Public health efforts to build a surveillance system for child maltreatment mortality: lessons learned for stakeholder engagement.

CONTEXT: Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts. OBJECTIVE: We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance. DESIGN: Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance. PARTICIPANTS: Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states. RESULTS: Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non-public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement. CONCLUSIONS: The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders.

Cultural context in the effort to improve oral health among Alaska Native people: the dental health aide therapist model.

The Alaska Native people in rural Alaska face serious challenges in obtaining dental care. Itinerant care models have failed to meet their needs for more than 50 years. The dental health aide therapist (DHAT) model, which entails training midlevel care providers to perform limited restorative, surgical, and preventive procedures, was adopted to address some of the limitations of the itinerant model. We used quantitative and qualitative methods to assess residents' satisfaction with the model and the role of DHATs in the cultural context in which they operate. Our findings suggest that the DHAT model can provide much-needed access to urgent care and is beneficial from a comprehensive cultural perspective.

Clinical technical performance of dental therapists in Alaska.

BACKGROUND: The Alaska Dental Health Aide Therapist program has matured to the point that therapists have been in practice for up to four years. METHODS: A case-study evaluation of the program included assessments of the clinical technical performance of five of these therapists practicing in clinics in small Alaskan villages and towns. RESULTS: The results indicate that therapists are performing at an acceptable level, with short-term restorative outcomes comparable with those of dentists treating the same populations. CONCLUSIONS: Therapists' performance when operating within their scope of practice suggested no reason for continued close scrutiny. Further evaluations of therapists should shift their principal focus from clinical technical performance of therapists to effectiveness of the therapist program in improving the targeted population's oral health. CLINICAL IMPLICATIONS: Therapists are capable of providing acceptable restorative treatment under indirect supervision.

Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research.

In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.

Defining and applying a method for improving the sensitivity and specificity of an emergency department early event detection system.

The sensitivity and specificity of syndrome definitions used in early event detection (EED) systems affect the usefulness of the system for end-users. The ability to calculate these values aids system designers in the refinement of syndrome definitions to better meet public health needs. Utilizing a stratified sampling method and expert review to create a gold standard dataset for the calculation of sensitivity and specificity, we describe how varying syndrome structure impacts these statistical parameters and discuss the relevance of this to outbreak detection and investigation.

Incorporating community mental health into local bioterrorism response planning: experiences from the DeKalb County Board of Health.

Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.

Pre-event willingness to receive smallpox vaccine among physicians and public safety personnel.

BACKGROUND: Planning for voluntary smallpox vaccination of health and safety officials began in December 2002. MATERIALS AND METHODS: Surveys were conducted among physicians and fire and police department personnel in Atlanta, Georgia. Information on demographics, willingness to receive smallpox vaccine, self-reported knowledge level, and potential vaccine contraindications was analyzed. RESULTS: Forty-one percent of physicians (n = 199) were undecided on vaccination (32% would receive vaccine and 27% would not). Forty-eight percent of firefighters (n = 343) and 41% of police (n = 466) were undecided; 23% and 41% would receive vaccine, whereas 28% and 18% would not (fire and police, respectively). Absence of contraindications was associated with physicians' willingness to be vaccinated (P = 0.006). Many physicians (66%) and most public safety personnel (88%) considered themselves inadequately informed on smallpox vaccine. In a multivariate analysis, inadequately informed respondents were more likely to be undecided (OR = 2.23, CI = 1.39 to 3.56). CONCLUSIONS: Before implementation of the smallpox vaccination program, self-assessed knowledge about smallpox disease and vaccine were poor.

Development of an interactive bioterrorism and emerging infections curriculum for medical students and internal medicine residents.

While awareness of bioterrorism threats and emerging infectious diseases has resulted in an increased sense of urgency to improve the knowledge base and response capability of physicians, few medical schools and residency programs have curricula in place to teach these concepts. Public health agencies are an essential component of a response to these types of emergencies. Public health education during medical school is usually limited to the non-clinical years. With collaboration from our local public health agency, the Emory University School of Medicine developed a curriculum in bioterrorism and emerging infections. By implementing this curriculum in the clinical years of medical school and residency programs, we seek to foster improved interactions between clinicians and their local public health agencies.

The recording of demographic information on death certificates: a national survey of funeral directors.

OBJECTIVE: The authors sought to ascertain the methods used by funeral directors to determine the demographic information recorded on death certificates. METHODS: Standardized questionnaires were administered to funeral directors in five urban locations in the U.S. In addition, personnel on four Indian reservations were interviewed. Study sites were selected for diverse racial/ethnic populations and variability in recording practices; funeral homes were selected by stratified random sampling. RESULTS: Fifty-two percent of responding funeral directors reported receiving no formal training in death certification. Seventy-nine percent of respondents reported finding certain demographic items difficult to complete--26% first specified race as the problematic item, and 25% first specified education. The decedent's race was "sometimes" or "often" determined through personal knowledge of the family by 58% of respondents; 43% reported "sometimes" or "often" determining race by observation. Only three respondents reported that occupation was a problematic item. CONCLUSIONS: The authors recommend that the importance of demographic data and the instructions for data collection be clarified for funeral directors, that standard data collection worksheets be developed, and that training videos be developed.

Vigilancia y epidemiología / Vigilance and Epidemiology

Se hace una relación entre la vigilancia en salud pública (VSP) y la epidemiología. La vigilancia en salud pública es vista como herramienta para identificar los problemas en un área determinada, establecer las prioridades para quienes toman decisiones y evaluar la efectividad de las actividades realizadas. Se encuentran definiciones de la VSP y su uso en la planeación, implementación y evaluación de los programas de salud pública. Incluye información sobre el ciclo de la vigilancia en salud pública, las características de los métodos de recolección de datos en escenarios de desastre y los pasos en la planificación del sistema de vigilancia. Se refiere también a los problemas metodológicos como la evaluación y la vigilancia post-desastre e incluye ejemplos seleccionados de estrategias y métodos que incluyen la planificación, la evaluación epidemiológica rápida, vigilancia activa que usa servicios médicos existentes y temporales, vigilancia centinela, investigación de rumores, investigaciones por conglomerados para estimar las necesidades de los servicios de salud. Finalmente incluye recomendaciones para mejorar la eficiencia de la VSP en todas las fases del desastre

Vigilancia y epidemiología / Vigilance and Epidemiology

Se hace una relación entre la vigilancia en salud pública (VSP) y la epidemiología. La vigilancia en salud pública es vista como herramienta para identificar los problemas en un área determinada, establecer las prioridades para quienes toman decisiones y evaluar la efectividad de las actividades realizadas. Se encuentran definiciones de la VSP y su uso en la planeación, implementación y evaluación de los programas de salud pública. Incluye información sobre el ciclo de la vigilancia en salud pública, las características de los métodos de recolección de datos en escenarios de desastre y los pasos en la planificación del sistema de vigilancia. Se refiere también a los problemas metodológicos como la evaluación y la vigilancia post-desastre e incluye ejemplos seleccionados de estrategias y métodos que incluyen la planificación, la evaluación epidemiológica rápida, vigilancia activa que usa servicios médicos existentes y temporales, vigilancia centinela, investigación de rumores, investigaciones por conglomerados para estimar las necesidades de los servicios de salud. Finalmente incluye recomendaciones para mejorar la eficiencia de la VSP en todas las fases del desastre