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The linking of surveillance data sets has increasingly become an essential public health activity. We compared a traditional method in North Carolina (NC) with a newer collaborative approach when linking Hospital Discharge Data (HDD) and NC Violent Death Reporting System (NC-VDRS) data. We found the collaborative approach to be superior, enabling wider ownership combined with subject matter expertise the traditional method lacked. We used Link Plus and Match*Pro software for linkage, which had similar matching results. However, the collaborative process using Match*Pro resulted in fewer matches requiring review and enabled better case adjudication and collaboration between partners. Of the 1361 unique suicides that matched to HDD, 44% (n = 599) had multiple prior hospitalizations. Public health needs to innovate and enable partners to foster solutions when traditional methods are dated and result in less reliable data. The process outlined builds consensus, increases trust, and ultimately saves time.

BACKGROUND Research on intimate partner homicide (IPH), when someone is killed by a current or former intimate partner, in North Carolina is limited, making it difficult to understand the magnitude of IPHs and identify strategies for prevention.METHOD We used North Carolina Violent Death Reporting System (NC-VDRS) data to assess IPHs among North Carolina residents between 2011 and 2015. Homicides were considered IPHs if intimate partner violence was identified and the victim was the suspect's current or former intimate partner. Proportions and rates of demographic characteristics and circumstances were assessed.RESULTS Of the 2,299 homicides that occurred between 2011 and 2015, 350 were IPHs (0.9 per 100,000 person-years). Most (72.3%) IPH victims were female (n = 253). Among all female homicides almost half (48.2%) were IPHs, while only 5.4% of all male homicides were IPHs. The highest rate of IPH occurred among women aged 20-44 (2.1 per 100,000 person-years). Most victims were non-Hispanic (NH) white (54.0%, n = 189), although rates for NH American Indians and NH blacks were 1.8 and 2.0 times those among NH whites respectively. Most victims, 86.6% male and 82.6% female, were the suspect's current partner. Firearms were the most common weapon used (62.6%, n = 219).LIMITATIONS NC-VDRS data are not representative of all IPHs in the United States. Circumstance data were sometimes incomplete and categories of circumstance variables restrictive, limiting available information on IPHs.CONCLUSION Future interventions focused on women aged 20-44, NH American Indian and NH Black communities, and firearm access could be effective in preventing IPHs in North Carolina.

Prevention of HIV outbreaks among people who inject drugs remains a challenge to ending the HIV epidemic in the United States. The first legal syringe services program (SSP) in Florida implemented routine screening in 2018 leading to the identification of ten anonymous HIV seroconversions. The SSP collaborated with the Department of Health to conduct an epidemiologic investigation. All seven acute HIV seroconversions were linked to care (86% within 30 days) and achieved viral suppression (mean 70 days). Six of the seven individuals are epidemiologically and/or socially linked to at least two other seroconversions. Analysis of the HIV genotypes revealed that two individuals are connected molecularly at 0.5% genetic distance. We identified a risk network with complex transmission dynamics that could not be explained by epidemiological methods or molecular analyses alone. Providing wrap-around services through the SSP, including routine screening, intensive linkage and patient navigation, could be an effective model for achieving viral suppression for people who inject drugs.

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors’ engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.

Objective To describe how a successful partnership between state public health and a university organization has used epidemiologic data, such as mortality, hospital discharge, and emergency department (ED) visit data, to inform falls prevention activities in North Carolina (NC). Introduction Falls are a leading cause of fatal and nonfatal injury in NC. As the size of the older adult population is predicted to increase over the next few decades, it is likely that the incidence of falls-related morbidity and mortality will increase in tandem. 1 In order to address this public health emergency, the Injury and Violence Prevention Branch (IVPB) of the NC Division of Public Health has partnered with the Carolina Center for Health Informatics (CCHI) in the Department of Emergency Medicine at the University of North Carolina at Chapel Hill to perform falls surveillance activities. This abstract describes some of the specific research and surveillance activities currently ongoing in NC. Methods IVPB developed the Special Emphasis Report (SER) on Fall Injuries among Older Adults, 2005-2014 to describe the demographic characteristics and trends of falls-related mortality and hospitalization among adults 65 and older, associated costs of falls-related injury, and current falls prevention activities in NC. The NC SER was based on the Centers for Disease Control and Prevention’s Injury SER template, a tool designed to facilitate the dissemination of injury data for public health action. While the SER focused primarily on falls among adults > 65 years of age, CCHI was interested in using ED visit data to identify the age at which falls morbidity begins to increase as a means of informing prevention activities to be implemented before the advent of an injurious fall. Therefore, CCHI performed a descriptive epidemiologic study using ED visit data collected by NC DETECT. CCHI identified all NC ED visits from January 1, 2010 – December 31, 2014 that met the National Center for Injury Prevention and Control definition of a fall of unintentional intent. 2 During 2010-2014, NC DETECT captured ED visit data from all 125 24/7, acute care, hospital-affiliated, civilian EDs and over 99% of all ED visits in the state. 3 Results Analysis for the SER found that falls-related death rates increased by 43.1% from 2005 (47.0 per 100,000) to 2014 (67.3 per 100,000), with the greatest increase among males (61.3%) and adults 85 and older (74.4%). Conversely, rates of non-fatal hospitalization remained relatively stable and were 1.6 times higher among females than males in 2014 (84.0 and 56.8 per 100,000 respectively). Projected lifetime costs associated with falls among NC older adults was approximately $1.4 billion in 2014. NC DETECT captured 986,024 ED visits during the period 2010-2014 among adults > 20 years of age (27.4 ED visits/1,000 person-years; 95% CI: 27.4-27.5). Throughout the adult lifespan, fall incidence rates in women (33.0 ED visits/1,000 person-years; 95% CI: 32.9-33.1) exceeded those in men (21.3 ED visits/1,000 person-years; 95% CI: 21.3-21.4). Starting at age 45, fall rates in women continued to exceed fall rates in men, climbing each year, while rates in men remained stable until after age 65. These results suggest that the risk of having an injurious fall may increase before age 65, particularly among women. Due to the public health implications of the results obtained by IVPB and CCHI, both organizations are working closely to ensure that relevant information reaches a wide net of potential partners in the effort to reduce falls morbidity and mortality. To date, IVPB and CCHI have collaborated on generating fact sheets and short reports available to the public, syndromic surveillance custom event reports available to authorized users, and presenting information to local, state, and national partners. Conclusions Falls morbidity and mortality are major concerns for the state of NC and the country as a whole. Falls surveillance benefits from the collaboration of governmental and university organizations with community partners. For example, when CCHI identified an increase in falls incidence in middle age, and, therefore, the potential need to begin falls risk assessment activities at ages < 65, particularly among women, NC DPH had the resources to communicate these results to relevant local and state programs and organizations. References 1. R Tippett. Population Growth in the Carolinas: Projected vs. Observed Trends. Carolina Demography, Carolina Population Center, University of North Carolina at Chapel Hill. http://demography.cpc.unc.edu/2015/12/08/population-growth-in-the-carolinas-projected-vs-observed-trends/. Page last reviewed December 8, 2015. Accessed October 9, 2017. 2. National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC). Matrix of E-code Groupings. www.cdc.gov/injury/wisqars/ecode_matrix.html. Page last reviewed on August 29, 2014. Accessed October 12, 2016. 3. Carolina Center for Health Informatics, University of North Carolina at Chapel Hill. NC DETECT: Background. http://ncdetect.org/background/. Page last reviewed January 2017. Accessed March 8, 2017.

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.