The Perinatal Database of the Netherlands

OBJECTIVE

In the Netherlands, the Perinatal Database of the Netherlands (Landelijke Verloskunderegistratie, LVR) was set up in 1982 for secondary care obstetric departments on a voluntary participation basis, its main goal being quality monitoring. At the outset of the database, 70% of Dutch obstetric departments participated immediately. This percentage has now increased to almost 100%. How the LVR was set up, its aims, participation, general function and some aspects of the reliability are described in this article.

RESULTS

Assessment of the reliability of the data on a number of points found that the frequency of various types of nearly all errors has decreased during the existence of the LVR, with the exception of a complete registration of the first-week mortality.

CONCLUSIONS

The quality of the data has improved over the years. More reliable figures for the first-week mortality would be available if the LVR data were linked to those of the Neonatal Database of the Netherlands (Landelijk Neonatale Registratie, LNR), so that the condition of each child is known up to and including 28 days after birth. Improvements in the reliability of other items can be attained by implementing more checks during the data input stage and by making the data more accessible to the gynaecologists, in order to further increase motivation to record the data.

[Vaccination policy in Flanders]

In the recent past (1997) the Flemish authorities have turned the vaccination policy into one of the top priorities of their health policy. Following the WHO-guidelines they have brought forward a health objective anticipating a significant increase of the vaccination rate for a number of infectious diseases by 2002. Recent research shows that attention should be paid especially to measles, mumps and rubella (83% vaccination rate at 18-24 months), hepatitis B (74-69%) and type b haemophilus influenzae (78%). The vaccination rate in Flanders for polio, diphtheria, tetanus and whooping cough is good or adequate at the age of 18-24 months. In 2000, the Flemish authorities reserve about BEF 80 million for the purchase of basic vaccines distributed for free through their health inspections, just like in the previous years. In order to realise this objective, all medical bodies carrying responsibility in this field are appealed to. Moreover, the local regional consultative bodies, financially supported by the Flemish Community, may be expected to play a stimulating role in, so far, four out of the five Flemish provinces. A strong management from a central Flemish vaccination umbrella organisation is considered to be indispensable in order to have the vaccinating bodies deliberate, have them build a consensus and motivate them. This should result in clear and generally accepted vaccination schedules and a well-informed and sensitised population. A project in view of a rapid and efficient registration of vaccination data in a central Flemish vaccination database, accessible for vaccinating doctors is now running with 'Child and Family' and can subsequently be extended to the entire target group.

Children dying in car trunks: how adequate are child death databases?

OBJECTIVE

To determine the frequency of and circumstances surrounding child deaths resulting from inadvertent entrapment in motor vehicle trunks in the US by querying child fatality review databases.

METHOD

A telephone survey was conducted with the persons or offices identified as having primary responsibility for child fatality review programs in each state. The survey requested information on the number of child deaths resulting from trunk entrapments, the ages of the victims, the time period covered by the surveillance system, and variables concerning the circumstances surrounding each incident.

RESULTS

All states reported that these deaths are exceedingly rare, with most reporting no such events in recent history. However, state databases could not be readily accessed to identify such deaths. There was enormous interstate variation in guidelines governing the population covered by the child fatality review process. The age range varied greatly from one jurisdiction to another, and often only children in the state's welfare system were included. Interstate differences in practices preclude meaningful compilation of data across jurisdictions.

CONCLUSIONS

It was not possible to ascertain the incidence of inadvertent entrapment of children in vehicle trunks because there is no consistency in the available databases. A national database of child fatalities, based on standardized guidelines and definitions, is needed to identify causes and magnitude of specific child deaths, in order to design, implement, and evaluate interventions.

Iceland's plan for genomics research: facts and implications

The government of Iceland has authorized a private, for-profit firm, deCODE Genetics, to construct a database of the population's medical records as part of a larger plan by deCODE for human genetics research. This article presents the background for genetics research in Iceland, the history of deCODE, and the terms of the law authorizing the database. It then examines five objections to the law, based on commercialization, lack of informed consent, risks to privacy, the effects of other research, and financial unfairness. It concludes that the Icelandic model is not a good precedent for similar research elsewhere.

Hospitals won't be able to access HIPAA data bank

The new Healthcare Integrity and Protection Data Bank, designed to complement the 10-year-old National Practitioner Data Bank, offers a wealth of information on final adverse actions taken against health care providers. The catch? By law, hospitals are barred from accessing the data bank.

Morality of the privacy of genetic information: possible improvements of procedures

Genetic screening has opened up new paths for progress in preventive and curative medicine, and will probably progressively increase its positive contribution in the future. Rules and regulations have been established attempting to protect the donors' rights and to avoid damage to the donor and to others. Present day regulations seem unable to prevent the occurrence of serious problems and possible dangers. These are: 1. Ownership of genetic information and right to determine to whom it is divulged. 2. Direct emotional damage to individuals (mainly young persons expecting late-onset catastrophes) by having the information. 3. Damage caused by unsought for findings. 4. Restriction of transfer of information to the stated aim. 5. Right to release information important for public safety. The aim of this article is to propose that the donor's ownership of the information be abolished and that a board should decide to whom the genetic information should be given. An alternative solution is to leave the decisions regarding to whom genetic information should be divulged in the hands of the donor and his physician, controlled by an institutional review board.

Coping with change: intellectual property rights, new legislation, and the human mutation database initiative

In 1996, the European Union issued a directive requiring member states to protect databases against unauthorized copying. Similar legislation is currently being considered and will probably be enacted in the US. Such database legislation 1) will almost certainly increase existing pressures on human mutation databases to commercialize, and 2) could inadvertently make human mutation data harder to acquire and use. Strategies for minimizing these difficulties are discussed. Alternatively, a nonprofit, community-wide "depository" could probably support itself by selling sophisticated bioinformatic products to the private sector. The proposed depository would offer substantially similar databases to academic and government users at little or no cost.

Central health database in Iceland and patients' rights

Abstract

No Abstract

Health care data and their sources

This article outlines the types of health care data currently available from internal and external sources. It describes utilization, outcomes, and financial data. It focuses on information available through computer abstract hospital databases. It provides information concerning the sources and content of these databases.

The EMBL Nucleotide Sequence Database. Contributing and accessing data

The European Molecular Biology Laboratory Nucleotide Sequence Database receives sequence and sequence annotation data from genome projects, sequencing centers, individual scientists, and patent offices. Data may be most efficiently submitted to the database using the Internet based submission tool WEBIN or via previously established genome project accounts. Biologist curators will review the data and provide accession numbers within two working days. Non-confidential data are exchanged daily in an international collaboration between EMBL. DDBJ (the DNA Databank of Japan) and GenBank (USA) and may be accessed and retrieved via the Internet with the Sequence Retrieval System (SRS). Sequence database searching algorithms (e.g., Blitz, Fasta, Blast) are available for comparison of query to database sequences.