Over the weekend, NewPublicHealth conducted an email interview with Tarik Jasarevic, a spokesperson for the World Health Organization (WHO), on Ebola efforts on the ground in West Africa and the impact on the global effort of the cases recently diagnosed in the United States.
NewPublicHealth: Is there concern among global health leaders that the attention on a handful of cases is taking away attention from the thousands of cases in West Africa?
Tarik Jasarevic: While countries need to be vigilant and prepared for a possible case of Ebola, we need to focus on getting all possible resources—trained health workers, medical facilities with beds and money—to the affected countries in West Africa.
NPH: Several weeks ago global health leaders had a checklist of things, including money and personnel, needed to stem the outbreaks in the various countries. Where do things stand now, and what is still needed?
Jasarevic: We need a lot of resources if we’re going to get the virus under control. WHO and partners constructed 12 Ebola Treatment Centers in Liberia, 15 in Sierra Leone and 3 in Guinea—30 out of the 50 that are needed. These facilities contain more than 1,100 beds for patients, out of the more than 4,000 needed. There are more than 2,500 beds becoming available in the next few weeks, but we still need more. We also need international health workers to come work alongside national health workers to manage and run the health facilities. WHO has set up “training academies” in each of the affected countries to train more local health workers, but more are needed.
NPH: What is the current fatality rate?
Jasarevic: The fatality rate for this particular outbreak has always been approximately 70 percent. We are seeing higher numbers of cases and deaths because of the geographic spread of the disease, from urban city centers to rural, hard to reach villages. There is also significant under reporting of cases in the three countries, especially Liberia.
CDC Updates Guidelines on Health Worker Protective Gear when Treating Ebola Patients
The U.S. Centers for Disease Control and Prevention (CDC) announced last night that it is tightening its infection control guidance for health care workers caring for patients with Ebola, with a specific focus on several key steps:
- All health care workers must undergo rigorous training and become practiced and competent with protective equipment, including taking it on and off in a systemic manner.
- No skin exposure is allowed when the equipment is worn.
- All workers must be supervised by a trained monitor who watches each worker taking the equipment on and off.
The CDC is recommending all of the same equipment in its earlier guidance, with the addition of coveralls and single-use, disposable hoods. Single-use face shields are now recommended instead of goggles. Read more on Ebola.
Most People Polled Don’t Know New ACA Enrollment Period Begins in November
A poll just released from the Kaiser Family Foundation finds few people know that open enrollment for 2015 health insurance coverage under the Affordable Care Act begins next month. Other findings of the poll:
- Two-thirds of responders say they know “only a little” or “nothing at all” about the marketplaces where people who don’t get coverage through their employers can shop for insurance.
- Just over half say they know that financial assistance is available to help low- and moderate-income individuals purchase insurance.
Risk Factors for Sexual Assault Need to be Included in Prevention Efforts
Researchers who conducted a Danish study on sexual assault say that certain risk factors for the attacks—including the age of the victim and their prior relationship with the attacker—must be considered when developing strategies to help prevent sexual assaults. The researchers looked at data from more than 250 women who sought help at a Danish center for sexual assault victims between 2001 and 2010. The researchers found that 66 percent of the women were 15-24 years old and 75 percent had met their attacker before the assault. Nearly half of the women reported that the attacker was a current or former boyfriend, a family member or someone they considered a friend. Women who did not know their attacker previously were more likely to report the assault to the police. “We need to raise awareness of the fact that most sexual assaults are perpetrated by someone known to the woman, often in familiar surroundings ... in order to change the general attitudes towards sexual assault, this information should not only target young people, but also the police, health care professionals and the general public,” said Mie-Louise Larsen, of the Centre for Victims of Sexual Assault and the University of Copenhagen and a coauthor of the study, which appeared in BJOG: An International Journal of Obstetrics and Gynaecology. Read more on injury prevention.
Positive Images Improve Function in Older Adults
Older individuals who are subliminally exposed to positive stereotypes about aging showed improved physical functioning that can last for several weeks, according to work done by researchers at the Yale School of Public Health. The study, which will be published in Psychological Science, included 100 older individuals with an average age of 81 years. Some participants saw positive age stereotypes on a computer screen that flashed words such as “spry” and “creative.” Those participants who were exposed to positive messaging displayed both psychological and physical improvements but control participants did not. Read more on aging.
Parents know how difficult it can be to find kid-friendly supermarket checkout counters without candy or magazines. Now a new mobile-friendly website from the Campaign for Tobacco-Free Kids offers parents a way to find retailers who don’t sell tobacco. Public health experts applaud its debut:
- Tobacco companies spend more than 90 percent of their annual $8.8 billion marketing budget at the point-of-sale in stores, and this marketing has been shown to increase youth tobacco use.
- Every day, more than 2,800 U.S. kids try their first cigarette. That’s more than one million kids who take their first puff each year.
- 5.6 million children alive today will die prematurely from smoking unless current trends are reversed.
- An estimated 375,000 U.S. retail stores sell tobacco products. That sends a terrible message to kids that tobacco use is normal, acceptable and appealing.
The new website includes an interactive map that shows the locations of Tobacco-Free Retailers across the country. All CVS Pharmacies have just gone tobacco-free and other retailers who don’t sell tobacco include Wegmans and Target. As part of a new national campaign, stores that are tobacco-free can also display stickers from Tobacco-Free Kids.
EBOLA UPDATE: 43 People Cleared from Ebola Watch Lists in Texas
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Dozens of people in the United States came off of Ebola watch lists this morning after showing no symptoms for 21 days. A total of forty-three people who came into contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, were cleared by Texas’ state health department. Another 120 people are still being monitored. The news comes as lawmakers continue to debate the feasibility and prudence of enacting a travel ban from West Africa. Read more on Ebola.
Healthy lifestyle habits such as maintaining a normal weight, not smoking and staying physically active may help prevent as many as half of all gestational diabetes cases, according to a new study in the journal BMJ. Researchers analyzed data on more than 14,000 U.S. women, finding that women who were overweight or obese during pregnancy were at four times the risk of developing gestational diabetes. Women with all three of the identified healthy lifestyle behaviors were 83 percent less likely to develop gestational diabetes than were women who lacked all three. Read more on maternal and infant health.
Study: Men with IBS Report Greater Interpersonal Difficulties
Men with irritable bowel syndrome (IBS) experience more interpersonal difficulties than do women with the condition, according to a surprising new study presented at the American College of Gastroenterology annual meeting in Philadelphia. IBS symptoms include abdominal pain, diarrhea and/or constipation; it affects an estimate 25 million to 50 million Americans, but is twice as common among women, meaning less is known about how men experience the disorder. The study determined that men report feeling cold and detached, which leads to difficulties in interpersonal relationships. "Our findings underscore the significance of studying gender-based differences in how people experience the same disease or condition," says Jeffrey Lackner, PsyD, professor of medicine in the UB School of Medicine and Biomedical Sciences, in a release. "That discrepancy underscores our need to move beyond clinical intuition and anecdote, and systematically study the different ways that each gender experiences disease in general. Patients who have a domineering and distant interpersonal style may need to work more closely with the physicians.” Read more on health disparities.
Earlier this year, Brownsville, Tex., was chosen by the Robert Wood Johnson Foundation as a Culture of Health Prize winner for its efforts to improve community health. As part of a new ongoing series, Health Affairs blog has featured a piece by local Brownsville leader Belinda Reininger on the community’s health successes.
Brownsville is a mostly Spanish-speaking town on the Texas border. The community, which is home to approximately 180,000 people, is also among the poorest metropolitan areas in the country. Approximately 48 percent of its children live in poverty, 80 percent of its population is obese or overweight, 30 percent have diabetes and about 67 percent have no health insurance.
However, over the last decade it has also become a “robust, bike-friendly city” that also promotes health through community gardens and the world’s largest Zumba class, according to Reininger. This is thanks in large part to the University of Texas’ decision to open its School of Public Health in Brownsville and the formation of Community Advisory Board that brings together 200 people and organizations, from private citizens and elected officials to business executives and nonprofits.
The board’s members “carry the message of wellness into their homes and businesses, and they’re able to affect policy and environmental changes by voting and leadership—and that’s how we have been able to include the community, by engaging them every single step of the way,” said Reininger, DrPh, to NewPublicHealth earlier this year.
Brownsville’s efforts include:
- Using data to assess the community’s health issues and then to engage with community members in a way that is both informative and beneficial to their health.
- Creating diverse programs — from Brownsville in Motion to promote physical activity through safe access to trails and bike lanes, to the Brownsville Farmers’ Market and Community Garden—to address the relationships between health, poverty, education and the economy.
To learn more about Brownsville’s prize-winning efforts to improve public health, read the Health Affairs blog post.
>>Bonus Content: Watch a NewPublicHealth video on Brownsville's efforts to build a Culture of Health.
EBOLA UPDATE: HHS Accelerates Development of an Ebola Vaccine
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) is working to accelerate the development of a vaccine to prevent Ebola through a one-year, $5.8 million contract with Profectus BioSciences Inc. ASPR’s Biomedical Advanced Research and Development Authority (BARDA) will also provide subject matter expertise and technical assistance. Plans call for the vaccine to first be tested in animal safety studies. “We are pushing hard to advance the development of multiple products as quickly as possible for clinical evaluation and future use in preventing or treating this deadly disease,” said BARDA Director Robin Robinson, PhD. “Our goal is to close the global gap in vaccines and therapeutics needed to protect the public health from Ebola as highlighted by the epidemic in West Africa.” Read more on Ebola.
High-Fat Meals Could Be More Harmful to Men than to Women
High-fat meals could be more harmful to men than they are to women, according to a new study in the journal Cell Reports. Researchers at the Cedars-Sinai Diabetes and Obesity Research Institute and funded by the National Institutes of Health determined that male mice who received high-fat diets experienced greater health complications than did female mice who received the same. "For the first time, we have identified remarkable differences in the sexes when it comes to how the body responds to high-fat diets," said Deborah Clegg, PhD. "In the study, the mice were given the equivalent of a steady diet of hamburgers and soda. The brains of the male mice became inflamed and their hearts were damaged. But the female mice showed no brain inflammation and had normal hearts during the diet." Richard Bergman, PhD, director of the Diabetes and Obesity Research Institute, said the findings suggest that physicians must “reconsider whether the diets and drugs we recommend for managing obesity may need to be sex-specific to be more effective.” Read more on obesity.
Study Links Metal-Contaminated Well Water to Birth Defects, Other Detrimental Health Outcomes
Increased levels of metals in private well water may be linked to birth defects and other detrimental health outcomes, according to a new study in the journal BiodMed Central Public Health. Researchers at the UNC Gillings School of Global Public Health utilized well water data from between 11,000 and 47,000 wells provided by the North Carolina Department of Health and Human Services. They determined that metals such as cadmium, arsenic, lead and manganese in drinking water can lead to spontaneous abortion, stillbirth, low birth weight and impaired neural development in infants. Read more on water and air quality.
People tuning into news coverage of the Dallas Ebola cases have come to recognize David Lakey, the Texas state health officer. Every state has a similar position and those officials are charged with improving population health—from holding immunization clinics to responding to potentially fatal illnesses. The Association of State and Territorial Health Officers (ASTHO) is the professional association of the 50 state health officers. Jim Blumenstock is the chief program officer of ASTHO’s public health practice division. NewPublicHealth spoke to Blumenstock this week about state and federal coordination on Ebola detection and case treatment.
NewPublicHealth: What is ASTHO’s role in dealing with preparedness for Ebola in the United States and with the current cases?
Jim Blumenstock: In a crisis or a public health emergency like we’re experiencing with Ebola, ASTHO’s role principally is to do two things. Number one is to sort of be the glue or the hub that helps pull together the 50 states, the nine territories and the District of Columbia as an integrated, harmonious component of our public health infrastructure. The second feature is to provide a solid interface between federal efforts and state efforts. So, that’s our role with any significant public health issue.
During the H1N1 outbreak several years ago, both ASTHO and the National Association of County and City Health Officials (NACCHO) had key staff embedded in the U.S. Centers for Disease Control and Prevention’s (CDC) Emergency Operation Center because it was recognized that the value of the insight of a national organization that represents all the states and locals was so critical to the federal planning and response process. That was the first time it was done.
We’re on standby to do it and we’re sort of functioning in that capacity right now, but sort of in a virtual or remote area. For example, I’m not today embedded in CDC’s Emergency Operation Center. However, I would say I’m on the phone with them at least six to eight times a day—including last evening—and have had email exchanges already this morning, not only to get information, but also to be part of some planning and problem solving efforts they’ve requested our help on, or a request for our help on state consensus around a strategy or a tactic or an approach on a particular matter.
And our other critical roles are to help our members; to talk to federal public health officials; and to educate and inform the public.
EBOLA UPDATE: CDC May Add Some Health Care Workers to Federal No-Fly List
(NewPublicHealth is monitoring the public health crisis in West Africa.)
In response to the news that a Dallas nurse who tested positive for Ebola flew on a commercial airliner between when she was exposed to the disease and when she was diagnosed, the U.S. Centers for Disease Control and Prevention (CDC) is considering adding the names of health care workers being monitored for Ebola to the government’s no-fly list, according to Fox News. Seventy workers who helped treat Ebola patient Thomas Edward Duncan at Texas Health Presbyterian Hospital are being monitored by the CDC. Read more on Ebola.
HUD: $38.3 Million to Enforce Fair Housing Practices
The U.S. Department of Housing and Urban Development (HUD) has awarded $38.3 million to help enforce the Fair Housing Act through investigations of alleged discriminatory practices, as well as to educate housing providers, local governments and potential victims of housing discrimination about the Fair Housing Act. More than 100 fair housing organizations and other non-profit agencies in 43 states and the District of Columbia will share the funding, which is available through HUD’s Fair Housing Initiatives Program. “Ending housing discrimination is at the core of HUD’s mission and it takes dedicated people on the ground to address it,” said HUD Secretary Julián Castro, in a release. “These funds support community-based organizations that do great work every day on the front lines in the fight for fairness and equality in our nation’s housing market.” Read more on housing.
Study: Adults Who Are Comfortable With Aging More Likely to Seek Preventive Health Care
Older adults who are comfortable with aging are also more likely to be proactive in getting preventive health care services, according to a new study in the journal Preventive Medicine. One of the obstacles that keeps some older adults from seeking out preventive care is the belief that all their physical and mental declines are typical of old age. Researchers at the University of Michigan examined data on 6,177 participants age 50 and older. Among their findings for individuals who reported higher satisfaction with aging:
- They were more likely to obtain a cholesterol test and colonoscopy over time
- Women received a mammogram/X-ray or pap smear with greater frequency
- Men made medical appointments more often to get a prostate exam
Read more on aging.
The American Academy of Pediatrics (AAP) met in San Diego this week for the group’s annual meeting. Key issues addressed included car seat safety for newborns, care for immigrant children, reducing poverty and young children’s exposure to media.
A study presented at the meeting found that most newborns leave the hospital with their car seat incorrectly installed, posing a risk of injury or death. A trained installer hired by the researchers observed 300 parents and babies about to leave the hospital, noting mistakes such as harnesses that were too high and clips fastened incorrectly. The technician made adjustments before the families left the hospital.
“Car safety seats can be difficult to use correctly for many families, and we need to provide the resources and services they need to help ensure the safest possible travel for newborns and all children,” said Benjamin Hoffman, MD, FAAP, lead author of the study “Unsafe from the Start: Critical Misuse of Car Safety Seats for Newborns at Initial Hospital Discharge.”
AAP released its first media policy urging parents to limit screen time for kids in 1999. That recommendation was solely about television, and since then AAP policies have proliferated. Dimitri Christakis, MD, MPH, and Donald Shifrin, MD, both members of the AAP Council on Communication and Media, debated touchscreen use by toddlers.
“Touchscreens are merely a platform. If a toddler watches a movie on an iPad, it’s no different than watching a movie on a DVD player,” said Christakis. “However, tablets also can be used to read books to children, and high-quality apps are similar to toys. Therefore, the AAP needs to consider how these devices are used instead of discouraging their use across the board.”
EBOLA UPDATE: Second Dallas Health Care Work Tests Positive for Ebola
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The Texas hospital that treated a man who has since died from Ebola has reported that a second health care worker has tested positive for the disease. The patient has been isolated at Texas Presbyterian Hospital in Dallas; the health care worker is being monitored for fever and symptoms while confirmation testing is performed at the Texas Department of State Health Services’ laboratory. The U.S. Centers for Disease Control and Prevention has interviewed the patient about any contacts or potential exposures. Read more on Ebola.
CDC is Utilizing New, Faster Lab Test for Enterovirus D68
The U.S. Centers for Disease Control and Prevention (CDC) has developed and is now using a new laboratory test that will enable it to more quickly test remaining specimens for the presence of enterovirus D68 (EV-D68). EV-D68 has been identified as the most common type of enterovirus this year; enteroviruses and rhinoviruses lead to millions of respiratory illnesses in children annually, and can be especially harmful to kids with asthma. “CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations,” said Anne Schuchat, MD, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases. “When rare or uncommon viruses suddenly begin causing severe illness, CDC works quickly to develop diagnostic tests to enhance our response and investigations. This new lab test will reduce what would normally take several weeks to get results to a few days.” Read more on pediatrics.
Study: Health Disparities at the Root of Post-Cancer Surgery Deaths
Approximately 5 percent of more than 1 million cancer patients who had surgery died within one month of their operation, according to a new study by Harvard researchers. Study lead author Brandon Mahal, a research fellow at the Dana-Farber Cancer Institute in Boston, cited disparities such as access to quality care, biological or genetic factors, social support and treatment differences as the most likely reasons for the death rate. The study determined that married patients had a 20 percent lower risk of dying within the month after surgery; insured patients had a 12 percent lower risk; wealthier patients had a 5 percent lower risk; and more-educated patients had a 2 percent lower risk. "Efforts to reduce deaths and eliminate disparities have the potential to significantly improve survival among patients with cancer," Mahal said. Read more on health disparities.