Examining public health financing in New York State: a methodology for evaluating local and national public health data.

Historically, there has been little national, standardized data collection on the financing of public health. In part this is due to the diverse way in which local public health is organized and funded. The lack of consistent financial data to adequately evaluate performance severely limits the ability of policy makers to set standards for improving quality. However, even in the absence of such data and analysis, policies have been established by local, state, and national governments to reduce public health funding, while at the same time, placing additional responsibilities on local public health. In an effort to understand fiscal trends for local health departments in New York State, the New York State Association of County Health Officials conducted a survey in December 2002 that collected data on spending and funding sources from calendar year 2000 to calendar year 2002. The survey instrument presents a model for state and local public health departments to evaluate their own resources/needs and to promote information exchange within and between localities. With limited resources, local public health officials must make difficult choices about their programs. By encouraging localities to collect uniform financial data sets, public health will be better suited to support its case for stable and sufficient funding.     

Risk profile forchlamydia infection in women from public health clinics in New York State

The prevalence of chlamydial infection and associated risk factors were studied in 1531 women from ten clinics in New York State excluding New York City. OverallChlamydia infection rates were 13.6%; 17.6% in eight high risk family planning and STD clinics, and 5.7% in two low risk college and private clinics. Risk factors forChlamydia infection included: age <20 years (odds ratio 1.6), use of oral contraceptives (odds ratio 2.0), a history of having more than one sexual partner (odds ratio 1.7) and, in one clinic where data was available, inflammation on Papanicolaou smears (odds ratio 2.1).These data helped secure funding forChlamydia preventive services and permitted development of a risk profile (score card) ofChlamydia for each age group. Use of such a score card can be most helpful in assigning which patients could benefit most fromChlamydia cultures, especially in those areas where testing is unavailable or too costly to screen all patients.All authors are from the New York State Department of Health. Yangsook Han is a research scientist, AIDS Institute; Dale Morse is Director of the Bureau of Communicable Disease Control, Charles Lawrence is chief of the Biometrics Laboratory, Wadsworth Center for Laboratories and Research; Dennis Murphy is STD program director and Sally Hipp is STD special projects director.     

Employee-management relations in the New York State public sector

Conclusion Despite what has been said above, it is safe to state that management in the public sector is not in danger of being deposed. Both labor and management can survive; they have in the private sector and the relationship has proven mutually beneficial. But continued interaction and cooperation is needed to assure a lasting relationship, even though new challenges are inherent in it.     

New data for the public health importance of hantaviruses in Hungary

INTRODUCTION: The authors present recent results in the Hungarian hantavirus ecology and epidemiology. Most of the research was done between 1992-2000. AIM: To determine the presence and geographic distribution of hantaviruses and to get more detailed information of human and small-mammal infection with these viruses in Hungary. METHODS: For diagnostic purposes (patients' sera), serosurvey of healthy persons and serological investigations of small mammals, the following tests were used: indirect fluorescent antibody, high density particle agglutination and enzyme-linked immunosorbent assay (ELISA). Virus isolation, antigen-, and nucleic acid detection were conducted for ecological investigations. RESULTS: 235 of 831 patients proved to be seropositive. 2257 sera of age matched Hungarian citizens above 20 years were tested in 2000. The average seropositivity proved to be about 10% using two different methods. Sera of 1512 individuals of nearly 20 different mammalian species were tested. Serological results revealed the prevalence of antibodies to human pathogen hantaviruses among rodents of about 7.25 percent. Molecular analysis of viral nucleic acid isolates from organs of four rodents proved directly the presence of viruses belonging to Puumala and Dobrava/Belgrade species in Hungary. Sequences corresponding to the Dobrava/Belgrade type viruses were found in two different rodent species. This suggests the existence of two hosts with different living preferences. CONCLUSIONS: At least two different human pathogen hantaviruses are circulating in Hungary. It has to be considered, that viruses belonging to the Dobrava/Belgrade species could emerge not only in the forested areas, but in the agricultural areas as well. Commercially available kits are not perfectly suitable for the detection of antibodies rised to domestic hantaviruses. It is necessary to built an appropriate laboratory for the hantavirus research in Hungary.     

Factors associated with repeat mammography in a New York State public health screening program.

Screening mammography is the most effective method for early detection of breast cancer, but repeat mammography rates are not optimal in most populations. Since 1988, New York State has supported a program of breast cancer screening for underserved, uninsured, or underinsured women. The present study was designed to identify sociodemographic and clinical factors associated with failure to return for repeat mammography screening after a negative initial mammogram. Of women initially screened between 1988 and 1991 (N = 9,485), 27 percent obtained repeat mammograms by 1993. The final logistic regression model contained program site, race and ethnicity, family income, and time since last mammogram.     

The importance of the past in public health

STUDY OBJECTIVE: To explore the role of history in public health and its relevance to current practice and professional development. DESIGN: An analysis of the issues surrounding the poor attention paid to the history of public health by its current practitioners. SETTING: The paper is written from the perspective of practitioners in the UK but has wide applicability. MAIN RESULTS: The paper makes the case that the current neglect of public health history is to the detriment of public health practice. CONCLUSIONS: There is a strong case for more attention to be paid to public health history in professional formation, development, and communication.     

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.     

The importance of hormesis to public health

Hormesis is a specific type of nonmonotonic dose response whose occurrence has been documented across a broad range of biological models and diverse types of exposure. The effects that occur at various points along this curve can be interpreted as beneficial or detrimental, depending on the biological or ecologic context in which they occur. Because hormesis appears to be a relatively common phenomenon that has not yet been incorporated into regulatory practice, the objective of this commentary is to explore some of its more obvious public health and risk assessment implications, with particular reference to issues raised recently within this journal by other authors. Hormesis appears to be more common than doseresponse curves that are currently used in the risk assessment process. Although a number of mechanisms have been identified that explain many hormetic doseresponse relationships, better understanding of this phenomenon will likely lead to different strategies not only for the prevention and treatment of disease but also for the promotion of improved public health as it relates to both specific and more holistic health outcomes. We believe that ignoring hormesis is poor policy because it ignores knowledge that could be used to improve public health.     

The importance of hormesis to public health

BACKGROUND: Hormesis is a specific type of nonmonotonic dose response whose occurrence has been documented across a broad range of biological models, diverse types of exposure, and a variety of outcomes. The effects that occur at various points along this curve can be interpreted as beneficial or detrimental, depending on the biological or ecologic context in which they occur. OBJECTIVE: Because hormesis appears to be a relatively common phenomenon that has not yet been incorporated into regulatory practice, the objective of this commentary is to explore some of its more obvious public health and risk assessment implications, with particular reference to issues raised recently within this journal by other authors. DISCUSSION: Hormesis appears to be more common than dose-response curves that are currently used in the risk assessment process [e.g., linear no-threshold (LNT)]. Although a number of mechanisms have been identified that explain many hormetic dose-response relationships, better understanding of this phenomenon will likely lead to different strategies not only for the prevention and treatment of disease but also for the promotion of improved public health as it relates to both specific and more holistic health outcomes. CONCLUSIONS: We believe that ignoring hormesis is poor policy because it ignores knowledge that could be used to improve public health.     

West Nile virus infection in birds and mosquitoes, New York State, 2000

West Nile (WN) virus was found throughout New York State in 2000, with the epicenter in New York City and surrounding counties. We tested 3,403 dead birds and 9,954 mosquito pools for WN virus during the transmission season. Sixty-three avian species, representing 30 families and 14 orders, tested positive for WN virus. The highest proportion of dead birds that tested positive for WN virus was in American Crows in the epicenter (67% positive, n=907). Eight mosquito species, representing four genera, were positive for WN virus. The minimum infection rate per 1,000 mosquitoes (MIR) was highest for Culex pipiens in the epicenter: 3.53 for the entire season and 7.49 for the peak week of August 13. Staten Island had the highest MIR (11.42 for Cx. pipiens), which was associated with the highest proportion of dead American Crows that tested positive for WN virus (92%, n=48) and the highest number of human cases (n=10).     

Health characteristics and utilization of public sector health facilities among migrant agricultural workers in Orange County, New York

Publicly subsidized medical clinics were established to provide migrant farmworkers with minimal access to mainstream medical care. Nevertheless, migrant farmworkers delay treatment of health problems and refrain totally from use of medical facilities. The present study explores the health status and utilization of subsidized migrant clinics by farmworkers in a vegetable production county (Orange County) in upstate New York. Multivariate analysis indicated that economic resources, mental health status, health insurance coverage, language, education and utilization of acute care facilities are important predictors of these decisions.