An
Ounce of Prevention...
A Publication of the
Program on Prevention
In Education & Practice
January
2001 - Volume 1, Number 7
Rubella Cases Concentrated in North Carolina
According to the North Carolina Department of Health and Human Services, the number of rubella cases in 2000 was 152 nationwide*, with the most- 95 cases- occurring in the North Carolina counties of Forsyth, Alamance, Wake, Orange and Union. Rubella, which was almost completely eliminated in the US once the vaccine was developed in 1960, has resurfaced, particularly among the Latino population. Latinos accounted for more than 80% of the rubella cases statewide. Latinos often live in communal type settings which allows the disease to spread more easily. Also, many Latinos have immigrated to the US from Mexico and other Latin American countries that did not routinely vaccinate children for rubella until 1998. The real danger with Rubella is in passing it on to pregnant women, where it can cause severe birth defects, including deafness, cataracts, heart disease and mild retardation in babies. The NC Department of Health and Human Services points out that the number of NC cases may seem artificially inflated for several reasons. First, several states with a high Latino population and vast agricultural base do not aggressively track cases, unlike NC, which has an extremely effective surveillance system that aggressively looks for cases. Also, these numbers represent only confirmed or suspected cases. Many people with only a mild case may not be treated.
Despite these cautions, the state has planned a major public education effort to raise awareness about rubella among the Latino population. One step in this effort is to make rubella vaccinations free to all adults and children, all year round- rather than just to children and young women during an outbreak. Public health workers have found it easiest to improve vaccination rates among this group if they go to where people work and play. The most successful event thus far was at a Latino soccer tournament. The Health Department is expecting another season of high numbers of rubella cases, which starts in February and runs through the early fall.
* This number is as of
1/5/01 but will likely change due to lag time in reporting cases. MMWR. Jan.
5, 2001/vol.49/No. 51.
Frago C. N.C. Leads nation in rubella. Greensboro News and Record. 1/9/01.
Kinzie S. Immigrant spreads the word
about rubella among Latinos. News and Observer.
1/25/01.
Childhood Immunization Schedule for 2001
Each year, the CDC's Advisory Committee on Immunization Practices (ACIP) reviews the Childhood Immunization Schedule and recommends updates from the previous year. The 2001 Schedule has a couple of changes for this year. The ACIP along with the American Academy of Family Physicians and the American Academy of Pediatrics, has added pneumococcal conjugate vaccine to the schedule and has extended the recommendation for the use of hepatitis A vaccine to include persons through age 18 years in selected geographic areas and in certain high-risk groups.
Lessons from Russia's
Misfortune 
In our focus on health care problems, it is worthwhile to sometimes pause and think about what is right about the health of American citizens. This was brought home by recent reports from JAMA (Norton et al. 1998;279:793-800) and the New York Times (12/3/00 and 1/2/01) about declines in life expectancy in Russia.
We are used to reading each year that life expectancy at birth in the U.S. is getting longer. In 1999, life expectancy at birth in the U.S. was 74.1 years for a man (77.4 years in Japan) and 79.7 years for a woman (83.9 years in Japan). These numbers have been steadily rising for some 30 years. In Russia, life expectancy began a sharp decline in about 1990. The decline was greater for men than for women and primarily affected those from 25 to 64 years. In 1999, the life expectancy at birth was 59.9 years for a Russian male and 72.4 years for a Russian Woman. Thus, the U.S. male can expect to live more than 14 years longer than a male in Russia; a U.S. female can expect to live more than 7 years longer than a Russian female.
The chief causes of the decline in life expectancy in Russia are increases in homicide, suicide, alcohol-related deaths, and cardiovascular disease. In addition, HIV and tuberculosis are rapidly increasing, as are other vaccine-preventable infections such as polio and diphtheria. The death rate from cancer has shown little change.
There may be many underlying reasons for the decline in life expectancy in Russia. Among them are increasing poverty, joblessness, depression and cigarette and alcohol consumption. Another important factor may be the nearly total collapse of the Russian health care system. Clearly the political, social, and economic upheaval in Russia over the past decade has been associated with the decline in the health of the Russian people. The combination of social turbulence and lack of adequate health care is a particularly deadly combination.
Although the news from Russia may make us feel more positive about our own state of health, there may be lessons for us as well. There are still wide gaps in health status between socioeconomic groups in this country. Perhaps both social and health care changes should be involved in narrowing these gaps and improving the health of our own most unfortunate citizens.
We wish our Russian brothers and sisters well in turning their situation around. We would rather learn from their successes than from their failures.
Notzon FC, Komarov YM,
Ermanov SP, Sempos CT, Marks JS and Sempos EV. Causes of Declining Life Expectancy
in Russia. JAMA. 1998;279:793-800.
Wines M. An Ailing Russia Lives a Tough Life That's Getting Shorter. NYTimes.
12/3/00.
Editorial. Russia's Health Care Emergency. NY Times. 1/2/01.
Back Belts Offer No Relief from Back Pain and Injury
An estimated 10 to 15% of Americans experience back pain at any given time. Back pain is the number one problem facing the workforce in the United States today and it is the second most common cause of missed work days. "Work-related musculoskeletal disorders cost the economy an estimated $1.3 billion every year, and a substantial proportion of these are back injuries," said CDC Director Jeffrey P. Koplan, MD, MPH. Prevention of these injuries could not only save the economy a great deal of money but employees a great deal of agony related to back pain.
A recent study by the CDC's National Institute for Occupational Safety and Health (NIOSH) showed that back belts worn by workers in jobs that involved lifting and moving had no effect on reducing the incidence of back pain or injury. The study, which was conducted over a two-year period, compared employees who wore back belts with those who did not, or did so rarely, and found the following:
No statistically significant difference in rates of back injuries;
No statistically significant
difference in incidence of self-reported back pain;
No statistically significant
difference in the rate of back injury claims; and
A history of back injury was
strongest risk for predicting a back-injury claim or reported back pain.
The CDC plans to work closely with industry officials to get these findings out to workers.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Two UNC faculty members, Drs. Nortin Hadler and Tim Carey, responded to the article in an editorial stressing that preventing and treating back pain is a complicated problem in which psychological as well as physiological issues must be addressed. The way an individual adjusts to chronic back pain is very dependent on larger life issues and when life is challenging, coping with back pain is confounded and more memorable. Another confounding factor is when an individual's life stresses make life seem hopeless and therefore there is less motivation to adjust to the physical pain and get on with life. Drs. Hadler and Carey suggestion that the "challenge is to fashion employment that is comfortable when workers are well and accommodating when they are ill or incapacitated."
Wassell, JT; Garner LI;
Lansittel DP; Johnson JJ; Johnson JM. Prospective study of back belts for prevention
of back pain and injury. JAMA. 2000;284:2727-2732.
Hadler N and Carey T. Back belts in the workplace. JAMA (editorial). 2000;284:2780-2781.
No evidence that
back belts reduce injury seen in landmark study of retain users. CDC press release.
12/5/00.
Newsworthy
Notes 
Prevention News Around The Program...
Case-Based Learning Experience for First-Year Students
The Program on Prevention along with the Office of Educational Development recently held a two-day session for first-year medical students bringing together the basic sciences and clinical practice to solve a patient problem. This case-based problem solving session utilized some components of problem based learning in which students decide on learning issues and do individual research to answer the questions posed.
First-year students were presented a case of a woman concerned about her risk of breast cancer since her sister was diagnosed. Some of the learning issues included breast cancer risk factors, screening, genetic testing and chemoprevention with tamoxifen. After small-group analysis and discussion and individual investigation of these learning issues, the students regrouped and learned that the patient later was found to have breast cancer herself. Some of the learning issues involved in this second portion of the case included treatment options, surgery options and psychosocial implications of this diagnosis. Students once again worked with their groups and individually to investigate these learning issues. The session concluded with a panel of UNC physician experts in surgery, oncology, radiology, primary care and pathology who addressed the learning issues and answered student questions. At the end of the panel discussion, a breast cancer survivor shared her remarkable story with the students.
Student feedback from this session has been extremely positive and we are excited about the possibility of more case-based prevention-related learning opportunities.
Hidden Topics Days have Focus on Prevention
The "Hidden Topics" series (formerly Special Topics) is intended to give first-year medical students an introduction to topics that are critically important to physicians, but are sometimes neglected in the curriculum and in medical practice. These special days are meant to introduce and stimulate interest in such topics, so that students will be better prepared to deal with them as they arise later in their educational experience. Four days will be dedicated to the following topics:
January 26- Substance Abuse
February 1- Domestic Violence
February 6- Sexual Health
February 21- Health Issues in Geriatric Populations
The thread of prevention will run through all four days with each topic including a specific prevention focus. For example, during the substance abuse day, Dr. Kinsinger will give a brief presentation on patient-centered counseling and the 5A's for behavior change. The domestic violence seminar will emphasize the role of public education and advocacy. Students will learn about prevention as a means of decreasing risk of poor health outcomes, as related to sexual health. During the geriatrics seminar, Dr. Harris will discuss prevention, including screening, in the elderly.
TODAY- Student Research Day to Include Prevention-Related
Research Presentations
Student research day is a wonderful opportunity for students to share their research with the medical school community. Much of the research is making significant contributions to medial research. This event is dedicated to their accomplishments and contributions.
The Ralph R. Landes Lecture will kick off the day and be given by Nobel Laureate Joesph E. Murray, MD (Emeritus). Dr. Murray is Emeritus Professor of Surgery, Harvard Medical School, and Chief of Plastic Surgery at Brigham and Women's Hospital and at Children's Hospital Medical Center. Among Dr. Murray's many accomplishments includes performing the first successful human renal transplant in 1954. For his work discoveries in organ and cell transplantation in the treatment of human disease, he was awarded the Nobel Prize in Medicine in 1990. Dr. Murray will speak from 12:30-1:30 pm about the "Joy of Caring". From 2:00-5:30 students will be giving slide presentations and poster presentations and this year, several students will be speaking about prevention-related research.
Some of the prevention-related presentations
are listed below:
LaNelle Bortz (MS2)- Comparison of
cancer incidence between symptomatic and asymptomatic women undergoing screening
mammography
Molly P. Blackley (MS1)- A survey of the delivery of mammography services
in North Carolina
Ben Wilson (MS2)- Young adult preventive health care survey
Sophia M. Rothberger (MS2)- A latina's perspective: Hispanic women and
their barriers to STD healthcare
Around Campus...
From the Department of Surgery:
Think First
"Think First" is an award-winning National Brain and Spinal Cord Injury Prevention Program created in 1986 with a goal of educating young people about injury prevention. Target audiences include middle and high school students and students in grades one through three. The Neurosurgery Division began the UNC chapter in 1995. After spending some time organizing programs, training speakers and increasing public awareness, in-school presentations began at Orange County High School in 1997. In the let year the Program has reached 2,490 high school students and is having a tremendous impact on the safe behavior of teens. According to before and after surveys, students increased seat belt usage from 64 to 90% and increased bike helmet use from 70 to 85%. The percentage of students who rode with a driver who was impaired dropped from 36 to 4%.
Congratulations to the Neurosciences Division on a successful program! Keep up the great work! If you'd like further information, contact Susan Fairholm in the division of neurosurgery.
Safe Communities Coalition
The Trauma Outreach and Injury Prevention Program of the UNC Health Care System has received a three year grant totaling over $300,000 from the North Carolina's Governor's Highway Safety Program (GHSP) to implement a Safe Communities Coalition Chapter in Orange County. The coalition will target traffic safety issues in the County.
Trauma is the leading cause of death for persons between the ages of 1 and 44 years in the United States. It is the third leading cause of death overall in the U.S. making injury prevention a vital need in the community. Prevention is the key to reducing injury, disability or death from traumatic events.
The purpose of the Safe Communities Coalition is to organize community members (civic, political, special interest organizations and individuals) to collect and analyze trauma data for Orange County. Once the needs assessment is collected, 2-3 overall topics will be chosen and public campaigns will be developed and implemented in Orange County. Cities involved in the project are Chapel Hill, Carrboro, Hillsborough and Efland. Possible topics to consider are pedestrian safety, aggressive driving and alcohol-related crashes as well as a number of other issues of interest.
A local coalition of concerned community members will be critical for this project to have a major impact. If you are interested in being involved with the coalition, the first meeting will be February 21, 2001, 10:30am-12pm at the Hedrick Building. For more information please contact either Michele Ziglar or Linda Wiandt (Interim Coordinator, Orange County Safe Communities).
The Lighter Side of Things....
The story of creation you never heard......
In the beginning, God created the heavens and the Earth, and the Earth was without form, and void, and darkness was upon the face of the deep. And Satan said, "It doesn't get any better than this."
And God said, Let there be light," and there was light. And God said,"Let the earth bring forth grass, the herb yielding seed, and the fruit tree yielding fruit," and God saw that it was good. And Satan said, "There goes the neighborhood."
And God said, "Let us make Man in our image, after our likeness and let them have dominion over the fish of the sea, and over the fowl of the air, and over the cattle, and over all the Earth, and over every creeping thing that creepeth upon the Earth." And so God created Man in his own image: Male and Memale created he them. And God looked upon man and woman and saw that they were lean and fit. And Satan said, "I know how I can get back in this game."
And God populated the earth with broccoli and cauliflower and spinach, green and yellow vegetables of all kinds, so Man and Woman would live long and healthy lives. And Satan created fast food and brought forth the 99-cent double cheeseburger. And Satan said to Man, "You want fries with that?" And Man said, "Supersize them." And Man gained five pounds.
And God created the healthful yogurt, that Woman might keep her figure that man found so fair. And Satan brought forth chocolate. And Woman gained five pounds.
And God said, "Try my crispy fresh salad." And Satan brought forth Ben and Jerry's®. And Woman gained 10 pounds.
And God said, "I have sent thee heart-healthy vegetables and olive oil with which to cook them." And Satan brought forth chicken-fried steak so big it needed its own platter. And Man gained 10 pounds and his LDL cholesterol went through the roof.
And God brought forth running shoes, and Man resolved to lose those extra pounds. And Satan brought forth cable TV with remote control so Man would not have to toil to change channels between ESPN® and ESPN2®. And Man gained another 20 pounds.
And God said, "You're running up the score, Devil!" And God brought forth the potato, a vegetable naturally low in fat and brimming with nutrition. And Satan peeled off the healthful skin and sliced the starchy center into chips and deep-fat fried them. And he created sour cream dip also. And Man clutched his remote control and ate the potato chips swaddled in cholesterol. And Satan saw and said, "It is good." And Man went into cardiac arrest. And God sighed and created quadruple bypass surgery. And Satan created HMO's.
Around the World Wide Web...
People have more access to health care information than ever before. Not only do they hear about health news in the media but more and more individuals are looking to the WWW for information. Directing your patients to credible and reliable information is key. The Web can be a valuable resource for educational material for patients and providers alike if it is used wisely.
Heartpoint.com is an interesting site concerned with cardiovascular health concerns.
The site is graphically pleasing and offers links to patient information on
a variety of heart-related disorders, risk factors and drug therapies.
http://www.heartpoint.com/gallery.html
The start of a new year brings many resolutions of
weight loss and healthier living. The NIH Aim for a Healthy Weight obesity education
initiative offers weight loss information for both the physician and patient.
Among the features at this site are a list of key recommendations, a risk assessment
tool, and a list of resources to help patients control their weight. Other resources
include physical activity recommendations and meal planning help with recipes,
diaries and menus.
http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm
Look for our next edition
of "An
Ounce of Prevention" in March,
2001.
If you have comments or questions
about this newsletter or its contents, please e-mail alward@med.unc.edu.
Program Co-Directors:
Russ Harris, MD, MPH and Linda Kinsinger, MD, MPH
Education Coordinator
& Editor: Amy L. Ward
Go to the Program on Prevention Homepage