Even Healthy Weight Adults with High Body Fat at Increased Risk of Heart Disease
Even older adults with healthy body weights can be at increased risk of cardiovascular diseases if they have high percentages of body fat, according to a new study The American Journal of Cardiology. "Just because someone has a normal BMI does not necessarily mean they are metabolically normal," said lead researcher Dr. John Batsis, a geriatrician at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. The study found that women with excess body fat (above 35 percent) were 57 percent more likely to die from heart-related causes within 11 years than were women with healthy body fat levels. Javier Salvador, MD, an endocrinologist at the University Clinic of Navarra in Pamplona, Spain, who was not involved in the study, said the findings demonstrate the limits of body mass index (BMI), which measures weight in relation to height. Read more on heart health.

‘Image Discrepancies’ of Job Roles Can Hurt Job Satisfaction, Performance and Pay
The lack of client understanding of the actual job roles of nurse practitioners and other professionals can negatively impact job satisfaction, performance and pay, according to a recent study in the Academy of Management Journal. "If people don't understand what you do, they tend to devalue what you do," study co-author Michael Pratt, a professor of management and organization at Boston College. "They don't understand why you're making all this money—'Why should I pay you all this money?' is a common question these professionals keep hearing." The study looked at “image discrepancies” in four professions—nurse practitioners, architects, litigation attorneys and certified public accountants—finding a noticeable and negative lack of understanding by clients for each. For example, many patients don’t realize that nurse practitioners can examine patients and prescribe medicine, and instead insist on seeing a doctor. "I assumed professionals would actually get over it, that there would be frustration, it would be an interpersonal problem, and that would be the extent of it," Pratt said. "I didn't think it would have such a big impact on how they did their job, how it affected their pay and how they performed. I was surprised at the depth of how this affected job performance. It's not simply annoying -- it has real impact.” Read more on mental health.

CDC Emphasizing Electronic Laboratory Reporting to Improve Public Health’s Response to Disease Outbreaks
The U.S. Centers for Disease Control and Prevention’s (CDC) emphasis on the widespread adoption of electronic laboratory reporting (ELR) has helped improve public health’s response to dangerous infections, according to data from CDC’s Morbidity and Mortality Weekly Report (MMWR). ELRs enable labs to report disease outbreak information quickly and in a usable format. The number of labs that utilize ELRs has more than doubled since 2005, and CDC has helped fund their increased use since 2010 in 57 state, local and territorial health departments. Current estimates are that about 62 percent of lab reports were received electronically. “Electronic laboratory reporting can give health officials better, more timely and complete information on emerging infections and outbreaks than they have ever received before,” said Robert Pinner, MD, associate director for surveillance, programs and informatics in CDC’s National Center for Emerging and Zoonotic Diseases. “Implementing these systems is a complex task that requires substantial investment, but ELR will provide health departments the tools they need to quickly identify and respond to disease threats and monitor disease trends now and in the future.” Read more on technology.

Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.

Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.

The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.

Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?

“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”

That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.

The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.

That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.

“That’s a story that needs to be told, with context.”

>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”

CDC: 200,000 Lives Lost Each Year to Preventable Heart Disease, Stroke
Healthier living and improved preventative efforts could help save more than 200,000 U.S. lives lost each year to preventable heart disease and stroke, according to a new report from the U.S. Centers for Disease Control and Prevention. That’s approximately one in four of heart disease deaths. More than half of those deaths were people younger than 65, with blacks twice as likely as whites to die of the preventable conditions and men more likely than women. Still, the overall rate fell approximately 30 percent from 2001 to 2010. To further improve these rates, health care providers should encourage healthy habits such as not smoking, increasing physical activity, eating a healthy diet, maintaining a healthy weight and taking medicines as directed. At the community level, health departments can promote healthier living spaces, including tobacco-free areas and safe walking areas, as well as access to healthy food options. Read more on heart health.

Patients More Likely to Take Multiple Medications When Combined in Single Pill
Patients are more likely to take multiple medications if they are combined into a single pill—or “polypill”—according to a new study in the Journal of the American Medical Association. This finding could be especially important for people dealing with chronic conditions such as heart disease, who are often prescribed a combination of blood pressure medication, cholesterol medication and aspirin to break up blood clots. Only about half the patients in prosperous countries take all three prescribed pills and as few as 5 percent of patients in developing countries do so. One of the obstacles is simply remembering to take the many medications on time. "The simplification of the delivery of care we provide to our patients is a significant part of the improvement we can gain by this type of strategy," said David May, MD, chair of the board of governors for the American College of Cardiology. "Oftentimes we become enamored with the idea of how much improvement we get with this or that medication, on top of the other drugs a patient has been prescribed. The short answer is, if they don't take it, you don't get any improvement." Read more on prescription drugs.

Common Hospital Infections Cost $10B Annually
In addition endangering patients’ health and lives, the five most common hospital-acquired infections cost the U.S. health care system an estimated $10 billion annually, according to a new study in the journal JAMA Internal Medicine. About one in 20 patients contract an infection after being admitted to a hospital, according to the U.S. Centers for Disease Control and Prevention, and studies indicate that as many as half may be preventable. The found that central line-associated bloodstream infections averaged about $45,000 per case, pneumonia infections that lead to ventilators cost about $40,000 per case and surgical site infections—a result of about one in 50 operations—cost about $21,000 per case. In a previous study, Trish Perl, MD, a professor of medicine and pathology at the Johns Hopkins School of Public Health in Baltimore, found that eliminating surgical site infections alone would save the four hospitals in the Johns Hopkins Health System approximately $2 million in revenue each year. Perl was not involved in the new study. Read more on infectious diseases.

Rotavirus Vaccinations for Babies Also Reduce Disease in Older Children, Adults
Regular rotavirus vaccinations for babies have also helped lower the rate of rotavirus-related hospitalizations for older children and adults since 2006, according to a new study in the Journal of the American Medical Association. Rotavirus can cause gastroenteritis, leading to severe diarrhea, vomiting, fever and abdominal pain. Ben Lopman, who worked on the study at the U.S. Centers for Disease Control and Prevention, told Reuters that the improved rates for older children and adults was an unexpected benefit of the vaccinations. An oral form of the vaccination became routine in 2007, after which rotavirus-related hospital discharges dropped by 70 percent for children ages 5-14, by 53 percent for people ages 15-24 and by 43 percent for adults ages 25-44. "This is one example of what we call herd immunity," he said. "By vaccinating young children you prevent them from getting sick, but you also prevent them from transmitting (rotavirus) to their siblings and their parents." Read more on vaccines.

Report: Fewer Kids Illegally Buying Tobacco Products
The Synar Amendment Program was started 16 years ago in an effort to prevent the sale of tobacco products to people under the age of 18. A new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) shows that it’s working, with only about 9 percent of retailers violating the ban, the second lowest rate since the law was enacted and far better than SAMHSA’s goal of 20 percent. In addition, 33 states and the District of Columbia now have local violation rates below 10 percent; and nine states have statewide violation rates below 5 percent. Still, Frances Harding, director of SAMHSA's Center for Substance Abuse Prevention, said that "Far more needs to be done to prevent kids and young adults from using tobacco, which is still the nation's leading cause of preventable death.” Read more on tobacco.

High Cholesterol Levels Dramatically Increases Heart Attack Risk in Middle-aged Men
While high cholesterol levels are dangerous for both men and women, middle-aged men with high levels have three times the risk of heart attack, according to a new study in the journal Epidemiology. Lead researcher Erik Madssen, MD, of the department of circulation and medical imaging at the Norwegian University of Science and Technology, said this means men with high cholesterol levels should be receiving more aggressive treatment than is currently common. The reason for the difference in risk still isn’t known, though Madssen said one possibility is the positive effects of estrogen. Both men and women can reduce the risk of heart attack by making lifestyle changes such as improved diet and exercise, as well as through medication; preventative efforts are especially important for people with a family history of heart disease. Read more on heart health.

U.S. Circumcision Rate Down 10 Percent over Past Three Decades
The circumcision rate of U.S. newborns dropped approximately 10 percent from 1979 to 2010, according to new date from the National Center for Health Statistics. In 2010 about 58.3 percent of boys born in U.S. hospitals were circumcised; the rate was 64.5 percent in 1979. While beginning as a religious ritual, the use of circumcision expanded due to potential health benefits such as reduced risk of urinary tract infections in infants and reduced risk of sexually transmitted diseases. Last August the American Academy of Pediatrics said that these benefits outweigh any risks. However, the procedure also has many opponents. While the report did not go much into the reasons for the decline, possible explanations include the fact that Medicaid has stopped paying for circumcisions in 18 U.S. states, some insurers are not covering procedures without strong medical justifications and shorter hospital stays for new mothers means some circumcisions are performed later as outpatient procedures. Read more on maternal and infant health.

Eating Fruit Helps Prevent Certain Aneurysms
An apple—or any other fruit—a day may lower a person’s risk of an abdominal aneurysm, according to a new study in the journal Circulation. The thirteen year study of 80,000 people ages 48 to 64 in Swede found that people who reported eating more than two servings of fruit daily had a 25 to 31 percent lower risk of abdominal aortic aneurysm than those who ate little or no fruit. High levels of antioxidants in fruits might protect against abdominal aortic aneurysm by preventing oxidative stress that can promote inflammation, according to the researchers, who found no similar association for vegetables, which are also rich in antioxidants, but may lack some of the components in fruits. However, vegetables remain important to a person’s diet, say the study authors. Combined with fruit they may help decrease the risk of cardiovascular diseases, type 2 diabetes, high blood pressure and several cancers. The American Heart Association advises the average adult to eat four to five servings each of fruits and vegetables daily, based on a 2,000 calorie diet. Read more on nutrition.

Study: CTE Victims First Present with Impaired Mood or Thinking
People suffering from chronic traumatic encephalopathy (CTE)—a neurodegenerative disease that can only be diagnosed after death—will likely first begin exhibiting either impaired behavior and mood or impaired memory and thinking abilities, according to a new study in the journal Neurology. CTE is characterized by impulsivity, depression and erratic behavior. "The study itself is relatively preliminary, [but] we found two relatively distinct presentations of the disease," said study co-author Daniel Daneshvar, a postdoctoral researcher at the university's Center for the Study of Traumatic Encephalopathy. "So little is known about the clinical presentation of CTE that anything we found is not necessarily surprising, simply because there's a dearth of information about CTE." Researchers emphasized that far more study is needed. CTE and other head trauma have become increasingly prominent issues over the last several years, with cases linked to both sports injuries and battlefield injuries. There is currently a lawsuit by almost 4,000 former NFL players claiming the league did not properly inform them of the dangers of concussions or adequately protect their health. Read more on injury prevention.

Almost everything touches public health. From understanding care options to access to nutritious food to being able to breathe clean air—it all works together to prevent disease and promote healthy living. That includes the types of available transportation.

>>View NewPublicHealth’s infographic exploring the role of transportation in the health of our communities, “Better Transportation Options = Healthier Lives.”

The Transportation Research Board Subcommittee on Health and Transportation (H+T) was formed in the Summer of 2011 to provide a variety of disciplines the opportunity to share and compare transportation-related health research in an academic environment. It’s a place where engineers, public health professionals, planners, epidemiologists, advocates and others can identify, advance and publish research that advances our understanding of transportation infrastructure and policies affect public health. [Editor’s Note: Read NewPublicHealth’s coverage of last year’s Transportation Research Board conference.]

The H+T Subcommittee’s areas of interest and study include sustainable and active transportation modes (e.g., walking, biking, transit); mobility and accessibility; safety; transportation-related air pollution and noise impacts; and social cohesion and other social, physical and mental health impacts.

State and local government across the country are already utilizing engineering and design solutions to improve public health in their communities, according to The Network for Public Health Law, which provides information and technical assistance on issues related to public health and is funded by the Robert Wood Johnson Foundation.

“In Massachusetts and Minnesota, transportation officials are exploring infrastructures that allow for ‘active transportation’—like walking and bicycling—which can help prevent weight gain and lower the risks of obesity, diabetes and heart disease. In Washington and California, programs are incorporating transit-oriented development strategies to improve environmental health and access to healthy foods.”

>>Read the full story, “Two Worlds, One Goal,” and follow H+T on Twitter, Facebook and LinkedIn.

>>Read more on how transportation can impact health.

Self-monitoring Tied to Improved Blood Pressure
Self-monitoring of blood pressure is tied to lower blood pressure in people with hypertension, according to a new study in the Annals of Internal Medicine. The study found the strategy was most successful when combined with providing extra resources to patients, such as online materials. Hayden Bosworth, of the Duke University Medical Center and the Durham Veterans Affairs Medical Center in North Carolina, said self-monitoring can provide more accurate results because the patients are not feeling the stress that they would in the doctor’s office. It also provides more in terms of actual data, which helps physicians to better determine treatments, and helps patients take a constant ownership of their health. "If you eat five ham biscuits for breakfast … you can see the implications of that through your blood pressure in monitoring that relatively quickly, as well as if you exercise," said Bosworth to Reuters. "It's no different than tracking your own weight. You need to know, on a daily basis, how you're doing, what sets it off and are you going too high or too low." Read more on heart health.

New Association Represents Accredited Public Health Schools and Programs
The new Association of Schools and Programs of Public Health (ASPPH), which represents schools and programs of public health accredited by the Council on Education for Public Health (CEPH), officially launched on August 1. “This is a seminal moment in CEPH-accredited public health education,” says Dr. Harrison Spencer, president and CEO of ASPPH. “Representing both accredited schools and programs of public health gives the association and our members an opportunity to strengthen public health education, research, teaching, and practice.” The U.S. Department of Education has recognized CEPH as the accrediting body for public health schools and programs, which helps ensure the quality education and training necessary to prepare graduates for the future of public health work. Read more on accreditation.

Flu Vaccine for All Four Seasonal Strains Approved for Shipment
The first vaccine to protect against all four strains of seasonal influenza has been approved for shipment for the U.S. Food and Drug Administration. GlaxoSmithKline’s Fluarix Quadrivalent vaccine was approved late last year for use in adults and children aged 3 and older, but regulations require flu vaccines to be approved before they are shipped to health care providers each season. The company estimates it will ship approximately 22 to 24 million doses globally, with 10 million doses in the United States. The U.S. Centers for Disease Control and Prevention has ordered more than 4 million doses. Read more on influenza.

FDA Issues New Food Safety Measures for Foreign Imports
As part of the Food Safety Modernization Act (FSMA), the U.S. Food and Drug Administration (FDA) has issued two new rules regarding the safety of imported foods. The first rule requires that importers verify that suppliers utilize modern, prevention-oriented safety practices. The second rules establishes third-party food safety auditors in the foreign countries that supply food to the United States. Each year the U.S. imports food from about 150 countries, accounting for about 15 percent of the nation’s food supply. “We must work toward global solutions to food safety so that whether you serve your family food grown locally or imported you can be confident that it is safe,” said FDA Commissioner Margaret A. Hamburg, MD. “Today’s announcement of these two new proposed rules will help to meet the challenges of our complex global food supply system. Our success will depend in large part on partnerships across nations, industries, and business sectors.” Read more on food safety.

Study: U.S. Adults with Atrial Fibrillation to Double by 2030
At the current rate, the number of U.S. adults with atrial fibrillation (AF) will more than double to an estimated 12 million cases by 2030, according to a new study in the American Journal of Cardiology. About 5 million Americans suffered from the dangerous irregular heartbeat in 2010, which can lead to severe chest pains, limit the ability to exercise or even cause heart failure. "Even AF patients without symptoms are at five-fold increased risk of stroke, which often leads to major disability or death," said study coauthor Daniel Singer, MD, professor of medicine at Harvard Medical School in Boston. The risk for the illness, which is most common in older people, can be reduced through preventive health care that includes the diagnosis and treatment of hypertension, diabetes and sleep apnea, as well as by getting exercise and maintaining a healthy body weight. Read more on heart health.

Tips on Preventing Playground Injuries
About 600,000 kids were injured at playgrounds in 2012, according to the U.S. Consumer Product Safety Commission, including about 210,000 on monkey bars/climbing structures, 151,000 on swing sets, 125,000 on slides, 10,000 on seesaws/teeterboards and 56,000 on other playground equipment. However, with proper knowledge and care, it’s possible to prevent injuries, according to the Commission. "Parents and caretakers should steer clear from playgrounds with asphalt or concrete surfaces, metal or wood swing sets, or any apparatus that can trap a child's head,” said Jennifer Weiss, MD, an American Academy of Orthopaedic Surgeons spokeswoman. “Before children start to play, remind them of basic playground rules, such as one person on the slide at a time, and no running in front of moving swings and teeter-totters. Make sure that you can clearly see your child on the playground at all times.”

Other safety tips for parents and caregivers include:

• Use age-appropriate playground equipment
• Avoid swing sets with metal or wood seats—stick to plastic and rubber
• Be careful in the sun
• Make sure there is enough space for play
  

Read more on safety.

Passengers at the Dallas Fort Worth Airport in Texas can now go from “killing time” to “savings lives” while they wait for their flights.

Since last month, a new, innovative kiosk not much bigger than an ATM machine and installed at the American Airlines terminal, lets travelers stop and learn the basics of CPR in just minutes using a chest model and an audio instructor. The CPR pilot project, which will be tested for six months, is a joint effort of the American Heart Association (AHA) and American Airlines, part of a plan by the AHA to train millions more lay people to perform CPR, and potentially saves tens of thousands of lives.  

Now, a few minutes at the kiosk won’t get most bystanders up to the level of paramedics, but “any chest compression is better than none and can increase survival,” says Ahamed Idris, MD, a spokesman for the AHA and professor of Surgery and Internal Medicine at the University of Texas Southwestern Medical Center in Dallas. Dr. Idris helped develop the kiosk.

According to AHA, about 360,000 U.S. adults suffer cardiac arrest outside of hospitals each year, but only about 10 percent survive. Vastly increasing the number of citizens who can call for help and then start CPR on a victim could more than double that survival rate, says Dr. Idris.

FDA Invites Public Comment on Menthol Cigarettes
The U.S. Food and Drug Administration (FDA) is taking a closer look at menthol cigarettes. The health agency issued an Advance Notice of Proposed Rulemaking (ANPRM) to gather more information to guide potential regulatory options, such as setting new tobacco standards. The ANPRM is available for public comment for 60 days. “Menthol cigarettes raise critical public health questions,” said FDA Commissioner Margaret A. Hamburg, MD. “The FDA is committed to a science-based approach that addresses the public health issues raised by menthol cigarettes, and public input will help us make more informed decisions about how best to tackle this important issue moving forward.” About 30 percent of U.S. adult smokers and about 40 percent of youth smokers use menthol cigarettes, according to the FDA. Read more on tobacco.

Skipping Breakfast, Increased Risk for Heart Disease Linked in Men
Skipping breakfast is linked to a dramatic increase in the risk for heart disease in men, according to a new study in the journal Circulation. Researchers found that the men who miss the morning meal are more likely to gain weight, develop diabetes and have hypertension. That all adds up to a 27 percent higher risk of heart attack or heart disease. Possible reasons include a likelihood to “feast” on higher calorie meals later in the day or that fact that the breakfast food skipped includes, on average, healthier types of food that lower the risk for heart disease.  "We've focused so much on the quality of food and what kind of diet everyone should be eating, and we don't talk as often on the manner of eating," said Suzanne Steinbaum, MD, a preventive cardiologist at Lenox Hill Hospital in New York City. "This study is not even discussing the type of food. It's just talking about behavior and lifestyle choice. Part of heart-healthy living is eating breakfast because that prevents you from doing a lot of other unhealthy things." Read more on heart health.

CDC Investigating Multi-state Intestinal Infection; 200 Sick so Far
The U.S. Centers for Disease Control and Prevention (CDC) is looking into a multi-state outbreak of cyclosporiasis, an intestinal infection that can cause watery diarrhea, vomiting and body ache, as well as headache, fever, weight loss and fatigue. CDC has identified more than 200 cases in states including Iowa, Nebraska, Texas and Wisconsin. The agency has yet to identify a cause. If left untreated it can last for up to a month; most immune systems can handle the infection without treatment, but older adults and people with weakened immune systems are at increased risk. Read more on infectious disease.