Using a dual method needs assessment to evaluate the training needs of public health professionals.

A dual method research approach was used to identify the training needs of the public health professionals in Washington. A mail questionnaire was implemented, followed by focus groups with Washington State Department of Health (DOH) and local health department (LHD) professionals. Focus groups were used successfully to enhance and clarify the survey findings by identifying the specific content of the highest rated training needs (interpersonal communication, cross-culture and cross-age communication, participatory teaching/training skills, and electronic communication) and by pinpointing preference for different modes of training delivery for different training needs.     

Preterm delivery in Boston before and after September 11th, 2001

BACKGROUND: We hypothesized that stress induced by the terrorist attacks of September 11, 2001 might shorten pregnancy. To test this hypothesis, we compared gestational duration and risk of preterm delivery among women who were pregnant on September 11 with women who had delivered before that date. STUDY DESIGN: We conducted a matched cohort study among pregnant women enrolled in the Boston-based cohort study Project Viva between 1999 and 2001. Each of 606 participants, pregnant on September 11, 2001, was matched to 1 or 2 participants who delivered before that date. RESULTS: Compared with women who delivered before September 11th, women who were pregnant on September 11th had mean gestation length that was 0.13 weeks longer (95% confidence interval = -0.05 to 0.30) and an odds ratio for preterm delivery before 37 weeks' gestation of 0.60 (0.36 to 0.98). Only women exposed in the first trimester had longer gestation. CONCLUSIONS: Contrary to expectation, Boston-area women who were pregnant on September 11th had a lower risk of preterm delivery than women who delivered before that date. Although the interpretation of this finding is difficult, it is clear that the acute psychologic stress documented nationwide after the terrorist attacks did not increase the risk of preterm delivery in this population at some distance from the attacks.     

Hispanic ethnicity and post-traumatic stress disorder after a disaster: evidence from a general population survey after September 11, 2001

PURPOSE: To assess ethnic differences in the risk of post-traumatic stress disorder (PTSD) after a disaster, and to assess the factors that may explain these differences. METHODS: We used data from a representative survey of the New York City metropolitan area (n=2,616) conducted 6 months after September 11, 2001. Linear models were fit to assess differences in the prevalence of PTSD between different groups of Hispanics and non-Hispanics and to evaluate potential explanatory variables. RESULTS: Hispanics of Dominican or Puerto Rican origin (14.3% and 13.2%, respectively) were more likely than other Hispanics (6.1%) and non-Hispanics (5.2%) to report symptoms consistent with probable PTSD after the September 11 terrorist attacks. Dominicans and Puerto Ricans were more likely than persons of other races/ethnicities to have lower incomes, be younger, have lower social support, have had greater exposure to the September 11 attacks, and to have experienced a peri-event panic attack upon hearing of the September 11 attacks; these variables accounted for 60% to 74% of the observed higher prevalence of probable PTSD in these groups. CONCLUSION: Socio-economic position, event exposures, social support, and peri-event emotional reactions may help explain differences in PTSD risk after disaster between Hispanic subgroups and non-Hispanics.     

Health needs assessment and needs-led health service change: a survey of projects involving public health doctors

OBJECTIVES: To describe the criteria that define an effective health needs assessment and to explore which factors are important for the delivery of effective health needs assessment in the English National Health Service (NHS). METHODS: A postal questionnaire to all public health doctors in an English health region to describe health needs assessment activity, including initiating factors, methods and outcomes. This was followed by semi-structured interviews with public health professionals and others involved in 10 purposively selected needs assessments. RESULTS: A response rate of 62% identified a total of 102 health needs assessments undertaken between 1993 and 1998. A number of themes emerged as being important in the impact of health needs assessments on policy and planning. These included careful design, methodological rigour, decisive leadership, good communication, involvement and ownership of the work from relevant stakeholders, support from senior decision-makers, appreciation of the political dynamics and engagement with local priorities, availability of resources and, finally, an element of chance. These themes can be categorised broadly into contextual factors and quality or robustness of the work. Our findings suggest that, although methodological and analytical quality are necessary characteristics of effective health needs assessment, they are not sufficient without a favourable political environment. CONCLUSION: There appear to be conditions under which needs assessment is more likely to be effective in terms of its influence on policy and planning. However, it is clear that needs assessment does not occupy a central position in health service decision-making, remaining vulnerable to a range of factors over which those responsible for its conduct have little or no control.     

Bioterrorism: a challenge to public health and medicine.

Only a few years ago, an attack with a biological agent would have been considered almost unthinkable. Today, however, the threat of bioterrorism is real and growing. This article will provide a brief overview of the threat of bioterrorism, the special role of public health and medicine, and some of the critical issues that need to be addressed as this nation prepares for this disturbing and potentially catastrophic threat.     

Assessing the professional development needs of public health professionals.

This article describes the major activities associated with designing and implementing a comprehensive, professional development needs assessment of public health professionals in four states of the South Central region of the United States. The instrumentation, research design, and summary results of the needs assessment described in this article may facilitate similar efforts by interested researchers and program developers to assess the public health professional workforce training needs. Results of needs assessments can be useful in designing and evaluating professional development curricula and activities to strengthen public health services in the United States.     

Critical issues in bioterrorism preparedness: before and after September 2001.

The Bioterrorism Preparedness and Response Survey (BPRS) was a survey of Ohio local health departments' capacity to respond to bioterrorism. Soon after completion of the BPRS, the events of September 11 occurred, followed by the human cases of anthrax. The Ohio Response to Bioterrorism 2001 Survey (ORB) identified bioterrorism preparedness issues related to the suspected anthrax incidents. The BPRS measured capacity before September 11, 2001, and the ORB measured Ohio communities' response to white powder incidents. The BPRS and ORB provided independent and outcome measures related to the 2001-bioterrorism events. The significant bioterrorism response issues were: monitoring critical or unexplained deaths and clusters or symptoms; training on bioterrorism agents; integration of medical and criminal investigations of bioterrorism incidents; development of bioterrorism emergency response plans to include agencies to be contacted, management strategies for implementing mass vaccination, prophylaxis, treatment distribution and administration; and participation in a bioterrorism field or tabletop exercise. These results are confirmed and extended by studies by the US General Accounting Office, the Rand Corporation, Trust in the Future of America's Health foundation, and a follow-up survey of issues during a simulated covert smallpox attack.     

Development and implementation of a public health workforce training needs assessment survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.     

卫生应急人员对突发事件风险评估的认知分析

目的 :了解我国卫生应急人员对突发公共卫生事件风险评估的认知状况,从文化程度、职称情况、单位性质、单位级别等方面进行比较,为提高卫生应急人员风险评估的认识和能力提供依据。方法 :采用问卷调查的方法,对全国(大陆地区)31个省(自治区、直辖市)承担突发公共卫生事件应急处置的卫生应急工作人员进行调查。采用描述性分析和χ2检验对调查数据进行分析。结果 :我国卫生应急人员对风险评估概念熟悉程度较低,且不同学历、不同职称、不同工作年限、不同机构、不同层级之间的认知存在一定差异;对风险评估工作内容的认知也存在分歧。结论 :应加强风险评估培训,健全风险评估制度,以全面提高卫生应急人员对风险评估的认知水平。     

Expanding the public health emergency preparedness competency set to meet specialized local and evolving national needs: a needs assessment and training approach.

This article presents an approach to competency development created at the South Central Center for Public Health Preparedness to expand and refine existing competency sets for public health emergency responders. The technique uses course content generated by subject matter experts to validate and expand existing national competency sets. New competencies based on local needs were identified that provide coverage of subject matter appropriate to local public health emergency responders beyond the focus of existing national competency sets.     

Patient education for sickle cell disease: a national survey of health care professionals.

Despite emphasis on including patient and parent education in sickle cell comprehensive clinical care, literature on the use of such materials is scarce. To discover the availability of, satisfaction with, use of and interest in patient and parent education materials for sickle cell disease, we surveyed, with a 176-item self-administered questionnaire, 209 sickle cell professionals nationwide. Respondents came from 74 sickle cell programs, were 63.4% female and 37.7% African American, and represented many health professions. We found that materials about patient behavior and psycho-social issues, as opposed to those about the disease and treatment, were more often unavailable and, when available, more often unsatisfactory and less frequently used. When available, use of materials was unrelated to satisfaction and perceptions of patient problems for most topics. For each of 10 topics, over 90% of the respondents were interested in materials covering the topic. Future research should examine the low to moderate use of psycho-social and behavioral materials with sickle cell patients, and should assess the appropriateness and effectiveness of existing and new materials.     

Privatization and the scope of public health: a national survey of local health department directors

OBJECTIVES: This study sought to obtain and analyze nationally representative data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on privatization practices. METHODS: A stratified representative national sample of 380 local health department directors was drawn, and 347 directors were interviewed by telephone. Logistic regression established the independent effects of various factors on decisions to privatize. RESULTS: Almost three quarters (73%) of the local health departments privatized public health services of some type. The 12% of the directors who believed that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal health care were more likely to privatize services. The 77% of the directors who believed that local health departments should be involved in an increasing array of social problems were more likely to privatize. CONCLUSIONS: Privatization has quietly and quickly become commonplace in public health, and privatization practices are intimately related to divergent conceptions of public health and the role of local health departments.     

Perceived outcomes of public health privatization: a national survey of local health department directors

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises.     

Predictors of help seeking among Connecticut adults after September 11, 2001

OBJECTIVES: We conducted a population-based telephone survey in an attempt to determine correlates of formal and informal help seeking after September 11, 2001. METHODS: Between October 15 and December 31, 2001, 1774 Connecticut Behavioral Risk Factor Surveillance System respondents were asked questions directly related to their experiences of September 11. RESULTS: Multivariate logistic regression analyses showed that receipt of formal help was predicted by sleep problems, close association with a victim, reports of increased smoking or drinking, and receipt of informal help. Age, gender, reports of 1 or more problems, and formal help seeking predicted receipt of informal help. CONCLUSIONS: Public health planning and bioterrorism preparedness should include programs addressing increased smoking and drinking, sleep problems, and bereavement in the wake of disasters.     

A health needs assessment of street-based prostitutes: cross-sectional survey

BACKGROUND: Research with prostitutes has tended to concentrate on sexual health rather than wider health issues, and has failed to differentiate between street-based prostitutes and off-street workers. Little is known about the general health and background of street-based sex workers, the group likely to have the greatest needs. METHODS: An interview-based survey amongst street-based sex workers in central Bristol was employed. RESULTS: Seventy-one women were interviewed. All reported chronic health problems. Sexually transmitted infections were between nine and 60 times more common than the general population. Many women (44 per cent; n = 31) had experienced sexual abuse and 38 per cent (n = 27) had been in care. Women who had experienced care left school earlier (14.1 versus 15.5 years; p < 0.0001 unpaired t-test) and were less likely to have their own children at home [1/18 (5.5 per cent) versus 8/25 (32 per cent); p = 0.06) The stillbirth rate was 50/1000. Most (97 per cent; n = 69) had been offered more money for unprotected sex. Half (51 per cent; n = 36) had unprotected sex in the last week. All had drug or alcohol dependency problems. In the last week, 22 per cent (n = 9/41) of injecting drug users had shared needles and 59 per cent (n = 24/41) had shared injecting equipment, despite most (96 per cent; n = 39/41) knowing the risks. CONCLUSIONS: The health and social inequalities experienced by this group are much worse than any group highlighted in the 'Tackling Health Inequalities Review 2002' and appear cross generational. In neither that report nor the Sexual Health and HIV Strategy report are sex workers identified as a particularly high priority group. There is the potential for their needs to continue to be unmet.