Category Archives: Access to Health Care

Apr 18 2014
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Public Health News Roundup: April 18

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CDC: Mixed Progress in Food Safety Efforts
A new food safety progress report from the U.S. Centers for Disease Control and Prevention (CDC) shows mixed results for the country’s safety efforts. While the rate of salmonella infections was down approximately 9 percent in 2013 compared to the previous three years, campylobacter infections—often linked to dairy products and chicken—are up 13 percent since 2006-2008. The CDC also found that vibrio infections, which are often linked to raw shellfish, were at the highest level since tracking began in 1996. “This year’s data show some recent progress in reducing salmonella rates, and also highlight that our work to reduce the burden of foodborne illness is far from over,” said Robert Tauxe, MD, MPH, deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “To keep salmonella on the decline, we need to work with the food industry and our federal, state and local partners to implement strong actions to control known risks and to detect foodborne germs lurking in unsuspected foods.” The report’s data comes from the Foodborne Diseases Active Surveillance Network (FoodNet), a group of experts from CDC; ten state health departments; the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS); and the U.S. Food and Drug Administration (FDA). Read more on food safety.

FDA: Common Procedure to Remove Uterus, Uterine Fibroids Can Spread Cancer
A common procedure to remove the uterus or uterine fibroids can unintentionally spread cancerous tissue—such as uterine sarcomas—according to a new safety communication from the U.S. Food and Drug Administration (FDA), which is discouraging the use of laparoscopic power morcellation. The procedure divides the uterine tissue into smaller fragments in order to remove them via a small abdominal incision. “The FDA’s primary concern as we consider the continued use of these devices is the safety and well-being of patients,” said William Maisel, MD, MPH, deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health. “There is no reliable way to determine if a uterine fibroid is cancerous prior to removal. Patients should know that the FDA is discouraging the use of laparoscopic power morcellation for hysterectomy or myomectomy, and they should discuss the risks and benefits of the available treatment options with their health care professionals.” Read more on cancer.

Approximately 12M U.S. Outpatients Misdiagnosed Each Year
Approximately 12 million U.S. adults are misdiagnosed each year in doctors’ office and other outpatient settings, with an estimated half of those mistakes potentially leading to serious harm, according to a new study set to be published in the journal BMJ Quality & Safety. The overall total means about one in every 20 patients are misdiagnosed. For the study researchers used data from three studies covering a sample pool of approximately 3,000 medical records. "It's important to outline the fact that this is a problem," said Hardeep Singh, MD, the study's lead author and a patient safety researcher at Baylor College of Medicine and at the Michael E. DeBakey VA Medical Center, both in Houston, according to Reuters. "Because of the large number of outpatient visits, this is a huge vulnerability. This is a huge number and we need to do something about it.” Read more on access to care.

Apr 15 2014
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Public Health News Roundup: April 15

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Urban Gardeners May Be Unaware of Harmful Soil Contaminants
In their quest to consume healthier foods, urban gardeners may actually be unaware of the presence of soil contaminants and how to deal with the issue, putting both gardeners and consumers at risk, according to a new study in PLOS One. Potential contaminants include heavy metals, petroleum products and asbestos, which can result when urban soil is near pollution sources, such as industrial areas and roads with heavy traffic. “Our study suggests gardeners generally recognize the importance of knowing a garden site’s prior uses, but they may lack the information and expertise to determine accurately the prior use of their garden site and potential contaminants in the soil,” said Keeve Nachman, PhD, senior author of the study and director of the Food Production and Public Health Program with the Johns Hopkins Center for a Livable Future. “They may also have misperceptions or gaps in knowledge about how best to minimize their risk of exposure to contaminants that may be in urban soil.” Read more food safety.

Study: 1 in 10 U.S. Adults Have Diabetes
Nearly one in 10 U.S. adults had diabetes in 2010, nearly double the percentage a little more than two decades ago, in 1988, according to a new study in the Annals of Internal Medicine. The study determined that 21 million American adults—or 9.3 percent of all American adults—had either type 1 or type 2 diabetes in 2010. As many as 95 percent of diabetes cases are type 2 cases. "This study also highlights that the increase in diabetes really tracks closely with the epidemic of obesity,” said Elizabeth Selvin, the study's lead author and an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. “The diabetes epidemic is really a direct consequence of the rise in obesity.” However, the report did find that cases of undiagnosed diabetes were down, indicating new screen techniques are effective. It also found that overall blood sugar control was improved. Read more on obesity.

U.S. Health Care Costs Climbed 3.2% in 2013, to $329.2 Billion
The cost of new medicines, price increases on some branded drugs and patent expirations helped cause the first rise in the overall cost of health services in the United States in three years, according to a new report from IMS Health Holdings Inc., a health care information company. Americans spent a total of $329.2 billion on health services in 2013, up from 3.2 percent from 2012, which had seen a 1 percent decline. However, the report noted that expanded use of cheaper generic drugs—86 percent of all prescription drugs—did help costs from rising even higher. Read more on access to health care.

Apr 11 2014
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Public Health News Roundup: April 11

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Sebelius to Step Down as Head of HHS
Kathleen Sebelius is resigning as secretary of the U.S. Department of Health and Human Services (HHS). The formal announcement is expected to come at 11 a.m. this morning, with President Obama to name Office of Management and Budget Director Sylvia Mathews Burwell as the replacement for the former Kansas governor. Sebelius assumed the HHS position in April 2009. Read more on the HHS.

FDA Expands Approved Use of Certain Pacemakers, Defibrillators
The U.S. Food and Drug Administration (FDA) has expanded the approved application of certain pacemakers and defibrillators, allowing them to also be used for patients with atrioventricular (AV) block and less severe heart failure. Previously the devices—which provide electrical impulses to the heart through implanted leads in the ventricles—were approved only for people with more severe heart failure as evaluated by their physician using specific criteria. The expansion covers two cardiac resynchronization pacemakers (CRT-P) and eight cardiac resynchronization defibrillators produced by Medtronic. Approximately 5.1 million people in the United States have heart failure. Read more on heart health.

Study: Doctor’s ‘Bedside Manner’ Has Real Effect on Patient Health
The doctor-patient relationship can have a real and significant impact on patient health, with doctors with better “beside manner” also having patients who fare better in efforts to lose weight, lower their blood pressure or manage pain, according to a new study in the journal PLOS One. Researchers reviewed 13 clinical trials, finding that improved patient outcomes were linked directly to doctors who had undergone training to hone their people skills. "I think that intuitively, people think that if you have an open, caring relationship with your provider, that's beneficial," said Helen Riess, the senior researcher on the new study, according to HealthDay. Read more on access to health care.

Apr 10 2014
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Public Health News Roundup: April 10

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HHS Releases Data Giving Consumers Greater Transparency on Costs of Medical Procedures
The U.S. Department of Health and Human (HHS) services has released of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data—which includes payment and submitted charges, or bills, for those services and procedures by provider—provides consumers with more information on how physicians and other health care professionals practice medicine, according to HHS Secretary Kathleen Sebelius. “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice,” she said. “The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.” The release includes information for more than 880,000 distinct health care providers who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program. Read more on access to care.

HUD Grants $1.6B to Support 7,100 Local Homeless Housing and Service Programs
The U.S. Department of Housing and Urban Development (HUD) has announced approximately $1.6 billion in grants to continue support for 7,100 local homeless housing and service programs in all 50 states, as well as Puerto Rico, Guam and the U.S. Virgin Islands. The grants, which come through HUD’s Continuum of Care Program, support programs such as street outreach; client assessment; and direct housing assistance to individuals and families with children who are experiencing homelessness. "Whether it's helping to rapidly re-house families with young children or finding a permanent home for an individual with serious health conditions, HUD is working with our local partners to end homelessness as we know it," said HUD Secretary Shaun Donovan. Read more on housing.

Study: Concussion Symptoms May Be Worse For Girls than for Boys
Concussions may have a more severe and longer-lasting effect for girls than they do for boys, according to new research. Shayne Fehr, MD, a pediatrician at Children's Hospital of Wisconsin, tracked 549 patients who sought treatment at a pediatric concussion clinic, finding that girls on average reported more severe symptoms than boys and needed an additional 22 days to recover (56 days for girls, compared to 34 for boys). Approximately 76 percent of the injuries were sports related and the top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. More research is needed to determine the cause of the disparity. Read more on injury prevention.

Feb 7 2014
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Faces of Public Health: Dennis Andrulis

Dennis Andrulis

In January 2008, the Texas Health Institute received support from the Joint Center for Political and Economic Studies, a policy think tank with a particular focus on people of color, to track progress on efforts to advance racial and health equity through provisions of the Affordable Care Act (ACA). Shortly after the ACA became law, new support from the W.K. Kellogg Foundation and the California Endowment has led to a series of four reports that have assessed how well the law has been implemented in a way that addresses racial and ethnic health equity across five topic areas:

  • Health insurance and exchanges;
  • Health care safety net;
  • Workforce support and diversity;
  • Data, research and quality; and
  • Public health and prevention.

To learn more about the reports’ findings, NewPublicHealth recently talked with Dennis Andrulis, PhD, MPH, the Senior Research Scientist at the Texas Health Institute and an Associate Professor at the University of Texas School of Public Health.

NewPublicHealth:  How have the reports produced by the Texas Health Institute helped advance what we know about the ability of the Affordable Care Act to advance health equity?

Dennis Andrulis: The reports have provided an update of the progress, or lack thereof, in implementing race, ethnicity, language and equity provisions in the law. Did Congress appropriate dollars to support these provisions? If so, did the appropriations match the original requests and will they continue in future years?

The result is we have mapped out what we believe is a comprehensive overview of about 60 provisions related to health equity. Additionally, we have reported on the content and shape of related new initiatives, innovations, program support and other health care efforts.

NPH: What are some short-term and long-term efforts that your work indicated will help improve some health disparities?

Dennis Andrulis: First we need to have accurate and well-disseminated information about what’s in the law and the opportunities to change disparities that it provides.

Read more

Feb 4 2014
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Public Health News Roundup: February 4

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FDA’s ‘The Real Cost’ Multimedia Campaign to Graphically Depict the Health Consequences of Smoking
The U.S. Food and Drug Administration (FDA) has launched a new national public education campaign combating youth tobacco use. “The Real Cost” multimedia campaign—with television, radio, print, online and out-of-home advertising—brings together vivid imagery and compelling facts to graphically depict the health consequences of smoking, such as tooth loss and skin damage. The new campaign, which will run in 200 U.S. markets for at least 12 months, targets the 10 million kids ages 12 to 17 who have never smoked, but are at risk, as well as kids who have experimented with smoking. “We know that early intervention is critical, with almost nine out of every ten regular adult smokers picking up their first cigarette by age 18,” said FDA Commissioner Margaret A. Hamburg, MD. Each day, more than 3,200 youth under ages and younger try their first cigarette and more than 700 become daily smokers. Read more on tobacco.

HHS Expands Patient Access to Lab Records
The U.S. Department of Health and Human Services (HHS) is expanding patient access to health records by allowing patients, or their designated “personal representative,” access complete test reports from laboratories. The final rule also eliminates the exception under the Health Insurance Portability and Accountability Act of 1996 Privacy Rule to a patient’s right to access protected health information when it is held by a CLIA-certified or CLIA-exempt laboratory. “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,” said HHS Secretary Kathleen Sebelius. “Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.” Read more on access to health care.

Study: Climate Change Could Mean Significantly More Heat-related Summer Deaths
The combination of climate change and the growing elderly population could mean a dramatic increase in the number of heat-related summer deaths over the next decades, according to a new study in the Journal of Epidemiology and Community Health. Using data on weather patterns and death rates from 1993 to 2006, researchers at the London School of Hygiene and Tropical Medicine, and Public Health England, concluded that if no preventive measures are taken then the number of 2,000 annual heat-related deaths in England and Wales will climb 257 percent by the 2050s, while the number of 41,000 deaths related to cold will fall two percent. People ages 75 and older are at the greatest risk. Preventive measures could air conditioning, as well as more sustainable options such as shading and changes in building insulation and construction materials. Read more on the environment.

Jan 31 2014
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Public Health News Roundup: January 31

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Tips on a Healthy Super Bowl Sunday
Super Bowl Sunday usually also means super-sized portions of unhealthy foods. Knowing this side of the annual event, gastroenterology experts from NewYork-Presbyterian are offering advice on how to get through game day as healthy as possible. "Fats, spices and carbonated beverages are likely to wreak havoc on the gastrointestinal tract, if not at the time of ingestion, then in the hours that follow," said Christine Frissora, MD, a gastroenterologist at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. "Pass on the junk food at the Super Bowl party and your body will thank you later.” Among the “do” and “don’t” tips:

  • Avoid spicy foods, which can trigger irritable bowel syndrome, indigestion and acid reflux.
  • Reduce dairy intake, or try cheeses that are low in lactose, including brie, parmesan and aged cheddar.
  • Beans are challenging to digest, so limit intake.
  • Avoid "high fiber" snacks, which can leave you feeling bloated.
  • Reduce fat intake, which can lead to indigestion.
  • Make sure you provide your guests with nutritional options, such as yogurt dip, nuts, fruits, multigrain or whole-grain crackers and chips, non-spicy guacamole, baked chicken or fish, salads, fresh vegetables, and water with lemon or citrus garnishes.

Read more on nutrition.

Study: One-third of Adults with Chronic Diseases Have Trouble Paying for Both Food and Medicine
One in three U.S. adults living with chronic diseases such as diabetes, arthritis or high blood pressure have difficulty paying for both food and their needed medications—and sometimes both—according to a new study in The American Journal of Medicine. Using data collected by the 2011 National Health Interview Survey, which covered almost 10,000 people ages 20 and older, researchers determined that people who had difficult affording food were also four times more likely to skip medications because of their cost. They also found that 23 percent took their medication less often than prescribed because of the cost, 19 percent reported difficulty affording food and 11 percent said they were having trouble paying for both food and medications. "This leads to an obvious tension between 'milk' or 'med,'" said Niteesh Choudhry, MD, who worked on the study at Brigham and Women's Hospital in Boston. "If you have a fixed income, should you treat or should you eat?" The researchers recommend that patients speak to their doctors about difficulties affording medications and look food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), as well as food banks, for help with food. Read more on access to health care.

Exercise Can Help Relieve Stress of Work/Home Conflict
Increased exercise can help relieve stress over the conflict between balancing work and family life, according to a new study in the journal Human Resource Management. Utilizing a survey of 476 working adults who were asked about their exercise behavior and their confidence in handling work-family conflicts, researchers determined that people who engaged in regular exercise were also more confident in both their home and work environments. "If, for example, you go for a two-mile jog or walk 10 flights of steps at work and feel good about yourself for doing that, it will translate and carry over into other areas of life," said study author Russell Clayton, an assistant professor of management at Saint Leo University in Florida. "We found that [participants] who exercised felt good about themselves, that they felt that they could accomplish tough tasks, and that carried over into work and family life," Clayton added. Read more on physical activity.

Jan 29 2014
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Public Health News Roundup: January 29

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NIDA Releases Resources on Identifying, Treating Teen Drug Abuse
As part of the annual National Drug Facts Week, the National Institute on Drug Abuse (NIDA) has released a collection of resources to help parents, health care providers and substance abuse treatment specialists identify teens at risk and help those struggling with drug abuse. The new resources include:

  • Thirteen principles to consider in treating adolescent substance use disorders
  • Frequently asked questions about adolescent drug use
  • Settings in which adolescent drug abuse treatment most often occurs
  • Evidence-based approaches to treating adolescent substance use disorders
  • The role of the family and medical professionals in identifying teen substance use and supporting treatment and recovery.

“Because critical brain circuits are still developing during the teen years, this age group is particularly susceptible to drug abuse and addiction,” said NIDA Director Nora D. Volkow, MD. “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.” Currently only 10 percent of adolescents ages 12 to 17 who need substance abuse treatment receive it, according to the 2012 National Survey on Drug Use and Health.  Read more on substance abuse.

Study: Public Transit Drivers Distracted an Estimated 39 Percent of their Time on the Road
Public transit bus drivers spend an estimated 39 percent of their time on the road distracted, according to a new study in the journal Traffic Injury Prevention. Researchers in the Department of Epidemiology at the University of Alabama at Birmingham observed and recorded distraction behaviors for three months, then compared them by route characteristics. Interactions with other passengers are the most common source of distraction. Drivers younger than 30 or older than 50, on city streets or highways, or who were driving more than 20 passengers were the most likely to be distracted. Researchers concluded that more needs to be done to educate drivers on the hazards of distracted driving and ways to avoid distractions. Read more on transportation.

Improved Education on Subsidies, Medicaid Could Reduce Number of Uninsured U.S. Adults
The number of U.S. adults who are uninsured could be significantly reduced with improved education on available subsidies and Medicaid expansion, according to the new quarterly Health Reform Monitoring Survey, conducted by Urban Institute researchers with funding from the Robert Wood Johnson Foundation and the Ford Foundation. The survey found that 39.3 percent of uninsured adults expect to have health insurance in 2014, and that four in 10 adults who expect to remain uninsured also think they will have to pay some sort of penalty. Read more on access to health care.

Jan 17 2014
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Public Health News Roundup: January 17

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USDA: Americans Are Eating Healthier
A new report from the U.S. Department of Agriculture finds that American diets improved between 2005 and 2010. The report, which relied on responses to the National Health Examination and Nutrition Survey, found that American adults are making better use of available nutrition information; consuming fewer calories coming from fat and saturated fat; consuming less cholesterol; and eating more fiber. Daily calorie intake declined by 78 calories per day between 2005 and 2010. The report also found declines in calories from total fat (3.3 percent), saturated fat (5.9 percent), and intake of cholesterol (7.9 percent). Overall fiber intake increased by 1.2 grams per day (7.5 percent). Read more on nutrition.

ACEP Emergency Care Report Card Gives Public Health a ‘C’
Public health and injury prevention received a “C” grade in the new "America's Emergency Care Environment: A State-by-State Report Card." The nation overall received a “D” in the American College of Emergency Physicians report, which looks at the conditions and policies under which emergency care is being delivered, not the quality of the care. Public health and prevention was one of five categories of 136 total measures used to grade the quality of emergency care, along with access to emergency care; quality and patient safety; medical liability and environment; and disaster preparedness. Read more on access to health care.

Mental Health Problems in Middle Aged and Older Adults May be Underreported
A new study by researchers at the Johns Hopkins School of Public Health and published in JAMA Psychiatry finds than the number of people in middle and old age with mental health disorders may be higher than previously thought. The study was based on a survey of just over 1,000 adults who were part of a long-term longitudinal study. The participants were asked questions about mental health disorders and then were also given an assessment for the disorders by health professionals. The survey found that while the responders underreported mental health issues, they were fairly accurate when reporting physical health problems. Read more on mental health.

New Interventions Needed to Reduce Underage Drinking
Strategies recommended by the Surgeon General to reduce underage drinking have shown promise when put into practice, according to scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The approaches include nighttime restrictions on young drivers and strict license suspension policies; partnerships between college campuses and the community; and routine screening by doctors to identify and counsel underage drinkers. However, Ralph Hingson, SCD, director of NIAAA's Division of Epidemiology and Prevention Research says that “while progress has been made in addressing underage drinking, the consequences still remain unacceptably high. We must continue research to develop new interventions and implement existing strategies that have been shown to be effective.” According to Hingson, new research areas could include more studies of the effects of alcohol on the developing brain, legal penalties for providing alcohol to minors and parent-family alcohol interventions. Preliminary NIAAA research also shows that interventions aimed at strengthening family relationships in the middle-school years can have a lasting effect on students’ drinking behavior. Underage drinking is linked to 5,000 injury deaths per year, poor academic performance, potential damage to the developing brain, and risky sexual behavior. Read more on alcohol.

Jan 3 2014
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Public Health News Roundup: January 3

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Study: Newly Insured Visit Emergency Departments More Often
While some experts have speculated that expanded insurance under the Affordable Care Act would decrease the rate of emergency department visits, a new study in the journal Science indicates that newly insured people actually visit the departments significantly more than people who were uninsured. The study of 25,000 Medicaid lottery participants in Oregon in 2008 found that people who received expanded coverage increased their visits by 40 percent—or 0.41 visits—over a period of 18 months. The visits encompassed all manner of health issues, included issues that could have been treated by a primary care physician and would have been covered by the insurance. Read more on access to health care.

Electronic Media Use During Family Meals Tied to Poorer Nutrition and Communication
The use of electronic devices—including television, music with headphones and texting—by teens during meals is linked to less nutritious food and poorer family communication, according to a new study in the Journal of the Academy of Nutrition and Dietetics. In a survey of more than 1,800 parents, researchers asked how often adolescent children used a variety of electronics during family meals, whether they had any rules regarding their use and whether they felt family meals were important; the children were asked questions about family communication, such as how often they discussed their problems with their parents. The study found that two thirds of the teens watched television or movies some of the time, with one quarter watching frequently. Other electronic activities were less common, occurring 18 to 28 percent of the time. About 75 percent of the families had limits on mealtime media. "There is no magic number of how many (family meals) to have, not all food at meals has to be 100% healthy and having electronic media at meals is not all bad (e.g., an occasional movie night with dinner) if it facilitates family time," said lead author Jayne A. Fulkerson. "But, parents can take small steps to have quality time with their children by reducing media use at mealtimes." Read more on nutrition.

Smoking Adds $17 Billion to Post-Surgery Costs Each Year
Smoking-related complications following surgery—for both current and former smokers—add an estimated $17 billion in direct U.S. medical costs each year, according to a new study in JAMA Surgery. The study, led by David Warner, MD, of the Mayo Clinic, looked at surgical patients between April 2008 and December 2009. While the costs for initial hospitalizations was relatively consistent for current smokers, former smokers and people who never smoked, post-surgery costs were an estimated $400 higher for current smokers and $273 higher for former smokers. Read more on tobacco.