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Thu Dec 9 03:57:02 EST 2010

Must for Young Women.   Adolescents and young women are not being
routinely screened for chlamydia, said experts from The American College
of Obstetricians and Gynecologists' (ACOG) at their 55th Annual Clinical
Meeting in San Diego. Each year an estimated 2 million cases of
chlamydia go undiagnosed and untreated, leading to serious health
consequences for women. More attention needs to be focused on getting
adolescent girls and young women screened yearly for chlamydia.
According to the National Center for Health Statistics (NCHS), chlamydia
remains the most commonly reported STD in the US. In 2005, there were
just over 976,000 reported chlamydial infections, but because many cases
are not diagnosed or reported, there may be as many as 2.8 million new
cases annually. About 75% of chlamydial infections in women don't
produce symptoms or if they do, they are often vague, causing women to
delay seeking medical care and treatment. If not treated, up to 40% of
women infected with chlamydia may develop pelvic inflammatory disease
(PID), which can lead to ectopic pregnancy and infertility. One in five
women with PID becomes infertile. A study sponsored by the CDC and the
Agency for Healthcare Research and Quality lists chlamydia screening as
one of the top most effective but underutilized preventive health
services. It found that chlamydia screening provides great health
benefits, both in terms of improving quality of life and offering the
most value for health care dollars. To learn more go to

A new house-to-house survey of people living in Orleans, Jefferson,
Plaquemines and St. Bernard Parishes documents the devastating impact
Hurricane Katrina and the failure to respond quickly and effectively to
it has had on the economic well-being, physical and mental health, and
personal lives of the people of the New Orleans area. The survey
provides a portrait of the enormous needs of the population, to inform
recovery efforts and policy debate in Washington. Future Kaiser surveys
planned in 18 months and 36 months will monitor progress and changes.
This Kaiser Family Foundation study found that in the aftermath of
Katrina, the vast majority (81%) of those now living in Greater New
Orleans have seen their quality of life deteriorate in at least one of
seven critical aspects of their lives. More than half (55%) reported
problems in two or more areas, including 67% in Orleans Parish, which is
the city itself. To learn more go to 
Also see this 5/15/07 NYT editorial: “Homes and schools remain empty
or imaginary; evacuees and survivors wait in cramped trailers, unable to
return or rebuild. A huge silence still hangs over the Lower Ninth Ward,
a place every American should see, to witness firsthand how truckloads
of promises have filled New Orleans’s vast devastation with
nothing.” To read more go to

APHA Supports Legislation to Bring More Healthy Foods to Vulnerable
Communities. The American Public Health Association (APHA) announced its
support for legislation introduced today by U.S. Sens. Sherrod Brown
(D-OH) and Hillary Rodham Clinton (D-NY) to expand access to affordable
healthy foods for at-risk populations, such as school children,
low-income senior citizens and families living in underserved areas.
APHA also supports the bill’s proposal to create and broaden programs
to help communities develop farmers’ markets, roadside stands and
other activities to make fresh fruits and vegetables available to
residents. The bill also provides resources that would make healthy
foods more affordable to people such as providing coupons to low-income
seniors to buy fresh produce at farmers’ markets and other community
agriculture programs.
To read more, go to

The National Campaign Expands Its Mission
One-third of pregnancies in the United States are unwanted, according
to a new analysis released by the National Campaign to Prevent Teen
Pregnancy. That is, two million of the 6.4 million pregnancies in 2001
were unwanted (most recent data available). Over half (54%) of unwanted
pregnancies occur to women in their twenties. And there is evidence that
the rate of unwanted pregnancies may be increasing. This large number of
unwanted pregnancies has far-reaching consequences for women, men,
children, families, and society. To help ensure that more pregnancies
are wanted and welcomed, the National Campaign announced on May 9 that
it is expanding its work to include young adults while still maintaining
its focus on teens. In support of the National Campaign’s expanded
focus, they have created a sister website,
Our new website for teens- now also up and running.
For more, go to 

The Environmental Defense Fund and Yahoo have teamed up to help
families have an energy saving house. To learn how to save energy room
by room, go to 

FDA Approves Contraceptive for Continuous Use. The Food and Drug
Administration (FDA) approved Lybrel, the first continuous use drug
product for prevention of pregnancy. The new contraceptive, Lybrel,
comes in a 28 day-pill pack with low-dose combination tablets that
contain 90 micrograms of a progestin, levonorgestrel, and 20 micrograms
of an estrogen, ethinyl estradiol, which are active ingredients
available in other approved oral contraceptives. Continuous
contraception works the same way as the 21 days on-seven days off cycle.
It stops the body's monthly preparation for pregnancy by lowering the
production of hormones that make pregnancy possible. Other contraceptive
pill regimens have placebo or pill-free intervals lasting four to seven
days that stimulate a menstrual cycle. Lybrel is designed to be taken
without the placebo or pill-free time interval. Women who use Lybrel
would not have a scheduled menstrual period, but will most likely have
unplanned, breakthrough, unscheduled bleeding or spotting. To read more
go to 
NB: How will this affect long term fertility and uterine health?

Two more large recalls from the Consumer Product Safety Commission due
to high lead levels - both products were made in China: 
1) In cooperation with the U.S. Consumer Product Safety Commission
(CPSC), Cardinal Distributing Co. Inc., of Baltimore, Md., is
voluntarily recalling about 300,000 Children’s Turquoise Rings. The
recalled jewelry contains high levels of lead. Lead is toxic if ingested
by young children and can cause adverse health effects. To learn more or
to view the product, go to 

2) In cooperation with the U.S. Consumer Product Safety Commission
(CPSC), Spandrel Sales and Marketing Inc., of Tempe, Ariz., is
voluntarily recalling about 200,000 Children’s Necklaces, Bracelets
and Rings. The recalled jewelry contains high levels of lead. Lead is
toxic if ingested by young children and can cause adverse health
effects. To learn more or to view the product, go to 

CPSC Warns Toddler Drownings Happen Quickly and Silently!
The U.S. Consumer Product Safety Commission (CPSC) reports there are
about 260 drowning deaths of children younger than 5 each year in
swimming pools, and an estimated 2,725 children are treated annually in
hospital emergency rooms for pool submersion injuries - mostly in
residential pools. CPSC strongly advises that parents use layers of
protection around the pool to prevent their children from becoming a
drowning victim.In conjunction with this year’s drowning prevention
campaign, CPSC has produced a public service announcement (transcript)
to illustrate what happens when a toddler falls into a pool. It vividly
demonstrates what you expect to hear and what the reality often sounds
like. To download the announcement or health education pamphlets, go to  

Callaghan WM et al. Health Concerns of Women and Infants in Times of
Natural Disasters: Lessons Learned from Hurricane Katrina. Maternal and
Child Health Journal. Volume 11, Number 4 / July, 2007
Pregnant women and infants have unique health concerns in the aftermath
of a natural disaster such as Hurricane Katrina. Although exact numbers
are lacking, these CDC authors  estimate that approximately 56,000
pregnant women and 75,000 infants were directly affected by the
hurricane. Disruptions in the supply of clean water for drinking and
bathing, inadequate access to safe food, exposure to environmental
toxins, interruption of health care, crowded conditions in shelters, and
disruption of public health and clinical care infrastructure posed
threats to these vulnerable populations. This report cites the example
of Hurricane Katrina to focus on the needs of pregnant women and infants
during times of natural disasters and provides considerations for those
who plan for the response to these events.
Phibbs CS et al. Level and Volume of Neonatal Intensive Care and
Mortality in Very-Low-Birth-Weight Infants. NEJM. Vol 356, No 21, 2165

The authors set out to examine differences in neonatal mortality among
infants with very low birth weight (below 1500 g) among NICUs with
various levels of care and different volumes of very-low-birth-weight
infants.They linked birth certificates, hospital discharge abstracts
(including interhospital transfers), and fetal and infant death
certificates to assess neonatal mortality rates among 48,237
very-low-birth-weight infants who were born in California hospitals
between 1991 and 2000. 
The authors found that mortality rates among very-low-birth-weight
infants varied according to both the volume of patients and the level of
care at the delivery hospital. The effect of volume also varied
according to the level of care. As compared with a high level of care
and a high volume of very-low-birth-weight infants (more than 100 per
year), lower levels of care and lower volumes (except for those of two
small groups of hospitals) were associated with significantly higher
odds ratios for death, ranging from 1.19 to 2.72 Less than one quarter
of very-low-birth-weight deliveries occurred in facilities with NICUs
that offered a high level of care and had a high volume, but 92% of
very-low-birth-weight deliveries occurred in urban areas with more than
100 such deliveries. 
The authors conclude that mortality among very-low-birth-weight infants
was lowest for deliveries that occurred in hospitals with NICUs that had
both a high level of care and a high volume of such patients. They
suggest that increased use of such facilities might reduce mortality
among very-low-birth-weight infants

Rimsza ME et al. Impact of Medicaid Disenrollment on Health Care Use
and Cost PEDIATRICS Vol. 119 No. 5 May 2007, pp. e1026-e1032
The authors set out to compare the health care use of children who are
covered by public insurance and uninsured children who live in a large
urban area and the potential impact of disenrollment on health care use
and costs if these children become uninsured. 
They analyzed the 2004 health care transactions for 43313 uninsured
children and 168722 children who were insured by Medicaid/State
Children's Health Insurance Program and living in the Phoenix
metropolitan area were analyzed using a community-wide administrative
health database (Arizona HealthQuery). Using a multivariate model of
health care use by currently uninsured children, they examined the
effect of 10% disenrollment of the children who were currently insured
by Medicaid/State Children's Health Insurance Program. 
The authors found that a 10% disenrollment would increase the costs of
health care in the community by $3460398 annually, or $2121 for each
child disenrolled. This increase in costs is attributed to a shift of
care from ambulatory settings to more expensive emergency departments
and an increase in hospital days. They determined that 69% of the change
in emergency department visits, 58% of the change in hospital stays, and
74% of the change in ambulatory visits would be attributable to the
change in insurance status. 
The authors conclude that programmatic changes that result in
disenrollment from public insurance programs will increase the number of
emergency department visits and hospital days as well as the total
community costs of health care. These increases in health care use can
be expected to aggravate community problems of emergency department
overcrowding and inpatient bed shortages. The majority of the changes in
use are attributable to changes in insurance status, which results in a
shift of care from less expensive ambulatory settings to emergency
departments and increases in hospital days when children lose
Medicaid/State Children's Health Insurance Program coverage. 
Sapkota AR et al. What Do We Feed to Food-Production Animals? A Review
of Animal Feed Ingredients and Their Potential Impacts on Human Health
Environmental Health Perspectives Volume 115, Number 5, May
2007nvironmental Health Perspectives Volume 115, Number 5, May 2007 
These authors from 1Johns Hopkins Center for a Livable Future say that
animal feeding practices in the United States have changed considerably
over the past century. As large-scale, concentrated production methods
have become the predominant model for animal husbandry, animal feeds
have been modified to include ingredients ranging from rendered animals
and animal waste to antibiotics and organoarsenicals. In this article
they review current U.S. animal feeding practices and etiologic agents
that have been detected in animal feed. Evidence that current feeding
practices may lead to adverse human health impacts is also evaluated. 

The authors found that current animal feeding practices can result in
the presence of bacteria, antibiotic-resistant bacteria, prions,
arsenicals, and dioxins in feed and animal-based food products. 
Despite a range of potential human health impacts that could ensue,
there are significant data gaps that prevent comprehensive assessments
of human health risks associated with animal feed. NB: YIKES!!

Limited data are collected at the federal or state level concerning the
amounts of specific ingredients used in animal feed, and there are
insufficient surveillance systems to monitor etiologic agents "from farm
to fork." 
The authors conclude that Increased funding for integrated veterinary
and human health surveillance systems and increased collaboration among
feed professionals, animal producers, and veterinary and public health
officials is necessary to effectively address these issues.
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Rev. Martin Luther King, Jr

The National Fetal and Infant Mortality Review Program is a partnership
between ACOG and federal MCHB.

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