IOM Report Finds U.S. Global AIDS Efforts Successful, Stresses the Need to Help Countries Manage their Own Programs
A new report from the Institute of Medicine finds that the President's Emergency Plan for AIDS Relief (PEPFAR) has saved and improved millions of lives around the world. The report says the program also shows that HIV/AIDS services can be effectively delivered on a large scale even in countries with high rates of disease and resource challenges. The report also stresses the need for the program to increase its efforts to help partner countries develop the capacity to manage their own programs, sustain the gains that have been made in controlling the HIV epidemic and improve their citizens' access to services. PEPFAR was established in 2003 through legislation that authorized $15 billion for HIV/AIDS and other related global health issues over five years. In 2008, the legislation was reauthorized, providing up to $39 billion through 2013 for PEPFAR bilateral HIV/AIDS programs as well as U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. PEPFAR has supported HIV/AIDS programs in over 100 countries. As part of the reauthorization, Congress requested that IOM evaluate the program. That evaluation included visits to thirteen countries by the IOM's international committee of experts. Read more on HIV/AIDS.

Flu Vaccine 56 Percent Effective Overall, 27 Percent for Seniors
This season’s flu vaccine has been only 56 percent effective as of February and largely ineffective at protecting the elderly, according to the U.S. Centers for Disease Control and Prevention. It was only 27 percent effective for people ages 65 and older; 71 percent of Americans in that age group have been vaccinated. “The older you get, the less potent is your immune response,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Reuters. “This is just a fact of physiological life in the immune system.” He said better data on seniors is needed and there are ways to improve the vaccine going forward. Read more on influenza.

‘Smarter Lunchroom’ Setups Increase Kids’ Consumption of Fruits, Vegetables
Improving the location and attractiveness of fruits and vegetables in school cafeterias can help kids make healthier food choices, according to a new report in the Journal of Pediatrics. Researchers at the Cornell Center for Behavioral Economics in Child Nutrition Programs, in Ithaca, N.Y. also found that simply asking kids if they want to try one of the healthier choices can increase the odds. The inexpensive “smarter lunchroom” setup "not only preserves choice, but has the potential to lead children to develop lifelong habits of selecting and consuming healthier foods even when confronted with less healthy options," said study author Andrew Hanks. They found that post-makeover kids were 13 percent more likely to choose fruits and 23 percent more likely to choose vegetables. Read more on nutrition.

U.S. Adults with Mental Illness Have Higher Smoking Rates
Adults with mental illness have a smoking rate 70 percent higher than adults with no mental illness, according to the February 2013 Vital Signs report released yesterday by the U.S. Centers for Disease Control and Prevention. The report was done in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) and found that 36 percent of adults with a mental illness are cigarette smokers, compared with only 21 percent of adults who do not have a mental illness. Among adults with mental illness, smoking prevalence is especially high among younger adults, American Indians, Alaska Natives, those living below the poverty line, and those with lower levels of education. Differences also exist across states. Smoking prevalence for people with mental illness ranges from 18.2 percent in Utah to 48.7 percent in West Virginia. The data used to determine the smoking rates in the Vital Signs report comes from 2009–2011 National Survey on Drug Use and Health. Mental illness was defined as having a diagnosable mental, behavioral, or emotional disorder, excluding developmental and substance use disorders, in the past 12 months. The report also found that, on average, adult smokers with mental illness smoke more cigarettes per month than those without mental illness (331 vs. 310 cigarettes) and are less likely to quit smoking. “Special efforts are needed to raise awareness about the burden of smoking among people with mental illness and to monitor progress in addressing this disparity,” said SAMHSA administrator, Pamela S. Hyde. Read more on tobacco.

NIH Announces Three Major Clinical Trials for Influenza Treatments
Three clinical trials aimed at finding more effective flu treatments are enrolling volunteers who have the virus at the National Institutes of Health’s Clinical Center in Bethesda, Md., as well as at several dozen other domestic and international sites.

• One study will look at whether the drug Tamiflu reduces the time that infected people continue to produce virus in the upper airway.
• The second trial will test whether a combination of three licensed antiviral drugs works better than Tamiflu in people with influenza that have chronic health conditions, such as heart or lung disease, which put them at greater risk of severe illness.
• The third trial will test whether treatment with plasma enriched with anti-influenza antibodies improves the condition of hospitalized influenza patients compared to standard antiviral treatment on its own.

“This year’s flu season came earlier than usual and has been particularly hard on the elderly,” said Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious diseases. “Despite our best efforts to prevent influenza through vaccination, people still get sick every year with the flu. At best, influenza infection is a miserable experience. At worst, it can be a deadly one. We need better ways to treat people with influenza, which kills thousands of people in the United States each year, and clinical research supported by NIAID helps to address that need.” Read more on flu.

Doctors Miss Opportunities for Underage Alcohol Screening
A new survey of more than 2,500 10th grade students published in Pediatrics found that 34 percent reported drinking alcohol in the past month and 26 percent said they had binged, defined as five or more drinks per occasion for males, and four or more for females. However, while more than 80 percent of those surveyed said they’d seen a doctor in the past year, just 54 percent of that group was asked by their physicians about drinking, and only 40 percent were advised about dangers associated with alcohol. In addition, of those students who had been seen by a doctor in the past year and who reported drinking in the past month, only 23 percent said they were advised to reduce or stop drinking. The survey was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAA). The researchers say studies have shown that screening and brief interventions by health care providers, such as asking patients about alcohol use and advising them to reduce risky drinking, can result in significant, lasting reductions in drinking levels and alcohol-related problems among adults.  “Alcohol is by far the drug of choice among youth," says NIAAA acting director Kenneth R. Warren, PhD. “The findings reported [in this study] indicate that we must redouble our efforts to help clinicians make alcohol screening a routine part of patient care for young people in the United States.” Read more on alcohol.

USDA Releases New Regulations on Snack Foods Sold at Schools
New rules proposed by the U.S. Department of Agriculture would require snacks sold at schools to be lower in fat, salt and sugar and include more nutritious items such as whole grains, vegetables and fruits. The rules also require a limit of 200 calories on food items not sold in the school cafeteria. According to Reuters, the rules would apply to about 50 million children who are part of the school lunch program. “These proposed nutrition standards, the first update in more than 30 years, are long overdue and badly needed,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation. The proposed regulations will be open for public comment once the rule is published in the Federal Register, which is likely to be this week. The final rule would probably not take effect before the fall of 2015. Read more on obesity.

Flu Shot May Protect Older People Against Heart Attacks
A new study from researchers at the University Of Iowa College Of Public Health suggests that the flu vaccine may provide protection against heart attacks in older adults, especially people over age 80. The researchers suspected acute infection caused by flu may trigger events leading to heart attacks and strokes, so they created a set of time-series models using inpatient data from a national sample of more than 1,000 hospitals and used flu activity to predict the incidence of heart attack and stroke. The team produced national models, as well as models based on four geographical regions and five age groups and across all models, and found consistent significant associations between heart attacks and influenza activity.

Flu Season 2013 Update: The most recent report from the U.S. Centers for Disease Control and Prevention finds that while there is still widespread flu activity in much of the country, an increasing number of states are starting to see a decline in reported flu cases.

Read more on flu.

Public Health School Partners with Churches to Improve Healthier Living
As part of a project led by the University Of South Carolina Arnold School Of Public Health, about 1,250 members of 74 African Methodist Episcopal churches in South Carolina participated in a program to help members lead healthier lifestyles through increased physical activity and healthier food choices. The five-year project was funded by the National Institutes of Health and found that members of churches who were part of the healthier lifestyle training were more likely to engage in physical activity and eat more fruits and vegetables than members from churches that did not undergo the training. The study's findings were published in the American Journal of Preventive Medicine. “Churches are natural partners to help eliminate health disparities in the African-American community, says Sara Wilcox, PHD, director of the school’s prevention research center. “For many, especially in the South, the church is the center of their life and is a trusted institution.” Read more on prevention.

The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.

NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.

NewPublicHealth: What, if anything, is different about the flu this year?

Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.

During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.

Hopkins Researchers Use Twitter to Track the Flu
A new method of tracking influenza cases using Twitter could also be utilized to track other illnesses, according to researchers at the Johns Hopkins University. The researchers, along with computer scientists, created an algorithm that uses human language-processing technologies to filter out general discussion about the flu and zeroes in on messages about actual flu cases, according to Reuters. The National Institutes of Health's Models of Infectious Disease Agent Study contributed funding to the research. Read more on influenza.

Recalls Announced by Two Well-known Food Companies
Some well-known food companies recalled products yesterday. ConAgra Foods, of Omaha, Neb., has initiated a voluntary recall for lots of its 8 ounce Hunt's Tomato Sauce (regular variety) and Hunt's Tomato Sauce No Salt Added. There are no concerns about the actual food, but a defect in the can cause them to burst when opening. Also BBU Inc., the parent of the Bimbo Bakeries companies, is voluntarily recalling certain of its fresh bagels due to the possibility of metal fragments. Read more on food safety.

Study: Bad News Leads to More Eating, Calorie Cravings
Bringing new meaning to the concept of “comfort food,” researchers have found that bad news—messages of struggle and adversity—can cause people to overeat. In the study, participants shown negative messages ate 40 percent more than those who saw neutral messages. They were also more drawn to high calorie foods. "It is clear from the studies that taste was not what caused the reactions, it was a longing for calories," said study author Juliano Laran, an assistant professor of marketing at the University of Miami School of Business Administration, in a release. “These findings could have positive implications for individuals in the health care field, government campaigns on nutrition, and companies promoting wellness. And, certainly beware of savvy food marketers bearing bad news." The study appears in the journal Psychological Science. Read more on nutrition.

Add electronic health records to the critical weapons health professionals have against the flu, as 48 states currently deal with widespread flu activity and the U.S. Centers for Disease Control and Prevention (CDC) reports at least 30 pediatric deaths so far. At least half of those children had not received a flu shot, according to CDC Director Thomas Frieden.

A CDC report from September 2012 found that about 128 million people, or about 42 percent of the U.S. population, got the flu shot during the 2011-2012 season, which started later and proved milder than the one we’re in now. That number has been holding steady for several years, but is below the CDC’s goal of 80 percent of the U.S. population receiving a flu shot.

Kaiser Permanente in Northern California, however, has seen a 6 percent increase in its two-million plus members getting the 2012-2013 flu shot over previous years, for which it gives credit to HealthConnect, the largest civilian health record data base in the United States. Randy Bergen, MD, the vaccine lead at Kaiser in Northern California, says the system lets Kaiser Staff “proactively reach out to all its members and even identify those at greatest risk from contracting the flu [which includes children, the elderly and people with chronic diseases] to give them an extra nudge.”

The timeliest presentation at this year’s Public Health Law Research Program annual meeting taking place this week in New Orleans was likely the study presented by Richard Zimmerman, MD, MPH, and a professor of family medicine at the University Of Pittsburgh School Of Medicine. Zimmerman’s research looked at factors—including hospital policies—that help drive health workers to get a flu shot. The study looked at 429 hospitals in 41 states and found that 31 employed a mandate that fired workers who refused a flu shot, while 131 has other types of mandated requirements. For example, a health worker who refused the flu shot was required to wear a mask at all times while on the job during flu season.

NewPublicHealth: Tell us about your study.

Dr. Zimmerman: It was essentially a nationwide study that looked at the worker vaccination rate and what policies to use to increase vaccination rates. Factors associated with the highest rates are hospital mandates, either making vaccination a condition of employment or requiring safeguards such as mandating that health workers who don’t get a flu shot wear a mask during the flu season. The U.S. Centers for Disease Control and Prevention goal for the percentage of health workers getting flu shots is 90 percent, but many institutions achieve rates in the 60 percent to 75 percent range.

NPH: How do you increase that?

Dr. Zimmerman: It’s a high bar. We see over a decade that we’ve moved from the 40s to the 60s, but I fear we are going to plateau at the 65 to 75 percent ranges.

NPH: What reasons do workers, and the general public, give for not getting the flu vaccine

New York Declares Public Health Emergency for Flu
The state of New York has declared a public health emergency due to the increasingly severe flu season, which has reached epidemic levels. The declaration allows pharmacists to administer flu vaccinations to patients between six months and 18 years of age and suspends for the next 30 days the state’s law that limits the authority of pharmacists to administer vaccinations only to people 18 and older. "We are experiencing the worst flu season since at least 2009, and influenza activity in New York state is widespread, with cases reported in all 57 counties and all five boroughs of New York City," said Governor Andrew Cuomo, according to Reuters. According to the U.S. Centers for Disease Control and Prevention, nine of the ten regions of the United States have “elevated” flu activity. Last week the city of Boston, Ma., declared a public health emergency in response to the flu. Read more on influenza.

High Noise Levels in Sports Stadiums Hurts Workers, Spectators
High noise levels in the workplace—especially in nontraditional workplaces such as sports stadiums—are often unappreciated and can lead to permanent hearing loss, according to two new studies in the Journal of Occupational and Environmental Hygiene (JOEH). The can also be damaging to spectators. “While severe traumatic injuries and degenerative brain disorders due to concussive blows are recognized as severe hazards among athletes, exposure to high noise likely affects far more individuals (spectators and referees), and the resulting permanent hearing loss decreases the quality of life of those affected,” said JOEH Editor in Chief Mark Nicas, PhD, CIH. Read more on business.

Simple Traffic Changes Make Streets Safer, Save Pedestrian Lives
Traffic changes around schools in New York City helped cut child pedestrian injuries by 44 percent during “school travel” hours, according to the results of the National Safe Routes to School program published in the journal Pediatrics. "The study shows that safety programs really do work," said Kate Carr, president and CEO of Safe Kids Worldwide, according to HealthDay. "Making common sense improvements around schools by adding sidewalks and speed bumps, improving signage, and creating more visible crosswalks prevents injuries and saves lives." Safer streets also encourage kids and their parents to get more physical activity. Read more on safety.

MLB to Test for Human Growth Hormone During the Season
Major League Baseball and the Major League Baseball Players Association have agreed to perform in-season blood testing for human growth hormone, as well as a test to detect synthetic testosterone. The use of performance-enhancing drugs has become a significant issue in baseball over the past several years, calling into question the accomplishments of many players going back to the 1980s. Earlier this week the sport’s Hall of Fame announced no one had been elected on this year’s ballot, which included perhaps the greatest batter and the greatest pitcher of the past 40 years—both of whom are tainted by the scandal of the steroid era. Read more on substance abuse.

Flu Season Seeing Shortages of Vaccine, Tamiflu
The increasingly bad flu season is also now seeing a shortage of flu vaccine and the Tamiflu treatment for children. Many forms of the vaccine are sold out and major vaccine provider Sanofi SA said it cannot make any more vaccine for this season because its facilities are already preparing for next season, according to Reuters. "People who haven't been vaccinated and want to get the vaccine may have to look in several places for it," said Tom Skinner, a spokesman for the U.S. Centers for Disease Control and Prevention. Earlier this week the city of Boston declared a public health emergency due to the flu. The city has reported about 700 cases since October 1. Read more on influenza.

Prescription Painkiller Misuse Trails only Marijuana Abuse In U.S.
Prescription painkillers trail only marijuana when it comes to substance abuse in the United States, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Approximately 22 million people have misused the drugs since 2002. "Any time you have 2 percent of the population using medications like this there is a lot to do, but we are doing a lot with a combination of putting tighter controls on who can get these drugs and public education," said Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality, according to HealthDay. Painkiller abuse is also taking a growing toll on emergency departments who deal with people seeking treatment. Read more on prescription drugs.

Boston Declares Public Health Emergency over Flu
The city of Boston has declared a public health emergency in response to the severe flu season. Approximately 700 people are believed to have contracted the flu since October 1—up dramatically from the total of 70 cases for the entirety of last flu season. The Boston Public Health Commission is offering free vaccination clinics this weekend.  “This is not only a health concern, but also an economic concern for families, and I’m urging residents to get vaccinated if they haven’t already,” said Mayor Thomas M. Menino in a release. “It’s the best thing you can do to protect yourself and your family.  If you’re sick, please stay home from work or school.” Read more on influenza.

FDA Releases Draft Guidance on Abuse-Resistant Opioids
The U.S. Food and Drug Administration (FDA) has issued draft guidance to help the pharmaceutical industry develop new formulations of opioid drugs that are less likely to be abused. Included in the guidance is information on studies the agencies would like to see that demonstrate that a formulation has “abuse-deterrent properties,” how those studies will be evaluated by the FDA and what labeling claims may be approved based on the results of the studies. “The FDA is extremely concerned about the inappropriate use of prescription opioids, which is a major public health challenge for our nation,” said FDA Commissioner Margaret A. Hamburg, MD. “This draft guidance is an important part of a larger effort by FDA aimed at preventing prescription drug abuse and misuse.” According to the FDA, abuse-deterrent formulations target the known types of opioid abuse, such as crushing in order to snort or dissolving in order to inject, for the specific opioid drug substance in that formulation. The science of abuse deterrence is relatively new, and both the formulation technologies and the analytical, clinical and statistical methods for evaluating those technologies are developing quickly, according to the agency. “Our nation is in the midst of a prescription drug abuse epidemic,” said R. Gil Kerlikowske, director of National Drug Control Policy. “While there are no silver bullet solutions to this public health and safety challenge, abuse-deterrent formulations of powerful prescription opioids can make a difference in addressing this epidemic.” Read a NewPublicHealth interview with director Kerlikowske.

Report Says Cost-Cutting Measures Now Could Save $2 Trillion in Health Care Costs
Implementing cost-cutting measures now could help the United States save $2 trillion on health care over the next 10 years, according to a new report from the Commonwealth Fund. The plan calls for using gross domestic product per capita to determine overall healthcare spending growth, which would include Medicare, Medicaid, other government programs and private insurers. Commonwealth Fund President David Blumenthal said the proposal is an alternative to some of the possibilities being floated for the upcoming deficit talks, which could end up cutting entitlement programs. "In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve." Read more on access to health care.