The Health Consequences of Smoking-50 Years of Progress

The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General was released on Jan. 17, a half century after the historic 1964 Surgeon General's report that concluded that cigarette smoking causes lung cancer. Since that time, smoking has been identified as a cause of serious diseases of nearly all the body's organs. 

Today, scientists add diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and other conditions to the list of diseases that cigarette smoking causes. In addition, the report concludes that secondhand smoke exposure is now known to cause strokes in nonsmokers.

For the full report, executive summary, consumer guide and PSA, visit http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html.

For free help quitting smoking, visit www.tobaccofreemaine.org or call 1-800-207-1230

Prevent adult-onset occupational asthma

Isocyanates (eye-so-sigh-a-nates) are chemicals that can cause asthma and cancer, irritate the skin, eyes, nose and throat, and even cause death.  It is important for medical providers to know the health risks associated with isocyanates and be aware that patients who work in certain industries are in danger of being exposed.  The risks are so well documented that the Occupational Safety and Health Administration (OSHA) has announced an emphasis program to protect workers from exposure to isocyanates.

  

Patients potentially exposed to isocyanates may have:

• Persistent or recurring eye irritation
• Nasal congestion
• Dry or sore throat
• Cold-like symptoms
• Cough
• Shortness of breath
• Wheezing
• Chest-tightness

Direct skin contact can cause:

• Sensitization
• Inflammation
• Rash
• Itching
• Hives
• Swelling

Isocyanates are found in the following compounds:

• Paints
• Varnishes
• Foams
• Sealants

They are used in the following industries:

• Residential/commercial construction to coat cement, wood, fiberglass, steel and aluminum
• Automotive painting and spray on bed-liners
• Commercial manufacturing of ridged and flexible foams
• Boatbuilding coatings to protect boats

  

When dealing with a patient, medical providers should consider that patient's occupation and work environment. Isocyanates are powerful irritants to the eyes, gastrointestinal, and respiratory tracts. Isocyanates can sensitize a patient through skin contact which means a patient could be subject to a severe asthma attack if they come into contact again (death from severe asthma in some sensitized subjects has been reported).  Isocyanates cannot easily be washed off skin or clothing because they are not water soluble.  OSHA is hoping that by focusing on this problem it will raise physician awareness of the risk, reduce employee exposure, and lessen the overall negative health effects associated with isocyanates. 

  

For more on the National Emphasis Program, visit: http://go.usa.gov/Zp7h (See appendix C for a patient questionnaire.)

 

Maine Youth and Suicide Prevention

Maine youth are making healthier choices, including smoking and drinking less, but are increasingly struggling with their emotional wellbeing.

Those findings and other insights directly from tens of thousands of Maine students about their health and habits are detailed in the newly released results of the 2013 Maine Integrated Youth Health Survey (MIYHS).

The survey, which has been given every odd year since 2009, is a collaboration of the Maine Department of Education and the Maine Center for Disease Control and Substance Abuse and Mental Health Services in the Department of Health and Human Services. The results inform prevention and program planning, as well as future funding proposals.

While students largely feel more supported by parents, teachers and their communities, they also admit they are increasingly struggling with feelings of sadness and hopelessness. At the high school level, 14.6 percent of students said they have seriously considered attempting suicide, and 16.8 percent of seventh and eighth graders said the same. 

In October, Maine was one of six states awarded a 3-year federal Substance Abuse Mental Health Services Administration grant, which will expand statewide education, training, and outreach services and offers new screening, assessment, treatment and follow-up services for youth to age 24 at risk for suicide.

The Maine Suicide Prevention Program is collaborative initiative among: the Departments of Health and Human Services, Education, Corrections, Labor, Public Safety, and Veteran's Affairs; advocacy organizations like American Foundation for Suicide Prevention, NAMI ME; crisis agencies; parents, survivors and young adults.

Although suicide is a rare event, we must encourage and support our youth and young adults who may be feeling overwhelmed and hopeless to reach out to a trusted adult who will provide support and connect them to helping resources, such as:

• Statewide Crisis Hotline: 1-888-568-1112 - connects callers to crisis service provider in area from which they are calling. This is for ALL individuals in crisis to provide immediate, local assistance in a crisis situation. The crisis worker will ask what is going on and ask about everyone's safety to help figure out what kind of help is need. If you believe a person might be in danger of suicide, call the statewide crisis hotline or the police (911) to keep the person safe if needed.

• Statewide Information Resource Center (IRC): 1-800-499-0027 Office of Substance Abuse and Mental Health Services IRC has suicide prevention informational materials for adults and teens including: print and audio/visual educational materials, Maine and national data, etc.

For more information:

• Maine Suicide Prevention Program: www.maine.gov/suicide

• Maine Integrated Youth Health Survey summary results and press release: at http://mainedoenews.net/category/news-views/press-releases/

• 2013 Maine Integrated Youth Health Survey result: https://data.mainepublichealth.gov/miyhs/

Update on tickborne diseases

The deer tick can remain active in its adult stage from fall to spring as long as the temperature is above freezing. The tick will remain alive, but inactive when temperatures are below 40 degrees Fahrenheit.

Maine CDC saw increased numbers of tickborne disease reports in 2013, including multiple cases with onset of symptoms as late as December and the first documented case of Powassan encephalitis in the state since 2004. Providers should continue to consider tick borne illnesses, even during the winter months.

For more information, see the update from Dec. 18 at http://go.usa.gov/ZpAG 

Cervical Cancer

January is Cervical Cancer Awareness Month.

Before the development of the Pap test, cervical cancer was one of the most common causes of cancer death for American women.  As an available, accepted, and cost-effective screening test, the Pap test can detect cervical cancer early when treatment is most effective. If women receive regular screenings, the Pap test can detect cervical cell changes before they become cancerous.

Help is available for qualifying women age 40 and older who are in need of breast or cervical screening tests. The Maine CDC Cancer Prevention and Control programs can provide information about cancer screening tests as well as resources for free cancer screenings.

Interested women are encouraged to call 1-800-350-5180 or 1-207-287-8068. TTY users should call Maine Relay at 711. 

For more information, visit http://go.usa.gov/ZpFh 

Flu update 1/9/14

Influenza activity in Maine is widespread with laboratory confirmed influenza reported in all counties. Influenza A/pH1N1, Influenza A/H3, and influenza B have been confirmed in Maine indicating all three strains are circulating.  Maine CDC has followed up on six outbreaks of influenza as of Tuesday, January 7th. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of severe disease.  The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated.  

For more information, see the Health Alert from Dec. 26 about Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season at http://go.usa.gov/Zp6w and the Health Alert from Jan. 8 about Widespread Influenza Activity in Maine at http://go.usa.gov/ZdAj

Weekly updates on flu activity are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

In addition, people and clinicians may review or anonymously report flu at www.flunearyou.org  

Prevention 

Take everyday preventive measures against the flu:

• Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
• Avoid touching your nose, mouth, and eyes. Germs can spread this way.
• Consult your health care provider about getting a pneumococcal vaccine for anyone who is younger than 5, between ages 5 and 64 with high risk conditions, or age 65 and older.
• Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.

Vaccination

There is still time to get vaccinated against the flu for this season. Full immunity develops 7-10 days after the vaccine is administered. To find locations where vaccine is available, contact your health care provider or pharmacy, call 211, or visit www.211maine.org  or www.flu.gov 

Maine CDC recommends that Health Care Providers continue vaccinating to protect against influenza this year. To ensure that vaccine is available for all Maine people who are seeking it, please use the following as guidelines:

Health Care Providers should use state-supplied vaccine for patients in the following circumstances:

• The patient is a child ages 6 months through 18 years;
• The patient is pregnant or the partner of a pregnant patient;
• The patient's insurance does not cover vaccinations;
• The patient is uninsured.

Health Care Providers may use state-supplied vaccine for other patients only if:

• The Health Care Provider has already vaccinated all eligible patients listed above and has excess state-supplied vaccine; and
• Privately purchased vaccine is not available.

Please remember that providers may not charge for state-supplied vaccine. It is reasonable and allowable to charge an administration fee for administration of state-supplied vaccine in some circumstances provided that:

1. MaineCare-eligible children are not charged an out of pocket administration fee;
2. Administration fees do not exceed the regional Medicare maximum; and
3. No one is denied vaccine because of their inability to pay an administration fee.  

Treatment

If you have the flu:

• Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
• Cough and sneeze into your elbow or into a tissue. Throw the tissue away.
• Although most people can stay home to recover without seeing a health care provider, it is possible for healthy people to develop severe illness from the flu. Anyone with the flu should seek medical attention for:
• Dehydration
• Trouble breathing
• Getting better, then suddenly getting a lot worse
• Any major change in condition

For more information, visit www.maineflu.gov. 

Birth Defects

January is National Birth Defects Prevention Month and this year’s theme is “Birth defects are common, costly, and critical.”

Every 4.5 minutes, a baby is born in the U.S. with a birth defect. Major birth defects are conditions present at birth that cause structural changes in one or more parts of the body. They can have a serious adverse effect on health, development, or functional ability. Babies who survive and live with birth defects are at increased risk for developing many lifelong physical, cognitive, and social challenges. Medical care and support services only scrape the surface of the financial and emotional impact of living with birth defects.

Not all birth defects can be prevented, but a woman can increase her own chances of having a healthy baby by managing health conditions and adopting healthy behaviors before becoming pregnant. This is important because many birth defects happen very early during pregnancy, sometimes before a woman even knows she is pregnant. Here are some steps a woman can take to get ready for a healthy pregnancy:

• consume 400 micrograms of folic acid daily
• manage chronic maternal illnesses such as diabetes, seizure disorders, or phenylketonuria (PKU)
• reach and maintain a healthy weight
• talk to a health care provider about taking any medications, both prescription and over-the-counter
• avoid alcohol, smoking, and illicit drugs
• see a health care provider regularly
• avoid toxic substances at work or at home
• ensure protection against domestic violence
• know their family history and seek reproductive genetic counseling, if appropriate

For more information, visit http://go.usa.gov/Zd8w or http://go.usa.gov/Zd9x

America's Health Rankings

The United Health Foundation recently released its annual America's Health Rankings. The ranking system was revised this year (for more information, see "Impact of Model Changes" at http://www.americashealthrankings.org/About/Methodology). As a result of these changes, Maine's rank for 2012 was revised to 15 from 9.

In 2013, Maine was ranked 16th healthiest state in the nation.

These rankings are used to stimulate action by individuals, elected officials, medical professionals, public health professionals, employers, educators and communities to improve the health of the population of the U.S.

For more information, visit http://www.americashealthrankings.org/ME 

Prematurity Leadership Award

Maine CDC was honored by the National March of Dimes last month with the Franklin Delano Roosevelt Prematurity Leadership Award for decreasing the prematurity rate in the state from 9.9% in 2011 to 9.2%.  

Dr. Sheila Pinette, Director of Maine CDC, pledged in 2011 to work to meet the Association of State and Territorial Health Officials' Presidential challenge to try to decrease the preterm birth rate in our state by 8% by 2014 (goal is 9). 

This progress has been achieved through partnership and collaboration with more than 30 hospitals, insurance companies, and our strong perinatal/neonatal healthcare system in this state.

Maine delivers approximately 13,000 infants annually, with 1,030 born prior to 36 weeks gestation.  Of those, approximately 22.6% will go on to die in the first year due to complications of prematurity. Maine  has the fifth-lowest infant mortality rate in the nation. 

Maine CDC is honored to receive this award on behalf of our collaborative partnerships throughout the state. We still have much work to do, but together we can make a difference in the lives of Maine families.

Public Health Accreditation Update

Maine CDC submitted its Statement of Intent to apply for national Public Health Accreditation on Dec. 5. The Statement of Intent is the last official step before Maine CDC applies for Accreditation in early 2014. 

In November, Maine CDC's Accreditation Coordinator presented during a session titled Preparing for Accreditation: Readiness Review and Other Lessons from Maine at the American Public Health Association (APHA) annual conference. The presentation showcased efforts in Maine to build accreditation support, assess Maine CDC's readiness, and address specific gaps in performance through quality improvement efforts. 

To read more, go to   https://apha.confex.com/apha/141am/webprogram/Paper282264.html

Vigilant Guard

Maine CDC staff recently participated in a five-day full-scale disaster response exercise. The Vigilant Guard exercise began with a briefing to the Initial Response Team on Monday, Nov. 5, and concluded on Friday, Nov. 8.

Vigilant Guard is a national-level exercise conducted four times a year by the National Guard Bureau and the United States Northern Command in conjunction with civilian first responders and local governments around the United States. This year, Maine was chosen to participate in Vigilant Guard. The response to participate from Maine's emergency preparedness and health care communities was impressive. Maine CDC participated along with multitude of partners including the Maine Emergency Management Agency, local EMA, Regional Resource Centers, physicians and hospitals, EMS, Civil Air Patrol, National Guard, hospitals, police, and fire departments. Federal partners from FEMA and US CDC as well as partners from other states and Canada participated as well.

Maine CDC's Public Health Emergency Preparedness team has been planning this exercise with our health care partners for well over a year to test our response capabilities and identify any gaps in those capabilities. The exercise scenario was developed in collaboration with Maine CDC's Infectious Disease and Medical Epidemiology programs in order to develop a plausible and realistic scenario that would push our response capabilities to the breaking point.

The exercise scenario involved an intentional release of anthrax, which allowed us to test our request process with US CDC regarding receiving assets from the Strategic National Stockpile. We also tested the delivery, receipt, and distribution of medical countermeasures to closed and open Points of Dispensing (PODs) statewide. In addition to responding to the anthrax scenario, the Public Health Emergency Operations Center (PHEOC) also provided support to health care facilities for numerous simulated mass casualties, hazardous materials incidents, major blizzards, freezing temperatures, and significant power outages statewide.

The Public Health Emergency Preparedness staff would like to thank everyone who helped us plan for this exercise as well as those staff members who placed their regular work duties on hold in order to staff the PHEOC during the exercise. We could not have done it without your help!

National Diabetes Awareness Month

November is National Diabetes Awareness Month.

You have the power to help prevent and control diabetes. If you already have diabetes, work to lower your risk of serious complications. If you don't have diabetes, learn if you are at high risk for developing type 2 diabetes. You may also find out more about the National Diabetes Prevention Program by visiting http://go.usa.gov/W26W. You can take the Pre-Diabetes Risk Quiz, find a Lifestyle Change program near you, or learn more about how you can support family and friends in their prevention of type 2 diabetes. US CDC also has a special feature about diabetes available at http://go.usa.gov/W26R

This year the National Diabetes Education Program is focusing on the theme, “Diabetes is a family affair.” Diabetes is a challenging disease that affects the entire family in many ways. If you are living with diabetes or have a loved one with the disease, family support is very important when it comes to managing diabetes and preventing serious health problems. It's also important to know that if you have a family history of diabetes, such as a mother, father, brother, or sister, you are at higher risk for developing type 2 diabetes.

For more information go to: http://go.usa.gov/W26C

Maine CDC’s Diabetes Prevention and Control Program focuses on promoting excellence in diabetes care; increasing access to care; promoting and supporting diabetes self-management education; preventing and reducing diabetes risk factors; and eliminating disparities related to diabetes prevention and control.

For more information visit: http://go.usa.gov/W26d

Flu update 10/30/13

Maine CDC issued a health alert about the beginning of flu season in Maine on Oct. 28. The health alert is available at: http://go.usa.gov/W2jz

Maine reported sporadic flu activity for the week ending Oct. 26. Weekly updates are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

Prevention and Treatment

Take everyday preventive measures against the flu:

• Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
• Avoid touching your nose, mouth, and eyes. Germs can spread this way.
• Get vaccinated against the flu. To find locations where vaccine is available, contact your health care provider or pharmacy, call 211, or visit www.211maine.org or www.flu.gov
• Consult your health care provider about getting a pneumococcal vaccine for anyone who is younger than 5, between ages 5 and 64 with high risk conditions, or age 65 and older.
• Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.

If you have the flu:

• Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
• Cough and sneeze into your elbow or into a tissue. Throw the tissue away.
• Although most people can stay home to recover without seeing a health care provider, it is possible for healthy people to develop severe illness from the flu. Anyone with the flu should seek medical attention for:
• Dehydration
• Trouble breathing
• Getting better, then suddenly getting a lot worse
• Any major change in condition

Guidance

US CDC has published a summary of the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2013-2014 flu season at http://go.usa.gov/jdfB

US CDC has an influenza app for clinicians and health care providers to make it easy to access the latest guidelines and information. For more information about the app, go to http://go.usa.gov/43nR

The Vaccine Information Statements (VIS) for this coming season’s vaccines are available at http://go.usa.gov/jdAC

For more information, visit www.maineflu.gov.

Hepatitis A outbreak and response

Maine CDC’s Infectious Disease Epidemiology Program recently investigated a case of hepatitis A virus (HAV) infection that was traced to a community event in Durham. A person infected with HAV prepared and served food at a church supper attended by about 100 people.

When administered within two weeks of exposure to hepatitis A, vaccination is very effective in preventing illness. Representatives from Maine CDC’s Public Health Nursing (PHN) Program, Infectious Disease Epidemiology Program, and Maine Immunization Program collaborated to plan and execute a free, public hepatitis A vaccine clinic.

The Maine Immunization Program procured the vaccine and assisted in the clinic logistics, including answering questions about the vaccine and other doses needed. Five public health nurses and the PHN supervisor participated in the clinic, administering vaccine to 52 adults and six children.

For more information about the initial investigation and response, see the press release at http://go.usa.gov/Dz4F

For more information about prophylaxis and treatment, see the health alert at http://go.usa.gov/Dz23

Gluten-free standardization on food labels

The Food and Drug Administration (FDA) has finalized the definition of the term “gluten-free” and is regulating its use on food labels. No longer can manufacturers simply label foods as “gluten-free” without following proper guidelines. The term "gluten" refers to proteins that occur naturally in wheat, rye, barley and cross-bred hybrids of these grains. In people with celiac disease, an autoimmune digestive condition, foods that contain gluten trigger production of antibodies that attack and damage the lining of the small intestine. Such damage limits the ability of celiac disease patients to absorb nutrients and puts them at risk of other very serious health problems, including nutritional deficiencies, osteoporosis, growth retardation, infertility, miscarriages, short stature, and intestinal cancers.

Here are the guidelines:

According to the FDA, the term “gluten-free” now refers to foods that are either inherently gluten-free or foods that do not contain any ingredient that is:

• A gluten-containing grain (e.g. spelt wheat)
• Derived from a gluten-containing grain that has not been processed to remove gluten (e.g. wheat flour)
• Derived from a gluten-containing grain that has been processed to remove gluten (e.g. wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food

Foods that contain an unavoidable bit of gluten must keep that presence to less than 20 ppm.

The guidelines are based on the smallest amount of gluten that can be detected using scientific analysis tools and are in line with the international bodies that set guidelines for food safety standards. Manufacturers have until Aug. 5, 2014, to comply with the rule. For more information, go to http://go.usa.gov/DHe2

Meaningful use

The American Reinvestment & Recovery Act of 2009 includes many measures to modernize our nation's infrastructure, one of which is the "Health Information Technology for Economic and Clinical Health (HITECH) Act." The HITECH Act supports the concept of meaningful use of electronic health records.

The Stage 2 measures for public health reporting state that an Eligible Hospital (EH) or Eligible Provider (EP) must register intent to submit ongoing submission of electronic data to the Public Health Authority (PHA) for the following types of reporting:

• Immunization Registries
• Syndromic Surveillance
• Reportable Lab Results
• Cancer Registries
• Specialized Registries

The EH or EP must register with the PHA within 60 days of the start of the organization’s EHR reporting period, if they plan on attesting for such public health reporting for that period. Once registered, the EH or EP is immediately considered to be engaged in ongoing submission to the PHA. However, to remain engaged in ongoing submission the EH or EP must do the following:

• Be ready to participate in the on-boarding process when the PHA is ready to engage.
• Respond to any PHA written requests for actions. Note: The EH or EP does not meet the measure if there is a failure to respond to two written requests within 30 days on two separate occasions.

For more information about meaningful use, visit http://go.usa.gov/DHhC. For Maine CDC’s Meaningful Use Stage 2 Registration page, go to http://go.usa.gov/DHS4.