Students, Research, and the Health of Appalachia.

The notion of publication in the peer-reviewed literature out of your doctoral or master's thesis/dissertation or capstone is a characteristic of those who choose a career in the academy. This paper illustrates my pleasure by reflecting a student taking the additional step in research achievement by publishing results that contribute new knowledge to evidence-driven research and practice.

From service provision to function based performance - perspectives on public health systems from the USA and Israel.

If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S.This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS), and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF), that describes the activities of Israel's public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system.Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being.

Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant.

OBJECTIVE: The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. MATERIALS AND METHODS: We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). RESULTS: No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. CONCLUSIONS: Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Communication efforts among local health departments and health care professionals during the 2009 H1N1 outbreak.

OBJECTIVES: The purpose of this study was to examine the public health response to the emergence of influenza H1N1 by evaluating the effectiveness of communication between health departments, community physicians, and pharmacists in Kentucky during the initial H1N1 outbreak. METHODS: This study used a cross-sectional survey design to gather information from health departments, physicians, and pharmacists regarding information dissemination and receipt during the early H1N1 outbreak (April to July2009). Study participants included members of practice-based research networks in public health, primary care, pharmacy, and their partners. RESULTS: Ninety-five percent of participating local health departments (LHDs) reported that health care professional notification was a risk mitigation strategy initiated in their local jurisdiction, and 81% of responding LHDs rated their capacity to disseminate information to health care providers as very good or excellent. However, only 52% of surveyed physicians and 16% of surveyed pharmacists reported receiving any information about H1N1 from an LHD. Seventy-four percent of pharmacists were not aware of their LHD's emergency plan in the event of an influenza outbreak. CONCLUSION: These findings suggest that deficiencies exist in the outreach and effectiveness of information dissemination efforts from LHDs to health care professionals during an influenza outbreak. Research that identifies improved methods for members of public health and health care systems to communicate and share information with one another is needed. An intervention focused on improving communication about infectious disease outbreaks and examining the impact of such an intervention would be useful and productive.