As colder weather begins to set in, a new story on the homeless from Atlantic Cities is particularly striking: According to the U.S. Department of Education, the number of homeless students in the United States has hit a record high number.
For the 2011 school year—the latest year for which the department has data—1,168,354 homeless children were enrolled in U.S. schools from nursery through 12th grade. Nationally, that is a 10 percent jump over the previous school year, and a whopping 72 percent increase since the recession began in 2008. More striking numbers: more than 40 states showed a rise in homelessness among kids and ten states saw the number of kids without a space to call their own rise more than 20 percent since 2008.
The lack of a safe home and limited access to health care leaves America’s homeless at especially high risk for a large number of health problems. According to a fact sheet from the National Health Care for the Homeless Council, “Without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems.”
>>Bonus link: Continue reading even after the numbers jump out at you to learn about a ten year old girl, reported by the San Jose Mercury News, who rides a bus with her father in Santa Clara County, Calif., each night since the $70 monthly pass makes it an affordable option. The fact that the young girl is having “one of her best years so far in school,” according to her father, is all the more remarkable considering they have to get off and reboard that bus about every two hours.
NHTSA: Motorcoaches, Large Buses to Require Seatbelts for All Passengers and Driver
New motorcoaches and large buses will be required to provide lap and shoulder seatbelts for all passengers and driver, under a new rule issued by the U.S. Department of Transportation's National Highway Traffic Safety Administration (NHTSA). While the buses are an overall safe way to travel, the large numbers of people they carry and the high speeds at which they travel mean a single collision can lead to a significant number of injuries, according to NHTSA. An average of 7,934 riders are injured each year in motorcoaches, and an average of 21 passengers are killed. "Buckling up is the most effective way to prevent deaths and injuries in all vehicular crashes, including motorcoaches," said Federal Motor Carrier Safety Administrator Anne S. Ferro, in a release. "Requiring seat belts in new models is another strong step we are taking to reach an even higher level of safety for bus passengers." The rule will apply to buses with a gross vehicle weight rating (GVWR) greater than 26,000 pounds,) excluding transit buses and school buses. Read more on transportation.
Study: Women With Breast Cancer Should Get Mammograms Every 12 to 18 Months
Breast cancer patients should undergo mammograms every 12 to 18 months to determine whether their cancer has spread to the lymph nodes, according to a new study to be presented today at the annual meeting of the Radiological Society of North America. Study researcher Lilian Wang, MD, evaluated more than 300 women who were diagnosed with breast cancer because of a routine mammogram, dividing them into three groups based on their treatment history. She found that only 9 percent of the women who had 12- to 18-month intervals between mammograms saw their cancer spread to their lymph nodes; the rates were 21 percent for those who waited one-and-a-half to three years and 15 percent for those who waited three or more years. "If you catch someone with early stage cancer, they are going to need less extensive surgery, and maybe no chemo," said Laura Kruper, MD, director of the Cooper-Finkel Women's Health Center at the City of Hope Cancer Center, in Duarte, Calif., who was not a part of the study. "[The new study] adds more power behind the fact that we do need screening mammograms starting at age 40 and every year.” Read more on cancer.
FDA: Certain HeartStart AEDs May Not Work During Cardiac Emergencies
The U.S. Food and Drug Administration (FDA) announced yesterday that certain automated external defibrillator (AED) devices made by Philips Medical Systems may not function properly when needed. In a new safety communication, FDA revealed that the devices may not deliver the needed shock to restore normal heart rhythm during a cardiac emergency. “The FDA advises keeping all recalled HeartStart AEDs in service until you obtain a replacement from Philips Healthcare or another AED manufacturer, even if the device indicates it has detected an error during a self-test,” said Steve Silverman, director of the Office of Compliance in the FDA’s Center for Devices and Radiological Health. “Despite current manufacturing and performance problems, the FDA considers the benefits of attempting to use an AED in a cardiac arrest emergency greater than the risk of not attempting to use the defibrillator.” Read more on heart health.
Several weeks ago, the Harvard School of Public Health celebrated its Centennial with fanfare, fundraising and a panel discussion featuring world health leaders who are graduates of the school. Following the centennial, NewPublicHealth spoke with the School’s Dean, Julio Frenk, MD, MPH, PHD, who has a joint appointment at the Harvard Kennedy School of Government. He is also a former health minister of Mexico and a former senior fellow in the global health program of the Bill and Melinda Gates Foundation.
NewPublicHealth: What do you think have been the key changes in public health efforts since the Harvard School of Public Health was founded 100 years ago?
Julio Frenk: The 100 years that have passed since the School of Public Health was founded are not just any 100 years—they’re the 100 years with the most intense transformations in health in human history. We have seen a more than doubling of life expectancy since the school was founded. Around 1900, the global average for life expectancy was 30 years. At the end of the century, the global average was about 65 years. It more than doubled in the 20th century, and that increase has continued with some setbacks, most notably the AIDS epidemic in Saharan Africa. And we have had a qualitative shift not just in the level of mortality, but in the causes of death. So we went from a preponderance of acute infections to now a predominance of mostly chronic non-communicable diseases, and that’s an incredible transition.
A critical change is that the experience of illness became very different starting from the beginning of the 20th century. Before then, illness was mostly a succession of acute episodes, from which one either recovered or died. If you recovered, you went on to get your next acute illness. Now, illness is more a condition of living. People live with cancer. People live with AIDS. So that’s a big transformation of the patterns of health, disease and death.
Another big change is the emergence of complex health systems, and that’s—again—a process that started at the beginning of the 20th century. Before the 20th century, the social function of the sick was mostly trusted to undifferentiated institutions, such as the family or religious institutions, and it’s not until the 20th century when you see this incredible explosion of specialized institutions and specialized human resources, doctors, nurses and other health professionals. In the 20th century, healthcare is 10 percent of the global economy and employs millions of people, including eight million doctors. These are all profound transformations.
NPH: How has the training of students of public health changed in the last 100 years?
Frenk: There has been profound change. What happened at the beginning of the 20th century was the emergence of public health as a field of action. The practices of engineering emerged in Europe, especially with the rapid urbanization there starting around the 17th century, but then greatly expanded in the 18th century. Engineering allowed for access to clean water and taking care of waste, which resulted in some diseases coming under control. In the 19th century the discovery of microbiology gave rise to the abolishment of the germs as causes of illness. That is the junction that gives birth to public health, along with the idea of social policy, of social activism that actually changed social conditions. It’s in that mix that public health gets shaped.
NIH to Direct Additional $100M Toward Research in an HIV Cure
The National Institutes of Health (NIH) has announced plans to invest an additional $100 million over the next three fiscal years in research directed toward a cure for HIV. Over the past three decades, NIH-funded research has led to the development of more than 30 antiretroviral drugs and drug combinations targeting HIV. Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases, said that growing knowledge about HIV, along with the development of new treatment strategies, makes the moment “ripe to pursue HIV cure research with vigor.” “Although the HIV/AIDS pandemic can theoretically be ended with a concerted and sustained scale-up of implementation of existing tools for HIV prevention and treatment, the development of a cure is critically important, as it may not be feasible for tens of millions of people living with HIV infection to access and adhere to a lifetime of antiretroviral therapy,” he said in a statement. Read more on HIV/AIDS.
Hong Kong Announces First Human Case of H7N9 Avian Flu
H7N9 avian flu appears to have spread from mainland China, with Hong Kong reporting its first human case of the deadly avian flu strain. A 36-year-old Indonesian domestic helper is in critical condition after travelling to Shenzhen and buying, slaughtering and eating an apparently infected chicken. Earlier this year a report of human infection in Shanghai was quickly followed by the confirmation of more than 100 cases. While closing down live poultry markets in the area caused the number of new cases to drop, the World Health Organization has confirmed a total of 139 cases and 45 deaths. Ko Wing-man, Hong Kong's secretary for food and health, said Hong Kong has raised its level of preparedness for an avian flu pandemic to "serious," and the city has suspended the importation of live chickens from certain Shenzhen farms as it also investigates its own stock. Read more on infectious disease.
Study: ‘Benign’ or ‘Healthy’ Obesity May Not Exist
Despite what some health professionals believe, “benign obesity” may not exist, according to a new study in the Annals of Internal Medicine. People who are overweight or obese without health issues such as high blood pressure, diabetes or other metabolic issues are still at increased risk of major health problems when compared with metabolically healthy, normal-weight people. The researchers looked at the results of eight studies covering more than 61,000 people, finding that in follow-ups of at least 10 years later the people who were overweight but without the risk factors were still at an increased risk of 24 percent for heart attack, stroke and even death. One explanation could be that these overweight people without the risk factors actually do have the risk factors, only at low levels that are difficult to detect, and that then become gradually worse. The results indicate that physicians should look at both body mass and metabolic tests when determining a patient’s health. Read more on obesity.
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
Study: Gay, Bisexual Men Who Know Their HIV Status Less Likely to Engage in Risky Sex
Gay and bisexual men who know their HIV status are far less likely to engage in unprotected sex, which in lessens the sexual risk both for them and for their partner, according to the U.S. Centers for Disease Control and Prevention's (CDC) latest Morbidity and Mortality Weekly Report. An analysis of HIV-positive men who have sex with men (MSM) in 20 U.S. cities found that about 33 percent of those who did not know their status engaged in unprotected sex with a partner, and also did not know the status of the partner; men who knew their status were 60 percent less likely to do so, for an overall rate of 13 percent. MSM account for about two-thirds of new HIV infections and about half of the 1.1 million people in the United States with HIV. "While we remain concerned about potentially increasing levels of sexual risk, it is encouraging to see that risk is substantially lower in those who know they have HIV," said CDC Director Tom Frieden, MD, MPH. "HIV testing remains one of our most powerful tools to reverse the epidemic. Everyone should know their HIV status." Read more on HIV/AIDS.
Improved HealthCare.gov Faces Next Challenges
HealthCare.gov, the online portal for the Affordable Care Act, faces another test starting today as the Obama administration announced it met a weekend deadline to make the site easier to use and more accessible for most users. The original launch of the site was met with must frustration across the county as many people were unable to navigate the site properly or even to log in. The administration now expects a rush of people--both a backlog and people who have yet to try the site--to enroll by the December 23 deadline for coverage that would begin January 1. Multiple organizations, including Enroll America and AIDS Alabama, have announced plans to help people enroll. Jeffrey Zients, an administration advisor, warned that the post-Thanksgiving wave of enrollment could still overwhelm the servers at times. Read more on the Affordable Care Act.
Study: Energy Drinks Can Increase Strain on Heart
People who consume energy drinks can experience rapid heart contractions and increased strain on the heart up to an hour later, according to new research to be presented today at the annual meeting of the Radiological Society of North America, in Chicago. The findings raise concerns over the effects of caffeine and taurine on heart health, especially for people who already suffer from heart disease. Researchers used magnetic resonance imaging to measure the heart function of 18 health people both before and after they consumed an energy drink, finding an average 6 percent increase in the heart contraction rate afterward. "We know there are drugs that can improve the function of the heart, but in the long term they have a detrimental effect on the heart," said Williams, a cardiology professor at Wayne State University School of Medicine, in Detroit. Researchers noted that further study is needed to determine the reason for the apparent link. Read more on heart health.
Among the best pieces of advice people can look to today, the day before Thanksgiving, is a primer on safe food preparation from the U.S. Food and Drug Administration, including a video on just how to stuff that turkey.
Additionally, when it comes to safety this holiday season, there are also ways to help keep yourself and your purchases safe as Thanksgiving morphs into Black Friday. Tech guru Shelly Palmer reported recently that, according to the New York City police department, 14 percent of crime in that city is linked to Apple computer products, while police in other cities note technology thefts of all kinds as the holiday shopping season gets into full swing. Apple is alerting buyers of the latest model iPhones that the devices now come with a security feature that requires a User ID and password to disable the "Find my Phone" feature, which helps police track down stolen phones. Tech experts say widespread use of the Apple feature can help deter theft--and possible harm--during a robbery.
Another thing to be aware of this shopping season, when people will be out and about on busy streets, is what's come to be known as the "Knockout Game," where the goal is knock a random person unconscious with a single punch. CNN and other news outlets have posted stories about reports of random violence in several U.S. and foreign cities, and at least one city is considering punishing juveniles found guilty of the attack as an adult rather than a child--which can mean years of jail time. However, The New York Times recently added its voice to the growing national discussion with a story questioning whether the "game" is in fact an urban myth, saying that it's possible these assaults are random acts of violence, and that even New York City police officials are still trying to determine the truth.
Nonetheless, while questions over the "game" remain, the assaults are very real. According to CNN, a police spokesman in Pittsburgh says people who appear distracted--such as those checking phones or listening to music through headphones--may be more vulnerable to attacks.
>>Bonus Link: The National Crime Prevention Council offers tips on safe holiday shopping, including shopping with a friend for added security.
Study: U.S. Graphic Warning Labels Could Get 8.6M Smokers to Quit
A new study out of Canada indicates that the U.S. Food and Drug Administration may have underestimated the potential impact of graphic warning labels on tobacco products. From 2000 to 2009, the warning labels cut Canada's smoking rate somewhere between 12 and 20 percent, which would be the equivalent of between 5.3 million and 8.6 million U.S. smokers. That's also 33 to 53 times larger than the FDA's estimates when they pushed for the warning labels--and when the tobacco industry successfully challenged the measure, with the court pointing to the low impact as one of the reasons for the ruling. "Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found," said Jidong Huang, MD, the study's author. "Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future." Read more on tobacco.
Expanding Nurse Practitioner Abilities Could Save Patients $472M by 2015
Expanding which health services nurse practitioners at retail health clinics can provide could save at least $34 per visit, or as much as $472 million in health costs by 2015, according to a new study in the journal Health Affairs. The estimated 6,000 retail health clinics, often found in chain pharmacies or "big box" stores, provide walk-in care for minor health problems. The rules for nurse practitioners vary from state to state, with some allowing them to prescribe medications and practice independently of a doctor's supervision. Researchers looked at insurance claims from 2004 through 2007, finding that the state's that grant wider latitude also tend to see lower costs for the patients:
- $704 -- Average cost of treatment in the 14 days after a traditional doctor's office visit
- $543 -- Average cost of care during and after a retail visit in states where nurse practitioners had no independence and could not prescribe medication
- $484 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without the supervision of a doctor
- $509 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without supervision and prescribe medication
Read more on access to health care.
New Estimate Puts 2009 Swine Flu Global Death Toll at More than 200K
The death toll from the 2009 swine flu epidemic was likely far higher than previously believed, according to a new study in the journal PLoS Medicine. Previously, the total stood at about 18,500 laboratory-confirmed deaths, though experts considered that to be a low estimate because it only factored in confirmed cases of H1N1. A new study, bringing together 60 researchers in 26 countries, now places the toll at as many as 203,000 global deaths--or 11 times higher than the previous estimate. "This study confirms that the H1N1 virus killed many more people globally than originally believed," study lead author Lone Simonsen, a research professor in the department of global health at the George Washington University School of Public Health and Health Services. "We also found that the mortality burden of this pandemic fell most heavily on younger people and those living in certain parts of the Americas." Read more on global health.
The normally hectic pre-Thanksgiving travel day could be more frenzied than usual this year because of predicted storms in the west that could move east—and storms are often a precursor to flight delays. So why not use the extra time to get a jump start on 2014 resolutions?
Mindful that air passengers are captive audiences, many airports have added fitness options ranging from trail markers to let you know how far you’ve walked on the airport’s walking trail (Baltimore Washington International) to a yoga room (San Francisco International and Dallas Fort Worth) and even a full fitness center with workout clothes for rent (Toronto Pearson).
Airport Hotel Gyms
While most airports don’t yet have a gym right on the premises, a growing number of airports have hotels with attached gyms in one of the terminals, including Chicago O’Hare and Orlando International. (The hotels are located outside of the security areas, so if you’re planning a workout, build in the time you need to shower, dress and clear security before boarding your flight.) Passes to the airport gyms are typically under $20 per person. Check your airport’s website for hotels onsite, and then check the hotel to find out rates and rules for short term use. And remember to wear your sneakers to the airport so you’re sure you have them for the workout.
Airport Walking Trails
In addition to the walking trail at Baltimore Washington International, a growing number of airports have marked walking trails. Keep that in mind when you pack your carryon, as there aren’t usually storage facilities for luggage once you pass security, though for $39-50 you can get a day pass at many airline clubs where you can find a quiet corner, snacks and a place to store you hand luggage while you walk the indoor trail. Ask at the airport information desk where the trail begins, or check the American Heart Association walking path website or phone app, and put in “airport” for the search engine section marked “type of path.”
Chicago Announces Trio of Anti-tobacco Initiatives to Curb Youth Smoking
The city of Chicago and Mayor Rahm Emanuel this morning announced a trio of anti-tobacco initiatives designed to reduce youth access to tobacco. The first would regulate e-cigarettes as tobacco products, while the second would restrict the sale of flavored tobacco products near schools and the third would work to educate the public on the dangers of menthol-flavored cigarettes. Further details:
- By defining “tobacco products” as products that are made of tobacco or include tobacco-derived nicotine, the city would be able to regulate e-cigarettes as they do any other tobacco product. This would mean that under the Chicago Clean Indoor Air Act, e-cigarette use would be restricted everywhere where smoking is restricted, including almost all public places and places of employment.
- Flavored tobacco products, including menthol products, could not be sold within 500 feet of schools, and existing stores would not be grandfathered in. This would be the first regulation of menthol-flavored cigarettes anywhere at the federal, state or local levels.
- Understanding that menthol-cigarettes are often—and wrongly—viewed as less unhealthy than other tobacco products, as well as that fact that the flavoring makes them more appealing to kids, the city is launching a public service advertising campaign on the realities of the products.
“E-cigarettes, as well as flavored products, are gateway tobacco products targeted at our kids,” said Emanuel. “The tobacco industry has spent years developing products that are aimed at hooking our youth on nicotine and getting them smoking for their entire life.” Read more on tobacco.
FDA to Investigate Reports on Weight-related Problems with the Morning-After-Pill
Following yesterday’s report that the European equivalent of the Plan B One-Step “morning after pill,” Norlevo, is less effective for women who weigh 165 pounds or more and ineffective for women who weigh 176 pounds or more, the U.S. Food and Drug Administration (FDA) has announced it will perform its own investigation into the product. The agency is "currently reviewing the available and related scientific information on this issue, including the publication upon which the Norlevo labeling change was based," said FDA spokeswoman Erica Jefferson said in a Monday statement. "The agency will then determine what, if any, labeling changes to approved emergency contraceptives are warranted." By law, the morning-after pill is available to all U.S. women of child-bearing age, over the county and with no point-of-sale restrictions. Read more on sexual health.
Concerns Over Cost, Sexual Activity Keep Many Parents From Having Kids Vaccinated Against HPV
Costs and parental concern over their kids’ sexual activity may be the reason that so view children—both girls and boys—are not being vaccinated against the human papillomavirus (HPV), according to a new review of 55 studies appearing in JAMA Pediatrics. HPV vaccines protect against the strains of genital warts that cause approximately 70 percent of cervical cancers, and they are recommended for girls aged 11 to 12. Boys are recommended to receive the vaccine as young as age 11, as it protects not just against genital warts, but also oral, penis and rectal cancers. However, the review found that many parents put off the vaccination either because they believe their child is not sexually active—so doesn’t “need” the vaccine—or because they fear it will encourage them to become sexually active. Researchers determined that a physician’s recommendation was one of the strongest motivators toward deciding to accept the vaccination, although this did not happen nearly enough. The researchers recommended improving these statistics by educating doctors and parents on the importance of the vaccine. Read more on cancer.