OBJECTIVES: To evaluate knowledge and prescribing changes following a 2-month public health detailing campaign (one-to-one educational visits) about judicious opioid analgesic prescribing conducted among health care providers in Staten Island, New York City, in 2013. METHODS: Three detailing campaign recommendations were (1) a 3-day supply of opioids is usually sufficient for acute pain, (2) avoid prescribing opioids for chronic noncancer pain, and (3) avoid high-dose opioid prescriptions. Evaluation consisted of a knowledge survey, and assessing prescribing rates and median day supply per prescription. Prescribing data from the 3-month period before the campaign were compared with 2 sequential 3-month periods after the campaign. RESULTS: Among 866 health care providers visited, knowledge increased for all 3 recommendations (P < .01). After the campaign, the overall prescribing rate decreased similarly in Staten Island and other New York City counties (boroughs), but the high-dose prescribing rate decreased more in Staten Island than in other boroughs (P < .01). Median day supply remained stable in Staten Island and increased in other boroughs. CONCLUSIONS: The public health detailing campaign improved knowledge and likely prescribing practices and could be considered by other jurisdictions to promote judicious opioid prescribing.

CDC designed its Health Systems Integration Program to prepare leaders to function-at the interface of public health and health care. Specific Health Systems Integration Program competencies in the areas of communication, analysis and assessment, and health systems were developed to nurture evidence-based decision-making and leadership skills crucial for future public health leaders. The program therefore designed an innovative journal club as part of its competency-based curriculum not only to meet the standard goals for a journal club critical reading, interpretation, and acquiring content knowledge but also to foster leadership development. This report describes the Health Systems Integration Program journal club format, its implementation, challenges, and key elements of success. Other programs using a journal club model as a learning format might consider using the Health Systems Integration Program's innovative approach that focuses on leadership development.

OBJECTIVES:. We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan-funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months. METHODS: We examined predictors of underimmunization among the 2006 birth cohort (n = 34 568) in the state's Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses. RESULTS: Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization. CONCLUSIONS: SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities.

SETTING: Health Department Tuberculosis (TB) Control program, Connecticut, United States. OBJECTIVE: 1) To assess TB-relatedness of deaths and missed opportunities among Connecticut patients who died with TB, and 2) to identify factors associated with death. DESIGN: The study population consisted of all persons diagnosed with TB and reported to the Connecticut TB Control Program during 2007-2009. TB Control Program records, medical records, autopsy reports and death certificates of decedents were reviewed. A tool was used to categorize TB-relatedness of deaths and identify missed opportunities in diagnosis and medical treatment among TB-related deaths. Surveillance data regarding TB survivors were used for comparison to identify factors associated with death. RESULTS: During 2007-2009, 20/300 (7%) persons with TB died; 14 (70%) decedents had at least one medical comorbidity and 17 (85%) deaths were TB-related. Among patients who had a TB-related death, 16 (94%) had ≥1 missed opportunity identified. Excess alcohol use (risk ratio [RR] 4.4, 95% confidence interval [CI] 1.8-11.0) and age > 64 years (RR 5.7, 95%CI 2.5-13.1) were associated with death. CONCLUSIONS: The majority of deaths among Connecticut TB patients were TB-related. Missed opportunities were common. Excess alcohol use and older age might indicate a need for monitoring to prevent death.

We report a case of type F botulism in a patient with bilateral but asymmetric neurologic deficits. Cranial nerve demyelination was found during autopsy. Bilateral, asymmetric clinical signs, although rare, do not rule out botulism. Demyelination of cranial nerves might be underrecognized during autopsy of botulism patients.

In 2006, the Advisory Committee on Immunization Practices recommended that children routinely receive 2 varicella vaccine doses in place of the 1 dose previously recommended. This recommendation's initial impact on varicella epidemiology in Connecticut was assessed. Reported incidence and case-specific data were compared for 2005 and 2008. Varicella incidence decreased from 48.7 cases/100,000 persons in 2005 to 24.5 in 2008. Age-specific incidence decreased significantly (P < .05) among children aged 1-14 years. Reported varicella incidence has declined in Connecticut after implementation of routine 2-dose varicella vaccination for children. Continued surveillance is needed to determine the recommendation's full impact.