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1.
MMWR Morb Mortal Wkly Rep ; 71(13): 484-488, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35358167

RESUMO

In 2021, during the COVID-19 response, the Council of State and Territorial Epidemiologists (CSTE) conducted its seventh periodic Epidemiology Capacity Assessment (ECA), a national assessment that evaluates trends in applied epidemiology workforce size, funding, and epidemiology capacity at state health departments.* A standardized web-based questionnaire was sent to state epidemiologists in 50 states and the District of Columbia (DC). The questionnaire assessed the number of current and optimal epidemiologist positions; sources of epidemiology activity and personnel funding; and each health department's self-perceived capacity to lead activities, provide subject matter expertise, and obtain and manage resources for the three essential public health services (EPHS) most closely linked to epidemiology.† CSTE enumerated 4,136 epidemiology positions across the United States, with an additional 2,196 positions needed to provide basic public health services. From 2017 to 2021, the number of epidemiologists in state health departments increased 23%, an increase primarily accounted for by the number of those supporting the COVID-19 response§. The number of staff members decreased in program areas of infectious diseases, chronic diseases, and maternal and child health (MCH). Federal funding supports most epidemiology activities (85%) and epidemiology personnel (83%). Overall capacity to deliver the EPHS has declined, and epidemiology workforce and capacity needs remain unmet. More epidemiologists and sustainable funding are needed to consistently and effectively deliver EPHS. Additional resources (e.g., funding for competitive compensation and pathways for career advancement) are essential for recruitment and retention of epidemiologists to support public health activities across all program areas.


Assuntos
COVID-19 , Administração em Saúde Pública , COVID-19/epidemiologia , Criança , District of Columbia , Humanos , Governo Estadual , Estados Unidos/epidemiologia , Recursos Humanos
5.
Am J Public Health ; 112(3): 397-400, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35196042

RESUMO

During the COVID-19 pandemic, media accounts emerged describing faith-based organizations (FBOs) working alongside health departments to support the COVID-19 response. In May 2021, the Department of Health and Human Services, Centers for Disease Control and Prevention, and the Association of State and Territorial Health Officials (ASTHO) sent an electronic survey to the 59 ASTHO member jurisdictions and four major US cities to assess state and territorial engagement with FBOs. Findings suggest that public health officials in many jurisdictions were able to work effectively with FBOs during the COVID-19 pandemic to provide essential education and mitigation tools to diverse communities. (Am J Public Health. 2022;112(3):397-400. https://doi.org/10.2105/AJPH.2021.306620).


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/etnologia , COVID-19/prevenção & controle , Organizações Religiosas/organização & administração , Promoção da Saúde/organização & administração , Relações Comunidade-Instituição , Organizações Religiosas/economia , Equidade em Saúde , Promoção da Saúde/economia , Humanos , Pandemias , Administração em Saúde Pública , SARS-CoV-2 , Governo Estadual , Estados Unidos/epidemiologia , /etnologia
6.
MMWR Morb Mortal Wkly Rep ; 71(2): 37-42, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35025857

RESUMO

Opioid use disorder (OUD) is a significant public health problem in the United States, which affects children as well as adults. During 2010-2017, maternal opioid-related diagnoses increased approximately 130%, from 3.5 to 8.2 per 1,000 hospital deliveries, and neonatal abstinence syndrome (NAS) increased 83%, from 4.0 to 7.3 per 1,000 hospital deliveries (1). NAS, a withdrawal syndrome, can occur among infants following in utero exposure to opioids and other psychotropic substances (2). In 2018, a study of six states with mandated NAS case reporting for public health surveillance (2013-2017) found that mandated reporting helped quantify NAS incidence and guide programs and services (3). To review surveillance features and programmatic development in the same six states, a questionnaire and interview with state health department officials on postimplementation efforts were developed and implemented in 2021. All states reported ongoing challenges with initial case reporting, limited capacity to track social and developmental outcomes, and no requirement for long-term follow-up in state-mandated case reporting; only one state instituted health-related outcomes monitoring. The primary surveillance barrier beyond initial case reporting was lack of infrastructure. To serve identified needs of opioid- or other substance-exposed mother-infant dyads, state health departments reported programmatic successes expanding education and access to maternal medication for opioid use disorder (MOUD), community and provider education or support services, and partnerships with perinatal quality collaboratives. Development of additional infrastructure is needed for states aiming to advance NAS surveillance beyond initial case reporting.


Assuntos
Analgésicos Opioides/efeitos adversos , Notificação de Abuso , Síndrome de Abstinência Neonatal/epidemiologia , Avaliação de Programas e Projetos de Saúde , Vigilância em Saúde Pública , Seguimentos , Humanos , Pesquisa Qualitativa , Governo Estadual , Estados Unidos/epidemiologia
8.
J Trauma Acute Care Surg ; 92(2): e25-e27, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35081099

RESUMO

ABSTRACT: In recent years, calls to address gun violence through public health approaches have increased. However, securing funding for health-based community violence intervention models has remained a challenge. New actions suggest that this may be shifting. Upon taking office, the Biden administration announced a series of funding opportunities for these programs, which ranged from competitive grant programs to a proposed 8-year, $5 billion plan. Less publicized, but just as important, is the administration's announcement that Medicaid can be used to reimburse this work, specifically noting the eligibility of hospital-based violence intervention and prevention programs. For these programs, this creates a predictable and reliable funding source that has not existed to date. This integration of violence prevention programming in the traditional health care and financing systems represents a critical inflection point in the United States' shifting response to community violence. However, the decision to use this optional benefit lies with each state. States should strongly consider harnessing Medicaid as a wise investment to address the United States' gun violence epidemic. LEVEL OF EVIDENCE: Economic and value-based evaluation, level IV.


Assuntos
Financiamento Governamental , Violência com Arma de Fogo/prevenção & controle , Medicaid/economia , Humanos , Política , Governo Estadual , Estados Unidos
13.
Nurs Outlook ; 70(1): 47-54, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34620493

RESUMO

BACKGROUND: The enduring absence of robust nursing workforce data creates gaps to support evidence-based workforce planning and policy development. PURPOSE: The purpose of this study was to examine Georgia nursing workforce data available through state and national agencies to determine if significance differences exist among data sources. METHODS: A cross-sectional, descriptive analysis of 2017 Georgia nursing workforce data was used to examine and compare workforce characteristics available from five data sources. The advantages and limitations of each data source were reviewed. FINDINGS: Significant differences were noted in the quality and quantity of data collected on the Georgia nursing workforce as reported by state and national agencies. None of the datasets include in our analysis had comprehensive and timely data on the Georgia nursing workforce. DISCUSSION: Nursing workforce stakeholders must work collaboratively to require and implement a comprehensive re-licensure survey. It is only though a standardized national minimum dataset that we can ensure an adequate nursing workforce.


Assuntos
Confiabilidade dos Dados , Coleta de Dados , Recursos Humanos de Enfermagem/estatística & dados numéricos , Governo Estadual , Recursos Humanos/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Georgia , Humanos , Licenciamento/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
14.
Nurs Outlook ; 70(1): 28-35, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34763899

RESUMO

BACKGROUND: During the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions. PURPOSE: To support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research. METHODS: We have conducted a thorough review of the existing literature. FINDINGS: NP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost. DISCUSSION: The changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.


Assuntos
Profissionais de Enfermagem/legislação & jurisprudência , Padrões de Prática em Enfermagem/tendências , Atenção Primária à Saúde , Âmbito da Prática/legislação & jurisprudência , Governo Estadual , COVID-19 , Governo Federal , Acesso aos Serviços de Saúde , Humanos , Âmbito da Prática/tendências
17.
J Gerontol B Psychol Sci Soc Sci ; 77(1): 191-200, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33631012

RESUMO

OBJECTIVES: The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program. METHODS: Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors was considered representing states' economic, political, and programmatic conditions. RESULTS: The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP. DISCUSSION: The findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports.


Assuntos
Serviços de Saúde Comunitária , Pessoas com Deficiência , Programas Governamentais , Serviços de Assistência Domiciliar , Medicaid , Casas de Saúde , Patient Protection and Affordable Care Act , Política , Governo Estadual , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/legislação & jurisprudência , Humanos , Assistência de Longa Duração/economia , Assistência de Longa Duração/legislação & jurisprudência , Medicaid/economia , Medicaid/legislação & jurisprudência , Casas de Saúde/economia , Casas de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados Unidos
18.
Psychiatr Serv ; 73(3): 265-270, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34320828

RESUMO

OBJECTIVE: This article describes policy surveillance methodology used to track changes in the comprehensiveness of state mental health insurance laws over 23 years, resulting in a data set that supports legal epidemiology studies measuring effects of these laws on mental health outcomes. METHODS: Structured policy surveillance methods, including a coding protocol, blind coding of laws in 10% of states, and consensus meetings, were used to track changes in state laws from 1997 through 2019-2020. The legal database Westlaw was used to identify relevant statutes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definitions of mental health conditions, and enforcement-compliance. Points (range 0-7) were assigned to reflect the laws' comprehensiveness and aid interpretation of changes over time. RESULTS: The search resulted in 147 coding time periods across 51 jurisdictions (50 states, District of Columbia). Intercoder consensus rates increased from 89% to 100% in the final round of blinded duplicate coding. Since 1997, average comprehensiveness scores increased from 1.31 to 3.82. In 1997, 41% of jurisdictions had a parity law, 28% mandated coverage, 31% defined mental health conditions, and 8% required state agency enforcement. In 2019-2020, 94% of jurisdictions had a parity law, 63% mandated coverage, 75% defined mental health conditions, and 29% required state enforcement efforts. CONCLUSIONS: Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.


Assuntos
Seguro Psiquiátrico , Transtornos Mentais , District of Columbia , Humanos , Seguro Saúde , Epidemiologia Legal , Governo Estadual , Estados Unidos
19.
Am J Prev Med ; 62(1): 1-8, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34446314

RESUMO

INTRODUCTION: State policies and programs affect population health; yet, little is known about the connections between health and the political institutions and actors that prescribe and execute those policies and programs. METHODS: The 2-way fixed-effects regression models were fitted to data from the National Center for Health Statistics, 1969-2014, to estimate logged infant mortality rate differentials between Republican- and non-Republican‒controlled state legislatures. These data were used in 2020 to hypothesize that net of trend, fluctuations in infant mortality rates-overall and by race-correlate with the party that controls state legislatures (the Lower House, the Upper House, and Congress). RESULTS: Findings show that state infant and postneonatal mortality rates are substantively higher under Republican-controlled state legislatures than under non-Republican‒controlled ones. The effect size is larger for postneonatal than for neonatal mortality. Findings suggest that effects may be greater for Black than for White infants, although the race-specific results are estimated imprecisely. The governor's party shows no substantive impacts on infant mortality rates net of party control of the Lower House. CONCLUSIONS: Findings support the proposition that the social determinants of health are constructed, at least in part, by the power vested in governments.


Assuntos
Saúde do Lactente , Determinantes Sociais da Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Política , Governo Estadual , Estados Unidos
20.
J Public Health Manag Pract ; 28(2): E552-E559, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34347653

RESUMO

CONTEXT: State health departments report that recruitment and retention of qualified epidemiologists is a significant challenge to ensuring epidemiology capacity to support essential public health services. OBJECTIVE: To collect information on the use of epidemiology job classifications, career ladders, and professional competencies in state health departments to inform workforce development activities that improve epidemiology capacity. DESIGN: Electronic survey of the designated state epidemiologist. SETTING: Fifty state health departments and the District of Columbia. PARTICIPANTS: State epidemiologists working in state health departments. MAIN OUTCOME MEASURES: Use and perceived benefit of epidemiology job classifications, career ladders, and professional competencies. RESULTS: All 50 states and the District of Columbia responded to the survey. Most state health departments reported having epidemiology-specific job classifications (n = 44, 90%) and career ladders (n = 36, 71%) in place. State epidemiologists strongly agreed or agreed that having an epidemiology-specific classification positively contributed to recruitment (n = 37, 84%) and retention (n = 29, 66%) of epidemiologists in their agency. State epidemiologists strongly agreed or agreed that having an epidemiology-specific career ladder positively contributed to recruitment (n = 24, 69%) and retention (n = 23, 66%) of epidemiologists in their agency. Only 10 (29%) state epidemiologists reported using the applied epidemiology competencies to develop or revise their jurisdiction's epidemiology career ladder. CONCLUSIONS: State health departments should implement well-maintained epidemiology-specific job classifications and career ladders that are based on current epidemiology competencies. Career ladders should be supported with opportunities for competency-based training to support career progression.


Assuntos
Epidemiologistas , Epidemiologia , Mobilidade Ocupacional , Humanos , Descrição de Cargo , Governo Estadual , Recursos Humanos
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