Syndromic surveillance for influenza in the emergency department-A systematic review

The science of surveillance is rapidly evolving due to changes in public health information and preparedness as national security issues, new information technologies and health reform. As the Emergency Department has become a much more utilized venue for acute care, it has also become a more attractive data source for disease surveillance. In recent years, influenza surveillance from the Emergency Department has increased in scope and breadth and has resulted in innovative and increasingly accepted methods of surveillance for influenza and influenza-like-illness (ILI). We undertook a systematic review of published Emergency Department-based influenza and ILI syndromic surveillance systems. A PubMed search using the keywords "syndromic", "surveillance", "influenza" and "emergency" was performed. Manuscripts were included in the analysis if they described (1) data from an Emergency Department (2) surveillance of influenza or ILI and (3) syndromic or clinical data. Meeting abstracts were excluded. The references of included manuscripts were examined for additional studies. A total of 38 manuscripts met the inclusion criteria, describing 24 discrete syndromic surveillance systems. Emergency Department-based influenza syndromic surveillance has been described worldwide. A wide variety of clinical data was used for surveillance, including chief complaint/presentation, preliminary or discharge diagnosis, free text analysis of the entire medical record, Google flu trends, calls to teletriage and help lines, ambulance dispatch calls, case reports of H1N1 in the media, markers of ED crowding, admission and Left Without Being Seen rates. Syndromes used to capture influenza rates were nearly always related to ILI (i.e. fever +/- a respiratory or constitutional complaint), however, other syndromes used for surveillance included fever alone, "respiratory complaint" and seizure. Two very large surveillance networks, the North American DiSTRIBuTE network and the European Triple S system have collected large-scale Emergency Department-based influenza and ILI syndromic surveillance data. Syndromic surveillance for influenza and ILI from the Emergency Department is becoming more prevalent as a measure of yearly influenza outbreaks.

Automated biosurveillance data from England and Wales, 1991-2011

Outbreak detection systems for use with very large multiple surveillance databases must be suited both to the data available and to the requirements of full automation. To inform the development of more effective outbreak detection algorithms, we analyzed 20 years of data (1991-2011) from a large laboratory surveillance database used for outbreak detection in England and Wales. The data relate to 3,303 distinct types of infectious pathogens, with a frequency range spanning 6 orders of magnitude. Several hundred organism types were reported each week. We describe the diversity of seasonal patterns, trends, artifacts, and extra-Poisson variability to which an effective multiple laboratory-based outbreak detection system must adjust. We provide empirical information to guide the selection of simple statistical models for automated surveillance of multiple organisms, in the light of the key requirements of such outbreak detection systems, namely, robustness, flexibility, and sensitivity.

Do we have the reliable data? An exploration of data quality for AIDS information system in China

A national AIDS program evaluation system has been applied to the ranking of the performance of involved public health organizations in China since 2007. The system provides quantitative performance comparison information based on automatic mining of the data stored in a unified web-based national information system, China AIDS Comprehensive Response Information Management System (the CRIMS). Hence, the quality of the AIDS program evaluation system is directly related to the data quality in the CRIMS. This study aims to evaluate the performance of the AIDS program evaluation system. The research method is qualitative interview of public health practitioners in Jiangxi Province. The public health practitioners believed that the introduction and ongoing usage of the CRIMS has significantly transformed the practice of AIDS prevention and control. They believed that the AIDS program evaluation system has brought in increased accountability of public health. They suggested that the accuracy and completeness of AIDS program evaluation needs to go beyond the data from the CRIMS. Further research will continue to identify the unknown factors that undermine the performance of AIDS programs in China.

Alumni's perception of public health informatics competencies: lessons from the Graduate Program of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Indonesia

Public health informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning [1]. Unfortunately, limited reports exist concerning to the capacity building strategies to improve public health informatics workforce in limited-resources setting. In Indonesia, only three universities, including Universitas Gadjah Mada (UGM), offer master degree program on related public health informatics discipline. UGM started a new dedicated master program on Health Management Information Systems in 2005, under the auspice of the Graduate Program of Public Health at the Faculty of Medicine. This is the first tracer study to the alumni aiming to a) identify the gaps between curriculum and the current jobs and b) describe their perception on public health informatics competencies. We distributed questionnaires to 114 alumni with 36.84 % response rate. Despite low response rate, this study provided valuable resources to set up appropriate competencies, curriculum and capacity building strategies of public health informatics workforce in Indonesia.

[The possibility of using neural networks for the 3D visualization of hygienic studies of the health status on the example of the physical development of the child population]

In the course of the research the possibility of using 3d visualization of the results of hygienic investigations using software package STATISTICA Neural Networks as exemplified by the physical development of children in the Kursk region has been demonstrated, assessment of the possibility of application the proposed method has been done.

Completeness of notification of adult tuberculosis in Iasi County, Romania: a capture-recapture analysis

SETTING

Iasi County, Romania.

OBJECTIVE

To assess the completeness of notification of adult tuberculosis (TB; age > or=15 years) in 2004.

DESIGN

Record-linkage and capture-recapture analysis of three TB-related registers: a notification register, a laboratory register and a prescriptions register.

RESULTS

After record linkage, the observed completeness of the notification register was 86.4%, giving an observed adult TB incidence rate of 202 per 100,000 population. After capture-recapture analysis, internal validity analysis and application of alternative truncated population estimation models, the estimated completeness of the notification register was 82-85%, giving an estimated adult TB incidence rate of between 204 and 212/100,000.

CONCLUSION

This study shows that the severity of the TB problem in Iasi County is under-reported. The results are in agreement with a previous estimate of the undernotification of TB in Romania by the the World Health Organization.

Connecting public health IT systems with enacted work: report of an ethnographic study

As part of a larger project to improve information transfer within public health settings, we studied the information workflow associated with communicable disease (CD) activities in a local health department. As part of that study we examined a newly adopted online system used for reporting CD data to the state department of public health. An information workflow analysis was performed using the ethnographic methods of interviews and observations. In addition to providing a detailed description of the context of CD reporting activities in a local health department, our study uncovered a mismatch between the newly piloted electronic reporting system and the CD work as enacted by health department personnel.

Standards for measures used for public reporting of efficiency in health care: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research and the American College of Cardiology Foundation

The assessment of medical practice is evolving rapidly in the United States. An initial focus on structure and process performance measures assessing the quality of medical care is now being supplemented with efficiency measures to quantify the "value" of healthcare delivery. This statement, building on prior work that articulated standards for publicly reported outcomes measures, identifies preferred attributes for measures used to assess efficiency in the allocation of healthcare resources. The attributes identified in this document combined with the previously published standards are intended to serve as criteria for assessing the suitability of efficiency measures for public reporting. This statement identifies the following attributes to be considered for publicly reported efficiency measures: integration of the quality and cost; valid cost measurement and analysis; minimal incentive to provide poor quality care; and proper attribution of the measure. The attributes described in this statement are relevant to a wide range of efforts to profile the efficiency of various healthcare providers, including hospitals, healthcare systems, managed-care organizations, physicians, group practices, and others that deliver coordinated care.

Internet death notices as a novel source of mortality surveillance data

Concerns about bioterrorism and influenza have focused attention on identifying novel data sources to enhance public health surveillance. The authors evaluated free Pittsburgh Post-Gazette Internet death notices for Allegheny County, Pennsylvania, as a potentially timely source of mortality data. Data abstracted from Internet death notices for 1998-2001 were compared with mortality records from the Pennsylvania Department of Health. Approximately 75% (44,294/60,281) of state records had death notices, and 91% (44,294/48,651) of death notices corresponded to a state record. There was a 2-day median lag from the date of death to online death notice publication. The date of death, gender, age, and name data were nearly 90% accurate and 60-100% complete. Increasing education and age were independently associated with increased Pittsburgh Post-Gazette reporting. Being non-White, female, or a nursing home resident were independently associated with decreased reporting. The Pittsburgh Post-Gazette Internet death notices provided accurate, timely mortality data for nearly three fourths of all Allegheny County deaths.

Enhancing public health law communication linkages

Although interest in the field of public health law has dramatically increased over the past two decades, there remain significant challenges in communicating and sharing public health law-related knowledge. Access to quality information, which may assist in a public health department's efforts to protect the public's health, welfare, and safety, varies widely from jurisdiction to jurisdiction, and interjurisdictional communication remains at best a patchwork quilt with many holes. What follows is an analysis of several approaches the Public Health Law Association or other public health law-related organizations might undertake to serve as a conduit for the identification, gathering, and dissemination of extant public health law information, as well as the development of new public health law-related content, with a particular focus on the use of electronic means for such efforts.

[The conceptual framework for decision making data elements in public health]

OBJECTIVE

To develop a conceptual framework for decision-making data elements (indicator) in public health through determining its dimensions, sub-dimensions and their interrelationships.

METHODS

On the basis of literatures review, conceptual analysis and health determinant models, a conceptual framework was set up. This framework construction followed five principles: evidence-based, applicable, public health relevant, systemic and extensible. While, with the principles of conceptualization, objective-orientation, independence, and number-restriction, the domain and subdomains were also developed.

RESULTS

A conceptual framework consisting of five domains and 20 sub-domains was developed. The 5 domains were health status, non-medical health determinants, public health system performance, the resources of public health system, and characteristics of community and assurance system. The health outcome included three subdomains of health status, functional status, and death; Non-medicine health determinants domain consisted of health behavior, working and living conditions, personal resources and environmental factors; performance domain was made up of effectiveness, accessibility, efficiency, responsibility and safety; resources domain had institution resources, human resources, financial resources, equipment resources and information resources; The characteristics of community and assurance system domain was the last domain which comprises characteristics of community, public health related policy and assurance system. The complicated relationship between these domains was also described.

CONCLUSION

As the abstraction of public health system, this conceptual framework comprehensively depicts the components of public health system and complicated process of public health system. This framework conforms to the medical care quality model which is made up of structure, process, intermediate results and outcomes.

[Standardizing basic data set in public health information system]

OBJECTIVES

To study methodologies and relevant data-element specifications for basic dataset development in China public health information system construction

METHODS

The goals and scopes were determined through data-viewing analysis, while the function model was developed through information viewing analysis. The components and the structure of the data sets were also identified to distill data elements.

RESULTS

50 basic datasets were developed and 1513 data elements were determined in 8 main domains and one public domain in China's public health information system. The 8 domains included Expanded Immunization Program (including 7 Basic Datasets and 326 data elements), Occupational Health and Poisoning (5 Basic Datasets and 158 data elements developed), Laboratory Management (9 Basic Datasets and 118 data elements included), Public Health Emergencies (including 3 Basic Datasets and 47 data elements), Infectious Disease Surveillance (4 Basic Datasets and 177 data elements developed), Non-Chronic Disease Surveillance (3 Basic Datasets and 64 data elements developed), Maternal and Child Health (totally 8 Basic Datasets and 368 data elements developed) and Environment Health (including 4 Basic Datasets and 72 data elements). One common domain consisted of 7 basic datasets and 183 data elements.

CONCLUSION

Standardizing basic datasets in public health information systems is an essential foundation in facilitating information system planning and the effective utilization of resources.

[Study on classification and coding for public health information]

OBJECTIVE

To improve data unified descriptions, identification, query and management in public health service by means of establishing public health information classification framework and coding system.

METHODS

Data sets created from all fields in public health, scientific research, health management were classified into four layers of frameworks primary class, sub-class, main class and subject areas by means of integration of vertical with horizontal classifications. All these classes were further abstracted, merged and coded by individual characteristics in public health systems.

RESULTS

(1) 4 subject areas in diseases control and prevention, public health service, public health management and sanitation surveillance were established including a total of 18 main classes, 49 sub-classes and 205 primary classes. (2) 7 digits and 4 segments (area code, code, disease classification code) were designed including a total of 30 digits multi-classification codes. The purpose of data effectively classifying and coding by application of 50 basic data sets in 9 areas fo public health has been realized.

CONCLUSION

We believe that this method is of efficiency in data classification and code for public health information communication.

Role of the Centers for Education and Research on Therapeutics (CERTs) in Pharmacovigilance and Proper Use of Therapeutics

According to the Institute of Medicine (IOM) Committee on the Assessment of the U.S. Drug Safety System, "The recent highly publicized controversies surrounding the safety of some drugs have contributed to a public perception that the drug safety system is in crisis. It seems fair to say that this perception has created an opportunity for a thorough evaluation of the U.S. drug safety system." The evaluation was focused on the U.S. Food and Drug Administration (FDA). To improve the FDA and its function in the public health system to improve therapeutics, it is critical to understand the contributions of other components.

Human error and time of occurrence in hazardous material events in mining and manufacturing

Human error has played a role in several large-scale hazardous materials events. To assess how human error and time of occurrence may have contributed to acute chemical releases, data from the Hazardous Substances Emergency Events Surveillance (HSEES) system for 1996-2003 were analyzed. Analyses were restricted to events in mining or manufacturing where human error was a contributing factor. The temporal distribution of releases was also evaluated to determine if the night shift impacted releases due to human error. Human error-related events in mining and manufacturing resulted in almost four times as many events with victims and almost three times as many events with evacuations compared with events in these industries where human error was not a contributing factor (10.3% versus 2.7% and 11.8% versus 4.5%, respectively). Time of occurrence of events attributable to human error in mining and manufacturing showed a widespread distribution for number of events, events with victims and evacuations, and hospitalizations and deaths, without apparent increased occurrence during the night shift. Utilizing human factor engineering in both front-end ergonomic design and retrospective incident investigation provides one potential systematic approach that may help minimize human error in workplace-related acute chemical releases and their resulting injuries.

Validation of the Provincial Transfer Authorization Centre database: a comprehensive database containing records of all inter-facility patient transfers in the province of Ontario

BACKGROUND

The Provincial Transfer Authorization Centre (PTAC) was established as a part of the emergency response in Ontario, Canada to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Prior to 2003, data relating to inter-facility patient transfers were not collected in a systematic manner. Then, in an emergency setting, a comprehensive database with a complex data collection process was established. For the first time in Ontario, population-based data for patient movement between healthcare facilities for a population of twelve million are available. The PTAC database stores all patient transfer data in a large database. There are few population-based patient transfer databases and the PTAC database is believed to be the largest example to house this novel dataset. A patient transfer database has also never been validated. This paper presents the validation of the PTAC database.

METHODS

A random sample of 100 patient inter-facility transfer records was compared to the corresponding institutional patient records from the sending healthcare facilities. Measures of agreement, including sensitivity, were calculated for the 12 common data variables.

RESULTS

Of the 100 randomly selected patient transfer records, 95 (95%) of the corresponding institutional patient records were located. Data variables in the categories patient demographics, facility identification and timing of transfer and reason and urgency of transfer had strong agreement levels. The 10 most commonly used data variables had accuracy rates that ranged from 85.3% to 100% and error rates ranging from 0 to 12.6%. These same variables had sensitivity values ranging from 0.87 to 1.0.

CONCLUSION

The very high level of agreement between institutional patient records and the PTAC data for fields compared in this study supports the validity of the PTAC database. For the first time, a population-based patient transfer database has been established. Although it was created during an emergency situation and data collection is dependent on front-line medical workers, the PTAC data has achieved a high level of validity, perhaps even higher than many purpose built databases created during non-emergency settings.

Standards for Statistical Models Used for Public Reporting of Health Outcomes

With the proliferation of efforts to report publicly the outcomes of healthcare providers and institutions, there is a growing need to define standards for the methods that are being employed. An interdisciplinary writing group identified 7 preferred attributes of statistical models used for publicly reported outcomes. These attributes include (1) clear and explicit definition of an appropriate patient sample, (2) clinical coherence of model variables, (3) sufficiently high-quality and timely data, (4) designation of an appropriate reference time before which covariates are derived and after which outcomes are measured, (5) use of an appropriate outcome and a standardized period of outcome assessment, (6) application of an analytical approach that takes into account the multilevel organization of data, and (7) disclosure of the methods used to compare outcomes, including disclosure of performance of risk-adjustment methodology in derivation and validation samples.

[Survey among local health departments concerning the implementation of the new infectious disease reporting system]

The Infectious Disease Control Act enacted in Germany in January 2001 led to the establishment of a new reporting system for infectious disease. The implementation of this system was evaluated to identify opportunities for further improvement. In a survey of all German local health departments the following criteria were analyzed: resources (staff and technical equipment), information needs (satisfaction with current offers/further training requirements), data analysis (extent of local data analysis/feedback of national data), and acceptability (case definitions/electronic reporting). In local health departments, 11% of the staff were assigned to the infectious disease reporting system. Data were processed mainly by nonmedical staff (78.4%). A computer work-station is available for most staff members. One-third of the local health departments uses the RKI software "SurvNet@rki" for data transmission. All others use commercial software. Experience with the electronic reporting system was rated as very good/good by 47.1% of local health departments, as satisfactory by 44.5%, and as problematic by 8.4%. Most of the local health departments were satisfied with the offers of information provided by RKI (96.4%) and state health departments (83.7%), respectively. However, 49.1% of the local health departments saw a need for further education and training. The implementation of case definitions was supported by 95% of the local health departments, but transmission criteria were criticized. In summary, the new infectious disease reporting system in Germany was successfully implemented. However, the system could be improved through reduction of software problems concerning electronic data processing and transmission, expansion of current offers of in-formation and provision of special staff training programs, and revision of the case definitions concerning clearness and simpler handling.

Recent irregularities in Table II of Morbidity and Mortality Weekly Report

Table II of Morbidity and Mortality Weekly Report each week displays the cumulative year-to-date provisional number of cases of selected notifiable diseases in the United States, by state. Thus comparisons between the same weeks for different years can allow a rough rapid tracking of trends. In recent years, particularly 2004, the reported provisional cases showed incongruities. As of April 16, 2004, for example, no AIDS cases at all appeared in Table II. Responses from government public health officials (Centers for Disease Control and Prevention (CDC) and State of California) indicate instabilities and problems in the public health surveillance and reporting system. Such instabilities and problems, if serious and enduring enough, could impair detection of threats to public health.

Der neue L�nderindikatorensatz f�r die Gesundheitsberichterstattung

In May 2003, the third revised version of the indicator set for health reporting activities was confirmed by the health ministries of all German States (Bundesländer). Modeled on the restructured indicator set which has been annotated with meta-data descriptions, most Bundesländer have now started to collect data for their specific health reporting activities. Thanks to the support provided by national data holders and the Federal Statistical Office, it has been possible to further enlarge the database and for the first time also ensure access via the Federal Statistical Office. In this contribution the authors describe the methodological and statistical principles of the indicator set. Another aspect is the benefit of the indicator set for the health reporting activities in the German States.

Quality of age data in patients from developing countries

BACKGROUND

Age misreporting is common in demographic studies but the prevalence and magnitude of age misreporting in clinical cohorts is unknown. We analysed single-year age distribution and terminal digit preference in cancer patients from developing countries.

METHOD

Age distribution was analysed by plotting a single-year age of 3874 cancer patients from 72 different countries, mainly from the Indian subcontinent and the Middle East, who resided in the UAE at the time of cancer diagnosis. Preference for age ending with digits '0' and '5' was evaluated using Whipple's index (WI), which has value 100 in cohorts without preference. Preference for all 10 terminal digits was expressed as the difference between the found and expected frequencies using Myers blended method and was graphed.

RESULTS

Age data quality was low in cancer patients from the Indian subcontinent (WI = 177) and Middle Eastern countries (WI = 113-204). Females of all nationalities supplied better quality of age data (lower WI) than males. Preference for age ending with digits '0' and '5' was found in all populations except the UAE male citizens who did not show preference for terminal digit '0'.

CONCLUSION

Age data quality in this cohort of patients from developing countries was low. Preference for age ending with numbers '0' and '5' is common. In studies conducted in developing countries, age data quality should be analysed as it may bias results and weaken the power of the study.

Completeness of ascertainment by cancer registries: putting bounds on the number of missing cases

BACKGROUND

When comparing cancer incidence or mortality rates between different regions, it is important to know how complete the registration data are on which these figures are based. A number of ways of estimating completeness have been proposed, but it is often difficult to say how precise these estimates are. We describe a computer program developed to produce measures of precision for estimates of completeness obtained by one such method, the flow method.

METHODS

The program works by resampling the required data sets, and repeatedly calculating completeness estimates until convergence of the standard errors occurs. It was tested on colorectal tumours from a single health district, and empirical confidence limits for 1 and 5 year completeness were compared with those obtained by applying various normalizing transformations and a beta distribution. The method was then applied to tumours of the head and neck, breast and lung and the results compared with those from a capture-mark-recapture exercise carried out 4 years previously.

RESULTS

The sampling distribution was close to normal for 1 year completeness, but much less so for 5 year completeness, as assessed by quantile plots. Approximation by a beta distribution was better than by normalizing transformation. Although there were differences between the results produced by the flow method and capture-recapture, the flow method is more reproducible and easier to apply.

CONCLUSION

It is now possible to estimate confidence limits for the results of the flow method, and thus determine whether comparative results between registries are likely to be affected by sampling error.

An evaluation of completeness of tuberculosis notification in the United Kingdom

BACKGROUND

There has been a resurgence of tuberculosis worldwide, mainly in developing countries but also affecting the United Kingdom (UK), and other Western countries. The control of tuberculosis is dependent on early identification of cases and timely notification to public health departments to ensure appropriate treatment of cases and screening of contacts. Tuberculosis is compulsorily notifiable in the UK, and the doctor making or suspecting the diagnosis is legally responsible for notification. There is evidence of under-reporting of tuberculosis. This has implications for the control of tuberculosis as a disproportionate number of people who become infected are the most vulnerable in society, and are less likely to be identified and notified to the public health system. These include the poor, the homeless, refugees and ethnic minorities.

METHOD

This study was a critical literature review on completeness of tuberculosis notification within the UK National Health Service (NHS) context. The review also identified data sources associated with reporting completeness and assessed whether studies corrected for undercount using capture-recapture (CR) methodology. Studies were included if they assessed completeness of tuberculosis notification quantitatively. The outcome measure used was notification completeness expressed between 0% and 100% of a defined denominator, or in numbers not notified where the denominator was unknown.

RESULTS

Seven studies that met the inclusion and exclusion criteria were identified through electronic and manual search of published and unpublished literature. One study used CR methodology. Analysis of the seven studies showed that undernotification varied from 7% to 27% in studies that had a denominator; and 38%-49% extra cases were identified in studies which examined specific data sources like pathology reports or prescriptions for anti-tuberculosis drugs. Cases notified were more likely to have positive microbiology than cases not notified which were more likely to have positive histopathology or be surgical in-patients. Collation of prescription data of two or more anti-tuberculosis drugs increases case ascertainment of tuberculosis.

CONCLUSION

The reporting of tuberculosis is incomplete in the UK, although notification is a statutory requirement. Undernotification leads to an underestimation of the disease burden and hinders implementation of appropriate prevention and control strategies. The notification system needs to be strengthened to include education and training of all sub-specialities involved in diagnosis and treatment of tuberculosis.

Benchmarking information needs and use in the Tennessee public health community

OBJECTIVE

The objective is to provide insight to understanding public health officials' needs and promote access to data repositories and communication tools.

METHODS

Survey questions were identified by a focus group with members drawn from the fields of librarianship, public health, and informatics. The resulting comprehensive information needs survey, organized in five distinct broad categories, was distributed to 775 Tennessee public health workers from ninety-five counties in 1999 as part of the National Library of Medicine-funded Partners in Information Access contract.

RESULTS

The assessment pooled responses from 571 public health workers (73% return rate) representing seventy-two of ninety-five counties (53.4% urban and 46.6% rural) about their information-seeking behaviors, frequency of resources used, computer skills, and level of Internet access. Sixty-four percent of urban and 43% of rural respondents had email access at work and more than 50% of both urban and rural respondents had email at home (N = 289). Approximately 70% of urban and 78% of rural public health officials never or seldom used or needed the Centers for Disease Control (CDC) Website. Frequency data pooled from eleven job categories representing a subgroup of 232 health care professionals showed 72% never or seldom used or needed MEDLINE. Electronic resources used daily or weekly were email, Internet search engines, internal databases and mailing lists, and the Tennessee Department of Health Website.

CONCLUSIONS

While, due to the small sample size, data cannot be generalized to the larger population, a clear trend of significant barriers to computer and Internet access can be identified across the public health community. This contributes to an overall limited use of existing electronic resources that inhibits evidence-based practice.

LASIK complications and the Internet: is the public being misled?

BACKGROUND

LASIK (Laser in Situ Keratomileusis) is a very popular combined surgical and laser procedure, which is used to correct myopia (shortsightedness) and hyperopia (farsightedness). There is concern that the public is being misled regarding the safety of the procedure.

OBJECTIVES

To assess the quality and quantity of the information on complications on LASIK Web sites.

METHOD

Serial analysis and evaluation of the authorship, content, and technical quality of the information on the complications of LASIK on 21 Web sites.

RESULTS

Of the 21 LASIK Web sites visited, 17 were commercial. Of the 21 Web sites, 5 (24%) had no information on complications. Of the 16 sites that had information on complications the author of the information was clearly identified in 5 (31%), the content was only referenced in 2 (12.5%), and evidence of the information having been updated was only seen in 2 (12.5%). The quantity of information is generally minimal and the information itself is generally difficult to understand and locate.

CONCLUSION

The quality and quantity of the information on the Web on the complications of LASIK are poor. More work is required to encourage clear, accurate, up-to-date, clearly authored, and well-referenced, balanced ophthalmic information.

Classification of transmission risk in the national HIV/AIDS surveillance system

Risk behavior information is essential for allocating resources and developing effective HIV prevention strategies. Over time, transmission risk information on HIV/AIDS cases has been less likely to be reported to the national surveillance system. The Centers for Disease Control and Prevention (CDC) invited approximately 30 experts in HIV/AIDS and behavioral research from state and local health departments, academia, community-based organizations, and the CDC to participate in a consultation in December 2001 to generate ideas on how best to deal with the lack of risk data. The group was charged with providing recommendations on methods for classifying and reporting risk information and for identifying methods and sources for improving ascertainment of transmission risk behaviors for individuals infected with HIV. This report describes the recommendations and the effects of implementing such recommended procedures on the national HIV/AIDS surveillance database.