Archive

Archive for the ‘public health’ Category

Hierarchical Genetic Analysis of German Cockroach (Blattella germanica) Populations from within Buildings to across Continents

July 27, 2014 Comments off

Hierarchical Genetic Analysis of German Cockroach (Blattella germanica) Populations from within Buildings to across Continents</strong>
Soure: PLoS ONE

Understanding the population structure of species that disperse primarily by human transport is essential to predicting and controlling human-mediated spread of invasive species. The German cockroach (Blattella germanica) is a widespread urban invader that can actively disperse within buildings but is spread solely by human-mediated dispersal over longer distances; however, its population structure is poorly understood. Using microsatellite markers we investigated population structure at several spatial scales, from populations within single apartment buildings to populations from several cities across the U.S. and Eurasia. Both traditional measures of genetic differentiation and Bayesian clustering methods revealed increasing levels of genetic differentiation at greater geographic scales. Our results are consistent with active dispersal of cockroaches largely limited to movement within a building. Their low levels of genetic differentiation, yet limited active spread between buildings, suggests a greater likelihood of human-mediated dispersal at more local scales (within a city) than at larger spatial scales (within and between continents). About half the populations from across the U.S. clustered together with other U.S. populations, and isolation by distance was evident across the U.S. Levels of genetic differentiation among Eurasian cities were greater than those in the U.S. and greater than those between the U.S. and Eurasia, but no clear pattern of structure at the continent level was detected. MtDNA sequence variation was low and failed to reveal any geographical structure. The weak genetic structure detected here is likely due to a combination of historical admixture among populations and periodic population bottlenecks and founder events, but more extensive studies are needed to determine whether signatures of global movement may be present in this species.

See: Your Building’s Roach Problem Is a Family Affair (Atlantic CityLab)

About these ads

Differences in Time Use and Activity Patterns When Adding a Second Job: Implications for Health and Safety in the United States

July 24, 2014 Comments off

Differences in Time Use and Activity Patterns When Adding a Second Job: Implications for Health and Safety in the United States
Source: American Journal of Public Health

Objectives.
We compared work and lifestyle activities for workers who work in 1 job with those who work in multiple jobs during a 1-week period.

Methods.
We used information from the 2003–2011 American Time Use Survey to classify workers into 6 work groups based on whether they were a single (SJH) or multiple (MJH) job holder and whether they worked their primary, other, multiple, or no job on the diary day.

Results.
The MJHs often worked 2 part-time jobs (20%), long weekly hours (27% worked 60+ hours), and on weekends. The MJHs working multiple jobs on the diary day averaged more than 2 additional work hours (2.25 weekday, 2.75 weekend day; P < .05), odd hours (more often between 5 pm and 7 am), with more work travel time (10 minutes weekday, 9 minutes weekend day; P < .05) and less sleep (–45 minutes weekday, −62 minutes weekend day; P < .05) and time for other household (P < .05) and leisure (P < .05) activities than SJHs.

Conclusions.
Because of long work hours, long daily commutes, multiple shifts, and less sleep and leisure time, MJHs may be at heightened risk of fatigue and injury.

Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012

July 21, 2014 Comments off

Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012
Source: Preventing Chronic Disease (CDC)

Introduction
In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children’s meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children’s menus), and the energy and nutrient content of all orders and children’s-meal–only orders purchased for children aged 0 through 12 years.

Methods
Restaurant responses were examined from January 2010 through March 2012. Parent–caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.

Results
Both restaurant chains responded to the ordinance by selling toys separately from children’s meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children’s meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children’s side dishes and beverages at Chain A.

Conclusion
Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.

New From the GAO

July 16, 2014 Comments off

New GAO Reports and Testimonies
Source: Government Accountability Office

Reports

1. Medicaid: Assessment of Variation among States in Per-Enrollee Spending. GAO-14-456, June 16.
http://www.gao.gov/products/GAO-14-456
Highlights - http://www.gao.gov/assets/670/664114.pdf

2. Special Education: Additional Federal Actions Could Help Address Unique Challenges of Educating Children in Nursing Homes. GAO-14-585, July 16.
http://www.gao.gov/products/GAO-14-585
Highlights - http://www.gao.gov/assets/670/664821.pdf

3. Coastal Zone Management: Opportunities Exist for NOAA to Enhance Its Use of Performance Information. GAO-14-592, July 16.
http://www.gao.gov/products/GAO-14-592
Highlights - http://www.gao.gov/assets/670/664805.pdf

4. Supplemental Security Income: Wages Reported for Recipients Show Indications of Possible SSN Misuse. GAO-14-597, July 16.
http://www.gao.gov/products/GAO-14-597
Highlights - http://www.gao.gov/assets/670/664795.pdf

Testimonies

1. U.S. Launch Enterprise: Acquisition Best Practices Can Benefit Future Efforts, by Cristina Chaplain, director, acquisition and sourcing management, before the Senate Committee on Commerce, Science, and Transportation and the Subcommittee on Strategic Forces, Senate Committee on Armed Services. GAO-14-776T, July 16.
http://www.gao.gov/products/GAO-14-776T

2. High-Containment Laboratories: Recent Incidents of Biosafety Lapses, by Nancy Kingsbury, Ph.D., managing director, applied research and methods, before the Subcommittee on Oversight and Investigations, House Committee on Energy and Commerce. GAO-14-785T, July 16.
http://www.gao.gov/products/GAO-14-785T
Highlights - http://www.gao.gov/assets/670/664800.pdf

Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: a systematic literature review and meta-analyses

July 16, 2014 Comments off

Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: a systematic literature review and meta-analyses (PDF)
Source: British Journal of Nutrition

Demand for organic foods is partially driven by consumers’ perceptions that they are more nutritious. However, scientific opinion is divided on whether there are significant nutritional differences between organic and non-organic foods, and two recent reviews have concluded that there are no differences. In the present study, we carried out meta-analyses based on 343 peer-reviewed publications that indicate statistically significant and meaningful differences in composition between organic and non-organic crops/crop-based foods. Most importantly, the concentrations of a range of antioxidants such as polyphenolics were found to be substantially higher in organic crops/ crop-based foods, with those of phenolic acids, flavanones, stilbenes, flavones, flavonols and anthocyanins being an estimated 19 (95% CI 5, 33) %, 69 (95% CI 13, 125) %, 28 (95% CI 12, 44) %, 26 (95% CI 3, 48) %, 50 (95% CI 28, 72)% and 51 (95% CI 17, 86)% higher, respectively. Many of these compounds have previously been linked to a reduced risk of chronic diseases, including CVD and neurodegenerative diseases and certain cancers, in dietary intervention and epidemiological studies. Additionally, the frequency of occurrence of pesticide residues was found to be four times higher in conventional crops, which also contained significantly higher concentrations of the toxic metal Cd. Significant differences were also detected for some other (e.g. minerals and vitamins) compounds. There is evidence that higher antioxidant concentrations and lower Cd concentrations are linked to specific agronomic practices (e.g. non-use of mineral Nand P fertilisers, respectively) prescribed in organic farming systems. In conclusion, organic crops, on average, have higher concentrations of antioxidants, lower concentrations of Cd and a lower incidence of pesticide residues than the non-organic comparators across regions and production seasons.

The Societal Costs and Benefits of Commuter Bicycling: Simulating the Effects of Specific Policies Using System Dynamics Modeling

July 14, 2014 Comments off

The Societal Costs and Benefits of Commuter Bicycling: Simulating the Effects of Specific Policies Using System Dynamics Modeling
Source: Environmental Health Perspectives

Background:
Shifting to active modes of transport in the trip to work can achieve substantial co-benefits for health, social equity, and climate change mitigation. Previous integrated modeling of transport scenarios has assumed active transport mode share and has been unable to incorporate acknowledged system feedbacks.

Objectives:
We compared the effects of policies to increase bicycle commuting in a car-dominated city and explored the role of participatory modeling to support transport planning in the face of complexity.

Methods:
We used system dynamics modeling (SDM) to compare realistic policies, incorporating feedback effects, nonlinear relationships, and time delays between variables. We developed a system dynamics model of commuter bicycling through interviews and workshops with policy, community, and academic stakeholders. We incorporated best available evidence to simulate five policy scenarios over the next 40 years in Auckland, New Zealand. Injury, physical activity, fuel costs, air pollution, and carbon emissions outcomes were simulated.

Results:
Using the simulation model, we demonstrated the kinds of policies that would likely be needed to change a historical pattern of decline in cycling into a pattern of growth that would meet policy goals. Our model projections suggest that transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10–25 times greater than costs.

Conclusions:
To our knowledge, this is the first integrated simulation model of future specific bicycling policies. Our projections provide practical evidence that may be used by health and transport policy makers to optimize the benefits of transport bicycling while minimizing negative consequences in a cost-effective manner. The modeling process enhanced understanding by a range of stakeholders of cycling as a complex system. Participatory SDM can be a helpful method for integrating health and environmental outcomes in transport and urban planning.

Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample

July 10, 2014 Comments off

Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample
Source: Environmental Health Perspectives

Background:
Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits.

Objective:
To describe acute heat illness visits to US EDs from 2006-2010 and identify factors associated with hospital admission or death-in-the-ED.

Methods:
We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006-10, defining cases as ED visits from May-September with any heat illness diagnosis (ICD-9-CM 992.0-992.9). We correlated visit rates and temperature anomalies analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR).

Results:
There were 326,497 (95% CI: 308,372-344,658) cases, with 287,875 (88.2%) treated-and-released, 38,392 (11.8%) admitted, and 230 (0.07%) died-in-the-ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (correlation coefficient 0.90, p=0.037). Treat-and-release rates were highest for younger adults (26.2/100,000/year), while hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (78.7-120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death-in-the-ED were higher among elders, males, urban and low income residents, and those with chronic conditions.

Conclusions:
Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death-in-the-ED. Chronic disease burden exponentially increased this risk.

EWG’s 2014 Shopper’s Guide to Pesticides in Produce

July 10, 2014 Comments off

EWG’s 2014 Shopper’s Guide to Pesticides in Produce
Source: Environmental Working Group

Two-thirds of produce samples in recent government tests had pesticide residues. Don’t want to eat bug- and weed-killers? EWG’s Shopper’s Guide to Pesticides in Produce helps you shop smart. We highlight the cleanest and dirtiest conventionally-raised fruits and vegetables. If a conventionally grown food you want tests high for pesticides, go for the organic version instead. And remember – the health benefits of a diet rich in fruits and vegetables outweigh risks of pesticide exposure. Dirty Dozen™ Plus highlights hot peppers and leafy greens – kale and collard greens – often tainted with unusually hazardous pesticides.

Dating Violence Among Male and Female Youth Seeking Emergency Department Care

July 3, 2014 Comments off

Dating Violence Among Male and Female Youth Seeking Emergency Department Care
Source: Annals of Emergency Medicine

Study objective
We determine prevalence and correlates of dating violence, dating victimization, and dating aggression among male and female patients aged 14 to 20 years seeking emergency department (ED) care.

Methods
This was a systematic sampling of subjects aged 14 to 20 years seeking care at a single large academic ED between September 2010 and March 2013. Participants completed a computerized, self-administered, cross-sectional survey of demographics, dating violence from physical abuse measures of the Conflict in Adolescent Dating Relationships Inventory, associated behaviors, and ED health service use. Separate analyses were conducted for male and female patients.

Results
Four thousand three hundred eighty-nine youths (86.1% participation rate) were screened, and 4,089 (mean age 17.5 years; 58% female patients) were eligible for analysis. Almost 1 in 5 female patients (n=215; 18.4%) and 1 in 8 male patients (n=212; 12.5%) reported past-year dating violence. Of female patients, 10.6% reported dating victimization and 14.6% dating aggression, whereas of male patients, 11.7% reported dating victimization and 4.9% reported dating aggression. Multivariate analyses showed that variables associated with any male dating violence were black race (adjusted odds ratio [AOR] 2.26; 95% CI 1.54 to 3.32), alcohol misuse (AOR 1.03; 95% CI 1.00 to 1.06), illicit drug use (AOR 2.38; 95% CI 1.68 to 3.38), and depression (AOR 2.13; 95% CI 1.46 to 3.10); any female dating violence was associated with black race (AOR 1.68; 95% CI 1.25 to 2.25), public assistance (AOR 1.64; 95% CI 1.28 to 2.09), grades D and below (AOR 1.62; 95% CI 1.07 to 2.43), alcohol misuse (AOR 1.04; 95% CI 1.02 to 1.07), illicit drug use (AOR 2.85; 95% CI 2.22 to 3.66), depression (AOR 1.86; 95% CI 1.42 to 2.44), and any past year ED visit for intentional injury (AOR 2.64; 95% CI 1.30 to 5.40).

Conclusion
Nearly 1 of 6 male and female patients aged 14 to 20 years and seeking ED care report recent dating violence, and health disparities remain among this population. Dating violence was strongly associated with alcohol, illicit drug use, and depression and correlated with previous ED service use among female youths. ED interventions should consider addressing these associated health conditions, as well as improving screening protocols to address dating violence among male and female youths.

Drug Safety in the Digital Age

July 2, 2014 Comments off

Drug Safety in the Digital Age
Source: New England Journal of Medicine

In this digital age, engaging with new media offers an unparalleled opportunity for medical and public health professionals to find information they need and to interactively reach out to patients and their support networks. One domain where these capabilities may have far-reaching effects that are currently undefined is drug safety. As the volume of health-related information on the Internet has grown, important questions have emerged. How are messages from regulators — for example, warnings against using a drug in a specific patient population — diffused digitally? And are the messages still accurate when they reach the general population?

Despite debates over its credibility, Wikipedia is reportedly the most frequently consulted online health care resource globally: Wikipedia pages typically appear among the top few Google search results and are among the references most likely to be checked by Internet users. We therefore evaluated Google searches and Wikipedia page views for each drug in our sample. We also examined the content of Wikipedia pages, looking specifically for references to safety warnings. To control for secular trends, we examined results from a 120-day window around the date of the announcement (from 60 days before the announcement to 60 days after it) and constructed a baseline period for comparison that ran from 60 days to 10 days before the period of interest began.

We identified safety warnings for 22 prescription drugs that are indicated for a range of clinical conditions, including primary hypertension, chronic myelogenous leukemia, and hepatitis C. Collectively, these drugs triggered 13 million searches on Google and 5 million Wikipedia page views annually during the study period. FDA safety warnings were associated with an 82% increase, on average, in Google searches for the drugs during the week after the announcement and a 175% increase in views of Wikipedia pages for the drugs on the day of the announcement, as compared with baseline trends.

Did users find accurate information on the drugs’ safety? We found that 41% of Wikipedia pages pertaining to the drugs with new safety warnings were updated within 2 weeks after the warning was issued with information provided in the FDA announcements. The Wikipedia pages for drugs that were intended for treatment of highly prevalent diseases (affecting more than 1 million people in the United States) were more likely to be updated quickly (58% were updated within 2 weeks) than were those for drugs designed to treat less-prevalent conditions (20% were updated within 2 weeks, P=0.03; see Fig. S2 in the Supplementary Appendix).

Overall, 23% of Wikipedia pages were updated more than 2 weeks after the FDA warning was issued (average, 42 days), and 36% of pages remained unchanged more than 1 year later (as of January 2014). For example, the FDA issued a safety communication on January 13, 2012, that brentuximab vedotin (Adcetris), used to treat Hodgkin’s lymphoma and systemic anaplastic large-cell lymphoma, had been linked to two cases of progressive multifocal leukoencephalopathy. As a result, the FDA placed a new black-box warning about this risk on the drug label, a move that was followed by a 50% increase in Google searches for the drug during the ensuing week and a 141% increase in views of the drug’s Wikipedia page. However, there was still no mention of the new black-box warning on Wikipedia 2 years later, a discrepancy that substantiates concerns raised by previous studies over the reliability of online drug information.

FDA outlines expectations for human drug compounders, including registered outsourcing facilities

July 2, 2014 Comments off

FDA outlines expectations for human drug compounders, including registered outsourcing facilities
Source: U.S. Food and Drug Administration

Today, the U.S. Food and Drug Administration issued several policy documents regarding compounded drug products for human use, as part of the agency’s continuing effort to implement the compounding provisions of the Drug Quality and Security Act (DQSA), enacted in November 2013. The policy documents consist of a draft interim guidance, a proposed rule, a final guidance, and two revised requests for nominations for the bulk drug substances lists.

“Providing clarity to the compounding industry on the agency’s expectations for these unapproved drug products is a priority for the agency,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “These actions are essential next steps in providing the compounding industry with the appropriate tools to comply with the law and advancing the FDA’s efforts to continue protecting patients.”

Take Care in the Kitchen: Avoiding Cooking-Related Pollutants

June 25, 2014 Comments off

Take Care in the Kitchen: Avoiding Cooking-Related Pollutants
Source: Environmental Health Perspectives

Carbon monoxide (CO), nitrogen dioxide (NO2), and particulate matter (PM) are harmful air pollutants that pose significant short- and long-term health risks. Emitted from coal-fired power plants, vehicle exhaust pipes, and other combustion sources, they’re among six primary pollutants monitored by the U.S. Environmental Protection Agency (EPA) through the Clean Air Act. These same pollutants are also some of the most common contributors to unhealthy air inside U.S. homes, due in part to a ubiquitous and possibly surprising activity: cooking.

Researchers now understand that the process of cooking food and even simply operating stoves—particularly gas appliances—can emit a cocktail of potentially hazardous chemicals and compounds. Within our homes, these pollutants are less diluted than they are outdoors, and in the absence of proper ventilation, they often are trapped inside. The World Health Organization has established general guidelines for indoor air quality and is currently developing specific limits related to burning solid fuels for cooking and heating. However, indoor air in nonindustrial buildings is not regulated by the EPA or any other U.S. agency.

Canada — Increasing opportunities for children living with intellectual disabilities to participate in physical activity

June 25, 2014 Comments off

Increasing opportunities for children living with intellectual disabilities to participate in physical activity
Source: Public Health Agency of Canada

The Public Health Agency of Canada has partnered with Special Olympics Canada, the RBC Foundation and the Samuel Family Foundation to increase opportunities for children living with intellectual disabilities to participate in physical activity.

Special Olympics Canada currently runs two initiatives, called “Active Start” and “FUNdamentals,” that provide children with an intellectual disability the opportunity to improve physical, social and cognitive abilities, thereby establishing a foundation for being physically active and healthy. With funding from the Government of Canada, the RBC Foundation and the Samuel Family Foundation, these programs will be expanded, reaching more children across Canada.

The goal of this partnership is to promote healthy living and healthy weights among children living with intellectual disability.

FDA issues guidance to support the responsible development of nanotechnology products

June 24, 2014 Comments off

FDA issues guidance to support the responsible development of nanotechnology products
Source: U.S. Food and Drug Administration

Today, three final guidances and one draft guidance were issued by the U.S. Food and Drug Administration providing greater regulatory clarity for industry on the use of nanotechnology in FDA-regulated products.

One final guidance addresses the agency’s overall approach for all products that it regulates, while the two additional final guidances and the new draft guidance provide specific guidance for the areas of foods, cosmetics and food for animals, respectively.

Nanotechnology is an emerging technology that allows scientists to create, explore and manipulate materials on a scale measured in nanometers—particles so small that they cannot be seen with a regular microscope. The technology has a broad range of potential applications, such as improving the packaging of food and altering the look and feel of cosmetics.

The three final guidance documents reflect the FDA’s current thinking on these issues after taking into account public comment received on the corresponding draft guidance documents previously issued (draft agency guidance in 2011; and draft cosmetics and foods guidances in 2012).

The FDA does not make a categorical judgment that nanotechnology is inherently safe or harmful, and will continue to consider the specific characteristics of individual products. All four guidance documents encourage manufacturers to consult with the agency before taking their products to market. Consultations with the FDA early in the product development process help to facilitate a mutual understanding about specific scientific and regulatory issues relevant to the nanotechnology product, and help address questions related to safety, effectiveness, public health impact and/or regulatory status of the product.

Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study

June 24, 2014 Comments off

Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study
Source: Environmental Health Perspectives

Background:
Gestational exposure to several common agricultural pesticides can induce developmental neurotoxicity in humans, and has been associated with developmental delay and autism.

Objectives:
To evaluate whether residential proximity to agricultural pesticides during pregnancy is associated with autism spectrum disorders (ASD) or developmental delay (DD) in the Childhood Autism Risks from Genetics and Environment (CHARGE) Study.

Methods:
The CHARGE study is a population-based case-control study of ASD, developmental delay (DD), and typical development. For 970 participants, commercial pesticide application data from the California Pesticide Use Report (1997-2008) were linked to the addresses during pregnancy. Pounds of active ingredient applied for organophophates, organochlorines, pyrethroids, and carbamates were aggregated within 1.25km, 1.5km, and 1.75km buffer distances from the home. Multinomial logistic regression was used to estimate the odds ratio (OR) of exposure comparing confirmed cases of ASD (n = 486) or DD (n = 168) with typically developing referents (n = 316).

Results:
Approximately one-third of CHARGE Study mothers lived, during pregnancy, within 1.5 km (just under one mile) of an agricultural pesticide application. Proximity to organophosphates at some point during gestation was associated with a 60% increased risk for ASD, higher for 3rd trimester exposures [OR = 2.0, 95% confidence interval (CI) = (1.1, 3.6)], and 2nd trimester chlorpyrifos applications: OR = 3.3 [95% CI = (1.5, 7.4)]. Children of mothers residing near pyrethroid insecticide applications just prior to conception or during 3rd trimester were at greater risk for both ASD and DD, with OR’s ranging from 1.7 to 2.3. Risk for DD was increased in those near carbamate applications, but no specific vulnerable period was identified.

Conclusions:
This study of ASD strengthens the evidence linking neurodevelopmental disorders with gestational pesticide exposures, and particularly, organophosphates and provides novel results of ASD and DD associations with, respectively, pyrethroids and carbamates.

Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2009

June 21, 2014 Comments off

Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2009
Source: Morbidity and Mortality Weekly Report (CDC)

Problem:
As of December 31, 2009, an estimated 864,748 persons were living with human immunodeficiency virus (HIV) infection in the 50 U.S. states, the District of Columbia, and six U.S.-dependent areas. Whereas HIV surveillance programs in the United States collect information about persons with a diagnosis of HIV infection, supplemental surveillance systems collect in-depth information about the behavioral and clinical characteristics of persons receiving outpatient medical care for HIV infection. These data are needed to reduce HIV-related morbidity and mortality and HIV transmission.

Reporting Period Covered:
Data were collected during June 2009–May 2010 for patients receiving medical care at least once during January–April 2009.

Description of the System:
The Medical Monitoring Project (MMP) is an ongoing surveillance system that assesses behaviors and clinical characteristics of HIV-infected persons who have received outpatient medical care. For the 2009 data collection cycle, participants must have been aged ≥18 years and have received medical care during January–April 2009 at sampled facilities that provide HIV medical care within participating MMP project areas. Behavioral and selected clinical data were collected using an in-person interview, and most clinical data were collected using medical record abstraction. A total of 23 project areas in 16 states and Puerto Rico were funded to collect data during the 2009 data collection cycle. The data were weighted for probability of selection and nonresponse to be representative of adults receiving outpatient medical care for HIV infection in the United States and Puerto Rico. Prevalence estimates are presented as weighted percentages. The period of reference is the 12 months before the patient interview unless otherwise noted.

Results:
The patients in MMP represent 421,186 adults who received outpatient medical care for HIV infection in the United States and Puerto Rico during January–April 2009. Of adults who received medical care for HIV infection, an estimated 71.2% were male, 27.2% were female, and 1.6% were transgender. An estimated 41.4% were black or African American, 34.6% were white, and 19.1% were Hispanic or Latino. The largest proportion (23.1%) were aged 45–49 years. Most patients (81.1%) had medical coverage; 40.3% had Medicaid, 30.6% had private health insurance, and 25.7% had Medicare.

An estimated 69.6% of patients had three or more documented CD4+ T-lymphocyte cell (CD4+) or HIV viral load tests. Most patients (88.7%) were prescribed antiretroviral therapy (ART), and 71.6% had a documented viral load that was undetectable or ≤200 copies/mL at their most recent test. Among sexually active patients, 55.0% had documentation in the medical record of being tested for syphilis, 23.2% for gonorrhea, and 23.9% for chlamydia.

Noninjection drugs were used for nonmedical purposes by an estimated 27.1% of patients, whereas injection drugs were used for nonmedical purposes by 2.1% of patients. Overall, 12.9% of patients engaged in unprotected sex with a partner of negative or unknown HIV status.

Unmet supportive service needs were prevalent, with an estimated 22.8% in need of dental care and 12.0% in need of public benefits, including Social Security Income or Social Security Disability Insurance. Fewer than half of patients (44.8%) reported receiving HIV and sexually transmitted disease prevention counseling from a health-care provider.

Interpretation:
The findings in this report indicate that most adults living with HIV who received medical care in 2009 were taking ART, had CD4+ and HIV viral load testing at regular intervals, and had health insurance or other coverage. However, some patients did not receive clinical services and treatment in accordance with guidelines. Some patients engaged in behaviors, such as unprotected sex, that increase the risk for transmitting HIV to sex partners, and some used noninjection or injection drugs or both.

Public Health Actions:
Local and state health departments and federal agencies can use MMP data for program planning to determine allocation of services and resources, guide prevention planning, assess unmet medical and supportive service needs, inform health-care providers, and help focus intervention programs and health policies at the local, state, and national levels.

Promoting Health Equity Through Education Programs and Policies: Full-Day Kindergarten Programs

June 20, 2014 Comments off

Promoting Health Equity Through Education Programs and Policies: Full-Day Kindergarten Programs
Source: Community Preventive Services Task Force

The Community Preventive Services Task Force recommends full-day kindergarten programs to improve the health prospects of low-income and racial and ethnic minority children, based on strong evidence that full-day programs substantially improve reading and mathematics achievement–determinants of long-term academic and health-related outcomes (e.g., reduced teen pregnancy and risk behaviors)–when compared with half-day kindergarten or full-day kindergarten on alternating days.

The achievement gains apparent at the beginning of first grade do not, themselves, guarantee academic achievement in later years. Ongoing school environments that support learning and development are essential.

Because academic achievement is linked with long-term health, and because full-day kindergarten programs are commonly implemented in racial and ethnic minority or low-income communities, these programs are likely to improve health equity. Equity in health is the widespread, achievable, equality in health and in the major social determinants of health in all the principal social divisions of a population.

New From the GAO

June 20, 2014 Comments off

New GAO Report and Testimony
Source: Government Accountability Office

Report

1. Tobacco Product Regulation: Most FDA Spending Funded Public Education, Regulatory Science, and Compliance and Enforcement Activities. GAO-14-561, June 20.
http://www.gao.gov/products/GAO-14-561
Highlights – http://www.gao.gov/assets/670/664278.pdf

Testimony

1. Export Controls: NASA Management Action and Improved Oversight Needed to Reduce the Risk of Unauthorized Access to Its Technologies, by Belva Martin, director, acquisition and sourcing management, before the Subcommittees on
Space and Oversight, House Committee on Science, Space, and Technology. GAO-14-690T, June 20.
http://www.gao.gov/products/GAO-14-690T
Highlights – http://www.gao.gov/assets/670/664274.pdf

Smokeless Tobacco Use Among Working Adults — United States, 2005 and 2010

June 16, 2014 Comments off

Smokeless Tobacco Use Among Working Adults — United States, 2005 and 2010
Source: Morbidity and Mortality Weekly Report (CDC)

Smokeless tobacco causes cancers of the oral cavity, esophagus, and pancreas (1). CDC analyzed National Health Interview Survey (NHIS) data to estimate the proportion of U.S. working adults who used smokeless tobacco in 2005 and 2010, by industry and occupation. This report describes the results of that analysis, which showed no statistically significant change in the prevalence of smokeless tobacco use among workers from 2005 (2.7%) to 2010 (3.0%). In 2010, smokeless tobacco use was highest among adults aged 25–44 years (3.9%), males (5.6%), non-Hispanic whites (4.0%), those with no more than a high school education (3.9%), and those living in the South (3.9%). By industry, the prevalence of smokeless tobacco use ranged from 1.5% in education services to 18.8% in mining industries, and by occupation from 1.3% in office and administrative support to 10.8% in construction and extraction. These findings highlight opportunities for reducing the health and economic burdens of tobacco use among U.S. workers, especially those in certain industries (e.g., mining) and occupations (e.g., construction and extraction) where use of smokeless tobacco is especially common. CDC recommends best practices for comprehensive tobacco control programs, including effective employer interventions, such as providing employee health insurance coverage for proven cessation treatments, offering easily accessible help for those who want to quit, and establishing and enforcing tobacco-free workplace policies.

Youth Risk Behavior Surveillance—United States, 2013

June 13, 2014 Comments off

Youth Risk Behavior Surveillance—United States, 2013 (PDF)
Source: Morbidity and Mortality Weekly Report (CDC)
From press release:

Cigarette smoking rates among high school students have dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, according to the 2013 results released today by the Centers for Disease Control and Prevention.

By achieving a teen smoking rate of 15.7 percent, the United States has met its national Healthy People 2020External Web Site Icon objective of reducing adolescent cigarette use to 16 percent or less.

Despite this progress, reducing overall tobacco use remains a significant challenge. For example, other national surveys show increases in hookah and e-cigarette use. In the YRBS, no change in smokeless tobacco use was observed among adolescents since 1999, and the decline in cigar use has slowed in recent years, with cigar use now at 23 percent among male high school seniors.

Follow

Get every new post delivered to your Inbox.

Join 857 other followers