The Update is a biweekly web newsletter published by

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The Update is a biweekly web newsletter published by Powered By Docstoc
					The Update is a bi-
weekly web newsletter
published by the Iowa
Department of Public
Health's Bureau of
Family Health. It is
posted every 2nd and        June 14, 2004
4th Monday of the           Iowa Department of Public Health
month, and provides         Bureau of Family Health
useful job-resource
information for
departmental health-
care professionals,          90 Million Americans are Burdened with Inadequate Health
information on training      Literacy
intradepartmental            Institute of Medicine of the National Academy of Science
reports and meetings,

and additional                        early half of all American
information pertinent to              adults - 90 million
health-care                           people - have difficulty
                             understanding and using health                                The widespread use of
I N S I D E                  information, and there is a                                  medical jargon magnifies
                             higher rate of hospitalization                                     the problem
1-2 Americans                and use of emergency services
                             among patients with limited
Burdened with
                             health literacy, says a new
Inadequate Health
                             report from the Institute of
                             Medicine of the National
2-3 Surgeon                  Academies. Limited health
General's Report on          literacy may lead to billions of
Tobacco                      dollars in avoidable health care
4 Public Input for Title                                                         Consider these words:        Why not use these?:
V Block Grant                                                                           jaundice                     yellow
                             More than a measurement of
                                                                                    immunization                      shot
4-5 Termination of           reading skills, health literacy                         unconscious                not responding
John Deere Plan              also includes writing, listening,                           tremors                    shaking
                             speaking, arithmetic, and                                   fracture                    break
5-6 Vision Screening         conceptual knowledge. Health                              umbilicus                 belly button
for Children Younger         literacy is defined as the degree                      contraception                birth control
than 5                       to which individuals have the                             insomnia                   can't sleep
                             capacity to obtain, process, and                              acne                     pimples
6-7 Special Olympics                                                                       CVA                       stroke
                             understand basic information
Special Smiles                                                                          bacteria                     germs
                             and services needed to make
                                                                                       influenza                       flu
7 Iowa Interpreters          appropriate decisions regarding
                                                                                        vomiting                 throwing up
Forum                        their health.

8 Calendar of Events         A concerted effort by the public health and health care systems, the education system, the
9 Directory                  media, and health care consumers is needed to improve the nation’s health literacy, the
                             report says. If patients cannot comprehend needed health information, attempts to improve
                             the quality of care and reduce health care costs and disparities may fail.

                             Limited health literacy affects more than just the uneducated and poor, the report says. At
                             some point, most individuals will encounter health information they cannot understand.
                             Even well educated people with strong reading and writing skills may have trouble
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                       comprehending a medical form or doctor’s instructions regarding a drug or procedure.

                       Health literacy skills are needed for discussing care with health professionals; reading
                       and understanding patient information sheets, consent forms, and advertising; and using
                       medical tools such as a thermometer. Over 300 studies indicate that health-related
                       materials cannot be understood by most of the people for whom they are intended.

                       Individuals are increasingly responsible for managing their own health care, the
                       committee noted. They are assuming new roles in seeking information, measuring and
                       monitoring their own health, and making decisions about insurance and options for care.
                       Patients’ health often depends on their ability and willingness to carry out a set of
                       activities needed to manage and treat their disease. This self-management is essential
                       to successful care of chronic diseases such as diabetes, HIV and hypertension.
                       Patients with chronic illness who have limited health literacy are less knowledgeable
                       about disease management and less likely to use preventive measures.

                       Limited health literacy is not a problem that starts and ends with patients, the committee
                       added. Health systems are becoming increasingly complex, involving new technologies,
                       scientific jargon, and complicated medical procedures and forms. All of these aspects of
                       the health system can be confusing to patients. Moreover, care providers frequently
                       need to communicate with patients who have different language and cultural
                       backgrounds. Culture and ethnicity may influence patients’ perceptions of health, illness,
                       and the risks and benefits of treatments. Differing cultural and educational backgrounds
                       between a patient and provider also contribute to problems in the patient’s

                       Health care systems should develop and support programs to reduce the negative
                       effects of limited health literacy. Responsibility for improving health literacy must be
                       borne not only by the health system, but also by educators, employers, community
                       organizations, and other groups with social and cultural influence.

                       The report recommends that health knowledge and skills be incorporated into the
                       existing curricula of kindergarten through 12th grade classes, as well as into adult
                       education and community programs. Furthermore, programs to promote health literacy,
                       health education, and health promotion programs should be developed with involvement
                       from the people who will use them. And all such efforts must be sensitive to cultural and
                       language preferences.

                       Floods and Mosquitoes
                       By Kevin Teale, Communications Director
                       Iowa Department of Public Health

                          owa's May rains might lead to higher than normal mosquito populations, but not a
                          higher risk of mosquito-borne disease right away. That was the word on May 27 from
                          the Iowa Department of Public Health. The department and its public health partners
                       across the state have already implemented mosquito-borne illness surveillance
                       programs that will give Iowans an early warning when those illnesses do appear. Those
                       programs involve the trapping and testing of mosquitoes, testing chicken flocks placed
                       around the state, and testing dead blue jays and crows sent in from around the state.

                       It comes down to an issue of timing. "The heavy rains have led to high mosquito
                       populations in some areas," said Dr. Patricia Quinlisk, Iowa state epidemiologist.

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                        "However, while a tremendous nuisance, floodwater mosquitoes normally don't carry
                        diseases such as West Nile and LaCrosse Encephalitis."

                        The mosquitoes that                                                         typically spread disease in
                        Iowa usually appear later                                                   in the year. However,
                        Iowans should be taking                                                     steps now to help reduce the
                        risk in the future. This                                                    includes steps such as
                        eliminating places where                                                    water can accumulate (such
                        as old tires and open                                                       containers). Consider
                        larvicides for continual                                                    water sources such as
                        ponds and lakes, and                                                        repair screens and gutters
                        around the home.

                        Iowans shouldn't wait for                                    diseases such as West Nile
                        to appear before taking                                      personal precautions.
                        Those      precautions                                       include using a DEET-based
                        mosquito     repellent,                                      wearing long-sleeved shirts
                        and pants, and avoiding the outdoor in peak mosquito periods such as dusk and dawn.

                        "While some municipal governments in Iowa do have mosquito programs, they cannot
                        eliminate all mosquitoes in a given area. It's best to take steps as an individual to protect
                        yourself," said Dr. Quinlisk. "These steps will help protect you against West Nile and they
                        can also reduce your exposure to other insects such as ticks, which potentially carry Lyme

                        For more information on mosquito control and personal protection, visit the department's
                        web site at or call the toll-free West Nile hotline at (866) 968-4692

                        New Surgeon General's Report Gives Even More Reasons
                        to Avoid Tobacco
                        By Kevin Teale, Communications Director
                        Iowa Department of Public Health

                                  n May 27, 2004, the U.S. Surgeon General Richard H. Carmona released a new,
                                  comprehensive report on smoking and health, revealing for the first time that
                                  smoking causes diseases in nearly every organ of the body.

                        Published 40 years after the surgeon general's first report on smoking - which concluded
                        that smoking was a definite cause of three serious diseases - this newest report finds that
                        cigarette smoking is conclusively linked to diseases such as leukemia, cataracts,
                        pneumonia and cancers of the cervix, kidney, pancreas and stomach.

                        "We've known for decades that smoking is bad for your health, but this report shows that
                        it's even worse." Dr. Carmona said. "The toxins from cigarette smoke go everywhere the
                        blood flows. I'm hoping this new information will help motivate people to quit smoking and
                        convince young people not to start in the first place."

                        According to the report, smoking kills an estimated 440,000 Americans each year. On
                        average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5
                        years. The economic toll exceeds $157 billion each year in the U.S. -- $75 billion in direct
                        medical costs and $82 billion in lost productivity.
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                        Proportionally, Iowa numbers are equally disturbing. "If I told you that 13 Iowans would die
                        today, tomorrow and each day thereafter, I would get your attention," said Dr. Mary Mincer
                        Hansen, director of the Iowa Department of Public Health, "and this would be headline
                        news every day. But somehow, we've come to accept it when it's due to tobacco use."

                        Hansen pointed out that Iowa loses 4,600 adults each year from smoking, and about
                        80,000 Iowa kids now under 18 and alive will ultimately die prematurely from smoking.
                        Another 500 or so Iowans die each year from disease caused by secondhand smoke -
                        more than die from accidents, AIDS, homicide and illegal drugs.

                        For more information on the report, and other useful information, go to

                              P R O G R A M M A N A G E M E N T

                        Administration/Program Management

                        Public Input for Title V Block Grant:

                              he Bureau of Family Health and Child Health Specialty Clinics would like input
                             concerning the Title V priority needs and performance measures for the Title V
                             Block Grant application for FFY05. The priorities, proposed program activities, and
                        emerging issues will be available through June 10 for public input. The web site address

                        We would like individuals to review the priorities and proposed public health strategies for
                        Iowa. Priorities are based on the 2000 needs assessment, emerging issues from the
                        Iowa Child and Family Household Health Survey, the 18 National Performance Measures,
                        and the eight State Performance Measures.

                        We welcome your feedback. After your review of the priorities and performance
                        measures, please e-mail your name and comments to Marcus Johnson at
               Even if you do not have comments regarding the proposed
                        activities, please take a moment to e-mail Marcus so we can track and evaluate the
                        effectiveness of the web-based distribution.

                        If you have questions about the public input, contact Marcus Johnson at
               or (515) 242-6284.

                        Termination of John Deere Health Plan:

                              he Department of Human Services (DHS) issued Informational Letter No. 380 on
                              May 20, 2004. This letter addresses the termination of the John Deere Health Plan
                              contract with DHS. This directly affects providers in Clayton, Delaware, Dubuque,
                        Jackson, Muscatine and Scott Counties. The effective date is July 1, 2004.
                        "The Department of Human Services has received notification that John Deere Health
                        Plan will not continue its contract with DHS for the next fiscal year. The last month in
                        which John Deere will have enrollees will be June 2004. After that, recipients will receive
                        a regular Title XIX medical assistance card. Any covered service provided to those

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                        persons previously enrolled on or after July 1, 2004 should be billed directly to ACS, the
                        fiscal agent for Medicaid. The department reminds you to continue to view the medical
                        assistance eligibility card to ascertain eligibility and possible enrolment into other
                        managed care plans. Those persons currently enrolled in the MediPASS program will not
                        be affected by this change.

                        All John Deere enrollees will be receiving a letter outlining their options. However, for the
                        month of July, 2004, the department will be sending a regular card to these enrollees.
                        Depending upon availability of optional medical managed care plans, enrollments may be
                        made into those plans in the future.

                        If you have questions regarding billing, contact Provider Relations at 1-800-338-7909. If
                        you have questions regarding managed health care enrollment, call Managed Health Care
                        at 1-800-338-8435.

                        Child & Adolescent Health
                        Task Force Recommends Vision Screening for Children Younger
                        than 5 Years Old:

                                                                                                     hildren who are
                                                                                                     younger than 5 years old
                                                                                                     should be screened in
                                                                                             the primary care setting for
                                                                                             vision problems, including lazy
                                                                                             eye, crossed eyes, and near-
                                                                                             and far-sightedness, according
                                                                                             to a new recommendation
                                                                                             issued on May 28 from the U.S.
                                                                                             Preventive Services Task Force.
                                                                                             The finding is published in the
                                                                                             May/June issue of the Annals of
                                                                                             Family Medicine.

                        The task force, an independent panel of experts sponsored by the Agency for Healthcare
                        Research and Quality, found fair evidence that screening tests can lead to detection of
                        lazy eye (known the clinical term "amblyopia"), crossed eyes (known as "strabismus")
                        and near-and far-sightedness. Children found to have one of these conditions should be
                        referred to a specialized eye care professional for further testing. Left untreated,
                        amblyopia may lead to visual impairment and may harm a child's ability to learn or affect
                        his or her performance in school.

                        Visual impairment is a common condition that affects 5 percent to 10 percent of
                        preschool age children. Between 1 percent and 4 percent of preschool age children have
                        amblyopia, and an estimated 5 percent to 7 percent have refractive errors.

                        "Early testing for vision problems is key to preventing learning disabilities or in some
                        cases, significant visual impairment in children," said task force chair, Ned Calonge, M.D.,
                        who is also Chief Medical Officer and State Epidemiologist for the Colorado Department
                        of Public Health and Environment. "Screening, including the newer methods available,
                        can help parents and clinicians detect and treat vision problems early."

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                        Typically, children who are 3 or older are tested in the primary care setting using wall
                        charts that ask the child to identify specific letters or symbols. For younger children who
                        may have difficulty communicating verbally, new methods of photoscreening using
                        specially equipped cameras to capture a picture of the child's pupil have been developed
                        for use by trained eye care professionals. Because photoscreening requires minimal
                        cooperation from the child, this method has the potential to increase vision screening
                        rates among children.

                        Other methods used by primary care physicians for screening children under 1 year of
                        age include the cover test and the Hirschberg light reflex test. The cover test is
                        performed by covering each eye and observing the other eye for movement. The
                        Hirschberg light reflex test is performed by shining a light and observing the reflection of
                        light from the patient's cornea.

                        The task force is the leading independent panel of private-sector experts in prevention
                        and primary care and conducts rigorous, impartial assessments of the scientific
                        evidence for a broad range of preventive services. Its recommendations are considered
                        the gold standard for clinical preventive services. The task force based its conclusions
                        on reports from research teams lead by AHRQ's Evidence-based Practice Centers at
                        RTI-International-University of North Carolina at Chapel Hill and the Oregon Evidence-
                        based Practice Center in Portland.

                        The task force grades the strength of the evidence from "A" (strongly recommends), "B"
                        (recommends), "C" (no recommendation for or against), "D" (recommends against) or
                        "I" (insufficient evidence to recommend for or against screening). The task force
                        recommends screening children younger than 5 years of age for amblyopia, strabismus,
                        and defects in visual acuity (B recommendation).

                        The screening for visual impairment in children younger than 5 years of age
                        recommendations and materials for clinicians are available on the AHRQ web site at

                        Oral Health
                        Special Olympics Special Smiles:
                        By Tracy Rodgers, Oral Health Bureau
                        Iowa Department of Public Health

                                 n Friday, May 21, over 260 athletes participated in the Special Olympics Special
                                 Smiles® screening program in Ames. Special Smiles is one of the core
                                 components of the Special Olympics Healthy Athletes initiative. The mission of
                        Special Smiles is to increase access to dental care for Special Olympics athletes, as
                        well as all people with intellectual disabilities.

                        Special Smiles events are located in the state/provincial, national or regional Special
                        Olympic Games around the world. Iowa’s Special Smiles initiative is in its fourth year.
                        Dr. Rhys Jones (Cedar Rapids) is Iowa’s volunteer local coordinator. In addition to Dr.
                        Jones, Dr. Ty Erickson, Des Moines; Kathy Thorsteinson, Cedar Rapids; and Mary Kelly,
                        Des Moines are all involved in planning Iowa’s Special Smiles initiative. The Director of
                        Special Programs for Iowa’s Special Olympics, Kathy Agard-Irving, is also instrumental
                        in planning for the screening program.

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                        Over 30 volunteers, including dental professionals (dental assistants, dental hygienists,
                        dentists, and dental hygiene students) and others, implemented Iowa’s Special Smiles
                        event this year. Athletes received a dental screening and instruction on how to keep their
                        teeth and gums healthy through brushing, flossing, and good nutrition. Athletes identified
                        with treatment needs were given contact information for care coordinators in their areas.
                        The care coordinators will assist families in locating dentists to provide needed
                        treatment. Special Smiles organizers will also follow up with families of athletes needing
                        treatment to ensure they are able to access dental care.

                        Data collected will be compiled for analysis. This generates a snapshot of the oral
                        health of a representative sample of the hundreds of thousands of Special Olympics
                        athletes around the world. These data are used to encourage more dental schools to
                        increase the special needs instruction they offer, and to demonstrate to governments of
                        all levels that access to oral health providers for this population must be increased.

                        Clinical supplies for the screenings are donated by one of the national sponsors of
                        Special Smiles, and products for the “goody bags” (toothbrush, toothpaste and floss)
                        given to each participating athlete are supplied or paid for by other sponsors. Additional
                        sponsor contributions help expand the Special Smiles initiative, primarily through
                        education and/or research and data collection project.

                        Iowa's Special Smiles continues to grow each year, and organizers are looking forward
                        to July of 2006 when Ames hosts the National Special Olympics, for the ability to
                        encourage good oral health to even more athletes.

                        For more information on Special Smiles and the Special Olympics Healthy Athletes
                        program, visit

                        Minority Health
                        Iowa Interpreters Forum:
                        Iowa Division of Latino Affairs

                                   ith the passage of HF244 (Iowa Interpreter’s Bill) the Iowa Division
                                    of Latino Affairs began working to develop a “mechanism for establishing the
                                    qualification” of interpreters by reaching out to all affected constituencies. We
                        feel that process must be transparent, equitable, and open and the result must be a
                        system that improves the quality of interpretation but is still cost-effective for providers,
                        interpreters and clients. The first step in this process is the Iowa Interpreters Forum.

                        The goal of the forum is to educate constituencies on the legal, professional, and
                        financial issues related to the creation of qualification standards for interpreters; to guide
                        the Administrative Rule process by eliciting input from as many interested parties as
                        possible; and to assist in the identification of individuals and organizations whom will
                        serve on a variety of interpreter related task forces.
                        All Iowa citizens or visitors living in Iowa are welcome to attend. The Iowa Division of
                        Latino Affairs (IDLA) especially encourages political leaders, government officials, social
                        service providers, health care professionals, community organizations, interpreters, law
                        enforcement professionals, business leaders, educational institutions, and individuals
                        affected by interpretation services to attend. To learn more about the forum or to
                        download a registration form, go to
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                                C A L E N D A R                                 O F           E V E N T S

                        June 17 - Bureau of Family Health Grantee Committee Meeting
                        9 a.m. - 11 a.m., ICN
                        For more information, contact Heather Hobert Hoch at (515) 281-6880

                        June 17 - MCH Advisory Council
                        1 p.m. - 3:30 p.m., Iowa Lutheran Hospital, Conference Rooms 1 & 2
                        For more information, contact Marcus Johnson at (515) 242-6284

                        August 4 - Covering Kids and Families Now Task Force Meeting
                        11 a.m. - 2 p.m., United Way Conference Center, Des Moines
                        For more information, contact Beth Jones at (515) 242-6382.

                        August 16 - hawk-i Board Meeting
                        1:30 p.m. - 4 p.m., Botanical Center, Des Moines
                        For more information, contact Angie Doyle Scar at (515) 242-5980.

                        September 9-10 - Iowa Training Project for Child Care Health Consultants
                        For more information, contact Kim Tichy at (515) 281-7519.

                        September 16 - MCH Advisory Council
                        1 p.m. - 3:30 p.m., Iowa Lutheran Hospital, Conference Rooms 1 & 2
                        For more information, contact Marcus Johnson at (515) 242-6284 (new member
                        orientation 11 a.m. - 2 p.m.)

                        October 6-8 - Iowa Training Project for Child Care Health Consultants
                        For more information, contact Kim Tichy at (515) 281-7519.

                        November 4-5 - Iowa Training Project for Child Care Health Consultants
                        For more information, contact Kim Tichy at (515) 281-7519.

                            The UPdate Editor: Heather Hobert

                            If you have an article you would like
                            to have included in The UPdate, or
                            suggestions on how I could improve
                            The UPdate, please e-mail me at

                                                                                        Iowa Department of Public Health
                                                                                            Bureau of Family Health
                                                                                              321 East 12th Street
                                                                                            Des Moines, Iowa 50319


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                                  Brought to you by the Bureau of Family Health

Bureau of Family Health: 1-800-383-3826
Teen Line: 1-800-443-8336
Healthy Families Line: 1-800-369-2229
FAX: 515-242-6384

           NAME               PHONE                   E-MAIL
Barkema, Erin                281-7721
Beaman, Janet                281-3052
Borst, M. Jane               281-4911
(Bureau Chief)
Brown, Kim                   281-3126
Clausen, Sally               281-6071
Dhooge, Lucia                281-7613
Doyle Scar, Angie            242-5980
Fitzgerald, Carrie           242-6167
Gelhaus, Martha              242-5224
Hageman, Gretchen            281-7585
Heinen, Shannon              281-7184
Hinton, Carol                281-6924
Hobert, Heather              281-6880
Johnson, Marcus              242-6284
Jones, Beth                  242-6382
Konz, Bridget                281-7044
Monsma, Alison               281-7368
Peterson, Janet              242-6388
Piper, Kim                   281-6466
Ramsey, Denise               242-5639
Tichy, Kim                   281-7519
Tokheim Kongshaug, Erin      281-4653
Widelski, Kathy              281-4907
Wooddell, Kevin              281-5401

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