Describing the continuum of collaboration among local health departments with hospitals around the community health assessments.

BACKGROUND: Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through the Public Health Accreditation Board. Tax exempt hospitals must perform a community health needs assessment (CHNA), similar to the community health assessment (CHA) required for LHDs. These efforts have led to a renewed interest in hospitals and LHDs working together to achieve common goals. PURPOSE: The purpose of this study is to gain a better understanding of levels of joint action leading toward collaboration between LHDs and hospitals and describe collaboration around CHAs. METHODS: Local health departments were selected on the basis of reporting collaboration (n = 26) or unsure about collaboration (n = 29) with local hospitals. Local health departments were surveyed regarding their relationship with local hospitals. For LHDs currently collaborating with a hospital, a collaboration continuum scale was calculated. Appropriate nonparametric tests, chi-squares, and Spearman's rank correlations were conducted to determine differences between groups. RESULTS: A total of 44 LHDs responded to the survey (80.0%). Currently collaborating LHDs were more likely to be interested in accreditation and to refer to their CHA 5 or more times a year compared to the unsure LHDs. In the analysis, a collaboration continuum was created and is positively correlated with aspects of the CHA and CHA process. CONCLUSIONS: This study is the first attempt to quantify the level of collaboration between LHDs and hospitals around CHAs. Better understanding of the levels of joint action required may assist LHDs in making informed decisions regarding deployment of resources on the path to accreditation.

Bioterrorism knowledge and educational participation of nurses in Missouri.

BACKGROUND: Nurses are integral to bioterrorism preparedness, but nurses' bioterrorism preparedness knowledge has not been evaluated well. METHODS: Missouri Nurses Association members (1,528) were studied in the summer of 2006 to assess their bioterrorism knowledge and the perceived benefits of education as well as barriers to education. RESULTS: The response rate was 31%. Most respondents (60%, n = 284) received no bioterrorism education. Nurses who were nurse practitioners (t = -2.42, p < .05), were male (t = -2.99, p < .01), or were on a planning committee (t = -1.96, p = .05) had received more education than other nurses. The most commonly cited barrier to education (46.6%, n = 221) was not knowing where to obtain training. One third of respondents (31.2%) reported no interest in receiving bioterrorism education in the future. Nurses' average score on the knowledge test was 73%. The most commonly missed questions pertained to infection control and decontamination procedures. CONCLUSION: Bioterrorism preparedness training should be offered through continuing education and nursing school curricula.

Influence of season and temperature on the relationship of elemental carbon air pollution to pediatric asthma emergency room visits.

Previous studies have demonstrated an association between air pollution and asthma exacerbation. Less understood is the effect of elemental carbon (EC), and the interaction of EC with temperature, on increases in pediatric asthma emergency department visits and how these relationships change across the seasons in a metropolitan area with several industries and relatively low air pollution. Measurements of EC, ozone (O(3)), sulfur dioxide (SO(2)), and total oxides of nitrogen (NO(x)) were available from the St. Louis EPA Supersite for June 1, 2001 to May 31, 2003. We obtained ICD-9 information on 281,763 pediatric ED visits from 27 hospitals in the St. Louis, MO metropolitan area. The relationship between EC and pediatric asthma ED visits, controlling for season, weekend exposure, allergens, and other pollutants known to exacerbate asthma, was assessed using Poisson generalized estimating equations using a 1-day lag between exposure and ED visit. We evaluated the interaction of EC and temperature and EC and weekend vs. weekday exposure. An interaction effect existed between EC and temperature for 11-17-year-olds during the summer and winter seasons. During the summer, a 0.10 microg/m(3) increase in EC resulted in a 9.45% increase in asthma ED visits among 11-17-year-olds (95%CI = 1.02,1.17) at the median seasonal temperature (86.5 degrees F). This risk increased with increasing temperature. During the winter, a 0.10 microg/m(3) increase in EC resulted in 2.80% increase in asthma ED visits among 11-17-year-olds (95%CI = 1.01,1.05) at the median seasonal temperature (43.3 degrees F). This risk increased with decreasing temperature. Among 11-17-year-olds, daily number of asthma ED visits is associated with increased levels of EC at higher temperatures in the summer and lower temperatures in the winter.

Missouri nurses' bioterrorism preparedness.

Nurses are the largest group of healthcare providers and will be at the forefront during a response to a bioterrorism attack in the U.S. However, nurses' bioterrorism risk perceptions and their participation in bioterrorism preparedness activities, such as bioterrorism-related exercises or drills, have not been evaluated. We mailed a survey to all members of the Missouri Nurses Association in July 2006, consisting of 1,528 registered nurses. The instrument measured risk perception, perceived susceptibility, perceived seriousness, bioterrorism education received, participation in exercises/drills, and personal response plan thoroughness. The response rate was 31% (474/1,528). Most respondents believe that a bioterrorism attack will occur in the U.S. (82.3%; n = 390), but few (21.3%; n = 101) believe that one will occur in their community. The majority of nurses reported that they believe that a bioterrorism attack would have serious consequences (96.1%, n = 448), including having a serious impact on U.S. citizens' safety (90.7%, n = 446) and on their own safety (84.3%, n = 379). Most (60%, n = 284) reported that they had not received any bioterrorism-related education nor participated in any drills/exercises (82.7%, n = 392). Of those who had received education, most had participated in 3 or fewer programs and in only 1 drill. Few nurses (3.6%, n = 15) reported having all aspects of a personal bioterrorism response plan; approximately 20% (19.4%, n = 81) did not have any components of a plan. Most of the registered nurses in Missouri who were surveyed are not receiving bioterrorism education, participating in bioterrorism exercises, or developing thorough personal response plans. Nurses need to be aware of and encouraged to participate in the many education and training opportunities on bioterrorism and infectious disease disasters.