Update on health reform

This Kaiser Health Tracking Poll indicates that many Americans are still confused about health reform and what it means to them.

This Health Reform Implementation Brief describes the Prevention and Public Health Fund: http://healthreformgps.org/resources/prevention-and-public-health-fund/

The Internal Revenue Service has released guidance on the health reform law’s health care tax credit for small businesses. More information is available here: http://healthreformgps.org/resources/irs-releases-guidance-on-small-business-tax-credit/

The National Association of Public Hospitals and Health Systems has developed this simple tool to help determine what health reform means to an individual, based on insurance status and age.

National Recreational Water Illness Prevention Week

Just in time for the warm weather, it's National Recreational Water Illness Prevention Week.

Recreational water illnesses (RWIs) are caused by germs spread by swallowing, breathing in mists or aerosols of, or having contact with contaminated water in swimming pools, hot tubs, water parks, water play areas, interactive fountains, lakes, rivers, or oceans. RWIs can be a wide variety of infections, including stomach, skin, ear, respiratory, eye, neurologic and wound infections. The most commonly reported RWI is diarrhea.

Staying healthy while enjoying summer activities is important. Keeping our recreational water sources clean is also important. Here are some very simple steps you can take to keep yourself and others safe:

• Don’t swim when you have diarrhea
• Don’t swallow water when swimming
• Shower with soap before swimming and wash your hands after using the toilet or changing diapers
• Take kids on bathroom breaks or check diapers often
• Change diapers in a bathroom or a diaper-changing area and not at poolside
• Wash children thoroughly (especially the rear end) with soap and water before they go swimming

For more information, check out: www.mainepublichealth.gov/healthyswimming

What's new with the flu?

Flu Activity. Flu activity decreased nationally last week. Read the full national report here. There was no reported influenza activity in Maine last week. Maine’s weekly influenza surveillance report can be found here.

School-based Vaccine Clinics. Maine CDC’s school-based vaccine clinics web page has been updated to include a letter to school nurses and instructions for completing the Maine Immunization Program’s Provider Agreement for schools.

The web page also includes an order form for some of the equipment and supplies schools may need to hold vaccine clinics in the fall, which will be provided by Maine CDC at no charge. Any school that intends to hold a flu vaccine clinic in the fall may now place an order for a small vaccine refrigerator (34” high, 23 7/8” wide, 24 3/8” deep); a cold chain transportation and storage kit, which will include a cooler, ice packs, and related items required to maintain the temperature of the vaccine when transporting it between locations and during clinics; and a vaccine clinic go-kit, which includes the medical and administrative supplies necessary to hold a vaccine clinic.

Health care providers working with schools to store and administer vaccine are also eligible to place an order for these items.

Once received, Maine CDC is not responsible for maintaining the refrigerator. Please contact the manufacturer with any problems, particularly during the one-year warranty period. Refrigerators this size can store more than 1,000 doses of vaccine for school-based clinics. Thermometers, and information related to vaccine storage, will be shipped separately.

A representative from Maine CDC will call to confirm orders prior to shipment. This order process is not the vaccine order. Vaccine order forms will be sent to all providers who have been assigned four-digit PINs by the Maine Immunization Program. Completed order forms should be sent to william.jenkins@maine.gov or faxed to 287-4612 by Tuesday, May 25.

Revised recommendations for rotavirus vaccines

The U.S. Food and Drug Administration has revised its recommendations for rotavirus vaccines and has determined that it is appropriate for clinicians and health care professionals to resume the use of Rotarix and to continue the use of RotaTeq.

In March, FDA recommended temporary suspension of Rotarix after learning that DNA material from porcine circovirus type 1 (PCV1) was present in the vaccine.

The agency reached its decision to recommend resumed use of Rotarix based on a careful evaluation of information from laboratory results from the manufacturers and the FDA’s own laboratories, a thorough review of the scientific literature, and input from scientific and public health experts.

Rotavirus vaccines are given by mouth to young infants to prevent rotavirus disease, which can cause severe diarrhea and dehydration. Rotavirus disease causes the deaths of more than 500,000 infants around the world each year, primarily in low- and middle-income countries. Before the introduction of vaccination, the disease caused more than 50,000 hospitalizations and several dozen deaths in the U.S. each year.

More information for parents and caregivers: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205547.htm

More information for health care providers: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205548.htm

State Public Health System Assessment

National Public Health Performance Standards Program (NPHPSP) is a partnership among six national public health organizations with the goal of improving the quality of public health practice and the performance of public health systems. Stakeholders from a variety of agencies in the public and private sectors came together at the Augusta Civic Center on May 13 for a day-long assessment of the public health system in Maine. The assessment was based on the ten Essential Public Health Services and will be a helpful guide in improving the state’s public health infrastructure. The report out meeting will be held from 9 a.m. to noon June 17 at the Augusta Civic Center.

Stroke Awareness Month: Learn the Symptoms and Act Quickly

A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is either blocked or bursts, and part of the brain begins to die. A person experiencing a stroke may not realize it is occurring, but bystanders can recognize the symptoms and act immediately.

Chances of survival and recovery are improved if immediate medical attention is given; the sooner a stroke patient receives treatment, the more likely that long-term brain damage and disability may be avoided.

Stroke symptoms include SUDDEN:
> Numbness in the face, arm, or leg
> Slurred speech
> Blurred vision
> Dizziness or loss of balance
> Severe headaches

Any ONE of these symptoms is a reason to take action. At the first sign of stroke, Call 911 immediately.

Stroke is the third leading cause of death and a leading cause of adult disability in Maine.

To help increase the number of stroke victims who receive timely treatment, the Maine CDC/DHHS Cardiovascular Health Program (MCVHP) is working with several statewide partners, including the Maine Affiliate of the American Stroke Association, to raise awareness of stroke symptoms and to help improve health care for stroke patients. You can play a key role too, learn the symptoms and at the first sign of stroke call 911.

Drinking Water Week

This week is National Drinking Water Week-– a time to recognize the important role that safe, reliable drinking water plays in our everyday lives. It’s easy to take our drinking water for granted, but every day around the world, thousands of people die from lack of access to clean water. Maine has abundant and safe sources of drinking water and we all work hard to keep it this way.

Three things you can do to help keep your drinking water clean:

1. Handle gasoline, motor oil, fertilizers, pesticides and other hazardous chemicals with care, making sure not to dump them on the ground or pour them down the sink. When you’re done with them, dispose of them properly at a recycling center.
2. Maintain your septic system and make sure it is in good working condition. Failing septic systems are one of the major sources of nitrates in surface water supplies.
3. Encourage your neighbors to take care of their septic tanks, petroleum, and chemicals with as much care as you do

For more information, see this press release.

Women's Health Week coming up

The 11th annual National Women’s Health Week will kick off on Mother’s Day, May 9, 2010 and will be celebrated until May 15, 2010. National Women’s Checkup Day will be Monday, May 10, 2010.

National Women’s Health Week is a week-long health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women's Health (OWH). National Women’s Health Week empowers women to make their health a top priority. With the theme “It’s Your Time,” the nationwide initiative encourages women to take simple steps for a longer, healthier, and happier life. Important steps include:

• Getting at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both each week
• Eating a nutritious diet
• Visiting a health care professional to receive regular checkups and preventive screenings
• Avoiding risky behaviors, such as smoking and not wearing a seatbelt
• Paying attention to mental health, including getting enough sleep and managing stress

Learn more about National Women's Health Week.

Smokeless Tobacco Dangers

The Partnership for a Tobacco-free Maine (PTM) is the Maine CDC’s tobacco prevention and control program. Its mission is to reduce death and disability from tobacco use among Maine citizens by creating an environment supportive of a tobacco-free life.

Snus is a new smokeless tobacco product that can be found nationwide and is becoming more prevalent. Consumption of smokeless products has risen over the past few years as cigarette consumption has decreased.

A recent segment on 60 Minutes about snus may not have presented enough information about the harmful effects of these products, such as:

· Tobacco is tobacco. ALL tobacco is harmful. Snus is not a safe alternative to smoking. National agencies such as CDC, NCI, and NIH all recommend that any form of tobacco be avoided and discontinued.

· Maine's strong tobacco laws have been proven to discourage youth smoking and support people seeking tobacco treatment, but these new products counter our efforts. Smokers wishing to quit should be encouraged to use approved methods such as counseling, NRT, and medications.

· These products appeal especially to young people and can be a gateway to addiction. These products can be used discretely and are advertised as a way to circumvent smoke-free laws. The piece also briefly discusses the new dissolvables and how they are attractive to youth.

· Using smokeless products can, in a dual user, increase the level of addiction to nicotine. These products allow the individual who may have otherwise quit smoking to perpetuate his or her addiction to nicotine by allowing use in areas where smoking is prohibited.

· Swedish snus and U.S. snus are not the same product. They are regulated and manufactured differently. Dr. Fagerstrom discusses the Swedish form. The Swedish version contains fewer toxins than the American counterpart. Long term research on the health effects of the U.S. snus does not exist.

· Placement of advertising for new products is an issue (most signs are on convenience store entry doors below the waist high handle to become familiar and seen by children). This is not addressed in the piece.

· These are cheap products – they cost about half the price of a pack of cigarettes. Taxes on non-cigarette products have not increased at the same rate as taxes on cigarettes. Increased prices discourage initiation among youth and young adults, prompt quit attempts, and reduce consumption among current users.

· The very fact that the tobacco industry is promoting these products as a harm reduction tool should be concerning to us. Harm reduction is neither an acceptable nor ethical public health practice.

Important information on Lyme disease

A special Review Panel has unanimously agreed that no changes need be made to the 2006 Lyme disease treatment guidelines developed by the Infectious Diseases Society of America (IDSA), the nation’s pre-eminent authority on infectious diseases. These guidelines promote a short-term course of antibiotics for the treatment of Lyme disease.

IDSA’s guidelines, voluntarily used by physicians to help them decide what treatments are best and safest for patients, were the subject of an antitrust investigation about whether the guidelines’ authors had conflicts of interest and failed to consider divergent medical opinions. IDSA maintains those assertions were unfounded and voluntarily agreed to a one-time special review of the guidelines by an independent scientific Review Panel whose members were certified to be free from any conflicts of interest by an independent ombudsman.

The review panel concurred that IDSA’s guidelines, which stated that long-term antibiotic treatment is unwarranted and potentially dangerous, are medically and scientifically valid and do not need to be changed. The full report is available here.

Follow these links for more information on Lyme disease in Maine and recently signed legislation to expand Lyme disease awareness in Maine.

Update on Health Reform

The Congressional Research Service issued this 100-page report reviewing the public health, health workforce, and quality provisions in the Patient Protection and Affordable Care Act (health reform).


Healthreform.gov is a comprehensive federal website on health reform, including this webpage with information on Maine. This link on the same site has information about dependent adults under age 26 being eligible for health insurance in advance of September’s start up date.


This open letter from the president and CEO of the Maine Health Access Foundation includes a summary of the health reform legislation and how it relates to Maine. It also includes links to other summaries.


Gov. Baldacci has formed a committee to work on implementing the health reforms in Maine.

Flu Update 4/8/10

What’s New with Flu?

Flu Activity. Virtually all detected influenza activity seen across the country is with the pandemic strain of H1N1. Most states are reporting sporadic, local, or no flu activity. The full national report can be found at: http://www.cdc.gov/flu/weekly/index.htm.

Maine’s influenza activity was coded “local” this week, mainly because of continued reports of influenza-like illness. Maine’s weekly influenza surveillance report can be found at: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml. Maine and the U.S. continue to see virtually no seasonal influenza virus strains except for some occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

Fall Flu Vaccine Campaign. Flu vaccine is recommended for all people for the 2010-2011 season. Although Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine, we are able to purchase sufficient seasonal flu vaccine for the 2010-2011 season for:
· all Maine children ages 6 months to 18 years-old;
· employees of schools that are providing onsite vaccine clinics on school days;
· pregnant women and their partners;
· nursing home employees and residents;
· high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

The decision on which populations we plan on purchasing vaccine for is based on several factors, including: populations designated by some of the vaccine funding sources available (federal funding sources for flu vaccine for some children); populations without other easy access to vaccine (homeless shelter residents); and people who are at high risk for severe complications (pregnant women, nursing home residents). Seniors and health care workers are in high priority groups for vaccine, but generally have existing access to flu vaccine that is not dependent on state dollars.

Please note that, as in years past, the only state-supplied vaccine earmarked for health care workers is for those who work in nursing homes. However, we strongly encourage all health care personnel, including EMS, to be vaccinated.

Anyone wishing to provide state-supplied flu vaccine in the fall must be a registered Maine Immunization Program (MIP) provider; those who are not currently MIP providers must register by April 30. Vaccine order forms will be sent to all registered providers by the middle of May. More detailed instructions, including a timeline for fall flu vaccine campaign activities, are available in this Health Alert.

A conference call for those interested in providing state-supplied seasonal flu vaccine in the fall will be held from 12 noon to 1 p.m. Monday, April 12. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and to un-mute when you are actively participating.

Don’t Forget Spring Break. This US CDC web page provides information and links for travelers who want to reduce their risk of becoming sick with 2009 H1N1. With spring break coming up and large numbers of students expected to travel both domestically and internationally, vaccination of college-age students, who have been hard-hit by illness during this pandemic, continues to be recommended. Vaccine clinics can be located by calling 211 or by visiting http://www.maineflu.gov/. The free clinics are in bold font.

Maine Among Top States in H1N1 Vaccine Coverage:

US CDC recently issued two reports that highlight H1N1 vaccine successes as well as opportunities to improve future vaccination rates. Maine is among the top states for vaccine coverage against H1N1 flu for all ages.

Maine’s vaccine rate for those in US CDC’s highest priority groups was tied for first place among all states at 51%, compared with the national rate of 33%. These highest priority groups include pregnant women, all people ages six months to 25 years-old, people ages 25 to 65 with chronic health conditions, and health care workers, including emergency medical services personnel.

60% of Maine’s children ages 6 months to 17 years were vaccinated, compared to 37% nationally. Maine’s childhood vaccination rate was tied for second with Vermont and Massachusetts. Rhode Island was first.

Seniors in Maine also had among the highest vaccination rates in the nation. 40% of Maine residents age 65 and older were vaccinated, which is nearly twice the national rate of 22%, and tied for first among all states.

Maine’s overall rate of vaccinating 37% of all people older than 6 months is significantly higher than the national average of 24%

We at Maine CDC are exceedingly grateful to the thousands of Mainers who worked hard to achieve such remarkable success!

Ongoing Flu Issues:

Flu activity, caused by either 2009 H1N1 or seasonal flu viruses, may rise and fall, but is expected to continue, especially in areas that did not see large surges in disease and/or did not have high vaccine rates. Testing for and reporting of cases and outbreaks to Maine CDC continue to be important strategies to track the virus’s spread.

It is still important to continue to offer the H1N1 vaccine to those at high risk for severe disease or those who are in a high priority category and who may have been missed earlier. If someone is vaccinated now, they can still receive the seasonal flu vaccine in the fall, which will contain the 2009 H1N1 strain. Those who should be focused on for ongoing H1N1 flu vaccination include:
women who are now pregnant;
infants who are now 6 months of old or older;
caregivers and household contacts of newborns and other young infants;
people 65 and older who may have been waiting for others to be vaccinated;
those with chronic diseases;
all young people ages 6 months to 25 years of age; and
all health care workers and EMS, including caregivers of people with developmental and/or physical disabilities.

In particular, US CDC strongly urges people with underlying health conditions and those over age 65 to get vaccinated against H1N1.

Vaccine supplies are plentiful and the circulating virus still closely matches the one in the pandemic vaccine. We have excellent safety data on the H1N1 vaccine.

Disposing of and Reporting Unused/Expired Vaccine
US CDC issued this Q&A on 2009 H1N1 flu vaccine with long-dated expirations. US CDC is also currently conducting a survey to determine how state laws affect the ability to ship expired vaccine for disposal. The results of this survey will help determine CDC’s centralized national system for vaccine disposal.

Discarded vaccine needs to be reported to Maine CDC. Providers should report the doses discarded on the same weekly reporting form for vaccine administration – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”

Health Reform

President Obama signed the Patient Protection and Affordable Care Act into law on March 23. Last week, he spoke about health reform when he visited Portland. The entire speech is available here.

This National Association of State Medicaid Directors document gives a side-by-side comparison of the different health care reform bills, while the Kaiser Family Foundation developed this summary of the final law and implementation timeline.

This Trust for America’s Health web page describes the prevention components of the final legislation.

The Association of Maternal and Child Health Programs’ Health Reform web page has a number of helpful links focused on the impact on maternal and child health programs as well as more general information.

Universal Childhood Immunization Program

LD 1408, An Act to Establish the Universal Childhood Immunization Program, has passed both chambers of the state Legislature and been signed into law by the Governor.

The program provides universal immunization coverage to children in the state by purchasing and making available to health care providers every vaccine for childhood immunization that is recommended by the US CDC’s Advisory Committee on Immunization Practices, approved by the FDA, and available under contract with US CDC.

For more information on this legislation, visit: http://mainelegislature.org/legis/bills/display_ps.asp?paper=HP0984&snum=124

Thank you to the many stakeholders who worked on this bill for 4 years, and to the bill’s sponsor, Representative Connor! Updates on the bill’s implementation, including timelines, will be forthcoming.

April is STD Awareness Month

April is STD Awareness Month. Maine CDC’s STD program conducts disease surveillance for gonorrhea, chlamydia and syphilis. Disease intervention specialists provide critical follow-up activities, including notification of disease; treatment verification for chlamydia, gonorrhea, syphilis and HIV; and partner services for all.

The HIV, STD and Viral Hepatitis Program funds STD clinics in Portland, Bangor, and Lewiston, and partners with the Family Planning Association of Maine and Planned Parenthood of Northern New England on the Infertility Prevention Project, which targets females 15-24 years-old and their partners.

Chlamydia is the most frequently reported STD in Maine, with 2,443 cases in 2009. Chlamydia disproportionately affects individuals in the 15-24 age group, and is reported in three females for every one male.

Gonorrhea typically affects a slightly older age range than Chlamydia, but during 2008 and 2009 nearly half of diagnoses occurred in the 15-24 age range, while less than a quarter were 25-29 years-old. There were 143 cases of gonorrhea reported in 2009, and 60 cases have already been reported in the first three months of 2010. We are seeing more cases among females and fewer diagnoses among men who have sex with men (MSM).

Over the past decade, annual syphilis counts have varied and until recent years had remained low, with fewer than 5 cases during most years. Cases counts peaked in 2008, with 20 cases, compared to 14 last year. Syphilis in Maine affects MSM disproportionately.

For more information about National STD Awareness month visit: www.cdcnpin.org/stdawareness or www.gyt10.org

April is Autism Awareness Month

US HHS Secretary Kathleen Sebelius issued this statement on National Autism Awareness month. This video shows the signs of autism. US CDC’s Study to Explore Early Development (SEED) is the largest collaborative scientific study to date of the risk factors of autism.

This web site discusses the purported link between vaccines and autism. For more information, see our Thimerosal fact sheet and presentation.

Maine CDC/DHHS Public Health Update 03/26/10

MAINE H1N1 FEEDBACK SURVEY

Maine CDC is conducting numerous in-person debriefings across the state with stakeholders on our H1N1 efforts. In addition, this Maine CDC H1N1 Feedback Survey is being distributed widely. If you have not done so already, please complete the survey and share the link with others.

INFECTIOUS DISEASE SURVEILLANCE REPORTS

Maine CDC’s Infectious Epidemiology Program has issued several disease surveillance reports for distribution.

A graph of selected reportable diseases that displays preliminary Year-To-Date (through February, 2010) totals with median Year-To-Date totals for the previous five-year period is available at: http://www.maine.gov/dhhs/boh/ddc/epi/publications/reportable-diseases-0210.pdf. This graph shows higher reported cases of Lyme Disease and Gonorrhea through February than the 5-year median.

The annual surveillance report on Group A Strep can be found here: http://www.maine.gov/dhhs/boh/ddc/epi/airborne/gas_survreport2009.pdf

The annual surveillance report on Group B strep is available here: http://www.maine.gov/dhhs/boh/ddc/epi/airborne/gbs_survreport2009.pdf


INFLUENZA UPDATE

What’s New With Flu?

Flu Activity. Virtually all detected influenza activity seen across the country is with the pandemic strain of H1N1. Most states are reporting sporadic, local, or no flu activity. The full national report can be found at: http://www.cdc.gov/flu/weekly/index.htm.

Maine’s influenza activity was coded “sporadic” this week, mainly because of continued reports of influenza-like-illness. Maine’s weekly influenza surveillance report can be found at: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml. Maine and the U.S. continue to see virtually no seasonal influenza virus strains except for some very occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

For the 2010-2011 season, flu vaccine will be recommended for all people. Although Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine, we are able to purchase sufficient seasonal flu vaccine for the 2010-2011 season for:
· all Maine children ages 6 months to 18 years-old;
· employees of schools that are providing onsite vaccine clinics on school days;
· pregnant women and their partners;
· nursing home employees and residents;
· high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

The 2010-2011 seasonal flu vaccine will contain the pandemic Type A H1N1 component as well as a strain of Type B and Type A H3N2. Those who received the pandemic H1N1 vaccine will need to also receive the seasonal flu vaccine this coming season. More details about ordering will be coming soon.

Morbid Obesity and Flu: Increasingly the national data are showing that minority populations have been harder-hit by the 2009 H1N1 pandemic than non-minority groups, and there is growing evidence to support early concerns that people who are morbidly obese are at greater risk of serious 2009 H1N1 complications.

Don’t Forget Spring Break: With spring break coming up and large numbers of students expected to travel both domestically and internationally, vaccination of college-age students, who have been hard-hit by illness during this pandemic, continues to be recommended. Vaccine clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Ongoing Flu Issues:

Flu activity, caused by either 2009 H1N1 or seasonal flu viruses, may rise and fall, but is expected to continue, especially in areas that did not see large surges in disease and/or did not have high vaccine rates. Testing for and reporting of cases and outbreaks to Maine CDC continue to be important strategies to track the virus’s spread.

It is still important to continue to offer the H1N1 vaccine to those at high risk for severe disease or those who are in a high priority category and who may have been missed earlier. If someone is vaccinated now, they can still receive the seasonal flu vaccine in the fall, which will contain the 2009 H1N1 strain. Those who should be focused on for ongoing H1N1 flu vaccination include:
women who are now pregnant;
infants who are now 6 months of old or older;
caregivers and household contacts of newborns and other young infants;
people 65 and older who may have been waiting for others to be vaccinated;
those with chronic diseases;
all young people ages 6 months to 25 years of age; and
all health care workers and EMS, including caregivers of people with developmental and/or physical disabilities.

Disposing of and Reporting Unused/Expired Vaccine
Unused or expired H1N1 vaccines may not be returned to the distributor. If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately, in compliance with Maine’s biomedical and/or hazardous waste rules. However, US CDC is working on a possible centralized national system for disposal of vaccine, and we will know more about this later this month.

Discarded vaccine needs to be reported to Maine CDC. Providers should report the doses discarded on the same weekly reporting form used for vaccine administration (http://www.maine.gov/dhhs/boh/maineflu/schools/documents/Aggregate-H1N1-weekly-reporting_V3.pdf) – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”


WORLD TUBERCULOSIS DAY

TB Elimination: Together We Can! was the U.S. theme for World TB Day on March 24. World TB Day is observed each year to commemorate the date in 1882 when Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB).

Tuberculosis is a disease caused by bacteria that usually infects the lungs but can affect any part of the body. TB is spread through the air when a person with active TB disease of the lungs or throat coughs, speaks, sneezes or sings. Signs and symptoms include a cough lasting 3 weeks or more, night sweats, fatigue, weight loss, coughing up blood, fever, and chills.

Worldwide, TB remains one of the leading causes of death from infectious disease. Each year, approximately 9 million persons around the world become ill with TB, and nearly 2 million TB-related deaths occur worldwide. In the United States, however, the number of reported TB cases is at an all-time low with 17 consecutive years of decline.

Although both the nation and the state of Maine have successfully achieved decreased numbers of tuberculosis cases, there is still much to be done in the elimination of TB in at-risk populations, including minorities, foreign-born persons, substance abusers and those associated with homelessness who account for a disproportionate percentage of TB cases.

In 2009, Maine had 9 cases of TB, the same number of cases that were reported in 2008. Males accounted for 6 of the cases (67%). The median age of cases was 48 years (range 5-86 years). Risk factors included substance abuse (33%), homelessness (11%), and foreign-born status (44%).

The state of Maine is actively engaged in partnerships and collaborations with community-based organizations throughout the state to reach this population and succeed in the elimination of TB. For more information: http://www.cdc.gov/Features/WorldTBDay/

Maine CDC has recently identified TB among two people who are homeless in Cumberland County. More information on this can be found at:
http://www.maine.gov/tools/whatsnew/attach.php?id=94284&an=1

RABIES

US CDC has established a new rabies webpage, which includes updated ACIP recommendations on human rabies post-exposure prophylaxis and new content organization: http://www.cdc.gov/rabies/

Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine. The 4th quarter update is available here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2

FDA RECOMMENDS TEMPORARY SUSPENSION OF ROTARIX VACCINE

The US Food and Drug Administration (FDA) has learned that DNA material from porcine circovirus type 1 (PCV1) is present in Rotarix, a vaccine used to prevent rotavirus disease. Although there is no evidence at this time that this DNA material poses a safety risk, finding the material was unexpected and FDA is assessing the situation. As a result, FDA is recommending that clinicians temporarily suspend the use of Rotarix. FDA will keep the public and clinical community updated through www.fda.gov.

Rotavirus vaccines are given by mouth to young infants to prevent rotavirus disease, which can cause severe diarrhea and dehydration. Rotavirus disease causes the deaths of more than 500,000 infants around the world each year, primarily in low- and middle-income countries. Before the introduction of vaccination, the disease caused more than 50,000 hospitalizations and several dozen deaths in the United States each year.

There are two licensed rotavirus vaccines in the United States: RotaTeq (Merck) and Rotarix (GlaxoSmithKline). Because RotaTeq was licensed in 2006 and Rotarix in 2008, most children vaccinated in the United States received RotaTeq.

RotaTeq is made using a different process from Rotarix. Preliminary studies on the RotaTeq vaccine, both by the academic research team and by FDA, have not shown the presence of PCV1 DNA. FDA is working with Merck to confirm these findings.

Within approximately four to six weeks, FDA will convene an advisory committee to review the available data and make recommendations on the licensed rotavirus vaccines. FDA will also seek input on the use of new techniques for identifying viruses or viral particles in vaccines.


MAINE AWARDED FEDERAL OBESITY PREVENTION FUNDS

First Lady Michelle Obama and US DHHS Secretary Kathleen Sebelius announced last week that Maine is one of 9 states to receive American Recovery & Reinvestment Act funds focused on preventing obesity. Maine’s award is $4.28 million over a 2-year period.

Maine CDC’s Division of Chronic Disease conducted a mini-RFP process prior to submitting the federal application, which resulted in the selection of two Healthy Maine Partnerships – Healthy Portland and Communities Promoting Health Coalition, which serves the Sebago Lakes region.

To view a complete listing of grant awardees, visit http://www.hhs.gov/recovery/programs/cppw/grantees.html

To view a fact sheet on Communities Putting Prevention to Work visit http://www.hhs.gov/recovery/programs/cppw/factsheet.html

To learn more about Communities Putting Prevention to Work, visit http://www.hhs.gov/recovery and http://www.cdc.gov/chronicdisease/recovery

STAY UPDATED

· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”) http://www.facebook.com/pages/Augusta-ME/Maine-CDC/135584761549
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
· For clinical consultation and outbreak management guidance, call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
· For general questions on flu, call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

Selected Prevention, Public Health & Workforce Provisions in the Patient Protection and Affordable Care Act (HR 3590)

from Trust for America's Health (www.healthyamericans.org)

Selected Prevention and Public Health Provisions

Essential Health Benefits Requirements (Sec. 1302) – Includes an essential health benefits package that covers essential health benefits defined by the Secretary and limits cost-sharing. Included in the general benefit categories are preventive and wellness services and chronic disease management, maternity and newborn care, mental health and substance use disorder services, and pediatric services, among other things.

Coverage of Preventive Health Services (Sec. 2713) – Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for:
(1) evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force (USPSTF);
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the CDC with respect to the individual involved;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by HRSA;
(4) with respect to women, additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by HRSA;States that for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

States that nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by the Task Force.

Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan (Sec. 4103) – Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors. The personal prevention plan would take into account the findings of the health risk assessment and would be completed prior to or as part of a visit with a health professional. The personalized health advice and referral may include community-based lifestyle interventions to reduce health risks and promote self-management and wellness, as well as lists of risk factors and a screening schedule.

Directs the Secretary to establish publicly available guidelines for health risk assessments, standards for interactive telephonic or web-based programs to furnish health-risk assessments and a health risk assessment model.

Removal of Barriers to Preventive Services in Medicare (Sec. 4104) – Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the USPSTF. Clarifies that cost sharing for colorectal cancer screening services would be waived.

Evidence-Based Coverage of Preventive Services in Medicare (Sec. 4105) – Provides the Secretary with the authority to modify coverage of existing preventive services, consistent with USPSTF recommendations. It would allow the Secretary to withdraw Medicare coverage for services not rated as A, B, C, or I by the USPSTF.

Improving Access to Preventive Services for Eligible Adults in Medicaid (Sec. 4106) – The current Medicaid State option to provide other diagnostic, screening, preventive, and rehabilitation services would be expanded to include: (1) any clinical preventive service recommended with a grade of A or B by the USPSTF and (2) with respect to adults, immunizations recommended by the Advisory Committee on Immunization Practices and their administration. States that cover these additional services and vaccines, and also prohibit costsharing for such services and vaccines, would receive an increased Federal medical assistance percentage (FMAP) of one percentage point for these services.

Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid (4107) - States would be required to provide Medicaid coverage for counseling andpharmacotherapy for tobacco cessation by pregnant women. Prohibits cost-sharing for these services.

Incentives for Prevention of Chronic Diseases in Medicaid (Sec. 4108) – Directs the Secretary to award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a healthy lifestyles program and demonstrate changes in health risk and outcomes. The program shall be comprehensive, evidence-based, widely available, and easily accessible and shall be proposed by the state and approved by the Secretary. It shall be designed to address the needs of Medicaid beneficiaries to achieve: ceasing the use of tobacco;controlling or reducing weight; lowering cholesterol; lowering blood pressure; avoiding the onset of diabetes or improving management of diabetes.
The programs shall last for 5 years. The section includes impact assessments, evaluation and reporting requirements. The section appropriates $100 million for the program, out of any funds not otherwise appropriated in the Treasury.

National Prevention, Health Promotion & Public Health Council (Sec. 4001) – Creates a Council within HHS to provide coordination and leadership at the Federal level, and among Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care in the U.S. & to develop the National Prevention Strategy. The Council shall be composed of departmental Secretaries from across the federal government, with the Surgeon General serving as Chair.

National Prevention and Health Promotion Strategy (Sec. 4001) – Tasks the Council with creating a national strategy to: set goals and objectives for improving health through federally-supported prevention, health promotion and public health programs, establish measurable actions and timelines to carry out the strategy, and make recommendations to improve Federal prevention, health promotion, public health and integrative health care practices.

Prevention and Public Health Fund (Sec. 4002) Establishes a fund, to be administered through the Office of the Secretary at HHS, to provide for an expanded and sustained national investment in prevention and public health programs (over the FY 2008 level). The Fund will support programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs. Funding levels: FY 2010 - $500 million; FY2011 - $750 million; FY 2012 - $1 billion; FY 2013 - $1.25 billion; FY 2014 - $1.5 billion; FY 2015 and each fiscal year thereafter- $2 billion.

Community Health Centers and the National Health Service Corps Fund (Sec. 10503) -Creates a Community Health Center Fund that provides enhanced funding for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers. Fund totals $10 billion over 5 years. **Of note, the President’s proposal would invest $11 billion in Community Health Centers over five years.

Clinical and Community Preventive Services Task Forces (Sec. 4003) – Defines, clarifies duties of, and provides better coordination between the U.S. Preventive Services Task Force and the Community Preventive Services Task Force.

Education & Outreach Campaign Regarding Preventive Benefits (Sec. 4004) - Directs the Secretary to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the lifespan.

Requires the Secretary, acting through the CDC Director, to establish and implement a national science-based media campaign on health promotion and disease prevention. Directs the Secretary, acting through the CDC Director, to enter into a contract for the development and operation of a Federal Internet website personalized prevention plan tool. Funding for activities authorized under this section shall take priority over funding provided by CDC for grants with similar purposes. Funding for this section shall not exceed $500 million.

Directs the Secretary to provide guidance and relevant information to States and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults. States shall design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services. The Secretary shall report on the status and effectiveness of these efforts.

School-Based Health Centers (Sec. 4101) – Directs the Secretary to award grants to support the operation of school-based health centers, with an emphasis on communities with barriers in access to health services. Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of the fiscal years FY 2010-2013 $50 million for expenditures for facilities and equipment or similar expenditures. Authorizes the Secretary to award grants to pay the costsassociated with expanding and modernizing existing buildings for use as a School-Based Health Center.

Oral Health (Sec. 4102) Directs the Secretary (subject to the availability of appropriations) to establish a 5-year national public health education campaign focused on oral healthcare prevention and education. Establishes demonstration grants to show the effectiveness of research-based dental caries disease management. Includes various oral health improvement provisions relating to school-based sealant programs, oral health infrastructure, and surveillance.

Community Transformation Grants (Sec. 4201) – Authorizes CDC to award competitivegrants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming. Eligible entities shall submit to the Director a detailed plan including the policy, environmental programmatic and as appropriate infrastructure changes needed to promote healthy living and reduce disparities. Activities may focus on creating healthier schoolenvironments, creating infrastructure or programs to support active living and access to nutritious foods, smoking cessation and other chronic disease priorities; implementing worksite wellness; working to highlight healthy options in food venues; reducing disparities; and addressing special population needs. The section includes evaluation and reporting requirements.

Healthy Aging, Living Well; Evaluation of Community-Based Prevention; and WellnessPrograms for Medicare Beneficiaries (Sec. 4202) - Authorizes the Secretary, acting through the CDC Director, to award competitive grants to health departments and Indian tribes to carry out five-year pilot programs to provide public health community interventions, screenings, and when necessary, clinical referrals for individuals who are between 55-64 years old. Grantees must design a strategy to improve the health status of this population through community based public health interventions. Intervention activities may include efforts to improve nutrition,increase physical activity, reduce tobacco use and substance abuse, improve mental health and promote healthy lifestyles among the target population. Screenings may include mental health/behavioral health and substance abuse disorders; physical activity, smoking and nutrition; and any other measures deemed appropriate by the Secretary. The section includes an evaluation component.

The Secretary shall conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. The evaluation shall include programs sponsored by the Administration on Aging that are evidence-based and have demonstrated potential to help Medicare beneficiaries reduce their risk of disease, disability and injury by making healthy lifestyle choices. CMS and AOA shall also conduct an evaluation of exiting community prevention and wellness programs. The Secretary shall submit a report to Congress on recommendations to promote healthy lifestyles and chronic disease self-management for Medicare beneficiaries; relevant findings; and the results of the evaluation.

Removing Barriers and Improving Access to Wellness for Individuals with Disabilities (Sec. 4203) – Requires the establishment of standards for accessible medical diagnostic equipment for individuals with disabilities.

Immunizations (Sec. 4204) – Authorizes states to obtain additional quantities of adult vaccines through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary and authorizes a demonstration program to improve immunization coverage.

Reauthorizes the Immunization Program under Section 317 of the PHSA. Requires a GAO study and report on Medicare beneficiary access to vaccines and coverage of vaccines under Medicare Part D.

Nutrition Labeling of Standard Menu Items at Chain Restaurants (Sec. 4205) – Establishes nutrition labeling of standard menu items at chain restaurants (20 or more locations doing business under the same name). This includes disclosing calories on menu boards and in a written form, available on request, additional information pertaining to total calories and calories from fat, amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.

Demonstration Project Concerning Individualized Wellness Plan (Sec. 4206) – Directs the Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan designed to reduce risk factors for preventable conditions identified by a comprehensive risk factor assessment.

Reasonable Break Time for Nursing Mothers (Sec. 4207) – Requires employers to provide reasonable break times for nursing mothers and a place, other than a bathroom, which may be used to express breast milk. Employers with less than 50 employees shall not be subject to this requirement if it would impose an undue hardship by causing significant difficulty or expense.

Research on Optimizing the Delivery of Public Health Services (Sec. 4301) – Directs the Secretary, acting through the CDC Director, to fund research in the area of public health services and systems. Research shall include examining best practices relating to prevention, with a particular focus on high priority areas identified by the Secretary in the National Prevention Strategy or Healthy People 2020; analyzing the translation of interventions to real-world settings;and identifying effective strategies for organizing, financing or delivering public health services in real world community settings, including comparing State and local health department structures and systems in terms of effectiveness and cost.

Understanding Health Disparities: Data Collection and Analysis (Sec. 4302) – Requires the Secretary to ensure that any ongoing or federally conducted or supported health care or public health program, activity, or survey collects and reports, to the extent practicable, data on race,ethnicity, gender, geographic location, socioeconomic status, language and disability status, inaddition to data at the smallest geographic level. The Secretary shall analyze the data to detect and monitor trends in health disparities and disseminate this information to relevant Federal agencies.

Employer-Based Wellness Programs (Sec. 4303) – Directs CDC to provide employers with TA, consultation and tools in evaluating wellness programs and build evaluation capacity among workplace staff. Directs CDC to study and evaluate employer-based wellness practices. Clarifies that any recommendations, data or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs(Sec. 10408) - Directs the Secretary to award grants to small businesses to provide employees with access to comprehensive workplace wellness programs.

Pain Management (Sec. 4305) – Calls for an IOM Conference on Pain and includes various provisions relating to pain research and pain care education and training.

Funding for Childhood Obesity Demonstration Project (Sec. 4306) – CHIPRA established a Childhood Obesity Demonstration Project and authorized $25 million for FY 2009-2013. This section appropriates $25 million for the Secretary to carry out the demonstration project in FY 2010 – FY 2014.

Effectiveness of Federal Health and Wellness Initiatives (Sec. 4402) - Requires the Secretary of HHS to evaluate all existing Federal health and wellness initiatives and report to Congress concerning the evaluation, including conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.

Better Diabetes Care (Sec. 10407) - Directs the Secretary, acting through the CDC Director, to prepare on a biennial basis, a national diabetes report card. Directs the Secretary and the IOM to study the impact of diabetes on the practice of medicine and the level of diabetes medical education that should be required prior to licensure, board certification and board recertification.

Cures Acceleration Network (Sec. 10409) - Requires the NIH Director to establish a Cures Acceleration Network to accelerate the development of high need cures, including the development of medical products and behavioral therapies.

Centers of Excellence for Depression (Sec. 10410) - Establishes a Network of HealthAdvancing National Centers of Excellence for Depression.

Programs Relating to Congenital Heart Disease (Sec. 10411) - Authorizes the Secretary, acting through the Director, to establish programs relating to congenital heart disease, including the formation of a National Congenital Heart Disease Surveillance System.

Young Women’s Breast Health Awareness and Support of Young Women Diagnosed withBreast Cancer (Sec. 10413) - Establishes a public education and a healthcare professional education campaign regarding women’s breast health.

National Diabetes Prevention Program (Sec. 5316) - Creates a CDC National DiabetesPrevention Program targeted at adults at high risk for diabetes, which entails a grant program for community-based diabetes prevention program model sites.

Selected Workforce Provisions

National Health Care Workforce Commission (Sec. 5101) – Establishes a commission toserve as a national resource for Congress, the President, States and Localities, determine whether the demand for health care workers is being met, identify barriers to coordination and encourage innovation. It shall disseminate information on retention practices for health care professionals and shall review current and projected health care workforce supply and demand and make recommendations regarding healthcare workforce priorities, goals and policies. The Commissionshall communicate and coordinate with a variety of federal agencies and departments. Specific topics to be reviewed include health care workforce supply and distribution, health care workforce education and training capacity; existing education loan and grant programs, the implications of federal policies; the healthcare workforce needs of specific populations, and recommendations creating or revising loan repayment and scholarship programs. Public health professionals are included in the definition of health care workforce and the definition of healthprofessionals. Public health workforce capacity is also included in the high priority areas list.

State Health Care Workforce Development Grants (Sec. 5102) – Establishes a competitive healthcare workforce development grant program to enable Statepartnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels.

Authorizes $8 million for planning grants and $150 million for implementation grants for FY 2010 and such sums for each subsequent year.

Health Care Workforce Program Assessment (Sec. 5103) – Codifies the existing National Center for Health Care Workforce Analysis to provide for the development of information describing the health care workforce and the analysis of related issues and collect, analyze and report data related to programs under this title. The National Center and relevant regional and State centers and agencies shall collect labor and workforce information and provide analyses and reports to the Commission.

Public Health Workforce Recruitment and Retention Programs (Sec. 5204) – Establishes a public health workforce loan repayment program to eliminate critical public health workforce shortages in Federal, State, local and tribal public health agencies. Individuals receiving assistance must work at least three years in these agencies. In FY 2010, $195 million is authorized to be appropriated for this program, and such sums as necessary for FY 2011-2015. Sec. 5205 creates allied health workforce recruitment and retention programs.

Training for Mid-Career Public and Allied Health Professionals (Sec. 5206) - Authorizes the Secretary to make grants or enter into contracts to award scholarships to mid-career public health and allied health professionals to enroll in degree or professional training programs. Authorizes $60 million for these programs in FY 2010 and such sums as necessary for FY 2011-2015.

Elimination of cap on Commissioned Corps (Sec. 5209) This section strikes the required cap of 2,800 for members of the Regular Corps.

Establishing a Ready Reserve Corps (Sec. 5210) - Assimilates active duty Ready Reserve Officers into the Regular Corps & establishes a Ready Reserve to participate in training exercises, be available and ready for involuntary calls to active duty during national emergencies and public health crises, be available for deployment and for backfilling positions left vacant during deployment of active duty Corps members, and be available for service in isolated, hardship & medically underserved communities. This section authorizes $5 million for FY 2010– FY 2014 for carrying out the duties and responsibilities of the Commissioned Corps under this section and for recruitment and training; and $12.5 million for the Ready Reserve Corps for FY 2010 – FY 2014.

Grants to Promote the Community Health Workforce (Sec. 5313) – Directs the Director of CDC to award grants to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.

Epidemiology-Laboratory Capacity Grants (Sec. 4304) Directs the Secretary (subject to the availability of appropriations) to establish an Epidemiology and Laboratory Capacity Grant Program to award grants to eligible entities to assist public health agencies in improving surveillance for and response to infectious diseases and other conditions of public health importance. Authorizes $190 million for each year of fiscal years 2010-2013 to carry out this section.

Fellowship Training in Public Health (Sec. 5314) – Authorizes funding for fellowship training in applied public health epidemiology, public health laboratory science, public health informatics, and expansion of the epidemic intelligence service in order to address documented workforce shortages in State and local health departments. Authorizes, for each of fiscal years 2010 through 2013, $5 million for epidemiology fellowship training programs, $5 million forlaboratory fellowship training programs; $5 million for the Public Health Informatics Fellowship Program; and $24,500,000 for expanding the Epidemic Intelligence Service.

Training in General, Pediatric and Public Health Dentistry (Sec. 5303) – Authorizes the Secretary to make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital or a public or private nonprofit entity to plan, develop and operate or participate in an approved professional dentistry program; to provide financial assistance to dental students, residents, practicing dentists and dental hygiene students, and for other purposes.

United States Public Health Sciences Track (Sec. 5315) Authorizes the establishment of a United States Public Health Sciences Track with authority to grant appropriate advanced degrees in a manner that uniquely emphasizes team based service, public health, epidemiology, and emergency preparedness and response. Students receive tuition remission and a stipend and are accepted as Commissioned Corps officers with a 2-year service commitment for each year of school covered. Included among the graduates shall be 100 public health students annually. Includes a provision that would develop elite federal disaster teams.

Preventive Medicine & Public Health Training Grant Program - Directs the Secretary to award grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties.

What is Maine's HealthInfoNet?

HealthInfoNet is an important statewide patient information resource that can help support health care providers’ treatment of patients. Clinicians from around Maine have reported on how they are using HealthInfoNet today to improve their access to patient clinical information when they need it most.

Take eight minutes to learn more about HealthInfoNet from Maine clinicians who are finding real value in using the statewide health information exchange. As you'll see, the video includes interviews from sites across the state. Just click on this link: http://www.youtube.com/watch?v=sXJXg4vNbOM.

Cell Phone Use and Possible Health Effects

A number of people have been asking about possible health effects from cell phone use. Below is an excerpt from the US FDA’s website that is an excellent brief summary of the knowledge to date. Links to additional resources are also included.

Do cell phones pose a health hazard?

Many people are concerned that cell phone radiation will cause cancer or other serious health hazards. The weight of scientific evidence has not linked cell phones with any health problems.

Cell phones emit low levels of radiofrequency energy (RF). Over the past 15 years, scientists have conducted hundreds of studies looking at the biological effects of the radiofrequency energy emitted by cell phones. While some researchers have reported biological changes associated with RF energy, these studies have failed to be replicated. The majority of studies published have failed to show an association between exposure to radiofrequency from a cell phone and health problems.

The low levels of RF cell phones emit while in use are in the microwave frequency range. They also emit RF at substantially reduced time intervals when in the stand-by mode. Whereas high levels of RF can produce health effects (by heating tissue), exposure to low level RF that does not produce heating effects causes no known adverse health effects.

The biological effects of radiofrequency energy should not be confused with the effects from other types of electromagnetic energy.

Very high levels of electromagnetic energy, such as is found in X-rays and gamma rays can ionize biological tissues. Ionization is a process where electrons are stripped away from their normal locations in atoms and molecules. It can permanently damage biological tissues including DNA, the genetic material.

The energy levels associated with radiofrequency energy, including both radio waves and microwaves, are not great enough to cause the ionization of atoms and molecules. Therefore, RF energy is a type of non-ionizing radiation. Other types of non-ionizing radiation include visible light, infrared radiation (heat) and other forms of electromagnetic radiation with relatively low frequencies.

While RF energy doesn’t ionize particles, large amounts can increase body temperatures and cause tissue damage. Two areas of the body, the eyes and the testes, are particularly vulnerable to RF heating because there is relatively little blood flow in them to carry away excess heat.

Cell Phone Use and Children
The scientific evidence does not show a danger to any users of cell phones from RF exposure, including children and teenagers. The steps adults can take to reduce RF exposure apply to children and teenagers as well.
• Reduce the amount of time spent on the cell phone
• Use speaker mode or a headset to place more distance between the head and the cell phone.

Some groups sponsored by other national governments have advised that children be discouraged from using cell phones at all. For example, The Stewart Report from the United Kingdom made such a recommendation in December 2000. In this report a group of independent experts noted that no evidence exists that using a cell phone causes brain tumors or other ill effects. Their recommendation to limit cell phone use by children was strictly precautionary; it was not based on scientific evidence that any health hazard exists.

Cell Phones (excerpt above is from this website)http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/HomeBusinessandEntertainment/CellPhones/default.htm

Radiofrequency Safety
http://www.fcc.gov/oet/rfsafety/rf-faqs.html

Wireless Safety
http://www.fcc.gov/cgb/cellular.html

National Cancer Institute (part of National Institutes of Health)
Fact Sheet on Cell Phone Use and Cancer Risks
http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones