Local cross-border disease surveillance and control: experiences from the Mekong Basin.

Background: The Mekong Basin Disease Surveillance cooperation (MBDS) is one of several sub-regional disease surveillance networks that have emerged in recent years as an approach to transnational cooperation for infectious disease prevention and control. Since 2003 MBDS has pioneered a unique model for local cross-border cooperation. This study examines stakeholders' perspectives of these MBDS experiences, based on a survey of local managers and semi-structured interviews with MBDS leaders and the central coordinator.

Using exercises to improve public health preparedness in Asia, the Middle East and Africa.

Background: Exercises are increasingly common tools used by the health sector and other sectors to evaluate their preparedness to respond to public health threats. Exercises provide an opportunity for multiple sectors to practice, test and evaluate their response to all types of public health emergencies. The information from these exercises can be used to refine and improve preparedness plans.

Response to the 2009-H1N1 influenza pandemic in the Mekong Basin: surveys of country health leaders.

Background: Soon after the 2009-H1N1 virus emerged as the first influenza pandemic in 41 years, countries had an early opportunity to test their preparedness plans, protocols and procedures, including their cooperation with other countries in responding to the global pandemic threat. The Mekong Basin Disease Surveillance cooperation (MBDS) comprises six countries - Cambodia, China (Yunnan and Guangxi Provinces), Lao People's Democratic Republic, Myanmar, Thailand and Vietnam - that formally organized themselves in 2001 to cooperate in disease surveillance and control. The pandemic presented an opportunity to assess their responses in light of their individual and joint planning.

Performance measurement for co-occurring mental health and substance use disorders.

Background: Co-occurring mental health and substance use disorders (COD) are the norm rather than the exception. It is therefore critical that performance measures are developed to assess the quality of care for individuals with COD irrespective of whether they seek care in mental health systems or substance abuse systems or both.

Methods: We convened an expert panel and asked them to rate a series of structure, process, and outcomes measures for COD using a structured evaluation tool with domains for importance, usefulness, validity, and practicality.

How can we strengthen the evidence base in public health preparedness?

The lack of frequent real-world opportunities to study preparedness for large-scale public health emergencies has hindered the development of an evidence base to support best practices, performance measures, standards, and other tools needed to assess and improve the nation's multibillion dollar investment in public health preparedness. In this article, we argue that initial funding priorities for public health systems research on preparedness should focus on using engineering-style methods to identify core preparedness processes, developing novel data sources and measures based on smaller-scale proxy events, and developing performance improvement approaches to support the translation of research into practice within the wide variety of public health systems found in the nation.

Community planning for pandemic influenza: lessons from the VA health care system.

Background: Coordination and communication among community partners-including health departments, emergency management agencies, and hospitals-are essential for effective pandemic influenza planning and response. As the nation's largest integrated health care system, the US Department of Veterans Affairs (VA) could be a key component of community planning.

Purpose: To identify issues relevant to VA-community pandemic influenza preparedness.

Measuring the performance of telephone-based disease surveillance systems in local health departments.

Objectives: We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports.

Methods: We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional).

State mental health policy: states' early experience in improving systems-level care for persons with co-occurring disorders.

This column discusses the experiences of the original cohort of seven states participating in the first two years of a national demonstration project known as the Co-occurring State Incentive Grant (COSIG) initiative. COSIG was designed to help state mental health and substance abuse authorities develop innovative strategies to better integrate or coordinate services for persons with co-occurring mental and substance use disorders. Powerful factors of early project success included careful planning, which was based on experience with anticipating and planning around bureaucratic barriers, and gaining early consensus from a few key stakeholders.

Designing and conducting tabletop exercises to assess public health preparedness for manmade and naturally occurring biological threats.

Background: Since 2001, state and local health departments in the United States (US) have accelerated efforts to prepare for high-impact public health emergencies. One component of these activities has been the development and conduct of exercise programs to assess capabilities, train staff and build relationships. This paper summarizes lessons learned from tabletop exercises about public health emergency preparedness and about the process of developing, conducting, and evaluating them.

Bioterrorism with zoonotic disease: public health preparedness lessons from a multiagency exercise.

Responding to agricultural bioterrorism with pathogenic agents that are communicable from animals to humans (zoonotic diseases) requires effective coordination of many organizations, both inside and outside of government. Action must be simultaneously taken to address public health concerns, respond to the agricultural dimensions of the event, and carry out the necessary law enforcement investigation. As part of a project focused on examining public health preparedness in Georgia, an exercise was carried out in July 2005 examining the intentional introduction of avian influenza (H5N1) in commercial poultry operations.

Public health response to urgent case reports.

We evaluated the ability of local public health agencies (LPHAs) to meet a preparedness standard set by the U.S. Centers for Disease Control and Prevention (CDC): to receive and respond to urgent case reports of communicable diseases twenty-four hours a day, seven days a week.

The effects of federal versus state funding and academic affiliation on mental health services.

This study compares mental health services in three facilities on two domains: federal versus state funding and academic affiliation. Data from a cross-sectional study of psychiatric outpatients is utilized to compare 196 VA patients to 337 non-VA patients treated in two state mental health agencies. The strength of academic affiliation of the facilities and the degree of participation in research and training activities differs significantly across facilities but is not associated with quality of care, clinical outcomes, or satisfaction with care.

Health correlates of recreational gambling in older adults.

Objective: Prior studies have found high rates of alcohol use and abuse/dependence, depression, bankruptcy, and incarceration associated with recreational gambling. Despite growing rates of recreational gambling in older adults, little is known regarding its health correlates in this age group. The objective of this study was to identify health and well-being correlates of past-year recreational gambling in adults age 65 years and older, compared to adults age 18-64 years.

Psychiatric comorbidity and the prevalence of HIV infection in a sample of patients in treatment for substance abuse.

This article compares the differences in HIV prevalence and risk behaviors in singly diagnosed patients with substance abuse problems and dually diagnosed patients with comorbid psychiatric and substance abuse problems. The National Treatment Improvement Evaluation Study (NTIES) was used to conduct a cross-sectional study on 6593 persons treated for substance abuse disorders. Logistic regression using hierarchal linear modeling (HLM) was utilized to compare risk behaviors of singly and dually diagnosed persons.

Preadmission care as a new mental health performance indicator.

Objective: This study examined the relationship between receipt of preadmission outpatient care during the month before an episode of hospitalization and the patients' subsequent treatment.

Methods: A total of 37,852 psychiatric inpatients who were discharged from 122 Veterans Affairs medical centers between October 1, 1997, and March 31, 1998, were studied. Linear and logistic regression were used to examine the relationship between receipt of preadmission outpatient care and length of hospital stay, use of postdischarge aftercare, and readmission.