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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Modeling the public health response to bioterrorism: using discrete event simulation to design antibiotic distribution centers.

BACKGROUND: Post-exposure prophylaxis is a critical component of the public health response to bioterrorism. Computer simulation modeling may assist in designing antibiotic distribution centers for this task. METHODS: The authors used discrete event simulation modeling to determine staffing levels for entry screening, triage, medical evaluation, and drug dispensing stations in a hypothetical antibiotic distribution center operating in low, medium, and high disease prevalence bioterrorism response scenarios. Patient arrival rates and processing times were based on prior mass prophylaxis campaigns. Multiple sensitivity analyses examined the relationship between average staff utilization rate (UR) (i.e., percentage of time occupied in patient contact) and capacity of the model to handle surge arrivals. RESULTS: Distribution center operation required from 93 staff for the low-prevalence scenario to 111 staff for the high-prevalence scenario to process approximately 1000 people per hour within the baseline model assumptions. Excess capacity to process surge arrivals approximated (1-UR) for triage staffing. CONCLUSIONS: Discrete event simulation modeling is a useful tool in developing the public health infrastructure for bioterrorism response. Live exercises to validate the assumptions and outcomes presented here may improve preparedness to respond to bioterrorism.

Anti-Bacterial Agents↗
PubMed1998

Foodborne diseases. Emerging pathogens and trends.

The epidemiology of foodborne diseases is rapidly changing. In the past 15 years, new foodborne pathogens, such as Campylobacter jejuni and Escherichia coli O157:H7, have emerged as important public health problems. Well-recognized pathogens, such as Salmonella serotype Enteritidis, have increased in prevalence or become associated with new vehicles, and pathogens such as C. jejuni and S. Typhimurium are becoming increasingly resistant to antimicrobial agents. Evolving trends in foodborne diseases are being driven by the same factors that have led to the emergence of other infectious diseases: changes in demographic characteristics of the population, human behavior, industry, and technology and the shift toward a global economy, microbial adaptation, and breakdown in the public health infrastructure. Addressing emerging foodborne disease will require more sensitive and timely surveillance, enhanced methods of laboratory identification and subtyping, and identification of effective prevention and control strategies.

Bacterial Infections↗
PubMed2004

Barriers to public health management of a pertussis outbreak in Arkansas.

BACKGROUND: During the 2001-2002 respiratory season, Arkansas experienced one of its worst pertussis outbreaks. This crisis occurred shortly after the September 11, 2001, terrorist attacks. OBJECTIVE: To determine whether vulnerabilities in the public health infrastructure existed in the context of emerging infectious diseases or possible bioterrorist attacks. DESIGN: Key personnel involved in the Arkansas pertussis outbreak were interviewed, and health department epidemiologic data were reviewed. SETTING: Observations were made for the statewide private-public management of the epidemic. PARTICIPANTS: Physicians, infectious disease specialists, epidemiologists, field nurses, health department staff, laboratory staff, and administrators. MAIN OUTCOME MEASURES: Diagnosis capability; vaccine, prophylaxis, and treatment programs; and effectiveness of global outbreak management. RESULTS: Diagnosis of pertussis was a major barrier to management of the outbreak. The nonspecific clinical diagnosis, unreliability of testing methods, excessive number of samples, unavailability of reagents, and inadequate transport system, laboratory personnel, and equipment all impeded effective diagnosis. Vaccine shortage was not believed to contribute to the extent of the outbreak. Prophylaxis was problematic because of feared adverse effects of drugs and uncertainty about the efficacy of new drugs, but compliance was found to be good. From a public health perspective, isolation procedures, school absence policies, and health department referrals to private physicians all contributed to confusion. Problems with communications, staffing, and public cooperation were identified. Despite these barriers, the epidemic was well tolerated, with no known mortality and limited morbidity. CONCLUSIONS: Despite many identified barriers to effective public health management, Arkansas tolerated its worst epidemic of pertussis in many years. However, were the state to experience an outbreak of a more pathogenic agent, introduced either naturally or of bioterrorist origin, these vulnerabilities could become critical. Natural outbreaks serve as excellent experiences on which to recognize and correct barriers to public health management.

Arkansas↗
PubMed1994

Addressing emerging infectious disease threats: a prevention strategy for the United States. Executive summary.

The spectrum of infectious disease is changing rapidly in conjunction with dramatic societal and environmental changes. Worldwide, explosive population growth with expanding poverty and urban migration is occurring; international travel and commerce are increasing; and technology is rapidly changing-all of which affect the risk of exposure to infectious agents. Recent examples of important emerging infectious diseases include prolonged diarrheal illness due to waterborne cryptosporidium, hemorrhagic colitis and renal failure from foodborne Escherichia coli O157:H7, pneumonia and middle-ear infections caused by drug-resistant pneumococci, and rodentborne hantavirus pulmonary syndrome. These diseases as well as resurgent diseases (e.g., tuberculosis and cholera) illustrate human vulnerability to microorganisms in the environment. Three recent reports by the Institute of Medicine document the need to address emerging infectious disease threats. In partnership with representatives from health departments, other federal agencies, medical and public health professional associations, and international organizations, CDC has developed a strategic plan to address emerging infectious disease threats. The plain contains four goals that emphasize surveillance, applied research, prevention and control, and public health infrastructure. To ensure sustainability, plan implementation will be approached in stages, as a long-term endeavor with emphasis on extramural programs. As health-care reform proceeds, priority should be given to strengthening partnerships between health-care providers, microbiologists, and public health professionals to detect and control emerging infectious diseases.

Communicable Disease Control↗
PubMedDate not supplied

Leveraging the nation's anti-bioterrorism investments: foundation efforts to ensure a revitalized public health system.

The emerging potential threats of bioterrorism combined with critical existing epidemics facing the United States call for immediate and urgent attention to the U.S. public health system. The foundation world is helping to answer that call and is sounding the alarm that our health defenses must be able to do "double duty" to protect us from the full spectrum of modern health threats. This Special Report presents a selective sample of recent and ongoing grant activities designed to revitalize and modernize the public health infrastructure, which is vital to protecting the nation's health and ensuring its safety.

Bioterrorism↗
PubMed2002

Rapid DOTS expansion in India.

Since late 1998 the coverage of the DOTS strategy in India has been expanded rapidly. In both 2000 and 2001 the country probably accounted for more than half the global increase in the number of patients treated under DOTS and by early 2002 more than a million patients were being treated in this way in India. As a result, nearly 200 000 lives were saved. The lessons learnt relate to the importance of the following elements of the programme: (1) getting the science right and ensuring technical excellence; (2) building commitment and ensuring the provision of funds and flexibility in their utilization; (3) maintaining focus and priorities; (4) systematically appraising each area before starting service delivery; (5) ensuring an uninterrupted drug supply; (6) strengthening the established infrastructure and providing support for staff; (7) supporting the infrastructure required in urban areas; (8) ensuring full-time independent technical support and supervision, particularly during the initial phases of implementation; (9) monitoring intensively and giving timely feedback; and (10) continuous supervision. Tuberculosis (TB) control still faces major challenges in India. To reach its potential, the control programme needs to: continue to expand so as to cover the remaining half of the country, much of which has a weaker health infrastructure than the areas already covered; increase its reach in the areas already covered so that a greater proportion of patients is treated; ensure sustainability; improve the patient-friendliness of services; confront TB associated with human immunodeficiency virus (HIV) infection. It is expected that HIV will increase the number of TB cases by at least 10% and by a considerably higher percentage if HIV becomes much more widespread. India's experience shows that DOTS can achieve high case-detection and cure rates even with imperfect technology and often with an inadequate public health infrastructure. However, this can only happen if the delivery programme is appropriately designed and effectively managed.

Antitubercular Agents↗
PubMedDate not supplied

Emerging foodborne diseases.

The epidemiology of foodborne diseases is rapidly changing. Recently described pathogens, such as Escherichia coli O157:H7 and the epidemic strain of Salmonella serotype Typhimurium Definitive Type 104 (which is resistant to at least five antimicrobial drugs), have become important public health problems. Well-recognized pathogens, such as Salmonella serotype Enteritidis, have increased in prevalence or become associated with new vehicles. Emergence in foodborne diseases is driven by the same forces as emergence in other infectious diseases: changes in demographic characteristics, human behavior, industry, and technology; the shift toward a global economy; microbial adaptation; and the breakdown in the public health infrastructure. Addressing emerging foodborne diseases will require more sensitive and rapid surveillance, enhanced methods of laboratory identification and subtyping, and effective prevention and control.

Adaptation, Physiological↗
PubMed1999

Public health in the twentieth century: advances and challenges.

Substantial advances in public health methods, practice, and the health of the public have occurred in the twentieth century. Some of the contributions most notable for their impact on mortality and longevity are vaccine development and widespread use, smallpox eradication, large reductions in communicable disease epidemics, and the rise and decline of several serious chronic diseases. Many methodological advances have facilitated better understanding of disease processes and opportunities for control. Epidemiological methods have advanced, but studies often ignore the determinants of health at the community level and above, leading to simplistic formulations of multiple risk factors contributing to chronic and other diseases and injuries. Occupational and environmental health developed as disciplines in this century, making significant contributions to current and future population health. The health care system became more organized, technologically sophisticated, and costly. New tools to assess health and the burden of ill health, to improve the effectiveness of interventions, and to measure economic effects of alternative investments promise greater efficiency and effectiveness for public health. An increasingly fragmented public health infrastructure must confront unprecedented challenges including dramatic global population growth, increased aging of the population associated with enhanced longevity, and possible irreversible changes in key environmental health determinants.

Health Care Reform↗
PubMed2003

The organisation of federal Veterinary Services in Canada: the Canadian Food Inspection Agency.

The organisational design of a national Veterinary Service is critical to the overall quality and integrity of its animal health and veterinary public health infrastructure. It is well recognised that the diversity of political, economic and social situations which exist in and between countries dictates that no one model of organisational structure can be applied to all circumstances. In Canada, a re-organisation of the approach of the federal government to food inspection in 1997 resulted in the transfer of the veterinary administration to a newly created agency called the Canadian Food Inspection Agency (CFIA). The authors provide a short background on the impetus for the creation of the CFIA and an overview of its organisational structure and responsibilities in animal and veterinary public health and food safety. Also included are the logic models that were developed for the federal Veterinary Services as part of their quality and performance management framework. Integrating all federally mandated food inspection systems under the CFIA has had concrete benefits in clarifying roles and responsibilities, reducing overlap and duplication of programme functions, improving service delivery and facilitating federal-provincial collaboration. Moreover, the strength of the organisation lies in the ability of the Canadian Veterinary Services to adhere to the fundamental principles of quality which are recommended by the OIE (World organisation for animal health) for the evaluation of Veterinary Services. No single organisational structure can guarantee a highly effective or competent Veterinary Service. Common challenges exist that may or may not be addressed in whole or in part by the organisational structure. The challenges highlighted in this paper provide further thoughts on the management of shared jurisdiction, meeting public health objectives, balancing science and political accountability, and defining the role and jurisdiction of veterinarians.

Animal Welfare↗
PubMed1997

Business prospective: a complement to a successful public health agenda.

Business planning is an analytical and practical exercise that will help better understand your organization's position and capabilities with regard to the competitive market place. This clarification will help set direction referencing an organization's mission, alternative service delivery options and managed care network opportunities. The Bergen County Department of Health is an organization in transition, building capabilities and credibility to assume leadership responsibilities in the development of a sustained Public Health infrastructure. In addition, the department is attuned to the changing health care industry's responsibility and incentives, is actively pursuing appropriate service delivery roles as a complement to the county-wide community health system capacity.

Commerce↗
PubMedDate not supplied

The impact of 9/11 on HIV policy and politics.

In the aftermath of 9/11, shifts in federal priorities have threatened HIV funding, public financing of the health and public health infrastructures in which HIV services are embedded, and key HIV policies. However, the best strategies to address terrorism, especially bioterrorism, also strengthen its capacity for HIV surveillance, prevention, and care. AIDS advocates need to argue for appropriate antiterrorism measures that focus resources and technology on upgrading the capacity and scope of our health care and public health systems. This broad focus is not only the best protection against terrorism, it benefits all Americans, including people living with HIV.

Financing, Government↗
PubMed2006

"Everything depends on good nursing".

Nurses have always played a vital role in the response to outbreaks of deadly illnesses. The story of Alberta nurses' heroic efforts in the face of the Spanish influenza epidemic of 1918-19, in the absence of public health infrastructure, reminds us of the importance of preparedness. The virus, which accompanied soldiers returning from Europe after the First World War, spread quickly along transportation routes from Eastern Canada to the West. Although many nurses had not yet returned from war service, or were assisting in Halifax following the explosion of 1917, those who were available in Alberta vo unteered without hesitation to care for victims of the virus. In the absence of cure, good nursing care was usually the only treatment for the illness. Recognition of the need for planned response to crises, availability of resources and excellent skills and knowledge prompted nursing leaders to lobby the government for a formal public health system and contributed to the organization of professional nursing associations. In the likely event of another global influenza pandemic, nurses may draw upon the lessons of the past as they once again face the complex challenges of a modern health crisis.

Animals↗
PubMed2000

Preparing currently employed public health nurses for changes in the health system.

OBJECTIVES: This article describes a core public health nursing curriculum, part of a larger project designed to identify the skills needed by practicing public health workers if they are to successfully fill roles in the current and emerging public health system. METHODS: Two focus groups of key informants, representing state and local public health nursing practice, public health nursing education, organizations interested in public health and nursing education, federal agencies, and academia, synthesized material from multiple sources and outlined the key content for a continuing education curriculum appropriate to the current public health nursing workforce. RESULTS: The skills identified as most needed were those required for analyzing data, practicing epidemiology, measuring health status and organizational change, connecting people to organizations, bringing about change in organizations, building strength in diversity, conducting population-based intervention, building coalitions, strengthening environmental health, developing interdisciplinary teams, developing and advocating policy, evaluating programs, and devising approaches to quality improvement. CONCLUSIONS: Collaboration between public health nursing practice and education and partnerships with other public health agencies will be essential for public health nurses to achieve the required skills to enhance public health infrastructure.

Clinical Competence↗
PubMed2000

Changing patterns of infectious disease.

Despite a century of often successful prevention and control efforts, infectious diseases remain an important global problem in public health, causing over 13 million deaths each year. Changes in society, technology and the microorganisms themselves are contributing to the emergence of new diseases, the re-emergence of diseases once controlled, and to the development of antimicrobial resistance. Two areas of special concern in the twenty-first century are food-borne disease and antimicrobial resistance. The effective control of infectious diseases in the new millennium will require effective public health infrastructures that will rapidly recognize and respond to them and will prevent emerging problems.

Animals↗
PubMed1998

Australia's health system: the search for a cure. The Australian Democrats' discussion paper on Australia's health system.

The Australian Democrats' believe that Australia is currently at a critical time in the development of its health care system. The twin pressures of higher demands and inadequate funding have led to alarmingly heavier pressure on the public health infrastructure. Increasingly, the choices confronting society is one of how to allocate limited resources in the health sector. Awareness is growing on the impact wider issues such as unemployment, fragmentation of communities are having on society's health. In the face of new challenges confronting Australia's health system of the needs of an aging population, adoption of new developments in medical treatment and technology and new relationships which are developing between the public and private health sector, the Democrats acknowledge that although there are no easy responses, it is important, nonetheless to recognise their complexities and work collaboratively towards viable solutions. Through this discussion paper, based on consultation with a wide range of stakeholder groups and individuals, the Australian Democrats' have sought to outline the options for addressing the challenges and debate which will serve to contribute to the development of a fair, efficient and equitable health care system for all Australians, now and into the future.

Australia↗
PubMed2000

Women's health programs at the Centers for Disease Control and Prevention.

The Centers for Disease Control and Prevention (CDC) offers a variety of resources for health care professionals and agencies, policy makers, consumers, academicians, and others. As the nation's prevention agency, the CDC supports epidemiologic and behavioral research, national and state-based surveillance activities, disease prevention programs, scientific and public health infrastructure development, and much more. Selected resources that may be helpful to those who work to improve the health and safety of women are described.

Adult↗
PubMed1998

New emerging zoonoses: a challenge and an opportunity for the veterinary profession.

The concept of emerging infectious diseases appeared in the late 1980s, when major outbreaks occurred around the globe and surprised many scientists who considered infectious diseases to be maladies of the past or limited to the under-developed world. Several reports identified erosion of the public health infrastructure among the factors contributing to new and re-emerging infectious diseases. As indicated by Morse, "Disease emergence often follows ecological changes caused by human activities such as agriculture or agricultural change, migration, urbanization, deforestation, or dam building". "Among these new diseases, surprisingly, most emergent viruses and many emergent bacteria are zoonotic". Several new zoonoses have been recently identified. Many of these diseases were either unknown, because we were not able to isolate the infectious agent or to distinguish them from other clinical syndromes, or discovered accidentally. Much of the recent identification of new pathogens has been based on new molecular biology tools or epidemiological studies. For all these diseases or infections, veterinarians played a key role in their identification, isolation of the causative organisms and understanding of the epidemiology of the infection. The role of the veterinary profession is very important in public health and on the rise again in the U.S.A., as it should be in many other countries. Surveillance, clinical curiosity and awareness, epidemiology and laboratory training are the essential tools and competency that the veterinary profession must use to meet the challenge of new emerging zoonoses.

Animals↗
PubMed2006

Infectious diseases of severe weather-related and flood-related natural disasters.

PURPOSE OF REVIEW: The present review will focus on some of the possible infectious disease consequences of disastrous natural phenomena and severe weather, with a particular emphasis on infections associated with floods and the destruction of infrastructure. RECENT FINDINGS: The risk of infectious diseases after weather or flood-related natural disasters is often specific to the event itself and is dependent on a number of factors, including the endemicity of specific pathogens in the affected region before the disaster, the type of disaster itself, the impact of the disaster on water and sanitation systems, the availability of shelter, the congregating of displaced persons, the functionality of the surviving public health infrastructure, the availability of healthcare services, and the rapidity, extent, and sustainability of the response after the disaster. Weather events and floods may also impact disease vectors and animal hosts in a complex system. SUMMARY: Weather or flood-related natural disasters may be associated with an increased risk of soft tissue, respiratory, diarrheal, and vector-borne infectious diseases among survivors and responders.

Communicable Disease Control↗