Improving Childhood Nutrition One Breakfast at a Time

March 11, 2018 by

The United States Centers for Disease Control and Prevention (CDC) has highlighted the positive effects of school breakfast programs. The CDC has recognized nutritional benefits of “school meal programs” including the inclusion of more fruits and vegetables in meals, and the overall improvement of the nutritional components in meals. The CDC also has noted that school breakfast programs have been associated with improvements in academic performance measures, including “better attendance rates, fewer missed school days, and better test scores.”

The earliest form of the School Breakfast Program (SBP) was created in 1966 as a “pilot project,” and provided financial support for designated regions. During the following decade, the program itself underwent numerous revisions, and ultimately became a permanent program in 1975.

The United States Department of Agriculture (USDA) has published literature explaining not only the components of school breakfasts, but also providing educational material for both students and families to learn about nutrition.

In 2017, the School Nutrition Association (SNA) and the American Commodity Distribution Association (ACDA) drafted a joint letter of support for the expansion of resources to support school breakfast programs. In this letter, they noted that while the Healthy, Hunger-Free Kids Act of 2010 set guidelines for school breakfasts, it did not allocate additional resources to support SBPs. They therefore offered support for H.R. 3738, the Healthy Breakfasts Help Kids Learn Act of 2017 proposed by Representatives Jim McGovern and Rodney Davis, which would increase “commodity support” for school breakfast programs. This proposal is currently under review.

This resolution shows one approach by which legislators and organizations are working to support improvements in childhood nutrition. What can you do? Contact your school district to find out more information about your local school breakfast program, and other ways in which you can support initiatives to improve childhood nutrition.

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Jump In The Pool

March 11, 2018 by

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Health insurance. The topic is enough to make anyone anxious—and rightfully so. The United States’ health care system is the most expensive in the world, averaging $10,348 spent per person per year. With the linkage of health insurance to employment and no publically-financed universal option, Americans are fractured into smaller and smaller coverage pools.

As a result, employee health insurance benefits are a significant portion of health spending. The State of Maryland is no exception. In 2017, the State spent $1.6 billion on state employee health insurance benefits alone. As of 2016, Maryland pays $9,745 for each active state employee’s health insurance benefits.

The State must share the costs and risks. The larger the insurance pool, the greater the spread. Therefore, Maryland should expand its state employee health insurance pool as a means to lower employee benefit costs for public employers.

In fact, statutes already exist in the Maryland Code enabling consortium health insurance purchasing for county, local government, and select non-profit employees who opt into the state pool. However, this legislation has not been maximally leveraged to reduce healthcare costs since few entities have joined in. Furthermore, Maryland’s 100,000 public-school employees are currently in their own independent plans negotiated by the teachers’ unions. Legislation to include them as part of the state-wide insurance pool should be a priority.

By amending the law to include all 501(c)(3) non-profits, Maryland can take advantage of the its unique non-profit landscape. Over 260,000 Marylanders are employed by non-profits representing 11% of the state’s workforce. Of the 32,000 registered Maryland non-profits, half are estimated to employ 50 full-time staff or less. Because of their limited beneficiaries, these non-profits could benefit the most from opting into the state pool.

Maryland should expand its state employee health insurance pool as a means to lower employee benefit costs for public employers. To this end, stakeholders should adopt the following recommendations:

  • The General Assembly should amend Maryland Code to include all 501(c)(3) non-profit organizations
  • County and local governments should take advantage of existing statutes allowing consortium health insurance purchasing by the State
  • With enabling legislation, Maryland public school employees should opt into the State employee insurance pool

 

Glocality and harmful consumption of alcohol: The SDG target 3.5 and the Alto Tâmega and Barroso region

March 11, 2018 by

In 2015, the United Nations General Assembly approved the 17 Sustainable Development Goals (SDGs). One of the targets (3.5) of the SDG 3, underlined the importance of “Strengthen the prevention and treatment of substance abuse, including (…) harmful use of alcohol”.  However, several of the targets don’t apply to all the communities. While the epidemics of AIDS is a major concern in several communities, in others the harmful consumption of alcohol is a priority. Taking that into account, there is need to push forward the creation of local policies targeting alcohol abuse that are also related with global policies – the creation of glocal policies.

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Portugal isn’t an exception. According to the Institute for Health Metrics and Evaluation (IHME), alcohol is the major component that hinders the health development in Portugal. According to SICAD (General Directorate for Intervention on Addictive Behaviors and Dependencies), this harmful habit starts at young age, with almost 50% of the men aged 18 years old registering an episode of drunkenness in the previous 12 months.

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Since the majority of our behaviors are developed inside of our households and in our communities, it is important to tackle this problem locally. As an example, the Alto Tâmega and Barroso region has the third highest number of patients with the diagnose of Chronic Abuse of Alcohol in north of Portugal. According to the North Health Observatory, Chronic Liver disease and Cirrhosis are the principal specific cause of mortality that leads to potential years of life lost in this region – 396.3/1000000. Although this is a major health concern and the existence of Local and National Plans, there is the need to support the creation and funding of specific strategies developed by local health departments that target this problem.

By 2020, the Ministry of Health (MoH) should give more autonomy and funding for local diagonal health programs for the reduction of harmful consumption of alcohol. The national guidelines’ development to support these programs is essential. The MoH, the Directorate-General of Health and the SICAD should serve as advisers and monitors of the implementation of those strategies at local level, as the UN is to Portugal, at national level. The national agencies should support the implementation of international decisions by focusing on the local problems. Only by then, we will be able to achieve the SDGs and the reduction of alcohol consumption.

The Teen Mom Trend: Effective Sex Education

March 11, 2018 by

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In 2015, 22.3 of every 100 babies were born to women between the ages of 15-19 in the US. While this rate is gradually decreasing, teen pregnancy is still a serious issue for many reasons. Teen pregnancy and childbirth accounted for an estimated $9.4 billion in excess costs to United States taxpayers due to increased foster care, increased incarceration rates for children born to teen parents, and lost tax revenue due to lower educational achievement and lower income for teen mothers. Additionally, teen mothers have higher high school dropout rates; only 50% of teen mothers receive a high school diploma before the age of 22. This is in contrast to a rate of 90% for women who do not give birth during high school years. Furthermore, the children of teen parents are more likely to have lower educational achievement, have more health problems, be incarcerated, face unemployment, as well as continue the cycle and give birth as a teenager. Not only does this signify a serious economic burden on taxpayer money for healthcare, jails, foster care homes, and welfare, but it is also a serious public health issue.

Preventing teen pregnancy has wide support, as it is one of the CDC’s seven top priorities in public health. However, while agreement that teen pregnancy is a serious, widespread issue in the US, agreement on what to do about it is not. Because the issue of free birth control is complicated and would require years to pass as a bill in the federal government, implementing an educational policy that can be put to use much more quickly is the best option. A successful program would be adopted in all US public schools to increase awareness and promote safe sex practices in hopes that teen pregnancy rates reduce. The program will be made available to private schools, but as most private schools are religious there may be resistance –because concerns have been made that sex education should be the right and responsibility of the parents. Therefore, the public school sex education system will be the main target. School boards that may be hesitant to adopt a federally regulated sex ed curriculum, should be reminded that their main concern should be on lowering teen pregnancy and keeping girls in school. While sex education does exist in some public schools, it is difficult to regulate the curriculum and the education is focused primarily on abstinence. A new program should  be put in place to provide a more well rounded sexual education that is relatable and up to date on current teenage culture. This will help to increase the chances of teenagers receiving and internalizing the message of safe sex practices. Since 1997, the US government has spent billions of taxpayer dollars investing in abstinence only programs which have been “proven ineffective” and “censor or exclude important information” that could only help adolescents make better decisions about their own sexual health. In 2004, a report released by the US House of Representatives Committee on Government Reform showed that 80% of the most popular federally funded abstinence only education programs “use curricula that distort information…misrepresent risks of abortion, blur religion and science… and contain basic scientific errors.” Furthermore, 88% of youth participating in virginity pledges broke the pledge and had sex before marriage. This demonstrates the need to target the government to reform the sex education system in order to address the severe issues associated with the current sex education curriculum. Societal beliefs and practices have changed in regards to sex, especially amongst the younger generations. Abstinence is considered to be an outdated belief that teenagers most likely will not follow. On the other hand, studies on comprehensive sex education reveal significant effectiveness. Sex education programs funded by the National Campaign to End Teen and Unplanned Pregnancy lead to 40% delayed sexual initiation, 60% reduced unprotected sex and much more. Having a comprehensive sex education program that will include abstinence, but emphasize attainable and current safe sex practices is the only option that can be implemented quickly and has seen success amongst the target audience. Thus, a federally funded and regulated comprehensive sex education program would significantly reduce the rates of teen pregnancy, and thus reduce the burden on American taxpayers, as well as better the quality of life for teens and families across the country.  

Naloxone in every school is the new rule By: S.Blake

March 11, 2018 by

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According to the Centers for Disease and Control and Prevention, drug overdose deaths and opioid-involved deaths continue to increase in the United States. From 2000 to 2016, more than 600,000 people died from drug overdoses. Even more alarming is the fact that teen drug overdose deaths in the United States climbed 19% from 2014 to 2015, from 3.1 deaths per 100,000 teens to 3.7 per 100,000. These numbers involve teen ages 15 to 19 and were released by the National Center for Health Statistics.

Also, in 2015 the American Society of Addiction Medicine reported 276,000 adolescents were current nonmedical users of pain reliever, with 122,000 having an addiction to prescription pain relievers. In 2015, an estimated 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users.

In 2017, the General Assembly passed the Heroin and Opioid Education and CommunityAction Act of 2017, also known as the “Start Talking Maryland Act.” The Act requires county boards to establish policies for obtaining and storing overdose-reversing medications, including naloxone, and for school nurses, and other school staff to administer those medications if a student is reasonably believed to be experiencing an opioid overdose. This requirement went into effect July 1, 2017. Naloxone (Narcan) is a medication to prevent overdose by opioids. Because an opioid overdose can be fatal within minutes it is imperative to have over-dose reversal medications on-site as time is of the essence.

The producer of Narcan-ADAPT Pharma understands the crucial role that schools can play to change the course of the opioid overdose epidemic. ADAPT is committed to working with each State Department of Education and Health or individual school to help prepare schools for an opioid overdose emergency by providing NARCAN® Nasal Spray. ADAPT will provide access to 1 carton of NARCAN® Nasal Spray to high schools throughout the country.

As a registered nurse serving in the state of Maryland and former school nurse in two public school systems in the state of Maryland, I confidently support the “Start Talking Maryland Act.” I stand with the Maryland Board of Nursing, the National Association of School Nurses, the Maryland State Department Board of Education and ADAPT Pharma in the promotion of naloxone in schools across the state of Maryland and call on parents, educators and health professionals to support this life saving act as well by becoming aware of over-dose statistics, ensuring schools in their district are adhering to the “Start Talking Maryland Act” and educating others regarding the fatal preventable epidemic.

Drug Dependence in Pennsylvania: Regulating Opioid Prescribing Practices

March 11, 2018 by

graphic-drugabuse_xxThe Department of Health and Human Services (HHS) declared opioid addiction a public health emergency within theUnited States during 2017. Opioid-related overdose deaths have steadily climbed over the past decade with more than 40,000 deaths reported in 2016, five times that seen only a decade prior. The problem arose in the late 1990’s when the prescribing rate of opioid pain relievers increased, with little thought to the devastating effects it would have in leaving patients addicted and dependent on opioids, inciting the nationwide opioid epidemic we currently face.

Evidence from 2016 showed that Pennsylvania fell into the top 5 states with the highest rates of death due to drug overdose, with a rate of 37.9 per 100,000. The state should enact policy addressing opioid addiction. To implement rapid change, the length of time that opioid prescriptions are written for should be reduced to decrease potential of dependence. The prescription of opioids for an acute pain may lead to long term use, and the probability of long term use increases with the length of the initial prescription,4 with the probability spiking after the 3rd and 5th days, and then again on the 31st day. Many states have enacted legislation to change the way pain is being treated, to adopt alternate methods for pain control, set dosing limits, and most importantly, limit first time opioid prescriptions to a set number of days. Currently, Pennsylvania is set at 14 days limit of a first-time supply for an acute problem (excluding cancer care, palliative care and long-term use). Policies should focus on a reducing prescription length from 14 to 3- 5 days, to minimize risk of opioid dependence.

 

 

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In order to prevent the crisis in Pennsylvania from getting worse, it is crucial that state policy-makers collaborate with pharmaceutical companies, doctors, and patients to incorporate preventative solutions into drug-related policies and regulations. One way to address this is to reduce the number of days doctors can prescribe opioids to non-cancer and non- palliative patients from 2 weeks to 3-5 days in the coming year.

 

Covering a molecular targeting drug for lung cancer highlighted the problem of continuity of the universal public health insurance in Japan.

March 11, 2018 by

There has been a continuous discussion about the price of a new molecular targeting drug for lung cancer, which is the leading cause of cancer death in Japan. When the drug was introduced, the price was over $300,000 per person per year.

In Japan, the universal public health insurance has helped people access to good clinical practice without the need of patience. Through the system, people can receive medical examinations by paying thirty percent of the whole expense. Seniors over seventy-five years of age are to pay ten percent with a few exceptions. Furthermore, regardless of the entire cost, when a specific condition is satisfied, the maximum amount of money they should pay per year would be below $20,000 per year at most. The rest of the money is to be paid by insurers. The molecular targeting drug for lung cancer is no exception.

While this system is thought to contribute to building a society of longevity, some people are worried that it will finally face a crisis of existence in the near future, because of an increase in a burden of treatment cost resulted from an aging population and advance in medicine.

 With the price of the drug mentioned above, a doctor posed a problem that extremely costly medicines would affect the continuity of the universal public health insurance, and the mass media also picked up this issue. Although Pharmaceutical Manufacturers Association took an opposing position, a council of Ministry of Health, Labour and Welfare, which decided the price of medicines declared that drugs which met some criteria should be brought down the price. As a result, the cost of the prescription for lung cancer was reduced by half, and now an additional reduction in price is planned.      

In order to maintain our insurance system and prevent the bankruptcy, this countermeasure should be supported. However, the administration needs to consider not only a first-aid treatment but also how to maintain the insurance system from various angles regarding health continuously. 

Increasing Safety injection sites (SIS) in Montreal, Canada

March 11, 2018 by

Montreal is Canada’s second-most populated metropolis and like most cities in North America, it is struggling to fight an increasingly large opioid crisis. Safety injection sites (SIS) are centers in which drug users can inject intravenous drugs with sterile syringes under medical supervision. In addition to decreasing overdose deaths and the spread of HIV and hepatitis, they provide access to addiction treatment and medical care. In Vancouver, Canada, a SIS has existed since 2003 with beneficial outcomes.

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Heroin preparation by a man at a safety injection site in Vancouver, Canada (Darryl Dyck / THE CANADIAN PRESS)

In February 2017, three SIS were launched in Montreal, the first of their kind in Eastern Canada. Their launch has been reportedly successful. The federal Liberal government is giving its full support to the founding of SIS by passing legislation that facilitates the founding of SIS (Bill C-37). As of February 2017, the Federal Minister of Health is reviewing applications for multiple SIS in each major city in Canada including Montreal.

Montreal SIS have recently been launched, but these are not wide-reaching as of yet. There is resistance to SIS from community members who may believe that they will make their neighborhoods unsafe and encourage drug use. In one instance, parents of elementary school children in the Ville Marie neighborhood protested the launch of the SIS run by Spectre de Rue.

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If your area is establishing a local SIS, you might share these concerns. We want to stress that SIS encourage needle injection occuring in the facility instead of in local streets, alleys or public spaces, making your community safer. Furthermore, SIS provide a gateway to addiction and medical treatment. There is an on-duty nurse and counsellor present at each SIS for this purpose. Within a week of SIS opening in Montreal, many drug users visited the facility. The more drug users visit SIS, the fewer syringes are on the streets and the greater the chance that these people will have access to the services they need.
We understand your concern, but the opioid crisis does not just span a concentrated area of the city. It affects the community at large and can affect your children, neighbors, and friends. SIS are effective and make communities safer. There is an abundance of research demonstrating the beneficial effects of SIS programs in Canada, Europe, and Australia. SIS need your support to proliferate. Doing so will save more lives.

The Counter Argument: A Push for Over-the-Counter Naloxone

March 11, 2018 by

Drug overdoses account for the majority of deaths among individuals under 50, and two thirds of those overdoses are from opioids. Deaths from opioid medications outnumber deaths from automobile accidents, and are soon going to outnumber its peak in 1972. In response to the nearly universal elevating prevalence of overdoses, action must be taken.

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An immediate treatment of opiate overdose is Naloxone; an opiate antagonist that rapidly reverses the symptoms of opioid overdose. While it is not a controlled substance, it is a prescription medication that requires a physician to prescribe the medication prior to dispensing.

It’s readily apparent that naloxone saves lives, and in the state of Michigan, as with many other states, there is an emergency standing order from the chief medical executive to allow for pharmacists to distribute intranasal naloxone. Some pharmacy chains have even allowed for pharmacists to provide prescriptions for naloxone, but this is an unnecessary barrier to obtaining a life-saving medication with no risk of abuse.

The transition of naloxone to an over the counter medication would allow for wider distribution of the medication and increase probability of having the medication available in the time of necessity. Currently, the FDA is pushing for a broad access to naloxone, and broad access is supported as one of the CDC’s three pronged approach towards reducing opioid deaths.

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Despite the universal agreement that naloxone accessibility is an important means of harm reduction, and the aid of the FDA itself, there continues to be harmful barriers to life-saving medication and although states have taken it upon themselves to issue emergency standing orders, after two years, it remains a matter of critical importance that is deadlocked.

Expanding Aid To Eviction Prevention Programs

March 11, 2018 by

Over 500,000 people were experiencing homelessness in the United States on a single night in 2017, so for every 10,000 people, 17 were experiencing homelessness.

The best way to end homelessness is to prevent it.

Eviction is a leading cause of homelessness. Every year, 2.5 million people in the United States face eviction. Preventing these people from being evicted will help prevent homelessness. The main cause of eviction is nonpayment of the rent, and low-income families are mostly affected by it. Over half of poor renting families spend at least 50 percent of their income on housing; a quarter of them spend over 70 percent of their income on housing. This results in many of them being behind on their rent or not being able to consistently afford to pay the rent; leading to their eviction.

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image source: http://www.bostonglobe.com

Eviction Prevention Programs are programs funded by the federal government to provide housing and rent assistance to tenants with low/moderate income facing imminent eviction. They assist those who are behind on their rent and help with unpaid water bills, legal conflicts and other problems. Unfortunately, there is only a fraction of people who can be assisted because of the high demand and limited funds. Therefore, for these programs to have more impact and assist a larger number of people, it is critical for the government to expand funds allocated to them.

The national Housing Trust Fund (HTF), established under the Housing and Economic Recovery Act of 2008, is a new housing resource that focuses on building, rehabilitating, preserving, and operating rental housing for low-income people. $174 million in HTF dollars were allocated to states in 2016 and $219 million in 2017. Although it is a step forward, far more resources are needed.

Too many people are being evicted yearly; however, eviction prevention programs can only assist a fraction of them due to limited funds. It is hence essential for important stakeholders like the Continuum of Care Program, Emergency Solutions Grant Program, National Coalition for The Homeless and Federal Finance Housing Agency to work with the National Low Income Housing coalition and Housing Trust Fund Implementation and Policy Group to build congressional support to protect and expand HTF, as well as other funds for eviction prevention programs. Expanding these funds will help prevent evictions, which will ultimately help with homelessness prevention.