Archive
Near-Roadway Pollution and Childhood Asthma: Implications for Developing “Win-Win” Compact Urban Development and Clean Vehicle Strategies
Source: Environmental Health Perspectives
Background: The emerging consensus that exposure to near-roadway traffic-related pollution causes asthma has implications for compact urban development policies designed to reduce driving and greenhouse gases.
Objectives: We estimated the current burden of childhood asthma-related disease attributable to near-roadway and regional air pollution in Los Angeles County (LAC) and the potential health impact of regional pollution reduction associated with changes in population along major traffic corridors.
Methods: The burden of asthma attributable to the dual effects of near-roadway and regional air pollution was estimated, using nitrogen dioxide and ozone as markers of urban combustion-related and secondary oxidant pollution, respectively. We also estimated the impact of alternative scenarios that assumed a 20% reduction in regional pollution in combination with a 3.6% reduction or 3.6% increase in the proportion of the total population living near major roads, a proxy for near-roadway exposure.
Results: We estimated that 27,100 cases of childhood asthma (8% of total) in LAC were at
least partly attributable to pollution associated with residential location within 75m of a major
road. As a result, a substantial proportion of asthma-related morbidity is a consequence of nearroadway
pollution, even if symptoms are triggered by other factors. Benefits resulting from a
20% regional pollution reduction varied markedly depending on the associated change in nearroadway
proximity.
Conclusions: Our findings suggest that there are large and previously unappreciated public health consequences of air pollution in LAC and probably in other metropolitan areas with dense traffic corridors. To maximize health benefits, compact urban development strategies should be coupled with policies to reduce near-roadway pollution exposure.
Evaluation of Consumer Understanding of Different Front-of-Package Nutrition Labels, 2010–2011
Evaluation of Consumer Understanding of Different Front-of-Package Nutrition Labels, 2010–2011
Source: Preventing Chronic Disease
Introduction
Governments throughout the world are using or considering various front-of-package (FOP) food labeling systems to provide nutrition information to consumers. Our web-based study tested consumer understanding of different FOP labeling systems.Methods
Adult participants (N = 480) were randomized to 1 of 5 groups to evaluate FOP labels: 1) no label; 2) multiple traffic light (MTL); 3) MTL plus daily caloric requirement icon (MTL+caloric intake); 4) traffic light with specific nutrients to limit based on food category (TL+SNL); or 5) the Choices logo. Total percentage correct quiz scores were created reflecting participants’ ability to select the healthier of 2 foods and estimate amounts of saturated fat, sugar, and sodium in foods. Participants also rated products on taste, healthfulness, and how likely they were to purchase the product. Quiz scores and product perceptions were compared with 1-way analysis of variance followed by post-hoc Tukey tests.Results
The MTL+caloric intake group (mean [standard deviation], 73.3% [6.9%]) and Choices group (72.5% [13.2%]) significantly outperformed the no label group (67.8% [10.3%]) and the TL+SNL group (65.8% [7.3%]) in selecting the more healthful product on the healthier product quiz. The MTL and MTL+caloric intake groups achieved average scores of more than 90% on the saturated fat, sugar, and sodium quizzes, which were significantly better than the no label and Choices group average scores, which were between 34% and 47%.Conclusion
An MTL+caloric intake label and the Choices symbol hold promise as FOP labeling systems and require further testing in different environments and population subgroups.
Household Preparedness for Public Health Emergencies — 14 States, 2006–2010
Household Preparedness for Public Health Emergencies — 14 States, 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Populations affected by disaster increase the demand on emergency response and public health systems and on acute care hospitals, often causing disruptions of services (1). Household preparedness measures, such as having a 3-day supply of food, water, and medication and a written household evacuation plan, can improve a population’s ability to cope with service disruption, decreasing the number of persons who might otherwise overwhelm emergency services and health-care systems (2). To estimate current levels of self-reported household preparedness by state and sociodemographic characteristics, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) survey data collected in 14 states during 2006–2010. The results of this analysis indicated that an estimated 94.8% of households had a working battery-operated flashlight, 89.7% had a 3-day supply of medications for everyone who required them, 82.9% had a 3-day supply of food, 77.7% had a working battery-operated radio, 53.6% had a 3-day supply of water, and 21.1% had a written evacuation plan. Non-English speaking and minority respondents, particularly Hispanics, were less likely to report household preparedness for an emergency or disaster, suggesting that more outreach activities should be directed toward these populations.
The Air That We Breathe: Addressing the Risks of Global Urbanization on Health
The Air That We Breathe: Addressing the Risks of Global Urbanization on Health
Source: PLoS Medicine
More than half of the world’s population now live in cities [1], and while urbanization has the potential to allow greater access to health care for all, huge discrepancies in how resources are allocated within cities result in major inequities in health [2]. Addressing these discrepancies and improving health require accurate assessment. To that point, earlier this month PLOS Medicine published a Policy Forum article by Jason Corburn and Alison Cohen that focused on the urbanizing planet and the need for health equity indicators to guide public health policy in cities and urban areas [2].
The major theme of Corburn and Cohen’s argument is that if societies are to ensure those living in the poorest urban slums have the same right to health as people living on the richest boulevards, health indicators must allow for the identification of where health inequities exist. For example, while indicators in Nairobi measure population access to communal toilet blocks, they give no information as to whether the toilet blocks are hygienic or safe to use and therefore mask inequity within the city. Such indicators, however, would have little value in cities like London or New York, which illustrates the need for context-specific measures.
Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review
Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review
Source: Annals of Internal Medicine
Background: The health benefits of organic foods are unclear.
Purpose: To review evidence comparing the health effects of organic and conventional foods.
Data Sources: MEDLINE (January 1966 to May 2011), EMBASE, CAB Direct, Agricola, TOXNET, Cochrane Library (January 1966 to May 2009), and bibliographies of retrieved articles.
Study Selection: English-language reports of comparisons of organically and conventionally grown food or of populations consuming these foods.
Data Extraction: 2 independent investigators extracted data on methods, health outcomes, and nutrient and contaminant levels.
Data Synthesis: 17 studies in humans and 223 studies of nutrient and contaminant levels in foods met inclusion criteria. Only 3 of the human studies examined clinical outcomes, finding no significant differences between populations by food type for allergic outcomes (eczema, wheeze, atopic sensitization) or symptomatic Campylobacter infection. Two studies reported significantly lower urinary pesticide levels among children consuming organic versus conventional diets, but studies of biomarker and nutrient levels in serum, urine, breast milk, and semen in adults did not identify clinically meaningful differences. All estimates of differences in nutrient and contaminant levels in foods were highly heterogeneous except for the estimate for phosphorus; phosphorus levels were significantly higher than in conventional produce, although this difference is not clinically significant. The risk for contamination with detectable pesticide residues was lower among organic than conventional produce (risk difference, 30% [CI, −37% to −23%]), but differences in risk for exceeding maximum allowed limits were small. Escherichia coli contamination risk did not differ between organic and conventional produce. Bacterial contamination of retail chicken and pork was common but unrelated to farming method. However, the risk for isolating bacteria resistant to 3 or more antibiotics was higher in conventional than in organic chicken and pork (risk difference, 33% [CI, 21% to 45%]).
Limitation: Studies were heterogeneous and limited in number, and publication bias may be present.
Conclusion: The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods. Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.
Environmental Inequality in Exposures to Airborne Particulate Matter Components in the United States
Environmental Inequality in Exposures to Airborne Particulate Matter Components in the United States
Source: Environmental Health Perspective
Background:
Growing evidence indicates that toxicity of fine particles (PM2.5) differs by chemical component. Exposure to components may differ by population.Objectives:
We investigated whether exposures to PM2.5 components differ by race/ethnicity, age, and socio-economic status (SES).Methods:
Long-term exposures (2000-2006) were estimated for 215 US census tracts for PM2.5 and 14 PM2.5 components. Population-weighted exposures were combined to generate overall estimated exposures by race/ethnicity, education, poverty status, employment, age, and earnings. Population characteristics for tracts with and without PM2.5 component monitors were compared.Results:
Larger disparities in estimated exposures were observed for components than for PM2.5 total mass. For race/ethnicity, whites generally had the lowest exposures. Non-Hispanic blacks had higher exposures than whites for 13 of the 14 components. Hispanics generally had the highest exposures (e.g., 152% higher than whites for chlorine, 94% higher for aluminum). Young persons (0-19yrs) had levels as high as or higher than other ages for all exposures except sulfate. Persons with lower SES had higher estimated exposures, with some exceptions. For example, a 10% increase in the proportion unemployed was associated with a 20.0% increase in vanadium and an 18.3% increase in elemental carbon. Census tracts with monitors had more non-Hispanic blacks, lower education and earnings, and higher unemployment and poverty than tracts without monitors.Conclusions:
Exposures to PM2.5 components differed by race/ethnicity, age, and SES. If some components are more toxic than others, certain populations are likely to suffer higher health burdens. Demographics differed between populations covered and not covered by monitors.
Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Pra ctices (ACIP) — United States, 2012–13 Influenza Season
Source: Morbidity and Mortality Weekly Report (CDC)
In 2010, the Advisory Committee on Immunization Practices (ACIP) first recommended annual influenza vaccination for all persons aged ≥6 months in the United States (1). Annual influenza vaccination of all persons aged ≥6 months continues to be recommended. This document 1) describes influenza vaccine virus strains included in the U.S. seasonal influenza vaccine for 2012–13; 2) provides guidance for the use of influenza vaccines during the 2012–13 season, including an updated vaccination schedule for children aged 6 months through 8 years and a description of available vaccine products and indications; 3) discusses febrile seizures associated with administration of influenza and 13-valent pneumococcal conjugate (PCV-13) vaccines; 4) provides vaccination recommendations for persons with a history of egg allergy; and 5) discusses the development of quadrivalent influenza vaccines for use in future influenza seasons. Information regarding issues related to influenza vaccination that are not addressed in this update is available in CDC’s Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010 and associated updates (1,2).
Evidence of Rabies Virus Exposure among Humans in the Peruvian Amazon
Evidence of Rabies Virus Exposure among Humans in the Peruvian Amazon
In May of 2010, two communities (Truenococha and Santa Marta) reported to be at risk of vampire bat depredation were surveyed in the Province Datem del Marañón in the Loreto Department of Perú. Risk factors for bat exposure included age less than or equal to 25 years and owning animals that had been bitten by bats. Rabies virus neutralizing antibodies (rVNAs) were detected in 11% (7 of 63) of human sera tested. Rabies virus ribonucleoprotein (RNP) immunoglobulin G (IgG) antibodies were detected in the sera of three individuals, two of whom were also seropositive for rVNA. Rabies virus RNP IgM antibodies were detected in one respondent with no evidence of rVNA or RNP IgG antibodies. Because one respondent with positive rVNA results reported prior vaccination and 86% (six of seven) of rVNA-positive respondents reported being bitten by bats, these data suggest nonfatal exposure of persons to rabies virus, which is likely associated with vampire bat depredation.
A Metric of Influential Spreading during Contagion Dynamics through the Air Transportation Network
A Metric of Influential Spreading during Contagion Dynamics through the Air Transportation Network
Source: PLoS ONE
The spread of infectious diseases at the global scale is mediated by long-range human travel. Our ability to predict the impact of an outbreak on human health requires understanding the spatiotemporal signature of early-time spreading from a specific location. Here, we show that network topology, geography, traffic structure and individual mobility patterns are all essential for accurate predictions of disease spreading. Specifically, we study contagion dynamics through the air transportation network by means of a stochastic agent-tracking model that accounts for the spatial distribution of airports, detailed air traffic and the correlated nature of mobility patterns and waiting-time distributions of individual agents. From the simulation results and the empirical air-travel data, we formulate a metric of influential spreading––the geographic spreading centrality––which accounts for spatial organization and the hierarchical structure of the network traffic, and provides an accurate measure of the early-time spreading power of individual nodes.
See: New Model of Disease Contagion Ranks US Airports in Terms of Their Spreading Influence (Science Daily)
Operational Templates and Guidance for EMS Mass Incident Deployment
Operational Templates and Guidance for EMS Mass Incident Deployment (PDF)
Source: U.S. Fire Administration
The Department of Homeland Security’s (DHS) U.S. Fire Administration (USFA), supported by the DHS Office of Health Affairs (OHA) and the National Emergency Medical Services Management Association (NEMSMA), announces the release of a new guide for Emergency Medical Services (EMS) providers: Operational Templates and Guidance for EMS Mass Care Incident Deployment (PDF, 1.5 Mb).
"This guide provides important information on preparing for events that can impact EMS preparedness and response in local departments," said U.S. Fire Administrator Ernest Mitchell. "The model policies and practices referenced in the guide will lead to a better prepared EMS deployment to mass care incidents."
The guide is intended to provide information to local-level EMS and fire departments on the development and enhancement of the organization and preparedness for mass care incidents, including natural and man-made disasters, large gathering and pandemic events, and other emergencies potentially resulting in large numbers of patients.
Designing Collaborative Networks
Designing Collaborative Networks
Source: IBM Center for the Business of Government
This report offers practical advice to public managers and political leaders who are addressing complex public challenges through multi-organizational networks. The use of collaborative networks of organizations has matured in the past decade. However, the developers of collaborative networks face political, organizational, and technological challenges in a world accustomed to the traditional, hierarchical approach to problem-solving and accountability.
Professors Fedorowicz and Sawyer draw on a six-year project which collected data on 266 collaborative networks of public safety organizations, such as law enforcement and first responders to emergencies. They found a great deal of diversity in these public safety networks. They also found, however, common patterns of issues. For example, most of the design issues surrounding public safety networks center on data security and access concerns of the various participants. The authors also found common principles for designing successful collaborative networks, and they believe that these design principles can be applied in policy arenas other than public safety.
One principle they present is the importance of leveraging the use of technology as a way to advance the work of a collaborative network. For example, to address the issue of data security and access, they recommend that those involved in designing a collaborative network “ensure that data custodianship remains with the data’s owners … the collaboration should be seen as providing a portal to data, not a warehouse for its storage.”
Much of their advice and recommendations come from the experience of people on the ground who have faced and solved knotty problems. As a result, we hope this report serves as a useful guide to federal managers as they develop collaborative networks to address challenges that reach across federal agency—and sometimes state, local, non-profit, and private sector—boundaries.
The Millennium Development Goals Report 2012
The Millennium Development Goals Report 2012 (PDF)
Source: United Nations
This year’s report on progress towards the Millennium Development Goals (MDGs) highlights several milestones. The target of reducing extreme poverty by half has been reached five years ahead of the 2015 deadline, as has the target of halving the proportion of people who lack dependable access to improved sources of drinking water. Conditions for more than 200 million people living in slums have been ameliorated—double the 2020 target. Primary school enrolment of girls equalled that of boys, and we have seen accelerating progress in reducing child and maternal mortality
These results represent a tremendous reduction in human suffering and are a clear validation of the approach embodied in the MDGs. But, they are not a reason to relax. Projections indicate that in 2015 more than 600 million people worldwide will still be using unimproved water sources, almost one billion will be living on an income of less than $1.25 per day, mothers will continue to die needlessly in childbirth, and children will suffer and die from preventable diseases. Hunger remains a global challenge, and ensuring that all children are able to complete primary education remains a fundamental, but unfulfilled, target that has an impact on all the other Goals. Lack of safe sanitation is hampering progress in health and nutrition, biodiversity loss continues apace, and greenhouse gas emissions continue to pose a major threat to people and ecosystems.
The goal of gender equality also remains unfulfilled, again with broad negative consequences, given that achieving the MDGs depends so much on women’s empowerment and equal access by women to education, work, health care and decision-making. We must also recognize the unevenness of progress within countries and regions, and the severe inequalities that exist among populations, especially between rural and urban areas.
Achieving the MDGs by 2015 is challenging but possible. Much depends on the fulfilment of MDG-8—the global partnership for development. The current economic crises besetting much of the developed world must not be allowed to decelerate or reverse the progress that has been made. Let us build on the successes we have achieved so far, and let us not relent until all the MDGs have been attained.
The Impact of Transnational “Big Food” Companies on the South: A View from Brazil
The Impact of Transnational “Big Food” Companies on the South: A View from Brazil
Source: PLoS ONE
Summary Points
- Traditional long-established food systems and dietary patterns are being displaced in Brazil and in other countries in the South (Africa, Asia, and Latin America) by ultra-processed products made by transnational food corporations (“Big Food” and “Big Snack”).
- This displacement increases the incidence of obesity and of major chronic diseases and affects public health and public goods by undermining culture, meals, the family, community life, local economies, and national identity.
- The penetration of transnational companies into Brazil has been rapid, but the tradition of shared and family meals remains strong and is likely to provide protection to national and regional food systems.
- The Brazilian government, under pressure from civil society organizations, has introduced legislation to protect and improve its traditional food system; by contrast, the governments of many industrialized countries have partly ceded their prime duty to protect public health to transnational companies.
- The experience of countries in the South that still retain traditional food systems provides a rational basis for policies that protect public health.
See: Brazil Has Laws That Protect Against ‘Big Food’ and ‘Big Snack’ (Science Daily)
Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010
Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Background:
Vital statistics data suggest that the opioid pain reliever (OPR) methadone is involved in one third of OPR-related overdose deaths, but it accounts for only a few percent of OPR prescriptions.Methods:
CDC analyzed rates of fatal methadone overdoses and sales nationally during 1999–2010 and rates of overdose death for methadone compared with rates for other major opioids in 13 states for 2009.Results:
Methadone overdose deaths and sales rates in the United States peaked in 2007. In 2010, methadone accounted for between 4.5% and 18.5% of the opioids distributed by state. Methadone was involved in 31.4% of OPR deaths in the 13 states. It accounted for 39.8% of single-drug OPR deaths. The overdose death rate for methadone was significantly greater than that for other OPR for multidrug and single-drug deaths.Conclusions:
Methadone remains a drug that contributes disproportionately to the excessive number of opioid pain reliever overdoses and associated medical and societal costs.Implications for Public Health Practice:
Health-care providers who choose to prescribe methadone should have substantial experience with its use and follow consensus guidelines for appropriate opioid prescribing. Providers should use methadone as an analgesic only for conditions where benefit outweighs risk to patients and society. Methadone and other extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis. For chronic noncancer pain, methadone should not be considered a drug of first choice by prescribers or insurers.
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Testing the Waters: A Guide to Water Quality at Vacation Beaches
Testing the Waters: A Guide to Water Quality at Vacation Beaches
Source: Natural Resources Defense Council
NRDC’s annual analysis of water quality and public notification data at coastal U.S. beaches found that the number of beach closing and advisory days in 2011 reached the third-highest level in the 22-year history of our report, totaling 23,481 days (a 3% decrease from 2010). More than two-thirds of closings and advisories were issued because bacteria levels in beachwater exceeded public health standards, indicating the presence of human or animal waste in the water. The portion of all monitoring samples that exceeded national recommended health standards for designated beach areas remained stable at 8% in 2011, compared with 8% in 2010 and 7% for the four previous years. In addition, the number of beaches monitored in 2011 increased slightly (2%) from a five-year low in 2010. The largest known source of pollution was stormwater runoff (47%, compared with 36% last year). The 2011 results confirm that our nation’s beaches continue to experience significant water pollution that puts swimmers and local economies at risk.
NRDC continues to push for improvements in beachwater quality standards and test methods. Most recently, the Environmental Protection Agency proposed an action that could leave the public inadequately protected if it is not strengthened—one establishing recommended standards for beach officials to use to keep people from being exposed to unsafe levels of disease-causing bacteria and viruses. While beachwater quality standards are critical, ultimately the most important long-term action is to adopt 21st-century solutions that address the sources of beachwater pollution, particularly stormwater runoff. The most important of these solutions remains incentivizing and implementing green infrastructure in our cities, such as green roofs, porous pavement, and street plantings, which stop rain where it falls. Green infrastructure effectively reduces the amount of runoff that makes its way into beachwater or triggers harmful sewage overflows, transforming potential beach pollution into a tremendous local water supply resource.
PLoS Medicine Series on Big Food
PLoS Medicine Series on Big Food
Source: PLoS Medicine
The PLoS Medicine series on Big Food aims to examine and stimulate debate about the activities and influence of the food industry in global health. We define “Big Food” as the multinational food and beverage industry with huge and concentrated market power. The series adopts a multi-disciplinary approach and includes critical perspectives from around the world. It represents one of first times such issues have been examined in the general medical literature.
The PLoS Medicine Editors begin the series with an editorial discussing the rationale and process of commissioning articles for the series. As they note, industry in health has long fascinated PLoS Medicine but the journal’s focus on Big Food is new. Food, unlike tobacco and drugs, is necessary to live and is central to health and disease. And yet the big multinational food companies control what people everywhere eat, resulting in a stark and sick irony: one billion people on the planet are hungry while two billion are obese or overweight. The guest editors, Marion Nestle and David Stuckler, then lay out a background to the role of Big Food in global health, and offer three competing views of how public health professionals can respond. Subsequent articles include: a comparison of soda companies’ corporate social responsibility campaigns with those of the tobacco industry; an analysis of the rapid rise of Big Food sales in developing countries; an essay on food sovereignty and who holds power over food; views from South America and Africa on the displacement of traditional diets by the incursion of multinational food companies; and a perspective arguing against an uncritical acceptance of the food industry in health.
Progress Made, but Some Handbags Still Pose Lead Threats
Progress Made, but Some Handbags Still Pose Lead Threats
Source: Center for Environmental Health
Testing this spring of nearly 300 handbags, purses, wallets and other accessories purchased from Bay Area outlets of leading national retailers found dozens of products still contain high levels of lead. As seen tonight on ABC World News with Diane Sawyer, the Center for Environmental Health (CEH) announced that independent lab tests it commissioned by the found high levels of lead in purses or wallets from Neiman Marcus, Bloomingdales, Nordstrom Rack, Forever 21, and many other retailers. Lead levels in the products range from nearly three times to more than 195 times higher than the level agreed to in a 2010 settlement between CEH and dozens of retailers, producers and distributors of the products.
…
Federal law limits lead in children’s products, but there is no federal standard for lead in adult handbags or wallets. In June 2010, CEH set a landmark industry standard by reaching legal agreements with more than 40 major retailers and vendors of handbags and other accessories sold in stores nationwide. The agreement called for no more than 300 ppm of lead in most materials used in handbags. CEH has since reached similar legal agreements with nearly 200 handbag producers, distributors and retailers.Since February, CEH has purchased and tested nearly 300 handbags, purses, wallets, and clutches from Bay Area outlets of major retailers and online retail outlets. Lead-tainted handbags or other accessories were found at 21 retailers. More than 300 parts per million (ppm) of lead were found in materials used in 43 products. Ten of the 43 products were found with materials containing lead levels in excess of 10,000 ppm; lab testing of one Tory Burch brand wallet from Neiman Marcus found 58,700 ppm of lead in, more than 195 times higher than the 300 ppm standard.
Lead exposure has been linked to higher rates of infertility in women, an increased risk of heart attacks, strokes, and high blood pressure, among other health problems. Scientists are increasingly concerned that there is no safe level of lead exposure, especially for pregnant women and young children. A recent study concluded that lead exposure during pregnancy could have "lasting and possibly permanent effects" on a child’s IQ, and another study showed that lead exposure during the first trimester (three month period), when some women are not even aware that they are pregnant, had the most pronounced effects on a child’s mental development. A 2009 study showed that chronic low-level lead exposures in young women could lead to impaired mental functioning as they age.
Rationale for Periodic Reporting on the Use of Selected Adult Clinical Preventive Services — United States
Rationale for Periodic Reporting on the Use of Selected Adult Clinical Preventive Services — United States
Source: Morbidity and Mortality Weekly Report (CDC)
This supplement introduces a CDC initiative to monitor and report periodically on the use of a set of selected clinical preventive services in the U.S. adult population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services has the potential to lead to substantial reductions in the burden of illness, death, and disability and to lower treatment costs. The majority of clinical preventive services are provided by the health-care sector, and public health agencies play important roles in helping to support increases in the use of these services (e.g., by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use). Recent health reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to enhance use of preventive services. This supplement provides baseline information on a set of selected clinical preventive services before implementation of these recent reforms and discusses opportunities to increase the use of such services. This information can help public health practitioners collaborate with other stakeholders that have key roles to play in improving public health (e.g., employers, health plans, health professionals, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders.
Focus on Community Resilience
Resilient communities prepare for, respond to, and recover from natural and man-made disasters. RAND has implemented and evaluated community resilience-building activities worldwide and identified opportunities to integrate governments with the nonprofit and for-profit sectors in public health and emergency preparedness, infrastructure protection, and development of economic recovery programs.
Office Space Bacterial Abundance and Diversity in Three Metropolitan Areas
People in developed countries spend approximately 90% of their lives indoors, yet we know little about the source and diversity of microbes in built environments. In this study, we combined culture-based cell counting and multiplexed pyrosequencing of environmental ribosomal RNA (rRNA) gene sequences to investigate office space bacterial diversity in three metropolitan areas. Five surfaces common to all offices were sampled using sterile double-tipped swabs, one tip for culturing and one for DNA extraction, in 30 different offices per city (90 offices, 450 total samples). 16S rRNA gene sequences were PCR amplified using bar-coded “universal” bacterial primers from 54 of the surfaces (18 per city) and pooled for pyrosequencing. A three-factorial Analysis of Variance (ANOVA) found significant differences in viable bacterial abundance between offices inhabited by men or women, among the various surface types, and among cities. Multiplex pyrosequencing identified more than 500 bacterial genera from 20 different bacterial divisions. The most abundant of these genera tended to be common inhabitants of human skin, nasal, oral or intestinal cavities. Other commonly occurring genera appeared to have environmental origins (e.g., soils). There were no significant differences in the bacterial diversity between offices inhabited by men or women or among surfaces, but the bacterial community diversity of the Tucson samples was clearly distinguishable from that of New York and San Francisco, which were indistinguishable. Overall, our comprehensive molecular analysis of office building microbial diversity shows the potential of these methods for studying patterns and origins of indoor bacterial contamination. “[H]umans move through a sea of microbial life that is seldom perceived except in the context of potential disease and decay.” – Feazel et al. (2009).
