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New Home Birth Data: Numbers Rise A Bit, Controversy Remains Unchanged

A new CDC analysis of trends in out-of-hospital births from 1990-2012 found that home births are on the rise — but only a tiny bit.

The federal agency reports that 1.36 percent of U.S. births occurred outside a hospital in 2012, up
from 1.26 percent in 2011. Those new numbers mark the highest level of non-hospital births since 1975, according to the CDC.

In terms of actual births, that means 53,635 births in the U.S. took place out of a hospital in 2012, including 35,184 home births and 15,577 birthing center births, the CDC says.

(Source: CDC)

(Source: CDC)

Here are some more findings from the CDC news release:

• In 2012, 1 in 49 births to non-Hispanic white women were out-of-hospital births;

•The percentage of out-of-hospital births was generally higher in the northwestern United States and lower in the southeastern United States;

•Out-of-hospital births generally had a lower risk profile than hospital births.

Continue reading

The Good News, Bad News Story On Measles

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

By Alexandra Morris
CommonHealth Intern

Lately, when you hear about measles in the news, the reports tend to be grim: outbreaks in 2011 and 2013 in the U.S., parents who are choosing not to vaccinate their children for religious or philosophical reasons. But a new report from the CDC this week paints a bigger – and far more heartening – picture: from 2000 to 2012, 13.8 million deaths were prevented through measles immunizations globally. In other words, a population roughly the size of New England is still alive thanks to the measles vaccine.

Deaths from measles have dropped 78% since 2000. “These figures represent historic lows for estimated measles deaths globally,” said James Goodson, a co-author of the CDC report published in this week’s Morbidity and Mortality Weekly Report.

Since 2000, the Measles and Rubella Initiative – a partnership between various agencies including the CDC and the World Health Organization – has provided over a billion doses of measles vaccinations worldwide.

Measles was eliminated in the U.S. in 2000, but there have been a couple of recent spikes in cases. Just last year, there were three times as many measles infections in the U.S. than in previous years. In raw numbers, that translates to 189 cases, according to the CDC. While that doesn’t seem like a lot, such a highly contagious disease can spread rapidly, especially among people who haven’t been vaccinated.

Countries around the world are also aiming to eliminate measles by 2020 or earlier. Europe, for example, set a goal of measles elimination by 2015. But it doesn’t look like they’re on track to meet that goal, said Goodson. That may be due in part to parents’ fears about the possibility of vaccine side effects.

In 1998, a British medical journal issued a report suggesting the measles vaccine was linked to autism cases, which led to a sharp decline in vaccinations. Although the report was discredited, and later retracted by the journal, parent and anti-vaccine groups continue to fight against routine immunizations.

Misinformation is a major threat to vaccine efforts, say public health officials. Continue reading

Want Better, Cheaper, More Seamless Health Care? Ask Me How

Dr. Myechia Jordan (Courtesy)

Dr. Myechia Minter-Jordan (Courtesy)

By Dr. Myechia Minter-Jordan
Guest contributor

Dr Myechia Minter-Jordan is president and CEO of the Dimock Center, a nationally recognized community health center in Roxbury.

Growing up, I always knew I wanted to be a doctor. I remember being fascinated by all the cool gadgets in the doctor’s office, from the cold feeling of the stethoscope on my skin as the doctor listened to my breathing, to the funny feeling as my doctor tapped my knee with the small hammer to test my reflexes. It always felt exciting to me, even when we had to make two or three visits to separate clinics for doctor’s appointments and medical care. As a young child, it seemed like an adventure.

What I didn’t realize was that it was not an adventure for my parents. They often had to take multiple days off of work to go to those appointments and they weren’t happy about it. They ran in circles giving the same information over and over to different nurses and doctors, receiving few helpful results. They often left those appointments more frustrated and perplexed than when we arrived.

Now, as an adult and a doctor reflecting back on those times, I can say with certainty that my family’s primary care provider never spoke with our dentist and eye doctors about our health and wellness. My mother’s OB-GYN never communicated directly to our pediatrician about her care or anticipated my needs as a new infant. Fragmented, clunky and often disempowering, that was our health care system then in many ways. And it still is now.

Why are there not more people knocking at my door to learn from our model of care?

Throughout its history, our health care system became increasingly disjointed, and we are now faced with the reality that we must seek alternate models that are centered on the patient. We must seek models that are streamlined, efficient, less expensive and more empowering for the patient. We need models that enhance communication among providers about the patient and their health care experience. And we need to improve the collective health of our communities.

In other words, we need a model that has existed in our country since 1965: the community health centers.

Here’s what community health centers offer: Continue reading

Cigarette Study: Increased Nicotine ‘Yield’ May Make Quitting Even Harder

kenji.aryan/flickr

kenji.aryan/flickr

Fifty years after the U.S. Surgeon General issued the first report on the health hazards of smoking, cigarettes are potentially more addictive than ever, according to a new study that examines so-called “nicotine yields” — essentially the amount of nicotine delivered via smoke.

The study, led by the Massachusetts Department of Public Health and researchers at UMass Medical School, found that nicotine yield “increased sharply from 1998 to 2012 even as the total amount of nicotine in cigarettes has leveled off.”

Public health officials suggest that cigarette makers have cleverly changed the design of their product to increase the amount of nicotine smokers are taking in. (I asked whether the researchers had confronted the tobacco companies directly on these findings. Their response: No, tobacco companies were not directly questioned: “We use the data that they are required to provide to DPH annually,” a UMass Medical School spokesperson emailed.

Here’s more from the news release:

“This study indicates that cigarette manufacturers have recently altered the design of cigarettes. This can significantly increase the amount of nicotine a person receives while smoking,” said Thomas Land, PhD, director of the Office of Health Information Policy and Informatics for the Massachusetts Department of Public Health (MDPH) and principal investigator for the study.

“Cigarettes have a more efficient nicotine delivery system than ever before,” Dr. Land said. “Because smokers have no way of knowing that the level of nicotine they are receiving has increased, they can become more addicted more easily without knowing why.” Continue reading

Flu Or Just Crud? Latest Wrinkle In Flu Tracking: Home Tests

The rapid home flu test distributed by GoViral (Courtesy GoViral)"

The rapid home flu test distributed by GoViral (Courtesy GoViral)

You’re aching, you’re shivering, you’re coughing. You’re definitely, miserably sick, but is this real, potentially serious flu or just some garden-variety winter crud?

Better find out. You pull your handy-dandy virus test kit from the shelf, insert the nasal swab gently into your nostril and twist it around three times to coat it with your (copious) mucus. You swish the swab in liquid and deposit drops of your germy mix on the four wells of the instant test. Ten minutes later — voila. Sure enough, you test positive for an influenza type A. You call your doctor to ask about anti-viral meds, and — as a good citizen of your disease-tracking community – you go online to report your diagnosis to Flu Near You. On its map, you see that you’re not alone: a dozen of your neighbors have the same bug.

Futuristic? Not if you live in the Boston area and are part of a new flu-tracking experiment funded by the National Science Foundation, called GoViral. Run by researchers at Boston Children’s Hospital, the three-year project is just getting under way now, as this year’s flu season takes on steam.

Flu is more than a nuisance. It’s a serious threat — infecting tens of millions of Americans a year and killing an average of 24,000 — and public health types try hard to track and understand it. The CDC monitors reports from doctors’ offices, including lab test results. Google Flu Trends watches online searches for telltale symptoms. Flu Near You, where GoViral is based, already brings together thousands of volunteer sentinels who report online when they have symptoms. Now, GoViral will take testing into the home, where many flu patients hole up rather than seeing the doctor.

“It’s never been done before, to give a lot of people in their homes these tests,” said Dr. Rumi Chunara, GoViral’s lead researcher. “This is the first time that we’re actually crowdsourcing diagnostic samples from people.”

The project breaks new ground in flu tracking, said Dr. Lyn Finelli, who leads flu surveillance and response at the National Center for Immunization and Respiratory Diseases at the CDC: “This is the first time that I know of that anybody has used what we call participatory surveillance,” she said, “where people indicate whether they’re well or ill, and participate in home testing and send the tests in. This is a very novel look at a surveillance system and home testing.”

Dr. Chunara plans to distribute several hundred free flu test kits to Boston-area members of the public who sign up (here) this winter, and expand to encompass more areas next year. The kits include the rapid test, which can only check for four common viruses but gives an instant answer, and also a saliva test that must be sent in to a laboratory and can reliably detect 20 common viruses (though you may be better by the time you get the result.) Continue reading

Public Health Alert: One In 10 High Schoolers Hurt By Dates With Slaps, Strikes

A new study by Boston public health researchers paints a bleak portrait of the dating scene among young people: One in 10 high schoolers say they’ve been hit or otherwise physically hurt by someone they dated in the past year.

The study, published in the Journal of School Violence, found that “9.3 percent of U.S. high school students have been ‘hit, slapped, or physically hurt on purpose’ by a boyfriend or girlfriend in the past year – an annual prevalence rate that has not changed significantly in the past 12 years.”

“Dating violence is a big deal. It’s one of the more serious public health problems that high school students are facing,” says Emily Rothman, the study’s lead author and an associate professor at Boston University School of Public Health. “But where it ranks in funding is not commensurate with how prevalent it is and how potentially harmful.”

Rothman says that several violence prevention programs have been shown to be effective, including one that trains middle and high school sports coaches to spend 15 minutes once a week at the end of practice talking to boys about healthy relationships with women and girls. Unfortunately, Rothman says, “too few schools have the support they need to implement these…programs.”

Here’s more from the BU news release:

HeatherKaiser/flickr

HeatherKaiser/flickr


Rothman and Ziming Xuan, faculty at Boston University, analyzed data from 100,901 students who participated in the national Youth Risk Behavior Surveillance System survey (YRBSS) for the years 1999-2011. They found that 9.3 percent of U.S. high school students have been “hit, slapped, or physically hurt on purpose” by a boyfriend or girlfriend in the past year – an annual prevalence rate that has not changed significantly in the past 12 years.

The experience of being hit, slapped or otherwise physically hurt was reported at nearly equivalent rates by males and females who participated in the survey. There was a statistically significant increased rate of dating-violence victimization among black (12.9 percent) and multiracial (12.2 percent) youth, as compared to whites and Asians (8 percent) or Hispanic youth (10.5 percent). The rate of dating violence victimization remained stable over the 1999-2011 period for both males and females, and for each racial subgroup, despite a number of efforts to curb dating violence in the last decade. Continue reading

Surgeon General Nominee: Not Likely To Suffer From Invisibility

Dr. Vivek Hallegere Murthy (AP, provided by Brigham and Women's Hospital)

Dr. Vivek  Murthy (AP, provided by Brigham and Women’s Hospital)

The last surgeon general of the United States, Dr. Regina Benjamin, took flak for not doing more — or at least, given the limited powers of the office, for not speaking out more.  Forbes called her not just ineffective but “invisible.” New York Times food columnist Mark Bittman wrote a piece headlined “Our M.I.A. Surgeon General,” and accused her of failing to counteract lies by “Big Food” with the truth: that the American diet is making millions of us sick.

Somehow, I think that if President Obama’s new nominee for surgeon general, Dr. Vivek Murthy, is confirmed in the post, he will not have an invisibility problem.

First clue: The striking Reuters photo at the top of the Boston Globe profile of Dr. Murthy, who’s now 36 and affiliated with Brigham and Women’s Hospital and Harvard Medical School. He’s standing in his white coat outside the Supreme Court during the legal arguments over Obamacare in 2012, his arms crossed and his expression — well, judge for yourself. To me, he looks appalled, in a long-suffering way. (Dr. Murthy is not available for comment, but my personal interpretation is that anyone confronted often by the flaws and gaps of the American health care system tends to start looking appalled in a long-suffering way…)

Second clue, from Dr. Neel Shah, founder of the non-profit Costs of Care and a friend of the nominee:

One of the things I admire and love about Vivek is that he beats to the tune of his own drum and in many ways worked outside of the medical establishment in order to advance the interests of the American people….Doctors for America was largely an answer to the less progressive AMA.

Dr. Murthy is co-founder and president of Doctors for America, which describes itself as “a national movement of physicians and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high quality health care.” The Globe notes that it began as Doctors For Obama in 2008, and that Dr. Murthy believes doctors should take more of the lead in efforts to improve the country’s health care system.

Other bona-fides, the Globe reports: Continue reading

Is It Time To Rethink Co-Sleeping?

sundaykofax/flickr

sundaykofax/flickr

By Sarah Kerrigan
Guest Contributor

Pediatricians and public health officials have long warned that “co-sleeping,” or sharing a bed with an infant, is unsafe.

But let’s face it: almost everybody does it. So perhaps the time has come for the public health message to focus less on advising against it and more on advising how to do it more safely.

Because despite all the finger-waggling, co-sleeping is, and will continue to be, extremely common.

For instance, a recent survey, “Listening to Mothers III,” found that about 41 percent of new mothers report that they always or often share a bed with their babies in order to be closer. A 2007 study in Los Angeles County found bed-sharing rates in the range of 70-80 percent across races. And it’s likely that bed-sharing rates are grossly underestimated.

In so many ways, sharing a bed with your infant makes sense. “There is no way I would have had the energy to get out of bed 3-5 times per night to go feed [my baby] in another room,” says Lee, a Boston mother who asked that her last name not be used due to what she says is bias against bed-sharers.

There’s no denying that there can be risks involved in sleeping in the same bed as your infant.

In the United States in 2010, 15 percent of all infant deaths were designated as Sudden Unexplained Infant Death, which includes SIDS, and some of these babies were likely in unsafe bed-sharing situations. “We feel a certain responsibility to work to prevent these deaths,” said Carlene Pavlos of the Massachusetts Department of Public Health.

But just as using a message of abstinence in place of sex education has been shown to be ineffective, so too might a one-sided message that only tells parents, “Don’t share a bed with your baby.” Without offering a positive message of how to make bed-sharing safer, and even its potential benefits, public health organizations may be neglecting a key element to saving babies’ lives. Another Boston-area co-sleeping mother, Lindsey, said: “The fear around (co-sleeping) prevents people from talking about it. I know in my case, I was doing it in an unsafe way for a while because I was afraid to ask for advice.”
Continue reading

Breaking News: FDA Takes First Steps To Ban Trans-Fat

Up until now, the FDA has deemed trans fat to be “GRAS” — Generally Regarded As Safe. Well, those days may be numbered. Medpage Today reports that the federal food and drug agency is moving to “eliminate partially hydrogenated oils — the main dietary source of artificial trans fat — in processed foods.”

Why? According to the FDA website:

Trans fat has been linked to an increased risk of coronary heart disease, in which plaque builds up inside the arteries and may cause a heart attack.

(FDA)

(FDA)

The Centers for Disease Control and Prevention estimates that a further reduction of trans fat in the food supply can prevent an additional 7,000 deaths from heart disease each year and up to 20,000 heart attacks each year.

In its inimitable bureaucrat-ese, the FDA website explains what today’s action means:

If FDA determines that PHOs are not GRAS, it could, in effect, mean the end of artificial, industrially-produced trans fat in foods, says Dennis M. Keefe, Ph.D., director of FDA’s Office of Food Additive Safety. FDA is soliciting comments on how such an action would impact small businesses and how to ensure a smooth transition if a final determination is issued.

And here’s more from the Medpage Today story:

On the basis of a review of scientific evidence and findings from expert panels, the agency made a preliminary determination that the oils “are not generally recognized as safe for use in food” and should be eliminated, FDA Commissioner Margaret Hamburg, MD, said on a conference call with reporters.

The decision “is very welcome and strongly supported by massive scientific evidence that trans fat has many adverse effects on health,” Walter Willett, MD, DrPH, of the Harvard School of Public Health, said in an email to MedPage Today. “Trans fat has no place on the table, and this step will help make the diets of Americans safer.” Continue reading

Mass. Rolling Out Registry To Track Who Got Which Vaccines

In the United States, the flu season can range from November through March, and even past March in some years. Here, a CDC employee receives a flu vaccine from CDC Staff Nurse. (James Gathany/CDC)

 (James Gathany/CDC)

“Hello. Just for your information, Massachusetts is rolling out a statewide database that will track everybody’s vaccines — it’s expected within the next few months — and you can opt out if you want, but otherwise, it will keep track of which vaccines you’ve gotten.”

That shpiel was my assignment at our school’s flu vaccine clinic yesterday, and I dutifully reeled it off several hundreds times to people waiting in line for their shots and sprays. Most commonly, the response was an indifferent nod; a few people seemed downright pleased and grateful, and one — exactly one — person sounded incensed and asked for more information about opting out.

In case you, too, are potentially incensed, or just naturally curious, the new vaccine registry is called the Massachusetts Immunization Information System, and I’m happy to report that its helpdesk actually did answer helpfully and promptly when I just called its number, 617-983-4335. The registry has been in the process of enrolling health-care providers over the last couple of years, I was told, and now has about one-third of the state’s providers enrolled.

Also: The law that creates the registry stipulates that patients must be informed when their doctor starts sharing their vaccine information with the state, and can limit that sharing if they choose.

The Boston Globe wrote back in 2011 that Massachusetts, normally a frontrunner on public health issues, is oddly lagging on its vaccine registry. Public health reporter Kay Lazar wrote:

State lawmakers, facing opposition from insurers, failed for the past two years to act on the proposal, which would assess a fee on health insurance plans to raise the estimated $1 million to $2 million a year needed to run a registry.

But now insurers have dropped their opposition, and supporters, worried that federal funding for the project will dry up, have ratcheted up their lobbying for the state’s financial support, suggesting that, for the first time, Massachusetts will join the rest of the country with a registry that physicians say is essential. Continue reading