Declining Trends in Local Health Department Preparedness Capacities

Objectives. We examined local health department (LHD) preparedness capacities in the context of participation in accreditation and other performance improvement efforts. Methods. We analyzed preparedness in 8 domains among LHDs responding to a preparedness capacity instrument from 2010 through 2012. Study groups included LHDs that (1) were exposed to a North Carolina state-based accreditation program, (2) participated in 1 or more performance improvement programs, and (3) had not participated in any performance improvement programs. We analyzed mean domain preparedness scores and applied a series of nonparametric Mann–Whitney Wilcoxon tests to determine whether preparedness domain scores differed significantly between study groups from 2010 to 2012. Results. Preparedness capacity scores fluctuated and decreased significantly for all study groups for 2 domains: surveillance and investigation and legal preparedness. Significant decreases also occurred among participants for plans and protocols, communication, and incident command. Declines in capacity scores were not as great and less likely to be significant among North Carolina LHDs. Conclusions. Decreases in preparedness capacities over the 3 survey years may reflect multiple years of funding cuts and job losses, specifically for preparedness. An accreditation program may have a protective effect against such contextual factors

Temporal Trends in Local Public Health Preparedness Capacity

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding

Measuring Changes in Local Surveillance and Investigation Capacity

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events

Building the Evidence for Decision-Making: The Relationship Between Local Public Health Capacity and Community Mortality

Objectives. We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. Methods. We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. Results. Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children’s services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). Conclusions. Our findings, in the context of other studies, provide support for investment in local public health services to improve community health

Testing the Hypothesis that Methanol Maser Rings Trace Circumstellar Disks: High Resolution Near-IR and Mid-IR Imaging

Milliarcsecond VLBI maps of regions containing 6.7 GHz methanol maser emission have lead to the recent discovery of ring-like distributions of maser spots and the plausible hypothesis that they may be tracing circumstellar disks around forming high mass stars. We aimed to test this hypothesis by imaging these regions in the near and mid-infrared at high spatial resolution and compare the observed emission to the expected infrared morphologies as inferred from the geometries of the maser rings. In the near infrared we used the Gemini North adaptive optics system of Altair/NIRI, while in the mid-infrared we used the combination of the Gemini South instrument T-ReCS and super-resolution techniques. Resultant images had a resolution of approximately 150 mas in both the near-infrared and mid-infrared. We discuss the expected distribution of circumstellar material around young and massive accreting (proto)stars and what infrared emission geometries would be expected for the different maser ring orientations under the assumption that the masers are coming from within circumstellar disks. Based upon the observed infrared emission geometries for the four targets in our sample and the results of SED modeling of the massive young stellar objects associated with the maser rings, we do not find compelling evidence in support of the hypothesis that methanol masers rings reside in circumstellar disks.Comment: 20 pages, 7 figures, accepted for publication by ApJ; article with full-resolution figures can be downloaded at http://www.jim-debuizer.ne

Engaging in Collaboration: Piloting an Interprofessional Population Health Course in a School of Public Health

In 2015 The Gillings School of Global Public Health engaged in an interprofessional collaboration across health affairs schools (medicine, nursing, social work, pharmacy) at the University of North Carolina at Chapel Hill to develop and implement an interprofessional graduate-level course on population health. This presentation will describe course development and implementation and describe case-based team building opportunities built into the didactic portion of the hybrid online/face-to-face course which was piloted with more than 20 students in the Fall of 2015. The presentation will also describe accompanying project-based activities at community clinical sites where students collaborated with primary care providers in quality improvement activities. Evaluation data from the pilot course will also be discussed

Effects of Performance Improvement Programs on Preparedness Capacities

In response to public health systems and services research priorities, we examined the extent to which participation in accreditation and performance improvement programs can be expected to enhance preparedness capacities

Measuring Changes in Local Surveillance and Investigation Capacity

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events

Temporal Trends in Preparedness Capacity

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding