Quantifying Health Systems' Investment In Social Determinants Of Health, By Sector, 2017-19.

The past decade has seen a growing recognition of the importance of social determinants of health for health outcomes. However, the degree to which US health systems are directly investing in community programs to address social determinants of health as opposed to screening and referral is uncertain. We searched for all public announcements of new programs involving direct financial investments in social determinants of health by US health systems from January 1, 2017, to November 30, 2019. We identified seventy-eight unique programs involving fifty-seven health systems that collectively included 917 hospitals. The programs involved at least $2.5 billion of health system funds, of which $1.6 billion in fifty-two programs was specifically committed to housing-focused interventions. Additional focus areas were employment (twenty-eight programs, $1.1 billion), education (fourteen programs, $476.4 million), food security (twenty-five programs, $294.2 million), social and community context (thirteen programs, $253.1 million), and transportation (six programs, $32 million). Health systems are making sizable investments in social determinants of health.

Analysis and modelling of powdered activated carbon dosing for taste and odour removal.

A series of experiments were undertaken in order to understand and predict the dosage of powdered activated carbon required to remove taste and odour compounds in an Australian drinking water treatment plant. Competitive effects with organic matter removal by aluminium sulphate during coagulation were also quantified. Data on raw and finished water quality following jar tests, as well as chemical dosages and treatment performance, were statistically analysed, and a data-driven prediction model was developed. The developed powdered activated carbon dosage prediction model can be used by the plant operators for rapid dosage assessment and can increase the preparedness of the plant to sudden taste and odour events. It was also found that total organic carbon levels and properties greatly affect the ability of powdered activated carbon to remove taste and odour compounds; on the other hand, total organic carbon removal is not affected by high taste and odour levels, since these were still much lower than organic carbon concentrations.

Public health laws and implications for a national accreditation program: parallel roadways without intersection?

Public health law has been one of the leading contributors to the extension of life expectancy in the 20th century. Nonetheless, the legal infrastructure supporting public health law in the United States is underdeveloped and nonuniform. With national interest growing in public health agency accreditation, the individual legal approach taken by states may pose an obstacle to wholesale adoption of a proposed voluntary national model. This article describes the legal foundations supporting accreditation or assessment programs in states participating in the Multi-State Learning Collaborative, a project funded by the Robert Wood Johnson Foundation. The Turning Point Model State Public Health Act is recommended as one option to resolve the current impasse, assist in acceptance of a national accreditation model, and provide a common public health legal infrastructure.

States gathering momentum: promising strategies for accreditation and assessment activities in multistate learning collaborative applicant States.

Strategies for establishing a national voluntary public health agency accreditation program have been gathering momentum. Recent efforts funded by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC) have made a significant impact on the potential for national diffusion of accreditation models. The Exploring Accreditation Project was a collaboration of the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the National Association of Local Boards of Health with a national steering committee that studied the feasibility and desirability of a national voluntary accreditation program for state and local public health agencies. Concurrently, the Robert Wood Johnson Foundation funded the "Multi-State Learning Collaborative on Performance and Capacity Assessment or Accreditation of Public Health Departments" (MLC). Among the other purposes of the MLC was the intent for states already engaged in accreditation or assessment activities to inform the national accreditation debate. Five states were selected to be MLC grantees from 18 states completing a formal application process. This article reviews data extracted from the applications of 16 of the 18 applicant states and reviews common themes emerging across programs. Other states contemplating similar programs, as well as those charged with implementing the voluntary model at the national level, may find guidance from these examples.

The operational definition of a functional local public health agency: the next strategic step in the quest for identity and relevance.

In 2002, the National Association of County and City Health Officials embarked on a quest to clarify, in a uniform way, the functions of governmental local public health agencies. Over the next 3 years, a diverse group of local health department officials and their partners developed an Operational Definition of a Functional Local Health Department, which included 45 standards matched to the 10 Essential Services. These standards serve as the first comprehensive and uniform articulation of local health department activities for which 250 prototype metrics have subsequently been developed. This article articulates the historical and policy significance of the Operational Definition, the methodological development of the recently published prototype metrics, and presents ideas for use of the metric tool especially in light of current accreditation and quality improvement initiatives.

Induction of chromosomally integrated HIV-1 LTR requires RBF-2 (USF/TFII-I) and Ras/MAPK signaling.

The HIV-1 LTR is regulated by multiple signaling pathways responsive to T cell activation. In this study, we have examined the contribution of the MAPK, calcineurin-NFAT and TNFalpha-NF-kappaB pathways on induction of chromosomally integrated HIV-1 LTR reporter genes. We find that induction by T-cell receptor (CD3) cross-linking and PMA is completely dependent upon a binding site for RBF-2 (USF1/2-TFII-I), known as RBEIII at -120. The MAPK pathway is essential for induction of the wild type LTR by these treatments, as the MEK inhibitors PD98059 and U0126 block induction by both PMA treatment and CD3 cross-linking. Stimulation of cells with ionomycin on its own has no effect on the integrated LTR, indicating that calcineurin-NFAT is incapable of causing induction in the absence of additional signals, but stimulation with both PMA and ionomycin produces a synergistic response. In contrast, stimulation of NF-kappaB by treatment with TNFalpha causes induction of both the wild type and RBEIII mutant LTRs, an effect that is independent of MAPK signaling. USF1, USF2 and TFII-I from unstimulated cells are capable of binding RBEIII in vitro, and furthermore can be observed on the LTR in vivo by chromatin imunoprecipitation from untreated cells. DNA binding activity of USF1/2 is marginally stimulated by PMA/ ionomycin treatment, and all three factors appear to remain associated with the LTR throughout the course of induction. These results implicate major roles for the MAPK pathway and RBF-2 (USF1/2-TFII-I) in coordinating events necessary for transition of latent integrated HIV-1 to active transcription in response to T cell signaling.

Using local health information to promote public health.

Local health information can be a powerful vehicle for improving the health of a community. It can highlight both the existence of problems and opportunities for improvement. It can also guide local action in support of policy changes and improve programs' effectiveness. However, efforts to expand the availability and use of local health information face major technical and institutional barriers, as well as health information privacy concerns. This paper provides an overview of current issues surrounding the availability and use of local health information, identifies barriers that hinder its use, and suggests potential solutions.

The multistate learning collaborative, states as laboratories: informing the national public health accreditation dialogue.

The Multistate Learning Collaborative on Performance and Capacity Assessment or Accreditation of Public Health Departments (MLC) is an initiative undertaken with the Exploring Accreditation Project (EAP). The EAP is jointly funded by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC), and staffed collaboratively by the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO) to explore the implications and feasibility of a national public health accreditation system. The MLC, also financially supported through grants from RWJF, is designed under the auspices of the National Network of Public Health Institutes (NNPHI) and the Public Health Leadership Society (PHLS) to enhance the accreditation/assessment activities already underway in each of the grantee states; to promote learning among the states participating in the collaborative; to disseminate information to state and local health departments nationally; and to inform the work of the EAP. Five states with mature accreditation or assessment programs were selected from among 18 applicants. This article describes the ongoing work, including breakthroughs and challenges, in these natural "laboratories" so that this information may be a resource for other states as well as nationally.

Academic health departments: from theory to practice.

In August of 2003, 23 institutions submitted proposals to build closer ties between state and local public health departments and schools of public health in response to a solicitation from the Association of Schools of Public Health supported by the Centers for Disease Control and Prevention. This article describes the strategies proposed to build collaboration between public health academia and practice. Qualitative analysis discerned five principal approaches: the development of comprehensive planning processes; reform of the way practica are planned and implemented; the identification and nurturing of boundary-spanning individuals in academia and health agencies; the fostering of new approaches to joint research; and workforce development programs. Major themes that emerged included the importance of achieving a balance of power between academic and health department partners; the need to address cultural differences between institutions; a conviction that efforts at institutional change require both strong leadership and the cultivation of boundary spanners farther down the chain of command; and the idea that prospects for success may be improved if faculty and practitioners have tangible incentives to collaborate.

Accuracy of early diagnosis and its impact on the management and course of Alzheimer's disease.

Alzheimer's disease is the most common form of dementia in the elderly and its prevalence is rapidly rising. Although there is no cure for Alzheimer's disease, treatment can be administered to slow progression or delay the onset of symptoms. A major challenge is the early identification of patients who will develop Alzheimer's disease. As disease-modifying treatments become available, enhancing our ability to identify Alzheimer's early and accurately would allow intervention to slow, halt or even prevent disease progression or onset. Early recognition and intervention facilitates optimal care of Alzheimer's patients and delays the morbidity associated with this progressive illness.

Prognostic value of regional cerebral metabolism in patients undergoing dementia evaluation: comparison to a quantifying parameter of subsequent cognitive performance and to prognostic assessment without PET.

It is difficult to accurately forecast the clinical course of many patients presenting with mild cognitive problems. The utility in prognostic evaluation of various parameters of brain structure and function that can now be noninvasively measured remains to be clearly defined. The present work examined the value of regional cerebral metabolism, assessed with positron emission tomography (PET) and [(18)F]fluoro-2-deoxyglucose, in this context. PET scans of 167 patients (mean Mini-Mental State Examination (MMSE)=24 of 30 possible points) were classified as being positive or negative for evidence of progressive dementia. Results of scans were compared to patients' subsequent clinical course in general and in particular, to their changes in MMSE scores, for up to 10 years following PET. Data were further stratified according to the predictions of referring physicians based upon clinical assessments that had been performed up until the time of PET. Among those patients for whom a progressive dementing course had been predicted by PET criteria (but not those who were predicted by PET criteria to remain stable) a significant decline in general cognitive performance and MMSE scores occurred in the period following PET. Among those patients predicted by clinical criteria to have a progressive dementing illness, 94% of those with positive PET scans did suffer a progressive decline, while only 25% of those with negative scans progressed (relative risk 3.8). Similarly, among those patients who had been predicted by clinical criteria to remain cognitively stable, 74% of those with positive PET scans nevertheless suffered progressive decline, compared with 4% of those with negative PET scans (relative risk 18.4). These data indicate that evaluation of brain metabolism by PET in appropriately selected patients may improve the accuracy of clinical prognostic assessment.