The 2009 Report to the Secretary: Rural Health and Human Services Issues

This is the 2009 Annual Report by the National Advisory Committee on Rural Health and Human Services (NACRHHS). This year’s report examines three key topics in health and human services and their effects in rural areas: workforce and community development, creating viable patient-centered medical homes, and serving at-risk children. All are pertinent and timely issues that the Committee chose during its February 2008 meeting. The chapters draw from published research and from information gathered during site visits to rural North Carolina and rural Minnesota

Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

Although the pathogenesis of human immunodeficiency virus (HIV) infection and the general virologic and immunologic principles underlying the use of antiretroviral therapy are similar for all HIV-infected persons, there are unique considerations needed for HIV-infected infants, children, and adolescents, including; A acquisition of infection through perinatal exposure for many infected children, In utero, intrapartum, and/or postpartum neonatal exposure to zidovudine (ZDV) and other antiretroviral medications in most perinatally infected children, Requirement for use of HIV virologic tests to diagnose perinatal HIV infection in infants under age 15 to 18 months old, Age-specific differences in immunologic markers (i.e., CD4+ T cell count), Changes in pharmacokinetic parameters with age caused by the continuing development and maturation of organ systems involved in drug metabolism and clearance, Differences in the clinical and virologic manifestations of perinatal HIV infection secondary to the occurrence of primary infection in growing, immunologically immature persons, and Special considerations associated with adherence to antiretroviral treatment for infants, children and adolescents. This report addresses the pediatric-specific issues associated with antiretroviral treatment and provides guidelines to health care providers caring for infected infants, children, and adolescents. It is recognized that guidelines for antiretroviral use in pediatric patients are rapidly evolving. The Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children will review new data on an ongoing basis and provide regular updates to the guidelines

Defining Comprehensive Public Health Delivery Systems

This brief describes the methodology for defining Comprehensive Public Health Delivery Systems using data from the National Longitudinal Survey of Public Health Systems. The systems meeting this definition have been shown to deliver a broader range of recommended public health services, using fewer resources, than the more prevalent types of U.S. public health systems that do not meet this definition. Over time, comprehensive systems are associated with larger gains in population health status than are their counterparts

A Guide to conducting household surveys for water safety plans

Water Safety Plans are a World Health Organization (WHO) methodology designed to assess and manage risk in drinking water systems. A Water Safety Plan (WSP) aims to identify hazards to drinking water quality that can be introduced at multiple points from the source to the tap. The WSP does not, however, traditionally provide for identifying hazards that could compromise drinking water quality after it reaches the household tap, such as contamination associated with water collection, storage, and treatment practices within the home. A household survey can help researchers to understand the fate of water from the time it reaches the home to the point of consumption. It can provide valuable information about the quality and reliability of water reaching the home and changes to water quality through household storage and treatment. It can also provide information on the prevalence of water-related illnesses, community perceptions and concerns, alternate or supplemental water sources, and customer satisfaction, information that may fall outside the purview of a traditional Water Safety Plan. A household survey contributes to Module 2 (System Assessment) of the Water Safety Plan, upon which the subsequent steps of hazard identification, consideration of control measures, and development of corrective actions, monitoring, and verification plans are based. Thus, the survey provides valuable information for the WSP team as the team goes through the process of system evaluation and implementation of changes resulting from the Water Safety Plan. The aim of this manual is to provide guidance on conducting a household survey as part of a Water Safety Plan for organized piped water supply systems in resource-limited settings. Specific examples intended to guide the planner in designing the survey are provided in the appendices.Introduction -- Before you start -- Time lines -- Budget planning -- Informed consent/human subjects protection -- Determining sample size -- Survey design -- Household selection -- Recruitment and training of the survey team -- Developing the survey questionnaire -- water quality testing of household sources -- Data entry, analysis and reporting -- Alternatives to a household survey -- Appendix A. Section-by-section summary survey planning checklist -- Appendix B. Sample budget estimate for WSP Household Survey -- Appendix C. Sample informed consent for WSP Household Survey -- Appendix D. Method for calculating sample size for a WSP Household Survey -- Appendix E. Sample household (HH) tracking log -- Appendix F. Sample daily household visitation log sheet -- Appendix G. Sample contracts for survey personnel -- Appendix H. Sample WSP Household Survey training program -- Appendix I. Survey instrument for a WSP Household Survey.U.S. Centers for Disease Control and Prevention (CDC).Available via the World Wide Web as an Acrobat .pdf file (379.12 KB, 52 p.).Centers for Disease Control and Prevention. 2008. A guide to conducting household surveys for Water Safety Plans. Atlanta: U. S. Department of Health and Human Services

Surveillance for elevated blood lead levels among children -- United States, 1997-2001

PROBLEM/CONDITION: Lead is neurotoxic and particularly harmful to the developing nervous systems of fetuses and young children. Extremely high blood lead levels (BLLs) (i.e.,> or =70 microg/dL) can cause severe neurologic problems (e.g., seizure, coma, and death). However, no threshold has been determined regarding lead's harmful effects on children's learning and behavior. In 1990, the U.S. Department of Health and Human Services established a national goal to eliminate BLLs >25 microg/dL by 2000; a new goal targets elimination of BLLs > or =10 microg/dL in children aged or =10 microg/dL or two capillary blood specimens > or =10 microg/dL drawn within 12 weeks of each other. RESULTS: The NHANES 1999-2000 survey estimated that 434,000 children (95% confidence interval = 189,000-846,000) or 2.2% of children aged 1-5 years had BLLs > or =10 microg/dL. For 2001, a total of 44 states, the District of Columbia (DC), and New York City (NYC) submitted child blood lead surveillance data to CDC. These jurisdictions represent 95% of the U.S. population of children aged or =10 microg/dL steadily decreased from 130,512 in 1997 to 74,887 in 2001. In 2000, the year targeted for national elimination of BLLs >25 microg/dL, a total of 8,723 children had BLLs > or =25 microg/dL. INTERPRETATION: Both national surveys and state surveillance data indicate children's BLLs continue to decline throughout the United States. However, thousands of children continue to be identified with elevated BLLs. The 2000 goal of eliminating BLLs >25 microg/dL was not met. Attaining the 2010 goal of eliminating BLLs > or =10 microg/dL will require intensified efforts to target areas at highest risk, evaluate preventive measures, and improve the quality of surveillance data. PUBLIC HEALTH ACTIONS: States will continue to use surveillance data to 1) promote legislation supporting lead poisoning prevention activities, 2) obtain funding, 3) identify risk groups, 4) target and evaluate prevention activities, and 5) monitor and describe progress toward elimination of BLLs > or =10 microg/dL. CDC will work with state and local programs to improve tracking systems and the collection, timeliness, and quality of surveillance data.Pamela A. Meyer, Timothy Pivetz, Timothy A. Dignam, David M. Homa, Jaime Schoonover, Debra Brody.September 12, 2003.Also available via the World Wide Web as an Acrobat .pdf file (333.29 KB, 24 p.).Includes bibliographical references (p. 7-8)

Lead in drinking water and human blood lead levels in the United States

"Lead is a pervasive environmental contaminant. The adverse health effects of lead exposure in children and adults are well documented, and no safe blood lead threshold in children has been identified. Lead can be ingested from various sources, including lead paint and house dust contaminated by lead paint, as well as soil, drinking water, and food. The concentration of lead, total amount of lead consumed, and duration of lead exposure influence the severity of health effects. Because lead accumulates in the body, all sources of lead should be controlled or eliminated to prevent childhood lead poisoning. Beginning in the 1970s, lead concentrations in air, tap water, food, dust, and soil began to be substantially reduced, resulting in significantly reduced blood lead levels (BLLs) in children throughout the United States. However, children are still being exposed to lead, and many of these children live in housing built before the 1978 ban on lead-based residential paint. These homes might contain lead paint hazards, as well as drinking water service lines made from lead, lead solder, or plumbing materials that contain lead. Adequate corrosion control reduces the leaching of lead plumbing components or solder into drinking water. The majority of public water utilities are in compliance with the Safe Drinking Water Act Lead and Copper Rule (LCR) of 1991. However, some children are still exposed to lead in drinking water. EPA is reviewing LCR, and additional changes to the rule are expected that will further protect public health. Childhood lead poisoning prevention programs should be made aware of the results of local public water system lead monitoring measurement under LCR and consider drinking water as a potential cause of increased BLLs, especially when other sources of lead exposure are not identified. This review describes a selection of peer-reviewed publications on childhood lead poisoning, sources of lead exposure for adults and children, particularly children aged <6 years, and LCR. What is known and unknown about tap water as a source of lead exposure is summarized, and ways that children might be exposed to lead in drinking water are identified. This report does not provide a comprehensive review of the current scientific literature but builds on other comprehensive reviews, including the Toxicological Profile for Lead and the 2005 CDC statement Preventing Lead Poisoning Among Young Children. When investigating cases of children with BLLs at or above the reference value established as the 97.5 percentile of the distribution of BLLs in U.S. children aged 1-5 years, drinking water should be considered as a source. The recent recommendations from the CDC Advisory Committee on Childhood Lead Poisoning Prevention to reduce or eliminate lead sources for children before they are exposed underscore the need to reduce lead concentrations in drinking water as much as possible.." -p. 1Introduction -- Background -- Historical trends in blood lead levels -- Lead in the environments of children -- Lead in drinking water -- Conclusion -- ReferencesMary Jean Brown, Stephen Margolis, Division of Emergency and Environmental Health Services, National Center for Environmental Health."August 10, 2012.."Also available via the World Wide Web as an Acrobat .pdf file (349.49 KB, 12 p.).Includes bibliographical references (p. 7-9)

Keeping your hands clean on a cruise

To stay healthy and clean, wash your hands with warm water and soap.August 2012.CS234329_BAvailable via the World Wide Web as an Acrobat .pdf file (164.78 KB, 1 p.)