Author: Anthony Scott

Over the course of the last years the American Publif Health Association (APHA) has hosted a series of webinars on the impact of climate change and health. More specially, they have hosted a webinar on climate changes impact towards children. In this webinar, Annie Willis discusses the impact it had in her as a teenager, while Dr. Laura Anderko and Dr. Stephanie Chalupka discussed the specifics impacts on health and some options for responses.

First, Annie Willis discussed the impact that hurricane sandy had on her, as a 15 year old. While physically there were no changes to her health, mentally, she was devastated by the event. Not only did she have to eventually relocate to NYC, she also lost all of her resources, and had very little when she moved. Additionally, she had no one to relate to or communicate with in her new school. This presented a unique problem because people did not know the struggles she had been through, and even if they did, they could not relate. This lead to increased stress and anxiety for her future. This was an interesting discussion, because the mental health component of dealing with a natural disaster is commonly overlooked, especially in our youth.

Next, Dr. Anderko discussed the specific health concerns for children and dealing with climate change. First, she discussed the key differences between children and adults. Children consume more water, eat more food, and breath more air per pound of body mass than adults. Additionally, children are not fully developed, and therefore can not react as well to environmental stresses. Children also spend more time outdoors and are more exposed to environmental changes. In addition to increased temperatures, and rising waters, climate change has also caused an increase in vector borne diseases (zika, Lyme disease, etc.). These diseases can be specifically more lethal to children because of their lower immunity, and less efficiently functioning bodies. Another key increase is heat related deaths in the last decade, specially seen in football. With rising temperatures, practices are forced to be moved into different times to limit exposure to heat.

The last presenter for the webinar was Dr. Chalupka. She discussed the different options for responses to climate change for our youth. Obviously the best response would be stronger policies to require a major change in energy expenditure to limit the impact humans will continue to have on the degradation of the environment. However, some other options include building resiliency against climate change and the impact its effects will have. Education on food, water, and vector borne diseases and the impact they can have in children. Lastly, providing more psychosocial programs for children that are displaced by natural disasters.

Obviosuly, the youth of the world is important, as they will be the one’s to suffer the harsh consequences of global warming. Additionally, their health could be affected even more than that of adults,. While recent policies have taken a step backwards in regards to improvements in public policy, there are still many things that could be done to improve the future health of the children facing global warming,

Human trafficking is a growing problem both globally, as well as nationally throughout the United States. The Hospitals in Pursuit of Excellence has recognized this, and organized a webinar for health care providers on the key role they could play in fixing this problem. The presenters for this webinar included Roy Ahn, Associate Director of Public Health at the University of Chicago, Laura Krausa, System’s Director st catholic health initiatives, and Dr. Wendy Macias from Massachusetts General Hospital.

To best address this problem, it’s imprtortant to know what all constitutes human trafficking. It can be defined as any of the following: sexual slavery, forced labor, forced begging, debt bondage, child soilders, or forced marriages,  child soilders being the only one not seen in the United States. Approximately 21 million indisdviudsls are forced into labor trafficking alone globally as of 2016. Its difficult to tell exactly how many are in the United States, but in 2016, 26727 calls were made to the us trwfficking hotline.

So, how can healthcare providers make such an impact on this problem? Well, in the most recent study conducted in the survivors of human trafficking, 87.8% reported having an encounter with a healthcare provider while they were being trafficked, and it was unreported. To have such a high number seen by healthcare providers without being reported is astonishing. 63% of survivors seen were in emergency departments, of which it is estimated that only about 3% of providers have proper training on identifying those being trafficked. Primary care clinics saw about 22.5% of survivors, urgent clinics 21.4%, and planned parenthood at 29.6%. With all of these numbers in mind, it is clear that better education and planning need to take place in our healthcare systems.

While it may appear to be difficult to address such a hidden problem, there are many steps that could be taken in our hospitals and health  services to have an impact on this problem. First, is proper training. This includes training on positive indentifiers of those at risk, knowing the referral process for someone you suspect to be involved in human trafficking, and knowing the reporting guidelines. Next is having an impact on public policy. Many hospitals can push for policy changes, and they should always be advocating for positive change at the local, state and federal levels. Another slightly more obscure measure that can be taken is through contracting with outside organizations. All contracts should state that there is no child labor or trafficking involved. Most companies will probably not have a problem with this, but can lead to an increased awareness among different companies. Hospitals are also great resources for community initiatives, and should provide community education, develop partnerships, and push for government involvement. Hospitals can also invest responsibly. This can change corporate policies, and they can also focus on travel and hospitality settings, as these are the most common areas of human trafficking. Lastly, providing proper education through web based resources, printed resources, and clinical education will improve providers knowledge on the topic.

Human trafficking is a crime that has been committed across the globe for far too long. Our healthcare systems, as well as many other agencies need to take positive action in eliminating this problem from modern society,

LiveStories, a company that provides an integrated civic dats hub to health departments recently hosted a webinar on the growing opioid epidemic in the United States. The guest speakers for the webinar were Dr. Tina Kim, Cory Kendrick, and Jackie Pollard from LA County Public Health department, and Summit County health department in Ohio. It was interesting to see how this crisis is impacting different areas of the country, and what the public health departments are doing to combat the problem.

First,  Cory Kendrick and Jackie Pollard discussed the growth of opioid use in the summit county Ohio area. For this area specifically, there was a 400% increase in opioid overdose when fentanyl, and its derivatives such as carfentanyl, were introduced in the area. Jumping from 100 OD ER visits in June 2016 to over 400 visits in July 2016. But while this drastic increase just pushed the area over the edge, they discussed problems that have contributed over the last decade. First, the incorporation of pain as the “5th vital sign” for physicians. FDA approval of highly addictive pain killers, the intractable pain act of 1998, Medicare and Medicaid grading system, direct consuming advertising by pharmaceutical companies, and unregulated pain management clinics. With all of these factors contributing, Ohio has seen a 413% increase in OD death since 1999. Most recently, Ohio had 4050 OD deaths in 2016, 58.2% of which were caused by fentanyl or its derivatives.

With all of these stats in mind, it’s clear that this crisis is quickly becoming a major problem for many areas of the country. Additionally, many accidental overdoses have been reported throughout the United States by children, police, or any other bystander who just happens to touch the fentsnyl substance, Fentanyl is approximately 1000 times stronger than morphine, and carfentanyl is about 1000 times stronger than that, just touching the substance can cause absorption through the skin and lead to overdose in those who are not use to the substance. So what can be done to decrease the grip that opioids have on America? Ohio has taken many steps to address this. At the state level, they have increased penalties for trafficking fentanyl, restricted prescribing guidelines for physicians and emergency rooms (a person can only go 7 days without seeing a doctor for a refill on medication), strict licensing guidelines for pain management clinics, drug take back programs, approval of naloxone (narcan) friends, family, and law enforcement, and lastly mandatory school based opiate prevention program.

At the county level, summit county has also initiated specific initiatives to further combat the problem. Summit county has distributed over 40000 drug disposal bags to pharmacists, supplied naloxone to community jails and schools, created a task force to further advance the initiatives, expanded medication assisted treatment and residential treatment services, offers a syringe exchange program, and lastly stated a quick response team for overdoses specifically in the community.

After this discussion, Dr. Tins Kim discussed the opioid crisis in LA county, and the number were very interesting, while overdoses have steadily risen in LA county recently, it has it been as drastic as most areas in the country, However, the health department knows that it could rise st anytime, and has stated to take action to prevent a drastic rise. LA county has started a prescription drug coalition to prevent the problem from expanding, the coalition consists of nine action teams, with 6 priorities, that possess 10 key objectives. Objectives include decreasing use, changing policy to prevent an influx of prescription drugs, and nary other objectives that are similar to the actions taken in Ohio.

It is clear that this crisis is a serious problem, as the United States population consists of 5% of the world population, but 80% of the world opioid abuse and 99% of hydrocodone use, strong changes need to be made to effectively change the course of this crisis.

In a recent webinar hosted by Dialogue4Health, Dr Robert Wallace from the University of Iowa presented on the Health Effects of Cannabis and Cannabinoids, Cureent State of Evidence and Recommendations for Future Research. Dr. Wallace presented on a variety of topics including therapeutics, respiratory disease, injury and death, cancer, immunity, prenatal, psychosocial, mental health, and other outcomes. With the recent legalization of cannabis in several states throughout the United States, the body of evidence for marijuana has been able to expand greatly, and better studies have been able to be produced to show its effects. This discussion is important for discussing the use of cannabis in states that are still attempting to prevent legalization.

With regards to therapeutic use of cannabis, or medical marijuana as is commonly used in the media, the systematic review showed moderate evidence in helping patients experiencing nausea from chemotherapy, reducing pain in patients with chronic pain, and decreasing self reported spasticity symptoms in patients with multiple sclerosis. It was also noted that all of these areas showed modest effects. However, it was noted that there were better options for some of these conditions. New studies that have been published since this review was released in 2016 have also shown some effects in children and adults with seizures, tremors, and adults with Parkinson’s, but a larger body of evidence needs to be produced before making a recommendation on those conditions.

As for the potential side effects, no evidence was shown to support the belief that cannabis smoking will lead to respiratory disease, COPD, or asthma. However there was substantial evidence with long term smoking and worse respiratory symptoms and chronic bronchitis. For cancer, there was moderate evidence of no statistical association between cannabis use and lung, head, neck, cervical, prostrate, penile, bladder, esophageal, lymphoma, anal, or liver cancers. With regards to injury and death, cannabis use before driving has shown to significantly increase the risk of causing a motor vehicle accident. It is unclear if it is associated with all cause mortality or occupational injury. No evidence was reported for immunity outcomes. For woman who are pregnant, moderate evidence was reported for lower weight birth in children whose mothers smoked cannabis during pregnancy. All other pregnancy related outcomes were unclear.

Psychosocial outcomes demonstrated that within 24 hours of using cannabis, there was a significant decrease in learning, memory, and attention. In addition, a limited number of studies showed long term decrease in all outcome after cessation of smoking cannabis.  Those who smoked cannabis long term were also substantially more likely to develop schizophrenia and other psychoses.

Dr. Wallace discussed that all of these outcomes do not necessarily prove or disprove any causation, but rather can guide research kn which outcomes may be more affected by cannabis use. As the prevelance of cannabis use continues to grow, more research studies will be able to be conducted and better recommendations can be made on its use. Based on this body of evidence that is available, it is difficult to see why cannabis use should be continued to be outlawed, at least for therapeutic purposes in all states. There is moderate evidence of its use for medicinal purposes, with low risk for most of the outcomes that were discussed. It will be interesting to see how this field continues to expand over the course of the next decade, and what uses it may develop.

In a recent webinar hosted by Action for Healthy Kids, the topic of school breakfast and having breakfast after the school day has started was brought up for discussion. But why is this an important discussion? Well, because there are currently some problems with the way the public school systems breakfast programs currently operate. Some of these problems include lack of space (not enough room in cafeteria for entire school, at once), timing is another problem (students need to arrive well before the bell to get breakfast), competining activities such as talking with their friends, and the negative stigma that only the poor kids eat breakfast at the school. With all of these aspects in mind, it is important to have an open discussion about the changes that could and should potentially be made.

So, what options are there for school corporations to look into? Some options include breakfast in the classroom, second chance breakfast, and grab n’ go breakfast. Breakfast in the classroom would obviously be after the bell in class, second chance breakfast would be mid morning and in between classes, and grab n’ breakfast would be set up throughout the school for students to get in their way to class. All of these options could work effectively, depending on each individual school system.

I’m sure interested in the potential pros and cons of having breakfast after the bell. In the webinar they discussed each. The pros of having breakfast after the bell include increased classroom participation, eliminating the stigma, increases academic performance, increase in school attendance, decrease in tardiness, and improved behavior. Other studies have also noted that schools with breakfast after the bell had decreased the number of nurse visits from previous years. But what potential cons could we see? Decrease in productivity? Actually most teachers found an increase in student productivity. The only true cons discussed were the logistics of making this transition, such as getting all the faculty on board, and working on proper waste disposal from classrooms.

How do we know this can work? This webinar brought in Jessica Sankey, Wellness Director of Bellingham School District in Washington. This district had 11 schools in the district, and the average school had over a third of its students on free or reduced meals including breakfast.  One school in particular had 80% of its students one free or reduced meals. The interesting statistic about this school in particular, was that only 43% of its students were taking advantage of the free breakfast, which they offered to all students regardless of meal price status. To address this, the school switched to breakfast in the classroom. They now have 100% participation, higher attendance and better test scores than previous years. The entire district is currently in the process of changing over.

Based on the case study discussed, it is clear that breakfast in the classroom can offer some serious benefits for students. Further research should be conducted at different schools and in different areas of the country to determine if it is a truly effective way of improving schools in America.

In a recent webinar from the American Society of Nutrition, Dr. Maret Traber and Dr. Joan M. Cook-Mills discussed the importance of meeting the ERA for vitamin E in expecting mothers and infants; specifically the a-tocopherol instead of g-tocopherol. In today’s society, we have some of the most advanced medical for people throughout the world, and new practices with pre-natal care that have shown to greatly help influence embryo development. However, even with all of these new practices and advancements, the current miscarriage rate amount women in the United States is over 20%. Currently, only about 4% of women meet the RDA for vitamin E, and 96% fall below the RDA of 15 mg a day.

So what role does vitamin E play in the development of the embryo and through the early stages of development, specifically to the brain? Vitamin e is a fat soluble antioxidant, meaning that it breaks down free radicals in the body, but not just any free radicals. This antioxidant breaks down a specific free radicals that can damage the brain and comes from a process known as lipid peroxidation.  Lipid peroxidation is the oxidative degradation of lipids, most commonly polyunsaturated fatty acids. In the process, free radicals “steal” electrons from the lipids in cell membranes, resulting in cell damage. Vitamin e, specifically a-tocopherol, block these free radicals from removing the electron from the cell membranes of these lipids and prevent cell damage.

You might be wondering how this matters, or if they can even tell that it has anything to do with embryonic development. However, Dr. Traber and Oregon State University conducted a study with zebra fish to examine the difference in embryo development in fish with a vitamin e sufficient diet compared to those with an insufficient vitamin e diet. Those fish who had a sufficient diet, had fully developed and normal functioning embryos. Those who were insufficient were not able to develop, specifically in the brain, and all fish had died after 5 days of birth. But how does this related to humans? Well upon examination of variations of vitamin e that was needed in a variety of species, all had the same core components, most specifically a-tocopherol.

Based on the current evidence paired with the lack of vitamin e intake in women, the speakers made some recommendations that could assist in improving vitamin e  supplementation. First, making sure that  an adequate amount of vitamin e is in pre natal vitamins. As for the diet during pregnancy, consuming more a-tocopherol and less g-tocopherol could be beneficial as g-tocopherol increases inflammation from allergic responses. Additionally, decrease the amount of N-6 fatty acids consumed as longer chain polyunsaturated fats increase the amount of free radicals produced, and increase the amount of N-3 fatty acids (omega-3) consumed as they are the shortest chains, and produce less free radicals. All of these recommendations could help improve the embryonic development and improve development in the early stages of childhood development.