A Novel Approach for Workforce Surveillance at the US Department of Health and Human Services.

BACKGROUND: Expert groups have recommended ongoing monitoring of the public health workforce to determine its ability to execute designated objectives. Resource- and time-intensive surveys have been a primary data source to monitor the workforce. We evaluated an administrative data source containing US Department of Health and Human Services (HHS) aggregate federal civil service workforce-related data to determine its potential as a workforce surveillance system for this component of the workforce. METHODS: We accessed FedScope, a publicly available online database containing federal administrative civilian HHS personnel data. Using established guidelines for evaluating surveillance systems and identified workforce characteristics, we evaluated FedScope attributes for workforce surveillance purposes. RESULTS: We determined FedScope to be a simple, highly accepted, flexible, stable, and timely system to support analyses of federal civil service workforce-related data. Data can be easily accessed, analyzed, and monitored for changes across years and draw conclusions about the workforce. FedScope data can be used to calculate demographics (eg, sex, race or ethnicity, age group, and education level), employment characteristics (ie, supervisory status, work schedule, and appointment type), retirement projections, and characterize the federal workforce into standard occupational categories. CONCLUSIONS: This study indicates that an administrative data source containing HHS personnel data can function as a workforce surveillance system valuable to researchers, public health leaders, and decision makers interested in the federal civil service public health workforce. Using administrative data for workforce development is a model that can be applicable to federal and nonfederal public health agencies and ultimately support improvements in public health.

Strategic Development of the Public Health Workforce: A Unified Logic Model for a Multifaceted Program at the Centers for Disease Control and Prevention.

CONTEXT: Public health has a responsibility to ensure the ability of its workforce to deliver essential services, including mastering the core public health competencies. PROGRAM: The Division of Scientific Education and Professional Development (DSEPD) of the Centers for Disease Control and Prevention has a mission to improve health outcomes through a competent, sustainable, and empowered public health workforce. The DSEPD programs offer fellowships and other training opportunities, develop and disseminate quality public health training, and advance public health workforce development science. EVALUATION: The DSEPD developed a unified division logic model to describe the combined activities and intended outcomes of all DSEPD programs and their intended contribution to a robust public health workforce and to support ongoing program planning and evaluation. The logic model has 4 streams of work that include (1) producing and disseminating quality learning products; (2) implementing and managing fellowship programs that support learning; (3) providing public health service through fellows; and (4) advancing workforce development science through collaboration with other public health leaders.The underlying program theory is that a robust workforce has sufficient workforce, organizational, and systems capacity to deliver public health essential services and, therefore, to protect the public's health. Three scientific theories support the program theory: the quality of learning; the accepted practice of competency-based programs and the service-learning model; and use of evidence-guided decision making in workforce development programs. DISCUSSION: A unified division logic model allows DSEPD to describe its combined approaches to workforce development as a coherent portfolio with well-defined goals and measureable outcomes. The logic model effectively communicates the relationship among division programs, their shared outcomes, and their combined contributions to developing and maintaining a robust public health workforce. A unified logic model can serve as effective frame of reference for division evaluation and as evidence in public health workforce development science.

Communicating Science: The Role of Centers for Disease Control and Prevention's Field-Based Epidemic Intelligence Service Officers, 2009-2014.

CONTEXT: A highly skilled public health workforce is needed for responding to health threats, and that workforce must be able to communicate its scientific findings effectively. OBJECTIVE: We evaluated the scientific communication effectiveness of the Centers for Disease Control and Prevention's (CDC's) field-based Epidemic Intelligence Service officers (EISOs). DESIGN: A descriptive analysis of all scientific information products produced and submitted for institutional clearance by CDC's field-based EISOs during 2009-2014. MAIN OUTCOME MEASURE(S): The number of abstracts, journal manuscripts, Morbidity and Mortality Weekly Reports (MMWRs), and other information products approved by CDC during 2009-2014; the number of those products published; and of those published, the number cited in the scientific literature. RESULTS: During 2009-2014, a total of 152 field-based EISOs produced 835 scientific information products, including 437 abstracts, 261 manuscripts, and 103 MMWRs. The majority of scientific information products submitted for clearance were abstracts (52.3%), and infectious diseases (75.3%) constituted the majority of topics. Among the 103 MMWRs and 261 manuscripts cleared, 88 (85%) and 199 (76%) were published, respectively, with the majority also infectious disease-related. The 199 published manuscripts were cited in the scientific literature 2415 times, and the 88 published MMWRs were cited 1249 times. Field-based EISOs published their work in 74 different peer-reviewed medical and public health journals, with 54% published in journals with impact factors of 1 to 5. CONCLUSIONS: Field-based EISOs' publications are a measurable marker that reflects proficiency in epidemiology, written communication, and professionalism, and those publications are a direct reflection of EISOs' contribution to local and state health departments. Our study establishes a baseline for future evaluations of publication outcome of scientific information products by EISOs. Information released by EISOs provides health professionals with the scientific knowledge necessary for improving their practice and helps CDC achieve a broader societal, environmental, cultural, and economic impact.

Perspectives on One Health: a survey of national Delegates to the World Organisation for Animal Health, 2012.

In 2012, the World Organisation for Animal Health (OIE) surveyed all 178 national Delegates to better understand the perceptions and priorities of Veterinary Services with respect to One Health efforts and to guide future work in that area. For the purposes of this survey, the concept or practice of One Health was defined as 'the intersectoral collaborative approach to preventing, detecting, and controlling diseases among animals and humans, including the collaboration among the institutions and systems that support their prevention, detection and control'. A total of 120 OlE Delegates, representing countries from all five OIE regions, responded to the survey. Delegates identified zoonoses, rabies and influenza as high-priority disease areas and disease reporting and food safety as high-priority programme areas for One Health approaches. Veterinary Services participated in joint programmes, involving these priority disease and programme areas, with national intersectoral partners. Delegates reported barriers to implementing One Health approaches, including a lack of resources, the complexity of collaboration, inadequate capacity within their Veterinary Services, and a lack of adequate legislation, policy, guidance and political will for One Health activities. Delegates supported OIE efforts to enhance One Health activities, and requested that the OIE and partners provide technical information and advice and conduct training and capacity-building seminars for One Health. Veterinary Services cannot effectively apply One Health approaches at the national level without effective partnerships across sectors. The OlE can serve as a model for countries by continuing its commitment to these intersectoral partnerships at the international level.

Characterization of the federal workforce at the Centers for Disease Control and Prevention.

CONTEXT: Studies characterizing the public health workforce are needed for providing the evidence on which to base planning and policy decision making both for workforce staffing and for addressing uncertainties regarding organizing, financing, and delivering effective public health strategies. The Centers for Disease Control and Prevention (CDC) is leading the enumeration of the US public health workforce with an initial focus on CDC as the leading federal public health agency. OBJECTIVE: To characterize CDC's workforce, assess retirement eligibility and potential staff losses, and contribute these data as the federal component of national enumeration efforts. METHODS: Two sources containing data related to CDC employees were analyzed. CDC's workforce was characterized by using data elements recommended for public health workforce enumeration and categorized the occupations of CDC staff into 15 standard occupational classifications by using position titles. Retirement eligibility and potential staffing losses were analyzed by using 1-, 3-, and 5-year increments and compared these data across occupational classifications to determine the future impact of potential loss of workforce. RESULTS: As of the first quarter of calendar year 2012, a total 11 223 persons were working at CDC; 10 316 were civil servants, and 907 were Commissioned Corps officers. Women accounted for 61%. Public health managers, laboratory workers, and administrative-clerical staff comprised the top 3 most common occupational classifications among CDC staff. Sixteen percent of the workforce was eligible to retire by December 2012, and more than 30% will be eligible to retire by December 2017. CONCLUSIONS: This study represents the first characterization of CDC's workforce and provides an evidence base upon which to develop policies for ensuring an ongoing ability to fulfill the CDC mission of maintaining and strengthening the public's health. Establishing a system for continually monitoring the public health workforce will support future efforts in understanding workforce shortages, capacity, and effectiveness; projecting trends; and initiating policies.

A qualitative study of carers' and professionals' views on the management of people with intellectual disability and epilepsy: a neglected population.

Little attention has been paid to the specific needs of people with intellectual disability and epilepsy despite evidence of increased prevalence of epilepsy, increased risk of complex epilepsy, and heightened use of health services among this group. In an attempt to address this gap, an online international survey was undertaken inviting health professionals and caregivers, both paid and family members, to share their views on the adequacy and quality of available treatment. This paper reports on the responses obtained from 113 individuals from the UK and Ireland. Findings revealed that professionals and carers differ in their expectations of treatment and with regard to maximizing communication during consultations. In addition, findings suggested that the potential of consultations to provide information for carers, as well as to allay concerns, may not be realized. Rescue medications were viewed favorably; however, respondents expressed less satisfaction with routine medications. These findings may reflect a failure by professionals to appropriately transfer knowledge of these treatments.

The role of the human homologue of Drosophila patched in sporadic basal cell carcinomas.

Basal cell carcinoma (BCC) is the most common cancer in humans. The majority of sporadic BCCs have allele loss on chromosome 9q22 implying that inactivation of a tumour suppressor in this region is an important step in BCC formation. The gene for nevoid basal cell carcinoma syndrome (NBCCS), an autosomal dominant disorder characterized by multiple BCCs, maps to the same region and is presumed to be the tumour suppressor inactivated at this site. NBCCS has been identified recently and encodes a protein with strong homology to the Drosophila segment polarity gene, patched. Analysis of Drosophila mutants indicates that patched interacts with the hedgehog signalling pathway, repressing the expression of various hedgehog target genes including wingless, decapentaplegic and patched itself. Using single strand conformational polymorphism (SSCP) to screen human patched in 37 sporadic BCCs, we detected mutations in one-third of the tumours. Direct sequencing of two BCCs without SSCP variants revealed mutations in those tumours as well suggesting that inactivation of patched is probably a necessary step in BCC development. Northern blots and RNA in situ hybridization showed that patched is expressed at high levels in tumour cells but not normal skin suggesting that mutational inactivation of the gene leads to overexpression of mutant transcript owing to failure of a negative feedback mechanism.

Characterization of formaldehyde exposure resulting from the use of four professional hair straightening products.

An exposure simulation study was conducted to characterize potential formaldehyde exposures of salon workers and clients during keratin hair smoothing treatments. Four different hair treatment brands (Brazilian Blowout, Coppola, Global Keratin, and La Brasiliana) were applied to separate human hair wigs mounted on mannequin heads. Short-term (6-16 min) and long-term (41-371 min) personal and area samples (at distances of 0.5 to 3.0 m from the source) were collected during each treatment for the 1-day simulation. A total of 88 personal, area, and clearance samples were collected. Results were analyzed based on task sampling (blow-dry, flat-iron), treatment sampling (per hair product), and time-weighted averages (per hair treatment, four consecutive treatments). Real-time monitoring of tracer gas levels, for determining the air exchange rate, and formaldehyde levels were logged throughout the simulation. Bulk samples of each hair treatment were collected to identify and quantify formaldehyde and other chemical components that may degrade to formaldehyde under excessive heat. Mean airborne concentrations of formaldehyde ranged from 0.08-3.47 ppm during blow-dry and 0.08-1.05 ppm during flat-iron. During each treatment, the mean airborne concentrations ranged from 0.02-1.19 ppm throughout different zones of the salon. Estimated 8-hr time-weighted averages for one treatment per day ranged from 0.02 ppm for La Brasiliana to 0.08-0.16 ppm for Brazilian Blowout. For four treatments per day, means ranged from 0.04-0.05 ppm for La Brasiliana to 0.44-0.75 ppm for Brazilian Blowout. Using all four products in one day resulted in estimated 8-hr time-weighted averages ranging from 0.17-0.29 ppm. Results from bulk sampling reported formaldehyde concentrations of 11.5% in Brazilian Blowout, 8.3% in Global Keratin, 3% in Coppola, and 0% in La Brasiliana. Other products that degrade into formaldehyde were detected in Global Keratin, Coppola, and La Brasiliana. The results of this study show that professional hair smoothing treatments--even those labeled "formaldehyde-free"--have the potential to produce formaldehyde concentrations that meet or exceed current occupational exposure limits.

COVID-19 infection in patients with intestinal failure: UK experience.

BACKGROUND: The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS: A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION: This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.

Alteration of the response of platelets to surface stimuli by pyrazole compounds.

Sulfinpyrazone and phenylbutazone block the aggregating action of collagen, antigen-antibody complexes, and gamma globulin-coated surfaces on blood platelets. These drugs do not block the action of ADP or thrombin. Inhibition of surface-induced aggregation appears to be the result of a decreased response of the platelets to surface stimuli, giving rise to diminished release of platelet constituents, such as ADP and serotonin. The intravenous infusion of these drugs produced results similar to those found in the in vitro experiments. Administration of phenylbutazone in doses sufficient to produce marked suppression of the platelet-collagen reaction impaired hemostatic plug formation at the ends of transected mesenteric vessels in rabbits. Since platelet function is considered a factor influencing platelet survival, the effect of phenylbutazone on platelet survival was examined. It was found that phenylbutazone prolonged platelet survival to more than twice the normal time and reduced platelet turnover by nearly 50%. These studies show that drugs which suppress platelet response to surface stimuli alter platelet function in vivo.

An exploratory review of the literature evaluating nonclinical fellowship programs.

Fellowship programs offer career development opportunities, provide experiential training, and can be used to recruit personnel to address specific challenges facing the public health workforce. Given the potential influence fellowships have on the future public health workforce, it is important to understand and articulate the results of such programs and to identify areas of improvement to meet current workforce needs. The purpose of this literature review was to identify common practices used to evaluate nonclinical fellowship programs. After a search of the internet and selected databases, we screened titles and abstracts using predetermined selection criteria. We then conducted a detailed review of selected papers to extract information about program characteristics (program description, sector, and program length) and evaluation characteristics (primary evaluation type, framework for evaluation, data collection methods, and respondent populations) from 33 papers. We found a limited number of published papers on the evaluation of nonclinical fellowship programs, and most focused on outcomes associated with fellows or alumni. The most useful papers for our purposes clearly described the evaluation framework that guided the evaluation.

Lockdown in a specialised rehabilitation unit: the best of times.

Specialised rehabilitation units offer inpatient multi-disciplinary rehabilitation for individuals with severe and enduring mental illness. A cornerstone of therapy is the work in the community through further education and community organisations. However, coronavirus restrictions have meant that such external supports are no longer available for the duration of the crisis. This has led to opportunities for developing new ways of offering rehabilitation within hospital environments. This article describes some of the new initiatives developed. The benefits of the lockdown for service users are also discussed. Many found the cessation of visits from family members with whom they had an ambivalent relationship helpful. The lockdown improved relationships between patients on the unit and encouraged a greater feeling of community. The lockdown has also emphasised the importance of team self-awareness and an awareness of the nature of the treatments offered.

Opening the window on public health to veterinary students.

Veterinary public health is defined by the World Health Organization as: 'the sum of all contributions to the physical, mental, and social well-being of humans through an understanding and application of veterinary science'. The role of animals and wildlife as sources of human diseases continues to increase. As demand for public health veterinarians will similarly continue to increase, the veterinary profession must make a concentrated effort to encourage veterinary students to pursue careers in this field, and increase the opportunities for training and experience in this area for both veterinary students and graduates. In this paper, the authors describe the existing opportunities for training in or practising as a public health veterinarian, with a particular focus on the United States of America.

Hourly and daily intake patterns among U.S. caffeinated beverage consumers based on the National Health and Nutrition Examination Survey (NHANES, 2013-2016).

Characterization of 'hour-of-day' or 'day-of-week' caffeine intake for the National Health and Nutrition Examination Survey (NHANES) population is limited. No study has focused on patterns from an individual perspective. The NHANES 2013-2016 survey respondents' dietary recalls were analyzed to gain a better understanding of caffeine intake patterns for different caffeinated beverage consumer types - defined by beverage type consumed and daily caffeine intake levels. Dominant caffeinated beverage consumers (≥143 mg) were identified by a reported daily caffeine intake level greater than or equal to the 50th percentile among those 1-80 y. Dominant caffeinated beverage consumers - irrespective of age groups investigated - typically reported the greatest caffeine intake early in the day from coffee. Analyses by consumer type, relevant age brackets and 'hour-of-day' or 'day-of-week' indicated that caffeinated beverage consumers generally do not cluster multiple caffeine intake events over short periods of time (i.e., less than fours). Dominant caffeinated beverage consumers appear to maintain a relatively stable daily caffeine intake by substitution of secondary sources of caffeine. Only a small fraction (4.1%) of individuals within 13-29 y respondents consumed caffeine at levels in excess of 400 mg/day, compared to 14% within the 30-80 y old survey respondent group.

Rapid HIV testing and prevention of perinatal HIV transmission in high-risk maternity hospitals in St. Petersburg, Russia.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a human immunodeficiency virus (HIV) rapid testing (RT) program. STUDY DESIGN: From April 13, 2004, to April 13, 2005, pregnant women at 2 high-risk maternity hospitals with no or incomplete HIV testing results (negative tests at <34 weeks, none thereafter) were offered point-of-care RT, with antiretroviral prophylaxis for RT-positive women and their infants. RESULTS: Overall, 89.2% of eligible women (3671/4117) underwent RT, of whom 90.4% received results before delivery. HIV seroprevalence among all women who underwent RT was 2.7% (100/3671 women); among previously untested women, seroprevalence was 6.5% (90/1375 women); the incidence of HIV seroconversion among women with previous negative tests during pregnancy was 0.4% (10/2296 women). After adjustment, the main predictor of receiving RT results after delivery was late admission. Among HIV-exposed infants, 97.9% (92/94) received prophylaxis; 61.7% (58/94) had available follow-up data, and 8.6% (5/58) met criteria for definitive or presumptive HIV infection. CONCLUSION: The RT program achieved timely detection of HIV-infected women in labor with unknown HIV status and effectively prevented perinatal HIV transmission.

Rheumatic manifestations in HIV-1 infected in-patients and literature review.

OBJECTIVE: To report the rate and spectrum of the rheumatic manifestations of human immunodeficiency virus (HIV) since the advent of highly active anti-retroviral therapy (HAART). METHODS: A retrospective record review of 888 inpatients with HIV for rheumatic manifestations was performed from January 1995 to March 2006. We then searched the 888 records for rheumatic diseases using International Classification Diagnostic (ICD) Codes. The medical records of the cases of HIV with the rheumatic conditions were then reviewed. A computer-assisted search of Medline/Pubmed for the medical literature from January 1981 to August 2007 using the keywords HIV, acquired immune-deficiency syndrome, rheumatic manifestations, combining with text words like systemic lupus erythematosus (SLE). Only English language literature was included. RESULTS: The demographic data of 888 cases of HIV included men (64%) and women (36%) with a mean age of 41.5+/-10.2 years. Race consisted of Black (70%), White (22.8%), Hispanic (6.5%), and others (1.1%). Rheumatic manifestations were present in 80 (9%) with arthritis/arthralgia 49 (5.5%), septic arthritis 9 (1%), and osteomyelitis 8 (0.9%), connective tissue diseases (CTDs) 6 (0.7%) (SLE 3, rheumatoid arthritis 1, polymyositis 1, and systemic sclerosis 1), avascular necrosis 6 (0.7%) (hips 3, knees 2, and shoulder 1). There were no cases of seronegative spondyloarthritis or Sjögren's syndrome. CONCLUSIONS: There was an association of HIV with rheumatic conditions in 9%, including CTDs and avascular necrosis. In addition, there were no cases of the seronegative spondyloarthritis subsets. This change in spectrum from prior reports suggests the rheumatic manifestations of HIV have changed, perhaps related to HAART.

The effect of platelet age on platelet adherence to collagen.

The adherence to collagen of rabbit platelets labeled in vivo with (35)SO(4) (=) has been studied both in vitro and in vivo. The young platelets are labeled with (35)SO(4) (=) 2-3 days after administration of the isotope to the animals. We exposed platelet-rich plasma (ethylenediamine-tetraacetate, EDTA, as anticoagulant), prepared from blood taken from rabbits 54 hr after giving the (35)SO(4) (=), to collagen in vitro. There was a fall in the specific radioactivity of the nonadherent platelets which indicated a selective adhesion of young platelets to the collagen. In experiments designed to have most of the (35)S label in the oldest platelets it was found that exposure of plasma containing these platelets to collagen resulted in an increase in the specific radioactivity of the nonadherent platelets. Similar observations were obtained when glycine-(14)C was used as a platelet label. However, when DF(32)P (di-isopropyl phosphorofluoridate-(32)P), which is thought to label platelets of all ages equally, was used, the adherence of platelets to collagen did not result in any changes in the specific activity of the nonadherent platelets. In in vivo studies in which we infused a collagen suspension into rabbits 54 hr after giving (35)SO(4) (=) we found that the specific radioactivity of the platelets remaining in the circulation fell. This did not occur when we infused the collagen 96 hr after giving the (35)SO(4) (=). The results from these studies indicate that young platelets adhere to collagen more readily than older platelets.