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1.
MMWR Morb Mortal Wkly Rep ; 68(46): 1081-1086, 2019 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-31751322

RESUMEN

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products.


Asunto(s)
Brotes de Enfermedades , Lesión Pulmonar/terapia , Guías de Práctica Clínica como Asunto , Vapeo/efectos adversos , Humanos , Lesión Pulmonar/epidemiología , Estados Unidos/epidemiología
3.
MMWR Morb Mortal Wkly Rep ; 68(41): 919-927, 2019 10 18.
Artículo en Inglés | MEDLINE | ID: mdl-31633675

RESUMEN

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical partners are investigating a multistate outbreak of lung injury associated with the use of electronic cigarette (e-cigarette), or vaping, products. In late August, CDC released recommendations for health care providers regarding e-cigarette, or vaping, product use associated lung injury (EVALI) based on limited data from the first reported cases (1,2). This report summarizes national surveillance data describing clinical features of more recently reported cases and interim recommendations based on these data for U.S. health care providers caring for patients with suspected or known EVALI. It provides interim guidance for 1) initial clinical evaluation; 2) suggested criteria for hospital admission and treatment; 3) patient follow-up; 4) special considerations for groups at high risk; and 5) clinical and public health recommendations. Health care providers evaluating patients suspected to have EVALI should ask about the use of e-cigarette, or vaping, products in a nonjudgmental and thorough manner. Patients suspected to have EVALI should have a chest radiograph (CXR), and hospital admission is recommended for patients who have decreased blood oxygen (O2) saturation (<95%) on room air or who are in respiratory distress. Health care providers should consider empiric use of a combination of antibiotics, antivirals, or steroids based upon clinical context. Evidence-based tobacco product cessation strategies, including behavioral counseling, are recommended to help patients discontinue use of e-cigarette, or vaping, products. To reduce the risk of recurrence, patients who have been treated for EVALI should not use e-cigarette, or vaping, products. CDC recommends that persons should not use e-cigarette, or vaping, products that contain tetrahydrocannabinol (THC). At present, CDC recommends persons consider refraining from using e-cigarette, or vaping, products that contain nicotine. Irrespective of the ongoing investigation, e-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant. Persons who do not currently use tobacco products should not start using e-cigarette, or vaping, products.


Asunto(s)
Brotes de Enfermedades , Sistemas Electrónicos de Liberación de Nicotina , Lesión Pulmonar/terapia , Guías de Práctica Clínica como Asunto , Vapeo/efectos adversos , Adolescente , Adulto , Anciano , Femenino , Humanos , Lesión Pulmonar/epidemiología , Lesión Pulmonar/mortalidad , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
4.
J Public Health Manag Pract ; 22(2): 194-9, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-25734653

RESUMEN

OBJECTIVE: To identify key competencies and skills that all master of public health (MPH) graduates should have to be prepared to work in a local health department. METHODS: In 2011-2012, the New York City Department of Health and Mental Hygiene administered electronic surveys to 2 categories of staff: current staff with an MPH as their highest degree, and current hiring managers. RESULTS: In all, 312 (77%) staff members with an MPH as their highest degree and 170 (57%) hiring managers responded to the survey. Of the respondents with an MPH as their highest degree, 85% stated that their MPH program prepared them for work at the New York City Health Department. Skills for which MPH graduates most often stated they were underprepared included facility in using SAS® statistical software, quantitative data analysis/statistics, personnel management/leadership, and data collection/database management/data cleaning. Among the skills hiring managers identified as required of MPH graduates, the following were most often cited as those for which newly hired MPH graduates were inadequately prepared: quantitative data analysis, researching/conducting literature reviews, scientific writing and publication, management skills, and working with contracts/requests for proposals. CONCLUSION: These findings suggest that MPH graduates could be better prepared to work in a local health department upon graduation. To be successful, new MPH graduate hires should possess fundamental skills and knowledge related to analysis, communication, management, and leadership. Local health departments and schools of public health must each contribute to the development of the current and future public health workforce through both formal learning opportunities and supplementary employment-based training to reinforce prior coursework and facilitate practical skill development.


Asunto(s)
Competencia Clínica/normas , Gobierno Local , Salud Pública/educación , Lugar de Trabajo , Educación en Salud Pública Profesional , Humanos , Ciudad de Nueva York , Encuestas y Cuestionarios , Recursos Humanos
5.
Prev Med Rep ; 2: 580-5, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26844121

RESUMEN

PURPOSE: Capacity to monitor non-communicable diseases (NCDs) at state or local levels is limited. Emerging approaches include using biomeasures and electronic health record (EHR) data. In 2004, New York City (NYC) performed a population-based health study on adult residents using biomeasures (NYC Health and Nutrition Examination Study, or NYC HANES), modeled after NHANES. A second NYC HANES was launched in 2013 to examine change over time, evaluate municipal policies, and validate a proposed EHR-based surveillance system. We describe the rationale and methods of NYC HANES 2013-2014. METHODS: NYC HANES was a population-based, cross-sectional survey of NYC adults using three-stage cluster sampling. Between August 2013 and June 2014, selected participants completed a health interview and physical exam (blood pressure, body mass index, and waist circumference). Fasting biomeasures included diabetes, lipid profiles, kidney function, environmental biomarkers, and select infectious diseases. RESULTS: Of the 3065 households approached, 2742 were eligible and 1827 were successfully screened (67%). A total of 1524 of eligible participants completed the survey (54%), for an overall response rate of 36%. CONCLUSION: Completing a second NYC HANES a decade after the first study affords an opportunity to understand changes in prevalence, awareness and control of NCDs and evaluate municipal efforts to manage them.

6.
Ann Am Thorac Soc ; 11(3): 407-16, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24673697

RESUMEN

As described in a recently released report of the Forum of International Respiratory Societies, four of the leading causes of death in the world are chronic obstructive pulmonary disease, acute respiratory tract infections, lung cancer, and tuberculosis. A fifth, asthma, causes enormous global morbidity. Not enough progress has been made in introducing new therapies and reducing disease burden for these illnesses in the last few decades, despite generous investments and some notable progress in biomedical research. Four external and modifiable drivers are responsible for a substantial percentage of the disease burden represented by the major lung diseases: tobacco, outdoor air pollution, household air pollution, and occupational exposures to lung toxins. Especially in low- and middle-income countries, but in highly developed economies as well, pressures for economic development and lax regulation are contributing to the continued proliferation of these drivers. Public health approaches to the most common lung diseases could have enormous effects on reducing morbidity and mortality. There must be increased advocacy from and mobilization of civil society to bring attention to the drivers of lung diseases in the world. The World Health Organization should negotiate accords similar to the Framework Convention on Tobacco Control to address air pollution and occupational exposures. Large increases in funding by government agencies and nongovernmental organizations around the world are needed to identify technologies that will reduce health risks while allowing populations to enjoy the benefits of economic development. This paradigm, focused more on public health than on individual medical treatment, has the best chance of substantial reduction in the burden of lung disease around the world in the next several years.


Asunto(s)
Contaminación del Aire/prevención & control , Costo de Enfermedad , Exposición a Riesgos Ambientales/prevención & control , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/prevención & control , Salud Pública , Humanos
7.
Prev Chronic Dis ; 9: E157, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23078668

RESUMEN

INTRODUCTION: Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC's health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting. METHODS: From June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals. RESULTS: At intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period. CONCLUSION: This NYC health department's hospital-level intervention led to durable changes in COD reporting.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Cardiopatías/mortalidad , Hospitales/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud , Algoritmos , Codificación Clínica/normas , Cardiopatías/clasificación , Cardiopatías/epidemiología , Hospitales/tendencias , Humanos , Capacitación en Servicio , Clasificación Internacional de Enfermedades , Cuerpo Médico de Hospitales/educación , Ciudad de Nueva York/epidemiología , Servicios Preventivos de Salud , Investigación Cualitativa , Análisis de Regresión
8.
Am J Public Health ; 102 Suppl 3: S333-5, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22690968

RESUMEN

The New York City (NYC) Department of Health and Mental Hygiene (Health Department) surveyed practicing NYC physicians to quantify Health Department resource use. Although the Health Department successfully reaches most physicians, and information is valued in practice, knowledge of several key resources was low. Findings suggested 3 recommendations for all local health departments seeking to enhance engagement with practicing physicians: (1) capitalize on physician interest, (2) engage physicians early and often, and (3) make interaction with the health department easy. Also, older physicians may require targeted outreach.


Asunto(s)
Relaciones Comunidad-Institución , Modelos Organizacionales , Médicos , Práctica de Salud Pública , Encuestas y Cuestionarios , Adulto , Anciano , Femenino , Recursos en Salud , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Salud Urbana
9.
Am J Public Health ; 102 Suppl 3: S353-6, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22690971

RESUMEN

OBJECTIVES: In fall 2008, the New York City Department of Health and Mental Hygiene collaborated with Albert Einstein College of Medicine residency program directors to assess the effectiveness of an e-learning course on accurate death certificate completion among resident physicians. METHODS: We invited postgraduate year 1 and 2 (PGY1 and PGY2) residents (n = 227) to participate and administered a pretest, e-learning module, posttest, and course evaluation to PGY1 residents; PGY2 residents completed a pretest and survey only. RESULTS: In all, 142 residents (63%) participated. The average pretest scores for PGY2 residents (61%) and PGY1 residents (59%) were not significantly different. The PGY1 residents' average test score increased significantly after taking the e-learning module (59% vs 72%; P < .01). The participants rated course length, delivery method, and utility highly. CONCLUSIONS: Results suggest that e-learning can effectively integrate public health-oriented training into clinical residency programs.


Asunto(s)
Instrucción por Computador , Certificado de Defunción , Educación de Postgrado en Medicina/organización & administración , Salud Pública/educación , Adulto , Evaluación Educacional , Femenino , Humanos , Internado y Residencia , Masculino , Ciudad de Nueva York
10.
Am J Prev Med ; 42(6 Suppl 2): S103-6, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22704427

RESUMEN

PURPOSE: In fall 2008, the New York City Department of Health and Mental Hygiene collaborated with Albert Einstein College of Medicine residency program directors to assess the effectiveness of an e-learning course on accurate death certificate completion among resident physicians. METHODS: We invited postgraduate year 1 and 2 (PGY1 and PGY2) residents (n = 227) to participate and administered a pretest, e-learning module, posttest, and course evaluation to PGY1 residents; PGY2 residents completed a pretest and survey only. RESULTS: In all, 142 residents (63%) participated. The average pretest scores for PGY2 residents (61%) and PGY1 residents (59%) were not significantly different. The PGY1 residents' average test score increased after taking the e-learning module (59% vs 72%, p<0.01). The participants rated course length, delivery method, and utility highly. CONCLUSIONS: Results suggest that e-learning can effectively integrate public health-oriented training into clinical residency programs.


Asunto(s)
Instrucción por Computador , Certificado de Defunción , Educación de Postgrado en Medicina/organización & administración , Salud Pública/educación , Evaluación Educacional , Humanos , Internado y Residencia , Ciudad de Nueva York
12.
J Public Health Manag Pract ; 17(4): 313-5, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21617405

RESUMEN

OBJECTIVE: Although health disparities research has already contributed to decreased mortality and morbidity in underserved communities, more work is needed. The NYC Epi Scholars program of the New York City Department of Health and Mental Hygiene (NYC DOHMH) aims to address gaps in critical public health needs and to train future public health leaders in epidemiology. The program is designed to increase racial/ethnic and socioeconomic diversity in the public health workforce, to provide fieldwork and practica opportunities, and to cultivate future leaders in epidemiology and public health. METHODS: Since its inception in 2007, the NYC Epi Scholars program of the NYC DOHMH has sought talented epidemiology students interested in gaining practical experience in applied health disparities research. NYC Epi Scholars is open to graduate epidemiology students who have demonstrated achievement and leadership potential and gives them an opportunity to provide high-quality research assistance to projects that identify and address health disparities of public health significance. RESULTS: Many of the program's 32 alumni have made notable contributions to public health: publishing articles in peer-reviewed journals; making presentations at national and international conferences; and after graduating, pursuing careers at the DOHMH, Centers for Disease Control and Prevention, the Environmental Protection Agency, and the National Institutes of Health. CONCLUSIONS: Because of its noted success, the NYC Epi Scholars program may serve as a "best-practice" model for expansion in other urban health departments.


Asunto(s)
Epidemiología/educación , Necesidades y Demandas de Servicios de Salud , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Salud Pública/educación , Liderazgo , Ciudad de Nueva York , Investigación/tendencias , Salud Urbana , Recursos Humanos
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