Category Archives: Disease Prevention and Health Promotion
Deaths and injuries from falls in people older than age 65 have doubled in the last decade. Last year, 24,000 older people died after a fall and more than two million sustained severe injuries—which can often lead to permanent disability. To find ways to prevent those falls and the injuries, deaths and costs that come with them, earlier this year the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute (PCORI) joined forces on the Falls Injuries Prevention Partnership, which will fund clinical trials at ten U.S. centers over the next five years.
The trials include some implementation of proven fall prevention strategies at the ten research sites. NIH researchers say a key goal is to help change physician behavior about fall prevention, because recent education efforts through conventional medical education channels and other methods have not been very effective.
“With this trial, we will be able to evaluate interventions on a comprehensive and very large scale,” said Richard J. Hodes, MD, director of the National Institute on Aging, which is a division of NIH. “This study will focus on people at increased risk for injuries from falls, the specific care plans that should be implemented—including interventions tailored to individual patients—and how physicians and others in health care and in the community can be involved.”
Each person in the trial will be assessed for their risk of falling, and receive either the current standard of care—information about preventing falls—or individualized care plans first shared with the trial participant’s primary care physician for review, modification and approval. They will include proven fall risk reduction interventions that can be implemented by the research team, physicians and other health care providers, caregivers and community-based organizations.
The trial directors hope to enroll 6,000 adults age 75 and older who have one or more risk factors for falls. The first year of the study is a pilot phase; if the go-ahead is given by NIH and PCORI to proceed with the study after that, enrollment for the full trial will start in June 2015, with participants followed for up to three years. The main goals of the trial are reductions in serious injuries from falls.
“With active input from patients and other stakeholders from the very beginning of this study, we think we can have a major impact, changing practice to make a real difference in the lives of older people,” says PCORI Executive Director Joe Selby, MD, MPH.
The ten trial sites and regions they serve are:
- Essentia Health, Duluth, Minnesota (Midwest)
- HealthCare Partners, Torrance, California (Southern California)
- Johns Hopkins Medicine, Baltimore (Mid-Atlantic)
- Mount Sinai Health System, New York City (Northeast)
- Partners HealthCare, Waltham, Massachusetts (Northeast)
- Reliant Medical Group, Worcester, Massachusetts (Northeast)
- University of Iowa Health Alliance, Iowa City (Midwest)
- University of Pittsburgh Medical Center (Mid-Atlantic)
- University of Texas Medical Branch, Galveston Health (Southwest)
- University of Michigan, Ann Arbor (Midwest)
Data management and analysis will be coordinated by the Yale School of Public Health.
Flu season in the United States typically runs from November through March, with the peak coming in January and February. But people can catch the flu both earlier than the usual start time and after the usual end of the season. In addition, the severity of the flu season can vary with from 3,000 to 49,000 U.S. deaths in a given year, an average of more than 200,000 hospitalizations and millions of illnesses, according to the U.S. Centers for Disease Control and Prevention (CDC).
Flu shot season has a shorter time table, so many pharmacies and doctors’ office that are well stocked at the moment can run out before Christmas, making it difficult for people who put off their vaccinations to find a vaccine location and protect themselves.
And despite a yearly campaign to get people to roll their arms up, less fewer than half of adults and less than 60 percent of kids received a flu shot last year. NewPublicHealth recently spoke with Carolyn Bridges, MD, the CDC’s associate director for adult immunizations about what keeps people from getting the flu shot and how more people can be encouraged to get the vaccine.
NewPublicHealth: What is it that keeps people from getting the shot?
Carolyn Bridges: I think there are a number of things. Certainly, we have pretty good awareness about the recommendations for the influenza vaccine, although some people may just not realize that they are potentially at risk. The current recommendations call for all persons six months of age and older to get an annual flu vaccine, with rare exceptions. But the vaccine recommendations have changed over time and in the last few years have been broadened to include [just about] everyone. For some people the message hasn’t gotten to them that in fact they are now included in the group recommended for a yearly flu vaccine
NPH: What common misconceptions do people still have about the flu vaccine?
Bridges: In terms of the safety, some people question or are worried about getting the flu from the flu vaccine. That’s still a common comment that we receive. Sometimes people will certainly have body aches or some tenderness in the arm where they get their flu vaccine, but that’s certainly not the same as getting influenza, and those symptoms generally are very self-limited and go away within two to three days. But the flu vaccine cannot cause the flu.
Over the weekend, NewPublicHealth conducted an email interview with Tarik Jasarevic, a spokesperson for the World Health Organization (WHO), on Ebola efforts on the ground in West Africa and the impact on the global effort of the cases recently diagnosed in the United States.
NewPublicHealth: Is there concern among global health leaders that the attention on a handful of cases is taking away attention from the thousands of cases in West Africa?
Tarik Jasarevic: While countries need to be vigilant and prepared for a possible case of Ebola, we need to focus on getting all possible resources—trained health workers, medical facilities with beds and money—to the affected countries in West Africa.
NPH: Several weeks ago global health leaders had a checklist of things, including money and personnel, needed to stem the outbreaks in the various countries. Where do things stand now, and what is still needed?
Jasarevic: We need a lot of resources if we’re going to get the virus under control. WHO and partners constructed 12 Ebola Treatment Centers in Liberia, 15 in Sierra Leone and 3 in Guinea—30 out of the 50 that are needed. These facilities contain more than 1,100 beds for patients, out of the more than 4,000 needed. There are more than 2,500 beds becoming available in the next few weeks, but we still need more. We also need international health workers to come work alongside national health workers to manage and run the health facilities. WHO has set up “training academies” in each of the affected countries to train more local health workers, but more are needed.
NPH: What is the current fatality rate?
Jasarevic: The fatality rate for this particular outbreak has always been approximately 70 percent. We are seeing higher numbers of cases and deaths because of the geographic spread of the disease, from urban city centers to rural, hard to reach villages. There is also significant under reporting of cases in the three countries, especially Liberia.
In light of the ongoing Ebola outbreak, NewPublicHealth recently launched an in-depth look at the current state of several infectious diseases and efforts to stem Ebola and other outbreaks. Tomorrow night the PBS documentary series Frontline will air “The Trouble with Antibiotics” (10 p.m. EST), taking a look at antibiotic use on American farms and the death of a patient being treated at the National Institutes of Health (NIH) three years ago who succumbed to a superbug the NIH was unable to treat.
According to the program’s correspondent, David Hoffman, a former journalist with the Washington Post, 70 percent of U.S. antibiotics are used on farms and are linked to at least some of the two million people who become ill and the more than twenty thousand people who die of antibiotic resistance each year.
NewPublicHealth recently spoke with Hoffman about the project.
NewPublicHealth: What made you interested in the topic of antibiotic resistance?
David Hoffman: In 2012, the Clinical Center at the National Institutes of Health disclosed the details of an outbreak of resistant bacteria in the hospital during 2011. It was a remarkable story in which advanced genomics from an NIH institute were used to unravel the mystery of how the organism had spread, and the hospital took extraordinary measures to combat it. This led to a 2013 Frontline film about the growing problem of resistance in human health, “Hunting the Nightmare Bacteria.” While working on “Hunting.”’ we heard a lot about antibiotics in animal agriculture. But the issues were complex and needed time for serious examination. We decided to devote our next film to answering some of the questions and that process took about a year.
Tomorrow, the U.S. Centers for Disease Control and Infection (CDC) will hold a conference call for medical personnel. The call will review and underline safeguards needed to help protect health workers who will be called on to help with care for U.S. Ebola patients, should more cased be diagnosed.
The first patient diagnosed with Ebola in the United States died in Dallas last week; a second, a nurse who looked after that patient, was confirmed yesterday by the CDC to have the virus. She is in isolation in a Dallas hospital.
CDC director Tom Frieden, MD, MPH, said the infected nurse may have contracted the disease through a “breach in protective gear protocol.” However, Ezekiel Emanuel, MD, a bioethicist and professor at the University of Pennsylvania, said this morning on MSNBC that he thought the problem was not so much a breach as the need for greater implementation. Medical checklist guru Atul Gawande, MD, agrees. In a short piece titled “Ebola is Stoppable” in The New Yorker last week, Gawande wrote “The main challenge is taking off the protective personal equipment—that’s when it is easiest to contaminate yourself.”
Public health experts are assessing what changes to make to reduce the chance of transmission without making suiting up so cumbersome that health workers are tempted to skip steps. At yesterday’s press conference, Frieden said that there have been reports out of West Africa of health workers who contaminated themselves when they pricked themselves with a clean needle that came in contact with contaminated gloves. For now, the procedures laid out in posters from the CDC on how to don and remove protective clothing remain in place.
>>Bonus Link: Over the weekend, an article in the Los Angeles Times questioned a key component of assessing people who may be infected with Ebola—assuming that they are not contagious if they don’t have fever. The study, funded by the World Health Organization and published online last month in the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola, finding that thirteen percent did not have a fever. U.S. public health experts told the Times that they continue to view fever as the key indicator that the virus is transmissible to other people.
Infectious diseases—and the treatment of infectious diseases—has been a common theme in the news recently, with almost 4,000 people now dead from an Ebola outbreak in West Africa. It was only yesterday that Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, died in a Dallas, Texas, hospital.
Earlier this week, some of the leading experts in infectious disease came together in the Google Hangout “TEDMED Great Challenges: Track, Treat, Prevent—A Better Battle Against Communicable Diseases.” They discussed the risk of communication, treatment, drug resistance, disease tracking innovation and related ethical issues. The event was moderated by Helen Branswell of the Canadian Press.
The panelists—across the board—agreed that the recent Ebola resurgence has served to highlight the importance of public health. Not just what it brings to the table during such emergencies, but the need for it to focus even more on prevention efforts and ensuring public health is fully funded and supported.
“Public health funding is one of those things people only really notice when something goes wrong,” said Dara Lieberman, a Senior Government Relations Manager at Trust for America's Health.
Amy L. Fairchild, PhD, MPH, Professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health, believes that “in many ways, we’ve really lost our way in public health.”
“There was a period at the end of the 19th/beginning of the 20th century in which the field made these enormous strides in combatting infectious diseases and combatting communicable disease,” Fairchild said. “And then, with the rise of chronic diseases, we began to forget some of those...lessons learned about the need to focus on broad, sweeping environmental changes.”
In connection with Domestic Violence Awareness Month, held each October, the U.S. Centers for Disease Control and Prevention (CDC) recently issued a stark report which found that sexual violence not only results in high rates of injury and death, but also other long-lasting and even lifetime health impacts. To best share the specifics of the report, the CDC created an infographic with the most striking numbers—including how many men are raped each year and how people under the age of five are sexually abused.
>>View the full infographic.
Perhaps most striking, the CDC found that a substantial proportion of U.S. female and male adults have experienced some form of sexual violence, stalking, or intimate partner violence at least once during their lifetimes.
Among the report’s recommended public health actions:
- Prevention of sexual violence must include the protection of young children.
- Strategies to prevent sexual violence must include strategies that address known risk factors for perpetration and emphasize changing social norms and behaviors by using bystander and other prevention strategies.
- Primary prevention of intimate partner violence should be focused on the promotion of healthy relationship behaviors and other protective factors, with the goal of helping adolescents develop positive behaviors before their first relationships.
>>Bonus Link: CDC’s Center for Injury Prevention and Control offers many resources on sexual violence prevention geared toward people of different ages and communities.
Have a Story about Implementing the National Prevention Strategy? The Office of the Surgeon General Wants to Hear It
The National Prevention Strategy (NPS), a federal-level initiative coordinated by the Office of the Surgeon General (OSG), was launched three years ago with the goal of promoting prevention and improving the nation’s health by engaging all sectors, not just health care.
Communities across the country are hard at work integrating different sectors in the joint purpose. For example, transportation agencies and senior health agencies are working to improve travel logistics for seniors who have different needs and schedules than the average commuter. The benefits for seniors can be many and huge, including engaging in social activities, recreation, timely visits to doctors, access to food shopping and greater independence.
In its 2014 required annual status report to the president and Congress on the progress of implementing the National Prevention Strategy, the OSG shared for the first time stories—called Partner Implementation Models (PIMs)—about communities and organizations implementing the strategies. One PIM showcased the work of the Robert Wood Johnson Foundation (RWJF), including:
- In 2013, RWJF re-convened the Commission to Build a Healthier America—an interdisciplinary group of leaders in the public, nonprofit and private sectors originally brought together in 2008—to develop recommendations to reduce health disparities. The Commission’s January 2014 report references the National Prevention Strategy.
- RWJF’s County Health Rankings & Roadmaps show how health is influenced by where people live, learn, work and play. Counties are ranked using data on health behaviors; clinical care; the physical environment; and social and economic factors such as family and social support. In 2014, new measures related to housing, transit, access to mental health providers, injury-related deaths, food environment and exercise opportunities were added to the Rankings. All of these measures directly reinforce the priorities outlined in the National Prevention Strategy.
Another PIM was shared by the Henry Ford Health System (HFHS) in Detroit, Mich., the fifth-largest employer in the city, which launched Henry Ford LiveWell (HF LiveWell) to improve the health of HFHS employees, patients, and surrounding communities.
As the number of cases and deaths soar, the Ebola outbreak in West Africa is rightfully front and center in the news, both in terms of the disease’s progress and of the need for funds and manpower. However, infectious disease specialists are urging public health leaders to also stay vigilant in preventing and handling outbreaks of many other infectious diseases. Earlier this month, the White House issued the first ever executive order on antibiotic resistance to help prevent the 20,000 U.S. deaths that occur each year because of infections are resistant to available antibiotics.
Writer David Olsen reported last week in GlobalHealthHub that, based on figures from the World Health Organization (WHO) and UNAIDS, at least three disease in West Africa are currently claiming more lives than Ebola: Malaria, tuberculosis and AIDS. No one is suggesting a slow down in the Ebola efforts—in fact public health experts are urging ever greater ramping up—but as Olsen points out, “another of [Ebola’s] terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people worldwide.”
Over the next few weeks NewPublicHealth will be doing a series of research and outbreak updates on several infectious diseases and their impact in both the United States and globally, starting today with HIV/AIDS.
This Saturday was HIV/AIDS awareness day for U.S. gay and bisexual men. According to the U.S. Centers for Disease Control and Prevention (CDC), one in five gay men in 20 major cities is estimated to be HIV positive, with about one third not knowing they are positive. The Kaiser Family Foundation (KFF) estimates that, based on CDC data, 12-13 percent of gay men are HIV positive and that there is evidence that the situation is worsening. Between 2008 and 2010, the CDC reported new infections rose 12 percent overall among gay men, and 22 percent among younger gay men, with the highest increases among men of color.
A new survey released late last week by KFF found that at a time when infections among gay and bisexual men are on the rise, more than half of gay and bisexual men say they are not personally concerned about becoming infected; only three in ten say they were tested for HIV within the last year, despite CDC recommendations for at least annual testing, with even more frequent testing recommended by many health departments.
U.S. public health officials have continually said that it is highly unlikely that the Ebola virus will spread in the United States, even if infected travelers land here. Officials at the U.S. Centers for Disease Control and Prevention (CDC) say that the disease is most contagious when people come into contact with the bodily fluids of someone who is ill—and someone that ill would be very likely be identified by border and airline personnel quickly. If hospital admission became necessary, U.S. infection control procedures could stem an outbreak, according to Tom Frieden, MD, the CDC’s director and the point person for the U.S. government on the current Ebola outbreak. Frieden has discussed the issue repeatedly during several news conferences in the last few weeks.
Of course, that changes if the virus becomes transmissible through the air, rather than just via bodily fluids, as Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, suggested in the New York Times last week. While Osterholm often addresses the direst potential outcomes of infectious disease outbreaks, it’s prudent to at least know what to do, which is why agencies such as the CDC and the Network for Public Health Law say what’s needed is information and procedures...but not panic.
Last month, the Network held an online webinar on preparedness measures and Ebola which was watched by more than 1,200 public health officials. Following the webinar, Network experts posted answers to follow-up questions, including one about the right of public health or hospital workers to refuse to care for/help with someone suspected of having Ebola.
The Network also recently created an online primer on preparedness and legal issues surrounding the Ebola outbreak, both for public health officials engaged in the response overseas and for those with current or future responsibility for handling Ebola-related issues in the United States.
>>Bonus Link: Richard Besser, MD, now the chief health editor for ABC News, was formerly the CDC’s head of disaster response and led the early response to the H1N1 outbreak in the United States several years ago. In a recent opinion piece for the Washington Post, Besser laid out what’s being accomplished and what still needs to be done to stem the Ebola outbreak in West Africa.