Cuyahoga County Board of Health

We discovered 2 or 3 metapopulations of the imperiled Notophthalmus perstriatus (Striped Newt) using 15 wetlands on Princess Place Preserve and the adjacent Pellicer Creek Conservation Area in Flagler County, FL. Some of these wetlands are too ephemeral for successful reproduction most years, but a 5.1-ha dome swamp, 2.9-ha basin marsh, and 4 smaller wetlands contain paedomorphic populations that probably have annual recruitment. Most wetlands are in or near open-canopied or recently restored sandhill habitat with suitable conditions for terrestrial life stages. Since the state and county purchased these properties circa 1995, clear-cutting of Pinus clausa (Sand Pine), prescribed burning, and thinning of P. elliottii (Slash Pine) and Quercus spp. (oaks) have improved upland habitat for the Striped Newt.

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.

IntroductionLittle is known regarding the impact of produce prescriptions within the context of hypertension visits at safety net clinics. We evaluated intervention effectiveness on patient usage of farmers markets and dietary change related to fruit and vegetable consumption.MethodsHealth Improvement Partnership — Cuyahoga worked with 3 clinics to integrate, implement, and evaluated a produce prescription for hypertension (PRxHTN) program. PRxHTN involves 3 monthly, nonphysician provider visits, comprising blood pressure measurement, nutrition counseling, and four $10 farmers market produce vouchers, for hypertensive adult patients screening positive for food insecurity. Dietary measures were collected at visits 1 and 3. Voucher use was tracked via farmers market redemption logs.ResultsOf the 224 participants from 3 clinics, most were middle-aged (mean age, 62 y), female (72%), and African American (97%) and had a high school education or less (62%). Eighty-six percent visited a farmers market to use their produce vouchers, with one-third reporting it was their first farmers market visit ever. Median number of farmers market visits was 2 (range: 0–6), and median number of vouchers redeemed was 8 (range: 0–12). Among the subsample with follow-up survey data (n = 137), significant improvement in fruit and vegetable consumption was observed as well as a decline in fast food consumption.ConclusionPRxHTN participants visited at least 1 farmers market, reported increases in provider communication related to diet, and exhibited significant changes in dietary behavior. PRxHTN can serve as a strong model for linking safety net clinics with farmers markets to promote community resource use and improve fruit and vegetable consumption among food-insecure patients with hypertension.

ABSTRACTFruit and vegetable consumption has been shown to be associated with positive birth outcomes. Farmers’ markets (FMs) are a growing opportunity to increase access in neighborhoods with limited access to fruits and vegetables. The objective of this mixed methods study was to determine the applicability of integrating a produce prescription intervention (PRx) with the existing health care and farmers’ market systems in Cuyahoga County, Ohio. The program served pregnant women within underserved areas with limited access to fruits and vegetables. The intervention included nutritional counseling and $40 FM vouchers at monthly prenatal visits. Monthly surveys with participants and voucher redemption logs from FM tracked participant use of PRx vouchers. Interviews with providers at 4 program sites assessed perceived impact of PRx on participants and patient–provider relationship. Of the 75 PRx participants, 56% redeemed at least one voucher, and 95% reported that program materials were relevant and useful. Providers (n = 10) indicated that PRx created opportunities to talk about diet with participants, greater awareness about FMs, and new shopping habits. The PRx model is an innovative approach to increase access to produce among low-income pregnant women. Future work should aim to increase voucher redemption and examine ways to implement PRx in more prenatal settings.

A reliable measure capable of detecting progression towards smoking cessation would be valuable for evaluating and optimizing the effectiveness of low- to moderate-intensity cessation interventions, such as brief advice in the primary care setting. This article presents the development and evaluation of a brief self-report measure of Incremental Behavior Change toward Smoking cessation (IBC-S). Sequential samples of 411 and 399 adult smokers completed items representing a spectrum of behavioral and cognitive changes antecedent to smoking cessation. The dimensionality, fit, range of difficulty, and reliability of items were evaluated using factor analysis and Rasch modeling. The final 15-item IBC-S measure met fit criteria and demonstrated acceptable reliability. Participants with a significant change in IBC-S score were over four times more likely to report cessation at 6-week follow-up (OR 4.37, 95% CI 1.83-10.42). The IBC-S is brief, reliable and associated with self-report of smoking reduction and cessation. This article presents the psychometric evaluation of a measure to assess a spectrum of behaviors and cognitions antecedent to smoking cessation. The findings indicate that the items show good measurement properties and good potential as a sensitive measure to evaluate interventions. This measure provides an alternative outcome for interventions that are designed to move individuals towards cessation attempts.

Health care disparities have been documented in cancer screenings of adults with intellectual and other developmental disabilities. Developmental disabilities nurses were surveyed to better understand and improve this deficiency. Two thirds of respondents believed that adults with intellectual and developmental disabilities received fewer cancer screenings compared with the general population. The most frequently cited barriers to cancer screenings were as follows: patient need for sedation, unsuccessful attempts at screening, and failure of the primary care clinician to order cancer screening tests. Nurses observed that health care providers frequently did not tailor cancer screening recommendations to individuals' family histories, life expectancies, or their disability-specific cancer risks. The authors suggest interventions to improve cancer screening centered around education and training, accessibility, financing-insurance, modification of procedures, and patient tracking.

Serum samples and sociodemographic data were obtained from 1,209 Ohio residents. West Nile virus immunoglobulin M (IgM) and IgG antibodies were detected by enzyme-linked immunosorbent assay and confirmed. Children were 4.5 times more likely to become infected yet 110× less likely to have neuroinvasive disease develop.

Fungal concentrations were measured in the dust of 6 homes in Cleveland, Ohio, where an infant developed pulmonary hemorrhage (pulmonary hemorrhage homes [PHH]) and 26 reference homes (RH) with no known fungal contamination. Quantitative polymerase chain reaction assays for 82 species (or assay groups) were used to identify and quantify fungal concentrations. The ratios of the geometric means of PHH to RH were >1 for 26 species (group I). However, the same ratios were <1 for 10 species (group II). Probit analysis of the sum of the logs of the concentrations of these 2 groups resulted in a 95% probability range for separating PHH from RH homes. The same 82 fungal species were also tested for hemolysin production on sheep's blood agar (incubated at 37 degree C). Hemolysins were more commonly produced by group I species (42%) compared with group II species (10%).

The study described in this paper utilized a qualitative case study method to assess the processes involved in inter-system collaboration in the context of one state's system change initiative. The collaborative experience is described from the perspective of participating service system professionals and family members. The major themes of collaboration that emerged from the study included changes in communication across systems, changes in inter-system relationships, changes in attitudes, changes in interactions with families, and changes in the ways services are delivered. Lessons learned and practice implications of each theme are discussed.