New NIH Study to Look at House-to-House HIV Testing, Other Measures, to Reduce HIV Burden in Africa
A study in South Africa and Zambia is assessing whether house-to-house voluntary HIV testing and prompt treatment of HIV infection, along with other proven HIV prevention measures, can substantially reduce the number of new HIV infections across communities. The trial is funded primarily by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), administered by the Office of the Global AIDS Coordinator. “Through this new study, we aim to learn whether the treatment of HIV-infected individuals as a form of HIV prevention, an approach previously tested in roughly 1,800 heterosexual couples where one partner was infected, will be just as effective when implemented across an entire adult population,” said NIAID Director Anthony S. Fauci, MD. “The study also will tell us whether this method of delivering population-wide HIV treatment as prevention is feasible and cost-effective.” The trial is being conducted in South Africa and Zambia because the HIV prevalence in those countries is among the highest in the world. An estimated 12.5 percent of adults in Zambia and 17.3 percent of adults in South Africa are infected. The study team will measure the impact of the two HIV prevention packages by determining the number of new HIV infections among a representative sample of 52,500 adults drawn from the 21 study communities and followed for three years. The study is expected to end in 2019. Read more on AIDS.

Study: Better Awareness Likely Reason for Increase in ER Visits for Youth Concussions
Improved awareness of the signs and symptoms of traumatic brain injuries (TMI)—such as concussions—is likely the cause of a noticeable increase in TMI-related emergency department visits by children, according to a new study from doctors at the Cincinnati Children's Hospital Medical Center. The study appeared in the journal pediatrics. Visits for these types of injuries climbed about 92 percent from 2002 to 2011, while the overall severity of the injuries decreased and the hospitalization rate remained at around 10 percent. "We are doing a better job at educating ourselves and educating the public about concussion," said Dr. Holly Hanson, lead study author and an emergency medicine fellow. "People and doctors are recognizing sports-related concussions more. People are recognizing the signs and symptoms. People are more aware of the complications. So people are coming in more." According to the U.S. Centers for Disease Control and Prevent, each year TMI accounts for about 630,000 emergency department visits, 67,000 hospitalizations and 6,100 deaths in children and teens annually. Read more on injury prevention.

HHS Developing New Burn Treatments to Improve Disaster Response, Daily Care
Through its Biomedical Advanced Research and Development Authority (BARDA), the U.S. Department of Health and Human Services (HUD) is working to develop five new types of burn treatments for disaster response and daily emergency medical care. The thermal burn medical countermeasures—which could take the form of drugs, vaccines or medical products—will be for chemical, radiological or nuclear incidents. Developing new measures is critical, because with only 127 burn centers in the country, a mass casualty event could quickly overwhelm the public health response. “Sustainability of these medical countermeasures for thermal burns is critical for their availability when they are needed most,” said BARDA Director Robin Robinson, PhD. “Our repurposing and multi-purpose strategy facilitates development, ensures availability, and reduces overall costs for thermal burn medical countermeasures.” Read more on disasters.

Report: U.S. Poverty, Uninsured Rates Remain Stagnant
Despite an improving economy that included the creation of more than 2 million jobs last year, the U.S. poverty rate in 2012 remained relatively equal to the previous year, according to a new report from the U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2012. About 46.5 million people lived at or below the poverty line in 2012, or about 15 percent of the nation. That’s about 2.5 percentage points higher than 2007, right before the economic recession. About 48 million people were without health insurance in 2012, only slightly lower than the 48.6 million in 2011. While the recession seems to have leveled out, the fact that poverty rates have yet to truly rebound has many experts concerned. “We’re supposed to be in recovery,” said Austin Nichols, a researcher at the Urban Institute. “Poverty rates should be falling because long-term unemployment is falling. And they're not.” Read more on poverty.

Economic, Mental Toll of Economic Crisis Likely Responsible for Global Jump in Men’s Suicide Rates
The economic and mental toll of the 2008 global economic crisis was likely a major contributor to the surprising increase in the U.S. and global male suicide rates in 2009, according to a new study in the journal BMJ. There were about 5,000 more suicides than expected that year. The male suicide rate in the United States climbed almost 9 percent in the United States in 2009; the overall global rate climbed 3.3 percent, with the largest increases seen in the European Union and North and South American countries. Depression and stress can lead to increased alcohol and drug abuse, which are also suicide risk factors. The study concluded that immediate action, such as job-creation programs, may help prevent a continued increase in suicides. "Unemployment appears to lead to an increase in anxiety and depression -- two psychiatric symptoms that might be intermediate steps toward suicide," said Robert Dicker, MD, associate director of the division of child and adolescent psychiatry at North Shore-LIJ, in New Hyde Park, N.Y., who was not a part of the study. "More unemployment, more family distress, more losses [of status and friends] also most likely are involved." Read more on mental health.

Study: Two Simple Questions on Mobility Can Help Assess, Treat Older Adults’ Physical Declines
Two simple questions about mobility could help doctors more accurately assess and treat an older adult’s physical decline, according to a new study in the Journal of the American Medical Association:

• For health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile?
• Because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?

The answers could help determine whether physical therapy or mobility-assistance devices are needed. The findings emphasize the importance of increased physical activity and exercise in health aging, according to Cynthia Brown, MD, of the division of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham. "With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently,” she said. “The major barriers—lack of physical activity, obesity and smoking—are all risk factors that can be successfully overcome with appropriate treatment and assistance." Read more on aging.

As part of a new series exploring the future of public health in conversations with public health students and emerging leaders, NewPublicHealth caught up with rising senior at DePaul University, Teresa Marx, who gained valuable hands-on experience in global health through her service trip with Global Brigades.

Marx signed up to travel to Ghana with Global Brigades, the world’s largest student-led global health and sustainable development organization. Through this program, teams of students and professionals work with communities in under-resourced regions to improve the quality of life while respecting local cultures. Global Brigades programs provide students with the opportunities to work with architecture, business, dental, environmental, human rights, medical, microfinance, public health and water awareness and development during their trips. Marx returned to the United States with the conviction that the public health aspects of her experience were the most valuable and held the most potential for impact on the local communities. Marx is a communication studies major and African Black Diaspora minor at DePaul, where she also hosts and produces a weekly radio show. In addition to her service trip to Ghana, she has also served as a counselor at AmeriCorps Camp Versity, where she developed daily activities for at-risk children and adolescents that helped encourage positive self-image, conflict resolution and healthy living. 

NewPublicHealth spoke with Teresa Marx about the lessons she learned during her trip to Ghana and how she can apply them back in the United States in her future work.

NewPublicHealth: What inspired your initial interest in Africa particularly and in public health overall?

Teresa Marx: I come from a really diverse family and I’ve always been really interested in learning about and immersing myself in other people’s cultures. I started minoring in African Black Studies and learning more about Africa [at DePaul University]. I wanted to actually go and experience Africa: the culture, the people and the food. It’s one thing to learn about it, but then it’s another to be immersed in it. Public health has always been an interest of mine because I love knowing that through education and awareness we can create healthier communities and a better world.

NPH: Tell us about the specific program that you were on. There was a medical and public health focus. What was it like to go straight from college to basically treating people?

Ahead of the annual pilgrimage of Muslims to Mecca and Medina in Saudi Arabia this October, the Saudi health ministry is limiting the number of foreign and local pilgrims in order to lower the risk of the spread of H7N9, a new form of avian flu identified several months ago in China, and MERS, or Middle East respiratory syndrome corona virus (MERS/MERS-CoV), a potentially fatal virus that emerged last year. The largest numbers of cases of the virus—and deaths—have been in Saudi Arabia. According to a recent post on the Network for Public Health Law’s (NPHL) blog by Daniel G. Orenstein, JD, deputy director of NPHL’s Western Region, so far neither the U.S. Centers for Disease Control and Prevention nor the World Health Organization have issued travel restrictions about the Hajj.

However, the post does note that the emergence of the two viruses has prompted the U.S. Food and Drug Administration (FDA) to take action under its legal authority to increase U.S. readiness to treat potential outbreaks of H7N9 and MERS. Under the Pandemic and All Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), the FDA recently issued Emergency Use Authorizations (EUAs) for diagnostic tests for both viruses. EUAs enable the FDA to temporarily allow use of unapproved medical products such as antibiotics, vaccines and diagnostic tests needed during emergencies.

Orenstein says that “issuing the EUAs illustrates the flexibility and adaptability of FDA authority as clarified under PAHPRA. As epidemiologic research develops further on these viruses, FDA will be able to respond quickly, hopefully mitigating the impact on population health.”

>>Read more: Read the full post on the Network for Public Health Law’s blog.

Yale Report Finds U.N. Responsible for Haiti Cholera Outbreak
A new report from the Yale University Schools of Public Health and Law finds that the United Nations (U.N.) inadvertently caused a deadly cholera epidemic in Haiti. The report confirms prior accounts that U.N. peacekeepers inadvertently but negligently brought cholera into Haiti, causing one of the largest epidemics in recent history. Because of inadequate water and sanitation facilities at the U.N. base in the Haitian town of Méyè, sewage from the base contaminated the Artibonite River, the largest river in Haiti and one the country’s main water sources. By July 2011, cholera spread through the country, infecting one new person per minute. The epidemic continues, and public health experts estimate it will take a decade or more to eliminate the disease from Haiti. Prior to this outbreak, cholera had not existed in Haiti for more than a century. The report calls for setting up a claims commission, as well as providing a public apology, direct aid to victims, infrastructural support, and adequate funding for the prevention and treatment of cholera. Read more on global health.

Eyes May be a Window to Stroke Risk
Retinal imaging—easily done in many ophthalmology practices and clinics—may alert practitioners to patients at higher risk of a stroke by providing information on the status of blood vessels in the brain, according to a new study in the journal Hypertension. Worldwide, high blood pressure is the single most important risk factor for stroke, however it is still not possible to predict which high blood pressure patients are most likely to develop a stroke. Researchers tracked stroke occurrence for an average of 13 years in close to 3,000 patients with high blood pressure who had not previously experienced a stroke. At baseline, each had photographs taken of the retina; damage to the retinal blood vessels was scored as none, mild or moderate to severe. During the follow-up, 146 participants experienced a stroke caused by a blood clot and 15 by bleeding in the brain, but even after adjusting for stroke risk factors such as age and cholesterol levels the researchers found that the risk of stroke was 35 percent higher in those with mild hypertensive retinopathy and 137 percent higher in those with moderate or severe hypertensive retinopathy. And risk remained high for patients with photographic evidence of retinopathy even if they were had good blood pressure control through medication. Read more on vision.

NIH Releases Online Alcohol Screening Course to Help Detect Problems in Young Adults
The National Institute on Alcohol Abuse and Alcoholism has released a new online training course to help health care professionals conduct fast, evidence-based alcohol screening and brief intervention with young adults. According to the Institute, underage drinking is widespread and a major public health problem. Over the course of adolescence, the proportion of youth who drink more than a few sips escalates from 7 percent of 12-year-olds to nearly 70 percent of 18-year-olds. Heavy drinking is common. Having five or more drinks on one occasion is reported by half of 12 to 15-year-olds who drink and two-thirds of 16 to 20-year olds who drink.

“Some may see underage drinking as a harmless rite of passage, but when you look at the risks, it is a big deal,” said Vivian B. Faden, PhD, associate director for behavioral research, director of the Office of Science Policy and Communications at NIAAA, and co-author of the course. “We developed the guide and the continuing medical education (CME) course to help health care professionals reduce underage drinking and its risks in a way that fits easily into their practice.”

Each year, about 190,000 people under age 21 visit emergency rooms for alcohol-related injuries and about 5,000 die as a result of underage drinking. And young adults who drink also have an increased risk of developing alcohol dependence later in life. The new course includes a two-question screening tool. One question asks about the drinking habits of an adolescent’s friends and the other question asks about the adolescent’s own drinking frequency. Read more on alcohol.

The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.

NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.

NewPublicHealth: What changes have you seen in global health during your time in the field?

Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.

So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.

NPH: When you talk about enlightened government, what are some examples? What is making the difference now?

Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.

Even as the global population continues to grow, technological and societal advances mean that our world is constantly getting smaller. Or at least that we are becoming more interconnected.

Understanding this—that a person in a Midwestern U.S. state is better off when a person on the other side of the world has access to quality health care—the U.S. Department of Health and Human Services’ (HHS) Global Health Strategy is working with partners across the globe to improve the health of everyone.

"Although the chief mission of [HHS] is to enhance the health and well being of Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world," said HHS Secretary Kathleen Sebelius.

One of the most powerful initiatives has been the push toward greater immunization rates. Immunizations alone saved 3 million children’s lives in 2011. Over the past decade, premature deaths from measles have been cut by 71 percent and from tetanus by more than 90 percent. And polio is closer and closer to complete eradication.

Still, vaccine-preventable diseases still account for approximately one in four global deaths of children under the age of 5. And of the 22 million children who go without the full benefits of vaccines each year, it is often the poorest that are most affected.

Among the greatest continuing obstacles are the persistent myths surrounding vaccinations, such as the false and repeatedly debunked belief that they cause autism.

“Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.”

>> Read the full “Beyond our borders: Why the U.S. Department of Health and Human Services invests in global efforts” at DefeatDD.org.

The final plenary session at this year’s NACCHO Annual included a talk by Christopher Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation at the University of Washington on how data is used to measure health, evaluate interventions and find ways to maximize health system impact. Dr. Murray was a lead author on three pivotal studies published last week that used data to assess the state of health in the United States compared with 34 other countries and county level data on diet and exercise. One of the key findings is that Americans are living longer, but not necessarily better—half of healthy life years are now lost to disability instead of mortality; and dietary risks are the leading cause of U.S. disease burden.

NewPublicHealth spoke with Dr. Murray about the study findings, their impact and upcoming research that can add to the data public health needs to improve the health of all Americans.

NewPublicHealth: Tell us about the three studies that were published this week using the Institute’s research.  

Dr. Murray: The study in JAMA [Journal of the American Medical Association] is an analysis of a comprehensive look at the health of the United States in comparison to the 34 OECD [Organisation for Economic Co-operation and Development] countries. The study looks at both causes of death and premature mortality through over 290 different diseases and puts them all together in a comprehensive analysis of what the contributors are to lost healthy life. That study also looks at the contribution to patterns of health in the U.S., from major environmental, behavioral, and metabolic risk factors. In each of those categories, there are important findings:

• The U.S. spends the most on healthcare but has pretty mediocre outcomes and ranks about 27th for life expectancy among its peer countries.
• For many large, important causes of premature death, the U.S. does pretty poorly. And we also see a big shift towards more and more individuals having major disability—from mental disorders, substance abuse, and bone and joint disease.
• On the risk factor front, the big surprise is that diet is the leading risk factor in the U.S. It is bigger than tobacco, which is second and then followed by obesity, high blood pressure, high blood sugar, and physical inactivity. Diet in this study is made up of 14 subcomponents, each analyzed separately and then put together.

CDC: Youth Homicide Rate at a 30-Year Low
The youth homicide rate reached a 30-year low in 2010, though a slowing of the decline since 2000 indicates the increased need for youth violence prevention strategies, according to a new data in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR). The 2010 rate was 7.5 per 100,000 U.S. youth, ages 10 to 24. Higher-risk youth, including males and non-Hispanic black youth, have seen slower declines in the homicide rate. “We are encouraged to see a decline in the homicide rate among our youth but unfortunately, homicide continues to rank in the top three leading causes of death for our young people,” said Linda C. Degutis, DrPH, MSN, director, CDC’s National Center for Injury Prevention and Control. “Our youth represent our future and one homicide is one too many.  Comprehensive approaches that include evidence-based prevention strategies are essential to eliminate homicide as a leading cause of death of young people.” Read more on violence.

FDA Proposes Arsenic Limit for Apple Juice
The U.S. Food and Drug administration has proposed a limit of 10 parts per billion of inorganic arsenic in apple juice, which is about the same levels permitted in drinking water. Inorganic arsenic, which is both naturally occurring in the environment and a product of arsenic-containing pesticides, is a known carcinogen linked to skin lesions, developmental effects, cardiovascular disease, neurotoxicity and diabetes. The non-profit Consumer Reports called the proposal a "reasonable first step in protecting consumers from unnecessary exposure to arsenic." Now that the FDA has released its proposed guidance, we look forward to analyzing the agency's risk assessment, submitting comments, and continuing the dialogue on this important public health issue," said Urvashi Rangan, Director of Consumer Safety and Sustainability at the organization. Read more on food safety.

Study: Air Pollution Kills 2.1 Million People Each Year
As many as 2.1 million people die every year because of global air pollution, according to a new study in the journal Environmental Research Letters. About 470,000 of those are linked to human-caused increases in ozone, although climate change is only a small factor. Fine particulate matter air pollution can get into the lungs, causing cancer and other respiratory illnesses. "Our estimates make outdoor air pollution among the most important environmental risk factors for health," study co-author Jason West, of the University of North Carolina, said in a release. "Many of these deaths are estimated to occur in East Asia and South Asia, where population is high and air pollution is severe." Read more on environment.

Study: Americans Living Longer…But Not Necessarily Healthier
A new study in the Journal of the American Medical Association paints a broad, sweeping picture of life expectancy and health in the United States, finding that while people are living long in general, they’re also spending more of their lives in poor health as illnesses that used to lead to early deaths have been replaced with chronic conditions. The overall average U.S. life expectancy in 2010 was 78.2 years. The new findings are part of the Global Burden of Disease Study, which is a collaboration of 488 researchers in 50 countries. "It's rare these days that you get information or studies that give you the big picture," said study author Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation at the University of Washington, in Seattle. "It's pretty uncommon to step back and say, 'What does all the evidence tell us about the most important health problems, and where does the U.S. fit in that landscape?'" While the United States has been making improvements, they’ve not been coming as quickly as they have in other countries. The main causes of earlier death in the country are heart disease, lung cancer, stroke, chronic obstructive pulmonary disease and road injuries, and the top causes of disability are lower back pain, depression and other musculoskeletal disorders. Read more on global health.

Five Daily Servings of Fruits, Vegetables Tied to Longer Lives
Eating plenty of fruits and vegetables is directly tied to living a longer life, according to a new study in the American Journal of Clinical Nutrition. Researchers found that consuming fewer than five servings a day—the recommended amount by many public health organizations—was tied to a higher chance of early death. They did not find that people who consumed more than the recommended level saw greater returns. They also found that while people who ate fewer fruits and vegetables were more likely to smoke, to eat more red meat, to eat high-fat dairy products and to be undereducated, the overall study results did not change even after accounting for gender, smoking, exercise, alcohol consumption and body weight. Read more on nutrition.

Red Cross: Emergency Call for Blood, Platelet Donations
A recent drop in blood donations has led the American Red Cross to issue an emergency request for more donors of all blood types. Donations were down about 10 percent in June and more is needed to ensure enough blood and platelets for the summer months. "We're asking for the public's help now to prevent a more serious shortage," said spokesperson Stephanie Millian in a release. "Each day donations come up short, less blood is available for patients in need. It's the blood products on the shelves today that help save lives in an emergency." To see if you are eligible to make a donation or to make an appointment either call 1-800-RED CROSS (1-800-733-2767) or go to RedCrossBlood.org. Read more on preparedness.