May is Stroke Awareness Month, a good time to bump up the percentage of Americans who recognize the most common symptoms of a stroke from only 38 percent, according to a Centers for Disease Control and Prevention (CDC) survey. Speedily identifying stroke symptoms and calling for an ambulance is essential because people who get to an emergency room for treatment within three hours are healthier three months later than people for whom stroke care was delayed, according to the CDC.

New this year to help increase symptom awareness is a free smartphone app from the American Heart Association/American Stroke Association called F.A.S.T. The acronym stands for common stroke symptoms and a critical call to action: Face drooping; Arm weakness; Speech difficulty; and Time to call 9-1-1. The app also includes a link to additional symptoms that bystanders and caregivers can access and a 9-1-1 button to call an ambulance. Using the 9-1-1 button saves time by not having to back out of the app to dial the number manually. And using the button also generates an automatic time stamp, which gives emergency room staff a good indication of when symptoms began. Some treatments can only be given within a specific time window.

IOM: Low Sodium Intake May Also Cause Adverse Health Effects
While multiple studies have shown that the average daily sodium intake for U.S. adults is far too high, lowering the intake too much could also lead to health problems, according to a new report from the Institute of Medicine. The average daily intake is 3,400 mg, or about 1.5 teaspoons. The Dietary Guidelines for Americans call for a maximum of 2,300 mg, and even 1,500 mg for certain demographics. However, there is also some evidence suggesting low sodium levels could be harmful to people such as those with mid- to late-stage heart failure. “These studies make clear that looking at sodium’s effects on blood pressure is not enough to determine dietary sodium’s ultimate impact on health,” said committee chair Brian Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania Perelman School of Medicine. “Changes in diet are more complex than simply changing a single mineral. More research is needed to understand these pathways.” Read more on heart health.

CDC Guidelines Help Cut Bloodstream Infections from Dialysis
Following the U.S. Centers for Disease Control and Prevention’s (CDC) prevention guidelines helped reduce overall bloodstream infection due to dialysis by 32 percent and vascular access-related bloodstream infections by 54 percent, according to a new study in the American Journal of Kidney Disease. There are approximately 37,000 bloodstream infections each year related to dialysis with central lines; in 2010 about 380,000 U.S. patients used hemodialysis for treatment of end-stage kidney disease, with 8 in 10 of utilizing central lines. "Dialysis patients often have multiple health concerns, and the last thing they need is a bloodstream infection from dialysis,” said CDC Director Tom Frieden, MD, MPH. “These infections are preventable. CDC has simple tools that dialysis facilities can use to help ensure patients have access to the safe healthcare they deserve.” Read more on prevention.

Study: Teen’s Use of Smokeless Tobacco Steady Over Past Decade
Despite a myriad of efforts to combat tobacco use by U.S. teens, their usage rate of “smokeless” tobacco products such as chew or snuff has remained steady since 2000, according to a new study in the Journal of the American Medical Association. The rate was 5.3 percent in 2000 and just barely lower in 2011, at 5.2 percent. While younger teens in the 9-14 age range have decreased their use, those in the 15-17 range have increased. The study suggests that the relatively low prices of smokeless tobacco products may be a contributor. About 9 million Americans used smokeless tobacco in 2012. Read more on tobacco.

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.

Drug Patent Expirations Helped Lower Patient Spending for First Time in 55 Years
Per patient spending on medicine dropped 3.5 percent from 2012 to 2011, the first such drop since 1957, according to the IMS Institute of Healthcare Informatics. Spending was $325.8 billion overall and $898 per person in 2012. The main contributor to the decline was the expiration of patents on major drugs such as Lipitor and Plavix, allowing people to instead opt for cheaper generic versions. Michael Kleinrock, director of research development at IMS, said this is likely the first of several years in which spending on prescriptions won’t grow as quickly as overall health care spending. Read more on prescription drugs.

CDC Releases New Resources on Lyme Disease Prevention, Treatment
As across the country the weather is gradually getting warmer and kids are spending more time outdoors, the U.S. Centers for Disease Control and Prevention (CDC) has released new resources to help kids prevent tick bites that can lead to Lyme disease and a reference guide for health care providers. The kid-targeted comic strip includes tips for both kids and their parents. Tickborne Diseases of the United States includes information on types of ticks and the various diseases they can transmit. There were more than 24,000 confirmed cases of Lyme disease in 2011, according to the CDC. Read more on infectious diseases.

Study: Everyday Noises Can Effect Heart Health
Even basic, everyday background noises can affect heart function, according to a new study in the journal Environmental Health Perspectives. That includes increased heart rate as noises become louder than normal conversation levels and a decrease in natural, healthy heart beat variability. A decrease in heart bear variability, such as when someone is stressed, has been linked to a greater risk for heart attack. While these noise effects to individuals is minimal, they could provide greater insight into the health effects of community noise on the broader population level, according to Charlotta Eriksson, a researcher at the Karolinska Institute, in Stockholm, Sweden, who was not involved in the study. Read more on heart health.

NIH Grants $40M to Combat Racial, Ethnic Disparities in Stroke Risk
The National Institutes of Health (NIH) has awarded $40 million in grants over five years to help four research centers investigate and develop strategies to reduce the risk of stroke in racial and ethnic minorities. The funds come from NIH’s National Institute of Neurological Disorders and Stroke (NINDS). Racial and ethnic minorities are at higher risk than non-whites due to higher prevalence of cardiovascular risk factors, according to said Walter J. Koroshetz, MD, deputy director, NINDS. "A few of the grantees are working closely with at-risk populations to develop interventions that give people tools to achieve blood pressure control," he said. "These research efforts will give us the traction we need to control the greatest modifiable stroke risk factor. Together, the Stroke Prevention /Intervention Research Programs represent a much needed effort to address stroke disparities in the United States." Read more on stroke.

People With Congenital Heart Disease Need Physical Activity
A new scientific statement from the American Heart Association serves to remind health professionals and patients that regular physical activity is important for people with congenital heart disease and should be promoted. Congenital heart disease (heart structural problems existing since birth) impacts close to 1 million children and 1 million adults in the United States. Specifics of the new statement include:

• While some irregular heart beat conditions may require a restriction in physical activity, “for most, physical activity can be unlimited and should be strongly promoted.”
• Most patients with congenital heart disease are relatively sedentary.  But the physical, psychological and social health benefits of physical activity are important for this population which is at risk for exercise intolerance, obesity and other diseases. .
• These are general recommendations and physicians may have to tailor some specific guidelines for individual patients.

Read more on heart health.

DOT Announces Funds to Help Improve Road Safety on Tribal Lands
The U.S. Department of Transportation (DOT) has announced the availability of more than $8.6 million in Tribal Transportation Program Safety Funds from the Federal Highway Administration (FHWA). According to Transportation Secretary Ray LaHood, the funds will help improve roads on tribal lands, which have consistently ranked among the nation’s highest road fatality rates. DOT will hold a webinar on May 8 from 4-5 p.m. EDT to provide information on the grants to potential applicants. Find a link to the webinar here. Read more on transportation.

CDC, SAMHSA and Red Cross Resources Help Individuals and Communities Cope with Disaster
Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages. CDC’s “Tips for Self Care” includes advice on dealing with stress and suggestions for connecting socially after a traumatic event, avoiding drugs and alcohol, as well as links to SAMHSA’s disaster distress helpline  which can be accessed by phone, text, twitter and Facebook. SAMHSA’s site also includes resources for students, parents, teachers, caregivers, children, first responders and health professionals.

Following the explosions, families and friends found that cell phone and in some cases even texting communication was jammed, making it difficult for people to know whereabouts of those involved in the explosion. The American Red Cross offers a free service called the Safe and Well website which is a central site for people in disaster areas in the United States to register their current status, and for their loved ones to access that information. The Red Cross says the site helps provide displaced families with relief and comfort during a stressful time. The site is easy to use:

• If you are currently being affected by a disaster somewhere in the United States, click List Myself as Safe and Well, enter your pre-disaster address and phone number, and select any of the standard message options.
• If you are concerned about a loved one in the United States, click Search Registrants and enter the person’s name and pre-disaster phone number OR address. If they have registered, you will be able to view the messages they have posted.

The site is available 24 hours a day, 365 days a year and is accessible in both English and Spanish. Read more on preparedness.

Mortality Rates Highest at Small Rural Hospitals
A new study by researchers at the Harvard School of Public Health (HSPH) finds that a failure to stay up to date in the treatments they provide may be a factor in climbing death rates at rural hospitals. The study appeared in the JAMA. The HSPH researchers reviewed data from small, rural hospitals that receive government reimbursements and are exempt from participation in national quality improvement programs. The researchers looked at data on 10 million Medicare patients who were admitted to these small rural hospitals or other hospitals with a heart attack, congestive heart failure, or pneumonia—and compared 30-day mortality rates for each of the three conditions over a nine-year period. While ten years ago, mortality rates for each of these conditions were about the same at hospitals, the researchers found that between 2002 and 2010, mortality rates at CAHs increased at a rate of 0.1% per year, while at non-CAHs they decreased 0.2% per year. By 2010, CAHs had higher overall mortality rates—13.3% versus 11.4% at non-CAHs. “Small rural hospitals are being left behind,” says Karen Joynt, MD, MPH, the lead author on the study. “By creating a separate category for these hospitals, we’ve really left them out of many of the advances in medical care over the past decade, and we need systems-level solutions to help improve healthcare in these rural areas.” Read more on health disparities.

High Resting Heart Rate Indicates Increased Risk of Early Death
Faster than normal heart rates—even in men who exercise—could indicate a higher risk of early death, according to a new study in the journal Heart. While previous studies have shown a connection between heart rate and life expectancy, this study looked specifically at whether that was also true for healthy people who got regular exercise; the results indicate that resting heart rate is a risk factor independent of other health markers. Each 10-beat-per-minute resting heart rate increase corresponded to a 16 percent increase in the likelihood of death. Gregg Fonarow, MD, a professor of cardiology at the University of California, Los Angeles, said there are ways to improve resting hear rate. "Increasing physical activity and decreasing periods of sitting can lower heart rate and lower cardiovascular risk," he said, adding that stopping smoking can also lower heart rate. Read more on heart health.

FDA Budget Includes Funds for Food, Medical Product Safety Improvements
The U.S. Food and Drug Administration’s (FDA) requested $4.7 billion budget will include funds to support the Food Safety Modernization Act and to help ensure the safety of medical products. However, the budget will also include a $15 million cut related to human drug, biologics and medical device programs. “Our budget increases are targeted to strategic areas that will benefit patients and consumers and overall strengthen our economy,” said Margaret A. Hamburg, M.D., Commissioner of Food and Drugs. “Through the good work of the FDA, Americans will receive life-saving medicines approved as fast as or faster than anywhere in the world, confidence in the medical products they rely on daily, and a food supply that is among the safest in the world.” Read more on food safety.

Study: No Link Between Fertility Drugs, Increased Ovarian Cancer Risk
There is no link between fertility drugs and an increased risk of ovarian cancer, according to a new study in the journal Fertility and Sterility. While previous studies have suggested a connection, Albert Asante, MD, lead author of the study and a clinical fellow in the division of reproductive endocrinology at the Mayo Clinic, said the results show that “women who need to use fertility drugs to get pregnant should not worry about using these fertility drugs." The study looked at the medical information of approximately 1,900 women who participated in an ovarian cancer study at the Mayo Clinic. Approximately 13 out of every 100,000 women will develop ovarian cancer in their lives. Read more on cancer.

Unemployment Stress Can Lead to Severe Cardiovascular Troubles
The stress and anxiety of unemployment can cause both immediate and long-lasting cardiovascular problems. There’s even a possibility of something called “broken heart syndrome.” "In a very stressful situation, you can actually get a severe release of adrenaline and sympathetic nerve discharges that cause the heart to beat irregularly," said John Higgins, MD, a sports cardiologist at the University of Texas Health Science Center in Houston, according to HealthDay. In the most severe cases this can lead to heart attack. However, Kavitha Chinnaiyan, MD, director of cardiac imaging at Beaumont Hospital in Royal Oak, Mich., said steps can be taken to reduce the damage. "We know from studies that behaviors such as meditation, yoga and tai chi work specifically to reduce our response to stress," she said, noting that meditation in particular “helps you see your choices and have a clearer perspective of what to do next. Stress may still be around us, but meditation gives us a better ability to cope with it." Learn more on the connection between stable employment and health in an INFOGRAPHIC.

CDC: Nearly 1 in 3 Americans Suffers from High Blood Pressure
Nearly one in three Americans have high blood pressure, according a new study in the journal Morbidity and Mortality Weekly Report. The number climbed 10 percent from 2005 to 2009, demonstrating an increased need to focus on prevention and treatment. "What we are really concerned about as well is that people who have high blood pressure are getting treated. Only about half of those with hypertension have it controlled," said Fleetwood Loustalot, a researcher at the National Center for Chronic Disease Prevention and Health Promotion, part of the U.S. Centers for Disease Control and Prevention. "Uncontrolled hypertension can lead to negative health consequences like heart attacks and strokes." A recent study in the journal BMJ found that even a small reduction in sodium intake can significantly reduce blood pressure, which in turn lessens the risk of heart disease. Read more on heart health.

Court Orders FDA to Make ‘Morning-After’ Pill Available to All Without a Prescription
Calling it the agency’s decision "an excuse to deprive the overwhelming majority of women of their rights to obtain contraceptives without unjustified and burdensome restrictions," a U.S. District Court judge has ordered the U.S. Food and Drug Administration (FDA) to reverse its stance on “morning-after” contraception pills and make them available to all women without a prescription. The pills are currently available without a prescription only to women age 17 and older. "Women all over the country will no longer face arbitrary delays and barriers just to get emergency contraception," said Nancy Northup, president of the Center for Reproductive Rights, which was one of the groups that petitioned FDA to remove the restrictions. Read more on sexual health.

Teen Vogue, Toyota Campaign to Emphasize Safe Driving for Teenage Girls
With automobile collisions the leading cause of teenage deaths, Teen Vogue and Toyota are partnering on the “Arrive in Style” safe driving campaign targeting teenage girls and their mothers. The print, digital, video and social media campaign is set to run through early next year. Teen Vogue will also have monthly features with advice on safe driving. “Teen Vogue’s influential young readers are the perfect ambassadors not only to participate in this initiative, but also to help build awareness and educate their peer groups on the importance of driver safety,” said Jason Wagenheim, Teen Vogue Vice President and Publisher. Read more on safety.

CDC Vital Signs: 1 in 5 Teen Births is a Repeat Birth
Although teen births have fallen over the past 20 years, nearly one in five is a repeat birth, according to a Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). More than 365,000 teenage girls ages 15-19 years gave birth in 2010, and almost 67,000 (18.3 percent) of those were repeat births. A repeat birth is a second (or more) pregnancy resulting in a live birth before the mother turns 20. “Teen birth rates in the United States have declined to a record low, which is good news,” said CDC Director Tom Frieden, MD, MPH. “But rates are still far too high. Repeat births can negatively impact the mother’s education and job opportunities as well as the health of the next generation. Teens, parents, health care providers, and others need to do much more to reduce unintended pregnancies.” Data from CDC’s National Vital Statistics System show that repeat teen births in the United States decreased by more than 6 percent between 2007 and 2010. Despite this decline, the number of repeat births remains high and there are substantial racial/ethnic and geographic differences. Repeat teen births were highest among American Indian/Alaska Natives (21.6 percent), Hispanics (20.9 percent), and non-Hispanic blacks (20.4 percent), and lowest among non-Hispanic whites (14.8 percent). Read more on maternal and child health.

Health Impact Project Announces Eight New Funded Projects
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, has recently added eight more grantees who will receive funding to conduct health impact assessments, or HIAs. The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy. “Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.” By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States. Read more on health impact assessment.

Post-ER Visit for Chest Pain Reduces Heart Attack Risk
Seeing a doctor within a month of an emergency room visit for chest pain significantly reduced the risk of a heart attack or death among high risk patients, according to a recent study in the journal Circulation. Researchers analyzed data on 56,767 adults (average age 66, 53 percent men) in Ontario, Canada, who were diagnosed with chest pain in an emergency room between April 2004 and March 2010 and had been previously diagnosed with heart disease or diabetes. They tracked data for a median 3.7 years and accounted for differences in key patient characteristics such as age, gender, health status and location. According to the study, only 17 percent of high risk chest pain patients seen in the emergency room were evaluated by cardiologists within a month; 58 percent saw a primary care physician and 25 percent had no physician follow-up within a month. Patients who followed up with a cardiologist within 30 days were 21 percent less likely to have a heart attack or die within one year, compared with patients who failed to seek additional care within that time. Patients seen by a primary care physician were 7 percent less likely to have a heart attack or die compared to those patients who sought no follow up care. Read more on heart health.

Study: Minor Injuries in Some Children May Indicate the Possibility of More Serious Child Abuse Later On
A study in Pediatrics finds that relatively minor abuse injuries often precede more serious abuse of children. The study refers to “sentinel” injuries—a previous injury reported in a child’s medical history that was suspicious or had an implausible explanation. Researchers examined records of infants seen by the child protection team at Children’s Hospital of Wisconsin between March 2001 and October 2011. Of the 200 children who were definitely abused, 55 (27 percent) had a sentinel injury. Of those, 80 percent had a bruise, 11 percent had an injury inside the mouth, and 7 percent had a fracture. Of 100 children where abuse was suspected but not confirmed, 8 had a sentinel injury. None of the infants in the control group—who had no history of abusive injuries—had a sentinel injury. The study authors say their findings suggest that in more than a quarter of cases of definite physical abuse, there may be escalating and repeated violence toward the infant instead of a single event of momentary loss of control by a frustrated or angry caregiver. Improved recognition of sentinel injuries and interventions would prevent additional cases of child abuse, according to the researchers. Read more on injury prevention.

HUD Renews Grants for Local Communities’ Response to Homelessness
The U.S. Housing and Urban Development Department (HUD) is renewing funding for 7,000 local homeless housing and service programs across the country. The funding ensures the programs will remain open for at least the coming year, according to HUD, which has challenged local communities to review their response to homelessness and to emphasize proven strategies including “rapid re-housing” for homeless families and permanent supportive housing for people who experience chronic homelessness. The amount of renewed funding is $1.5 billion in grants that will support programs including street outreach, client assessment and direct housing assistance. HUD expects to award additional grants later this year. HUD recently announced its 2012 “point in time” estimate of the number of homeless persons in America. Approximately 3,000 cities and counties reported 633,782 homeless persons on a single night in January of 2012. Read more on housing.

Policy and Practice Changes Needed to Improve Survival in People who have Heart Attacks in the Hospital
Policy and practice changes by healthcare institutions, providers and others could greatly improve survival for people who have a have a heart attack in the hospital, according to an American Heart Association (AHA) consensus statement in its journal, Circulation. Each year, more than 200,000 adults and 6,000 children have in-hospital cardiac arrests, and survival has remained essentially unchanged for decades, according to the AHA. Only 24.2 percent of in-hospital cardiac arrest patients survive to hospital discharge.

Key recommendations include:

• Establishing competency of all hospital staff in recognizing a cardiac arrest, performing chest compressions and using an automated external defibrillator or AED.
• Ensuring that best practices are used in all stages of care for cardiac arrest.
• Requiring that all in-hospital cardiac arrests be reported, with survival data, using consistent definitions across hospitals. Definitions currently are not standardized, according to the researchers.
• Modifying billing codes to allow collection of more specific and accurate data for in-hospital cardiac arrest.
• Separate guidelines for in-hospital versus out-of-hospital cardiac arrests.

Read more on heart health.