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Sep 18 2014
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Public Health News Roundup: September 18

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EBOLA UPDATE: Death Toll to at Least 2,622
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization announced today that the Ebola outbreak in West Africa has now claimed at least 2,622 lives and infected at least 5,335 people. "The upward epidemic trend continues in the three countries that have widespread and intense transmission—Guinea, Liberia and Sierra Leone," the global health agency said in a statement, adding that the disease’s spread through Liberia is in large part due to an increasing number of cases in the capital of Monrovia. Read more on Ebola.

HHS to Sponsor the Development of a Portable Ventilator for Use in Public Health Emergencies
The U.S. Department of Health and Human Services (HHS) is sponsoring the development of a next-generation portable ventilator for use in pandemics and other public health emergencies. The low-cost, user-friendly device will be developed with Philips Respironics under a $13.8 million contract; the project will be overseen by the Biomedical Advanced Research and Development Authority (BARDA) within the HHS Office of the Assistant Secretary for Preparedness and Response. “In pandemics and other emergencies, doctors must have medicines, vaccines, diagnostics, and critical equipment such as mechanical ventilators at the ready in order to save lives,” said BARDA Director Robin Robinson, PhD, in a release. Read more on preparedness.

HUD Launches $1B National Disaster Resilience Competition
The U.S. Department of Housing and Urban Development (HUD) is launching a $1 billion National Disaster Resilience Competition to help state, local and tribal leaders prepare their communities for the impacts of climate change and other factors using federal funds. “The National Disaster Resilience Competition is going to help communities that have been devastated by natural disasters build back stronger and better prepared for the future,” said HUD Secretary Julián Castro, in a release. “This competition will help spur innovation, creatively distribute limited federal resources, and help communities across the country cope with the reality of severe weather that is being made worse by climate change.” Read more on disasters.

Sep 17 2014
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Can Idea Sharing Among CEOs Improve Health and Bring Down Health Care Costs?

The Bipartisan Policy Center (BPC) in Washington, D.C., and nine CEOs from leading U.S. companies issued a report yesterday that lays out their ideas for improving individual and community health while reducing health care costs. The report, Building Better Health: Innovative Strategies from America's Business Leaders, shares strategies from all the companies and makes several recommendations:

  • Implement and track the outcomes of corporate health and wellness programs
  • Collaborate on the implementation of community-based programs
  • Improve the health care system by supporting the movement toward transparency and payment and delivery models that are based on outcomes rather than on volume

The CEOs are members of the BPC’s CEO Council and collectively employ more than one million people and provide coverage for over 150 million people. Council participants include McKinsey & Company, Aetna, Johnson & Johnson, The Coca-Cola Company, Verizon Communications, Bank of America, Blue Cross Blue Shield Association and Walgreens Co.

In addition to the report, the council released an interactive website with examples of initiatives the companies have taken to improve individual and community health. Some examples also improve the corporations’ bottom lines, such as Verizon’s partnerships with university research centers to test wireless health monitors that individuals or companies can download and buy through the technology company. However, David Erickson, director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, points out that no for-profit company can afford the investments required for improving public health without also being able to see an impact on their own bottom line. Examples include increased sales and greater efficiencies in delivering health care.

For example, Walgreens has increased its share of flu shots given from fewer than one million in 2009 to more than seven million in 2013. While that represents improved income for the company, Walgreens—which has stores within three miles of 63 percent of Americans, 75 percent of African-Americans and 78 percent of Latinos—has also worked with state and federal health officials to publicize and increase immunization initiatives. It has also worked with many third-party payers so that patients are often fully or largely covered for the vaccines, with little or no copayment required. Retail clinics such as those at many Walgreen stores also often improve on current health care delivery, such as being open 365 days a year, unlike most doctors’ offices.

Sep 17 2014
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Public Health News Roundup: September 17

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White House Announces Significant Increase in U.S. Ebola Response
Yesterday, NewPublicHealth reported President Obama’s initial planned response to the ongoing Ebola outbreak in West Africa. The White House has since expanded on the plans. They will include:

  • A military command center in Liberia.
  • A staging area in Senegal to help dispatch personnel and aid to affected communities more quickly
  • Personnel from the U.S. Public Health Service will deploy to a new field hospitals the U.S. is setting up in Liberia.
  • US AID will help distribute home kits with items such as gloves and masks to help reduce the number of Ebola cases.

Read more about Ebola.

Survey Finds Doctors are Overextended or At Capacity for Patients
A new survey of 20,000 doctors by the Physicians Foundation, a non-profit group that works with practicing physicians, finds that 81 percent of doctors say they are over-extended or at full capacity and only 19 percent indicate they have time to see more patients. Forty-four percent of doctors responding say they plan to take steps that would reduce patient access to their practices , including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of physicians in the United States. The timing of the survey is significant because signup for health insurance coverage under the Affordable Care Act begins in just a few weeks. Read more about access to care.

Number of Smokers Increases in New York City
Earlier this week the New York City Health Department released new 2013 data showing that 16.1 percent of adult New Yorkers are smokers, a significant increase from the city’s lowest recorded adult smoking rate of 14 percent in 2010. For the first time since 2007, there are more than one million smokers in New York City who are at risk of developing a smoking-related illness, including heart disease, stroke, diabetes, emphysema, lung and other cancers, according to the health department. So far, the city does not have strong data to explain the uptick in smoking. Nationally, the U.S. Centers for Disease Control and Prevention estimates that 18 percent of U.S. adults are smokers, down from 20 percent several years ago. However, New York City is often a bellwether for public health issues, and the health experts across the country will be looking to see whether the city’s tobacco control efforts—including a new ad campaign that focuses on both daily and occasional smokers—have an impact on smoking rates. Read more on tobacco.

Sep 16 2014
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Reading, Writing and Hands-Free CPR: AHA Calls for More CPR Training in Schools

The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.

The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.

New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.

“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”

The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.

>>Bonus Links:

  • Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
  • Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions. 
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: