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Oct 14 2014
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Public Health News Roundup: October 14

EBOLA UPDATE: Death Rate Now Stands at 70 Percent; 4,447 Dead
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization (WHO) now puts the Ebola outbreak death rate at 70 percent, up from a previous estimate of 50 percent. WHO assistant director- general Bruce Aylward, MD, who announced the figure at a news conference, said this classifies Ebola as a “high mortality disease.” The global health agency also predicts there could be as many as 10,000 new cases per week within two months. The official toll so far is 4,447 deaths in 8,914 cases. Read more on Ebola.

DOD Adds Climate Change Threats to its Defense Mandate
Citing its effect on issues such as infectious disease, hunger and poverty, the U.S. Department of Defense has announced its intention to integrate climate change threats into all of its “plans, operations, and training.” The assessment came in the Pentagon’s 20-page Climate Change Adaptation Roadmap. "Rising global temperatures, changing precipitation patterns, climbing sea levels, and more extreme weather events will intensify the challenges of global instability, hunger, poverty, and conflict. They will likely lead to food and water shortages, pandemic disease, disputes over refugees and resources, and destruction by natural disasters in regions across the globe," wrote Defense Secretary Chuck Hagel in the report. Read more on the environment.

Study: Smoking Linked to 14 Million Major Medical Conditions
Cigarette smoking harms nearly every bodily organ and is linked to an estimated 14 million major medical conditions in U.S. adults, such as chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema and is the illness most closely linked to smoking. The study was published in the journal JAMA Internal Medicine. “The disease burden of cigarette smoking in the United States remains immense, and updated estimates indicate that COPD may be substantially underreported in health survey data,” wrote the study authors. The study also linked smoking to 2.3 million cases of heart attack 1.3 million cases of cancer, 1.2 million cases of stroke and 1.8 million cases of diabetes. Read more on tobacco.

Sep 26 2014
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Public Health News Roundup: September 26

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EBOLA UPDATE: American Physician Declared Ebola-Free, Released From Hospital
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Rick Sacra, MD, an American physician who was working in an obstetrics clinic in Liberia when he became infected with the Ebola virus, has been cleared as disease-free by the U.S. Centers for Disease Control and Prevention and released from The Nebraska Medical Center. He entered the facility, which includes one of the United States’ few biocontainment units, three weeks ago. Kenty Brantly, MD, who was previously and successfully treated for Ebola at Emory Hospital in Atlanta, had donated two pints of his blood for Sacra’s treatment. Read more on Ebola.

UTHealth to Use $1.3M Grant to Study Asthma Risk for Health Care Workers
As asthma prevalence continues to rise across the country, the University of Texas Health Science Center at Houston (UTHealth) School of Public Health will utilize a four-year, $1.3 million grant from the U.S. Centers for Disease Control and Prevention (CDC) to study how the risk of asthma has changed for Texas health care workers over the past decade. The health care field is one of the population groups that see a higher risk for the breathing disorder. For the study, researchers will repeat a 2003 survey which found that, after entering the field, 7.3 percent of nurses and 4.2 to 5.6 percent of doctors, respiratory therapists and occupational therapists developed asthma. “Practices in hospitals have changed in 10 years. There are new cleaning chemicals, including many environmentally friendly ones, but are those products without risk? We want to find out,” said George Delclos, MD, PhD, co-principal investigator and professor in the Division of Epidemiology, Human Genetics & Environmental Sciences at the UTHealth School of Public Health. Read more on health disparities.

HHS: $212M to Strengthen State, Local Programs Designed to Prevent Chronic Diseases
The U.S. Department of Health and Human Services (HHS) announced yesterday that it will award nearly $212 million in grants to help all 50 states and the District of Columbia strengthen efforts to prevent chronic diseases. A total of 193 awards will go to state and local programs, and are funded in part through the Affordable Care Act. “Tobacco use, high blood pressure, and obesity are leading preventable causes of death in the United States,” said U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, in a release. “These grants will enable state and local health departments, national and community organizations, and other partners from all sectors of society to help us prevent heart disease, cancer, stroke, and other leading chronic diseases, and help Americans to live longer, healthier, and more productive lives.” Read more on prevention.

Sep 22 2014
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Public Health News Roundup: September 22

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UPDATE: Sierra Leone Ends Three-Day Lockdown, Reports 130 New Cases
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Officials in Sierra Leone have ended a three-day curfew designed to help contain the continuing spread of the Ebola virus, calling the effort a success. Authorities reported 130 new cases during the lockdown and are waiting for tests on 39 more people. The West African country has been one of the hardest hit by the outbreak—more than 550 of the nearly 2,800 total deaths have been in Sierra Leone. In addition more than 100 tons of health-related supplies are being flown to Sierra Leone and Liberia. They include gloves, masks, gowns, goggles, saline, antibiotics, oral rehydration solution and painkillers. "We must do all we can to reduce further the human tragedy caused by this deadly outbreak and help communities avoid an even deeper setback than has occurred already," said Chief Executive Thomas Tighe of Direct Relief, according to USA Today. Read more on Ebola.

Study: Medicare Patients Less Likely to Receive Post-Stroke Surgery
Despite the fact that it can significantly help recovery and reduce the risk of long-term disability or even death, a common post-stroke surgical treatment is far less likely to be referred by physicians of patients with Medicare, according to a new study in the journal PLOS One. Researchers at the University of Florida (UF) analyzed data on more than 21,000 adult patients discharged from 2003 to 2008 with a diagnosis of subarachnoid hemorrhage, finding that—when compared to patients with private insurance—Medicare patients were almost 45 percent less likely to receive surgery and were more than twice as likely to die in the hospital. Azra Bihorac, MD, the study’s senior author and an associate professor of anesthesiology, medicine and surgery at the UF College of Medicine, said the results could indicate a conscious or unconscious bias. “Not every hospital has skilled neurosurgeons who specialize in subarachnoid hemorrhage,” he said in a release. “If these hospitals don’t have the necessary expertise, then they may actually overestimate the risk of a bad prognosis. They may assume that the patient won’t do well anyway, so they won’t proceed with surgery.” Read more on access to care.

Study: Weekly Text Reminders about Calories Help People Make Healthier Choices
Something as simple as a weekly text reminder may help U.S. adults develop a better understanding of basic nutrition and make healthier food choices, according to a new study in Health Promotion Practice. Researchers from the Johns Hopkins Bloomberg School of Public Health sent either a weekly text message reminder, a weekly email reminder, or no weekly reminder about the U.S. Food and Drug Administration’s recommendation of a reasonable daily caloric intake—2,000 calories—to 246 participants dining in the Johns Hopkins Hospital cafeteria. They found that at the beginning of the study approximately 58 percent knew the recommended benchmark, but after four weeks the participants who received texts were twice as likely to know the benchmark. “While daily energy needs vary, the 2,000-calorie value provides a general frame of reference that can make menu and product nutrition labels more meaningful,” said study leader Lawrence J. Cheskin, MD, director of the Johns Hopkins Weight Management Center, in a release. “When people know their calorie ‘budget’ for the day, they have context for making healthier meal and snack choices.” Read more on nutrition.

Sep 17 2014
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Public Health News Roundup: September 17

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White House Announces Significant Increase in U.S. Ebola Response
Yesterday, NewPublicHealth reported President Obama’s initial planned response to the ongoing Ebola outbreak in West Africa. The White House has since expanded on the plans. They will include:

  • A military command center in Liberia.
  • A staging area in Senegal to help dispatch personnel and aid to affected communities more quickly
  • Personnel from the U.S. Public Health Service will deploy to a new field hospitals the U.S. is setting up in Liberia.
  • US AID will help distribute home kits with items such as gloves and masks to help reduce the number of Ebola cases.

Read more about Ebola.

Survey Finds Doctors are Overextended or At Capacity for Patients
A new survey of 20,000 doctors by the Physicians Foundation, a non-profit group that works with practicing physicians, finds that 81 percent of doctors say they are over-extended or at full capacity and only 19 percent indicate they have time to see more patients. Forty-four percent of doctors responding say they plan to take steps that would reduce patient access to their practices , including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of physicians in the United States. The timing of the survey is significant because signup for health insurance coverage under the Affordable Care Act begins in just a few weeks. Read more about access to care.

Number of Smokers Increases in New York City
Earlier this week the New York City Health Department released new 2013 data showing that 16.1 percent of adult New Yorkers are smokers, a significant increase from the city’s lowest recorded adult smoking rate of 14 percent in 2010. For the first time since 2007, there are more than one million smokers in New York City who are at risk of developing a smoking-related illness, including heart disease, stroke, diabetes, emphysema, lung and other cancers, according to the health department. So far, the city does not have strong data to explain the uptick in smoking. Nationally, the U.S. Centers for Disease Control and Prevention estimates that 18 percent of U.S. adults are smokers, down from 20 percent several years ago. However, New York City is often a bellwether for public health issues, and the health experts across the country will be looking to see whether the city’s tobacco control efforts—including a new ad campaign that focuses on both daily and occasional smokers—have an impact on smoking rates. Read more on tobacco.

Sep 11 2014
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For the Homeless, a Place to Call Home After a Hospital Stay

A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.

Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).

Medical Respite Centers Location of medical respite centers in the United States

Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.

Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.

The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.

The goals of the guidelines for the respite care centers are to:

  • Align with other health industry standards related to patient care
  • Represent the needs of the patients being served in the medical respite centers.
  • Promote quality care and improved health
  • Create standards for a range of respite center types with varying degrees of resources

NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.

There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.

“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.

Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.

>>Bonus Links:

Aug 19 2014
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Public Health News Roundup: August 19

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EBOLA UPDATE: Death Toll Passes 1,200; Improvement Seen in Three African Doctors Who Received Experimental Treatment
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The death toll in the ongoing Ebola outbreak in West Africa has passed 1,200, according to the World Health Organization, with infection rates continuing to outpace containment efforts. Concerns over the disease also continue to spread, with a 30-year-old woman in Germany isolated and then taken to a specialist medical unit after being found with a high fever. However, the Liberian information minister was also recently quoted as saying that three African doctors treated with the experimental ZMapp treatment are showing “remarkable signs of improvement.” The drug was used to treat two Americans who are now also showing signs of improvement. Read more on Ebola.

Study: Older Americans Receiving Cancer Screenings Against Recommendations
As many as half of older Americans continue to receive cancer screenings despite the recommendation by several professional societies that certain cancers not be screening for in people who aren’t expected to live for another 10 years, according to a new study in JAMA Internal Medicine. “There is general agreement that routine cancer screening has little likelihood to result in a net benefit for individuals with limited life expectancy,” wrote Trevor Royce, MD, in the study. Keith Bellizzi of the University of Connecticut‘s Center for Public Health and Health Policy in Storrs added that "Each screening test carries different risks and benefits ... Individuals should be counseled about these risks in order to make an informed decision (sometimes involving caregivers or family members)." Read more on cancer.

Study: Dramatic Drop in Deaths, Hospitalization for Heart Disease and Stroke
Lifestyle changes, better treatment and effective preventive measures have caused a dramatic drop in deaths and hospitalizations for heart disease over the past decade, according to a new study in the journal Circulation. In a review of data on nearly 34 million Americans covered by Medicare, researchers found that from 1999 to 2011 hospitalizations rates for heart attacks dropped by 38 percent; rates of unstable angina dropped by almost 85 percent; and hospitalizations for both heart failure and stroke dropped by approximately one-third. "The findings are jaw-dropping," said lead researcher Harlan Krumholz, MD, a professor of cardiology at the Yale School of Medicine in New Haven, Conn, according to HealthDay. "They really show that we have begun to reverse this epidemic of heart disease and stroke." Read more on heart and vascular health.

Aug 12 2014
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Public Health News Roundup: August 12

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EBOLA UPDATE: Death Toll at 1,013 as Two More Doctors are Set to Receive an Experimental Treatment
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Two more Ebola-infected doctors are set to receive the experimental ZMapp drug that was given to two American health workers and a Spanish priest. The Americans continue to receive treatment in an Atlanta hospital, while the 75-year-old missionary died early this morning. The death toll of the West African outbreak—the largest Ebola outbreak in history—now stands at 1,013, according to the World Health Organization. Read more on Ebola.

FDA Approves New Colorectal Screening Test
The U.S. Food and Drug Administration (FDA) has approved the first stool-based colorectal screening test to identify cancers such as colon cancer or precursors to cancer. The test can detect red blood cells and DNA mutations that can indicate certain types of abnormal growths. Colorectal cancer is the third most common cancer among those that affect both men and women, and regular screening tests for all people ages 50 and older could reduce related deaths by at least 60 percent, according to the U.S. Centers for Disease Control and Prevention. “This approval offers patients and physicians another option to screen for colorectal cancer,” said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Health at the FDA’s Center for Devices and Radiological Health, in a release. “Fecal blood testing is a well-established screening tool and the clinical data showed that the test detected more cancers than a commonly used fecal occult test.” Read more on cancer.

Study: Women, Blacks Affected Most by Heart Disease and Stroke
Women and African-Americans are affected the most by chronic diseases linked to increased risk of heart attack or stroke, according to a new population-based study in the journal Circulation. Researchers analyzed the five major risk factors for heart disease—high cholesterol, smoking, high blood pressure, obesity and diabetes—in more than 13,500 Americans from 1987 to 1998, finding that while the combined risk for women dropped from 68 percent to 58 percent, it was still higher than the risk for men, which dropped from 51 percent to 48 percent. The study also found that diabetes more than doubled the risk of heart disease for African-Americans when compared to whites—28 percent versus 13 percent. Researchers said the difference could be because heart disease has been traditionally viewed as a disease of white men, affecting how it is treated. Read more on health disparities.

Aug 4 2014
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Total Worker Health: Getting and Staying Healthy in the Workplace

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For the last several years, the U.S. Centers for Disease Control and Prevention (CDC) has been promoting a concept called “Total Worker Health,” which combines safety programs to prevent accidents on the job with health promotion programs such as smoking cessation. The idea is that emerging evidence recognizes that both work-related factors and health factors that are often beyond the workplace together contribute to many health and safety problems for employees and their families.

A new report in the CDC’s latest Morbidity and Mortality Weekly Report (MMWR) shows why the combination can be critical, finding that the risk for coronary heart disease (CHD) and stroke is higher for blue-collar and service workers than it is for white-collar workers. Studies have suggested that before, but the new MMWR recommends strategies that companies can implement to reduce that risk.

In the new report, CDC researcher Sarah Luckhaupt, MD, analyzed National Health Interview Survey data for 2008-2012. She found that the prevalence of a history of CHD or stroke among people ages 18 to 55 was 1.9 percent for employed adults, but among the employed the risk was 40 percent higher in blue-collar workers (e.g. construction workers and truck drivers) and 53 percent higher in service workers (e.g. hairdressers and restaurant servers). Luckhaupt says that job stress, shift work, exposure to particulate matter, noise and secondhand smoke are all likely contributing factors to the higher rates of CHD and stroke.

In a conversation with NewPublicHealth, Luckhaupt said that employers can help improve the health profiles of employees by using the Total Worker Health program, launched by CDC and the National Institute for Occupational Safety and Health three years ago as a guideline for workplace wellness programs. CDC now publishes quarterly reports on effective Total Worker Health programs established by employers across the United States. Recent examples include:

  • Live Well/Work Well at the Dartmouth-Hitchcock Medical Center in N.H., which aims to improve worker safety and health at the medical center.
  • Hearing loss prevention at the Domtar Paper Company in Kingsport, Tenn., and the 3M manufacturing plant in Hutchinson, Minn., which address both noise reduction exposure on the job and in the community.
  • A “Culture of Health” at Lincoln Industries, a manufacturing factory in Lincoln, Neb., which includes companywide stretching for 15 minutes every day to help prepare the muscles that will be used on the job; massage therapists who assess and treat people who may be at risk for injury; an on-site clinic for health maintenance, wellness coaching and acute care; counseling and support programs; and social and fitness events.
Jul 22 2014
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Public Health News Roundup: July 22

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Study: Low-income Teens in Better High Schools Engage in Fewer Risky Behaviors
Low-income teenagers attending “high-performing” high schools are less likely than their peers in lower-performing schools to engage in risky behaviors such as carrying a weapon, binge drinking, using drugs other than marijuana and having multiple sex partners, according to a new study in the journal Pediatrics. Researchers analyzed 521 students who were accepted into a high-performing charter school; when compared to 409 students who also applied to top charter schools but were not selected in a random lottery, the kids in the high-performing schools were less likely to engage in at least one of the identified “very risky” behaviors—36 percent, compared to 42 percent. There was no statistical difference for more common risky behaviors, such as lighter drinking and smoking cigarettes. Read more on education.

Too Few People At Risk for Heart Disease are Receiving Recommendations for Aspirin Therapy
Despite the important role it can play in preventing heart disease, only 40 percent of the people who are at high risk of cardiovascular disease reported receiving a doctor’s recommendation for aspirin therapy, according to a new study in the Journal of the American Heart Association. Approximately one-quarter of people at low risk received the recommendation. “Cardiovascular disease is a significant problem in the United States and the appropriate use of prevention strategies is particularly important,” said Arch G. Mainous III, PhD, the study’s lead investigator and chairman of the department of health services research, management and policy at the University of Florida’s College of Public Health and Health Professions, in a release. “Aspirin has been advocated as a prevention strategy but only for certain patients. There are health risks associated with the treatment. It is important that doctors are directing the right patients to get aspirin for cardiovascular disease prevention.” The U.S. Preventive Services Task Force recommends aspirin use to prevent heart attack and stroke in men ages 45-79 and women ages 55-79. Read more on heart health.

Study: Coping Skills Programs for Mothers of Children With Autism Helps All Involved
Mothers of children with autism who participated in coping skills programs saw reduced stress, illness and psychiatric problems—all of which they are at higher risk for—while also improving their connections with their children, according to a new study in the journal Pediatrics. Such programs also benefit their children, as these risk factors are associated with poorer health outcomes for the children. Researchers entered 243 mothers of children with disabilities (two-thirds of which were autism) into six weeks of either Mindfulness-Based Stress Reduction (mindfulness practice) or Positive Adult Development (positive psychology practice), finding that both reduced stress and other negative impacts. Read more on mental health.

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

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

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

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

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

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

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

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

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

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

>>Bonus Links: