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Jul 21 2014
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Child ‘Vehicular Heatstroke’: Good Samaritan Laws and Other Public Health Solutions

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Earlier this month, following the heatstroke death of a Georgia toddler who was left in a sweltering car for hours, Tennessee became the first state in the nation to pass a law that specifically protects people from liability for forcibly breaking into cars and rescuing kids they think are at risk of heatstroke. The law requires those individuals to call 911 first and follow instructions.

Many states have Good Samaritan laws that may protect people in such instances, but the specifics vary from state to state, according to Cristina M. Meneses, JD, MS, a staff attorney with the Network for Public Health Law’s Eastern Region. A recent Today show poll found that 88 percent of the 44,000 people asked would break into a car to rescue a child they thought was in danger, but specific laws can increase the response—and potentially remove penalties—while raising awareness of the issue. More such laws could soon follow. Janette Fennell, founder and head of KidsAndCars, a nonprofit based in Kansas City, Mo., which advocates for laws that will protect kids from heat in vehicles, said she’s received inquiries from two states about those laws since Tennessee’s law was passed. Another set of laws that KidsAndCars tracks are those that penalize adults for leaving kids in cars. Nineteen states currently have such laws on the books.

“It’s a good deterrent for anyone who might think, ‘Oh, I’ll just leave them in the car for a minute,’” said Fennell, “because it’s often that minute that turns into much longer and results in injury or death.”

According to the National Highway Traffic Safety Administration (NHTSA), more than 40 kids—often under age 2—die each year of “vehicular heatstroke.” Seventeen U.S. kids have died after being left or trapped in car since the beginning of 2014. Fennell and other experts say many people just don’t realize how quickly temperatures can climb in a car, even if the window is cracked open a bit—when outside temperatures are in the low 80's, the temperature inside a vehicle can reach deadly levels in only 10 minutes, even with a window rolled down two inches. Children's bodies, in particular, overheat easily; and infants and children under four years old are at the greatest risk for heat-related illness.

NHTSA research shows that heatstroke deaths and injuries often occur after a child gets into an unlocked vehicle to play without a parent or caregiver's knowledge. Other incidents can occur when a parent or caregiver who is not used to transporting a child as part of their daily routine inadvertently forgets a child sleeping in the back.

Last week, KidsAndCars launched a petition drive to encourage NHTSA to require technology in all cars that would remind a driver that there is a child in the back. There are devices parents can install, but a 2012 study by NHTSA found that none that the agency studied were consistently effective.

“You get a warning if you don't buckle your seatbelt, leave a car door open, your gas is low or you leave your headlights on,” said Fennell. “If a child is left behind then you absolutely need a warning.”

Guidelines from NHTSA and other safety experts aimed at never leaving a child unattended in a car include:

  • Make a habit of looking in the vehicle—front and back—before locking the door and walking away
  • Ask childcare providers to call if a child doesn't show up for care as expected
  • Put items in the back seat you’ll have to retrieve such as a purse or briefcase, or put a stuffed animal in sight of the driver to indicate there’s a child in the car.

>>Bonus Links:

Jul 21 2014
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Public Health News Roundup: July 21

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Strokes Fall Among Older Americans
Fewer older Americans are having strokes and those who do have a lower risk of dying from them, according to researchers at the Johns Hopkins Bloomberg School of Public Health. The study, published in JAMA, followed close to 15,000 stroke-free patients ages 45 to 64, beginning in the 1980s and ending in 2011. It found a 24 percent overall decline in first-time strokes in each of the last two decades and a 20 percent overall drop per decade in deaths after stroke. However, the decline was found mainly in people over age 65, with little progress in reducing the risk of strokes among younger people. The researchers say the decrease in stroke incidence and mortality is partly due to more successful control of risk factors such as blood pressure, smoking cessation and use of statin medications for controlling cholesterol, but that more efforts are needed to reduce strokes in younger people, including reducing obesity and diabetes and increasing physical activity. Read more on mortality.

Study: Insufficient Sleep Can Harm Memory
Lack of sleep, currently considered a public health epidemic in the United States, can also lead to errors in memory, according to a new study in Psychological Science. The study found that participants who didn’t get a full night’s sleep were more likely to make mistakes on the details of a simulated burglary they were shown in a series of images. “We found memory distortion is greater after sleep deprivation,” said Kimberly Fenn, an associate professor of psychology at Michigan State University and a co-investigator of the study. “And people are getting less sleep each night than they ever have.” The U.S. Centers for Disease Control and Prevention has linked the insufficient sleep epidemic to car crashes, industrial disasters and chronic diseases such as hypertension and diabetes. Read more on mental health.

New EPA Graphic Will Give Consumers More Information on Insect Repellent Products

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The U.S. Environmental Protection Agency (EPA) has recently released a new graphic design available for use by insect repellent makers to more easily show how long the product is effective. “We are working to create a system that does for bug repellents what SPF labeling did for sunscreens,” said Jim Jones, Assistant Administrator of the Office of Chemical Safety and Pollution Prevention. “By providing vital information to consumers, this new graphic will help parents, hikers and the general public better protect themselves and their families from serious health threats caused by mosquitoes and ticks.” The release of the graphic design was accompanied by a joint statement from the EPA and the U.S. Centers for Disease Control and Prevention (CDC) urging the public to use insect repellents and take other precautions to avoid biting insects that carry serious diseases, including Lyme and West Nile virus. Incidence of insect-borne diseases is on the rise, according to the CDC. In order to place the new graphic on their labels, manufacturers must submit a label amendment, including test results on effectiveness. The public could see the graphic on repellent products early next year. Read more on infectious disease.

Jul 18 2014
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Health Beyond Health Care: Q&A with Matthew Trowbridge, MD, MPH

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In 2012, a new campus was constructed for the Buckingham K-5 public school in rural Dillwyn, Va., replacing the original middle and high school buildings that had stood since 1954 and 1962.

The Charlottesville, Va., architectural firm VMDO Inc., which constructed the campus, says the sites were transformed into a modern learning campus with the aim of addressing the growing concerns of student health and wellbeing. New facilities include a teaching kitchen; innovative food and nutritional displays; an open servery to promote demonstration cooking; a food lab; a small group learning lounge; scratch bakery; dehydrating food composter; ample natural daylight; flexible seating arrangements; and outdoor student gardens. 

The firm took advantage of the school’s natural setting surrounding a pine and oak forest and wove them into the design and construction to showcase the “active landscape.” The school’s project committee and design team worked collaboratively to create a total learning environment in order to support learning both inside and outside the traditional classroom. Each grade level enjoys age-appropriate outdoor gardens and play terraces, which encourage children to re-connect and spend time in their natural surroundings. Inside the schools, in addition to core classrooms, each grade level has small group learning spaces that transform pathways into child-centric “learning streets” that have soft seating and fun colors that communicate both collaborative and shared learning experiences.

To study the impact of the healthy design features, VMDO teamed with Matthew Trowbridge, MD, MPH, an associate professor at the University of Virginia School of Medicine, with a special interest in the impact of the built environment on public health to study how health-promoting educational design strategies can support active communities and reduce incidence rates of childhood obesity.

NewPublicHealth recently spoke with Trowbridge about the project.

NewPublicHealth: How did the project come about?

Matthew Trowbridge: Through a collaboration between me and Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors. 

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One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.

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Jul 18 2014
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Public Health News Roundup: July 18

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Ukraine Crash Kills Scores of AIDS Researchers
Malaysian Flight 17, believed to have been shot down by a missile over Ukraine yesterday, included dozens of AIDs researchers headed to Melbourne for AIDS 2014, the annual international gathering of AIDS researchers. Global Health Now, a daily newsletter produced by the Johns Hopkins Bloomberg School of Public Health, interviewed Prof. Richard Boyd, director of the Monash Immunology and Stem Cell Laboratories in Melbourne, who said, "There were some serious HIV leaders on that plane. This will have ramifications globally because whenever you lose a leader in any field, it has an impact. That knowledge is irreplaceable.” Read more on HIV.

First Chikungunya Case Acquired in the United States reported in Florida
The first locally acquired case of Chikungunya was reported in Florida this week in a man who had not recently traveled outside the United States. The U.S. Centers for Disease Control and Prevention (CDC) is working with the Florida Department of Health to investigate how the patient contracted the virus and will also monitor for additional locally acquired U.S. cases of the virus.

“The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” said Roger Nasci, PhD, chief of CDC’s Arboviral Diseases Branch. Chikungunya virus is transmitted to people by two species of mosquitoes, Aedes aegypti and Aedes albopictus. Both species are found in the southeastern United States and limited parts of the southwest; Aedes albopictus is also found further north up the East Coast, through the Mid-Atlantic States and is also found in the lower Midwest.

The CDC has asked state health departments to report cases of chikungunya to help track the virus in the United States. Local transmission occurs when a mosquito bites someone who is infected with the virus and then bites another person. People infected with chikungunya virus typically develop fever and joint pain. Other symptoms can include muscle aches, headaches, joint swelling or rash. Read more on infectious diseases.

HHS Releases Health Insurance Information for Immigrant Families
The U.S. Department of Health and Human Services (HHS) recently released information clarifying health insurance coverage options for immigrant families, including:

  • In order to buy private health insurance through the Marketplace, individuals must be U.S. citizens or be lawfully present in the United States.
  • People who recently gained U.S. citizenship or had a change in their immigration status may qualify for a Special Enrollment Period.
  • Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for a tax credit or lower out-of-pocket costs for private insurance for their dependent family members who are eligible for coverage in the Marketplace or for Medicaid and CHIP coverage. Family members who aren't applying for health coverage for themselves won't be asked if they have eligible immigration status.
  • Federal and state Marketplaces and state Medicaid and CHIP agencies can’t require people to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage.
  • States can’t deny benefits because a family or household member who isn't applying hasn’t provided his or her citizenship or immigration status.
  • Information provided to the Marketplace won’t be used for immigration enforcement purposes.
  • If a person is not eligible for Marketplace coverage or can't afford a health plan, they can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents, including immigrant families, in the health center’s service area.

Read more on the Affordable Care Act.

Jul 17 2014
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2014 RWJF Culture of Health Prizes — Celebrating Communities’ Innovative Public Health Efforts

Building a Culture of Health means building a society where getting healthy and staying healthy is a fundamental and guiding social value that helps define American culture...and it’s a mission that communities across the country are eagerly taking on. They include the six communities honored by this year’s Culture of Health prizes from the Robert Wood Johnson Foundation (RWJF), who are coming together today and tomorrow at RWJF’s Princeton, N.J. campus to celebrate their efforts and share the lessons learned. Picked from more than 250 submissions, these six communities are leading some of the nation’s most innovative public health efforts. 

The RWJF Culture of Health Prize was launched to further the work of the County Healthy Rankings & Roadmaps program, which aims to educate the public and policy makers on the multiple factors that influence community health—such as education, economic conditions and the physical environment—and to provide solutions that will improve community health. The prizes honor communities that place a high priority on health and bring partners together to drive local change.

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Jul 17 2014
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Public Health News Roundup: July 17

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Study: Common Asthma Treatment Suppresses Growth in Children
A common treatment for asthma may suppress growth in children, according to a new review of two studies that was published in The Cochrane Library journal. The studies included 45 trials on corticosteroid drugs, which are delivered via inhalers to both children and adults with asthma and generally used as first-line treatments for persistent asthma. "The evidence... suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment," said Linjie Zhang at the Federal University of Rio Grande in Brazil, according to Reuters. "But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma." The World Health Organization estimates that there are approximately 235 million people living with asthma. Read more on pediatrics.

Study: Busiest ERs Often Provide the Best Care
People with life-threatening emergencies have better odds of survival when treated at busier emergency departments, according to a new study in the Annals of Emergency Medicine. The study found that patients admitted to a hospital after an emergency had a 10 percent lower chance of dying in the hospital if they initially went to one of the nation's busiest emergency departments; that people with sepsis had a 26 percent lower death rate at the busiest emergency centers; and that lung failure patients had a 22 percent lower death rate. The researchers behind the study estimate that if all emergency patients received the level of care provided by the busiest emergency departments then approximately 24,000 fewer people would die each year. "It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," said Keith Kocher, MD, MPH, the lead author of the new study and a University of Michigan Health System emergency physician, in a release. "But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter." Read more on health disparities.

HHS: $11M Toward Integrating HIV Services into Primary Care
As part of the ongoing National HIV/AIDS Strategy, the U.S. Department of Health and Human Services is making $11 million available for the integration of HIV services into primary care services in Florida, Massachusetts, Maryland and New York. The funds will go toward innovative partnerships between health centers and those states’ health departments. They are part of Partnerships for Care: Health Departments and Health Centers Collaborating to Improve HIV Health Outcomes, a multi-agency project that includes the U.S. Centers for Disease Control and Prevention and the Health Resources and Services Administration. Read more on HIV/AIDS.

Jul 16 2014
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Health Beyond Health Care: Expanding Physical Activity Opportunities in Every Neighborhood

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More than half of youths in the United States have access to parks or playground areas; recreation centers; boys’ and girls’ clubs; and walking paths or sidewalks in their neighborhoods, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC), State Indicator Report on Physical Activity, 2014.

While that information might conjure up images of newly built, dedicated playgrounds, the reality is different...and less expensive. Thousands of communities have created physical activity opportunities by developing shared use agreements with schools to allow the use of facilities after school hours and on weekends.

In 2011, for example, the nonprofit Partners for Active Living (PAL), in Spartanburg, S.C., met with the city’s Parks and Recreation Department and learned that while the city did have access to defunct school facilities, it had no shared use agreements that would let PAL use school facilities for exercise. With help from a board member (who was  also a member of the city council) and online resources for shared use agreements, PAL was able to move the concept forward by showing that:

  • Under South Carolina law, school districts and third parties would be protected under the recreational user statute.
  • The South Carolina Tort Claims Act imposes the same liabilities and protections both during and after the school day.
  • The school district may be liable for negligent supervision of a student only if a duty is executed in a grossly negligent manner.

After about a year of discussions with parents, activists, policymakers, school officials and others, agreements were worked out in 2012 for school soccer fields, basketball courts, trails, playgrounds and football fields to remain open to the community on weekends and from 9 a.m. to 6 p.m. on non-school days and after school until 6 p.m. on school days, with supervision by the Parks and Recreation Department to deal with damage, vandalism and other concerns. The agreement is automatically renewed every five years unless amended. To promote the continued usage of school playgrounds, the department will offer regularly scheduled programming at each site and PAL will be tracking usage.

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Jul 16 2014
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Public Health News Roundup: July 16

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Proposed Tobacco Merger Could Boost Smoking Rates
The proposed merger of the Reynolds American and Lorillard tobacco companies announced earlier this week could result in increased smoking rates, according to the Campaign for Tobacco-Free Kids. “This proposed merger is clearly driven by steep smoking declines in the U.S.,” said Matthew L. Myers, president of Tobacco-Free Kids. Myers said cigarette sales fell by 37.1 percent from 2000 to 2013, with the largest decline in 2009, when a 62 cent per-pack increase in the federal cigarette tax was implemented. “Reynolds and Lorillard no doubt hope the economic and political power of a merged company will help them slow or reverse these trends. Elected officials and regulators must be equally aggressive in working to accelerate progress in reducing smoking and other tobacco use.” Read more on tobacco.

Health Education Program Also Reduces Youth Dating Violence
A health education program designed to delay sexual behavior and promote healthy data relationships also significantly reduces dating violence behaviors among minority youth, according to a new study in the American Journal of Public Health. Researchers at the University of Texas Health Science Center at Houston (UTHealth) analyzed 766 students in 10 middle schools in a large, urban school district in southeast Texas, where 44 percent were African American and 42 percent were Hispanic. They looked at four areas—physical victimization, emotional victimization, physical perpetration and emotional perpetration—finding that the It’s Your Game...Keep it Real program reduced all but physical dating violence, which comprised the smallest portion of the program; a revised program with a heavier emphasis on this area is currently being tested in schools. The U.S. Centers for Disease Control and Prevention estimates that 10 percent of high school youth are victims of physical dating violence (with ethnic-minority students at increased risk), with other studies indicating that as many as 20 percent are victims of emotional dating violence. Read more on violence.

CDC Report Finds High Rates of Youth Fruit, Vegetable Consumption
Approximately 77.1 percent of U.S. youth ages 2-19 years consume fruit on any given day and 92 percent consume vegetables, according to a recent NCHS Data Brief from the U.S. Centers for Disease Control and Prevention. However, the rate drops as youth age, while at the same time the amount of fruits and vegetables they eat should be increasing. The report used data from the National Health and Nutrition Examination Survey, 2009–2010. The focused report looked only at whether the foods were consumed, and now how much was consumed. Read more on nutrition.

Jul 15 2014
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Wellness Rocks: National Prevention Council Releases its Third Annual Report

This week, the National Prevention, Health Promotion, and Public Health Council (National Prevention Council) submitted its annual status report  to the President and designated Congressional committees describing national progress in meeting specific prevention, health promotion and public health goals defined in the National Prevention Strategy first released three years ago. The National Prevention Strategy is required under the Patient Protection and Affordable Care Act and has the overarching goal of increasing the number of Americans who are healthy at every stage of life.

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The goal of the annual report is to show how cabinet-level agencies are working across the federal government to incorporate health in diverse sectors—such as housing, transportation and education—to advance the National Prevention Strategy and influence the health of individuals, families and communities. The status report also highlights how private- and public-sector partners across the country are advancing the National Prevention Strategy in organizations ranging from health care systems to national foundations.

Federal agency highlights for the past twelve months include:

The report also includes status updates from several partner organization promoting health and wellness, including the American Public Health Association; the Henry Ford Health System; the Delaware Department of Health and Social Services; and the Robert Wood Johnson Foundation. The health promotion efforts of these organizations over the last year includes the fifth annual release of the County Health Rankings, which shows how health is influenced by where we live, learn, work and play.

Read interviews and listen to podcasts with federal agency leaders about the National Prevention Strategy on NewPublicHealth.

Jul 15 2014
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Public Health News Roundup: July 15

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RWJF Analysis of ACA Effects Finds No Increase in New Patient Visits
A new report, ACAView, from the Robert Wood Johnson Foundation (RWJF) and athenahealth, finds that in the first five months of 2014 there was no increase in new patient visits, when compared to the same time last year. The ACAView initiative was created to measure the impact of the Affordable Care Act (ACA) on providers, patients and physicians from 2014 through 2016. The report focuses on the provider perspective, showcasing how the ACA affects the practice patterns and economics of physicians and other care team members around the country. Potential reasons for the lack of an increase in visits include the newly insured being unfamiliar with the health care system, or even the winter weather. Read more on the Affordable Care Act.

Study: Nickel in an iPad Linked to Boy’s Allergic Skin Reaction
An ever-increasing reliance on consumer electronics may also mean rarer allergies are becoming more common, according to researchers who linked an 11-year-old boy’s allergic skin reaction to the nickel found in a first-generation Apple iPad. The study was published in the journal Pediatrics. Previous studies have linked the nickel in computers, smartphones and other electronics to allergic reactions; other common sources of nickel include ear piercings, clothing fasteners and dental work. “With the increasing prevalence of nickel allergy in the pediatric population, it is important for clinicians to continue to consider metallic-appearing electronics and personal effects as potential sources of nickel exposure,” according to the study. Read more on pediatrics.

Study: Changing Generic Pill Color, Shape Can Decrease Prescription Adherence
In addition to known considerations such as side effects and cost, the change in the appearance of prescription medications may also lead some people to stop taking their prescriptions, according to a new study in the Annals of Internal Medicine. In a study of more than 11,000 patients, researchers determined that a change in pill color would increase the odds that a patient would stop taking their heart medication by 34 percent, while a change in pill shape would increase the chances by 66 percent. This adds another wrinkle to the series problem of medication adherence; the American Heart Association estimates that three out of four Americans do not take their medication as directed. Read more on prescription drugs.