Department Of Health And Mental Hygiene Research Articles

A Survey of Data Recording Procedures at New York City Emergency Departments

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) routinely collects daily emergency department (ED) data from 49 of NYC‰Ûªs 52 EDs. Very little information regarding ED-specific coding practices, procedures or health information systems was available to the DOHMH. With the goal of gaining more inforamtion about ED-specific coding practices, members of the DOHMH interviewed ED personnel at all 49 EDs. The information from these surveys is to be used to improve the DOHMH‰Ûªs ability to categorize ED visits into syndrome groupings.

Invasive Meningococcal Disease in MSM

Historically, the most common source of meningococcal infection in adults has been exposure to an asymptomatic person with nasopharyngeal carriage of the organism. Now, researchers at the New York City Department of Health and Mental Hygiene (DOHMH) and the CDC report 18 cases of invasive serogroup C Neisseria meningitidis disease (SCMD) diagnosed …

Identifying Older Adults at Risk for Depression in Senior Centers: The Educating About and Screening Elders for Depression Model

Depression is a serious illness that can significantly undermine successful aging. Clinically significant depression affects nearly 16.6% of adults during their lifetimes; approximately 6.7% of adults are affected by depression in any 12-month period (Kessler, Berglund, et al, 2005; Kessler, Chiu, et al., 2005). Although older adults, in general, have a lower prevalence of major depression than younger adults, they, too, are affected by clinical depression. In 2008, the 12-month prevalence for depression among adults 50 years of age and older was 4.5% (Substance Abuse and Mental Health Services Administration, 2010). Other studies of depression prevalence in older adults indicate that the rate of depression among community-dwelling elders ranges from 1%-4% (Alexopolous, 2005). However, the rates of depression rise dramatically for older adults living with a chronic illness or functional disability; these rates rise to 13.5% for those requiring home health care or 11.5% in older hospital patients (Hybels & Blazer, 2003).Depression is associated with poorer health outcomes, increased functional disability, and increased social isolation, all of which contribute to a poorer quality of life. It is also a contributing factor to suicide, for which depressed older adults are at high risk. Older adults who struggle with depression are at increased risk for completing suicide compared to older adults who are not depressed or to the general population at large (Butler, Cohen, Lewis, Simmons-Clemmons, & Sunderland, 1997). In 2004, although older adults comprised only 12% of the U.S. population, people aged 65 years and older accounted for 16% of suicide deaths ( Centers for Disease Control and Prevention, 2005). Despite the need to ascertain which older adults may be suffering from depression, identifying at risk older adults can be challenging for community-based providers of aging services, many of which lack the staff, training, and resources to determine systematically which older adults may be at risk. Additionally, many older adults are reluctant to discuss their emotional well-being with health care or social service providers. Some older adults may not realize that their symptoms of persistently sad mood, appetite changes, sleep disturbance, and lack of pleasure in their usual activities are hallmarks of depression and may associate these symptoms with the vagaries of later life. Unfortunately, despite the advancement of clinically effective pharmacologic and psychosocial therapies for depression in the past several decades, older adults may still be burdened by the stigma associated with depression and may be concerned that acknowledging symptoms will cause them to be treated against their will or may have other negative outcomes.A PUBLIC-PRIVATE PARTNERSHIPTo address the needs of community-dwelling older adults, the New York City Department of Health and Mental Hygiene (DOHMH), the New York City Department for the Aging (DFTA), and the Mental Health Association of New York City (MHA-NYC) have collaborated in a public-private partnership to provide New York City's aging services system with a program of mental health education, depression screening, and treatment linkage services to older adults who are at risk for depression. This tripartite intervention model entitled, Educating About and Screening Elders for Depression (EASE-D; Berman, & Furst, 2011) operates in DFTAfunded senior centers and in other settings, such as naturally occurring retirement communities (NORCs), where older adults regularly receive services and support.Senior centers and other community-based aging service programs are ideal places to conduct mental health outreach because they are usually programs from which older adults already receive ongoing support and which many older adults trust to provide services such as case management, educational, and recreational programming. Older adults who may be reluctant to seek information about or services for emotional problems can be aided in these programs without their having to make any particular effort to find services or health information. …

Using the Internet to Trace Contacts of a Fatal Meningococcemia Case—New York City, 2010

In August 2010, the New York City Department of Health and Mental Hygiene (DOHMH) conducted an investigation to identify and provide antibiotic prophylaxis to close contacts of a patient who had died of invasive meningococcal disease. Traditional contact tracing, which relies on interviews with the patient's close associates, identified 3 persons meeting prophylaxis criteria. In addition, DOHMH learned of an Internet site used by the patient to arrange anonymous sexual encounters. By working with the Internet site administrator through a liaison, DOHMH sent notification to 15 additional persons potentially at risk for meningococcal disease; of those, at least 1 met prophylaxis criteria. The Internet has been used previously for partner notification by sexually transmitted disease control programs. This case report illustrates how the Internet can aid contact investigations for other communicable diseases, especially when identifying potential contacts is urgent, patients have died, or contacts are unknown to the patient's associates.

Engaging Youth in Food Activism in New York City: Lessons Learned from a Youth Organization, Health Department, and University Partnership

Research indicates that insufficient emphasis on community collaboration and partnership can thwart innovative community-driven work on the social determinants of health by local health departments. Appreciating the importance of enhancing community participation, the New York City Department of Health and Mental Hygiene (DOHMH) helped lead the development of the Health Equity Project (HEP), an intervention aimed at increasing the capacity of urban youth to identify and take action to reduce food-related health disparities. DOHMH partnered with the City University of New York School of Public Health and several local youth organizations to design and implement the intervention. HEP was conducted with 373 young people in 17 cohorts at 14 unique sites: six in Brooklyn, six in the Bronx, and two in Harlem. Partnered youth organizations hosted three stages of work: interactive workshops on neighborhood health disparities, food environments, and health outcomes; food-focused research projects conducted by youth; and small-scale action projects designed to change local food environments. Through these activities, HEP appears to have been successful in introducing youth to the social, economic, and political factors that shape food environments and to the influence of food on health outcomes. The intervention was also somewhat successful in providing youth with community-based participatory research skills and engaging them in documenting and then acting to change their neighborhood food environments. In the short term, we are unable to assess how successful HEP has been in building young leaders who will continue to engage in this kind of activism, but we suspect that more extended interactions would be needed to achieve this more ambitious goal. Experiences at these sites suggest that youth organizations with a demonstrated capacity to engage youth in community service or activism and a commitment to improving food or other health-promoting community resources make the most suitable and successful partners for this kind of effort.

Pushing Produce: The New York City Green Carts Initiative

In 2008, the New York City Council and Mayor Bloomberg signed legislation for Local Law 9, which established 1,000 permits for a new street class of food vendors called Green Carts—mobile fruit and vegetable businesses. Each of the city’s five counties (boroughs) was allotted a number of carts that could move freely within areas where the consumption of fruits and vegetables was lowest; these are also neighborhoods where the prevalence of diet related diseases is high. As of May 2012, there were 477 active Green Cart permits, 200 of which reside in underserved areas of the Bronx, 142 in Brooklyn, 91 in Manhattan, and 41 in Queens. Green Cart permits were intended to create a low-cost and rapid mechanism to get more fruits and vegetables into neighborhoods that need them. The assumption was that with increased supply, there would be increased consumption. Green Cart-zoned areas were selected in neighborhoods where at least 14% of residents stated that they had not eaten any fruits or vegetables the previous day. These are the same neighborhoods that have both a shortage of supermarkets per capita and a heavy presence of corner stores.1 Most of these corner stores sell primarily unhealthy processed foods and few, if any, fresh fruits and vegetables. The introduction of Green Carts also created an economic opportunity to start a low-cost micro-enterprise that would provide a much needed service. Since the inception of the Green Carts program, the Department of Health and Mental Hygiene (DOHMH) has: (1) monitored factors that contribute to Green Cart vendors being successful and (2) assessed the change in overall neighborhood availability of fruits and vegetables in Green Cart neighborhoods. The primary factors that contribute to Green Carts’ success include: setting up in a good location, maintaining an attractive and diverse cart, the vendor speaking the same language as the community residents, having the support of one or several nearby community organizations, and having the ability to accept SNAP benefits. As free market participants, Green Cart vendors set up in locations that they foresee being most profitable; these are often commercial areas with significant foot traffic. While this may result in Green Carts clustering rather than spreading evenly throughout the permitted zones, it increases the likelihood of vendors’ being profitable Additionally, in areas of high population density, clustering may be beneficial to the vendor and the neighborhood residents, as multiple Green Carts may be necessary in order to meet demand. Through a private/public partnership grant, Green Cart vendors have been offered technical assistance on how to start and promote a business and staff has connected Green Cart vendors with community organizations to help them stimulate demand for produce. With assistance from New York State, 27 vendors now have remote terminals that enable them to accept EBT and this number continues to grow. Several organizations support vendors by hosting instructional workshops on how to start a Green Cart business, providing storage space for carts, and promoting Green Cart purchasing. These opportunities are growing as Green Carts become more established and visible through public and private publicity efforts. The NYC DOHMH’s evaluation of the Green Carts Initiative examines the availability of fruits and vegetables before and after implementation in selected neighborhoods. To control for secular trends, non-Green Cart neighborhoods have been and will continue to be evaluated. Results from the first phase of this evaluation show that from 2008 to 2009, the proportion of food establishments selling both fruits and vegetables tended to increase in Green Cart precincts but not in comparison precincts. When the availability directly attributable to sales by Green Carts was taken out of the analysis, the increased availability persisted in neighborhoods hosting Green Carts. These findings are particularly exciting because the increase in fresh fruit and vegetable availability may be primarily driven by corner stores, suggesting that Green Carts may be increasing overall demand, and encouraging other establishments to sell more produce. So far, we are pleased to find that the Green Carts may be increasing the availability of fresh fruits and vegetables in the areas of the city in greatest need. As Green Cart permits become more visible and widely distributed, we will continue to evaluate their impact (including their effect on consumption), and we expect that this trend will be maintained. We hope other urban environments with low fruit and vegetable availability learn from our experiences and consider adopting a similar initiative.

Using Public Health Detailing and a Family-Centered Ecological Approach To Promote Patient–Provider–Parent Action for Reducing Childhood Obesity

This paper describes the research and development of the Obesity in Children Action Kit, a paper-based chronic disease management tool of the Public Health Detailing Program (PHD) at the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). It also describes PHD's process for developing the Obesity in Children detailing campaign (targeting healthcare providers working with children aged 2-18) and its results, during which the Action Kit materials were a focal point. The campaign goals were to impact healthcare provider clinical behaviors, improve the health literacy of parents and children, instigate patient-provider-parent dialogue, and change family practices to prevent obesity. Qualitative research methods consisted of healthcare provider in-depth interviews and parent focus groups to aid campaign development. Evaluation of the Obesity in Children campaign included self-reported data on uptake and usage of clinical tools and action steps of matched assessments from 237 healthcare provider initial and follow-up visits, material stock counts, and DOHMH representative qualitative visit excerpts. Key themes identified in parent focus groups were concerns about childhood diabetes and high blood pressure, awareness of cultural pressure and our "supersize" culture, frustration with family communication around overweight and obesity, lack of knowledge about food quality and portion size, economic pressures, and the availability of healthy and nutritious foods. During the Obesity in Children campaign, six representatives reached 161 practices with 1,588 one-on-one interactions, and an additional 461 contacts were made through group presentations. After these interactions, there was a significant increase in the percentage of physicians self-reported use of key recommended practices: Use of BMI percentile-for-age to assess for overweight or obesity at every visit increased from 77% to 88% (p < 0.01); counseling all patients and their parents/caregivers about healthy eating and physical activity increased from 67% to 85% (p < 0.01); counseling all patients on reducing sugar-sweetened beverages increased from 63% to 78% (p < 0.01); and working with families to set realistic goals increased from 64% to 86% (p < 0.01). Clinical tools such as a soda bottle showing sugar content, pediatric plate planners, and goal setting posters were widely adopted (62%, 78%, and 41% respectively). The Obesity in Children campaign, as well as its predecessor, the Adult Obesity campaign and Action Kit, were amongst the best-received and most successful campaigns PHD has conducted since the inception of the program. They have elicited the most attention from healthcare providers and staff, with Obesity in Children Action Kit materials being requested throughout NYC, as well as nationally.

Evaluating the New York City Emergency Department Syndromic Surveillance for Monitoring Influenza Activity during the 2009-10 Influenza Season

Objective: To use laboratory data to assess the specificity of syndromes used by the New York City emergency department (ED) syndromic surveillance system to monitor influenza activity. Design: For the period from October 1, 2009 through March 31, 2010, we examined the correlation between citywide ED syndrome assignment and laboratory-confirmed influenza and respiratory syncytial virus (RSV). In addition, ED syndromic data from five select NYC hospitals were matched at the patient and visit level to corresponding laboratory reports of influenza and RSV. The matched dataset was used to evaluate syndrome assignment by disease and to calculate the sensitivity and specificity of the influenza-like illness (ILI) syndrome. Results: Citywide ED visits for ILI correlated well with influenza laboratory diagnoses (R=0.92). From October 1, 2009, through March 31, 2010, there were 264,532 ED visits at the five select hospitals, from which the NYC Department of Health and Mental Hygiene (DOHMH) received confirmatory laboratory reports of 655 unique cases of influenza and 1348 cases of RSV. The ED visit of most (56%) influenza cases had been categorized in the fever/flu syndrome; only 15% were labeled ILI. Compared to other influenza-related syndromes, ILI had the lowest sensitivity (15%) but the highest specificity (90%) for laboratory-confirmed influenza. Sensitivity and specificity varied by age group and influenza activity level. Conclusions: The ILI syndrome in the NYC ED syndromic surveillance system served as a specific but not sensitive indicator for influenza during the 2009-2010 influenza season. Despite its limited sensitivity, the ILI syndrome can be more informative for tracking influenza trends than the fever/flu or respiratory syndromes because it is less likely to capture cases of other respiratory viruses. However, ED ILI among specific age groups should be interpreted alongside laboratory surveillance data. ILI remains a valuable tool for monitoring influenza activity and trends as it facilitates comparisons nationally and across jurisdictions and is easily communicated to the public.

Infection Prevention Training Impacts Outbreak Recognition and Control in Long Term Care Facilities in Maryland

The Maryland Department of Health and Mental Hygiene (DHMH) surveyed all long term care (LTC) facilities (nursing homes) in the state in 2003 and determined that there was an urgent need for infection prevention and control training for this setting. In 2004 DHMH partnered with a large LTC trade association in Maryland to implement a basic training course, the two and one-half day Infection Prevention and Control Institute (IPCI), for individuals who have been assigned IPC duties in this setting. From March 2004 through October 2010, over seven hundred (700) registered nurses have been trained in the IPCI. Unpublished DHMH outbreak data was examined to determine if this training had an impact on the number of days taken to recognize and report outbreaks to local health departments.

(P1-103) Utilization of a Pediatric Disaster Coalition as a Model for Regional Pediatric Disaster Planning

PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.MethodsThe PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transport, matching patients' needs to resources, and increasing PCC Surge Capacities.ResultsSurge recommendations were formulated. The algorithm developed provides specific pediatric triage criteria that identify severity of illness using the traditional Red, Yellow, and Green categories plus an Orange designation for continual reassessments that has been adopted by FDNY that has trained &gt; 3,000 FDNY EMS personnel in its use. Triaged patients can be transported to appropriate resources based on a tiered system that defines pediatric hospital capabilities. The Surge Committee has created PCC Surge Capacity Guideline that can be used by hospitals to create their individual PCC surge plans. 15 of 25 NYC hospitals with PCC capabilities are participating with PDC planning; 5 have completed surge plans, 3 are nea completion, and 7 are in development. The completed plans add 92 surge beds to 244 regularly available PICU beds. The goal is to increase the PCC surge bed capacity by 200 + beds.ConclusionsThe project is an effective, multidisciplinary group approach to planning for a regional, large-scale pediatric MCI. Regional lead agencies must emphasize pediatric emergency preparedness in their disaster plans.

(P1-78) Utilizing New York City Pediatric Disaster Coalition Site Visits to Create Hospital Pediatric Critical Care Surge Plans

PurposeThe New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.MethodsMembers of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.ResultsNew York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.ConclusionsProviding surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.

How Maryland increased infection prevention and control activity in long-term care facilities, 2003-2008

In January 2003, the Maryland Department of Health and Mental Hygiene (DHMH) assessed the state of infection prevention and control (IPC) resources and practices in all long-term care facilities (LTC) in the state. Only 8.1% of facilities that responded employed a trained IPC professional (IP) who managed the facility IPC program. Between 2003 and 2008, the DHMH partnered with long-term care industry trade associations and spearheaded regulatory, educational, and financial initiatives to improve this situation. In January 2008, all LTC facilities in the state were resurveyed to determine the impact of these initiatives on IPC activities. The 2008 survey indicated that 44% of LTC facilities used a trained IP who managed the IPC program, a 5-fold increase from 2003. Unpublished DHMH outbreak data indicated that LTC facilities with a trained IP recognized and reported outbreaks to the local health department 2 days sooner than facilities without a trained IP, resulting in fewer cases of disease. Multiple initiatives with concerned stakeholders and LTC partners over the course of 5 years resulted in increased numbers of LTC facilities with trained IPs who recognized and responded to outbreaks sooner than facilities without trained IPs.

Protecting the Public from H1N1 through Points of Dispensing (PODs)

In fall 2009, the New York City Department of Health and Mental Hygiene (DOHMH) operated 58 points of dispensing (PODs) over 5 weekends to provide influenza A (H1N1) 2009 monovalent vaccination to New Yorkers. Up to 7 sites were opened each day across the 5 boroughs, with almost 50,000 New Yorkers being vaccinated. The policies and protocols used were based on those developed for New York City's POD Plan, the cornerstone of the city's mass prophylaxis planning. Before the H1N1 experience, NYC had not opened more than 5 PODs simultaneously and had only experienced the higher patient volume seen with the H1N1 PODs on 1 prior occasion. Therefore, DOHMH identified factors that contributed to the success of POD operations, as well as areas for improvement to inform future mass prophylaxis planning and response. Though this was a relatively small-scale, preplanned operation, during which a maximum of 7 PODs were operated on a given day, the findings have implications for larger-scale mass prophylaxis planning for emergencies.

Beastly Beauty Products: Exposure to Inorganic Mercury in Skin-Lightening Creams

Vol. 119, No. 2 NewsOpen AccessBeastly Beauty Products: Exposure to Inorganic Mercury in Skin-Lightening Creams Cynthia Washam Cynthia Washam Search for more papers by this author Published:1 February 2011https://doi.org/10.1289/ehp.119-a80bCited by:4AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit The most common exposure to mercury is from organic methylmercury found in fish. People with no workplace exposure to mercury typically have low levels of exposure to inorganic or elemental mercury, although nonoccupational exposure can occur from dental amalgams, some herbal medicine products, and cosmetics that contain mercury. When a New York City (NYC) biomonitoring study revealed that thousands of women in that city may have been exposed to dangerous levels of inorganic mercury from imported skin-lightening creams, city health officials enlisted the help of U.S. and international health agencies in getting the creams off local store shelves [EHP119(2):203–209; McKelvey et al.].In 2004 the NYC Department of Health and Mental Hygiene (DOHMH) conducted the nation’s first local Health and Nutrition Examination Survey. Analysis of urine specimens from 1,840 adult New Yorkers collected during the survey yielded a geometric mean mercury concentration of 0.73 μg/L, slightly higher than the national average of 0.5 μg/L. The authors took note when 13 women were found to have urine mercury concentrations exceeding the state’s reportable level of 20 μg/L; 4 women had levels exceeding 50 μg/L.All 13 highly exposed women were Hispanic or black, and 10 had been born in the Dominican Republic. Each of the 9 women interviewed on followup had used mercury-containing skin-lightening cream. One such product sampled by DOHMH workers contained 6,190 ppm mercury. The U.S. Food and Drug Administration (FDA) limit for mercury in skin-care products is 1 ppm.Extrapolating from the population sampled, the authors estimate nearly 27,000 New Yorkers may have urine mercury levels exceeding 20 μg/L. Although the researchers did not assess potential health effects among the highly exposed women, occupational studies indicate kidney and neurologic toxicity may occur when urine mercury levels exceed 20 μg/L.City health officials responded to the survey results by seizing 12 brands of illegally imported cosmetics from store shelves. All the products listed mercury as an active ingredient. Press releases issued by the DOHMH urged residents to report mercury-tainted cosmetics and the shops selling them, and New Jersey investigators were enlisted to plug the pipeline to importers in that state. The Pan American Health Organization called on the Dominican Republic to stop manufacturing the dangerous products. The Dominican Secretary of Health reportedly has notified all laboratories to stop manufacturing mercury-containing skin-care products.The authors realize some tainted products may still cross the border, as they have for years despite FDA prohibitions. But they believe their efforts, coupled with evidence of mercury’s toxicity and continued vigilance, will substantially reduce the availability and use of these products.Only half the sampled products listed mercury on the label. Most exceeded the FDA limit for mercury in personal care products by several hundred or thousand times.FiguresReferencesRelatedDetailsCited by Al-Saleh I (2016) Potential health consequences of applying mercury-containing skin-lightening creams during pregnancy and lactation periods, International Journal of Hygiene and Environmental Health, 10.1016/j.ijheh.2016.03.002, 219:4-5, (468-474), Online publication date: 1-Jul-2016. Chatterjee S, Sarkar S and Bhattacharya S (2014) Toxic Metals and Autophagy, Chemical Research in Toxicology, 10.1021/tx500264s, 27:11, (1887-1900), Online publication date: 17-Nov-2014. Yang H, Chen P, Ho P and Shih Y (2014) Direct Analysis of Mercury in Cosmetics Using Screen-Printed Silver Electrodes and Flow Injection Analysis, Journal of The Electrochemical Society, 10.1149/2.057406jes, 161:6, (B137-B142), . Secor J, Kotha S, Gurney T, Patel R, Kefauver N, Gupta N, Morris A, Haley B and Parinandi N (2011) Novel Lipid-Soluble Thiol-Redox Antioxidant and Heavy Metal Chelator, N , N ′-bis(2-Mercaptoethyl)Isophthalamide (NBMI) and Phospholipase D-Specific Inhibitor, 5-Fluoro-2-Indolyl Des-Chlorohalopemide (FIPI) Attenuate Mercury-Induced Lipid Signaling Leading to Protection Against Cytotoxicity in Aortic Endothelial Cells , International Journal of Toxicology, 10.1177/1091581811422413, 30:6, (619-638), Online publication date: 1-Dec-2011. Vol. 119, No. 2 February 2011Metrics About Article Metrics Publication History Originally published1 February 2011Published in print1 February 2011 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Pandemic (H1N1) 2009 surveillance for severe illness and response, New York, New York, USA, April-July 2009.

On April 23, 2009, the New York City Department of Health and Mental Hygiene (DOHMH) was notified of a school outbreak of respiratory illness; 2 days later the infection was identified as pandemic (H1N1) 2009. This was the first major outbreak of the illness in the United States. To guide decisions on the public health response, the DOHMH used active hospital-based surveillance and then enhanced passive reporting to collect data on demographics, risk conditions, and clinical severity. This surveillance identified 996 hospitalized patients with confirmed or probable pandemic (H1N1) 2009 virus infection from April 24 to July 7; fifty percent lived in high-poverty neighborhoods. Nearly half were <18 years of age. Surveillance data were critical in guiding the DOHMH response. The DOHMH experience during this outbreak illustrates the need for the capacity to rapidly expand and modify surveillance to adapt to changing conditions.

The Development and Implementation of a User-Friendly Priority Setting Tool for HIV Care and Treatment Services in New York City

The Ryan White Human Immunodeficiency Virus (HIV) Program is the largest federal program designed to provide medical and social support services for HIV infected persons who are uninsured or underinsured. In 2008, the Ryan White budget was $2.2 billion, of which over $100 million went to the New York City (NYC) eligible metropolitan area (EMA), which receives the largest Ryan White allocation targeted to any EMA. The NYC Department of Health and Mental Hygiene (DOHMH) is the grantee for the EMA. To implement HIV care and treatment programs funded by this grant, the DOHMH works closely with the NYC Ryan White Planning Council, a local community planning body that assesses needs, plans for service delivery and sets priorities for funds. This article describes priority setting principles, practices, findings and lessons learned. It also outlines how the legislatively mandated community planning body has developed and implemented a user-friendly priority setting process and tool.

Barriers at the Frontline: Assessing and Improving the Teen Friendliness of South Bronx Medical Practices

Despite improvements in New York City (NYC) residents’ health in the past decade,1 disparities exist between economically disadvantaged and advantaged neighborhoods.2 In 2002, the NYC Department of Health and Mental Hygiene (DOHMH) created three District Public Health Offices (DPHOs) in the impoverished neighborhoods of the South Bronx, East and Central Harlem, and North and Central Brooklyn. The DPHOs aim to promote health equity in these areas. The Bronx DPHO targeted teenage pregnancy rates, which are persistently higher in the South Bronx than in the United States. In 2007, the South Bronx teen pregnancy rate was 133 per 1,000 females aged 15 –19 years, compared with 72 per 1,000 in the U.S.3,4 We hypothesized that in addition to neighborhood determinants of poverty and education, the high teen pregnancy rate in the South Bronx was partly attributable to low hormonal contraceptive use. Findings from the 2005 Youth Risk Behavior Survey revealed that South Bronx students reported relatively high condom use (68%) but extremely low birth control pill use (6%) compared with U.S. teenagers (63% and 18%, respectively).5,6 A Bronx survey also found that teens with access to confidential services were three times as likely to initiate gynecologic care compared with teens who lacked such access.7 This article illustrates a novel approach taken by the New York City Department of Health and Mental Hygiene to rapidly test the efficacy of an intervention to improve teen friendliness of frontline staff working in South Bronx medical practices. It is not always clear exactly which aspects of poor access to care and poor utilization of services help drive high teen pregnancy rates in communities, but the authors have identified teen friendliness of services as an important intermediate outcome. Even when proved ineffective, their systematic efforts to achieve improvements are commendable as a way to target sexual and reproductive health care for teens. Lorna Thorpe Director, Epidemiology and Biostatistics Program City University of New York School of Public Health, Hunter College

OVERSTATING SOCIAL NETWORKS' ABILITY TO DIAGNOSE NEW CASES OF HIV

Kimbrough et al.1 describe a peer-driven, network-oriented strategy as highly efficient for HIV case finding. The study found a 5.6% prevalence rate among tested participants, but did not discuss the possibility that some of these positives may be repeat testers. Our experience in New York City shows that partners and network associates with known HIV diagnoses may not always disclose their HIV status to testers. In 2008, New York City's Department of Health and Mental Hygiene (DOHMH) funded 5 community-based organizations to conduct social network testing using a similar incentive structure to Kimbrough et al. Of 147 associates tested for HIV between January and June 2008, 8 were identified as newly positive based on self-report. We linked the identified positive cases to DOHMH's name-based registry of persons with HIV/AIDS—the HIV/AIDS Registry System (HARS)—and found that 3 cases were previously diagnosed. This caused the HIV prevalence rate for newly reported cases to drop from 5.4% (8 of 147) to 3.4% (5 of 147). Similarly, of 299 partners field-tested through DOHMH's HIV partner notification activities from February 19, 2008 to June 30, 2009, 23 tested HIV positive but only 16 were newly diagnosed as per HARS check, reducing the HIV prevalence rate for newly reported cases from 7.7% to 5.3%. “Waterfront Scene,” by Pino Janni, depicts the East River docks in New York City and was all about finding work for longshoremen as well as for artists. From the recent Smithsonian Art Museum exhibition, “1934: A New Deal for Artists.” Printed with permission. Pino Janni, “Waterfront Scene,” 1934, oil on canvas, Smithsonian American Art Museum, Transfer from the U.S. Department of Labor. Hanna et al.'s larger analysis further documented that HIV-positive tests cannot be assumed to represent new diagnoses.2 By matching Western blot tests reported in New York City to HARS, Hanna et al. found that only 36.8% of Western blots were new diagnoses and 63.2% were repeat tests. The amount of repeat testing varied by testing setting, with a higher proportion of repeat testers in community-based organizations (68.8%) than in private medical offices (41.7%) and health department clinics (35.6%). Our experience is that patients retest for a number of reasons, including denial of their HIV status, entry into medical care, or desire for the incentive given at testing. Some of these reasons preclude disclosure of a patient's known status to testers. Though social networking may indeed be an effective way to identify undiagnosed HIV infections, evaluation of these and other testing programs needs to account for repeat testing's impact on case-finding yield. Health department surveillance data can provide information on the true case-finding efficacy of HIV testing programs. However, access to HARS information is limited to state and local health departments. We recommend that the evaluation of testing strategies include collaboration with health departments to account for repeat testing.

Further confirmation of the relevance of cockroach and dust mite sensitization to inner‐city asthma morbidity

Further confirmation of the relevance of cockroach and dust mite sensitization to inner‐city asthma morbidity

The Free Condom Initiative: Promoting Condom Availability and Use in New York City

In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a Web-based ordering system. In 2006, we interviewed managers and patrons about free condom availability, acquisition, and use in venues where people at high risk for human immunodeficiency virus congregate. DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Overall, managers reported making condoms available at 76% (309/409) of high-priority venues, but only at 40% of gay bars. Among patrons who saw free condoms, 80% (280/351) reported taking them; 73% (205/280) of those who reported taking them also reported using them. A simple, Web-based ordering system dramatically increased condom distribution. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability may increase use. Special efforts are needed to ensure availability at gay bars.