Posts Tagged ‘epidemiology’

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Making a Public Health Difference

November 20th, 2012

In public health, we don’t gather data just for the sake of gathering data.  Our goal is use that data to see what kind of issues there are, look for programs that are proven to reduce bad outcomes and help the communities implement them. One key area we watch is Maternal and Child Health because making changes in that can help improve the health of the next generation.  But like all important professions, we need more people working in the field. 

That’s where the U of A’s Mel and Enid Zuckerman College of Public Health Graduate Certificate program in Maternal & Child Health Epidemiology comes in. What’s even better is that federal funds will provide 10-15 scholarships to professionals working with American Indian and underserved communities nationally.  The scholarships (valued at over $11K) will be awarded for the 2013-14 school year, but you can apply now. The deadline is March 1, 2013.

 

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Introducing Our New Licensing Director & Agency CMO

August 22nd, 2012

Please join me in welcoming Cara Christ, MD as our new Division of Licensing Services chief.  Cara has agreed to share her talents as the new Assistant Director for Licensing as well as serving as the Agency Chief Medical Officer.  Also, thanks a million to Colby Bower who’s been doing an excellent job serving as interim director for licensing since Alan passed away. 

Cara started her public health quest about a dozen years ago when she worked in our infectious disease epidemiology shop.  While there, she developed a passion for both medicine and epidemiology- so she left to study medicine with a goal of working as a CDC disease detective.  I can remember being disappointed when we lost her to medical school 10 years ago  but alas, she returned to us after graduating- and she’s been working in our Bureau of Epidemiology and Disease Control (EDC) for the last few years…  most recently serving as the EDC Bureau Chief (one of my old jobs). 

I think Cara will be perfect for this job- bringing value added from her solid leadership and management style to her eye for public health “leverage points”- and most of all her passion for improving outcomes and using public health principles to change lives and communities.  Our Licensing Division is perhaps our greatest leverage point for achieving these elements of our strategic map. 

Cara will also be providing Agency leadership in her new role as the ADHS Chief Medical Officer.  Dr. Nelson has been serving in the Agency CMO role for the last couple of years- doing an excellent job.  I’m certain that we can count on Cara to continue to carry that torch effectively for Arizona. 

Thanks!

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ADHS’ Disease Detectives

July 25th, 2012

Awhile back, our epidemiology and licensing team of disease detectives including Jason Lempp, Cara Christ, Vinita Oberoi, Jessica Rigler, Ken Komatsu, Kathy McCanna, Connie Belden, Ken Komatsu, and Shoana Anderson learned of a severe case of a Methicillin-resistant Staphylococcus aureus  (MRSA) through our 24-hour disease reporting system.  Our team quickly contacted the county public health department which immediately began an investigation into the cause.  

Their investigation quickly uncovered more people with the infection who had been seen the same day.  The detectives also found that a single-dose vial of solution used for pain meds was diluted and used for more than one patient.  Medication shortages often push health-care providers to search for solutions to provide comparable care using limited supplies- which is what looks like happened in this case.  

Our work with the county led to an improvement in the clinic’s practices through discontinued use of mixed products; appropriate use of single dose vials; using personal protective equipment, such as face masks, during medication preparation and injections procedures; education of all staff on infection control practices; and the development of a plan to report further suspected infections.  This Arizona investigation was written up in this week’s CDC Feature Article and has added to the national picture on injection safety best practices. 

Note: Health-care-associated infections (HAI) affect nearly 100,000 people every year and result in over $30B in unnecessary health-care costs (HHS).  Our HAI Program works with partners across the state to rapidly identify and help prevent these infections. Traditionally, the focus of preventing HAIs has been in hospital settings, but more and more people are being identified outside of hospital settings.  They can happen at any health-care facility, but simple steps can help protect patients.

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Influenza Wave Coming Ashore

March 9th, 2012

It took longer than usual- but Influenza is finally circulating in AZ- and we’ve moved to the “Regional” flu category now (Regional is sort of the middle of the scale).  The circulating strains in AZ (confirmed by our lab) are covered by this year’s vaccine- mostly our old friend the 2009 H1N1 virus and the familiar H3N2 virus.  The “Epi Curve” suggests that there’s more to come- with a peak in March.  Check out the most recent surveillance report for more info.  Meanwhile, the number of cases of Respiratory Syncytial Virus are still increasing- but that one looks like it’s closer to the annual peak.  Here’s this week’s RSV Report.

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Valley Fever Week

November 4th, 2011

This is Valley Fever Awareness Week- an annual event to provide awareness  of coccidioidomycosis (also known as Valley Fever)- the second most commonly reported infectious disease in Arizona.  Events for the general public include a “Learn about Valley Fever – Ask the Doctor Your Questions” held in Tucson on Sunday, Nov. 6 and the Walk for Valley Fever in Sun City West on Sunday, Nov. 6.  Healthcare providers can receive continuing medical education in Tucson on Saturday, Nov. 5:  “Coccidioidomycosis for the PCP” and “Advanced Clinical Aspects of Coccidioidomycosis”.  To find out more about valley fever awareness week events visit: http://www.vfce.arizona.edu/

Our epidemiology staff work closely with the Valley Fever Center for Excellence to promote education and awareness.  The Center is based at the U of A and will be opening a center in Phoenix in January.  Check out our home-grown video that’s designed help people understand the disease and how to talk to their doctors about it. To read more about valley fever and what has been done during past valley fever awareness weeks, please visit my blog.  I also wrote a piece about the effects that the large dust storms may have on valley fever, which by the way, we’re still investigating…

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Contagion

September 9th, 2011

In all my years in public health this is the first crack I’ve taken at being a movie critic- so give me a little slack on this one.  I checked out the new movie called Contagion- and really liked it. I won’t give up too much information and spoil the film, but it’s basically a fictional drama that portrays CDC and other public health folks responding to a new disease outbreak that ends up causing a pandemic.  While I thought some of the human behavior and public policy decisions in the film were over the top- I was pleasantly surprised that the Director made good efforts to capture the essence of epidemiology, surveillance and disease control, public health interventions, and laboratory science and how they fit together as part of a public health response.

Ok, so you might wonder as you leave the theater- “Could this really happen?”  The answer is “yes” and it kind of already has.  The 2002-03 Severe Acute Respiratory Syndrome (SARS) epidemic was remarkably similar to the core of what happens in Contagion.  SARS- which was a easily transmitted and had a case-fatality rate of more than 10% – rapidly spread from Hong Kong to 37 countries.  Fortunately, a robust international public health response that included effective public health interventions was able to prevent the virus from becoming a devastating global pandemic.

Public health from around the world worked to identify and isolate the virus and good and swift public health interventions were able to limit the spread of the disease.  Because of the quick and robust initial public health response it was fully contained – but it won’t ever be eradicated because it could still live in an animal reservoir and spread to people.  By the way- civet cats were the likely intermediate host for direct transmission of SARS to humans, but bats, or some other host, are likely the natural reservoir for the virus.

The good news is that you should still be able to sleep after you watch the film because you’re aware that a global, national, state and local public health system is in place that’s designed to quickly identify emerging infectious diseases.  Plus, we get better every day at crafting and implementing public health interventions.  Here’s a website called Contagion and CDC which was created by the CDC Foundation to help separate fact from fiction and to highlight CDC’s role in preparedness and response… Contagion Movie:  Fact and Fiction in the film, a CDC website….and CDC 24/7 – which is a website that includes information you may find useful on how the public health system protects us from outbreaks.

By the way- all the locations in the movie that depict the CDC were all taken on their campus.  I recognized their Emergency Operations Center in the movie- and have even been in meetings in the conference room you’ll see in the movie.  The lab’s you see are actually the CDC labs too… as are the rooms you see where staff are talking about the outbreak.

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Welcome Our New Teammates

August 1st, 2011

Please join me in welcoming three folks from the Arizona Biomedical Research Commission to the ADHS team today.  The Legislature and Governor made a statutory change last cycle that moved the Commission to us, and their mission is a good fit.  The Commission basically awards contracts for projects researching the causes, epidemiology and diagnosis, formulation of cures, medically accepted treatment and prevention of diseases, including drug discovery and development and provides some oversight of the projects that they approve.  Their funding (a few million dollars per year) comes from tobacco taxes and some lottery funds.

There had been some uncertainty about whether the Commission would actually move to our team because of a lawsuit that was filed several weeks ago asking the court to stop the move, but that suit was dismissed.  One of the Commissioners filed an appeal, but we don’t expect that action to change anything.

Shoana Anderson has volunteered to serve as the acting Executive Director for the Commission.  Cara Christ will also help out.  Both will continue with their other Department duties, but will add the Commission work to their responsibilities.  Please take a little time to welcome the 3 folks from the Commission staff that will be joining us.  They’ll be located on the NE side of 1st floor of the 150 Building.  Our first priorities will be to get a good handle on the “books” and make some recommendations to replace several expired Commission slots.

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Guillain Barre

July 11th, 2011

A couple of folks from the CDC have been in Arizona this week to help us (and Sonora) to investigate an unusual number of cases (8 in Arizona and 8 in Sonora) of Guillain Barre syndrome

.  The Arizona cases are in the Yuma area.  It’s a rare condition that rarely (but occasionally) happens several days after a person has been sick with diarrhea- often from a foodborne bacteria called Campylobacter jejuni.  The illness happens when person’s own immune system damages the nerves, causing muscle weakness and sometimes paralysis.  Most people recover fully from it but some people have nerve damage that doesn’t go away.

Our epidemiology team is working with folks from the CDC and Yuma County to track down the cause.  Most of the work is gumshoe type epidemiology and includes reviewing medical records to confirm diagnoses meeting with hospital staff and neurologists to discuss clinical signs and symptoms (they have already reviewed 3 records and are currently reviewing a fourth case at a second hospital), and interviewing patients and family members to determine exposure history, particularly related to foodborne illnesses.

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Who is John Snow?

May 25th, 2011

He’s a guy that’s often thought of as the founder of modern day epidemiology because of his work in tracing the source of a cholera outbreak in England in the mid 1800s.  At the time, scientists and the public believed that diseases like cholera were spread by “miasma”- basically that diseases like cholera were spread by pollution or “bad air”.   The “germ theory” of disease was in its infancy, so Snow didn’t have the advantage of knowing that microorganisms spread disease.  But he was skeptical that bad air was the cause.

During an outbreak of cholera in the mid 1860s he started talking to local residents and concluded that the source of the outbreak might actually be from the water in a public water pump on Broad Street.  He didn’t have the instruments to observe a problem with the water but the pattern of disease he documented was convincing enough to persuade the local council to disable the well pump by removing its handle.  He later developed a spot map to illustrate how cases of cholera clustered around the pump and statistically showed the connection between the quality of the source of water and cholera cases.

Looking behind the scenes, he found that homes that had an increased incidence of cholera were more likely to be delivered water from the parts of the Thames River that were polluted with sewage.  At the time, it was a really hard sell to convince the public that many diseases were spread through the fecal-oral route partly because it grossed people out.  However, the next decade (1860s-1870s) was a real growth period for public health as the germ theory developed, opening the possibilities for hundreds of public health interventions.

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Looking for a Dynamic and Rewarding Career?

May 10th, 2011

Life expectancy improved by more than 30 years in the US during the 20th Century.  Advances in diagnosis and treatment of disease have played a role, but the real reason we’re living longer today has a lot more to do with public health interventions than advances in health care.  Interventions like vaccines, motor vehicle safety, safer workplaces, clean water and food safety, tobacco control and improvements in maternal and child health are responsible for most of the improvement.  You can see the top 10 public health interventions of the 20th century in an article I wrote awhile ago in the old Prevention Bulletin.

If you want to be part of the movement that pushes public health improvements into the 21st century, you’re in luck.  Arizona has one of the most dynamic and flexible School of Public Health in the country.

For starters, there’s the Mel & Enid Zuckerman College of Public Health is the first nationally accredited college of public health in the Southwest. They offer a dynamic academic curriculum that includes the undergraduate degree in public health and graduate degrees in public health, epidemiology, biostatistics, and environmental health sciences. They’ve gained national and international recognition for research productivity and integration into communities across Arizona, the Southwest, Mexico and the globe. The faculty, alumni and students are consistently finding new approaches to chronic disease prevention, community public health preparedness, family wellness and advocacy for public health policy.

There’s also a new Phoenix-Collaborative MPH in Public Health Practice program as well as a distance learning Graduate Certificate in Public Health; which are great options for folks looking to advance their knowledge about public health. The Master of Public Health in Public Health Practice is a new interdisciplinary program that prepares students to develop the public health skills needed to work in a variety of governmental and non-governmental settings including the local, county and state departments of health, Medicaid and Medicare programs, hospitals, and community health centers.

They also have 3 certificate programs that are completely on-line.  These are graduate level programs where students get accepted to our graduate college and take 15 units. The programs include:

Graduate Certificate in Public Health which includes 5 core MPH courses;

Graduate Certificate in Maternal and Child Health Epidemiology;

Graduate Certificate in Global Health; and

Clinical Research Training Program (This isn’t all online yet but they’re making progress).

Interested?  Spend some time on the links above, and remember, public health is full of old-timers like me whose careers are long in the tooth and who are poaching great jobs.  But a lot of us will be out of the way in the next few years, and public health needs a new generation work-force to move us into the 21st century.

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