Inupiat Health and Proposed Alaskan Oil Development: Results of the First Integrated Health Impact Assessment/Environmental Impact Statement for Proposed Oil Development on Alaska’s North Slope

We report on the first Health Impact Assessment (HIA) for proposed oil and gas development in Alaska’s North Slope region. Public health is not generally analyzed in the Environmental Impact Statement (EIS) process in the U.S. We conducted an HIA for proposed oil development within the National Petroleum Reserve - Alaska in response to growing concerns among North Slope Inupiat communities regarding the potential impacts of regional industrial expansion on their health and culture. We employed a qualitative HIA methodology, involving a combination of stakeholder input, literature review, and qualitative analysis, through which we identified potential health effects. The possible health outcomes identified include increases in diabetes and related metabolic conditions as a result of dietary change; rising rates of substance abuse, domestic violence, and suicide; increased injury rates; more frequent asthma exacerbations; and increased exposure to organic pollutant, including carcinogens and endocrine disruptors. There are also potential benefits, including funding for infrastructure and health care; increased employment and income; and continued funding of existing infrastructure. Based on these findings, we recommend a series of public health mitigation measures. This project represents the first formal effort to include a systematic assessment of public health within the U.S. EIS process. The inclusion of public health concerns within an EIS may offer an important and underutilized avenue through which to argue for environmental management strategies that focus on public health, and may offer communities a stronger voice in the EIS process. An erratum to this article can be found at     

Disease intervention specialists as a resource in a public health emergency

With the current shortage of qualified staff at state and local public health departments, a flexible public health workforce could fill critical gaps in staffing. Disease intervention specialists (DISs) are public health outreach workers who are responsible for finding and counseling people with sexually transmitted diseases and their contacts. DIS skills and job duties parallel those that would be needed to respond quickly and efficiently to urgent public health problems, including bioterrorism. Including DISs in public health preparedness planning could be a practical way of providing surge capacity for departments of public health. In many states, DISs are already being used for functions that fall outside their traditional duties. However, planning and DIS training are essential for effective utilization of DIS skills in a public health emergency. North Carolina has included DISs in their bioterrorism response plans and currently deploys them on an as-needed basis for nonroutine activities.     

The development and evaluation of immunodiffusion,immunofluorescence and physiological tests for the differentiation of atypical trichophyton rubrum and T. mentagrophytes isolates

Five laboratory procedures: 1) immunodiffusion, 2) immunofluorescence, 3) in vitro hair perforation, 4) pigment stimulation, and 5) a urease test were compared for their ability to differentiateT. rubrum fromT. mentagrophytes. Of the physiological tests, thein vitro hair perforation technique was the most reliable for differentiating the two species. With the serological tests, the organisms were not differentiated by immunodiffusion, but if appropriate dilutions of the conjugates were used in immunofluorescence testing, most isolates could be differentiated.A portion of a Dissertation submitted by the senior author to the University of North Carolina in partial fulfillment of the requirements for the degree of Doctor of Public Health in the School of Public Health. Training was provided by the Laboratory Director's Program which is supported by Training Grant TO1 GM 00567-07 from the National Institute of General Medical Sciences, National Institutes of Health, United States Public Health Service. The laboratory research was performed at the Laboratory Division, Center for Disease Control, under the supervision of William Kaplan.     

Counties selecting public health priorities--a "bottom-up" approach (Croatian experience)

The subject of this paper is how to incorporate a multi-disciplinary and inter-sectored approach into development of public health policy and plans at the local (county) level in Croatia by educational program. Method used was the public health capacity building program "Health--Plan for it", which was developed with the aim to assist the counties to overcome recognized weaknesses and introduce more effective and efficient local public health practices. Two main instruments were used: Local Public Health Practice Performance Measures Instrument, and Basic Priority Rating System. This program has helped counties to asses population health needs in a participatory manner, to plan for health and, ultimately, assure provision of the right kind and quality of services (better tailored to population health needs). This program's benefits are going beyond and above the county level. It provides support for the Healthy Cities project locally, and facilitates changes in national policymaking body's mindset that a "one-size-fits-all" approach is sufficient.     

Introducing One Health to the Ethical Debate About Zoonotic Diseases in Southeast Asia

Pandemic plans recommend phases of response to an emergent infectious disease (EID) outbreak, and are primarily aimed at preventing and mitigating human‐to‐human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization (WHO). The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks.     

The effect of newer tubercle bacillus digestion and decontamination procedures on fungi causing pulmonary diseases

The paper concerns the effect of the newer tubercle bacillus digestion and decontamination procedures on the principal pulmonary mycotic disease agents in sputum The digestion-decontamination procedures used were: 1) N-acetyl-L-cysteine - sodium hydroxide, 2) dithiothreitol - sodium hydroxide, and 3) trisodium phosphate - Zephiran.A portion of a Dissertation submitted by the senior author to the University of North Carolina in partial fulfillment of the requirements for the degree of Doctor of Public Health in the School of Public Health. Training was provided by the Laboratory Director's Program which is supported by Training Grant 5 T1 GM 567 from the National Institute of General Medical Sciences, National Institutes of Health, United States Public Health Service. The laboratory research was performed at the Laboratory Division, Center for Disease Control, under the supervision of the junior author.     

Order of the ilv genes of Salmonella montevideo

Summary Ilv mutants of aSalmonella typhimurium-Salmonella montevideo hybrid were used in cotransduction studies to obtain evidence for the order of theilv genes ofS. montevideo. The following order, which is the same as that previously reported forS. typhimurium, is derived:ilvE-ilvD-ilvA-ilvC.From the Departments of Genetics and Biochemistry, School of Agriculture and Life Sciences, and School of Physical and Mathematical Sciences, North Carolina State University, Raleigh, North Carolina 27607. Paper No. 3300 of the Journal Series of the North Carolina State University Agricultural Experiment Station, Raleigh, North Carolina. Supported by Research Grant GM 14184-04 from the Public Health Service.     

Food systems microbiome-related educational needs

Within the European-funded Coordination and Support Action MicrobiomeSupport ( https://www.microbiomesupport.eu/ ), the Workshop ‘Education in Food Systems Microbiome Related Sciences: Needs for Universities, Industry and Public Health Systems’ brought together over 70 researchers, public health and industry partners from all over the world to work on elaborating microbiome-related educational needs in food systems. This publication provides a summary of discussions held during and after the workshop and the resulting recommendations.     

In-house quality assurance program in a state cytology laboratory

The history and procedures of the Cytology Branch of the North Carolina State Laboratory of Public Health are briefly reviewed, including its quality assurance procedures. The latter consists of (1) programs for education of smear providers (e.g., with printed material), (2) maintenance of optimal working conditions within the laboratory itself and (3) procedures to foster quality of screening (such as proper documentation, 10% rescreening of all negative smears, specimen reviews, educational programs and outside reviews).     

Developing a regional recovery framework

A biological attack would present an unprecedented challenge for local, state, and federal agencies, the military, the private sector, and individuals on many fronts, ranging from vaccination and treatment to prioritization of cleanup actions to waste disposal. To prepare for recovery from this type of incident, the Seattle Urban Area Security Initiative (UASI) partners collaborated with military and federal agencies to develop a regional recovery framework. The goal was to identify key information that will assist policymakers and emergency managers in shortening the timeline for recovery and minimizing the economic and public health impacts of a catastrophic anthrax attack. Based on discussions in workshops, tabletop exercises, and interviews with local, state, federal, military, and private sector entities responsible for recovery, the authors identified goals, assumptions, and concepts of operation for various areas to address critical issues the region will face as recovery progresses. Although the framework is specific to a catastrophic, wide-area biological attack using anthrax, it was designed to be flexible and scalable so it could also serve as the recovery framework for an all-hazards approach in other regions and jurisdictions. Benefits from this process include enhanced coordination and collaboration across agencies, a more thorough understanding of the anthrax threat, an opportunity to proactively consider long-term recovery, and a better understanding of the specific policy questions requiring resolution.     

Groundwater Manganese and Infant Mortality Rate by County in North Carolina: An Ecological Analysis

Manganese is an element essential in trace quantities but toxic in high concentrations. As a naturally occurring element in groundwater and a chemical of increasing global significance due to its growing trend of replacing lead in gasoline, vigilant assessment of its detrimental effects is essential. In response to previous research that showed a potential link between manganese and well water, we performed a pilot ecological study using data obtained from the North Carolina Center for Health Statistics, the North Carolina Geological Survey, and the U.S. Census. Our pilot study investigated the relationship between logarithmically transformed county level groundwater manganese concentrations with county level infant mortality rates (reported as deaths/1,000) within the state of North Carolina (n = 100 counties; North Carolina 2000 population = 8,049,313) using stepwise, multiple regression. Our model accounted for such confounders as low birth weight, economic status, education, and ethnicity. Across North Carolina counties, for every log increase in groundwater manganese concentration, there was a 2.074 increase in county level infant deaths per 1,000 live births. This study is the first to show on a statewide basis adverse infant mortality effects of environmental manganese. These pilot data argue for further research into a broad range of developmental effects and also may be useful to regulatory agencies interested in protecting communities’ health.     

PROVISION OF COMMUNITY‐WIDE BENEFITS IN PUBLIC HEALTH INTERVENTION RESEARCH: THE EXPERIENCE OF INVESTIGATORS CONDUCTING RESEARCH IN THE COMMUNITY SETTING IN SOUTH ASIA

Background: This article describes the types of community‐wide benefits provided by investigators conducting public health research in South Asia as well as their self‐reported reasons for providing such benefits. Methods: We conducted 52 in‐depth interviews to explore how public health investigators in low‐resource settings make decisions about the delivery of ancillary care to research subjects. In 39 of the interviews respondents described providing benefits to members of the community in which they conducted their study. We returned to our narrative dataset to find answers to two questions: What types of community‐wide benefits do researchers provide when conducting public health intervention studies in the community setting, and what reasons do researchers give when asked why they provided community‐wide benefits? Findings: The types of community‐wide benefits delivered were directed to the health and well‐being of the population. The most common types of benefits delivered were the facilitation of access to health care for individuals in acute medical need and emergency response to natural disasters. Respondents' self‐reported reasons when asked why they provided such benefits fell into 2 general categories: intrinsic importance and instrumental importance.     

Cat-2 gene expression

Summary Poly(A)⁴ RNA was isolated from maize scutella of different stages of post-germinative development and translated in vitro in a rabbit reticulocyte translation system. Immunoprecipitation of the translation products with CAT-2-specific antibody was used to quantitate the relative levels of translatable CAT-2 mRNA at each stage. The results show a close correlation between the developmental profile of Cat2 gene expression and the profile of CAT-2 mRNA levels. Evidence that the levels of CAT-2 mRNA are regulated by a temporal regulatory gene (Car1) is presented and the possible mechanism(s) of this regulation discussed.This work was supported by Research Grants No. GM22733 and No. GM33817 from the U.S. National Institutes of Health, Public Health Service to J.G.S. This is paper No. 9933 of the Journal Series of the North Carolina Agricultural Research Service, Raleigh, NC 27695, USA     

Parasites and progress: ethical decision-making and the Santee-Cooper Malaria study, 1944-1949

As part of a mid-1940s malaria research program, U.S. Public Health Service researchers working in South Carolina chose to withhold treatment from a group of subjects while testing the efficacy of a new insecticide. Research during World War II had generated new tools to fight malaria, including the insecticide DDT and the medication chloroquine. The choices made about how to conduct research in one of the last pockets of endemic malaria in the United States reveal much about prevailing attitudes and assumptions with regard to malaria control. We describe this research and explore the ethical choices inherent in the tension between environmentally based interventions and the individual health needs of the population living within the study domain. The singular focus on the mosquito and its lifecycle led some researchers to view the humans in their study area as little more than parasite reservoirs, an attitude fueled by the frustrating disappearance of malaria just when the scientists were on the verge of establishing the efficacy of a powerful new agent in the fight against malaria. This analysis of their choices has relevance to broader questions in public health ethics.     

IHE cross-enterprise document sharing for imaging: interoperability testing software

Background  

With the deployments of Electronic Health Records (EHR), interoperability testing in healthcare is becoming crucial. EHR enables access to prior diagnostic information in order to assist in health decisions. It is a virtual system that results from the cooperation of several heterogeneous distributed systems. Interoperability between peers is therefore essential. Achieving interoperability requires various types of testing. Implementations need to be tested using software that simulates communication partners, and that provides test data and test plans.     

The effect of rising obesity on eligibility to serve in the U.S. public health service commissioned corps

This study investigates how rising obesity has affected eligibility to serve in the United States Public Health Service Commissioned Corps (PHSCC), the uniformed service charged with protecting and promoting public health in the U.S. Data are drawn from the National Health and Nutrition Examination Surveys. Between 1959 and 2010, the percentage of eligible civilians who exceed the weight-for-height and body fat standards of the PHSCC rose from 9.05% to 18.24% among men, and from 6.13% to 23.10% among women. Simulations indicate that a further 1% increase in population body weight will result in an additional 3.42% of men and 5.08% of women exceeding PHSCC accession standards.This study documents an under appreciated consequence of the rise in obesity: fewer Americans eligible to develop and implement a public health response to obesity through the PHSCC. This illustrates how a public health problem can undermine the public health labor force, compromising a response and risking a self-reinforcing trend. These findings are timely as the Patient Protection and Affordable Care Act (ACA) calls for a major expansion of the PHSCC.     

Recovery and sequence analysis of hepatitis a virus from springwater implicated in an outbreak of acute viral hepatitis

An outbreak of acute hepatitis A virus in North Carolina was linked to drinking water from a contaminated shallow spring by phylogenetic analysis of hepatitis A virus (HAV) genomic sequences. Detection of HAV and fecal indicators in the water provided useful and timely information to assist with public health prevention and control measures.     

Environmental Manganese and Cancer Mortality Rates by County in North Carolina: An Ecological Study

Manganese is an element essential for health in trace amounts, but toxic at higher exposures. Since manganese is replacing lead in gasoline globally, evaluation of potential cancer effects is essential. To determine whether environmental manganese is related to cancer at the county level in North Carolina (n = 100 counties; North Carolina 2000 population = 8,049,313), we carried out an ecological study using data from the North Carolina State Center for Health Statistics, North Carolina Geological Survey, US Geological Survey, and US Census. County-level all-cause and cancer mortality rates between 1997 and 2001 reported in deaths per 100,000 population associated by multivariable regression with logarithmically transformed groundwater (microgram per liter) and airborne (microgram per cubic meter) manganese concentrations by county measured between 1973 and 1979 (water) and in1996 (air). Models controlled for county characteristics. Median all-cause and cancer mortality rates by county in North Carolina (1997–2001) exceeded those of the USA (2000). For each log increase in groundwater manganese concentration, there was a corresponding county-level increase of 12.10 deaths/100,000 population in all-site cancer rates, 2.84 deaths/100,000 in colon cancer rates, and 7.73 deaths/100,000 in lung cancer rates. For each log increase in airborne manganese concentration, there was a corresponding county-level decrease of 8.10 deaths/100,000 population in all-site cancer rates, 3.28 deaths/100,000 in breast cancer rates, and 3.97 deaths/100,000 in lung cancer rates. Neither groundwater nor air concentrations of manganese correlated with county-level all-cause or prostate cancer death rates. These are the first data we know of to document a potential relationship between environmental manganese and population-level cancer death rates. The positive association between groundwater manganese and specific cancer mortality rates might be a function of the high concentrations measured, while the inverse relationship between air manganese and death rates might point toward adequate (e.g., healthy) county-level manganese exposures. Since manganese is replacing lead in gasoline globally, these ecological findings should be confirmed at the individual level or in animal models.     

Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda,June 2019

The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda’s Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda’s Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda’s Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense’s Makerere University Walter Reed Project, and the United States Mission to Kampala’s Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda’s National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda.