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Oct 13 2014
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More Training On the Way—and Needed—for U.S. Health Care Workers Expected to Treat Ebola Patients

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.

Oct 13 2014
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Public Health News Roundup: October 13

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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.

Oct 10 2014
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Faces of Public Health: Margo DeMont, Memorial Hospital of South Bend

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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

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Oct 10 2014
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Public Health News Roundup: October 10

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EBOLA UPDATE: One-quarter of Americans View Ebola as a ‘Major Threat’ to the United States
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The percentage of Americans who view Ebola as a “major threat” to the United States stands at 27 percent, up from only 13 percent in mid-September, according to a new Harris Poll/HealthDay survey. While saying that the fear is unwarranted, Mayo Clinic infectious diseases physician and researcher Pritish Tosh, MD, said the rising concern is also understandable. "Ebola is an agent that evokes a lot of fear, and can result in societal disruption," said Tosh, according to HealthDay. "There's a reason why it's considered a possible bioterrorism agent. So any time you have any cases in the United States, there is a heightened amount of anxiety." Read more on Ebola.

In-home Parenting Education Improves Mother’s Health, Behavior
In-home, intensive parenting and health education reduces illegal drug use, depression and behavior problems in pregnant American Indian teens, while also improving the likelihood that their children will reach behavioral and emotional milestones, according to a new study in the American Journal of Psychiatry. Researchers at the Johns Hopkins Bloomberg School of Public Health analyzed 322 expectant American Indian teens in four Southwest communities, randomly assigning them to receive optimized care or optimized care plus 63 in-home education sessions, finding that the latter group saw greater improvements in various behaviors. "We found a consistent pattern of success across a number of different outcome measures," says the study's principal investigator John Walkup, MD, an adjunct professor at Johns Hopkins Bloomberg School of Public Health and a faculty member within the Center for American Indian Health. "These early years are critical ones for children. We teach these mothers not only how to be competent parents, but how to cope with stressors and other risk factors that could impede positive parenting skills." Read more on maternal and infant health.

Study: Hospital Patients Don’t Wash their Hands Nearly Enough
Hospital patients aren’t washing their hands nearly enough, according to new research from McMaster University. Researchers analyzed the hand hygiene behavior of 279 adult patients in three multi-organ transplant units of a Canadian acute care teaching hospital over an eight-month period, finding they washed their hands about 30 percent of the time while in the washroom, 40 percent during meals and only 3 percent when using the kitchens in their rooms. "This is important because getting patients to wash their hands more could potentially reduce their risk of picking up infections in the hospital," said principal investigator Jocelyn Srigley, MD, an assistant professor of medicine at McMaster's Michael G. DeGroote School of Medicine, in a release. Read more on prevention.

Oct 9 2014
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TEDMED Great Challenges: Public Health’s Work on Infectious Diseases

Infectious diseases—and the treatment of infectious diseases—has been a common theme in the news recently, with almost 4,000 people now dead from an Ebola outbreak in West Africa. It was only yesterday that Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, died in a Dallas, Texas, hospital.

Earlier this week, some of the leading experts in infectious disease came together in the Google Hangout “TEDMED Great Challenges: Track, Treat, Prevent—A Better Battle Against Communicable Diseases.” They discussed the risk of communication, treatment, drug resistance, disease tracking innovation and related ethical issues. The event was moderated by Helen Branswell of the Canadian Press.

The panelists—across the board—agreed that the recent Ebola resurgence has served to highlight the importance of public health. Not just what it brings to the table during such emergencies, but the need for it to focus even more on prevention efforts and ensuring public health is fully funded and supported.

“Public health funding is one of those things people only really notice when something goes wrong,” said Dara Lieberman, a Senior Government Relations Manager at Trust for America's Health.

Amy L. Fairchild, PhD, MPH, Professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health, believes that “in many ways, we’ve really lost our way in public health.”

“There was a period at the end of the 19th/beginning of the 20th century in which the field made these enormous strides in combatting infectious diseases and combatting communicable disease,” Fairchild said. “And then, with the rise of chronic diseases, we began to forget some of those...lessons learned about the need to focus on broad, sweeping environmental changes.”

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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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