Category Archives: Prevention
FDA Proposes New ‘Nutrition Facts’ Food Labels
The U.S. Food and Drug Administration (FDA) has put forth a new proposed Nutrition Facts label for packaged foods. The updated design would reflect scientific information not available when the current label was designed two decades ago. For example, it would replace out-of-date serving sizes and feature a design that highlights key parts of the label, such as calories and serving sizes. “For 20 years consumers have come to rely on the iconic nutrition label to help them make healthier food choices,” said FDA Commissioner Margaret A. Hamburg, MD. “To remain relevant, the FDA’s newly proposed Nutrition Facts label incorporates the latest in nutrition science as more has been learned about the connection between what we eat and the development of serious chronic diseases impacting millions of Americans.” Read more on nutrition.
Study: One in Five U.S. Health Facilities Don’t Provide Hand Sanitizer Everywhere Needed
One in five U.S. health facilities don’t make hand sanitizer available everywhere necessary, needlessly increasing the risk for health-care associated infections, according to a new study in the American Journal of Infection Control. In addition, approximately half of the hospitals, ambulatory care facilities and long-term care facilities included in their budgets funds for proper hand hygiene training. The study examine compliance with the World Health Organization’s hand hygiene guidelines at 168 facilities in 42 states and Puerto Rico. "When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections," said by Laurie Conway, RN, MS, CIC, PhD student at Columbia Nursing, in a release. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority." Read more on infectious disease.
CDC Foundation Expands Safe Injection Campaign
The CDC Foundation and Eli Lilly are partnering to expand the U.S. Centers for Disease Control and Prevention’s (CDC) Safe Injection Practices Coalition—a safety awareness campaign that provides information for health providers and patients. According to CDC data, more than 150,000 patients have been notified of potential exposure to hepatitis and HIV because of unsafe injection practices in U.S. health care settings since 2001, and CDC researchers have found that medical injections are an overlooked source of infections and outbreaks. Planned actives of the partnership include:
- Expand the One & Only Campaign to new audiences such as individual and group-owned physician practices
- Educate health care providers through new and enhanced training and communication materials to address emerging issues
- Improve the Safe Injection Practices Coalition website and social media platforms to share resources and toolkits with new audiences
- Engage new and existing Safe Injection Practices Coalition partners
Read more on prevention.
A new infographic from the Office of the U.S. Surgeon General highlights collaborations within the federal government and between the health and healthcare sectors to help improve prevention outreach. These efforts are part of the cross sector National Prevention Strategy launched by the office several years ago.
Current examples of collaboration include Million Hearts, an initiative of the U.S. Department of Health and Human Services to prevent one million heart attacks by 2017. The initiative includes a commitment by close to 150 large private medical practices in the United States to get hypertension control rates above 80 percent in their communities.
You can also view the fully interactive infographic here.
>>Bonus Link: Read interviews and listen to podcasts about the National Prevention Strategy conducted with former and current U.S. Cabinet Secretaries and agency heads.
IOM Report: More Evidence-Based Practices Needed to Help Treat and Prevent Psychological Disorders among Service Members and Families
Between 2000 and 2011, almost 1 million service members or former service members were diagnosed with at least one psychological disorder either during or after deployment, according to recent research by the Institute of Medicine (IOM). As a follow up, the U.S. Department of Defense (DOD) asked the IOM to evaluate the department’s efforts to prevent psychological disorders among active-duty service members and their families. That report was recently released.
The report includes recommendations on how the DOD can improve care.
Finding 1: DOD has implemented numerous resilience and prevention programs for service members and their families, but it faces a number of challenges, including an insufficient evidence base to support its interventions and a lack of systematic evaluation and performance measures.
Recommendation 1: By targeting resources to develop the evidence base and disseminate that evidence, DOD’s prevention efforts can be both more effective and cost effective.
Finding 2: There is a need for DOD to improve approaches for identifying and intervening with service members and their members who may already have or may be at risk for developing a psychological disorder.
Recommendation 2: DOD should dedicate funding, staffing and logistical support for data analysis and evaluation to support performance monitoring of programs for accountability and continuous improvement.
Finding 3: Screening, assessment and treatment approaches for psychological health problems are not always implemented between and within the DOD and the U.S. Department of Veterans Affairs (VA) in a consistent manner or aligned with the evidence base, which threatens the delivery of high-quality care and hampers evaluation efforts.
- There are opportunities to improve processes of training and evaluating clinicians, including the incorporation of continuing education and supervision; standardized periodic evaluation; and a greater emphasis on coordination and interdisciplinarity.
- The DOD and VA should invest in research to determine the efficacy of treatments that do not have a strong evidence base.
- Both departments should conduct systematic assessments to determine whether screening and treatment interventions are being implemented according to clinical guidelines and departmental policy.
- Accessible inter-department data systems should be developed to assess treatment outcomes, variations among treatment facilities and barriers to the use of evidence-based treatment.
- Read the complete report.
- Read a NewPublicHealth interview with Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs about the National Prevention Strategy.
- Learn more about the state of mental health in the military from this infographic from the American Psychiatric Association embedded below.
HHS, Heart Disease Organizations Join Forces to Vastly Reduce Premature Death Linked to Heart Conditions by 2025
Leaders from the World Heart Federation , the American Heart Association, the U.S. Department of Health and Human Services, and the American College of Cardiology are joining together to help cut premature mortality from cardiovascular disease by at least 25 percent by 2025. Key strategies will include secondary prevention efforts for people who have already experienced a heart incident, or have established heart disease, as well as primary prevention strategies in the United States and around the world. “Heart disease can touch anyone, no matter where you live,” said Nancy Brown, chief executive officer of the American Heart Association. “It will take the collective efforts of everyone from community leaders to healthcare professionals, educators and business leaders to stop this No. 1 killer at the national and global level...” Read more on heart health.
New Guidelines for Stroke Risk, Prevention in Women
The American Heart Association/American Stroke Association has published the first ever set of guidelines dedicated to stroke risk and prevention in women. The 86-page document appears in the journal Stroke and address risk factors distinct to women, including pregnancy, oral contraceptives, menopause and hormone replacement. It also covers factors that affect women more than men, including atrial fibrillation and migraine with aura. “We reviewed a large body of research to be able to summarize our current understanding of stroke risk and stroke prevention in women, information that is critically important for care providers and researchers in the field,” according to Judith Lichtman, MD, associate professor at the Yale School of Public Health and co-author of the study. “The guidelines are also important to empower women and their families to better understand their risk for stroke and be aware of ways they can minimize their likelihood of having a one.” Strokes are the third-leading cause of death among women in the United States. Read more on strokes.
Study: Indicators of Potential Heart Disease as Early as Age 18
Indicators of potential heart disease can be seen as early as age 18, according to a long-term study recently published in the Journal of the American Medical Association. Researchers found that elevated blood pressure at that age, as well as found distinct blood pressure patterns from ages 18-55, indicate people at high risk for calcification of coronary arteries by middle age. “This shows that your blood pressure in young adulthood can impact your risk for heart disease later in life,” said Norrina Allen, PhD, lead study author and assistant professor of Preventive Medicine at Northwestern University Feinberg School of Medicine, in a release. “We can’t wait until middle age to address it. If we can prevent their blood pressure from increasing earlier in life we can reduce their risk of future heart attacks and stroke.” Approximately one in three U.S. adults have hypertension. Read more on prevention.
“Building a culture of health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can,” wrote Robert Wood Johnson Foundation president and CEO Risa Lavizzo-Mourrey, MD, MBA in her 2014 President’s Message, released earlier this week. Laying out the plans for achieving those goals, Lavizzo-Mourrey added: “for the Foundation, it also means informing the dialogue and building demand for health by pursuing new partnerships, creating new networks to build momentum, and standing on the shoulders of others also striving to make America a healthier nation.”
The Foundation’s wide-ranging plans to “inform the dialogue” included a plenary talk by Mark McClellan, co-chair of the RWJF Commission to Build a Healthier America, and a former head of both the Food and Drug Administration and the Centers for Medicare and Medicaid Services. McClellan spoke at the AcademyHealth National Health Policy Conference in Washington, D.C., last week — less than a month after the release of the Commission’s 2014 report.
“To become healthier and reduce the growth of public and private spending on medical care, we must create a seismic shift in how we approach health and the actions we take,” said McClellan, “As a country, we need to expand our focus to address how to stay healthy in the first place.”
McClellan told a very attentive audience that critical needed changes include:
- Improve opportunities [for people] to make healthy decisions where we live, learn, work and play
- Improve access to a good education, jobs and health care
- Work across sectors, collaborating to improve the health of all Americans
- Make investing in America’s youngest children a high priority
- Fundamentally change how we revitalize neighborhoods, fully integrating health into community development
- Adopt new health “vital signs” to assess non-medical indicators for health such as jobs, income, housing, transportation and access to healthy food.
- Create incentives tied to reimbursement for health professionals and health care institutions to address non-medical factors that affect health.
McClellan cited two examples of organizations that are addressing issues beyond healthcare in order to improve health:
- Health Leads, a national health care organization, enables physicians and other health professionals to systematically screen patients for food, heat, and other basic resources that patients need to be healthy and “prescribe” these resources for patients.
- The Medical-Legal Partnership program removes legal barriers that impede health for low-income populations by integrating legal professionals into the care team. These volunteers intervene with landlords, social service agencies, and others to address health-harming conditions ranging from lack of utilities to bedbugs to mold in rental properties.
- Read Risa Lavizzo-Mourrey’s President’s Message
- Read the report of the 2014 Commission to Build a Healthier America
Obese Children More Susceptible to Air Pollution-Related Asthma
Obese children are more susceptible to air pollution-related asthma, according to a new study in the journal Environmental Research. Researchers followed the health of 311 children, ages 5 and 6, in predominantly Dominican and African-American neighborhoods of New York City, finding that high exposure to polycyclic aromatic hydrocarbons (PAH)—a family of air pollutants—was only associated with asthma among obese children The study determined that obese children exposed to the PAH chemicals 1-methylphenanthrene and 9- methylphenanthrene were two to three times more likely to have asthma. PAHs are emitted by vehicles, cigarette smoke, cooking, incense, burning candles and various other indoor sources. Two possible explanations for the disparity are that obese children tend to be less active, so are more likely to be exposed to indoors sources of PAH, and that they may breathe more rapidly than children of healthier weights Better understanding of the risk factors opens the door to more targeted interventions. “These findings suggest that we may be able to bring down childhood asthma rates by curbing indoor, as well as outdoor, air pollution and by implementing age-appropriate diet and exercise programs,” said senior author Rachel Miller, MD, professor of medicine (in pediatrics) and environmental health sciences, and co-deputy director of the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health. Read more on pediatrics.
Report: Antibiotics Dangerous to Humans Still Used in Livestock
Despite knowing their risk to humans, the U.S. Food and Drug Administration (FDA) continues to allow the use of certain antibiotics as additives in animal feed and water, according to a new report from the Natural Resources Defense Council based on documents acquired under the Freedom of Information Act. In a review from 2001 to 2010 the FDA concluded that 30 such antibiotics posed a significant risk of exposing people to antibiotic- resistance bacteria. The drugs were approved for “non-therapeutic” use in farm animals, such as preventing disease or promoting growth of the animals, instead of treating specific illnesses. In December the FDA announced its intention to combat the spread of antibacterial resistance by prohibiting the use of medically important antimicrobials in food animals for food production purposes, while also adding veterinary oversight to therapeutic use of the drugs in animals. Read more on food safety.
Residents of Public Housing Developments, Rental Assistance Units See Significant Gap in Oral Health Care
People who live in public housing developments and rental assistance units are less likely to have routine preventive dental care and more likely to have suffered serious oral health issues related to tooth loss, according to a new study in The Journal of Urban Health. The study was conducted by the Partners in Health and Housing Prevention Research Center (PHH-PRC) at the Boston University School of Public Health. The researchers looked at four indicators for people living in Boston’s publicly supported housing: having had a dental visit in the last year, having had a dental cleaning in the last year, having had six or more teeth extracted, and having dental insurance. They found that people in public housing, despite being as likely to have had a dental visit in the past year, were significantly less likely to have had a cleaning. The gap in health care is especially serious for the seniors in this already vulnerable population: Compared to younger residents, seniors 65-75 years old were 30 times as likely to have had six or more teeth removed. Read more on prevention.
NewPublicHealth Q&A: John Auerbach and Cheryl Bartlett on the Massachusetts Prevention and Wellness Trust
The Massachusetts Prevention and Wellness Trust is a four-year, $60 million project designed to support prevention and health-promotion activities in the state. The first project of its kind in the United States will fund six to 12 collaborative initiatives, and partners on the initiative will include municipalities, community-based organizations, health care providers, regional agencies and health plans. Information on the Trust is detailed in a new report prepared by the Institute on Urban Health Research and Practice at Northeastern University and funded by the Robert Wood Johnson Foundation.
The vision behind the creation of the project is to give all Massachusetts residents the opportunity to live in communities that promote health, as well as seamless access to all community and clinical services needed to prevent and control chronic diseases. It was created because while there is access to health insurance and health care in Massachusetts, health costs continue to rise. The goals of the project include:
- Reducing the rate of the state’s most costly preventable health conditions
- Reducing health disparities
- Increasing healthy behaviors
- Increasing the adoption of workplace wellness programs
- Developing a strong evidence base of effective prevention programs
In order to implement these goals, the Massachusetts Department of Public Health identified four priority areas: tobacco use, childhood asthma, hypertension and elder falls prevention—all of which should be considered closely when working to reduce health disparities and co-occurring mental health conditions in these areas.
A new infographic created for the Prevention and Wellness Trust’s inauguration perfectly illustrates how community links work together to improve health under the principles of the Trust. For example, a diagnosis of hypertension would need a provider to prescribe medications, but the obesity and exercise needs that would also improve the condition for many patients requires input from other community entities, including:
- Classes in exercise, medication and stress reduction by community agencies
- Chronic disease self management classes and home visits for medication use instruction by a community agency
- A neighborhood policy that provides support for transportation changes to encourage walking or biking and zoning for healthy food stores
- A neighborhood policy that provides support for more accessible recreation options in parks and city centers for increased stress reduction
- Workplace policies that provide support for workplace wellness programs that help provide and encourage exercise, healthy foods and stress reduction
NewPublicHealth recently spoke with John Auerbach, a Professor at Northeastern University and the primary author of a report on the Trust, and Cheryl Bartlett, public health commissioner of Massachusetts and the lead person charged with its implementation.
Improved Prevention and Treatment Decrease U.S. Stroke Deaths
Stroke deaths in the United States have declined dramatically in the last few decades because of improved prevention and treatment, according to a scientific statement published in Stroke, published by the American Heart Association. “The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, DrPH, chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. “The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death,” said Lackland, who added that “although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages [and] we need to keep doing what works and to better target these programs to groups at higher risk.” Public health efforts that have helped lower stroke rates include hypertension control that started in the 1970s; smoking cessation programs; improved control of diabetes and high cholesterol levels; and improved stroke treatment options. Read more on prevention.
NHTSA Announces New Safety Efforts for Older Drivers
The National Highway Traffic Safety Administration (NHTSA) has announced a new strategic plan to help ensure the safety of older drivers and passengers. In 2012, according to NHTSA, more than 5,560 people over the age of 65 died, and 214,000 were injured in motor vehicle crashes. That’s a three percent increase in the number of fatalities and a 16 percent increase in the number of injuries from the previous year. In addition, since 2003 the population of older adults—defined as age 65 and older—has increased by 20 percent and the number of licensed older drivers increased by 21 percent, to 35 million licensed older drivers in 2012.
NHTSA has several new efforts in place to reduce these deaths and injuries:
- The agency is researching advanced vehicle technologies, including vehicle-to-vehicle communications, collision avoidance and crashworthiness that could help reduce the risk of death or injury to older occupants in the event of a crash. It is also considering adding a “silver” rating system, meaning cars with certain technologies might be preferable for older drivers.
- NHTSA will conduct studies to better understand the effects of age-related medical conditions, including dementia.
- NHTSA will continue public education efforts on functional changes that can impact driving, including vision, strength, flexibility and cognition.
Read more on transportation.
Poll: Parents Concerned Over Lack of Physical Activity During School Day
A recent poll conducted by the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation found that many parents are concerned about inadequate levels of physical education at schools. More than 1,300 parents of public school students were polled on a range of issues concerning education and health in the their child’s school, and one in four parents (25 percent) said their child’s school gives too little emphasis to physical education, compared with one in seven who say the same thing about reading and writing (14 percent) or math (15 percent). About three in 10 parents (28 percent) give a low grade (C, D or F) to their child’s school on providing enough time for physical education, while almost seven in 10 parents (68 percent) report that their child’s school does not provide daily physical education classes, a recommendation included in U.S. Centers for Disease Control and Prevention guidelines for schools. “In a period with a significant public debate about the content of educational reform, it is significant that many parents feel that more physical education is needed in the schools,” said Robert Blendon, ScD, Richard L. Menschel professor of Health Policy and Political Analysis at Harvard. Read more on education.
Construction Workers Frequently Impacted by Pain and Stress
Construction workers are frequently stressed about work-related injuries and pain, but often fail to get help for either, putting themselves at risk for additional injuries and mental health issues, according to a new study in the Journal of Occupational and Environmental Medicine. The researchers, based at the Harvard School of Public Health, reviewed data compiled by the School’s Center for Work, Health and Wellbeing and found that the construction industry has one of the highest rates of work-related injuries and suicides in the U.S. workplace, as well as a high prevalence of musculoskeletal pain among its workers. The researchers also conducted a mental health survey of 172 New England construction workers at four construction sites. Sixteen percent of the workers reported being distressed, 75 percent had experienced musculoskeletal pain over the previous three months and 42 percent reported one or more work injuries in the preceding month. A follow-up survey found that more than half of those who previously said they felt distressed had not sought professional help—likely, say the researchers, because of fear of stigmatization or job loss. Read more on injury prevention and mental health.
USPSTF: Cannot Recommend For, or Against, Vitamin Supplements to Help Prevent Cancer, Heart Disease
Citing the fact that there is simply too little evidence to make a conclusion either way, the U.S. Preventive Services Task Force (USPSTF) has concluded at this time that it can’t recommend for or against taking vitamin and mineral supplements to help prevent cancer and heart problems. In a draft statement, the panel also ruled that neither beta-carotene nor vitamin E should be taken to prevent heart disease or cancer; beta-carotene was previously found to exacerbate the risk of lung cancer for people who were already at high risk. The researchers analyzed data from 26 studies between January 2005 and January 2013, which included people across an array of demographics, finding no difference between those who took the supplements and those who took placebos. Vitamin supplements are a $12 billion per year industry in the United States. Read more on prevention.
Study: Simple Urine Test Could Identify Young Type 1 Diabetes Patients with Highest Risk of Heart, Kidney Disease
A basic urine test could help doctors prevent heart and kidney disease in kids who are at higher risk due to their type 1 diabetes, according to a new study in the journal Diabetes Care. As many as 40 percent of youth with type 1 diabetes may be at increased risk for the health problems. Researchers at the University of Cambridge, in England, analyzed data on more than 3,300 diabetes patients between the ages of 10 and 16; an estimated 490,000 kids worldwide have type 1 diabetes. "Managing type 1 diabetes is difficult enough without having to deal with other health problems," study lead author David Dunger. "By using early screening, we can now identify young people at risk of heart and kidney disease. The next step will be to see if drugs used to treat heart and kidney disease—such as statins and blood-pressure-lowering drugs—can help prevent kidney and heart complications in this young, potentially vulnerable population.” Read more on pediatrics.
In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?
In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
Re-Thinking How We Pay for Public Health and Prevention
One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained. In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.
By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.