Archive for the ‘Patient Education’ Category

Florida High Schools Initiative for Community Engagement (ICE)

August 20, 2017

At a time when interracial turmoil and ideological divides are at a boiling point, it is incumbent upon us to introduce our young people to an alternative to bigotry and violence. What better way to do this than provide a platform from which students can engage their communities through mutually transformative service projects?

We are proposing the implementation of a service-learning program that will be fully integrated into Florida’s high school curriculum – the Florida High Schools Initiative for Community Engagement (ICE). Students will be introduced to the skills of community engagement in the classroom and linked with organizations in the community with whom they can collaborate.

Central Florida Urban League 2

 

The evidence for the benefits of service-learning abound.  Other states have successfully adopted similar initiatives.  While currently there are no statewide community service requirements for high school students in Florida, aspects of the infrastructure for the initiative are already in place through the Florida Bright Futures Scholarship Program (BFSP), making Florida ripe for the roll-out of the initiative.

Important stakeholders include high school students, parents, The Florida School Boards Association, the Florida Department of Education (DOE), the Corporation for National and Community Service (CNCS) and local businesses that employ high school students. Students will be introduced to the program through student champions recruited from BFSP. Parents will be engaged through newsletters, parent-teacher conferences and special forums. A grant proposal submitted to CNCS will request funding and logistical support.

Central Florida Urban League 1

Florida AmeriCorps volunteer. AmeriCorps is one of many initiatives of  CNCS

What Can I do to support the Initiative?

We’re so glad you asked!

  1. Contact your local school board and let them know you support the ICE program!
  2. Call or email  the Florida DOE and tell them you support the initiative!

Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

A Questionable Solution to Maryland’s Opioid Crisis

March 11, 2017

In 2015, over 1,000 Marylanders died due to opioid-related overdoses. This week, in response to increasing opioid-related deaths, Senate Bill 868 will be heard. This bill increases the scope of the Overdose Response Program (ORP), which provides education and reduces overdose by certifying and training Marylanders to assist overdose victims.

The bill allows healthcare professionals to dispense naloxone to individuals without any of the previously required education. The intent is remove the barrier of attending an educational session for obtaining naloxone, with the hope of curbing the opioid-overdose epidemic.

While naloxone is not difficult to administer, an overdose cannot be treated by just administering naloxone once. Naloxone wears off quickly, and it is critical to call emergency medical services and understand how to initiate CPR. Allowing access to the drug without education may not improve outcomes, and may become a financial burden to those trying to help.

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Image Credit: The Harm Reduction Coalition

While the Department of Hygiene and Mental Health, the Institute for Emergency Medical Services System, and The American Pharmacists Association are invested in this bill, other associations have yet to make formal statements. The American Medical Association has a task force increasing access to naloxone, the American Society of Addiction Medicine, and the Substance Abuse and Mental Health Services Administration recommend and encourage individuals who carry naloxone to receive a comprehensive overdose-related education.

While the bill’s intention is noble, removing education is not the right way forward. There are other possibilities, including requiring healthcare professionals to provide a standardized pamphlet each time they provide or dispense naloxone – which would please all stakeholders.

Nelson Mandela said, “Education is the most powerful weapon which [we] can use to change the world.” In our attempt to save lives, Maryland should be cautious in skipping education.

The Global Gag Rule

March 11, 2017

The Mexico City Policy, introduced at the 1984 United Nations International Conference on Population, was an expansion of the 1973 Helms Amendment that restricted NGOs receiving US federal funds from providing abortions as a family planning method. This policy, commonly known as the Global Gag Rule (GGR), prevents NGOs from performing or promoting abortion as a condition of receiving US federal funds earmarked for family planning purposes. This controversial policy has been repealed or reinstated by Executive Order with each presidential administration since the 1990s.

The Trump Administration iteration of the GGR goes a step further and applies the same limits to all US global health funding.

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via NPR

Groups currently receiving US global health funds are either remaining quiet about the policy or speaking against it. Those rejecting the policy stand to lose millions of dollars typically allocated to sexual and reproductive health (SRH) services globally, which could result in the closure of clinics, decreased access to care, and the associated increases in unplanned pregnancies, unsafe abortions, and maternal mortality.

Organizations working in SRH not reliant on US funding are coming out in opposition to the policy, signaling to other organizations their resistance to limitations on free speech in the delivery of care. Despite not receiving funds, these organizations will be indirectly impacted by the GGR as women seek care in areas where access is limited as a result of the GGR.

In the face of the GGR, the international community has stepped forward, with governments pledging funds for SRH organizations in an effort to cover the loss of funds, services, and care resulting from the policy.

To continue to undermine the efficacy of the policy, international NGOs and governments should reject the Mexico City policy while advocating for women’s rights and health globally. The US government should follow the lead of other western nations, permanently block the GGR (and Helm’s Amendment)and fight for the quality of SRH services, rather than their existence.

Regulation of the food industry is needed to ensure healthier foods and healthier food choices – A new law regulating salt reduction of commonly consumed goods comes into effect 30 June 2016 in South Africa

August 19, 2016

Hypertension affects a significant proportion of the South African population with the 2010 National Household Survey reporting a measured hypertension prevalence of over 40% in adults aged ≥25 years. Today, South Africa continues to have one of the highest hypertension prevalence rates in the world.

Excessive salt intake can cause raised blood pressure known to be associated with non-communicable diseases like heart disease, stroke and renal disease. On average, South African’s are reported to consume double the daily recommended salt limit. In 2011, the South African Minister of Health declared to set targets to reduce the populations’ average salt intake to 5g/day per person by 2020 by implementing a public health campaign and regulating the food industry. On June 30, 2016 lower salt targets became mandatory by food producers with stricter targets to be achieved by 2019. Commonly consumed foods targeted include bread, cereals, margarines and butter, savoury snacks, potato crisps, processed meats, sausages, soup and gravy powders, instant noodles and stocks.

Recommended daily salt intakeSource: Salt Watch

The South African Association for Food Science and Technology (SAAFoST) advised in official comment to the proposed law that an educational campaign capable of changing the salt habits of consumers was needed if salt intake was to be successfully reduced. To assist the public to make healthier food choices more easily, healthier options need to be more easily recognized. Most food labels declare sodium/salt content by mass not allowing consumers to easily identify the salt level of products at a glance.

saltwatch

Source: Salt Watch – A tool to help consumers decide if a food is low, moderate or high in sodium by looking at the value in the nutritional information table on the product label

New food labelling regulations addressing this, formulated by the SAAFoST (as a representative on the Food Legislation Advisory Group (FLAG) contributing towards the formulation and revision of food regulations as published by the Department of Health), to be implemented by the food industry would empower the South African public to make healthier food choices more easily.

Why telemedicine is limited in Japan?

August 19, 2016

Telemedicine is getting more required in Japan because some people don’t see doctors just because they are busy or reluctant to take time or it is very difficult to see doctors for patients living in isolated islands and extremely local areas. If stable patients consult doctors on video, they may continue to take medications.  However, Medical Practitioners Act in Japan requires doctors see patients in person. Therefore, it has been believed that seeing patients on video and prescribing medications can be illegal.

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Ministry of Health, Labor and Welfare (MHLW) tried to promote telemedicine because they are thinking that without telemedicine, there will be people who don’t see doctors from any reason and get ill in the end. Last year, director general of Health Policy Bureau of MHLW announced that telemedicine is open even for first visit. The Government of Japan is also promoting innovation in healthcare industry. As a member of committee of Japan healthcare ICT, I presented how to spread teleconsulataion and data sharing in community health.

Japan Medical Association, which is a strong political power composed of general practitioners at once pressed to retreat this announcement because they are afraid of losing their patients. They are thinking that teleconsultation may destroy reliable and continuous relationship between general practitioners and patients.  Seven months after the first announcement, the director delivered the second announcement to prohibit telemedicine for first visit patients.

Some patients and doctors feel reluctant to the second announcement. Patients who are have limited  access to universal healthcare services such as living on isolated places need telemedicine. Innovative doctors wants to bring the technology and system in order to save more patients more effectively and less costly for patients. Japanese Telemedicine and Telecare Association (JTTA) is a professional organization which consists of doctors and academia to promote telemedicine.

I think we should elaborate how to introduce “healthy” telemedicine in Japan. JMA needs to be convinced to this policy. Now I am proposing to them positioning telemedicine the way to strengthen relationship between GPs and patients. The system can be used at outpatient and home care settings. It will motivate patients to see doctors, listen to their advice and take medications without drop out. It may also improve input from patients or caregivers.

Low HPV Vaccination Rates in Tennessee: A Call for Patient Education

August 18, 2016

The Gardasil Vaccine, which has been available to both boys and girls aged 9-26 in United States for years, is a three-shot series defensive against four strains of the Human Papilloma Virus (HPV), a sexually transmitted infection which can lead to anal warts, and vaginal, vulvar, cervical and anal cancers.  After vaccination, 50-90% of these conditions can be protected against, and since the initial release of the vaccine, rates of HPV among adolescent girls have fallen.

Despite the apparent benefits, less than 40% of American adolescents in 2014 had completed the vaccination series, with some states, such as Tennessee, experiencing rates of less than 30%. Public support for the vaccine has been given by the Tennessee Commissioner of Health, yet unlike the Centers for Disease Control, the vaccine does not appear on Tennessee’s current immunization schedule, even as a recommendation.

Tennessee is also a state noted not to require public education regarding the vaccine, but studies have shown that improved education can increase rates of vaccine uptake. If the Tennessee Department of Health (TN DOH) were able to fund it, an educational campaign to increase awareness of what HPV is and how Gardasil works could help boost the rate of vaccine series completion.  Other advocacy groups working in the state, such as Team Up TN, have already created and been distributing educational materials about HPV and the vaccine to families and healthcare providers; they could prove a useful resource to the TN DOH. Concurrently, it will be important to find sources of outdated or incorrect information that are circulating, especially from groups fighting against routine Gardasil administration, to better address specific concerns consumers may have. For families deterred by cost, information about the Vaccines for Children program will be imperative. The campaign, occurring via television and radio PSAs, as well as pamphlets in public schools and clinics, may be the start to raising HPV vaccine compliance rates within Tennessee.

The Agony of Ecstasy: Amend the Illicit Drug Anti-proliferation Act

March 4, 2016

By refusing to amend the Illicit Drug Anti-Proliferation Act, Congress continues to stand in the way of harm-reduction services as the number of drug-related deaths continues to mount in the night life and music communities.

What is the Illicit Drug Anti-Proliferation Act?

In 2003, the Illicit Drug Anti-Proliferation Act (Read the full text here.) was passed by Congress in an effort to combat deaths due to ‘club’ drugs, such as MDMA. This act states that organizers of an event where controlled substances are suspected to be present can be charged with a felony for contributing to drug use, punishable by up to 20 years imprisonment, a fine of up to $500,000, and can have their venue seized by law enforcement.

What are the effects of this act?

This act has proven to be ineffective as stories of deaths at music events due to drug use continue to emerge. The Drug Abuse Warning network recently reported that national ED visits due to MDMA toxicity increased 120% between 2004 and 2011 while levels of MDMA use have remained relatively constant.

ecstasy graph

Past Month Ecstasy Use among People Aged 12 or Older, by Age Group: Percentages, 2002-2014. Figure produced by 2014 Drug Use report sponsored by HHS
Source: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm

 

One victim of this act was 19 year-old Shelly Goldsmith, a student at the University of Virginia, who died of dehydration and heatstroke after consuming MDMA at a rave in Washington D.C. Shelley collapsed while attempting to make her way through the hot, crowded venue to the bar to buy a bottle of water.  The current act discourages venues from distributing free water to prevent heat stroke or any other harm-reduction services, else they face federal prosecution for suspicion of contributing to drug use.

shelley-biden01

Shelley Goldsmith died at 19 years old from heatstroke after ingesting MDMA at an Electronic Dance Music concert where no free water was available, is seen here posing with Vice President Joe Biden, who authored the Anti Illicit Drug Proliferation Act
Source: https://www.amendtheraveact.org/

Advocates such as Shelley’s mother, Dede Goldsmith, have spoken to Congress on the importance of harm reduction and educating the public on safe drug use.  Senator Tim Kaine has recently announced that he intends to propose an amendment to current law which will allow venues to provide harm-reduction services without bearing the risk of legal consequences.

Unfortunately, the bill is unlikely to easily pass. Most members of Congress are nervous about appearing ‘soft’ on drug policies and will need to be shown that harm-reduction is the will of the people and that passing this amendment will save lives.

What can we do to show Congress how important this amendment is?

  • Sign the Petition! Send Congress a message that the American people want to stop the unnecessary deaths: Petition: https://www.amendtheraveact.org/sign-the-petition/
  • Donate! The organization, ATRA (AmendTheRaveAct.org) creates and distributes campaign materials to educate the public on the harms caused by this amendment
  • Speak out! By explaining the benefit of harm reduction, and the differences between harm-reduction and the promotion of drug use, you can help turn the tide of public opinion against using an abstinence only strategy to reduce drug related-deaths.

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Mandatory sexual health education for foreign domestic workers in Singapore

August 14, 2015

Singapore, despite being a small country with 5.5 million persons, has approximately 222,500 foreign domestic workers (FDW),aidha-Part-1-Figure-11 commonly termed as maids, working in the country. This number is increasing with each passing year. These FDW are typically young females aged 21-50 that come from around the region – Phillippines, Malaysia, Sri Lanka, Indonesia and Myanmar. FDWs may function in different roles depending on each family’s needs, taking up roles such as domestic help, behaving as a caregiver for the elderly, or to look after the children as both parents are working full-time.

Increasing attention has been paid to and legislation introduced to protect the welfare of these FDWs, as they are at risk for exploitation or marginalization in society. A recent rule introduced by the Ministry of Manpower was an obligatory day off every week to ensure that they have adequate rest, prevent social isolation and avoid depression. However, while the well-intended goal of ensuring that FDWs get a day off each week is to prevent over-working, it introduces a new problem.

Many FDWs socialize during their off days and may occasionally engage in sexual behavior. maids-pregnancyThe standard employment  contract for FDWs includes a clause where they are not allowed to become pregnant or deliver any child in Singapore  during and after the validity of the work permit, failing which it will lead to their repatriation. Abortion under 24 weeks of  gestation is legal in Singapore. While illegal abortions are rare, the concern here is that FDWs may seek illegal abortive  methods that may put themselves in undue risk as they may not want to seek help through their employer due to the fear  of deportation. In addition, they may also be at risk of contracting a sexually transmitted disease. Even though the  employer is required by law to pay for their medical needs, the FDW may not highlight this to the employer for fear of  shame or termination of contract, leading to a loss in income. This can result in an advanced presentation of illness and  can be a potential for unchecked disease transmission.

As a society strives to become more egalitarian, rights and welfare of all persons need to be maintained. As employers become more accepting of a mandatory day-off each week for FDWs, it may be inevitable that FDWs may have sexual encounters on their day-off. The goal cannot possibly be to constrain them but instead to de-stigmatize the issue so that they will seek appropriate medical help or advice. Hence, we need to ensure that adequate sex education on contraception and sexually transmitted diseases are readily available to this often marginalized population. My position on this issue is that sexual health for FDWs can be improved through mandatory sexual health education. This can be achieved through working together with UNIFEM Singapore (Singapore National Committee for the United Nations Development Fund for Women), AWARE (Association for Women for Action and Research) and TWC2 (Transient Workers Count Too) to reach out to them the moment they arrive in the country. We need to ensure that FDWs are aware of contraceptive methods, the risk of sexually transmitted disease and what to do should they require help.

Not Free Anymore for Taipei City Ambulance? ——A Possible New Change

March 6, 2015

Emergency medical system (EMS) has always been the first-line help for citizens, particularly during emergencies, just like everyone knows ambulances are designed for people requiring immediate medical assistance. Instead of calling 9-1-1, people in Taiwan dial 1-1-9 while there’s an urgent medical condition, and the ambulance would come in minutes to transport the patient to medical facilities–free of charge. But problems exist because there’re individuals who tend to abuse the ambulance use, calling just for minor ailments even alcohol intoxication.
Emergency ambulance are NOT taxis.

Such calls have placed unnecessary burdens on EMS medical teams and affected the system’s providing service to those who are in genuine need. Although the whole Taipei City fire department is equipped with 78 ambulances and 200 ambulance corps members, there is an average of 400 emergency calls every day to handle. While there’s only one at most two ambulances in one precinct, if one ambulance is called out, the region would have to be supported by neighboring teams in the following one hour.
Taipei EMS Dispatches Statistics (Source: Taipei City Fire Department)

Taipei City government has long been considering implementation of charges for ambulance transportation on people who use the service for non-emergency conditions, a fee of NT$1,800 (about USD$60), including NT$800 for ambulance transport and NT$1,000 for the two accompanying paramedics, which is levied in accordance with the Emergency Medical Care Act. Yet it was not enforced except for some extreme cases until lately, the new Taipei City mayor has determined to extend the policy.

Based on the spirit of “users pay” and “leaving the resources to whoever in real need”, Dr. Wen-Je Ko—the current Taipei City mayor and also a former trauma surgeon as well as ER chief—believed that the charges should be applied on all patients that are not true emergencies, such as level 4 or 5 patients at ER triage. There are arguments and criticism from other sectors toward this policy, however, worrying the impact on the underprivileged or social vulnerable groups that could prevent them from seeking medical help. The city government promised that the measure would not affect people’s right to emergency medical services: the ambulance service would remain free if people call for real emergencies. Taipei City Fire Department has been working with Department of Health and the City EMS review committee, to organize and plan more comprehensive rules of ambulance charging, which are expected to be on the way recently.