bluuebunny/crossref_metadata_2025 huggingface dataset:
A Shot in the Rear, Not a Shot in the Dark: Application of a Mass Clinic Framework in a Public Health Emergency
Authors: Erwin Paul Campbell , Sheeler Lorinda , Lott John M.
Published: July 2017

An outbreak of foodborne hepatitis A infection compelled two regional health departments in eastern Tennessee to implement an emergency mass clinic for providing hepatitis immune serum globulin (ISG) to several thousand potentially exposed people. For the mass clinic framework, we utilized the smallpox post-event clinic plans of the Centers for Disease Control and Prevention (CDC), although the plans had only been exercised for smallpox. Following CDC's guidelines for staffing and organizing the mass clinic, we provided 5,038 doses of ISG during a total of 24 hours of clinic operation, using 3,467 person-hours, or 1.45 ISG doses per person-hour—very close to the 1.58 doses per person-hour targeted in CDC's smallpox post-event clinic plans. The mass clinic showed that CDC's smallpox post-event clinic guidelines were feasible, practical, and adaptable to other mass clinic situations.
Do Traditional Measures of Water Quality in Swimming Pools and Spas Correspond with Beneficial Oxidation Reduction Potential?
Authors: Bastian Tiana , Brondum Jack
Published: July 2017

Objectives.

Oxidation reduction potential (ORP) is a more direct measure of water quality in swimming pools and spas than free chlorine. However, ORP is not considered in some state pool codes, including Minnesota's. This study examined whether compliance with the Minnesota Pool Code assured an ORP ≥650 millivolts (mV), a value defined in the literature as adequate to kill viral and bacterial pathogens within seconds. We also examined predictors of ORP.

Methods.

Water samples from public swimming pools and spas in Hennepin County, Minnesota, were collected during routine health inspections from May through August 2004 and assessed for compliance with the state pool code. ORP values were also recorded. A Chi-square test was used to evaluate the association between code compliance and ORP. Analysis of covariance (ANCOVA) and logistic regression models were used to determine predictors of ORP.

Results.

The study included 132 pools and 30 spas. Compliance with the Minnesota Pool Code did not assure an ORP≥650 mV ( p<0.01). Outdoor pools had significantly lower ORP values than indoor pools ( p<0.001). ANCOVA and logistic regression models showed that ORP decreased with increasing cyanuric acid, increasing pH, and decreasing free chlorine.

Conclusions.

Compliance with the Minnesota Pool Code did not coincide with adequate ORP values, particularly for outdoor pools and spas. Therefore, it may be appropriate for states to include a minimum ORP standard of ≥650 mV in their swimming pool regulations. Doing so would likely benefit the health of swimmers.
A Pilot Asthma Incidence Surveillance System and Case Definition: Lessons Learned
Authors: Trepka Mary Jo , Martin Pilar , Mavunda Kunjana , Rodriguez Diana , Zhang Guoyan , Brown Clive
Published: July 2017

Objectives.

Surveillance for incident asthma in the general population could provide timely information about asthma trends and new, emerging etiologic factors. We sought to determine the feasibility of an asthma incidence surveillance system using voluntary reporting of asthma by outpatient clinics and emergency departments (EDs).

Methods.

Voluntary reporting occurred from July 2002 through June 2006. We classified reported asthma based on a case definition adapted from one developed by the Council of State and Territorial Epidemiologists. We validated the case definition by having pulmonologists review data from participant interviews, medical record abstractions, and pulmonary function test (PFT) results.

Results.

The positive predictive value (PPV) of meeting any of the case definition criteria for asthma was 80% to 82%. The criterion of taking at least one rescue and one controller medication had the highest PPV (97% to 100%). Only 7% of people meeting the incident case definition had a PFT documented in their medical record, limiting the usefulness of PFT results for case classification. Compared with pediatric participants, adult participants were more likely to be uninsured and to obtain asthma care at EDs. The surveillance system cost $5,129 per enrolled person meeting the incident case definition and was difficult to implement in participating clinics and EDs because asthma reporting was not mandatory and informed consent was necessary.

Conclusions.

The project was useful in evaluating the case definition's validity and in describing the participants' characteristics and health-care use patterns. However, without mandatory reporting laws, reporting of incident asthma in the general population by clinicians is not likely to be a feasible method for asthma surveillance.
Resource Allocation on the Frontlines of Public Health Preparedness and Response: Report of a Summit on Legal and Ethical Issues
Authors: Barnett Daniel J. , Taylor Holly A. , Hodge James G. , Links Jonathan M.
Published: July 2017

Objectives.

In the face of all-hazards preparedness challenges, local and state health department personnel have to date lacked a discrete set of legally and ethically informed public health principles to guide the distribution of scarce resources in crisis settings. To help address this gap, we convened a Summit of academic and practice experts to develop a set of principles for legally and ethically sound public health resource triage decision-making in emergencies.

Methods.

The invitation-only Summit, held in Washington, D.C., on June 29, 2006, assembled 20 experts from a combination of academic institutions and nonacademic leadership, policy, and practice settings. The Summit featured a tabletop exercise designed to highlight resource scarcity challenges in a public health infectious disease emergency. This exercise served as a springboard for Summit participants' subsequent identification of 10 public health emergency resource allocation principles through an iterative process.

Results.

The final product of the Summit was a set of 10 principles to guide allocation decisions involving scarce resources in public health emergencies. The principles are grouped into three categories: obligations to community; balancing personal autonomy and community well-being/benefit; and good preparedness practice.

Conclusions.

The 10 Summit-derived principles represent an attempt to link law, ethics, and real-world public health emergency resource allocation practices, and can serve as a useful starting framework to guide further systematic approaches and future research on addressing public health resource scarcity in an all-hazards context.
Assessment of Geographic Information Systems and Data Confidentiality Guidelines in STD Programs
Authors: Bissette Jennifer M. , Stover Jeffrey A. , Newman Lori M. , Delcher Philip Christopher , Bernstein Kyle T. , Matthews Lindsey
Published: July 2017

Objective.

Advancements in technology, such as geographic information systems (GIS), expand sexually transmitted disease (STD) program capacity for data analysis and visualization, and introduce additional confidentiality considerations. We developed a survey to examine GIS use among STD programs and to better understand existing data confidentiality practices.

Methods.

A Web-based survey of eight to 22 questions, depending on program-specific GIS capacity, was e-mailed to all STD program directors through the National Coalition of STD Directors in November 2004. Survey responses were accepted until April 15, 2005.

Results.

Eighty-five percent of the 65 currently funded STD programs responded to the survey. Of those, 58% used GIS and 54% used geocoding. STD programs that did not use GIS (42%) identified lack of training and insufficient staff as primary barriers. Mapping, spatial analyses, and targeting program interventions were the main reasons for geocoding data. Nineteen of the 25 programs that responded to questions related to statistical disclosure rules employed a numerator rule, and 56% of those used a variation of the “Rule of 5.” Of the 28 programs that responded to questions pertaining to confidentiality guidelines, 82% addressed confidentiality of GIS data informally.

Conclusions.

Survey findings showed the increasing use of GIS and highlighted the struggles STD programs face in employing GIS and protecting confidentiality. Guidance related to data confidentiality and additional access to GIS software and training could assist programs in optimizing use of spatial data.
Here Comes the SSuN: Early Experiences with the STD Surveillance Network
Authors: Rietmeijer Cornelis A. , Donnelly Jennifer , Bernstein Kyle T. , Bissette Jennifer M. , Martins Summer , Pathela Preeti , Schillinger Julia A. , Stenger Mark R. , Weinstock Hillard , Newman Lori M.
Published: July 2017

In 2005, the Centers for Disease Control and Prevention established the STD Surveillance Network (SSuN), a sentinel surveillance system comprising local, enhanced sexually transmitted disease (STD) surveillance systems that follow common protocols. The purpose of SSuN is to improve the capacity of national, state, and local STD programs to detect, monitor, and respond rapidly to trends in STDs through enhanced collection, reporting, analysis, visualization, and interpretation of clinical, behavioral, and geographic information obtained from a geographically diverse sample of individuals diagnosed with STDs. To demonstrate the utility of a national sentinel surveillance network, this article reviews the lessons learned from the first three years of SSuN, which, through its enhanced gonorrhea and genital warts sentinel surveillance projects, has proved to be a useful adjunct to routine STD surveillance in the U.S. that can be expanded into other areas of STD public health interest.
California Gonorrhea Surveillance System: Methodologic Aspects and Key Results of a Sample-Based System
Authors: Samuel Michael C. , Mocello A. Rain , Gilson Denise , Bradbury K. Jayne , Bolan Gail
Published: July 2017

Objectives.

This article describes findings from the California Gonorrhea Surveillance System (CGSS), developed in response to the need for detailed risk behavior data and clinical data required to control increasing gonorrhea (GC) infections in California.

Methods.

CGSS is a sample-based surveillance system implemented throughout California in 2007. In 34 of 61 local health jurisdictions (LHJs), 10% of GC cases are sampled for interview; in the other 27 LHJs, all cases are followed. A standardized case investigation record collects case-reported risk data and provider-reported clinical data, and is electronically prepopulated with available contact data. Exclusion criteria include age younger than 14 years, a GC diagnosis within the previous 30 days, and provider request that patient not be contacted. Analyses are weighted to account for sample design.

Results.

In 2007, 31,192 cases of GC were reported in California. Of these, 5,388 were sampled for follow-up and 2,715 were interviewed, for a response rate of 54.2%. Of those interviewed, 49.6% were female, 28.8% were heterosexual males, and 21.6% were men who have sex with men (MSM). CGSS collects a wide range of behavioral and clinical data for targeted programmatic action. Findings from the 2007 CGSS included data on the following areas: incarceration (highest among heterosexual males [22.4%]); methamphetamine use (high overall [12.2%] and lower among African Americans [4.6%]); co-infection with human immunodeficiency virus (high among MSM [31.9%] and very low among heterosexual males and females [<0.5%]); and improper antibiotic use (8.3% overall; 25.6% among patients attending urgent care clinics).

Conclusion.

CGSS, an innovative sample-based surveillance system, is effective and flexible. The system provides actionable data on an ongoing basis.
Use of a Business Approach to Improve Disease Surveillance Data Management Systems and Information Technology Process in Florida's Bureau of STD Prevention and Control
Authors: Shiver Stacy A. , Schmitt Karla , Cooksey Adrian
Published: July 2017

The business of sexually transmitted disease (STD) prevention and control demands technology that is capable of supporting a wide array of program activities—from the processing of laboratory test results to the complex and confidential process involved in contact investigation. The need for a tool that enables public health officials to successfully manage the complex operations encountered in an STD prevention and control program, and the need to operate in an increasingly poor resource environment, led the Florida Bureau of STD to develop the Patient Reporting Investigation Surveillance Manager. Its unique approach, technical architecture, and sociotechnical philosophy have made this business application successful in real-time monitoring of disease burden for local communities, identification of emerging outbreaks, monitoring and assurance of appropriate treatments, improving access to laboratory data, and improving the quality of data for epidemiologic analysis. Additionally, the effort attempted to create and release a product that promoted the Centers for Disease Control and Prevention's ideas for integration of programs and processes.
Discrimination and Mental Health Problems among Homeless Minority Young People
Authors: Milburn Norweeta G. , Batterham Philip , Ayala George , Rice Eric , Solorio Rosa , Desmond Kate , Lord Lynwood , Iribarren Javier , Rotheram-Borus Mary Jane
Published: July 2017

Objective.

We examined the associations among perceived discrimination, racial/ethnic identification, and emotional distress in newly homeless adolescents.

Methods.

We assessed a sample of newly homeless adolescents ( n=254) in Los Angeles, California, with measures of perceived discrimination and racial/ethnic identification. We assessed emotional distress using the Brief Symptom Inventory and used multivariate linear regression modeling to gauge the impact of discrimination and racial identity on emotional distress.

Results.

Controlling for race and immigration status, gender, and age, young people with a greater sense of ethnic identification experienced less emotional distress. Young people with a history of racial/ethnic discrimination experienced more emotional distress.

Conclusion.

Intervention programs that contextualize discrimination and enhance racial/ethnic identification and pride among homeless young people are needed.
Intimate Partner Violence Perpetration, Immigration Status, and Disparities in a Community Health Center-Based Sample of Men
Authors: Gupta Jhumka , Acevedo-Garcia Dolores , Hemenway David , Decker Michele R. , Raj Anita , Silverman Jay G.
Published: July 2017

Objective.

We examined disparities in male perpetration of intimate partner violence (IPV) based on immigration status.

Methods.

From 2005 to 2006, 1,668 men aged 18–35 who were recruited from community health centers anonymously completed an automated, computer-assisted self-interview. Men self-reported their immigrant status (e.g., native-born, <6 years in the U.S. [recent immigrants], or ≥6 years in the U.S. [non-recent immigrants]) and IPV perpetration. We calculated differences in IPV perpetration based on immigrant status. Among immigrant men, we further examined differences in IPV perpetration based on English-speaking ability.

Results.

Recent immigrants were less likely to report IPV perpetration than native-born men in the overall sample (adjusted odds ratio [AOR] = 0.60, 95% confidence interval [CI] 0.36, 1.00). However, we observed no differences in IPV perpetration between non-recent immigrants and native-born men (AOR=0.88, 95% CI 0.63, 1.23). Among immigrant men, those who were non-recent immigrants and reported limited English-speaking ability were at the highest risk for IPV perpetration, compared with recent immigrants with high English-speaking ability (AOR=7.48, 95% CI 1.92, 29.08).

Conclusions.

Although immigrant men were at a lower risk as a group for IPV perpetration as compared with non-immigrants, this lower likelihood of IPV perpetration was only evident among recent immigrants. Among immigrant men, those who arrived in the U.S. more than six years ago and reported speaking English relatively poorly appeared to be at greatest risk for using violence against partners. Future research should examine the effects of fear of legal sanctions, discrimination, and changes in gender roles to clarify the present findings.
Pregnancy and HIV Infection in Young Women in North Carolina
Authors: Torrone Elizabeth A. , Wright Janell , Leone Peter A. , Hightow-Weidman Lisa B.
Published: July 2017

Objectives.

We described young women in North Carolina (NC) who were pregnant at the time of diagnosis with human immunodeficiency virus (HIV) infection to identify an at-risk population that could be targeted for increased HIV screening. We investigated the combined effect of partner counseling and referral services (PCRS) and comprehensive prenatal HIV screening.

Methods.

We conducted a retrospective review of PCRS charts on young women newly diagnosed with HIV in NC between 2002 and 2005. We determined the prevalence of pregnancy in the study sample and conducted bivariate analyses to assess predictors of pregnancy at the time of HIV diagnosis, calculating prevalence ratios (PRs) with 95% confidence intervals (CIs). We analyzed results of partner notification efforts, including timing and stage of diagnosis of HIV-positive partners.

Results.

During the four-year period, 551 women aged 18–30 years were newly diagnosed with HIV; 30% were pregnant at the time of HIV diagnosis. Pregnant women were more likely to be Hispanic (PR=1.58, 95% CI 1.15, 2.17) and not report typical risk factors. Fourteen percent of pregnant women's partners had an undiagnosed infection compared with slightly more than 8% of nonpregnant women's partners ( p<0.01).

Conclusions.

Ethnic differences in co-diagnosis of pregnancy and HIV suggest that young Hispanic women may have differential access to and acceptance of routine HIV screening. Comprehensive prenatal screening combined with partner notification can be effective in reaching infected male partners who are undiagnosed.
Adult Blood Lead Reporting in New York State, 1994–2006
Authors: Gelberg Kitty H. , Fletcher Alicia
Published: July 2017

Objectives.

Laboratories that test New York State (NYS) employees and adult residents for lead exposure are required to report blood lead test results to the NYS Department of Healths Heavy Metals Registry. This registry is used to monitor exposures and to identify new high-risk occupational and nonoccupational activities.

Methods.

We used interviews conducted with people having blood lead levels of ≥25 micrograms/deciliter (μg/dL) reported to the Heavy Metals Registry to determine the primary source of lead exposure. We reviewed this information, together with demographic information, for the years 1994 through 2006.

Results.

While overall there has been an increase in the number of tests being conducted on NYS residents since 1994, the vast majority of the increase is among those with the lowest blood lead levels (<10 μg/dL). Conversely, there has been a decline in the number of adults tested with blood lead levels of ≥25 μg/dL in NYS due primarily to occupational exposures. However, nonoccupational exposures do represent a relatively large percentage of the individuals with severely elevated blood lead levels (≥60 μg/dL).

Conclusions.

Although a surveillance system based on blood lead levels cannot identify the true magnitude of adult lead poisoning, the NYS Heavy Metals Registry has proven to be an important tool for identifying situations in which adult lead poisoning is occurring, and assists in guiding lead poisoning prevention among adults.
Pasa la Voz (Spread the Word): Using Women's Social Networks for HIV Education and Testing
Authors: Ramos Rebeca L. , Ferreira-Pinto João B. , Rusch Melanie L.A. , Ramos Maria Elena
Published: July 2017

Pasa la Voz (spread the word) is a human immunodeficiency virus (HIV) prevention methodology inspired by respondent-driven sampling (RDS) that uses social networks to access hard-to-reach populations. As field testing showed the approach to be efficacious among at-risk women in West Texas and Southern New Mexico, we set out to evaluate the methodology in a Mexican context. A local community organization, Programa Compañeros, first implemented a traditional one-on-one outreach strategy using promotoras (outreach workers) in Ciudad Juarez, Mexico, from September 2005 to January 2006. This was followed by implementation of Pasa la Voz from February 2006 to January 2007. The percentage of women agreeing to be tested increased from 11.9% to 49.9%, and staff time declined from 22.70 hours to 3.68 hours per HIV test, comparing the one-on-one with the Pasa la Voz methodology, respectively. Pasa la Voz was successful at imparting a cost-savings prevention education program with significant increases in the number of at-risk women being tested for HIV.
The Association between Intentional Delay of Vaccine Administration and Timely Childhood Vaccination Coverage
Authors: Smith Philip J. , Humiston Sharon G. , Parnell Trish , Vannice Kirsten S. , Salmon Daniel A.
Published: July 2017

Objectives.

We evaluated the association between intentional delay of vaccine administration and timely vaccination coverage.

Methods.

We used data from 2,921 parents of 19- to 35-month-old children that included parents' reports of intentional delay of vaccine administration. Timely vaccination was defined as administration with ≥4 doses of diphtheria, tetanus, and pertussis; ≥3 doses of polio vaccine; ≥1 dose of measles, mumps, and rubella vaccine; ≥3 doses of Haemophilus influenzae type b vaccine; ≥3 doses of hepatitis B vaccine; and ≥1 dose of varicella vaccine by 19 months of age, as reported by vaccination providers.

Results.

In all, 21.8% of parents reported intentionally delaying vaccinations for their children. Among parents who intentionally delayed, 44.8% did so because of concerns about vaccine safety or efficacy and 36.1% delayed because of an ill child. Children whose parents intentionally delayed were significantly less likely to receive all vaccines by 19 months of age than children whose parents did not delay (35.4% vs. 60.1%, p<0.05). Parents who intentionally delayed were significantly more likely to have heard or read unfavorable information about vaccines than parents who did not intentionally delay (87.6% vs. 71.9%, p<0.05). Compared with parents who intentionally delayed only because their child was ill, parents who intentionally delayed only because of vaccine safety or efficacy concerns were significantly more likely to seek additional information about their decision from the Internet (11.4% vs. 1.1%, p<0.05), and significantly less likely to seek information from a doctor (73.9% vs. 93.9%, p<0.05).

Conclusions.

Intentionally delayed vaccine doses are not uncommon. Children whose parents delay vaccinations may be at increased risk of not receiving all recommended vaccine doses by 19 months of age and are more vulnerable to vaccine-preventable diseases. Providers should consider strategies such as educational materials that address parents' vaccine safety and efficacy concerns to encourage timely vaccination.
State-Based Estimates of Mammography Screening Rates Based on Information from Two Health Surveys
Authors: Davis William W. , Parsons Van L. , Xie Dawei , Schenker Nathaniel , Town Machell , Raghunathan Trivellore E. , Feuer Eric J.
Published: July 2017

Objectives.

We compared national and state-based estimates for the prevalence of mammography screening from the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), and a model-based approach that combines information from the two surveys.

Methods.

At the state and national levels, we compared the three estimates of prevalence for two time periods (1997–1999 and 2000–2003) and the estimated difference between the periods. We included state-level covariates in the model-based approach through principal components.

Results.

The national mammography screening prevalence estimate based on the BRFSS was substantially larger than the NHIS estimate for both time periods. This difference may have been due to nonresponse and noncoverage biases, response mode (telephone vs. in-person) differences, or other factors. However, the estimated change between the two periods was similar for the two surveys. Consistent with the model assumptions, the model-based estimates were more similar to the NHIS estimates than to the BRFSS prevalence estimates. The state-level covariates (through the principal components) were shown to be related to the mammography prevalence with the expected positive relationship for socioeconomic status and urbanicity. In addition, several principal components were significantly related to the difference between NHIS and BRFSS telephone prevalence estimates.

Conclusions.

Model-based estimates, based on information from the two surveys, are useful tools in representing combined information about mammography prevalence estimates from the two surveys. The model-based approach adjusts for the possible nonresponse and noncoverage biases of the telephone survey while using the large BRFSS state sample size to increase precision.
Coverage of Obesity Treatment: A State-by-State Analysis of Medicaid and State Insurance Laws
Authors: Lee Jennifer S. , Sheer Jennifer L.O. , Lopez Nancy , Rosenbaum Sara
Published: July 2017

Objectives.

We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers.

Methods.

We conducted a state-by-state document review of Medicaid manuals and private insurance laws and regulations.

Results.

Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children. In the small-group insurance market, 35 states expressly allow obesity to be used for rate adjustments, while 10 states do so in the individual market. Two states expressly allow obesity to be used in eligibility decisions in the individual market. Five states provide for coverage of one or more treatments for obesity in both small-group and individual markets.

Conclusions.

Very few states ensure coverage of recommended treatments for adult and pediatric obesity through Medicaid or private insurance. Most states allow obesity to be used to adjust rates in the small-group and individual markets and to deny coverage in the individual market.
Pre-Risk HIV-Prevention Paradigm Shift: The Feasibility and Acceptability of the Parents Matter! Program in HIV Risk Communities
Authors: Miller Kim S. , Maxwell Karl D. , Fasula Amy M. , Parker J. Terry , Zackery Shannon , Wyckoff Sarah C.
Published: July 2017

Objectives.

Many youth begin human immunodeficiency virus (HIV) sexual risk behaviors in preadolescence, yet risk-reduction programs are typically implemented in middle or late adolescence, missing an important window for prevention. Parent-based programming may play an important role in reaching youth early with prevention messages. One such program is the Parents Matter! Program (PMP), a five-session theory- and evidence-based intervention for parents of children aged 9 to 12 years. A randomized controlled trial showed PMP to be efficacious in promoting effective parent-child communication about sexuality and sexual risk reduction. We assessed the feasibility and acceptability of PMP when implemented under typical programmatic circumstances in communities at high risk for HIV infection.

Methods.

We selected 15 sites (including health departments, local education agencies, community-based organizations, and faith-based organizations) throughout the U.S. and Puerto Rico to participate in delivering PMP. Sites were provided training, program materials, and ongoing technical assistance. We collected multilevel data to assess the feasibility of program implementation and delivery, program relevance, and satisfaction with PMP activities and materials.

Results.

PMP was successfully implemented and evaluated in 13 of 15 sites; 76% of parents attended at least four of five sessions. Organization-, facilitator-, and parent-level data indicated the feasibility and acceptability of PMP, and overall high satisfaction with PMP activities and materials.

Conclusion.

The results of this project demonstrate that HIV pre-risk prevention programs for parents can be implemented and embraced by a variety of community organizations in HIV at-risk communities. The time to embrace parents as partners in public health HIV-prevention efforts has come.
The State Public Health Laboratory System
Authors: Inhorn Stanley L. , Astles J. Rex , Gradus Stephen , Malmberg Veronica , Snippes Paula M. , Wilcke Burton W. , White Vanessa A.
Published: July 2017

This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance.

To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.
Public Health Laboratory System Improvement Program: Development and Implementation
Authors: Milne Kathleen C. , Milne Thomas L.
Published: July 2017

Instruments designed to measure the performance of public health systems at state and local levels were supported by the Centers for Disease Control and Prevention (CDC) and implemented in 2002. This article describes the process and outcomes of a system and tool designed to measure performance of State Public Health Laboratory Systems, accomplished by the Association of Public Health Laboratories (APHL) in partnership with CDC. We describe the process used to develop the instrument and its subsequent pilot testing and field testing in 11 states.

Throughout the field testing and early implementation phases, both CDC and APHL recognized that the core rationale for measuring system performance would be to provide the basis for subsequent system improvement. APHL implemented the Laboratory System Improvement Program (L-SIP) in 2007 and conducted an evaluation of the field testing of the instrument and related materials that same year. We conclude with a summary of future implications for L-SIP, the program's recognition as an international standard for laboratory systems, and the critical importance of its continuation.
Systematic Review of Antibiograms: A National Laboratory System Approach for Improving Antimicrobial Susceptibility Testing Practices in Michigan
Authors: Boehme Martha S. , Somsel Patricia A. , Downes Frances Pouch
Published: July 2017

Objectives.

Public health surveillance is often dependent on sentinel testing performed in clinical microbiology laboratories, and recognition of emerging/unusual antimicrobial resistance is especially challenging. We obtained cumulative antibiograms from hospitals to determine whether clinical laboratories recognized unusual resistance or reported antimicrobials inappropriate for various bacterial species, as measured before and after public health laboratory (PHL) educational and technical-support interventions.

Methods.

We compared cumulative antibiogram data from 81 clinical laboratories servicing 86 hospitals in Michigan from 2000 through 2005 with a standardized checklist derived from Clinical and Laboratory Standards Institute (CLSI) antimicrobial susceptibility testing (AST) documents. We considered the reporting of unlikely percent-susceptible results and/or inappropriate antimicrobials serious errors, and we calculated error rates for each data year. We used CLSI-recommendation compliance as a measure to determine whether laboratories were implementing changes.

Results.

Ninety-five of 239 (28%) cumulative antibiograms examined had one or more serious errors. The annual number of cumulative antibiograms with serious errors did not change radically (range: 10–13); however, when expressed as a percentage of cumulative antibiograms received, the occurrence of these errors declined from 59% in 2000 to 19% in 2005. The reporting of misleading or dangerous antimicrobial-organism combinations occurred less frequently than the reporting of unlikely percent-susceptible results. Compliance with new CLSI recommendations did not improve significantly.

Conclusions.

AST is complex and nuanced. PHL programs can provide resources, guidance, and technical support to help clinical microbiologists differentiate questionable AST results from true emerging antimicrobial resistance.
Pandemic Preparedness in Hawaii: A Multicenter Verification of Real-Time RT-PCR for the Direct Detection of Influenza Virus Types A and B
Authors: Whelen A. Christian , Bankowski Matthew J. , Furuya Glenn , Honda Stacey , Ueki Robert , Chan Amelia , Higa Karen , Kumashiro Diane , Moore Nathaniel , Lee Roland , Koyamatsu Terrie , Effler Paul V.
Published: July 2017

Objective.

We integrated multicenter, real-time (RTi) reverse transcription polymerase chain reaction (RT-PCR) screening into a statewide laboratory algorithm for influenza surveillance and response.

Methods.

Each of three sites developed its own testing strategy and was challenged with one randomized and blinded panel of 50 specimens previously tested for respiratory viruses. Following testing, each participating laboratory reported its results to the Hawaii State Department of Health, State Laboratories Division for evaluation and possible discrepant analysis.

Results.

Two of three laboratories reported a 100% sensitivity and specificity, resulting in a 100% positive predictive value and a 100% negative predictive value (NPV) for influenza type A. The third laboratory showed a 71% sensitivity for influenza type A (83% NPV) with 100% specificity. All three laboratories were 100% sensitive and specific for the detection of influenza type B. Discrepant analysis indicated that the lack of sensitivity experienced by the third laboratory may have been due to the analyte-specific reagent probe used by that laboratory. Use of a newer version of the product with a secondary panel of 20 specimens resulted in a sensitivity and specificity of 100%.

Conclusions.

All three laboratories successfully verified their ability to conduct clinical testing for influenza using diverse nucleic acid extraction and RTi RT-PCR platforms. Successful completion of the verification by all collaborating laboratories paved the way for the integration of those facilities into a statewide laboratory algorithm for influenza surveillance and response.
Developing Laboratory Networks: A Practical Guide and Application
Authors: Kirk Carol J. , Shult Peter A.
Published: July 2017

The role of the public health laboratory (PHL) in support of public health response has expanded beyond testing to include a number of other core functions, such as emergency response, training and outreach, communications, laboratory-based surveillance, and laboratory data management. These functions can only be accomplished by a network that includes public health and other agency laboratories and clinical laboratories. It is a primary responsibility of the PHL to develop and maintain such a network. In this article, we present practical recommendations—based on 17 years of network development experience—for the development of statewide laboratory networks. These recommendations, and examples of current laboratory networks, are provided to facilitate laboratory network development in other states. The development of laboratory networks will enhance each state's public health system and is critical to the development of a robust national Laboratory Response Network.
The Role of Local Public Health Laboratories
Authors: Wilson Michael L. , Gradus Stephen , Zimmerman Scott J.
Published: July 2017

Local public health laboratories (PHLs) serve many of the same roles as state PHLs and often perform many or portions of the 11 Core Functions and Capabilities of State Public Health Laboratories; however, they differ in several important ways. First, many local laboratories provide testing at the site of patient care (e.g., sexually transmitted infection clinics) or address local environmental issues (e.g., water quality). Second, local PHLs support the missions of local public health departments, which may differ from those at the state level. Third, local PHLs often serve as conduits, collecting specimens for various state-level screening and disease-control programs; and while they may not perform the testing, local PHLs are responsible for tracking specimens, ordering tests, and reporting results. Fourth, local PHLs often serve as surge capacity for state PHLs, particularly for testing to support emergency response. Last, local PHLs work with and are typically co-located in the local public health agency with other public health programs. Local PHL professionals work as a team with investigators, inspectors, and community and public health medical professionals and, thus, are poised to provide rapid and relevant responses to community needs.
The Evidence Base for Effectiveness of Preparedness Training: A Retrospective Analysis
Authors: Potter Margaret A. , Miner Kathleen R. , Barnett Daniel J. , Cadigan Rebecca , Lloyd Laura , Olson Debra K. , Parker Cindy , Savoia Elena , Shoaf Kimberley
Published: July 2017

Objectives.

In 2007, the Centers for Disease Control and Prevention (CDC) commissioned an Evidence-Based Gaps Collaboration Group to consider whether past experience could help guide future efforts to educate and train public health workers in responding to emergencies and disasters.

Methods.

The Group searched the peer-reviewed literature for preparedness training articles meeting three criteria: publication during the period when CDC's Centers for Public Health Preparedness were fully operational, content relevant to emergency response operations, and content particular to the emergency response roles of public health professionals. Articles underwent both quantitative and qualitative analyses.

Results.

The search identified 163 articles covering the topics of leadership and command structure (18.4%), information and communications (14.1%), organizational systems (78.5%), and others (23.9%). The number of reports was substantial, but their usefulness for trainers and educators was rated only “fair” to “good.” Thematic analysis of 137 articles found that organizational topics far outnumbered leadership, command structure, and communications topics. Disconnects among critical participants—including trainers, policy makers, and public health agencies—were noted. Generalizable evaluations were rare.

Conclusions.

Reviews of progress in preparedness training for the public health workforce should be repeated in the future. Governmental investment in training for preparedness should continue. Future training programs should be grounded in policy and practice needs, and evaluations should be based on performance improvement.
Understanding Quality: A Guide for Developers and Consumers of Public Health Emergency Preparedness Trainings
Authors: Hites Lisle , Altschuld James
Published: July 2017

The work described in this article represents two years of collaboration among 32 evaluators from 23 schools of public health involved in the Centers for Disease Control and Prevention's Centers for Public Health Preparedness program. Evaluators in public health emergency preparedness (PHEP) training were tasked with identifying what constitutes quality in PHEP training and providing guidance to practitioners in selecting training packages. The results of their deliberations included development and selection of guidelines for a high-quality course, a justification of the guidelines, and a Training Selection System (TSS) to assist in analyzing extant trainings. In this article, we present the TSS (along with explanatory notes for each of its sections), preliminary feedback from practitioners, and a discussion of next steps.
State Courts and Public Health: Building Partnerships to Enhance Preparedness
Authors: Sweeney Patricia M. , Stebbins Samuel , Stier Daniel D. , Pines Zygmont
Published: July 2017

Laws and regulations can facilitate or impede emergency preparedness and response activities. State legislators, judges, and lawyers play critically important roles in creating and interpreting laws that affect the ability of public health practitioners and their partners to effectively respond to emergencies. In an age when political unrest, global travel, and emerging biological threats can combine to create social and economic havoc worldwide, it is critical that those responsible for upholding the rule of law during emergencies understand the law and its implications.

In 2003, the University of Pittsburgh Center for Public Health Preparedness (UP-CPHP) created a Preparedness Law and Policy Program to advance legal preparedness for public health emergencies across Pennsylvania and the nation. To achieve this goal, UP-CPHP has partnered with local, state, and national organizations. In the course of these activities, Pennsylvania judges, the Administrative Office of Pennsylvania Courts, UP-CPHP, and the Centers for Disease Control and Prevention's Public Health Law Program have developed a strong and enduring collaborative relationship that has put the Pennsylvania judiciary in a better position today to plan for and respond to a public health crisis than it has been at any other point in its history. The tools and resources developed through this collaboration can readily be adapted to assist other jurisdictions nationwide in their efforts to ensure that their judicial systems are similarly prepared.
Trends in the Risk of U.S. Polio Outbreaks and Poliovirus Vaccine Availability for Response
Authors: Thompson Kimberly M. , Wallace Gregory S. , Tebbens Radboud J. Duintjer , Smith Philip J. , Barskey Albert E. , Pallansch Mark A. , Gallagher Kathleen M. , Alexander James P. , Armstrong Gregory L. , Cochi Stephen L. , Wassilak Steven G. F.
Published: July 2017

Objectives.

The United States eliminated indigenous wild polioviruses (WPVs) in 1979 and switched to inactivated poliovirus vaccine in 2000, which quickly ended all indigenous live poliovirus transmission. Continued WPV circulation and use of oral poliovirus vaccine globally allow for the possibility of reintroduction of these viruses. We evaluated the risk of a U.S. polio outbreak and explored potential vaccine needs for outbreak response.

Methods.

We synthesized information available on vaccine coverage, exemptor populations, and population immunity. We used an infection transmission model to explore the potential dynamics of a U.S. polio outbreak and potential vaccine needs for outbreak response, and assessed the impacts of heterogeneity in population immunity for two different subpopulations with potentially low coverage.

Results.

Although the risk of poliovirus introduction remains real, widespread transmission of polioviruses appears unlikely in the U.S., given high routine coverage. However, clusters of un- or underimmunized children might create pockets of susceptibility that could potentially lead to one or more paralytic polio cases. We found that the shift toward combination vaccine utilization, with limited age indications for use, and other current trends (e.g., decreasing proportion of the population with immunity induced by live polioviruses and aging of vaccine exemptor populations) might increase the vulnerability to poliovirus reintroduction at the same time that the ability to respond may decrease.

Conclusions.

The U.S. poliovirus vaccine stockpile remains an important resource that may potentially be needed in the future to respond to an outbreak if a live poliovirus gets imported into a subpopulation with low vaccination coverage.
Racial/Ethnic Variations in the Prevalence of Selected Major Birth Defects, Metropolitan Atlanta, 1994–2005
Authors: Kucik James E. , Alverson Clinton J. , Gilboa Suzanne M. , Correa Adolfo
Published: July 2017

Objectives.

Birth defects are the leading cause of infant mortality and are responsible for substantial child and adult morbidity. Documenting the variation in prevalence of birth defects among racial/ethnic subpopulations is critical for assessing possible variations in diagnosis, case ascertainment, or risk factors among such groups.

Methods.

We used data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth defects registry with active case ascertainment. We estimated the racial/ethnic variation in prevalence of 46 selected major birth defects among live births, stillbirths, and pregnancy terminations at >20 weeks gestation among mothers residing in the five central counties of metropolitan Atlanta between 1994 and 2005, adjusting for infant sex, maternal age, gravidity, and socioeconomic status (SES). We also explored SES as a potential effect measure modifier.

Results.

Compared with births to non-Hispanic white women, births to non-Hispanic black women had a significantly higher prevalence of five birth defects and a significantly lower prevalence of 10 birth defects, while births to Hispanic women had a significantly higher prevalence of four birth defects and a significantly lower prevalence of six birth defects. The racial/ethnic disparities in the prevalence of some defects varied by SES, but no clear pattern emerged.

Conclusions.

Racial/ethnic disparities were suggested in 57% of included birth defects. Disparities in the prevalence of birth defects may result from different underlying genetic susceptibilities; exposure to risk factors; or variability in case diagnosis, ascertainment, or reporting among the subpopulations examined. Policies that improve early diagnosis of birth defects could reduce associated morbidity and mortality.
Resources That May Matter: The Impact of Local Health Department Expenditures on Health Status
Authors: Erwin Paul Campbell , Mays Glen P. , Riley William J.
Published: July 2017

Objectives.

This study examines the association between changes in local health department (LHD) expenditures, aggregated to the state level, and changes in state-level measures of health, from 1993 to 2005. The literature on the impact of LHD resources on health status has been limited by cross-sectional designs. With repeated surveys of LHDs, it is now possible to use longitudinal designs to explore the association between LHD inputs and outcomes.

Methods.

This was a retrospective cohort study. We used a fixed-effects regression model to assess the association between LHD expenditures, aggregated to the state level, and seven separate health measures. We derived LHD expenditure data from the National Association of County and City Health Officials' surveys of LHDs in 1993, 1997, and 2005. We obtained secondary data on seven health measures—smoking and obesity prevalence, infectious disease morbidity, infant mortality, deaths due to cardiovascular disease and cancer, and overall premature death—through the America's Health Rankings® reports, 1990–2008. Usable data were available for 1,470 LHDs, representing 37 states.

Results.

An increase in LHD expenditures, aggregated to the state level, was associated with a statistically significant decline in state-level infectious disease morbidity (t= −3.28, p=0.002) and in years of potential life lost (YPLL) (t= −2.73, p=0.008). For every $10 increase in aggregated LHD expenditures per capita, infectious disease morbidity decreased by 7.4%, and YPLL decreased by 1.5%.

Conclusion.

LHD resources are associated with improvements in preventable causes of morbidity and mortality.