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Educational Highlight
November is Here- Time to Immunize!!

It's November, time for looking at, raking, and playing in the changing leaves. Time for family and fancy thanksgiving dinners. Time for cool temperatures and warm fireplaces. Time for FLU SEASON! You surely don't want to risk all of the fun of the fall season, by getting a bad case of the flu. Did you know:

that influenza causes an average of 20,000 deaths per year? (1)
that a 1995 study revealed that healthy working adults (age 18-64) who received the influenza vaccine missed 43% fewer days of sick leave from work due to upper respiratory illness? (2)
that those receiving the influenza vaccine also had 44% fewer visits to physicians' offices for upper respiratory illness? (2)
that the same study showed a cost-savings of $46.85 per person who received their influenza vaccination? (2)

There are many reasons why people don't bother to get their yearly influenza vaccination. According to the MMWR, the most common reported reason for people not receiving the vaccine is that they didn't know that they needed it. Other top reasons included forgetting about it, thinking they would get the flu or side effects as a result of the vaccine, and not thinking it really worked to prevent the flu. (1)

Current recommendations for the influenza vaccination include:(3)
any person (over 6 months) who wishes to reduce the likelihood of getting influenza and doesn't have contraindications to the vaccine

all persons 65 years of age and over

all health care workers

people with certain medical conditions, such as:
      - nursing home residents
      - chronic pulmonary or cardiovascular disorders
      - chronic metabolic diseases, renal dysfunction, hemoglobinopathies or immunosuppression
      - pregnant women in 3rd trimester or at increased risk of influenza complications
      - HIV infected persons

travelers

community service workers

students in dormitories

So, make sure to receive your influenza vaccine before the virus gets to you first. If you're a health care provider please make sure to recommend the influenza vaccine to your patients during the coming month and dispel some of the myths that people hold about the vaccination. Let's do the best we can to make sure we all have a great fall!

(1)Reasons Reported by Medicare Beneficiaries for Not Receiving Influenza and Pneumococcal Vaccinations - United States, 1996. MMWR. 1999.
(2)Nichol K et al. The Effectiveness of Vaccination against Influenza in Healthy, Working Adults. NEJM. 1995;333:889-893.
(3)Give These People Influenza Vaccine! Immunization Action Coalition website at http://www.immunize.org/catg.d/2013.flu.htm

Program Highlights
Prevention "Course without Walls"

The beginning of another school year brings an opportunity to teach medical students about the importance of health promotion & disease prevention in medical practice. We recently kicked off the third year of the Prevention "Course without Walls" with new and updated modules added to the Prevention Syllabus. The syllabus was given to all first-year students their first week of school. The Prevention Syllabus uses a series of modules (chapters) to introduce students to the principles of screening, counseling, public education and advocacy and immunization prevention strategies. Following each of these is another module describing an example of the prevention strategy; for example a smoking cessation chapter follows the counseling module and a domestic violence chapter follows the public education and advocacy module. The domestic violence module was updated this year and the Principles of Immunization and Principles of Public Education & Advocacy are new additions to the syllabus. The syllabus is a work-in-progress; future modules will be added as they are completed. Several of the modules are being used in various places throughout the curriculum. Future plans include increased implementation of modules within the curriculum.

If would like a copy of the Prevention Syllabus, e-mail alward@med.unc.edu with your request.

Health Care & Prevention MPH Program

We are now into the third year of the Health Care & Prevention (HC&P) MPH Program. HC&P is an MPH program designed specifically for health care professionals and students who are interested in bringing together the individual and population health perspectives. HC&P can be completed in 12 months, is flexible and is tailored to fit the needs of the clinician.

This year's 30 HC&P participants include both UNC and Duke medical students as well as practicing physicians, residents, fellows and RWJ Clinical Scholars. We encourage interested medical students to apply for the HC&P program following the third year of medical school, so that they may be able to incorporate their learning into practice. The Program is gaining momentum as the number of applicants continues to grow each year. In the past two years, we have awarded a total of 16 MPH degrees from classes of 16 and 25 respectively.

Prevention in ACTion Student Interest Group

The Prevention in Action (PACT) Student Interest Group kicked off the first week of class with a meeting informing students about opportunities to be involved in prevention-related projects. There was an incredible amount of interest by MSI and MSII students. The first opportunity that students jumped in line for was the chance to go to migrant health clinics in Zebulon and Fuquay Varina to provide patient education sessions to migrant workers in the waiting room. In addition to the educational sessions, students may be involved in intake and patient care at the clinic if they wish to spend extra time. Examples of the patient education sessions included Hypertension/Diet, Depression, Green Tobacco Sickness/Pesticides and Fungal Infection/Dermatitis. Many students are bilingual in Spanish, but those that are not were provided translators from the SALSA group. All sessions were completed by the end of Sept, as migrant season came to an end. These clinics are coordinated by Wake County Health Services who have been very eager and cooperative in involving our students in their medical services.

Those students who have prevention interests in areas other than migrant health will have opportunities during the fall and winter months to be involved in other prevention activities. Ideas for these activities include working with other interests groups possibly in the areas of pregnancy prevention and domestic violence.

Co-presidents Rachel Reisner and Miriah Teeters (both MSII's) have been the guiding force behind the success of this group thus far. And special thanks to SALSA for providing translators.

Summer Prevention Education Program

Last summer threee upcoming MSII students spent 8-weeks working on various prevention projects here on the UNC-CH campus. Students were recruited, selected and funded through the Program on Prevention.

Lori Haigler-Purvis worked on the inpatient cardiology service at the lipid clinic with Terry Thomas, RN, MSN. Lori and Terri were looking at the current utilization of recommended cardiovascular risk reduction therapies among patients recently discharged from the hospital.

Kenyon Chavis worked at the Teen Clinic with Carol Ford, MD where he developed a confidentiality survey for adolescent patients as well as STD patient education information.

Kathy Wistar worked at the Substance Abuse Clinic with William Renn, MSW, CCSW, CSAO. Kathy's work involved implementing an outreach program to assess trauma patients about substance abuse issues. Kathy also took part in treatment programs and groups provided by the clinic.

The Program on Prevention funded the three students in order to provide students real-life practical experiences of "Prevention in Action". The project was sponsored by the Prevention in Action Student Interest group. We hope to provide opportunities for five students this coming summer.

More to come on these projects and others in the next issue of "An Ounce of Prevention" January 1st, 2000.
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
Editor: Amy L. Ward

Go to Program on Prevention Homepage