Oct 9 2014
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‘Virtual’ Dental Exams Help the Underserved: Q&A with Jenny Kattlove, The Children’s Partnership

Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.

But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.

Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.

A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.

According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.

NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.

NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?

Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist. 

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Oct 9 2014
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Public Health News Roundup: October 9

EBOLA UPDATE: Five U.S. Airports to Screen Travelers from Ebola-Affected Nations
(NewPublicHealth is monitoring the public health crisis in West Africa.)
On the same day that the Dallas, Tex., patient being treated for Ebola succumbed to the disease, the U.S. Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security's Customs & Border Protection (CBP) announced that travelers from Ebola-affected nations would undergo increased entry screening when arriving in five U.S. airports. New York's JFK, Washington-Dulles, Newark, Chicago-O'Hare and Atlanta international airports receive more than 94 percent of travelers from the West African nations. According to the CDC:

  • Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
  • Trained CBP staff will observe them for signs of illness, ask them a series of health and exposure questions and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.
  • If the travelers have fever, symptoms or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.
  • Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.

Read more on Ebola.

Study: College Athletes in Contact Sports at Increased MRSA Risk
College athletes in contact sports are at increased risk of carrying and being infected with the superbug methicillin-resistant Staphylococcus aureus (MRSA), according to a new study presented this morning at IDWeek. In a two-year study, researchers determined that contact sport athletes were more than twice as likely as non-contact athletes to be colonized with MRSA. Colonization with MRSA ranged from 8 to 31 percent in contact sports athletes, compared to 0 to 23 percent of non-contact athletes; 5 to 10 percent of the general population is colonized with MRSA. "This study shows that even outside of a full scale outbreak, when athletes are healthy and there are no infections, there are still a substantial number of them who are colonized with these potentially harmful bacteria," said Natalia Jimenez-Truque, PhD, MSCI, research instructor, Vanderbilt University Medical Center, Nashville, Tenn., in a release "Sports teams can decrease the spread of MRSA by encouraging good hygiene in their athletes, including frequent hand washing and avoiding sharing towels and personal items such as soap and razors." Read more on prevention.

ACS: Overweight and Obese African-Americans, Whites at Similar Risk for Premature Death
Overweight and obese African-Americans and whites are at similar risk for premature death, according to a new study in the journal PLOS ONE. The findings contradict previous, smaller studies which indicated the link was less strong for African-Americans. For the study, researchers from the American Cancer Society analyzed data from the Cancer Prevention Study II (CPS-II), which included approximately one million men and women. “While recent large studies have examined the relationship between BMI and all-cause mortality in white and Asian populations in the United States, this relationship has not been well-characterized in African Americans,” said Alpa V. Patel, PhD, in a release. “The American Cancer Society’s Cancer Prevention Study-II is very well-suited to address this issue because of its large size, including nearly a million participants, and long-term follow-up of 28 years, making it the largest study to date in African Americans.” Read more on obesity.

Oct 8 2014
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Students Adjusting to Healthier School Lunches: Q&A with Lindsey Turner

A recently published research brief finds that six months after updated U.S. Department of Agriculture standards for healthier meals were implemented in public schools, elementary and high school students are buying—and eating—the healthier meals.

The brief published by Bridging the Gap, a national research program of the Robert Wood Johnson Foundation (RWJF), shows that 70 percent of elementary school principals and school food directors said that students generally liked the healthier school lunches that began being served in the fall of 2012. Similarly, 70 percent of middle school students and 63 percent of high school students also like the meals. These are the first national studies to examine students’ reactions to the healthier meals.

“The updated meals standards are resulting in healthier meals for tens of millions of kids,” said Lindsey Turner, lead author of the elementary school study, and a co-investigator for Bridging the Gap. “Our studies show that kids are OK with these changes, and that there have not been widespread challenges with kids not buying or eating the meals.”

The survey responders were asked about students’ initial reaction to the meals in fall 2012, and how things were progressing a few months afterwards. Findings included:

  • About half of the responders from elementary schools (56 percent) reported that students complained at first, but by spring 2013 64 percent of responders said few students were complaining.
  • In middle schools, the percentage of students complaining dropped from 44 percent in fall 2012 to 11 percent in spring 2013. High schools saw similar declines, from 53 percent to 18 percent.
  • Eighty-four percent of elementary school responders said approximately the same number of students (or more) were purchasing lunch this school year as did the previous year.
  • Seventy percent of responders said middle-school students generally liked the new lunches, as did 63 percent of responders from high schools.

“The updated meal standards are a landmark achievement—they make schools healthier places for our nation’s children and are a critical step toward reversing the childhood obesity epidemic and building a Culture of Health nationwide,” said Tina Kauh, program officer at RWJF. “Policymakers at all levels should be encouraged by these findings and should continue to support schools’ efforts to provide students with healthy meals and snacks.”

NewPublicHealth recently spoke with Lindsey Turner about the study findings.

NewPublicHealth: News reports from about a year back seemed to indicate some kids were not happy with the healthier lunches. But your studies show that for the most part school lunches are being well-received.

Lindsey Turner: Many of those news stories were early on soon after the lunches had been changed. They’re also based on fairly small numbers of schools or case reports, and so one challenge with that is that it may not necessarily be representative of schools in general across the country. One of the strengths of our study is that we were able to get data from a fairly large number of schools from all across the country, which presents a little bit more of a balanced picture of what’s actually going on.

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Oct 8 2014
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Public Health News Roundup: October 8

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EBOLA UPDATE: Kaiser Infographic Lays Out the Key Statistics
(NewPublicHealth is monitoring the public health crisis in West Africa.)
A new infographic on the current Ebola outbreak produced by the Kaiser Family Foundation and published in the Journal of the American Medical Association breaks down the crisis into key elements, including the disease count so far, the rate of response and the key U.S. government agencies charged with addressing the outbreak. Key numbers include:

  • Fatality rate — 53 percent which is lower than in previous outbreaks
  • Outbreak geography — In the current outbreak, five West African countries that have never had Ebola cases are now battling the disease including Guinea, Liberia, Nigeria, Senegal and Sierra Leone
  • U.S. agencies responding — Department of Defense, Department of States, U.S. Agency for International Development, Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health

The World Health Organization also maintains a dedicated Ebola information website that is updated frequently and includes case counts, studies, policy announcements and feature stories about aid in West Africa. Read more on Ebola.

CDC: 2.5M Emergency Department Visits for Vehicle Crashes in 2012
Motor vehicle crashes sent more than 2.5 million people to emergency departments (EDs) and led to more than 200,000 people being hospitalized in 2012, according to a new report from the U.S Centers for Disease Control and Prevention (CDC). All told, the lifetime medical costs for these crash injuries will be $18 billion and the lifetime work lost will be an estimated $33 billion. “In 2012, nearly 7,000 people went to the emergency department every day due to car crash injuries,” said CDC Principal Deputy Director Ileana Arias, PhD, in a release. “Motor vehicle crash injuries occur all too frequently and have health and economic costs for individuals, the health care system, and society.  We need to do more to keep people safe and reduce crash injuries and medical costs.” Read more on injury prevention.

Task Force Recommends Diabetes Screening for All Americans Over Age 45
Everyone over the age of 45 should be screening annually for type 2 diabetes and prediabetes, according to new recommendations from the U.S. Preventive Services Task Force. "For people with abnormal blood sugar, changes in their lifestyle, such as eating healthier and exercising more often, can help prevent or delay the onset of type 2 diabetes,” said Michael Pignone, MD, a task force member, in a release. “The best way to do that is to participate in a program that supports these behaviors. That's why we're recommending that people who are at increased risk be screened." According to the U.S. Centers for Disease Control and Prevention, approximately 29.1 million Americans have diabetes, although 8.1 million of those cases are undiagnosed. Read more on prevention.

Oct 7 2014
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Drug Abuse Control Gets a New, Important Rule

Later this week a final rule goes into effect from the U.S. Drug Enforcement Agency (DEA) aimed at reducing the misuse of controlled substances. The new rule will allow pharmacies and other approved outlets to accept unused controlled substances from people who want them out of their home so they can’t be abused by people with no medical need for the medications.

Previously, the drugs could only be disposed of at home, brought to a law enforcement agency or brought to one of two annual community “take back” days that the DEA started in 2011. Unused drugs are often found in homes because physicians typically prescribe thirty days’ worth of painkillers after surgery or illness, which can lead to addiction or to the drugs being left in home medicine cabinets where they are ripe for misuse.

Under the rule, certain outlets (including manufacturers, distributors, narcotic treatment programs, retail pharmacies and hospitals/clinics with an on-site pharmacy) can apply to the DEA to become authorized collectors. The public can find authorized collectors in their communities by calling the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539.

Experts say the rule is a good start toward getting millions of controlled substances out of the hands of abusers and potential abusers. Data clearly demonstrates the need:

  • According to the 2012 National Survey on Drug Use and Health, almost twice as many Americans (6.8 million) currently abuse pharmaceutical controlled substances than those using cocaine, hallucinogens, heroin and inhalants combined.
  • Nearly 110 Americans die every day from drug-related overdoses, and about half of those overdoses are related to opioids, a class of drug that includes prescription painkillers and heroin.
  • More than two-thirds of people who misuse prescription painkillers for the first time report obtaining the drugs from friends or relatives, including from a home medicine cabinet.

Writing for the Network for Public Health Law blog, lawyer Corey Davis said that while the new rule doesn’t address some key issues—such as who will pay for the returned drugs to be destroyed and whether pharmacies will face any liability if returned drugs are stolen—“it’s an important step forward in drug abuse and overdose prevention.” 

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Oct 7 2014
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Public Health News Roundup: October 7

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EBOLA UPDATE: Spain Sees Ebola’s First Transmission Outside of Africa
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Four people have been hospitalized and twenty-two are being monitored in Spain after the first confirmed transmission of Ebola outside of West Africa. The nurse, who tested positive yesterday, had treated two Spanish missionaries who contracted the disease in Africa. And while the World Health Organization believes the further spread of Ebola in Europe is “unavoidable,” the global health agency also says that the content is prepared to handle the disease. Read more on Ebola.

CDC Launches Social Media Campaign on the Importance of Tobacco Cessation
More than 20 million Americans have died from tobacco-related causes since the first U.S. Surgeon General’s Report on Smoking and Health more than 50 years ago. As a reminder of the ongoing need for tobacco cessation efforts—and in honor of those lost—the U.S. Centers for Disease Control and Prevention (CDC) has launched the “#20Million Memorial” social media campaign. The CDC will collect social media posts of people sharing messages or photos dedicated to someone they lost across Facebook, Google+, Instagram, Twitter or Vine using the hashtag "#20Million. Smokers looking for free help with quitting and go here; go here for more information on the #20Million Memorial. Read more on tobacco.

HUD: $60 Million to Improving Housing, Stimulate Growth in 90 Tribal Communities
The U.S. Department of Housing and Urban Development (HUD) has announced approximately $60 million in funding to help improve housing conditions and stimulate community development in more than 90 tribal communities across the country. The funds are provided through HUD’s Indian Community Development Block Grant (ICDBG) Program. “ICDBG funds are an important investment in the remote and low-income tribal communities that need it most,” said HUD Secretary Julián Castro, in a release. “Through this work, we’re proud to help our tribal partners expand opportunity in their community by determining on their own, not from Washington, which local projects meet their needs and strengthen their future.” Read more on health disparities.

Oct 6 2014
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PSA of the Month: CDC Infographic on Sexual Violence and Stalking

In connection with Domestic Violence Awareness Month, held each October, the U.S. Centers for Disease Control and Prevention (CDC) recently issued a stark report which found that sexual violence not only results in high rates of injury and death, but also other long-lasting and even lifetime health impacts. To best share the specifics of the report, the CDC created an infographic with the most striking numbers—including how many men are raped each year and how people under the age of five are sexually abused.

>>View the full infographic.

Perhaps most striking, the CDC found that a substantial proportion of U.S. female and male adults have experienced some form of sexual violence, stalking, or intimate partner violence at least once during their lifetimes.

Among the report’s recommended public health actions:

  • Prevention of sexual violence must include the protection of young children.
  • Strategies to prevent sexual violence must include strategies that address known risk factors for perpetration and emphasize changing social norms and behaviors by using bystander and other prevention strategies.
  • Primary prevention of intimate partner violence should be focused on the promotion of healthy relationship behaviors and other protective factors, with the goal of helping adolescents develop positive behaviors before their first relationships.

>>Bonus Link: CDC’s Center for Injury Prevention and Control offers many resources on sexual violence prevention geared toward people of different ages and communities. 

Oct 6 2014
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Public Health News Roundup: October 6

EBOLA UPDATE: 5th U.S. Patient Arrives as Dallas Man Remains in ‘Critical’ Condition
(NewPublicHealth is monitoring the public health crisis in West Africa.)
As a U.S. man being treated for Ebola in Dallas, Texas, remains in critical condition, a fifth American to have contracted the disease while in West Africa has arrived at the Nebraska Medical Center. U.S. Centers for Disease Control and Prevention (CDC) said it will work “very closely” with the Nebraska hospital on the treatment of Ashoka Mukpo, a freelance cameraman for NBC News. It is the same hospital that successfully treated and released Rick Sacra, MD, last month. Meanwhile, Thomas Eric Duncan continues to be treated at Texas Health Presbyterian Hospital. "Our hopes and prayers are with him. We recognize this is a critical time for him and for his family," said CDC Director Thomas Frieden, MD, MPH. Read more on Ebola.

Study: Days of Highest Physical Activity Are Also Days When We Drink the Most
The days when people get the most exercise are also the days when they drink the most alcohol, according to a new study in the journal Health Psychology. Researchers utilized smartphone technology to enable 150 participants ages 18-89 to record their physical activity and alcohol use every day for 21 consecutive days, three times a year. “Perhaps people reward themselves for working out by having more to drink or maybe being physically active leads them to encountering more social situations where alcohol is consumed—we don’t know,” said David E. Conroy, PhD, professor in Preventive Medicine-Behavioral Medicine at the Northwestern Feinberg School of Medicine. “Once we understand the connection between the two variables we can design novel interventions that promote physical activity while curbing alcohol use.” Read more on alcohol.

Study: Children in Walkable Communities Have Lower BMIs
Children who live in walkable neighborhoods also have lower average Body Mass Indexes (BMI), a popular measure used to assess physical health, according to a new study in journal Environmental Health Perspectives. Researcher analyzed geocoded residential address data from the electronic health records of nearly 50,000 children and adolescents, ages 4 to 18 years, finding that  several links between walkability and healthier weights, including the fact that quartile of children who lived closest to recreational open spaces had lower BMIs that the quartile of children who lived farthest from such spaces. The researchers concluded that modifying existing neighborhoods to make them more walkable could help reduce childhood obesity. Read more on obesity.

Oct 3 2014
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Recommended Reading: When Walking Turns Lethal

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The New York Times recently reported on the deaths of two pedestrians killed by bicyclists in the city’s storied Central Park. New York City has recently ramped up efforts to reduce pedestrian deaths—with a focus on car crashes—but anecdotal and police reports in the city find that the growing number of walkers, skaters, cyclists, pedibikers and other people heeding advice to get out and move is resulting in more injuries and deaths. Other cities have also reported increases in accidents linked to increases in physical activity. NewPublicHealth recently reported on efforts launched this year by the U.S. Department of Transportation to prevent and reduce pedestrian injuries.

Several conferences this year—including the annual meetings of the American Public Health Association, the Transportation Research Board and New Partners for Smart Growth—will have sessions looking at pedestrian safety in the wake of communities creating new opportunities for residents to get exercise outdoors. And Sunday Streets, a growing program across the country, shuts down main city streets to give walkers free reign, often with a booth set up by departments of public health or safety on staying safe when sharing the roads.

Read the full story from the New York Times.

Oct 3 2014
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Public Health News Roundup: October 3

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EBOLA UPDATE: U.S. Nurses Unsure of their Ability to Handle Ebola Patients
(NewPublicHealth is monitoring the public health crisis in West Africa.)
While the U.S. Centers for Disease Control and Prevention has repeatedly stated that the U.S. health care system and U.S. hospitals are prepared to treat any and all Ebola-infected patients, a new report from Reuters finds that many nurses aren’t as certain. According to Reuters, many “have gone to hospital managers, seeking training on how to best care for patients and protect themselves and their families from contracting the deadly disease,” and they are also concerned that “inadequate preparation could increase the chances of spreading Ebola if hospital staff fail to recognize a patient coming through their doors, or if personnel are not informed about how to properly protect themselves.” Approximately 3,338 people have died so far from the outbreak originating in West Africa. Read more on Ebola.

CDC: Smoking Prohibitions in Subsidized Housing Could Save $497 Annually
As much as $497 million could be saved each year in assorted costs by prohibiting smoking in government-subsidized housing, including public housing, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC estimates that the ban would save about $310 million in secondhand smoke-related health care, $134 million in renovation expenses and $53 million in smoking-attributable fire losses. “Already, over 500 public housing agencies have adopted some form of a smoke free policy, protecting approximately 200,000 families,” said Matthew Ammon, Acting Director of the Department of Housing and Urban Development’s (HUD) Office of Lead Hazard Control and Healthy Homes, in a release. “This study reinforces HUD’s work that promotes health and reduces costs by encouraging public housing agencies, multi-family housing owners and agents, as well as residents, to adopt and implement smoke-free housing policies.” Read more on housing.

HUD, VA Announced Grants to Help More than 9,000 Homeless Vets Find Housing
The U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Veterans Affairs (VA) have announced more than $62 million in rental assistance to help more than 9,000 homeless veterans find permanent supportive housing. The grants are provided through the HUD-Veterans Affairs Supportive Housing (HUD-VASH) Program. Approximately $57 million will provide 8,276 Tenant-Based Vouchers for rental units and $5 million will provide for 730 Project-Based Vouchers for existing units or new construction in specific developments. “It is unacceptable that after their service and sacrifice, too many of our veterans find themselves living on our streets and in our shelters,” said HUD Secretary Julián Castro, in a release. “We’ve made significant progress reducing homelessness among veterans by a third in just four years, and these vouchers will continue to help communities build on these gains, providing targeted assistance to those in need to ensure that every veteran has a home.” Read more on the military.