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Comparison of trends in colorectal cancer death rates in hotspots with those in the United States (excluding hotspots): three-year moving annual averages from 1970-1972 through 2009-2011.

Background: Although colorectal cancer death rates in the United States have declined by half since 1970, large geographic disparities persist. Spatial identification of high-risk areas can facilitate targeted screening interventions to close this gap.Methods: We used the Getis-Ord Gi* statistic within ArcGIS to identify contemporary colorectal cancer “hotspots” (spatial clusters of counties with high rates) based on county-level mortality data from the national vital statistics system. Hotspots were compared with the remaining aggregated counties (non-hotspot United States) by plotting trends from 1970 to 2011 and calculating rate ratios (RR). Trends were quantified using joinpoint regression.Results: Spatial mapping identified three distinct hotspots in the contemporary United States where colorectal cancer death rates were elevated. The highest rates were in the largest hotspot, which encompassed 94 counties in the Lower Mississippi Delta [Arkansas (17), Illinois (16), Kentucky (3), Louisiana (6), Mississippi (27), Missouri (15), and Tennessee (10)]. During 2009 to 2011, rates here were 40% higher than the non-hotspot United States [RR, 1.40; 95% confidence interval (CI), 1.34–1.46], despite being 18% lower during 1970 to 1972 (RR, 0.82; 95% CI, 0.78–0.86). The elevated risk was similar in blacks and whites. Notably, rates among black men in the Delta increased steadily by 3.5% per year from 1970 to 1990, and have since remained unchanged. Rates in hotspots in west central Appalachia and eastern Virginia/North Carolina were 18% and 9% higher, respectively, than the non-hotspot United States during 2009 to 2011.Conclusions: Advanced spatial analysis revealed large pockets of the United States with excessive colorectal cancer death rates.Impact: These well-defined areas warrant prioritized screening intervention. Cancer Epidemiol Biomarkers Prev; 24(8); 1151–6. ©2015 AACR.

Supplementary Figure Legend from Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Counties that comprise hotspots in 2000-2009 based on 95% confidence.

Laboratory-based respiratory pathogen surveillance for SARS-CoV-2 and other respiratory pathogens was conducted in the 2020-2021 surveillance season among U.S. Military Health System (MHS) beneficiaries through the Department of Defense Global Respiratory Pathogen Surveillance Program (DoDGRPSP). Sentinel and participating sites submitted 96,660 specimens for clinical diagnostic testing. A total of 12,282 SARS-CoV-2 positive cases were identified, and 7,286 of the associated viruses were successfully sequenced. Two overlapping waves of SARS-CoV-2 activity were observed during the season. The B.1.1.7 (Alpha) lineage was dominant during February 2021 through May 2021. By July 2021, and continuing through the rest of the season, B.1.617.2/AY.x (Delta) lineage predominated and by September 2021 comprised 100% of identified SARS-CoV-2 lineages. The emergence of SARS-CoV-2 coincided with substantial reductions in the circulation of seasonal influenza viruses and most other non-SARS-CoV-2 respiratory pathogens. A total of 4,426 non-SARS-CoV-2 respiratory pathogens were identified, including 71 influenza. Of the 71 influenza positives, 64 were successfully sequenced. The majority of influenza strains sequenced belonged to influenza A(H3N2) clades 3C.2a1b.2a2. The most common non-SARSCoV-2 respiratory pathogen detected was rhinovirus/enterovirus (n=3,058).

When the US Centers for Disease Control met a hard wall of political restraint in attempting a full response to the emergency of AIDS in the early 1980s, it was possible to move toward protection of blood and blood products from the legislative branch of government instead - despite resistance from the Red Cross, blood banks, and the Reagan Administration. A Congressional creation, the Office of Technology Assessment (OTA), received a request from the author, made on behalf of his employer, the Chairman of a Congressional Committee and a Member of the OTA Congressional Board. He asked the OTA to assess US blood policy in light of scientific and technological developments - most importantly the new disease, AIDS. The OTA issued its report in January 1985. In 1995, a new Republican majority in both legislative chambers eliminated the OTA - and thus a valuable source of policy analysis of scientific issues independent of the executive branch.

A one-day conference in Washington brought together leaders of community health centers and worker advocates to discuss collaboration. They agreed that health centers could help protect vulnerable workers. They agreed on use of electronic medical records; access to workers compensation; Medical-Legal Partnerships; better understanding of work settings in their communities; and educating clinicians on work and jobs.

Since the 1988 Institute of Medicine report The Future of Public Health, educators and practitioners have sought to better prepare students for practice. A review of these efforts suggests that they have yet to achieve an adequate synthesis of academic and practice-based education. The authors argue that a fundamental change in the structure of pubic health agencies is required so that all public health students receive practice training in teaching health departments. Academic programs must partner with these agencies but must also continue to teach students about the intellectual framework of public health.

Public health professionals recognize the critical role the law plays in determining the success of public health measures. Even before September 11, 2001, public health experience with tobacco use, HIV, industrial pollution and other potent threats to the health of the public demonstrated that laws can assist or thwart public health efforts. The new focus on infectious threats and bioterrorism, starting with the anthrax attacks through the mail and continuing with SARS, has highlighted the important role of law.For lawyers to serve as effective partners in public health, they should have a basic familiarity with public health: how public health professionals see the world and the key issues they tackle. A practical grasp of public health can be acquired, and often is acquired, “on the job.”

To the Editor: Since it officially went into effect on September 23, 2010, dependent-coverage expansion under the Affordable Care Act (ACA), which allows young adults to be covered under a parent's health insurance plan until they turn 26 years of age, has substantially improved the insurance coverage of persons between the ages of 19 and 25 years.1–4 However, it is unknown whether dependent-coverage expansion has improved the use of recommended preventive services in this age group. Using data from household interviews obtained in the nationally representative Medical Expenditure Panel Survey in the United States, we examined the use of . . .

The Air Force Medical Service is attempting to increase the screening mammography rate among women enrolled to U.S. Air Force military treatment facilities from 72% to 86% (a 20% relative increase). A study was performed to estimate the costs (from testing and first-year treatment) of this targeted increase. We estimated additional 1-year costs using two approaches referred to as the Primary Care Optimization (PCO) approach and the TRICARE Prime benefit (TPB) approach. Under the PCO approach, women ages > or = 50 years are screened every 2 years, whereas under the TPB approach, women are screened every 2 years from ages 40 to 49 years and annually beginning at age 50 years. As of December 31, 2000, 68,360 women ages 40 to 49 years and 70,563 women ages 50 to 69 years were enrolled to U.S. Air Force military treatment facilities. Additional 1-year costs (and additional cases detected by screening) were estimated at dollars 447,096 for the PCO approach (58 additional cases) and dollars 1,340,140 for the TPB approach (72 additional cases). Compared with the PCO approach, under the TPB approach, the 1-year costs of increased screening and treatment for breast cancer at U.S. Air Force military treatment facilities would be three times higher, but the number of additional cases detected by screening would be only 24% higher.

Purpose. To assess the relationships between active-duty military status, military weight standards, concern about weight gain, and anticipated relapse after smoking cessation. Design. Cross-sectional study. Setting. Hospital-based tobacco cessation program. Subjects. Two hundred fifty-two enrollees, of 253 eligible, to a tobacco cessation program in 1999 (135 men, 117 women; 43% on active duty in the military). Measures. Independent variables included gender, body mass index (weight/height2), and military status. Dependent variables included concern about weight gain with smoking cessation and anticipated relapse. Results. In multivariate regression analyses that controlled for gender and body mass index, active-duty military status was associated with an elevated level of concern about weight gain (1.9-point increase on a 10-point scale; 95% confidence interval [CI], 1.0- to 2.8-point increase), as well as higher anticipated relapse (odds ratio [OR] = 3.6; 95% CI, 1.3 to 9.8). Among subjects who were close to or over the U.S. Air Force maximum allowable weight for height, the analogous OR for active-duty military status was 6.9 ( p = .02). Conclusions. Occupational weight standards or expectations may pose additional barriers for individuals contemplating or attempting smoking cessation, as they do among active-duty military personnel. These barriers are likely to hinder efforts to decrease smoking prevalence in certain groups.

In this article, the American Cancer Society provides estimates of the number of new cancer cases and deaths for children and adolescents in the United States and summarizes the most recent and comprehensive data on cancer incidence, mortality, and survival from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries (which are reported in detail for the first time here and include high-quality data from 45 states and the District of Columbia, covering 90% of the US population). In 2014, an estimated 15,780 new cases of cancer will be diagnosed and 1960 deaths from cancer will occur among children and adolescents aged birth to 19 years. The annual incidence rate of cancer in children and adolescents is 186.6 per 1 million children aged birth to 19 years. Approximately 1 in 285 children will be diagnosed with cancer before age 20 years, and approximately 1 in 530 young adults between the ages of 20 and 39 years is a childhood cancer survivor. It is therefore likely that most pediatric and primary care practices will be involved in the diagnosis, treatment, and follow-up of young patients and survivors. In addition to cancer statistics, this article will provide an overview of risk factors, symptoms, treatment, and long-term and late effects for common pediatric cancers.

After 25 years of debate about privacy of automated personal health data, the U.S. Congress has set a deadline of August 1999 for enacting health information privacy legislation. The urgency to establish national policy in the United States re-emerges with implementation of a 1996 law mandating a unique identifier for each participant in the U.S. medical care system and the use of a uniform electronic data set for all health information transmitted in financial and administrative transactions. The impact of electronic data storage and transmittal on privacy, health outcomes, and medical care is unclear. A three-step analytic scheme can clarify the issues in the policy debate and for future assessment. The first step is intended to elicit, for the first time, a precise, accurate, and reproducible description of personal health data transactions and chains of transactions, independent of the policy preferences of any interested party. The second step allows the reader to analyze these transactions according to who benefits first and foremost from each. This scrutiny clarifies the reasons why parties to the debate tend to disagree. The third step characterizes how Congress is likely to perceive the policy process and consider its options before enacting any particular set of compromises. Understanding the policy deliberations and potential effects of evolving information technologies and new national privacy rules should aid assessment of results.

The practice of law has changed greatly since the days when judges based decisions on the maxim salus populi suprema lex, and Oliver Wendell Holmes disagreed, noting that “experience” has been the “life of the law.” In the intervening years, the profession has followed Holmes and the legal realists in recognizing that the law does not exist in a vacuum. It is a human endeavor, molded by experiences and filled with human consequences. Today, lawyers, jurists, and legal scholars everywhere on the political spectrum recognize the importance of social context, history, and a variety of non-legal disciplines, and non-legal insights to the intelligent practice of the law Unfortunately, in rejecting the old maxims, the legal profession also lost sight of the fundamental truth of salus populi suprema lex, Latin for “the health of the people is the highest law” - namely, it has lost sight of the truth that a population’s health is a critical part of law’s social context. One of the consequences of this is that the profession has failed to include public health - the study of the causes and prevention of disease, disability, and death in populations - among the non-legal disciplines regularly incorporated into legal analysis and routinely taught to all would-be lawyers. It is time to correct this oversight.