in AFRICA BUILD Portal. AFRICA BUILD Portal is an emerging socio-professional network with the objective of creating virtual communities to foster the capacity for health research and education in African countries. One way to foster this capacity of research and education is through the mobility of students and researches between institutions, thus appearing the Human Resource Management problem. Therefore, this dissertation focuses on solving the Human Resource Management problem in the specific environment of AFRICA BUILD Portal. To solve this problem, the objective is to develop a recommender system which assists the management of Human Resources with respect to the selection of the best mobility supplies and demands. The recommender system is a semantic system which will provide the recommendations according to the domain rules and restrictions. The proposed approach is based on semantic matchmaking solutions. So, this approach on the one hand uses a Description Logics reasoning engine which provides useful inferences to the recommendation process and on the other hand uses Natural Language Processing techniques to support the recommendation process. Finally, Web technologies are used in order to integrate the recommendation system into AFRICA BUILD Portal. The results of evaluating the system are based on the comparison between recommendations created by the system and by real users. These results have shown an acceptable behavior and performance. The average precision of the system has been obtained by evaluation measures for information retrieval systems, so the average precision of the system is at 52% which may be considered as a satisfactory result taking into account that the system is a semantic system. To conclude, it could be stated that the implemented system is stable and modular. This fact on the one hand allows an easy evolution that should aim to achieve a higher performance by increasing its average precision and on the other hand keeps open new ways to increase the functionality of the system oriented to exploit the potential of AFRICA BUILD Portal through Web 3.0.

Reversible inactivation of the nucleus basalis magnocellularis induces disruption of cortical acetylcholine release and acquisition, but not retrieval, of aversive memories

The basal forebrain complex, which includes the nucleus basalis magnocellularis (NBM), provides widespread cholinergic and γ-aminobutyric acid-containing projections throughout the brain, including the insular and pyriform cortices. A number of studies have implicated the cholinergic neurons in the mediation of learning and memory processes. However, the role of basal forebrain activity in information retrieval mechanisms is less known. The aim of the present study is to evaluate the effects of reversible inactivation of the NBM by tetrodotoxin (TTX, a voltage-sensitive sodium channel blocker) during the acquisition and retrieval of conditioned taste aversion (CTA) and to measure acetylcholine (ACh) release during TTX inactivation in the insular cortex, by means of the microdialysis technique in free-moving rats. Bilateral infusion of TTX in the NBM was performed 30 min before the presentation of gustative stimuli, in either the CTA acquisition trial or retrieval trial. At the same time, levels of extracellular ACh release were measured in the insular cortex. The behavioral results showed significant impairment in CTA acquisition when the TTX was infused in the NBM, whereas retrieval was not affected when the treatment was given during the test trial. Biochemical results showed that TTX infusion into the NBM produced a marked decrease in cortical ACh release as compared with the controls during consumption of saccharin in the acquisition trial. Depleted ACh levels were found during the test trial in all groups except in the group that received TTX during acquisition. These results suggest a cholinergic-dependent process during acquisition, but not during memory retrieval, and that NBM-mediated cholinergic cortical release may play an important role in early stages of learning, but not during recall of aversive memories.

MEDLINEplus: building and maintaining the National Library of Medicine's consumer health Web service

MEDLINEplus is a Web-based consumer health information resource, made available by the National Library of Medicine (NLM). MEDLINEplus has been designed to provide consumers with a well-organized, selective Web site facilitating access to reliable full-text health information. In addition to full-text resources, MEDLINEplus directs consumers to dictionaries, organizations, directories, libraries, and clearinghouses for answers to health questions. For each health topic, MEDLINEplus includes a preformulated MEDLINE search created by librarians. The site has been designed to match consumer language to medical terminology. NLM has used advances in database and Web technologies to build and maintain MEDLINEplus, allowing health sciences librarians to contribute remotely to the resource. This article describes the development and implementation of MEDLINEplus, its supporting technology, and plans for future development.

Spoken document retrieval experiments with IR-n system

This paper describes the first participation of IR-n system at Spoken Document Retrieval, focusing on the experiments we made before participation and showing the results we obtained. IR-n system is an Information Retrieval system based on passages and the recognition of sentences to define them. So, the main goal of this experiment is to adapt IR-n system to the spoken document structure by means of the utterance splitter and the overlapping passage technique allowing to match utterances and sentences.

A general proposal to multilingual information access based on syntactic-semantic patterns

In the last few years, there has been a wide development in the research on textual information systems. The goal is to improve these systems in order to allow an easy localization, treatment and access to the information stored in digital format (Digital Databases, Documental Databases, and so on). There are lots of applications focused on information access (for example, Web-search systems like Google or Altavista). However, these applications have problems when they must access to cross-language information, or when they need to show information in a language different from the one of the query. This paper explores the use of syntactic-sematic patterns as a method to access to multilingual information, and revise, in the case of Information Retrieval, where it is possible and useful to employ patterns when it comes to the multilingual and interactive aspects. On the one hand, the multilingual aspects that are going to be studied are the ones related to the access to documents in different languages from the one of the query, as well as the automatic translation of the document, i.e. a machine translation system based on patterns. On the other hand, this paper is going to go deep into the interactive aspects related to the reformulation of a query based on the syntactic-semantic pattern of the request.

Towards a unified framework for opinion retrieval, mining and summarization

The exponential increase of subjective, user-generated content since the birth of the Social Web, has led to the necessity of developing automatic text processing systems able to extract, process and present relevant knowledge. In this paper, we tackle the Opinion Retrieval, Mining and Summarization task, by proposing a unified framework, composed of three crucial components (information retrieval, opinion mining and text summarization) that allow the retrieval, classification and summarization of subjective information. An extensive analysis is conducted, where different configurations of the framework are suggested and analyzed, in order to determine which is the best one, and under which conditions. The evaluation carried out and the results obtained show the appropriateness of the individual components, as well as the framework as a whole. By achieving an improvement over 10% compared to the state-of-the-art approaches in the context of blogs, we can conclude that subjective text can be efficiently dealt with by means of our proposed framework.

The utilitarian and hedonic outcomes of music information seeking in everyday life

This qualitative study focuses on what contributes to making a music information-seeking experience satisfying in the context of everyday life. Data were collected through in-depth interviews conducted with 15 younger adults (18 to 29 years old). The analysis revealed that satisfaction could depend on both hedonic (i.e., experiencing pleasure) and utilitarian outcomes. It was found that two types of utilitarian outcomes contributed to satisfaction: (1) the acquisition of music, and (2) the acquisition of information about music. Information about music was gathered to (1) enrich the listening experience, (2) increase one's music knowledge, and/or (3) optimize future acquisition. This study contributes to a better understanding of music information-seeking behavior in recreational contexts. It also has implications for music information retrieval systems design: results suggest that these systems should be engaging, include a wealth of extra-musical information, allow users to navigate among music items, and encourage serendipitous encountering of music.

Improving the mortality information system in Portugal

The inability to invest in and develop mortality information systems has been considered the single most critical failure in health information systems. Health information systems are an integral part of health systems. This includes strengthening not only the information content but also the information systems themselves, health information platforms and infrastructure. In this article, particular focus has been placed on the regional and inter-sectoral approach to implementation adopted in Portugal. The article shows how legal and operational barriers have been overcome and focuses on the potential of the new system to improve the quality and timeliness of mortality statistics.

The utilitarian and hedonic outcomes of music information seeking in everyday life

This qualitative study focuses on what contributes to making a music information-seeking experience satisfying in the context of everyday life. Data were collected through in-depth interviews conducted with 15 younger adults (18 to 29 years old). The analysis revealed that satisfaction could depend on both hedonic (i.e., experiencing pleasure) and utilitarian outcomes. It was found that two types of utilitarian outcomes contributed to satisfaction: (1) the acquisition of music, and (2) the acquisition of information about music. Information about music was gathered to (1) enrich the listening experience, (2) increase one's music knowledge, and/or (3) optimize future acquisition. This study contributes to a better understanding of music information-seeking behavior in recreational contexts. It also has implications for music information retrieval systems design: results suggest that these systems should be engaging, include a wealth of extra-musical information, allow users to navigate among music items, and encourage serendipitous encountering of music.