scholarly journals Lessons Learned from an Extreme Heat Event using ACES for Situational Awareness, Ontario, Canada

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Nancy VanStone ◽  
Adam Van Dijk ◽  
Paul Belanger ◽  
Kieran Moore
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Syndromic Surveillance ◽  
Extreme Heat ◽  
Health Impacts ◽  
Health Authorities ◽  
Extreme Heat Event ◽  
Heat Event ◽  
Public Health Authorities ◽  
Ed Visits

ObjectiveTo describe the lessons learned for public health decision-makers from an analysis of Acute Care Enhanced Surveillance (ACES) data for the heatwaves experienced in Ontario, Canada in the summer of 2018.IntroductionThe Acute Care Enhanced Surveillance (ACES) system provides syndromic surveillance for Ontario’s acute care hospitals. ACES receives over 99% of acute care records for emergency department (ED) visits; mean daily volume is 17,500 visits. ACES uses a maximum entropy classifier and generates more than 80 standard syndromes, fifteen of which are actively monitored for aberrational activity and are considered of higher public health relevance, including RESP (respiratory infection, non-croup), ILI (influenza-like illness), TOX (toxicological, chemical/drug exposure), AST (asthma), OPI (opioid exposure), CELL (cellulitis), GASTRO (gastroenteritis), ENVIRO (environmental, heat/cold exposure), MH (mental health), EOH (alcohol intoxication), DERM (rash), and SEP (bacteremia, sepsis).Syndromic surveillance provides a salient source of public health surveillance during extreme heat events; monitoring real-time ED visits can inform local public health authorities of health impacts, provide situation awareness to initiate and/or inform public health response, and help decision-makers allocate resources according to geographic (or demographic) vulnerability. While the use of syndromic surveillance has been well-characterized to monitor infectious disease outbreaks, its use to monitor the heat-health impacts is relatively novel for ACES users, specifically local public health authorities. This report describes the the data collected during an extended extreme heat event in Ontario, Canada, to highlight the value of syndromic surveillance during extreme heat events and make recommendations regarding incorporating ACES data into routine workflows.MethodsTemperature data were retrieved from Environment Canada historical databases for mid-June to mid-July 2018. Aggregate counts per day for total ED visits and and for individual syndromes were retrieved from ACES databases. Descriptive statistics were used to analyze all datasets.ResultsAn extreme heat event occurred in the southern region of Ontario in early summer, 2018. Environment Canada issues heat warnings for regions throughout Canada according to region-specific criteria; for southern Ontario, heat warnings are issued when 2 or more consecutive days of daytime maximum temperatures are expected to reach 31°C or when 2 or more consecutive days of humidex values are expected to reach 40. Extended heat warnings are issued when the event lasts beyond 2 days. An extended heat event occurred June 29 to July 5, 2018. Although the region is large, temperature data from Environment Canada’s climate monitoring station at Toronto’s Pearson Airport are shown (Figure 1) as an example of the temperatures observed for this time period in the region.ConclusionsLessons learned from an analysis of ACES data during an extreme heat event:1. The ENVIRO syndrome provides real-time monitoring of the health impacts during a heat event and may provide proxy for estimating the indirect effects of heat (e.g., impacts on chronic conditions). Public health authorities can monitor local health impacts during an extreme heat event.2. Patients seeking help at the ED do not appear to be skewed in acuity, sex nor age. This does not necessarily reflect the population that experiences the greatest impact from extreme heat, but rather those that are seeking help at the ED for the direct effects of heat. That said, an increase in ENVIRO counts does not indicate whether the increase is due to greater exposure to the heat (or sun), engaging in vigorous outdoor activity during the event (recreational or occupational), or lack of access to air conditioning.3. ED visits for ENVIRO can be geolocated to determine areas experiencing greater health impacts. This may allow allocation of resources to specifically address vulnerabilities. ACES has built-in mapping capabilities that allows a geovisualization of the home addresses for patients. Furthermore, aggregate counts for relevant syndromes are available for registered users on the Public Health Information Management System (PHIMS), a web-accessible GIS tool for situational awareness that gives public health decision-makers access to real time health impacts in concert with demographics, weather, and other emergency management information. 

scholarly journals Characterizing the Effects of Extreme Cold Using Real-time Syndromic Surveillance, Ontario, Canada, 2010-2016

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 48S-52S ◽  
Author(s):  
Nancy VanStone ◽  
Adam van Dijk ◽  
Timothy Chisamore ◽  
Brian Mosley ◽  
Geoffrey Hall ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Cold Temperature ◽  
Syndromic Surveillance System ◽  
Southern Ontario ◽  
Threshold Temperatures ◽  
Ed Visits ◽  
Extreme Cold

Morbidity and mortality from exposure to extreme cold highlight the need for meaningful temperature thresholds to activate public health alerts. We analyzed emergency department (ED) records for cold temperature–related visits collected by the Acute Care Enhanced Surveillance system—a syndromic surveillance system that captures data on ED visits from hospitals in Ontario—for geographic trends related to ambient winter temperature. We used 3 Early Aberration Reporting System algorithms of increasing sensitivity—C1, C2, and C3—to determine the temperature at which anomalous counts of cold temperature–related ED visits occurred in northern and southern Ontario from 2010 to 2016. The C2 algorithm was the most sensitive detection method. Results showed lower threshold temperatures for Acute Care Enhanced Surveillance alerts in northern Ontario than in southern Ontario. Public health alerts for cold temperature warnings that are based on cold temperature–related ED visit counts and ambient temperature may improve the accuracy of public warnings about cold temperature risks.

scholarly journals Monitoring Heat-Related Illness through Syndromic Surveillance in Los Angeles County

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Jimmy Duong ◽  
Michael Lim ◽  
Emily Kajita ◽  
Bessie Hwang
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Syndromic Surveillance ◽  
Los Angeles County ◽  
Correlation Coefficients ◽  
Temperature Data ◽  
Extreme Heat ◽  
Chief Complaints ◽  
Ed Visits ◽  
Council Of State

ObjectiveTo analyze Los Angeles County’s (LAC) extreme heat season in 2018 and evaluate the Council of State and Territorial Epidemiologists’ (CSTE) syndrome query for heat-related-illness (HRI) in Los Angeles County (LAC)IntroductionLAC experienced several days of record-breaking temperatures during the summer of 2018. Downtown Los Angeles temperatures soared to 108°F in July with an average daily maximum of 92°F. Extreme heat events such as these can pose major risks to human health. Syndromic surveillance can be a useful tool in providing near real-time surveillance of HRI. In 2014, a working group was formed within the CSTE Climate Change Subcommittee to define and analyze HRI. The workgroup’s goal was to provide guidance to public health professionals in adapting and implementing an HRI syndrome surveillance query. The Acute Communicable Disease Control Program’s (ACDC) Syndromic Surveillance Unit utilized CSTE’s HRI query to provide surveillance during the extreme heat season in 2018 in LAC. Additional modifications to the CSTE query were evaluated for potential improvements towards characterizing HRI trends.MethodsFrom May 1 to September 30, 2018, Emergency Department (ED) data were queried for cases using the CSTEs definition for HRI. The queries consisted of key word searches within the chief complaint (CC) data field, and, if available, the diagnosis data fields. The query was derived from the CSTE HRI query published in 20161. In addition, ACDC explored the utility of expanding the CSTE syndrome definition to include additional chief complaints commonly associated with HRI such as dehydration and syncope. Both queries were applied on all participating syndromic EDs in LAC alongside daily high temperature data trends. Local temperature data for downtown Los Angeles weather station KCQT were taken from the Weather Underground website. Spearman correlation coefficients were calculated for each query during the heat season. Similarly, both queries were also applied during colder months from October 1, 2017 to April 30, 2018 for comparison. Lastly, results for dehydration and syncope were independently assessed apart from other HRI query terms during both heat seasons and colder months.ResultsThe CSTE HRI query and the query with the added terms yielded 1,258 and 63,332 ED visits, respectively, during the heat season. On July 6, the maximum daily temperature peaked at 108 °F; the HRI and the query with the added terms yielded 136 and 618 ED visits, respectively. The HRI query and the HRI query with the added terms had a correlation coefficient of 0.714 (p <0.0001) and 0.427 (p <0.0001), respectively. During colder months, the CSTE HRI query and the query with the added terms yielded 377 and 86,008, respectively, with correlation coefficients of 0.342 (p < 0.0001) and 0.133 (p < 0.052). The syncope-only query saw no variation in HRI classified encounters throughout the heat season (mean: 328; min: 228; max: 404) or colder months (mean: 328; min: 261; max: 404) with correlation coefficients of 0.238 (p = 0.003) and 0.155 (p = 0.024), respectively. Similarly, the dehydration-only query saw no variation in HRI classified encounters throughout the heat season (mean: 96; min: 58; max: 258) or colder months (mean: 94; min: 60; max: 160) with correlation coefficients of 0.596 (p < 0.0001) and -0.016 (p = 0.822).ConclusionsThe CSTE HRI query proved to be a strong indicator for HRI, and the addition of terms associated with dehydration and syncope to the CSTE HRI query weakened the correlation with temperature. Compared to the original CSTE HRI query, the added terms yielded a 4934% increase in HRI classified encounters during the heat season; however, these were likely due to causes other than HRI -- adding the extra terms resulted in a weaker correlation with temperature. Additionally, the comparative analysis showed that, with the added terms, the volume of HRI encounters was larger during colder months than hotter months suggesting misclassification of non-HRI illnesses. Surveillance of HRI has proven to be difficult because many of the HRI symptoms are too commonly associated with non-HRI conditions which would explain the weaker correlations when adding additional chief complaints associated with HRI. In conclusion, the CSTE syndrome definition for HRI proved to be the most robust query for HRI during the heat season. Case counts of HRI are difficult due to symptom overlap with many other medical conditions. However, syndromic surveillance using the CSTE HRI query is useful for trend analysis in near real-time during heat events.References1. Council of State and Territorial Epidemiologists. Heat-Related Illness Syndrome Query: A Guidance Document for Implementing Heat-Related Illness Syndromic Surveillance in Public Health Practice. Version 1.0. 2016 Sep. 12 p. 

scholarly journals Syndromic Surveillance Practice in the United States 2014: Results from a Nationwide Survey

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Tera Reynolds ◽  
Scott Gordon ◽  
Paula Soper ◽  
James Buehler ◽  
Richard Hopkins ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Capacity Building ◽  
Syndromic Surveillance ◽  
Nationwide Survey ◽  
The United States ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Surveillance Practice

Presentation of the results of a nationwide survey designed to assess the syndromic surveillance practices and capacity-building assistance needs of state and territorial public health authorities in the United States.

scholarly journals Characterizing and Forecasting Emergency Department Visits Related to COVID-19 Using Chief Complaints and Discharge Diagnoses

2020 ◽  
Author(s):  
Phillip Koshute ◽  
Rekha Holtry ◽  
Richard Wojcik ◽  
Wayne Loschen ◽  
Sheri Lewis
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
Logistic Growth ◽  
National Capital Region ◽  
Local Public Health ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Ed Visits

AbstractIn response to the unprecedented public health challenge posed by the SARS CoV-2 virus (COVID-19) in the United States, we and our colleagues at the Johns Hopkins University Applied Physics Laboratory (JHU/APL) have developed a model of COVID-19 progression using emergency department (ED) visit data from the National Capital Region (NCR). We obtained ED visits counts through targeted queries of the NCR Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE). To focus on ED visits by COVID-19 patients, we adjusted the query results for typical ED visit volumes and for reductions in ED volumes due to COVID-19 precautions. With these ED visit data, we fitted a logistic growth model to characterize and forecast the increase in cumulative COVID-19 ED visits. Our model achieves the best fit when we assume that the first NCR visit occurred in early January. We estimate that approximately 15,000 COVID-19 ED visits occurred prior to May 2020 and that approximately 17,000 more visits will occur in subsequent months. We plan to deploy an operational pilot of this model in the NCR ESSENCE environment, assisting local public health authorities as they brace for a second wave of COVID-19. Additionally, we will iteratively assess potential model refinements, aiming to maximize our model’s relevance for local public health authorities’ situational awareness and decision-making.

scholarly journals Users’ Beliefs Toward Physical Distancing in Facebook Pages of Public Health Authorities During COVID-19 Pandemic in Early 2020

2021 ◽  
pp. 109019812110144
Author(s):  
Soon Guan Tan ◽  
Aravind Sesagiri Raamkumar ◽  
Hwee Lin Wee
Keyword(s):  
Public Health ◽  
Health Belief Model ◽  
United States Public Health ◽  
Health Belief ◽  
The United States ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Control And Prevention ◽  
Belief Model ◽  
The Health Belief Model

This study aims to describe Facebook users’ beliefs toward physical distancing measures implemented during the Coronavirus disease (COVID-19) pandemic using the key constructs of the health belief model. A combination of rule-based filtering and manual classification methods was used to classify user comments on COVID-19 Facebook posts of three public health authorities: Centers for Disease Control and Prevention of the United States, Public Health England, and Ministry of Health, Singapore. A total of 104,304 comments were analyzed for posts published between 1 January, 2020, and 31 March, 2020, along with COVID-19 cases and deaths count data from the three countries. Findings indicate that the perceived benefits of physical distancing measures ( n = 3,463; 3.3%) was three times higher than perceived barriers ( n = 1,062; 1.0%). Perceived susceptibility to COVID-19 ( n = 2,934; 2.8%) was higher compared with perceived severity ( n = 2,081; 2.0%). Although susceptibility aspects of physical distancing were discussed more often at the start of the year, mentions on the benefits of intervention emerged stronger toward the end of the analysis period, highlighting the shift in beliefs. The health belief model is useful for understanding Facebook users’ beliefs at a basic level, and it provides a scope for further improvement.

scholarly journals Environmental Influences of Extreme Heat on the Health of Older Adults: A Retrospective Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 280-280
Author(s):  
Mei Liu ◽  
Carol Buller ◽  
Barbara Polivka ◽  
Terri Woodburn ◽  
Mark Jakubauskas ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Environmental Influence ◽  
Emergency Department Visits ◽  
Extreme Heat ◽  
Extreme Weather Events ◽  
Study Cohort ◽  
Outpatient Visits ◽  
Extreme Heat Event ◽  
Heat Event

Abstract Studies have suggested that extreme weather events have differential effects by age. By leveraging electronic medical records, we aim to analyze the environmental influence of extreme heat on the health of older adults. From our healthcare system’s de-identified data warehouse, we extracted a retrospective cohort of 108,192 patients who were ≥65 years of age as of 1/1/2018 with pre-existing chronic conditions including diabetes, COPD, cardiovascular disease, or kidney disease. Extreme heat event period was defined as 5/1/2018 to 9/1/2018 (79 days with temperature ≥90o; 15 days of moderately poor/poor air quality index (AQI) [≥75] values) and the comparison period was defined as 5/1/2019 to 9/1/2019 (51 days with temperature ≥90o; 0 days with moderately poor/poor AQI values) in the Kansas City area. We randomly partitioned the study cohort into two sets and demonstrated the two patient sets were statistically similar (p&gt;0.05) with respect to their demographic and underlying health conditions. Finally, we compared the respiratory, cardiovascular, and renal health outcomes between the 2018 and the 2019 cohorts. Most patients were Caucasians, female and had comorbid conditions. Results showed significantly higher number of all-cause emergency department visits (p=0.04) and outpatient visits (p=&lt;.001) during the extreme heat event period in 2018. Analyses also showed significantly higher number of outpatient visits due to upper respiratory diseases (p=0.008) and acute renal failure (p=0.01) in 2018. In conclusion, extreme heat increased use of healthcare services in older adults with chronic conditions.

scholarly journals Fueling the Covid-19 pandemic: summer school holidays and incidence rates in German districts

2021 ◽  
Author(s):  
Thomas Plümper ◽  
Eric Neumayer
Keyword(s):  
Public Health ◽  
Fixed Effects ◽  
Summer School ◽  
Incidence Rates ◽  
Contact Tracing ◽  
Robert Koch Institute ◽  
Cross Sectional ◽  
Holiday Period ◽  
Health Authorities ◽  
Public Health Authorities

AbstractBackgroundThe Robert-Koch-Institute reports that during the summer holiday period a foreign country is stated as the most likely place of infection for an average of 27 and a maximum of 49% of new SARS-CoV-2 infections in Germany.MethodsCross-sectional study on observational data. In Germany, summer school holidays are coordinated between states and spread out over 13 weeks. Employing a dynamic model with district fixed effects, we analyze the association between these holidays and weekly incidence rates across 401 German districts.ResultsWe find effects of the holiday period of around 45% of the average district incidence rates in Germany during their respective final week of holidays and the 2 weeks after holidays end. Western states tend to experience stronger effects than Eastern states. We also find statistically significant interaction effects of school holidays with per capita taxable income and the share of foreign residents in a district’s population.ConclusionsOur results suggest that changed behavior during the holiday season accelerated the pandemic and made it considerably more difficult for public health authorities to contain the spread of the virus by means of contact tracing. Germany’s public health authorities did not prepare adequately for this acceleration.

scholarly journals Indoor Environmental Quality in Dwellings and Lifestyle Behaviors during the COVID-19 Pandemic: Russian Perspective

2021 ◽  
Vol 18 (11) ◽  
pp. 5975
Author(s):  
Vladimir Reshetnikov ◽  
Oleg Mitrokhin ◽  
Elena Belova ◽  
Victor Mikhailovsky ◽  
Maria Mikerova ◽  
...  
Keyword(s):  
Public Health ◽  
Medical Students ◽  
Environmental Quality ◽  
Indoor Environmental Quality ◽  
Lifestyle Behaviors ◽  
Contagious Diseases ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Isolation Index ◽  
Novel Coronavirus

The novel coronavirus (COVID-19) outbreak is a public health emergency of international concern, and as a response, public health authorities started enforcing preventive measures like self-isolation and social distancing. The enforcement of isolation has consequences that may affect the lifestyle-related behavior of the general population. Quarantine encompasses a range of strategies that can be used to detain, isolate, or conditionally release individuals or populations infected or exposed to contagious diseases and should be tailored to circumstances. Interestingly, medical students may represent an example of how the COVID-19 pandemic can form new habits and change lifestyle behaviors. We conducted a web-based survey to assess changes in lifestyle-related behavior of self-isolated medical students during the COVID-19 pandemic. Then we analyzed the sanitary-hygienic regulations of the Russian Federation to determine the requirements for healthy buildings. Results showed that during the pandemic, the enforcement of isolation affects medical students’ lifestyle-related behavior and accompanies an increase in non-communicable diseases (NCDs). Indoor environmental quality (IEQ) and healthy buildings are cutting-edge factors in preventing COVID-19 and NCDs. The Russian sanitary-hygienic regulations support improving this factor with suitable requirements for ventilation, sewage, waste management, and disinfection. Herein, assessing isolation is possible through the hygienic self-isolation index.

Preparedness and response in Portuguese emergency plans - Interaction with public health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Leiras ◽  
A Martins
Keyword(s):  
Public Health ◽  
Health Authority ◽  
Civil Protection ◽  
Emergency Plans ◽  
Emergency Situations ◽  
Health Measures ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Protection Authority

Abstract Background Articulation between Civil Protection and Public Health authorities is of paramount importance to control, reduce and prevent threats to the health of the population in situations of crisis or catastrophes. National Civil Protection Authority produces Emergency Plans which describe the role of every stakeholder in emergency situations. Role and importance of Public Health and Public Health Authorities is not always present or well described and known amongst stakeholders. Methods Data was collected from all Districtal Emergency Plans (n = 18). Each document was analysed considering time frame, refences to Public Health and Health Authorities, definition of roles, communication channels, coordination and inclusion of intersectoral communication flow. Quantitative analysis included absolute and relative frequencies and qualitative analysis to all parts related to the terms “Public Health” and “Health Authority”. Each document was reviewed by 2 independent researchers. Results From 18 Districtal Emergency Plans (DEP) analysed, 94,4% (n = 17) had references to Public Health, but none referred the role of Public Health Officers. Only 16,7% referred to Health Authorities, although 94,4% mentioned the law 135/2013, defining the role and attributes of Health Authority. In 72,2%, coordination of Public Health Measures was attributed to the National Medical Emergency Institute. Epidemiological surveillance and Public Health Emergencies were referred in 55,6%, and attributed to the Regional Administration of Health. Conclusions Public Health Authorities and Public Health Medical Officers role in articulation with National Civil Protection Authority in emergency situations lacks severely, with this role being replaced by other entities. This is of great concern regarding management and control of diseases, particularly communicable diseases. Key messages Public Health Authorities lack the necessary involvement in Emergency Plans and emergency situations. Public health measures are coordinated by other entities rather than Public Health Authorities.

scholarly journals Communicating Recommendations in Public Health Emergencies: The Role of Public Health Authorities

2020 ◽  
Vol 18 (1) ◽  
pp. 21-28
Author(s):  
Taylor A. Holroyd ◽  
Oladeji K. Oloko ◽  
Daniel A. Salmon ◽  
Saad B. Omer ◽  
Rupali J. Limaye
Keyword(s):  
Public Health ◽  
Public Health Emergencies ◽  
Health Authorities ◽  
Public Health Authorities
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