Ethical Concepts of the New Public Health

I am currently working on two essays that I needed to submit with my fellowship application, but the event in Paris made me stop for a few minutes and reflect on the scorching reminder that terrorism has no religion, a brand of madness, not faith. Such event amplified the urgency to stress the significance of New Public Health that carries a high potential for healthy less aggressive societies.  The main principles of living together in healthy communities were summarized by Laaser et al. (2002) as four ethical concepts of the New Public Health essential to violence reduction – equity, participation, subsidiarity, and sustainability. The coupling of current economic, demographic, and social issues will play a role in guiding future policy revisions. While my fellowship of interest is in epidemiology and infectious diseases, increased understanding of the interrelated dimensions of deracination or forced migration using the modern concept of public health is warranted. It is critical to understand the determinants of violence: the type of stigmatization; the process of urbanization; religious, ethnic, and racial prejudices; women’s status; the level of education; employment status; socialization of the family; availability of firearms;  alcohol and drug consumption;  and poverty.


Laaser, U., Donev, D., Bjegovic, V., & Sarolli, Y. (2002). Public health and peace. Croatian medical journal, 43(2), 107-113.

The Silent Killer: Improving the Understanding of Chagas Disease

The protozoan parasite Trypanosoma cruzi was first described by Carlos Chagas after isolation of the organism from the blood of a Brazilian patient in 1909 (Garcia et al., 2015). An estimated 7.5 to 10 million persons are infected with Chagas disease worldwide (Hotez et al., 2008; Hotez et al., 2014). In the United States, the disease is anecdotally referred to as a “silent killer” with a 30% chance of those infected to develop a potentially fatal cardiac disease. According to Cantey et al. (2012), Chagas disease is emerging as a significant public health concern in the United States. Given the proximity of Texas to Latin America, cases imported from highly endemic areas in Latin America would likely occur in Texas. Recent communication from the Centers for Disease Control and Prevention that the bite of blood-sucking triatomine bugs in the subfamily Triatominae also termed “kissing bugs” that transfers the parasites to humans have now been found in 28 states, including California and Pennsylvania. Garcia et al. (2015) argued that despite the numerous publications related to Chagas disease in the southern US and northern regions of Mexico, very little is known about the disease burden from imported and locally acquired T. cruzi infection.There is concern that Chagas disease might be undiagnosed in the US as a result of documented low physician awareness (Stimpert & Montgomery, 2010). While the zoonotic nature of Chagas’ life cycle implies unfeasible eradication; entomological surveillance is and will remain crucial to containing Chagas disease transmission (Tarleton et al., 2007).

While it is considered safe to breastfeed even if the mother has Chagas disease (Centers for disease control and prevention, 2013); people can also become infected through blood transfusion, congenital transmission (from a pregnant woman to her baby), organ transplantation, accidental laboratory exposure and consumption of uncooked food contaminated with feces from infected bugs. If the mother has cracked nipples or blood in the breast milk, it is warranted to pump and discard the milk until the bleeding resolves and the nipples heal  (Centers for disease control and prevention, 2013). The enduring challenge of household reinfestation by locally native vectors as stated by Abad-Franch et al. (2011), horizontal strategies works better when the community takes on a protagonist role. Encouraging vector notification by residents and other simple forms of participation can substantially enhance the effectiveness of surveillance (Abad-Franch et al., 2011). Therefore, control programs in concert with community-based approaches as a strategic asset from inception that requires a timely, professional response to every notification, benefiting from a strengthened focus on community empowerment. According to Schofield (1978), when bug population density is low, vector detection failures are unavoidable. Decision-making will be dependent upon the accurate estimation of infestation rates (World Health Organization, 2002), and imperfect detection can seriously misguide Chagas disease control management program. Continued attentiveness from governmental and health organizations are warranted, as this disease continue to be a globalized public health issue. Improved diagnostic tools, expanded surveillance and increased research funding will be required in maintaining existing effective public health strategies and in preventing the spread of the disease to new areas and populations (Bonney, 2014). To improve outbreak control, and improve Chagas disease response, it is essential to discuss the gaps in the scientific knowledge of the disease. Moreover,  crucial in improving the morbidity in the state of Texas and neighboring states is the recommendation of the needed steps to enhance the understanding of T. cruzi.


Abad-Franch, F., Vega, M. C., Rolón, M. S., Santos, W. S., & de Arias, A. R. (2011). Community participation in Chagas disease vector surveillance: systematic review. PLoS Negl Trop Dis, 5(6), e1207.

Bonney, K. M. (2014). Chagas disease in the 21st century: a public health success or an emerging threat?. Parasite, 21, 11.

Cantey, P. T., Stramer, S. L., Townsend, R. L., Kamel, H., Ofafa, K., Todd, C. W., … & Hall, C. (2012). The United States Trypanosoma cruzi Infection Study: evidence for vector‐borne transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion, 52(9), 1922-1930.

Centers for disease control and prevention. (2013). Parasites-American Trypanosomiasis (also known as Chagas Disease). Retrieved 21 July, 2016, from

Garcia, M. N., Woc-Colburn, L., Aguilar, D., Hotez, P. J., & Murray, K. O. (2015). Historical perspectives on the epidemiology of human chagas disease in Texas and recommendations for enhanced understanding of clinical chagas disease in the Southern United States. PLOS Negl Trop Dis, 9(11), e0003981.

Hotez, P. J., Bottazzi, M. E., Franco-Paredes, C., Ault, S. K., & Periago, M. R. (2008). The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis, 2(9), e300.

Hotez, P. J., Alvarado, M., Basáñez, M. G., Bolliger, I., Bourne, R., Boussinesq, M., … & Carabin, H. (2014). The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis, 8(7), e2865.

Schofield, C. J. (1978). A comparison of sampling techniques for domestic populations of Triatominae. Transactions of the Royal Society of Tropical Medicine and Hygiene, 72(5), 449-455.

Stimpert, K. K., & Montgomery, S. P. (2010). Physician awareness of Chagas disease, USA. Emerging infectious diseases, 16(5), 871.

Tarleton, R. L., Reithinger, R., Urbina, J. A., Kitron, U., & Gürtler, R. E. (2007). The challenges of Chagas disease—Grim outlook or glimmer of hope?. PLoS Med, 4(12), e332.

World Health Organization. (2002). Control of Chagas disease: second report of the WHO expert committee.

Significance of Public Health Approach on Violent Radicalization

In most countries, public health approaches to address violent radicalization are already applied in street violence and bioterrorism; but leaders and stakeholders need to embrace the significance of public health interventions and research on violent radicalization (Bhui et al., 2012). While past studies (Bakker, 2006; Loza, 2007) found that overwhelming majority of people who become radicalized to violence in the West are young and male, generally aged between mid-teens and mid-20s; scarcity of research findings on the extent and nature of women’s roles in group and community radicalization (Carter, 2013). The recent acts of terrorism around the world, especially the event in San Bernardino California, it is important to note the urgent need to look at the significance of a public health approach to understanding violent radicalization. Recognizing this sense of urgency introduce the possible role of collective responsibility of leaders in epidemiology, sociology, psychology and other behavioral sciences in developing novel epidemiologic measures towards prevention strategies (Bhui, Hicks, Lashley, & Jones, 2012). While most nation’s counterterrorism approaches are grounded in inter-governmental intelligence data exchange and criminal justice systems, embracing the perceived belief that existing legal system can deal with violent radicalization effectively; it is paramount to argue that new players be included in the collection of relevant data needed in the development of public health approach to address violence such as the World Health Organization’s Violence Prevention Alliance, and the Centers for Disease Control and Prevention (CDC). The goal of CDC’s “Public Health Approach to Violence Prevention” is to decrease risk factors and increase protective factors. The logical argument for this proposed study is the need for public health research, and establish a new approach to guard against violent radicalization.

Given the current integrated surveillance system that monitors death and injuries as a direct effect of terrorism events, it is critical to recognize the risk and protective factors for violent radicalization. Bhui et al. (2102) noted “the perceived discrimination in the population as a whole or amongst distinct segments of the population; trust in authorities and their counterterrorism approaches; perceived or real economic inequalities patterned by ethnicity or religious groups; and international conflict in which the authorities appear to be biased or unfair towards a specific migrant, religious or ethnic group.”  For future research, it is paramount to identify the possible independent variables that are associated with the increased probability of radicalization in certain communities such as marginalized communities, diaspora communities, and ideology. The perceived feeling of inclusion or integration in a larger, popular community was theorized to amplify the extent of susceptibility to radicalization. Baumeister and Leary (1995) asserted on the importance of adapting psychological theories on stable interpersonal relationships. It is critical to examine the perceived instability in diaspora communities that could increase the risk of marginalization. Indicators related specifically to diaspora communities are language, the size of the community, the arrival age of immigrant(s) to the community, the age structure of the population, and the spatial concentration of the community.  Marret et al. (2013) asserted the importance of understanding the core of radicalization process that demands the necessity to question and debate the concept of violent radicalization at the theoretical level and the empirical level. The motivation for an individual or group to commit extremist violence or terrorism is not grounded in a single ideology, but selectively demonstrate their commitment from different clusters of belief systems. Behavioral indicators as stated by Fishman (2010) could be generated from social media, chat rooms, and involvement in public ideologically motivated legal activities might provide insights into community-based ideological sentiments.


Bakker, E. (2006). Jihadi terrorists in Europe, their characteristics and the circumstances in which they joined the jihad: an exploratory study.

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Bhui, K. S., Hicks, M. H., Lashley, M., & Jones, E. (2012). A public health approach to understanding and preventing violent radicalization. BMC medicine, 10(1), 16.

Carter, B. (2013). Women and violent extremism. GSDRC Helpdesk Research Report.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2008). The public health approach to violence prevention. Atlanta, GA: CDC.

Fishman, Shira. (2010). “Community-Level Indicators of Radicalization: A Data and Methods Task Force.”  Report to Human Factors / Behavioral Sciences Division, Science and Technology Directorate, U.S. Department of Homeland Security. Retrieved from

King, G., & Zeng, L. (2001). Logistic regression in rare events data. Political analysis9(2), 137-163.

Labilles, U. (2016). The significance of Public Health Approach on Violent Radicalization (Unpublished, Advanced Epidemiology Methods, PUBH-8520-1, 2016 Winter Qtr. Wk9Proj) Walden University, Minneapolis.

Loza, W. (2007). The psychology of extremism and terrorism: A Middle-Eastern perspective. Aggression and Violent Behavior12(2), 141-155.

Marret, J. L., Feddes, A. R., Mann, L., Doosje, B., & Griffioen-Young, H. (2013). An Overview of the SAFIRE Project: A Scientific Approach to Finding Indicators and Responses to Radicalization. Journal Exit-Deutschland. Zeitschrift für Deradikalisierung und demokratische Kultur, 2, 123-148.


Dallas’ Renaissance Plan: A Response to the Second Wave of Environmental Justice

Dallas is the seventh largest city in the United States with a population exceeding 1.1 million citizens in the year 2000. Dallas is the fourth largest park system in the United States. The second wave of the environmental justice movement is a concept concerned with urban design, public health, and availability of outdoor physical activities. The upgrade to the 21,526 acres of parkland will amplify the quality of and access to outdoor recreation. The Dallas Park and Recreation Department’s “Renaissance Plan” is a response to  the increased demand of the citizens for new and expanded park facilities, recreation programs, open space areas, and unique recreational amenities. Physical activity is one of the health indicators for Healthy People 2010, and responding to these demands is a step forward of meeting its goals.  Dallas’ wide spectrum of park facilities will provide physical activities that will have positive health outcome to Dallas residents including the low-income population of the Dallas County and contiguous counties. Recognition of environmental exposure affecting economically and politically disadvantaged members of the community gave birth to the first wave of environmental justice movement. In addition to health problems related to environmental exposures, environmental justice (EJ) also cover disparities in physical activity, dietary habits, and obesity among different populations. Disparities on the access of public facilities and resources for physical activity (PA) is an EJ issue that has a negative impact on health among low-income and racial/ethnic minorities (Labilles, 2013). The 2007 cross-sectional study of Taylor et al. suggest an association between disproportionate low access to parks and recreation services (PRS) and other activity-friendly environments in low-income and racial/ethnic minority communities.  The prevalence of lower levels of PA and higher rates of obesity was observed in the minority population, which is a direct outcome of the prevalence of lower levels of PA. These differences violate the fair treatment principle necessary for environmental justice.

The treatment of health conditions associated with physical inactivity such as obesity poses an economic cost of at least $117 billion each year. Physical inactivity contributes to many physical and mental health problems.  The reported 200,000-deaths per year in the US is attributed to physical inactivity, and data from surveillance system indicate that people from some racial/ethnic minority groups experience disproportionately higher rates of chronic diseases associated with physical inactivity. Taylor, Poston, Jones & Kraft (2006) findings, provided preliminary evidence for the hypothesis that socioeconomic status disparities in overweight and obesity are related to differences in environmental characteristics. However, most of the studies had encountered epidemiologic “black box” problem, making it impossible to determine which characteristics of the environment (e.g., density of food service outlets or physical activity resources) may be most important (Labilles, 2013). Ellaway et al. found that body-mass index (BMI), waist circumference, and prevalence of obesity, and greater obesity risk is associated with low area or neighborhood socio-economic status.


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Labilles, U. (2013). Environment Matters: The Disproportionate Burden of Environmental Challenges. PUBH 8115-1 Environmental Health Spring Qtr. Minneapolis: Walden University.

Taylor, W., Floyd, M., Whitt-Glover, M. & Brooks, J. (2007).  Environmental Justice: A Framework for Collaboration between the Public Health and Parks and Recreation Fields to Study Disparities in Physical Activity. Journal of Physical Activity & Health, 4, supp 1, s50-s63.

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A Summer Phenomenon

For 26 days in 2011, every place in Texas showed higher concentrations of lung-damaging ozone than allowed by federal air-quality standards, especially in Dallas. The federal standard set in 2008 is 75 parts per billion. The spike in ozone which is particularly a summer phenomenon is exacerbated by trucks carrying drilling materials that emit nitrogen oxides, and natural gas escaping from pipelines or storage tanks that emit volatile organic compounds, or VOCs. Known ozone “precursors” such as nitrogen oxides and VOCs can react with each other to form ozone when aided by sunlight. The most difficult environmental issue North Central Texas face today is air quality. Dallas Forth Worth (DFW) region meets the standard for five of six criteria air pollutants defined by the EPA. The six pollutants are carbon monoxide, lead, nitrogen dioxides, ozone, particulate matter, and sulfur dioxide. The only air pollutant for which DFW do not meet the National Ambient Air Quality Standard is the ozone. In hot summers, combination of nitrogen dioxides and VOCs and concentrations of traffic and industry, Dallas is an ideal incubator for the creation of ground-level ozone.


Under the Clean Air Act, ozone pollution has long been regulated because of its tremendous hazards to the public. Under the Clean Air Act, ozone poses tremendous hazards to the public health and the environment. High ozone levels lead to respiratory distress and disorders; decreased lung function; increases in the emergency room visits and sick days. To address the serious problem of ozone, the Clean Air Act provides a multi-step process for ensuring that all areas of the country achieve acceptable ozone levels. EPA establish nationwide air quality standards for ozone (called National Ambient Air Quality Standards), which are required to be strong enough to protect public health with an adequate margin of safety. The next step, EPA designate areas of the country that meet the standards, and those who do not. The last step, requiring states to submit plans for achieving and maintaining compliance with EPA’s ozone standards — with especially strict requirements for areas that currently do not meet the standards. The U.S. Environmental Protection Agency (EPA) updated its ozone air quality standards in March 2008. The EPA towards the end of 2012 promised the DFW residents for stronger protections against the harmful public health and environmental impacts of ground-level ozone. The agency announced on January 7, 2012 about its determination that Wise County, Texas contributes to high ozone levels in nearby Dallas-Fort Worth. This action required polluters in Wise County  to do their fair share to reduce ozone levels in Dallas-Fort Worth. Wise County was included in the DFW ozone designation due in large part to the emissions of nitrogen oxides, and volatile organic compounds from a recent boom in oil and gas production in the area. According to the Technical Support Document (TSD), the final area designations in the Dallas-Fort Worth (DFW) area for the 2008 ozone national ambient air quality standards are based on several factors and indicators. The population density and degree of urbanization were analyzed. TSD stated: EPA evaluated the population and vehicle use characteristics and trends of the area as indicators of the probable location and magnitude of non-point source emissions. These include ozone precursor emissions from on-road and off-road vehicles and engines, consumer products, residential fuel combustion, and consumer services. Areas of dense population or commercial development are an indicator of area source and mobile source NO2 and VOC emissions that may contribute to ozone formation that contributes to nonattainment in the area. Rapid growth in population or vehicle miles traveled (VMT) in a county on the urban perimeter signifies increasing integration with the core urban area and indicates that it may be appropriate to include such perimeter area(s) as part of the nonattainment area.


It is very important to recognize the effect of ozone to a population, especially adults and children who are already had chronic respiratory diseases such as asthma. Exposure may compromise the ability of the body to fight respiratory infections. Bell et al. (2004) a multisite time-series study of 95 large US urban communities throughout a 14-year period  found that widespread pollutant such as ozone adversely affects public health.


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Labilles, U. (2013). Obstacles of Disease Surveillance Interoperability: A Challenge to Public Health. (Unpublished,  PUBH-8115-1/HUMN-8115-1-Soc Behave Cultural Fact in Public Health. 2013 Spring Qtr. WK7Disc) Walden University, Minneapolis.





A Challenge to Public Health Surveillance Interoperability and Clinical Research

The obstacles that impact interoperability of the disease surveillance systems starts with the issue of balance between the public interest in the collection of information and the privacy rights. In theory, properly utilized, surveillance is a fundamental government activity, indispensable in nature (Gostin & Gostin, 2000). The legal complications brought about by the Fourth Amendment prohibition against unreasonable searches and seizures, triggered the social impetus behind HIPAA and the HHS Report. The Fourth Amendment is a constitutional protection against wrongful enforcement of the law on access to private medical records. These offers insight into the growth and development of non-Fourth Amendment protections for medical records privacy, and examines later actions that appear to restrict or undercut these potential medical record protections. The shared goals of both public health surveillance and the protection of health information privacy will encourage individuals to fully utilize health services and cooperate with health agencies. The key to protecting the well-being of the community is the optimum balance between public health activities and privacy protection. This balance is challenged by the enactment and enforcement of current legislation such as the Health Insurance Portability and Accountability Act’s Privacy (HIPAA). The way public health exception of HIPAA Rule was drafted resulted to confusion and put this balance in jeopardy, as well as recognized reluctance to provide information to state and local public health agencies. Wilson (2009) stated that the exception ambiguously defines the role of public health authorities in maintaining the privacy of personally identifiable health information. Incertitude about privacy can be equipoised by initiatives by state and federal policy makers such as the report “Confidentiality of Individually-Identifiable Health Information” issued by the Department of Health and Human Services (HHS).  This report reflected a legitimate interpretation and representation of the best aspects of constitutional and judicial protections of medical records privacy using current innovative technology in health information and communication.

State, local, and tribal public health authorities shares the privacy challenges that are inherent in data sharing. Wilson (2009) stated that, in the process of promulgating the Privacy Rule, HHS recognized the need to inscribe an exception for public health purposes in order to allow authorities at all levels of government to continue to collect, analyze, and use health information that would otherwise be unavailable without prior patient consent. State courts and policy makers have produced some protection for individuals’ medical histories which are characterized more by their diversity and conflicting standards than by the quality of protection. Unfortunately, state laws offer little additional support for medical records protection from law enforcement intrusion, thereby it is paramount for continued collaboration between public health professionals, health leaders and policy makers to focus on needed amendments to protect the interest of both the public, patients and researchers which will then bridge the divide on the interpretation of the law. It is critical to acknowledge that challenge of law- and policy-makers in finding common ground between individual privacy expectations and the communal health authorities’ needs for identifiable health data. The dissemination and use of identifiable health data for public health purposes are typically supported by the public, but it relies on how the government and other entities maintain appropriate privacy and security protections in acquiring the data. It is warranted for the continued improvement on the level of protection afforded to the public and patients by state laws governing medical records privacy. Moral justifications should be considered in establishing firm, consistent set of rules governing law enforcement’s use and exchange of private medical records and data needed in clinical research. The obstacles that forestall data-sharing practices should be assessed and remedied within each jurisdiction. Legal interpretations should be openly discussed to properly develop and implement model policy to strengthen disease surveillance, and increase the efficiency of data-sharing practices between researchers and public health authorities at all levels.


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Middle East Respiratory Syndrome (MERS) and Global Disease Surveillance System

The first confirmed case of Middle East Respiratory Syndrome (MERS) in the United States raised concerns about the rapid spread of the disease if there is no disease surveillance system in place. MERS infection was first reported in Saudi Arabia in 2012. MERS morbidity and mortality is alarming in which its clinical features resembles severe acute respiratory syndrome (SARS) with the mortality rate of approximately 60% for those who was hospitalized with severe acute respiratory condition. The federal and state health officials released the information about the first U.S. MERS case on May 2, 2014 which is an example of the importance of disease surveillance in the public health system. The patient is a health care provider who flew from Saudi Arabia’s capital Riyadh to the United States, with a stop in London. He took a bus to Indiana after landing in nearby Chicago. On April 27, he began experiencing shortness of breath, coughing, and fever. Medical staff members who came into direct contact with this patient was placed in full isolation at Community Hospital in Munster, then were taken off duty and put in temporary home isolation. MERS have no known treatments, and symptoms can take up to 14 days to occur. The exposed medical staff members will be allowed back to work after the incubation period ends and their laboratory results are confirmed to be negative for the virus. The most important factor that is needed to be considered is the probability of rapid situational changes on the progression of human-to-human transmission. Anticipating this probability will be dependent upon the quality of surveillance systems to monitor symptomatic and mild infections. These include the network structure of infections within the MERS-CoV clusters. Understanding the pandemic potential of this virus is paramount to saving lives, therefore, it is important to acknowledge the significance of the necessary requirements for a sustained globalized environment in which the continued commitment of richer countries to make it a moral obligation to help institute required reforms, policies, structures and systems required for public health and disease surveillance. It is important to develop counter-measures in the event MERS-CoV starts evolving, and mutate that will make it easier to infect humans. Mathematical epidemiologists use reproduction number (R0) to measure the average number of infections in a fully susceptible population caused by one infected individual. In this scenario, R0 of this virus will need to be increased which will then pose a relevant challenge for estimating R0 from a series of outbreaks distributed through time. In a bioterrorism standpoint, it is critical for investigators to explore the probability for this virus to be mutated in a laboratory setting. Enhanced surveillance is needed to trace active contacts, as well as vigorous monitoring of the MERS-CoV animal hosts and transmission routes to human beings within and beyond the target population. As long as the transmission properties remain small, the rapid identification, and isolation of cases with a basic R0 will keep human-to-human transmission under control. Early detection of milder, and asymptomatic cases is paramount for the reduction of case fatality rate, since mortality rate of this disease is related to late stage diagnosis and comorbid medical conditions. Globalization has its positive and negative impacts, making the world smaller and increase its vulnerability to infectious disease outbreak. Renewed commitment to public health, and strong international partnerships are essential to strengthen national and international cooperation in infectious disease prevention and control.


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Bridging the Technology Gap and Geographic Divide

This morning, I attended a webinar on the transitioning to ICD-10 CM and its impact on Public Health Surveillance presented by Peter Hicks of Centers for Disease Control and Prevention (CDC). While its benefits and challenges were discussed, the question to ask is the cost implications of the transition. Another question to ask is its compatibility to existing health information technology. I believe at this point, we need to embrace its advantages, and explore the merging of this initiative on its potential for higher quality and patient-centered care. Setting this topic aside for future dialogue, let me follow-up last week’s discussion on the true, meaningful use of personal health records (PHR), and health information exchange (HIE). In this milieu, let me discuss the promise of telehealth on higher quality and patient-centered care. The geographic separation between regional multi-site healthcare system in which one site is 32 miles or even 51.4 miles away is no longer a logistic problem using telehealth. The quality of care of the traditional model, where health care takes place when the patient and the provider are together at the same time and place can be amplified by current modern system of healthcare. It is important to acknowledge the importance of modern telecommunications and information technologies in providing management flexibility to providers, administrators and managers. It bridges the geographic separation between the patient-provider and management-staff, and allow us to challenge the notion of location and time. Video conferencing can be used to communicate with the provider, where the patient is located one part of the state and the physician is located at another part, or to show new Mohs technicians to perform cryotomy or frozen section immunohistochemistry. In this model, we can remotely monitor patient’s physical condition. Telehealth in concert with disease-specific surveillance data can assess the need for community outreach to educate and inform about the significance of the intervention.

The ability to capture and transmit images using the internet, teleconsultation can be used as an additional approach to teaching new surgical techniques, unbiased by doctrine or surgeon’s experience, enabling accurate quantitative criteria to evaluate the effectiveness of surgical cuts. In the context of cutaneous surgery, whereby contemporary research tools may become one of the criteria in the designing and performing of operations—telemedicine could be an innovative teaching platform presenting systematic pursuit of accurate, optimal cutting patterns and new surgical techniques. This capacity, when used in combination with digital pathology, could offer an alternative method to comply with Clinical Laboratory Improvement Amendments (CLIA) proficiency testing compliance on sharing Mohs slide images with another laboratory to confirm the quality of test of patient frozen section samples. In a multidisciplinary approach, it could bridge the consultation with dermatopathologist on the critical success of a high-quality Mohs surgery program. The dermatopathologist can play a role in quality assurance by reviewing Mohs slides at regular intervals to satisfy the requirement for proficiency testing. Teleconsultation and digital pathology can help assess margins in rare and difficult tumors. Moreover, consultation with dermatopathologist helps in ruling out residual disease or for further immunohistochemistry studies, as well as consultation to assess perineural involvement and uncertain frozen section diagnosis of unusual proliferative lesions. High ground such as remote monitoring of the progress of surgical repairs; we need to acknowledge the challenge in which many of these technologies can impact privacy and security. Telemedicine network structure may have an advantage over competitive hospital- or university-based networks, but the challenge will always be funding and organizational support.


Edwards, M. A., & Patel, A. C. (2003). Telemedicine in the state of Maine: A model for growth driven by rural needs. Telemedicine Journal and e-Health9(1), 25-39.

Labilles, U. (2014). Telehealth: Bridging the Geographic Challenge. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK8Disc) Walden University, Minneapolis.

Laureate Education, Inc. (Executive Producer). (2011). Introduction to health informatics and surveillance: Telehealth. Baltimore, MD: Johnson, K. & Speedie S.

Sanders, T. B., Bowens, F. M., Pierce, W., Stasher-Booker, B., Thompson, E. Q., & Jones, W. A. (2012). The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations. Perspectives in health information management/AHIMA, American Health Information Management Association9(winter).

Terry, N. P. (2012). Anticipating Stage Two: Assessing the Development of Meaningful Use and EMR Deployment. Annals Health L.21, 103.

Tilleman, T. R. Optimization of Incisions in Cutaneous Surgery including Mohs’ Micrographic Surgery.



“Personal Health Records (PHR) and Health Information Exchange (HIE) in Managing Regional Multi-Site Medical Specialty Practice”

The true, meaningful use of personal health records (PHR), and  health information exchange (HIE) between regional sites or multi-site specialty practice could amplify coordination and efficiency for higher quality and  patient-centered care. PHR and HIE have been advocated as key new components in the effective delivery of modern health care. What is the impact of PHR and HIE to healthcare system? How can sharing health information between regional sites or multi-site specialty practice bridge the communication gap?  What is the role of specific-disease surveillance system in enhancing the management and delivery of quality of care? The effective use of cancer-related information aggregated from evolving health communication and information technology can help identify disease cluster such as the incidence of skin cancer in a geographic area which could improve communication strategy on a population wide basis. The processes of health communication and supportive health information technology infrastructure can influence patients’ health decisions, health-related behavior, and health outcomes. These make health communication and health information technology play an increase central role in health care delivery and public health. HINTS data could help a regional manager harness the appropriate communication channel to coordinate between facilities, and to identify barriers to the use of health information across community. Gauging the target group’s attitudes, regarding perceptions of health-relevant topics such as cancer screening will help develop more effective communication strategies. For example, a marked increase in the incidence rate of non-melanoma skin cancer (NMSC) based on a comprehensive surveillance system could help Mohs Micrographic Surgery facilities coordinate with dermatologists and dermato-pathologists. HINTS data can help refine information age health communication theories, and offer unique recommendations for managers, communication planners and researchers in their common aim to reduce the population cancer burden through effective, evidence-based, and patient- or public-centered communication (Hesse et al., 2006; Hesse et al., 2005; Nelson et al., 2004). The concept that captures an interactive phenomenon such as shared decision-making (SDM) utilized in concert with HINTS data recommendations will improve clinicians and patients communication. Kasper, Légaré, Scheibler & Geiger (2012) asserted that the complexity of challenges physicians have to face in critical decision making, can be alleviated by outsourcing parts of the information and decision making process to other health or medical professionals to provide optimal conditions for communication in the physician patient dyad.


Finney Rutten, L. J., Davis, T., Beckjord, E. B., Blake, K., Moser, R. P., & Hesse, B. W. (2012). Picking up the pace: changes in method and frame for the health information National Trends Survey (2011–2014). Journal of health communication17(8), 979-989.

Hesse, B. W., Nelson, D. E., Kreps, G. L., Croyle, R. T., Arora, N. K., Rimer, B. K., . . . Viswanath, K. (2005). Trust and sources of health information: The impact of the Internet and its implications for health care providers: Findings from the first Health Information National Trends Survey. Archives of Internal Medicine, 165, 2618–2624.

Hesse, B. W., Moser, R. P., Rutten, L. J. F., & Kreps, G. L. (2006). The health information national trends survey: research from the baseline. Journal of Health Communication11(S1), vii-xvi.

Kasper, J., Légaré, F., Scheibler, F., & Geiger, F. (2012). Turning signals into meaning–‘Shared decision making’meets communication theory. Health Expectations15(1), 3-11.

Labilles, U. (2014). The Role of Disease-specific Surveillance and Health Information Exchange (HIE) in Managing Regional Multi-site Medical Specialty Practice. (Unpublished, RSCH-8100H-2. Research Theory, Design, and Methods. 2014 Spring Qtr. WK7Assgn) Walden University, Minneapolis.

Nelson, D. E., Kreps, G. L., Hesse, B. W., Croyle, R. T., Willis, G., Arora, N. K., . . . Alden, S.
(2004). The Health Information National Trends Survey (HINTS): Development, design,
and dissemination. Journal of Health Communication, 9, 443–460.

Office of Disease Prevention and Health Promotion. (2010). Healthy People 2020. Retrieved

Scholl, I., Loon, M. K. V., Sepucha, K., Elwyn, G., Légaré, F., Härter, M., & Dirmaier, J. (2011). Measurement of shared decision making–a review of instruments. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen105(4), 313-324.

Viswanath, K. (2005). Science and society: The communications revolution and cancer control. Nature Reviews Cancer, 5, 828–835.

Wen, K. Y., Kreps, G., Zhu, F., & Miller, S. (2010). Consumers’ perceptions about and use of the internet for personal health records and health information exchange: analysis of the 2007 Health Information National Trends Survey.Journal of medical Internet research12(4).

One Nation’s Echo (O.N.E.) will break the silence and create the echo needed to advance public health.


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