Category Archives: Recommended Reading
On a busy night at the Stamford (CT) Hospital ER on the snowy East Coast this past holiday weekend, wait times for emergencies were just minutes thanks to a system that has a technician take vital signs within moments of patients walking through the entrance. Those metrics are passed to the medical staff to review in a room just a couple of steps from the reception area which, through a back door, opens onto several emergency suites where treatment can begin almost instantaneously. Contrast that with recent reports of hours-long waits, reduced staff and insufficient equipment at many rural hospitals, which often face budget, staff and equipment constraints.
One solution may be sharing those resources, according to a new study in Health Affairs by researchers at the University of Iowa College of Public Health. The researchers evaluated a tele-emergency service in the upper Midwest that provides 24/7 connection between an urban “hub” emergency department and 71 remote hospitals. At any time, clinical staff at the remote hospitals can press a button for an immediate audio/video connection to the tele-emergency hub Emergency Department.
A survey of the staff members at the rural hospitals found that 95 percent of those responding found that that the relationship significantly improve care for their patients in several ways:
- Improved quality of care
- Provided clinical second opinions for the rural medical staff
- Increased the use of evidence based treatment
“Tele-emergency improves patient care through integrated services that deliver the right care at the right time and the right place,” says Keith Mueller, PHD, head of the Department of Health Management and Policy and lead author of the report. “Our country’s health care system is in a massive state of change, and it’s through services such as this that we’ll be able to address patient need and assist in the financial concerns of smaller medical care units.”
Read the Health Affairs abstract.
A recent essay by columnist Nicholas Kristof of The New York Times looked at a critical problem faced by jails across the country, which often double as behavioral health treatment centers. For many inmates, mental health problems have been the significant factor in committing a crime, with some even purposely flouting the law in the hopes of getting into jail where they can get free treatment. As a result, the United States has a national inmate population where half of all male inmates and three quarters of all female inmates have a behavioral health condition.
Solutions are beginning to emerge, though critical problems remain. At a recent health initiatives forum convened by the National Association of Counties and held in San Diego, county health officials talked about the promise of the Affordable Care Act, which will allow jail health specialists to help enroll inmates in coverage in advance of their discharge to help continue care—behavioral and physical—outside of jail.
Read the full column here.
>>Bonus Link: Read NewPublicHealth’s coverage of the recent NACo Health Initiatives Forum.
In reaching teens, crisis hotlines have had to adapt not only to what they say, but how they say it. While counseling teens by phone is still the dominant method of communication, texting has become a popular way for teens to contact crisis centers in their times of need. A recent story in The New York Times takes a look at what Crisis Text Line and other centers have accomplished in the field of helping teens using their preferred medium of communication.
For troubled teens, texting offers a critical element of privacy if they feel threatened by someone nearby and allows them to look and feel more natural if they are in a public space. Benefits for crisis counselors include the ability to deal with more than one person at a time and to introduce experts into the conversation without a lapse in contact. Organizations such as Crisis Text Line that offer text counseling report receiving messages from teens who might not have otherwise contacted the hotline by phone. People who text hotlines for help receive the same services as callers—risk assessment, emotional validation and problem solving—but the interactions are often longer and more direct than phone calls.
In addition to offering an effective way to communicate with teens, texting provides data and trends about people in different types of crises. “My dream is that public health officials will use this data and tailor public policy solutions around it,” says Nancy Lublin, founder of Crisis Text Line. The organization plans to compile the data and make it available to the public this spring.
The use of texting has extended beyond crisis centers. The four largest phone companies in the United States recently promised to make 911 texting possible by May for local response services that request the option.
Read more at The New York Times.
Texting while walking can have a way of changing where we go...such as into a tree trunk or a fountain. However, a recent study in the journal PLOS ONE finds that texting also dramatically changes how we walk.
Researchers from the University of Queensland in Australia analyzed 26 health people while walking normally, while reading texts on a cell phone, and while writing a text themselves. They looked at speed and gait, as well as the positions of their heads, torso and arms.
They found that, essentially, when we walk and text we walk in a way that makes texting easier. That focus has a significant impact on our movements, which limits the health benefits of the physical activity.
“We walk much slower when handling a cell phone (even moreso while texting than reading), and we're not very good at sticking to a straight line. Not surprisingly, we tend to keep our heads down, our necks immobile, and our arms locked at our sides. We don't swing our arms, which can be a crucial part of staying balanced while moving.”
Read more at Atlantic Cities.
A new report from the University of Michigan School of Public Health and published in the journal Environmental Health Perspectives urges government at the local, state and federal levels to address noise pollution, which the study estimates impacts 104 million Americans. The researchers say noise not only impacts hearing, but also contributes to heart disease, hypertension, sleep disturbances, stress, learning difficulties and even injuries.
"Everyone complains about noise, yet we do virtually nothing about it in this country," says Richard Neitzel, PHD, assistant professor of environmental health sciences at the School of Public Health and a co-author of the new report. “Noise is really up there in terms of health problems it causes, but it gets no attention—especially compared to other common exposures such as air pollution.”
Links between noise and health impacts are still being studied, but stress is thought to be a key factor.
The report suggests that noise be included in the federal public health agenda and recommends areas for regulation to reduce noise levels, including setting emission levels, improving information dissemination about the dangers of noise and a call to conduct more research to better understand the impact of noise on the population. Neitzel’s report includes recommendations for the National Prevention Strategy, a strategy to achieve prevention efforts across federal agencies:
- Exert noise control through direct regulation, setting maximum emissions levels.
- Require emissions disclosure on products, such as children’s toys.
- Improve information dissemination about the dangers of noise.
- Conduct more research to fully understand the impact of noise on the population.
The researchers also suggest ways state and local governments could fill the gaps:
- Enact regulations on sources of noise that aren’t covered by the Environmental Protection Agency or other federal agencies.
- Adopt procurement policies to reduce community noise caused by construction, emergency vehicles and maintenance equipment.
- Take steps to build or renovate housing that protects people from noise health initiatives across the federal government.
>>Bonus Link: Read a NewPublicHealth blog about a study by a visiting attorney fellow of the Network for Public Health Law on the health impacts of environmental noise.
To mark the 50th anniversary of the 1964 first Surgeon General’s Report on Smoking and Health, JAMA, the Journal of the American Medical Association, released a theme issue this week on fifty years of tobacco control. The study getting the most attention is one by researchers at several medical centers and schools of public health, who estimate that tobacco control efforts in the United States since 1964 have added decades to the lives of eight million American.
Other tobacco topics in the issue include:
- Adults with mental illness have a harder time quitting tobacco than do other smokers
- Smoking rates among most health care providers have dropped sharply in recent years, with the exception being licensed practical nurses
The issue also has several opinion pieces on tobacco-related issues, including one co-written by JAMA Editor Helene Cole, MD, and Michael Fiore, MD, MPH, director of the University of Wisconsin Center for Tobacco Research and Intervention, who call for key tobacco policy changes such as:
- Increasing tobacco taxes
- Stronger application of U.S. Food and Drug Administration (FDA) regulation of tobacco products, including cigars and e-cigarettes
- Massive public health campaigns
In fact, the FDA has announced it will spend $300 million in 2014 on ads urging teens to be tobacco free, and the U.S. Centers for Disease Control and Prevention plans to continue its “Tips from Former Smokers” campaign.
>>Bonus Link: Read a NewPublicHealth post on the press conference yesterday by the major tobacco control advocacy groups to mark the 50th anniversary of the 1964 Surgeon General Report on Smoking and Health.
A new study published recently in the American Journal of Public Health finds that non-medical exemption laws for vaccines required for school or daycare admission have significantly impacted the vaccination rates of at least one disease. The researchers reviewed relevant laws and regulations for each year between 2001 and 2008 and rated them on their restrictiveness in granting exemptions. The study was funded by a grant from the Public Health Law Research program, a national program of the Robert Wood Johnson Foundation.
According to the study, state laws that make it difficult for children to be exempted from vaccines on religious or philosophical grounds could reduce the number of whooping cough cases, but did not have an impact on cases of measles, mumps, haemophilus influenza type B (Hib) or Hepatitis B.
“Our research shows that during the study period, if all states increased the restrictiveness of their non-medical exemption laws by one level, the number of U.S. whooping cough cases would decline by 1.14 percent, resulting in 171 fewer cases per year,” according to study author Y. Tony Yang, ScD, MPH, associate professor at the College of Health and Human Services at George Mason University.
The study found that the impact on whooping cough may be greater than for the other diseases studied simply because whooping cough affects more people. Researchers call this a “threshold effect,” which means laws may not have a significant impact unless they works to prevent a disease that affects a critical mass of people. During the study period, whooping cough was much more prevalent than the four other diseases studied—the average incidence rate for whooping cough was 18 per 100,000 individuals from 2001 to 2008. For Hib, Hepatitis B, measles, and mumps, the mean incidence rates were less than 1 per 100,000.
It was 10 years ago that the Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century's released a report calling for an accreditation process for the nation’s public health departments. That recommendation led to the creation of the Public Health Accreditation Board (PHAB), which earlier this year named the first eleven departments to receive accreditation—there are now 22 accredited health departments.
Writing in a special issue of the Journal of Public Health Management and Practice that is dedicated to public health accreditation, Kaye Bender, PhD, RN, FAAN, and Carole Moehrle, BSN, RN, looked back on the first year, how the inaugural departments were selected and how they see accreditation changing the public health landscape moving forward. Bender is PHAB’s president and CEO, and Moehrle is chair of its executive committee.
“The first year of realizing the goal of accredited health departments has been outstanding, not only from the standpoint of reaching that goal but also from the perspective of experiencing firsthand what the public health community across this country can do when we all work together on a common goal,” they wrote in the article, PHAB: Reflections From the First Year of Accreditation. “As the next years unfold and accreditation changes with the inevitable changes in the public health practice environment, these initial days will long be remembered for establishing a sound foundation upon which to build.
Writing in the same issue, Pamela Russo, MD, MPH, and Paul Kuehnert, DNP, RN, in their commentary, Accreditation: A Lever for Transformation of Public Health Practice, discussed the role that the Robert Wood Johnson Foundation and other organizations played in making accreditation a success. Accreditation, they wrote, is a way for a public health department to demonstrate to its community that it’s committed to accountable, transparent and quality care.
“Those who have perceived health departments as simply administrative sites for a collection of miscellaneous services are beginning to recognize that accredited health departments are mission-driven organizations of excellence that are implementing strategic plans to improve and protect the health of their communities,” wrote Russo and Kuehnert. “Accreditation is rapidly proving itself to be a powerful lever for the transformation of public health practice.”
>>Bonus content: RWJF Senior Program Officer Pamela Russo recently sat down for an interview on the National Association of County & City Health Officials (NACCHO) podcast. Listen to Russo discuss how local partnerships can contribute to and improve community health.
Recommended Reading: ‘Retweet This’—Researchers See Rise in Use of Twitter to Share Scientific Journal Articles
The top two tweeted peer-reviewed science articles between 2010 and 2012 were about the effect of radiation on humans, according to a study published in the Journal of the Association for Information Science and Technology. Researchers reviewed 1.4 million articles to determine the most tweeted studies. Runners up in the top 15 of the most tweeted articles included studies on acne in teenagers and the link between physical activity and mortality rates. Nature, a highly regarded journal, received the most tweets: 13,430 Twitter mentions of 1,083 papers.
However, the researchers found that a retweet rate doesn’t necessarily correlate with a high rate of citations for an article in other studies, which is a standard measurement of significance for a scientific study. The most tweeted study—on genetic changes during radiation exposure—was tweeted 963 times but was cited in journals only nine times.
"The most popular scientific articles on Twitter stress health implications or have a humorous or surprising component. This suggests that articles having the broadest scientific impact do not have the widest distribution," said Stefanie Haustein, of the University of Montreal School of Library and Information Science, and a co-author of the study.
Still, the researchers say the increase in tweets that include a link or description of scientific studies is important even if the rates don’t correlate with journal citations. For one thing, the number of scientific researchers on Twitter is still low and “the fact that more and more articles are tweeted [at all] is good news because it helps scientific communication [and] regardless of whether non-scientists are sending this information, it proves that science is an aspect of general culture,” said Vincent Larivière, PHD, a co-author of the study and professor at the University of Montreal, who holds the Canada Research Chair on the Transformation of Academic Communication.
Read the full study.
Beginning later next year, more than a million workers in New York City will have a brand new, health-promoting benefit: paid sick leave days that guarantee wages on a set number of days when they or a family member they care for is ill.
The new law, passed last June by the New York City Council and overriding an earlier veto by the mayor, begins to go into effect in April 2014. New York now joins San Francisco, Calif., Washington, D.C., Seattle, Wash., Portland, Ore., and the state of Connecticut in adopting at least some sick leave provisions.
Not every employee in New York City will get paid sick leave under the new law. The bill that passed the City Council initially applies only to businesses with 20 or more employees, who will be required to provide five paid sick days a year; that extends to companies with 15 or more employees beginning October 1, 2015. Smaller businesses and manufacturing firms are exempt from the paid leave provisions for now, though these workers will gain five days of unpaid sick leave, so they can take time off without fear of losing their jobs. Advocates hope to extend paid leave to cover those workers before long.
Advocates say paid sick leave is critical for smaller businesses, and especially for low wage earners. A survey by the Community Service Society (CSS) of New York found that half of low-income respondents said they have less than $500 to fall back on in case of an emergency, and according to CSS, without compensation for sick days, people are often forced to choose between caring for themselves or a loved one and heading to work.
A 2012 study in the American Journal of Public Health shows why the measure that is critical to individuals and families is equally crucial to society as a whole. The study found that lack of certain workplace policies, including paid sick leave, led to an additional 5 million cases of adult H1N1 (swine flu) during the 2009 outbreak.
Funding for much of CSS’s advocacy came through a County Health Rankings & Roadmaps grant to focus on four areas in two New York City boroughs, the Bronx and Brooklyn, that have very poor health rankings. The goal was to build support among small businesses, faith-based organizations and low-wage workers for passage of the ordinance through grassroots events, town halls, story collection and media coverage, as well as by encouraging partners and allies to include this policy as part of their policy agendas. The grant runs through November 2014 and CSS will be focusing its efforts, now that legislation has passed, on creating awareness and implementation of the new law.
NewPublicHealth recently spoke with Nancy Rankin, vice president for policy, research and advocacy at CSS about the new law and its impact.
NewPublicHealth: Key components of the legislation you advocated for passed. What’s next in your efforts on paid sick leave?
Nancy Rankin: We are continuing to work on this issue because we recognize that having a law pass is not the end of the story. We now need to do outreach to inform workers about their new rights and employers about their new requirements, because a new law requires compliance and it requires people to be aware of its provisions.