A new American Public Health Association (APHA) Press book, “Veteran Suicide: A Public Health Imperative,” addresses the critical and growing issue of suicide among military veterans. The book is a collaboration between the APHA and the Department of Veterans Affairs. Both organizations previously partnered on a supplement to the American Journal of Public Health on suicide risks among veterans.

Topics addressed by the book include

• suicide prevention,
• substance abuse, and
  
• suicide surveillance.

The new book includes very recent research on suicide among veterans. "The research represented by the collection of manuscripts included in this volume is an important step towards addressing the national problem of suicide and a reminder that even one death by suicide is too many," said Janet Kemp, RN, PhD, Department of Veterans Affairs National Mental Health Program Director for Suicide Prevention.

“Veteran Suicide: A Public Health Imperative” is available for purchase online.

>>Bonus Link: This week the Huffington Post published an article by Kimberly Williams, Director of the Center for Policy, Advocacy, and Education of the Mental Health Association of New York City, pointing out that the connectedness members of the military feel with each other often disappears when they return to their communities, which may be a factor in the rising suicide rates among veterans.

Each year, the March of Dimes National Communications Advisory Council, which includes journalists from many websites and magazines that cover pregnancy and early childhood, holds a reporters’ luncheon to share information that can lead to healthier births, babies and mothers. This year’s luncheon, being held tomorrow, focuses on treating mental health conditions in mothers during and after pregnancy. The issue is important for many reasons, in particular because many women have been taking prescription medications for depression, anxiety, panic attacks, ADHD, and other mental health issues since adolescence and may need to change or stop the medicines in order to have a healthy baby, yet run the risk of a relapse or worsening of their health condition.

NewPublicHealth recently spoke with, Siobhan Dolan, MD, a consultant to the March of Dimes and an obstetrician gynecologist and clinical geneticist at Montefiore Medical Center/Albert Einstein College of Medicine about communicating information about treating mental health during pregnancy to both mothers and health care professionals.

NPH: For the upcoming luncheon, the March of Dimes has singled out mental health medications. Why that area of health?

Dr. Dolan: There is a huge overlap between women of reproductive age who are dealing with becoming pregnant and having families and caring for families and women who have mental health issues and may be entering their reproductive years already on medication.

And we know that bonding and creating a family and getting your family life off to a good start in the early postpartum period is much, much better when a woman is in a balanced mental health state. So if there’s either a preexisting depression or a postpartum depression, we need to pay attention to that.

Regular Aerobic Exercise Best for Treating Depression
Researchers have pinpointed which types of exercise are best for combating major depressive disorders, according to a new study in the Journal of Psychiatric Practice. By reviewing and analyzing data from nine trials, they discerned that aerobic exercise is best, three to five sessions a week are necessary, each session should last 45 minutes to one hour, at least 10 weeks of training are needed, and other details. Karen Cassiday, PhD, board member and secretary of the Anxiety and Depression Association of America, said physicians should help patients identify barriers to proper exercise. “Discuss with them how you can pair exercise with something fun—audio books, podcasts, music,” she said. “Suggest that they exercise with other people. If you are meeting someone, you are more likely to do it.” Read more on mental health.

Survey: Doctors Seeing Shortage of Critical Cancer Drugs
Shortages of cancer-fighting drugs are affecting patient care and increasing treatment costs across the country, according to new findings to be presented at the annual meeting of the American Society of Clinical Oncology in Chicago. "These drug shortages are persistent and pervasive," said Keerthi Gogineni, MD, an oncologist in the Abramson Cancer Center and the Perelman School of Medicine at the University of Pennsylvania. "They are affecting the treatment of curable cancers, forcing physicians to improvise." About 94 percent of physicians say their treatments were impacted, 83 percent said they couldn’t even offer standard chemotherapy and 13 percent said the shortage caused trouble with clinical trials. Leucovorin, liposomal doxorubicin, 5-fluorouracil, bleomycin and cytarabine are the most common drugs to see shortages. "Clearly, it impacts the treatments patients receive," said Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society, in reference to cytarabine, which is used to treat leukemia. "It takes a long time to develop an understanding of effective drug regimens. When you can't use a proven effective drug and you have to go to an alternative plan, you certainly become concerned about the effect of that switch on the health of your patient." Read more on cancer.

CMS: Estimates for Average Charges of 30 Hospital Procedures
Building on the release last month of the average charges for the 100 most common inpatient procedures, the Centers for Medicare and Medicaid Services (CMS) today released selected hospital outpatient data that includes estimates for average charges for 30 types of hospital outpatient procedures from hospitals across the country, such as clinic visits, echocardiograms and endoscopies. Read more on access to health care.

CDC Issues First Comprehensive Report on Children’s Mental Health in the United States
As many as one in five American children under the age of 17 has a diagnosable mental disorder according to a new report from the Centers for Disease Control and Prevention. The report is the first expansive report on children's mental health ever done by the U.S. government and looked at six conditions:

• attention-deficit/hyperactivity disorder (ADHD)
• behavioral or conduct disorders
• mood and anxiety disorders
• autism spectrum disorders
• substance abuse
• Tourette syndrome

The most common disorder for children age 3 through 17 is ADHD (7 percent) followed by behavioral or conduct problems (3.5 percent), anxiety (3 percent), depression (2 percent), and  autism spectrum disorders (1 percent).

Five percent of teens reported abusing or being dependent on illegal drugs, 4 percent abused alcohol and 3 percent reported smoking cigarettes regularly. Boys were more likely than girls to have the disorders. Read more on mental health.

New PSAs Help Parents Talk to Younger Kids about the Dangers of Underage Drinking
“Talk. They Hear You,” is a new national public service announcement (PSA) campaign from the Substance Abuse and Mental Health Services Administration (SAMHSA) to empower parents to talk to children as young as nine about the dangers of underage drinking. SAMHSA research shows that more than a quarter of American youth engage in underage drinking, and  though there has been progress in reducing the extent of underage drinking in recent years, particularly among those aged 17 and younger, the rates of underage drinking are still unacceptably high, according to SAMHSA. A report from late last year shows that 26.6 percent of 12-20 year-olds report drinking in the month before they were surveyed and 8.7 percent of them purchased their own alcohol the last time they drank, despite the fact that all fifty states and the District of Columbia currently have laws prohibiting the purchase and use of alcoholic beverages by anyone under age 21.  

“Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death,” said said SAMHSA Administrator Pamela S. Hyde.

The goal of the new PSA is to help parents start a conversation about alcohol before their children become teenagers. Read more on addiction.

Advocacy Groups Petition FDA to Ban Menthol Flavored Cigarettes
In response to a Citizen Petition by close to twenty health and tobacco control advocacy groups, the Food and Drug Administration has opened a docket for public comment on banning menthol in cigarettes. In 2009, according to the Tobacco Control Legal Consortium, the lead group on the petition, Congress banned all flavors in cigarettes except menthol, and directed the FDA to decide whether continued sale of menthol cigarettes is “appropriate for public health." According to the petition, menthol cigarettes are the source of addiction for nearly half of all teen smokers. Read more on tobacco.

Psychiatrist "Bible" Gets a Numeric Overhaul
The American Psychiatric Association will release the latest version of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) this Saturday at its annual meeting, according to Reuters. The current version is the DSM-IV, which was released a full 10 years ago -- the new version will be recast as DSM-5 (not DSM-V), with an eye toward updating the catalog of psychiatric conditions much more frequently with intermediate versions (DSM-5.1, DSM-5.2 and so on). The newest version also aims to introduce more scientific rigor and clinical confirmation of mental illness, such as, "using neuroscience in particular to tell the difference between, say, normal sadness and major depression." Though some criticize that the science just isn't there yet, and that the current version could lead to overdiagnosis. Read more on mental health.

Most Adults Enforce Smoke-Free Rules in Homes, Cars
Four out of five U.S. adults report having voluntary smoke-free rules in their homes and three out of four report having voluntary smoke-free rules in their vehicles, according to a study published in the journal Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention. Despite the high prevalence of voluntary smoke-free rules in homes and vehicles, the study found that almost 11 million non-smoking adults continue to be exposed to secondhand smoke in their home, and almost 17 million non-smoking adults continue to be exposed to secondhand smoke in a vehicle. The study also showed that voluntary smoke-free rules were more prevalent in states with comprehensive smoke-free laws and tobacco control programs. Read more on tobacco.

Living Near Fast-Food Outlets Might Boost Obesity Risk
Black Americans who live within two miles of a fast food outlet have a higher body-mass index than those living farther away -- and that link especially holds true for those with lower incomes, according to a new study published in the American Journal of Public Health. The study involved more than 1,400 black adults divided into two groups: those making less than $40,000 per year and those making $40,000 or more per year. Read more on what it takes to create healthy communities.

WHO Reports First Patient-to-Nurse Transmission of SARS-like Virus
The World Health Organization (WHO) is reporting that two health care workers in Saudi Arabia have become infected with a potentially fatal new SARS-like virus after catching it from patients, which represents the first case of the virus spreading this way within a hospital. Novel coronavirus, or nCoV, is thought to be spread through close contact, but, "scientists are on the alert for any sign that nCoV is mutating to become easily transmissible to multiple recipients, like SARS -- a scenario that could trigger a pandemic," according to Reuters. Read more on infectious disease.

Repeated Head Injuries Raise Soldiers' Suicide Risk
Soldiers who sustain multiple traumatic brain injuries, even if they are mild, are at greater risk for suicide, according to a study published in the journal JAMA Psychiatry. Researchers found that the risk for suicidal thoughts or behaviors increased for soldiers with such injuries over the course of a lifetime -- not just in the short term after the injuries occur. Suicide is the second-leading cause of death among U.S. military personnel, and researchers say this study provides further guidance on assessing risks and supporting wounded soldiers. Read more on military health.

HHS Announces $1 Billion to Fuel Health Care Innovation
The U.S. Department of Health and Human Services (HHS) launched a nearly $1 billion initiative -- the Health Care Innovation Awards -- that will fund work to transform the health care system by demonstrating better care and lower costs. This is the second round of the award. In the first round, the Centers for Medicare & Medicaid Services awarded 107 Awards out of nearly 3,000 applications. Round one awardees included a medical home for people with disabilities that showed a 71 percent reduction in hospitalization rates. Read more on access to health care.

One in Five Kids At Risk for Suicide Live in Homes with Guns
Nearly one in five children and teens found to be at risk for suicide report that there are guns in their homes and fifteen percent of those with guns in their home said they know how to access both the guns and the bullets, according to a study presented at the Pediatric Academic Societies annual meeting in Washington, D.C.

The study researchers recommend that emergency department doctors screen all children and teens for suicide risk. Suicide is the second leading cause of death among young people ages 10 to 24 years in the United States, according to Centers for Disease Control and Prevention. Nearly half of young people who die by suicide use a gun. Read more on injury prevention.

Teen Girls Who Exercise Are Less Likely to be Violent
A study from the Columbia University Mailman School of Public Health finds that high school girls who play sports or run have a lower risk of being in fights or in a gang. Researchers at the school reviewed results of a 2008 survey completed by 1,312 students at four inner-city high schools in New York to determine if there was an association between regular exercise and violence-related behaviors.

The survey results found that girls who had exercised more than 10 days in the last month had decreased odds of being in a gang, those who did more than 20 sit-ups in the past four weeks had decreased odds of carrying a weapon or being in a gang and those who reported running more than 20 minutes the last time they ran had lower odds of carrying a weapon. Girls who participated in team sports in the past year had decreased odds of carrying a weapon, being in a fight, or being in a gang.

Among boys, none of the exercise measures were linked to decrease in violence-related behaviors. But the researchers say that a connection may not have been found because a smaller percentage of boys than girls completed the survey and that more research is needed to see if exercise interventions can reduce youth violence. Read more on violence.

USDA Announces New Rules to Fund Broadband Service in Underserved Rural Communities
The USDA has announced new rules that simplify the proposals to request funds for internet broadband access in rural areas. USDA broadband funds have provided internet access for nearly 65,000 rural households, businesses, and community organizations such as libraries, schools and first responders. Read more on preparedness.

HHS Makes Hospital Cost Information Available to Consumers
The U.S. Department of Health and Human Services (HHS) has announced a new initiative that, for the first time, gives consumers information on what hospitals charge for many procedures and services. The information will be posted on the website of the Centers for Medicare and Medicaid Services and will show comparative charges for services that may be provided during the 100 most common Medicare inpatient stays, such as knee replacements. The new data shows significant variation across the country and within communities in what hospitals charge for common inpatient services. The agency is also providing close to $90 million to states to collect, analyze, and publish health pricing and medical claims reimbursement data. To help show how the data can be used the Robert Wood Johnson Foundation has announced a data visualization challenge. Read more on access to health care.

CDC Issues Updated Hepatitis C Screening Guidelines
The U.S. Centers for Disease Control and Prevention (CDC) has issued new screening guidelines for Hepatitis C that recommend anyone born between 1945 and 1965 be screened for the infection, as well as anyone who received a blood transfusion or organ donation before 1992 when screening of the blood supply was improved, and anyone who has ever injected drugs. The CDC is making the new recommendations because only half of Americans identified as ever having had hepatitis C received follow-up testing to see if they were still infected, according to a new Vital Signs issued by the agency. CDC researchers looked at data from eight areas across the country and found that of the hepatitis C cases reported in those areas, follow-up testing was only done in 51 percent of the cases. “Complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences,” says said CDC Director Tom Frieden, MD, MPH. According to the CDC, about 3 million Americans are infected with hepatitis C and up to 3 out of 4 do not know they are infected. Read more on infectious disease.

Researchers Call for Independent Review Process for DSM-5 Updates
Arguing that that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) missed “crucial population-level and social determinants of mental health disorders,” a group of researchers at the Columbia University Mailman School of Public Health and Columbia University Medical School are calling for an independent review for any future revisions of the American Psychiatric Association’s guidelines. The article appears in the journal Health Affairs. “As the DSM evolves, we must ensure the accuracy of psychiatric diagnoses and their equitable use in health care by systematically reviewing and applying the lessons in the population health and social science literature,” wrote the authors. The factors include various environmental factors, cultural perceptions and institutional pressures. Read more on mental health.

CDC: Only 20 Percent of U.S. Adults Meet Aerobic, Muscle-strengthening Requirements
Only about one in five U.S. adults meet the aerobic and muscle strengthening components of the federal government's Physical Activity Guidelines for Americans, according to a new report in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The guidelines call for a minimum of 2.5 hours of moderate-intensity aerobic activity each week, or 1.25 hours of vigorous-intensity aerobic activity, as well as at least two days of muscle-strengthening activities. About half of adults meet the aerobic minimums and 30 percent meet the muscle-strengthening requirements, which Carmen D. Harris, MPH, epidemiologist in CDC's physical activity and health branch, called “encouraging.” "This is a great foundation to build upon, but there is still much work to do,” she said. “Improving access to safe and convenient places where people can be physically active can help make the active choice the easy choice." Read more on physical activity.

Hospital Programs Find Success in Cutting Antibiotic Prescriptions, Drug-resistant Bacteria
Hospital programs designed to decrease the number of prescriptions for antibiotics also successfully cut the number of drug-resistant bacteria, according to a new study in the Cochrane Library. Such bacteria, as well as the possibility of secondary infections, can leave patients especially at risk. "Antibiotic resistance is recognized worldwide as a public health problem that's just getting worse. Really around the world people are worried that we'll end up with bacteria that are resistant to the antibiotics we've got," said Peter Davey, MD, of the University of Dundee in Scotland. Researchers found that while persuasion/education programs were effective, actually restricting prescriptions saw more improved outcomes early on, which persuasion/education’s effectiveness catching up later. "We got good evidence that restrictive interventions work faster in terms of changing prescribing and microbial outcomes," he said. Read more on preventing antibiotic resistance.

Suicide Rate Up Significantly for Middle-aged Americans
Attempts to explain the dramatic increase in suicides by middle-aged Americans over the past decade have left many public health experts “dumfounded,” according to Lanny Berman, executive director of the American Association of Suicidology. "The best we can come up with is maybe this is the group most likely to be affected by the recession and unemployment and [home] foreclosure," he said. "It affected suicide rates both nationally and internationally." A new report from the U.S. Centers for Disease Control and Prevention reveals that suicides for people aged 35-64 rose by 28 percent from 1999 to 2010. For comparison’s sake, more Americans died by suicide in 2010 (38,364) than in car crashes (33,687). According to an agency news release: "Suicide is a tragedy that is far too common. The stories we hear of those who are impacted by suicide are very difficult. This report highlights the need to expand our knowledge of risk factors so we can build on prevention programs that prevent suicide,” said CDC Director Tom Frieden, MD. Read more on mental health.

Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages.

Yesterday, NPR reported that business owners near the blast site are beginning to return and reopen their doors.

"They fled in a panic last week and returned both eager and anxious," said NPR reporter Tovia Smith. The piece describes how business owners returned to find food left half-eaten and rotting, because so many left in such a hurry, and blood splattered in some spots from those who were injured.

To help make sure businesses get the help they need to reopen safely, public health inspectors played a role in visiting every building on every block. "They also stood ready with trauma counselors, pro-bono attorneys and clean-up crews," said Smith.

But the public health response to any disaster goes beyond helping to restore normalcy in the immediate aftermath. An earlier interview with John Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, about the sustained response to Hurricane Sandy also applies here:

We saw with Katrina and are seeing again now with Sandy, [public health officials] are not only concerned with food, air, and water during and immediately after an emergency, but also with ensuring that services related to health care delivery and mental health are provided when and where they’re needed. It’s an interesting statistic, for instance, that the demand for mental health services was higher five years after Hurricane Katrina than it was immediately after the hurricane hit.

The Boston Public Health Commission announced this week, for example, that the organization has opened a new drop-in center to continue to provide emotional support to anyone affected by the Boston Marathon attack.

"While the physical injuries and destruction that resulted from the bombings might be the most visible signs of trauma, many people experience serious emotional distress based on what they saw, heard, and felt during and after the attack. Sometimes these symptoms do not surface immediately," according to the Commission release. "Understanding the deep impacts of this emotional distress, city officials opened the drop-in center as a safe place for people to come together and talk about their experiences over the past week."

>>Read more about building community resilience to recover from disaster.