OBJECTIVES. CDC WONDER, a comprehensive on-line public health information system of the Centers for Disease Control and Prevention (CDC), was developed to place timely, action-oriented information in the hands of public health professionals. METHODS. A unified system was developed de novo to be used for and to evolve along with public health. All data are stored and updated on the CDC mainframe. RESULTS. CDC WONDER provides menu-driven access to 24 databases with information on mortality, hospital discharges, cancer incidence, notifiable diseases, acquired immunodeficiency syndrome, the Morbidity and Mortality Weekly Report, etc.; each database has on-line documentation. Results can be tabulated and graphed, and there is full-text searching of textual databases. Non-CDC staff have access via telephone connection. From August 1991 through June 1992, system databases were accessed 10,698 times, and there were 842 users (mean of 97 new users per month). CONCLUSIONS. CDC WONDER has shown that it is possible to build a large, on-line database of scientific data for public health professionals. CDC WONDER provides a common foundation from which to build information-based public health plans and policy and could help strengthen the public health system.
The combination of the burgeoning interest in health, health care reform and the advent of the Information Age, represents a challenge and an opportunity for public health. If public health’s effectiveness and profile are to grow, practitioners and researchers will need reliable, timely informati6n with which to make information-driven decisions, better ways to communicate, and improved tools to analyze and present new knowledge. “Public Health Informatics” (PHI) is the science of applying Information- Age technology to serve the specialized needs of public health. In this paper we define Public Health Informatics, outline specific benefits that may accrue from its widespread application, and discuss why and how an academic discipline of public health informatics should be developed. Finally, we make specific recommendations for actions that government and academia can take to assure that public health professionals have the systems, tools, and training to use PHI to advance the mission of public health.
In 1983, 89,000 children were bom to United States women aged sl16. To reduce teenage fertility rates, public health workers will need to identify teenagers at elevated risk for childbearing. We tested the hypothesis that the sisters of childbearing teenagers may form such a group. We performed an historical cohort study of 3,767 teenagers aged 12-16 years who were enrolled in Arkansas Aid to Families with Dependent Children (AFDC), 1978-81; they had 247 pregnancies. Multivariable log-linear hazard models were used to control and study age, race, number of
(12).The purpose of this study was to estimate the half-life of PBB in human blood sera in order to contribute to our understanding of how continued body burden relates to the possible adverse health consequences of exposure. We found only one previous report of the half-life of PBB in humans (13). This study gave a median estimate of 12 years with a range of 4.6-94.7 years. This estimate was determined by serum measurements from 15 females and 12 males; the half-life for females and males was similar. An experimental half-life determined in rats using a multicompartment model that was then extrapolated to humans was reported as 6.5 years (14); the elimination of PBB from rat serum has been shown to be first order (15). A linear relationship between PBB concentrations in adipose tissue and in serum with a ratio of approximately 300:1 has been demonstrated; the different congeners of PBB do not have significantly different partition ratios (16,17). MethodsWe used data and participants from the Michigan PBB prospective cohort project, which was started in 1975 and was previously described by Pirkle et al. (18). The Michigan investigators enrolled people in the study if they were residents of farms quarantined because of PBB in milk detected at 300 ppb, in eggs detected at 50 ppb (N = 2148), or if they were recipients of food products from quarantined farms (N = 1421). Participation was over 95%. Subjects answered a questionnaire, provided a blood sample, and were followed over time to contribute new blood samples and answer follow-up questionnaires.Participants from the cohort were eligible for inclusion in our analysis if they: 1) lived on a quarantined farm or consumed food products from such a farm; 2) had at least two PBB level determinations between 1976 and 1982 that were a minimum of 1 year apart; 3) were over 18 years of age at the time of their first PBB level measurement; and 4) had an initial PBB level determination of at least 20 pbb. We included the age requirement because continued growth may affect measured PBB levels and half-life (19,20 Ct represents concentration at later times, and k is the rate of decline (21). After taking logarithms and rearranging, this formula is equivalent to -k = Alog(C)/At, where Alog(C) is the change in the log of PBB measurements and At is the change in time between the measurements. The estimated half-life is then equal to log(2)/X. We estimated k for each individual using simple linear regression of eligible PBB measurements and the times between them. We estimated the half-life using two methods in order to better summarize the data. The first method used the median of the individual x values to estimate the halflife. Confidence intervals (CI) were calculated using distribution-free techniques (22). The second method used the mean of the individual X values. Weighting subjects according to the number of available PBB measurements for sensitivity analysis did not change the results. The SAS system was used for calculations
WONDER is an information management architecture designed for public health. It provides access to information and communications without the user's needing to know the location of data or communication pathways and mechanisms. CDC WONDER users have access to extractions from some 40 databases; electronic mail (e-mail); and surveillance data processing. System components include the Remote Client, the Communications Server, the Queue Managers, and Data Servers and Process Servers. The Remote Client software resides in the user's machine; other components are at the Centers for Disease Control and Prevention (CDC). The Remote Client, the Communications Server, and the Applications Server provide access to the information and functions in the Data Servers and Process Servers. The system architecture is based on cooperative processing, and components are coupled via pure message passing, using several protocols. This architecture allows flexibility in the choice of hardware and software. One system limitation is that final results from some subsystems are obtained slowly. Although designed for public health, CDC WONDER could be useful for other disciplines that need flexible, integrated information exchange.
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