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Volume 5, No. 7, August 2007
From Your Colleagues
Scott Giberson, HQE
American Indian / Alaska Native (AI/AN) population has the shortest timeline HIV to AIDS
The American Indian / Alaska Native (AI/AN) population has the 3rd highest rate of HIV/AIDS, the shortest timeline between diagnosis and death and the highest percentage of ‘late’ diagnosis (determined by progression of disease at time of diagnosis) of any race/ethnic group.
This suggests the critical preventive component of missed screening opportunities. Reports of the percentage of AI/AN tested for HIV range anywhere from below 50% to roughly 75%. Given the risk factors and population vulnerabilities, it is imperative we screen individuals at every opportunity. The impact of screening early and often is easily justifiable as treatment and care is available. Screening also serves as a preventive measure since it is estimated that over half of newly infected individuals acquire HIV from those unaware of their status.
With the revised CDC testing guidelines, states are changing requirements and attempting to adjust policy to effectively implement more broad-based screening efforts. The IHS supports these CDC recommendations and have removed any potential barriers (at the Agency level) to increase screening efforts. It is a responsibility that each of us attempts to take on the role of an advocate, supporter, facilitator, or provider of prevention and care, to include advocacy for HIV screening.
More information can be found at www.aids.gov and / or www.ihs.gov/medicalprograms/hivaids/
Rapid HIV testing in emergency departments--three U.S. sites, January 2005-March 2006
Approximately one fourth of the estimated 1 million persons living with human immunodeficiency virus (HIV) in the United States are unaware that they are infected with HIV and at risk for transmitting the virus to others. In April 2003, CDC announced a new initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, aimed at reducing barriers to early diagnosis of HIV infection and increasing access of persons infected with HIV to medical care and prevention services. A priority strategy of this initiative is to make HIV testing a routine part of medical care. In April 2004, HIV testing was implemented in one emergency department (ED) in Los Angeles, California, and one in New York, New York, to determine the feasibility and acceptability of offering rapid HIV testing as a routine part of health care in EDs. In January 2005, an ED in Oakland, California, also began offering HIV testing routinely. This report summarizes the preliminary results of integrating rapid HIV testing into the health-care services routinely offered in the three EDs during January 2005-March 2006. Those results indicated that, of 9,365 persons tested, 97 (1.0%) ED patients had newly diagnosed HIV infection, and 85 (88%) of those 97 were linked after diagnosis to HIV care and treatment. EDs should consider integrating rapid HIV testing into their routine medical services to identify patients who are unaware that they are infected with HIV and link them to health and prevention services.
Centers for Disease Control and Prevention (CDC).
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a2.htm
Treating Antiretroviral-Experienced Patients: Case-based CME Program
This CME program, presented by The Johns Hopkins University School of Medicine,
provides clinicians with the latest information regarding the management of patients
living with HIV who have persistent viral levels despite initial therapy. This
educational activity focuses on the effectiveness of antiretroviral (ARV) therapy
using newer treatments and an optimized background regimen that has the potential
to achieve maximal viral suppression and immunologic improvement in a significant
proportion of ARV-experienced patients, preventing or delaying the development
of additional virologic resistance and AIDS-related events. This free CME
program is intended for physicians and other clinicians who actively manage patients
with HIV and AIDS.
http://www.hivcases.org/
Stop the Silence
The Red Talon project media campaign, “Stop the Silence” www.stopthesilence.org also offers posters, Public Service Announcements and an “Advocacy Kit”, which contains information about AI/AN STD rates, the social and economic impact of STDs on tribal communities, and steps that can be taken by tribal councils to improve school-based, clinic-based, and community-based prevention efforts. Attached is one of their posters. More information about this project and these materials will soon be posted on the IHS HIV/AIDS website under the “Toolkit” tab (left column) at http://www.ihs.gov/MedicalPrograms/hivaids/index.cfm?module=toolkit#top
James Holsinger Jr, Surgeon General Nominee
Physician professionalism for a new century (The latest publication by the SG nominee)
During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society
Holsinger JW, Beaton B. Physician professionalism for a new century. Clin Anat. 2006 Jul;19(5):473-9
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16506233
Favian Kennedy, Rapid City, SD
HOW long does it take Nicotine to reach your brain after inhaling ?
Check out the web site below:
- Tobacco facts - classroom discussions
- Sites for teens (see Resources)
- Smoke Free Homes – campaign materials – contact Favian for details
- Community resources - Smoking Cessation resources links for people who want to quit smoking and using chew
- Clinical treatment guidelines for health professionals
- Field community survey tool - American Indian Adult Tobacco Survey (AI-ATS).
- Provides tribal specific smoking rate estimates for national, state, regional, and Healthy People 2010 benchmarks comparison.
- Looks attitudes, behaviors, and beliefs related to tobacco use among tribal members
- Data for setting health priorities and policies
Answer: 7 seconds. http://www.worthit.org/
Northern Plains Tobacco Prevention Project: Spring Newsletter available online
We are currently promoting smoke-free policies among our consortium member tribes. Two of our tribes are currently considering policies so we want to provide as much support to those local coalitions who are doing all of the leg work. We are also trying to encourage direct service healthcare providers to increase their education of basic environmental asthma trigger identification and mitigation. See link below to Issue #7
http://www.aatchb.org/nptpp/Resources/publications.html
Favian Kennedy, MSW
Program Director
Northern Plains Tobacco Prevention Project Aberdeen Area Tribal Chairmen's Health Board 1770 Rand Road Rapid City, SD 57702
(605) 721- 1922 ext 112
(605) 721-1932 (fax)
Roberta Ward, Anchorage
All you need to know about food safety during pregnancy, FDA
The At-a-Glance Food Safety Brochure at the link below would be a good brochure to include in your New OB education materials.
http://www.cfsan.fda.gov/~pregnant/ataglanc.html
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
