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Cardiovascular disease is the focus of the 2013 annual report to Congress of the Community Preventive Services Task Force, an independent and unpaid panel of public health and preventive services experts. The report was discussed at a recent Congressional briefing that included health experts, Congressional staff, community health promotion partners and policy-makers.
Each year the Task Force reviews and updates the Guide to Community Preventive Services, a free resource that provides examples of evidence-based strategies to help communities choose programs and policies to improve health and prevent disease.
It’s not hard to understand why cardiovascular disease was the focus topic this year. According to John Clymer, executive director of the National Forum for Heart Disease & Stroke Prevention, almost half of all Americans have at least one of three modifiable risk factors for heart disease: tobacco use, high blood pressure or uncontrolled high cholesterol.
The Task Force has identified effective approaches to address most of the risk factors for heart disease, which include integrated community and health system practices. Some examples of such practices are a team approach to preventive care that includes doctors, nurses and community pharmacists; tobacco quitline interventions at no cost including follow-up counseling calls; and behavioral counseling and support for heart disease risk factor behaviors.
Jonathan Fielding, MD, MPH, co-chair of the Task Force and health director of Los Angeles County in California, says his county used evidence in the Guide that found that mass media efforts aimed at getting people to stop smoking only work in conjunction with other efforts.
Several community and health leaders of San Bernardino, Calif., the largest geographic county in the U.S., spoke at the recent briefing on use of the Community Guide to help improve population health in their county. San Bernardino ranked 44th out of 57 counties in the 2013 County Health Rankings. “The [Community] Guide has been instrumental in our work looking at population health,” says Dora Barilla, DrPH, Asst. Vice President for Strategy and Innovation at Loma Linda University Health, at the recent briefing. Loma Linda was part of a community initiative begun several years ago to improve population health in San Bernardino, which has 4.2 million residents in San Bernardino, “many with significant disparities,” said Barilla.
“We needed to identify the highest impact initiatives and without the community guide, we could not have done that,” said Barilla. “We used it to move forward fast. We needed science and evidence. Using the guide we were able to galvanize 20 of 24 cities. We were able to use what worked and not waste time on practices that were ineffective and outdated.”
Critical features of the Guide, said Barilla, is that it has targeted approaches for different populations “and does not take a one size fits all approach.” One key outcome, according to Barilla, was that hospitals engaged in community benefit efforts—a requirement for nonprofit hospitals under the Affordable Care Act. “We now had science and metrics to invest in upstream initiatives.”
>>Bonus Link: Watch a County Health Rankings and Roadmaps video on initiatives now in place to help improve population health in San Bernardino.
A new study from Columbia University finds that deaths linked to a warming climate may rise by as much as 20 percent by the 2020s. The study was published in Nature Climate Change, by an interdisciplinary team at Columbia University’s Earth Institute and the Mailman School of Public Health.
“This serves as a reminder that heat events are one of the greatest hazards faced by urban populations around the globe,” said coauthor Radley Horton, PhD, a climate scientist at the Center for Climate Systems Research. In fact, although tornadoes are currently trending as the most common “weather word” right now, according to the Centers for Disease Control and Prevention, extreme heat kills more Americans each year than tornadoes, hurricanes, flooding and earthquakes combined.
Cities could be hit harder than other areas, according to the new research that found that daily records from Central Park in Manhattan show that average monthly temperatures already increased by 3.6 degrees Fahrenheit from 1901 to 2000—substantially higher than the global and U.S. trends, according to the researchers, who say that cities tend to concentrate heat. Buildings and pavement soak it up during the day and give it off at night. Last year was the warmest year on record for New York City.
Legislation Would Dramatically Expand FDA’s Oversight of Compounding Pharmacies
New legislation proposed from Representative Edward Markey of Massachusetts would give the U.S. Food and Drug Administration (FDA) authority over compounding pharmacies that make and ship over state lines sterile and non-sterile products. This would be more significant than a bill recently approved by a Senate committee, which would give FDA authority only over sterile products, leaving states with the authority over non-sterile products. This has left some concerned that states would be overtaxed by the effort. “State pharmacy regulators vary widely in their ability to oversee large-scale non-traditional compounding," wrote the Pew Charitable Trusts in comments to the Senate health committee that drafted the legislation, according to Reuters. The calls for increased oversight come in response to a 2012 meningitis outbreak which killed 53 people and was linked to steroids produced by the Framingham, Massachusetts-based New England Compounding Center. Read more on infectious diseases.
Study: Diners Dramatically Underestimate Calories in Fast Food
Diners at fast food restaurants dramatically underestimate their caloric intake, according to a new study in BMJ. "Teens underestimate the number of calories in their meals by as much as 34 percent, parents of school-age children by as much as 23 percent, and adults by as much as 20 percent," study Jason Block, MD, in a release from the Robert Wood Johnson Foundation. Researchers found that the average adult meal was 836 calories—but they thought, on average, it was 175 fewer calories. As many as 1 in 4 of the people surveyed missed the mark by at least 500 calories. "These findings tell us that many people who eat at fast-food restaurants may not be making informed choices because they don't know how many calories they're consuming," Block said. "Having the information is an important first step for anyone wanting to make changes." Read more on nutrition.
FDA Approves Marketing of A1c Test for Diabetes
The U.S. Food and Drug Administration is for the first time allowing the marketing of an HbA1c (or A1c) test for the diagnosis of diabetes. A1c tests measure the percentage of hemoglobin A1c bound the glucose; people with diabetes are unable to properly convert glucose. Nearly 26 million Americans are estimated to have diabetes, which untreated can lead to heart disease, stroke and other serious medical conditions. “Providing health care professionals with another tool to identify undiagnosed cases of diabetes should help them provide patients appropriate guidance on treatment before problems develop,” said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Devices at FDA’s Center for Devices and Radiological Health. Read more on diabetes.
May is Stroke Awareness Month, a good time to bump up the percentage of Americans who recognize the most common symptoms of a stroke from only 38 percent, according to a Centers for Disease Control and Prevention (CDC) survey. Speedily identifying stroke symptoms and calling for an ambulance is essential because people who get to an emergency room for treatment within three hours are healthier three months later than people for whom stroke care was delayed, according to the CDC.
New this year to help increase symptom awareness is a free smartphone app from the American Heart Association/American Stroke Association called F.A.S.T. The acronym stands for common stroke symptoms and a critical call to action: Face drooping; Arm weakness; Speech difficulty; and Time to call 9-1-1. The app also includes a link to additional symptoms that bystanders and caregivers can access and a 9-1-1 button to call an ambulance. Using the 9-1-1 button saves time by not having to back out of the app to dial the number manually. And using the button also generates an automatic time stamp, which gives emergency room staff a good indication of when symptoms began. Some treatments can only be given within a specific time window.
Devastation in Oklahoma, More Storms Possible
Following tornadoes in Oklahoma yesterday that killed and injured scores of people and leveled whole communities, the National Weather Service is warning that that severe weather could move eastward as far as the Gulf Coast and Northeast on Tuesday and Wednesday. “These are dangerous storms and we urge people to monitor the situation closely and be alert for severe weather warnings in their community,” said Trevor Riggen, vice president of Disaster Operations and Logistics for the Red Cross. The Red Cross has created a free tornado app, available in English or Spanish, whose features include a high-pitched siren tornado warning alert that signals when an alert from a National Oceanic and Atmospheric Agency (NOAA) tornado warning has been issued. The app, found in the Apple App Store and the Google Play Store for Android by searching for American Red Cross, also includes an all-clear alert that lets users know when a tornado warning has expired or has been cancelled. The app also includes one-touch “I’m safe” messaging to alert family and friends through social media outlets. Read more on preparedness.
Cost, Other Factors May Keep African-Americans from Calling 911 when they have Stroke Symptoms
African-Americans often know the signs of stroke, but concerns about medical cost, ambulance response time and lack of familiarity with the need for prompt hospital care impacted whether they called 9-1-1 immediately, according to a new study of 77 African American community members in Flint, Michigan by researchers at the University of Michigan. The study was published in Circulation: Cardiovascular Quality and Outcomes. To encourage 9-1-1 calls even if a stroke victim is concerned about cost, the study authors recommended highlighting the reduction in post-stroke disability if treatment is given quickly. Read more on access to health care.
Report: High SPF Sunscreens Not Any More Effective
Just in time for the Memorial Day Weekend, the Environmental Working Group has released its 7th annual Sunscreen Guide, which rates the safety and efficacy of more than 1,400 sunscreens, lotions, lip products and makeups that advertise sun protection. EWG researchers found that only 25 percent of products on the market in 2013 offer strong and broad protection and pose few safety concerns. “The vast majority of sunscreens available to the consumer aren’t as good as most people think they are, but there are a handful of products that rise above the rest,” said Sonya Lunder, senior research analyst at EWG and lead author of the report. Lunder says that’s important because “despite an increasing awareness of the sun’s risks, rates of melanoma have tripled over the past 35 years, with an annual increase of 1.9 percent per year since 2000.” EWG says it thinks the U.S. Food and Drug Administration (FDA) should push companies to stop selling high-SPF sunscreens (above 50+), which account for 1 in 7 products on the market. The FDA has said that it cannot vouch for any sunscreen above 30. According to Lunder, as a result of misleading and confusing marketing claims, consumers frequently misuse sunscreens and spend more time in the sun than they should, putting them at greater risk. Read more on cancer.
NIH Grants $40M to Combat Racial, Ethnic Disparities in Stroke Risk
The National Institutes of Health (NIH) has awarded $40 million in grants over five years to help four research centers investigate and develop strategies to reduce the risk of stroke in racial and ethnic minorities. The funds come from NIH’s National Institute of Neurological Disorders and Stroke (NINDS). Racial and ethnic minorities are at higher risk than non-whites due to higher prevalence of cardiovascular risk factors, according to said Walter J. Koroshetz, MD, deputy director, NINDS. "A few of the grantees are working closely with at-risk populations to develop interventions that give people tools to achieve blood pressure control," he said. "These research efforts will give us the traction we need to control the greatest modifiable stroke risk factor. Together, the Stroke Prevention /Intervention Research Programs represent a much needed effort to address stroke disparities in the United States." Read more on stroke.
People With Congenital Heart Disease Need Physical Activity
A new scientific statement from the American Heart Association serves to remind health professionals and patients that regular physical activity is important for people with congenital heart disease and should be promoted. Congenital heart disease (heart structural problems existing since birth) impacts close to 1 million children and 1 million adults in the United States. Specifics of the new statement include:
- While some irregular heart beat conditions may require a restriction in physical activity, “for most, physical activity can be unlimited and should be strongly promoted.”
- Most patients with congenital heart disease are relatively sedentary. But the physical, psychological and social health benefits of physical activity are important for this population which is at risk for exercise intolerance, obesity and other diseases. .
- These are general recommendations and physicians may have to tailor some specific guidelines for individual patients.
Read more on heart health.
DOT Announces Funds to Help Improve Road Safety on Tribal Lands
The U.S. Department of Transportation (DOT) has announced the availability of more than $8.6 million in Tribal Transportation Program Safety Funds from the Federal Highway Administration (FHWA). According to Transportation Secretary Ray LaHood, the funds will help improve roads on tribal lands, which have consistently ranked among the nation’s highest road fatality rates. DOT will hold a webinar on May 8 from 4-5 p.m. EDT to provide information on the grants to potential applicants. Find a link to the webinar here. Read more on transportation.
USPSTF Recommends HIV Screening for All Americans 15-65
The U.S. Preventive Services Task Force (USPSTF) now recommends that all Americans ages 15 to 65 be screened for HIV, according to new guidelines appearing in the Annals of Internal Medicine. USPSTF’s previous 2005 guidelines recommended screening for only those people categorized as high-risk. The U.S. Centers for Disease Control and Prevention already recommends this course of action. "We do hope the fact that the guidelines are all very similar will provide an impetus for people to offer screening because it is a very critical public-health problem,” said task force member Douglas Owens, MD, a medical professor at Stanford University. Experts noted that the change will likely mean that testing will be covered as a preventive service under the Affordable Care Act. Read more on HIV/AIDS.
HUD’s $1.83B Plan Will Help Rebuild New Jersey, Prepare for Future Disasters
The U.S. Department of Housing and Urban Development’s (HUD) $1.83 billion New Jersey disaster recovery plan will help residents continue to recover from the damage caused by Hurricane Sandy and better prepare for future extreme weather events. “This infusion of federal funding will help New Jersey continue to recover from Superstorm Sandy and ensure that our state is rebuilt stronger and better prepared for future storms,” said Senator Frank Lautenberg (D-NJ). “Families that are rebuilding their homes, small businesses that are getting back on their feet, and communities that are repairing damaged public infrastructure will all benefit from this federal grant program.” The plan is funded through HUD’s Community Development Block Grant Program. The infrastructure restoration efforts will including elevating some homes to guard against future flooding. Read more on Hurricane Sandy.
Early Obesity Dramatically Increases Men’s Risk of Poor Health, Death
Obesity in the early 20’s can dramatically increased a man’s chance of suffering from serious health problems or even dying by the age of 55, according to a new study in the journal BMJ Open. A study tracking Danish men found that approximately half of the participants who were obese at the age of 22 had developed diabetes, developed high blood pressure, had a heart attack, had a stroke, or experienced blood clots or died by age 55. Men of a normal weight at age 22 saw only a 20 percent risk of developing these problems by age 55. Each unit increase in body mass index raised the risk of heart attack by 5 percent; high blood pressure and clots by 10 percent; and diabetes by 20 percent. In the United States approximately 35.7 percent of adults and 17 percent of children are obese, according to the U. S. Centers for Disease Control and Prevention. Read more on obesity.
Survey: Many Americans Still Unaware of or Confused About the Affordable Care Act
Signup for the Affordable Care Act (ACA) Health Insurance Marketplace begins in October, but a new poll from the Kaiser Family Foundation finds that many Americans are still confused about the law, which will require virtually all Americans to sign up for health insurance coverage that will take effect January 1, 2014.
Key poll findings include:
- More than 40 percent of Americans aren’t aware that the ACA is the law of the land.
- Of those who aren’t aware that the ACA is now law, 12 percent think the law was repealed by Congress and 7 percent think the law was overturned by the Supreme Court.
- About half of the respondents said they did not have enough information about the health reform law to understand how it will impact their family.
The poll findings also showed that people who are currently uninsured and those in low-income households were the most likely groups to say they did not understand how the ACA benefits them and their families. Read more on access to health care.
Study: Single Can of Sugary Soda Can Increase Diabetes Risk 22 Percent
Drinking even a single 12-ounce can of sugary soda once a day can up the risk of diabetes by 22 percent, according to a new study out of Imperial College London. Researchers looked at the data of approximately 350,000 European residents. "Given the increase in sweet beverage consumption in Europe, clear messages on the unhealthy effect of these drinks should be given to the population," said study leader Dora Romaguera, according to Reuters. Previous studies have also shown a link between sugary drinks and increased risk of obesity and type 2 diabetes, which affects approximately 310 million people, according to the World Health Organization. Read more on diabetes.
Teen Years in the ‘Stroke Belt’ Ups Risk of Stroke Later in Life
Growing up as a teenager in the U.S. “stroke belt”—an area in the country’s southeast—can increase the risk of stroke later in life by as much as 17 percent, according to a new study in the journal Neurology. Risk factors including high blood pressure and diabetes are only partially responsible for the increase risk. "Many social and behavioral risk factors, such as smoking, are set in place during the teenage years, and teens are more exposed to external influences and gain the knowledge to challenge or reaffirm their childhood habits and lifestyle," said study author Virginia Howard, with the School of Public Health at the University of Alabama at Birmingham, in a release. Across all age groups the risk was double for black Americans when compared to white Americans. Researchers were careful to note that the findings do not demonstration causation. Read more on strokes.
Poultry Probably Source of China’s New Bird Flu Strain
Researchers believe that poultry-to-human transmission from “wet” markets is likely responsible for the new H7N9 bird flu strain that has killed 22 people in China and infected more than 100. Wet markets sell and immediately slaughter poultry. So far the strain does not seem to pass easily between people, so the researchers feel relatively confident that closing the markets and slaughtering the birds will control the outbreak. “Overall, the evidence, in terms of epidemiology and virology, suggests that it is a pure poultry to human transmission, and that controlling [the epidemic in humans] will therefore depend on controlling the epidemic in poultry,” said Kwok-Yung Yuen of the University of Hong Kong, according to MSNBC. The findings were published in the journal Lancet. Read more on infectious disease.
AAP: Out-of-school Suspensions, Expulsions Harmful to Kids
Out-of-school suspensions and expulsions are generally counterproductive and can have profound long-term negative effects, according to the American Academy of Pediatrics (AAP). Data shows the youth are more likely to drop out of school, more likely to be involved in the juvenile justice system and will earn $400,000 less over a lifetime than a high school graduate. Such discipline also does not address potential underlying issues, such as drug abuse, racial tension, violence and bullying, according to AAP. AAP recommends early intervention programs to recognize and address behavioral and other problems. Recommendations also include a Positive Behavior Intervention and Support program to teach proper behavior at both the individual and school-wide levels. Read more on violence.
Study: 1 in 4 Admit to Bizarre Late-night Snacking
Approximately one in four students admit to creating and eating late-night crazy food concoctions, according to a new report in the International Journal of Eating Disorders. Researchers defined the relevant snacks as “strange food mixtures that you would be too embarrassed or ashamed to share with others” (e.g. sugar-covered scrambled eggs or mayo-smothered vegetables). While there is no inherent health danger in such mixing, health professionals recommend that people try to make healthy choices when selecting late-night snacks. About one-third of U.S. adults and nearly one in five youth ages 2-19 are obese, according to the U.S. Centers for Disease Control and Prevention. Read more on nutrition.
Study: Mediterranean Diet Good for Heart Health
A Mediterranean diet—rich in olive oil, nuts, fresh fruits, fresh vegetables and even red wine—is more effective than a low-fat diet at helping at helping people at high risk for cardiovascular disease to ward off health problems, according to a new report in the New England Journal of Medicine. Researchers found a 30 percent greater reduction in relative risk of a heart attack, stroke or death, according to lead author Miguel Angel Martinez-Gonzalez, MD, MPH, PhD, chairman of preventive medicine and public health at the Universidad de Navarra in Spain. He said the findings are likely to due to the good-quality fats and wide array of nutrients. The findings give further support to the effectiveness of a Mediterranean diet at preventing heart disease. Read more on heart health.
San Diego County in California has set out to become the nation’s first “heart attack and stroke-free zone.” In a collaborative effort, local hospitals and health care providers are using innovative health information technology and focusing heavily on prevention to achieve this important goal, while the public health community continues to work toward making the county a healthier place to live.
The community was inspired to set this unprecedented public health benchmark when the California Department of Managed Health Care (DMHC) launched the Right Care Initiative in 2008, setting a statewide goal of reaching the 90th percentile nationally for controlling many of the factors which lead to heart attacks and strokes. Prior to 2008, 16 million Californians – about 44 percent of the population – were affected by chronic disease, half of whom suffered from more than one chronic condition.
DMHC has formed key partnerships with California health plans and medical groups, the California Chronic Care Coalition, University of California, American Diabetes Association, American Heart/Stroke Association and community organizations throughout the state. As a result, doctors, patients, and community organizations are saturated with traditional and social media that stress the importance of being proactive.
Communities strive to meet the Right Care Initiative goals through the enhanced practice of patient-centered, evidence-based medicine focusing on the following efforts:
- engaging patients more actively to improve their health with diet and exercise;
- involving pharmacists as part of the patient’s care team; and
- learning proper medication protocol.
Since the Initiative started almost five years ago, eight of the nine largest health plans in California have made overall improvements on heart and diabetes quality measures, 11 groups in California have reached the 90th percentile of clinical control measures, and DMHC has assisted more than one million Californians to resolve their health plan problems.
San Diego is just one community among many waging a battle against chronic disease and the enormous toll it exacts on quality and years of life. Stroke alone takes more than 140,000 lives each year. According to the American Stroke Association, only two-thirds of Americans know at least one of the seven warning signs of stroke. The American Heart Association (AHA) and American Stroke Association (ASA) partnered with the Ad Council to launch their first national multimedia public service campaign to raise awareness in recognizing and responding to the warning signs of stroke by using the acronym: F.A.S.T.