Local Public Health Officials Research Articles

#Ebola: Emergency Risk Messages on Social Media.

Public health threats require effective communication. Evaluating effectiveness during a situation that requires emergency risk communication is difficult, however, because these events require an immediate response and collecting data may be secondary to more immediate needs. In this article, we draw on research analyzing the effectiveness of social media messages during times of imminent threat and research analyzing the emergency risk communication conceptual model in order to propose a method for evaluating emergency risk communication on social media. We demonstrate this method by evaluating 2,915 messages sent by local, state, and federal public health officials during the 2014 Ebola outbreak in the United States. The results provide empirical support for emergency risk communication and identify message strategies that have the potential to increase exposure to official communication on social media during future public health threats.

Integrating the Built and Social Environment into Health Assessments for Maternal and Child Health: Creating a Planning-Friendly Index.

Environmental and community context earliest in the life course have a profound effect on life-long health outcomes. Yet, standard needs assessments for maternal and child health (MCH) programs often overlook the full range of influences affecting health in-utero and early childhood. To address this, we developed a methodology for assessing community risk in MCH based on six domains integrating 66 indicators across community, environment, socioeconomic indicators, and MCH outcomes. We pilot this methodology in Pennsylvania, and share examples of how local governments, planners, and public health officials across the geographic spectrum can integrate this data into community planning for improved maternal and child health.

Containing COVID-19 Through Contact Tracing

Containing coronavirus disease 2019 (COVID-19) through case investigation and contact tracing is a crucial strategy for governmental public health agencies to control the spread of COVID-19 infection in the United States. Because of the recency of the pandemic, few examples of COVID-19 contact-tracing models have been shared among local, state, and federal public health officials to date. This case study of the Anne Arundel County Department of Health (Maryland) illustrates one model of contact-tracing activity developed early in the outbreak. We describe the contact-tracing effort’s place within the broader county health agency Incident Command System, as well as the capabilities needed, team composition, special considerations, and major lessons learned by county health officials. Other local, state, tribal, territorial, and federal health officials and policy makers can use this case study to innovate, iterate, and further refine contact-tracing efforts to prevent the spread of COVID-19 infection and support community members in isolation or quarantine.

Strategic testing plan for ambulatory surgery centers after the COVID-19 pandemic.

As the curve continues to flatten during the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic, and more physicians resume outpatient clinical work, the question arises of how to ensure the safety of the patients and staff while performing cases. Many institutions and health-care offices have turned to screening questionnaires to determine the likelihood of coronavirus disease 2019 (COVID-19) positivity. However, screening questionnaires are woefully inadequate as studies have shown that roughly 6.4% to 50% of patients may spread this virus without any symptoms. In this study, we have outlined a proposal to restart elective procedures after the curve has flattened in a certain locale, particularly for ambulatory surgery centers (ASCs). Until additional data are collected for specific sensitivity and specificity values for PCR testing, we recommend performing 2 consecutive polymerase chain reaction (PCR) tests to minimize false negative rates. The algorithm described in this study can help ASCs begin their practices and provide local public health officials with valuable data that can help establish true sensitivity and specificity rates for these tests.

Identifying septic pollution exposure routes during a waterborne norovirus outbreak - A new application for human-associated microbial source tracking qPCR

In June 2017, the Pennsylvania Department of Health (PADOH) was notified of multiple norovirus outbreaks associated with 179 ill individuals who attended separate events held at an outdoor venue and campground over a month period. Epidemiologic investigations were unable to identify a single exposure route and therefore unable to determine whether there was a persistent contamination source to target for exposure mitigation. Norovirus was detected in a fresh recreational water designated swimming area and a drinking water well. A hydrogeological site evaluation suggested a nearby septic leach field as a potential contamination source via ground water infiltration. Geological characterization revealed a steep dip of the bedrock beneath the septic leach field toward the well, providing a viral transport pathway in a geologic medium not previously documented as high risk for viral ground water contamination. The human-associated microbial source tracking (MST) genetic marker, HF183, was used as a microbial tracer to demonstrate the hydrogeological connection between the malfunctioning septic system, drinking water well, and recreational water area. Based on environmental investigation findings, venue management and local public health officials implemented a series of outbreak prevention strategies including discontinuing the use of the contaminated well, issuing a permit for a new drinking water well, increasing portable toilet and handwashing station availability, and promoting proper hand hygiene. Despite the outbreaks at the venue and evidence of ground water contamination impacting nearby recreational water and the drinking water well, no new norovirus cases were reported during a large event one week after implementing prevention practices. This investigation highlights a new application for human-associated MST methods to trace hydrological connections between multiple fecal pollutant exposure routes in an outbreak scenario. In turn, pollutant source information can be used to develop effective intervention practices to mitigate exposure and prevent future outbreaks associated with human fecal contaminated waters.

Translation of scientific research into Public Health Action: in the case of National Institute of Public Health, Japan

Background: The National Institute of Public Health (NIPH) conducts investigative public health science research to provide national and local public health sectors with scientific basis and specialized training courses. Objectives: To evaluate the training course for medical radiation inspectors in NIPH. Methods: To assess the self confidentially and the knowledge, we compared the responses for the self-administered questionnaire and basic radiation safety knowledge test before and after the course in 2016, 2018 and 2019. To evaluate the basic attitude on public health action regarding radiation, the ethical aspects regarding thyroid mass screenings in Fukushima were discussed during this course. Results: Before the course, 72 % of participants (n=46) were not confident on basic knowledge of radiation shielding design evaluation. After the course, 55 % of participants were confident. The average score for basic radiation safety knowledge was increased from 4.4 to 7.8 out of 10-point tests. Regarding thyroid mass screening, doubts were raised at the beginning of each course, participants gained an understanding of the scientific explanations. Discussions: With the promotion of decentralization, basic local governments are becoming finer, and securing professional human resources has become an issue so that local agencies often do not have opportunity to inform research activities owing to challenges such as skills, resources, and time. Therefore, we provide various training courses for local agencies. Although the explanation on cons of the thyroid-screening test would not be easy even for local public health officials to understand, they recognized the honest attitudes of the facilitators and eventually understood our explanations. Conclusions: The Fukushima nuclear accident has had also an inevitable impact on issues related to protection from medical radiation. However, sound risk communication activations on radiation are being accelerated on the premise of various experiences triggered by unfortunate accident in Japan.

Partnering with Local Hospitals and Public Health to Manage COVID-19 Outbreaks in Nursing Homes.

BACKGROUND/OBJECTIVESAlmost half of deaths related to COVID‐19 in the United States are linked to nursing homes (NHs). We describe among short‐term and long‐term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID‐19, and subsequent containment efforts, outcomes, and challenges.DESIGNOutbreak investigation.SETTINGThree NHs in southeast Michigan.PARTICIPANTSAll residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system.METHODSUpon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility‐wide testing and the following intervention measures: cohorting of COVID‐19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID‐19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14‐day outcomes.RESULTSA total of 29 cases of COVID‐19 were identified at three participating NHs. Nineteen cases of COVID‐19 were identified through symptom‐triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point‐prevalence survey required hospitalization, and five were discharged home within 14 days.CONCLUSIONProactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID‐19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.

A rapidly deployed, interactive, online visualization system to support fatality management during the coronavirus disease 2019 (COVID-19) pandemic.

ObjectiveTo create an online visualization to support fatality management in North Carolina.Materials and MethodsA web application aggregates online datasets for coronavirus disease 2019 (COVID-19) infection rates and morgue utilization. The data are visualized through an interactive, online dashboard.ResultsThe web application was shared with state and local public health officials across North Carolina. Users could adjust interactive maps and other statistical charts to view live reports of metrics at multiple aggregation levels (eg, county or region). The application also provides access to detailed tabular data for individual facilities.DiscussionStakeholders found this tool helpful for providing situational awareness of capacity, hotspots, and utilization fluctuations. Timely reporting of facility and county data were key, and future work can help streamline the data collection process. There is potential to generalize the technology to other use cases.ConclusionsThis dashboard facilitates fatality management by visualizing county and regional aggregate statistics in North Carolina.

PUBLIC AND ORAL HEALTH

The Affordable Care Act (ACA) expanded health insurance coverage and strengthened incentives for health care organizations to engage in community‐wide health improvement initiatives. These incentives include enhanced community benefit requirements for tax‐exempt hospitals, adjusted medical loss ratio requirements for health insurers, tax incentives for employers, and competitive federal funding through the Prevention and Public Health Fund. Reduced uncompensated care costs and cost‐shifting may allow hospitals and other institutions to increase investments in community health, particularly when coupled with incentives to do so. Prior research is inconsistent regarding how health care organizations have responded to these reforms, due in part to data limitations. This study uses novel longitudinal data from a national cohort of U.S. communities to estimate whether changes in coverage and uncompensated care have led to changes in the implementation of community health activities by hospitals, physicians, insurers, and employers.The National Longitudinal Survey of Public Health Systems (NALSYS) follows a national cohort of approximately 600 communities between 2012 and 2018 to measure the implementation of guideline‐recommended community health improvement activities in each community and the network of organizations contributing to each activity. Importantly, these data are reported by local public health officials rather than by hospitals and health care institutions who may inflate reported contributions. Survey data are linked with county‐level coverage estimates, demographic and socioeconomic characteristics, health care market structure data, and CMS hospital cost report data on uncompensated care costs. Fixed‐effects regression models with instrumental variables (IV) are used to estimate the causal effects of changes in coverage and uncompensated care on implementation of community health activities by hospitals, physicians, insurers, and employers while controlling for unmeasured confounding.Stratified random sample of 600 U.S. counties observed between 2012 and 2018.Coverage increased and uncompensated care costs declined after 2014 in 87% and 73% of communities, respectively, but by widely varying magnitudes. IV estimates indicate that a 10% reduction in uncompensated care costs resulted in a 14% increase in implementation of community health activities by hospitals (P < 0.01), along with an 8% increase in implementation by insurers (P < 0.05). Results for physicians and employers were not statistically significant. The estimated hospital and insurer effects were concentrated in states that expanded Medicaid eligibility under ACA (P < 0.01).Hospitals and insurers have expanded their involvement in community‐wide health activities proportionate with the level of decline in demand for uncompensated care in their communities.Incentives for health care institutions to engage in community‐wide health improvement initiatives appear effective in communities where gains in coverage lead to savings that can be redeployed for community benefit. This response may be an important but unrecognized pathway through which coverage gains improve population health, but recent erosion in coverage may dampen this effect.The Robert Wood Johnson Foundation.

The Diamond Project: A Quality Improvement Model for Adopting Shared Service Delivery in the Washington Vaccines for Children Program.

Context: Increasing federal requirements with no change in the Centers for Disease Control and Prevention budget creates an unsustainable delivery model between states and their local counterparts for programs like Vaccines for Children (VFC).Project: The Washington State Department of Health collaborated with the Washington Association of Local Public Health Officials to identify how best to improve the quality of the VFC program.Approach: Utilizing Quality improvement and Lean Six Sigma methods, the project team was able to adopt a new shared-service delivery model to improve the quality of the VFC program in Washington State.Discussion: Through utilization of quality improvement methods and Lean methodology Washington State Department of Health identified recommendations to adopt a shared-service delivery and implemented those changes.

Getting back on track: control of covid-19 outbreaks in the community.

Peter Roderick , Alison Macfarlane, and Allyson M Pollock argue there’s still time to change tack on the UK’s ad hoc system for covid-19 tracking, testing, and contact tracing Historically, England’s system of communicable disease control has relied on close cooperation between local health services and authorities. General practitioners, NHS and public health laboratories, and local public health officers play key roles, backed by legal notification requirements. That local system has gradually been eroded over several decades. (box 1) But instead of prioritising and rebuilding this system at the start of this epidemic, the government has created a separate system which steers patients away from GPs, avoids local authorities, and relies on commercial companies and laboratories to track, test, and contact trace. The ad hoc parallel system in England has three components: Box 1 ### Erosion of local communicable disease control in England At its height, local communicable disease control was supported by more than 60 national, regional, and local public health laboratories. The service was strengthened from 1977-2002 by the creation of the Communicable Disease Surveillance Centre in Colindale. Erosion began after NHS reorganisation in 1974 and continued when the Public Health Laboratory Service Board was abolished in 2003 and its local laboratories transferred to NHS trusts, at the same time as communicable disease control was centralised in the Health Protection Agency. In 2012, the Health and Social Care Act abolished locally based bodies in England and carved public health functions out of the NHS. Public Health England was set up as an executive agency to fulfil the government’s duty to protect the public from disease, with only nine laboratories and eight regional centres. Local authorities were charged with improving public health. Each local authority was required, acting jointly with the secretary of state, to appoint a director of public health, with responsibility for exercising the authority’s public health functions. … RETURN TO TEXT

Social Network Analysis of Patient Movement Across Health Care Entities in Orange County, Florida.

Multidrug-resistant organisms (MDROs) are continually emerging and threatening health care systems. Little attention has been paid to the effect of patient transfers on MDRO dissemination among health care entities in health care systems. In this study, the Florida Department of Health in Orange County (DOH-Orange) developed a baseline social network analysis of patient movement across health care entities in Orange County, Florida, and regionally, within 6 surrounding counties in Central Florida. DOH-Orange constructed 2 directed network sociograms-graphic visualizations that show the direction of relationships (ie, county and regional)-by using 2016 health insurance data from the Centers for Medicare & Medicaid Services, which include metrics that could be useful for local public health interventions, such as MDRO outbreaks. We found that both our county and regional networks were sparse and centralized. The county-level network showed that acute-care hospitals had the highest influence on controlling the flow of patients between health care entities that would otherwise not be connected. The regional-level network showed that post-acute-care hospitals and other facilities (behavioral hospitals and mental health/substance abuse facilities) served as the primary controls for flow of patients between health care entities. The most prominent health care entities in both networks were the same 2 acute-care hospitals. Social network analysis can help local public health officials respond to MDRO outbreak investigations by determining which health care facilities are the main contributors of dissemination of MDROs or are at high risk of receiving patients with MDROs. This information can help epidemiologists prioritize prevention efforts and develop county- or regional-specific interventions to control and halt MDRO transmission across a health care network.

Recommendations for Dermatology Office Reopening in the Era of COVID-19.

The COVID-19 pandemic, originating in Wuhan, China, has become a major public health and economic challenge for countries around the world. As of May 08, 2020, there are over 3 million COVID-19 cases, and 250,000 COVID-19- associated deaths in 215 countries. As more data is collected, updated infection control measures are continuously released and published by government, public health authorities, and physician specialty associations. Across the globe, dermatological practices have had to limit their operations to varying degrees to facilitate disease control, but as the pandemic subsides, they will broaden their operations. In light of the uncertainty surrounding safe and effective practice of medical and aesthetic dermatology in the era of COVID-19, fourteen international experts in the field contributed to recommendations for effective infection control protocols and practice management modifications. While guidance from the World Health Organization and local public health officials comes first, these recommendations are crafted as a starting point for dermatologists worldwide to commence either reopening their doors to patients or expanding available service offerings. This can help ensure that patients receive needed care in the short term and improve long term practice viability. J Drugs Dermatol. 2020;19(7):e-1-e-9. doi:10.36849/JDD.2020.5293.

Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19) Pandemic.

N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in health care facilities to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.

Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership

The coronavirus disease-2019 (COVID-19) pandemic has led to marked global morbidity and mortality ([1–3][1]). There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing and to help preserve or redirect limited

Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership

The coronavirus disease-2019 (COVID-19) pandemic has led to marked global morbidity and mortality ([1–3][1]). There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing and to help preserve or redirect limited

First report of the mcr-1 colistin resistance gene identified in two Escherichia coli isolates from clinical samples, Philippines, 2018

ObjectivesThe first report of a plasmid-borne colistin resistance gene (mcr-1) detected in an Escherichia coli isolate from China heralded the emergence of pandrug-resistant bacteria. Since then, the mcr-1 gene has been detected worldwide, but to date it has not been reported in the Philippines. MethodsIn this study, 123 antimicrobial-resistant isolates collected from January–June 2018 from patients admitted to a tertiary hospital in Manila, Philippines, were characterised. Biochemical identification and antimicrobial susceptibility testing were performed using a BD Phoenix™ M50 system with NMIC/ID-95 panel. Conventional PCR was performed to detect the genes mcr-1 to mcr-5, and short- and long-read whole-genome sequencing was performed. ResultsTwo mcr-1-positive E. coli clinical isolates from separate patients harboured mcr-1 on an IncI2 plasmid. One isolate was shown to carry 12 antimicrobial resistance genes (ARGs) in addition to mcr-1, including the extended-spectrum β-lactamase blaCTX-M-55, whilst the other E. coli isolate carried 6 ARGs in addition to mcr-1. ConclusionBoth patients had no prior colistin treatment recorded in their medical history and no travel history outside of the country within the past 6 months from the date of hospital admission, indicating local transmission and acquisition of the colistin-resistant strain from either community or hospital settings within the Philippines. This report should serve as a signal to local public-health officials of the need to intensify surveillance efforts and to increase vigilance and implementation of antimicrobial stewardship programmes to contain and slow the spread of antimicrobial resistance.

Chronic Methyl Mercury Toxicity in a 72 Year-Old Athletic Male from Southwestern Virginia

This research article focuses on the case report of a 72 years old athletic male from Southwestern Virginia who was chronically exposed to methylmercury via the consumption of tuna and swordfish steaks. The tuna and swordfish fish were wild-caught in the Pacific basin (Viet Nam or Thailand). As a comparison or analyses, Atlantic basin fish samples were obtained as fresh tuna and swordfish steaks from a seafood store in Salem, Virginia USA. Atlantic basin fish were caught off the coast of North Carolina, USA. The patient’s methylmercury toxicity presented clinically as an erythematous rash with macules, patches, papules and petechia on his bilateral ankles. The patient’s blood mercury level was extremely elevated at this time. The patient stopped his daily intake of fish and was observed at an out-patient dermatology clinic over the course of 11 months, during which time blood levels of mercury were repeatedly taken. The patient’s symptoms improved and the blood mercury levels declined. Additionally, Inductively Coupled Plasma with Mass Spectrometry (ICP-MS) analyzed mercury levels from the fish consumed by the patient as well as a group of fish from a different geographical region. While fish and other seafood is frequently noted for its health benefits, it is imperative that the potential toxicities be discussed and researched across the globe, especially in areas in which it is a primary dietary source. There is a great need for local and national public health officials and the various stores and markets where consumers purchase fresh and frozen fish, to provide the public with information on mercury content, and allowable amount and frequency that mercury-laden fish should be consumed, allowing consumers to make informed decisions about which fish to eat.

Nonpharmaceutical Interventions for Pandemic Influenza: Communication, Training, and Guidance Needs of Public Health Officials.

The aim of this study was to identify the needs of state, tribal, local, and territorial (STLT) public health officials in communicating, implementing, and monitoring nonpharmaceutical interventions (NPIs) during an influenza pandemic. A Web-based survey collected data from a nonrandom sample of STLT health departments. A total of 267 of 346 public health officials responded (77.2% response rate). STLTs identified the general public, families, childcare programs, K-12 schools, and workplaces as their priority audiences for NPI communication. Training needs included NPI decision-making strategies, triggers for implementing NPIs, and communicating NPI recommendations to families and communities, as well as a more practical orientation and real-world examples of how to incorporate NPI guidance into preparedness and response activities. Information is needed on health messaging for various populations and settings and on the legal authority for implementing specific NPIs. Future NPI recommendations by CDC should continue to be based on feedback solicited from STLT health departments. To fill identified gaps, CDC used these findings to create NPI guidance and materials to assist in prepandemic planning and preparedness for STLTs and various community settings.

Open Comparisons in Public Health Not Only a Report But Also a Practical Tool Package

Abstract Sweden is a high-income country with about 10 million people 2018. The public health policy has a clear focus on equitable health throughout the population, and a goal to reduce avoidable health inequalities within a generation. The 21 regions and 290 municipalities in Sweden are political self-government and important as most of the welfare services that impact citizens’ lifelong health fall under their remit, for example; healthcare, childcare, education, social service, elderly care and support to people with disabilities, some emergency services, environmental issues urban planning. Therefore, the municipalities and regions need reliable data that can be compared. Such data is available in the report Open Comparisons in Public Health (OCPH). The OPCH 2019 demonstrate large inequities in determinants of health and in health outcomes between municipalities in Sweden. Further work is needed to reduce these unjust and avoidable differences. The OPCH 2019 is not only a report, but rather a concept with additional practical tools to be used by local and regional public health officers, leaders and politicians. Following tools, developed in collaboration with stakeholders, are available in the concept OPCH. OPCH 2019: various managementresearch review, result comparisons, suggested improvement areas Factsheet: for leaders and politicians at policy level Municipality reports: tailored for public health officers to save time Socioeconomic compass: a tool to analyze differences in socioeconomics across municipalities Kolada: the Swedish database for municipal benchmarking Toolbox: tools to facilitate systematic interpretation and analysis The National Public Health Agency: various statistics are available for additional analyses Key messages The OPCH and the tools contributes to initiate local/regional development, improvement, monitoring and analysis concerning the quality and efficiency of the services delivered by these organisations. Governmental policies are important structural links16, but according to the OCPH 2019 the reduction of health disparities also requires measures in each local community.