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The ability to diagnose and screen for infection is an important component of the US COVID-19 response and is facilitated by public health laboratories (PHLs). Anecdotal media reports and limited case studies have described some of the challenges faced by PHLs during the pandemic, particularly initial challenges related to developing and deploying tests to PHLs, but there has not been a systematic evaluation of the experience of PHLs during the pandemic.To document challenges and lessons learned experienced by local and state PHLs during the COVID-19 pandemic to support generation of best practices for current and future similar emergencies.From February to June 2021, researchers conducted 24 interviews with 68 leaders and staff representing 28 local and state PHLs across 27 states. Thematic analysis of interview content documented operational challenges and any identified solutions or preventive measures used or proposed.Analysis identified the following themes regarding challenges faced among PHLs: strategic decision making and determining the mandate of the PHL; political interference by jurisdictional leadership; federal mismanagement of the emergency; regulatory challenges; managing partnerships with other laboratories; acquisition of appropriate supplies; insufficient information systems; acquiring and retaining workforce; and difficulty accessing sufficient funding.Within the identified themes, key informants provided further elaboration regarding how PHLs experienced, evaded, or solved these challenges. In addition, PHLs described how challenges evolved throughout the course of the COVID-19 pandemic and made proposals regarding how challenges could be prevented or further addressed in the future by laboratories or other decision makers and stakeholders.While fellow laboratories and political leadership may gain inspiration from creative solutions employed by PHLs, recognition of long-standing gaps related to funding, laboratory workforce, and consideration of laboratory needs in preparedness policies must be addressed for future large-scale outbreaks.

Background The Surgeon General oversees the Commissioned Corps of the U.S. Public Health Service (USPHS) and is viewed as the “Nation’s Doctor,” responsible for providing the public with information on living healthier and safer lives. The Surgeon General’s influence is seen through public health initiatives such as warning labels on tobacco and alcohol products. The objectives of this paper are to describe the tradition of the Office of the Surgeon General as created by Dr John M. Woodworth and to describe the careers of Dr C. Everett Koop and Dr Richard H. Carmona—the only 2 surgeons by training to hold the role. Methods This is a historical literature review using a combination of primary and secondary sources. Results Dr Woodworth set the priorities and responsibilities of the Surgeon General’s Office: education, public service, sanitation, and public health. Dr Koop is widely regarded as the most influential Surgeon General of all time. He was both a pioneer in pediatric surgery and a highly influential public figure, issuing landmark reports on smoking, violence, and AIDS. Dr Carmona is a trauma surgeon by training and focused on the dangers of second-hand smoke as Surgeon General. Dr Carmona served in a more political role as Surgeon General, eventually running for Senate at the end of his term. Conclusion This brief review of the history of the Surgeon General’s Office highlights the contributions of the first Surgeon General and the only 2 surgeons who have held the position.

The earliest sickness survey of the US Public Health Service, which started in 1915, was the Service's first socioeconomic study of an industrial community. It was also the first to define illness as a person's inability to work. The survey incorporated the Metropolitan Life Insurance Company's definition of illness, which, instead of sickness rates, focused on duration of illness as a proxy of time lost from work. This kind of survey took place in the broader context of the reform movements of the Progressive Era and the social surveys conducted in the United States, which led to the creation of the Federal Commission on Industrial Relations, where the Service's sickness survey originated. The Service's focus on the socioeconomic classification of families and definition of illness as the inability to work enabled it to show the strong link between poverty and illness among industrial workers. The leader of the survey, Edgar Sydenstricker, and the Metropolitan Life Insurance Company came up with new ways to measure the health of the population, which also influenced the Service's studies of the effects of the Great Depression on public health and the National Health Survey of 1935-1936. (Am J Public Health. Published online ahead of print October 28, 2021: e1-e9. https://doi.org/10.2105/AJPH.2021.306454).

Objective To describe the perceptions of healthcare workers employed at a metropolitan public health service, with respect to how they identify, manage and care for refugee patients. Methods This study surveyed healthcare workers using a cross-sectional, mixed methods descriptive design, which partially replicates a previous Australian study. A total of 215 responses to a brief online survey were received (n = 48 medical, n = 100 nursing and midwifery, n = 50 allied health, n = 4 other). Results Nurses and allied health respondents were more likely to record working with refugees rarely or never (P = 0.00). Most respondents (70.3%) identified no negative effects from working with refugees, and perceived this patient group enhanced (71.3%) their work. Insufficient identification, interpreter availability, education, healthcare worker capacity and providing culturally specific treatment were all identified as potential service barriers. Allied health respondents were more likely to report low confidence about working with refugees in general (P = 0.04). Respondents with more than 10 years’ experience with refugees (P = 0.02), and those with good self-perceived awareness of community services (P = 0.01), were more confident in their ability to manage social issues. Conclusions This study suggests that contextual factors influence the perceptions of healthcare workers who provide care to refugee patients; however, communication, health literacy and healthcare worker capacity were consistently raised as key issues when working with refugees. What is known about the topic? Refugee and asylum seeker patients may present with complex health needs to any part of the Australian health system. The majority of previous research has occurred in primary care settings. What does this paper add? This study adds an acute and subacute perspective to the evidence base, and also includes medical respondents for the first time. Compared to previous research, respondents of this study saw refugee patients more frequently in their practice, and also reported fewer negative effects from working with them. Most demographic characteristics had no significant effect on worker-reported confidence in this study; however, greater experience of working with refugees and good self-perceived awareness of community services were both identified as positive influences. What are the implications for practitioners? Practitioners should prioritise remedying barriers that are consistently identified as affecting the service provided to refugee patients (communication, health literacy and healthcare worker capacity) as part of their quality and service improvement efforts.

Force health protection (FHP) is defined as “the prevention of disease and injury in order to protect the strength and capabilities” of any service population. FHP was the foundational principal of the US Public Health Service (USPHS). President John Adams’ signing of An Act for Sick and Disabled Seamen on July 16, 1798, marked the first dedication of US federal resources to ensuring the well-being of US civilian sailors and Naval service members. On January 4, 1889, President Cleveland enacted the USPHS Commissioned Corps, creating the world’s first (and still only) uniformed service dedicated to promoting, protecting, and advancing the health and safety of the United States and the world. Building on the lessons of the 2014-2015 response to the Ebola virus pandemic, the Corps Care program was formalized in 2017 to establish and implement a uniform and comprehensive strategy to meet the behavioral health, medical, and spiritual needs of all Commissioned Corps officers. Its role was expanded in response to the coronavirus disease 2019 (COVID-19) pandemic, which has placed unprecedented demands on health care workers and spotlighted the need for FHP strategies. We describe the FHP roles of the Corps Care program for the resiliency of Commission Corps officers in general and the Corps’ impact during the response to the COVID-19 pandemic. Qualitative analysis of FHP discussions with deployed officers highlights the unique challenges to FHP presented by the pandemic response.

The Librarian Reserve Corps (LRC) is a volunteer network of medical, health sciences, and public health librarians who have responded to the urgent need for public health information during the early days of the COVID-19 crisis. The LRC was first formed to assist with the indexing of daily publication lists distributed within the World Health Organization's Global Outbreak Alert and Response Network (GOARN). With the explosion of information related to COVID-19 beginning in December 2019, librarians have brought critical skills and experience to the response, providing comprehensive literature searching and indexing to COVID-19 research publications. The evolution of this effort follows the trajectory of scientific publication trends and developments related to COVID-19.

Large urban health departments developed and implemented various approaches to prevent COVID-19 outbreaks and promote the health and well-being of individuals experiencing homelessness and housing insecurity throughout the pandemic. Reviewing the approaches of several large urban health departments, the most frequent practices included increasing housing options, on-the-ground outreach and resource allocation, and integrated communications. Key steps necessary to develop and implement these policies and procedures are discussed, and innovative approaches are highlighted.

Redoubling Efforts to Help Americans Quit Smoking Because the smoking rate among adults has fallen, and because smoking can be overshadowed by other public health issues, it’s possible to overlook ...

Using the infamous research studies in Tuskegee and Guatemala, the article examines the difference between victims and bystanders. The victims can include families, sexual partners, and children not just the participants. There are also the bystanders in the populations who are affected, even vaguely, decades after the initial studies took place. Differing reparations for victims and bystanders through lawsuits and historical acknowledgments has to be part of broader discussions of historical justice, and the weighing of the impact of racism and imperial research endeavors.

The objective of this study was to explore nonclinical predictors of cesarean sections (CS) and how they interact with each other, specifically in Turkey. Data was gathered from official statistical records for the year 2017 from the 81 different provinces throughout Turkey. A path analytic model was constructed to examine the interrelationships between socioeconomic factors, utilization of health services, patient satisfaction, and number of CS procedures. The overall performance of the final path model was quite good (GFI = 0.98, AGFI = 0.93, and CFI = 0.96). The study results emphasize the substantial impact of an increase in the number of hospital admissions on the increase in the rate of CS procedures (PC = 0.70). Additionally, the increase in the number of hospital admissions mediates the interrelationship between geographic region, high education, and CS. The findings demonstrate the significant interrelationships among the several major nonclinical predictors of CS in Turkey.Impact Statement

County health departments typically bear responsibility for implementing immunization programs. In 2011, the Florida state legislature made significant reductions in state health department funding, and responsibility for routine childhood immunizations in some counties was shifted to local federally qualified health centers. This study was conducted to assess the impact of these administrative changes on childhood immunization rates in one county. A secondary analysis of data in the state immunization registry was conducted to assess changes and patterns in childhood immunization rates within the local health department, federally qualified health centers, and private pediatric practices. These changes were compared in the 3-year period before, during, and after the change. Results revealed that there was no net negative change in the vaccination rates of 0- to 7-year-old children in the county. There was a shift in the proportion of vaccinations administered by each health care delivery setting. The majority of immunizations were administered in private pediatric practices. When state funding for the local public health department ceased, other delivery settings covered the immunizations previously provided in the public health sector.

Donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) transmissions in transplantation have led to policies mandating assessment of donor behavioral history, and disclosure of donor increased risk (IR) status to recipients. Organ Procurement Transplantation Network (OPTN) policy safeguards were promulgated in the context of deceased donation, with its narrow time window for organ utilization and uncertainty about donor history. These policies have been applied to living donation without substantive data on risk of disease transmission in living donor transplantation. Unlike for deceased donors, the OPTN does not collect data on living donor IR status. Given the feasibility of thorough living donor evaluation via already-mandated lab tests and clinical assessments, living donor IR assessment and associated disclosures may have limited benefit in improving recipient informed consent. Applying the current IR policy to living donors may also introduce unintended consequences to donors and recipients, causing donors psychological harm, delays in donation to avoid IR status disclosure, and potential withdrawal from donation. We suggest strategies that reduce risk of harm to donor candidates while maintaining policy compliance, and review additional approaches for evaluating risk of disease transmission in living donor candidates. Data on the risk of disease transmission by living donors are needed to inform policy modification.

Population-level prevention activities are often publicly invisible and excluded in planning and policymaking. This creates an incomplete picture of prevention service-related inputs, particularly at the local level. We describe the process and lessons learned by the Public Health Activities and Services Tracking team in promoting adoption of standardized service delivery measures developed to assess public health inputs and guide system transformations. The 3 factors depicted in our Public Health Activities and Services Tracking model—data need and use, data access, and standardized measures—must be realized to promote collection of standard public health system data. Bureaucratic, resource, system, and policy challenges hampered our efforts toward adoption of the standardized measures we promoted. Substantial investments of time, resources, and coordination appear necessary for systems to adopt changes needed for collecting comparable service delivery data. Lessons from our process of promoting adoption of standardized measures provide recommendations to support future efforts to measure public health system contributions to the public’s health.

Context Leaders of government agencies are responsible for stewardship over taxpayer investments. Stewardship strengthens agency performance that is critical to improving population health. Most industries, including health care, and public enterprises, such as education, have policies for uniform data reporting and financial systems for the application of theoretical analytical techniques to organizations and entire systems. However, this is not a mainstreamed practice in local and state government public health. Program The Public Health Uniform National Data System (PHUND$) is a financial information system for local health departments that advances the application of uniform practices to close financial analytical gaps. A 10-year retrospective overview on the development, implementation, and utility of PHUND$ is provided and supported by documented program and agency improvements to validate the analytical features and demonstrate a best practice. Results Benefits found from utilizing PHUND$ included reducing financial risks, supporting requests for increased revenues, providing comparative analysis, isolating drivers of costs and deficits, increasing workforce financial management skills, enhancing decision-making processes, and fostering agency sustainability to support continuous improvements in quality and population health. The PHUND$ financial data definitions in the data dictionary provided the structure needed for standardized data collection and confirmed the feasibility of a standardized public health chart of accounts. Conclusion PHUND$ analysis provided evidence on the relationship between financial and operational performance, as well as informing strategies for managing risks and improving quality. Such analysis is critical to identifying financial and operational problems and essential to mitigating financial crisis, avoiding disruption of services, and fostering agency sustainability. PHUND$ additionally serves as an instrument that can guide development of standards that measure for agency sound financial management systems.

Background Reducing maternal mortality remains a global priority. In 2000, the United Nations Member States pledged to work towards a series of Millennium Development Goals (MDGs), in which the fifth target was to reduce maternal mortality ratio by 75% from 1990 to 2015. The Chinese government introduced Basic Public Health Service project in 2009 to the further improvement of maternal health services and reduction in maternal mortality. China had achieved the goal of MDG5 1 year ahead of the schedule in 2014, but the effects of the project on reducing maternal mortality were rarely evaluated with robust methods. Methods We conducted a longitudinal study on maternal mortality ratio by extracting mortality data from the National Maternal Mortality Surveillance System (1991–2016) and maternal health services measures from the China health statistic yearbook (2001–2016). We utilized the segmented linear regression model to assess changes and trends of maternal mortality ratio and maternal health services before and after the introduction of Basic Public Health Service project. Pearson correlation analysis was conducted to measure the strength of association between the maternal mortality ratio and maternal health services. Results The yearly trend change of national maternal mortality ratio was − 1.76 (p

OBJECTIVE Evaluate an electronic health record (EHR) implementation across a large public health department to better understand and improve implementation effectiveness of EHRs in public health departments. DESIGN A survey based on Consolidated Framework for Implementation Research constructs was administered to staff before and after implementation of an EHR. SETTING Large suburban county department of health and human services that provides clinical, behavioral, social, and oral health services. PARTICIPANTS Staff across 4 program areas completed the survey prior to EHR implementation (n = 331, June 2014) and 3 months post-EHR final implementation (n = 229, December 2015). INTERVENTION Electronic health record MAIN OUTCOME MEASURES:: Constructs were validated using confirmatory factor analysis and included information strengths and information gaps in the current environment; EHR impacts; ease of use; future use intentions; usefulness; knowledge of system; and training. Paired t tests and Wilcoxon signed rank tests of a matched sample were performed to compare the pre-/postrespondent scores. RESULTS A majority of user perceptions and expectations showed a significant (P < .05) decline 3 months postimplementation as compared with the baseline with variation by service area and construct. Staff perceived the EHR to be less useful and more complex, provide fewer benefits, and reduce information access shortly after implementation. CONCLUSIONS Electronic health records can benefit public health practices in many ways; however, public health departments will face significant challenges incorporating EHRs, which are typically designed for non-public health settings, into the public health workflow. Electronic health record implementation recommendations for health departments are provided. When implementing an EHR in a public health setting, health departments should provide extensive preimplementation training opportunities, including EHR training tailored to job roles, competencies, and tasks; assess usability and specific capabilities at a more granular level as part of procurement processes and consider using contracting language to facilitate usability, patient safety, and related evaluations to enhance effectiveness and efficiencies and make results public; apply standard terminologies, processes, and data structures across different health department service areas using common public health terminologies; and craft workforce communication campaigns that balance potential expected benefits with realistic expectations.

More laboratories are screening for syphilis with automated treponemal immunoassays. We compared direct costs and downstream consequences when a local public health laboratory switches from a traditional algorithm (nontreponemal screening) to a reverse algorithm (treponemal screening).We created a decision analysis model based on laboratory and surveillance data to estimate the cost-effectiveness of a reverse syphilis-screening algorithm from the perspectives of the Los Angeles County Public Health Laboratory and the Los Angeles County Department of Public Health (laboratory + STD Program costs) in 2015 US dollars.The estimated total costs for the Department (Public Health Laboratories) were $2,153,225 ($367,119) for the traditional algorithm and $2,197,478 ($239,855) for the reverse algorithm. Reverse algorithm screening was estimated to detect an additional 626 cases of syphilis, 9.7% more than the traditional algorithm. The incremental cost-effectiveness ratio for the reverse algorithm from the Public Health Department's perspective was $39 per additional syphilis case detected. Cost of follow-up, screening test costs, positivity rates, and frequency of repeat infections most affected the cost-effectiveness of reverse algorithm. Costs were significantly higher for the reverse algorithm when the enzyme Immunoassay/chemiluminescence immunoassay screening test cost was the same as the published Centers for Medicaid Services treponemal test cost.Using the reverse algorithm would have been slightly more expensive for the Los Angeles County Department of Public Health, but would have identified more syphilis cases and would have resulted in lower laboratory costs.

On a global scale, bringing together schools and public child psychiatry services is favored to promote the development of early interventions that could improve health trajectories, from prevention to treatment, for children exposed to psychological and psychiatric difficulties. In a public health perspective, contextualizing these practices is essential in order to ensure their sustainability and efficiency. This article sheds light on the stakes of these partnerships and their advantages in responding to the health, social, and economic mark that has been left behind by the crisis accompanying the brutal onset of the Covid-19 epidemic.Improving the health care management for children with mental health problems or problems of a psychological nature implies taking into account their environment beyond the therapeutic framework. Interventional research, currently underway, is taking place in several sites in France: primary schools, Medical-psychological centers (CMP), and Local Committees on Mental Health (CLSM). The goal is to provide an inventory and an analysis of the partnership and interventional structures that are most efficient, based on the needs and available resources at each site. This research envisages a diversification and a contextualization of the offer of care, with great concern for equity and therapeutic efficacy, starting from school.More than simple results, our aim is to make suggestions as to how to better accompany the end of confinement and the months to come. The development of partnerships in regions that are strongly marked by social and economic inequalities is a priority in terms of public health and the direction of local policies. These partnerships would contribute to a global strategy of evaluating the needs and the personalized accompaniment of children. Formalizing the intervention with the interface being the school sector will support the school staff in overcoming the health crisis that is affecting their institution. The steady rise of CLSMs will enhance local coordination and collaboration to help the most psychologically vulnerable children and aid their parents, given their situation, to support the development of their children.Restoring human and material resources to existing structures, notably in the sector of child psychiatry so that it can accomplish its public service mission seems to be a priority today. Establishing school-CMP-CLSM partnerships can contribute to providing local policy direction in the interest of elaborating individual and collective strategies that can ensure needs-adapted care that is accessible to as many children as possible.

Public health laboratories (PHLs) provide specialized testing services for programs focused on the prevention and control of communicable diseases, early detection of congenital disorders, testing for antimicrobial resistance, and identification of environmental contaminants, among other responsibilities. Although national public health programs and partners provide some funding support, training, and technical resources to PHLs, no dedicated funding is provided from federal programs to fully support comprehensive PHL services across the United States or the underlying infrastructure needed for PHLs to provide and ensure their core functions and capabilities. Public health laboratories have begun to rely on a “community of practice” approach to addressing various service needs by creating and formalizing regional consortia, which are organized groups of geographically clustered PHLs that share expertise, capacities, and capabilities to enhance PHL services. The number of states participating in these networks increased from 13 to 48 from 2015 to 2020, including participation by multiple local PHLs and a territorial PHL. These consortia have enabled strengthening of partnerships and collaboration among PHLs to address regional priorities and challenges. We explore the background and evolution of regional consortia, outline some of their practices and activities, review lessons learned from these successful collaborations, and discuss the positive effect they have on the national public health system.

The unfolding events in Afghanistan have recently left us with scenes of chaos and desperation at Kabul airport where men, women and children risked their lives, and some tragically died in efforts to flee the country. However, it is important to note that even before these latest events, Afghanistan was the world's third largest humanitarian operation due to war, displacement, and, of course, the COVID-19 pandemic. Over 18 million people - more than half the population - already need humanitarian assistance to survive, and these needs are increasing daily.

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

People who use drugs (PWUD) face concurrent public health emergencies from overdoses, HIV, hepatitis C, and COVID-19, leading to an unprecedented syndemic. Responses to PWUD that go beyond treatment--such as decriminalization and providing a safe supply of pharmaceutical-grade drugs--could reduce impacts of this syndemic. Solutions already implemented for COVID-19, such as emergency safe-supply prescribing and providing housing to people experiencing homelessness, must be sustained once COVID-19 is contained. This pandemic is not only a public health crisis but also a chance to develop and maintain equitable and sustainable solutions to the harms associated with the criminalization of drug use.