Fast Healthcare Interoperability Resources (FHIR) for Interoperability in Health Research: A Systematic Review (Preprint)

BACKGROUND The standard Fast Healthcare Interoperability Resources (FHIR) is widely used in health information technology. However, its use as a standard for health research is still less prevalent. To use existing data sources more efficiently for health research, data interoperability becomes increasingly important. FHIR provides solutions by offering resource domains such as “Public Health & Research” and “Evidence-Based Medicine” while using already established web technologies. Therefore, FHIR could help to standardize data across different data sources and improve interoperability in health research. OBJECTIVE The aim of our study was to provide a systematic review of existing literature and determine the current state of FHIR implementations in health research and possible future directions. METHODS We searched PubMed/Medline, EMBASE, Web of Science, IEEE Xplore and the Cochrane Library databases for studies published from 2010 to 2021. Studies investigating the use of FHIR in health research were included. Articles published before 2010, abstracts, reviews, editorials and expert opinions were excluded. We followed the PRISMA guidelines and registered this study with PROSPERO, CRD42021235393. Data synthesis was done in tables and figures. RESULTS We identified a total of 674 studies, of which 28 studies were eligible for inclusion. Most studies covered the domain of clinical research (22/28) while the remaining studies focused on public health/ epidemiology (3/28) or did not specify their research domain (3/28). Studies used FHIR for data capture (11/28), standardization of data (7/28), analysis (4/28), recruitment (4/28) and consent management (2/28). Most studies had a generic approach (15/28) and nine of 13 studies focusing on specific medical specialties (infectious disease, genomics, oncology, environmental health, imaging, pulmonary hypertension) reported their solutions to be conferrable to other use cases. Half of the studies reported using additional data models or terminologies: SNOMED CT (8/14), LOINC (8/14), ICD-10 (6/14), OMOP CDM (3/14) and others (9/14). Only one study used a FHIR resource from the domain “Public Health & Research”. Limitations using FHIR included the possible change in the content of FHIR resources, safety and legal matters and the need for a FHIR server. CONCLUSIONS Our review found that FHIR can be implemented in health research and that the areas of application are broad and generalizable in most use cases. Implementation of international terminologies was common and other standards such as OMOP CDM could be used complementary with FHIR. Limitations such as change of FHIR content, lack of FHIR implementation, safety and legal matters need to be addressed in future releases to expand the use of FHIR and therefore interoperability in health research.

Research themes of family and community physicians in Brazil

Family and community medicine is a specialty dedicated to primary care, the cornerstone of effective health systems. Research capacity in primary care varies worldwide, and bibliographic databases such as MEDLINE, Scopus and Web of Science do not index most primary care research coming from Latin America. Our objective was to investigate the research themes of family and community physicians in Brazil, and to correlate the articles' research themes with their authors' trajectories in postgraduate education. For that, we compiled a national list of family and community physicians, retrieved their curricula from the Lattes Platform, compiled a list of journal articles, and obtained their keywords from LILACS and MEDLINE. Treating journal articles and their keywords as the two node types in a bipartite network, we derived research themes using the dual-projection algorithm, combining the Leiden algorithm with hierarchical clustering. We found two research themes to be the largest, most developed, and most central ones: human health and primary care. Authors with a master's or PhD in collective health (public health, epidemiology, and social sciences and humanities in health) were as likely as those with no postgraduate degree to publish articles on primary care. On the other hand, authors with a postgraduate degree in medicine were more likely to publish articles on human health. After discussing the findings in light of previous research and methodological aspects, we conclude there's a relative divide between primary care and clinical research, and the highlight policy implications.

Comparative Analysis and Data Provenance for 1,113 Bacterial Genome Assemblies

The quality and traceability of microbial genomics data in public databases is deteriorating as they rapidly expand and struggle to cope with data curation challenges. While the availability of public genomic data has become essential for modern life sciences research, the curation of the data is a growing area of concern that has significant real-world impacts on public health epidemiology, drug discovery, and environmental biosurveillance research. While public microbial genome databases such as NCBI's RefSeq database leverage the scalability of crowd sourcing for growth, they do not require data provenance to the original biological source materials or accurate descriptions of how the data was produced. Here, we describe the de novo assembly of 1,113 bacterial genome references produced from authenticated materials sourced from the American Type Culture Collection (ATCC), each with full data provenance. Over 98% of these ATCC Standard Reference Genomes (ASRGs) are superior to assemblies for comparable strains found in NCBI's RefSeq database. Comparative genomics analysis revealed significant issues in RefSeq bacterial genome assemblies related to genome completeness, mutations, structural differences, metadata errors, and gaps in traceability to the original biological source materials. For example, nearly half of RefSeq assemblies lack details on sample source information, sequencing technology, or bioinformatics methods. We suggest there is an intrinsic connection between the quality of genomic metadata, the traceability of the data, and the methods used to produce them with the quality of the resulting genome assemblies themselves. Our results highlight common problems with "reference genomes" and underscore the importance of data provenance for precision science and reproducibility. These gaps in metadata accuracy and data provenance represent an "elephant in the room" for microbial genomics research, but addressing these issues would require raising the level of accountability for data depositors and our own expectations of data quality.

Nutrient Density as a Dimension of Dietary Quality: Findings of the Nutrient Density Approach in a Multi-Center Evaluation

The nutrient adequacy of a diet is typically assessed by comparing estimated nutrient intakes with established average nutrient requirements; this approach does not consider total energy consumed. In this multinational survey investigation in Indonesia, Mexico, and South Africa, we explore the applications of the “critical nutrient-density approach”—which brings energy requirements into the equation—in the context of public health epidemiology. We conducted 24 h dietary recalls in convenience samples of normal-weight (BMI 18.5–25 kg/m2) or obese (BMI > 30 kg/m2), low-income women in three settings (n = 290). Dietary adequacy was assessed both in absolute terms and using the nutrient density approach. No significant differences in energy and nutrient intakes were observed between normal-weight and obese women within any of the three samples (p > 0.05). Both the cut-point method (% of EAR) and critical nutrient density approach revealed a high probability of inadequate intakes for several micronutrients but with poor concordance between the two methods. We conclude that it may often require some approximate estimate of the habitual energy intake from an empirical source to apply a true critical nutrient density reference for a population or subgroup. This will logically signify that there would be more “problem nutrients” in the diets examined with this nutrient density approach, and efforts toward improved food selection or food- or biofortification will frequently be indicated.

Developing Status and Hotspot Analysis of Health Policy With Bibliometrics Methods: 2011-2020

Objectives: This study mainly discusses the developing status in the field of health policy in recent two decades to provide an effective reference for researchers.Methods: Health policy publications published in Web of Science between 2011 to 2020 were searched, screened, organized, and analyzed the yearly-outputs, research author, institution, regional distribution, keywords, subject categories, and so on.Results: The total number of publications in health policy has shown a trend of upward in the past twenty years. Health policy was identified as the most productive journal. The research of United States takes the lead in this field. Health care, public health, epidemiology, children, and quality of life will likely to take a dominant position in future research.Conclusion: The field of health policy has developed a stable research community with good partnerships, and the high-impact authors lead the development of the discipline. The hotspots of health policy research are constantly updated with the trend of social development and have strong timeliness. With constantly study, health policy has become a relatively mature research topic, but it doesn't mean the termination of the study. It remains to be properly explored and improved to protect people’s health and promote the quality of life in the future.

The history of the F. Erisman Institute of Public Health and its directions of activity during the COVID-19 pandemic

In 2020, exactly 90 years have passed since the first sanitary faculty in the history of medical education (F. ErismannInstitute of Public Health, nowadays) was found in the 1st Moscow Medical Institute (Sechenov University, nowadays).The history of the faculty unites the names of prominent scientists in the field of preventive medicine: F. Erismann, N.A. Semashko, A.V. Molkov, A.N. Sysin, E.M. Tareev and many, many others. New challenges to public health continueto appear in our time. The direction of “preventive medicine” has become more important than ever in the context of a pandemic of infection caused by the novel coronavirus (COronaVIrus Disease-19, COVID-19). The issues of epidemiologyand hygiene have become extremely relevant for doctors of any profile, not only for preventive ones (epidemiologists and hygienists). The strategic task today is to increase the “preventive medicine” specialty’s authority. It is also important to preserve and enhance the domestic experience of studying the disciplines of preventive medicine, harmonizing the content of educational programs with the world community. Research work at the Institute is carried out in 4 main areas of preventive medicine and public health: epidemiology, public health, microbiology, and hygiene.This review presents the main historical milestones in the development of teaching the specialty “preventive medicine” at the Sechenov University, the current state, and prospects for further development.

Real-World Skills in a Virtual World: An Innovative Activity for Teaching Developmental Psychopathology

Background Incorporating professional development into undergraduate psychology coursework is an ongoing area of improvement for educators. Objective We present a novel activity encouraging students to explore various professional skills and roles for which their psychology major prepares them through application to real-world issues. Method Students participated in one of two virtual mental health summits and formed working groups to present from different perspectives (e.g., public health, epidemiology, etc.). Students collectively voted on resolutions at the end of each summit (e.g., budgetary recommendations for a county health department). Results We examined student perceptions of confidence in their professional skills and content knowledge before and after summits. Students indicated that they wanted more applied assignments like the mental health summit in other psychology classes and preferred the activity to exams or papers in a virtual course.Teaching Implications The mental health summit represented a real-world application activity that students indicated wanting in their courses. Recommendations for how to adapt the presented activity for non-clinical psychology courses are discussed. Conclusion The mental health summit activity supported the real-world application that students desire. Future iterations of the activity can build on the model we describe to support greater skill improvement.

Causal and Associational Linking Language From Observational Research and Health Evaluation Literature in Practice: A systematic language evaluation

Background: Avoiding "causal" language with observational study designs is common publication practice, often justified as being a more cautious approach to interpretation. Objectives: We aimed to i) estimate the degree to which causality was implied by both the language linking exposures to outcomes and by action recommendations in the high-profile health literature ii) examine disconnects between language and recommendations, iii) identify which linking phrases were most common, and iv) generate estimates by which these phrases imply causality. Methods: We identified 18 of the most prominent general medical/public health/epidemiology journals, and searched and screened for articles published from 2010 to 2019 that investigated exposure/outcome pairs until we reached 65 non-RCT articles per journal (n=1,170). Two reviewers and an arbitrating reviewer rated the degree to which they believed causality had been implied by the language in abstracts based on written guidance. Reviewers then rated causal implications of linking words in isolation. For comparison, additional review was performed for full texts and for a secondary sample of RCTs. Results: Reviewers rated the causal implication of the sentence and phrase linking the exposure and outcome as None (i.e. makes no causal implication) in 13.8%, Weak in 34.2%, Moderate in 33.2%, and Strong in 18.7% of abstracts. Reviewers identified an action recommendation in 34.2% of abstracts. Of these action recommendations, reviewers rated the causal implications as None in 5.3%, Weak in 19.0%, Moderate in 42.8% and Strong in 33.0% of cases. The implied causality of action recommendations was often higher than the implied causality of linking sentences (44.5%) or commensurate (40.3%), with 15.3% being weaker. The most common linking word root identified in abstracts was "associate" (n=535/1,170; 45.7%) (e.g. "association," "associated," etc). There were only 16 (1.4%) abstracts using "cause" in the linking or modifying phrases. Reviewer ratings for causal implications of word roots were highly heterogeneous, including those commonly considered non-causal. Discussion: We found substantial disconnects between causal implications used to link an exposure to an outcome vs action implications made. This undercuts common assumptions about what words are often considered non-causal and that policing them eliminates causal implications. We recommend that instead of policing words; editors, researchers, and communicators should increase efforts at making research questions, as well as the potential of studies to answer them, more transparent.

Evaluating the Continued Integration of Genetics into Medical Sociology

The 2010 special issue of Journal of Health and Social Behavior, titled “Fifty Years of Medical Sociology,” defined the contours of the medical sociological perspective. We use this as a backdrop to outline and assess the continued integration of genetics into medical sociology research. We contend that the explosion of genetic and epigenetic data in population health data sources has made the medical sociological perspective increasingly relevant to researchers outside of sociology, including public health, epidemiology, and quantitative genetics. We describe vast, underappreciated, and mostly unsolved challenges that limit the scientifically appropriate interest in incorporating genetics into existing paradigms. It is our hope that medical sociologists continue this integration but redouble efforts to maintain the core insights in social science research, such as the importance of environmental and structural (i.e., nonbiological) factors in determining health processes and outcomes and the use of rich, integrated, and rigorous empirical analyses.

Understanding and Analyzing Social Network Structure Among University Students

Mobile phone arguably is one of the most reached and used technology in human history. Technology has become ubiquitous in the life of human beings. Equipped with multiple sensors and devices, smartphones can record each and every action, psychological and environmental states of users, making it a goldmine of rich data about and insight into the dynamics of human communication, human behavior, relationships, and social interaction. As a source of data for empirical research, this device has gotten much attention from scholars in various disciplines like sociology, social psychology, urban studies, communication and media studies, public health, epidemiology, and computer science. This research tries to understand the structure of social networks of university students by investigating their communication patterns using self-reported mobile phone data. We collected behavioral data for one month using a Call Log Analytics mobile phone app. The data contained information about respondents’ contacts, date and time of call, duration of the call, call type (e.g., incoming, outgoing, missed), and frequency of the call. We used UCINET to analyze the data. In this investigation, we can find those students who are connected to most of the classmates and maintain a strong relationship and perform a task successfully using the values of eigenvector, closeness, and betweenness centrality, respectively. Moreover, this study also helps us to find out the pattern of the students using contact duration, incoming and outgoing calls.