Local Health Board Research Articles

Developing Continuing Education for Ohio’s Local Boards of Health

Background: Public health functions at the county level and city level through the work of local health departments (LHDs). Local boards of health (LBoHs) work closely with LHDs as an administrative oversight body. In 2013, legislation was passed in the state of Ohio pertaining to the accreditation of LHDs, which included a provision requiring that Ohio’s LBoH members engage in 2 hours of continuing education (CE) per year. To assist LBoHs in fulfilling these requirements, a partnership was developed between the Ohio Association of Boards of Health (OABH) and the Kent State University College of Public Health (KSU-CPH) to deliver CE content.
 Methods: The process for developing the CE modules encompasses 3 steps: (1) needs assessment, (2) module development and delivery, and (3) evaluation. Feedback was solicited from Ohio’s LBoH members to determine topics of interest for CE modules. Taking this feedback, a curated set of 8 modules will be developed. Module content will be derived from graduate courses within KSU-CPH as well as from subject matter experts. The modules will be delivered online to LBoH members during their regularly scheduled meetings.
 Results: This program proposes to fulfill state requirements that LBoH members regularly engage in CE. Partner-ing with KSU-CPH allows for the use of academic content in these trainings.
 Conclusion: An adequately trained public health workforce is essential for a well-functioning public health system, which includes governing entities like LBoHs. There is limited understanding of how workforce development can be targeted specifically to LBoHs. This CE program contributes to current efforts to promote workforce development within the field of public health.

Use of prescribing indicators as a means of identifying variation in the prevalence of valproate prescribing between health communities: a cross-sectional study

ObjectiveTo determine the appropriateness of valproate prescribing indicators in England and Wales as a means of identifying variation in the prevalence of valproate use among women and girls of childbearing...

The Burden of Antimicrobial Resistant Infections in Wales: a population-level modelling analysis

Abstract Background Antimicrobial Resistance (AMR) threatens the sustainability of an effective, global public health response to infectious disease. This study uses routine surveillance data to estimate the public health burden (PHB) of AMR infections in Wales for the period 2017-19, with further stratification by Age, Sex, local Health Board (HB) area and relative deprivation, to guide public health action. Methods Welsh AMR Surveillance data, collected as part of the European AMR Surveillance Network (EARS-Net), was collated for the period 2017-19. Adapting the methodology of the European Centres for Disease Control Burden of Communicable Diseases in Europe (BCoDE), we modelled the PHB of five types of antibiotic-resistant infection (invasive and non-invasive), and 7 pathogens which associated with AMR, using the Burden of Healthcare-Acquire Infection (BHAI) R package. Postcodes were used to assign patients' resident health board, as well as their relative socio-economic deprivation, using the Welsh Index of Multiple Deprivation (WIMD). Results Preliminary results (median estimation with 95% confidence interval (CI)) were calculated for: number of infections with AMRnumber of deaths attributable to AMRnumber of DALYs attributable to AMR Estimates were stratified by age; sex; HB; relative deprivation; and pathogen and infection type. Conclusions This is the first study of its kind to study the relationship between AMR incidence and relative deprivation. It offers a clear picture of the epidemiology of AMR within Wales to support public health action. Key messages Infections from AMR bacteria represent a major PHB in Wales, and the modelling PHB of AMR by socioeconomic group and local area can inform effective public health action. The results of this study are valuable for guiding public health action to address AMR at the national and international level.

School Nursing and Public Health: The Case for School Nurse Investigators and Contact Tracing Monitors of COVID-19 Patients in Massachusetts.

School nurses across Massachusetts and the nation rose to the challenges presented by the pandemic of the coronavirus disease 2019 (COVID-19). One of the many ways in which school nurses responded to the pandemic was to work in collaboration with their Local Boards of Health in a variety of capacities. The essential functions of a school nurse uniquely prepare them for the roles of case investigators and contact tracing monitors as a means to ensure population health. In addition to both individual and population health within the school setting, school nurses are effective partner in emergency planning and can help inform decision making and policy making within communities.

Social Return on Investment Analysis of the Health Precinct Community Hub for Chronic Conditions.

Local governments and Health Boards are seeking to develop integrated services to promote well-being. Social participation and physical activity are key in promoting well-being for older people. The Health Precinct is a community hub in North Wales that people with chronic conditions are referred to through social prescribing. To improve community-based assets there is a need to understand and evidence the social value they generate. Data collection took place October 2017–September 2019. Social Return on Investment (SROI) analysis was used to evaluate the Health Precinct. Stakeholders included participants aged 55+, participants’ families, staff, the National Health Service and local government. Participants’ health and well-being data were collected upon referral and four months later using the EQ-5D-5L, Campaign to End Loneliness Scale and the Rosenberg Self-Esteem Scale. Family members completed questionnaires at four months. Baseline data were collected for 159 participants. Follow-up data were available for 66 participants and 38 family members. The value of inputs was £55,389 (attendance fees, staffing, equipment, overheads), and the value of resulting benefits was £281,010; leading to a base case SROI ratio of £5.07 of social value generated for every £1 invested. Sensitivity analysis yielded estimates of between 2.60:1 and 5.16:1.

Impact of a pilot NHS-funded sore throat test and treat service in community pharmacies on provision and quality of patient care

ObjectiveA National Health Service (NHS)-funded sore throat test and treat (STTT) service was introduced in selected pharmacies in two local health boards in Wales, as an extension to the national...

The use of THRIVE throughout local health boards in Wales

The use of THRIVE throughout local health boards in Wales

Fighting obesity at the local level? An analysis of predictors of local health departments' policy involvement

Obesity is a critical public health issue in the United States. Local health departments (LHDs) can play a crucial role in public health policy, and are well-positioned to address obesity in their communities. We assess the obesity policy involvement among LHDs across the United States and the factors associated with increased involvement. Data come from 1803 LHDs in the 2016 National Profile of Local Health Department survey, supplemented with county-level obesity prevalence and political ideology. Negative binomial regressions examined LHD and regional characteristics associated with the number of obesity policies with which LHDs were involved. Almost half (46.1%) of LHDs reported no involvement with local obesity policies. Several factors were associated with increased policy involvement: having local boards of health with advisory (IRR = 1.31, p < 0.05) or governance roles (IRR = 1.27, p < 0.01), larger workforces (IRR = 1.34, p < 0.001), accreditation (IRR = 1.40, p < 0.001), higher obesity prevalence (IRR = 1.03, p < 0.01), and being politically more liberal (IRR = 1.01, p < 0.05). Overall, the large number of LHDs with no or limited involvement in obesity policies is a missed opportunity for local action. A better understanding of LHD policy involvement, how organizational and political factors enable or constrain their actions, and how they can leverage their current authority is needed to help LDHs serve local needs.

The First 10,000 Responses - End of Video Consultation Patient &amp;amp; Professional Feedback on ‘Use &amp;amp; Value’. The Satisfaction, Suitability &amp;amp; Acceptability in Primary, Secondary &amp;amp; Community Care in NHS Wales During the COVID-19 Pandemic

Prior to the COVID-19 pandemic, adoption of video consulting (VC) in the UK was relatively low. Since March 2020 VC was recognised as a viable option for healthcare delivery at a time where mobility was being restricted, and available space in healthcare settings was constrained by the need for social distancing. We report a rapid expansion of its use in the health and care service in Wales. The NHS Wales Video Consulting Service shows high levels of acceptability to patients and professionals. This service was set-up and implemented as a collaborative approach between Technology Enabled Care (TEC) Cymru and its local Health Boards and Trusts, and supported by the Welsh Government to be delivered this way. Due to its nature (a national programme), an all-Wales evaluation of VC was made possible. The ‘live’ end of consultation surveys from patients and professionals are presented in this paper to demonstrate a national VC picture. The data from 10,401 research participants exhibits VC as generally well accepted by Welsh patients and professionals, with high satisfaction and suitability. Our data demonstrate greater satisfaction among patients than professionals, although levels are high in both groups. Interestingly there is little difference in outcomes across urban and rural parts of Wales, which suggests that VC is nationally accepted and suitable. More in-depth and mixed-methods research in these areas is underway, and to date, we have recruited more than 28,000 research participants.Funding Statement: Technology Enabled Care (TEC) Cymru and the NHS Wales Video Consultation (VC) Service is funded by the Welsh Government.Declaration of Interests: None.Ethics Approval Statement: TEC Cymru obtained full service evaluation approval from Research and Development departments from all Health Boards and Trust, and consent from each participant was provided by way of agreeing to a statement of consent at the end of each survey.

Local Health Department Accreditation Is Associated With Organizational Supports for Evidence-Based Decision Making.

Introduction: Recent studies show that health department accreditation from the U.S. Public Health Accreditation Board (PHAB) drives performance management and quality improvement. PHAB standards call for agencies to use evidence in decision making. It is unknown whether accreditation is associated with organizational supports for evidence-based decision making (EBDM). Self-report data from a 2017 survey of U.S. local health departments were analyzed to test relationships of accreditation status with organizational supports for EBDM.Methods: A cross-sectional survey was conducted in this observational study. A total of 579 local health departments were invited to complete an online survey; 350 (60.4%) provided complete data for the present study. The dependent variables were six factors of organizational supports for EBDM previously validated through confirmatory factor analyses. Accreditation status (PHAB-accredited, preparing, not preparing) was the independent variable of interest. Logistic regression analyses controlled for governance (presence of a local board of health; state, local, or shared state and local governance) and jurisdiction population size.Results: PHAB-accredited health departments were more likely to report higher capacity for EBDM, resource availability for EBDM, and evaluation capacity than health departments that reported not yet preparing for accreditation. Health departments that reported preparing for PHAB accreditation showed a non-significant pattern of higher perceived supports for EBDM compared to departments not preparing for accreditation.Conclusion: PHAB standards and the accreditation process may help stimulate health department organizational supports for EBDM.

A Model for Designing Authentic Learning

Student internships and work experience schemes provide students with highly authentic learning experiences (Bosco &amp; Fern, 2014). Therefore many university programmes include a job-experience element that students must demonstrate completion of, usually through a report signed by the employer that the student has managed to find work with over their summer break. Auckland University of Technology provides a summer student scholarship scheme that provides contestable scholarship funding for students to work on university specified projects over the summer break. Each scholarship requires 370 hours of project-related work, followed by a summary report. In this presentation we explore a model that extends the summer student scholarship concept as part of a longer term collaboration between university students, academic supervisors, and industry representatives. This extended model brokers real world projects that benefit the wider community through developing solutions to health care problems in collaboration with a local district health board (ADHB or Auckland District Health Board). In this model communication design students apply to form design teams, selected and supervised by university academics, to address design briefs from the district health board’s Design Lab. Key aspects of this collaboration include: developing a sense of trust between the university and the district health Design Lab, establishing a supervision team and protocols, and establishing an ecology of supporting resources - including providing students with the work space and infrastructure access to achieve the project goals. The summer student scholarships are designed to be the first step in a long term collaboration that will potentially lead into major undergraduate student projects and post-graduate research. The summer scholarship projects use a Design Based Research (DBR) methodology (McKenney &amp; Reeves, 2018) to address the first design stages of specific health care problems: analysis and exploration, and initial prototype design. The following stages of a DBR methodology (design implementation, evaluation, and redesign) are addressed through subsequent major student projects or post graduate research following agreement with the district health Design Lab after the presentation of the summer student scholarship project outcomes. The scope of the projects aim to explore the potential of wearable and mobile technologies to enhance health care practice and the patient experience (Rich &amp; Miah, 2017). The research questions underpinning the extended student scholarship model are:&#x0D; &#x0D; &#x0D; In what scenarios can wearable and mobile technologies most effectively enhance health care practice and the patient experience?&#x0D; What are the design principles that can guide the development of authentic mobile learning collaborative student projects?&#x0D; &#x0D; References&#x0D; &#x0D; Bosco, A. M., &amp; Fern, S. (2014). Embedding of authentic assessment in work-integrated learning curriculum. Asia-Pacific Journal of Cooperative Education, 15(4), 281-290.&#x0D; McKenney, S., &amp; Reeves, T. C. (2018). Conducting educational design research: Routledge.&#x0D; Rich, E., &amp; Miah, A. (2017). Mobile, wearable and ingestible health technologies: towards a critical research agenda. Health Sociology Review, 26(1), 84-97.&#x0D;

Injury narratives in occupational safety and health prevention in Italy.

Storytelling is an effective information source when coupled with technical-scientific evidence. It can promote a structured relationship between evidence-based knowledge and field experience of workplace safety and prevention services (WSPS) inspectors. This is key to identifying the causes of workplace injuries and to set priorities for prevention strategies. The main aim was to describe and report how story collection can be used for deriving validated indications for injury prevention. The specific objectives were to report the results of the creation and dissemination on the web of the story collection and the experience of setting up a community of practice (CoP) to develop preventive recommendations. WSPS inspectors from local health boards in Piedmont (northwest Italy) were asked to write injury stories. They identified the key elements of their stories and developed a narrative of witness accounts to explore the critical issues identified during the investigation. In sessions with the CoP, the inspectors validated the indications for prevention elaborated in each story to reduce bias and standardize recommendations. Between 2012 and 2017, 60 WSPS inspectors wrote 53 injury stories which were collected and published on the institutional website. Twenty-two stories were selected for discussion during peer review sessions in the CoP and the indications for prevention were transformed as preventive solutions. Occupational safety and health prevention can benefit from a narrative-based approach that provides a more comprehensive look at health and safety by facilitating knowledge improvement and sharing.

Health Inspectors on Local Boards of Health: the Impact on Communities’ Environmental Health Governance

Health Inspectors on Local Boards of Health: the Impact on Communities’ Environmental Health Governance

121 - Partnering With the Cree to Develop a Diabetes Prevention Strategy in Families With Prior Gestational Diabetes: In-Depth Interview Results

The prevalence type 2 diabetes (DM2) in Eeyou Istchee Cree communities are rapidly rising. Women with a history of gestational diabetes mellitus (GDM) and their families are at high risk for DM2. The local health board has programs for diabetes management, but identified gaps in diabetes prevention.

National Diabetes Audits inform best practice for diabetes foot care and hospital inpatients

National Diabetes Audits inform best practice for diabetes foot care and hospital inpatients

Realist evaluation of cancer rehabilitation services in South Wales (REEACaRS): a mixed methods study protocol

Introduction Long-term and late effects of cancer treatments can cause functional limitations and reduce quality of life. Cancer rehabilitation services, which can comprise physical exercise, psychological support and educational interventions...

Core medical skills training days: streamlining practical and resuscitation skills training in our local health board

To create a training day of practical and resuscitation skills tailored specifically for core medical trainees (CMTs) within the local health board. The annual review of competence progression (ARCP) decision aid was used to identify key practical skills for CMTs. The CMT curriculum was used to identify ‘emergency’ and ‘top’ presentations suitable for the resuscitation skills stations, with emphasis on the use of simulation to provide experience in a variety of critical conditions including less-common presentations such as anaphylaxis. Faculty for the training …

Fracture Liaison Services in England and Wales, inequity of access and quality of care after a fragility fracture

The Fracture Liaison Service Database (FLS-DB) aims to measure the volume and quality of care in secondary fracture prevention delivery across England and Wales. In 2015 a facilities audit of all acute trusts and local health boards (LHBs) in England and Wales was completed in order to establish

Stakeholders’ Awareness and Integration of Global and National Health Agenda in the Ilocos Norte’s Local Health System

This study determined the stakeholders' level of awareness on the global, national and local health agenda as well as the extent of integrating the global and national health goals into the local health system. Qualitative and quantitative approaches were used in exploring the problem. Respondents are five groups of stakeholders: 1) public service providers, 2) private sector 3) educational institutions, 4) community leaders, and 5) service users. In determining the samples, total enumeration was employed to public service providers (Local Health Board) and health personnel (Municipal Health Office); heads of educational institution, officers of health-related NGOs and businesses (private) and community leaders. There were a total of 744 respondents. Purposive sampling was used for service users or those who availed of essential health services in the last 12 months who were intercepted during the study. A questionnaire was used in data gathering supplemented with documentary analysis on the vision of the Local Government Units to see the relevance to health agenda. The questionnaire was reviewed by knowledgeable evaluators from the health stakeholders. The researcher sought endorsement from LGUs to gather data from concerned departments and groups of stakeholders. The statistical tools used in the data analysis are frequency counts and means. Results of the study revealed that public service providers, community leaders and service users have “High” level of awareness on the Health Agenda and “High” level of perception on the Local Health System’s Integration of the City/Municipal Health Agenda. Those in the private sector and educational institutions had “moderate” level of awareness and perception on the integration of the global and national health agenda in the local health system.

Community Dentistry: A Service Evaluation Study for 'Looked After Children' in England and Wales.

Historically, the healthcare needs of 'Looked After Children' (LAC) within the UK have been relatively neglected and there is no universally adopted designated dental care pathway (DDCP) in place to ensure their care. This paper aims to discover the contribution of the community dental service (CDS) to the dental health of LAC throughout England and Wales. An electronic questionnaire was sent to CDS Clinical Directors in England and local health boards in Wales between November 2011 and January 2012. Ten questions were included with 5-point Likert scale responses and the option for free text comments. In Wales, 41 questionnaires were returned (35% response rate) of which 37 services provided care for LAC. In England, 67 questionnaires were returned (44% response rate), of which 59 services provided care for LAC. The study found that the majority of CDSs in the UK provide care for LAC, However, we cannot ascertain if the CDS is the most appropriate service to provide dental care for this group of patients. The use of DDCPs, non-attendance and other care policies varied markedly amongst respondents, which may suggest that provision of dental care for LAC within the CDS in England and Wales is inconsistent. The authors believe that the utilisation of an LAC-specific and universally accepted DDCP that has been developed could help to reduce these inconsistencies. Further surveys are planned in order to monitor the care of this vulnerable group of patients and assess the impact of these recommendations.