Browsing by Subject "Outbreaks"
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Item Evaluation and continuous improvement of foodborne disease surveillance.(2012-08) Henke, Evan ElliotThe purpose of this thesis is to contribute to the evidence base of public health performance evaluation by applying innovative measurement and improvement methods to a foodborne disease outbreak detection and investigation process. This thesis is the results of investigation into the three following research questions: 1) can foodborne disease outbreak responder training and work experience be measured in an electronic survey, 2) what is the performance of the Minnesota Department of Health in detecting and investigating foodborne disease outbreaks, and 3) can quality improvement and evaluation tools be used to evaluate MDH process stability and capability? Three research studies were developed to address these research questions. In Chapter 1, the development and analysis of an online survey to ascertain foodborne disease outbreak responder training and work experience is described. In Chapter 2, a bacterial foodborne disease surveillance program in a state health department is described and its performance is evaluated. In Chapter 3, four processes that are conducted by a bacterial foodborne disease surveillance program are evaluated for stability and capability over three years using statistical process control charts. I conclude that methods for evaluating predictive factors of public health performance need to be improved, and that quantitative performance evaluation, within context, has great potential for improving evidenced-based public health preparedness, demonstrating changes in departmental performance, and enabling internal public health practice quality improvement.Item Foodborne disease surveillance: evaluation of a consumer driven complaint system and development of methods for screening of pathogens and cluster detection.(2010-09) Li, John JiuhanIntroduction: Foodborne illnesses are common, with an estimated 76 million cases in the U.S. annually. They are also becoming harder to prevent with the increasing complexity of food distribution networks and product types. There has been an increased call to improve the food safety in the United States through improved foodborne disease surveillance. The aim of this dissertation was to improve foodborne illness surveillance, by examining a statewide complaint surveillance system and development of methods to more effectively use incoming data. Methods: In manuscript one, the complaint surveillance system in Minnesota from 2000-2006 was evaluated and characteristics of outbreak related complaints were analyzed. In manuscript two, predictors for Salmonella complaint calls were examined to develop a screening tool to be used on incoming complaint data. A predictive model for Salmonella-like calls was developed and validated using bootstrap methods. The third manuscript used cusum methods to detect temporal correlations in complaint calls and flag weeks of unusually high calls. The fourth manuscript, described the current use of complaint based surveillance systems by local health departments in the U.S. Results: Complaint based surveillance was responsible for detection of 72% of outbreaks in Minnesota. The predictive model for Salmonella was able to discriminate between Salmonella-like and non-Salmonella-like calls with an adjusted AUC of 0.88. An algorithm to flag suspected outbreak weeks had a sensitivity and specificity of 63% and 84% in detection of norovirus outbreaks. An estimated 81% of health departments in the U.S. use a complaint based surveillance system; however, ability of the system to detect outbreaks varies between jurisdictions.] Conclusions: This dissertation provides a framework to improve food safety in the U.S. through the development of complaint based surveillance systems and application of methods to better use incoming data. Complaint systems are a powerful tool to complement pathogen specific surveillance.Item Increasing Health System Resilience During Times of Crisis: Application of Systems Thinking & Creative Problem-Solving Methodologies(2020-12) Durski, KaraDisease outbreaks and health emergencies cause substantial human suffering, death and economic loss and often test the responsiveness and resilience of health systems. It is therefore necessary to shift the current paradigm of managing outbreaks to include health system strengthening as a critical component of the response. Yet, this is not systematically being done as there is limited evidence on how to do so effectively. Using methodologies that allow for the acute challenges in outbreak response to be addressed while identifying and supporting the strengthening of components of health systems and enabling optimization of resources (both human and financial) is critical. My research aims to lay the foundation for future work in this area through the piloting of systems thinking (process mapping) and creative problem-solving methodologies (design thinking). Process mapping and design thinking are particularly useful methodologies as they can be applied to any country that has an outbreak during any timepoint. These approaches were chosen as they have proven success in other industries, have documented use-cases in healthcare and public health, have a low-cost of implementation, have a low barrier to entry requiring minimal training, and are collaborative methodologies. By using these methods in three settings with three different emerging pathogen outbreaks I was able to show that despite the chaos and complexities associated with them, process mapping can address immediate response priorities while simultaneously strengthening components of a health system. Further, the design thinking principles were used to develop a data collection and reporting system which contains all laboratory data from one of the most complicated multi-country outbreaks to date demonstrating both short and long-term benefits to the response and information management systems Process mapping and design thinking are effective methods to strengthen components of a health system while responding to disease outbreaks. Testing and piloting additional systems thinking and critical problem-solving methodologies is recommended. It is through trying novel approaches, working together and remaining in a growth mind-set that we will be able to address acute and long-term challenges that impact the health of our populations.Item Restaurants And Salmonella: Using Surveillance Data To Improve Policy Development For The Enhancement Of Food Safety(2020-03) Firestone, MelanieAs the landscape of the diet in the United States changes in response to shifts in consumer preferences and migrating populations, foodborne illnesses remain an important public health challenge. Public health surveillance – the ongoing, systematic collection and analysis of data to prevent and control disease and injury – is the foundation of a prevention-focused food system. As technological advancements simultaneously enhance and disrupt our current surveillance efforts, there is an increasing need to adapt investigation and prevention activities. There is an opportunity to identify novel methods that use existing data to improve surveillance activities. Salmonella – a bacterial foodborne pathogen – is estimated to cause more than one million illnesses per year and is the leading cause of foodborne illness hospitalization. Restaurants are a frequent setting for outbreak and sporadic (non-outbreak) cases of Salmonella infection. Since Salmonella can take advantage of the major pathways for foodborne illness transmission in a restaurant, understanding and controlling its transmission in restaurants is a useful prevention strategy. This dissertation aims to identify opportunities to improve surveillance activities to drive declines in the incidence of foodborne illness using restaurants and Salmonella as a model. The application of novel methods to outbreak investigations and special studies are used to demonstrate an expanded role for surveillance in enhancing food safety. An outbreak of Salmonella infections associated with a chain of quick-service restaurants (Chapter 2) highlights the importance of using all available information in a restaurant-associated outbreak investigation in order to make informed conclusions. An evaluation of restaurant inspection disclosure methods in New York City (Chapter 3) demonstrates the use of surveillance data to evaluate the public health impact of a public disclosure program for restaurant inspections and creates a framework for evaluating future programs. A survey of Minnesota State Fairgoers (Chapter 4) assesses the consumer interest and preferred formats for public disclosure of restaurant inspection results. A second Salmonella outbreak (Chapter 5) explores routine restaurant inspection data to better understand transmission dynamics in a restaurant-associated outbreak, highlighting the value of these data as hazard surveillance. Collectively, the findings from this dissertation demonstrate an important role for linking routine food establishment inspection data with conventional illness surveillance data to improve our food safety systems. These findings will be useful for policymakers, public health officials, and restaurant operators for surveillance-driven prevention of foodborne illness and create a framework for future work in this area.