WHO Reports First Patient-to-Nurse Transmission of SARS-like Virus
The World Health Organization (WHO) is reporting that two health care workers in Saudi Arabia have become infected with a potentially fatal new SARS-like virus after catching it from patients, which represents the first case of the virus spreading this way within a hospital. Novel coronavirus, or nCoV, is thought to be spread through close contact, but, "scientists are on the alert for any sign that nCoV is mutating to become easily transmissible to multiple recipients, like SARS -- a scenario that could trigger a pandemic," according to Reuters. Read more on infectious disease.

Repeated Head Injuries Raise Soldiers' Suicide Risk
Soldiers who sustain multiple traumatic brain injuries, even if they are mild, are at greater risk for suicide, according to a study published in the journal JAMA Psychiatry. Researchers found that the risk for suicidal thoughts or behaviors increased for soldiers with such injuries over the course of a lifetime -- not just in the short term after the injuries occur. Suicide is the second-leading cause of death among U.S. military personnel, and researchers say this study provides further guidance on assessing risks and supporting wounded soldiers. Read more on military health.

HHS Announces $1 Billion to Fuel Health Care Innovation
The U.S. Department of Health and Human Services (HHS) launched a nearly $1 billion initiative -- the Health Care Innovation Awards -- that will fund work to transform the health care system by demonstrating better care and lower costs. This is the second round of the award. In the first round, the Centers for Medicare & Medicaid Services awarded 107 Awards out of nearly 3,000 applications. Round one awardees included a medical home for people with disabilities that showed a 71 percent reduction in hospitalization rates. Read more on access to health care.

A recent Opinionator column in The New York Times by Nancy DiTomaso, vice dean for faculty and research at Rutgers Business School in New Jersey, suggests that some of the reason for the 13 percent unemployment rate among African-Americans—double the rate for whites—may stem from the fact that whites are more able to rely on their social networks for an edge when finding out about and applying for higher-wage jobs.

“Getting an inside edge by using help from family and friends is a powerful, hidden force driving inequality in the United States,” says DiTomaso, who adds that whites helping other whites is not the same as discrimination, and it is not illegal, “yet it may have a powerful effect on the access that African-Americans and other minorities have to good jobs, or even to the job market itself.”

Income—and lack of it—impact every aspect of health, from being able to afford safe housing to being able to purchase nutritious food to accessing high-quality healthcare. A study published in the British Medical Journal earlier this year found that there were nearly 40,000 extra hospital readmissions over a three-year period in states with the greatest income inequality.

NewPublicHealth illustrated the link between jobs and health in a recent infographic.

>> Read the post from The New York Times.

Business Coalitions to Receive Funds to Improve Community Health
The Robert Wood Johnson Foundation and United Health Foundation will award $700,000 in grants to nine National Business Coalition on Health member coalitions. The community health grants will fund resources to help the communities assess their health problems and come up with solutions. The issues include obesity rates, tobacco use, healthy living efforts and pre-term births. “Supporting and nurturing businesses to engage with their communities to identify and address priority local health issues is the first step in solving them,” said Reed Tuckson, MD, senior advisor of the United Health Foundation. Read more on community health.

AHA: Dog Owners at Reduced Risk of Heart Disease
Owning a pet—especially a dog—may help cut a person’s chance of heart disease, according to a new scientific statement from the American Heart Association (AHA). A study of more than 5,200 U.S. adults found a link between owning a dog and being more physically fit, because of the need to talk dogs on frequent walks. There are also calming effects to consider when looking at the lower levels of obesity, blood pressure and cholesterol. Glenn N. Levine, a professor at Baylor College of Medicine in Houston, said more research is needed to determine whether adopting a pet can help improve pre-existing cardiovascular conditions. Read more on heart health.

HHS: $150M to Help Uninsured Enroll in New Health Insurance Options
Approximately $150 million in funding from the U.S. Department of Health and Human Services (HHS) will go toward community health centers to help uninsured Americans understand and enroll in new health insurance coverage options. The improvements will include hiring new staff, staff training and community outreach. There are about 1,200 health centers serving 21 million people annually. “Health centers have extensive experience providing eligibility assistance to patients, are providing care in communities across the nation, and are well-positioned to support enrollment efforts,” said HHS Secretary Kathleen Sebelius. Read more on access to health care.

HHS Makes Hospital Cost Information Available to Consumers
The U.S. Department of Health and Human Services (HHS) has announced a new initiative that, for the first time, gives consumers information on what hospitals charge for many procedures and services. The information will be posted on the website of the Centers for Medicare and Medicaid Services and will show comparative charges for services that may be provided during the 100 most common Medicare inpatient stays, such as knee replacements. The new data shows significant variation across the country and within communities in what hospitals charge for common inpatient services. The agency is also providing close to $90 million to states to collect, analyze, and publish health pricing and medical claims reimbursement data. To help show how the data can be used the Robert Wood Johnson Foundation has announced a data visualization challenge. Read more on access to health care.

CDC Issues Updated Hepatitis C Screening Guidelines
The U.S. Centers for Disease Control and Prevention (CDC) has issued new screening guidelines for Hepatitis C that recommend anyone born between 1945 and 1965 be screened for the infection, as well as anyone who received a blood transfusion or organ donation before 1992 when screening of the blood supply was improved, and anyone who has ever injected drugs. The CDC is making the new recommendations because only half of Americans identified as ever having had hepatitis C received follow-up testing to see if they were still infected, according to a new Vital Signs issued by the agency. CDC researchers looked at data from eight areas across the country and found that of the hepatitis C cases reported in those areas, follow-up testing was only done in 51 percent of the cases. “Complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences,” says said CDC Director Tom Frieden, MD, MPH. According to the CDC, about 3 million Americans are infected with hepatitis C and up to 3 out of 4 do not know they are infected. Read more on infectious disease.

Researchers Call for Independent Review Process for DSM-5 Updates
Arguing that that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) missed “crucial population-level and social determinants of mental health disorders,” a group of researchers at the Columbia University Mailman School of Public Health and Columbia University Medical School are calling for an independent review for any future revisions of the American Psychiatric Association’s guidelines. The article appears in the journal Health Affairs. “As the DSM evolves, we must ensure the accuracy of psychiatric diagnoses and their equitable use in health care by systematically reviewing and applying the lessons in the population health and social science literature,” wrote the authors. The factors include various environmental factors, cultural perceptions and institutional pressures. Read more on mental health.

USPSTF Recommends HIV Screening for All Americans 15-65
The U.S. Preventive Services Task Force (USPSTF) now recommends that all Americans ages 15 to 65 be screened for HIV, according to new guidelines appearing in the Annals of Internal Medicine. USPSTF’s previous 2005 guidelines recommended screening for only those people categorized as high-risk. The U.S. Centers for Disease Control and Prevention already recommends this course of action. "We do hope the fact that the guidelines are all very similar will provide an impetus for people to offer screening because it is a very critical public-health problem,” said task force member Douglas Owens, MD, a medical professor at Stanford University. Experts noted that the change will likely mean that testing will be covered as a preventive service under the Affordable Care Act. Read more on HIV/AIDS.

HUD’s $1.83B Plan Will Help Rebuild New Jersey, Prepare for Future Disasters
The U.S. Department of Housing and Urban Development’s (HUD) $1.83 billion New Jersey disaster recovery plan will help residents continue to recover from the damage caused by Hurricane Sandy and better prepare for future extreme weather events. “This infusion of federal funding will help New Jersey continue to recover from Superstorm Sandy and ensure that our state is rebuilt stronger and better prepared for future storms,” said Senator Frank Lautenberg (D-NJ). “Families that are rebuilding their homes, small businesses that are getting back on their feet, and communities that are repairing damaged public infrastructure will all benefit from this federal grant program.” The plan is funded through HUD’s Community Development Block Grant Program. The infrastructure restoration efforts will including elevating some homes to guard against future flooding. Read more on Hurricane Sandy.

Early Obesity Dramatically Increases Men’s Risk of Poor Health, Death
Obesity in the early 20’s can dramatically increased a man’s chance of suffering from serious health problems or even dying by the age of 55, according to a new study in the journal BMJ Open. A study tracking Danish men found that approximately half of the participants who were obese at the age of 22 had developed diabetes, developed high blood pressure, had a heart attack, had a stroke, or experienced blood clots or died by age 55. Men of a normal weight at age 22 saw only a 20 percent risk of developing these problems by age 55. Each unit increase in body mass index raised the risk of heart attack by 5 percent; high blood pressure and clots by 10 percent; and diabetes by 20 percent. In the United States approximately 35.7 percent of adults and 17 percent of children are obese, according to the U. S. Centers for Disease Control and Prevention. Read more on obesity.

Survey: Many Americans Still Unaware of or Confused About the Affordable Care Act
Signup for the Affordable Care Act (ACA) Health Insurance Marketplace begins in October, but a new poll from the Kaiser Family Foundation finds that many Americans are still confused about the law, which will require virtually all Americans to sign up for health insurance coverage that will take effect January 1, 2014.

Key poll findings include:

• More than 40 percent of Americans aren’t aware that the ACA is the law of the land.
• Of those who aren’t aware that the ACA is now law, 12 percent think the law was repealed by Congress and 7 percent think the law was overturned by the Supreme Court.
• About half of the respondents said they did not have enough information about the health reform law to understand how it will impact their family.

The poll findings also showed that people who are currently uninsured and those in low-income households were the most likely groups to say they did not understand how the ACA benefits them and their families. Read more on access to health care.

‘Clean Your Plate’ Order Can Lead to Negative Results
The seemingly reasonable parental edict of “clean your plate” may in fact be counterproductive toward maintaining a healthy weight, according to a new study in the journal Pediatrics. The same can be true with instruction to eat less. Researchers found that restrictive instructions were more common with kids who were overweight and obese, while kids who weren’t overweight were more often linked to encouragement to finish meals. "In the 1950s, cleaning your plate meant something different,” said author Katie Loth, a registered dietician, doctoral candidate and research assistant at the University of Minnesota in Minneapolis. “Portion sizes have gotten bigger over time, and if you encourage kids to rely on environmental indicators, like how much food is on their plates or the time of day, they'll lose the ability to rely on internal cues to know whether they're hungry or full." About 17 percent of U.S. youth and adolescents are obese, according to the U.S. Centers for Disease Control and Prevention. Read more on obesity.

Study: Lack of Insurance Leading Cause of Difficulty for Young Adults with Asthma
Leaving high school and a lack of adult supervision are both factors that may explain the general decline in asthma control for young adults once they’re over the age of 18. However, the main cause is a loss of health insurance, according to a new study in the journal Pediatrics. Researchers found that those under 18 were more likely to utilize primate care and medications. On the other hand, those over age 18 were more likely to turn to emergency care and have difficulty getting costly treatments. While young adults are generally healthier than older adults, people with chronic conditions such as asthma still need to be sure to seek out proper treatment. "Young people with asthma need to work with their care providers to create transition plans from pediatric to adult care that take into account their medical and social history," said study leader Kao-Ping Chua, a staff physician in the division of emergency medicine at Boston Children's Hospital. Read more on access to health care.

China’s Bird Flu Outbreak Keeps Growing; 20 Dead, 105 Infected
China’s outbreak of H7N9 virus—a new strain of bird flu—continues to spread, with 20 people dead and 105 overall infected, according to Reuters. The World Health Organization is conducting field investigations into the infections and the public health response to the outbreak. Ho Pak-leung, an associate professor in the Department of Microbiology at the University of Hong Kong, recently British Medical Journal that this outbreak has already caused twice as many Chinese infections as the H5N1 strain did in about a decade. "H7N9 is much more transmissible to humans, and it's much more difficult to track down," he said. "We don't understand why it's so difficult to find." Read more on infectious disease. Also, read more on what you need to know about H7N9 on APHA's Get Ready blog.

Doctors’ Knowledge of Lab Test Costs Reduces Unnecessary Testing
Knowing the cost of a laboratory tests makes doctors less inclined to order them for hospitalized patients, according to a new study in JAMA Internal Medicine. About $226 billion was wasted on unnecessary tests in 2011, according to the study from researchers at The Johns Hopkins University School of Medicine in Baltimore. Unnecessary tests also increase the risk of patient harm and false positives. "The rational approach to ordering tests is something we should all be interested in, and something—if we did better—that would save the system money and save the patients the horror of causing harm," said Leonard Feldman, MD, of Johns Hopkins. Read more on access to health care.

Mass. Study Shows Importance of Simplifying Health Insurance Benefits Options
Just six months before open enrollment for the Affordable Care Act’s health insurance marketplaces begins, a new study in the journal Health Affairs shows that some Massachusetts families who enrolled in unsubsidized Commonwealth Health Insurance Connector Authority plans experienced higher financial burdens due to health care costs. The study found that 38 percent saw financial burdens and 45 percent saw higher-than-expected out-of-pocket costs—indicating that lower-income families with increased health care needs and multiple children are at particular risk for higher costs. “Given the complexity of health insurance choices and consumers’ limited understanding of health insurance benefits, policy makers need to reach out and simplify information to promote optimal plan choices for the people,” wrote the study’s authors. Read more on community health.

CSPI Classifies Ginkgo Biloba as ‘Avoid’
The Center for Science in the Public Interest (CSPI) is now recommending people avoid Ginkgo biloba after a National Toxicology Program study linked it to liver cancer in mice and thyroid cancer in rats. The substance can be found in many dietary supplements, herbal teas and energy drinks. "Ginkgo has been used in recent years to let companies pretend that supplements or energy drinks with it confer some sort of benefit for memory or concentration," said CSPI executive director Michael F. Jacobson. "The evidence for those claims has been dubious, at best. The pretend benefits are now outweighed by the real risk of harm." The U.S. Food and Drug Administration has previously sent warning to drink manufacturers stating that the ingredient is not generally considered safe for food. Read more on nutrition.

Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in three U.S. cities to explore what it takes to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.

NewPublicHealth recently spoke with Robert Simmons, DrPH, MPH, head of the Master’s Program in Public Health at Thomas Jefferson University who was part of a recent panel. Other speakers on that panel included entertainer and activist Dr. Bill Cosby; Dr. Alvin Poussaint, professor of psychiatry at Harvard Medical School; Dr. Irwin Redlener, Clinical Professor of Population and Family Health at the Columbia University School of Public Health; Diane Cornman-Levy, executive director of the Federation of Neighborhood Centers and Sarah Martinez-Helfman, executive director of the Eagles Youth Partnership.

NewPublicHealth: Tell us a bit about your background.

Dr. Simmons: I’ve worked in public health for 40 years including at the County Health Department in San Diego, the State Health Department in California, and the American Lung Association, where I was program director on issues of asthma and tobacco and cardiopulmonary disease. In the last five and a half years, I’ve been directing the public health program at Thomas Jefferson University in Philadelphia.

NPH: What do you think have been key improvements in addressing population health?

Each year hundreds of public health researchers and practitioners meet to share research and best practices on creating a stronger public health system at the annual Keeneland Conference in Lexington, Ky. The conference, which will be held this year April 8-11, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, based at the University of Kentucky.

Paul Kuehnert, MS, RN, senior program officer and director of the Public Health Team at the Robert Wood Johnson Foundation (RWJF), will speak at the opening lunch about threats and opportunities for public health, and how we can re-shape the system to create a healthier future for all. We caught up with him to get his insights before the conference on the evolving role of public health. Prior to joining the Foundation, he was county health officer and executive director for health for Kane County, Ill., where he led a partnership between the health department, hospitals and other partners to assess and address the community’s health needs. Kuehnert is a Pediatric Nurse Practitioner and worked as a primary care provider in schools and other community settings in Missouri and Illinois. 

NewPublicHealth: What are you going to talk about at Keeneland?

Paul Kuehnert: I think a lot of us are familiar with the data on our health care system, and the inter-twined issues of access, quality and cost. And the fact that younger Americans have a lower life expectancy than young people in other developed countries. We’re just not getting the health outcomes that one would expect from the amount we’re spending.

When you pit that against our legacy in public health, and what’s happening in the environment we operate in, I think there’s a real need to identify the threats and opportunities and re-imagine what we’re doing. We’re working from old models that need to be really questioned. What I’m hoping to do, and that others will do, is to provoke some creative thinking about where we need to go in public health to truly meet the challenges that face our communities and our nation.

NPH: What do you see as some of the major public health challenges today?

Kuehnert: For me, one of the first that comes to mind is that issue of life expectancy. With all the resources we have, we’re actually losing ground. It’s extremely concerning and has to do with a number of underlying dynamics—but particularly the epidemic of chronic disease, things such as obesity, heart disease, cancer, and all of those threats to our health. And there are also the incredible health disparities, the inequities that are reflected in our health across the country.

Today, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities, and is the result of a collaboration with 140 organizations, including hospitals, local health departments, health providers, health plans, employers and schools that identified key priorities.

Dr. Shah, the architect behind today’s prevention agenda, was confirmed as New York State’s youngest Commissioner of Health two years ago. The state’s governor, Andrew Cuomo, had three critical goals: reduce the state’s annual Medicaid growth rate of 13 percent, increase access to care and improve health care outcomes.

Shah, a former Robert Wood Johnson Foundation Physician Faculty Scholar and Clinical Scholar, has already made important inroads in all three goals and the prevention agenda builds on that. NewPublicHealth spoke with Dr. Shah about prevention efforts already underway in the state, and what it takes to partner health and health care to achieve needed changes in population health.

NewPublicHealth: How does improving the social determinants of health help you achieve your goals in New York State?

Dr. Shah: New York’s Medicaid program covers 40 percent of the health care dollars spent in the state. We were growing at an unsustainable rate, and we needed a rapid, but effective solution. So, we engaged the health care community, including advocates, physician representatives, the legislature, unions, management, and launched a process that enables continuous, incremental, but real change toward the Triple Aim—improved individual health care, improved population health and lower costs.

Collectively, these efforts resulted in a $4 billion savings last year in the State’s Medicaid program, increased the Medicaid rolls by 154,000 people, and resulted in demonstrable improvements in quality throughout the system.

NPH: What opportunities do you see for public health and health care to work together in New York State?