Our Midwifery Scope of Practice Advisory Committee Meeting is meeting from 4 to 6 pm this evening in the Lab conference room (250 N 17 Avenue, Phoenix). The Agenda includes a discussion of the draft U of A Literature Review including a Presentation of the results along with the Draft Rules for Public Comment. The meeting will be broadcast live on Livestream and we’ll have an opportunity for folks to follow the conversation on Twitter with #azmidwives.
Our Arizona State Hospital (ASH) and the U of A share a birthday. Both were established by the 13th Territorial Legislature in 1885. The City of Tucson had wanted ASH (it came with a $100K appropriation) but their delegation got to Prescott (the Territorial Capitol) late because the Salt was flooded… and Tucson ended up getting the U of A instead (which only carried a $25K appropriation). ASH opened its doors in 1887 and the U of A held their first classes in 1891.
The UA football team played their first games in 1899 as the U of A “Varsity”… and the first Big Game between the Varsity and the Tempe “Normals” (ASU) was played on Thanksgiving in 1899 at Carillo Gardens field in Tucson in front of 300 fans. The U of A met the Normals at the Tucson train station and the teams had a post-game Thanksgiving feast. I don’t think they do that anymore— or we’d probably have to test the food in advance at our Lab. The local newspaper reported that this was U of A’s first game and that “… the Normal squad was physically larger and better conditioned”, with the Normals winning 11 to 2. The Territorial Cup is the trophy that’ll be awarded again to the winner of Friday’s Duel in the Desert (in Tucson this year)… it’s the oldest Trophy of its kind.
I’ve mentioned in previous posts about how I’d like to build more bridges between the Arizona’s academic public health infrastructure and Arizona’s public health system. After all- our goal is to use evidence-based practices to drive our interventions- and the U of A’s expertise at the Mel & Enid Zuckerman College of Public Health is a key resource within AZ’s public health system to accomplish those goals.
We reached an important milestone this week when we turned the key on our new electronic public health classroom- in Room 411 in the 1740 Building. The on-line learning center will allow our employees (and staff from the local health departments) to continue their education and obtain a degree in Public Health or complete advance degrees. In addition, we’ll be working to develop distance learning classes on specific areas such as Quality Improvement to help us gain the knowledge and skill necessary to become accredited and assist our local public health departments as well. The possibilities are unlimited. I’ll kick off the use of the classroom next week by using it for a lecture on Environmental and Occupational Health for students in Tucson.
My blog post from March has more information about the host of career training and development opportunities available through the U of A’s College of Public Health. You can book the new classroom with America Coles. We’re also planning to have it on the Intranet/e-mail system to reserve room like all the other conference rooms- along with its own web page which will include a calendar of events.
I’m happy to announce that we’ve been able to draft Pat Benchik to serve as our new Assistant Director for Behavioral Health Services.
Pat’s had a long career in behavioral health here in Arizona. He started his career in the 1980s working as an administrator at La Frontera in Tucson. He worked at the Pima County Regional Behavioral Health Authority in the early 1990s doing contract administration. Pat was the President and CEO of COPE Community Services, Inc. from 1992 – 2009… where he transformed a small behavioral health provider organization with a negative fund balance into one of the largest and most successful behavioral health provider organizations in Southern Arizona.
Pat has most recently served as a Pima County Behavioral Health Administrator where he has been responsible for development, administration and oversight of Pima County behavioral health care programs and initiatives- promoting recovery and resiliency through integrated health and health promotion strategies. He earned a Masters in Public Administration (MPA) from the U of A and has a BA in Psychology from St. Louis University.
He’ll be joining our team on September 17th… welcome to the Transformation Express.
Medicine and public health have relied on peer-reviewed published scientific literature to help guide progress in patient treatment and public health interventions for decades- even centuries. For example, when we did the fact-finding to inform our decision about whether to add the petitioned conditions to the list of disorders that qualify for AZ medical marijuana cards- we (and the UA) turned to the scientific literature. Within the scientific literature- there are different categories of research designs that each have their strengths and weaknesses.
Studies to assess the effectiveness of an intervention (like whether Cannabis is an effective treatment for depression) can have an Experimental or Observational design. For example, a randomized and controlled experimental study selects participants at random and places them in the intervention or control group and then follows up on the subjects over time to assess any differences in outcomes. Experimental studies generally provide the highest quality and most reliable results.
An Observational study isn’t really experimental- rather, it’s a study that looks at natural variation regarding an intervention (or exposure) and looks at differences in outcomes among people or populations. Controlled observational studies can look at before and after conditions. For example, a cohort observational study can look at populations prospectively, retrospectively, or as part of a time series. Observational studies can also be of case-control or cross-sectional design. Observational studies can also simply look at a series of cases and look at interventions and outcomes without a control group.
In general, the highest quality studies use the experimental approach and include a randomized design. Studies in the category can be very high quality if there is little bias and confounders are identified and controlled for… and if the study is large. Observational studies are generally of lower quality- although they can be quite useful if they limit bias, are consistent, direct, and control for confounding factors. The lowest quality study is what’s called a case series with no controls. Often, case series studies are simply observations made by clinicians- but without control groups… and they usually don’t control for confounders or bias.
Anyway- you get the idea… scientific studies are absolutely critical to helping the public health system design interventions, make policy decisions, and measure results. Published scientific literature allows us to use science to inform our policy decisions and interventions in an objective way- increasing the likelihood that the public health system makes a positive impact in people’s lives. Understanding what makes a published scientific study strong and compelling is critical to sorting through the published scientific literature for the types of strong studies that make for solid foundations for policy and intervention decisions.
My post tomorrow will summarize ways to evaluate the quality and reliability of various kinds of studies.
The AZ Medical Marijuana Act requires us to periodically accept petitions to add new medical conditions to the list of conditions that qualify folks for an AZ Medical Marijuana Registration Card. In January, we accepted petitions from the public and had a public hearing in May. Folks submitted numerous articles as a part their petitions for PTSD 1; PTSD 2; Depression; Migraines; and Generalized Anxiety Disorder. We also received lots of informal comments regarding adding PTSD; Depression; Migraines; Generalized Anxiety Disorder and General comments.
We also contracted with the U of A to review published scientific studies related to marijuana use and the petitioned conditions. You can see the UA analyses for Depression; Generalized Anxiety Disorder; Migraine Headaches; and Post Traumatic Stress Disorder (PTSD) on our petition website. Our ADHS medical team will be meeting within the next week or so and will be providing me with their analysis and recommendations. The ultimate decision rests with me, the Director, and I have a decision deadline in late July.
The U of A has developed an Arizona Public Health Training Center whose mission is to assess, develop, and deliver training to current and future public health professionals and other community leaders… building and strengthening our public health infrastructure. One of their strategies is to develop what they call “academic health departments”.
They’ve asked us to partner with them and become an academic health department, which is an exciting new opportunity. By the end of March we’ll be identifying 6 projects with a year-long scope of work. U of A Mel and Enid Zuckerman College of Public Health students will be offered a range of different public health projects to apply for, and internships will begin this June for this highly competitive program. The U of A requires their students to complete an internship to meet their degree requirements and these students will be part of a prestigious program of U of A - ADHS Fellows that will have an opportunity to get paid while getting real world job experience. They’ve offered us 2 paid $4K fellowships to fund student internship projects over a one year period.
This is an opportunity to partner with the University and an exciting chance to cultivate new talent. The application and more details are posted on our Managing for Excellence website at: http://www.azdhs.gov/diro/excellence/documents/Public-Health-Education-Internship-Application.pdf
I thought it would be fun to give some perspective on public health and the Department’s activities 100 years ago as we approach our Centennial in a few weeks.
Our AZ Public Health Laboratory is celebrating its 100th birthday shortly- just like the State. Our Lab was one of the first parts of state government- it created by the first State Legislature in 1912… and was called the “Pure Food and Drug Laboratory”. It was at U of A’s in Old Main. The earliest work of the laboratory was focused on food safety. For example, they discovered that some canned peas had been artificially colored with copper sulfate and the presence of absinthe in saloons. They also discovered that some dairies were adding formaldehyde to milk to prevent spoilage.
Steve Baker in the Lab has been working late over the last couple of weeks to put together a photo collage of early Lab work and some short stories. The full collage isn’t ready yet- but you can check out their starter Lab history web-page which has a picture of the 1912 Lab.
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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