A plan for community event-based surveillance to reduce Ebola transmission - Sierra Leone, 2014-2015.

Ebola virus disease (Ebola) was first detected in Sierra Leone in May 2014 and was likely introduced into the eastern part of the country from Guinea. The disease spread westward, eventually affecting Freetown, Sierra Leone's densely populated capital. By December 2014, Sierra Leone had more Ebola cases than Guinea and Liberia, the other two West African countries that have experienced widespread transmission. As the epidemic intensified through the summer and fall, an increasing number of infected persons were not being detected by the county's surveillance system until they had died. Instead of being found early in the disease course and quickly isolated, these persons remained in their communities throughout their illness, likely spreading the disease.

Hysterectomy Among Women Age 18 and Older: United States, 2021.

Hysterectomy is one of the most common procedures for women in the United States (1,2). Hysterectomy removes the uterus and is used to treat conditions such as uterine fibroids, endometriosis, and gynecological cancer (3). It can be performed on an inpatient or outpatient basis (4,5). This report uses 2021 National Health Interview Survey (NHIS) data to describe the percentage of women age 18 and older who have had a hysterectomy by selected sociodemographic characteristics.

Patterns of Mammography, Pap Smear, and Colorectal Cancer Screening Services Among Women Aged 45 and Over.

Background-Regular screening tests can lead to early detection of breast, cervical, and colorectal cancers, when treatment is likely to be more effective. This study examines and compares sociodemographic, health status, and health behavior patterns of screening for breast cancer, cervical cancer, and colorectal cancer among women aged 45 and over in the United States. Methods-This study is based on data from the 2015 and 2018 National Health Interview Surveys. Women were considered to have received colorectal cancer screening if they reported having one of the following: a) report of a home fecal occult blood test (FOBT) in the past year, b) sigmoidoscopy procedure in the past 5 years with FOBT in the past 3 years, or c) colonoscopy in the past 10 years. Women were considered to have received breast cancer screening if they had a mammogram within the past 2 years. Women were considered to have received cervical cancer screening if they reported having a Pap smear in the past 3 years. Cancer screening was analyzed by sociodemographic, health status, health behavior, and health care use characteristics. Results-Among women aged 45 and over, higher percentages of screening were associated with higher socioeconomic status, being married or living with a partner, and healthy behaviors such as not smoking, participating in physical activity, and receiving a flu shot. Conclusion-Differences in screening identified in this study are generally consistent with previous studies on screening for colorectal, breast, and cervical cancers for women at average risk and within the age groups recommended for screening. The results of this study support other findings showing the persistence of disparities in cancer screening among women aged 45 and over according to most of the selected characteristics regardless of recommended age of screening.

Finding the graves: SLED Family Reunification Program.

PURPOSE: In 2015, the Sierra Leone Ministry of Health and Sanitation (MoHS) and the Centers for Disease Control and Prevention (CDC) agreed to consolidate data recorded by MoHS and international partners during the Ebola epidemic and create the Sierra Leone Ebola Database (SLED). The primary objectives were helping families to identify the location of graves of their loved ones who died from any cause at the time of the Ebola epidemic and creating a data source for epidemiological research. The Family Reunification Program fulfills the first SLED objective. The purpose of this paper is to describe the Family Reunification Program (Program) development, functioning, and results. METHODS: The MoHS, CDC, SLED Team, and Concern Worldwide developed, tested, and implemented methodology and tools to conduct the Program. Family liaisons were trained in protection of the personally identifiable information. RESULTS: The SLED Family Reunification Program allows families in Sierra Leone, who did not know the final resting place of their loved ones, to be reunited with their graves and to bring them relief and closure. CONCLUSION: Continuing family requests in search of the burial place of loved ones 5 years after the end of the epidemic shows that the emotional burden of losing a family member and not knowing the place of burial does not diminish with time. As of February 2021, the Program continues and is described to allow its replication for other emergency events including COVID-19 and new Ebola outbreaks.

Building the Sierra Leone Ebola Database: organization and characteristics of data systematically collected during 2014-2015 Ebola epidemic.

PURPOSE: During the 2014-2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS), the US Centers for Disease Control and Prevention, and responding partners under the coordination of the National Ebola Response Center (NERC) and the MoHS's Emergency Operation Center (EOC) systematically recorded information from the 117 Call Center system and district alert phone lines, case investigations, laboratory sample testing, clinical management, and safe and dignified burial records. Since 2017, CDC assisted MoHS in building and managing the Sierra Leone Ebola Database (SLED) to consolidate these major data sources. The primary objectives of the project were helping families to identify the location of graves of their loved ones who died at the time of the Ebola epidemic through the SLED Family Reunification Program and creating a data source for epidemiological research. The objective of this paper is to describe the process of consolidating epidemic records into a useful and accessible data collection and to summarize data characteristics, strength, and limitations of this unique information source for public health research. METHODS: Because of the unprecedented conditions during the epidemic, most of the records collected from responding organizations required extensive processing before they could be used as a data source for research or the humanitarian purpose of locating burial sites. This process required understanding how the data were collected and used during the outbreak. To manage the complexity of processing the data obtained from various sources, the Sierra Leone Ebola Database (SLED) Team used an organizational strategy that allowed tracking of the data provenance and lifecycle. RESULTS: The SLED project brought raw data into one consolidated data collection. It provides researchers with secure and ethical access to the SLED data and serves as a basis for the research capacity building in Sierra Leone. The SLED Family Reunification Program allowed Sierra Leonean families to identify location of the graves of loved ones who died during the Ebola epidemic. CONCLUSIONS: The SLED project consolidated and utilized epidemic data recorded during the Sierra Leone Ebola Virus Disease outbreak that were collected and contributed to SLED by national and international organizations. This project has provided a foundation for developing a method of ethical and secure SLED data access while preserving the host nation's data ownership. SLED serves as a data source for the SLED Family Reunification Program and for epidemiological research. It presents an opportunity for building research capacity in Sierra Leone and provides a foundation for developing a relational database. Large outbreak data systems such as SLED provide a unique opportunity for researchers to improve responses to epidemics and indicate the need to include data management preparedness in the plans for emergency response.

Ensuring ethical data access: the Sierra Leone Ebola Database (SLED) model.

PURPOSE: Organizations responding to the 2014-2016 Ebola epidemic in Sierra Leone collected information from multiple sources and kept it in separate databases, including distinct data systems for Ebola hot line calls, patient information collected by field surveillance officers, laboratory testing results, clinical information from Ebola treatment and isolation facilities, and burial team records. METHODS: After the conclusion of the epidemic, the Sierra Leone Ministry of Health and Sanitation and the U.S. Centers for Disease Control and Prevention partnered to collect these disparate records and consolidate them in the Sierra Leone Ebola Database. RESULTS: The Sierra Leone Ebola Database data are providing a lasting resource for postepidemic data analysis and epidemiologic research, including identifying best strategies in outbreak response, and are used to help families locate the graves of family members who died during the epidemic. CONCLUSION: This report describes the Ministry of Health and Sanitation and Centers for Disease Control and Prevention processes to safeguard Ebola records while making the data available for public health research.

Ebola Surveillance - Guinea, Liberia, and Sierra Leone.

Developing a surveillance system during a public health emergency is always challenging but is especially so in countries with limited public health infrastructure. Surveillance for Ebola virus disease (Ebola) in the West African countries heavily affected by Ebola (Guinea, Liberia, and Sierra Leone) faced numerous impediments, including insufficient numbers of trained staff, community reticence to report cases and contacts, limited information technology resources, limited telephone and Internet service, and overwhelming numbers of infected persons. Through the work of CDC and numerous partners, including the countries' ministries of health, the World Health Organization, and other government and nongovernment organizations, functional Ebola surveillance was established and maintained in these countries. CDC staff were heavily involved in implementing case-based surveillance systems, sustaining case surveillance and contact tracing, and interpreting surveillance data. In addition to helping the ministries of health and other partners understand and manage the epidemic, CDC's activities strengthened epidemiologic and data management capacity to improve routine surveillance in the countries affected, even after the Ebola epidemic ended, and enhanced local capacity to respond quickly to future public health emergencies. However, the many obstacles overcome during development of these Ebola surveillance systems highlight the need to have strong public health, surveillance, and information technology infrastructure in place before a public health emergency occurs. Intense, long-term focus on strengthening public health surveillance systems in developing countries, as described in the Global Health Security Agenda, is needed.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Hospitalization, Readmission, and Death Experience of Noninstitutionalized Medicare Fee-for-service Beneficiaries Aged 65 and Over.

OBJECTIVE: This report provides descriptive measures of hospitalization, readmission, and death among the noninstitutionalized population aged 65 and over using data from a national survey of the noninstitutionalized population linked to Medicare data and the National Death Index. The estimates are presented by self-reported demographic, socioeconomic, heath status, and other characteristics gathered during the interview with the survey participants. METHODS: Data are from the 2000­2005 National Health Interview Survey (NHIS) linked to 2000­2006 Medicare data and the National Center for Health Statistics 2011 Linked Mortality Files. Findings are based on in-home interviews with 25,593 linkage-eligible noninstitutionalized respondents aged 65 and over who were enrolled in fee-for-service (FFS) Medicare during the year following the interview. Among them, 1,100 died during the year following the interview, 5,456 were hospitalized with 3,490 hospitalized once, 1,192 hospitalized twice, and 774 hospitalized three or more times. Among those hospitalized, 1,491 were readmitted to the hospital within 30 days since the discharge. Both population-based and discharge-based measures are used to present the estimates. RESULTS: This is the first report presenting national estimates on hospitalization, readmission, and death using NHIS data linked to the Medicare claims and death data. Among noninstitutionalized Medicare FFS beneficiaries aged 65 and over, 4.5% died in the year following the interview and 21.6% were hospitalized, with a discharge rate of 348.4 per 1,000 population. Among those who were hospitalized and discharged alive, 17.3% were readmitted within 30 days after discharge. About one-quarter of the deceased died in the hospital (including 7.1% who died during a readmission stay).

Prevalence of incontinence among older americans.

Objective - This report presents national estimates of incontinence prevalence in the United States using data source-specific definitions of incontinence among persons aged 65 and over by sociodemographic characteristics during 2007-2010. Methods - Data are from the 2007-2010 National Health and Nutrition Examination Survey (NHANES), the 2010 National Survey of Residential Care Facilities (NSRCF), the 2007 National Home and Hospice Care Survey (NHHCS), and the 2009 Long Term Care Minimum Data Set (MDS). Findings are based on in-home interviews with 2,625 noninstitutionalized respondents (NHANES) and reports provided by designated facility or agency staff members for 6,856 residential care facility (RCF) residents (NSRCF), 3,226 current home health care patients (NHHCS), 3,918 hospice discharges (NHHCS), and 2,416,705 nursing home residents (MDS). Response rates for incontinence questions were 84% among noninstitutionalized persons (NHANES), 98% among RCF residents and home health and hospice care patients (NSRCF and NHHCS), and 99% for nursing home residents (MDS). Results - This is the first report presenting national estimates on incontinence for subpopulations of older persons sampled in the Centers for Disease Control and Prevention's National Center for Health Statistics surveys and the Centers for Medicare and Medicaid Services' Long Term Care Minimum Data Set. Because a different definition of incontinence is used by each data collection system, it is not possible to make data comparisons between them or to summarize results across all surveys. Accordingly, only survey-specific results are presented. Including recent data from all of these data collection systems facilitates a multidimensional picture of incontinence, while underscoring the need for a standardized definition.

A longitudinal view of child enrollment in Medicaid.

BACKGROUND: Although national cross-sectional estimates of the percentage of children enrolled in Medicaid are available, the percentage of children enrolled in Medicaid over longer periods of time is unknown. Also, the percentage and characteristics of children who rely on Medicaid throughout childhood, rather than transiently, are unknown. METHODS: We performed a longitudinal examination of Medicaid coverage among children across a 5-year period. Children 0 to 13 years of age in the 2004 National Health Interview Survey file were linked to Medicaid Analytic eXtract files from 2004 to 2008. The percentage of children enrolled in Medicaid at any time during the 5-year observation period and the number of years during which children were enrolled in Medicaid were calculated. Duration of Medicaid enrollment was compared across sociodemographic characteristics by using χ(2) tests. RESULTS: Forty-one percent of all US children were enrolled in Medicaid at least some time during the 5-year period, compared with a single-year estimate of 32.8% in 2004 alone. Of enrolled children, 51.5% were enrolled during all 5 years. Children with lower parental education, with lower household income, of minority race or ethnicity, and in suboptimal health were more likely to be enrolled in Medicaid during all 5 years. CONCLUSIONS: Longitudinal data reveal higher percentages of children with Medicaid insurance than shown by cross-sectional data. Half of children enrolled in Medicaid are enrolled during at least 5 consecutive years, and these children have higher risk sociodemographic profiles.

Comparability between the rates for all-listed inpatient procedures using National Hospital Discharge Survey and Medicare claims, 1999 and 2007.

OBJECTIVES: This report examines the comparability between the rates of inpatient procedures for persons aged 65 and over using the National Hospital Discharge Survey (NHDS) and Medicare claims data. METHODS: The estimates in this report are based on data from NHDS and Medicare claims submitted by hospital providers for inpatient stays among Part A fee-for-service Medicare beneficiaries aged 65 and over. The discharge rates, selected procedures rates, and comparability ratios are reported for older men and women, by age and sex, for 1999 and 2007. RESULTS: Between 1999 and 2007, observed decreases in discharge rates and in all-listed procedure rates derived from NHDS were not significant, while Medicare discharge rates decreased and procedure rates increased significantly. In 1999 and 2007, no statistically significant differences were found between NHDS and Medicare estimates for discharge rates in the age-sex groups examined except for those aged 85 and over. In both years, the comparability ratios between Medicare and NHDS procedure rates were significantly different from one for about 50% of selected procedures, and ranged from 1.12 to 1.26 in 1999 and from 1.16 to 1.41 in 2007. This reflects more procedures recorded in 1999 and 2007 in Medicare data per discharge. The comparability ratio was higher for most of the cardiac procedures, and in general, was closer to one when fewer procedures were performed per discharge and for procedures with lower utilization rates.

Identifying chronic conditions in Medicare claims data: evaluating the Chronic Condition Data Warehouse algorithm.

OBJECTIVE: To examine the strengths and limitations of the Center for Medicare and Medicaid Services' Chronic Condition Data Warehouse (CCW) algorithm for identifying chronic conditions in older persons from Medicare beneficiary data. DATA SOURCES: Records from participants of the NHANES I Epidemiologic Follow-up Study (NHEFS 1971-1992) linked to Medicare claims data from 1991 to 2000. STUDY DESIGN: We estimated the percent of preexisting cases of chronic conditions correctly identified by the CCW algorithm during its reference period and the number of years of claims data necessary to find a preexisting condition. PRINCIPAL FINDINGS: The CCW algorithm identified 69 percent of preexisting diabetes cases but only 17 percent of preexisting arthritis cases. Cases identified by the CCW are a mix of preexisting and newly diagnosed conditions. CONCLUSIONS: The prevalence of conditions needing less frequent health care utilization (e.g., arthritis) may be underestimated by the CCW algorithm. The CCW reference periods may not be sufficient for all analytic purposes.

Trends in health status and health care use among older men.

OBJECTIVES: This report examines trends in health status and risk factors, health care utilization, and health care expenditures among older men in the United States. METHODS: The estimates in this report are based on data from the National Vital Statistics System, National Health Interview Survey, National Health and Nutrition Examination Survey, National Health Care Surveys, Medicare Current Beneficiary Survey, and Current Population Survey. Trends in death rates, prevalence of chronic conditions, risk factors, vaccinations, health care utilization, and expenditures are summarized. Major differences in these indicators are described for older men and women and by age, race, and Hispanic origin. RESULTS: The difference in life expectancy between older men and women has narrowed since 1980, but a gap remains. Older men have lower hypertension and cholesterol levels and exercise regularly at higher rates than older women; however, the rates of obesity and cigarette smoking are similar in older men and women. Although health status has improved for all racial and ethnic groups, racial and ethnic disparities remain for many indicators. Older men and women have similar rates of hospital admissions and visits to emergency departments and physician offices.

Trends in the health of older Americans, 1970-2005.

The health of Americans age sixty-five and older has improved on nearly all major indicators: longevity, self-reported health, and functioning. Both health care services use and health spending have risen. The increased use of restorative procedures and prescription medicines suggests that medical advances have had an important role in the better health of older Americans. Factors that might limit prospects for future improvements include rising rates of obesity and diabetes, particularly among the middle-aged.