Sep 16 2014
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Public Health News Roundup: September 16

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EBOLA UPDATE: Obama to Commit as Many as 3,000 Troops to Epidemic Response
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama will today announce an expansion of military and medical resources that could send as many as 3,000 people to West Africa to help combat the ongoing Ebola outbreak. According to The New York Times, the United States will help train health workers and build as many as 17 Ebola treatment centers, which will house approximately 1,700 treatment beds. The U.S. Department of Defense will also open a joint command operation in Liberia in order to coordinate an international response to the outbreak. Read more on Ebola.

Report: 1 in 9 People Worldwide are Chronically Undernourished
An estimated 805 million people in the world are chronically undernourished, according to a new report, The State of Food Insecurity in the World 2014, from the Food and Agriculture Organization of the United Nations. While that means that approximately one in every nine people are undernourished, the number is down more than 100 million over the past decade and 209 million since 1990-1992. In the past two decades the prevalence of undernourishment has also dropped from 23.4 percent to 13.5 percent in developing countries. According to the health agency, the eradication of hunger requires a sustained political commitment that emphasizes food security and nutrition. Read more on global health.

SAMHSA: Percentage of Youth Using Illegal Drugs is Down Over the Past Decade
The percentage of U.S. teens using illegal drugs is down over the past decade, according to a new study from the Substance Abuse and Mental Health Services Administration’s (SAMHSA). The report, the 2013 National Survey on Drug Use and Health, found that the rate of illicit drug use in the past month for adolescents ages 12-17 was 8.8 percent, down from 9.5 percent in 2012 and 11.6 percent in 2002. From 2002 to 2013, the percentage of youth in that age group with a substance abuse or dependence problem dropped from 8.9 percent to 5.2 percent. “This report shows that we have made important progress in some key areas, but that we need to rejuvenate our efforts to promote prevention, treatment and recovery to reach all aspects of our community,” said SAMHSA Administrator Pamela S. Hyde, in a release. “The real lives represented by these statistics deserve our protection and help from the ravages of substance use disorders. Through a comprehensive, national effort we can help people avoid, or recover from substance use problems and lead, healthy, productive lives.” Read more on substance abuse.

Sep 15 2014
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Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years

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Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.

Recent Government Accountability Office reports have found several reasons for the shortages, including:

  • Difficulty acquiring raw materials
  • Manufacturing problems
  • A loss of drug products when factories are updated and modernized
  • Low reimbursement by Medicare and other government payment programs
  • FDA regulations that may slow down new drug approvals

The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.

Read the full issue brief.

Sep 15 2014
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Public Health News Roundup: September 15

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EBOLA UPDATE: Obama to Announce New Ebola Plan Tomorrow
(NewPublicHealth is monitoring the public health crisis in West Africa.)
President Obama is expected to make an announcement tomorrow detailing the United States’ increased involvement in combatting the Ebola outbreak in West Africa. The plan would likely involve an increased U.S. military presence; the government has already committed approximately $100 million related to protective equipment for health care workers; food; water; and medical and hygiene equipment. More than 2,400 people have so far died in the outbreak. Read more on Ebola.

HHS: $295M to Expand Health Services for 1.5M New Patients
Late last week, the U.S. Department of Health and Human Services (HHS) announced $295 million in funds to enable 1,195 health centers across the country to hire approximately 4,750 new staff, stay open later and expand their services to cover areas such as oral health, behavioral health, pharmacy and vision services. The funds are available through the Affordable Care Act. HHS estimates that this will help 1.5 million new patients. “These funds will enable health centers to provide high-quality primary health care to more people including the newly insured, many of whom may be accessing primary care for the first time,” said HHS Secretary Sylvia M. Burwell, in a release. Read more on the Affordable Care Act.

Study: 11 Million Unnecessary Antibiotic Prescriptions for Kids Annually
Physicians prescribe antibiotics for kids approximately twice as often than they are needed, contributing to the growing problem of antibiotic resistance, according to a new study in the journal Pediatrics. Researchers analyzed a selection of studies published between 2000 and 2011, as well as data on children examined at outpatient clinics, finding that an estimated 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria, yet antibiotics were prescribed for approximately 57 percent of these visits. They estimate that there are more than 11 million such unnecessary prescriptions for kids each year. Read more on prescription drugs.

Sep 12 2014
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Faces of Public Health: Q&A with Andrea Gielen, the Johns Hopkins Center for Injury Research and Policy

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The U.S. Centers for Disease Control and Prevention (CDC) recently awarded $4 million to the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health to further fund its work on injury prevention research and policy development. According to the CDC, injuries are the leading cause of death in the United States among people ages 1 to 44, costing the country $406 billion each year. And across the globe, 16,000 people die from largely preventable injuries every day.

“This funding will allow us to advance our work in closing the gap between research and practice in new and innovative ways,” said Andrea Gielen, ScD, ScM, the center’s director. “Whether fatal or non-fatal, injuries take an enormous toll on communities. Our faculty, staff and students are dedicated to preventing injuries and ameliorating their effects through better design of products and environments, more effective policies, increased education and improved treatment.”

The five-year grant will support several innovative research projects on key issues, including evaluating motor vehicle ignition interlock laws, studying universal bicycle helmet policies, testing m-Health tools to reduce prescription drug overdose and evaluating programs to prevent falls among older adults. The center will also continue to offer training and education to public health students and practitioners, as well as to new audiences that can contribute to injury prevention.

NewPublicHealth recently spoke with Gielen about the CDC grant

NewPublicHealth: What are the goals for each of the four research areas for which you’ve received funding?

Andrea Gielen: Each of the four is a full research projects with specific aims. For example, with ignition interlock laws—which are car ignitions that can’t start unless a breathalyzer confirms that a driver is sober—there’s been a little bit of evidence that they reduce alcohol-related motor vehicle crash injuries and deaths, but there are two gaps. There has never been a national study of the impact of these laws, and we don’t know a whole lot about how they’re implemented. What is it about ignition interlock policies and how they’re implemented that’s really related to their impact on reducing fatal crashes?

We want to look at all four projects in the same way: We’ll be looking at barriers and facilitators to how policies that we think are effective are adopted and implemented, and what it is about that adoption and implementation of the processes that make these policies effective. 

Read more

Sep 12 2014
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Public Health News Roundup: September 12

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EBOLA OUTBREAK: WHO Says Ebola is Spreading at a Faster Rate than Health Workers Can Handle
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Earlier this week, the World Health Organization (WHO) announced that the Ebola outbreak in West Africa—the largest in history—shows no signs of slowing down. Today the global health organization followed that by declaring that health officials are currently unable to handle the growing number of cases. "In the three hardest hit countries, Guinea, Liberia and Sierra Leone, the number of new cases is moving far faster than the capacity to manage them in the Ebola-specific treatment centers," said Margaret Chan, the WHO director-general, according to CNN. "Today, there is not one single bed available for the treatment of an Ebola patient in the entire country of Liberia." More than 2,400 people have died from Ebola since the start of the outbreak. Read more on Ebola.

Study: Majority of Nursing Home Residents with Advanced Dementia Receive Questionable Medications
The majority of nursing home residents dealing with advanced dementia receive medications that are both questionable—if not outright ineffective—and cost them needless amounts of money, according to a new study in JAMA Internal Medicine. In a review of 5,406 nursing home residents with advanced dementia, researchers determined that slightly more than half (53.9 percent) received at least one medication with questionable benefit; the medications constituted approximately 35.2 percent of the total cost of care for those patients. According to the researchers, the patients’ goals of care should dictate the treatment they receive when dealing with a terminal illness, and medications that don’t promote that primary goal should be minimized. Read more on aging.

Study: ‘Fat Shaming’ is Counterproductive
“Fat shaming” does not promote weight loss and in fact can be counterproductive, according to a new study in the journal Obesity. In an analysis of nearly 3,000 adults tracked over four years, researchers determined that weight discrimination was associated with a weight gain of approximately 2 pounds, while the participants who reported no fat shaming lost an average of 1.5 pounds. "Our study clearly shows that weight discrimination is part of the obesity problem and not the solution," said the study's senior author, Jane Wardle, director of the Cancer Research UK Health Behaviour Centre at University College London (UCL), in a release. "Weight bias has been documented not only among the general public but also among health professionals, and many obese patients report being treated disrespectfully by doctors because of their weight. Everyone, including doctors, should stop blaming and shaming people for their weight and offer support, and where appropriate, treatment.” Read more on obesity.

Sep 11 2014
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For the Homeless, a Place to Call Home After a Hospital Stay

A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.

Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).

Medical Respite Centers Location of medical respite centers in the United States

Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.

Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.

The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.

The goals of the guidelines for the respite care centers are to:

  • Align with other health industry standards related to patient care
  • Represent the needs of the patients being served in the medical respite centers.
  • Promote quality care and improved health
  • Create standards for a range of respite center types with varying degrees of resources

NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.

There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.

“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.

Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.

>>Bonus Links:

Sep 11 2014
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Public Health News Roundup: September 11

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EBOLA UPDATE: Gates Foundation Commits $50M to Fight Ebola Epidemic
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The Bill & Melinda Gates Foundation will commit $50 million to combat the ongoing Ebola outbreak in West Africa. The flexible funds will enable United Nations agencies and international organizations to purchase supplies and scale up their operations; the funds will also go toward the development of Ebola treatments. The foundation has already committed $5 million to the World Health Organization for emergency operations and R&D assessments and $5 million to the U.S. Fund for UNICEF to support public health efforts in Liberia, Sierra Leone and Guinea. “We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease,” said Sue Desmond-Hellmann, CEO of the Gates Foundation, in a release. “We also want to accelerate the development of treatments, vaccines and diagnostics that can help end this epidemic and prevent future outbreaks.” Read more on Ebola.

CDC: Millions of U.S. Kids Don’t Receive Proper Preventive Care
Millions of U.S. infants, children and adolescents do not receive key clinical preventive services, according to the U.S. Centers for Disease Control and Prevention’s (CDC) latest Morbidity and Mortality Weekly Report (MMWR) Supplement. Preventive services from doctors, dentists, nurses and allied health providers help prevent and detect diseases in their earliest stages, when they are the most treatable. Among the report’s findings:

  • In 2007, parents of 79 percent of children aged 10-47 months reported that they were not asked by health care providers to complete a formal screen for developmental delays in the past year.
  • In 2009, 56 percent of children and adolescents did not visit the dentist in the past year and 86 percent of children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.
  • 47 percent of females aged 13-17 years had not received their recommended first dose of HPV vaccine in 2011.
  • Approximately 31 percent of outpatient clinic visits made by 11-21 year-olds during 2004–2010 had no documentation of tobacco use status; 80 percent of those who screened positive for tobacco use did not receive any cessation assistance.
  • Approximately 24 percent of outpatient clinic visits for preventive care made by 3-17 year olds during 2009-2010 had no documentation of blood pressure measurement.

“We must protect the health of all children and ensure that they receive recommended screenings and services. Together, parents and the public health and healthcare communities can work to ensure that children have health insurance and receive vital preventive services,” said Stuart K. Shapira, MD, PhD, chief medical officer and associate director for science in CDC’s National Center on Birth Defects and Developmental Disabilities. “Increased use of clinical preventive services could improve the health of infants, children and teens and promote healthy lifestyles that will enable them to achieve their full potential.” Read more on pediatrics.

GAO: More Data Needed to Help Veterans Readjust to Civilian Life
More information is needed in order to best provide services to military veterans readjusting to civilian life, according to a new review by the U.S. Government Accountability Office (GAO). The review found that while many veterans readjust with little difficulty, others experience financial, employment, relationship, legal, housing and substance abuse difficulties. While the U.S. Department of Veterans Affairs is working to improve veteran wellness and economic security, “there is limited and incomplete data to assess the extent to which veterans experience readjustment difficulties,” according to the GAO. Read more on the military.

Sep 10 2014
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With Classes Well Underway, It’s a Good Time for Colleges and Universities to Think about their Campus Tobacco Policies

Just a few weeks ago the Bloomberg School of Public Health at Johns Hopkins University announced that it had launched the Tobacco-Free Campus Initiative, which prohibits the use of any tobacco product—not just cigarettes—in all buildings, facilities and vehicles. The initiative also forbids e-cigarettes and discourages the use of tobacco products on all outdoor campus grounds. Organizers of the initiative say that deterring the use of tobacco in all forms is crucial to protect the health of the students and workforce of the campus community.

“By keeping out all tobacco products, the initiative ensures that the School doesn’t unintentionally encourage or reinforce tobacco addiction among students, faculty and staff,” according to a statement released by the school.

However, the rest of the university won’t be taking the same steps, at least for now. In 1991, all Johns Hopkins campuses followed the example first set by the School of Public Health in becoming smoke-free, said Dennis O’Shea, a spokesman for the university, adding that the “school could follow the new initiative, but no decision has been made.”

Hopkins is not the only college deliberating. While there are a few states that require state campuses to adopt smoke-free policies most campuses voluntarily adopt them, according to Cynthia Hallett, the executive director of Americans for Non-Smokers Rights (ANR). According to ANR, there are a little more than 4,000 colleges and universities in the United States, and as of July 2014 there were 1,372 smoke-free campuses in the United States, of which 938 are 100 percent tobacco-free and 176 prohibit the use of e-cigarettes anywhere on campus. That’s up from 446 smoke-free campuses in 2010; reporting on tobacco-free campuses began in 2012, when there were 608.

Credit some of that change to the Tobacco-Free College Campus Initiative (TFCCI) of the U.S. Department of Health and Human Services (HHS), launched two years ago to promote and support the adoption and implementation of tobacco-free policies at colleges and universities. TFCCI is a partnership of HHS, the American College Health Association and the University of Michigan, with sponsorship from the American Legacy Foundation.

While support for making campuses smoke- and even tobacco-free is growing, it’s hardly a slam dunk, especially when the move requires students to vote. Universities say opposition can come from foreign students who are sometimes more likely to smoke than their U.S. counterparts or contract employees who don’t want to be barred from smoking on campus. It can even come from the media. Two years ago, when UCLA announced its campus-wide tobacco free policy, the Los Angeles Times published an editorial titled “A Smoke Free UC Goes too Far” which said that “[s]moking is a detestable, dangerous habit—but it's also a legal one, and there is plenty to say in defense of allowing adults to make bad decisions if they're not breaking the law or harming others.”

Hoping to get the initiatives to pick up steam, TFCCI has launched challenges aimed at getting more campuses—and their students, faculty and employees—to give up their smokes.

>>Bonus Links:

Sep 10 2014
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Public Health News Roundup: September 10

EBOLA UPDATE: Death Toll Now to at Least 2,296
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The death toll from the ongoing Ebola outbreak in West Africa is now at least 2,296, according to the World Health Organization. However, the global health agency does not have the latest figures from Liberia—the country that has been hit hardest by the disease—making the true toll likely much higher. "It remains a very grave situation," said Liberian President Ellen Johnson Sirleaf on Tuesday, according to Reuters. "It is taking a long time to respond effectively .... We expect it to accelerate for at least another two or three weeks before we can look forward to a decline." As of Sept. 6 there were 4,293 recorded cases in five countries. Read more on Ebola.

Johns Hopkins Bloomberg School of Public Health, Clinton Foundation Announce Consensus Statement on Treating Prescription Drug Abuse and Misuse
The Johns Hopkins Bloomberg School of Public Health and the Clinton Foundation have released a consensus statement calling for a public health frame to analyze and disseminate proven, evidence-based intervention to combat prescription drug abuse and misuse. The statement is in response to President Clinton’s call-to-action on the subject in May of this year. “Prescription drug abuse and misuse, as well as widespread addiction and diversion of these products to the illicit market, represents one of the greatest challenges to our country’s public health in recent memory,” said Michael J. Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health, in a release. “This consensus statement marks a continuation of our school’s commitment, as well as that of the Clinton Foundation, to address epidemic rates of poisonings and deaths that are occurring due to prescription opioids and other prescription drugs that are highly prone to abuse and misuse.” According to the U.S. Centers for Disease Control and Prevention, drug overdoses killed 41,430 people in 2011, making it the leading cause of injury deaths. Read more on substance abuse.

CDC: 90% of Youth Ages 6-18 Consume Too Much Sodium
Approximately 9 in 10 U.S. children ages 6-18 consume more than the recommended amount of sodium, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). The report also found that approximately 43 percent of the sodium comes from the ten foods they eat the most often: pizza; bread and rolls; cold cuts/cured meats; savory snacks; sandwiches; cheese; chicken patties/nuggets/tenders; pasta mixed dishes; Mexican mixed dishes; and soups. “Too many children are consuming way too much sodium, and the result will be risks of high blood pressure and heart disease in the future,” said CDC Director Tom Frieden, MD, MPH, in a release. “Most sodium is from processed and restaurant food, not the salt shaker. Reducing sodium intake will help our children avoid tragic and expensive health problems.” Read more on nutrition.

Sep 9 2014
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The Ebola Response: Q&A with Laurie Garrett, Council on Foreign Relations

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Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.

Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.

NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?

Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.

NPH: How do you account for such a poor response?

Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly. 

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