bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study
Authors: Jennings Jacky M. , Stover Jeffrey A. , Bair-Merritt Megan H. , Fichtenberg Caroline , Munoz Mary Grace , Maziad Rafiq , Ketemepi Sherry Johnson , Zenilman Jonathan 
Published: July 2017

Objective. Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems. Methods. The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected. Results. Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture. Conclusions. The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.
Sexual and Drug Use Risk Behaviors of Long-Haul Truck Drivers and Their Commercial Sex Contacts in New Mexico
Authors: McCree Donna Hubbard , Cosgrove Shannon , Stratford Dale , Valway Sarah , Keller Nick , Vega-Hernandez Jaime , Jenison Steven A. 
Published: July 2017

Objectives. Long-haul truck drivers and their commercial sex contacts (CCs) have been associated with the spread of sexually transmitted infections (STIs) in the developing world. However, there is a paucity of information about the STI risk behaviors of these populations in the U.S. We conducted a qualitative phase of a two-phase study to gather information about STI-related risk behaviors in drivers and their CCs in New Mexico. Methods. Between July and September 2004, we conducted face-to-face unstructured and semistructured qualitative interviews at trucking venues, health department facilities, and a community-based organization to solicit information on sexual behavior and condom and illicit drug use. The interviews were audiotaped, transcribed, reviewed for quality control, and then coded and analyzed for emerging themes using NVivo® software. Results. Thirty-three long-haul truck drivers and 15 CCs completed the interview. The truck drivers were mostly male and non-Hispanic white with a mean age of 41 years. The majority of the CCs were female, the largest percentage was Hispanic, and the mean age was 36 years. Data suggested risky sexual behavior and drug use (i.e., inconsistent condom use, illicit drug use including intravenous drug use, and the exchange of sex for drugs) that could facilitate STI/human immunodeficiency virus (HIV) and hepatitis virus transmission. Results also showed a low knowledge about STIs and lack of access to general health care for both populations. Conclusions. Additional studies are needed to further assess risk and inform the development of prevention interventions and methods to provide STI/HIV and other medical services to these populations.
Assessing Health Status, Behavioral Risks, and Health Disparities in American Indians Living on the Northern Plains of the U.S.
Authors: Holm Jeffrey E. , Vogeltanz-Holm Nancy , Poltavski Dmitri , McDonald Leander 
Published: July 2017

Objective. We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities. Methods. AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews. Results. AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease. Conclusions. Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.
Understanding People Who Have Never Received HIV Medical Care: A Population-Based Approach
Authors: Fagan Jennifer L. , Bertolli Jeanne , McNaghten A.D. 
Published: July 2017

A substantial number of people living with human immunodeficiency virus (HIV) have never received HIV medical care despite the benefits of early entry to care. The United States has no population-based system that can be used to estimate the number of people who have never received HIV care or to monitor the reasons that care is delayed. Although local efforts to describe unmet need and barriers to care have been informative, nationally representative data are needed to increase the number of people who enter care soon after diagnosis. Legal requirements to report all CD4 counts and all HIV viral load levels (indicators of HIV care) in most states now make national estimates of both care entry and non-entry feasible. The Centers for Disease Control and Prevention (CDC) and five state and local health department jurisdictions are testing and evaluating methods for a standardized supplemental HIV surveillance system to characterize HIV-infected people across the U.S. who have not entered HIV care after their diagnosis. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care, and provides data from the formative phase of the CDC pilot project.
Origins and Development of the National Laboratory System for Public Health Testing
Authors: Astles J. Rex , White Vanessa A. , Williams Laurina O. 
Published: July 2017

Although not recognized as such, a National Laboratory System (NLS) has existed since the inception of public health laboratory (PHL) testing more than a century ago. The NLS has always relied upon the participation of clinical laboratories, both to report test results that represent public health threats and to submit specimens and isolates to PHLs for additional or confirmatory testing. Historically, a number of factors have hindered the strengthening of the relationships between clinical laboratories and PHLs, but the reality of bioterrorism and subsequent focus on strengthening public-private relationships has stimulated the development of a more robust NLS. Since 2002, there has been substantial strengthening of the NLS through the sharing of lessons learned from several demonstration projects. There is a growing emphasis on defining critical elements of the NLS, including the State Public Health Laboratory System (SPH Laboratory System) and the functions of the Laboratory Program Advisor, a position that every state should have at the center of its laboratory system's capacity-building. Additional strengthening of the NLS is occurring through ( 1) national biennial measurement of state PHLs' abilities to meet the Core Functions and Capabilities of State PHLs, ( 2) the new Laboratory System Improvement Program (L-SIP) for the SPH Laboratory System, and ( 3) sharing ideas to integrate and improve the SPH Laboratory System (e.g., using the L-SIP Online Resource Center). Public health emergencies, such as the recent H1N1 epidemic, illustrate and reinforce the need for a strong NLS within which federal, public health, and clinical (i.e., hospital and private reference) laboratories function in close collaboration.
Implementing Routine Testing for Severe Combined Immunodeficiency within Wisconsin's Newborn Screening Program
Authors: Baker Mei Wang , Laessig Ronald H. , Katcher Murray L. , Routes John M. , Grossman William J. , Verbsky James , Kurtycz Daniel F. , Brokopp Charles D. 
Published: July 2017

Severe combined immunodeficiency (SCID) is the result of genetic defects that impair normal T-cell development. SCID babies typically appear normal at birth, but acquire multiple life-threatening infections within a few months. Early diagnosis and treatment with a bone-marrow transplant markedly improves long-term outcomes. On January 1, 2008, the newborn screening (NBS) program in Wisconsin became the first in the world to routinely test all newborns for SCID. A realtime quantitative polymerase chain reaction assay measures T-cell receptor excision circles (TRECs), which are formed during the maturation of normal T-cells. A lack or very low number of TRECs is consistent with T-cell lymphopenia. The development and validation of the TREC assay and the results of the first year of screening have been published. This article describes the process used to add SCID to the NBS panel, the establishment of follow-up capacity, and the integration of SCID screening into routine NBS workflows. The development of this expanded NBS program is described so that other states might benefit from the processes used in Wisconsin.
Training the Public Health Workforce from Albany to Zambia: Technology Lessons Learned along the Way
Authors: Waltz Edward C. , Maniccia Dayna M. , Bryde Regina L. , Murphy Kristin , Harris Brett R. , Waldenmaier Mark N. 
Published: July 2017

This article describes lessons learned by the University at Albany Center for Public Health Preparedness (UA-CPHP) in using three technologies to deliver preparedness training for public health professionals in New York State. These three technologies are: Audience response system (ARS, or the “clicker” system)—Purchased to improve engagement of all participants in heterogeneous training audiences, it also markedly reduces staff time while improving training evaluation (cost: $4,500). Satellite broadcast programs—UA-CPHP produced more than 50 broadcasts, which remain available as videostreams and/or podcasts. Viewership of archived programs sometimes surpasses that of the live event (cost estimate: $23,000 to $39,000). Interactive online courses—Seventeen courses have registered more than 44,000 learners worldwide. The Pandemic Influenza course alone has reached more than 16,000 registrants from all 50 U.S. states and at least 56 other countries (cost estimate: $30,000 to $65,000). UA-CPHP's experience as a preparedness training center has confirmed that contemporary technology can be employed to improve and increase the reach of these training efforts. An additional finding was that, quite unintentionally, the intensive use of distance-based educational modalities designed to reach public health practitioners in New York State has afforded UA-CPHP a substantial national and international audience as well, and at no additional cost.
Actions to Control High Blood Pressure among Hypertensive Adults in Texas Counties along the Mexico Border: Texas BRFSS, 2007
Authors: Ayala Carma , Fang Jing , Escobedo Luis , Pan Stephen , Balcazar Hector G. , Wang Guijing , Merritt Robert 
Published: July 2017

Objectives. We examined the prevalence of actions taken to control blood pressure as measured by taking antihypertensive medication or making lifestyle modifications among hypertensive adults residing along the Texas/Mexico border. Methods. We used self-reported data from the 2007 Texas Behavioral Risk Factor Surveillance System, with oversampling of border counties. We calculated the age-standardized prevalence of actions taken to control hypertension by selected characteristics. Results. In analyses that combined ethnicity with predominant language spoken, those least likely to take any action to control their blood pressure—either by taking an antihypertensive medication or by making any of four lifestyle modifications—were Spanish-speaking Hispanic people (83.2% ± 2.7% standard error [SE]), with English-speaking non-Hispanic people (88.9% ± 0.8% SE) having the highest prevalence of taking action to control blood pressure. When analyzed by type of medical category, uninsured Hispanic people (63.8% ± 4.8% SE) had the lowest prevalence of taking action to control their blood pressure compared with uninsured non-Hispanic people (75.4% ± 4.7% SE). Nonborder Texas residents with hypertension were more likely to take antihypertensive medications (78.4% ± 1.0% SE) than border county residents with hypertension (70.7% ± 2.0% SE). Conclusions. Public health efforts must be undertaken to improve the control of hypertension among residents of Texas counties along the Mexico border, particularly for uninsured Hispanic people.
The Economic, Institutional, and Political Determinants of Public Health Delivery System Structures
Authors: Ingram Richard C. , Scutchfield F. Douglas , Mays Glen P. , Bhandari Michelyn W. 
Published: July 2017

Objectives. A typology of local public health systems was recently introduced, and a large degree of structural transformation over time was discovered in the systems analyzed. We present a qualitative exploration of the factors that determine variation and change in the seven structural configurations that comprise the local public health delivery system typology. Methods. We applied a 10-item semistructured telephone interview protocol to representatives from the local health agency in two randomly selected systems from each configuration—one that had maintained configuration over time and one that had changed configuration over time. We assessed the interviews for patterns of variation between the configurations. Results. Four key determinants of structural change emerged: availability of financial resources, interorganizational relationships, public health agency organization, and political relationships. Systems that had changed were more likely to experience strengthened partnerships between public health agencies and other community organizations and enjoy support from policy makers, while stable systems were more likely to be characterized by strong partnerships between public health agencies and other governmental bodies and less supportive relationships with policy makers. Conclusions. This research provides information regarding the determinants of system change, and may help public health leaders to better prepare for the impacts of change in the areas discussed. It may also help those who are seeking to implement change to determine the contextual factors that need to be in place before change can happen, or how best to implement change in the face of contextual factors that are beyond their control.
Dental Anxiety and the Use of Oral Health Services among People Attending Two HIV Primary Care Clinics in Miami
Authors: Singer Richard , Cardenas Gabriel , Xavier Jessica , Jeanty Yves , Pereyra Margaret , Rodriguez Allan , Metsch Lisa R. 
Published: July 2017

Objectives. We examined factors associated with dental anxiety among a sample of HIV primary care patients and investigated the independent association of dental anxiety with oral health care. Methods. Cross-sectional data were collected in 2010 from 444 patients attending two HIV primary care clinics in Miami-Dade County, Florida. Corah Dental Anxiety Scores and use of oral health-care services were obtained from all HIV-positive patients in the survey. Results. The prevalence of moderate to severe dental anxiety in this sample was 37.8%, while 7.9% of the sample was characterized with severe dental anxiety. The adjusted odds of having severe dental anxiety were 3.962 times greater for females than for males (95% confidence interval [CI] 1.688, 9.130). After controlling for age, ethnicity, gender, education, access to dental care, and HIV primary clinic experience, participants with severe dental anxiety had 69.3% lower adjusted odds of using oral health-care services within the past 12 months (vs. longer than 12 months ago) compared with participants with less-than-severe dental anxiety (adjusted odds ratio 5 0.307, 95% CI 0.127, 0.742). Conclusion. A sizable number of patients living with HIV have anxiety associated with obtaining needed dental care. Routine screening for dental anxiety and counseling to reduce dental anxiety are supported by this study as a means of addressing the impact of dental anxiety on the use of oral health services among HIV-positive individuals.
Mortality Rates and Age at Death from Sickle Cell Disease: U.S., 1979–2005
Authors: Lanzkron Sophie , Carroll C. Patrick , Haywood Carlton 
Published: July 2017

Objectives. Improvements in survival for children with sickle cell disease (SCD) during the last 30 years have been well established. Whether similar improvements for adults with the disease have occurred is unknown. We investigated mortality rates for children and adults with SCD. Methods. We used the National Center for Health Statistics multiple-cause-of-death files to examine age at death and calculate mortality rates from 1979 to 2005. We examined trends in mortality rates using negative binomial regression, and we examined age at death using t-tests and linear regression. Results. We identified 16,654 sickle cell-related deaths. Mean age at death was significantly different for males (33.4 years, 95% confidence interval [CI] 33.0, 33.7) than for females (36.9 years, 95% CI 36.5, 37.4). In a regression model controlling for gender, the mean age at death increased by 0.36 years for each year of the study. The median age at death in 2005 was 42 years for females and 38 years for males. The overall mortality rate increased 0.7% ( p<0.001) each year during the time period studied. The adult (>19 years of age) mortality rate increased by 1% ( p<0.001) each year during the time period studied. The pediatric mortality rate decreased by 3% ( p<0.001) each year during the time period studied. Conclusions. These data confirm prior findings of a significant decrease in mortality for children with SCD The mortality rate for adults appears to have increased during the same time period It seems unlikely that this increase is due merely to an influx of younger patients surviving to adulthood and may reflect a lack of access to high-quality care for adults with SCD.
Geographic and Racial Patterns of Preventable Hospitalizations for Hypertension: Medicare Beneficiaries, 2004–2009
Authors: Will Julie C. , Nwaise Isaac A. , Schieb Linda , Zhong Yuna 
Published: July 2017

Objectives. Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race. Methods. We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004–2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates. Results. Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama. Conclusions. Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.
Urban-Rural Differences in Coronary Heart Disease Mortality in the United States: 1999–2009
Authors: Kulshreshtha Ambar , Goyal Abhinav , Dabhadkar Kaustubh , Veledar Emir , Vaccarino Viola 
Published: July 2017

Objective. Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S. Methods. Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35–84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years. Results. From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar. Conclusion. Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).