Massachusetts Department Of Public Health Research Articles

Altered standards of care during an influenza pandemic: identifying ethical, legal, and practical principles to guide decision making.

Although widespread support favors prospective planning for altered standards of care during mass casualty events, the literature includes few, if any, accounts of groups that have formally addressed the overarching policy considerations at the state level. We describe the planning process undertaken by public health officials in the Commonwealth of Massachusetts, along with community and academic partners, to explore the issues surrounding altered standards of care in the event of pandemic influenza. Throughout 2006, the Massachusetts Department of Public Health and the Harvard School of Public Health Center for Public Health Preparedness jointly convened a working group comprising ethicists, lawyers, clinicians, and local and state public health officials to consider issues such as allocation of antiviral medications, prioritization of critical care, and state seizure of private assets. Community stakeholders were also engaged in the process through facilitated discussion of case scenarios focused on these and other issues. The objective of this initiative was to establish a framework and some fundamental principles that would subsequently guide the process of establishing specific altered standards of care protocols. The group collectively identified 4 goals and 7 principles to guide the equitable allocation of limited resources and establishment of altered standards of care protocols. Reviewing and analyzing this process to date may serve as a resource for other states.

CDC Links Data on Health and Environment

EPIDEMIOLOGICAL SURVEILLANCE designed to assess the relationship between environmental exposures and disease can take weeks, months, or even years to complete. Now, however, a new tool launched in July by the federal Centers for Disease Control and Prevention (CDC) might help scientists, clinicians, and citizens complete some environmental public health queries in a matter of minutes. This Web-based tool, the CDC’s Environmental Public Health Tracking Network, allows individuals for the first time to query data from an array of federal, state, and localdatabases that trackhealth conditions or environmental exposures. It is freely available for use by anyone at the program’s Web site, http: //www.cdc.gov/ephtracking, which also serves as a clearinghouse for environmental health information. Despite the growing availability of tools and technologies to identify the genetic contributions to chronic diseases, there are insufficient resources to effectively track the contributions of environmental factors to such diseases. For example, although evidence that rates of health conditions such as autoimmune and developmental disorders are increasing, being able to identify environmental components has been hindered because states have not consistently tracked such disorders. Moreover, even when diseases or potentially disease-causing environmental exposures are tracked, the data are kept in a patchwork of state, local, and federal databases. The US Congress in 2002 appropriated funds for the CDC to strengthen local and state environmental health tracking programs and to create a nationwide surveillance tool as well, said Judy Qualters, MPH, PhD, chief of the CDC’s environmental health tracking branch. The resulting tool brings together various types of state-level data, such as data on hospitalization for such conditions as asthma and cardiac arrest, on emergency department visits for such conditions as carbon monoxide poisoning, and on air quality, air pollution, and water contamination with such substances as arsenic and nitrates. Additionally, it includes data from national surveillance programs such as the CDC’s Childhood Lead Poisoning Prevention Program, water quality data collected by US Geological Survey, and cancer registry data collected by the National Cancer Institute and the CDC. Qualters said data on birth defects and other reproductive outcomes will be added this fall and that she expects it to continue to grow and evolve. Someoftheparticipatingstatesalready have put data derived from the network to use. For example, Maine and Florida have tracked data on carbon monoxide poisoningintheirstatesandusedit todevelop and target prevention campaigns. In Utah, within a day of receiving a call from a resident who was concerned that aparticularneighborhoodmighthavean unusually high rate of cancer, health officials using the system found data that the neighborhood’s rate was no higher than that of the state as a whole. Using the network, the Massachusetts Department of Public Health found that exposure to mold or moisture in schools was associated with higher rates of asthma and that the greater the exposure the higher the risk, said Suzanne K. Condon, MSM, director of the department’s Bureau of Environmental Health. Armed with this information, the department immediately began working with school and local health officials to mitigate mold and moisture problems in schools. The development of this program and similar ones at state and local levels marks a major advance for the field of public health, said Condon. Such programs will help identify public health threats more rapidly and allow better targeting of resources to solve the most urgent concerns, she said. “It really advances the field of environmental health in way we have not seen since its inception in the public health world,” Condon said.

Integrating Occupational Health with Mainstream Public Health in Massachusetts: An Approach to Intervention

In the late 19th century, workers' health was among the central concerns of the social reform movement to improve public health. Today, few state health agencies have comprehensive occupational health programs. Yet, state public health agencies have critical roles to play in occupational health and may be particularly instrumental in addressing the occupational health needs of underserved worker populations. Since the mid-1980s, with support from the National Institute for Occupational Safety and Health, the Massachusetts Department of Public Health has been working to build an occupational health program and promote the integration of occupational health concerns with ongoing public health activities in the state. This article provides a framework for considering the range of integration activities and presents examples of successful occupational health integration efforts in Massachusetts.

Reducing hazardous cleaning product use: a collaborative effort.

Workplace hazards affecting vulnerable populations of low-wage and immigrant workers present a special challenge to the practice of occupational health. Unions, Coalition for Occupational Safety and Health (COSH) groups, and other organizations have developed worker-led approaches to promoting safety. Public health practitioners can provide support for these efforts. This article describes a successful multiyear project led by immigrant cleaning workers with their union, the Service Employees International Union (SEIU) Local 615, and with support from the Massachusetts COSH (MassCOSH) to address exposure to hazardous chemicals. After the union had identified key issues and built a strategy, the union and MassCOSH invited staff from the Massachusetts Department of Public Health's Occupational Health Surveillance Program (OHSP) to provide technical information about health effects and preventive measures. Results included eliminating the most hazardous chemicals, reducing the number of products used, banning mixing products, and improving safety training. OHSP's history of public health practice regarding cleaning products enabled staff to respond promptly. MassCOSH's staff expertise and commitment to immigrant workers allowed it to play a vital role.

Medicine in the Era of Outcomes Measurement

On February 9, 2009, the headlines of the Boston Globe proclaimed that two hospitals in Massachusetts, including an institution considered one of the nation’s best, had significantly higher than expected mortality rates for patients undergoing percutaneous coronary intervention (PCI). The story was based on the in-hospital risk-standardized mortality rates for hospitals throughout the state, released by the Massachusetts Department of Public Health.1 The unexpected result raised questions, concerns, and some confusion about hospital performance and the validity of the measures. The recent focus on hospital outcomes measures seems likely to intensify with the anticipated release by the Centers for Medicare &Medicaid Services of 30-day risk-standardized mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia. After more than a decade of focus on structure and process, there is a growing sense that, in a health care system that strives to be patient-centered, we need assessments of what actually happens to patients. The structural characteristics of an institution—such as equipment, certification, or procedural volume—do not guarantee higher quality of patient care or superior outcomes, nor does its reputation necessarily reflect actual experience. Process measures can capture key actions by clinical teams that are strongly related to outcomes, but they may typically focus on only a small subset of the complex array of interactions, decisions, and activities that contribute to the quality of patient care. Many aspects of care that defy easy measurement contribute importantly to a patient’s likelihood of a successful outcome. Thus, to describe the performance of the system we should also pay attention to patient outcomes. The approach to the mortality measures that is used in Massachusetts improves on what was used by the Health Care Financing Administration to report outcomes in the 1980s.2 The Massachusetts Data Analysis Center (Mass-DAC), the data-coordinating center responsible for …

Drug-Eluting or Bare-Metal Stents for Acute Myocardial Infarction

Conclusion: Treatment with drug-eluting stents in patients with acute myocardial infarction (AMI) results in a decreased 2-year mortality rate and a reduction in need for repeat revascularization procedures compared with treatment of AMI with bare-metal stents. Summary: The Massachusetts Department of Public Health in 2002 established a requirement that hospitals in that state providing interventional cardiology services collect data on percutaneous coronary interventions (PCIs). Data are collected by trained data collectors and are submitted electronically to the Massachusetts Data Analysis Center. Analysis of this data forms the basis of this study. The authors identify patients undergoing PCI using coronary stents with an indication of AMI. Data were analyzed from April 1, 2003, to September 30, 2004. The authors used a propensity-score matching analysis on three patient groups: all patients with AMI, all patients with AMI and ST-segment elevation, and all patients with AMI without ST-segment elevation. Analysis was based on clinical, procedural, hospital, and insurance information collected at the time of the PCI procedure. Vital statistics records were used to determine risk of death in patients receiving drug-eluting stents and those receiving bare-metal stents. During the study, 7217 patients were treated for AMI, of which 4016 were treated with drug-eluting stents and 3201 with bare-metal stents. Matched pair analysis showed the 2-year risk-adjusted mortality rates were lower for drug-eluting stents among all patients with AMI (10.7% vs 12.8%, P = .02). The 2-year risk-adjusted mortality rate was also lower among patients with AMI with ST-segment elevation (8.5% vs 11.6%, P = .008) and among patients with AMI without ST-segment elevation (12.8% vs 15.6%, P = .04). Repeat revascularization rates in all groups were also significantly reduced with drug-eluting stents. Comment: During the time of this study, patients with MI accounted for 40% of coronary stent procedures in Massachusetts. Drug-eluting stents appeared to reduce restenosis in the coronary circulation after stent treatment. Previous studies have reported an association between restenosis and risk of death for MI; therefore, the findings of the study make inherent sense. These data were observational, however, and although the authors tried to make their groups comparable, there are potential confounding variables. In particular, during the time of this study, drug-eluting stents were not available in the same size ranges as non-drug-eluting stents. Small-vessel stenting is associated with higher risks during follow-up and during the procedure. Therefore, because the study was not randomized, treatment choices may have been influenced by stent availability.

Evaluating Parent Satisfaction of School Nursing Services

The Conceptual Model of Nursing Health Policy (CMNHP) was used to guide this study of client satisfaction as one component of an ongoing assessment of the Essential School Health Service (ESHS) Programs conducted by the Massachusetts Department of Public Health. Random samples of parents/guardians of students who use the school nursing services were surveyed to determine the extent to which they were satisfied with school nursing services. The results indicate that parents/guardians have a high level of satisfaction with school nursing services. Mean rank satisfaction scores of parents of children with special health care needs were significantly higher then those parents of children without special health care needs. School nurses were encouraged to share the results of the study with various stakeholders in their school district.

Outbreak of <emph type="ital">Listeria monocytogenes</emph> Infections Associated With Pasteurized Milk From a Local Dairy—Massachusetts, 2007

On November 27, 2007, a local health officer in central Massachusetts contacted the Massachusetts Department of Public Health (MDPH) to report listeriosis in a man aged 87 years. Pulsed-field gel electrophoresis (PFGE) performed on the patient's Listeria monocytogenes isolate produced a pattern indistinguishable from that of isolates from three other cases identified in residents of central Massachusetts in June, October, and early November 2007. MDPH, in collaboration with local public health officials, conducted an investigation, which implicated pasteurized, flavored and nonflavored, fluid milk produced by a local dairy (dairy A) as the source of the outbreak. This report summarizes the results of that investigation. In all, five cases were identified, and three deaths occurred. This outbreak illustrates the potential for contamination of fluid milk products after pasteurization and the difficulty in detecting outbreaks of L. monocytogenes infections.

Cost of hospital-associated infections in Massachusetts

The Massachusetts Department of Public Health appointed an Expert Panel to assess the problem of health care-associated infections (HAI) in the state and make recommendations regarding mandatory reporting. At the Expert Panel's request, a cost-of-illness study was conducted using available data sources. In Massachusetts, the excess hospital costs attributed to HAIs were estimated at approximately $233 to $275 million in 2006.

Stroke Center Designation Can be Achieved by Small Hospitals

In January 2005, the Massachusetts Department of Public Health announced the designation of approved hospitals as Primary Stroke Services (PSS), based on verifiable demonstration of care pathways for acute ischemic stroke. We investigated the effect of hospital characteristics on participation in the PSS program.In 2003, the Massachusetts Department of Public Health surveyed 72 Massachusetts hospitals on their readiness for PSS designation. Survey results and PSS participation rates were compared among hospitals categorized by bed size (<150 vs. > or =150 beds), rural location, and major teaching hospital status. In answer to 2003 survey questions, smaller hospitals (n = 35) were less likely than larger hospitals to have acute stroke teams (P = 0.01), 24-hour rapid computed tomography scanning and interpretation (P = 0.0006), 24-hour neurosurgery coverage (P = 0.001), and a stroke registry (P = 0.007). Smaller hospitals were less likely to be interested in PSS application in 2003 (P = 0.008), and less likely to be designated PSS when ambulance rerouting to PSS hospitals began in July 2005 (P < 0.0001). Despite this, by December 2005 the majority of Massachusetts hospitals (66/71, 92%) had achieved PSS designation. Smaller hospitals were more likely to use telemedicine to access acute stroke teams (P = 0.003).Many smaller hospitals are able to acquire the resources needed for provision of acute stroke care, despite initial limitations. Innovative strategies, such as telemedicine consultation and transfer agreements, may successfully allow smaller hospitals to satisfy Brain Attack Coalition criteria for primary stroke centers.

Polysubstance Use and HIV/STD Risk Behavior among Massachusetts Men Who Have Sex with Men Accessing Department of Public Health Mobile Van Services: Implications for Intervention Development

Polysubstance use has been posited to be a significant contributor to excess burden of HIV disease among men who have sex with men (MSM). The current study investigated polysubstance use and sexual risk among men who utilize Massachusetts Department of Public Health (MDPH) van services (such as HIV, chlamydia, gonorrhea, or syphilis testing; Hepatitis A and B vaccinations) at venues targeting MSM. Participants (n = 214) completed a one-time, cross-sectional survey via an audio computer-assisted self-interview (ACASI) in English or Spanish between June 2007 and September 2007. Fifteen percent of the overall sample did not know their HIV status; 11% reported polysubstance use (concurrent use of three or more: poppers, ecstasy, GHB, cocaine, crystal methamphetamine, Viagra) during sex in the 12 months prior to study enrollment. Polysubstance users were more likely to be HIV infected (odds ratio [OR] = 4.62; p = 0.03) and to have a history of one or more sexually transmitted diseases (STDs; OR = 4.74; p = 0.03) relative to participants who did not report polysubstance use during sex. After controlling for covariates of age, race/ethnicity, education level, insurance status, sexual orientation, STD history, HIV status, and depression, multivariable logistic regression analyses revealed that polysubstance users were 9 times more likely to have reported unprotected anal (insertive or receptive) sex in the 12 months prior to study enrollment (adjusted OR = 9.53; p = 0.007) compared to nonpolysubstance-using MSM. Polysubstance users lacked access to care (21% were uninsured) and the overwhelming majority (96%) were first time users of mobile health van services. Accessible outreach services for MSM such as mobile van services need to include drug screening and interventions that triage men into treatment programs; year-round availability of van services is warranted.

Public Reporting of 30-Day Mortality for Patients Hospitalized With Acute Myocardial Infarction and Heart Failure

For cardiac care, the Centers for Medicare M how often smokers are counseled to quit; how rapidly hospitals provide reperfusion therapy for patients with an ST-segment elevation myocardial infarction; and how often the ejection fraction is measured for patients with heart failure. All of these measures assess care that is strongly recommended by guidelines. The measures include only those patients who should receive this care and are reported at the hospital level simply as percentages. The performance on these measures should ideally be 100%, and the rates have improved markedly over time. ; View this table: Table. Acute Myocardial Infarction and Heart Failure Process-of-Care Measures On June 21, 2007, CMS expanded the measures to include outcomes and posted information on its “Hospital Compare” website1 regarding hospital-specific 30-day mortality rates for patients with acute myocardial infarction and heart failure. These measures used administrative claims data and were validated against measures using medical record data; the measures were approved by the National Quality Forum.2,3 In 2007, the publicly reported information was limited to describing hospitals as having rates that were higher, lower, or no different than the national average. Hospitals received information about their rates, their patients, and comparisons with other hospitals in their state and with the nation. This year, CMS is expanding the publicly available information. For acute myocardial infarction, heart failure, and now pneumonia, CMS will post the calculated risk-standardized 30-day mortality rates (RSMRs) and the 95% interval estimates for each hospital that treated Medicare patients with these conditions; hospital volume for each condition also will be posted. As …

The SEEDs of two gastrointestinal diseases: Socioeconomic, environmental, and demographic factors related to cryptosporidiosis and giardiasis in Massachusetts

Objectives We assessed associations between community-level socioeconomic, demographic, and environmental characteristics, and the presence of two potentially waterborne infectious diseases, cryptosporidiosis and giardiasis, as reported to the Massachusetts Department of Public Health. Methods We created a series of maps showing the spatial distribution of cryptosporidiosis and giardiasis in Massachusetts (1993–2002) overall and by age, using logistic regression to analyze associations between community-level characteristics and the presence of at least one reported case of each disease. This analysis was repeated for communities with predominantly private water supplies. Result After adjusting for population size, higher population density and larger than average household sizes were associated with increased odds of reported cases of cryptosporidiosis. Giardiasis was also associated with high population density, but was not associated with household size. In the elderly, income was positively associated with the presence of giardiasis. Discussion These findings suggest that greater population density and larger household sizes may increase the likelihood of protozoan gastrointestinal infection. The results emphasize the necessity to account for distal factors, such as demographic characteristics, that may ultimately play a role in the transmission or reporting of disease.

Regional Public Health Emergency Preparedness: The Experience of Massachusetts Region 4b

Historically, local public health in Massachusetts has been largely decentralized, with each town responsible for providing local public health services. After 9/11, the Massachusetts Department of Public Health (MDPH) began to plan for bioterrorism and other possible public health emergencies and found that having 351 separate departments made emergency planning difficult and dispersing of funds a challenge. To facilitate this process, MDPH created seven emergency preparedness regions and asked local public health departments to engage in joint planning. This article describes the formation of Region 4b and how the region came together to work on emergency preparedness issues. It also examines the organizational, financial, and planning challenges associated with organizing these towns as a unified entity.

Lesbian, Gay, Bisexual, and Transgender Public Health: Progress and Challenges

Ten years ago, when I left my position as an assistant commissioner at the Massachusetts Department of Public Health, very few state—or local or federal—health departments mounted health initiatives targeted at lesbian, gay, bisexual, or transgender (LGBT) populations. The only exception involved HIV/AIDS, which the large numbers of HIV-positive gay and bisexual men made virtually (although not always) impossible to ignore. Over the past decade, several city health departments, including the one I led as commissioner of health for Boston, have created staff positions or offices to address the health of the LGBT community. Yet, when I returned to the Massachusetts Department of Public Health a year ago, I found that there had been little progress at the state level in addressing either the diverse health needs of LGBT populations or the complex ways in which discrimination negatively affects health—even though, in the interim, there had been important and groundbreaking efforts, such as the founding of the National Coalition of LGBT Health and the publication of the Healthy People 2010 Companion Document for LGBT Health. In addition, of course, the LGBT community made significant progress in other arenas, including the historic legalization of gay marriage in Massachusetts, where the marriage licenses of gay couples are proudly filed alongside those of heterosexual couples. Outstanding researchers like the ones whose works are highlighted in this edition of the Journal are admirably addressing a range of public health issues that affect the LGBT community, including smoking, violence, chronic disease, tuberculosis, and access to care. The emphasis of much of the published work, however, continues to be on HIV and sexually transmitted diseases. While this work is essential, so is the need to increase the range of the subject matter. The current, overly narrow focus on HIV and sexually transmitted diseases within the LGBT community reflects the continuing existence of homophobia and transphobia, but it also results from the rarity with which data on sexual orientation and gender identity are collected in public health or clinical settings. The vast majority of our survey instruments do not inquire about these characteristics (to be fair, neither do they ask about economic class or ethnicity). This leaves anecdotal observation or limited-size studies as the only evidence of which health conditions and risks disproportionately affect LGBT populations. We can observe the impact of this barrier in this special issue of the Journal, the content of which makes it clear that some of the finest researchers in the country have an easier time getting funding for their work when they focus on sexually related conditions. This is unfortunate. It brings to mind other stereotyping of specific populations (e.g., categorizing women’s needs as being mainly about reproductive health, and assuming that adolescent needs are mainly about drugs and sex). Both the public and the private sectors need to address this deficiency. We can learn from the recent successful efforts of numerous cities and states to implement major initiatives to combat racial and ethnic health disparities, which have included improved collection and analysis of data. Without a greater foundation for routinely obtaining accurate population-based data, though, researchers will continue looking at the same incomplete picture. In addition, the public health community will lack the information it needs to understand and address the health issues of LGBT communities. The Journal’s necessary attention to LGBT health will advance this effort—not only by showcasing superb researchers who help us gain useful insights, but also by reminding us of the important work yet to be done.

Cigarette smoke chemistry market maps under Massachusetts Department of Public Health smoking conditions

This study extends the market mapping concept introduced by Counts et al. (Counts, M.E., Hsu, F.S., Tewes, F.J., 2006. Development of a commercial cigarette “market map” comparison methodology for evaluating new or non-conventional cigarettes. Regul. Toxicol. Pharmacol. 46, 225–242) to include both temporal cigarette and testing variation and also machine smoking with more intense puffing parameters, as defined by the Massachusetts Department of Public Health (MDPH). The study was conducted over a two year period and involved a total of 23 different commercial cigarette brands from the U.S. marketplace. Market mapping prediction intervals were developed for 40 mainstream cigarette smoke constituents and the potential utility of the market map as a comparison tool for new brands was demonstrated. The over-time character of the data allowed for the variance structure of the smoke constituents to be more completely characterized than is possible with one-time sample data. The variance was partitioned among brand-to-brand differences, temporal differences, and the remaining residual variation using a mixed random and fixed effects model. It was shown that a conventional weighted least squares model typically gave similar prediction intervals to those of the more complicated mixed model. For most constituents there was less difference in the prediction intervals calculated from over-time samples and those calculated from one-time samples than had been anticipated. One-time sample maps may be adequate for many purposes if the user is aware of their limitations. Cigarette tobacco fillers were analyzed for nitrate, nicotine, tobacco-specific nitrosamines, ammonia, chlorogenic acid, and reducing sugars. The filler information was used to improve predicting relationships for several of the smoke constituents, and it was concluded that the effects of filler chemistry on smoke chemistry were partial explanations of the observed brand-to-brand variation.

Establishing a Practice‐Based Research Network: Lessons From the Massachusetts Experience

Journal of School HealthVolume 78, Issue 3 p. 172-174 Establishing a Practice-Based Research Network: Lessons From the Massachusetts Experience Joyce Pulcini PhD, APRN, BC, FAAN, Corresponding Author Joyce Pulcini PhD, APRN, BC, FAAN Associate Professor, (pulcinjo@bc.edu), Boston College Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467.Joyce Pulcini, Associate Professor, (pulcinjo@bc.edu), Boston College Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467.Search for more papers by this authorAnne Sheetz RN, MPH, Anne Sheetz RN, MPH Director of School Health Services, (anne.sheetz@state.ma.us), Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108.Search for more papers by this authorMarie DeSisto RN, MSN, Marie DeSisto RN, MSN Director of Nurses, Waltham Public Schools, and President, Massachusetts School Nurse Organization, (desisto.tm@verizon.net), 251C Watertown St, Newton, MA 02458.Search for more papers by this author Joyce Pulcini PhD, APRN, BC, FAAN, Corresponding Author Joyce Pulcini PhD, APRN, BC, FAAN Associate Professor, (pulcinjo@bc.edu), Boston College Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467.Joyce Pulcini, Associate Professor, (pulcinjo@bc.edu), Boston College Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467.Search for more papers by this authorAnne Sheetz RN, MPH, Anne Sheetz RN, MPH Director of School Health Services, (anne.sheetz@state.ma.us), Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108.Search for more papers by this authorMarie DeSisto RN, MSN, Marie DeSisto RN, MSN Director of Nurses, Waltham Public Schools, and President, Massachusetts School Nurse Organization, (desisto.tm@verizon.net), 251C Watertown St, Newton, MA 02458.Search for more papers by this author First published: 28 February 2008 https://doi.org/10.1111/j.1746-1561.2007.00280.xCitations: 3 The authors would like to acknowledge the MASNRN Oversight Board Members for their support and contributions to school nursing research. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume78, Issue3March 2008Pages 172-174 RelatedInformation

Anatomy of the Cape Cod Oral Rabies Vaccination Program

Author(s): Algeo, Timothy P.; Chipman, Richard; Bjorklund, Brian M.; Chandler, Monte D.; Wang, Xingtai; Slate, Dennis; Rupprecht, Charles E. | Abstract: Rabies remains a globally significant zoonotic disease, but rabies control is achievable under certain circumstances. Canine rabies has been eliminated from the U.S.; however, approximately 55,000 humans die annually worldwide from the disease. In the U.S., economic losses continue to be substantial and the risk to humans and domestic animals has not been eliminated. As an example of the complexity of rabies management, we describe a local rabies control program and efforts to restore Cape Cod, MA to terrestrial rabies-free status, after a 2004 oral rabies vaccination (ORV) barrier breach following 10 years of rabies-free status. The emergence of raccoon rabies in southeastern New England in 1992 prompted the U.S. Centers for Disease Control and Prevention, the Tufts Cummings School of Veterinary Medicine, and the Massachusetts Department of Public Health to begin an ORV program to reduce the occurrence of carnivore rabies in an area directly adjacent to the Cape Cod Canal. In 2001, USDA APHIS Wildlife Services began full-time collaboration on the Cape Cod Oral Rabies Vaccination Program (CCORVP) as part of national wildlife rabies control efforts. The primary objective of the CCORVP was to use ORV in tandem with the physical barrier created by the Canal to prevent the spread of rabies to peninsular Cape Cod, a heavily-populated tourist destination southeast of Boston. After an increase in rabies cases within the traditional Cape Cod ORV zone, ORV bait distribution efforts were modified to reduce the risk of rabies spread onto the Cape. In spite of these modifications, raccoon rabies was detected for the first time on peninsular Cape Cod in March 2004. A trap-vaccinate-release campaign, removal of suspect raccoons and skunks, and expanded ORV efforts were unsuccessful in preventing the spread of the virus. Rabies surveillance became the priority of the Cape Cod Rabies Task Force. In 2006, rabies was finally detected at the eastern extremity of the peninsula. In this paper, we summarize ORV efforts, explore possible causes for the spread of raccoon rabies onto the Cape, summarize several small-scale Cape Cod rabies research projects, and suggest a 5-year plan for future Cape Cod rabies controls efforts.

Residential Health Near Major Construction Projects: Unexplored Hazards

Few studies have been made of the impact of major construction on the health of nearby residents. We conducted a feasibility study in one zip code (02111; Chinatown, Boston, MA, USA) in which four large buildings (20-30 stories) were built between 1999 and 2004 and adjacent to which a major highway construction project was in progress. Information about major construction project start and end dates were obtained from a variety of sources. Three sets of health data--emergency department and mortality-were obtained from the Massachusetts Department of Public Health for the years of 1998 - 2004. We used ICD-9 and ICD-10 disease codes to aggregate selected pulmonary and cardiac-related categories that could reasonably be expected to be aggravated by air pollution released from construction sites, including diesel and dust, and noise and vibration. We propose that larger-scale studies are possible and needed using approaches similar to ours.

The CATCH Project: Central Mass Access to Child Health Information*

Parents of disabled children have substantial health and social care needs and therefore, a great need for information. Access to health information for parents and health professionals has been revolutionized by the Internet [1]; however, as Blackburn and Read note, “The provision of crucial information to parents of disabled children, at the time when they need it and in a form that they can use, is an intractable problem” [2]. Relevant health information can be difficult to find and is variable in quality [3]. How can medical librarians work with community groups, public health workers, and health providers to assist parents of chronically ill children find and obtain information? The Central Mass Access to Child Health Information (CATCH) project attempted to address this problem. CATCH targeted eleven public health agencies in central Massachusetts that serve chronically ill and/or developmentally disabled children and their families. Participants varied from early intervention centers to disease-specific agencies (Table 1). CATCH provided these community-based, public health agency staff members with training to locate and effectively use quality Internet health information. CATCH developed a model for outreach and collaboration as well as established new community partnerships for the Lamar Soutter Library (LSL) of the University of Massachusetts Medical School. Table 1 Targeted agencies TARGET POPULATION AND SIGNIFICANT ISSUES Massachusetts is home to approximately 221,840 parent-reported children with special health care needs, nearly 15% of children in the state (national average 12.8%) [4]. Previous projects have explored this population's need for health information [5, 6]. The Finding Information Resources and Services through Technology (FIRST) project, funded by the Massachusetts Department of Public Health and located in the UMass Memorial Children's Medical Center (CMC), served the information needs of families with chronically ill children from 1995 to 1999. Parents participating in the FIRST project stated that they need information about their children's health conditions beyond what physicians provide. When the FIRST project ended due to state budget cuts, CATCH filled the gap. CATCH targeted public health agencies in central Massachusetts (Figure 1) that serve children with chronic physical, developmental, behavioral, or emotional disorders and their families. To establish relationships with relevant organizations, project investigators identified community-based agencies in the New England Information on Disabilities Exchange (INDEX) database that serve children in central Massachusetts and invited these agencies to participate in the project [7]. Eleven agencies responded positively. Table 1 lists these agencies and their corresponding target populations (650 staff serving 25,000 children).