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CDC and ATSDR electronic information resources for health officers.

Introduction

The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) are national resources for both public health information and information retrieval tools. (Hereafter, CDC will be used to refer to both CDC and ATSDR.) To help public health practitioners make better use of these resources, some of the more important information resources and information technology (IT) tools available from CDC are described. These tools make public health information accessible via computer and automated telephone systems and on electronic media (diskette and CD-ROM). At CDC, the Information Resources Management Office has lead responsibility for developing enterprise-wide information and computer systems and for exploring new technologies for CDC's use. However, many systems (and almost all data resources) are developed by CDC offices that have responsibility for a specific disease (e.g., acquired immunodeficiency syndrome [AIDS]) or a public health practice area (e.g., surveillance or training). Hence, there is no single point of inquiry for the public health official who wants to learn about CDC's information and IT offerings. This article is written with the needs of this prototypical "public health official" in mind.

To assemble this list of systems, key informants at CDC were contacted regarding known systems. In addition, the assistance of the CDC Excellence in Science Committee and the CDC Information Resource Management coordinators was requested in identifying other useful systems. The system descriptions were prepared by the authors, often with the assistance of the CDC office responsible for the system.

This listing is not all-inclusive, but rather it highlights those systems that were judged to be of most general use to the health officer. Mechanisms for finding and retrieving CDC reports, querying CDC's numeric data files, transmitting surveillance and other data files to CDC, exchanging electronic mail with CDC staff, and disseminating state and local public health information and data using CDC IT tools are reviewed. Within each of these sections, the resources are ordered roughly by the level of complexity of the required technology at the user's end (from telephone, to standalone microcomputer, to microcomputer-plus-modem, to the Internet) and then alphabetically. Each resource is followed by a list that details information on obtaining access, equipment required, cost, and cognizant CDC office. Further information about any of these systems may be requested by writing the specific CDC office, at 1600 Clifton Road NE, Atlanta, GA 30333; the CDC switchboard can be reached at (404) 639-3311. (Individual telephone numbers are not provided because they change so frequently.) Note that certain key information resources (e.g., the Morbidity and Mortality Weekly Report [MMWR] and international travel advisories) may be accessed several ways.

The potential user of these systems must be forewarned that most of these systems are not integrated with each other, nor do they share common interfaces or data standards (1). CDC is aware of this problem and is currently working hard to streamline and coordinate its IT efforts.

OBTAINING REPORTS

This section summarizes access to reports (i.e., articles that contain a mix of text, tables, and figures). They typically represent summaries of important recommendations, topics, or research findings.

Information available by telephone or fax

CDC Voice Information System

The CDC Voice Information System (VIS) provides telephone access to hundreds of prerecorded messages on subjects such as AIDS, immunizations, hepatitis, chronic fatigue syndrome, Lyme disease, and injuries (to name just a few). There is a special section for information for travelers. The injury choice has a section on obtaining grants.

Hundreds of documents can be "faxed back" to the caller (callers enter their fax number using a touch-tone telephone). Callers may request up to five documents at a time; certain documents can be mailed. Most of the documents are written for the lay public.

There is often information on late-breaking news (e.g., outbreaks). Some choices offer the option of being transferred to a CDC professional who can answer more specific questions.

Obtaining access: (404) 332-4555 (voice and fax); (404) 332-4565 (fax only)

Required equipment: Touch-tone telephone; access to long distance line

Cost: None, except for long distance charges; there is no charge for documents faxed or mailed to users

CDC office: Information Center, Information Resources Management Office (Dorothy S. Knight)

National Institute for Occupational Safety and Health (NIOSH) Information System

The NIOSH Information System provides telephone access to ordering information on NIOSH publications and databases (including the Pocket Guide to Chemical Hazards, Manual of Analytical Methods, NIOSHTIC[R], and RTECS[R] [the databases are discussed separately in the text that follows]); prerecorded information on timely topics such as indoor air quality, carpal tunnel syndrome, homicide in the workplace, and so on; information about NIOSH training materials, including videos; information on obtaining NIOSH grants; and an explanation on how to request a NIOSH investigation of workplace hazards. There is also the option of being transferred to a CDC professional who can answer more specific questions. Unlike the CDC VIS described previously, much of this information is targeted at public health professionals, although some of the material is intended to provide the general public with access to NIOSH information.

Obtaining access: (800) 356-4674

Required equipment: Touch-tone telephone; access to long distance line

Cost: None

CDC office: National Institute for Occupational Safety and Health (Rodger Tatken)

Information available on CD-ROM and diskettes

Toxicological profiles

ATSDR's Toxicological Profiles (on CD-ROM) consists of all final ATSDR toxicological profiles, which are extensively peer-reviewed, covering the toxicological effects of hazardous substances, chemicals, and compounds. It contains more than 14,000 pages worth of comprehensive, up-to-date data on the mitigation of health effects, all available health data, and data gaps. Each profile includes an examination, summary, and interpretation of available toxicological and epidemiological data evaluations of the hazardous substance, including environmental fate; and a determination of the levels of significant human exposure for the substance and the associated acute, intermediate, and chronic health effects. It is fully indexed and can be searched easily (including across profiles).

Obtaining access: Order from CRC Press Inc., 2000 Corporate Blvd., NW, Boca Raton, FL 33431; (800) 272-7737; (800) 374-3401 (fax)

Required equipment: DOS-based microcomputer, Windows, CD-ROM drive

Cost: $125

CDC office: Agency for Toxic Substances and Disease Registry (Lester Smith, Ph.D.)

CDC Prevention Guidelines Database

The CDC Prevention Guidelines Database (PGDB; on diskettes and CD-ROM) contains all of CDC's officially cleared recommendations and guidelines for the prevention of disease, injury, and disability, and many of CDC's guidelines for public health practice. The material for this database was assembled in a cooperative project by liaisons in all of CDC's centers, institutes, and offices, under the guidance of a steering committee from the Public Health Practices Program Office, the Information Resources Management Office, and the Epidemiology Program Office.

The PGDB contains over 400 prevention guidelines documents. About two thirds of these documents were originally published in the MMWR; the rest were published as CDC monographs, brochures, book chapters, and peer-reviewed journal articles.

Most of the articles are relatively short; some (such as Health Information for International Travel 1994 and Youth Suicide Prevention Programs: A Resource Guide) are book length. Although the main PGDB at CDC is updated weekly, the CD-ROM/diskettes version is published quarterly.

Obtaining access: See CDC office; note that the PGDB may also be accessed via CDC WONDER (discussed below)

Required equipment: DOS-based personal computer and Microsoft Windows; a CD-ROM drive is required for the CD-ROM version

Cost: $49.95 for initial dataset; there is a small charge every year for updates

CDC office: Information Resources Management Office, Public Health Information Systems Branch (Patrick W. O'Carroll, M.D., M.P.H.)

Chronic Disease Prevention File

The Chronic Disease Prevention (CDP) File (CD-ROM version) contains six comprehensive bibliographic datasets:

1. The Health Promotion and Education Dataset, which contains over 25,000 bibliographic citations and abstracts focusing on disease prevention and health promotion, including program information;

2. The Comprehensive School Health Dataset, which contains citations and abstracts focusing on various aspects of comprehensive school health programs. A core component of the dataset includes information on resources for human immunodeficiency virus (HIV) prevention education;

3. The Cancer Prevention and Control Dataset, which contains entries emphasizing the application of effective breast, cervical, and skin cancer early detection and control program activities and risk reduction efforts;

4. The Prenatal Smoking Cessation Dataset, which contains information on the application of effective prenatal smoking cessation program activities and risk reduction efforts;

5. The Epilepsy Education and Prevention Activities Dataset, which contains entries emphasizing the application of effective epilepsy early detection and control program activities, education, and prevention efforts; and

6. The Smoking and Health Dataset, which includes bibliographic references and abstracts of scientific and technical literature about smoking and tobacco use.

A CDP directory listing key contacts and organizations in areas of chronic disease prevention (such as nutrition and cancer) is also included.

Obtaining access: The CDP File CD-ROM is available on a paid, annual subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402; (202) 512-1800. It is updated every six months. The order number for the CDP File is 717-145-00000-3. (Note that there is also at least one site in each state where health professionals and educators can search the CDP File; in addition, the CDP File may also be accessed via CDC WONDER [discussed later]. Contact the CDC office for more information)

Required equipment: DOS-based personal computer with a CD-ROM drive

Cost: $44 annually

CDC office: Technical Information Services Branch, National Center for Chronic Disease Prevention and Health Promotion (Christine S. Fralish)

Health, United States

Health, United States (on diskette) contains the annual report to the president and Congress on the health of the nation. There are data on mortality, morbidity, hospitalizations, and so on, largely at the national and state levels. It is available as either spreadsheet files of the tables only, or a more enhanced version that uses a text viewer to provide access to text, charts, and tables.

Obtaining access: See CDC Office

Required equipment: DOS-based microcomputer and software that can read Lotus files (for spreadsheet version); or microcomputer with Windows 3.0 or higher (for text viewer version)

Cost: $15 to $55 (spreadsheet version); $27 to $90 (text viewer version); costs vary by vendor (as do accepted forms of payment and delivery time)

CDC office: Data Dissemination Branch, National Center for Health Statistics; (301) 436-8500 (Robert J. Weinzimer)

NIOSHTIC[R]

NIOSHTIC[R] is the National Institute of Occupational Safety and Health's electronic, bibliographic database of literature in the field of occupational safety and health that is updated quarterly. About 160 current, English language technical journals provide approximately 35 percent of the additions to NIOSHTIC[R] annually. Retrospective information (some from the 19th century) is also acquired and entered. It includes information on behavioral sciences; biochemistry, physiology, and metabolism; toxicology; pathology and histology; chemistry; control technology; education and training; epidemiological studies of diseases and disorders; ergonomics; health physics; occupational medicine; safety; and hazardous waste.

Obtaining access: NIOSHTIC[R] is available on CD-ROM from several commercial vendors. For information about vendors of all NIOSH electronic products, call (800) 356-4674; there is an option to speak directly with a NIOSH information specialist. Or, write to NIOSH, 4676 Columbia Parkway, Cincinnati, OH 45226

Required equipment: DOS-based personal computer and a CD-ROM drive

Cost: $250 to $950 (the software varies by vendor [who set costs], and other databases are sometimes packaged with NIOSHTIC[R])

CDC office: National Institute for Occupational Safety and Health (William D. Bennett)

Registry of Toxic Effects of Chemical Substances

The Registry of Toxic Effects of Chemical Substances (RTECS[R]) is a database of toxicological information compiled, maintained, and updated by NIOSH. It represents NIOSH's effort to list all known toxic substances and the concentrations at which toxicity is known to occur. It contains data on over 130,000 chemicals, abstracted from the open scientific literature.

Obtaining access: RTECS[R] on CD-ROM may be acquired from several commercial vendors. For information about vendors of all NIOSH electronic products, call (800) 356-4674. Or, write to NIOSH, 4676 Columbia Parkway, Cincinnati, OH 45226

Required equipment: DOS-based personal computer and a CD-ROM drive

Cost: $250 to $2,000 (the software varies by vendor [who set costs], and other databases are sometimes packaged with RTECS[R])

CDC office: National Institute for Occupational Safety and Health (Doris V. Sweet)

Information available by modem

CDC National AIDS Clearinghouse ONLINE

CDC NAC ONLINE is the computerized information network of the CDC National AIDS Clearinghouse (CDC NAC). It is designed for nonprofit AIDS-related organizations and other HIV/AIDS professionals. Users must be granted access by CDC NAC staff. Users include CDC and Public Health Service (PHS) staff, other health administrators, universities, community-based organizations, health educators, and service providers. CDC NAC ONLINE contains the latest news and announcements about AIDS- and HIV-related issues, including prevention and education campaigns, treatment and clinical trials, legislation and regulation, and upcoming events.

CDC NAC ONLINE provides direct access to CDC clearinghouse text databases such as the Resources and Services Database of organizations providing AIDS-related services. The system also features electronic mail and interactive bulletin board forums, and it is the original source of the AIDS Daily Summaries newsclipping service.

Obtaining access: Contact CDC NAC, P.O. Box 6003, Rockville, MD 20849-6003; (800) 458-5231; (800) 243-7012 (TDD); (301) 738-6616 (fax)

Required equipment: DOS-based or Macintosh personal computer and a modem (CDC NAC provides the software)

Cost: Software and access are provided free of charge to nonprofit AIDS-related organizations and other authorized HIV/AIDS professionals

CDC office: Division of HIV/AIDS, National Center for Prevention Services (Kenneth Williams)

CDC WONDER

CDC WONDER, an information and communication system developed by CDC specifically for public health, provides access to a wide variety of reports, including CDC publications (title, author, abstract) and other bibliographies; the Chronic Disease Prevention bibliographic files; the Healthy People 2000 objectives and associated data sources; all of CDC's official prevention guidelines; a calendar of public health training courses and resources at CDC and elsewhere; CDC's Emerging Infectious Diseases journal (see later discussion); and advisories for overseas travelers (1-3).

The full text of the MMWR (1982 to present) is searchable on-line. MMWR articles may be downloaded in full, and (for MMWR articles since September 1993) figures and tables are included in downloaded articles. There is also a listing of CDC experts by their area of specialization.

CDC WONDER's Info Exchange is a special bulletin board-like database for posting and exchanging materials among CDC staff and the 16,000 registered CDC WONDER users in health departments, schools of public health and medicine, laboratories, clinicians' offices, and elsewhere. All requested documents are automatically downloaded for printing or inclusion in other materials.

Obtaining access: Special software is required, and may be ordered from USD, 2075 A West Park Place, Stone Mountain, GA 30087; (770) 469-4098; (770) 469-0681 (fax). Product literature and registration forms: (770) 469-0503. (All materials may be obtained from a colleague; there are no restrictions on duplication. However, each user needs his or her own account)

Required equipment: DOS-based microcomputer and a modem

Cost: Software, manual, and account: $50, manual only: $25, software only: $10, account only: $23, usage fees: none (there is a toll-free telephone line). Training video ("Cafe WONDER"): $19.95. Employees of state and local health departments may obtain an account (not software or manuals) free of charge by mailing (not faxing) a CDC WONDER user registration form, and a letter on official health department stationery to CDC WONDER User Support, 4770 Buford Highway, Mailstop F-51, Atlanta, GA 30341. The letter should state that, as an employee of the health department, they are requesting that CDC provide a CDC WONDER User ID at no charge. Health department staff who receive an account this way will need to acquire a copy of the software and documentation from a colleague, or purchase them from USD

CDC office: Public Health Information Systems Branch, Information Resources Management Office (Andrew Friede, M.D., M.P.H.)

NIOSHTIC[R]

NIOSHTIC[R] (described previously) is also available on-line.

Obtaining access: NIOSHTIC[R] is accessible Online from several commercial vendors. (Those who cannot access NIOSHTIC[R] through the NIOSH-listed commercial sources may still have the search performed by a public library or an information broker/computer search service) For information about vendors of all NIOSH electronic products, call (800) 356-4674. Or, write to: NIOSH, 4676 Columbia Parkway, Cincinnati, OH 45226

Required equipment: DOS-based personal computer, a modem, and basic telecommunications software

Cost: On-line prices range from $30 to $60 per connect hour plus print charges. NIOSH does not set prices; vendors should be contacted directly for price information

RTECS[R]

RTECS[R] (described previously) is also available on-line.

Obtaining access: RTECS[R] is accessible on-line from several commercial vendors. For information about vendors of all NIOSH electronic products, call (800) 356-4674; there is a direct option as well as an opportunity to speak with a NIOSH information specialist. Or, write to NIOSH, 4676 Columbia Parkway, Cincinnati, OH 45226

Required equipment: DOS-based personal computer, a modem, and basic telecommunications software

Cost: On-line prices range from $30 to $60 per connect hour, plus print charges. NIOSH does not set prices; vendors should be contacted directly for price information

Information available via the Internet

CDC Home Page

The CDC Home Page on the Internet provides detailed information on CDC programs; access to CDC information resources such as CDC WONDER, Emerging Infectious Diseases, HazDat, and the MMWR (see details, below); and pointers to other public health resources on the Internet, including servers at the Department of Health and Human Services, the National Institutes of Health, the National Library of Medicine, and the World Health Organization. There is also an FTP (file transfer protocol for the Internet) service for obtaining documents, including selections from Emerging Infectious Diseases, the MMWR, tuberculosis recommendations, and ratings of the inspection records of cruise ships; and for downloading Epi Info and related software (see below).

Obtaining access: HTTP://www.cdc.gov or Gopher://gopher.cdc.gov or ftp.cdc.gov/pub

Required equipment: Access to the Internet, and a Web browser (such as National Center for Supercomputing Applications [NCSA], Mosaic or Netscape) for access to CDC's Web server

Cost: None

CDC office: Information Center, Information Resources Management Office (Marilyn Mollenkamp)

CDC NAC Internet Services

The CDC NAC Internet Services provides access to the AIDS Daily Summary, AIDS-related MMWR articles; tables from CDCs HIV/AIDS Surveillance Report, and other CDC documents, as well as information about prevention, treatment, and living with HIV.

Obtaining access: Gopher address: cdcnac.aspensys.com; select CDC NAC. Via a Web browser, the Uniform Resource Location (URL) is Gopher://cdcnac.aspensys.com:72. Files may be accessed via FIP at the same address; pub/cdcnac. Via a Web browser the URL is FTP://cdcnac.aspensys.com/pub/cdcnac. To subscribe to an electronic mail listing of files, press releases, and so forth, send electronic mail to listserv@cdcnac.aspensys.com with subscribe AIDSnews firstname lastname as the message

Required equipment: Access to the Internet (or just access to Internet mail to receive mailings)

Cost: None

CDC office: CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; (800) 458-5231 (voice); or (800) 243-7012 (deaf access/TDD); aidsinfo@cdcnac.aspensys.com (Kenneth Williams)

CDC WONDER

CDC WONDER via the Internet provides the same data that are available in CDC WONDER by modem (see previous discussions). Because this system allows the submission of ad hoc database queries, the user may be required to complete a "request" and await a "response" (or receive a response via electronic mail).

Obtaining access: HTTP.//www.cdc.gov (the CDC Home Page)

Required equipment: Access to the Internet and a Web browser

Cost: None

CDC office: Public Health Information Systems Branch, Information Resources Management Office (Andrew Friede, M.D., M.P.H.)

Emerging Infectious Diseases

Emerging Infectious Diseases (EID) is a quarterly peer-reviewed journal distributed on the Internet. Its goals are to promote the recognition of new and reemerging infectious diseases and to improve the understanding of factors involved in disease emergence, prevention, and elimination. EID has an international scope and is intended for professionals in infectious diseases and related sciences. It is divided into three sections:

1. Perspectives - A section addressing factors that underlie disease emergence, including microbial adaptation and change, human demographics and behavior, technology and industry, economic development and land use, international travel and commerce, and breakdown of public health measures.

2. Synopses - Concise, state-of-the-art summaries of specific diseases or syndromes and related emerging infectious disease issues.

3. Dispatches - Brief laboratory or epidemiologic reports with an international scope.

Obtaining access: HTTP://www.cdc.gov/ncidod/eid/eid.htm (or from CDC Home Page); or ftp.cdc.gov; or Gopher.cdc.gov:70/11/infectious_diseases/EID

Required equipment: Access to the Internet (and a Web browser for World Wide Web version)

Cost: None

CDC office: National Center for Infectious Diseases (Joseph McDade, Ph.D.)

HazDat

HazDat (Hazardous Substance Release/Health Effects Database) contains information on the release of hazardous substances from Superfund sites and emergency events, including information on site characteristics, contaminants found, impact on population, community health concerns, ATSDR recommendations, environmental fate of hazardous substances, exposure routes, and physical hazards at the site/event. HazDat also contains substance-specific information, such as the ATSDR Priority List of Hazardous Substances, health effects by route and duration of exposure, metabolites, interactions of substances, susceptible populations, and biomarkers of exposure and effects. There are hundreds of lengthy, detailed entries that can be searched by single words. Access to the Internet is required for use.

Obtaining access: HTTP://atsdrl.atsdr.cdc.gov:8080/hazdat.html

Required equipment: Access to the Internet and a Web browser for Mosaic version

Cost: None

CDC office: Agency for Toxic Substances and Disease Registry (Sandra Susten, Ph. D.)

MMWR

The MMWR contains brief articles on timely issues and provisional notifiable disease data, based on weekly reports to CDC by state health departments. (The reporting week concludes at close of business on Friday; data compiled nationally are released to the public on the succeeding Friday.) Current issues and some back issues and selected associated publications (Reports and Recommendations, Surveillance Summaries) are available for downloading from a Web server. The files are in Adobe Acrobat format (the viewer is available for downloading). Typical issues are 250 to 400 Kbytes, but summaries are available on-line.

Obtaining access: HTTP://www.crawford.com/cdc/mmwr/mmwr.html (or from CDC Home Page). To receive a weekly table of contents and announcements, send electronic mail to lists@list.cdc.gov, with SUBSCRIBE MMWR-TOC as the message.

Required equipment: Access to the Internet and a Web browser (or just access to Internet mail to receive the MMWR electronically mailed)

Cost: None

CDC office: Epidemiology Program Office (Richard Goodman, M.D.)

OBTAINING DATA

Data available via CD-ROM/diskettes

AIDS Public Information Data Set

The AIDS Public Information Data Set (on diskette) contains summary surveillance data on the AIDS epidemic in the United States. The dataset has two components. The first is a file with one record per patient diagnosed and reported with AIDS. These records contain basic demographic, clinical, and HIV transmission risk information. This component is best used for analyzing trends and characteristics of the AIDS epidemic at the national level. The patient-level file can be exported in either ASCII or dBASE compatible format for analysis. The second component is a set of predefined tables that contains much of the information available on the patient-level dataset together with geographic identifiers (state and metropolitan statistical area). This component is most appropriate for analysis of data at the state and local levels. Software for viewing, printing, and exporting the data and tables is included.

Obtaining access: CDC, National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; (800) 458-5231 (voice); (800) 243- 7012 (deaf access/TDD); request inventory number #D206

Cost: None

Equipment required: DOS-based microcomputer

CDC office: Division of HIV/AIDS (Meade Morgan, Ph.D.; Kenneth Williams)

Behavioral Risk Factor Surveillance System

Data from the Behavioral Risk Factor Surveillance System (BRFSS; 1984-1993; on CD-ROM) contains prevalence information on state level risk factors for chronic diseases, including smoking, drinking alcohol, seat belt usage, and so forth. Included software facilitates exploratory analysis and mapping. An updated CD-ROM, including 1994 data, standardized geocoding, and additional documentation, became available in late 1995.

Obtaining access: See CDC office

Required equipment: DOS-based personal computer (80386 or better) and a CD-ROM drive

Cost: To be determined

CDC office: Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion (David McQueen, Ph.D.)

National Center for Health Statistics (NCHS) data files

NCHS data files (on CD-ROM) are available for the National Health Interview Survey (1988-1992); the National Ambulatory Care Survey (1990); the National Hospital Discharge Survey (1990); the Longitudinal Study of Aging (1984-1990); and the Live Birth/Infant Death files (1985-1988). These data are accessed via the Statistical Export and Tabulation System (SETS), a software program written by NCHS to provide a query interface to national data and dataset documentation on CD-ROMs or diskettes that will allow public health practitioners to make wide use of the benefits of the information age.

Obtaining access: For ordering information, contact the Data Dissemination Branch, NCHS, CDC Presidential Building, Room 1064, 6525 Belcrest Road, Hyattsville, MD 20782; (301) 436-8500; or address electronic mail to SETS@NCH10A.EM.CDC.GOV

Required equipment: DOS-based micro-computer, CD-ROM drive

Cost: $15 to $30

CDC office: Data Dissemination Branch, National Center for Health Statistics (Robert J. Weinzimer)

Data available by modem

CDC WONDER

CDC WONDER via modem provides access to data on mortality, natality, population, cancer incidence, motor vehicle and occupational injuries, hospitalizations, AIDS and other sexually transmitted diseases, and many other numeric datasets. Results are downloaded to the user's microcomputer where, using integrated software supplied with the system, results can be viewed, tabulated, graphed, and printed; or exported for editing, inclusion in other documents, or analysis in specialized statistical software. Most queries take one to two minutes (2,3). Data are derived from standard public use files, or data prepared especially for CDC WONDER from existing data. The databases and associated reports are developed cooperatively with data providers who add information to the system. Each dataset has on-line documentation (i.e., information on how the data were collected, the phrasing of the question on a questionnaire, sampling methods, known biases and errors, and references). New data are added regularly.

Obtaining access: Special software is required, and may be ordered from USD, 2075 A West Park Place, Stone Mountain, GA 30087; (770) 469-4098; (770) 469-0681 (fax). Product literature and registration forms: (770) 469-0503. (All materials may be obtained from a colleague; there are no restrictions on duplication. However, each user needs his or her own account)

Required equipment: DOS-based microcomputer and a modem

Cost: Software, manual, and account: $50, manual only: $25, software only: $10, account only: $23, usage fees: none (there is a toll-free telephone line). Training video ("Care WONDER"): $19.95. Employees of state and local health departments may obtain an account (not software or manuals) free of charge by mailing (not faxing) a CDC WONDER user registration form, and a letter on official health department stationery to CDC WONDER User Support, 4770 Buford Highway, Mailstop F-51, Atlanta, GA 30341. The letter should state that, as an employee of the health department, they are requesting that CDC provide a CDC WONDER User ID at no charge. Health department staff who receive an account this way will need to acquire a copy of the software and documentation from a colleague, or purchase them from USD.

CDC office: Public Health Information Systems Branch, Information Resources Management Office (Andrew Friede, M.D., M.P.H.)

Data available via the Internet

CDC WONDER

CDC WONDER via the Internet provides access to much of the same data that are available in CDC WONDER via modem. Tabulating and graphing will require the user to download CDC WONDER Tables and Graphs, which is the no-cost, DOS-based software built into the CDC WONDER DOS client. Alternatively, users may use their own software for this purpose; CDC WONDER Tables and Graphs has an exporting module to facilitate conversions to any one of 10 common formats.

Obtaining access: HTTP://www.cdc.gov (CDC Home Page)

Required equipment: Access to the Internet and a Web browser

Cost: None

CDC office: Information Resources Management Office (Andrew Friede, M.D., M.P.H.)

Surveillance with CDC

National Electronic Telecommunications System for Surveillance

The National Electronic Telecommunications System for Surveillance (NETSS) is used to collect, transmit, and analyze weekly reports of notifiable diseases from state and territorial health offices, Washington, D.C., New York City, and U.S. Territories (4). NETSS uses CDC/Council of State and Territorial Epidemiologists (CSTE) agreements on reportable conditions, protocols for formatting and transmitting data, standard case definitions, and designated staff members in each participating health department who provide and prepare the data for weekly publication in the MMWR. The system is based on a common record format permitting health agencies to use different computer software and hardware. A variety of computer systems is used to create data files in the standard NETSS format without names or other personal identifiers (CDC provides direct technical support to those using Epi Info, and consultation to those using other software). Reports of notifiable conditions are forwarded from local sources (e.g., health care providers and health departments) to the participating agencies, where they are entered into a computer in a format chosen by each agency. Since January 1991, the format provides for transmission of both individual and summary (aggregate) records, supplementary disease-specific epidemiological data, frequent updating of state and national databases, and other improvements.

Obtaining access: Contact CDC Office

Required equipment: DOS-based microcomputer and modem

Cost: None (but must be eligible state, New York City, Washington, D.C., or U.S. territory)

CDC office: Division of Surveillance and Epidemiology, Epidemiology Program Office (Scott Wetterhall, M.D.)

HIV/AIDS Reporting System

The HIV/AIDS Reporting System (HARS) is used to collect detailed demographic, risk, and clinical information on persons diagnosed with either AIDS or HIV infection. Since 1985, the CDC has provided state and local health departments nationwide with standardized case report forms and microcomputer-based software for managing HIV and AIDS surveillance data in their areas. It allows health department staff to produce statistical analyses and local tabulations and to report AIDS cases (without names) monthly to CDC. In addition to routine HIV/AIDS surveillance, HARS supports a number of special projects to evaluate and improve the accuracy of reported information on modes of HIV exposure, to characterize persons infected with both HIV and tuberculosis, and to evaluate the impact of the 1993 AIDS surveillance definition on reporting of AIDS-defining opportunistic infections. Currently there are about 250 sites using the package, including state, county, and local health departments in all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands, roughly 7,000 new and 20,000 to 30,000 updated patient records are reported each month.

Obtaining access: Division of HIV/AIDS Prevention, National Center for Prevention Services

Cost: None (but must be eligible)

Equipment required: DOS-based microcomputer (CDC supplies software)

CDC office: Division of HIV/AIDS Prevention, National Center for Prevention Services (Meade Morgan, Ph.D.)

Public Health Laboratory Information System

The Public Health Laboratory Information System (PHLIS) is an electronic system for reporting laboratory isolates to the CDC (5). Its goals are to reduce the enormous paper burden in the state laboratories; to reduce the lag between the time an isolate is obtained and when the information is available on the CDC computer; to develop a system whereby an unusual cluster of isolates could be detected and information about that cluster could be relayed to the states; and to provide states access to data. It was developed by the National Center for Infectious Diseases, at the request of the Association of State and Territorial Public Health Laboratory Directors. PHLIS is currently used in all 50 state health departments, New York City, the District of Columbia, and Guam. It contains modules on animal rabies, campylobacteriosis, E. coli O157:H7, Lyme disease, mycobacterial disease, respiratory and enteric viruses (including influenza), salmonellosis human, salmonellosis non-human, and shigellosis.

Obtaining access: Contact CDC office

Required equipment: DOS-based microcomputer and modem

Cost: None

CDC office: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Nancy H. Bean, Ph.D.)

CDC WONDER

CDC WONDER is used as a vehicle for transmission of surveillance files by a variety of CDC surveillance systems. The CDC programs responsible for these surveillance systems usually supply custom database "frontend" software for entering the surveillance data. Several methods are currently used to transmit surveillance files using CDC WONDER. Some surveillance systems simply attach data files to CDC WONDER electronic mail messages addressed to the CDC surveillance program coordinator. This approach is used, for example, for sending Behavioral Risk Factor Surveillance files and NIOSH SENSOR data files to CDC, and for state-level surveillance efforts in Louisiana and Iowa (where electronic mail addressees are state surveillance managers using CDC WONDER) (6). Other surveillance activities use an automated upload facility in CDC WONDER to transmit data files to CDC. With this approach, incoming files are automatically processed on arrival at CDC, and reports are automatically generated and sent to users. Surveillance programs using this automated approach include the NIOSH Fatalities Assessment and Control Evaluation (FACE) system, the National Center for Environmental Health (NCEH) Childhood Lead Poisoning Surveillance System, and the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Pregnancy Risk Assessment and Monitoring System (PRAMS).

Obtaining access: Contact administrator of specific surveillance system

Required equipment: DOS-based microcomputer and a modem

Cost: None (CDC provides CDC WONDER to Surveillance partners at no charge)

CDC office: Public Health Information Systems Branch, Information Resources Management Office (Patrick W. O'Carroll, M.D., M.P.H.)

Electronic Mail: Communicating with CDC Staff

Many users of electronic mail report that it has transformed the way they work by vastly increasing their ability to exchange information with colleagues. Everyone at CDC can be reached via Internet Simple Mail Transfer Protocol (SMTP) electronic mail (and the less used X.400 electronic mail). All users of CDC WONDER can also receive mail via the Internet, even if they are not CDC staff. Electronic mail systems vary in terms of their capabilities. Distinguishing features include the capability to exchange "attached" files (e.g., a word processing file or spreadsheet); to hook up addresses; to send a message to a preconfigured list of addresses; and to send a fax as an alternative for a recipient who does not have electronic mail.

Communicating via modem

CDC WONDER

CDC WONDER's electronic mail system was specifically designed to meet the needs of state and local health officials. It provides a text editor for composing off-line, on-line lookup of the electronic mail addresses of all CDC staff (7,000) and all CDC WONDER users (another 15,000 people). Users can send and receive Internet and X.400 mail. Attachments of any size and type are handled efficiently. The interface is DOS-based. (Note that CDC WONDER via modem users have access to the CDC Resource Index, a dataset that lists CDC staff with special expertise in any one of 1,400 disease topics. Searching on the individual topic brings back a list of experts, their departmental affiliation, and telephone numbers. CDC WONDER via the Internet also provides a way to find electronic mail addresses for CDC staff.

Obtaining access: Special software is required, and may be ordered from USD, 2075 A West Park Place, Stone Mountain, GA 30087; (770) 469-4098; (770) 469-0681 (fax). Product literature and registration forms: (770) 469-0503. (All materials may be obtained from a colleague; there are no restrictions on duplication. However, each user needs his or her own account).

Required equipment: DOS-based microcomputer and a modem.

Cost: Software, manual, and account: $50, manual only: $25, software only: $10, account only: $23, usage fees: none (there is a toll-free telephone line). Training video ("Cafe WONDER"): $19.95. Employees of state and local health departments may obtain an account (not software or manuals) free of charge by mailing (not faxing) a CDC WONDER user registration form, and a letter on official health department stationery to CDC WONDER User Support, 4770 Buford Highway, Mailstop F-51, Atlanta, GA 30341. The letter should state that, as an employee of the health department, they are requesting that CDC provide a CDC WONDER User ID at no charge. Health department staff who receive an account this way will need to acquire a copy of the software and documentation from a colleague, or purchase them from USD.

CDC office: Public Health Information Systems Branch, Information Resources Management Office (Andrew Friede, M.D., M.P.H.)

Commercial on-line services

Commercial online services, such as America Online, CompuServe, e-World, and Prodigy can be used to exchange electronic mail within or across these systems, or to anyone on the Internet. Attachment handling varies (and may be different by the time this article is printed), but some systems do not support sending attachments outside their own systems, nor do they typically provide a way to look up addressees. Costs vary by usage, and a credit card may be required.

Obtaining access: Contact individual vendors

Long distance providers

Long distance providers, including AT&T, MCI, and Sprint, are now electronic mail services that include Internet mail. They do not currently offer other information services, but if the user's only need is electronic mail, and an office system is not available, or if the user is working from home or traveling, this option is a viable one. They provide software that is electronic-mail specific, and may be less confusing than general on-line services. Because it only does one thing, it may be easier to monitor costs.

Obtaining access: Contact long distance providers

Communicating via the Internet

Electronic mail via an Internet connection

Sending electronic mail to CDC via an Internet connection to the user's office electronic mail is one option to consider. The relationship between any given office's electronic mail and Internet mail is often a source of confusion. To exchange mail with Internet users, an office system (or other on-line service) must be connected to the Internet (just as a telephone system must be connected to the main telephone system; otherwise, it is just an intercom). Hence "Internet mail" has come to mean two things: an underlying format and access to the network of computers that makes up the Internet. Nowadays, almost all commercial electronic mail systems can read and write E-mail in the Internet format, but making the connection to the Internet must be done separately, and may be difficult and expensive. Hence, the ease of Internet connectivity is one of the most important criteria in selecting an E-mail system. Finally, there is no easy, universal way to look up someone's Internet mail address.

Obtaining access: Users should work through their network administrator

Tools for Disseminating Information

Increasingly, IT activities are taking place in state and local offices. This trend is accelerating, driven by the fact that IT resources are becoming even less expensive and easier to use, and local capacities are growing fast (7). This trend needs to be strongly encouraged, and many of the tools described subsequently will help empower state and local health departments to use information technology to make yet more data-driven decisions. It must be borne in mind that a detailed plan to maintain data integrity and security, from the point of organization through analysis to the final release of information, must underlie any successful dissemination plan.

Analyzing and disseminating information via stand-alone systems (no communications needed)

EDITS is software for standardizing the way data are edited across applications, languages, and platforms. EDITS consists of an integrated development environment for creating, maintaining, and testing data edits; a special-purpose language for writing edit logic; and a library of functions used for real-time or batch editing of data entry. The EDITS Engine can be linked to DOS, Windows, and UNIX programs written in C; or called as a Dynamic kink Library from most Windows languages such as Visual Basic, and Access. Current production uses of EDITS include the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute, CDC's Behavioral Risk Factor Surveillance System, and the North American Association of Central Cancer Registries.

Obtaining access: Contact CDC office

Required equipment: DOS-based microcomputer (386 or higher), 4 megabytes of RAM, and 10 megabytes free disk space

CDC office: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion: (404) 488-4682 (James Tebbel).

Epi Info and Epi Map

Epi Info and Epi Map are software programs for analyzing epidemiological data (8). These two standalone programs can be used separately or together, and share a common file type. Epi Info is a software system for word processing, data entry, database management, and public health statistics. It can import and export a variety of file types, and has facilities for producing and using hypertext (active text), and producing additional statistics. Epi Map works independently or as a companion to Epi Info. For example, data can be entered in Epi Info, manipulated and analyzed, and then sent to Epi Map for display and printing in map form. Supplied outline files include all U.S. states and counties. Others can be drawn within Epi Map for other communities.

Obtaining access: Epi Info and Epi Map (sold separately) are distributed by USD Incorporated, 2075 A West Park Place, Stone Mountain, GA 30077; and Brixton Books (North America), 740 Marigny Street, New Orleans, LA 70117; (504) 944-1074

Required equipment: DOS-based personal computer (80286 or better)

Cost: USD, $55; Brixton (Epi Info only): $13 per manual and $4 for disks. Both suppliers offer quantity discounts

CDC office: Division of Surveillance and Epidemiology, Epidemiology Program Office (Andrew G. Dean. M.D., M.P.H.)

Health Information Retrieval System

The Health Information Retrieval System (HIRS) is a database system that provides menu-driven information retrieval; exploratory analysis; and tables, histograms, and maps (via link with Epi Map). It is designed for rapid retrieval from very large datasets (multimillions of records). Once data are imported into HIRS, retrieval of basic statistics is nearly immediate, regardless of the size of the dataset. No programming is required for information retrieval, though basic data management skill is useful for initial data import. Imported data can be distributed or shared on a local area network (LAN). Outputs can include counts and rates (crude and adjusted) stratified by any variables in the user's HIRS dataset.

Obtaining access: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion: (404) 488-4682; fax: (404) 488-4639

Required equipment: DOS-based personal computer (80386DX or better) and at least 4 megabytes of RAM and 16 megabytes of free disk space

Cost: None

CDC office: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (Thomas Rawson)

The Statistical Export and Tabulation System

The Statistical Export and Tabulation System (SETS) Designer Kit allows developers to prepare large databases for statistical use via a menu-based interface. This software can be used to make microdata available on CD-ROMs, WORM (Write Once, Read Many) drives, and diskettes. Data systems created with the kit may be installed on LANs to facilitate access remotely or within large organizations.

Obtaining access: For ordering information, contact the Data Dissemination Branch, NCHS, CDC Presidential Building, Room 1064, 6525 Belcrest Road, Hyattsville, MD 20782; (301) 436-8500

Required equipment: DOS-based microcomputer with at least 20 megabytes free space on the hard drive

Cost: $52

CDC office: Data Dissemination Branch, National Center for Health Statistics (Robert J. Weinzimer)

Disseminating information via telephone or fax

Establishing a voice information system

Establishing a voice information system with or without "faxback" is an attractive option because users need only a telephone. A simple system that can handle one call at a time and has six short choices can cost as little as a good microcomputer with modem and some specialized software ($2,000). A system that can handle multiple calls simultaneously and that has many and longer texts can cost 10 to 25 times as much. On the other hand, there are likely to be very significant cost savings, as compared to having staff respond to these calls, and these systems can operate 24 hours a day. There are many commercial vendors offering these services. Because maintenance will be frequent, having a local vendor is imperative. Some local telephone companies are now also offering these services.

Obtaining access: Contact a local telephone company or local computer consultant/vendor

Disseminating information via modem or the Internet

Establishing a microcomputer-based bulletin board

Establishing a microcomputer-based bulletin board can be a relatively inexpensive way to provide information to clients who have microcomputers and modems. The main cost is personnel time and installing telephone lines.

Obtaining access: Contact a local computer consultant or vendor

CDC WONDER's Information Exchange

CDC WONDER's Information Exchange was designed as a mechanism for local health departments to share information with each other and with CDC. Items are "posted" simply by electronic mailing them to a "Topic," and they are retrieved by browsing or searching using CDC WONDER. A user may restrict access to his or her information to specific users (and maintain the list of authorized users personally). Postings may contain attached files of any form, including word processing documents, spreadsheets, and so forth.

Obtaining access: Special software is required, and may be ordered from USD, 2075 A West Park Place, Stone Mountain, GA 30087; (770) 469-4098; (770) 469-0681 (fax). Product literature and registration forms: (770) 469-0503. (All materials may be obtained from a colleague; there are no restrictions on duplication. However, each user needs his or her own account.)

Required equipment: DOS-based microcomputer and a modem

Cost: Software, manual, and account: $50, manual only: $25, software only: $10, account only: $23, usage fees: none (there is a toll-free telephone line). Training video ("Cafe WONDER"): $19.95. Employees of state and local health departments may obtain an account (not software or manuals) free of charge by mailing (not faxing) a CDC WONDER user registration form, and a letter on official health department stationery to CDC WONDER User Support, 4770 Buford Highway, Mailstop F-51, Atlanta, GA 30341. The letter should state that, as an employee of the health department, they are requesting that CDC provide a CDC WONDER User ID at no charge. Health department staff who receive an account this way will need to acquire a copy of the software and documentation from a colleague, or purchase them from USD.

CDC office: Public Health Information Systems Branch, Information Resources Management Office (Andrew Friede, M.D., M.P.H.)

A Departmental Internet World Wide Web Server

A departmental Internet World Wide Web Server may be a useful way to provide information if clients have Internet access (either directly or through a dial-up service). Implementation may not be more difficult than establishing a microcomputer-based bulletin board, but it will probably be more expensive because of the requirement to be connected to the Internet, either through a dedicated hardwired connection (may be thousands of dollars per month, depending on usage) or via a telephone connection (hundreds of dollars per month, but slower).

Obtaining access: Contact local vendor of Internet services

Disseminating information via local area networks

The Executive Health Information Shell (EHIS) is a software module included with Epi Info version 6 that allows users to create a DOS-based "executive information system" using whatever text and graphics software they currently have available (including Epi Info itself). In essence, EHIS is a powerful menuing system with integrated hypertext capabilities. Menu items execute programs (e.g., a presentation graphics program, or Epi Map) in a way analogous to DOS batch files. Generally, these EHIS "batch files" load a prespecified document, graph, or map. By tying together and displaying a logically related collection of documents, charts, and maps from one menu - despite the fact that these files may have been created using a variety of disparate programs - the EHIS can be used to create an integrated information system for those with access to the EHIS application (e.g., those connected to a LAN where an EHIS application has been installed).

Obtaining access: Epi Info (which includes the EHIS module) is distributed by USD Incorporated, 2075 A West Park Place, Stone Mountain, GA 30077; and Brixton Books (North America), 740 Marigny Street, New Orleans, LA 70117; (504) 944-1074

Required equipment: DOS-based personal computer (80286 or better)

Cost: USD: $55; Brixton, $13 per manual and $4 for disks. Both suppliers offer quantity discounts

CDC office: Division of Surveillance and Epidemiology, Epidemiology Program Office (Robert Fagan)

DocView

DocView is CDC-developed Windows software that is designed to provide access to documents distributed across a NovelNetware LAN. DocView permits the documents to be stored in any format, and maintained anywhere on any Novell network, but viewed locally. To view the documents, the user can either use the software that was used to create the document (say, WordPerfect to view a WordPerfect file), or employ "viewers" (software programs that can read and display files created in a wide variety of formats). There are a number of commercial viewers (e.g., Outside-In, the Norton Desktop). The central virtue of DocView is that it allows the document's originator to maintain it on his or her own LAN, but make it available to anyone on a given LAN, or network of LANs (wide area network [WAN]).

Obtaining access: See CDC office

Required equipment: LAN

Cost: None

CDC office: Information Resources Management Office (Joseph A. Reid, Ph.D.)

Conclusion

CDC has invested substantial resources in developing information technology resources for its constituents. Moreover, these resources are heavily used by public health practitioners; there are over 20,000 transactions each week on the CDC WONDER system and 3,000 per week on HazDat. These figures strongly suggest that these systems are of direct utility in the practice of public health.

What should a public health official do to take advantage of information technology resources? First and foremost, the official should obtain access to electronic mail. Second, he or she should buy a modem and CD-ROM drive (about $150 each). Third, the official should develop a feel for what it takes to create an easier way to get at and distribute his or her own data, using CDC-developed tools or commercial ones. Finally, this official should connect- via a high-speed attachment - to the Internet (a low-speed one is very frustrating). Although much of what has been on the Internet has not been of direct use to public health, that situation is changing very fast. By the time this article is read, there will be a great deal of useful public health information available.

Although CDC's national reports and data are valuable, a great deal of critically important public health information is not located at CDC, but rather in state and local health departments. Moreover, there is evidence that the need to access and share public health within and between states is as great as the need for locales to communicate with CDC (4). Recognizing this fact, CDC has fostered the Information Network for Public Health Officials (INPHO), a vision of interconnected state, local, and national public health institutions, which can seamlessly share public health information on demand (7). Georgia was the first INPHO state, but 12 additional states have now been funded to develop or implement various information technologies in furtherance of the INPHO vision (9). One of INPHO's most important contributions is the promotion of communications standards within and between states. At CDC, INPHO has guided the development of the CDC Prevention Guidelines Database and the Executive Health Information Shell. Most recently, INPHO is guiding the development of Distributed WONDER, which is a system of data standards and software utilities designed to allow state health departments and other non CDC sites to make their numeric datasets remotely queryable via CDC WONDER via modem and the Internet. Ultimately, it will be developing these kinds of standards - data standards for storing information and communications standards for exchanging it - that will allow public health practitioners to make wide use of the benefits of the Information Age (1).

Acknowledgements

Use of all trademarks is for informational purposes only and does not constitute endorsement by the U.S. Public Health Service. The authors thank Nancy H. Bean, Ph.D.; William D. Bennett; Andrew G. Dean, M.D., M.P.H.; Kathryn S. Deck; Christine S. Fralish; Jeanne C. Gilliland, M.B.I.S.; Dorothy S. Knight; Denise T. Koo, M.D., M.P.H.; Meade Morgan, Ph.D.; J. Mark Shields, M.D.;James Tubbel, and Robert J. Weinzimer for contributing to the description of the systems; and the Centers for Disease Control and Prevention (CDC) Excellence in Science Committee and the CDC Information Resources Management coordinators for reviewing the manuscript and bringing new systems to the authors' attention.

REFERENCES

1. Friede, A., H. Blum, and M.C. McDonald (1995), Public Health Informatics: How Information-Age Technology Can Strengthen Public Health," Ann. Rev. Pub. Health, 16:239-52.

2. Friede, A., H.W. Ory, and I.A. Reid (1993), "CDC WONDER: A Comprehensive Online Public Health Information System of the Centers for Disease Control and Prevention," Am. J. Pub. Health, 83:1289-94.

3. Friede, A., J.A. Reid, and D.R. Rosen (1994), "CDC WONDER/PC: Cooperative Processing for Public Heath Informatics," J. Am. Med. Informatics Ass'n., 1:303-12.

4. Centers for Disease Control (1991), "National Electronic Telecommunications System for Surveillance - United States, 1990-1991," Morbidity and Mortality Weekly Report, 40:502.

5. Bean, N.H., H. Bradford, and S.M. Martin (1992), "PHLIS: An Electronic System for Reporting Public Health Data from Remote Sites," Am. J. Pub. Health, 82:1273-76.

6. O'Carroll, P.W., et al. (1995), "The Rapid Implementation of a Statewide Emergency Health Information System During the 1993 Iowa Flood," Am. J. Pub. Health, 85:564-67.

7. Baker, E.L., et al. (1995), "CDCs Information Network for Public Health Officials (INPHO): A Framework for Integrated Public Health Information and Practice," J. Pub. Health Mgmt. Prac., 1:43-47.

8. Dean, A.G., et al. (1991), "Epi Info: A General Purpose Microcomputer Program for Public Health Information Systems," Am. J. Preventive Med., 7:178-82.

9. Chapman, K.A., and A.D. Moulton (1995), "The Georgia Information Network for Public Health Officials (INPHO): A Demonstration of the CDC INPHO Concept," J. Pub. Health Mgmt. Prac., 1:39-43.

Authors

Andrew Friede, M.D., M.P.H., is Chief, and Patrick W. O'Carroll, M.D., M.P.H., is Deputy Chief, both at Public Health Information Systems Branch, Information Resources Management Office at the Centers for Disease Control and Prevention in Atlanta, Georgia.
COPYRIGHT 1996 National Environmental Health Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Centers for Disease Control and Prevention; Agency for Toxic Substances and Disease Registry
Author:O'Carroll, Patrick W.
Publication:Journal of Environmental Health
Date:Nov 1, 1996
Words:9120
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