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  1. Definition
    of Health Information System (HIS)
    • HIS are a tool used by Public Health,
    • intended to obtain predictions  about
    • size and trends of health problems in the community.
    • This information systems include information about mortality, morbidity and risk
    • factors.

    • Kurz: HIS
    • obtain info about health of a population
  2. HIS: how do
    they work
    • Information
    • is collected, analyzed and issued to health planners, in order to let them
    • establish priorities , means to
    • attain
    • them (resources), and how to measure results of proposed actions( Assessment)
  3. Types of HIS
    • depending on which are data sources
    • 2 types:
    • - HIS based on population
    • - HIS based on health services
  4. Definition of HIS based on
    • some Information Systems obtain
    • data about  health issues from all individuals of the community (total population) or from a representative
    • sample of the community
  5. Definition of HIS based on
    health services
    • other Information Systems obtain
    • data from health centers (example: average permanence of
    • patients in the hospital (average  number
    • of days that a patient stays at the hospital) (HIS based on health services). In this case, date are
    • referred to health care users.
  6. Where do ”
    HIS based on population” collect information from?
    • from the
    • population of the country
  7. Where do
    “HIS based on health services” collect information from?
    • from health
    • system users
  8. Classification
    of “HIS based on population” 
    3 examples
    • Records
    • (disease, mortality , birth record
    • = every single person who is going to die/ be born, will be registered in the birth civil record;
    •  it must be accompanied by medical certificate of death. 
    • = a system where info is
    • collected continously, this means the info is collected as soon as it appear
    •              e.g. a child is born -
    • registered
    •              = is the only trustable one),

    • surveys
    • (= interview = questionnar=
    • survey, e.g. national health survey= survey done to the whole population,
    • medical exam, general population survey;
    •  info is collected from time to time /
    • occationally;
    • Surveys based on interviews or
    • health exams)

    • notifying systems
    • (victims at traffic accident
    • =if nobody transmitt info, nobody will know
    • work accident= happen, and
    • when nobody communicate that, nobody will recognize it
    • occcational disease;
    •  system where info is collected passivly,;
    • info is not collected, when the person who is in charge, doesnt do it.)
  9. Classification
    of “HIS based on health services”
    • • Records:
    • data from hospitals( ex.. Number of beds per public hospital)
    • Minimum  basic group of  hospital data
    • National record of AIDS cases
    • • Surveys:
    • on hospitals morbidity( ex.. Number of patients under surgical treatment)
    • Survey on hospitals morbidity
    • Survey on drugs abusers receiving medical treatment
    • • Notifying systems:
    • mandatory notifying diseases; drugs abuse; 
    • volunteer pregnancy interruption (induced abortion)
    • - Mandatory notifying diseases (MND) 
    •             (EDO: enfermedades de declaración
    • obligatoria)
    • - Governmental information systems about:
    •     a) drugs abuse 
    •     b) volunteer pregnancy interruption
    • (induced abortion)
  10. HIS based on
    •  state several records, surveys and notifying
    • systems
  11. HIS based on
    health services:
    • state
    • several records, surveys and notifying systems
  12. Identify
    “type of HIS” and “subtype of HIS”:
    • Type---------------------
    • -------- subtype
    • Ex.: HIS
    • based on population--------------disease record
    •         HIS based on Health
    • services--------data from hospitals
    •         HIS based on
    • population--------------surveys on drugs use
    •         HIS based on Health services-----
    • --surveys on hospitals morbidity
  13. methods to
    collect data at HIS
    • records,
    • surveys, notifying systems
  14. definition
    of “record”:
    • HIS where
    • information is collected continuously
  15. definition
    of “survey”:
    • HIS where
    • information is collected occasionally
    • • We
    • assess health level of population through 
    • health condition perceived by themselves.
    • • Surveys
    • are done using interviews and they should be completed with a health exam.
  16. definition
    of “Notifying System”:
     HIS where information is collected passively
  17. difference
    between” primary” and ”secondary” data
    • primary
    • data: data that come directly from each individual, including the whole
    • population of the country;
    • secondary
    • data: data that come from a representative sample of the population
  18. state
    several criteria to design a questionnaire
    • questions
    • short and simple, arising closed answers, clear content
    • Define  information we need to find out
    • (necessary information)
    • • Choose
    • the type of questionnaire to be used
    • • Define
    • questions for each variable: questions should be:
    •         - Necessary
    •         - Self-explaining
    •         - Avoid ambiguous questions
    •         - Try to arise closed answers
    •         - Short and simple
    •         - Do not include value judgment (self
    • previous opinion)
    • • Rational
    • order
    • • Start it
    • with general questions and topics or greater interest
    • Establish order of questions
    • • Define
    • grading  and coding norms
    • is smoking
    • bad?= neutral, smoking is very bad- 
    • what do you think ?= bias
  19. definition of “grade of trust”
    • = reliability
    • - Grade of trust (fiabilidad):
    • ability to reproduce the same results, when we repeat the questionnaire
  20. definition of “validity”  (!)
    • - Validity (validez): ability to
    • measure what we intend to measure
  21. definition of “external validity
    • we compare criteria applied at
    • the interpretation of the questionnaire with an external criteria of
    • reference  (ex.: external
    • validation of laboratories
    • carrying out measurement of glycosilated hemoglobin; same for radiological
    • findings)
  22. definition
    of Likert  Scale
    •  scale used to answer a questionnaire, where
    • the user must choose an answer scaled in 5 grades of agreement  or disagreement
    • •  Likert scale expresses self perception of
    • health care, received by patients.
    • Ex.:   “the information you have
    • received about your disease has been appropriate”
  23. characteristics
    of Likert Scale
    • 5 optional
    • answers, grading and scoring of the answers etc
  24. definition
    of MND
    •  Mandatory Notifying  Diseases
    • MND is one
    • of the notifying systems included in” HIS based on Health services”.
    • Mandatory
    • notifying refers to new cases appeared during the week. 
    • • “One
    • week” is the time unit 
    • • Types of
    • notification: manual or digital surveys  

    • Notification is made on Primary Health Care level, Specialized Level and
    • rising to  Ministry of Health
  25. Definition of Epidemiological
    Surveillance (ES)
    •  continuous watching of distribution and trends of diseases, through systematic
    • collection of morbidity , mortality and other data ,and submission of these
    • data to all  who need to know them (
    • health planners, managers and health care providers)
  26. Relation
    between MND and Epidemiological Surveillance
    • MND is a
    • notifying system included in Epidemiological Surveillance
  27. Characteristics
    of ES
    of diseases included in MND depending on urgency to be notified
    • simple,
    • flexible/high adaptation, sensitive and fast; it includes mandatory notifying
    • diseases (MND)
    • urgent and
    • non urgent
  28.  State several urgent notifying diseases
    • Botulism,
    • cholera, diptheria, rabies, measles
  29. State several non urgent
    notifying diseases
    • Brucellosis,
    • hepatitis A, B, C, Tetanus, rubella, varicella (chickenpox), mumps, influenza
  30. Modes for
    urgent and non-urgent notifying diseases
    • Urgent:
    • -Nominal (last/first name), numerical (number of affected people)
    • Non-urgent:
    • -Nominal, numerical (except influenza)
    • -Numerical (only influenza)
  31. Definitions
    of “Epidemic” ( classic and Last definitions ) and “outbreak”
    • Classic
    • definition of epidemic:
    • disease
    • that at not always regular intervals of time, affects population in an
    • important way, causing a high morbidity or mortality.
    • Last
    • definition of epidemic:
    • appearance
    • in a community or geographical region , of an increased number of cases of a
    • disease, specific behaviour or other events related to health, in relation to
    • expected values under normal circumstances.( ex.: epidemic of suicides;
    • epidemic of AIDS)
    • Outbreak:
    •  ( or epidemic outbreak ) (brote epidémico):
    • localized increase in the incidence of a disease in a village, city or closed
    • institution like a hospital, school or 
    • factory. ( ex.: outbreak of influenza; outbreak of meningitis by
    • meningococco)
  32. State 4 items included in
    “Epidemic” concept
    Short question
    • -Relevant increase in the
    • number of cases in relation to expected values ,
    • e.g. 10 new
    • cases of influenza in valencia
    • -Appearance of a disease,
    • health problem or health risk in an area until then free of it.
    • e.g. colera:
    • next monday 2 new cases -> it would be registered that there is a new
    • epidemic of colera
    • -Presence of any relevant
    • event of collective acute intoxication due to accident, handling or
    • consumption
    • e.g. a big
    • dinner -> after that all the people are ill who ate the meal by drinking
    • contaminated water
    • -Occurrence of a catastrophe
    • that can affect community health
    • e.g. earth quake
    • -> destroying hospitals tsunami -> affect the health of many people
  33. Why Working
    procedures / protocol at MND
    • to define a
    • “case” and “lab diagnostic criteria"
  34. Classification
    of “cases” at MND ( suspicious, probable, confirmed)
    • suspicious (compatible with clinical
    • definition),
    • probable (compatible with clinical definition
    • and epidemiologically related to a confirmed case or coming from an endemic
    • area,
    • confirmed (compatible with clinical
    • definition and confirmed by the lab.).
  35.  Characteristics of notification at MND
    • numeric ,
    • individualized, urgent and weekly
  36. Control
    methods used at MND
    • preventive
    • measures (e.g. vaccination), control of patients (e.g. quarantäne), contacts
    • and environment: isolation, vaccination prophylaxis
  37. Steps to be followed at the
    investigation of an outbreak
    How to do an investigation
    Short question
    • -determine existence of an
    • outbreak
    • -confirm diagnose
    • -establish a definition of
    • “case”
    • -define where data must be
    • collected (time, place and persons)
    • -determine population on risk
    • -create an hypothesis
    • -control measures
    • implementation
    • -checking the hypothesis
    • -establish conclusions and
    • recommendations
    • -issue a written report
  38. Questions
    about MND
    • • Who can
    • notify? ( Who is obligued to notify? ): doctors, nurses, directors of
    • schools, hotels and company managers.
    • • Time
    • reference unit? One week
    • • AIDS is
    • MND? It is not included in the list of MND but it has to be mandatorily
    • declared in an independent specific chart for AIDS.

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2015-04-23 14:17:23
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