Highly Contagious: Pertussis Makes Its Rounds in Crawford County

At the end of last summer, The Pennsylvania Department of Health issued a health advisory regarding the potential outbreak of pertussis, commonly known as whooping cough. Although several months have since passed, the health department is still seeing increased cases of the disease, which can spread rapidly throughout the population with little to no warning.
According to the Centers for Disease Control and Prevention, pertussis is a common disease that often shows up in outbreaks every 3 to 5 years. In 2009, nearly 17,000 cases were reported to the CDC, and just last year in California, 19 children under age 2 died from the disease. In fact, California saw the largest number of reported pertussis cases (8,383) since 1947, when 9,935 people contracted the disease. In Pennsylvania, 508 people had suffered from pertussis, according to a 2010 report from the Pennsylvania Health Department.

In Crawford County, the number of reported pertussis cases continues to rise.  While the county is not in an official “outbreak,” the region is not immune to localized outbreaks by municipality or school district.  In a 2010 report, 27 cases of pertussis were reported in the county, which is at a rate of 10.1 per 100,000 people. As we move into 2011, the health department notes that more cases are routinely being identified.
Furthermore, to our southeast, neighboring Venango County is suffering from double the incidence rate of pertussis than reported in Crawford over the past few months. The health department statistics show that Venango County saw 5 cases in the past year and previously had not seen any.  While the number of cases doesn’t seem like many, this number when compared to the total population of Venango County puts the county’s pertussis incidence rate at 20 per 100,000 people. To our south in Mercer County, 85 people were diagnosed with the disease, which is a rate of 24.1 per 100,000, and to our north, Erie County has seen 48 cases with a rate of 5.7 per 100,000 people.
Considering the highly contagious nature of pertussis, the disease could very quickly infect the residents of Crawford County. Pertussis is caused by a bacterium called Bordetella Pertussis, which attaches to the cilia in the lungs causing damage and inflammation. It’s quickly transmitted through close contact with others through sneezing or coughing – much like the common cold or influenza. Symptoms are often not noticeable for 7-10 days after the initial infection and often mimic a cold or the flu. The difference is that these symptoms last for 1-2 weeks and cause coughing fits that sound like a high-pitched “whoop.” In infants, the disease can cause apnea associated with serious breathing difficulties that lead to death.
There is an easy way to prevent pertussis infection – being vaccinated with Tdap, which protects against tetanus, diphtheria-acellular, pertussis . Because of the urgency to halt any further spread of the disease, the CDC’s Advisory Committee on Immunization Practices recently issued new guidelines for vaccine administration. Here is a quick status report:

·        Children ages 7-9 should receive a one-time dose of the vaccine if they have never completed the original series begun at infancy.

·        Adolescents ages 10-18 years should receive a one-time dose of the vaccine.

·        Adults ages 19 through 65 years should receive a one-time dose – especially if prior immunization records against pertussis are unknown.

·        Adults age 65 and older who come in contact with infants and children should receive a one-time dose.

The traditional immunization schedule for children under age 7 for pertussis involves a series of four doses of vaccine, given at 2, 4 and 6 months of age. The fourth dose is given at least 6 months after the third, usually at 12-15 months of age.  A booster dose is given between the ages of 4-6 years, prior to school entry. 
If you are uncertain about your vaccination history or needs, check with your primary care physician.  You can find out more details on pertussis and immunization schedules at the CDC’s website: www/cdc.gov.

References

 Centers for Disease Control and Prevention. (2011). Pertussis (Whooping Cough). Retrieved February 2, 2011 from http://www.cdc.gov/pertussis/outbreaks.html.

Centers for Disease Control and Prevention. (2011). Recommended immunization schedule for persons aged 0-6 years: United States 2011. Retrieved February 2, 2011 http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2011/11_0-6yrs-schedule-pr.pdf.

Pennsylvania Department of Health. (2010). Pennsylvania health profiles. Retrieved February 10, 2011 from http://www.portal.state.pa.us/portal/server.pt?open=space&name=Dir&psname=SearchResult&psid=12&cached=true&in_hi_userid=2&control=OpenSubFolder&subfolderID=156603&DirMode=1

Pennsylvania Department of Health. (2011). Pennsylvania pertussis incidence rates by county: 2010. Pennsylvania Epi Notes, 1(1), 2.

Excessive Drinking Prevalent Among the Elderly

Studies over the past decade have shown that excessive drinking as well as binge drinking (drinking more than seven drinks in one week) is commonplace among elderly individuals. While that may seem like a small amount to some, public health professionals are concerned for these senior citizens, who are more sensitive to alcohol than their younger counterparts.  In a recent study of nearly 13,000 Medicare beneficiaries aged 65 or older, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that 9 percent (about 1200 people) consumed unhealthy amounts of alcohol. Yet, according to a Pennsylvania State University study, less than half of those who are age 65 and older are diagnosed with alcoholism or alcohol-related problems. 

The NIAAA also revealed that the prevalence of alcoholism is steadily rising among the older population. Considering that the general population is also aging, this may not be surprising that the problems of alcoholism will grow along with them. Yet, here are some staggering revelations that worry public health professionals:

• 6-11 percent of elderly patients admitted to hospitals, 20 percent admitted to mental health facilities, and 14% seen in emergency rooms exhibit some sign of alcoholism.
• Within the hospital setting, rates of alcohol-related admissions of those ages 65 and older are similar to those for heart attacks.
• Incidence rates of hip fractures increase with alcohol consumption.
• Reaction times while driving slow in the elderly, and slow even further when alcohol is added to the mix.
• Moderate to heavy drinkers are 16 times more likely than nondrinkers to die of suicide, which is commonly associated with depression (exasperated by alcohol in the elderly).

Furthermore, alcoholism or alcohol-related problems in senior citizens is associated with poor mental health functioning, loss of physical brain tissue that may result in permanent brain damage, and increased risks of falls and injuries, according to a study done through Washington University in St. Louis, Missouri. Unfortunately, as people age, their interactions with others are limited; therefore, drinking alone or away from others can often go unnoticed by family and friends. The longer the problem exists, the more damage it can cause.

There are several behaviors that family members and caregivers should watch for to identify signs of elderly alcohol misuse. The National Center of Substance Abuse Treatment has identified 13 key areas to be watchful in senior citizens. These include memory loss (especially after taking medications or a drink), loss of coordination, changes in sleep habits, unexplained bruises, being unsure of themselves, irritability or sadness, unexplained chronic pain, changes in eating habits, an increasing desire to be alone, failing to maintain personal hygiene, difficulty concentrating, unable or unwilling to stay in touch with family and friends, and lack of interest in normal activities.

If any of these signs emerge in an elderly person, the first point of contact is with the person’s primary healthcare physician. Screening tests can be used to determine is alcohol is the culprit for the behaviors or if the cause points toward other health issues. Paying attention to the lives of the senior citizens around you is the key to keeping alcoholism and alcohol abuse from taking the life of a close friend or family member.

References:

National Institute on Alcohol Abuse and Alcoholism. (1998). Alcohol Alert. Retrieved January 14, 2011 from http://pubs.niaaa.nih.gov/publications/aa40.htm.

New York State Office of Alcoholism and Substance Abuse Services. (2011). Elderly alcohol and substance abuse. Retrieved January 14, 2011 from http://www.oasas.state.ny.us/AdMed/FYI/FYIInDepth-Elderly.cfm.

Sacco, P., Bucholz, K. K., & Spitznagel, E. L. (2009). Alcohol use among older adults in the National Epidemiologic Survey on Alcohol and Related Conditions: A latent class analysis. Journal of Studies on Alcohol and Drugs, November, 829-838.

Science Daily. (2008). New study sheds light on excessive drinking among the elderly. Retrieved January 14, 2011 from http://www.sciencedaily.com/releases/2008/03/080305173347.htm.

Older Adults Should Subscribe to Daily Walks

While there is no question that childhood obesity has moved to epidemic proportions, adult obesity is no better. Public health officials around the country are equally concerned about adult obesity, yet, and unfortunately, more recent programs seem to focus on children.  Adults and even senior citizens can reduce their body mass indices through behavioral changes that can ward off diabetes, heart disease, and hypertension.

As the population grows and the Baby Boomers start turning 65, the health needs of this group will also expand. According to the journal Long-Term Living: For the Continuing Care Professional, the aging of the population is expected to bring an increase of chronic illnesses, many which can be avoided or delayed through a change in health habits. Numerous studies have shown that healthy habits, even when formed late in life, can improve health and delay the onset of diseases or even prevent them from occurring. Illnesses such as diabetes, high blood pressure or hypertension, cardiovascular disease are costly to treat, especially in the elderly who often suffer from multiple health issues. Slowing the progression of such diseases through improved health habits could lower the costs of health care, reducing the payment requirements from Medicare or Medicaid as well as out-of-pocket and private insurance expenses.

While most adults, especially senior citizens, cannot participate in high-intensity sporting activities, they can do one cost-effective and easy activity: walking. Research around the world has discovered that walking at any age can combat obesity. Senior citizens who walk every day can increase their lean muscle mass, reduce their body fat, and increase their heart health.  The benefits of walking for senior citizens are numerous and include improved mobility that can lead to an improved quality of life.

Anyone over the age of 60 should be able to slip on a pair of sneakers and go for a walk. Walking can be done anywhere, but in Crawford County, we are especially blessed with multiple walking paths. These include the trail at Oil Creek State Park in Titusville as well as the Ernst Trail in Meadville. Other walking places include neighborhoods with little traffic as well as college campuses throughout Crawford County. If the weather is too cold, treadmill walking is a good option. Various fitness centers or senior citizen centers offer free or low-cost memberships for older adults.

With so many options, there is no excuse for not walking.  And the benefits can result in a higher quality of life and reduce health care expenses over the long haul. So, what are you waiting for?

Reference:

Keogh, S. V. (2010). Promoting best outcomes in the bariatric elder. Long-Term Living: For the Continuing Care Professional, January, 14-15.

Health Care Reform: The Good, the Bad, & the Ugly

Health care reform, also known as the Affordable Care Act of 2010, could probably be considered one of the largest inter-country controversies since the Civil War. The Civil War certainly divided the nation into blue and gray, and today, the ACA has again divided us by blue and red. But, is this really necessary? Is the ACA really as bad as some strongly believe or as fantastic as others vehemently argue?  While the ACA and associated legislation is not necessarily a light read, there are a few elements that separate out the good, the bad, and the ugly.

In a presentation I attended on health care reform, leading legislative health affairs expert and President/CEO of Grinnell Regional Medical Center in Iowa Todd Linden noted that the Act has some long-awaited improvements to America’s healthcare system. First and probably the most important issue comes in the form of improvements to insurance access. Basically, this act forbids insurance companies to deny coverage for people with pre-existing conditions.  Second, the Act extends coverage to millions more people who could neither obtain nor afford health insurance in the past.  (Note: Some reports claim that number is 32 million, others claim it to be much lower…regardless, the Act does extend coverage to uninsured.)  However, in a country that claims to be one of the richest nations in the world, we should feel ashamed that a large number of our residents do not have basic healthcare benefits in some form or another. This Act provides the extended coverage that should have always existed to enhance the health and well-being of this nation’s people. Third, the Act truly focuses on wellness and prevention. From a public health viewpoint, the wellness/prevention focus is a positive change that has the potential to reduce the prevalence of diseases such as obesity, diabetes, cardiovascular disease, and other behavioral-related illnesses. In turn, this disease reduction will lower overall medical costs.

The ACA is not all positive, and the bad portions are just as abundant.  As one example, the ACA leads us down a road of significant reductions in Medicare payments and reimbursement rates for thousands of healthcare providers.  Medicare covers health needs of senior citizens, a growing population throughout the country. In Crawford County, this reimbursement reduction will significantly affect the number of services that can be offered at hospitals, nursing facilities, and through other elderly care programs. While on the positive side, the ACA expands coverage to young Americans, but on the negative side, it decreases coverage for the fastest-growing population in America – our senior citizens. Thus, the ACA seems to be avoiding the needs of the Baby Boomers, who will eventually be utilizing the majority of the health services across the nation. Another bad element of the ACA is the requirements now imposed on all hospitals (regardless of their size). A listing of all the new mandates for charitable hospitals is published online at www.healthreformgps.org, a joint project of The George Washington University’s Hirsh Health Law and Policy Program and The Robert Woods Johnson Foundation.  One of the mandates requires hospitals to invest in a Community Health Needs Assessment every three years. While community health needs assessments are important in order to provide the most necessary services for the community, should they really be required and required every three years?  Assessments can cost upwards of $100,000 – money that will most likely be pulled from services and programs in order to assess the county’s health every three years. The Health Reform GPS website lists many more mandates that could be extremely costly to smaller, non-profit hospitals who often cannot afford to perform such tasks so often.

Finally, the ACA does contain some pretty ugly concepts. The worst, and the issue that is creating the most controversy, is the argument that this law moves us closer to becoming a socialistic system, breaking down the concept of the capitalistic system for which America is known. Healthcare for everyone – especially free care – is a socialistic concept. Those who can afford healthcare will pay for those who cannot, generally through an increase in taxes (which is forthcoming).  Isn’t this one form of wealth redistribution more commonly found through socialism? A second and just as equally ugly concept is the cost of the ACA along with all of the Health Care Reforms that came with it. The Congressional Budget Office claims that the ACA and associated reforms will reduce the deficit over the next 10 years. Yet, Mr. Linden and many others (including economists, politicians, and health professionals) have indicated that this reform will cost more than $1 trillion. In a country that is failing miserably in lowering its current deficit, we cannot afford to take on any more debt let alone handle a $1 trillion invoice to pay for an act that is stirring up a new kind of war…one that will debate the healthcare reform…all of it: the good, the bad, and the ugly.

References:

Congressional Budget Office. (2010). Selected CBO publications related to health care legislation, 2009-2010. Retrieved January 4, 2011, from http://cbo.gov/ftpdocs/120xx/doc12033/12-23-SelectedHealthcarePublications.pdf.

Linden, Todd. (2010). Presentation titled “An Objective Look at the New Healthcare Legislation.” 295 Attendees; Presented Dec. 7, 2010 from Grinnell Regional Medical Center, Iowa.

Rosenbaum, S. & Margulies, R. (2010). New requirements for tax-exempt charitable hospitals. Retrieved January 4, 2011, from http://healthreformgps.org/resources/new-requirements-for-tax-exempt-charitable-hospitals/.

Are Electronic Cigarettes Really Safe?

Quit smoking options are abundant and include the patch, nicotine gum, anti-smoking oral medications, and the age-old cold turkey technique. Despite all of these options, smoking is still prevalent across the country and right here in Crawford County where almost one-quarter of the population takes part in the habit. Studies have shown that smoking is one of the hardest addictions to give up because of the strong addictive quality of the drug nicotine. Thanks to decades of public health outcry, product manufacturers have attempted to reduce the effects of smoking by introducing light or slim cigarette versions, and today we have the most recent option: the electronic cigarette. Several brands are now on the market, all of which are being marketed as the safest alternative to smoking actual cigarettes.

Crawford County’s tobacco coalition, under the auspices of the Crawford Health Improvement Coalition, isn’t fully convinced that this is truly a “healthier” option to smoking. The American Journal of Health-System Pharmacy recently studied the electronic cigarette and found some surprising revelations. The journal reported that the electronic cigarette is constructed with three specific elements: a nicotine chamber, an atomization chamber with a membrane that suspends the ingredients, and an electronic chip with a rechargeable lithium battery. While this construction sounds like the cigarettes protect against inhaling the addictive nicotine drug, there are several aspects of these cigarettes that are not commonly known. The Federal Department of Agriculture’s Division of Pharmacy’s analysis discovered the presence of two lethal chemicals within two brands of the electronic units: diethylene glycol (a compound found in antifreeze) and nitrosamine (a known carcinogen).  Furthermore, the vapor released from the electronic cigarettes still contains nicotine; yet, it is too early to determine if secondary exposure to this vapor poses any threat.

In addition, the product is designed to actually release just enough nicotine to feed the nicotine addiction. According to The American Journal of Health-System Pharmacy, “it appears that electronic cigarettes are intended to deliver addictive levels of nicotine, which could lead to adverse affects.” Unfortunately, this new product is not subject to the FDA regulatory action as they do not fall under the Family Smoking Prevention and Tobacco Control Act. Furthermore, no electronic cigarette has received FDA approval; therefore, manufacturers can continue to make claims of the product being a safe alternative to smoking. The cigarettes are too new to have undergone significant clinical trials that would reveal any possible dangers.

Unless the cigarettes are truly deemed safe, smokers should consider more traditional methods to quit smoking. The tobacco coalition within Crawford County continues to advocate for safe quit smoking options and is willing to assist anyone interested in giving up the unhealthy habit. To date, the best and most effective quit smoking option is to remove the nicotine completely from your body. To do so requires absolute abstinence from smoking. Smokers should discuss the options with their primary care physician and start moving toward removing the lethal drug from their system. Eliminating the drug from the body will improve your lung capacity, energy level, and overall quality of life.

References:

Wollscheid, K.A. & Kremzner, M. E. (2009). Electronic cigarettes: Safety concerns and regulatory issues. American Journal of Health-System Pharmacy, 66, 1740-1742.

Is Santa Claus really a good role model?

Last year, the British Medical Journal found that Santa Claus is more commonly recognized by American children than the President or the Pope… or even the baby Jesus. In fact, the journal noted that among American youngsters, “Santa Claus was the only fictional character more highly recognized than Ronald McDonald.” But, public health practitioners question whether the jolly fellow is truly a good role model. In the past, the traditional overweight Santa has been used to sell multiple unhealthy products such as cola and candy as well as cigarettes. While the latter has been banned from use in advertising today, the concept of Santa marketing high-fat, high-sugar foods still exists.

Countries that revere Santa Claus as a holiday icon have higher levels of childhood obesity, according to numerous international Santa Claus studies. Because of his round belly and obvious overweight physical condition, Santa Claus has taught our children (albeit, subtly) that obesity is associated with good cheer and happiness.  While that may seem like a ludicrous suggestion, let’s look at a few of our traditions in connection with health habits. First, we are asked to leave Santa a plate of cookies and a glass of brandy for him to enjoy during his visit to our home. However, his waistline really can’t afford the sugar and fat in the cookies let alone the alcohol that he will drink before driving off your roof in his sleigh. So, not only are we encouraging high-fat, high-sugar foods, we’re also endorsing drinking and driving – even if it is only a subtle endorsement. The carrots and milk we leave for the reindeer would be a much better snack choice for Santa himself.

Second, the Santa “helpers” found at the thousands of malls and department stores across the nation are not necessarily the best “helpers.” According to studies of these Santa Clauses, most countries, including the United States, do not require medical or health check-ups for immunizations or other medical conditions for these mall/store employees. Thus, a Santa could potentially carry the H1N1 virus, Tuberculosis, or other infectious disease that could become an unwelcomed gift given freely to your child as he or she sits on Santa’s lap.

Because Santa Claus is not likely to be removed from the public realm anytime soon, parents can protect their health as well as the health of their children with a few simple precautions. If you visit an unknown Santa’s helper at a mall or department store, one of the first methods to protect against infectious diseases is to make sure you and your child’s immunizations are up to date.  Next, washing your hands and using hand sanitizers (when washing is not readily available) is also an option after sitting on Santa’s lap. Most of all, keep unwashed hands away from your face, eyes, and mouth to protect against transferring any infectious diseases.

Next, tackle the cookies and alcohol issue by replacing Santa’s snack with a healthy alternative – you may actually create a new and improved holiday tradition at your house. While you need not leave a salad and glass of ice water (although that may be the optimal snack for Santa), you could leave reduced fat crackers and low-fat peanut butter with a glass of juice to teach your child about healthy snack choices. Better yet, you might even consider having your child leave a non-food gift for Santa such as a homemade thank you card or special picture painted on holiday paper. Not only will this remove unhealthy eating habits from the concept of cheer and happiness, it will provide an activity for you and your child that could turn into a unique annual holiday tradition.

While Santa Claus’ overall presence at this time of year does involve the spreading of good cheer to all, it’s important to remove his connections to unhealthy habits or unwanted diseases. Teach your child to focus on Santa’s message of giving instead of the food products and other unhealthy behaviors associated with this holiday icon.

Reference:

Grills, N. & Halyday, B. (2009). Santa Claus: A public health pariah? British Medical Journal, 339, 1424-1426.

Breakfast + Play = Improved Health

Poor health can often be attributed to social and behavioral actions that learned over time. These social activities that lead to illnesses include smoking, drinking, using illicit drugs, and overeating. While this is not necessarily new news for our community, the fact that there is a group of concerned citizens focused on improving the health of Crawford County’s residents may be an enlightening news bulletin. The Crawford Health Improvement Coalition (CHIC) is a group of individuals who represent health agencies across the county who are aiming to reduce poor health among Crawford County’s residents.  CHIC’s most critical focus areas revolve around childhood obesity, tobacco and other drug use, and cancer awareness.

According to the County’s Health Rankings as performed by a study out of the University of Wisconsin, Crawford County contains a significant percentage of people who participate in unhealthy behaviors. Out of the state’s 67 counties, Crawford ranked 33^rd in overall physical and mental health but 45^th in healthy behaviors. What this latter number means is that Crawford County’s population engages in more unhealthy behaviors than most of the state’s population. Only 22 counties ranked worse than Crawford; yet, 44 counties fared better. Factors for such behavioral rankings included the fact that the county includes 23% smokers, 30% obese residents, 15% binge drinkers, and 18% who are considered to be in poor or fair health.

Public health professionals discovered that behaviors learned early in childhood often remain with the person throughout their lifespan. A recent study published in a recent issue of Psychology journal discovered that eating breakfast and participating in spontaneous activities (such as active play) were associated with healthy development of children in terms of building healthy relationships and not being overweight or obese. By contrast, children who did not eat breakfast and spent more time being sedentary (such as sitting in front of the television or computer) were more likely to be overweight and less able to develop social relationships with others.

While it may seem obvious, the most important behavior that parents and legal guardians can offer their children is feeding them a nutritious breakfast. A second behavior is engaging them in some sort of active play, which may involve something as simple as going for a walk.  Increasing physical activity is one of the major focus areas for CHIC. For example, the Penncrest School District offers the program “Caring Habits” for its 7^th graders at Maplewood and Cambridge Springs Middle Schools. Through their Caring Habits program, the district incorporates a physical activity into the youth’s school day as a means of encouraging spontaneous play. These activities have included bicycling, strength training, and track and field. The idea is to break up the day with movement – a means of warding off sedentary behaviors that can lead to obesity.

It’s important to instill healthy behaviors into our children today so that they can grow into healthy adults. However, anyone can retrain themselves and more from poor behaviors to healthy ones. Therefore, everyone – regardless of your age – should sit down to a nutritious breakfast and engage in spontaneously active play every day.

References:

Silvia, C., Giulia, B., Emanuela, R., Vacirca, M. F. (2010). Positive development in children and the precursors of healthy life-styles: The role of eating regularly and level of leisure activity. Psychology, 1, 151-158.

University of Wisconsin. (2010). County Health Rankings. Retrieved November 12, 2010 from http://www.countyhealthrankings.org/.