Category Archives: Public health
Study: Acetaminophen Use and Even Light Drinking Dramatically Raises Kidney Dysfunction Risk
Acetaminophen use when paired with even moderate or light drinking can increase the risk of kidney dysfunction by 123 percent, according to a new study released today at the American Public Health Association’s 141st Annual Meeting in Boston. Using data from the 2003-2004 National Health and Nutrition Examination Survey, researchers analyzed data on more than 10,000 people who were asked questions about their alcohol consumption, use of acetaminophen and health conditions. “Pain is the most common symptom among the general public and is also most frequently self-treated with acetaminophens,” noted Harrison Ndetan, lead researcher of the study. “Where this becomes a greater concern is among young adults, who have a higher prevalence of alcohol consumption. These findings highlight a serious concern among health professionals who deal frequently with pain patients, particularly those with mild pain who are more susceptible to consuming both.” Read more on substance abuse.
Flight Attendants: Expanded Use of Electronic Devices In-flight Needs Reworked Safety Messaging for Flyers
The decision by the Federal Aviation Administration (FAA) last week to let passengers use electronic devices—but not make cell phone calls—during all phases of a flight has flight attendants concerned that the ruling could compromise passenger safety if flyers are distracted by the devices when the cabin crew makes its safety announcements before takeoff.
Most airlines will introduce the new rule on devices by the end of the year. To qualify they have to assure the FDA that their fleet’s airplanes can tolerate any potential radio interference from the devices. Flight attendants would like heavy devices stored under seats or in the overhead bins during takeoff and landing for added safety. In a statement released just after the FAA ruling, the Association of Flight attendants said “AFA will work diligently alongside the FAA and industry to find creative, science-based approaches to ensure that passengers comply with the new operator policies and that their attention is not diverted from the important safety information provided by cabin crew during routine pre-flight briefings and unexpected emergencies, and that risks posed by loose items in the cabin are safely managed during the most critical portions of [a] flight.” Read more on injury prevention.
Two Questions Could Help Diagnose Strep, Reduce Unnecessary Antibiotic Prescriptions
“Do you have a cough and have you had a fever in the last 24 hours?” These two simple questions could help people determine whether they need to see a doctor for strep throat, which could in turn limit unnecessary antibiotic prescriptions, according to a new study in the Annals of Internal Medicine. While high fevers can indicate strep, coughs do not. The study found the questions, when paired with an accounting of how common strep infections were in a particular area, where nearly as effective as lab tests at determining whether a patient actually had a strep infection. "This enables us to use the test of time," said co-study author Dr. Kenneth Mandl, a professor of bioinformatics at Harvard. "If we determine that you're low risk and most cases will not have an important complication from strep anyway, then you can be followed clinically rather than come in for a test right away, and you may improve." About 15 million people in the United States see a doctor for a sore throat each year, with 70 receiving antibiotics; estimates indicate that only 20-30 percent of children and 5-15 percent of adults actually benefit from the medications. Read more on prescription drugs.
Firearm Injuries Cost $16B in U.S. Health Care in Less than a Decade
Firearm injuries cost more than $16 billion in hospital care between from 2000 to 2008, according to new research to be presented today at the American Public Health Association’s 141st Annual Meeting in Boston. The 275,939 victims spent approximately 1.7 million days in the hospital, for an average stay of 6.7 days and an average cost of medical treatment of $59,620. About one in three patients did not have insurance. “The impact is probably much higher than $16 billion since the years of life lost, disability, lack of productivity, societal well-being and emotional turmoil associated with such injuries is far-reaching,” said Min Kyeong Lee, DMD, Annual Meeting presenter. “This is one of the foremost reasons why health care costs in this country have gotten out of control and underlies the need for better preventive policies.” Read more on violence.
Study: Secondhand Smoke in the Workplace Down Overall, But Certain Groups Still at Risk
While recent policies and regulations have helped reduce the overall exposure rates of secondhand smoke in the workplace, certain professions continue to experience high rates, according to new findings to be presented today at the American Public Health Association’s 141st Annual Meeting. The study looked at exposure rates in Massachusetts since 2004, when its Smoke-Free Workplace Law was enacted to require all enclosed workplaces to be smoke free. However, that means that workers in installation, repair and maintenance still experience an overall secondhand smoke exposure rate of 37.4 percent; the national rate in 2010 was 5.4 percent. “We’re seeing a steady decline in prevalence of exposure, but it’s clear that there are still specific groups of workers that deserve our attention,” said Kathleen Fitzsimmons, MPH, lead researcher of the study. “Findings like these that combine information about occupation and environmental tobacco smoke provide helpful information for evaluating comprehensive statewide smoke-free workplace laws and for targeting interventions to reduce risks.” Read more on tobacco.
Study: HPV Screenings Better than Pap Tests at Protecting Against Invasive Cervical Cancer
Human papillomavirus (HPV) screenings are both more effective than Pap tests when it comes to screening against invasive cervical cancer, according to a new study in the journal The Lancet. Researchers analyzed the results of four clinical trials in Europe covering more than 175,000 women ages 20 to 64. The studies tracked them women for an average of 6.5 years after one of the screening types, finding that they were about equal in protection levels for the first 2.5 years, but that following that short time frame HPV screening provided as much as 70 percent greater protection. The findings were particularly significant in women ages 30 to 35. Read more on cancer.
In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?
In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
Re-Thinking How We Pay for Public Health and Prevention
One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained. In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.
By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.
CDC: U.S. Malaria Cases Reached 40-year High in 2011
U.S. malaria cases reach a 40-year high in 2011, with 1,925 total cases and five associated deaths, according to a supplement of the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR). The 2011 total was a 14 percent increase over the 2010 statistic. According to the CDC, the vast majority of the U.S. cases were acquired overseas, with about 69 percent coming from Africa, and 63 percent of those cases from West Africa. “Malaria isn’t something many doctors see frequently in the United States thanks to successful malaria elimination efforts in the 1940s,” said CDC Director Tom Frieden, MD, MPH. “The increase in malaria cases reminds us that Americans remain vulnerable and must be vigilant against diseases like malaria because our world is so interconnected by travel.” Preventative measures include antimalarial drugs, insect repellent, insecticide-treated bed nets, and protective clothing. Read more on infectious disease.
FDA Proposes New Rules to Combat Prescription Drug Shortages
The U.S. Food and Drug Administration (FDA) yesterday proposed a new plan to combat drug shortages by requiring drug and biotechnology firms to immediately notify the FDA of any potential disruptions in the supply of medically important drugs. These drug shortages can delay or even deny care to patients in critical need. There were 117 drug shortages in 2012, down from 251 in 2011, when the White House issued an executive order to solve the public health problem. The new plan calls for companies to promptly notify the FDA of a permanent discontinuance or a temporary interruption likely to disrupt the supply of a prescription drug. Early notification enables the FDA to work with manufacturers to investigate the reasons for disruptions; identify other manufacturers who can help make up for the shortfall; and expedite inspections and reviews of drugs that could help mitigate a shortage. The FDA also released a strategic plan that “highlights opportunities for drug manufacturers and others to prevent drug shortages by promoting and sustaining quality manufacturing.” “The complex issue of drug shortages continues to be a high priority for the FDA, and early notification is a critical tool that helps mitigate or prevent looming shortages,” said Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research. “The FDA continues to take all steps it can within its authority, but the FDA alone cannot solve shortages. Success depends upon a commitment from all stakeholders.” Read more on prescription drugs.
March of Dimes: U.S. Preterm Birthrate at 15-year Low, But Country Still Gets a ‘C’ Grade
The U.S. preterm birthrate fell to a 15-year low of 11.5 percent in 2012, according to a new report from the March of Dimes. While that’s also a six consecutive year of lower rates, the national still received a “C” on the report card when compared to other countries. "Although we have made great progress in reducing our nation's preterm birth rate from historic highs, the U.S. still has the highest rate of preterm birth of any industrialized country. We must continue to invest in premature birth prevention because every baby deserves a healthy start in life," said Jennifer Howse, MD, president of the March of Dimes. Only six U.S. states received an “A” on the annual report card: Alaska, California, Maine, New Hampshire, Oregon and Vermont. An infant is premature if they are born before 37 weeks of pregnancy; the potential health complications include breathing problems, developmental delays, cerebral palsy and even death. Read more on maternal and infant health.
New York City Council Votes to Raise Tobacco-purchasing Age to 21
With studies repeatedly showing that the earlier someone begins smoking, the more likely they are to become addicted, the New York City Council has voted to raise the age minimum required to buy tobacco products from to 21 years, up from 18 years. The bill passed 35-11. Mayor Michael R. Bloomberg has already announced he will sign the bill. The law would apply to all tobacco products, including cigarettes, electronic cigarettes, cigars and cigarillos. “This is literally legislation that will save lives,” said Christine C. Quinn, the Council speaker, according to The New York Times. The Council also voted to increase the penalties for retailers who evade tobacco taxes; for a prohibition on discounts for tobacco products; and for a minimum price of $10.50 a pack for cigarettes and little cigars. Read more on tobacco.
Analysis: Sports-related Youth Concussion Diagnoses Climbing
The growing number of diagnosed concussions in young athletes and their reluctance to admit when they have suffered a head injury—despite ever-growing awareness of the dangers of concussions—demonstrates the need for sports leagues and government agencies to become more active in preventing traumatic brain injuries, according to a new report from the Institute of Medicine and the National Research Council. In 2009, about 250,000 youth ages 5-21 were treated for sports-related concussions and other brain injuries in U.S. hospitals, up from approximately 150,000 in 2001. The analysis pointed to Hannah Steenhuysen, a high school soccer goalie in Rehoboth, Massachusetts, as an example of why relying on youth to report their head injuries on their own is not always an effective strategy. "You don't tell anyone usually when you get a headache because you don't want to be out of the game," she said. "I couldn't watch TV or text or even read—it was really tough. When I tried to go back to school, I couldn't keep up and everything got jumbled in my head." Read more on injury prevention.
Tips for Kids with Food Allergies on Halloween
Trick-or-treating and Halloween parties can be difficult for kids with food allergies. However, there are steps both kids and parents can take to make sure kids with food allergies still have a full night of fun, according to Joyce Rabbat, MD, a pediatric allergy specialist with the Loyola University Health System, in Chicago. "The key is education,” she said. “Make sure your child knows what he or she can eat. When in doubt, throw it out." Among her tips:
- Plan parties and events that do not include food, candy or other edible treats.
- Inform the host of any Halloween party if your child has a food allergy. You can also provide a list of foods that may trigger an allergic reaction.
- Clean all cooking utensils, pans or other dishes if they have been in contact with a food allergen. Also make sure to wipe down surfaces.
- Read labels to find out whether foods contain allergens or have been made on the same machine as other products that contain an allergen.
- Carry self-injectable epinephrine.
Read more on food safety.
HPV Vaccines Less Effective in African-American Women than in White Women
Perhaps because of their lower participation rates in clinical trials, African-American women are less likely to benefit from available human papillomavirus (HPV) vaccines that guard against cervical cancer, according to new findings presented at the 12th annual International Conference on Frontiers in Cancer Prevention Research. The two most popular vaccines in use protect against infection by HPV 16 and HPV 18, which are responsible for about 70 percent of cervical cancers. However, these two subtypes are half as likely to be found in black women as they are in white women. Researchers found that the most common infections for white women are from subtypes 16, 18, 56, 39 and 66; the most common for black women are 33, 35, 58 and 68. "Since African-American women don't seem to be getting the same subtypes of HPV with the same frequency, the vaccines aren't helping all women equally," said study author Adriana Vidal, Ph.D., assistant professor of obstetrics and gynecology at Duke University School of Medicine. Read more on health disparities.
San Francisco Proposes Tax on Soda, Other Sugary Beverages
In an effort to curb the growing rate of obesity and obesity-related health issues, a San Francisco, California city supervisor has proposed a ballot measure that would impose a 2-cents-per-ounce tax on soda and other sugary beverages with at least 25 calories per ounce. This would be the first and strongest such city measure in the country, amounting to an additional 24 cents for a normal 12-ounce can of soda. Supervisor Scott Wiener said the tax proceeds, which he estimates would be $30 million annually, would go toward physical education and healthy lunch programs in city schools, as well as city parks, recreation programs and community health organizations. The California cities of Richmond and El Monte last year failed to enact similar taxes. A ballot measure requires a two-thirds majority to pass. "We know that this will be a long road," said Wiener. "This type of proposal has occurred in other cities and the beverage industry always comes out full guns blaring, so we're going to need to pull together to make sure that this wins." Read more on obesity.
Study: Young Cancer Patients at Increased Risk for Suicide
The stress of a cancer diagnosis means that teens and young adults who are diagnosed should be carefully monitored for behavior changes and other issues that could be a sign of suicidal thoughts, according to a new study in the Annals of Oncology. While there is an elevated risk of suicide for cancer patients of all ages, “because adolescents and young adults are still developing their coping strategies for stress, they may be more affected than adults when facing major adversity such as a cancer diagnosis," said lead researcher Donghao Lu, from the department of medical epidemiology and biostatistics at the Karolinska Institute in Stockholm, Sweden. Lu and his team found that Swedes ages 15-30 with a cancer diagnosis were at a 60 percent greater risk of suicide or attempted suicide, compared to people in the same age group but without cancer; in the first year after the diagnosis the risk was 150 percent higher. Lu said the findings indicate the need for greater communication and cooperation among medical professionals, psychological professionals, family members and social workers. Read more on cancer.
On First Anniversary, States Still Helping Residents Displaced and Impacted by Hurricane Sandy
Flags will fly at half mast in New York State and other regions of the Northeast today as residents mark the one year anniversary of the day that Hurricane Sandy made landfall. New York, New Jersey, and Connecticut—which saw dozens killed and hundreds injured—continue to help residents rebuild and recover from injuries, loss of homes and loss of businesses. Read more about Hurricane Sandy.
AAP: Parental ‘Media Use Plans’ Needed to Limit Kids’ Time in Front of TVs, Other Screens
Parents should create a “media use plan” that limits kids’ screen time to no more than two hours per day, as well as keeps television and Internet access out of their bedrooms, according to a new policy statement from the American Academy of Pediatrics (AAP) Council on Communications and Media. Marjorie Hogan, MD, one of the statement's lead authors, said the issue isn’t television and other media access overall, but the fact that excessive media use been linked to obesity, sleep problems, school problems and aggression; the average child spends about eight hours each day in front of various screens. The key is for parents to find a balance between the positives and negatives of media. "We're not media-bashers," said Hogan. "We love media…For teens, connectivity, being connected to your peers, having a chance to create your persona, can be a really positive thing.” Read more on pediatrics.
Study: Smokers Most Likely to Think About Quitting on Mondays
An analysis of online searches related to smoking cessation shows that smokers are most likely to think about quitting smoking on Mondays, which could give anti-tobacco efforts a new way to make anti-smoking campaigns more effective by enacting weekly cues to remind smokers to keep trying on Mondays, according to a new study in JAMA Internal Medicine. Researchers found the number of Monday searches was 25 percent higher than the combined average of the rest of the days of the week; the findings were the same for searches conducted in English, French, Chinese, Portuguese, Russian and Spanish. "Popular belief has been that the decision to quit smoking is unpredictable or even chaotic," said study lead author John Ayers, of San Diego State University."By taking a bird's-eye view of Google searches, however, we find anything but chaos. Instead, Google search data reveals interest in quitting is part of a larger collective pattern of behavior dependent on the day of the week." Read more on tobacco.
Pediatricians: Parent’s Religion Should Not Stand in the Way of Child’s Medical Care
While noting that parents have the right to determine a child’s medical care, a parent’s religious beliefs should not stand in the way of necessary medical care when the child is at risk for serious disability or death, according to a new policy statement from the American Academy of Pediatrics Committee on Bioethics. The organization is also calling for a repeal of all state exemptions to child abuse and neglect laws, as well as an end to funding for any religious or spiritual healing. "I think it's important that all children get appropriate medical care, that state policies should be clear about the obligations to provide this care and that state monies directed toward medical care should be used for established and effective therapies," said Armand Antommaria, MD, directors of the Ethics Center at Cincinnati Children's Hospital Medical Center in Ohio and one of the statement’s lead authors. Many religious groups currently decline mainstream and proven medical treatments. For example, Christian Scientists advocate prayer over medical treatment, and Jehovah’s Witnesses opposed blood transfusions. Read more on pediatrics
Study: Low-cost Football Gear as Effective as High-tech, High-cost Equipment at Preventing Head Injuries
A group of experts has performed an extensive study to determine which football helmets and mouth guards are best at preventing youth concussions: none of them. The researchers compared high-tech and custom equipment to low-cost, off-the-shelf equipment, finding no difference in the number of concussions for 1,300 players at 36 high schools during the 2012 football season. There are approximately 40,000 sports-related concussions in U.S. high schools every year. "We're certainly not saying that helmets and mouth guards aren't important. They do what they are supposed to do. Mouth guards prevent dental injuries, and helmets prevent skull fractures and scalp and face lacerations," said Margaret Alison Brooks, MD, the study's lead co-investigator. "But I don't think the manufacturing companies have the data to support [the claim that] if a parent buys a specific model, their child will have a reduced risk of concussion." The findings will be presented today at an American Academy of Pediatrics meeting in Orlando, Fla. Read more on injury prevention.
FDA: Recall of Certain Kraft and Polly-O String Cheese Products
Kraft Foods Group has announced a voluntary recall of some varieties of Kraft and Polly-O String Cheese and String Cheese Twists products because they might spoil before their “Best When Use By” code dates. Approximately 735,000 cases of the product will be affected throughout the United States, each with code dates between October 25, 2013 and February 11, 2014. Kraft announced the recall after receiving several reports of premature spoilage and ceasing the production and distribution of the questionable products. For full refunds, customers can return the products to the store where they were purchased or call Kraft Foods Consumer Relations at 1-800-816-9432 between 9 am and 6 pm (Eastern). Read more on food safety.
FDA Recommends Tighter Regulations for Hydrocodone
The U.S. Food and Drug Administration (FDA) is recommending that products that contain hydrocodone be reclassified more restrictively, possibly putting them in the Schedule II category that already includes other opioid painkillers such as oxycodone and morphine. Products that contain less than 15 milligrams of hydrocodone, such as Vicodin, are currently classified as Schedule III controlled substances. The change would mean patients would need to present a written prescription at a pharmacy and could not get as many refills before returning to their doctors for a new prescription. While this would help limit access by addicts, these greater restrictions would also affect people with legitimate chronic pain, potentially placing undue hardship on their already painful conditions. The Drug Enforcement Agency (DEA) is pushing for the restrictions in an effort to combat the increasing problem of prescription drug abuse;
the change must be approved by the U.S. Department of Health and Human Services and the DEA, which will make a final scheduling decision. This Saturday is also National Prescription Drug Take-Back Day, sponsored by the DEA, when people can anonymously and safely dispose of expired or unused prescription medicines. Read more on prescription drugs.
ONC Releases New Online Security Tool for Disaster Preparedness
The Office of the National Coordinator for Health Information Technology (ONC), part of the U.S. Department of Health and Human Services, has released a new online security training tool to help health care providers and staff with contingency planning in the case of power outages, floods, fires, hurricanes or other events. Such events can damage important patient information, or even make it unavailable. "We know from recent experiences such as Hurricane Sandy, that these events can very adversely impact the delivery of health care," said ONC Chief Privacy Officer Joy Pritts. "We hope that this video game will raise awareness of contingency planning and help practices begin to develop their own disaster plans, backup and recovery processes and other vital activities." The "CyberSecure: Your Medical Practice” tool is available here. Read more on disasters.
Study: Kids with Concussion at Higher Risk for Depression
Children with concussions or other head injuries are at increased risk of later being diagnosed with depression, according to new findings to be presented today at the American Academy of Pediatrics national conference in Orlando, Fla. Researchers found that about 15 percent of children and teenagers who ever suffered a brain injury were later diagnosed with depression, compared to the national average of 4 percent. While the findings did not determine causation, they do suggest that doctors should make assessments or mood and behavior problems part of and follow-up treatment for head injuries. Read more on mental health.
In honor of World Polio Day, the U.S. Centers for Disease Control and Prevention (CDC) will highlight polio eradication work around the globe on Twitter and Facebook. Development of the polio vaccine has reduced the disease worldwide by 99 percent, with only Afghanistan, Nigeria and Pakistan as the remaining polio endemic countries in 2012.
But both in endemic countries and in countries where polio was thought to have been vanquished, cases persist. According to the Global Polio Eradication Initiative, just this week eleven new wild poliovirus (WPV) cases were reported, including one from Afghanistan, two from Ethiopia, four from Pakistan and four from Somalia. The total number of WPV cases for 2013 is now 296, with 99 from countries that have not yet been able to eradicate the disease and 197 from countries that have seen outbreaks. In Israel, for example, while no cases of paralytic polio have been reported, environmental surveillance suggests that virus transmission (first detected in February 2013) continues in parts of the country’s southern and central regions. A vaccination campaign for children under age ten is ongoing.
On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). Activation of the EOC has provided enhanced capacity for CDC’s polio eradication support program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement and evaluate vaccination campaigns.
Additional EOC activities include:
- Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress.
- Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
- Provision of operational support to Nigeria for the country’s FY 2012 Polio Eradication Emergency Response Plan. The plan focuses on enhancing management and leadership skills to improve program performance.
- The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation and evaluation.
- Review of WHO-proposed outbreak response protocols for all polio-affected countries.
“If we fail to get over the finish line [to fully eradicate polio],” says Frieden, “we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.”