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During this week’s Spotlight: Health at the annual Aspen Ideas Festival, Cleveland Clinic CEO Toby Cosgrove, MD, will be talking about the future of academic medicine. The topic has received a great deal of attention recently, including a white paper from the Bipartisan Policy Center (BPC) and a pilot program from the American Medical Association (AMA) to give $1 million each to eleven medical schools redesigning their teaching programs—many of which include a focus on prevention, wellness and population health.
Teamwork is a recent and critical emphasis at the Cleveland Clinic Lerner College of Medicine, said Cosgrove in a conversation with NewPublicHealth ahead of the Aspen conference.
“When a lot of us went to medical school we were all taught to be rugged individuals, and so [now] we’re trying to teach teamwork...at the very beginning of health care education,” he said. To that end, instruction at the medical school now emphasizes team-based learning and the students will begin doing some of their work with nursing and dental students in the same physical facility “so we begin to break down the silos that are going on right now and encourage team play.”
The 11 medical schools that received the recent AMA grants were chosen from among 119 schools that submitted proposals. “Their bold, transformative proposals [are] designed to close the gaps between how medical students are trained and how health care is delivered,” said former AMA President Jeremy A. Lazarus, MD, when the AMA awarded the grants last year. Among the winners:
- The Alpert Medical School of Brown University, which has proposed establishing a dual MD-MS degree program in primary care and population health. A clerkship during the third year of medical school will integrate care of the individual patient and population health, and the fourth year will include population health course content and require a Master's thesis. The admissions process will include required interviews with stakeholders and patients.
- The University of California-Davis School of Medicine is partnering with Kaiser Permanente to create the Accelerated Competency-based Education in Primary Care (ACE-PC) program, which will require all students to work in the Kaiser Health system so that they can learn by experiencing the patient-centered medical home model. Changes to curriculum include population management, chronic disease management, quality improvement, patient safety, team-based care and preventive health skills, with a special emphasis on diverse and underserved populations.
The eleven schools won’t be working in silos, either. Susan Skochelak, MD, the AMA’s group vice president for medical education, told NewPublicHealth that the initiative was designed “very specifically to bring the schools together in a consortium, because we wanted to disseminate the best practices rapidly.”
CDC: American Indians, Alaska Natives Have 50 Percent Higher Death Rates than Non-Hispanic Whites
American Indian and Alaska Native (AI/AN) death rates were approximately 50 percent higher than rates among non-Hispanic whites—for both men and women—from 1999 to 2009, according to a new study in the American Journal of Public Health. The study determined that patterns of mortality were strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking and health-harming social determinants. Among the findings:
- Among AI/AN people, cancer is the leading cause of death followed by heart disease. Among other races, it is the opposite.
- Death rates from lung cancer have shown little improvement in AI/AN populations and AI/AN people have the highest prevalence of tobacco use
- Suicide rates were nearly 50 percent higher for AI/AN people
- Death rates from motor vehicle crashes, poisoning and falls were two times higher among AI/AN people
- Death rates were higher among AI/AN infants
“The Indian Health Service is grateful for this important research and encouraged about its potential to help guide efforts to improve health and wellness among American Indians and Alaska Natives,” said Yvette Roubideaux, MD, MPH, acting IHS director, in a release from the U.S. Centers for Disease Control and Prevention. “Having more accurate data along with our understanding of the contributing social factors can lead to more aggressive public health interventions that we know can make a difference.” Read more on health disparities.
FDA Proposes New Program to Help Patients With Unmet Tech Needs
The U.S. Food and Drug Administration (FDA) has proposed a new program designed to help treat or diagnose people with serious conditions, but whose needs aren’t met by current technology. The proposed Expedited Access Premarket Approval Application for Unmet Medical Needs for Life Threatening or Irreversibly Debilitating Diseases or Conditions (“Expedited Access PMA” or “EAP”) program would include earlier and more interactive engagement with FDA staff, with the goal of providing patients with earlier access to safe and effective medical equipment. “The program allows manufacturers to engage early and often with the agency,” said Jeffrey Shuren, MD, director of the FDA’s Center for Devices and Radiological Health. “We expect most devices that enter this program will be in the pre-clinical trial phase.” Read more on technology.
Study Links Internet Use, Lower Depression Rates in Older Americans
Older Americans who spend more time online are also less likely to suffer from depression, according to a new study in The Journals of Gerontology: Series B. Using data on 3,075 retired men and women who didn’t live in nursing homes gathered by the U.S. Health and Retirement Survey, researchers determined that the 30 percent who were Internet users also had a 33 percent lower probability of depression. "The largest impacts on depression were actually for those people who lived alone, so it's really suggesting that it's about connecting with others, eliminating isolation and loneliness," lead study author Shelia Cotton, according to Reuters. Read more on aging.
Rockingham County, N.C., is one of several counties profiled in videos produced for the 2014 report of the County Health Rankings, a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and released yesterday. The Rankings shows how communities across the country are doing and how they can improve on their health.
Rockingham evolved from a wealthy county to a poor one very quickly after losing two major industries only a couple of decades ago. The community suffers from high general smoking rates, high obesity rates and high rates of smoking during pregnancy. When the 2010 County Health Rankings were released, Rockingham was ranked at 71 out of 100 counties on health measures. The community's poor standing served as a wake-up call.
One new program set to begin this spring is the Nurse-Family Partnership, a decades-old, evidence-based community health program that serves low-income women pregnant with their first child.
Nurse-Family Partnership is based on the work of David Olds, MD, a professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Denver. While working in an inner-city day care center in the early 1970s, Olds was struck by the risks and difficulties in the lives of low-income children and over the next decades tested nurse home visitation for low income families in randomized controlled trials in Elmira, New York, Memphis, Tennessee and Denver. Results have shown that the program improved pregnancy outcomes; improved the health and development of children; and helped parents create a positive life course for themselves. There are now Nurse-Family Partnership programs in 43 states, the U.S. Virgin Islands and six Indian tribal communities.
In the Nurse-Family Partnership programs, the mothers receive ongoing visits from the nurses in their homes from the first trimester until the baby is two years old. Program goals include:
- Improve pregnancy outcomes by helping the new mothers engage in good preventive health practices, including comprehensive prenatal care from their healthcare providers, improving their diets and reducing their use of cigarettes, alcohol and illegal substances.
- Improve child health and development by helping parents provide responsible and competent care.
- Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.
According to Heather Adams, executive director of the Rockingham County Partnership for Children, there are about 5,000 children under the age of five in Rockingham County. Over half live in poverty and are born to mothers under the age of 20 and many of the children are in single parent households.
“The County Health Rankings really gave us some concrete data to show us what we knew anecdotally was really true,” said Adams. “Nurse-Family Partnership really rose to the top as a really strong program that could help meet some of our needs.”
As part of its County Health Rankings coverage, NewPublicHealth recently spoke with Elly Yost, MSN, PNP, director of nursing practice at the Nurse-Family Partnership national office in Denver, Co. Yost is a pediatric nurse practitioner who previously worked in hospitals and community practice settings.
Study Finds Many Older Adults Often Not Prepared for Disasters
A recent University of Iowa study finds that, compared to younger adults, older adults are more vulnerable when natural disasters, hit yet most U.S. adults ages 50 and older may not be prepared for a serious flood, earthquake, tornado, or other natural disaster. The report is based on a 2010 survey that was part of the Health and Retirement Study, which collects social, economic, and health information on adults age 50 and older in the United States. The survey did not include older adults living in nursing homes or other institutional settings. Among the findings:
- Only about one-third of the 1,304 adults interviewed said they had participated in an educational program or read information on how to prepare for a disaster.
- Fewer than 25 percent had an emergency plan in place, although the same percentage lived alone.
- Almost one-third reported being disabled or in fair or poor health.
“Our analysis underscores that older adults living at home often have special needs and situations that put their health and safety at risk in the face of natural disasters,” said Tala Al-Rousan, MD, the study’s primary author and a graduate student in epidemiology at the UI College of Public Health. “The oldest respondents, 80- to 90-year-olds, were significantly less prepared than 65- to 79-year-olds.”
>>NewPublicHealth will be on the ground at the 2014 Preparedness Coverage this week. Follow our coverage here.
Healthy Foods Can Increase Concession Stand Sales A new small study by researchers at the University of Iowa found that adding healthy foods to a football game concession stand appears to increase sales. The researchers asked a college club to add healthy foods such as apples and string cheese to its concession stand menu open during football season, as well as put healthier ingredients into other items including nachos and popcorn. Sales rose four percent over the previous year, and the healthier foods making up almost ten percent of sales. The study was published in the Journal of Public Health. Read more on nutrition.
Study: Gastric-Bypass Surgery Linked to Remission of Type 2 Diabetes
People who undergo gastric-bypass surgery to deal with their weight are more likely to see their type 2 diabetes go into remission without medication that are people who undergo a sleeve gastrectomy, according to a new study in the New England Journal of Medicine. "One-third [of patients] in the gastric bypass group had remission of diabetes—meaning they had normal blood sugar control—and a quarter of the people in the sleeve gastrectomy group had remission of type 2 diabetes," said study co-author Sangeeta Kashyap, MD, an endocrinologist at the Cleveland Clinic's Endocrinology & Metabolism Institute, according to HealthDay. "These effects are real, and they're persistent for at least three years. Essentially, these patients have had a vacation from diabetes for three years." The study included 150 people with type 2 diabetes, with an average age of 49 and two-thirds female. Read more on obesity.
Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.
NewPublicHealth: Looking back, what can you share about the highlights of your career in medicine and health promotion?
Louis Sullivan: Highlights would certainly include my time at the Boston University School of Medicine. That had many significant points. It was my first time living in an integrated environment because up until that time I spent all of my life in the South. Working in an environment without concerns about discrimination and bias, that was a great experience; my classmates and the faculty at Boston University were all welcoming.
Another highlight was later when I was a research fellow in hematology in the Harvard unit at Boston City Hospital. I had a paper accepted for presentation at a major research conference in Atlantic City. It was a paper showing that heavy drinking suppressed the production of red blood cells by the bone marrow.
And of course a tremendous highlight was going back to Morehouse College, my alma mater, to start the Morehouse School of Medicine. I was returning home in a sense. I had gained experience as a faculty member at Boston University, had been steeped in medicine and now I was in the process of establishing a new institution to train young people for the future.
NewPublicHealth: What changes have you created and supported to improve population health.
Sullivan: Well, certainly becoming Secretary of Health and Human Services was indeed an honor and a great opportunity for me, and it was also a very challenging experience.
In the late ‘80s, when I became Secretary, AIDS was a new disease. There were many demonstrations by various advocacy groups, groups that didn’t trust the government, and we had to work to develop a relationship with them. I convinced President Bush to put $1.6 billion in his budget to be used for research on this new disease, to develop mechanisms for treating the disease and to educate the public. And as a result of that initial investment and ones that followed, this disease has been transformed from a virtual death sentence to a chronic disease which is controlled by medication. And people, rather than living a few months, which was the case once the diagnosis was made in 1989, are now living for decades with the virus suppressed on medication, raising their families, working, earning wages, paying taxes. So that has been really a very satisfying outcome from that experience. And we hopefully are close to finding a cure for this disease as well.
FDA Proposes New ‘Nutrition Facts’ Food Labels
The U.S. Food and Drug Administration (FDA) has put forth a new proposed Nutrition Facts label for packaged foods. The updated design would reflect scientific information not available when the current label was designed two decades ago. For example, it would replace out-of-date serving sizes and feature a design that highlights key parts of the label, such as calories and serving sizes. “For 20 years consumers have come to rely on the iconic nutrition label to help them make healthier food choices,” said FDA Commissioner Margaret A. Hamburg, MD. “To remain relevant, the FDA’s newly proposed Nutrition Facts label incorporates the latest in nutrition science as more has been learned about the connection between what we eat and the development of serious chronic diseases impacting millions of Americans.” Read more on nutrition.
Study: One in Five U.S. Health Facilities Don’t Provide Hand Sanitizer Everywhere Needed
One in five U.S. health facilities don’t make hand sanitizer available everywhere necessary, needlessly increasing the risk for health-care associated infections, according to a new study in the American Journal of Infection Control. In addition, approximately half of the hospitals, ambulatory care facilities and long-term care facilities included in their budgets funds for proper hand hygiene training. The study examine compliance with the World Health Organization’s hand hygiene guidelines at 168 facilities in 42 states and Puerto Rico. "When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections," said by Laurie Conway, RN, MS, CIC, PhD student at Columbia Nursing, in a release. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority." Read more on infectious disease.
CDC Foundation Expands Safe Injection Campaign
The CDC Foundation and Eli Lilly are partnering to expand the U.S. Centers for Disease Control and Prevention’s (CDC) Safe Injection Practices Coalition—a safety awareness campaign that provides information for health providers and patients. According to CDC data, more than 150,000 patients have been notified of potential exposure to hepatitis and HIV because of unsafe injection practices in U.S. health care settings since 2001, and CDC researchers have found that medical injections are an overlooked source of infections and outbreaks. Planned actives of the partnership include:
- Expand the One & Only Campaign to new audiences such as individual and group-owned physician practices
- Educate health care providers through new and enhanced training and communication materials to address emerging issues
- Improve the Safe Injection Practices Coalition website and social media platforms to share resources and toolkits with new audiences
- Engage new and existing Safe Injection Practices Coalition partners
Read more on prevention.
Health care professionals who smoke often represent a significant obstacle to getting patients to stop smoking. Among registered nurses (RNs) in particular—whose population historically has a high percentage of smokers—smoking limits their ability to be strong advocates for cessation interventions. In 2003, Robert Wood Johnson Foundation (RWJF) grantee Linda Sarna, PhD, RN, FAAN, began a study at the UCLA School of Nursing to monitor smoking rates among health care professionals, with an emphasis on RNs. The study showed a significant drop in smoking rates among registered nurses and the results were featured in the January special issue of the Journal of American Medicine, which commemorated the 50th anniversary of the U.S. Surgeon General’s landmark report on the health consequences of smoking.
The UCLA study found that the proportion of registered nurses who smoke dropped by more than a third from 2003 to 2011. While RN smoking rates held relatively steady between 2003 and 2007, they fell from 11 percent in 2007 to 7 percent in 2011. The drop represents a 36 percent decrease in smoking rates among RNs—more than double the 13 percent decline among the general U.S. population during the same time period. The study also found that RNs were more likely to quit smoking than the general population.
Tobacco Free Nurses, an RWJF-funded national campaign led by Sarna and Stella Aguinaga Bialous, DrPH, RN, helped to reduce the prevalence of smoking among RNs. Founded in 2003, the nurse-led program aimed to dissuade nurses from smoking in order to prevent smoking-related health issues among RNs and their patients. Tobacco Free Nurses works by supporting smoking cessation efforts among nurses and nursing students; encouraging nurses to advocate for a smoke-free society; and giving nurses tobacco control resources to help patients with cessation efforts.
In addition to the significant decline among registered nurses, the UCLA study found that smoking rates also fell for most other health care professionals. However, licensed practical nurses (LPNs) did not see any significant decreases. Approximately 25 percent of the LPN population still smokes, which is the highest percentage of smokers among health care professionals.
>>Bonus Link: Learn more about the last 50 years of tobacco control in RWJF’s interactive timeline.
Decrease in Pediatric Antibiotic Leveling Off
The number of children taking antibiotics has decreased over the past decade, but that decrease has stalled in recent years in certain age groups and geographic locations, according to a study in Pediatrics. Researchers reviewed pharmacy and outpatient claims over a 10-year period (2000 to 2010) in three health plans located in three different geographic locations to determine the number of antibiotics dispensed each year for children ages 3 months to 18 years. Although the overall antibiotic-dispensing rate in each age group and health plan was lower in 2009-2010 than in 2000-2001, the rate of decline in antibiotic use has slowed. The highest rate of antibiotic use was in children age 3 months to less than 24 months of age in all years of the study.
The study authors say the previous downward trend in antibiotic use in children may have reached a plateau, and continued improvements in judicious antibiotic dispensing are needed. Read more on pediatrics.
NHTSA Gives Okay for Vehicle to Vehicle Communication to Help Prevent Crashes
The National Highway Traffic Safety Administration has announced that it will begin taking steps to allow vehicle-to-vehicle (V2V) communication technology for light vehicles, which will allow vehicles to "talk" to each other and ultimately avoid many crashes by exchanging basic safety data, such as speed and position, ten times per second.
The safety applications currently being developed provide warnings to drivers so that they can prevent imminent collisions, but do not automatically operate any vehicle systems, such as braking or steering, although NHTSA is also considering future actions on active safety technologies that rely on on-board sensors.
V2V communications can provide the vehicle and driver with 360-degree situational awareness to address additional crash situations — including those, for example, in which a driver needs to decide if it is safe to pass on a two-lane road (potential head-on collision), make a left turn across the path of oncoming traffic, or in which a vehicle approaching at an intersection appears to be on a collision course. In those situations, V2V communications can detect threats hundreds of yards from other vehicles that cannot be seen, often in situations in which on-board sensors alone cannot detect the threat. Read more on transportation.
Many Hospital ICUs Don't Follow Infection Prevention Rules
While most hospitals have evidence-based guidelines in place to prevent health care-associated infections in intensive care units (ICUs), clinicians often fail to follow them according to new research from the Columbia University School of Nursing published in the American Journal of Infection Control. The study, on over 1600 ICUs, found lax compliance in intensive care units where patients are more likely to be treated with devices linked to preventable infections – such as central lines, urinary catheters and ventilators.
The study focused on three of the most common preventable infections — central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections and determined that despite decades of research, establishing best practices for prevention of these infections, approximately one in 10 hospitals lack checklists to prevent bloodstream infections, and one in four lack checklists to help avoid pneumonia in ventilator patients, and that in hospitals with checklists, they are followed only about half of the time.
Health care-associated infections kill an estimated 100,000 Americans a year and result in over $30 billion in excess medical costs, according to the Centers for Disease Control and Prevention. Read more on injury prevention.
NewPublicHealth is on the ground at the NACo 2014 Healthy Counties Initiative Forum. The theme of the forum this year is “Improving Health in a Climate of Change.” Ahead of the meeting we spoke with James McDonough, county commissioner in Ramsey, Minn., and chair of the Healthy Counties initiative about the meeting and the health changes he is seeing at the county level.
NewPublicHealth: Can you tell us how the NACo Healthy Counties Initiative got its start?
James McDonough: Three years ago the president of NACo at that time, Lenny Eliason, from Athens County, Ohio, really was concerned about how the majority of health care dollars were being spent on treating preventable conditions and the whole issue of the wellbeing of our constituents and our employees. So he elevated the issue of wellness and health in counties as a presidential initiative. Typically those are short term and last for a year or two, but NACo has embraced this and has continued this on as a task force to really embed it in the work that we do—elevating how counties can have an impact on wellness in communities.
NPH: What are the current goals?
McDonough: To really elevate and get the county commissioners and county managers throughout the country to just pause and take a look at what they're doing and what they could be doing. We’ve been talking about how we can do a better job supporting counties that are already doing great work in this area and helping share those best practices, and then helping counties that haven’t really taken a look at what their role is. That can help us have a better impact on getting ahead of some of the major preventable diseases in our communities.
NPH: How important is county-level action when it comes to health?
McDonough: For the most part, counties really are responsible for the public health departments within their communities. Throughout the country we operate almost 1,000 county hospitals and close to 700 county nursing homes, so we have a lot of responsibility for public health and—just as important—we employ more than 30 million people throughout the country.
Action, responsibility and efforts vary county to county, but for example, in Ramsey County, Minnesota, where I’m the County Commissioner, we run the public health department working with our cities, the state and with the federal government. So for us it’s a really big opportunity to be the convener as well to lead the Healthy Cities Initiatives as well to a larger regional more focused and concentrated effort.
NPH: The focus of the forum includes some critical topics such as behavioral health and key health issues in jails. How much of a financial burden do these health issues place on counties?
Tips on Staying Warm During the ‘Polar Vortex’
As much of the country faces record lows due to a polar vortex, with many areas suffering through below-zero temperatures, experts are offering advice on how to stay warm and healthy. The first tip is staying indoors. "It's best to limit your outdoor activity as much as possible, since prolonged exposure can lead to frostbite and hypothermia," said John Marshall, MD, chair of emergency medicine at Maimonides Medical Center in New York City. "Both of these conditions can become serious, and even life-threatening if untreated." However, when you must go outside, follow these tips:
- Dress warmly — Layer clothing to retain body heat, and a non-permeable outer layer will help against strong winds.
- Protect your extremities — Wear extra socks. Also go with mittens over gloves, since fingers stay warmer when they’re next to each other.
- Wear a hat — And cover the ears and nose if possible.
- Wear properly fitted winter boots — If they’re too tight they can cut off circulation. Also go for a pair that’s insulated with treads.
- Stay hydrated — Drink fluids to replenish the energy your body spends to stay warm.
- Stay dry — Get out of wet clothing as soon as possible.
Read more on preparedness.
Study: Health Care Spending Remained Low as Economy Struggled
Health care spending has now stayed relatively steady—and low—for four consecutive years, rising by 3.7 percent in 2012 to $2.8 trillion. according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS). The study, published in Health Affairs, found that faster growth in hospital, physician and clinical services was somewhat offset by slower growth in prescription drug and nursing home services prices. Spending growth and growth in private health insurance for Medicaid were also near historic lows. "The low rates of national health spending growth and relative stability since 2009 primarily reflect the lagged impacts of the recent severe economic recession," said Anne B. Martin, an economist in the Office of the Actuary at CMS and the study’s lead author. "Additionally, 2012 was impacted by the mostly one-time effects of a large number of blockbuster prescription drugs losing patent protection and a Medicare payment reduction to skilled nursing facilities." Read more on budgets.
Study: Newer Antidepressant Drugs All Carry About Equal Risk of Suicidal Thoughts
New antidepressants all come with about the same level of risk for suicidal thoughts and behaviors in children, according to a new study in the journal Pediatrics. Previous studies identified the increased risk, especially within the first few weeks of treatment, but there were still questions of whether some drugs came with higher risks. The study analyzed the medical histories of almost 37,000 children, average age 14, enrolled in Tennessee's Medicaid program between 1995 and 2006. Each child was a new user of one of six antidepressants: Prozac, Zoloft, Paxil, Celexa, Lexapro or Effexor. The study found little difference in the rate of suicidal thoughts and attempts before and after they began the medications. However, they did note that children on multiple medications were at higher risk, though that could also be a result of more severe depression. Read more on mental health.