Environmental Health Services Research Articles

Responding to the risk of reducing resources: Development of a framework for future change programmes in Environmental Health Services

Environmental Health services in the UK have been subject to significant resource reduction over the last 5 years. It is suggested that services risk becoming unsustainable unless efficient and effective ways of working are employed. With this in mind this paper presents the findings of research into the experience of practitioners who are developing and delivering evolving Environmental Health services in English local authorities in the context of deep cutting budget reductions. The research explores the experience of change and identifies lessons learnt in the development and execution of new models of Environmental Health service delivery to mitigate against risks of unsustainable or undeliverable services. Interviews were carried out with the participants to capture their experience of change and the impact on service delivery. A range of service delivery models have been examined including outsourcing, shared services, regional delivery models and discussion of mutual arrangements and at various stages of development from planning through to full transformation. Field work was undertaken between 2014 and 2016. Thematic analysis of interview transcripts has identified six emergent themes of the experience of change: managing changes effectively; understanding the reasons for change; understanding the nature of Environmental Health; meaningful consultation; viability of the proposal; planning and timeliness. Environmental Health services undergoing transformation may benefit from taking into account the lessons learnt by organisations that have previously undergone significant change in their response to the risk of a reducing resource.

Terrestrial primary productivity indicators for inclusion in the National Climate Indicators System

The National Climate Indicators System (NCIS) aims to provide a suite of systematically updated, easily interpretable, and policy relevant national metrics of key physical, ecological, and societal conditions. The NCIS will distill and communicate complex scientific information to a broad audience as part of sustained National Climate Assessments. The current NCIS has made significant strides in defining its scope, providing an initial suite of indicators, and outlining its future development goals. In line with the scope and aims of the NCIS, we present a set of terrestrial primary productivity indicators that are scientifically defensible, scalable, directly related to climate, nationally important, built on existing agency efforts, and linked to the conceptual framework of the NCIS. The Gross Primary Productivity (GPP) and Net Primary Productivity (NPP) indicators provide seasonal and annual metrics of the growth of all plant material across the contiguous U.S., Alaska, Hawaii, and Puerto Rico. The GPP and NPP products used to produce the indicators have become key carbon measurements of environmental health and ecosystem services, including food, fiber, and fuels supporting national economies, human sustainability, and quality of life. We demonstrate how the proposed GPP and NPP indicators are relevant across indicator system sector topics of Forests, Grassland/Rangelands/Pastures, Agriculture, Wildfire, and Seasonal Timing and Phenology, can be used in concert with existing proposed indicators, and will aid to filling current gaps in the NCIS.

Interdisciplinary Dissertation Research Among Public Health Doctoral Trainees, 2003-2015.

Given the call for more interdisciplinary research in public health, the objectives of this study were to (1) examine the correlates of interdisciplinary dissertation completion and (2) identify secondary fields most common among interdisciplinary public health graduates. We analyzed pooled cross-sectional data from 11 120 doctoral graduates in the Survey of Earned Doctorates, 2003-2015. The primary outcome was interdisciplinary dissertation completion. Covariates included primary public health field, sociodemographic characteristics, and institutional attributes. From 2003 to 2015, a total of 4005 of 11 120 (36.0%) doctoral graduates in public health reported interdisciplinary dissertations, with significant increases observed in recent years. Compared with general public health graduates, graduates of environmental health (odds ratio [OR] = 1.74; P < .001) and health services administration (OR = 1.38; P < .001) doctoral programs were significantly more likely to report completing interdisciplinary dissertation work, whereas graduates from biostatistics (OR = 0.51; P < .001) and epidemiology (OR = 0.76; P < .001) were less likely to do so. Completing an interdisciplinary dissertation was associated with being male, a non-US citizen, a graduate of a private institution, and a graduate of an institution with high but not the highest level of research activity. Many secondary dissertation fields reported by interdisciplinary graduates included other public health fields. Although interdisciplinary dissertation research among doctoral graduates in public health has increased in recent years, such work is bounded in certain fields of public health and certain types of graduates and institutions. Academic administrators and other stakeholders may use these results to inform greater interdisciplinary activity during doctoral training and to evaluate current and future collaborations across departments or schools.

Social accounting matrix and the effects of economic reform on health price index and household expenditures: Evidence from Iran

Background: Socioeconomic indicators are the main factors that affect health outcome. Health price index (HPI) and households living costs (HLC) are affected by economic reform. This study aimed at examining the effect of subsidy targeting plan (STP) on HPI and HLC. Methods: The social accounting matrix was used to study the direct and indirect effects of STP. We chose 11 health related goods and services including insurance, compulsory social security services, hospital services, medical and dental services, other human health services, veterinary services, social services, environmental health services, laundry& cleaning and dyeing services, cosmetic and physical health services, and pharmaceutical products in the social accounting matrix to examine the health price index. Data were analyzed by the I-O&SAM software. Results: Due to the subsidy release on energy, water, and bread prices, we found that (i) health related goods and services groups’ price index rose between 33.43% and 77.3%, (ii) the living cost index of urban households increased between 48.75% and 58.21%, and (iii) the living cost index of rural households grew between 53.51% and 68.23%. The results demonstrated that the elimination of subsidy would have negative effects on health subdivision and households’ costs such that subsidy elimination increased the health prices index and the household living costs, especially among low-income families. The STP had considerable effects on health subdivision price index. Conclusion: The elimination or reduction of energy carriers and basic commodities subsidies have changed health price and households living cost index. Therefore, the policymakers should consider controlling the price of health sectors, price fluctuations and shocks.

Engagement Strategies to Advance Community-Centered Primary Care.

The Louisiana Public Health Institute designed and implemented the Primary Care Capacity Project (PCCP) with the purpose of expanding access to high-quality, integrated, and sustainable community-based primary care, including linkages to behavioral health services, as well as environmental and occupational health services. With a primary focus to invest in community health centers across 17 Gulf Coast counties and parishes, PCCP engaged stakeholders, including 4 primary care organizations, over 20 federally qualified health centers, public health institutes, health information exchanges, national experts, academic organizations, and health departments along with their relevant community partners. This article examines the strategies PCCP used to engage stakeholders and partners throughout the project in order to strengthen sustainable primary care systems. The PCCP team fostered trusted partnerships with a wide range of stakeholders to not only understand the need of the communities but to also identify ways to complement and not duplicate already existing efforts. Specifically, community prioritization convenings, peer-to-peer learning through the Regional Care Collaborative, and dyadic interviews were instrumental in linking stakeholders and maximizing capacity-building efforts. Health partners across the 4 states are now better positioned to collaborate on future regional opportunities including continued knowledge transfer through special interest groups, ongoing engagement with an annual regional convening, continued efforts to advance emergency management and resiliency, and potential development of group purchasing and other shared services. The PCCP experience suggests that in disaster-prone areas the sustainability of integrated primary care and behavioral health services is enhanced when cross-jurisdiction collaborations are established.

Secondary Use and Analysis of Big Data Collected for Patient Care

Summary Objectives: To identify common methodological challenges and review relevant initiatives related to the re-use of patient data collected in routine clinical care, as well as to analyze the economic benefits derived from the secondary use of this data. Through the use of several examples, this article aims to provide a glimpse into the different areas of application, namely clinical research, genomic research, study of environmental factors, and population and health services research. This paper describes some of the informatics methods and Big Data resources developed in this context, such as electronic phenotyping, clinical research networks, biorepositories, screening data banks, and wide association studies. Lastly, some of the potential limitations of these approaches are discussed, focusing on confounding factors and data quality. Methods: A series of literature searches in main bibliographic databases have been conducted in order to assess the extent to which existing patient data has been repurposed for research. This contribution from the IMIA working group on “Data mining and Big Data analytics” focuses on the literature published during the last two years, covering the timeframe since the working group’s last survey. Results and Conclusions: Although most of the examples of secondary use of patient data lie in the arena of clinical and health services research, we have started to witness other important applications, particularly in the area of genomic research and the study of health effects of environmental factors. Further research is needed to characterize the economic impact of secondary use across the broad spectrum of translational research.

Too Big, Too Small, or Just Right? Cost-Efficiency of Environmental Inspection Services in Connecticut.

To assess optimal activity size/mix of Connecticut local public health jurisdictions, through estimating economies of scale/scope/specialization for environmental inspections/services. Connecticut's 74 local health jurisdictions (LHJs) must provide environmental health services, but their efficiency or reasons for wide cost variation are unknown. The public health system is decentralized, with variation in organizational structure/size. We develop/compile a longitudinal dataset covering all 74 LHJs, annually from 2005 to 2012. We estimate a public health services/inspections cost function, where inputs are translated into outputs. We consider separate estimates of economies of scale/scope/specialization for four mandated inspection types. We obtain data from Connecticut Department of Public Health databases, reports, and other publicly available sources. There has been no known previous utilization of this combined dataset. On average, regional districts, municipal departments, and part-time LHJs are performing fewer than the efficient number of inspections. The full-time municipal departments and regional districts are more efficient but still not at the minimum efficient scale. The regional districts' elasticities of scale are larger, implying they are more efficient than municipal health departments. Local health jurisdictions may enhance efficiency by increasing inspections and/or sharing some services.

The etiology of rampant caries in pre-school children in TK Pertiwi Jembungan I Boyolali

TITLE The etiology of rampant caries in pre-school children in TK Pertiwi Jembungan I Boyolali ABSTRACT Baby bottle caries is a dental disease that begins from a tooth and concerns the multi-surface and spreads rapidly to other teeth due to persistent exposure to factors of cause. This study aims to determine the factors that cause rampan caries in students TK Pertiwi Jembungan I Boyolali District. The type of this research is quantitative descriptive with case study research method. The data were collected by examination of caries trajectory, saliva pH and PHP-M index, and questionnaires for time and questionnaire variables based on Bloom's approach theory covering environmental factors, behavior, health service and heredity. Priority problem using odd ratio data analysis test result obtained that the most dominant cause factor is practice (OR value = 16,25), attitude (OR value = 15,00) and knowledge (OR value = 9,3). The results showed that salivary pH value of all respondents was acid (pH <7.0) and 57% of respondents had bad category plaque index value. Time factor showed 57% of respondents were bad category. 48% of respondents who have knowledge of bad category. 61% of respondents already have a good attitude. 100% of respondents did not brush their teeth before bedtime. 83% of respondents have a habit of brushing their teeth only when bathing. Health care factors, 100% of respondents have never treated dental cavities and have not received dental health education, 52% of respondents have fragile teeth and 26% of respondents have a dental structure of crowding. Keywords : Caries rampan, kindergarten students

Secondary Use and Analysis of Big Data Collected for Patient Care.

Objectives: To identify common methodological challenges and review relevant initiatives related to the re-use of patient data collected in routine clinical care, as well as to analyze the economic benefits derived from the secondary use of this data. Through the use of several examples, this article aims to provide a glimpse into the different areas of application, namely clinical research, genomic research, study of environmental factors, and population and health services research. This paper describes some of the informatics methods and Big Data resources developed in this context, such as electronic phenotyping, clinical research networks, biorepositories, screening data banks, and wide association studies. Lastly, some of the potential limitations of these approaches are discussed, focusing on confounding factors and data quality. Methods: A series of literature searches in main bibliographic databases have been conducted in order to assess the extent to which existing patient data has been repurposed for research. This contribution from the IMIA working group on "Data mining and Big Data analytics" focuses on the literature published during the last two years, covering the timeframe since the working group's last survey. Results and Conclusions: Although most of the examples of secondary use of patient data lie in the arena of clinical and health services research, we have started to witness other important applications, particularly in the area of genomic research and the study of health effects of environmental factors. Further research is needed to characterize the economic impact of secondary use across the broad spectrum of translational research.

Exploring Costing Methods for Environmental Health Services in North Carolina.

All local health departments in North Carolina are mandated to provide a defined set of environmental health services, yet few have the tools to understand the costs incurred in delivering these services. The objectives of this study were to (1) derive cost estimates for 2 commonly provided environmental health services-food and lodging inspections and on-site water services-and (2) explore factors that drive variations in costs, focusing on the roles of economies of scale and scope. Using data from 15 local health departments in North Carolina, we found that costs varied substantially. A bivariate analysis found evidence of economies of scale: higher volumes of services were associated with lower costs per service. Providing a greater scope of services, however, was not consistently associated with reduced costs. In-depth cost data provide public health officials with key information when deciding how to best serve their communities.

Social impact assessment process for an efficient socio-economic transformation towards poverty alleviation and sustainable development

&#x0D; &#x0D; &#x0D; Abstract&#x0D; Sustainable social entrepreneurship (SSE) is a kind of entrepreneurship that meets the needs of the present without compromising the ability, efficiency and values of future generations to meet their own needs. SSE leads to sustainable development. Social entrepreneurs were developed through well-conceived and well directed training programmes around thrust areas, thus advancing the frontiers of theories and practice SSE. The concept of SSE challenges that fosters long-term protection of the society, environment and its habitants as the technological or engineering developments are guided by efficiency, productivity, profitability, health and environmental impacts, resource and energy conservation, waste management, and social impacts such as public convenience, unemployment and crime. The specific objectives of this research were: (i) To formulate and appraise forty-three number of detailed project reports (DPRs) of Diploma in Entrepreneurship and Business Management (DEBM ) course extension learners in eleven batches attached with the DEBM Counsellor and Co- ordinator of Entrepreneurship Development Institute of India -Ahmedabad (EDI),India as well author of this research during the research year (RY) 2007-2014 , (ii) To conduct social impact assessment and environmental health impact assessment (EHIA) for projects , (iii) To design and develop a comprehensive and green economic system modelling and (iv) To promote sustainable socio- economic policies of SIA process for an efficient socio- economic transformation development based on social entrepreneurial research conducted in South India . The design of the study is cross sectional. SIA is defined as the systematic identification and evaluation of the potential social impacts of proposed projects, plans, programs, policies or legislative actions relative to the socio- economic components of the society and total environment. Social factor has been considered in project planning and decision-making process in order to arrive at action which should be socio-economically compatible. Environmental health impact assessment process has been conducted in order to mitigate the environmental health impacts. Socio-economic environment is a man-made environment related to a set of considerations such as demographical study including population trends and population distribution , population interaction and interrelation to the social problem and solution, economic indicators of human welfare services, educational systems, transportation systems, environmental protective infrastructural facilities such as water supply system, waste water treatment system, solid and hazardous waste management, resource conservation and recovery process, environmental public health services and medical facilities. Social impact assessment process should be enacted as social policy act in order to encourage the considerations of human society in project planning and decision making process . Extension learners were equipped with the knowledge, skills and motivation to set up their sustainable social enterprises and function dynamically and manage successfully. DPRs proposed by learners have been investigated as per guidelines provided by EDI. Entrepreneurial business planning assessment regimes (EBPARs) have been accomplished for their credibility and communicability. DEBM projects were screened for the seven fatal flaws viz., (i) Scientific feasibility, (ii) technical feasibility, (iii) economic feasibility, (iv) marketing feasibility, (v) environmental feasibility, (vi) social feasibility and (vii) fundamental legality. Social entrepreneur of an entrepreneurial team should need skills in ethics, accounting, law, finance, team creation and marketing aspects in order to avoid failures in the process. The result analysis of forty- three learners has been discussed. Based on comprehensive socio-economic analysis, a green socio-economic system model has been presented. A famous project case of a DPR-I has been presented on unsafe chromium pollution and contamination of about 18 000 to 30 000 mg/kg from Indian cotton roller ginneries and development of green design roller gin rollers for cotton gins duly investigated in a ginning factory. Such low-carbon and energy-efficient agricultural technologies of agricultural hi-tech industries have made important contributions to mitigating the impacts of economic growth on global warming. Hitherto state-of-the- art literatures, market effects have been considered. It is reported that non-market impacts such as social and environmental impact assessment should be considered for proposed projects, plans, programs, policies and legislative action. It is concluded that this action-based and extension learning field study on SSE shall promote sustainable socio-economic policies for sustainable development and poverty alleviation.&#x0D; &#x0D; &#x0D; &#x0D; Keywords: action, efficient, entrepreneurship, environmental impact assessment process, project, social impact assessment (SIA) process, transformation.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Developing an Environmental Public Health Surveillance System for England

Introduction: The preventable environmental burden of disease estimated for the UK is 14%. To support primary prevention of non-communicable disease, robust information leading to actions that reduce environmental hazard exposures is required, that could support an environmental public health service and a Health in All Policies approach. In England, no comprehensive population-based surveillance exists that integrates environmental hazard and health information. Public Health England (PHE) decided to develop an Environmental Public Health Surveillance System (EPHSS), with a first phase to build capabilities for surveillance of acute incidents, and a second phase to extend to datasets relevant to chronic exposures. Methods: A governance system was established with representation across PHE groups. EPHSS development started from consultation of stakeholders in public health service, government, academia and NGOs. In 2014 user requirements were identified for phase one leading to development of software as a web-based system capturing information on environmental events and exposures of interest to public health and to be shared across contributing agencies. In 2015, 106 stakeholders were consulted for phase two, and user priorities and requirements related to chronic exposure were documented, with related software development expected for 2017-18. Results: EPHSS software for Phase one is expected to be completed in 2016, several topics were identified of interest to specific users, who are expected to pilot applications of acute incident information surveillance on topics including poisonings, housing-related chemical hazards, and exposures from waste sites. Phase two stakeholder consultation highlighted several priority topic areas. Conclusions: EPHSS has developed a tool expected to lead to improved intelligence across a range of sectors and thus support public health practitioners aiming to prevent acute and chronic exposures and related health effects.

A Tool to Cost Environmental Health Services in North Carolina Local Health Departments

Introduction: The cost of providing a basic set of public health services necessary not been well-described. Recent work suggests public health practitioners are unlikely to have the empirically-based financing information necessary to make informed decisions regarding practice. The purpose of this paper is to describe the development of a costing tool used to collect primary data on the number of services provided, staff employed, and costs incurred for two types of mandated environmental health services: food and lodging inspections and onsite water services. Methods: The tool was iteratively reviewed, revised, and piloted with local health department (LHD) environmental health and finance managers. LHDs (n=15) received technical support to estimate costs for fiscal year 2012. Results: The tool contained the following sections: Agency/Respondent Information, Service Counts, Direct Labor Costs, Direct Non-Labor Costs, and Indirect/Overhead Costs. The time required to complete the tool ranged from 2 to 12 hours (median = 4). Implications: LHDs typically did not track costs by program area, nor did they acknowledge indirect costs or costs absorbed by the county. Nonetheless, this costing tool is one of the first to estimate costs associated with environmental health programs at the LHD level and has important implications for practitioners and researchers, particularly when these limitations are recognized.

Blood concentrations of lead and mercury in British Columbians (2009-2010)

&#x0D; Background and Purpose: Adverse effects of lead and mercury on human health due to environmental and occupational exposures require a public health attention. These metals can cause severe harm to vulnerable populations such as children and pregnant women. The probability of chronic and harmful exposure is higher in occupational settings. Monitoring the levels of these two metals in blood is an important tool to identify and quantify exposure to these metals in the environment. Monitoring data provides vital information required for management of health risk posed by these metals. The purpose of this study was to perform a comparative analysis of blood lead levels and blood mercury levels within the province of British Columbia on the health services data obtained from BC Centre of Disease Control. The primary objective was to compare the levels of lead and mercury in blood among different health authorities of British Columbia. The secondary objective was to compare the levels of lead and mercury among different age groups and gender. Methods: The blood lead and mercury concentrations used for the analysis were provided by Environmental Health Services at the British Columbia Centre for Disease Control (BCCDC). The data comprised of blood analyses that were ordered by physicians during the period of 2009-2010 for reasons not disclosed. Access to this data was provided by Dr. Reza Afshari with the permission of Dr. Tom Kosastsky for the completion of this project only. Statistical analysis of data was performed using Microsoft Excel 2013 and SAS University Edition Analytic Software. Various descriptive and inferential statistical tests were performed on the data to determine the differences of blood mercury and lead levels among different genders, Health Authorities and age groups. Results: The levels of blood mercury and lead concentrations were not significantly different in males and females in province (p-value 0.5543 for mercury; p-value 0.5336 lead). However, it was found that blood levels of lead were higher in Interior Health and “Unknown” category (p&lt;0.02), while blood mercury levels were significantly higher in coastal health authorities (highest in Vancouver Coastal Health Authority, followed by Fraser Health Authority and Vancouver Island Health Authority) (p&lt;0.001). For both toxic metals, levels were highest in age group of 50 and above. (p&lt;0.0001 for mercury, p&lt;0.02 for lead). Conclusion: The statistical analysis of lead and mercury data was useful in characterizing the exposure among Health Authorities, age and sex of the people tested in province of British Columbia. Analysis of mercury data has generated clear patterns inferring association between coastal Health Authorities and elevated mercury levels. Vancouver Coastal Health had highest median mercury levels 4.02 μg/L higher than other health authorities (p&lt;0.0001). Analysis of lead data established a pattern among physicians suggesting that they are more likely to order a test if the patient is under 18 years of age. Median levels were found to be highest in Interior Health Authority and “Unknown”&#x0D;

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era.

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty.

Application of Qualified Environmental Health Service in Multinational Tasks

AbstractProtecting the heath of the personnel who are working in the public and private sector and assigned abroad for various reasons is important to provide quality services. Many diseases in the personnel are initiated, maintained or inflamed due to environmental factors. Health of the personnel is affected by the environment during abroad assignments in many aspects. This paper presents solution offers for planning and implementation of quality environmental health services in order to protect the health of Turkish Armed Forces personnel who are assigned in international tasks with the purpose of protecting peace and ballast.

Local Health Departments' Costs of Providing Environmental Health Services

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services. Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure. Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per service provided. In a second step, total costs are decomposed into key components, including direct and indirect costs. Both data collection and analysis were conducted in 2014. Results: For the LHDs examined in this report, median cost per service amounted to $145 for food and lodging and $82 for onsite water. Service costs, however, varied widely across agencies. Decomposition showed that direct labor costs represented more than 80% of total costs. Other direct costs accounted for 10% to 15% of total costs, while indirect costs represented 5% to 6% of total costs. Implications: The finding that labor costs represent a majority of the total costs of service provision has important implications for public health practitioners. Perhaps most importantly, for the purpose of costing public health services, estimation procedures may be simplified by focusing primarily on the cost of labor required to provide any given service.

Accounting for nonverbal communication in interpreter-mediated events in healthcare settings

Interpreters express in one language what is said in another. Verbal language is, of course, the basic system by which humans often interact, and a large percentage of our communication is based on the exchange of words. Bilingual language skills are fundamental and are, as might be expected, emphasized in any interpreter-training program. Issues dealing with verbal language such as knowledge of medical terminology in two languages, cognates, false cognates, syntactical structures, and idioms are essential. They should be a very important part of the training provided for interpreters working in many public service settings (legal, health, education, housing, environmental health, and social services). Although the organized system of vocal sounds, known as verbal language, is fundamental to communicate meaning between individuals, there are also nonverbal features that are utilized in everyday conversation (including interpreted-mediated events). Following Fernando Poyatos (2002a, 2002b, 2002c), this article briefly examines the triple structure of discourse, language-paralanguage-kinesics, and its relevance for interpreters. One of the main differences between public service interpreting and other types of interpreting (such as conference interpreting) is the opportunity for interpreters to intervene, particularly in healthcare settings. These interventions occur in order to stop the flow of the conversation and clarify terms, expressions or ideas; point to a misunderstanding; signal a cultural reference; and/or relay the meaning of specific nonverbal behavior. The idea of the interpreter as mereconduithas now been put into question, and with reason. S/he is now regarded as a visible co-participant in a verbal and nonverbal interaction that allows two people from different languages and cultures to communicate with each other. Because nonverbal communication is an important part of the triadic interpreted-mediated events that take place in healthcare settings, it is becoming much more visible as part of interpreter education. The present article first considers communication through nonverbal signs, and oftenjustthrough nonverbal signs. Next, it stresses the need for interpreters to account for nonverbal cues in the routine triadic events taking place in healthcare settings. The article adopts an expanded definition of interpreting, a particular notion of language, and a constructivist approach to learning.

Epidemiology and statistics at the Nordic School of Public Health: Teaching and research 1979-2014.

The Nordic School of Public Health (NHV) was jointly founded in 1953 by the Nordic countries. Until 1979, the school provided ad hoc courses on public health topics, using external teachers drawn mainly from the Nordic countries. At the time, the permanent staff of the school was small. In 1979, it began a Master's degree programme and a few academic positions were established and filled, to support these courses. The programme included four main areas: Epidemiology, Social Medicine, Environmental Health and Health Services Administration. Epidemiology was compulsory in all Master of Public Health (MPH) exams, but there were a handful of optional courses that could be substituted for the other subjects.This paper tells the story of Epidemiology at NHV from about 1980, up until closure of the school in 2014. The original MPH model ran until 1995. Nursing Science entered NHV from about 1985 and worked mainly with qualitative research that often focused on individual patients. The new methods attracted nurses, midwives, psychologists and other groups that previously had been less represented in NHV. Being quantitative and population oriented, Epidemiology lost its unique position as a mandatory subject for the MPH examination. In addition the 'New Public Health' proposed by the World Health Organisation (WHO) that advocated health promotion and the philosophy of salutogenesis became a challenge for the programme in epidemiology: pathogenesis no longer was of primary interest. From 1995, the MPH format changed repeatedly and a DrPH programme was begun. For the last 8 years of its existence, NHV offered a reasonably comprehensive, basic course in Epidemiology.Throughout the years, epidemiology training and research at NHV were very traditional. In being a relatively free institution in terms of academic choices, NHV should have contributed to the development and innovation of epidemiology in public health. For several reasons, this did not happen.

What's Past is Prologue: A Scoping Review of Recent Public Health and Global Health Informatics Literature.

Objective: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014.Methods: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups.Results: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we identified a small but growing set of articles that measure the impact of ICT on clinical outcomes.Discussion: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles.Conclusion: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in ICT by governmental health agencies.