Northern Nevada Public Health: Utilizing the Public Health Workforce Calculator and Workforce Capacity Self-assessment Tools to Develop a Framework for Workforce Investment.

CONTEXT: Health departments nationally are critically understaffed and lack infrastructure support. By examining current staffing and allocations through a Foundational Public Health Services (FPHS) lens at the Northern Nevada Public Health (NNPH), there is an opportunity to make a strong case for greater investment if current dedicated full-time equivalents are inadequate and to guide which investments in public health workforce are prioritized. OBJECTIVE: To assess the use of the Public Health Workforce Calculator (calculator) and other tools to identify and prioritize FPHS workforce needs in a field application. DESIGN: Field application of the calculator in conjunction with the use of FPHS workforce capacity self-assessment tools. SETTING: NNPH. PARTICIPANTS: NNPH and Public Health Foundation (PHF). INTERVENTION: From June 2022 through April 2023, PHF collaborated with NNPH, serving Washoe County, to provide expertise and assistance as NNPH undertook an assessment of its workforce needs based upon the FPHS model. MAIN OUTCOME MEASURES: Comparison of the calculator output with FPHS workforce capacity self-assessment tools. RESULTS: The calculator and the FPHS capacity self-assessment process yielded complementary FPHS workforce capacity gap data. The use of a structured and transparent process, coupled with additional tools that included prioritizing needs, provided a viable and sustainable process for public health workforce investment planning. NNPH successfully utilized the results to bolster a supplemental funding request and a state public health appropriation. CONCLUSIONS: The use of the calculator and an FPHS workforce capacity self-assessment in a facilitated and structured process such as that used by NNPH to identify staffing priorities may hold promise as an approach that could be used to support decision-making and justification for infrastructure resources when funding for public health increases in the future.

Low-level nutrient enrichment during thermal stress delays bleaching and ameliorates calcification in three Hawaiian reef coral species.

Terrestrial-based nutrient pollution has emerged as one of the most detrimental factors to coral health in many reef habitats. Recent studies have shown that excessive dissolved inorganic nutrients can reduce coral thermal tolerance thresholds and even exacerbate bleaching during thermal stress, yet the effects of minor nutrient enrichment under heat stress have not been extensively studied. In this study, Lobactis scutaria, Montipora capitata, and Pocillopora acuta colonies under heated conditions (~30.5 °C) were exposed to low and balanced nitrogen and phosphorous concentrations over a 31-day heating period. Coral colonies were collected from Kane'ohe Bay, O'ahu, which has a unique history of nutrient pollution, and held in mesocosms that allowed for environmental manipulation yet are also influenced by local field conditions. Principal findings included delays in the bleaching of nutrient-enriched heated colonies as compared to heated-only colonies, in addition to relatively greater calcification rates and lower proportions of early-stage paling. Species-specific outcomes were prevalent, with L. scutaria demonstrating no difference in calcification with enrichment under heat stress. By the end of the heating stage, however, many heated colonies were at least partially impacted by bleaching or mortality. Despite this, our findings suggest that low levels of balanced nutrient enrichment may serve as a mitigative force during thermal events. Further field-based studies will be required to assess these results in different reef habitats.

High concentrations of urinary ethanol metabolites in neonatal intensive care unit infants.

BACKGROUND: Infants in the neonatal intensive care unit may be exposed to ethanol via medications that contain ethanol as an excipient and through inhalation of ethanol vapor from hand sanitizers. We hypothesized that both pathways of exposure would result in elevated urinary biomarkers of ethanol. METHODS: Urine samples were collected from infants in incubators and in open cribs. Two ethanol metabolites, ethyl sulfate (EtS) and ethyl glucuronide (EtG), were quantified in infants' urine. RESULTS: A subset of infants both in incubators and open cribs had ethanol biomarkers greater than the cutoff concentration that identifies adult alcohol consumption. These concentrations were associated with the infant having received an ethanol-containing medication on the day of urine collection. When infants who received an ethanol-containing medication were excluded from analysis, there was no difference in ethanol biomarker concentrations between the incubator and crib groups. CONCLUSIONS: Some infants who received ethanol-containing medications had concentrations of ethanol biomarkers that are indicative of adult alcohol consumption, suggesting potential exposure via ethanol excipients. IMPACT: Infants and newborns in the neonatal intensive care unit are exposed to concerning amounts of ethanol. No one has shown exposure to ethanol in these infants before this study. The impact is that better understanding of the excipients in medications given to patients in the NICU is needed. When physicians order medications in the NICU, the amount of excipient needs to be indicated.

Urinary metabolites of volatile organic compounds of infants in the neonatal intensive care unit.

BackgroundPreterm infants (PTI) in the NICU are often placed in incubators that may increase their exposure to volatile organic chemicals (VOCs). To determine whether PTI in incubators have higher urinary concentrations of VOC metabolites compared with infants in cribs.MethodsUrine from 40 PTI in incubators and 40 infants in cribs was collected and analyzed for 28 urinary VOC biomarkers. Differences in metabolite concentrations between the two groups were compared.ResultsTwenty two of the VOC metabolites were detected in at least one urine sample. All urine samples tested had measurable levels of six VOC metabolites. Biomarkers for acrolein, acrylonitrile, carbon disulfide, cyanide, N-dimethylformamide, ethylbenzene, ethylene oxide, propylene oxide, styrene, toluene/benzyl alcohol, vinyl chloride, and xylene were higher in the incubator group. The geometric means of five VOC metabolites were 2-fold higher than those reported for NHANES children 6-11 years of age in one or both of the groups with benzyl mercapturic acid being 7-fold and 12-fold greater than NHANES in the crib and incubator group, respectively.ConclusionAll infants were exposed to VOCs. PTI in incubators have a different VOC exposure profile compared with infants in cribs. The health implications associated with these exposures require further study.

The impacts of local health department consolidation on public health expenditures: evidence from Ohio.

We examined the effects of local health department (LHD) consolidations on the total and administrative expenditures of LHDs in Ohio from 2001 to 2011. We obtained data from annual records maintained by the state of Ohio and through interviews conducted with senior local health officials and identified 20 consolidations of LHDs occurring in Ohio in this time period. We found that consolidating LHDs experienced a reduction in total expenditures of approximately 16% (P = .017), although we found no statistically significant change in administrative expenses. County health officials who were interviewed concurred that their consolidations yielded financial benefits, and they also asserted that their consolidations yielded public health service improvements.

Enforcement of Ohio's Smoke Free Workplace Law through the lens of public health practice.

OBJECTIVES: Little is known about whether public health (PH) enforcement of Ohio's 2007 Smoke Free Workplace Law (SFWPL) is associated with department (agency) characteristics, practice, or state reimbursement to local PH agencies for enforcement. We used mixed methods to determine practice patterns, perceptions, and opinions among the PH workforce involved in enforcement to identify agency and workforce associations. METHODS: Focus groups and phone interviews (n=13) provided comments and identified issues in developing an online survey targeting PH workers through e-mail recruitment (433 addresses). RESULTS: A total of 171 PH workers responded to the survey. Of Ohio's 88 counties, 81 (43% rural and 57% urban) were represented. More urban than rural agencies agreed that SFWPL enforcement was worth the effort and cost (80% vs. 61%, p=0.021). The State Attorney General's collection of large outstanding fines was perceived as unreliable. An estimated 77% of agencies lose money on enforcement annually; 18% broke even, 56% attributed a financial loss to uncollected fines, and 63% occasionally or never fully recovered fines. About half of agency leaders (49%) felt that state reimbursements were inadequate to cover inspection costs. Rural agencies (59%) indicated they would be more likely than urban agencies (40%) to drop enforcement if reimbursements ended (p=0.0070). Prioritization of SFWPL vs. routine code enforcement differed between rural and urban agencies. CONCLUSIONS: These findings demonstrate the importance of increasing state health department financial support of local enforcement activities and improving collection of fines for noncompliance. Otherwise, many PH agencies, especially rural ones, will opt out, thereby increasing the state's burden to enforce SFWPL and challenging widespread public support for the law.

Public health accreditation and metrics for ethics: a case study on environmental health and community engagement.

As public health departments around the country undergo accreditation using the Public Health Accreditation Board standards, the process provides a new opportunity to integrate ethics metrics into day-to-day public health practice. While the accreditation standards do not explicitly address ethics, ethical tools and considerations can enrich the accreditation process by helping health departments and their communities understand what ethical principles underlie the accreditation standards and how to use metrics based on these ethical principles to support decision making in public health practice. We provide a crosswalk between a public health essential service, Public Health Accreditation Board community engagement domain standards, and the relevant ethical principles in the Public Health Code of Ethics (Code). A case study illustrates how the accreditation standards and the ethical principles in the Code together can enhance the practice of engaging the community in decision making in the local health department.

Anatomy of a public health agency turnaround: the case of the general health district in Mahoning County.

A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.

Cost of child lead poisoning to taxpayers in Mahoning County, Ohio.

Lead poisoning in children imposes both immediate and long-term financial burdens on taxpayers. The District Board of Health of Mahoning County, Ohio, quantified some of the direct costs to taxpayers of providing medical care and public health services to the 279 children diagnosed with lead poisoning in the county in 2002, using methods described by Katrina Korfmacher at the University of Rochester. The Board of Health also attempted to quantify the longer-term costs of special education and juvenile justice services attributable to lead exposure. The realization that lead poisoning costs local government on the order of 0.5 million dollars each year has mobilized community leaders in education and juvenile justice to demand more aggressive action against rental property owners who fail to remediate lead hazards.