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Bonevski B.,University of Newcastle | Campbell E.,Population Health | Sanson-Fisher R.W.,University of Newcastle
Addictive Behaviors | Year: 2010

Background: Uncertainty regarding the accuracy of the computer as a data collection or patient screening tool persists. Previous research evaluating the validity of computer health surveys have tended to compare those responses to that of paper survey or clinical interview (as the gold standard). This approach is limited as it assumes that the paper version of the self-report survey is valid and an appropriate gold standard. Objectives: First, to compare the accuracy of computer and paper methods of assessing self-reported smoking and alcohol use in general practice with biochemical measures as gold standard. Second, to compare the test re-test reliability of computer administration, paper administration and mixed methods of assessing self-reported smoking status and alcohol use in general practice. Methods: A randomised cross-over design was used. Consenting patients were randomly assigned to one of four groups; Group 1. C-C : completing a computer survey at the time of that consultation (Time 1) and a computer survey 4-7 days later (Time 2); Group 2. C-P: completing a computer survey at Time 1 and a paper survey at Time 2; Group 3. P-C: completing a paper survey at Time 1 and a computer survey at Time 2; and Group 4. P-P: completing a paper survey at Time 1 and 2. At Time 1 all participants also completed biochemical measures to validate self-reported smoking status (expired air carbon monoxide breath test) and alcohol consumption (ethyl alcohol urine assay). Results: Of the 618 who were eligible, 575 (93%) consented to completing the Time 1 surveys. Of these, 71% (N = 411) completed Time 2 surveys. Compared to CO, the computer smoking self-report survey demonstrated 91% sensitivity, 94% specificity, 75% positive predictive value (PPV) and 98% negative predictive value (NPV). The equivalent paper survey demonstrated 86% sensitivity, 95% specificity, 80% PPV, and 96% NPV. Compared to urine assay, the computer alcohol use self-report survey demonstrated 92% sensitivity, 50% specificity, 10% PPV and 99% NPV. The equivalent paper survey demonstrated 75% sensitivity, 57% specificity, 6% PPV, and 98% NPV. Level of agreement of smoking self-reports at Time 1 and Time 2 revealed kappa coefficients ranging from 0.95 to 0.98 in each group and hazardous alcohol use self-reports at Time 1 and Time 2 revealed kappa coefficients ranging from 0.90 to 0.96 in each group. Conclusion: The collection of self-reported health risk information is equally accurate and reliable using computer interface in the general practice setting as traditional paper survey. Computer survey appears highly reliable and accurate for the measurement of smoking status. Further research is needed to confirm the adequacy of the quantity/frequency measure in detecting those who drink alcohol. Interactive computer administered health surveys offer a number of advantages to researchers and clinicians and further research is warranted. © 2010 Elsevier Ltd. All rights reserved.

Sainsbury P.G.,Population Health | Sainsbury P.G.,University of Sydney | Sainsbury P.G.,University of New South Wales
Journal of Bioethical Inquiry | Year: 2013

The prevalence of chronic diseases has increased in recent decades. Some forms of the built environment adopted during the 20th century-e. g., urban sprawl, car dependency, and dysfunctional streetscapes-have contributed to this. In this article, I summarise ways in which the built environment influences health and how it can be constructed differently to promote health. I argue that urban planning is inevitably a social and political activity with many ethical dimensions, and I illustrate this with two examples: the construction of a hypothetical new suburb and a current review of planning legislation in Australia. I conclude that (1) constructing the built environment in ways that promote health can be ethically justified, (2) urban planners and public health workers should become more skilled in the application of ethical considerations to practical problems, and (3) the public health workforce needs to become more competent at influencing the activities of other sectors. © 2012 Springer Science+Business Media Dordrecht.

Millar J.,University of British Columbia | Bruce T.,Population Health
Healthcare Papers | Year: 2013

The healthcare system in Canada is undergoing significant transformation in response to three major interrelated pressures: the overall burden of illness is rising, patients are getting poor quality of care and healthcare costs are inexorably rising. One idea to guide this change is to transform the primary care system into a community-based primary healthcare (CBPH) system. This paper discusses, in particular, the readiness of public health to participate in the transformation to a CBPH system.

Wall R.,Population Health
The New Zealand medical journal | Year: 2011

We report on the investigations of two gastroenteritis outbreaks, which were linked to a common source. Retrospective cohort studies were conducted for two gastroenteritis outbreaks which occurred in Auckland and in Waikato. Faecal samples and samples of oyster meat were analysed. Environmental surveys of implicated areas were conducted. 10 out of 16 people who had eaten at a catered event in Auckland, and 3 out of 15 people who had eaten at a Waikato restaurant, experienced gastroenteritis. The symptoms, duration of illness and incubation periods were consistent with norovirus gastroenteritis in both outbreaks. The consumption of oysters was strongly associated with an increased risk of illness. Faecal samples were positive for norovirus. Oysters from both outbreaks were traced back to the same growing area. Samples of oyster meat from one of the restaurants and from the growing area were positive for norovirus. The growing area was closed for further investigation. A pipe from a waste water treatment plant was later found to be leaking partially treated effluent into a stream discharging near the implicated growing area. Investigation of these two outbreaks led to the discovery of a common source of norovirus at a commercial oyster growing area.

Li Q.,Retrospective Observational Studies | Blume S.W.,Retrospective Observational Studies | Huang J.C.,Novo Nordisk AS | Hammer M.,Novo Nordisk AS | Graf T.R.,Population Health
PharmacoEconomics | Year: 2015

Background: Electronic medical records and insurance claims data from the Geisinger Health System were examined to assess the real-world healthcare costs of being overweight or obese at different glycemic stages, including normal glycemia, pre-diabetes (PreD), and type 2 diabetes (T2D). Methods: The medical history of the sample subjects was segmented into different glycemic stages via diagnosis codes, glycosylated hemoglobin A1c or fasting plasma glucose laboratory results, and use of antidiabetic drugs. Healthcare resource utilization captured by the claims and associated costs (in 2013 values) were examined for each glycemic stage. The association between costs and body mass index (BMI) was estimated by regressions, and adjusted for sociodemographics. We predicted the adjusted incremental annual costs associated with high BMI, relative to normal BMI (18.5–24.9 kg/m2). Results: We identified 48,344 adults in normal glycemic stage, 3,085 in the PreD stage, and 9,526 in the T2D stage (mean age 46, 58, and 60 years, respectively; mean BMI 29, 32, and 33 kg/m2, respectively). The adjusted incremental annual costs associated with high BMI relative to normal BMI ranged from $336 for overweight (25–29.9 kg/m2) to $1,850 for class III obesity (≥40 kg/m2) during normal glycemic stage; were only significant for class III ($2,434) during the PreD stage; and ranged from $1,139 for overweight to $4,649 for class III during the T2D stage (all p < 0.05). Conclusions: Positive associations between healthcare costs and BMI levels were observed within each glycemic stage. Management of body weight is important in reducing the overall healthcare costs, especially for subjects with PreD or T2D. © 2015, The Author(s).

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