We've all read the peer-reviewed evidence and heard countless compelling success stories from healthy homes demonstration projects across the country. So why aren't these services available in more communities? Why can't doctors write prescriptions for healthy housing for patients with housing-related illnesses? Many states are exploring Medicaid reimbursement as a strategy for bringing healthy homes interventions to scale and integrating home-based interventions into a patient's usual care. Using asthma as a case study, this session will explore the opportunities and challenges associated with seeking Medicaid reimbursement for home-based interventions.
As part of NEHA's continuos effort to provide convenient access to information and resources, we have gathered together for you the links in this section. Our mission is "to advance the environmental health and protection professional for the purpose of providing a healthful environment for all,” as well as to educate and inform those outside the profession.
Transcending the Demonstration Project: Emerging Trends in Medicaid Reimb for Healthy Homes Services
Septic systems are considered a source of groundwater contamination. In the study described in this article, the fate of microbes applied to a sandy loam soil from North Carolina coastal plain as impacted by water table depth was studied. Soil materials were packed to a depth of 65 cm in 17 columns (15-cm diameter), and a water table was established at 30, 45, and 60 cm depths using five replications. Each day, 200 mL of an artificial septic tank effluent inoculated with E. coli were applied to the top of each column, a 100-mL sample was collected at the water table level and analyzed for E. coli, and 100 mL was drained from the bottom to maintain the water table. Two columns were used as control and received 200 mL/day of sterilized effluent. Neither 30 nor 45 cm of unsaturated soil was adequate to attenuate bacterial contamination, while 60 cm of separation appeared to be sufficient. Little bacterial contamination moved with the water table when it was lowered from 30 to 60 cm.
Type II Diabetes Emergency Room Visits Associated With Hurricane Sandy in New Jersey: Implications for Preparedness
On October 29, 2012, Hurricane Sandy made landfall in New Jersey, causing major power outages, flooded roads, and disruption of public transportation. Individuals diagnosed with diabetes may be especially vulnerable to natural disasters because of limited access to medications or use of glucose monitoring devices. We examined changes in emergency room visits (ERVs) for type II diabetes mellitus potentially associated with Hurricane Sandy in New Jersey. Data analyzed in 2014 included ERVs to general acute care hospitals in New Jersey among residents of three counties with a primary or secondary type II diabetes diagnosis (PDD or SDD) in 2011–2012. Compared to the previous year, results showed an 84% increased rate of PDD ERVs during the week of Hurricane Sandy, after adjusting for age and sex (rate ratio (RR) = 1.84, 95% confidence interval (CI) 1.12, 3.04). Results were nonsignificant for SDD (RR = 0.94, 95% CI 0.83, 1.08). Spatial analysis showed the increase in visits was not consistently associated with flood zone areas. We observed substantial increases in ERVs for primary type II diabetes diagnoses associated with Hurricane Sandy in New Jersey. Future public health preparedness efforts during storms should include planning for the healthcare needs of populations living with diabetes.
79.2 | 30-37
Household bleach is typically used as a disinfectant for water in times of emergencies and by those engaging in recreational activities such as camping or rafting. The Centers for Disease Control and Prevention recommend a concentration of free chlorine of 1 mg/L for 30 minutes, or about 0.75 mL (1/8 teaspoon) of household bleach per gallon of water. The goal of the study described in this article was to assess two household bleach products to kill waterborne bacteria and viruses using the test procedures in the U.S. Environmental Protection Agency’s Guide Standard and Protocol for Testing Microbiological Purifiers. Bleach was found to meet these requirements in waters of low turbidity and organic matter. While the test bacterium was reduced by six logs in high turbid and organic-laden waters, the test viruses were reduced only by one-half to one log. In such waters greater chlorine doses or contact times are needed to achieve greater reduction of viruses.
76.9 | 22-25
West Nile virus (WNV) continues to persist in Mississippi; 2012 was the worse year for human infections, with a total of 247 reported human cases and five deaths. Public health officials are keenly interested in ways to detect WNV in advance in their jurisdictions, so they can implement appropriate and timely mosquito control in affected areas. A total of 40,312 female Culex quinquefasciatus mosquitoes were collected by gravid traps in Mississippi in 2013 and 2014 and tested by VectorTest, a rapid immunochromatographic assay (“dip-stick” test) that is a highly specific and effective rapid threat assessment tool. This study evaluated if and to what extent VectorTest could provide advanced warning of impending human WNV cases in a specific area. These data were examined with regard to date of onset of human WNV cases to determine the predictive value of VectorTest for WNV activity. Both years, positive mosquito pools appeared before the vast majority (87.2%) of reported human cases. Overall, in 27 out of 37 human WNV cases (73.0 %) occurring in our study sites, there was an average advanced warning of 26 days (range 11–53 days) as indicated by positive mosquito collections near the patient’s home. This operational health department study, although somewhat limited, reveals that mosquito sampling and testing can inform public health and mosquito control personnel of WNV activity in an area and of impending human cases.
79.5 | 20-24
Using Multiple Antibiotic Resistance Profiles of Coliforms as a Tool to Investigate Combined Sewer Overflow Contamination
Studies have shown that fecal contamination can be determined by conducting multiple antibiotic resistance (MAR) analyses. The hypothesis is if bacteria exhibit resistance, they are likely to be derived from organisms exposed to antimicrobial agents. Therefore, this project seeks to apply MAR analysis to nonpoint source (NPS) and combined sewer overflow (CSO) areas along the Anacostia River in Washington, DC. Presumptive E. coli was isolated from NPS and CSO samples and tested with eight different antimicrobial agents to assess MAR indices. Isolates from CSO sources showed significantly greater resistance (p < .05) and higher MAR indices, with an average MAR index of 0.36 for CSO samples and 0.07 for NPS samples. It was also revealed that 96.9% of CSO isolates exhibited resistance, versus only 43.8% of NPS isolates. Our study on the Anacostia River using this approach clearly shows fecal coliforms are associated with CSO overflows, indicating that pollution-derived coliform levels are strongly linked to antimicrobial resistance. The implementation of this method as an index for water quality in the remediation of the Anacostia River has the ability to serve as a model and monitoring tool for the rehabilitation of urban watersheds.
79.3 | 36-39
Using Underreporting Estimates to Mobilize the Development of Targeted, Proactive Food Safety Policy
Public health policy targeting populations at greatest risk can be used to significantly reduce the burden of foodborne disease. This study calculated incidence rates, disability adjusted life years, and quality adjusted life years estimates for salmonellosis and campylobacteriosis, adjusted for underreporting. Investigators then looked at how these measures of disease burden can contribute to the policy debate on the public health significance of foodborne disease. Targeting food safety activities through proactive public health policy and by using underreporting estimates of reported cases of foodborne illness may raise the issue of foodborne disease in the policy agenda.
This presentation shares the Lakota Sioux experience through the view of a USPHS Team Commander who participated in a Community Health and Service Mission, designed to meet the field-based training needs of emergency response teams. During the session, there will also be a discussion of the partnership between the U.S. Public Health Service (USPHS), the Lakota Sioux Tribe, and a non-government organization (Remote Area Medical). Many photos and cultural experiences will be shared to illustrate the mission.