Ozaukee County, Wisconsin

Annual Report of the Public Health Deparmtent - 2004

Printable Word Document

January 1 thru December 31

This is the second consecutive year that Ozaukee County is ranked number one in health outcomes among the state’s 72 counties, according to the report issued by the Wisconsin Public Health and Health Policy Institute. This report demonstrates how health in populations compares across Wisconsin counties.  While in general terms our health is getting better, there are significant challenges ahead if we want to continue to maintain our number one ranking. Public Health will continue efforts toward improving the health and well being of our citizens through education and prevention initiatives. This is vitally important with the ever-increasing health care costs and insurance rates.

This report provides a tool to remember and a method to evaluate our past year’s experiences and help guide planning for future public health programs in Ozaukee County. I would like to extend my gratitude for the continued support and leadership provided by the Board of Health, as well as, to thank all public health staff for working together to achieve a healthier community. The full report is located on the county web page at: http://www.co.ozaukee.wi.us/AnnualReports/2004/Index.htm

BOARD OF HEALTH MEMBERS HOME HEALTH PROFESSIONAL ADVISORY

Glenda S. Madlom, RN, BS, BSN Director / Health Officer

Mary B. DeLuca, RN, BSN Assistant Director / Deputy Health Officer

Julie Sauer Administrative Service Coordinator

Deborah Bartlett, RN, BSN Home Health Care Case Manager

Kathy Bleau, RN, BSN Communicable Disease

Peggy Fero, RN, BSN Home Health Care Case Manager

Caralee Jacque, RN, BSN Immunization Program

Jan Koeppen, RN, BSN Flu/Pneumonia/Hepatitis B / MCH team

Jill LackovickRN,BSN MCH/ Healthy Child Wellness Clinic

Abbie Povletich, RN, BSN Adult Health Services / MCH team

Donna Ubbink, RN, BSN Women’s Health / Student Nurse

Joanne Viesselmann, RN, BSN WIC: Women, Infant, and Children, MCH team

Daniel Ziegler, R.S. Environmental Health Specialist, Lead, Beach

Scott Vesely, R.S. Environmental Health Specialist, Bioterrorism

Marsha Ingamells Office Assistant Mary Aikins Home Health Aide

Mary Johnson Account Clerk Bonnie Penkwitz Home Health Aide

Marilynn Martin School Health Tech. Lori Schultz Home Health Aide

Wendy Schwab Office Assistant Leann Tucker Home Health Aide

Cindy Kapp Office Assistant / WIC Vacant Position Home Health Aide

WIC: Carol Birkeland, Director/Registered Dietician

Quad County Bioterrorism Consortium Staff:

Kathy Riehle, Director; Ann Sayer, Health Educator; Jennifer Evertson, Epidemiologist

Medical Advisor: Celestino Perez, MD,

*MCH = Maternal Child Health **CSHCN=Children with Special Health Care needs

***Presumptive Eligibility WIC = Women Infant Children

Public Health services with a focus on the entire population include enforcement of health regulations, community health education regarding disease prevention, health promotion and community disease control activities. Services with a focus on sub-populations aim to improve the health status of that population in order to improve the health of all. Public health nurses have expertise in the collaborative interdisciplinary process of assessment, policy development, assurance activities, as well as health education and evaluation to promote healthy outcomes in a community. Health outcome indicators of public health nursing intervention include reductions in family violence, poor pregnancy outcomes, communicable disease, morbidity and premature mortality. Our cost-effective outreach, intervention and care coordination efforts result in disease prevention and health promotion. This is accomplished through managing and facilitating departmental and community efforts for the ongoing assessment of the community’s health status, advancing a safe and healthful environment, promoting healthful behavior and providing or arranging for the provision of health services for the early diagnosis and treatment of disease and promoting an improved quality of life.

The Meningococcal vaccine is now into a second year of being offered through the Health department. In cooperation with area high schools, letters and information were disseminated to high school seniors in the spring of 2004, to promote Meningococcal vaccination for those attending college. The newspaper advertising was issued several times during the year to encourage vaccination. A pilot project was offered to Cedarburg School District offering on-site clinics for graduating seniors in May of 2004. The pilot was well accepted by students and parents providing 33 vaccinations on-site. By years end, the health department provided a total of 111 vaccinations to those attending college, traveling to endemic areas or entering the military.

Meningococcal disease is a serious bacterial illness and the leading cause of bacterial meningitis in children ages 2–18 years in the United States. Meningitis is an infection of the brain and spinal cord coverings. Meningococcal disease can also cause blood infections.

Meningococcal vaccine is not a routine vaccine for most people. Reasons to consider

receiving Meningococcal vaccine are:

Those who should be vaccinated are:

This vaccine is offered to anyone two years of age or older. Interested persons may call the health department to reserve a dose(s). This vaccine will be offered during regular office hours, 8:30 a.m. to 5:00 p.m., Monday through Friday.

Late in 2003, Pneumococcal Conjugate Vaccine (Prevnar) began experiencing another production shortage resulting in limited supplies. The shortage continued through much of 2004. In September 2004, the 4 dose recommended series was again reinstituted and currently in effect. This production shortage resulted in overall decrease in a total number of doses given over the year.

The immunization program, through grant support, reached a vaccination coverage level of 92.5%. These children aged 2, served by the Health Department, have received all childhood vaccinations. This grant objective has been a continuing goal since 1997 and improved each year since inception, with annual review using the CDC CASA-(Clinical Assessment Software Application) program and continuing review using the WIR (Wisconsin Immunization Registry) program. The goal of healthy people 2010 is for 90% of children aged 2 to be completely vaccinated. The Health Department has achieved their objective for 2004 to reach the 90% level for those clients in the 2-year old age group. To maintain this high level of coverage, the Health Department partnered with area physicians and county WIC program to document all doses of vaccines given to our clients by comparing and combining individual vaccine records into the WIR. The registry, utilized by the department since August of 2000, has continued to improve levels of complete records and decrease chances of duplicate immunization being provided. Two large group private medical providers in the county have signed on to use the WIR in 2004 enabling the public and private sector providers to increase their ability to share and use the new data.

Three communities assisted us in providing sites for our four regular immunization clinics. A special thanks, to the American Legion Post-Cedarburg who have allowed use of their building for clinics. Due to declining attendance at this site, this clinic site closed in October 2004 after almost 2 decades of service. Sincere thanks also goes to the Mequon Police Department, for use of their building for our monthly clinics. At each of the regularly scheduled immunization clinics, vaccines for all ages were offered. Immunizations were also provided in public and worksite Adult Health Screenings, Healthy Child Wellness Clinics, Flu/Pneumonia clinics, WIC clinics, and special university and school clinics.

The following table indicates the number and kinds of vaccine administered:

Vaccine Type 2003 2004 Increases/Decrease

Injected Polio 298 231 -67

DTaP 355 305 -50

Td 508 388 -120

MMR 206 186 -20

Hib 21 22 + 1

Hib/Hep B 167 134 -33

Hepatitis B (0-19 yrs) 185 73 -112

Hepatitis A – Adult 64 81 +17

Hepatitis A – Child 28 17 -11

Meningococcal 103 111 +8

Pneumococcal Conjugate (Prevnar) 221 157 -64

Varicella (Chicken Pox) 76 109 +33

School Immunizations Audit 12/31/2003 Audit 12/31/2004

  The Ozaukee County Public Health Dept continues to provide Adult Hepatitis B vaccine to agencies that might be at high-risk for exposure to hepatitis. These agencies might include local fire, emergency and police department personnel, as well as day cares, local school and group home personnel. This past year we administered 260 doses of private pay Adult Hepatitis B. This is about the average that we have done in the last 3 years.

The health department also provides yearly-required TB skin testing for private and public agencies as needed.

COMMUNICABLE DISEASE INVESTIGATIONS: (Exhibit I)

Communicable disease control is a major function of the Public Health Department, as required by state statutes. Approximately 80 different diseases are mandated as reportable to the local public health department for investigation and follow-up. The focus of the health department investigation is to stop the transmission of the infectious disease. The first priority is to take action to prevent spread from the infected individual to others in the community. Efforts also involve attempts to locate the source of the infection and to identify any outbreaks or community wide increases in illness.

The number of sexually transmitted diseases, especially Chlamydia and genital herpes, also increased in 2004. This is most likely due to improved reporting by the medical community and may not reflect a true increase in sexually transmitted diseases.

Intestinal infections that can be caused by such organisms as E.Coli 0157, salmonella, campylobacter, cryptosporidium, and giardia continue to be reported. An important piece of any investigation into these illnesses is evaluating whether the person is involved in a high-risk occupation (such as food handling, day care, or health care) and to take measures to protect the public from possible exposure and infection.

In 2004, Pertussis (whooping cough) was a challenge for communicable disease investigation and follow-up. In past years, Pertussis has not been a prevalent disease. Ozaukee County normally averages 1-4 cases per year. However, during this last year there was a major outbreak in Wisconsin, particularly in the southeast part of the state. In 2004, Ozaukee County had 100 reported cases of Pertussis. It is quite contagious, and spreads easily to those in close contact with an infected individual. Therefore, the Public Health Department takes an active role in trying to contain the spread of Pertussis. All diagnosed individuals are kept in home isolation until they are no longer contagious. In addition, anyone who was in close contact with them is interviewed, questioned about possible symptoms, and given recommendations for treatment or symptom monitoring.

Although Pertussis vaccine is one of the routine childhood immunizations, it is not used after age six, and immunity wanes after several years. The majority of recent cases are being seen in adolescents. A safe and effective Pertussis vaccine for adolescents and adults is under development but not yet available.

Pertussis cases by case status:

Cases Reported By Month:

Pertussis cases by date reported:

Tuberculosis is a major public health threat. The health department investigates and does follow up on all suspected cases until they are proven to be free of TB.

There were three cases of active tuberculosis (TB) reported in 2004. One patient was in home isolation and needed daily visits by a nurse for several weeks.

The Public Health Department also provides medication for latent TB infection to persons who may have a positive skin test, but have negative chest x-rays and do not have active tuberculosis. These individuals show signs of exposure to TB, but have not developed infectious cases. In order to prevent them from going on to active disease in the future, six to twelve months of medication is often prescribed by the physician. The medication is supplied by the Wisconsin Division of Public Health to the Ozaukee County Public Health Department at no cost to the client. A public health nurse on a monthly basis then issues the medications to the client. At medication pick up, the public health nurse evaluates for compliance and side effects at each visit.

Tuberculin skin testing is offered on both a routine and a post-exposure basis throughout the year. The nurses also provide education on tuberculosis prevention and treatment.

The Ozaukee County Public Health Department is notified of anyone who is newly diagnosed with HIV infection. The public health nurse contacts those individuals and assists them in identifying anyone who may have been exposed to their infection. These persons are notified that they may have been exposed to HIV and are counseled on testing and risk reduction. Strict confidentiality is maintained throughout all aspects of investigation and follow-up.

INFLUENZA AND PNEMONIA VACCINE: 

Every year we believe we are going to have a routine year for the dispensing of the inactivated influenza (flu) vaccine, yet each year seems to present a new challenge. This year, one of the two manufacturers of the flu vaccine had production problems. This manufacturer was to have provided 50% of the flu vaccine for the United States. Due to this situation, there was only one U.S. manufacturer producing the flu vaccine for the United States.

The Center for Disease Control (CDC) in coordination with the Advisory Committee on Immunization Practices (ACIP) initiated recommendations for the administration of the flu vaccine. Priority categories were established to cover the High-Risk individuals first and gradually opened to everyone by the latter part of December into January.

During the flu season The Ozaukee County Public Health Department was very fortunate to have received our full order of flu vaccine from the one and only flu manufacturing company. We did receive all of the seven 7,500 doses of flu vaccine that we had ordered, but there were many restrictions put on the use of this vaccine. Because many of the agencies that fell into the high priority groupings did not receive any flu vaccine, the Public Health Dept was able to redistribute some of our supply or provide vaccinations to those high-risk agencies and clients. Some of these agencies were the local nursing homes, St Mary’s Hospital Ozaukee, several of the doctor’s offices, and other local health departments in the southeast region. Because of the high-risk priority categories, all of our vaccines were given at group homes, open clinics in the community, or at the Ozaukee County Public Health office. We were not able to offer flu clinics in many of the industries this year.

The State of Wisconsin Dept of Health and Family Services also provides flu vaccine for eligible children under the age of eighteen (18) through the Vaccine For Children (VFC) program. We received 310 doses for eligible children.

This is a broad list of distribution of the flu vaccine:

Adult Vaccine VFC Vaccine

Vaccines given: 3373 and continue to give in our office 310 (plus)

Vaccines redistributed: 4160

Total vaccines: 7533

Some of the reasons for the discrepancy in numbers are:

Adult pneumonia vaccines are usually administered at the same time as the flu vaccine for individuals needing updates. This year’s flu season, as mentioned above was quite unusual, therefore we administered only 131 doses of adult pneumonia. This is about half of our usual doses administered during flu season. 

The Ozaukee County Public Health Department’s Maternal Child Health Program has continued to emphasize outreach and collaboration with community agencies and services in 2004 as an ongoing effort to strengthen families in Ozaukee County. If the family requests, a home visit is arranged by the public health nurse and follow up to the medical care provider after the visit to coordinate services is provided. Our goal is to improve the health status of pregnant women, parents, infants and children. We assist uninsured, presumptive eligibility pregnant women, postpartum women and families to gain access to medical services and follow-up.

This program collaborates with Columbia-St. Mary’s-Ozaukee Hospital and other surrounding counties hospitals for the purpose of promoting healthy families. Newly delivered mothers, who are referred, will receive a phone call from a public health nurse to address questions or concerns that develop during the transition from hospital to home. This service is free of charge and available to any one who lives in Ozaukee County.. The majority of the referrals are first-time moms or those that are breastfeeding. Families with new babies are mailed an educational packet that provides information about available community resources and educational material necessary to make a smooth transition from birth to home. They are also offered a monthly mailing of educational information regarding parenting the first year and a bi-monthly mailing for parenting the second and third year. We received 126 requests for these mailings. This is accomplished through the collaboration of the Ozaukee County Public Health Department and the UW Extension office. This information is also available on-line if families have computer access. The information in the folders is made available with the financial assistance of the Family Preservation and Support and Mequon -Thiensville Women’s Club. The feedback from families as well as health care providers and hospital staff has continued to be very positive. This program is supported through a grant from the Division of Public Health

The Children With Special Health Care Needs (CSHCN) program is funded through the Division of Public Health–WI Maternal and Child Health. The target is families with children ages 0-21yrs with special health care needs. The long-range goal is to better coordinate delivery of resources at the local level. Ozaukee County Public Health Department continues to work closely with grant administrators through Children’s Hospital of Milwaukee. This the 5^th year of the 5-year grant cycle. The most frequently seen diagnosis in 2004 continued to be that of prematurity and low birth weight. Surrounding hospitals referred many of these infants. The Parent Liaison is an important partner in advocating for those children. Early intervention and referral to specialty services is the key to helping these families make a successful transition from hospital to home.

In 2004, the MCH program identified two areas of need for education of families under the Wisconsin DPH (Division of Public Health) Consolidated Grants. The first was in the area of childhood obesity. The 2002 Community Assessment showed our county shares in the nationwide epidemic of childhood obesity. In 2003, a pilot program was designed to find families at risk for obesity targeting children ages 3 thru 12 years. We developed the programs education modules on the food pyramid, fast food, healthy food choices, label reading, and the importance of increased physical activity. This year the nutritional program was offered again to continue to motivate change in lifestyle and behaviors in our adult and child population.

The second educational need was in the area of postpartum depression. Depression is a major public health problem affecting 10% to 15% of all women and can affect up to 28% of women living in poverty. The CES-D (Center for Epidemiological studies-Depression) was the tool that was used to screen new mothers regarding women’s emotional health. The screening was either face to face or by telephone contact. The first screening was done at 4 weeks post delivery and again at 2 months.

We were able to complete the screening tool on 65 clients. Referrals of eleven (11) clients were made to a physician for further emotional health follow-up. Additional counseling regarding women’s emotional health was done with seven (7) clients.

Because bioterrorism is a concern nationwide, a MCH grant was established to help local health department prepare for emergencies and establish a response plan. The Public Health MCH bioterrorism committee, working in cooperation with the Ozaukee County Register of Deeds Office, was able to identify the MCH at risk population and where they were located in the county. With this knowledge, a computerized GIS mapping was completed. The GIS mapping is also printable and can be used by other county members, if needed in case of a local disaster.  

The Public Health Department continues to be represented on the Ozaukee County Child Abuse Prevention Committee (CAP). This committee includes Ozaukee Council, the DA’s office, Ozaukee Counseling Center, Department of Social Services, St. Mary’s – Ozaukee and, Big Brothers-Big Sisters. The Ozaukee County Public Health Department is involved in the blue ribbon campaign to increase awareness and prevention of child abuse. This year, the Ozaukee County CAP committee collaborated with the Washington County CAP committee in order to strengthen partners, effectiveness and expand awareness of community resources.  

A Public Health Nurse is a representative on the Birth to 3 Advisory Committee. This representation keeps lines of communication open for referrals especially for Children with Special Care Needs. 

MCH Reporting System: 

For the year 2004, the SPHERE Data Base Computer Program was used by Ozaukee County Public Health Department in entering all daily activities for an entire year. This allowed for recovery of data on demographics of clients and staff activity. According to the SPHERE Database System, a total of 707 visit sessions were made to families in Ozaukee County in 2004. The following is a summary of the number of visit sessions under each of the specific MCH programs. A visit session is defined as one of the

following: a home visit, office, telephone, clinic, community, worksite or other.

Presumptive Eligibility (P.E.) is a service that has been provided by the Ozaukee County Public Health Department since 1999. The program targets uninsured pregnant women whose income does not exceed 185% of the federal poverty level. Recipients found eligible for this service receive a temporary Medicaid certification that allows them to receive immediate pregnancy related outpatient services while the application for Healthy Start is being processed. Early prenatal care helps in achieving healthy birth outcomes-an ongoing goal of Ozaukee County for its prenatal population. With this program’s aim being early prenatal care, this goal was again achieved in 2004. Out of the 38 clients receiving this service, which is up 9% from 2003, 71% of enrollees began prenatal care in the 1^st trimester.

Prenatal Care Coordination (PNCC) is a service that has been provided to Ozaukee County’s pregnant women population since 1993. This program helps pregnant women and their families gain access to medical, social, educational, and other services related to the pregnancy. These services are available during the pregnancy through the first 60 days following delivery. Services include:

The goal of the program is to improve birth outcomes among women who may be at high risk for poor birth outcomes. Healthy birth outcomes continue to be an ongoing goal of the Maternal/Child Health team of nurses here in Ozaukee County. The main objectives for obtaining this goal include ensuring that women at high risk:

In 2004, 96 referrals were received. This is up 11.4% from 2003. 58 women began services in the 1^st trimester---that is 60% of the referrals. 38 of the 95 referrals were women who also received P.E. services through our agency. This pocket of need continues to be addressed and serviced by our department.

The Ozaukee County Public Health Department is working toward expanding a program in 2004 called Targeted Case Management (TCM). This program will increase service coordination to those who qualify in the community and generate revenue for the health department. This is a benefit that is available to Medical Assistance (MA) eligible clients who reside in Ozaukee County, and are determined to be eligible under the following target populations:

The goal of the program is to improve a recipient’s access to health care and managing of services received by a recipient including, medical, social, educational, vocational, and rehabilitation services. The objectives identified by the department are as follows:

The program remains in its development stages, but plans are underway for full implementation by February 1, 2005.

SCHOOL SCREENING SERVICES: (Exhibit II and III)

Hearing and vision screening programs are conducted from September through February of the school year. Rechecks for vision and hearing are done onsite when initial screenings indicate a possible problem. When indicated, referrals are then made to physicians. In 2004-2005, our Health Screening Technician performed all hearing and vision screenings, allowing the public health nurses to address other growing responsibilities.

Wisconsin passed a law in 2002-2003 academic year, stating children entering kindergarten in Wisconsin public schools will be encouraged to undergo a vision examination by a optometrist or eye evaluation by a physician.

VISION USA—The Wisconsin Project provides free eye exams to eligible children age 18 and under from low-income working families who have no vision health insurance. Services are donated by volunteer optometrists and may be limited in some areas. Applications are available at schools and our public health office. Eligibility requirements must be met to qualify.

Students screened for scoliosis are boys in the 8th grade and girls in the 6th and 7th grades. Students are screened for scoliosis (curvature of the spine) and certain other spinal curvature problems. A Board Certified Orthopedists who specializes in scoliosis rechecks students suspected of having spinal curvature. M.D Rotter and M.D Major volunteer their time and services. Public health nurses will follow up after a referral is made to assure the child has received medical care.

The Scoliosis Program’s brochures and procedures are reviewed and updated yearly to provide current educational material and improved screening technique.

During the 2004 school year, 1,832 children were screened for spine curvature. The referral rate to the health care provider is approximately 1%. The following summarizes the 2004 school year:

Total NumberChildrenScreened 1,238

Total Number Children Rescreened 71

Total Number Children Referred 14

WIC is a Supplemental Nutrition Program that provides food vouchers and education to women, infants and children who exhibit a nutritional risk and are financially eligible. A grant from the State of Wisconsin fully funds this program.

In 2004 the Ozaukee County WIC Program served an average of 354 participants each month. The number of food packages issued this year was 4246. The following is a breakdown by percentages of clients per program category:

31 % were women (either pregnant, or postpartum)

33% were infants under one year

36% were children ages one to five

WIC foods available with vouchers include milk, eggs, natural fruit juices, cheese, iron fortified cereals, peanut butter and infant formula. Ozaukee County has 12 contracted vendors where clients can redeem their vouchers. In 2004, WIC drafts generated $210,572.00.

Each participant receives a nutrition and health assessment at each 6-month certification. Lead screening and needed immunizations are offered at each visit. This year again, flu vaccine was offered to eligible clients after their WIC visit. A public health nurse offers to assess every pregnant woman participating in WIC and educates her pregnancy/parenting issues along with information on available community resources. In 2004, there were 70 women assessed and offered services. Breastfeeding continues to be recommended as the best nutrition for each pregnant participant’s baby after delivery. This year, WIC was able to meet its goal to have more postpartum mothers continue to breastfeed after returning to work. We developed a protocol to inform all pregnant women of the availability of breast pumps through the WIC Program. Early postpartum contact to evaluate success, along with evaluation of the need for a breast pump, helped with the continuation of breastfeeding.

This year the Farmers Market Nutrition Program was again offered in our WIC program. Its major goal is to increase the choice and consumption of fresh fruits and vegetables. WIC participants also have a greater awareness of the local Farmers Markets and utilized this resource more than last year. This year we had 18 farmers accepting drafts at the various markets.

This program is designed to assist families with children between 0 and 18 years old, living in Ozaukee County who have no medical insurance, insurance that does not cover well child check-ups, insurance with high deductibles and/or high out–of-pocket costs or families with a low income who do not qualify for Medicaid or BadgerCare. Families can be assisted in signing up for Medicaid or BadgerCare.

In 2004, 36 families utilized our well child services. Fifteen new clients from 10 new families were served with a total of 66 office visits provided. The health department receives clients from a variety of sources including WIC, school programs, immunization program, friends/family, and St. Mary’s Ozaukee Free Clinic for adults. We offer special thanks to our volunteer physicians who offered their services at our 7 scheduled clinics in 2004: Dr. Daniel Hagerman, Dr. Beth Hagen. Dr. Carol Estill, and Dr. Lorraine Gauthier.

Well Child Service Providers: Physician services are provided voluntarily through St. Mary’s Hospital Ozaukee and other area physician groups. Nursing services, immunizations, hemoglobin and lead tests are provided by the Ozaukee County Public Health Department. A one-time amount of money was given to the program for medication vouchers for children through a community donation from the Mequon Thiensville Junior Women’s Club. The Port Apothecary-Port Washington and Ye Olde Pharmacy – Cedarburg have agreed to accept the medication vouchers for prescriptions provided by our volunteer physicians.

The Ozaukee County Public Health Department is also represented on the Southeast Wisconsin Safe Kids Coalition. This is a four county coalition created to reduce unintentional childhood injuries through educational, technical, policy and advocacy initiatives. Ozaukee, Waukesha, Milwaukee and Washington counties participate together to provide the educational and community programs to reduce injuries and mortalities to children. This year our agency participated in several activities coordinated by Safe Kids such as car seat checks, smoke alarm education, safety towns, and water safety programs for preschoolers held in our public libraries.

Heart disease is the #1 cause of death in Ozaukee County and the United States. High blood pressure (hypertension) is a major risk factor for both heart attacks and strokes. Screening programs can identify people with hypertension who were unaware of their problem.

The Ozaukee County Public Health Department conducts 5 FREE blood pressure screenings every month at different Ozaukee County locations – Cedarburg, Grafton, Mequon, Thiensville and Port Washington. In 2004, FREE blood pressure screenings were also conducted at Breakfast on the Farm, the Senior Conference, and the Ozaukee County Fair as part of our Adult Health Screening program.

Participants receive a pamphlet explaining what their blood pressure means, what action they need to take and lifestyle modifications to lower blood pressure.

In 2004, 1,555* people participated in the Blood Pressure Screening program and 146 were referred for follow-up medical care. (*Corrected from the earlier published Executive Summary report)

Focusing on prevention of chronic health problems, the Ozaukee County Public Health Department provides screenings for blood pressure, near vision, distance vision, visual field analysis, hearing, diabetes, total cholesterol and HDL (good) cholesterol.

Both public and private screening programs are conducted. Each site determines which screenings to offer.

In 2004, public screening sites included Manchester Mall (3^rd Tuesday of every month), Ozaukee County Administration Center, St. Paul’s Church in Grafton, Cedarburg Fire Department’s "Safety Day".

Ozaukee County businesses are invited to conduct Adult Health Screening clinics at their worksite. In 2004, 7 businesses offered these clinics to their employees.

Counseling by a Public Health Nurse is an integral part of every screening. All participants are given their screening results, informed whether results are normal or not, and instructed what to do about abnormal results.

In 2004, a total of 1,696 people were screened and counseled and 433 of them were referred for follow-up medical care.

This year’s objective was to have either a worksite or public venue purchase a Public Access Defibrillator and make it available for public use.

Public Access Defibrillators (PADs) are Automatic External Defibrillators available for public use by trained lay-people. They do save lives! If you would like more information about Public Access Defibrillators, you can get a PAD PowerPoint presentation from the Health Department.

Ozaukee County purchased 4 PADs. Two are located in the Justice Center and two are located in the Administration Center.

The Wisconsin Well Woman Program (WWWP), a state and federally funded program, helps low income, uninsured, and underserved women gain access to lifesaving screenings for early detection of breast and cervical cancer. Deaths from these diseases occur disproportionately among women who are uninsured and underinsured. The program provides both screening and diagnostic services, including clinical breast exam, mammograms, pap tests, surgical consultation and diagnostic testing for women whose screening outcome is abnormal. The WWWP coordinator provides case management services to ensure that women are screened at appropriate intervals, access appropriate diagnostic services and receive medical treatment as needed. Women who are screened through WWW P who are diagnosed with breast or cervical cancer are eligible for full Medicaid coverage for treating the condition. This includes all Medicaid mandated and optional services. In 2002, one Ozaukee county woman was diagnosed with breast cancer and continues to receive Well Woman Medicaid benefits. The WWWP also pays for selected screenings and diagnostic tests related to depression, domestic abuse, high blood pressure, cholesterol levels, and osteoporosis.

Eligible women are enrolled through the Ozaukee County WWWP program coordinator. The screening program focuses on women who are 35 through 64 years old with a household income at or below 250% of the current poverty level. The priority of the mammography component of the program is to screen women ages 50 –64. By federal mandate 75% of women receiving mammograms through WWWP must be 50-64 years old. In 2003, 75 Ozaukee county women were enrolled in WWWP. 52 women received mammograms and 11 needed follow-up studies for abnormal results. 43 Pap and pelvic exams were performed, two had abnormal results and needed further evaluation.

The Ozaukee 100 Breast cancer-screening program encourages 100% of women in Ozaukee County to have routine breast cancer screenings. The Ozaukee 100 fund provides financial assistance for women who need mammography screening, and follow-up testing for breast related concerns and who lack resources to pay for these services. The work of the coalition is supported by donations to the Ozaukee 100 fund. In 2003, twenty-four women received 42 breast related services.

The Ozaukee County Smoke Free Coalition ceased existence after December 31, 2003, due to state budget cuts. The 2004 tobacco funds were reduced and seven health departments in the southeast region lost their funds to continue a tobacco coalition and a coalition coordinator.

A separate grant for youth tobacco education was received by our Health Department and sub-contracted to the Ozaukee Council, Inc. This grant objective was met in working with a group of John Long Middle School 8^th grade students. Both the Ozaukee Council and the Health Department will continue to address the Board of Health’s appointed health priority, to reduce tobacco use and second hand tobacco exposure. Public Health clients are counseled on the negative effects of tobacco smoking and exposure to environmental smoke at the health departments Adult Health Screenings, WIC and with our Maternal Child Health population.

The Health Department maintains representation on the Ozaukee County ATOD Prevention Consortium, which has greatly increased its activity in 2004. Meetings changed from quarterly to monthly and members from many more avenues of our community are in attendance to meet requirements for a new federal grant. This grant is from the Federal Drug-Free Communities Support Program, is worth $86,933.00, and its goal is to reduce or eliminate substance use by youth and eventually reduce use by adults.

This year the Environmental Health Specialist addressed over 749 citizen environmental concerns, a 33% increase over 2003. These concerns included issues of housing and home safety, lead, indoor air quality (mold), food safety, drinking, pond and beach water quality, pest and animal control, sewage, solid and hazardous waste, radon, asbestos, west nile virus, occupational health, and emergency preparedness.

Many of the duties of the EHS have included providing consultation to citizens and staff on environmental issues, investigation of potential human health hazards, writing press releases, maintaining aspects of the department website, presenting monthly reports to the Ozaukee County Board of Health, grant writing, assisting nursing staff with the follow up and investigation of food and waterborne disease outbreaks, and program development and administration.

In 2004, the Health department signed a fee for services contract with the Ozaukee County Housing Initiative. The Health department contracted to conduct field inspections and administer a federally funded housing rehab program for area homeowners and rental property owners. To date, approximately one half of the federal dollars allocated to this program have been committed in projects in Ozaukee County.

Other duties of the EHS have included creating news articles and public service announcements, participating in educational workshops, career days and committee membership. The EHS is a member of the following committees: the WDNR Beach Advisory Workgroup, the Health Department Emergency Planning Committee, and the OCHI Applicant Review Board. The EHS continues to be a member of the County Emergency Management Level B Hazardous Materials Team.

From May through September the EHS assisted the health department with a beach monitoring program in Port Washington and at Harrington State Park. The health department teamed with city officials to sample and test the waters for a pathogenic indicator (E. coli) from Thursday through Monday. In 2004, the beach program was reduced to 15 weeks of beach sampling. The EHS regularly attended DNR Beach Advisory Workgroup meetings to discuss and share information relative to administration of this field program and reported to the Board of Health via a beach season summary.

The table below contains a numerical summary of the number of closures and ‘poor’ advisories for each beach combination and the total percent of the sampling time that those beach combinations were under both closed and ‘poor’ advisory for 2003 and 2004.

The EHS provided assistance to the health department by writing a grant that would provide local fire departments with updated information and training on carbon monoxide hazards in residential settings. Also as a consequence of this same grant, the health department received carbon monoxide testing equipment and supplies. Coupons were made available for residents to redeem money off to purchase Carbon Monoxide detectors at Home Depot. Six area fire departments scheduled and received a two-hour block of instruction.

As a follow-up to the state 2002 WNV bird surveillance activities which indicated that virus infected birds were present in Ozaukee County, the EHS coordinated a county-wide mosquito surveillance program in 2003. Our 2003 surveillance results showed a higher concentration of mosquitoes in Mequon. As a result, in 2004, our surveillance efforts focused in Mequon. For a 16-week period from June through September, participating public properties were monitored for adult mosquito and larvae populations, so as to confirm information on what species were present in Mequon and in what relative numbers. These insects were also tested for the presence of the WNV. The Marshfield Clinic provided laboratory support for these surveillance activities. The 2004 mosquito surveillance results, along with suggestions for future abatement, were presented to the Board of Health and are scheduled for presentation to Mequon municipal officials and citizens in January of 2005.

The health department continues its effort to reduce childhood lead exposure and to identify children that have been lead poisoned. The department provides free blood lead screening to children ages six months to less than six years at WIC, primary care clinics, and upon request. The total number of children screened in the county in 2004 was 401. This department screened 40 children or 10% of that total. Of the total number of children screened, four cases or less than 1% had levels of blood lead that would be a serious health concern. In all cases, PHN’s and EHS’s work jointly to provide both information and services. Families are provided counseling on proper nutrition and lead hazard reduction techniques. The department provides a no-cost HEPA vacuum to parents for use in the home. Case management by a Public Health Nurse is provided when necessary, as per state protocol. The EHS conducts home risk assessments, which include lead inspection and the collection of lead samples. This year Wisconsin Division of Health grant funding provided for homeowner training in lead safe working techniques. A free PowerPoint presentation entitled ‘Home Health Hazards’ was offered to area citizens at the Mequon MATC campus.

In September of 2003, the health department hired an additional full-time Environmental Health Specialist (EHS). Fifty percent of one Environmental Health Specialist’s salary is funded by bioterrorism dollars. This EHS functions in coordinating the department’s efforts for homeland security issues, which include bioterrorism and other related man-made or natural emergency response type activities. Besides assisting in on-going environmental health activities that the department now provides, this EHS is a representative on the Quad-Counties Consortium, a mutual aid organization including staff from Ozaukee, Washington, Sheboygan, and Fond du Lac counties. This involvement will foster communication between departments of county government, encourage the sharing of local resources, and coordinate area training events.

Ozaukee County, along with Fond du Lac, Washington, and Sheboygan counties, make up the Quad Counties Consortia (QCC), which is one of 12 consortia in Wisconsin organized to prepare for bioterrorism or other disasters. Representatives from the four counties meet monthly to discuss and coordinate plans for various man-made or natural disasters.

As part of our preparation, we are constructing plans to effectively vaccinate all of Ozaukee County in a limited period of time in the event of a smallpox or flu epidemic. This may involve vaccinating 84,000 people over the course of four or five days. To this end, we have worked with different organizations and partners that would be needed in an undertaking this large mass vaccination clinic plan, including, schools, bus companies, law enforcement, hospitals and volunteer groups. We have chosen tentative locations for registration and vaccination sites that would be used during a mass vaccination clinic. This Mass Vaccination Plan includes mapping of site locations, tours of the proposed facilities, agreements with facility managers, and appendices that contain the details for job descriptions, lists of supplies needed, contact numbers and other emergency information. The plan will be modified as new information and new requirements are revealed.

This year Ozaukee County, in cooperation with the Quad County Consortium (QCC), continued the process of testing and refining that plan by participating in tabletop exercises. These exercises allow us to walk through possible scenarios with our staff and partners to see where our plans need to be adjusted. The Health Department also purchased equipment and supplies that can be used when disaster strikes.

We have set up off-work communication networks consisting of phone trees, pager numbers and emergency contact numbers. Both the Health Department and the QCC networks were successfully tested for 24/7 responses this year and will continue to be tested on an annual basis.

Health Department staff continued their training related to bioterrorism subjects this year, including

The Wisconsin Division of Public Health directs each county health department to perform a community assessment every 5 years. In 2003, the third health study was completed for Ozaukee County. After the 2003 Community Health Survey results where completed, our Board of Health added an additional (fifth) health priority to the original four priorities selected after the 2002 community health study. The five health priorities for Ozaukee County are listed below:

Aurora Healthcare conducted the 2003 Community Health Survey through grant procurement. Forty communities in the southeast region were surveyed through the grant. These surveys are pursuant to the Wisconsin Division of Health’s priority, "Healthiest Wisconsin 2010". The Ozaukee County studies were conducted by JVK Research to gather information on the health practices and health-related behavioral risks of residents. The 2003 survey can be viewed via this link on our web page:

http://www.aurorahealthcare.org/yourhealth/comm-health-reports/art/ozaukee.pdf.

Many of our public health grant objectives negotiated with the Wisconsin Division of Health are based on the five priorities selected by the Ozaukee County Board of Health.

The Ozaukee Health Initiative (OHI) is a group of county and community members who also review the health survey results, forward information to the Board of Health, and monitor community activity relating to the five health priorities. Through this Community Assessment process, the OHI has evaluated other communities and ascertained how they addressed awareness of their health priorities. Our goal is to increase community awareness of the Ozaukee County Health Priorities.

The Migrant Health program addresses health needs of migrant workers and their families. Approximately 150 Latino workers and their families came from southern Texas to work at the Lakeside Foods cannery in Belgium and their produce freezing plant in Random Lake. Most workers live in one of the two "migrant camps" in Belgium during their five-month stay in Wisconsin. They have low annual incomes; often have no health insurance, and minimal routine or preventive health care. Public health nursing services provided to the migrant population includes health teaching, communicable disease follow-up, assistance with scheduling medical care appointments and coordination of care with other community agencies. There is a federally funded program for migrant workers outpatient health needs administered through Family Health Medical and Dental Center in Wautoma, WI. Public health nurses assist migrant workers to access providers who participate in a discounted voucher reimbursement program with this clinic. Primary care, specialty care, diagnostic testing, dental care, prescription medication, and many more outpatient healthcare needs are coordinated through a public health nurse for the migrant workers. State program immunizations and WIC services are also provided through the Health Department.

Once again this year, we would like to give special thanks to the following primary care providers who have been very generous in meeting the migrant worker’s needs in Ozaukee County and participate in the voucher program with Family Health Medical Clinic in Wautoma:

Without the caring and assistance of these community partners, the Migrant Health Program would suffer, being unable to meet the immediate health needs of these workers and their families.

The public health department participates in providing public health clinical experiences to nursing students. The public health department has contracts with seven colleges and universities of nursing. Twenty- seven senior nursing students from Concordia University participated in the immunization clinics in 2004. Two nursing students from Columbia College of Nursing had their fall semester clinical experience at the health department. One Concordia BSN completion student participated in the preceptor program this fall.

Our homecare agency is state licensed and available to all eligible Ozaukee County residents who need assistance in their home. We provide skilled nursing, bath service and medication management that is reimbursed by private pay (sliding scale for low income residents) or private insurance and also provide personal care services reimbursed by Medicaid. Our Home Care Program serves those community residents who would otherwise be underserved or forced into a nursing home environment earlier than they wish.

Our unique approach to homecare service is holistic and provides quality health care that assist our clients in maintaining their independence through evaluation of the client’s environmental, physiological and psychological needs. We work closely with the client’s support systems to assure a safe home environment. Our mission is to improve and/or maintain our client’s health through skilled intervention, personal care assistance, ongoing education and exploration of community resources.

The Ozaukee County Department of Social Services, who has a Personal Care Only agency, contracts with our department for a full time RN to supervise their Personal Care Workers.

Our department continues to outreach to community members and partners in an effort to increase awareness of our program. Board of Health approval was received to increase the fee scale for home care effective September 1, 2004. This revenue helps to support the home care program.

A difference was made in 2004 by our dedicated and caring volunteers. Our department program benefited greatly from the numerous hours and talents of our many volunteers. In 2004, 405 volunteers donated 868 hours of service to the school hearing, vision, and scoliosis screening programs. Fifteen volunteers donated 319 hours at our blood pressure and adult health screenings; 2 volunteers donated 20 hours to our Wisconsin Well Woman Program activities; two volunteers donated 240 hours to our Children with Special Health Care Needs program and 16 volunteers donated 190 hours of service at our monthly immunization and flu/pneumonia clinics. Four physicians donated a total of 24 hours at our Healthy Child Wellness Clinics and two physicians donated 12 hours at our scoliosis re-screens. Volunteers provided a total of 1,601 hours of service.

The Volunteer program is coordinated by a clerical staff member with the help of the public health nurses. The individual program managers train and supervise the many volunteers.

In spring the health department sponsors an annual Volunteer Luncheon to show our appreciation to our volunteers for all their hours of service. Their dedication enables our department to provide valuable services to the citizens of Ozaukee County.

WEB page: Public Health Department

The health department maintains current information and links for health issues on their web page.

FALL 2004 HEARING SCREENING STATISTICS Exhibit II

"Screened" - HST will use total enrollment for each grade, subtracting absentees.

(*Total numbers screened corrected from the earlier published 2004 Executive Summary report)

NUMBER OF HOME CARE CLIENTS BY AGE AND RACE/ETHNICITY
 

2003 Annual Report