Challenges in surveillance of dementias in New York State

Prevalence of dementia is expected to increase three- to four-fold in the next 50 years. In 1986, New York State established the Alzheimer's Disease and Other Dementias Registry, one of a few such registries in the United States. We identify surveillance challenges within the Registry. Data quality--specifically, the attributes of completeness and accuracy--is the primary challenge to the New York State dementias registry. Completeness may be undermined when hospitals and nursing homes fail to report data, and hospital charts do not record dementia diagnoses. Failure to record diagnoses may occur because of diagnosis uncertainty, perceived stigma, clinical attention on the primary reason for hospitalization, and financial disincentives. Dementia is well recorded in nursing home data because care planning requires frequent resident evaluations. The accuracy of recording specific forms of dementia is limited because coding terminology has not kept pace with physicians' perspectives on dementias. Hospitals and nursing homes document dementia and comorbidities more effectively among frail individuals and those with advanced dementias than among individuals who appear to be relatively healthy. One way to overcome challenges of data quality is to form partnerships with organizations that have expertise in managing medical records and coding dementias. As medical advances make early diagnoses more possible outside the hospital or nursing home setting, we will need to redesign the current surveillance system to capture this additional dementia data and ensure a representative system.     

The process to develop a meaningful community health assessment in New York State.

Conducting and producing a meaningful Community Health Assessment (CHA) is an important and essential public health service and a mandatory biennial activity for New York State's (NYS) Local Health Departments. The Assessment Initiative project has allowed the NYS Department of Health to better understand and identify strategies to strengthen CHAs and to develop training, education, and technical assistance programs. The Assessment Initiative project has benefited from participation, coordination, and sharing of resources and expertise with other community health improvement initiatives in NYS, including those that emphasize collaborative approaches to health improvement, workforce development, and expanding access to data.     

Sentinel health event surveillance: skin cancer of the scrotum in New York State.

Skin cancer of the scrotum is a disease that has been identified as a sentinel health event (occupational) (SHE(O] that is necessarily occupationally related. The present paper examines the feasibility of using this disease in active cancer surveillance in New York State. After consulting cancer case reports, hospital records, death certificates, and city directories, we obtained occupational data for 17 of 22 cases of nonmelanoma skin cancer of the scrotum diagnosed between 1979 and 1984. Only three cases had occupations previously linked to scrotal cancer, while 11 of 19 cases had one or more possibly contributory medical conditions. The probable under-reporting of scrotal cancer cases and incompleteness of occupational data may limit the usefulness of scrotal cancer as a sentinel health event (occupational) unless additional steps are taken.     

Characteristics of a random sample of emergency food program users in New York: I. Food pantries.

Food pantry users throughout New York State were studied and many demographic differences found between New York City and Upstate New York respondents. Seven percent of households had no income and median income as percent of the poverty level was 59 percent. Slightly more than 40 percent were spending over 60 percent of their incomes on housing. The data from this survey, the first in New York State to employ a random sampling design, demonstrate a sizable gap between household needs and available resources.     

Characteristics of a random sample of emergency food program users in New York: II. Soup kitchens.

A random sample of soup kitchen clients in New York City was studied and specific comparisons made on various parameters including homelessness. Compared with the general population of low income persons, soup kitchen users were overwhelmingly male, disproportionately African-American, and more likely to live alone. The homeless (41 percent of the sample) were less likely to receive food stamps or free food, or to use food pantries. Fewer of them received Medicaid or had health insurance. Forty-seven percent had no income in contrast to 29 percent of the total sample.     

Technology-dependent children in New York State.

A survey in New York State revealed 210 medically stable technology-dependent children retained inappropriately in acute-care hospitals. They remained in hospitals primarily because of a shortage of skilled home nursing services in the communities where they lived, family problems that prevented their care at home, and a shortage of beds in appropriate skilled nursing facilities. Most of the children were younger than one year of age, most had disorders of the central nervous system or respiratory system, and most needed respiratory support. The average child needed more than 13 hours of skilled nursing care per day. With adequate nursing services, many of these children could be cared for in their homes. For some, family care was not feasible because of social, psychological, and economic problems. To make it possible to care for medically stable technology-dependent children most effectively, we must develop additional community-based resources. Home nursing services of the highly skilled kind needed to care for them are in short supply today in New York State. There is a shortage of beds in extended care nursing facilities capable of caring for them, especially for infants and very young children. There is a shortage of the other supportive social services needed by families who attempt to care for them at home. Until we address these needs and develop these services, technology-dependent children medically appropriate for care outside acute-care hospitals will be forced to remain hospitalized, to the detriment of the children and their families.     

West Nile virus surveillance in mosquitoes in New York State, 2000-2004

A West Nile virus (WNV) surveillance system was created and implemented in New York State (NYS) in 2000 and described previously (White et al. 2001). We examine and evaluate the results of mosquito and virus surveillance for 2000 through 2004 exclusive of New York City. Forty-nine counties submitted 1,095,426 mosquitoes in 35,280 pools for WNV assay. Specimens of 47 species were tested, with Culex species accounting for 47.6% of all pools tested. WNV was detected in 814 pools from 10 species, with combined Culex pipiens/Culex restuans pools accounting for 90.8% of all detections. Pools submitted from gravid traps were 5.7 times more likely to be positive than submissions from carbon dioxide-baited light traps. Most human WNV cases resided in counties that conducted mosquito surveillance. Local health departments' use of mosquito surveillance information often led to an enhanced disease prevention response. In NYS, Cx. pipiens/Cx. restuans groups are most likely vectors of WNV. Future efforts to improve system efficacy are discussed.     

Evaluation of a school-based sealant program in New York State.

This study evaluated the outcome of a targeted dental sealant program by comparing the survival probabilities of sealed high-risk first molar tooth sites to unsealed low-risk tooth sites in 1,122 children enrolled in a school-based sealant program. A comparison of the survival probabilities between low-risk first molar teeth that did not receive sealants and the sealed high-risk first molar teeth did not show significant differences. The results suggest that the protocol used by the program provides a satisfactory method for identification of children who could best benefit from sealants in a school-based situation.     

Gonorrhea screening program in New York State.

Of 171,089 mailed specimens examined for Neisseria gonorrhoeae, 88% were submitted by family planning clinics, physicians in private practice, and other non-VD clinics. To process a large volume of specimen bottles, we developed a swab-oxidase test and demonstrated it to be reliable for the initial screening of all specimens. Our protocol permitted the isolation and confirmation by sugar fermentation of 95% of all presumed N. gonorrhoeae cultures within 1 or 2 days after growth was observed. The results obtained over a 2-year period indicate that the positivity rate is directly related to the lag period between specimen collection and examination. There was no adverse effect of cold weather on the positivity rate, but, irrespective of the season, 3 to 9% of the positive specimens required incubation for 3 days before gonococcal growth appeared.