Category Archives: Public Health

Why I love family-run restaurants: Insights from a food inspector

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cropped-eyob-in-idBy Eyob Mazengia, PhD, RS, Food Protection Program
Public Health – Seattle & King County

When I started as a food inspector, I was assigned to the International District. And I liked it. It was almost like walking into a new culture, a new era.

What fascinated me was that as a public health worker, I had permission to walk into people’s personal spaces. I liked the smells, the sounds of their languages, their wall hangings and the way things looked.

It was a privilege, really, to be allowed into their personal spaces. Going on food inspections in the I.D., it was like walking into 3-4 different countries every day, without traveling outside the neighborhood.

Over the years, I established good relationships with the restaurant establishments. They were no longer just restaurant operators—they were mothers, fathers, grown kids. They’re not just businesses—there’s a family behind every door, people who had often gone through difficult times to be here.

And as I got to know them, I could recognize the sacrifices they made to give their children better opportunities in the U.S., and what they left behind. Even those born and raised here, you could recognize the sacrifices they were making. Continue reading

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Colorado’s pregnancy prevention breakthrough

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Flag_of_ColoradoBy Christine Vestal
Stateline

President Barack Obama hailed a landmark achievement in his State of the Union address last month: Teen pregnancies in the U.S. have hit an all-time low.

But the U.S. still has a teen birthrate of 31.2 per 1,000 teens, nearly one-and-a-half times the rate in the United Kingdom, which has one of the highest rates in Western Europe.

Colorado may have found a way to close the gap. The state’s teen birthrate dropped 40 percent between 2009 and 2013, driven largely by a public health initiative that gives low-income young women across the state long-acting contraceptives such as intrauterine devices (IUDs) and hormonal implants.

Colorado has a successful model for stemming teen pregnancies. But will state lawmakers continue paying for it?

Backed by $23.5 million from the Susan Thompson Buffett Foundation, Colorado attracted national recognition for its program after Democratic Gov. John Hickenlooper announced the results of a cost-savings study last summer.

The state saved $42.5 million in 2010 alone, an average return of $5.85 in avoided Medicaid costs for prenatal, delivery and first year of infant care for every $1 spent on the program.

More important, Hickenlooper said, the initiative “has helped thousands of young Colorado women continue their education, pursue their professional goals and postpone pregnancy until they are ready to start a family.”

According to program supervisor Greta Klingler, Illinois, Nevada, New Jersey, New York, Ohio, Virginia and Wisconsin have asked Colorado to share its techniques and lessons learned. Illinois is already adopting some of Colorado’s methods in a statewide Medicaid program for unwanted pregnancy prevention, she said. The U.S. Centers for Disease Control and Prevention is also seeking more details from Colorado.

Bill Albert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy, pointed to the promise of state-based programs that rely on low-maintenance, highly effective methods of contraception coupled with good counseling.

“We’ve made progress, but if we’re going to continue making progress, efforts going forward will have to be as innovative and up-to-date as possible,” Albert said.

But Colorado’s program will end this June when its private grant runs out, unless lawmakers approve state funding to keep it going for another year. A $5 million funding bill was introduced this month with bipartisan sponsorship, but it won’t necessarily be an easy win, especially in the Republican-led state Senate.   Continue reading

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Standing up to senior falls: local program promotes independence and safety at home

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By Alan Abe, Emergency Medical Services Division
Public Health – Seattle & King County

ems-falls

Do you know someone over 65 who has fallen? Have you reached that age and are concerned about your risk?

Senior falls are all too common, with results that are often serious and sometime even grave.

Nearly 24,000 seniors died nationally in 2012 due to falls, nearly doubling in ten years. And over 2.4 million people – almost four times the population of Seattle – were hospitalized.

What’s driving this toppling trend? More of us are living longer, and as a society, we’re getting older. And with the aging of the baby boomer generation, this trend will continue.  By 2030, the US Census Bureau estimates that there could be about 75 million people over 65 in the United States.

As we age, we tend to collect conditions that make us more vulnerable to falls: diabetes, heart disease, stroke, arthritis and Parkinson’s disease.

So, what can we do about it? We know that 60% of senior falls happen in the home, so if we improve safety and reduce risks there, we can make a big difference.

That’s where King County Emergency Medical Services/Medic One comes in. They have developed the One Step Ahead Fall Prevention Program to help at-risk seniors stay healthy, independent and safe in their homes.

How does the program work? Continue reading

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States with looser immunization laws have lower immunization rates

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By Christine Vestal
Stateline

The U.S. Centers for Disease Control and Prevention issued a health advisory  this month about an ongoing measles outbreak, with more than 102 cases in 14 states so far. The highly contagious disease can cause severe health complications, including pneumonia, encephalitis, and death.

By 2000, measles had been nearly wiped out in the U.S., with fewer than 60 cases per year – most connected with foreign travel. Public health officials declared victory, the result of effective state-based immunization campaigns requiring kids to be vaccinated before they enter public schools.

Since then, however, the number of cases has risen along with the number of parents who have received religious or philosophical exceptions to state rules. In 2014, there were at least 23 outbreaks and more than 600 cases.

Measles graphic 2

The federal government’s goal is to immunize at least 90 percent of all children before they enter school to keep measles and other childhood diseases at bay.  Although the national average immunization rate (91.1 percent) exceeds that number, several states fall below it.

“To have pockets where community immunity is below 90 percent is worrisome as they will be the ones most vulnerable to a case of measles exploding into an outbreak,” said Litjen (L.J) Tan, chief strategy officer of the Immunization Action Coalition, which advocates for higher levels of immunization.

State immunization rates vary widely, with generally lower rates of inoculation occurring in states that make it relatively easy to get an exception. Lawmakers in California, Oregon, and Washington state are trying to tighten their laws to allow fewer nonmedical exemptions.

Laws allowing religious exemptions have been around longer than those allowing philosophical or “personal belief” exemptions, said Joy Wilson, of the National Conference of State Legislatures.

In many but not all states, philosophical exemptions are easier to get than religious exemptions, which typically require parents to cite and explain the religious doctrine in question.  Overall, states with philosophical exemptions have 2.5 times the rate of opt-outs than states with only religious exemptions.

SLN_Feb09_vaccinationRates

Stateline logo Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Measles outbreak sparks bid to strengthen California’s vaccine law

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Boy gets shot vaccine injectionBy Jenny Gold
KHN

State lawmakers in California introduced legislation Wednesday that would require children to be fully vaccinated before going to school, a response to a measles outbreak that started in Southern California and has reached 107 cases in 14 states.

California is one of 19 states that allows parents to enroll their children in school unvaccinated through a “personal belief exemption” to public health laws. The outbreak of measles that began in December in Anaheim’s Disneyland amusement park has spread more quickly in communities where many parents claim the exemption.

State Sens. Dr. Richard Pan and Ben Allen have proposed eliminating the personal belief exemption altogether in California.

“Every year that goes by we are adding to the number of unvaccinated people and so that’s putting everyone at greater risk,” said Pan, who is also a pediatrician. “We shouldn’t have to wait until someone sickens and dies to act.”

The exemption isn’t new — it’s been around since the 1960s. But the number of parents taking the exemption went way up in the past decade. In some schools in California, more than half of children have an exemption.

If their law passes, all of those children would be required to get fully vaccinated in order to go to school. Pan says the most parents in the state would support that. Continue reading

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Q & A about Public Health’s investigation of an endoscope associated outbreak

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Tcrehe Seattle Times reported this morning that there had been an outbreak of multidrug-resistant “superbug” infections spread by contaminated endoscopes between 2012 and 2014 in which at least 32 patients at Virginia Mason Medical Center were infected .

Neither the hospital nor health officials notified patients or the public, the Seattle Times reported.

In response to the paper’s report, Public Health – Seattle & King County has posted the following  Q & A on its Public Health Insider blog:

Q & A about Public Health’s investigation of an endoscope associated outbreak

Voluntary reporting by Virginia Mason Medical Center led to identification of an outbreak of multidrug resistant bacterial infections in 2013. After months of investigative work, Public Health—working with Virginia Mason Medical Center, Washington State Department of Health and the Centers for Disease Control Prevention (CDC)—linked the outbreak to a procedure called endoscopic retrograde cholanCREgiopancreatography (ERCP). Since discovering the risk from this procedure, our Communicable Disease Epidemiology staff has taken a leadership role in drawing national attention to this issue in the medical community. Dr. Jeff Duchin, Interim Health Officer and Chief of Communicable Disease Epidemiology answered questions about this outbreak.

What is an ERCP used for?

The ERCP procedure uses a scope, or tube, that goes through a patient’s mouth and throat to reach their upper small bowel and bile duct system. ERCP is used in persons with serious medical problems including cancers and other diseases that cause obstruction or narrowing of the bile ducts.

What kind of bacteria caused the infections?

Infections were caused by two closely-related types of bacteria that are resistant to many antibiotics. In some cases, the bacteria were also resistant to powerful antibiotics called carbapenems.  These bacteria are referred to as CRE (carbapenem resistant Enterobacteriaceae).

Was the outbreak caused by a CRE “superbug?”

No. The type of CRE that has caused outbreaks in other healthcare facilities has been referred to as a “CRE superbug.” It usually produces an enzyme that inactivates carbapenem antibiotics. The outbreak we investigated was not caused by this type of CRE, which did not have a carbapenemase enzyme.

What is the role of Public Health in this investigation? Continue reading

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Public Health asks court to stop two hookah bars from violating smoking law

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Hookah

Photo courtesy of Solix via Wikipedia

From Public Health – Seattle & King County

Public Health – Seattle & King County has filed papers in King County Superior Court asking the court to stop two hookah bars for exposing employees and the public to tobacco smoke in violation of Washington’s Smoking in Public Places Act and local Board of Health Code.

The request for an injunction was filed against The Night Owl in Seattle’s University District and Medina Hookah Lounge in south Seattle.

A hookah is a glass pipe filled with water that is used for smoking flavored tobacco, often by several people at once.

During a typical 45-minute session of hookah use, a person may inhale as much smoke, tobacco and carcinogens as smoking 100 cigarettes or more.

Smoking in public places law

Washington’s Smoking in Public Places law was passed by voters in 2005 and prohibits smoking in public places and places of employment. The local Board of Health code mirrors the state law and includes provisions that prohibit the use of electronic smoking devices.

Hookah bars have claimed that they are exempt from the indoor smoking law because they are private clubs. However, smoking is prohibited by law if an establishment has employees and/or the club is open to the public.

A previous ruling by a King County Hearing Examiner on February 12, 2014 found that both the Night Owl and Medina are open to the public, operating similarly to night clubs that charge a cover for admission.

“Hookah smoke is as addictive as traditional cigarettes”, said Patty Hayes, Interim Director, Public Health- Seattle & King County. “Asking the court for an injunction is a measure of last resort, but it is necessary now to ensure all our businesses are protecting the health of employees and the public.” Continue reading

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Listeria outbreak linked to Latin-style soft cheeses

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Pregnant women, newborns and adults with weakened immune systems most at risk

cheeseWashington State health and agriculture officials are working with the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration on an ongoing outbreak of Listeria monocytogenes infections linked to consumption of Latin-style soft cheese produced by Queseria Bendita, a Yakima, Washington firm. 

As of January 16, 2015, a total of three cases have been identified from Washington in King, Pierce and Yakima counties. One illness was pregnancy-associated, two people were hospitalized and one death was reported.

The affected products made by the Yakima-based Queseria Bendita are subject to a voluntary recall and the firm has stopped producing cheese.

Health officials are warning consumers who may have purchased these three Queseria Bendita brand cheeses: Queso Fresco, Panela, and Requeson and still have it in their refrigerators to throw the product away and not eat it. Grocery stores and distributors should pull and not sell these products.  Continue reading

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U.S. still unprepared for epidemics – Modern Healthcare

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Ebola NIAIDLocal health departments cut about 4,400 positions in 2013, according to an April report from the National Association of County & City Health Officials. Since 2008, more than 48,000 jobs in local health departments have been eliminated through layoffs and attrition.

The cuts have left state and local health departments stretched thin to provide services such as vaccinations and HIV/AIDS education, and have limited their ability to recruit personnel who can help detect and identify disease threats.

via U.S. still unprepared for epidemics – Modern Healthcare.

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Public health appoints new interim Local Health Officer

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Duchin

Jeffrey Duchin

Dr. Jeffrey Duchin, MD, was appointed today as Interim Local Health Officer for Public Health – Seattle & King County.

Duchin is a familiar figure in the health field, having held the position of chief of the department’s Communicable Disease Epidemiology and Immunization Section since 1999 and frequently serving as a department spokesperson.

In his new role, Duchin will provide leadership in developing priorities and setting strategies for the health department, with a particular role as the key science advisor on program and policy development.

Duchin will split time between his Health Officer duties and his continued direction of communicable disease and immunization activities. He will also maintain an affiliation with the University of Washington as a Professor of Medicine.

As part of his Health Officer duties, he will work with other health officers in Washington State on health issues that cross county borders.

In addition, Duchin will represent Public Health – Seattle & King County on external committees, task forces, and as a liaison to regional and national professional organizations.

Duchin’s is currently the Chair of the Public Health Committee of the Infectious Disease Society of America and has served in many other advisory roles, including the CDC’s Advisory Committee on Immunization Practices and the Institute of Medicine.

The Interim Local Health Officer reports to Patty Hayes, Interim Director of Public Health – Seattle & King County.  Prior to Duchin, the position was held by the previous Director, Dr. David Fleming.

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Locking up firearms to prevent suicide

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GunBy Tony Gomez, BS, RS, Manager, Violence and Injury Prevention
Public Health — Seattle & King County

I’ve worked on Violence and Injury Prevention for over thirty years. I consistently notice in the media and in conversations about firearms that usually the discussion focuses on tragic homicides.

But, the truth is that most firearm deaths are suicides—often hidden from the public conversation. In King County, nearly 70% of firearm deaths being suicides, it’s crucial we come together despite different ideologies.

The truth is that most firearm deaths are suicides.

There are numerous entities including King County that have a deep commitment to suicide prevention and are working together to address this “silent” killer of our residents.

With firearm ownership so prevalent in King County (~25%) – and some estimated 30,000 households that keep at least one firearm loaded and unlocked – we can’t afford to wait any longer to get those easily stolen and accessed firearms locked up.

We know that impulsivity plays a significant role in suicide attempts; easy access to highly lethal means, such as firearms, increases risk.  Strong evidence exists, both in the United States and abroad, that restricting access to lethal means is an effective way to reduce suicide.

Suicide prevention efforts in King County and elsewhere in the United States now champion safe storage of firearms. Continue reading

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Washington scores four out of 10 on key indicators related to preventing and responding to infectious disease outbreaks

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From Trust for America’s Health and the Robert Wood Johnson Foundation 

Washington scored only four out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks, like Ebola, Enterovirus and antibiotic-resistant Superbugs.

Some key Washington findings include:

No. Indicator Washington Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding: Increased or maintained level of funding for public health services from FY 2012-13 to FY 2013-14. N 28
2 Preparing for Emerging Threats: State scored equal to or higher than the national average on the Incident & Information Management domain of the National Health Security Preparedness Index. Y 27 + D.C.
3 Vaccinations: Met the Healthy People 2020 target of 90 percent of children ages 19-35 months receiving recommended ≥3 doses of HBV vaccine. N 35 + D.C.
4 Vaccinations: Vaccinated at least half of their population (ages 6 months and older) for the seasonal flu for fall 2013 to spring 2014. N 14
5 Climate Change: State currently has completed climate change adaption plans – including the impact on human health. Y 15
6 Healthcare-acquired Infections: State performed better than the national standardized infection ratio (SIR) for central line-associated bloodstream infections. N 16
7 Healthcare-acquired Infections: Between 2011 and 2012, state reduced the number of central line-associated blood stream infections. N 10
8 Preparing for Emerging Threats: From July 1, 2013 to June 30, 2014, public health lab reports conducting an exercise or utilizing a real event to evaluate the time for sentinel clinical laboratories to acknowledge receipt of an urgent message from laboratory. N 47 + D.C.
9 HIV/AIDS: State requires reporting of all CD4 and HIV viral load data to their state HIV surveillance program. Y 37 + D.C.
10 Food Safety: State met the national performance target of testing 90 percent of reported Escherichia coli (E. coli) O157 cases within four days. Y 38 + D.C.
Total  4

 Read the full report here.

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Food inspection grades: A – B – C , easy as 1 – 2 – 3 … or is it?

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EatBy hilarykaraszkc
Public Health Insider: Behind-the-scenes of the agency protecting the health and well-being of all people in Seattle & King County

New York City has them, so does L.A. Even Toronto has them. So why aren’t there food safety inspection grades posted outside of restaurants in King County?

The answer? Food safety performance placarding is coming, and when it does, it will give patrons and establishments alike information that is meaningful, clear, and motivating.

Diners need to know actual risk

There’s a lot on the line: Studies show that restaurant placards influence consumer behavior. But research on the systems that give A-B-C grades shows that A-B-C placards don’t communicate what consumers are expect. Continue reading

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