A set of training materials for professionals working in intervention epidemiology, public health microbiology and infection control and hospital hygiene.
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The domain of medical informatics has evolved fast since the early 90ies. Until that moment there had been many developments in information systems to support the infrastructure of medicine. Gradually the awareness emerged that medical doctors and other health care professionals (including managers) needed support in education, decision making, communication and other professional activities. As the focus shifted to information management of the health care professionals, the discipline of 'medical informatics' took further shape.
"Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks."
The field is very much interdisciplinary, with branches of high applied activities and also involved in fundamental research. Medical informatics currently is a distinct academic entity in most countries, with a strong network between EU countries in particular. And the focus is on medical practice.
The domain of public health informatics seems not yet so clearly defined in the EU. Most of the time, IT in public health (e.g. supporting new surveillance systems), follow standards defined within medical informatics (e.g. standards such as LOINC, SNOMED, HL7).
Where medical informatics comes from a predominantly patient oriented focus, it follows that choices in IT architecture, standards, protocols etc have been made from that perspective (e.g. high requirements for confidentiality. data protection, and accuracy of information of individual diagnostics and diagnosis).
Key requirements from the public health perspective focus on populations rather than individuals and may include timely data access (which can conflict with decisions for data shielding in medical informatics systems) and representativeness for (sub)populations (e.g. high focus on getting continuous and unbiassed samples of information on subpopulations; accuracy of information on individual diagnosis would be much less important). These key requirements could (and probably should) lead to appropriate choices for IT architecture that may be different from those in medical informatics.
Therefore there is a need for building and maintaining a critical mass of public health information experts, that are well versed in core activities of public health (e.g. surveillance, outbreak investigations, field epidemiology, public health microbiology, screening) and who are able to use that knowledge in developing IT infrastructure that serves the needs of public health profesionals and that is well integrated in health care systems.
"Public health informatics is the systematic application of information and computer science and technology to public health practice, research, and learning."
The USCDC has developed a 2 year fellowship in public health informatics, with the goal to provide training and experience in applying computer and information science and technology to real public health problems. In the EU, the public health informatics is not yet coordinated at the Community level in either development of professional standards or training.
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sdesai posted on 9/21/2010 10:45:08 AM:
This chapter is well-written, covers the subject area comprehensively and is easy to read. I have made a few minor editorial changes to the text and below are a few comments and suggestions on specific sections of the chapter.
1. Should biases be mentioned here with a link to the chapter on biases? It is an important consideration when selecting controls and maybe a sentence or two could then really highlight the role of controls.
1. In the text you have differentiated controls by random sampling and by matching and I think it would also be clearer if you made this separation at the beginning. Your options could be:
1. Unmatched controls/Randomly selected
a. Population etc
2. Matched controls
a. Neighbourhood etc
This way the text has the same chronological order as the above list.
2. I think it would be a shame not to include control selection in case-case, and case-cross over designs as these are used even if not as commonly as classical case control studies. Their inclusion would complete the picture of control selection.
3. Would it be useful to provide links/references to articles for each type of control selection? For case-case you could use
a. Aiken et al Risk of Salmonella infection with exposure to reptiles in England, 2004-2007. Euro Surveill. 2010; 15(22).
b. McCarthy and Giesecke. Case-case comparisons to study causation of common infectious diseases. Int J Epidemiol 1999; 28:764-8.
For case-crossover you could use
a. Soverow et al. Infectious disease in a warming world: how weather influenced West Nile virus in the United States (2001-2005). Environ Health Perspect. 2009; 117:1049-52.
There is an article by Grimes that might be nice to reference (Grimes DA and Schulz KF. Compared to what? Finding controls for case-control studies. Lancet. 2005;365:1429-33).
“Special considerations in control selection”
1. I think it would be useful to have links to other sections of the manual embedded into the text for “case cohort, traditional case control, density case control”.
“Developing a control definition”
1. I feel it would be more appropriate if this section came straight after the summary page as for me it is more logical to define controls and then determine how to select them.
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