Please send items of interest for the E-News -- and any other feedback -- to E-News editor Dave Cundiff, MD, MPH. Thanks!
CONTENTS:
1) AAPHP Members Approve Bylaws Change, New Dues Level
2) Over 110 Attend CDLS Course Co-Sponsored by AAPHP
3) "Notes" on Violence Against Women, Adoption, COPD
4) Avian Influenza Recording is on the Web
5) Three Health Topics in 2005-12-12 Newsweek
6) PHLN - Pandemic Planning, Violent Games, Food Ads
7) E. coli O157:H7 Outbreak From Unpasteurized Milk
8) Member Update
9) Acknowledgements
1) AAPHP Members Approve Bylaws Change, New Dues Level:
At AAPHP's Membership Meeting in Philadelphia on 2005-12-11, members approved a bylaws amendment to add a non-voting "Associate Member" category of membership. This will allow participation in AAPHP by non-physicians; by international physicians without U.S. licenses; and by academic physicians who no longer maintain a U.S. medical license. AAPHP still requires U.S.
licensure for Active members; an appropriate history of U.S. licensure for Retired members; and a reasonable expectation of U.S. licensure eligibility for Resident and Medical Student members.
"Associate Member" status is only available to those who are not eligible for one of the voting categories of AAPHP membership. Details are available in Article III of the AAPHP Bylaws at http://www.aaphp.org/bylaws/Bylaws_2005_revdec05.htm.
AAPHP members at the Philadelphia meeting also determined 2006 AAPHP dues levels as follows:
Active Members: $95.00 for 2006
Associate Members: $60.00 for 2006
Medical Students: FREE for 2006-2007
Resident Members: FREE for 2006-2007
Retired Members: $40.00 for 2006
Lifetime memberships for Active and for Retired members are still set at ten times the annual dues rate for the respective category. Lifetime memberships for fully retired physicians are now $400.00 and lifetime for active physicians are now $950.00.
New membership forms will be posted on the AAPHP Web site soon, and 2006 membership renewal notices will be sent to all AAPHP members within the next few weeks.
2) Over 110 Attend CDLS Course Co-Sponsored by AAPHP:
On Sunday afternoon 2005-12-11, more than 110 people filled the room as David Lakey, MD and Ms. Tina Fields presented the AMA's "Core Disaster Life Support" course to AAPHP and APHA attenders. Participant feedback was very positive.
In addition to sponsorship and support from AAPHP, AMA, and APHA, we would like to thank the Health Policy Institute of the Joint Center for Political and Economic Studies http://www.jointcenter.org/. The Joint Center's generous support made this event possible.
Those who returned CME forms should receive a Category 1 CME certificate from the AMA within the next six weeks.
3) "Notes" on Violence Against Women, Adoption, COPD:
AAPHP member Don S. MacCorquodale, MD, MSPH has posted another issue in his "Notes Washed Up In a Bottle" series. In Dr. MacCorquodale's 2005-12-13 "Notes", Dr. MacCorquodale discusses recent surveys of "Violence Against Women" around the world. He reviews hormonal changes, at baseline and after social interactions, seen in a controlled study of infants adopted from orphanages. (He finds this research on children's oxytocin and arginine vasopressin levels to be fascinating, but not yet convincing.) Finally, he notes a decrease in COPD rates when Chinese families add chimneys to their indoor stoves.
The 2005-12-13 issue of "Notes in a Bottle" is posted at http://www.aaphp.org/bottle/2005/dec13.htm. Past issues are indexed at http://www.aaphp.org/bottle/allnotes.htm.
Dr. MacCorquodale also sent this "Letter to Santa" to the E-News editor:
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"Dear Santa:
"Several years ago Yvette Roubideaux, an American Indian physician, was driving along an isolated stretch of highway in rural Arizona on her way to an Indian Health Service Hospital where she was to work for three years.
"As she entered the reservation she noticed a number of small houses in rather precarious condition, which were surrounded by mounds of litter and beer cans. There were often four or five cars parked around a single house, and she later learned that many houses sheltered more than one family. The government owned houses for the hospital staff were in much better condition.
"The community of some 10,000 souls faced enormous challenges: an unemployment rate of nearly 90 percent; alcoholism; substance abuse; accidental injuries; and widespread violence. Decades of poor education and the lack of opportunity on most Indian reservations had contributed substantially to striking disparities in mortality rates. In 1997 almost 480 Americans per 100,000 population died. During the same period 715 American Indians per 100,000 population failed to survive.
"When Dr. Roubideaux began to work in the emergency room of the reservation hospital, the latter was supposed to have a staff of 12 physicians. Only three were actually working there when she arrived. During every working shift, she took care of adults and children with broken bones from car accidents, miserable wretches in various stages of alcohol and drug intoxication, and men and women with serous complications of various diseases, many of which were clearly preventable.
"According to Dr. Roubideaux, the Indian Health Service can take credit for great improvements in the health status of American Indians, but it is woefully under funded and understaffed. During the year 2000, Medicare expenditures amounted to about $5,400 per enrollee. In 2001 Indian Health Service personnel services were funded at the level of $1,776 per user about one-third the amount spent per enrollee in Medicare just a year earlier.
"Santa, I don¹t want very much for Christmas, but if you and your elves could persuade our government to make a serious effort to improve the health of the American Indian, I¹d be forever grateful.
"Kindly Old Doctor Mac"
Dr. MacCorquodale is referring to a Perspective article, "Beyond Red Lake ‹ The Persistent Crisis in American Indian Health Care", by Yvette Roubideaux, MD, MPH, in the New England Journal of Medicine (NEJM) 2005-11-03. The NEJM has posted the full text of this article for free on-line access at http://content.nejm.org/cgi/reprint/353/18/1881.pdf (PDF) or
http://content.nejm.org/cgi/content/full/353/18/1881 (HTML).
4) Avian Influenza Recording is on the Web:
CDC's Clinician Outreach and Communication Activity (COCA) has posted an audio recording of the 2005-12-06 "Avian Influenza" conference call by Scott Dowell, MD, MPH on the Web. The slides and audio recording are available at http://www.bt.cdc.gov/coca/callsummary.asp.
The audio recording is a 30-MB WAV file, and the slides are a 2.5 MB PowerPoint file. Please make sure your system is prepared.
5) Three Health Topics in 2005-12-12 Newsweek:
The 2005-12-12 issue of Newsweek presented three timely, and very diverse, articles on health topics.
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First is an interview with British public health physician Dr. David Nabarro, an international civil servant with extensive crisis management experience. Dr. Nabarro was named in September as the United Nations'
senior coordinator for avian and human influenza.
Dr. Nabarro notes the "inadequate" state of investment on global public health systems (including veterinary public health). He describes the effect of influenza outbreaks on multiple economic and physical infrastructures in a community -- not just on the health system. This complexity is being incorporated into international simulation exercises.
Dr. Nabarro says, "The surest way to prevent a human pandemic is to control influenza in domestic birds."
Creating an effective global surveillance and response network could cost $2 billion U.S. dollars. Of the USA's $7 billion preparedness plan, most is earmarked for much-needed vaccine research. The U.S. plan anticipates $250 million of U.S. contributions for control efforts in other countries.
Dr. Nabarro's interview is on Newsweek's ad-supported Web site at http://msnbc.msn.com/id/10312471/site/newsweek/.
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Next is an article by Donald M. Berwick, MD, President and CEO of the Institute for Healthcare Improvement (http://www.ihi.org <http://www.ihi.org/> ). He discusses the IHI's "100,000 Lives Campaign"
under the heading, "Six Keys to Safer Hospitals". The six components of this initiative, with summaries of how to implement each strategy:
(1) Prevent Respirator Pneumonia.
(2) Prevent IV-Catheter Infections.
(3) Stop Surgical-Site Infections.
(4) Respond Rapidly to Early-Warning Signals.
(5) Make Heart-Attack Care Absolutely Reliable.
(6) Stop Medication Errors.
Dr. Berwick's interview is on the ad-supported site at http://www.msnbc.msn.com/id/10312472/site/newsweek/.
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The third article, "Diagnosis: Not Enough Nurses", quotes American Nurses Association CEO Linda Stierly: "You're not admitted to the hospital for medical care, but for nursing care."
Nurses leave the bedside because they're overloaded. There aren't enough slots for all the nursing students we need. This shortage is expensive and deadly. A 2002 study showed a 7% rise in mortality for every additional patient added to hospital nurses' workload. A nursing study showed that total healthcare costs were lowered -- not increased! -- when nursing homes invested in 30-40 minutes of daily nursing care for each resident.
About 3% of U.S. hospitals have become "magnet hospitals" -- recognized by the American Nurses Credentialing Center for actions that emphasize excellence and promote nursing retention. It's too early to tell whether this will entice more nurses into the patient-care nursing workforce.
The nurse-shortage article is on Newsweek's Web site at http://www.msnbc.msn.com/id/10312473/site/newsweek/.
6) PHLN - Pandemic Planning, Violent Games, Food Ads:
CDC's Public Health Law News (PHLN) for 2005-12-14 had several items of interest, including the following:
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Business Pandemic Influenza Planning Checklist [Announcement as published in PHLN]. Predicated on the vital role that businesses play in protecting employees¹ health and safety, the U.S. Department of Health and Human Services has released a checklist to assist businesses prepare for a possible influenza pandemic. The checklist can be downloaded here:
http://www.pandemicflu.gov/plan/businesschecklist.html.
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Illinois' Ban on Violent Video Games For Kids is Struck Down [Summary from PHLN article by AAPHP E-News editor]. Illinois won't be able to enforce a law banning distribution of violent video games to minors, at least not until there is direct evidence of a cause-and-effect link between these games and violence. Because of the First Amendment protection of free expression, U.S. District Court Judge Matthew F. Kennelly has applied a "strict scrutiny" approach, has overturned the Legislature's judgment, and has granted video game sale and rental trade groups a permanent injunction against any enforcement action. Judge Kennelly's decision is at http://www2a.cdc.gov/phlp/docs/ESA_v_BLAGOJEVICH_decision.pdf. CDC's summary of this issue is in the archived 2005-12-14 issue of PHLN at http://www2a.cdc.gov/phlp/dailynews/default.asp?specific=287.
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Scientists say kids¹ food ads are junk² [Summary by PHLN Staff of an outside article].
Chicago Tribune (12/07/05) Jeremy Manier and Delroy Alexander
http://www.chicagotribune.com/features/health/chi-0512070360dec07,1,1879716.
story
[AAPHP E-News Editor's Note: Free registration is required to view this story.]
Last week, the Institute of Medicine (IOM) released a report entitled ³Food Marketing to Children and Youth: Threat or Opportunity?² The report found that while there is no conclusive proof that junk food marketing leads to childhood obesity, evidence does show that such ads cause kids to eat more high-calorie foods. The study¹s authors -- experts in psychology, nutrition, law, and education -- argued that advertising standards must be higher for young children than for adults. The report recommended that food companies stop using characters like SpongeBob SquarePants to sell high calorie, low nutrition foods. The authors called on companies to advertise healthier products and urged Congress to restrict junk food marketing if food companies do not do so on their own. But Wally Snyder, CEO of the American Advertising Federation, says the report did not define ³healthier products,² which will make it difficult for companies to self-regulate. Snyder also said government regulation could violate companies¹ First Amendment rights.
³The proposition we have lived by in this country is that you can give information as long as it¹s truthful to consumers,² he said. But the IOM authors pointed out that that the courts make a distinction between adults and children for advertising purposes. ³Advertisements that are acceptable if addressed to an adult, might be deceptive, unfair, or misleading when directed to a child.²
[PHLN Editor¹s Note: To read ³Food Marketing to Children and Youth,² visit the National Academies Press: http://www.nap.edu/books/0309097134/html/
AAPHP E-News Editor's Note:
That full-text version is free of charge, but loads one page at a time into your browser. It's a great preview, but it may be more convenient to purchase the book.]
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The CDC Public Health Law News is distributed free by E-mail on request.
Further information is available at http://www2a.cdc.gov/phlp/cphln.asp.
7) E. coli O157:H7 Outbreak From Unpasteurized Milk:
Farmers wanting to sell unpasteurized milk have developed a new sales technique, based on the Community Supported Agriculture movement. Rather than sell milk as a product or commodity, they sell shares in the cow -- or, more precisely, shares of the cow's output. Although the numbers of exposed consumers are small, they appear to be growing. Public health officials have generally been watching this development with concern.
Public Health physicians Justin Denny, MD, MPH and Mimi Fields, MD, MPH are investigating a two-state outbreak of E. coli O157:H7 in Washington and Oregon, involving at least 18 cases. Five patients were hospitalized; two are recovering from hemolytic uremic syndrome (HUS) with renal failure. All cases reported consuming unpasteurized milk from Dee Creek Dairy in Cowlitz County, Washington. This family-owned dairy was apparently "selling shares"
and calling customers "co-owners" in the belief that this would exempt them from state regulations for registration, cleanliness, and inspection of raw-milk dairies. One recent update, from an ad-supported newspaper site, is at http://www.tdn.com/articles/2005/12/23/area_news/news03.txt.
Whether to allow raw-milk sales is still a matter of public debate.
Cleanliness and testing can minimize some hazards. (For instance, E. coli
O157:H7 is generally thought to originate from fecal contamination of the milk, not from the milk itself.) However, there are intrinsic risks from other organisms in the milk. Pasteurization --controlled heat treatment of the milk -- is still the only way to achieve adequate control of biologic hazards in the milk industry. Pasteurization is required for all milk products transported across state lines, but states are free to regulate intra-state milk sales more leniently. An FDA update about the need for pasteurization is at http://www.fda.gov/bbs/topics/NEWS/2005/NEW01278.html.
8) Member Update:
Thanks to Diane L. Adams, MD, MPH; Paul T. Antony, MD, MPH, MBA; Jennifer Caves; Thomas R. Coleman, MD, MS; Andrew Deckert, MD, MPH; James D. Felsen, MD, MPH; Daniel O. Haight, MD; Annette E. Kussmaul, MD, MPH; Susan E.
Manning, MD, MPH; Doruk Ozgediz, MD, MSc; John C. Pellosie Jr, DO, MPH; John Rush Pierce Jr, MD, MPH; Jocelyn T. Serrano, MD; Daniel Shodell, MD, MPH; and Peter P. Sylvester, MD, for joining or renewing AAPHP membership since the last E-News update.
Several more membership applications and renewals were given to various AAPHP officers on 2005-12-11 and have not yet been fully processed. We will acknowledge these members in the next regular issue of the E-News. Please be patient!
9) Acknowledgements:
In addition to sources, teachers, and benefactors cited above, AAPHP thanks the ProMED-Mail service of the International Society for Infectious Diseases (http://www.promedmail.org <http://www.promedmail.org/> ), AAPHP Webmaster Kim Buttery, MD, MPH, and staff of the Clark County (WA) Health Department, Cowlitz County (WA) Health Department, and Washington State Department of Health, for updates on the E. coli O157:H7 outbreak in Washington and Oregon.
From all of us at AAPHP, best wishes for a happy and blessed holiday season!
Dave Cundiff, MD, MPH (cundiff@reachone.com) AAPHP Secretary and E-News Editor
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