Posts Tagged ‘public health interventions’

Licensing’s “ADVICE Collaborative”

March 28th, 2013

Our Licensing team routinely analyzes the most frequent and important deficiencies that we observe and posts the data on our website.  We use the data to help educate the folks that we license… and to identify good topics for provider training and technical assistance (public health interventions).  For example, our medical facilities licensing team has found that infection control is becoming increasingly troublesome among some dialysis providers. 

That info led our medical facilities licensing team to join with our Office of Infectious Disease Services and the ADHS Healthcare Associated Infections Advisory Committee to plan and provide a day-long collaboration to our licensed dialysis providers and public health professionals. This collaborative- (known as the ADVICE collaborative – Arizona Developing Value through Innovation and Communication) will provide tools for dialysis providers to improve their infection control performance by building relationships with public health, renal associations, federal partners and other stakeholders. 

The day will be spent sharing best practices, identifying new ways to promote infection control, and developing a strategic plan for future activities. We’ll also be passing on what we learn to our Healthcare Associated Infection Advisory Committee so they can develop and produce trainings and resources that will improve infection control.  You can find out more about the collaborative by visiting our website. This is just one of our many examples of how we’re leveraging licensing to improve public health outcomes.

New Electronic Birth Certificate ‘Round the Corner

December 26th, 2012

Our Vital Records shop does a lot more than manage the State’s birth and death certificate system (which we’ve been doing since 1885).  We’re also an integral part of the Nation’s Vital Statistics System, which serves as the backbone of national data sharing in public health. The data collected under the National Vital Statistics System works in partnership with the National Center for Health Statistics to produce critical information on public health topics like teenage births and birth rates, prenatal care and birth weight, risk factors for adverse pregnancy outcomes, infant mortality rates, leading causes of death, and life expectancy.  All these data are retrieved from the nation’s network of Vital Records shops like ours. 

There have been two birth certificate standards that the states are currently following – the 1989 and the 2003 standard. We’ve been one of the states that had been following the 1989 standard- but not anymore.  Beginning the first week in January, we’ll be turning the key on the new 2003 Standard.  The new Electronic Birth Registration System that we’ll be using will collect a lot more public health surveillance data.  It’s also an electronic system- which will make things much faster and efficient.  The new system will have impacts all throughout our Strategic Plan.  Here are a couple examples: 

  • A1 – Reduce Obesity – The former 1989 standard had zero data on the mother’s height and weight- meaning we couldn’t calculate the mom’s BMI.  Starting next week, we’ll be able to collect this data- which will give us better surveillance- and in turn, help us identify more targeted public health interventions- helping us to make progress in reducing critical risk factors for poor maternal and child health outcomes.
  • A2 – Reduce Tobacco Use and Substance Abuse –  The old system only captured generic measures about maternal smoking during pregnancy.  The new system will have specific cigarette smoking data before and during pregnancy- providing rich data for prevention activities- helping us to improve birth outcomes. 

Other important data elements include information on breastfeeding, whether mother received food during pregnancy from the WIC program (helping us to better evaluate our WIC program), critical medical data elements like congenital anomalies, and fertility treatments (Assisted Reproductive Technology)…  all of which provide newer opportunities for prevention.  The public health applications that the new system will provide are too long to list in a short blog like this… but they’re substantial- believe me.  We’re even going to be able to incorporate the data we’ll be collecting in the new system into our new Midwife rules. 

From a customer service perspective, the new system has improved security for fraud prevention and will provide speedier transactions for printing birth certificates at the county level.  Thanks to all the IT and vital records team that put in the endless hours to make this new application possible.

The Scientific Literature Gradient

July 18th, 2012

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.

Whooping it Up

August 30th, 2011

When it comes to microbes- the whooping cough (pertussis) is a contrarian.  Unlike most other pathogens- it does better in the summer than the winter.  While most other infectious diseases are on the wane right now- whooping cough is whooping it up.  We’ve been seeing an increase in whooping cough cases in Arizona this summer- but not enough top call it an outbreak.   

Our public health interventions have focused on educational pushes to encourage folks (especially teenagers and adults) to get their “TDaP” booster (which includes the whooping cough vaccine).  Whooping cough causes a severe and persistent coughing in anybody, but our biggest concern is that it can be deadly in infants who are too young to be vaccinated.  In fact, more than 85% of all deaths from whooping cough are among kids less than 6 months old.  That’s why we’ve also focused on our “cocooning” initiative. 

Infants are usually infected with whooping cough from people who are in close contact with them like parents, siblings, grandparents, and babysitters.   Because of this, we’re encouraging families and health care providers use a strategy to protect infants called “cocooning.” By immunizing everyone who comes in contact with infants, it prevents those people from getting infected and provides a cocoon of protection around the infant.  Last month’s Arizona Vaccine News was dedicated specifically to whooping cough and provides more details about cocooning.

Who is Bob Koch?

June 7th, 2011

Robert Koch was a German physician that’s considered one of the primary founders of microbiology- setting the foundation for loads of public health interventions that have drastically improved our quality of life.  He was the first scientist to verify the Germ Theory of Disease (in 1876) by showing that anthrax is caused by a bacteria (the previous theory was that disease was spread by “bad air”).  Koch later discovered that bacteria cause tuberculosis and cholera.

He went on to develop what became known as “Koch’s Postulates” – which consist of 4 criteria that establish a causal relationship between a microbe and disease.  These principles led to large advances in identifying the organisms that were responsible for major public health issues at the time- diptheria, typhoid, pneumonia, gonorrhea, leprosy, plague, tetanus, and syphilis.

His most important work was with tuberculosis (called consumption at the time).  Between 1700 and 1900 TB is thought to have caused nearly 1 billion deaths.  Koch’s discovery that the TB was caused by a bacteria led to public health interventions that helped limit the spread of TB… and eventually led to the development of medications to kill the bacteria.  You can read more about his story on the Official Website of the Nobel Prize.

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.