Monthly Highlights 

National Suicide Prevention Week (Sept. 8-14)

Image source: https://www.cdc.gov/mmwr/volumes/73/ss/ss7305a1.htm

This month, we want to highlight that our nation’s suicide rates are highest among Native Americans (30.2 per 100,000) and people aged 85 and older (22.2 per 100,000), according to the latest report on violent deaths from the Centers for Disease Control & Prevention (CDC). Across 48 states, the District of Columbia and Puerto Rico, firearms were the most common method used to complete suicides, regardless of gender. The report also found that nearly half (49%) of those who died had a current diagnosed mental health problem.

The U.S. Preventive Services Task Force recommends screening all adults for major depressive disorder (MDD), including pregnant and postpartum people, and adults aged 65 years and older (Grade B). Validated screening tools include the Edinburgh Postnatal Depression Scale, Geriatric Depression Scale (GDS-15 or GDS-30), Patient Health Questionnaire (PHQ), GAD-7 and Columbia-Suicide Severity Rating Scale (C-SSRS), all available in multiple languages.

• The AMA’s “Suicide Prevention How-To Guide” offers actionable, evidence-based best practices on suicide prevention in the primary care setting.
• For a deeper dive, read the 2024 National Strategy for Suicide Prevention, a 10-year, comprehensive approach from the U.S. Department of Health and Human Services.  
• Free clinician trainings can be found from the AMA here and here (each 1 hour CME), as well as at Zero Suicide and the Suicide Prevention Research Center.

If you or someone you know is experiencing a crisis…

988 - The 988 Lifeline provides 24/7 free and confidential support for people in distress and prevention resources.

Call 1 (800) 316-9241 or (210) 223-SAFE (7233) for our local 24-hour crisis/mental health and substance abuse helpline at the Center for Health Care Services.

San Antonio Metropolitan Health District Achieves Accreditation from American Nurses Credentialing Center and Texas Medical Association 

The San Antonio Metropolitan Health District was recently granted accreditation as a provider of nursing continuing professional development from the American Nurses Credentialing Center (ANCC). This accreditation demonstrates Metro Health’s commitment to using evidence-based criteria when developing high-quality educational activities that promote the professional growth of nurses and physicians.

Additionally, the Texas Medical Association (TMA) awarded us Provisional Accreditation for two years as a provider of continuing medical education (CME) for physicians. This accreditation confirms our commitment to delivering relevant, evidence-based education that is free from commercial influence, aiming to improve healthcare practice and patient outcomes.

Finally, we are proud to be one of only three public health departments in the state authorized to award continuing education credits (CEs) for Community Health Workers (CHWs). Since our designation as a sponsoring organization in August 2022, Metro Health has awarded 231.5 state-certified CEs to approximately 60 CHWs and CHWIs.

These credits are available for select trainings provided by the Access to Care Office's Clinician Ambassadors and the CHW Hub.

We are proud to be the only local health department in Texas with all 3 distinctions.

HEALTH NEWS

CDC Addresses Pain Management during IUD Insertion

Intrauterine devices (IUD) are safe and effective methods of long-acting reversible contraception, however, some women forgo this family planning option due to insertion pain, particularly among nulliparous women. Recent updates to the U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) include guidance on topical lidocaine or paracervical block for IUD placement. Other additions include ways to manage bleeding irregularities caused by contraceptive implants, advising gender-diverse people with a uterus that testosterone use might not prevent pregnancy, and offering self-administered subcutaneous depot medroxyprogesterone as a contraceptive option. Click here to read the 2024 U.S. SPR.

FDA Approves First Nasal Spray for Anaphylaxis

People who live with the threat of life-threatening allergic reactions soon will have a needle-free tool for managing anaphylaxis. The U.S. Food and Drug Administration approved the first epinephrine nasal spray to treat type I allergic reactions for anyone weighing at least 66 pounds (about 30 kg.), based on pharmacokinetics in 175 adults without anaphylaxis. The most common side effects are intranasal paraesthesia, throat irritation, headache, and nasal discomfort. To read the FDA’s news release, click here. The product is expected to become available in October.

Human Parvovirus B19 (Fifth Disease) Trending Up

An unusual increase in parvovirus B19 in Europe in the first quarter of 2024 and a rise in U.S. cases, especially among children ages 5-9 years, prompted CDC to issue a Health Advisory about the highly transmissible, seasonal respiratory illness. Human parvovirus B19 is not a notifiable condition in the U.S. It spreads through respiratory droplets and is highly infectious, with daycare and school workers often exposed. It can be transmitted from mother to fetus during pregnancy, and clusters of pregnancy-related complications were recently reported in this group and among those with sickle-cell disease. Although about half of adults have antibodies to the virus by age 20 and 70% by age 40, infection can cause complications in those without prior exposure who are pregnant, immunocompromised or with chronic hemolytic disorders. In pregnancy, complication risk is highest during weeks 9-20.

CDC recommends that healthcare providers keep parvovirus B19 in their differential and have a low threshold for testing people who are pregnant, immunocompromised or have chronic hemolytic disorders. For people presenting with compatible symptoms, provide preventive counseling, especially in those with higher risk for complications. Read the full alert here.  Download a fact sheet for pregnant patients here. General information about parvovirus B19 can be found here.

RESOURCE(S) OF THE MONTH

Help Postpartum Medicaid Patients Know They're Still Covered

As of March 1, 2024, postpartum Medicaid and CHIP coverage was extended to 12 months in Texas. This extended coverage begins the month after the pregnancy ends. Many patients remain unaware of this important benefit. Patients now have ongoing coverage for chronic and complex conditions and can access care before problems become life-threatening. This helps close a critical access gap noted by the Texas Maternal Mortality and Morbidity Review Committee: More than 1 in 4 pregnancy-related deaths that they reviewed occurred in the 1 year after the pregnancy ended.

Learn more at noon on Sept. 6 here with the Texas Women’s Health Coalition, watch a 5-minute recorded presentation by the Texas Health & Human Services Commission here or read flyers and a FAQ here; email managed_care_initiatives@hhs.texas.gov  with any questions.

For pregnant patients needing to enroll in CHIP and Medicaid, on-site HHSC enrollers can help them secure coverage in just days, rather than weeks or months, and are available at selected University Health, CentroMed and Communicare locations.

Medications for Opioid Use Disorder (MOUD) Mentoring Program

The Center for Substance Use Training & Telementoring (C-STAT) by Be Well Texas and University Health is launching a new MOUD Mentoring Program. This is an opportunity for prescribers to receive personalized, one-on-one mentorship to integrate medications for opioid use disorder (MOUD) services into their daily clinical practice. The program is available to a select few in the Texas Public Health District Region 8.

Benefits include:

• Personalized, one-on-one virtual guidance with flexible schedules
• Access to top subject matter experts in substance use disorders
• Complimentary case consultations
• Assistance in implementation challenges
• Guidance on standard practice (e.g., clinical, billing, etc.)

Access the application here: https://redcap.link/MOUDMentoringReg. Questions or requests for additional information can be sent to: cstat@uthscsa.edu.

EDUCATIONAL OPPORTUNITIES

Sept. 4, 6:30 p.m. to 7:30 p.m. - Syphilis 201 (1.00 hours CME/CNE)

Metro Health’s Clinician Ambassadors invite you to join us for an interactive, intermediate-level training. Apply your knowledge of syphilis testing, staging, treatment and follow-up using a set of diverse patient case scenarios. Register here.

Sept. 5-6, 8 a.m. to 4:30 p.m. - STI Intensive Course (up to 14 hours CME)

St. Louis’ STD/HIV Prevention Training Center hosts a free, virtual two-day webinar for clinicians, midlevel providers, and RNs featuring an intensive overview of STIs. Topics include gonorrhea, chlamydia, syphilis, trichomoniasis, PID, genital herpes, HPV, hepatitis B, chancroid, urethritis/cervicitis syndromes, pediculosis/ scabies, HIV/AIDS, prevention strategies / PrEP / EPT and case studies. Register here for this virtual session, part of Sexual Health Awareness Month.

Sept. 10, 11 a.m. to noon - Future Forward: Emerging Trends in the Syphilis Syndemic

This virtual training is part of Stopping Syphilis: The HHS Summer Seminar Series, designed to share knowledge and reverse the syphilis and congenital syphilis epidemic in the U.S. Register here. Access slide decks and resources here.

Sept. 12, 11 a.m. - Ending the HIV Epidemic in the United States, First Steps for Health Centers

Listen in on an hour-long webinar covering effective strategies for coordinating care for newly diagnosed people with HIV. Topics include linkage to care, retention in care, and the latest advances in HIV treatment and management. Click here to register.

Sept. 12, 12:30 p.m. - Why Improving Access to Mental Health Care is an Ethical Imperative (1.00 hours CE)

One in four youth and one in five women have treatable mental health concerns. Suicide is the 2nd leading cause of death for Texas youth ages 12-24, and a significant cause in the first year postpartum. Join Dr. Megan Howard, MD, MPH, for a 1-hour virtual lecture on the effects of delays in screening, assessing, and treating common mental health conditions, and the improved outcomes resulting from collaborative care, including consultation services provided by CPAN and PeriPAN. Register here.

Sept. 14, 8:30 a.m.- 3 p.m. - UT Health San Antonio Radiology Symposium 2024

Medical students: Looking to gain hands-on experience with a reading room station and IR procedure simulator? Attend the Radiology Symposium hosted by the UT Health San Antonio Department of Radiology and Radiology Interest Group. The event will include panel discussions, research posters and a Q&A on residency applications. Click here to read more and here to register.

Sept. 20, 12:45 p.m. to 5 p.m. - Texas Congenital Syphilis Summit (CE available)

Maternal and pediatric healthcare providers are invited to join the Texas Department of State Health Services in Houston or virtually for the 2024 Congenital Syphilis Summit. The theme of this free conference is “What Can I Do Today,” with the goal of giving each attendee ideas about how to reduce congenital syphilis in their communities.  Click here to register.

Sept. 24, 12:30 p.m. - Achieving Universal Syphilis Screening in All Patient Populations (1.00 hours CME/CNE)

Join Dr. Luke Newton, Medical Director for University Health’s Mommies Program, for an enlightening discussion on implementing syphilis screening for all pregnant people. Register online with rebecca.terrazas@uhtx.com or by phone at 210-644-4112. Join the Webex here.

Sept. 25, 8:45 a.m. to 3 p.m. - Texas Public Health Summit

The Texas Epidemic Public Health Institute will host their third annual Public Health Summit, “From Pasture to Patient: Preparing for Zoonotic Health Risks.” Experts will cover zoonotic risks throughout Texas, current infectious outbreaks, vector control diagnostic tools and more, virtually and in-person. In-person attendance will be limited. Click here to register at no cost.

Getting In Sync with Sexual Health ECHO: STIs - Testing, Treatment and Prevention (1 hour CME)

Project Echo will host an STI series every other Tuesday from 11 a.m. – noon. until the end of the year to cover sexual history-taking and STI screening, prevention, and treatment. Register now for one of the sessions below.

Sept. 3 – STI Epidemiology and At Risk Populations
Sept. 17 – Sexual History Taking and Sexual Culture/Practices

Oct. 1 – Gonorrhea, Chlamydia/LGV, Trichomonas, DoxyPEP

Oct. 15 – Syphilis

Oct. 29 – HSV

Nov. 12 – HIV (PrEP and nPEP)

Nov. 26 – Hepatitis B and C

Dec. 10 – HPV, Mpox, Mycoplasma/Ureaplasma

Texas PeriPAN Grand Round Series (1 hour CME)

The Perinatal Psychiatry Access Network (PeriPAN) is hosting evidence-based practice discussions with Texas Tech University Health Sciences Center every 3^rd Tuesday of the month from noon – 1 p.m. Register now for one of the sessions below.

Sept. 17 – Perinatal and Postpartum Psychosis
Oct. 15 – Paternal Mental Health and the Perinatal-Postpartum Periods
Nov. 19 – NICU Parent Supports and Considerations

ON-DEMAND EDUCATION

(Free unless otherwise specified)

Understanding the IGRA: What You Need to Know – Webcast (Heartland National TB Center)