Centers for Disease Control and Prevention Harvard Program Evaluation Practicum: 10 Years of Partnership in Public Health Program Evaluation.

The Centers for Disease Control and Prevention (CDC)'s Division of Reproductive Health and Harvard T.H. Chan School of Public Health (HSPH) Program Evaluation Practicum (CDC/HSPH Practicum) is a mutually beneficial workforce development partnership formed to provide state, local, and tribal public health organizations with an evaluation plan for a maternal and child health (MCH) program. State, local, and tribal public health organizations submit an MCH program in need of evaluation for inclusion consideration. Student pairs are matched with the selected programs in a 3-week practical field-based experience. This Practicum provides didactic training for both program staff and students followed by field work at the public health organizations. Students provide organizations with comprehensive evaluation plans, complete with logic model, methodology, and indicators. Since the Practicum's inception in 2013, 104 HSPH graduate students have been trained and 30 states and 1 territory have participated and received evaluation plans for their MCH programs. The utility and importance of the CDC/HSPH Practicum is evidenced by program staff and student feedback. Multiple states have implemented the plans designed by the students, with some evaluations leading to program enhancements. The CDC/HSPH Practicum prepares students for the workforce and adds much needed capacity to public health organizations by providing them with evaluation knowledge and skills, and usable evaluation plans to improve MCH-a win-win for all.

Antiviral CD19+CD27+ Memory B Cells Are Associated with Protection from Recurrent Asymptomatic Ocular Herpesvirus Infection.

Reactivation of herpes simplex virus 1 (HSV-1) from latently infected neurons of the trigeminal ganglia (TG) leads to blinding recurrent herpetic disease in symptomatic (SYMP) individuals. Although the role of T cells in herpes immunity seen in asymptomatic (ASYMP) individuals is heavily explored, the role of B cells is less investigated. In the present study, we evaluated whether B cells are associated with protective immunity against recurrent ocular herpes. The frequencies of circulating HSV-specific memory B cells and of memory follicular helper T cells (CD4+ Tfh cells), which help B cells produce antibodies, were compared between HSV-1-infected SYMP and ASYMP individuals. The levels of IgG/IgA and neutralizing antibodies were compared in SYMP and ASYMP individuals. We found that (i) the ASYMP individuals had increased frequencies of HSV-specific CD19+CD27+ memory B cells, and (ii) high frequencies of HSV-specific switched IgG+CD19+CD27+ memory B cells detected in ASYMP individuals were directly proportional to high frequencies of CD45R0+CXCR5+CD4+ memory Tfh cells. However, no differences were detected in the level of HSV-specific IgG/IgA antibodies in SYMP and ASYMP individuals. Using the UV-B-induced HSV-1 reactivation mouse model, we found increased frequencies of HSV-specific antibody-secreting plasma HSV-1 gD+CD138+ B cells within the TG and circulation of ASYMP mice compared to those of SYMP mice. In contrast, no significant differences in the frequencies of B cells were found in the cornea, spleen, and bone-marrow. Our findings suggest that circulating antibody-producing HSV-specific memory B cells recruited locally to the TG may contribute to protection from symptomatic recurrent ocular herpes. IMPORTANCE Reactivation of herpes simplex virus 1 (HSV-1) from latently infected neurons of the trigeminal ganglia (TG) leads to blinding recurrent herpetic disease in symptomatic (SYMP) individuals. Although the role of T cells in herpes immunity against blinding recurrent herpetic disease is heavily explored, the role of B cells is less investigated. In the present study, we found that in both asymptomatic (ASYMP) individuals and ASYMP mice, there were increased frequencies of HSV-specific memory B cells that were directly proportional to high frequencies of memory Tfh cells. Moreover, following UV-B-induced reactivation, we found increased frequencies of HSV-specific antibody-secreting plasma B cells within the TG and circulation of ASYMP mice compared to those of SYMP mice. Our findings suggest that circulating antibody-producing HSV-specific memory B cells recruited locally to the TG may contribute to protection from recurrent ocular herpes.

Obstetric emergencies at the United States-Mexico border crossings in El Paso, Texas.

OBJECTIVE: To describe the frequency, characteristics, and patient outcomes for women who accessed Emergency Medical Services (EMS) for obstetric emergencies at the ports of entry (POE) between El Paso, Texas, United States of America, and Ciudad Juárez, Chihuahua, Mexico. METHODS: A descriptive study of women 12-49 years of age for whom an EMS ambulance was called to an El Paso POE location from December 2008-April 2011 was conducted. Women were identified through surveillance of EMS records. EMS and emergency department (ED) records were abstracted for all women through December 2009 and for women with an obstetric emergency through April 2011. For obstetric patients admitted to the hospital, additional prenatal and birth characteristics were collected. Frequencies and proportions were estimated for each variable; differences between residents of the United States and Mexico were tested. RESULTS: During December 2008-December 2009, 47.6% (68/143) of women receiving EMS assistance at an El Paso POE had an obstetric emergency, nearly 20 times the proportion for Texas overall. During December 2008-April 2011, 60.1% (66/109) of obstetric patients with ED records were admitted to hospital and 52 gave birth before discharge. Preterm birth (23.1%; No. = 12), low birth weight (9.6%; No. = 5), birth in transit (7.7%; No. = 4), and postpartum hemorrhage (5.8%; No. = 3) were common; fewer than one-half the women (46.2%; No. = 24) had evidence of prenatal care. CONCLUSIONS: The high proportion of obstetric EMS transports and high prevalence of complications in this population suggest a need for binational risk reduction efforts.

Obstetric emergencies at the United States-Mexico border crossings in El Paso, Texas / Urgencias obstétricas en la frontera entre los Estados Unidos y México en El Paso, Texas

Objective. To describe the frequency, characteristics, and patient outcomes for women who accessed Emergency Medical Services (EMS) for obstetric emergencies at the ports of entry (POE) between El Paso, Texas, United States of America, and Ciudad Juárez, Chihuahua, Mexico. Methods. A descriptive study of women 12-49 years of age for whom an EMS ambulance was called to an El Paso POE location from December 2008-April 2011 was conducted. Women were identified through surveillance of EMS records. EMS and emergency department (ED) records were abstracted for all women through December 2009 and for women with an obstetric emergency through April 2011. For obstetric patients admitted to the hospital, additional prenatal and birth characteristics were collected. Frequencies and proportions were estimated for each variable; differences between residents of the United States and Mexico were tested. Results. During December 2008-December 2009, 47.6% (68/143) of women receiving EMS assistance at an El Paso POE had an obstetric emergency, nearly 20 times the proportion for Texas overall. During December 2008-April 2011, 60.1% (66/109) of obstetric patients with ED records were admitted to hospital and 52 gave birth before discharge. Preterm birth (23.1%; No. = 12), low birth weight (9.6%; No. = 5), birth in transit (7.7%; No. = 4), and postpartum hemorrhage (5.8%; No. = 3) were common; fewer than one-half the women (46.2%; No. = 24) had evidence of prenatal care. Conclusions. The high proportion of obstetric EMS transports and high prevalence of complications in this population suggest a need for binational risk reduction efforts.

Objetivo. Describir la frecuencia, las características y los resultados asistenciales de las mujeres que recibieron atención médica de urgencia por problemas obstétricos en los puntos fronterizos entre El Paso (Texas, Estados Unidos) y Ciudad Juárez (Chihuahua, México). Métodos. Se realizó un estudio descriptivo de las mujeres de 12 a 49 años de edad para las que se solicitó una ambulancia de urgencia desde los puntos de ingreso de El Paso entre diciembre del 2008 y abril del 2011. Para identificar a las mujeres se hizo un seguimiento de los archivos de los servicios de urgencias. Se resumieron los historiales de los servicios de urgencias y del departamento de urgencias hasta diciembre del 2009 en el caso de todas las mujeres y hasta abril del 2011 en el caso de las mujeres con una urgencia obstétrica. Respecto a las pacientes ingresadas en hospitales por cuadros obstétricos, se recopilaron además las características prenatales y los datos del parto. Se calcularon las frecuencias y las proporciones relativas a cada variable; se analizaron las diferencias entre las residentes de los Estados Unidos y las de México. Resultados. En el período comprendido entre diciembre del 2008 y diciembre del 2009, 47,6% (68/143) de las mujeres atendidas de urgencia en un punto fronterizo de El Paso presentó una urgencia obstétrica, casi 20 veces la proporción correspondiente al estado de Texas en general. Entre diciembre del 2008 y abril del 2011, 60,1% (66/109) de las pacientes obstétricas con historial en el departamento de urgencias fueron ingresadas en un hospital y 52 dieron a luz antes de recibir el alta. Fueron frecuentes los partos prematuros (23,1%; No. = 12), el peso bajo al nacer (9,6%, No. = 5), los partos en tránsito (7,7%; No. = 4) y las hemorragias posparto (5,8%; No. = 3); en menos de la mitad de los casos (46,2%; No. = 24) no se constató que las mujeres hubiesen recibido asistencia prenatal. Conclusiones. La elevada proporción de transportes por urgencias obstétricas y la alta prevalencia de complicaciones en esta población ponen de manifiesto la necesidad de actuaciones binacionales para reducir los riesgos.

Evaluation of the 2012 18th Maternal and Child Health (MCH) Epidemiology and 22nd CityMatCH MCH Urban Leadership Conference: six month impact on science, program, and policy.

The 18th Maternal and Child Health (MCH) Epidemiology and 22nd CityMatCH MCH Urban Leadership Conference took place in December 2012, covering MCH science, program, and policy issues. Assessing the impact of the Conference on attendees' work 6 months post-Conference provides information critical to understanding the impact and the use of new partnerships, knowledge, and skills gained during the Conference. Evaluation assessments, which included collection of quantitative and qualitative data, were administered at two time points: at Conference registration and 6 months post-Conference. The evaluation files were merged using computer IP address, linking responses from each assessment. Percentages of attendees reporting Conference impacts were calculated from quantitative data, and common themes and supporting examples were identified from qualitative data. Online registration was completed by 650 individuals. Of registrants, 30 % responded to the 6 month post-Conference assessment. Between registration and 6 month post-Conference evaluation, the distribution of respondents did not significantly differ by organizational affiliation. In the 6 months following the Conference, 65 % of respondents reported pursuing a networking interaction; 96 % shared knowledge from the Conference with co-workers and others in their agency; and 74 % utilized knowledge from the Conference to translate data into public health action. The Conference produced far-reaching impacts among Conference attendees. The Conference served as a platform for networking, knowledge sharing, and attaining skills that advance the work of attendees, with the potential of impacting organizational and workforce capacity. Increasing capacity could improve MCH programs, policies, and services, ultimately impacting the health of women, infants, and children.