Journal Club Slides

Objectives Describe the core public health functions and essential services. Explain what is meant by active surveillance. Describe the role of the physician in the public health system. Explain what is meant by a case series.

What is Public Health? Organized effort to promote and protect the health and well-being of patients and communities. Public health system consists of all private, public and voluntary individuals or groups that contribute to the health of a community. Medical providers are a very important part of the public health system.

Core Public Health Functions Three Core Functions: Assessment Policy Development Assurance Ten Essential Services Activities that communities should undertake to improve the well-being of their constituents

Importance for Patient Management Public health core functions and essential services help you manage your patients Zika example https://www.cdc.gov/zika/

MONITOR HEALTH Surveillance: Systematic, continuous, organized way to collect and analyze data Need information on Zika, number of cases, risk factors, outcomes, etc. IRB NOT REQUIRED – NOT RESEARCH! Active surveillance: Providers and labs are required to report cases and public health agencies are proactive and contact providers and labs to get more complete information about cases

MONITOR HEALTH Zika is on the list of 2016 Nationally Notifiable Conditions https://wwwn.cdc.gov/nndss/conditions/notifiable/2016/ Zika virus disease, congenital Zika virus disease, no-congenital Zika virus infection, congenital Zika virus infection, non-congenital Providers, labs required to report Case definition identifies clinical criteria

Zika Pregnancy Registry Need an information system for surveillance US Zika Pregnancy Registry http://www.cdc.gov/zika/hc-providers/registry.html

What can Ob/Gyns Do?

US Data on Zika - 2016 As of October 20, 2016 953 pregnant women with lab evidence of possible Zika infection 23 live births with birth defects 5 pregnancy losses (miscarriages, stillbirths, terminations with evidence of birth defects) Source: https://www.cdc.gov/zika/

NYSDOH Zika Report – YTD* Source: * As of October 26, 2016.https://www.health.ny.gov/diseases/west_nile_virus/docs/weekly_arboviral_surveillance_report.pdf

What if patient wants to be tested? Criteria for testing Pregnant and travelled to place where Zika is being transmitted Ill with Zika symptoms within 4 weeks of travel Need approval from local health department Physician can write a script for testing NYSDOH fact sheet https://www.health.ny.gov/diseases/zika_virus/docs/testing_fact_sheet.pdf

Case Series Several clinical cases with something in common (often the exposure) Recommend at least five cases to be called a series, but studies with fewer cases have been called case series Descriptive study Describe the exposure (Zika virus) and outcomes (birth defects, pregnancy losses, normal births) Step beyond a case report