Month: August 2019

Oregon ends nearly 50-year participation in federal Title X program in response to Trump administration gag rule

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Malheur County Health Department is affected by the termination of Title X funding, but will continue to provide reproductive health services, including birth control, STI testing and treatment, at low to no cost with other funding. Call 541-889-7279 to schedule an appointment.

Published on Oregon Health Authority External Relations August 27, 2019

After the Oregon Health Authority declined to use federal dollars in the wake of new Trump administration rules that prevent health practitioners from discussing abortion with their patients, the federal Department of Health and Human Services directed Oregon to give up its Title X grant or face grant termination. In response, Oregon has no choice but to relinquish funding and end its Title X grant.

Health clinics that received Title X funding provide comprehensive reproductive health care that helps their patients plan the timing and size of their families, prevent unwanted pregnancies, diagnose and treat sexually transmitted infections and detect cancer. Last year Title X-funded clinics served 44,241 Oregonians.

Patrick Allen, director of the Oregon Health Authority, issued the following statement regarding the new federal gag rule and OHA’s decision to leave the Title X program:

Yesterday the Oregon Health Authority faced a deadline imposed by the federal government to withdraw from the Title X family planning program, or face termination for non-compliance. Last week Oregon informed the United States Department of Health and Human Services that we had suspended the use of the federal funds to avoid imposing the administration’s newly implemented gag rule on Oregon women. The federal government has rejected Oregon’s plan.

The new federal gag rule, which was not informed by evidence-based medical practice, bars health care providers from fully informing Oregon women about their most personal reproductive health choices and denies them access to a comprehensive range of health services. Oregon is the lead plaintiff, joined by 19 other states and the District of Columbia, as well as Planned Parenthood Federation of America and the American Medical Association, in a lawsuit challenging the Title X rule.

The federal deadline leaves Oregon no choice but to end our nearly 50-year participation in Title X and relinquish our grant. We cannot violate our own state laws that guarantee Oregon women full access to reproductive health services and prohibit any restriction on benefits, services or information regarding a woman’s right to choose to terminate a pregnancy.

Yesterday the Oregon Health Authority faced a deadline imposed by the federal government to withdraw from the Title X family planning program, or face termination for non-compliance. Last week Oregon informed the United States Department of Health and Human Services that we had suspended the use of the federal funds to avoid imposing the administration’s newly implemented gag rule on Oregon women. The federal government has rejected Oregon’s plan.

The new federal gag rule, which was not informed by evidence-based medical practice, bars health care providers from fully informing Oregon women about their most personal reproductive health choices and denies them access to a comprehensive range of health services. Oregon is the lead plaintiff, joined by 19 other states and the District of Columbia, as well as Planned Parenthood Federation of America and the American Medical Association, in a lawsuit challenging the Title X rule.

The federal deadline leaves Oregon no choice but to end our nearly 50-year participation in Title X and relinquish our grant. We cannot violate our own state laws that guarantee Oregon women full access to reproductive health services and prohibit any restriction on benefits, services or information regarding a woman’s right to choose to terminate a pregnancy.

Oregon stands in solidarity with other states in maintaining that the new Title X rule will reduce access to birth control, cancer screenings and reproductive choices. Oregon is fortunate to have funds available to continue offering comprehensive reproductive health care services. Every person in Oregon should know this federal action will not prevent health clinics and care providers from continuing to offer the full range of high-quality, personalized and trusted reproductive health services they have always delivered.

Vaping Sicknesses Rising: 153 Cases Reported in 16 States

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Sean Bills, a West Valley City, Utah resident, on life support in Jordan Valley Hospital. Bills’ family said he was admitted to the hospital Saturday after vaping gave him lipoid pneumonia. More on his story HERE.

Sixteen states have now reported 153 cases of serious, vaping-related respiratory illnesses in the past two months, and many of the patients are teenagers or young adults.

In a statement on Wednesday, the Centers for Disease Control and Prevention said that all of the cases occurred in people who acknowledged vaping either nicotine or tetrahydrocannabinol, known as THC, the high-inducing chemical in marijuana.

Federal and state officials say that they are mystified as to what is causing the illnesses, but that it does not appear that an infectious disease is responsible. No one product or device is common among the cases, the agency said. It also was unclear whether a contaminant in a used cartridge or a home-brewed concoction of vaping liquids contributed to some of the ailments.

The patients, most of whom were adolescents or young adults, were admitted to hospitals with difficulty breathing. Many also reported chest pain, vomiting and fatigue.

The most seriously ill patients had serious lung damage that required treatment with oxygen and days on a ventilator. Some are expected to have permanent lung damage. Some severe cases were earlier reported in Wisconsin, Minnesota, Illinois and California.

In an email, the C.D.C. said that while more study was needed, vaping either cannabis or nicotine could be dangerous.

“E-cigarettes are still fairly new, and scientists are still learning about their long-term health effects,” said Brian King, deputy director for research translation in the agency’s smoking and health office. “Adverse respiratory effects associated with e-cigarette use could be the result of a variety of factors, including intended and unintended constituents of these products.”

Mr. King said numerous ingredients in e-cigarette aerosol could harm the lungs, including ultrafine particles that could be inhaled deeply, heavy metals like lead, volatile organic compounds and cancer-causing agents.

The C.D.C. urged doctors to report suspected cases to their state health agencies. The Food and Drug Administration is also collecting information about illnesses related to e-cigarettes and vaping.

“Oftentimes people are vaping both nicotine and the THC products, so it’s unclear which may be responsible,” said Dr. Michael Lynch, medical director of the poison center at the University of Pittsburgh Medical Center. “Probably this has been happening occasionally and we haven’t been aware of it, because the association with vaping wasn’t necessarily made. Now people are on the lookout, which is good, because we want to make sure we have an understanding of how prevalent an issue this is.”

Article adapted from The New York Times. A version of this article appears in print on Aug. 21, 2019, Section A, Page 13 of the New York edition with the headline: More Youth Getting Sick From Vaping, C.D.C.

7 Things You Should Know About Bats and Rabies

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70% of Americans who die from rabies in the US were infected by bats – CDC Vital Signs. But bats are not bad! We need to know more to prevent infection and protect this species that protects us from other diseases.

As the weather warms up, adult bats come out of hibernation, baby bats are learning to fly, and humans get outdoors, which means a big increase in human-bat interactions compared to other times of year. Bats can be infected with rabies and can spread that infection to humans who have bare skin contact with bats or bat saliva. 

Oregon has 15 species of bats. Learn more about them at the Oregon Department of Fish & Wildlife. Bats are flying mammals that can reach speeds of 20 to 30 mph. Some of Oregon’s species migrate south in winter while some remain here and hibernate. Bats have ecolocation which allows them to make high-pitched sounds then listen to the echo of those sounds to locate where objects are. Echolocation helps them find even the smallest insect. 

Kate Cole from Public Health Insider compiled seven important things to know about bats and rabies. Please share this information with your friends, family, and children to make sure they know how to protect themselves from rabies in bats.

7. Bats are the main source of rabies in the United States. 

All mammals can get rabies, but in the United States, bats are the primary animal source of rabies. 

6. If you see a bat, do not touch it!! 

Any bare skin contact with a bat or its saliva, or waking up to a bat in your room, could put you at risk for exposure to rabies. Teach your kids not to touch bats, or any wild animal, and be sure to keep your pets away from bats. Talk to your family about the importance of respecting wildlife from a distance.  

5. If you think you or your children or pets may have touched or picked up a bat, take immediate action: 

  • Immediately wash the area that came into contact with the bat thoroughly with soap and water.  
  • Call your medical provider. If a person has been exposed to rabies, an injection of immune globulin and a series of rabies vaccinations need to be given as soon as possible to prevent infection and death. 
  • If you think you had contact with a bat, try to trap it! Trapping it means it can be tested for rabies and people potentially exposed can get the treatment they need. “How am I supposed to trap a bat?” you ask. Good news – there’s a how-to video.

4. Pets are at-risk for getting rabies from bats, too. 

Vaccinate your pets against rabies to protect them in case they are exposed. Talk to your veterinarian to see if your furry family members need to update their rabies vaccine.  

Keep your pet under direct supervision so they don’t come into contact with bats. If you suspect your pet has come into contact with a bat, call your veterinarian, even if your pet is up to date on its vaccinations. Your veterinarian may need to give it a booster shot to protect it! 

3. If you have problems with bats getting inside your house, you can do a lot to make your home more bat-proof. 

Putting screens on windows can prevent bats from accidentally flying into your home. Sometimes, bats are attracted to nesting in attics or inside a wall. The Washington State Department of Fish and Wildlife has excellent tips on easy things you can do to your home or building to prevent bats from getting inside. 

2. Most bats don’t have rabies. 

Although exact numbers are not known, it is estimated that less than 1% of bats are infected with rabies. Unfortunately, you cannot tell if a bat has rabies by looking at it; only testing the brain tissue on a dead bat can confirm if a bat has rabies (live bats need to be humanely euthanized before they can be tested for rabies). So, assume all bats may have rabies and never touch them. 

1. Bats are a vital part of our local ecosystem.  

Don’t let all this information about rabies give you a negative opinion on bats. What bats enjoy is eating large amounts of night-flying insects like mosquitos, termites, and agricultural pests, diminishing mosquito-related diseases and the need for pesticides in our community. In fact, some people try to attract bats to their property to help reduce the number of insects. For information on how to build a bat house for your yard, check out this resource.

Article adapted from Public Health Insider.

Identity-first vs. person-first language is an important distinction

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Tara Haelle, the Association of Health Care Journalists medical studies core topic leader, recently wrote a post on the AHCJ’s blog, Covering Health, on how to use respectful language when it comes to how we identify the people who are living with various conditions or disabilities.

Haelle’s post was in response to a question about the acceptability of referring to someone with a condition as a descriptor, such as “epileptic child” or “diabetic adults.” Those constructions are called “identity-first” language, as opposed to “person-first” language where the person literally comes first: “children with epilepsy” and “adults with diabetes.”

The use or not of person-first language is a sensitive, important discussion, not unlike discussion of appropriate and respectful gender terminology in stories involving individuals who self-identify with a non-binary gender (something other than “male” or “female”).

This is a particularly relevant concern in the disability community, where a long history of erasure, exploitation, stigma and misunderstanding has led to strong emotions about how people with disabilities — or disabled people, depending on what someone prefers — are identified and discussed.

This is also true for the importance of person-first language when discussing addiction. “People who use intravenous drugs” or “woman with opioid use disorder” or “person with alcohol addiction,” as opposed to “drug users” or “opioid addict” or “alcoholic.”

As is already clear, person-first language is a complex issue depending on the condition and the person. Usually, with clear diseases like epilepsy and diabetes, it’s always best to use person-first language: men with diabetes, children with epilepsy. Although some controversy exists about obesity as a disease state, person-first language is also recommended: “man with obesity” is preferred to “obese man.”

With mental health disorders, it’s usually best to use person-first: a man with schizophrenia (not schizophrenic) or woman with bipolar disorder (not a bipolar woman). However, when you get to conditions that relate to different ways of perceiving or interacting with the world, person-first is often discouraged by those in that community, the source Haelle prioritizes highest. Two examples are autism and deafness.

Most deaf people prefer identity-first language, not person-first, and they reject “hearing impaired” because many do not perceive an inability to hear as a deficit. It’s always best to confirm with the person if there’s one person involved. If there isn’t, then I default to what the community at large generally uses. For Haelle, a community’s preference trumps even “official” sources, since agencies such as the CDC do not always recommend what the community itself prefers (e.g., deafness here.)

Autism is trickier, and Haelle has relied heavily on the Autistic Self Advocacy Network. Many autistic people see autism as an intrinsic part of their identity — a disability, yes, but one that also confers benefits and is simply a different way of perceiving and interacting with the world. This is where one can most frequently run into challenges.

But this preference isn’t across the board, as the ASAN essay notes. Some may prefer “person with autism,” and sometimes parents prefer “child with autism” while their child prefers “autistic child.” Yet the former can (but not always) connote a perception of autism as an unfortunate disorder or disease that someone wants to be cured while the latter connotes “aspect of my identity that is important to my sense of self.” Hence the importance of asking.

Article adapted from AHCJ blog post by Tara Haelle. July 31, 2019.

Housing as a Platform for Health and Equity

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Recently in the American Journal of Public Health, Diana Hernández PhD, and Carolyn B. Swope MPH, assess the current state of research on housing and health disparities, and share recommendations for achieving opportunities for health equity centered on a comprehensive framing of housing.

The links between housing and health are now known to be strong and multifaceted and to generally span across 4 key pillars: stability, affordability, quality and safety, and neighborhood opportunity. Housing disparities in the United States are tenaciously patterned along axes of social inequality and contribute to the burden related to persistently adverse health outcomes in affected groups. Appreciating the multidimensional relationship between housing and health is critical in moving the housing and health agenda forward to inspire greater equity.

Despite the vastness of existing research, we must contextualize the housing and health disparities nexus in a broader web of interrelated variables emerging from the same roots of structural inequalities.

Source: Am J Public Health. Diana Hernández PhD, and Carolyn B. Swope MPH. Published online ahead of print August 15, 2019: e1–e4. doi:10.2105/AJPH.2019.305210

A Framework for Increasing Equity Impact in Obesity Prevention

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One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.

In THIS ARTICLE recently published in the American Journal of Public Health, Shiriki K. Kumanyika, PhD, MPHI, proposes a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. The core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health. Kumanyika provides research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

Source: Am J Public Health. Shiriki K. Kumanyika. Published online ahead of print August 15, 2019: e1–e8. doi:10. 2105/AJPH.2019.305221