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.
Oral health received some recent attention with the passage of a law in California that allows dental hygienists to perform some procedures under the supervision of a remote dentist checking in via video screen. The goal is to improve the oral health of kids in that state. Other states are watching the rollout in the hopes of implementing similar programs.
With that same goal in mind, the Ad Council and dozens of partners have just launched a new series of quirky public service announcements (PSAs) aimed at getting kids to brush their teeth twice a day, two minutes each time. The PSAs highlight how teaching kids to brush their teeth is far easier than other lessons parents impart, including cooking, manners and getting dressed.
The PSAs will appear as television, radio, print, outdoor and digital ads, and can also be found online. Campaign partners include the American Dental Association and the American Academy of Pediatrics. Ad Council spokeswoman Ellyn Fisher said the campaign is timed to coincide with Halloween—“as kids get ready to dig into their candy bags.”
A recent Ad Council survey found that three quarters of parents said their kids often forget to brush their teeth. The survey also found that while it’s estimated that children miss more than 51 million school hours each year due to dental-related illnesses, parents rank their children’s dental health as a low priority relative to other health issues, such as nutrition or cold and flu season.
The new PSAs are available in both English and Spanish and direct viewers to the campaign’s website, where parents and children can watch the videos—all 2 minutes in length, or the exact amount of time they should spend brushing their teeth. More than 1.7 million people have visited the website since its launch in 2012. A 2013 Ad Council survey showed that in one year, English-speaking parents reported that their children were significantly more likely to brush twice a day (55 percent in 2013, up from 48 percent in 2012) and significantly more likely to brush for two minutes each time (64 percent in 2013, up from 60 percent in 2012). Spanish-speaking parents also saw significant increases in brushing twice a day, from 63 percent in 2012 to 66 percent in 2013; 77 percent reported kids brushed for the recommended two minutes 2013, up from 69 percent in 2012.
“We’ve had some extraordinary success with this campaign so far,” said Fisher, “But we have a long way to go to make brushing for 2 minutes, twice a day a social norm.”
EBOLA UPDATE: Death Rate Now Stands at 70 Percent; 4,447 Dead
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization (WHO) now puts the Ebola outbreak death rate at 70 percent, up from a previous estimate of 50 percent. WHO assistant director- general Bruce Aylward, MD, who announced the figure at a news conference, said this classifies Ebola as a “high mortality disease.” The global health agency also predicts there could be as many as 10,000 new cases per week within two months. The official toll so far is 4,447 deaths in 8,914 cases. Read more on Ebola.
DOD Adds Climate Change Threats to its Defense Mandate
Citing its effect on issues such as infectious disease, hunger and poverty, the U.S. Department of Defense has announced its intention to integrate climate change threats into all of its “plans, operations, and training.” The assessment came in the Pentagon’s 20-page Climate Change Adaptation Roadmap. "Rising global temperatures, changing precipitation patterns, climbing sea levels, and more extreme weather events will intensify the challenges of global instability, hunger, poverty, and conflict. They will likely lead to food and water shortages, pandemic disease, disputes over refugees and resources, and destruction by natural disasters in regions across the globe," wrote Defense Secretary Chuck Hagel in the report. Read more on the environment.
Study: Smoking Linked to 14 Million Major Medical Conditions
Cigarette smoking harms nearly every bodily organ and is linked to an estimated 14 million major medical conditions in U.S. adults, such as chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema and is the illness most closely linked to smoking. The study was published in the journal JAMA Internal Medicine. “The disease burden of cigarette smoking in the United States remains immense, and updated estimates indicate that COPD may be substantially underreported in health survey data,” wrote the study authors. The study also linked smoking to 2.3 million cases of heart attack 1.3 million cases of cancer, 1.2 million cases of stroke and 1.8 million cases of diabetes. Read more on tobacco.
In light of the ongoing Ebola outbreak, NewPublicHealth recently launched an in-depth look at the current state of several infectious diseases and efforts to stem Ebola and other outbreaks. Tomorrow night the PBS documentary series Frontline will air “The Trouble with Antibiotics” (10 p.m. EST), taking a look at antibiotic use on American farms and the death of a patient being treated at the National Institutes of Health (NIH) three years ago who succumbed to a superbug the NIH was unable to treat.
According to the program’s correspondent, David Hoffman, a former journalist with the Washington Post, 70 percent of U.S. antibiotics are used on farms and are linked to at least some of the two million people who become ill and the more than twenty thousand people who die of antibiotic resistance each year.
NewPublicHealth recently spoke with Hoffman about the project.
NewPublicHealth: What made you interested in the topic of antibiotic resistance?
David Hoffman: In 2012, the Clinical Center at the National Institutes of Health disclosed the details of an outbreak of resistant bacteria in the hospital during 2011. It was a remarkable story in which advanced genomics from an NIH institute were used to unravel the mystery of how the organism had spread, and the hospital took extraordinary measures to combat it. This led to a 2013 Frontline film about the growing problem of resistance in human health, “Hunting the Nightmare Bacteria.” While working on “Hunting.”’ we heard a lot about antibiotics in animal agriculture. But the issues were complex and needed time for serious examination. We decided to devote our next film to answering some of the questions and that process took about a year.
Tomorrow, the U.S. Centers for Disease Control and Infection (CDC) will hold a conference call for medical personnel. The call will review and underline safeguards needed to help protect health workers who will be called on to help with care for U.S. Ebola patients, should more cased be diagnosed.
The first patient diagnosed with Ebola in the United States died in Dallas last week; a second, a nurse who looked after that patient, was confirmed yesterday by the CDC to have the virus. She is in isolation in a Dallas hospital.
CDC director Tom Frieden, MD, MPH, said the infected nurse may have contracted the disease through a “breach in protective gear protocol.” However, Ezekiel Emanuel, MD, a bioethicist and professor at the University of Pennsylvania, said this morning on MSNBC that he thought the problem was not so much a breach as the need for greater implementation. Medical checklist guru Atul Gawande, MD, agrees. In a short piece titled “Ebola is Stoppable” in The New Yorker last week, Gawande wrote “The main challenge is taking off the protective personal equipment—that’s when it is easiest to contaminate yourself.”
Public health experts are assessing what changes to make to reduce the chance of transmission without making suiting up so cumbersome that health workers are tempted to skip steps. At yesterday’s press conference, Frieden said that there have been reports out of West Africa of health workers who contaminated themselves when they pricked themselves with a clean needle that came in contact with contaminated gloves. For now, the procedures laid out in posters from the CDC on how to don and remove protective clothing remain in place.
>>Bonus Link: Over the weekend, an article in the Los Angeles Times questioned a key component of assessing people who may be infected with Ebola—assuming that they are not contagious if they don’t have fever. The study, funded by the World Health Organization and published online last month in the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola, finding that thirteen percent did not have a fever. U.S. public health experts told the Times that they continue to view fever as the key indicator that the virus is transmissible to other people.
CDC Confirms Texas Hospital Nurse Who Cared for Infected Patient Has Ebola
On Sunday, the U.S. Centers for Disease Control and Prevention (CDC) confirmed test results that found that a healthcare worker at Texas Presbyterian Hospital in Dallas is positive for Ebola. The health care worker provided care for a Dallas patient who contracted Ebola in Liberia and died last week. The nurse is being cared for in an isolation unit. In a statement released on Sunday, the CDC said “this development is understandably disturbing news for the patient, the patient’s family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures, including ongoing contact tracing, health monitoring among those known to have been in contact with the index [first]patient, and immediate isolations if symptoms develop.” Read more on Ebola.
Medicare Part B Premiums and Deductibles Will Remain the Same for 2015 as Rates of the Past Two Years
The U.S. Department of Health and Human Services has announced that the standard Medicare Part B monthly premium and deductible for 2015 will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. About 50 million Americans are enrolled in Medicare Part B and their monthly premiums and annual deductibles will be $104.90 and $147, respectively. Read more on Access to Health Care.
Monitoring Illness at Preschools Could Offer Early Avert for Some Disease Outbreaks
A web-based system that allows preschools and child care centers to report illnesses to local public health departments could improve the detection of community disease outbreaks and allow resources to be mobilized faster according to a study presented at the American Academy of Pediatrics meeting in San Diego. The researchers created a computerized system and tested it at four early learning centers in Michigan. Staff was trained to use the system daily and send illness updates to local health department weekly, or more frequently if spikes in illnesses were seen. Among their findings: the four preschools reported a gastroenteritis outbreak three weeks earlier than other area schools. Read more on infectious disease.
During a recent webinar held by Stakeholder Health, a learning collaborative of health leaders aimed at improving population health, Margo DeMont, PhD, head of community health enhancement at Memorial Hospital of South Bend, Ind., shared about the hospital’s recent efforts to build a trauma-informed community through several innovative therapeutic programs.
For example, using eye motion desensitization and reprocessing (EMDR), a trained practitioner takes a person through their traumatic experience, and then follows with a series of hand movements, asking the patient to follow the movements with their eyes. After the sequence of movements, the patients are asked to review the intensity of their feelings about the trauma, with the goal of reducing the heightened emotions. The goal is to reprocess the information from the incident in their brain from the right hemisphere, where emotional experiences can be locked up, to the left hemisphere, which is the more cognitive area of the brain. While EMDR is still quite new and studies are still needed, some use of the technique has been suggested by both the U.S. Department of Defense and the American Psychiatric Association.
The goal of the behavioral interventions is to reach people who have suffered through adverse childhood experiences (ACE). Studies have shown that without help dealing with those childhood experiences, people are more likely to face long-term health problems such as substance abuse, cardiopulmonary disease, diabetes and obesity. Memorial Hospital assessed the impact of childhood trauma on adults in the community through a community health assessment.
NewPublicHealth recently spoke with DeMont about the initiatives.
NewPublicHealth: When was the community health assessment done that indicated that there was a great deal of trauma in the community related to adverse events in childhood?
Margo DeMont: That was done in 2012 as part of the community benefit requirement for non-profit hospitals under the Affordable Care Act. And we saw that in terms of health issues perceived by the community, violence was rated pretty high, it was one of the priorities, and it came out as both street violence and relationship violence. I was familiar with the work done by Kaiser Permanente on childhood trauma, and we included eight questions from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance Survey that dealt with adverse childhood experiences in random phone surveys completed by 599 adults