Department Of Health Research Articles

Oklahoma leaders reject settlement on jail MH services

Oklahoma Gov. Kevin Stitt and other state leaders have rejected a legal settlement of a federal lawsuit over long delays in providing mental health treatment to jail detainees found not competent to stand trial, the Oklahoma Voice policy news service reported Oct. 8. State Attorney General Gentner Drummond had pushed for the negotiated settlement, which included a remediation plan that would revamp the state's current system for restoring offender competency and increase the state's number of forensic beds devoted to competency restoration (see “Legal settlement would expedite MH treatment for Oklahoma detainees,” MHW, July 1, 2024; https://doi.org/10.1002/mhw.34099). But Stitt and the commissioner of the state Department of Mental Health and Substance Abuse Services, Allie Friesen, have characterized the settlement as overly costly and burdensome. Shortly before an Oct. 8 meeting of a review board chaired by Stitt, Friesen announced that she was terminating Drummond as the state's counsel in the case. Friesen indicated with regard to the proposed settlement that she would “resign before signing an agreement like this,” Oklahoma Voice reported. The lawsuit was originally filed in March 2023 in U.S. District Court on behalf of three incarcerated inmates. It alleges that detainees' long waits for needed mental health treatment have caused their conditions to deteriorate, and this violates the Fourteenth Amendment of the Constitution and the Americans with Disabilities Act.

Factors Related to Evidence-Based Practices Among Mental Health Nurses in Thailand: A Cross-Sectional Study.

Despite the robustness of evidence-based practice in increasing efficiency in nursing care and improving patient safety, using evidence in practice is still rare in mental health nursing. This correlational descriptive research aimed to explore the factors and examine the relationship between attitudes, knowledge/skills, organizational culture, mentorship, and demographic factors to evidence-based practices among mental health nurses working in psychiatric hospitals in Thailand. The sample consisted of 255 nurses working in psychiatric hospitals under the Thai Department of Mental Health, located in service units across the country's four regions. The data collection tools included (1) a demographic questionnaire, (2) the Evidence-Based Practice Questionnaire: EBPQ, (3) Organizational Culture & Readiness for System-wide Integration of Evidence-Based Practice: OCRSIEP, and (4) the Evidence-Based Practice Mentorship Scale. Descriptive statistics and Spearman's correlation coefficient were used for data analysis. The findings revealed that the factors positively correlated with evidence-based practice among mental health nurses in Thailand were attitude with a mean score of 4.90 (r = 0.39, p-value < 0.001), knowledge/skills with a mean score of 4.69 (r = 0.61, p-value < 0.001), organizational culture with a mean score of 3.94 (r = 0.26, p-value < 0.001), and mentorship with a mean score of 2.77 (r = 0.16, p-value = 0.011). Demographic factors such as educational level (r = 0.21, p-value < 0.001) and work experience in psychiatric and mental health nursing (r = 0.14, p-value = 0.031) were also positively correlated. This research revealed that EBP knowledge and skills are the most significant factors related to evidence-based practice among Thai mental health nurses. Therefore, EBP knowledge and skills should be enhanced in the curriculum during the nursing study and through continuing education once nurses graduate. Organizational culture and mentorship also need to be promoted to strengthen the use of EBP in Thailand.

A qualitative exploration of the implementation facilitators and challenges of a community health worker program to address health disparities for people recently released from incarceration using the consolidated framework for implementation research

BackgroundDespite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI.MethodsEighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation.ResultsImportant facilitators to implementation included: lived experience of CHWs, as well as NYC HJN’s voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication.ConclusionsFindings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.

Applying an Evaluation Framework of Hospital CHA/CHIP Quality and Heterogeneity to Accredited Local Health Departments in Kentucky, 2015-2022.

This study aimed to assess the quality of community health assessments (CHA) and community health improvement plans conducted by Public Health Accreditation Board (PHAB)-accredited local health departments (LHDs) in Kentucky. Quality assessment of CHAs and community health improvement plan documents using criteria adapted from Pennel et al (2015). PHAB-accredited LHDs in Kentucky. Seventeen CHAs and community health improvement plan documents from PHAB-accredited LHD. Quality scores based on 17 evaluation criteria, including stakeholder involvement, data examination, plan feasibility, and LHD-hospital collaboration. The study found significant variation in the quality of CHAs and community health improvement plan documents. The highest scores were for partner involvement, data examination, and plan feasibility. The lowest scores were for LHD-hospital collaboration, use of evidence-based strategies, and plan evaluation. No community variables significantly predicted overall report scores. The quality of CHAs and community health improvement plan documents varies among Kentucky LHDs, highlighting the need for more robust guidance and standardized criteria. Strengthening hospital-LHD collaboration and focusing on evidence-based strategies can improve public health outcomes. Enhancing CHAs and community health improvement plan processes through legislative changes, better guidance, and improved collaboration between hospitals and LHD can lead to more effective public health interventions and outcomes.

Safety of Kidney Transplantation from Donors with HIV

BackgroundKidney transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV is an emerging practice. It has been performed since 2016 under the U.S. congressional HIV Organ Policy Equity Act and is currently approved for research only. The Department of Health and Human Services is considering expanding the procedure to clinical practice, but data are limited to small case series that did not include donors without HIV as controls.MethodsIn an observational study conducted at 26 U.S. centers, we compared transplantation of kidneys from deceased donors with HIV and donors without HIV to recipients with HIV. The primary outcome was a safety event (a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection), assessed for noninferiority (margin for the upper bound of the 95% confidence interval, 3.00). Secondary outcomes included overall survival, survival without graft loss, rejection, infection, cancer, and HIV superinfection.ResultsWe enrolled 408 transplantation candidates, of whom 198 received a kidney from a deceased donor; 99 received a kidney from a donor with HIV and 99 from a donor without HIV. The adjusted hazard ratio for the composite primary outcome was 1.00 (95% confidence interval [CI], 0.73 to 1.38), which showed noninferiority. The following secondary outcomes were similar whether the donor had HIV or not: overall survival at 1 year (94% vs. 95%) and 3 years (85% vs. 87%), survival without graft loss at 1 year (93% vs. 90%) and 3 years (84% vs. 81%), and rejection at 1 year (13% vs. 21%) and 3 years (21% vs. 24%). The incidence of serious adverse events, infections, surgical or vascular complications, and cancer was similar in the groups. The incidence of HIV breakthrough infection was higher among recipients of kidneys from donors with HIV (incidence rate ratio, 3.14; 95%, CI, 1.02 to 9.63), with one potential HIV superinfection among the 58 recipients in this group with sequence data and no persistent failures of HIV treatment.ConclusionsIn this observational study of kidney transplantation in persons with HIV, transplantation from donors with HIV appeared to be noninferior to that from donors without HIV. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT03500315.)

Assessment of Public Health Impact of 20 Non-Research HIV Demonstration Projects by Use of the CDC Science Impact Framework, United States, 2018-2022.

Compared with traditional measures of scientific impact, the CDC Science Impact Framework more broadly, directly, and quickly assesses impact of public health science. For 20 CDC-funded HIV prevention projects that were conducted during 2018-2022, health departments documented impact, based on CDC Science Impact Framework domains: Disseminating Science, Creating Awareness, Catalyzing Action, Effecting Change, and Shaping the Future. Health departments reported 282 impacts: the most common were new partnerships (n=17, Catalyzing Action), capacity building (n=16, Effecting Change), new projects or initiatives begun (n=15, Shaping the Future), new collaborations (n=14, Catalyzing Action), improved program (n=13, Shaping the Future), new guidelines or practices (n=13, Effecting Change), and informed persons affected by work (n=13, Creating Awareness). Health departments documented substantial impact with a simple, timely, and broad approach. Demonstrating impact is important for community-based organizations, funders, and others interested in public health and helps them better understand the value of public health.

Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2023-24 School Year.

In the United States, states and local jurisdictions set vaccination requirements for school attendance, conditions and procedures for exemptions from these requirements, grace periods for submitting documentation, and provisional enrollment for students who need more time to be vaccinated. States annually report data to CDC on the number of children in kindergarten who meet, are exempt from, or are in the process of meeting requirements. Data reported by 49 states and the District of Columbia (DC) for the 2023-24 school year were used for national- and state-level estimates of the following measures: complete vaccination with required doses of measles, mumps, and rubella vaccine (MMR), diphtheria, tetanus, and acellular pertussis vaccine (DTaP), poliovirus vaccine (polio), and varicella vaccine (VAR); exemptions from vaccination; and school attendance while meeting requirements. The 2023-24 kindergarten class became age-eligible to complete most state-required vaccinations during the COVID-19 pandemic, after schools had returned to routine in-person learning. Compared with approximated national coverage levels across all reported vaccines for the 2019-20 (95%) and 2022-23 (93%) school years, coverage dropped below 93% for the 2023-24 school year, ranging from 92.3% for DTaP to 92.7% for MMR. Exemptions increased to 3.3%, compared with those during the 2022-23 (3.0%) and 2021-22 school years (2.6%). Coverage with MMR, DTaP, polio, and VAR decreased in 35, 32, 33, and 36 jurisdictions, respectively, compared with the 2022-23 school year. Exemptions increased in 41 jurisdictions, with 14 reporting that >5% of kindergartners had an exemption from one or more vaccine. Efforts by health departments, schools, and providers are needed to ensure that students begin school fully vaccinated.

A Genetic algorithm approach for improving the probabilistic inventory model with the continuous review: A practical application in the department of pharmacy

This study investigates to shed light on artificial intelligence techniques, specifically the genetic algorithm, to improving traditional solutions, as well as finding the best policy for the problem of probabilistic inventory with continuous review by finding the optimal reorder point and the optimal economic quantity to avoid the risk of stock out (shortage), reduce total costs, and reach the optimal solution with little time and effort. The research was conducted in the stores of the department of pharmacy of the Ninawa health department for the period from January 1, 2021, to January 1, 2023, on a sample of three drugs (most demanded drugs). An analysis of the demand data for the study sample was conducted using the statistical program (SPSS Statistics Version 22) to determine the type of inventory. it was found that the type of inventory is probabilistic and the demand data follows a normal distribution. Based on this foundation, the mathematical model for the study problem was built. Given the complexity of the steps and iterations of the traditional solution, the solution steps were applied using the R programming language to reach the model's solution. Additionally, the solution steps were programmed for the genetic algorithm and applied using the R programming language. The results of the genetic algorithm showed an improvement in the traditional solution results by reducing total costs. Based on the results of the genetic algorithm, the economic order quantity, safety stock, reorder period, and safety period were found. Paper type: Research Paper

Don’t Read the Comments: Discourse About COVID-19 Vaccines in a State Health Department's Social Media Comments

Don’t Read the Comments: Discourse About COVID-19 Vaccines in a State Health Department's Social Media Comments

The Use of the CDC Preventive Health and Health Services Block Grant to Address Social Determinants of Health to Advance Health Equity.

State public health departments use federal funding to examine and address social determinants of health (SDOH) within their communities to improve health and advance health equity. Yet, most federal funding is categorical (ie, funding used for a specific program or narrow purpose), which can create barriers to addressing social and structural drivers of inequity. The Preventive Health and Health Services Block Grant (PHHS Block Grant) is a flexible funding mechanism that provides health departments the latitude to identify and fund initiatives that address local public health needs. It is unclear, however, to what extent health departments use this flexible resource to incorporate SDOH into their programs. Cross-sectional, descriptive analysis of state health department PHHS Block Grant program administrative data. This study examined PHHS Block Grant budgets and workplans for the federal Fiscal Year 2021 to assess whether state health departments aligned their grant-funded program with the national objectives associated with the Healthy People 2030 SDOH Framework. Forty-seven states and the District of Columbia were included in this study. Percent of states that used PHHS Block Grant funds to address SDOH; proportion of funding allocated to address SDOH; percentage of programs that addressed SDOH. Three-fourths (75%) of states allocated funds to 97 programs aligning with at least 1 Healthy People 2030 SDOH-related objective. Fifty of the programs were fully or primarily funded by the PHHS Block Grant. Results also show that as the states' PHHS Block Grant funding level increased so did the percent of states that allocated funding toward SDOH programs. This study shows that state health departments are using the PHHS Block Grant to address SDOH, and that the grant plays an important funding role for these programs. States are incorporating the grant into their funding strategies to address SDOH.

New York City’s Public Health Approach to Reexamining Race-Based Clinical Algorithms

Clinical algorithms are utilized in clinical decision-making — whether for diagnosis or treatment — with the aim of accounting for pertinent biological factors. However, the use of race in some clinical algorithms disproportionately harms patients of color, often delaying necessary care. The erroneous use of race as a biological variable perpetuates the antiquated notion of race essentialism and demonstrates how medical racism is embedded in health care. In 2021, the New York City (NYC) Department of Health and Mental Hygiene launched the Coalition to End Racism in Clinical Algorithms (CERCA). To the authors’ knowledge, CERCA was the first citywide effort to convene seven safety-net and four private health care systems for the elimination of harmful race-based clinical algorithms, representing the health institutions in NYC serving the most patients. Focusing on estimated glomerular filtration rate, vaginal birth after cesarean, and pulmonary function testing, CERCA serves as a platform for health systems to discuss and strategize how to effectively de-implement these harmful race-based algorithms. NYC CERCA serves as a model for how a public health department can leverage its role as a convener by collaborating with health systems to address matters of racial inequities caused by systemic racism in medicine and supporting the swift implementation of reparative initiatives on a systems level.

Validation of a Simplified Laboratory-Based HCV Clearance Definition Using New York City Hepatitis C Program and Surveillance Data.

Laboratory-based hepatitis C virus (HCV) clearance cascades are an important tool for health departments to track progress toward HCV elimination, but a laboratory-based definition of HCV clearance has not yet been validated. To compare agreement between a laboratory-based HCV clearance definition with a clinical cure definition. Observational. New York City Department of Health and Mental Hygiene HCV surveillance system data and New York City hepatitis C linkage-to-care program data. Linkage-to-care program participants who were diagnosed with hepatitis C and enrolled in the linkage-to-care program from July 1, 2016, through June 30, 2020. Percent agreement between a laboratory-based HCV clearance definition (surveillance system) and a clinical cure definition (program data). Among 591 program participants with known treatment outcome, the laboratory-based HCV clearance definition and clinical cure definition were concordant in 573 cases (97%). A laboratory-based HCV clearance definition based on public health surveillance data can be a reliable source for monitoring HCV elimination.

Spatiotemporal Cluster Detection for COVID-19 Outbreak Surveillance: Descriptive Analysis Study.

During the peak of the winter 2020-2021 surge, the number of weekly reported COVID-19 outbreaks in Washington State was 231; the majority occurred in high-priority settings such as workplaces, community settings, and schools. The Washington State Department of Health used automated address matching to identify clusters at health care facilities. No other systematic, statewide outbreak detection methods were in place. This was a gap given the high volume of cases, which delayed investigations and decreased data completeness, potentially leading to undetected outbreaks. We initiated statewide cluster detection using SaTScan, implementing a space-time permutation model to identify COVID-19 clusters for investigation. To improve outbreak detection, the Washington State Department of Health initiated a systematic cluster detection model to identify timely and actionable COVID-19 clusters for local health jurisdiction (LHJ) investigation and resource prioritization. This report details the model's implementation and the assessment of the tool's effectiveness. In total, 6 LHJs participated in a pilot to test model parameters including analysis type, geographic aggregation, cluster radius, and data lag. Parameters were determined through heuristic criteria to detect clusters early when they are smaller, making interventions more feasible. This study reviews all clusters detected after statewide implementation from July 17 to December 17, 2021. The clusters were analyzed by LHJ population and disease incidence. Clusters were compared with reported outbreaks. A weekly, LHJ-specific retrospective space-time permutation model identified 2874 new clusters during this period. While the weekly analysis included case data from the prior 3 weeks, 58.25% (n=1674) of all clusters identified were timely-having occurred within 1 week of the analysis and early enough for intervention to prevent further transmission. There were 2874 reported outbreaks during this same period. Of those, 363 (12.63%) matched to at least one SaTScan cluster. The most frequent settings among reported and matched outbreaks were schools and youth programs (n=825, 28.71% and n=108, 29.8%), workplaces (n=617, 21.46% and n=56, 15%), and long-term care facilities (n=541, 18.82% and n=99, 27.3%). Settings with the highest percentage of clusters that matched outbreaks were community settings (16/72, 22%) and congregate housing (44/212, 20.8%). The model identified approximately one-third (119/363, 32.8%) of matched outbreaks before cases were associated with the outbreak event in our surveillance system. Our goal was to routinely and systematically identify timely and actionable COVID-19 clusters statewide. Regardless of population or incidence, the model identified reasonably sized, timely clusters statewide, meeting the objective. Among some high-priority settings subject to public health interventions throughout the pandemic, such as schools and community settings, the model identified clusters that were matched to reported outbreaks. In workplaces, another high-priority setting, results suggest the model might be able to identify outbreaks sooner than existing outbreak detection methods.

Wildland Fire-Related Smoke PM 2.5 and Cardiovascular Disease ED Visits in the Western United States.

The impact of short-term exposure to fine particulate matter (PM 2.5 ) due to wildland fire smoke on the risk of cardiovascular disease (CVD) remains unclear. We investigated the association between short-term exposure to wildfire smoke PM 2.5 and Emergency Department (ED) visits for acute CVD in the Western United States from 2007 to 2018. ED visits for primary or secondary diagnoses of atrial fibrillation (AF), acute myocardial infarction (AMI), heart failure (HF), stroke, and total CVD were obtained from hospital associations or state health departments in California, Arizona, Nevada, Oregon, and Utah. ED visits included those that were subsequently hospitalized. Daily smoke, non-smoke, and total PM 2.5 were estimated using a satellite-driven multi-stage model with a high resolution of 1 km. The data were aggregated to the zip code level and a case-crossover study design was employed. Temperature, relative humidity, and day of the year were included as covariates. We analyzed 49,759,958 ED visits for primary or secondary CVD diagnoses, which included 6,808,839 (13.7%) AFs, 1,222,053 (2.5%) AMIs, 7,194,474 (14.5%) HFs, and 808,396 (1.6%) strokes. Over the study period from 2007-01-01 to 2018-12-31, the mean smoke PM 2.5 was 1.27 (Q1: 0, Q3: 1.29) µg/m 3 . A 10 µg/m 3 increase in smoke PM 2.5 was associated with a minuscule decreased risk for AF (OR 0.994, 95% CI 0.991-0.997), HF (OR 0.995, 95% CI 0.992-0.998), and CVD (OR 0.9997, 95% CI 0.996-0.998), but not for AMI and stroke. Adjusting for non-smoke PM 2.5 did not alter these associations. A 10 µg/m 3 increase in total PM 2.5 was linked to a small increased risk for all outcomes except stroke (OR for CVD 1.006, 95% CI 1.006-1.007). Associations were similar across sex and age groups. We identified an unexpected slight lower risk of CVD ED visits associated with short-term wildfire smoke PM 2.5 exposure. Whether these findings are due to methodological issues, behavioral changes, or other factors requires further investigation.

Xylazine awareness and attitudes among people who use drugs in Ohio, 2023–2024

BackgroundThe prevalence of xylazine, a non-opioid tranquilizer not for human consumption, in illicitly manufactured fentanyl is increasing in the United States. However, little is known about xylazine awareness and attitudes among people who use drugs.MethodsA cross-sectional survey of people who use drugs in Ohio was conducted from November 2023 – May 2024 to identify xylazine awareness and attitudes in rural and urban counties across the state. Study participants were recruited from naloxone distribution sites, including health departments, syringe service programs, and community-based organizations.ResultsAmong 630 people who use drugs in Ohio, more than one-half (53.5%) were unaware of xylazine being in “street drugs,” regardless of urbanicity. Among individuals who were aware of xylazine, most (73.0%) indicated they did not want to use the drug and try to avoid it. In addition, 75.8% of this group felt it was “very” or “extremely” important to know if xylazine was in their drugs.DiscussionThis research found that many people who use drugs in Ohio are unaware of xylazine and its risks. An important finding of this study is that most individuals who had heard of xylazine did not want to use it and were concerned about knowing whether xylazine was in their drugs.

New US DHHS Guidelines for Feeding of HIV Exposed Infants: Uptake, Practice Variability and Concerns

Abstract Background Approximately 5000 infants are born to mothers living with HIV annually in the US. In the past, the Center for Disease Control (CDC), American Academy of Pediatrics (AAP), and US Department of Health and Human Services (DHHS) have recommended that people living with HIV (PWH) not breast/chest feed their infants. Recent changes published in January 2023 in the “Section on Infant Feeding for Individuals Living with HIV” in the US DHHS HIV Guidelines, now include that individuals with HIV who are on antiretroviral therapy (ART) with a sustained undetectable viral load (VL) and who choose to breastfeed should be supported in this decision. We evaluated the uptake of these guidelines, and practice variability across providers who care for such mothers and infants. Methods We surveyed Pediatric Infectious Diseases Society members who practice clinically in the US, via an internal email list serve. The ten-question survey assessed uptake of the updated DHHS guidelines and respondents’ clinical practice in three key areas that are subject to interpretation in the guidelines: VL control, mixed feeding, and ART prophylaxis. We used descriptive statistics to examine guideline uptake and variability in practice. We used inductive qualitative thematic analysis to identify themes in open-ended survey responses. Results Of 915 individuals who opened the survey, 165 responded and 129 were included in the final analysis. Respondents represented 86 US clinical centers. Uptake varied: 14 respondents (10.8%) were unaware of the new guidelines, 103 (79.8%) had implemented or were planning to implement the new guidelines, and 12 (9.3%) were not planning to implement the guidelines. The table summarizes variability in pre-delivery VL suppression and mixed feeding criteria used by 117 respondents who are either planning/already implementing guidelines or who are unaware of guidelines. Areas of concern revealed by thematic analysis included insufficient data to support guidelines and lack of specific criteria for implementation. Conclusion We identified substantial heterogeneity in provider uptake and comfort with new breastfeeding guidelines among US pediatric infectious diseases practitioners, and variability in assessment of safety to breastfeed. Further research is essential to explore patient preferences, define necessary follow-up, and address provider concerns regarding insufficient data to support guidelines and lack of specific criteria for implementation.

Public and health care provider attitudes, understanding, and behaviors regarding emergency use authorizations: a scoping literature review

BackgroundUnder Sect. 564 of the Federal Food, Drug, and Cosmetic Act, when the US Department of Health and Human Services Secretary issues a declaration based on one of four types of determinations, FDA may authorize an unapproved product or unapproved uses of an approved product for emergency use. It is unclear how much the public and health care providers understand about emergency use authorizations and how that understanding influences perceptions or behavioral intentions. The current study aimed to explore consumer and health care provider perceptions of emergency use authorizations and how promotion of emergency use authorizations has been investigated in the literature.MethodsWe conducted a scoping review via PubMed, Embase, Web of Science, and CINAHL for original research published in English from January 1, 2012, through November 10, 2022. We conducted surveillance of the literature through March 2023.ResultsWe identified 13 studies reported in 14 publications that addressed public and health care provider attitudes, understanding, and behaviors with regard to products authorized under an emergency use authorization. We did not identify any articles describing research regarding the promotion of emergency use authorization products. Findings suggest gaps in understanding of emergency use authorizations, both for the public and health care providers. Findings also suggest the public and health care providers have concerns about safety or the lack of full FDA approval that may contribute to decreased willingness to receive treatments and vaccines under an emergency use authorization.ConclusionsFuture research should explore how emergency use authorizations have been promoted and how that promotion impacts public and health care provider perceptions.

Pengaruh Capacity Building dan Motivasi Kerja terhadap Produktivitas Kerja Pegawai Puskesmas Limo

UPTD Puskesmas Limo is a regional public health center for Limo sub-district which is underpinned by the health department and health facilities managed by the local government. The health Dcenter has the responsibility of providing primary health services to the people of Limo city. With these demands and types of work, training or employee self-development is needed to hone employees' abilities and work motivation. To find out how much influence capacity building and work motivation have on the productivity of UPTD Puskesmas Limo employees, this title was raised. This study uses quantitative methods using non-probability sampling techniques, namely saturated sampling techniques. The sample of this study amounted to 50 people. Then tested quantitative statistical analysis, multiple linear regression analysis and coefficient of determination analysis using a data processing program, namely SPSS 25 software. This study found the results using the t test stated that Capacity Building partially has a significant effect on work productivity with a significant level of 0.02 &lt;0.05 and the t test results of 3.021&gt; 2.008. and work motivation partially has a positive and significant effect on work productivity with a significant value of 0.01 &lt;0.05 and a t test value of 3.146&gt; 2.008 Capacity Building d is a positive and significant effect on work productivity.

Development, Evaluation, and Initial Findings of New York State Department of Health Community Drug Checking Pilot Programs.

The illicit drug landscape in the United States is dynamic, featuring a risky and erratic drug supply. Drug checking programs (DCP) have been successfully implemented and studied extensively in Canada and Europe but are scarce in the United States. Integrating DCP at harm reduction programs provides an opportunity to engage people at the point-of-care and deliver a combination of harm reduction services, access to healthcare services, and linkages to treatment. The New York State Department of Health (NYSDOH) developed and supports operation of 8 pilot community DCP sites throughout the state. The DCP were trained to utilize Fourier-transform infrared spectroscopy (FTIR) technology to deliver real-time results to participants. The NYSDOH community DCP pilot began development in 2022. Partnerships were formed across multiple domains including other DCP, universities, forensic laboratories, syringe service and harm reduction programs, and legal and regulatory offices within the NYSDOH. The first pilot sites began operating in mid-2023 and program expansion is on-going. Evaluation staff were extensively engaged in development and implementation phases. Qualitative evaluation focused on barriers, facilitators, and lessons learned from program staff and technicians. Quantitative evidence was gathered to assess the reach of the DCP and accuracy of results attained by drug checking technicians during their training periods. Drug checking results helped characterize the illicit drug supply. Development and implementation of DCP in NYS was facilitated by strong partnerships across sectors including public health and harm reduction. DCP may involve diverse partners who do not regularly collaborate, and health departments are positioned to build relationships and convene partners for program implementation. Evaluation findings highlight the importance of facilitating on-going training and technical assistance to DCP for quality assurance. The initial successes and lessons learned from the NYSDOH DCP demonstrate state public health departments' ability to successfully deploy this innovative harm reduction strategy.

Emergency surgery for traumatic brain injury in geriatric patients

Objectives: Verify the sociodemographic profile of an elderly victim of trauma due to a fall who is admitted to the ICU of a public reference hospital to determine whether there are relationships between his age, comorbidities, length of stay, complications and clinical results. A retrospective analytical study with a quantitative approach was carried out between April and October 2014 in the Intensive Care Unit (ICU) of the Hospital de Base do Distrito Federal, administered by the State Department of Health of the Federal District, DF. Using the TrakCare® computerized medical record, sociodemographic data were found on elderly people hospitalized between the fall of July 2012 and July 2014, including mechanisms of trauma, comorbidities, length of stay, use of invasive devices, vasoactive and sedative drugs, complications and clinical internships. Results: The sample was made up of 52 elderly people, the majority of whom were men and the injury was a fall in height. Lung infection, septic shock, use of blood products and acute renal failure were the main complications. Despite the high mortality observed in the study, the majority of elderly people survived the traumatic event. Male sex, traumatic brain injury (TBI), pulmonary septic shock and dialysis were the main causes of mortality. Conclusion: Falling in height, fractures and severe TBI were extremely common, and most patients had more than one complication during hospitalization. No significant difference was found between age and mortality.