“It’s good to feel like you’re doing something”: a qualitative study examining state health department employees’ views on why ineffective programs continue to be implemented in the USA

Background Mis-implementation, the inappropriate continuation of programs or policies that are not evidence-based or the inappropriate termination of evidence-based programs and policies, can lead to the inefficient use of scarce resources in public health agencies and decrease the ability of these agencies to deliver effective programs and improve population health. Little is known about why mis-implementation occurs, which is needed to understand how to address it. This study sought to understand the state health department practitioners’ perspectives about what makes programs ineffective and the reasons why ineffective programs continue. Methods Eight state health departments (SHDs) were selected to participate in telephone-administered qualitative interviews about decision-making around ending or continuing programs. States were selected based on geographic representation and on their level of mis-implementation (low and high) categorized from our previous national survey. Forty-four SHD chronic disease staff participated in interviews, which were audio-recorded and transcribed verbatim. Transcripts were consensus coded, and themes were identified and summarized. This paper presents two sets of themes, related to (1) what makes a program ineffective and (2) why ineffective programs continue to be implemented according to SHD staff. Results Participants considered programs ineffective if they were not evidence-based or if they did not fit well within the population; could not be implemented well due to program restraints or a lack of staff time and resources; did not reach those who could most benefit from the program; or did not show the expected program outcomes through evaluation. Practitioners described several reasons why ineffective programs continued to be implemented, including concerns about damaging the relationships with partner organizations, the presence of program champions, agency capacity, and funding restrictions. Conclusions The continued implementation of ineffective programs occurs due to a number of interrelated organizational, relational, human resources, and economic factors. Efforts should focus on preventing mis-implementation since it limits public health agencies’ ability to conduct evidence-based public health, implement evidence-based programs effectively, and reduce the high burden of chronic diseases. The use of evidence-based decision-making in public health agencies and supporting adaptation of programs to improve their fit may prevent mis-implementation. Future work should identify effective strategies to reduce mis-implementation, which can optimize public health practice and improve population health.

An Evaluation of Epidemic Intelligence Service Alumni in Public Health Leadership Roles

Background The U.S. Centers for Disease Control and Prevention (CDC) has administered the Epidemic Intelligence Service (EIS) fellowship for over 50 years, with the goal of developing scientists and leaders in applied epidemiology. Our objective was to understand the extent to which CDC EIS alumni are present in select public health leadership roles. Methods We conducted an evaluation describing EIS alumni representation in five preselected leadership positions (CDC director [1953–2016]; CDC center director, state epidemiologist, Field Epidemiology Training Program [FETP] resident advisor, and Career Epidemiology Field Officer [CEFO] [2000–2016]). We developed a dataset using multiple sources to identify staff in selected positions. We then matched these data with an internal EIS alumni dataset. Results Selected positions were staffed by 353 persons, of which 185 (52%) were EIS alumni; 10 persons served in >1 leadership position, of which 6 were EIS alumni. Among 12 CDC directors, four (33%) were EIS alumni; collectively these alumni led CDC for approximately 25 years. EIS alumni accounted for 29 (58%) of 50 CDC center directors, 61 (35%) of 175 state epidemiologists, 27 (56%) of 48 Field Epidemiology Training Program resident advisors, and 70 (90%) of 78 Career Epidemiology Field Officers. Of 185 EIS alumni in leadership positions, 136 (74%) were physicians, 22 (12%) were scientists, 21 (11%) were veterinarians, 6 (3%) were nurses; 94 (51%) were assigned to a state or local health department. Among 61 EIS alumni who served as state epidemiologists, 40 (66%) were assigned to a state or local health department during EIS. Conclusions EIS alumni accounted for between approximately one-third (CDC directors and state epidemiologists) and 90% (CEFOs) of people serving in essential leadership positions at multiple levels.

Does health service funding go where the need is? A prototype spatial access analysis for new urban contracts data

Background Much of spatial access research measures the proximity to health service locations. We advance this research by focusing on whether health service funding is within walkable reach of neighborhoods with high hardship. This is made possible by a new administrative data source: financial contracts data for those human services that are delivered by nonprofits under contract with the government. Methods In a prototypical spatial access study we apply a classic 2-step floating area catchment model for walkable network access to analyze 2018 data about contracted nonprofit health services funded by the Chicago Department of Public Health (CDPH). CDPH collected the data for the purpose of this study. Results We find that the common container approach of aggregating contract amounts by provider headquarter locations in a given area (ignoring satellite service sites) underestimates the share of funding that goes to Chicago neighborhoods with higher hardship. Once service sites and spatial access are taken into account, a larger share of CDPH funds was found to be within walkable reach of Chicago’s high hardship areas. This was followed by low hardship areas (which could be driven by more headquarter locations there that do serve areas throughout the city). Medium hardship areas trail both, perhaps warranting closer attention. We explore these results by program type and neighborhood with a spatial decision support system developed for the health department. Conclusions The typical approach for analyzing human service contracts based on headquarters is misleading -- in fact, we find that results are reversed when service sites and walkable access are taken into account. This prototype provides an alternative framework for avoiding these misleading results.

Pengembangan Media Pembelajaran Berbasis Video Tutorial Praktik Pada Mata Kuliah Keselamatan Dan Kesehatan Kerja

This study aims to produce learning videos that are feasible as learning media. The resulting video is a Spirometer Practice Tutorial Video in the Occupational Safety and Health (K3) subject for students of the Environmental Health Department of the Health Ministry of Health Yogyakarta. The method used in research is the method of research and development (Research and Development). This development research uses the Borg & Gall development procedure model which is simplified by the Puslitjaknov Team (2008: 11) with the following steps: 1) Analyzing the product to be developed, 2) Developing the initial product, 3) Expert validation and revision, 4) Testing small-scale field and revisions, 5). Large-scale field trials and final products. The research location was carried out at the Hyperkes Laboratory of Environmental Health Department. This research was conducted in July - September 2020. The results showed that the Spirometer Practice Tutorial video in the occupational safety and health course can be used as a learning medium or learning resource for students, especially for the K3 (Occupational Health Safety) practical course in the Environmental Health Department. the feasibility level is 86.84 5%. Keywords: Learning Media , Video Tutorial, K3 Practice Course

Cryptoccoccal meningitis in post-covid 19 patient in the city of manaus: Case report

Cryptococcosis is a cosmopolitan and opportunistic mycosis, caused mainly by the etiological agent Cryptococcus neoformans, through the inhalation of fungal structures, especially in bird feces. The aim of this study was to report a reported case of cryptococcal meningitis in an immunosuppressed patient due to previous COVID-19 infection in the city of Manaus-AM, as well as to implement health education actions to prevent cryptococcosis in the region of the disease. Information about the case was obtained through access to the database of the Information System for Notifiable Diseases (SINAN), made available by the Center for Control of Zoonoses Dr. Carlos Durand (CCZ), an agency belonging to the Municipal Health Department of Manaus (SEMSA). The case patient, male, presented symptoms such as headache, fever, vomiting, seizures, neck stiffness, petechiae and hemorrhagic suffusions, hearing loss and signs of Kernig and Brudzinski. In a zoosanitary visit to the site of the injury, the presence of pigeon excreta on the walls of the residence was found, and cleaning was carried out without the use of personal protective equipment (PPE’s). The contact with the residents evidenced the lack of information about the zoonosis addressed, including the risk of transmission of cryptococcosis by pigeons, facts that make necessary more sanitary actions on zoonoses among the population of Manaus.

The Landscape of State and Local School-Located Vaccination Clinics: Practices, Policies, and Lessons Learned for Providing COVID-19 and Routine Vaccinations

For decades, school-located vaccinations clinics (SLVs) have successfully offered influenza and routine childhood immunizations that have contributed to lowering the morbidity and mortality of vaccine-preventable diseases. These SLVs laid the foundation for state and local health departments and school districts to quickly implement SLVs in response to COVID-19. To support school nurses and immunization programs in implementing future SLVs during the COVID-19 pandemic, we explored the landscape of SLVs between August 2019 and late summer 2021 using publicly available information from school and health department websites, news articles reporting on SLVs, and internal documents provided by school nurses and immunization programs who hosted SLVs. Our scan identified variability in the reach, scope, and approach to SLVs, but consistent themes persist such as the importance of partnerships and SLVs as an opportunity to promote equitable access to vaccinations. Useful documents and resources for planning and hosting SLV clinics were compiled into a table. With COVID-19 vaccines now available to all school-age children, SLVs provide an even greater opportunity to improve school and community health. The included resources are designed to provide support for those interested in SLV implementation.

History of Rabies Incidence and Rabies Control in Serbia in Support of the Zero by 2030 Campaign to Eliminate Dog-Mediated Human Rabies

Urban (principally canine-mediated) rabies has been a public health risk for people living in Serbia for centuries. The first legal act in urban rabies prevention in Serbia was established in 1834 by introducing high taxes for pet dog owners. Five years later in 1839, the first set of literature describing rabies prevention was issued by the health department from The Serbian Ministry of Interior. An overview of cauterization of rabies wounds was presented as the principal method of rabies post exposure prophylaxis. In 1890, a human rabies vaccination was introduced in Serbia with the royal government directive which ordered patients to be treated at the Pasteur Institute in Budapest in receipt of rabies vaccination. Urban (canine) rabies was eliminated during the 1980s, but sylvatic (principally fox-mediated) rabies still prevailed. The last human rabies case was recorded in the Province of Kosovo and Metohija in 1980. Sylvatic rabies in Serbia is in the final stages of elimination by orally vaccinating foxes (Vulpes vulpes). The only published finding of a lyssavirus among Serbian bats was made in 1954 by Dr Milan Nikolić in the vicinity of Novi Sad. In 2006, a comprehensive two-year active surveillance program of lyssaviruses in bats in Serbia was undertaken. In this single study, all of the bats from Serbia tested negative for a lyssavirus.

Prescription Dose Analysis of Quetiapine in the Elderly and Insomnia

Objective: The purpose of this study is to investigate the appropriate dose of quetiapine in clinical psychiatric diseases by examining the drug prescription dose in the elderly and insomnia group through an analysis of the tendency of quetiapine dose prescribed by psychiatric diagnosis.Methods: Among the patients who had been taking outpatient treatment to the mental health department for about 7 years and 8 months from May 1, 2010 to December 31, 2017, 2,794 patients who were continuously taking quetiapine immediate-release form drugs were retrospectively tested. In addition, all subjects were classified into a total of four groups according to their maintenance dose, four mental diseases that most commonly prescribe quetiapine were selected and grouped, and further analyzed whether there was a difference in prescription capacity by age and comorbidities for the insomnia group.Results: Prescription dose of quetiapine was found to be less than 50 mg in depressive disorders and insomnia, which is a relatively low dose prescribed compared to schizophrenia and bipolar disorder. In the case of insomnia, quetiapine prescribed in the elderly patient group was 30.03±9.14 mg, which was relatively high compared to the non-elderly group. And in the case of insomnia accompanied by depressive disorder, 50.28±11.41 mg was prescribed, more than 60% higher doses than that of primary insomnia.Conclusion: In the case of primary insomnia, quetiapine dose prescribed in the elderly patient group is higher than that in the non-elderly patient group.