We Can Have It All: Improved Surveillance Outcomes and Decreased Personnel Costs Associated With Electronic Reportable Disease Surveillance, North Carolina, 2010

Objectives. We assessed the timeliness, accuracy, and cost of a new electronic disease surveillance system at the local health department level. We describe practices associated with lower cost and better surveillance timeliness and accuracy. Methods. Interviews conducted May through August 2010 with local health department (LHD) staff at a simple random sample of 30 of 100 North Carolina counties provided information on surveillance practices and costs; we used surveillance system data to calculate timeliness and accuracy. We identified LHDs with best timeliness and accuracy and used these categories to compare surveillance practices and costs. Results. Local health departments in the top tertiles for surveillance timeliness and accuracy had a lower cost per case reported than LHDs with lower timeliness and accuracy ($71 and$124 per case reported, respectively; P = .03). Best surveillance practices fell into 2 domains: efficient use of the electronic surveillance system and use of surveillance data for local evaluation and program management. Conclusions. Timely and accurate surveillance can be achieved in the setting of restricted funding experienced by many LHDs. Adopting best surveillance practices may improve both efficiency and public health outcomes

Life, Life Support, and Death Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life

The following is the third edition of a booklet by the American Life League, Inc. The section on Ordinary/Extraordinary Means has been revised. The sections on Quality of Life, Pain, Paired Organ and Non-vital Organ and Tissue Transplant, and Determination of Death have been added. There are other changes throughout the booklet

Improvements in Timeliness Resulting from Implementation of Electronic Laboratory Reporting and an Electronic Disease Surveillance System

Electronic laboratory reporting (ELR) reduces the time between communicable disease diagnosis and case reporting to local health departments (LHDs). However, it also imposes burdens on public health agencies, such as increases in the number of unique and duplicate case reports. We assessed how ELR affects the timeliness and accuracy of case report processing within public health agencies

Relative validity and reliability of a food frequency questionnaire in youth with type 1 diabetes

To evaluate the relative validity and reliability of the SEARCH food frequency questionnaire (FFQ) that was modified from the Block Kids Questionnaire

A Life in Letters: Personal Essays

By formatting my dissertation as a series of letters to famous writers, artists, and musicians, I have attempted to establish an intimate, detailed connection between my life story and the words of the artists I am addressing. At the same time, I aimed to stray from their stories and see where my own musings about their lives would take me, to what parts of the past and not-so-distant past their words could transport me. While the dissertaion I have written is essayistic in nature, a case could be made that it is a kind of memoir, because of its somewhat autobiographical arc, its episodic reflections that hinge on traditional literary forms. As for forms, I turned to the letter as my medium for conveying past experience, because I wished to enter into a conversation with sages and fools of old. Dialogue, then, became a key component of these personal essays. My goal was to make the art of letter writing new again, to draw on the rich tradition of correspondence ranging from Pauline letters to Seneca's letter to his wife, and the host of letters borne of the lives of great artists like Jane Austen, Ezra Pound, John Keats, and many others

Adapting Syndromic Surveillance Systems to Increase Value to Local Health Departments

As syndromic surveillance systems continue to evolve, they are being tailored for a broader set of users. In North Carolina, changes designed to facilitate efficient access for small public health agencies have been implemented to the syndromic surveillance system NC DETECT. We will describe these changes and use of syndromic surveillance information at local health departments in North Carolina prior to and following changes to North Carolina's syndromic surveillance system

Adapting Syndromic Surveillance Systems to Increase Value to Local Health Departments

OBJECTIVE: Our objective was to describe changes in use following syndromic surveillance system modifications and assess the effectiveness of these modifications. INTRODUCTION: Syndromic surveillance systems offer richer understanding of population health. However, because of their complexity, they are less used at small public health agencies, such as many local health departments (LHDs). The evolution of these systems has included modifying user interfaces for more efficient and effective use at the local level. The North Carolina Preparedness and Emergency Response Research Center previously evaluated use of syndromic surveillance information at LHDs in North Carolina. Since this time, both the NC DETECT system and distribution of syndromic surveillance information by the state public health agency have changed. This work describes use following these changes. METHODS: Data from NC DETECT were used to assess the number of users and usage time. Staff from 14 NC LHDs in 2009 and from 39 LHDs in 2012 were surveyed (May–August of 2009 and June of 2012) to gather information on the mode of access to syndromic surveillance information and how this information was used. Data were analyzed to assess the link between the mode of access and use of syndromic surveillance data. RESULTS: System changes made between 2009 and 2012 included the creation of “dashboards” (Figure 1) which present users with LHD-specific charts and graphs upon login and increases in the distribution of syndromic surveillance information by the state public health agency. The number of LHD-based NC DETECT system users increased from 99 in 2009 to 175 in 2012. Sixty-two of 72 respondents completed the 2012 survey (86%). Syndromic surveillance information was used in 28/40 LHDs (70%) for key public health tasks. Among 20 NC EDSS leads reporting an outbreak in the past year, 25% reported using data from NC DETECT for outbreak response, compared to 23% in 2009 (Figure 2). Among 30 responding NC EDSS leads, 57% reported using data from NC DETECT to respond to seasonal events such as heat-related illness or influenza, compared to 46% in 2009. NC DETECT data were reported to have been used for program management by 30% (compared to 25% in 2009), and to have been used in reports by 33% (compared to 23% in 2009). CONCLUSIONS: Changes in how syndromic surveillance information was distributed supported modest increases in use in LHDs. Because use of syndromic surveillance data at smaller LHDs is rare, these modest increases are important indicators of effective modification of the NC syndromic surveillance system