Interviewing Key Informants: Strategic Planning for a Global Public Health Management Program

The Centers for Disease Control and Prevention’s Sustainable Management Development Program (SMDP) partners with low - and middle - resource countries to develop management capacity so that effective global public health programs can be implemented and better health outcomes can be achieved. The program’s impact however, was variable. Hence, there was a need to both engage in a strategic planning process and collect useful data to inform the process. We therefore designed a qualitative evaluation and findings that emerged concerning o ur program’s contribution to individual career advancement and professional growth; the need for institutional support and a champion to move public health management capacity development efforts forward in low - and middle - resource countries; and interest in diverse professional learning opportunities contributed to program improvement and suggested new strategic directions for CDC’s global public health management service delivery. Our inquiry provides a concrete example of how qualitative methods, specifically key informant interviews, can provide useful data for strategic planning within public health settings. It may be useful to readers who are interested in conducting strategic planning within public health and other related areas including health care, mental and behavioral health, and the social sciences

Evaluating Application of Knowledge and Skills: The Use of Consensus Expert Review to Assess Conference Abstracts of Field Epidemiology Training Participants

Background: Often evaluations of training programs are limited — with many focusing on the aspects that are easy to measure (e.g., reaction of trainees) without addressing the important outcomes of training, such as how trainees applied their new knowledge, skills, and attitudes. Numerous evaluations fail to measure training’s effect on job performance because few effective methods are available to do so. Particularly difficult is the problem of evaluating multisite training programs that vary considerably in structure and implementation from one site to another. Purpose: NA Setting: NA  Intervention: NA Research Design: We devised a method of a consensus expert review to evaluate the quality of conference abstracts submitted by participants in Field Epidemiology Training Programs – an approach that can provide useful information on how well trainees apply knowledge and skills gained in training, complementing data obtained from other sources and methods. This method is practical, minimally intrusive, and resource-efficient, and it may prove useful for evaluation practice in diverse fields that require training. Data Collection and Analysis: NA Findings: NA

Application of Confocal Laser Scanning Microscopy to Cytocompatibility Testing of Potential Orthopaedic Materials in Immortalised Osteoblast-Like Cell Lines

Confocal laser scanning microscopy (CLSM) was used in conjunction with in vitro cell culture to investigate cellular interactions with orthopaedic biomaterials. Transfected rat and human osteoblasts were seeded on two potential isoelastic hip prosthesis materials, carbon fibre reinforced polyetheretherketone (PEEK) and epoxy. Titanium 318 alloy was employed as a control. Determination of the material surface contour, an important factor influencing cellular adhesion, proliferation and function, was performed using the industry standard Talysurf® and compared to analogous results obtained using the CLSM. The latter technique consistently gave higher values of material roughness but offers the advantage that it can be used to correlate roughness with cell distribution on the same samples, whereas Talysurf® measurement of roughness requires clean rigid samples. Image analysis and processing, performed on cells after attachment and culture on the materials for 48 hours, provided cell morphology data. Cells cultured on titanium were larger, with a higher percentage of cytoplasm, than those grown on either of the other materials. The macroscopic surface of epoxy resulted in smaller cells with altered morphology, which orientated themselves along carbon fibres. In conclusion, we believe CLSM offers great potential for investigating the cellular interactions of biomaterials involving minimal sample preparation, non-invasive optical sectioning of samples and minimal opportunity for generation of cellular deformation and sample preparation artefacts

What do we know about how the Program Evaluation Standards are used in public health?

Background: Released by the Centers for Disease Control and Prevention (CDC), Framework for Program Evaluation in Public Health prominently features the program evaluation standards (1999). The program evaluation standards (PES) include 30 statements in five domains: utility, feasibility, propriety, accuracy, and evaluation accountability. Despite decades of attention to the PES among framework users and others, how public health professionals apply these standards in their work is not well understood. Purpose: The study sought to identify notable commonalities in how the PES are used in public health. Setting: Application of the PES in evaluative work in public health and allied fields. Intervention: Not applicable. Research Design:  The study included a search of subscription and nonsubscription sources to identify documents that included explicit content concerning use of standards in evaluative work in public health. Documents identified were screened using predetermined criteria to include or exclude each item in the study. Items included were reviewed and coded using codes developed before examining all documents. For each code, reviewers discussed data from all documents to identify commonalities and variations in application of standards. Findings: The literature search returned 405 documents to be screened (179 from subscription and 226 from nonsubscription sources). Thirty-eight items were included in the study based on initial screening (11 from subscription and 27 from nonsubscription sources). The study revealed that authors discussed standards as a regular component of evaluation work, but precisely how standards were used was not always explained in detail. Also, authors did not always discuss standards statements but sometimes solely focused on general domains (e.g., feasibility or accuracy). When authors discussed specific statements, they were more descriptive in how they applied the PES (i.e., compared with articles that focused on general domains). Overall, authors placed far greater emphasis on Accuracy and Utility standards, compared with Propriety, Evaluation Accountability, or Feasibility. In many cases, authors used the PES in combination with other resources (e.g., checklists, guidelines, or other standards). Although program evaluation is crucial to public health practice, the mechanics of how professionals consider, integrate, or use evaluation standards is not fully understood. Keywords: program evaluation; program evaluation standards; public healt

Process Evaluation to Document Crucial Moments in Development of the National Neurological Conditions Surveillance System at the U.S. Centers for Disease Control and Prevention

Background: Neurological conditions or disorders strike roughly 50 million Americans annually but accurate and comprehensive national estimates for many of these conditions are not available. In 2019, Congress provided $5 million to Centers for Disease Control and Prevention (CDC) to establish the National Neurological Conditions Surveillance System (NNCSS). CDC focused initial activities on multiple sclerosis and Parkinson’s disease. Purpose: We conducted a process evaluation to document and understand multifaceted work to implement a new surveillance activity for two neurological conditions. Setting: We conducted this evaluation with government personnel internal to the Center for Surveillance, Epidemiology, and Laboratory Services at the Centers for Disease Control and Prevention in Atlanta, GA. Intervention: A new public health surveillance activity for two neurological conditions, multiple sclerosis and Parkinson’s disease, that uses existing data resources and systems. Research design: The evaluation included interviews with CDC personnel and review of administrative and programmatic information. Data were analyzed and interpreted to identify crucial moments in the first year of funded work on NNCSS. The study revealed that this surveillance activity required diverse contributions and collaboration within the federal government and with non-governmental organizations. The findings can be used to guide work to enhance surveillance for many neurological conditions. Findings: The study revealed that this surveillance activity required diverse contributions and collaboration within the federal government and with non-governmental organizations. While collaboration is a cornerstone of public health practice, it is not always well-documented in planning or implementation of surveillance or other data-related activities. Keywords: program evaluation; surveillance; neurological conditions; neurological disorders; multiple sclerosis; Parkinson’s disease

Native New Zealand plants with inhibitory activity towards Mycobacterium tuberculosis

<p>Abstract</p> <p>Background</p> <p>Plants have long been investigated as a source of antibiotics and other bioactives for the treatment of human disease. New Zealand contains a diverse and unique flora, however, few of its endemic plants have been used to treat tuberculosis. One plant, <it>Laurelia novae-zelandiae</it>, was reportedly used by indigenous Maori for the treatment of tubercular lesions.</p> <p>Methods</p> <p><it>Laurelia novae-zelandiae </it>and 44 other native plants were tested for direct anti-bacterial activity. Plants were extracted with different solvents and extracts screened for inhibition of the surrogate species, <it>Mycobacterium smegmatis</it>. Active plant samples were then tested for bacteriostatic activity towards <it>M. tuberculosis </it>and other clinically-important species.</p> <p>Results</p> <p>Extracts of six native plants were active against <it>M. smegmatis</it>. Many of these were also inhibitory towards <it>M. tuberculosis </it>including <it>Laurelia novae-zelandiae </it>(Pukatea). <it>M. excelsa </it>(Pohutukawa) was the only plant extract tested that was active against <it>Staphylococcus aureus</it>.</p> <p>Conclusions</p> <p>Our data provide support for the traditional use of Pukatea in treating tuberculosis. In addition, our analyses indicate that other native plant species possess antibiotic activity.</p

Urine tests for Down's syndrome screening

Background Down's syndrome occurs when a person has three copies of chromosome 21, or the specific area of chromosome 21 implicated in causing Down's syndrome, rather than two. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life. The risk of a Down's syndrome affected pregnancy increases with advancing maternal age. Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive and false negative screening tests (i.e. invasive diagnostic testing, and the possibility that a miscarried fetus may be chromosomally normal). The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down's syndrome will have. Objectives To estimate and compare the accuracy of first and second trimester urine markers for the detection of Down's syndrome. Search methods We carried out a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), EMBASE (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2011, Issue 7), MEDION (25 August 2011), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), The National Research Register (archived 2007), Health Services Research Projects in Progress database (25 August 2011). We studied reference lists and published review articles. Selection criteria Studies evaluating tests of maternal urine in women up to 24 weeks of gestation for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection. Data collection and analysis We extracted data as test positive or test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. We used hierarchical summary ROC (receiver operating characteristic) meta-analytical methods to analyse test performance and compare test accuracy. We performed analysis of studies allowing direct comparison between tests. We investigated the impact of maternal age on test performance in subgroup analyses. Main results We included 19 studies involving 18,013 pregnancies (including 527 with Down's syndrome). Studies were generally of high quality, although differential verification was common with invasive testing of only high-risk pregnancies. Twenty-four test combinations were evaluated formed from combinations of the following seven different markers with and without maternal age: AFP (alpha-fetoprotein), ITA (invasive trophoblast antigen), ß-core fragment, free ßhCG (beta human chorionic gonadotrophin), total hCG, oestriol, gonadotropin peptide and various marker ratios. The strategies evaluated included three double tests and seven single tests in combination with maternal age, and one triple test, two double tests and 11 single tests without maternal age. Twelve of the 19 studies only evaluated the performance of a single test strategy while the remaining seven evaluated at least two test strategies. Two marker combinations were evaluated in more than four studies; second trimester ß-core fragment (six studies), and second trimester ß-core fragment with maternal age (five studies). In direct test comparisons, for a 5% false positive rate (FPR), the diagnostic accuracy of the double marker second trimester ß-core fragment and oestriol with maternal age test combination was significantly better (ratio of diagnostic odds ratio (RDOR): 2.2 (95% confidence interval (CI) 1.1 to 4.5), P = 0.02) (summary sensitivity of 73% (CI 57 to 85) at a cut-point of 5% FPR) than that of the single marker test strategy of second trimester ß-core fragment and maternal age (summary sensitivity of 56% (CI 45 to 66) at a cut-point of 5% FPR), but was not significantly better (RDOR: 1.5 (0.8 to 2.8), P = 0.21) than that of the second trimester ß-core fragment to oestriol ratio and maternal age test strategy (summary sensitivity of 71% (CI 51 to 86) at a cut-point of 5% FPR). Authors' conclusions Tests involving second trimester ß-core fragment and oestriol with maternal age are significantly more sensitive than the single marker second trimester ß-core fragment and maternal age, however, there were few studies. There is a paucity of evidence available to support the use of urine testing for Down's syndrome screening in clinical practice where alternatives are available