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Zika Funding Before Mosquito Season – Where Are We Now?

Posted By Emily Holubowich and Zara Day, Thursday, May 26, 2016
Updated: Thursday, May 26, 2016
Washington representatives Zara Day (left) and Emily Holubowich (right)

In February, the Obama administration requested from Congress $1.9 billion in supplemental, emergency funding to combat the Zika virus through a comprehensive approach: prevention and mosquito control; development of and access to therapeutics; further study into the biological implications of Zika and its transmission; and funding to the states so that they can attack the threat. It also includes additional funding to Medicaid in Puerto Rico and other U.S. territories to support pregnant women at-risk or who have contracted Zika, children with microcephaly, and to cover other healthcare costs.


After more than 40 congressional hearings this year, the good news is that lawmakers from both sides of the aisle agree that the Zika threat justifies new funding. The bad news is, three months after the White House's initial request, there remains little agreement about how much funding to provide, for what, when to provide it, and through what mechanism. And while Congress debates the details, public health agencies can't afford to wait. The administration has been forced to redirect nearly $600 million previously allocated to fight the ongoing Ebola threat toward the Zika efforts--under the assumption this funding will eventually be made whole by Congress in the Zika package--as well as $44 million from emergency preparedness grants intended for use by the states. As the Washington Post recently reported, the reallocation of these Public Health and Emergency Preparedness (PHEP) funds is particularly concerning because that money is critical for states to address ongoing and emerging public health crises such as outbreaks and natural disasters in real time. As Cynthia Harding, interim director of the Los Angeles Department of Public Health told the Post, "this is stealing from Peter to pay Paul."


So where are we now?


On May 18, the House of Representatives passed a $622 million Zika supplemental bill, which was completely offset using “unobligated” Ebola funds and unused administrative funds at the Department of Health and Human Services. As expected, the vote was almost entirely partisan, highlighting the fundamental differences in strategies between parties on almost every piece of the supplemental funding process. The House bill provides funding only for FY2016, as lawmakers plan to use the normal appropriations process to provide additional funds for 2017. This would inevitably lead to cuts to other programs. On May 19, the Senate passed the Blunt-Murray amendment to a transportation appropriations package which would provide $1.1 billion for the public health response, and the funding by the Senate is not offset and would be available for FY2016 and FY2017. The White House will likely support the Senate compromise, but there have already been veto threats from the administration for the House bill. In short: as usual, we are functioning in dysfunction here in Washington.


Zika is pressing. In doing the necessary and immediate work of responding to Zika, however, lawmakers should not ignore the underlying public health infrastructure that has been neglected and is in dire need of repair. We need to keep training our public health workforce, reinvesting in early warning systems, and continuing our upkeep of preventive and responsive public health services on a state and local level. We need Congress to support supplemental funding for Zika now, and to continue to support the public health system that protects us against the next Zika that has yet to emerge.


CSTE has been closely involved with advocacy efforts to support robust a supplemental funding stream for Zika prevention, research, and therapeutics development which does not steal from our already eroding public health infrastructure. CSTE representatives have joined meetings on the Hill to discuss the needs of the states, and have vocally opposed any funding which pulls from PHEP, the Public Health Prevention Fund, or other public health funding streams.


Emily Holubowich, MPH and Zara Day, JD, MPH are CSTE’s Washington representatives in the nation’s capital at Cavarocchi Ruscio Dennis Associates, LLC. Find out more about CSTE’s advocacy activities on the CSTE Advocacy page. You can also read Executive Director Jeff Engel’s article in the new edition of journal JPHMP. Log in as a CSTE member through this link to access it for free or visit the journal’s public webpage.

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Share Your Expertise with Readers of CDC’s MMWR

Posted By Sonja Rasmussen, MD, MS, Friday, May 20, 2016
Updated: Thursday, May 19, 2016
Untitled Document

A month from now many of you will be in Anchorage, gathered for the CSTE Annual Conference, sharing your expertise and building collaborations.

Those are the very reasons it was important to me as the Editor-in-Chief of CDC’s Morbidity and Mortality Weekly Report (MMWR) that we be there, too.

On Monday, June 20 (2:00-3:30 p.m.), Jeff Sokolow, Technical Writer/Editor for MMWR, and I will be presenting on “Publishing in Today’s MMWR: Widely Read, Widely Respected.” MMWR is often considered “the voice of CDC,” but that doesn’t mean the reports are only from CDC authors. We want to be publishing your scientific work and we welcome your submissions.

Tim Jones will be moderating our session. Since 2015, he has served as chair of the MMWR Editorial Board, but his history with the publication goes back many years including during his time as a part of CDC’s Epidemic Intelligence Service. He’s now the State Epidemiologist for the Tennessee Department of Health and of course is a past president of CSTE.


 
When outbreaks are first identified, we don’t always know what they will become. This 1976 MMWR report on a “Respiratory Infection -- Pennsylvania” was the first report on what became known as Legionnaires’ disease.

 
CDC discovered that two cases of febrile respiratory illness in children from Southern California were caused by a new H1N1 influenza virus of swine origin. These two cases – the first of the 2009 H1N1 pandemic – were reported as an MMWR Early Release.

Maybe you know the history of MMWR, the first journal to publish descriptions of cases of Legionnaires’ disease, AIDS, and 2009 H1N1 influenza. I’ll talk about how MMWR has informed and shaped public health for many decades and I’ll introduce you to our broad readership that runs the gamut from physicians to epidemiologists and educators. And we’ll talk about how MMWR reports are widely highlighted in news reports and redistributed by other journals and medical associations.

 
After being alerted by a CDC Epidemic Intelligence Service officer assigned to the Los Angeles County Department of Health, MMWR published a report in 1981 on five cases of a rare type of pneumonia in otherwise healthy young men – the first indication of the AIDS epidemic.

Jeff Sokolow will outline the structure of an MMWR Weekly Report, highlighting how the first paragraph serves as an abstract containing background, methods, main results, discussion, and a SOCO (single overriding communications objective) that states the public health action recommended. He will also discuss the MMWR editorial review process, give clear writing tips and note errors to avoid.

It will also be our pleasure to introduce you to two MMWR authors from state health departments. We will be joined by Joan M. Duwve of the Indiana State Department of Health. Joan and her department colleagues used an MMWR template to develop their report on a community outbreak of HIV infection and in three weeks’ time went from inception to publication. Her description of the process and the impact of the publication will put you in the shoes of an MMWR author.

Ali Hamade of the Alaska Section of Epidemiology will talk about publishing on what might have seemed to be a very esoteric topic - suspected palytoxin inhalation exposures – that ended up garnering widespread attention. In his words, “Publishing in MMWR with its wide reach and open access has helped serve global public health by spreading the message. We saw evidence of this from the many technical assistance requests from the public and public health agencies, to national and international media inquiries and postings on multiple hobbyist and professional blogs.”

As Ali notes, he and his co-authors chose MMWR because it reaches a broad audience including state and federal public health officials, is open access and therefore freely available to all, and is easily retrieved in internet searches.

Please come hear their stories and learn how publishing in MMWR can further your own public health impact.

Our goal is to help you share what you’ve learned. We’re coming to the conference hoping to build many collaborations. We look forward to meeting you in June.

 
Sonja Rasmussen, MD, MS is editor-in-chief of the Morbidity and Mortality Weekly Report (MMWR) and director of the Division of Public Health Information Dissemination at the CDC Center for Surveillance, Epidemiology, and Laboratory Services. Visit the publication on the web at http://www.cdc.gov/mmwr/.
 

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Announcing New Recommendations for Epidemiologists to Improve Reporting of Drug Overdose Deaths on Death Certificates

Posted By Jennifer Sabel, Friday, May 13, 2016
Updated: Thursday, May 12, 2016

Did you know that drug overdoses are the leading cause of injury death in the nation? However, about 20% of death certificates on drug overdose deaths do not include information about the specific drugs involved in the overdose. The lack of detail on the specific drugs involved varies between 1-52% of drug overdose deaths by state. Knowing the specific drugs involved is critical to developing appropriate prevention strategies.

A new recommendations document developed by the CSTE Overdose Subcommittee provides concrete steps and lessons learned to epidemiologists and public health professionals wanting to improve drug overdose reporting in their jurisdiction.

These new recommendations include resources for how to review the quality of your jurisdiction’s drug overdose data, and how and why to collaborate with your state’s vital statistics registrar and medical examiners and/or coroners to enlist their support in helping to improve the quality of the data.

The new recommendations document also includes specific examples from jurisdictions that have made efforts to improve data quality. For example, in Kentucky, staff produced a figure showing that a third of drug overdose deaths had no specific drugs listed on the death certificate. This figure was widely shared with stakeholders who then collaborated to develop a drug overdose fatality reporting framework to improve the reporting of drug overdose deaths.

In New York City, staff identified a large number of deaths that listed “morphine” on the death certificate. Morphine is identified in toxicology testing, but the original source can be either heroin or pharmaceutical morphine. Discussions with the chief medical examiner identified that the majority of these deaths involved heroin. Staff worked with the chief medical examiner to develop recommendations to improve reporting of deaths involving heroin or morphine.

In Washington State, staff worked with the vital statistics office to start a query process for gathering additional information for the unspecific drug overdose death certificates that were submitted to their office. Receipt of an unspecific death certificate generated questions back to the medical examiner or coroner for more detailed information on the death and the drugs involved.


The new recommendations document is available on the CSTE website: http://www.cste.org/OverdoseRecommendations.
We hope that you will use the recommendations to improve specific drug reporting on drug overdose death certificates in your jurisdiction.


Jennifer Sabel, PhD is an epidemiologist in Non-Infectious Conditions Epidemiology in the Office of the Secretary at the Washington State Department of Health. Holly Hedegaard, MD, MSPH is an injury epidemiologist at the National Center for Health Statistics at the CDC Office of Analysis of Epidemiology. David Nordstrom, PhD, MPH, MS resides in Oregon and Wisconsin and works as a consultant in injury epidemiology for government and academic settings. Svetla Slavova, PhD is associate professor at the Kentucky Injury Prevention and Research Center at the University of Kentucky. Denise Paone, EdD, is senior director of research and surveillance and Ellenie Tuazon, MPH is an epidemiologist at the Bureau of Alcohol and Drug Use Prevention, Care, and Treatment at the New York City Department of Health and Mental Hygiene. Amy Poel, MPH is an epidemiologist at the Center for Health Statistics, Washington State Department of Health.

Join the Overdose Subcommittee by logging in as a CSTE member and clicking “join” on the webpage. The Overdose Subcommittee meets on the second Thursday each month at 1-2PM Eastern. Join the subcommittee to receive the monthly phone number and passcode, and contact CSTE Senior Research Analyst Megan Toe for more information.

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Ebola Active Monitoring After-Action Review

Posted By Lucretia Jones, Friday, May 6, 2016
Updated: Thursday, April 28, 2016

Active monitoring of travelers who are at low (but not zero) risk for Ebola Virus Disease (EVD) for 21 days was a labor-intensive activity for health departments, especially those with large volumes of returning travelers. Taking on this new and daunting task was especially demanding while also sustaining ongoing public health responsibilities. New York City Department of Health and Mental Hygiene (NYC DOHMH) began receiving files from CDC with contact information for travelers who had arrived from West Africa in the fall 2014. An active monitoring call center (AMCC) was set up and staff from several different programs were reassigned from their regular jobs to serve as AMCC operators. After several months, these staff were replaced with grant hires and temp agency staff. They called travelers daily to collect temperatures and document any symptoms; these efforts are described in more detail at http://www.cdc.gov/mmwr/volumes/65/wr/mm6503a3.htm.

When a traveler was unable to be reached by AMCC for two consecutive days, the traveler was referred to the DOHMH Surveillance and Epidemiology Emergency Response Group’s Field Surveillance Unit (FSU). Activated under DOHMH’s Incident Command System, FSU consists of approximately 200 staff from six different bureaus. FSU staff are trained and experienced in patient/provider outreach, interviewing, and medical chart abstraction. Upon being assigned a traveler who was lost to follow-up, FSU staff initially attempted to contact the traveler or his or her listed emergency contact by phone. FSU staff used subscription-based people search databases to search for travelers or their emergency contacts to identify additional contact information. After calling all phone numbers and leaving messages for the traveler to call the AMCC, FSU staff would send an email to the traveler if an email address was available. If there was no response by phone or email after 2–3 hours, a FSU staff or team of two staff would conduct a site visit to the traveler’s home, hotel, or local address. If the traveler was not found, a letter from DOHMH explaining the need to speak with the traveler was left at the hotel’s front desk or under the apartment door, if possible.

From October 11, 2014 to May 31, 2015, DOHMH conducted active monitoring for 2,941 travelers, which resulted in 235 (8%) hard-to-locate referrals to FSU. Of the 235 referrals, 80 (34%) were successfully contacted by phone within a day of referral and 67 (29%) required a field visit. Of these 67 field visits, 17 (25%) were located and interviewed, letters asking the traveler to call were left with someone at the home/hotel or placed it under the door for 41 (61%), and 9 (13%) did not have a valid address. Seventy-eight (33%) of all referrals had other outcomes (e.g. traveler left NYC or contact made after 24 hours) and for 10 (4%) FSU was unable to proceed with any outreach due to lack of valid contact information.

Challenges in NYC to locating these travelers differed depending on if the traveler was a NYC resident returning from a trip abroad versus a foreign resident visiting the city. Challenges included the traveler not being reachable in the daytime because they were at work or not at the hotel because they were out sightseeing or visiting relatives. Incorrect or incomplete addresses lacking apartment numbers, no access to apartment buildings, common last names, language barriers, and safety in the field also hindered our ability to locate travelers.

Distributing pre-paid cell phones to travelers when they arrived facilitated efforts to contact them for daily active monitoring. In the first four weeks of active monitoring before CDC phones were given to travelers upon arrival in NYC, FSU had to identify additional contact information on travelers for 41 of 136 (30%) of referrals; after phones were distributed, only 14 of 99 (14%) required identifying additional contact information (2 P=0.004). Before phones were distributed, 49 of 136 (36%) referrals required a field visit; after phones were distributed, only 18 of 99 (18%) referrals required a field visit (2 P=0.003).

The number of referrals for locating hard-to-reach travelers decreased from 136 in November 2014 to 30 in December 2014 and remained less than 17 a month for the remaining months. This decrease was due to several reasons including AMCC’s success in contacting travelers by phone within 48 hours and the addition of free cellphones to travelers. However, valuable time and resources were still expended on calling travelers daily for 21 days and sending field staff to locate and make contact with travelers who did not respond to the cellphone attempts. Having a unit of staff trained and experienced in tracking down additional contact information, finding hard-to-reach people in the field, and interviewing reluctant clients was critical to the success of Ebola virus active monitoring in New York City.

 


Lucretia Jones, DrPH, MPH is director of the General Surveillance Unit at the Bureau of Communicable Disease at the New York City Department of Health and Mental Hygiene (NYC DOHMH). For more information about preparedness, join the Public Health Emergency Preparedness Subcommittee.

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“Cloudy with a chance of…” Classification of Emergency Department Visits related to Extreme Weather

Posted By Teresa J. Hamby, Hui Gu, and Stella Tsai, Friday, April 29, 2016
Updated: Thursday, April 28, 2016
 

In New Jersey, real-time emergency department (ED) data are received from 78 of 80 EDs by Health Monitoring Systems Inc.’s (HMS) EpiCenter system, which collects, manages, and analyzes ED registration data for syndromic surveillance.

Hurricane ‘Superstorm’ Sandy struck October 29, 2012, causing harm to New Jersey residents and extensive damage to businesses, transportation, and infrastructure. Monitoring health outcomes for increased illness and injury due to a severe weather event is important in measuring the severity of conditions and the efficacy of state response, as well as in emergency response preparations for future severe weather events. After Hurricane Sandy, the need to be prepared for future severe weather events prompted the New Jersey Department of Health (NJDOH) to develop a suite of 19 syndromic surveillance classifications for extreme weather-related conditions in EpiCenter. Examples include carbon monoxide poisonings resulting from generator misuse and disrupted medical care where patients needed emergency visits for medicine refills after losing their medicines in the flood or running out with no pharmacy available, and the need for oxygen or dialysis due to power outages at homes and procedure locations.

The development of these classifications followed a two-stage validation of keyword lists using diagnostic codes. First, staff identified possible inclusion keywords using records with ICD codes that met case definition. Then, exclusion text was determined by evaluation of cases with keywords of interest but without ICDs meeting case definition. Sensitivity and positive predictive values were computed for both the initial keyword list and the final keyword list to ensure the keywords were a good fit for the process.

NJDOH has since used these classifiers in more recent events to monitor for weather-related visits to storm-affected area ED’s. In June, 2015, a squall line of damaging thunderstorms, known as a “bow echo,” caused downed wires and power outages in two southern New Jersey counties. In the aftermath, there was a spike in the rate of visits for disrupted medical care, in particular for oxygen needs. In January, 2016, Winter Storm Jonas dropped more than a foot of snow over New Jersey. During and after that storm, carbon monoxide poisoning visits spiked, likely due to the misuse of generators, as did visits for medication refills.

While not every classification would be relevant in every extreme weather event, having the elements available provides tools for state and local users to monitor storm impacts locally and at the state level.

Teresa Hamby, MSPH is a data analyst, Hui Gu, MS is a health data specialist, and Stella Tsai, PhD, CIH is a research scientist at the New Jersey Department of Health. For more information about disaster epidemiology, join the Disaster Epidemiology Subcommittee.

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Participatory Program Evaluation Planning in Support of the Vermont Comprehensive Cancer Control Initiative

Posted By Leanne Shulman, Friday, April 22, 2016
Updated: Friday, April 22, 2016

In the fall of 2014 the Comprehensive Cancer Control (CCC) program in Vermont was in particular need of evaluation expertise. In the next year (2015) the program oversaw the creation of a new five-year cancer plan, the 2020 Vermont Cancer Plan, and the end of the existing external evaluation contract. Financial resources for evaluation were very limited, with no funding available until 2016 to contract out the development of a new evaluation plan, evaluation questions and revised logic model to accompany the new cancer plan.

As described in CSTE’s 2004 white paper “Essential Functions of Chronic Disease Epidemiology in State Health Departments,” evaluation is a Tier 2 Essential Function of chronic disease epidemiology. Chronic disease epidemiologists play a supportive or coordinating role in delivering Tier 2 functions. As the Vermont CCC program does not have dedicated evaluation staff, it is my responsibility to coordinate evaluation of the CCC program in Vermont.

Ideally, I would develop the evaluation plan alongside the 2020 Vermont Cancer Plan rather than contracting out the evaluation the year after the plan was written. However, given my limited (aka non-existent) experience in developing evaluation plans and limited access to internal evaluators within the Vermont Department of Health, I was not in a position to develop a high-quality evaluation plan.

In an effort to gain access to evaluation expertise I applied to the National Association of Chronic Disease Directors (NACDD) Epidemiology Mentorship program with a proposed project of creating an evaluation plan for the CCC program. The mentorship program paired me with Dr. Ericka Welsh of the Kansas Department of Health and Environment, Bureau of Health Promotion, a senior epidemiologist with expertise in evaluation.

With Dr. Welsh’s assistance I coordinated the development of a five-year evaluation plan to accompany the new five-year state cancer plan. We used the Comprehensive Cancer Control Branch Program Evaluation Toolkit (2010) as a framework. A participatory evaluation approach was employed, which began with an invitation to join the Vermont comprehensive cancer control coalition – Vermonters Taking Action Against Cancer (VTAAC) Evaluation Committee. The invitation was sent to the general coalition membership, as well as to specific partners with evaluation experience.

The ensuing Evaluation Committee consists of three staff from the Vermont Department of Health, the VTAAC coordinator, a cancer center communications manager, a quality improvement liaison for a major private insurer, and the coordinator for the Vermont Cancer Survivor Network.


The 2015 VTAAC Evaluation Committee: Sarah Keblin, Ali Johnson, David Cranmer, Sharon Mallory and Leanne Shulman. Not pictured – Sherry Rhynard and Micah Demers. Photo by Ali Johnson

The Evaluation Committee met five times over the course of nine months in 2015 to provide input on each step of the evaluation plan. Under my leadership, the Evaluation Committee revised the CCC initiative logic model, determined the program’s evaluation questions and created the evaluation planning matrix.


Leadership in this case entailed preparing draft documents, which were critiqued during the meeting, and then creating revised versions, which were further edited via email. This process was repeated for each of the pieces of the evaluation plan. I made a significant effort to do as much preparatory work as possible before committee meetings in order to limit the demands placed on the stakeholders. It took a full nine months to complete the evaluation plan. Although there was a great deal of investment in building relationships, creating drafts and rewriting, the ultimate product is stronger as a result of the input of a variety of voices.

The evaluation plan includes both process and outcome evaluation and is designed to measure and improve the effectiveness of the CCC program and VTAAC, to inform future program and coalition development, and to demonstrate accountability to funders.

The participatory approach, with guidance from a senior-level mentor, resulted in an evaluation plan that has buy-in from key VTAAC partners while maintaining the framework required by the funder (CDC). Activities in the plan will be implemented by staff within the Vermont Department of Health, primarily the CCC epidemiologist (me) with assistance from an external contractor who will conduct individual evaluation activities, such as focus groups. The work done by the Evaluation Committee was presented to and approved by the VTAAC Steering Committee in November 2015. The Evaluation Committee has a continued role in overseeing the implementation of the plan throughout the next five years.

If you are interested in hearing more about the participatory evaluation planning process we undertook, please come to my presentation at the CSTE Annual Conference – 11am at the Cross Cutting I – “No Seward’s Folly: Quality Improvement, Collaboration, and Evaluation” session on Wednesday, June 22, 2016.

The 2016-2020 Vermont Comprehensive Cancer Control Initiative Evaluation Plan can be found here: http://healthvermont.gov/pubs/cancerpubs/documents/evaluation_plan_comprehensive_cancer_control_program.pdf.

Leanne Shulman is the epidemiologist and evaluator for the Comprehensive Cancer Control Program in Vermont. She is also the epidemiologist for the Vermont Office of the Chief Medical Examiner. She was a mentee in the 2015 National Association of Chronic Disease Directors (NACDD) Epidemiology Mentorship program. For more information on CSTE activities, join the Cancer Subcommittee.

Photo by Ali Johnson

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Announcing the #CSTE2016 Plenary Speakers and Mann Memorial Lecturer

Posted By CSTE, Friday, April 15, 2016
Updated: Friday, April 15, 2016
CSTE is pleased to announce an exciting lineup of speakers at this year’s conference in Anchorage, Alaska with diverse professional backgrounds and insightful presentations to share. Each speaker will shed light on applied public health epidemiology, year’s conference theme “Exploring New Frontiers.”

Camara Phyllis Jones – Jonathan M. Mann Memorial Lecture

Camara Phyllis Jones, MD, MPH, PhD is President of the American Public Health Association, and a Senior Fellow at the Satcher Health Leadership Institute and the Cardiovascular Research Institute, Morehouse School of Medicine. Dr. Jones is a family physician and epidemiologist whose work focuses on the impacts of racism on the health and well-being of the nation. She seeks to broaden the national health debate to include not only universal access to high quality health care, but also attention to the social determinants of health (including poverty) and the social determinants of equity (including racism). (read more)
   

Robin Bronen

Robin Bronen works as a human rights attorney and has been researching the climate-induced relocation of Alaska Native communities since 2007. Her research has been publicized by CNN and the Guardian among others. She has worked with the White House Council on Environmental Quality to implement President Obama’s Climate Change Task Force recommendation to address climate displacement as well as the UN High Commissioner for Refugees Climate Change Office. (read more)
   

Valerie “Nurr’araaluk” Davidson

Valerie “Nurr’araaluk” Davidson was appointed by Governor Bill Walker as Commissioner of the Alaska Department of Health & Social Services in December 2014. Prior to leading the department, she worked for over 15 years as a national policy maker on matters affecting Alaska Native and Indian health. Ms. Davidson currently serves on the U.S. Department of Justice Advisory Committee on American Indian and Alaska Native Children Exposed to Violence and as a Trustee of the First Alaskans Institute. (read more)
   

Susan Huang

Susan Huang, MD MPH is a Professor of Medicine in the Division of Infectious Diseases and Health Policy Research Institute at the University of California Irvine School of Medicine, and the Medical Director of Epidemiology and Infection Prevention at UC Irvine Health. She received her MD degree from the Johns Hopkins University School of Medicine and her MPH degree from the Harvard School of Public Health in Quantitative Methods. She completed her residency at the University of California San Francisco and her ID fellowship at the combined Harvard program at Brigham & Women’s Hospital and Massachusetts General Hospital. (read more)
   

Michael Landen

Michael Landen is the State Epidemiologist with the New Mexico Department of Health. His principal areas of professional interest include tribal epidemiology, substance abuse epidemiology, and injury prevention. Michael Landen has worked as a family physician and clinical director for the Indian Health Service in Arizona and New Mexico, and as a volunteer physician in Belize. In 1995 he began work as an Epidemic Intelligence Service officer assigned to the Alaska Department of Health and Social Services. He has been with the New Mexico Department of Health since 1997. He served as a CSTE Executive Board member from 2007-2010.
   

Stephen Ostroff

Dr. Stephen Ostroff, M.D., has been FDA’s Acting Commissioner since April 2015. Previously, he was FDA’s Chief Scientist, where he was responsible for leading and coordinating FDA’s cross-cutting scientific and public health efforts. The Office of the Chief Scientist works closely with FDA’s product centers, providing strategic leadership and support for FDA’s regulatory science and innovation initiatives. Dr. Ostroff joined FDA in 2013 as Chief Medical Officer in the Center for Food Safety and Applied Nutrition and Senior Public Health Advisor to FDA’s Office of Foods and Veterinary Medicine. (read more)
   

Pam Pontones

Pam Pontones, State Epidemiologist, has served at the Indiana State Department of Health for 25 years. She began her career as a microbiologist in 1990 and transitioned to epidemiology in 1999, serving as the Enteric Epidemiologist, Field Epidemiology Director, and Director of Surveillance and Investigation. During this time, she led investigations of many infectious disease outbreaks and served a key role in the 2009 influenza pandemic response. (read more)
   
To learn more, visit www.csteconference.org. Remember to register by April 29 to take advantage of the Early Bird discount.

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Community Health Assessment Data Visualized

Posted By Lois Haggard, Friday, April 8, 2016
Updated: Thursday, March 31, 2016

The New Mexico Department of Health has made significant improvements to its Indicator-based Information System for Public Health (NM-IBIS, https://ibis.health.state.nm.us), a web-based population health assessment and data query tool. New Mexico is one of about a dozen public health organizations, known as the IBIS-PH Community of Practice (http://www.ibisph.org), currently using the software and contributing to its development.

The IBIS-PH website content is maintained by public health program staff (subject-matter experts) across the department. Distributing the workload not only makes it feasible to keep the content up to date, but it ensures that the content reflects the public health communication objectives for a given topic.

The latest version of IBIS-PH features significant improvements in data discovery and visualization. Data discovery includes navigation by health topic.

The new data visualization features include interactive graphics (tables that sort and user-specified graph types) as well as dynamic maps for both our indicator reports (https://ibis.health.state.nm.us/indicator/index/Alphabetical.html) and custom data queries (https://ibis.health.state.nm.us/query/ContentUsage.html).



One of the features that is popular with community groups is the “Community Snapshot Report” (https://ibis.health.state.nm.us/community/snapshot/Builder.html). That report allows New Mexico communities to see at a glance how they compare to the state overall and the U.S.


NM-IBIS is used by community members, epidemiologists, educators, researchers, legislators, non-profits, and many other groups to access data and information on a broad range of New Mexico’s priority health issues. Use of the system has steadily grown since the release of the latest version in March of 2015. Currently the system is seeing about 1,000 unique users each week. That is 1,000 different people finding New Mexico data and information for public health assessment and other purposes. A recent increase in use during the state’s 2016 one-month legislative session was very encouraging.

“NM-IBIS has changed the way we share health data in New Mexico,” says New Mexico State Epidemiologist Michael Landen. “Disseminating data through IBIS not only maintains the security of the data, but using IBIS, we can provide data with a public health message at the same time.”

Most NM-IBIS users live within the state’s borders, but since it’s a public website, NM-IBIS regularly sees users from other states, and places as far-flung as Australia, Sweden and Spain.

States interested in adopting the IBIS-PH software can visit the IBIS-PH Community of Practice “Adopt IBIS” (http://www.ibisph.org/trac/wiki/adoptibis) page.

 
Lois M. Haggard, PhD is community epidemiologist and program manager of the Community Health Assessment Program at the New Mexico Department of Health. To learn more about surveillance, consider joining and participating in subcommittees in the CSTE Surveillance/Informatics Steering Committee.

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Council District Reports: A Project Manager’s Perspective

Posted By Anna Oberste, Friday, April 1, 2016
Updated: Thursday, March 31, 2016

Managing the development and dissemination of 11 City Council District health reports was my first SHINE fellow assignment at Denver Public Health (DPH). Reports first created in 2011 brought community health assessment findings to the individual council districts. Being well received and promoting dialogue with policy makers, the same process was repeated with 2014 community health assessment findings. These 2015 council district reports focused on three main themes: the importance of place, prevention, and health equity.

Spanning nine months (July 2015-March 2016), the report creation process involved three phases: definition and planning, data analysis and information development, and dissemination and assessment. Each phase involved meetings with content experts, data presentation and design experts, and work group approval.

First steps included charter creation to establish stakeholder roles and expectations. To track the project, weekly and monthly status reports and timeline updates were created to facilitate problem solving at various project stages. Data analysis sources included: Medicaid enrollment, electronic health records, and calculated BMI screening. Four high-priority health topics were analyzed: access to healthcare, childhood obesity, tobacco use among young adults, and adult depression prevalence. Once analytic approaches and content were approved, we created a dissemination plan.

Eleven district reports were disseminated to council district members and the public. In addition, a website was created, containing links to information and suggesting programs to assist with addressing these health concerns. Each council district member has a meeting arranged with the director of Denver Public Health to discuss health concerns in the report and to identify opportunities to take action.



Denver Public Health believes local health data can inspire action. Community health assessments, health impact assessments, and geographically targeted reports used to engage community partners, healthcare providers, and policy makers permit collaborative health improvement efforts.
Lessons Learned
By clearly defining roles and responsibilities, we increased the efficiency of the collaborative processes. Communication has been key and different communication modes work better for different people. Timelines need to be flexible to adjust to obstacles and competing demands by subject matter experts and analytic and design staff. Learning to adjust schedules and anticipate delays helped me manage my own, and others’ expectations, creating a more relaxed environment. Using project management tools permitted me to stay organized and identify problems earlier. The DPH team’s comments and recommendations helped provide valuable insight which positively impacted the project to completion.
Anna Oberste PharmD, MPH, BCNSP is a Health System Integration Program (HSIP) fellow at Denver Public Health. To learn more about mentoring an HSIP fellow or applying to be one, visit www.shinefellows.org. Participate in CSTE’s Public Health Law Subcommittee to engage in related national activities.

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The Contribution of Local Public Health to Heroin Surveillance in Orange County, Florida

Posted By Ben Klekamp, Toni Hudson, and Sarah Matthews, Friday, March 25, 2016
Updated: Tuesday, March 22, 2016

From left to right, Sarah Matthews, Ben Klekamp, and Toni Hudson

 

To better inform community decisions in the fight against heroin addiction, the Florida Department of Health in Orange County used multiple data sources to conducted heroin-related morbidity and mortality surveillance from 2010 to present.

Data from the Orange County Medical Examiner’s Office and Florida Department of Health was used to conduct a descriptive analysis on Orange County deaths where heroin was listed as the cause of death or heroin was in the blood stream at the time of death (Figure 1). To identify areas for potential interventions, addresses where heroin-related deaths occurred were analyzed using spatial cluster analysis (i.e., kernel density) in ArcGIS (Figure 2).

 

Figure 1. Epidemic Curve of Heroin-related Deaths in Orange County, Florida 2010-2014.

 

Figure 2. Cluster Analysis of Heroin-related Deaths in Orange County, Florida 2010-2014.

 
Two data sources were used in heroin-related morbidity surveillance. The Florida Agency for Health Care Administration (ACHA) is the regulatory authority for Florida’s health facilities, which includes capturing health data from these facilities. AHCA data was queried utilizing heroin specific international classification of disease (ICD) codes in Orange County hospitals. This analysis provided information on the heroin-related hospital burden including hospital specific information, insurance status, and demographic information of identified patients. Zip Codes of patients utilizing hospitals for heroin-related healthcare needs were mapped to better understand the geographic burden of heroin morbidity in Orange County (Figure 3).
 

Figure 3. Agency for Health Care Administration Data: Rate and Frequency of Heroin-related Morbidity by Zip Code, Orange County, Florida 2010-2014.

 
Due to the delay in data availability in both the Medical Examiner and AHCA datasets, the Department’s syndromic surveillance system ESSENCE-FL (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) was utilized to understand current demographic and geographic trends related to heroin morbidity (Figure 4). ESSENCE-FL is the Florida Department in Health’s syndromic surveillance system and captures data on hospital emergency department visits, poison control consultations, Merlin reportable diseases, and vital statistics death records. All hospital emergency departments in Orange County send daily updates to ESSENCE-FL on chief complaints and discharge diagnoses. A query for heroin (and common misspellings) was developed and compared to the AHCA data to understand if the developed ESSENCE-FL data query was comparable to the AHCA data.
 

Figure 4. ESSENCE-FL Data: Rate and Frequency of Heroin-related Morbidity by Zip Code, Orange County, Florida 2010-2014.

 
Overlay of the three data sources used in this surveillance highlights the data trend agreement between data sources and relative timeliness of data availability of each source (Figure 5). While ESSENCE-FL data may misclassify and overestimate the true burden of heroin-related morbidity in a community compared to the AHCA data trends, the rapid availability of the data may prove useful in understanding a population health problem until more accurate datasets (e.g., medical examiner) become available for analysis.
 

Figure 5. Heroin-related Morbidity and Mortality, Orange County Florida 2010-2016


The Department presented the surveillance findings to the public and community leaders as part of the Orange County Mayor’s Heroin Taskforce on February 29, 2016. The full presentation and an Orange County Heroin factsheet, in addition to other Orange County authored publications, can be viewed on the Epidemiology Program Publications webpage. The Epidemiology Program will continue to support and track the health related outcomes of community efforts to combat the heroin epidemic through ongoing surveillance.

Questions and comments on the Florida Department of Health in Orange County Epidemiology Program heroin-related morbidity and mortality surveillance can be directed to Ben Klekamp at ben.klekamp@flhealth.gov or Toni Hudson at tonimarie.hudson@flhealth.gov.

Ben Klekamp, MSPH, CPH, is an epidemiologist and Project SHINE I-TIPP fellow, Toni Hudson, MSPH, CIC, is an epidemiologist, and Sarah Matthews, MPH, is the epidemiology program manager for the Florida Department of Health in Orange County. To learn more about substance abuse surveillance, visit the Substance Abuse Subcommittee. Informatics-Training in Place Program (I-TIPP) fellowships enable current health department staff to develop capacity in their roles—learn more and apply by April 1, 2016 at http://www.shinefellows.org/.

 

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