RWIs can occur when a person:

• swallows water
• breathes in water, or
• comes in contact with contaminated recreational water.

Recreational water includes:

• swimming pools
• hot tubs
• water parks
• water play areas
• interactive fountains
• lakes, rivers, or other bodies of water

This week also begins the Utah Department of Health (UDOH) Bureau of Epidemiology’s surveillance efforts for cryptosporidium. In the summer and fall of 2007, Utah experienced the largest reported recreational water-associated outbreak of cryptosporidiosis (crypto) in the United States. Between June and December, public health officials confirmed more than 1,900 cases of crypto throughout the state. Most of the victims reported swimming at a recreational water facility prior to getting sick. Infection with cryptosporidiosis causes watery diarrhea, stomach cramps/pain, nausea, vomiting, fever, and as a result of the diarrhea, dehydration and weight loss. Symptoms usually last about one to two weeks, and may go in cycles in which a person may feel better for a few days, and then feels worse again.

To keep yourself and others safe from crypto, follow the guidelines below.

• Do not swim if you have diarrhea and don’t let family members, especially young children, either.
• Wait two weeks after diarrhea has stopped before swimming.
• Take a shower with soap and water before swimming (referred to as a “cleansing shower”).
• Do not swallow pool water or get pool water into your mouth.
• Wash your hands with soap and water after using the bathroom or changing a diaper.
• Take regular bathroom breaks while swimming.
• Change diapers often. Change diapers in the bathroom, not at the poolside.
• Wash your child’s bottom with soap and water after changing a diaper and then wash your hands with soap and water.

For more information on RWI prevention, visit www.cdc.gov/healthywater/swimming/rwi/rwi-prevent.html
For more information on drowning prevention, visit www.cdc.gov/SafeChild/Drowning/index.html
For more information about healthy swimming, visit CDC’s Healthy Swimming website at www.cdc.gov/healthyswimming

The study compared home and public cardiac arrests under various scenarios. For example, the study considered whether bystanders or emergency medical services (EMS) personnel witnessed the cardiac arrest, and whether the person experiencing the arrest received treatment with an automatic external defibrillator (AED).

In every scenario, a higher percentage of public cardiac arrests were classified as ventricular tachycardia (VT) or ventricular fibrillation (VF), the types of abnormal heart rhythms that can be treated by electric shock.

More than one-third of the people who had a cardiac arrest in public and were treated with an AED survived. This is a significant improvement over the roughly 8 percent national average of cardiac arrest survival. In comparison, the overall survival for home-occurring cardiac arrests treated with an AED was 12 percent.

“To improve the overall disappointing outcome for persons experiencing cardiac arrest, we must know the best immediate treatment,” said Susan Shurin, M.D., acting director of the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH and the major funding agency of this study. “This study provides rich data which indicate the need for further evidence to guide clinical practice and public policy.”

The study is based on data from the world’s largest data registry of pre-hospital cardiac arrest and life-threatening trauma, which is part of the Resuscitation Outcomes Consortium (ROC). The researchers collected cardiac arrest data for over 14,000 people between Dec. 2005 and April 2007. The data spanned over 200 EMS agencies and their receiving hospitals across the United States and Canada.

Among the key findings were that 79 percent of documented cardiac arrests in high-traffic public places where AEDs were available and administered, such as airports or office buildings, were VT or VF. An AED can automatically diagnose an arrhythmia and shock an arrest victim if necessary. In contrast, only 36 percent of home cardiac arrests in which an AED was applied were VT/VF.

Previous studies have found that home-based cardiac arrests have far lower survival rates than arrests that occur in public locations. This study found that only a third of arrests which occurred in homes were witnessed, while over half of those in public locations had witnesses who could immediately call 911 and provide assistance.

The importance of having someone who can provide or call for help does not exclude the possibility that the types of cardiac arrests occurring in home may differ from those occurring in public settings, or that those occurring in public may be more likely to be effectively treated with electrical stimulation.

The study noted that this significant contrast in prevalence could be due to the fact that individuals who spend more time in public places typically are younger, more active, and have fewer chronic diseases, thus predisposing them to a different class of arrest.

However, according to Dr. Shurin, more work is needed to know whether the differences in rates of rhythms and in outcome are due to underlying differences in severity of disease or in how rapidly responders provide effective therapy.

“These survival results affirm the value of putting AEDs in public locales,” said Myron Weisfeldt, M.D., a cardiologist at Johns Hopkins University in Baltimore and lead author of the study. “Even though the overall frequency of VT/VF arrests has declined over the past few decades, they are still a fairly common occurrence in public settings.”

George Sopko, M.D., ROC project officer and program director in the NHLBI’s Heart Failure and Arrhythmias Branch, added that public awareness and education are still important. The best chance of surviving a cardiac arrest, he noted, involves using AEDs in conjunction with cardiopulmonary resuscitation and immediately calling for medical help.

The drug is not intended for use in women with a multiple pregnancy, such as a twin pregnancy, or other risk factors for preterm birth.

The FDA approved Makena under the agency’s accelerated approval regulations that allow promising drugs to be approved based on a surrogate endpoint benefit (here, reducing the risk of delivery before 37 weeks of pregnancy) that is reasonably likely to predict a clinical benefit.

Under these regulations, the manufacturer must conduct additional studies after the product is approved to demonstrate that the drug does, in fact, have a clinical benefit.  An international trial is ongoing to learn if there is also improvement in the outcome of babies born to women given Makena. Such outcomes include reducing the number of babies who do not survive or who suffer serious health problems shortly after birth.

“Preterm birth is a significant public health issue in the United States,” said Sandra Kweder, M.D., deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research. “This is the first drug approved by the FDA that is indicated to specifically reduce this risk.”

A health care provider would give Makena once a week by injection into the hip. Treatment should begin at 16 weeks and no later than 21 weeks of pregnancy.

The FDA reviewed data on the safety and effectiveness of Makena in a multicenter randomized double-blind clinical trial. The study included 463 women 16 to 43 years of age who were pregnant with a single fetus and had a history of a prior spontaneous preterm birth. Among women treated with Makena, 37 percent delivered early (before 37 weeks) as compared with 55 percent of women in the control group.

A separate study evaluated the development of children born to mothers enrolled in the controlled trial. In this study, children ages 2.5 years to 5 years reached similar developmental targets, regardless of the mother’s treatment.  The confirmatory study that is ongoing will be followed by a similar infant follow-up study, to be completed about 2018.  That study is expected to include 580-750 infants, depending on the number of study sites and mothers willing to participate.

The most common side effects reported with Makena included pain, swelling, or itching at the injection site; hives, nausea and diarrhea. Serious adverse reactions were rare; there was a single report each of blood clot in the lungs (pulmonary embolism) and an infection at the injection site.

The FDA originally approved hydroxyprogesterone caproate under the trade name Delalutin in 1956 for use in pregnant women. The approved indications include threatened miscarriage. The original manufacturer requested the withdrawal of Delalutin from the market in 2000 for reasons unrelated to safety.

Consumers and health care professionals are encouraged to report adverse events from medications to the FDA’s MedWatch program at 800-FDA-1088 or online at www.fda.gov/medwatch/how.htm¹.

Makena is sponsored by Hologic, Inc., based in Sunnyvale, California.

Asthma is a disease that affects your lungs. It is one of the most common long-term diseases of children, but adults have asthma, too. Asthma causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs.

In most cases, we don’t know what causes asthma, and we don’t know how to cure it. We know that if someone in your family has asthma, you are also more likely to have it.

You can control your asthma by knowing the warning signs of an attack, staying away from things that trigger an attack, and following the advice of your doctor or other medical professional. When you control your asthma:

• you won’t have symptoms such as wheezing or coughing,
• you’ll sleep better,
• you won’t miss work or school,
• you can take part in all physical activities, and
• you won’t have to go to the hospital.

How Is Asthma Diagnosed?

Asthma can be hard to diagnose, especially in children younger than 5 years of age. Regular physical checkups that include checking your lung function and checking for allergies can help your doctor or other medical professional make the right diagnosis.

During a checkup, the doctor or other medical professional will ask you questions about whether you cough a lot, especially at night, and whether your breathing problems are worse after physical activity or during a particular time of year. Doctors will also ask about other symptoms, such as chest tightness, wheezing, and colds that last more than 10 days. They will ask you whether your family members have or have had asthma, allergies, or other breathing problems, and they will ask you questions about your home. The doctor will also ask you about missing school or work and about any trouble you may have doing certain activities.

A lung function test, called spirometry (spy-rom-e-tree), is another way to diagnose asthma. A spirometer (spy-rom-e-ter) measures the largest amount of air you can exhale, or breathe out, after taking a very deep breath. The spirometer can measure airflow before and after you use asthma medicine.

What Is an Asthma Attack?

An asthma attack happens in your body’s airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucus that your body produces clogs up the airways even more. The attack may include coughing, chest tightness, wheezing, and trouble breathing. Some people call an asthma attack an episode.

What Causes an Asthma Attack?

An asthma attack can occur when you are exposed to things in the environment, such as house dust mites and tobacco smoke. These are called asthma triggers.

ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• have a hard time paying attention
• daydream a lot
• not seem to listen
• be easily distracted from schoolwork or play
• forget things
• be in constant motion or unable to stay seated
• squirm or fidget
• talk too much
• not be able to play quietly
• act and speak without thinking
• have trouble taking turns
• interrupt others

Types

There are three different types of ADHD, depending on which symptoms are strongest in the individual:

• Predominantly Inattentive Type: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Type: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

• Combined Type: Symptoms of the above two types are equally present in the person.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD.  The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.¹

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Environmental exposures (e.g., lead)
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people.  But the evidence is not strong enough to conclude that they are the main causes of ADHD.

For more information about cause(s) and risk factors, visit the National Resource Center on ADHD or the National Institute of Mental Health.

Diagnosis

Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Treatments

In most cases, ADHD is best treated with a combination of medication and behavior therapy. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) sponsors the National Resource Center, a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their Web site has links to information for people with ADHD and their families. The National Resources Center operates a call center with trained staff to answer questions about ADHD. The number is 1-800-233-4050.

To find out who to speak to in your area, you can contact the National Dissemination Center for Children with Disabilities by logging on to http://www.nichcy.org/ or calling 1-800-695-0285.

In order to make sure your child reaches his or her full potential, it is very important to get help for ADHD as early as possible.

It is well established that breastfeeding gives children the healthiest possible start in their lives, but it has also encountered barriers in different areas of society. Some of the 20 steps that can be taken to break down these barriers include: developing programs to educate fathers and grandmothers about breastfeeding; strengthening programs that provide mother-to-mother support and peer counseling within the community; ensuring that maternity care practices are fully supportive of breastfeeding; providing education and training in breastfeeding for all health professionals who care for women and children; and ensuring that employers establish and maintain comprehensive, high-quality lactation support programs for their employees.

This is a very important document, said Patrice Isabella, UDOH Physical Activity, Nutrition and Obesity Program (PANO) Nutrition Coordinator. It asks everyone in a community from the family to health care providers and businesses to remove barriers so mothers can breastfeed their children without embarrassment or worry, added Isabella.

Breastfeeding advocates say that, when women are able to reach their personal breastfeeding goals, it helps the entire population achieve optimum health.

PANO and its partners are working to remove breastfeeding barriers by encouraging and helping businesses to start lactation programs and policies, educating health care providers on lactation and the importance of breastfeeding for at least six months, and reaching out with many other awareness and education messages.

In Utah, about 90% of mothers initiate breastfeeding when their children are born, making Utah one of the states with the highest breastfeeding initiation rates in the nation. However, by the time the child is six months old, only 16% of mothers are still exclusively breastfeeding their children. Exclusive breastfeeding for 6 months is recommended for optimal health.

For more information on The Surgeon Generals Call to Action to Support Breastfeeding visit www.health.utah.gov/obesity

“Studies show that treating tobacco use along with drug or alcohol abuse increases recovery rates,” said UDOH Division of Disease Control and Prevention Director Dr. Robert Rolfs. “Many people have such severe problems that at times we forget that tobacco use kills more people than all those other so-called ‘serious’ drugs combined,” Rolfs added. “As clinicians, it’s our duty to treat all forms of addiction – knowing that we’re saving lives by doing so.”

The Recovery Plus program includes a comprehensive tobacco-free campus policy and integrates tobacco cessation into treatment protocols. The key is to have a holistic treatment plan for all patients in the facilities.

According to the National Association of State Mental Health Program Directors, people with mental illness die 25 years earlier than the general population, largely due to conditions caused or worsened by smoking.

“Patients who smoke and have a substance abuse problem can increase their recovery rates up to 25% when they receive treatment for substance abuse and smoking cessation simultaneously,” said Department of Human Services Director Palmer DePaulis. “Treatment recommendations are clear: Nobody will be refused treatment based on tobacco use status, but if patients use tobacco and want to increase their chances of recovery, providing a tobacco-free environment will help more people recover and protect their health, too,” he said.

For more information, visit www.RecoveryPlus.Utah.Gov and for free help quitting tobacco, call the Utah Tobacco Quit Line at 1.800.QUIT.NOW or visit www.UtahQuitNet.com

Studies show that two out of every three women take medications during pregnancy. As part of National Birth Defects Prevention Month, staff of the Utah Department of Health Birth Defect Network (UBDN) and Pregnancy Risk Line (PRL) encourage women of childbearing age to talk with their heath care provider about ANY medications (prescription or over-the-counter) and supplements before they start trying to conceive.

“Though many women know that certain prescription medications can cause birth defects, they may not be aware that some dietary supplements and herbal remedies can also harm a developing baby,” said Dr. John Carey, pediatrician at U of U Health Sciences and medical director of PRL.

It’s important that moms understand that not all medications should be discontinued during pregnancy; some may need to be changed or adjusted. Medical conditions like diabetes, influenza, seizure disorders and asthma need to be managed during pregnancy and may harm both mother and baby if left untreated. In some cases, health care providers may need to weigh the benefits of a medication against the potentially harmful effects. For that reason, it’s important for women to have conversations with their health care providers about any medical conditions before and during pregnancy.

In addition, every woman should take a multivitamin with 400 mcg of folic acid daily, starting before pregnancy, to improve the likelihood of delivering a healthy baby. A baby’s spine and other organs (e.g., heart and brain) begin developing in the first few weeks, before a woman may realize she is pregnant. Pregnant women should also eat a healthy diet, avoid alcohol, and get a flu shot.

For a list of medications and maternal conditions that have been known to increase the risk of birth defects, please visit http://www.health.utah.gov/prl/teratogens.htm.

UBDN and PRL are participating in National Birth Defects Prevention Month by distributing information to health care providers and women throughout the state. To learn more, please contact UBDN at 866-818-7096, or visit www.health.utah.gov/birthdefect

For information about medications and other exposures during pregnancy and breastfeeding, please contact PRL at 800-822-2229, or visit www.pregnancyriskline.org

The lower ranking can be traced to several key factors, most notably an increase in the percentage of children in poverty (8.8 percent in 2009 to 13.9 percent in 2010). However, Utah still receives high marks for low smoking, binge drinking and preventable hospitalization rates in the Foundation’s 21st annual report.

“The UHF report is an important public health tool that helps us evaluate our progress in many areas,” said Dr. David Sundwall, Utah Department of Health (UDOH) Executive Director. “While it puts the spotlight on our state’s strengths, it reinforces some things we already knew and highlights areas where we need to improve.”

Other low marks were seen in the rate of premature deaths, which dropped Utah from 7th to 13th place, and in immunization coverage, with the state falling from 21st to 30th.

“Some Utahns still believe we don’t have a problem with diseases like measles and whooping cough, which are preventable by simply vaccinating our children,” said Sundwall. “But the fact is, every year we have cases of vaccine-preventable illnesses and children do suffer. So we never let up in our efforts to educate parents about the benefits of immunizations.”

Utah also saw a jump in adult obesity rates. “We already knew obesity was a growing problem in Utah and the report backs that up,” said Sundwall. The 2010 rankings have Utah moving from 5th to 9th place, with 24 percent of Utahns now considered obese.

The UHF report also cites the state’s high geographic disparity and low public health funding at $65 per person. In addition, Utah’s continuing shortage of primary care physicians places the state in 45th position for that measure.

“As I predicted last year, our national ranking is suffering from our serious lack of physicians, both primary care and specialists,” said Sundwall. “It can take months for Utahns to get in to see a rheumatologist or many other specialty practitioners,” he added.

Utah did fare better in other areas, and ranks in the top 10 in 10 of the report’s 22 determinants, including;

“This year’s influenza season is much less hectic than last year when H1N1 was so prevalent,” says Dr. David Sundwall, Utah Department of Health (UDOH) Executive Director. “Unlike last year, there is only one seasonal influenza vaccine needed this year and it includes the H1N1 strain.”

Additionally, Utah reports a significant decrease in the number of influenza-associated hospitalizations (IAH) from last year at this time–-807 cases in 2009-2010 vs. 21 cases to date in 2010-2011. As a result, health care providers can direct more efforts toward preventing influenza rather than treating it.

Health officials stress that any influenza infection can be serious, not just new influenza viruses. Every year, thousands of people are hospitalized and die from complications of influenza infection. Getting vaccinated every year remains the best method of prevention.

In addition to encouraging influenza vaccination, health officials want to dispel two of the biggest myths associated with the influenza vaccine.

Myth #1: The influenza vaccine causes influenza (flu).
Fact: It doesn’t. The particles in the vaccine are inactive and can’t transmit the live virus to a person who gets vaccinated or from the vaccinated person to others. Even the particles in the live-virus nasal spray are so weakened, they don’t cause the severe symptoms associated with influenza infection. Sometimes, a vaccinated person may experience minor reactions to the vaccine, such as muscle aches or stomach upset, but this isn’t the influenza infection and the symptoms will usually last for 1-2 days.

Myth #2: Young and healthy people don’t need to get vaccinated.
Fact: Even young, healthy people can get seriously ill and die from influenza. The recent H1N1 pandemic affected the younger population more than is typically seen with seasonal influenza. The good news is this group usually responds better to the flu vaccine than older adults. But even if a person doesn’t want the vaccine for personal protection, getting vaccinated can help prevent a person from spreading the flu to others, such as infants who may be too young to be vaccinated and to people with weakened immune systems or older people who don’t respond as well to the vaccine.

A three-step approach is recommended to fighting influenza: 1) vaccination, 2) everyday preventive actions, such as covering your coughs and sneezes, washing hands, and staying home when sick, and 3) the correct use of antiviral drugs, if your doctor recommends them. If you think you have influenza (abrupt onset of fever, muscle aches and pains, cough and or sore throat), see your physician within 24 hours. Contact your local health department or health care provider, the Immunization Hotline at 1-800-275-0659, or check the Flu Vaccination Locator at www.utahflufighters.org to find an influenza vaccination clinic.