State Surveillance Systems Research Articles

국가의 전자적 모니터링 인식에 영향을 미치는 인지적 요인에 관한 연구

As the number of state surveillance systems utilizing advanced technologies increases, the view that the establishment of such systems is an irresistible trend of the times is conflicting with the view that excessive state surveillance can lead to adverse effects such as invasion of privacy. This study empirically analyzed the cognitive factors affecting people's perceptions of state internet monitoring through a survey. The results show that respondents' negative perceptions of science and technology have a negative impact on their perceptions of the state's electronic monitoring. Respondents with a strong sense of national pride are more likely to have positive perceptions of the state's internet monitoring, but respondents who are sensitive to the government's violation of their rights tend to view the government's internet monitoring negatively. Finally, respondents with a higher perception of the state's role in protecting public safety are more likely to have a negative perception of internet monitoring by the state. The significance of this study is that it analyzes the public's perceptions of state surveillance of electronic information and the factors that influence them, providing a basis for exploring effective and acceptable policy alternatives.

Gastrointestinal Infection in South African Children under the Age of 5 years: A Mini Review.

To estimate gastroenteritis disease and its etiological agents in children under the age of 5 years living in South Africa. A mini literature review of pertinent articles published in ScienceDirect, PubMed, GoogleScholar, and Scopus was conducted using search terms: "Gastroenteritis in children," "Gastroenteritis in the world," Gastroenteritis in South Africa," "Prevalence of gastroenteritis," "Epidemiological surveillance of gastroenteritis in the world," and "Causes of gastroenteritis". A total of 174 published articles were included in this mini review. In the last 20 years, the mortality rate resulting from diarrhea in children under the age of 5 years has declined and this is influenced by improved hygiene practices, awareness programs, an improved water and sanitation supply, and the availability of vaccines. More modern genomic amplification techniques were used to re-analyze stool specimens collected from children in eight low-resource settings in Asia, South America, and Africa reported improved sensitivity of pathogen detection to about 65%, that viruses were the main etiological agents in patients with diarrhea aged from 0 to 11 months but that Shigella, followed by sapovirus and enterotoxigenic Escherichia coli had a high incidence in children aged 12-24 months. In addition, co-infections were noted in nearly 10% of diarrhea cases, with rotavirus and Shigella being the main co-infecting agents together with adenovirus, enteropathogenic E. coli, Clostridium jejuni, or Clostridium coli. This mini review outlines the epidemiology and trends relating to parasitic, viral, and bacterial agents responsible for gastroenteritis in children in South Africa. An increase in sequence-independent diagnostic approaches will improve the identification of pathogens to resolve undiagnosed cases of gastroenteritis. Emerging state and national surveillance systems should focus on improving the identification of gastrointestinal pathogens in children and the development of further vaccines against gastrointestinal pathogens.

Study finds CDC OD definition better than state surveillance

A study published in the June 28 issue of JAMA Network Open has found that a standardized case definition of “opioid overdose” currently being implemented by the federal Centers for Disease Control and Prevention (CDC) is more accurate than the one being used by state surveillance systems.

Old Adversary, New Challenges: Childhood Lead Exposure and Testing.

Old Adversary, New Challenges: Childhood Lead Exposure and Testing.

Evaluating the Quality of Federal SARS-CoV-2 Diagnostic Testing Data

PurposeIn April 2020, the US Department of Health and Human Services (HHS) and the US Centers for Disease Control and Prevention established the COVID-19 Electronic Laboratory Reporting program (CELR) to collect data on SARS-CoV-2 laboratory tests. Over the course of the following year, the federal government, partnering with the Association for Public Health Laboratories, onboarded every state to submit laboratory results to this system—the first of its kind in the US. We set out to evaluate the quality of data collected by CELR.Methods & MaterialsWe compared jurisdiction-level data collected through CELR and published by HHS to the testing data published by jurisdictions on their health department webpages. Because jurisdictions define their testing data differently, we anticipated some differences from federal testing data. However, jurisdictions also tend to prioritize their dashboard reporting—since it is what is used for policy decisions like reopening—so we hypothesized that differences from federal data absent a definitional explanation could point to problems with federal data. Where we found differences between jurisdictional and federal data, we conducted interviews with public health officials to understand their cause.ResultsOf the 56 states and territories, as of April 2021 (the first month when all states were onboarded to CELR), 38 had federal total data that diverges from state data by more than 5%. Of those states, the differences of 27 could not be explained by definitional factors. Based on our interviews, we identified three problems: non-electronic reporting streams, out-of-date surveillance systems, and deduplication of laboratory data.ConclusionThe federal testing dataset displays major unresolved quality problems, and because states present testing data so differently, state-published data forms a poor alternative to federal datasets. The federal government, which is uniquely positioned to provide testing data on infectious diseases, must work to improve the quality of laboratory data submissions by states. To support better national laboratory data, the United States should invest in updating state and laboratory data surveillance infrastructure—including updates to state surveillance systems and laboratory system updates to eliminate outdated reporting methods like faxes—and in creating more national laboratory data infrastructure.

Adverse childhood experiences and marijuana use during pregnancy: Findings from the North Dakota and South Dakota PRAMS, 2017–2019

BackgroundEmerging research suggests that adverse childhood experiences (ACEs) may be a risk factor for prenatal marijuana use. This study is the first to use a representative sample from state surveillance systems to assess the connection between accumulating ACEs and marijuana use during pregnancy. MethodsData are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2017–2019 (N = 5399). The bivariate association between number of ACEs and marijuana use during pregnancy is assessed using a chi-square test. The multivariable association is assessed using linear probability modeling. ResultsOnly 0.9% of women with zero ACEs reported marijuana use during pregnancy, compared to 11.7% of women with four or more ACEs. Findings from linear probability models showed that mothers reporting two ACEs (b =0.023, 95% CI =0.003,.043), three ACEs (b =0.042, 95% CI =0.014,.069), and four or more ACEs (b =0.053, 95% CI =0.035,.071) are more likely to report marijuana use during pregnancy relative to those with zero ACEs, net of demographic and socioeconomic control variables. ConclusionsAccumulating maternal ACEs —especially four or more— is associated with increased likelihood of using marijuana during pregnancy. These findings demonstrate the early life trauma is a key social determinant of health over the life course and highlights how ACEs can contribute to intergenerational harm via the worsening of health behaviors during pregnancy.

PIN67 Real-Time Analysis of COVID-19 DATA Using Sequential Monte Carlo Methods

Research on health outcomes and resource utilization for patients affected by coronavirus disease 2019 (COVID-19) demands rapid analysis of real-world data (RWD) as it becomes available in real time. While most RWD studies have a lag of few months between when data become available and when analysis is performed, RWD on patients with COVID-19 are reported daily by state and federal surveillance systems. As such, statistical methods amenable to real-time updating can help speed up research and aid health policy responses with most up-to-date RWD.

PND41 Costs Associated with Migraine in Russia in 2018

to estimate annual cost of migraine (episodic and chronic) in Russia in 2018. It was a prevalence-based cost of illness study from state and social perspective. Direct medical costs included inpatient and outpatient diagnostics and treatment. Non-medical direct costs included temporary social disability payments and out of pocket expenses. The indirect costs were calculated using the human-capital approach. Data was obtained from the national state (Federal State Statistics Service) and healthcare statistics surveillance systems, literature sources and analysis of pharmaceutical market by consulting agency. All costs, except out of pocket expenses were calculated by the bottom-up costing approach. Estimated number of migraine patients was 18.524 million, of which 12.475 were adults (age 18-65), 4.129 million were children (age 0-17) and 1.919 million were elderly (more than age 65). During the year were 7.751 million outpatient visits to doctors, 5.672 inpatient hospitalizations and 2.919 outpatient hospitalizations. Total time lost due to migraine was 2.273 million days, from which 2.204 million days after outpatient visits (mean duration per patient – 5 days). Total economic burden of migraine in 2018 in Russia was equivalent to € 0.361 billion. Direct medical costs were € 58.07 million, which consisted of outpatient treatment (€ 55.20 million), inpatient treatment (€ 2.18 million) and treatment in a day hospital department (€ 0.67 million). Direct non-medical costs were about € 184.70 million: temporary social disability payments were about € 162.20 million and out of pocket expenses were € 22.50 million. The indirect costs were estimated at € 118.50 million. The average cost per patient with episodic migraine was € 576, and with chronic migraine - € 1475. Migraine imposes significant burden on economic system of the Russian Federation. Main costs associated with migraine in Russia are outpatient visits to doctors and indirect costs.

COVID-19 Highlights Critical Need for Public Health Data Modernization to Remain a Priority.

COVID-19 Highlights Critical Need for Public Health Data Modernization to Remain a Priority.

Evaluating Chronic Disease Surveillance Systems: Lessons Learned From Applying a Framework to Assess the Alaska Behavioral Risk Factor Surveillance System

Chronic diseases with behavioral risk factors are now the leading causes of death in the United States. A national Behavioral Risk Factor Surveillance System (BRFSS) monitors those risk factors; however, there is a need for national and state evaluations of chronic disease surveillance systems. The Department of Health and Human Services/Centers for Disease Control and Prevention (CDC) has developed a framework on evaluating noncommunicable disease–related surveillance systems; however, no implementation of this framework has yet been published. This article describes the process of, and offers lessons learned from, implementing the evaluation framework to assess the Alaska BRFSS. This implementation evaluation may inform assessments of other state and regional chronic disease surveillance systems and offers insight on the positive potential to consult key stakeholders to guide evaluation priorities.

Implementing Cancer Genomics in State Health Agencies: Mapping Activities to an Implementation Science Outcome Framework

Objective: To show how state health agencies can plan and evaluate activities to strengthen the evidence base for public health genomics, we mapped state cancer genomics activities to the Doyle et al. [Genet Med. 2018;20(9):995–1003] implementation science outcome framework. Methods: We identified state health agency activities addressing hereditary breast and ovarian cancer and Lynch syndrome by reviewing project narratives from Centers for Disease Control and Prevention Cancer Genomics Program funding recipients, leading discussions with state health agencies, and conducting an environmental scan. Results: State health agencies’ cancer genomics activities included developing or adding to state surveillance systems, developing educational materials, bidirectional reporting, promoting health plan policy change, training providers, and promoting recommendations and standards. To address health disparities, programs have tracked group differences, developed culturally appropriate educational materials, and promoted access to services for underserved populations. Conclusion: State health agencies can use the Doyle et al. [Genet Med. 2018;20(9):995–1003] performance objectives and outcome measures to evaluate proposed and ongoing activities. By demonstrating whether activities result in improved outcomes, state health agencies can build the evidence for the implementation of cancer genomics activities.

A Moving Targetis Harderto Hit: Border-Crossingasa Resistance Weapon in Jackie Kay’s The Smuggled Person’s Tale

The sovereign State system relies on the idea that all the territory of the world is divided into separate spaces, which are controlled by distinct sovereign governments that make and enforce laws in those territories (Agnew and Corbridge 1995; Jones 2012). Along these lines, Reece Jones claims that those individuals who defy the national demarcations through cross-border movement can be approached as resistant subjects who “disrupt the clean, territorially-based identity categories of the State by evading State surveillance systems and creating alternative networks of connection outside State territoriality” (Jones 2012: 689). In this article, I will analyze the short story “The Smuggled Person’s Tale” (2017), written by Jackie Kay and included in the short story collection Refugee Tales (2017). I argue that this narrative portrays a literary voice of a refugee who, in the need for leaving Afghanistan because of political and social conflicts, defies the sovereign State system by avoiding territorial entrapment through a constant border-crossing. His journey across nations allows him to break the national borders’ dichotomies (in-out / native-immigrant / citizen-exile) (Bhabha 1994; Rojas 2006; Jones 2012; Konrad 2015), thus achieving a nomadic consciousness and reclaiming his right to redefine himself as a global citizen.

Behavioral Factors and Unintentional Injuries After Spinal Cord Injury

ObjectiveTo identify the relationships of behavioral factors with unintentional injuries among participants with traumatic spinal cord injury (SCI). DesignCross-sectional. SettingMedical university in the Southeastern United States. ParticipantsParticipants (N=4670) met the following inclusion criteria: traumatic SCI of at least 1-year duration, minimum of 18 years of age, and residual impairment from SCI (noncomplete recovery). Of these, 2516 were identified from a specialty hospital and 2154 were identified from population-based state surveillance systems. InterventionsNot applicable. Main Outcome MeasuresParticipants completed self-report assessments including multiple behavioral variables, SCI variables, and demographic characteristics. Primary outcome was unintentional injuries during the past 12 months. ResultsTwenty-three percent (n=969) reported at least 1 unintentional injury in the past year serious enough to receive medical care in a clinic, emergency department, or hospital, and the average number of times injured was 1.82 among those with at least 1 injury. Prescription medication use for pain and depression, nonmedical medication use, use of prescription medication for purposes other than prescribed, and binge drinking were associated with a greater odds of unintentional injury. There were some differences between fall-related and non–fall-related unintentional injuries, with ambulation associated with greater odds of fall-related injuries but lower odds of non–fall-related injuries. Participants identified through population-based systems were at greater risk of falls compared with those identified through a traditional specialty hospital. ConclusionsUnintentional injuries were prevalent among people with SCI. After controlling for injury and demographic characteristics, multiple risk behaviors were related to the odds of unintentional injuries. Intervention studies are needed to address modifiable behaviors that may reduce the risk of injury.

Using State and National Surveillance Systems during World Equestrian Games in NC

ObjectiveTo describe surveillance activities and use of existing state (NC DETECT) and national (NSSP) syndromic surveillance systems during the International Federation for Equestrian Sports (FEI) World Equestrian Games (WEG), in Mill Spring, NC from September 11 to September 23, 2018MethodsNC DETECT collects statewide data from hospital emergency department (ED) visits and Carolinas Poison Center (CPC) calls. NC DETECT also collects data from select Urgent Care Centers (UCC) in the Charlotte area. CPC data are updated hourly, while ED data are updated twice a day. NC DETECT data were monitored daily for census (total ED visits), communicable disease syndromes, injury syndromes, and other occurrences of public health significance related to the event. The geographic areas monitored were Polk County (the location of the main event), the counties where the guests were lodging in the Western NC Region (Henderson, Transylvania, Buncombe, Rutherford, McDowell, and Cleveland), the Charlotte Metropolitan area, and statewide. Because of the large number of people from other states and countries who attended, ED surveillance was mainly conducted by hospitals so that visits were captured for all patients and not just NC residents. WEG dashboards containing ED data were created prior to the event using NC DETECT and NSSP ESSENCE systems, and were accessible to epidemiologists at the state level. NSSP syndrome queries were shared with the neighboring state (SC) public health agency. Surveillance began two weeks prior to the event to establish baseline levels for all ED visits for hospitals in Polk County and the Western NC Region. Surveillance occurred daily before the event, during the event, and for two weeks following the event to account for incubation periods of potential diseases.ResultsThe 2018 Equestrian games in Western NC were affected by heavy rain and heat. The weather led to low attendance and cancellation of a few competitions. During the observation period, ED admissions and most of the mass gathering related syndromes in both NC DETECT and NSSP systems were at baseline. ED admissions for motor vehicle collisions and dehydration syndromes were above baseline for 09/19 and 09/21/18 (Figures 3-4). CPC calls and UC admissions for selected UC centers in the Charlotte area were also monitored, and were at baseline.ConclusionsNC DETECT and NSSP Dashboards provided effective and timely surveillance for the WEG event to assist local public health in the rural NC area with epidemiologic investigations and appropriate response. NC DETECT’s CPC and UC data provided additional valuable information, and complemented ED surveillance during the mass gathering event. Syndromic surveillance became essential during WEG, as NC DPH deployment plans and resource availability changed when Hurricane Florence bore down on the region.

Incidence of community onset MRSA in Australia: least reported where it is Most prevalent

BackgroundThis is the first review of literature and synthesis of data on community onset methicillin resistant Staphylococcus aureus (CO-MRSA) infections in Australia. Incidence of CO-MRSA varies considerably in Australia, depending on geographic and demographic factors.MethodsData for the rates of MRSA infections were collected from articles identified using PubMed, Scopus, the grey literature and data from State and Federal Government Surveillance Systems. We synthesized data and developed a framework for how data was selected, collated, linked, organized and interpreted.ResultsThe results of our literature search demonstrates considerable gaps in the reporting of CO-MRSA in Australia. Consequently, total incidences were under reported; however the available data suggests the incidence varied between 44 (Tasmania) and 388 (southern Northern Territory) cases per 100,000 person years. Hospitalised cases of CO-MRSA varied between 3.8 (regional Victoria) and 329 (southern Northern Territory). Taking the median percentage of infections by site for all regions available, skin and soft tissue infections (SSTIs) consisted of 56% of hospitalized CO-MRSA, compared with bacteremias, which represented 14%. No region had a complete data set of CO-MRSA infections treated in out-patient settings and so incidences were underestimates. Nevertheless, estimates of the incidence of CO-MRSA treated outside hospitals varied between 11.3 (Melbourne) and 285 (Northern Territory) per 100,000 person-years. These infections were chiefly SSTIs, although urinary tract infections were also noted.Incidences of CO-MRSA blood-stream infections and outpatient skin and soft tissue infections have been increasing with time, except in Tasmania. CO-MRSA is observed to affect people living in remote areas and areas of socioeconomic disadvantage disproportionately.ConclusionsWe generated the first estimates of the incidence of CO-MRSA infections in Australia and identified stark regional differences in the nature and frequency of infections. Critically, we demonstrate that there has been a lack of consistency in reporting CO-MRSA and a general dearth of data. The only government in Australia that requires reporting of CO-MRSA is the Tasmanian, where the infection was least prevalent. Some regions of Australia have very high incidences of CO-MRSA. To improve surveillance and inform effective interventions, we recommend a standardized national reporting system in Australia that reports infections at a range of infection sites, has broad geographic coverage and consistent use of terminology. We have identified limitations in the available data that hinder understanding the prevalence of CO-MRSA.

Addressing Data Inequities in American Indian Communities Through an Environmental Public Health Tracking Pilot Project

National and state surveillance systems identify American Indians/Alaska Natives inconsistently and often inaccurately within their data sets. Consequently, communities may not be represented with data at the level of geography needed. Collecting and presenting environmental and health-related data to the public are done by state Tracking Networks. Great Lakes Inter-Tribal Epidemiology Center (GLITEC) conducted a groundbreaking 2014 Tribal Environmental Health Tracking pilot project that engaged tribes, an urban Indian community, 3 state health departments, a Tribal Epidemiology Center (TEC), and a federal agency. Two other TECs-the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC) and Northwest Tribal Epidemiology Center (NW EpiCenter)-are now modeling GLITEC's project. They will forge active partnerships with at least one tribe and build relationships with state Tracking programs, explore environmental priorities, identify health outcomes of greatest concern for each community, and determine whether environmental or health inquiries can be addressed through state Tracking data. The Tribal Environmental Health Tracking pilot project provides an example of how state public health Tracking programs can be responsive to data inequities, build relationships between tribes/urban Indian communities, and increase their competency for working with indigenous communities.

"Out of Care" HIV Case Investigations: A Collaborative Analysis Across 6 States in the Northwest US.

HIV care continuum estimates derived from laboratory surveillance typically assume that persons without recently reported CD4 count or viral load results are out of care. We conducted a multistate project (Alaska, Idaho, Montana, Oregon, Washington, and Wyoming) to ascertain the status of HIV cases that appeared to be out of care during a 12-month period. We used laboratory surveillance to identify cases in all states but Idaho, where viral load reporting is not mandatory, requiring us to rely on clinic records. After complete investigation, we assigned each case one of the following dispositions: moved out of state, died, in HIV care, no evidence of HIV care, or data error. We identified 3866 cases with no CD4 count or viral load result in a ≥12-month period during 2012-2014, most (85%) of which were in Washington or Oregon. A median of 43% (range: 20%-67%) of cases investigated in each state had moved, 9% (0%-16%) had died, and 11% (8%-33%) were in care during the 12-month surveillance period. Only 28% of investigated cases in the region and a median of 30% (10%-57%) of investigated cases in each state had no evidence of care, migration, or death after investigation. Most persons living with HIV in the Northwest United States who appear to be out of care based on laboratory surveillance are not truly out of care. Our findings highlight the importance of improving state surveillance systems to ensure accurate care continuum estimates and guide Data to Care efforts.

Public health impacts of culture independent diagnostic testing in Australia

Culture independent diagnostic tests (CIDT) for detection of pathogens in clinical specimens have become widely adopted in Australian pathology laboratories. Pathology laboratories are the primary source of notification of pathogens to state and territory surveillance systems. Monitoring and analysis of surveillance data is integral to guiding public health actions to reduce the incidence of disease and respond to outbreaks. As with any change in testing protocol, the advantages and disadvantages of the change from culture based testing to culture independent testing need to be weighed up and the impact on surveillance and outbreak detection assessed. This article discusses the effect of this change in testing on surveillance and public health management of pathogens in Australia, with specific focus on gastrointestinal pathogens.

A Community-Engaged Approach to Collecting Rural Health Surveillance Data.

In order for communities to make health-related, data-driven decisions concerning resource allocation, needed services, and intervention priorities, they need an accurate picture of the health status of residents. While state and national health surveillance systems exist to help local communities make data-driven health decisions, rural communities face unique challenges including: (1) limited county-level data; (2) underrepresented segments of the population; and (3) a lack of survey items to address local health concerns. The purpose of this study was to take a community-engaged approach to collecting population-based health status data in a rural area in an effort to address some of these unique challenges. Using a community-based participatory research (CBPR) approach, over 1,500 residents from 6 rural and frontier counties were randomly selected with a stratified, multistage cluster study design. Surveys were primarily completed over the phone. Response rates by county ranged from 59% to 80% (overall = 66%). Males and younger adults (18-24 year olds) were underrepresented in the sample, but Hispanics, low-income residents, and cell phone-only users were adequately represented. Prevalence rates for chronic disease and health behavior varied by county. The implications of this project are that engaging stakeholders in community surveillance efforts increases the quality, relevance and utility of the information collected and can help reach otherwise difficult-to-reach populations. This can result in a more accurate picture of the health status of residents, which can lead to making health-related, data-driven decisions concerning resource allocation, needed services, and intervention priorities.

Biosense and Violence: Progress Toward Violence Prevention Using Syndromic Surveillance

Intentional violence is a leading cause of injury and death in the United States. Syndromic surveillance may complement national and state surveillance systems by increasing the timeliness and quality of data on violence and its impact on data-driven practices, programs, and policies that reduce violence and improve population health outcomes.