Apr 18 2014
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Faces of Public Health: Esther Chernak, Drexel University School of Public Health

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The Center for Public Health Readiness and Communication (CPHRC) at the Drexel University School of Public Health in Philadelphia recently re-launched DiversityPreparedness.org, a clearinghouse of resources and an information exchange portal to facilitate communication, networking and collaboration to improve preparedness, build resilience and eliminate disparities for culturally diverse communities across all phases of an emergency. The site had originally been developed by Dennis Andrulis, now at the Texas Health Institute, and Jonathan Purtle, who co-writes a blog on public health for the Philadelphia Inquirer.

>>Bonus Links:

NewPublicHealth recently spoke with Esther Chernak, MD, MPH, the head of CPHRC, about the re-launched site and her work in preparedness.

NewPublicHealth: Tell us a little bit about your background and how you came to lead the Center for Public Health Readiness and Communication.

Esther Chernak: I’m an infectious disease physician by training and pretty much have been working in public health since I finished my infectious disease fellowship in 1991 at the University of Pennsylvania. I started working in the Philadelphia Department of Public Health in its city clinic system doing HIV/AIDS care, and then became the Clinical Director of HIV Clinical Programs for the health centers back in the early ’90s when the epidemic was obviously very different. I then moved to working in infectious disease epidemiology as a staff doctor in the acute communicable disease control program and was involved in infectious disease surveillance and outbreak investigations for a number of years.

Then in 1999, I took a job with the City Health Department in what was then called bioterrorism preparedness. That was the time when major cities in the country were just beginning to be funded to do bioterrorism response plans. Groups that were involved in bioterrorism preparedness recognized relatively quickly that despite the fact that we were dealing with planning for novel strains of influenza and pandemic preparedness and SARS and smallpox, we were also dealing with many, many really significant infectious disease outbreaks, and then ultimately non-infectious disease related issues that had huge impacts on public health, such as earthquakes and hurricanes. Those links helped prepare me for my role at the Center.

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Apr 18 2014
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Public Health News Roundup: April 18

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CDC: Mixed Progress in Food Safety Efforts
A new food safety progress report from the U.S. Centers for Disease Control and Prevention (CDC) shows mixed results for the country’s safety efforts. While the rate of salmonella infections was down approximately 9 percent in 2013 compared to the previous three years, campylobacter infections—often linked to dairy products and chicken—are up 13 percent since 2006-2008. The CDC also found that vibrio infections, which are often linked to raw shellfish, were at the highest level since tracking began in 1996. “This year’s data show some recent progress in reducing salmonella rates, and also highlight that our work to reduce the burden of foodborne illness is far from over,” said Robert Tauxe, MD, MPH, deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “To keep salmonella on the decline, we need to work with the food industry and our federal, state and local partners to implement strong actions to control known risks and to detect foodborne germs lurking in unsuspected foods.” The report’s data comes from the Foodborne Diseases Active Surveillance Network (FoodNet), a group of experts from CDC; ten state health departments; the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS); and the U.S. Food and Drug Administration (FDA). Read more on food safety.

FDA: Common Procedure to Remove Uterus, Uterine Fibroids Can Spread Cancer
A common procedure to remove the uterus or uterine fibroids can unintentionally spread cancerous tissue—such as uterine sarcomas—according to a new safety communication from the U.S. Food and Drug Administration (FDA), which is discouraging the use of laparoscopic power morcellation. The procedure divides the uterine tissue into smaller fragments in order to remove them via a small abdominal incision. “The FDA’s primary concern as we consider the continued use of these devices is the safety and well-being of patients,” said William Maisel, MD, MPH, deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health. “There is no reliable way to determine if a uterine fibroid is cancerous prior to removal. Patients should know that the FDA is discouraging the use of laparoscopic power morcellation for hysterectomy or myomectomy, and they should discuss the risks and benefits of the available treatment options with their health care professionals.” Read more on cancer.

Approximately 12M U.S. Outpatients Misdiagnosed Each Year
Approximately 12 million U.S. adults are misdiagnosed each year in doctors’ office and other outpatient settings, with an estimated half of those mistakes potentially leading to serious harm, according to a new study set to be published in the journal BMJ Quality & Safety. The overall total means about one in every 20 patients are misdiagnosed. For the study researchers used data from three studies covering a sample pool of approximately 3,000 medical records. "It's important to outline the fact that this is a problem," said Hardeep Singh, MD, the study's lead author and a patient safety researcher at Baylor College of Medicine and at the Michael E. DeBakey VA Medical Center, both in Houston, according to Reuters. "Because of the large number of outpatient visits, this is a huge vulnerability. This is a huge number and we need to do something about it.” Read more on access to care.

Apr 17 2014
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Recommended Reading: ‘Pollution is Segregated, Too’

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After decades of studies demonstrating that poor people and minorities are more likely than their white counterparts to live near health hazards such as toxic waste sites, landfills and congested highways, a new study in the journal PLOS One took a more refined look at a particular aspect in the area of “environmental injustice”: exposure to nitrogen dioxide. The pollutant—which is produced by cars, construction equipment and industrial sources—is linked to higher risk of both asthma and heart attack.

Using data from the 2000 Census, researchers determined that minorities are on average exposed to 38 percent higher levels of outdoor nitrogen dioxide. The gap varies depending where in the country they live, with the upper Midwest and the Northeast seeing the greatest disparities, as well as major cities. All told the disparity accounts for an additional 7,000 deaths due to heart disease annually.

"The biggest finding is that we have this national picture of environmental injustice and how it varies by state and by city," said Julian Marshall, a professor of environmental engineering at the University of Minnesota and one of the authors of the study, according to The Washington Post. "The levels of disparity that we see here are large and likely have health implications."

There are a number of possibilities to account for the disparities. For example, according to The Post, many “urban highways...were originally routed through minority communities that were politically easier to uproot than middle-class white neighborhoods” and “highways and landfills also depress nearby property values, meaning that people who can afford to live elsewhere do, while those who can't remain within their influence.”

Read the full story from The New York Times here.

>>Bonus Link: April is National Minority Health Awareness month. Read more of NewPublicHealth’s coverage of the annual event here.

Apr 17 2014
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Public Health News Roundup: April 17

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Study: Banning Chocolate Milk in Elementary Schools Also Decreases Overall Sales, Increases Waste
Banning chocolate milk in 11 Oregon elementary schools and replacing it with healthier fat-free white milk had the unintended consequence of reducing milk consumption overall, according to a recent study in the journal PLOS One. The study determined that the chocolate milk ban led to a 10 percent overall drop in milk sales; a 29 percent increase in the amount of wasted milk; drops in calcium and protein intake; and a 7 percent decrease in the number of students taking part in the Eugene School District's lunch program. "Given that the role of the federal school meal program is to provide nutritious meals to students who may otherwise have no access to healthy foods, I wouldn't recommend banning flavored milk unless you have a comprehensive plan in place to compensate for the lost nutrients when kids stop drinking milk altogether,” said Nicole Zammit, former assistant director of nutrition services at the Eugene School District in Oregon, in a Cornell University news release. The study was conducted by the Cornell Food and Brand Lab. Read more on nutrition.

CDC: Significant Drops in Five Major Diabetes-related Complications
The last two decades has seen declines in five major diabetes-related complications, according to a new study in the New England Journal of Medicine. Researchers at the U.S. Centers for Disease Control and Prevention (CDC) found declining rates of lower-limb amputation (about 50 percent), end-stage kidney failure (about 30 percent, heart attack (more than 60 percent) , stroke (about 50 percent) and deaths due to high blood sugar (more than 60 percent). “These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.” A recent study determined that approximately one in 10 U.S. adults have either type 1 or type 2 diabetes. Read more on diabetes.

FDA Sees Rising Number of Cases of Injuries Linked to E-cigarettes
The rising use of e-cigarettes has been accompanied by a rising number of injury complaints linked to e-cigarettes, including burns, nicotine toxicity, respiratory problems and cardiovascular problems, according to new data. From March 2013 to March 2014 there were more than 50 such complaints filed with the U.S. Food and Drug Administration (FDA), roughly the total reported over the previous five years. The findings come as the FDA prepares to regulate e-cigarettes and other "vaping" devices for the first time. Read more on injury prevention.

Apr 16 2014
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Future of Public Health: Q&A with Patrick Ten Eyck, PhD Candidate at the University of Iowa

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Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Patrick Ten Eyck, MS, a PhD candidate in the Department of Biostatistics at the University of Iowa’s College of Public Health, about what helped lead him to the field, his work in biostatistics to determine the impact of anti-bullying policies and where he hopes to go from here.

NewPublicHealth: What encouraged you to pursue a degree and career in public health?

Patrick Ten Eyck: I received my undergraduate degree in math because it’s been an interest of mine and then I got my Master’s in statistics because I found it to be the most interesting. I wasn’t really interested so much in the theory of statistics as much as the application. So, when I decided to pursue my PhD I thought biostatistics would be the perfect route because it applied my knowledge of statistics to really practical applications in the real world, especially public health. It’s convenient that the Biostatistics Department is in the College of Public Health at the University of Iowa. I have the opportunity to collaborate with other departments and help share our knowledge of statistics. Together, we can make sense of large data sets and hopefully get some very useful results out of it.

NPH: Do you have primary interests on the public health side of biostatistics?

Ten Eyck: Actually, when I started at the program I really didn’t have any particular area that I was that interested in researching. Obviously, one of the big areas that the Biostatistics Department pursues is medical data, but we also work with more broad areas than just medical data. We help out with occupational, environmental, community and behavioral health topics, too. These topics opened many more doors as far as piquing my interest in different areas. So, I still don’t have a particular area that I’m focused on, but I like to get involved in a lot of different areas because it’s really interesting to see what’s going on in the different fields.

NPH: Tell us more about the work you’ve done to analyze the bullying data in the Iowa Youth Survey?

Ten Eyck: Obviously, bullying has been quite a large focus, especially in the media lately with many stories of students being bullied in schools. So, the Iowa Youth Survey looks at data from 2005, 2008 and 2010 and now we just got the data set for 2012. There was an anti-bullying law passed in 2007 in the state of Iowa that outlines what bullying is and helps teachers to recognize bullying and intervene to prevent it as best as possible. A survey was given to sixth-, eighth- and eleventh-grade students throughout the state of Iowa and more than 250,000 students filled out the survey and gave information.

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Apr 16 2014
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Public Health News Roundup: April 16

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Study: More ‘Masculine’ and ‘Feminine’ Youth at Higher Risk for Cancer-risk Behaviors
The most “feminine” girls and the most “masculine” boys are also the most likely to engage in behaviors that pose cancer risks, according to a new study in the Journal of Adolescent Health. Researchers at the Harvard School of Public Health (HSPH) analyzed data on 9,354 adolescents in the ongoing Growing Up Today Study, finding that cancer-risk behaviors such as tobacco use, indoor tanning and physical inactivity were significantly more common in adolescents who more closely adhered to the traditional societal norms of masculinity and femininity. "Our findings indicate that socially constructed ideas of masculinity and femininity heavily influence teens' behaviors and put them at increased risk for cancer,” said lead author Andrea Roberts, research associate in the Department of Social and Behavioral Sciences at HSPH. “Though there is nothing inherently masculine about chewing tobacco, or inherently feminine about using a tanning booth, these industries have convinced some teens that these behaviors are a way to express their masculinity or femininity." Read more on cancer.

Study: Casual Marijuana Use Can Cause Dangerous Changes in Youths’ Brains
Casual marijuana use in young people can lead to potentially harmful changes in the brain, according to a new study in the Journal of Neuroscience. Researchers from Northwestern University's medical school, Massachusetts General Hospital and Harvard Medical School determined that casual marijuana smoking—defined as one to seven joints per week—could lead to changes to the nucleus accumbens and the nucleus amygdale, which help regulate emotion and motivation. "What we're seeing is changes in people who are 18 to 25 in core brain regions that you never, ever want to fool around with," said co-senior study author Hans Beiter, PhD, professor of psychiatry and behavioral sciences at Northwestern University, according to Reuters, adding, "Our hypothesis from this early work is that these changes may be an early sign of what later becomes amotivation, where people aren't focused on their goals.” Read more on substance abuse.

CDC: ‘Herd Immunity’ Helped Reduce H1N1 Flu Strain’s Impact This Season
While the H1N1 influenza strain was the predominant strain in the United States this past flu season, prior widespread exposure and its inclusion in the current flu vaccine meant it did not have nearly the impact it did in 2009, according to the U.S. Centers for Disease Control and Prevention (CDC). According to Michael Jhung, MD, a medical officer in the CDC’s influenza division, an overall “herd immunity” helped stop this season from turning into the worldwide pandemic seen in 2009. "This year, not only do we have a vaccine that works well, but millions of people have already been exposed to the H1N1 virus," he said, according to HealthDay. The flu strain also hit differently this season, peaking earlier, although once again younger adults were affected more than the elderly. Read more on the flu.

Apr 15 2014
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Recommended Reading: Where Teens Spend Their Time

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A new article from The Atlantic Cities reports on a recent study that finds that restaurants are shifting to become the predominant teen hang-out spot, rather than the malls of the past. According to a recent report on teen behavior, teenagers now spend more money on food and events than on clothes. And while an increase in mall closings may be driving younger people to eateries, the report finds that a greater interest in hanging out at restaurants also drove some of the drop in mall traffic—along with competition from the Internet.

The report doesn’t say what the teens are eating while they mingle, but the trend comes at a good time for them to access information on healthier diets, as under the Affordable Care Act many restaurants must now post nutrition information. Though studies have been mixed about the results of menu labeling, the U.S. Centers for Disease Control and Prevention notes that, overall, public health studies may be beginning to show that menu labeling may influence consumers to choose healthier options. And while many food outlets have chosen to share that information online rather than on walls, digital-savvy teens may already have the tools to find it—though they may need a push from social media or other educational outreach channels to do so.

Read the article from The Atlantic Cities.

Apr 15 2014
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Public Health News Roundup: April 15

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Urban Gardeners May Be Unaware of Harmful Soil Contaminants
In their quest to consume healthier foods, urban gardeners may actually be unaware of the presence of soil contaminants and how to deal with the issue, putting both gardeners and consumers at risk, according to a new study in PLOS One. Potential contaminants include heavy metals, petroleum products and asbestos, which can result when urban soil is near pollution sources, such as industrial areas and roads with heavy traffic. “Our study suggests gardeners generally recognize the importance of knowing a garden site’s prior uses, but they may lack the information and expertise to determine accurately the prior use of their garden site and potential contaminants in the soil,” said Keeve Nachman, PhD, senior author of the study and director of the Food Production and Public Health Program with the Johns Hopkins Center for a Livable Future. “They may also have misperceptions or gaps in knowledge about how best to minimize their risk of exposure to contaminants that may be in urban soil.” Read more food safety.

Study: 1 in 10 U.S. Adults Have Diabetes
Nearly one in 10 U.S. adults had diabetes in 2010, nearly double the percentage a little more than two decades ago, in 1988, according to a new study in the Annals of Internal Medicine. The study determined that 21 million American adults—or 9.3 percent of all American adults—had either type 1 or type 2 diabetes in 2010. As many as 95 percent of diabetes cases are type 2 cases. "This study also highlights that the increase in diabetes really tracks closely with the epidemic of obesity,” said Elizabeth Selvin, the study's lead author and an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. “The diabetes epidemic is really a direct consequence of the rise in obesity.” However, the report did find that cases of undiagnosed diabetes were down, indicating new screen techniques are effective. It also found that overall blood sugar control was improved. Read more on obesity.

U.S. Health Care Costs Climbed 3.2% in 2013, to $329.2 Billion
The cost of new medicines, price increases on some branded drugs and patent expirations helped cause the first rise in the overall cost of health services in the United States in three years, according to a new report from IMS Health Holdings Inc., a health care information company. Americans spent a total of $329.2 billion on health services in 2013, up from 3.2 percent from 2012, which had seen a 1 percent decline. However, the report noted that expanded use of cheaper generic drugs—86 percent of all prescription drugs—did help costs from rising even higher. Read more on access to health care.

Apr 14 2014
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Upcoming Webinar: Public Health Perspectives in Regulating Non-Medical Marijuana

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 On Thursday, April 17, from 1-2 p.m. (ET), the Network for Public Health Law, Public Health Law Research and the American Society of Law Medicine and Ethics (ASLME) will be holding a free webinar around public health perspectives on regulating non-medical marijuana in states where it has been made legal or decriminalized. Whatever course a state may take, public health’s expertise and experience in public policy means it should be a major voice in the discussion surrounding legislation from the very start. The issue is a critical one now as Colorado and Washington State have legalized the commercial production, distribution and sale of marijuana for non-medical use and a number of other states are considering similar legislation.

“Policy-makers, advocates and others are grappling with how to process licenses, develop regulations and manage production in an industry that is still largely illegal both in the U.S. and around the world,” said Alexander Wagenaar, PhD, Professor in the Institute for Child Health Policy at the University of Florida who will be the moderator for the webinar.

The webinar’s aim is to provide an overview of issues related to non-medical marijuana regulation through, among other things, the lessons learned from decades of alcohol and tobacco regulation and through insights from Washington State’s recent implementation of a marijuana law with participant Laura Hitchcock, JD, Policy, Research & Development Specialist in the public health department of Seattle & King County in Washington State. Additional speakers include Beau Kilmer, PhD, Co-Director of the RAND Drug Policy Research Center and Amanda Reiman, PhD, the Policy Manager of the Drug Policy Alliance of California.

>>Register for the webinar Regulating Non-Medical Marijuana: Lessons Learned and Paths Forward.

Ahead of the webinar, NewPublicHealth spoke with Wagenaar about who in public health will find the webinar important, as well as public health’s role both before and after a jurisdiction considers legalizing non-medical marijuana.

NewPublicHealth: Who is the webinar primarily geared toward?

Alexander Wagenaar: There are lots of different audiences that are interested in this, including the public health research community such as academics, scientists, health department and agency staff who are looking at the issue or will be looking at it in the future.

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Apr 14 2014
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Public Health News Roundup: April 14

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Study: Mean Devices Approved for Pediatric Use Never Tested on Kids
The majority of medical devices recently approved for pediatric use were never actually tested on kids, but rather only on people ages 18 and older, according to a new study in the journal Pediatrics. Researchers analyzed the clinical data used to get each device approved, finding that 11 of 25 examined devices were not tested on any patient age 21 and younger, and that only four had been tested on patients under the age of 18; three devices were specifically approved for patients under age 18, while the test were approved for people ages 18 to 21. "Children are not simply 'small adults,' and a device found to be safe and effective in adults may have a very different safety and effectiveness profile when used in a pediatric population," said Brigham and Women's Hospital and Harvard Medical School research fellow Thomas J. Hwang, one of the study’s authors, according to Reuters. "Without this data, it is difficult for clinicians and parents to make informed treatment decisions that weigh the risks and benefits of a particular treatment.” Read more on pediatrics.

Kaiser Report Examines Employer-Sponsored Retiree Health Benefits
A new report from the Kaiser Family Foundation on employer-sponsored retiree health benefits for pre-65 and Medicare-eligible retirees finds that the percentage of employers sponsoring retiree health coverage has declined, while employers that offer coverage are redesigning their plans almost annually in response to rising health care costs. The report, Retiree Health Benefits At the Crossroads, also examines the effect of recent legislation on retiree health coverage, such as the Medicare drug benefit and the Affordable Care Act. Read more on aging.

Study: Fewer Blood Transfusions Would Mean Fewer Infections
The increased use of blood transfusions in hospitals also leads to the increased risk of infection, according to a new study in the Journal of the American Medical Association. In a review of 21 randomized control trials, researchers from the University of Michigan School of Public Health determined that for every 38 patients considered for a red blood cell transfusion, the reduction of transfusions would mean one patient did not develop a serious infection, with the elderly undergoing hip and knee surgeries benefiting the most. “The fewer the red blood cell transfusions, the less likely hospitalized patients were to develop infections, “ says lead author Jeffrey M. Rohde, MD, assistant professor of internal medicine in the division of general medicine at the U-M Medical School, in a release. “This is most likely due to the patient’s immune system reacting to donor blood (known as transfusion-associated immunomodulation or TRIM). Transfusions may benefit patients with severe anemia or blood loss; however, for patients with higher red blood cell levels, the risks may outweigh the benefits.” Read more on prevention.