Del activismo comunista a figura clave dentro y fuera de la Resistencia

(dollars in millions) Budget Authority $63.580 $64.366 $46.932 -$17.434 Autism (non-add) $21.665 $23.031 $23.031 $0.000 ACA/PPHF $0.000 $0.000 $17.434 +$17.434 Total $63.580 $64.366 $64.366 $0.000

1FY 2013 levels have been made comparable to FY 2014 Enacted to reflect the permanent realignment of the BSS budget line.

Overview

Birth defects are common, costly, and critical. They include conditions like fetal alcohol spectrum disorders, spina bifida and other neural tube defects, congenital heart defects, and craniofacial defects. Developmental disabilities (including autism, cerebral palsy, and other conditions) involve an impairment in physical, learning, language, or behavioral areas. CDC’s core activities in child health and development employ surveillance and science to understand the characteristics of birth defects and developmental disabilities and then use these findings to inform actions to prevent them and enhance the health of people affected by them:

 State-based birth defects surveillance¹²⁴, intervention, and prevention programs are working to understand more about the characteristics and prevalence of birth defects and fetal deaths

 National Birth Defects Prevention Network¹²⁵, a national network of state and population-based birth defects programs, focuses on understanding factors that may lead to birth defects, identifying strategies for reducing birth defects, and working to prevent potential secondary disabilities

 Centers for Birth Defects Research and Prevention¹²⁶, which collaborated on the National Birth Defects Prevention Study and began collaborating on the Birth Defects Study to Evaluate Pregnancy exposures (BD-STEPS) in late 2013, are investigating risk factors for birth defects as the first step toward preventing them and reducing their effects

 Autism and Developmental Disabilities Monitoring (ADDM) Network¹²⁷ is studying the number and characteristics of children with autism at different points in time and among different groups to guide research into potential risk factors and to help communities strategically direct outreach

 Study to Explore Early Development (SEED)¹²⁸, the largest study of its kind in the United States, is identifying factors that may put children at risk for autism and other developmental disabilities Budget Request

CDC’s FY 2015 request of $64,366,000 for Child Health and Development is level with the FY 2014 Enacted level.

These funds will enable CDC to continue monitoring birth defects and developmental disabilities, uncovering their causes and modifiable risk factors, and turning these findings into real-world practice and prevention strategies.

CDC’s continuing work will focus on eight main areas: birth defects, congenital heart defects, fetal death, fetal alcohol spectrum disorders, folic acid, spina bifida, infant health, and autism.

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Birth Defects

Every 4.5 minutes, a baby is born with a birth defect¹²⁹ in the United States. Major birth defects are responsible for an estimated $2.6 billion in hospitalization costs each year. In FY 2015, CDC will invest in state and local programs that gather data needed to understand how birth defects can be prevented and to improve the lives of people who have them. This includes funding 22 competitive awards to track birth defects, collect and analyze data on risk factors, refer individuals born with birth defects to appropriate medical and social services, and implement prevention strategies to reduce the number of babies affected by major birth defects.

Toward the goal of understanding how birth defects can be prevented, CDC will continue the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS). BD-STEPS builds upon experience from previous collaborative case-control studies of birth defects, such as the National Birth Defects Prevention Study (NBDPS)¹³⁰. BD-STEPS identifies modifiable maternal exposures in early pregnancy that may increase the risk for having a pregnancy affected by certain major structural birth defects, with a focus on four main areas:

 Maternal diabetes, obesity, and physical activity

 Chronic maternal medical conditions

 Infertility

 Medication use during pregnancy

CDC’s research efforts will support the interagency initiative launched in FY 2013, TRxeating for Two¹³¹, which aims to increase the evidence base for the risk of birth defects associated with maternal health conditions and their treatments during pregnancy and disseminate this information to assist pregnant women and their healthcare providers in making informed treatment decisions.

To improve the lives of people who have birth defects, CDC will continue working with state-based programs and academic partners to assess health services use, longer-term health outcomes, and the healthcare costs for individuals with birth defects. The aim is to identify potential interventions to reduce disparities in care and outcomes to improve the length and quality of life. CDC will also continue conducting surveillance of both fetal deaths and birth defects.

In FY 2015, CDC will fund 14 new awardees for state-based birth defects surveillance, intervention, and

prevention activities and determined through a competitive application process. Funding will primarily support birth defects surveillance, research, intervention, and prevention activities to advance the aforementioned goals. The majority of the FY 2015 grantees will consist of state/territory health departments, academic research centers, and a non-governmental organization.

Table: Birth Defects and Surveillance of Fetal Deaths Grant Table

(dollars in millions) FY 2013

Final

Range of Awards $0.005–$0.571 $0.005–$0.800 $0.005–$0.800 N/A

Total Awards $8.712 $7.985 $7.985 $0.000

129 http://www.cdc.gov/ncbddd/birthdefects/index.html

130 http://www.nbdps.org/

131 http://www.cdc.gov/ncbddd/birthdefects/documents/ncbddd_birth-defects_medicationuseonepager_cdcrole.pdf

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Fetal Alcohol Syndrome

Fetal Alcohol Syndrome (FAS) costs the United States over a $4 billion annually; this does not include costs for less severe types of fetal alcohol spectrum disorders (FASDs)¹³². CDC will reduce risky alcohol use among women who may become pregnant to prevent exposure to alcohol during pregnancy, which can result in FAS and other FASDs. These conditions can result in physical, behavioral, and learning problems of varying severity.

FASDs are 100% preventable if a woman does not drink alcohol during pregnancy, but about 1 in 13 pregnant women report recent alcohol use, and the Indian Health Service estimates that rates are 1 in 2 for American Indian women. In partnership with organizations serving American Indian communities, CDC will provide training on alcohol screening and brief intervention approaches, including CHOICES¹³³ – an intervention for preventing alcohol-exposed pregnancy in high risk women before they become pregnant.

Through the FASD Training Centers¹³⁴ and enhanced collaboration with medical societies and national partners, CDC will improve the knowledge and skills of healthcare professionals on the prevention, identification, and management of FASDs. In FY 2014, CDC will transition these training efforts from a regional to a national approach—strengthening FASD expertise and capacity across the nation and improving provider practice.

In FY 2015, CDC will fund 12 competitively-selected FAS grants to train medical and allied health students and practitioners and to implement and evaluate prevention strategies to reduce alcohol-exposed pregnancies. The awards include a continuation of the FY 2013 grantees, the Denver Health and Hospital Authority and Board of Regents, and University of Wisconsin System. In FY 2014, two FOAs will be released and expected to support five academic research centers, four medical societies/professional organizations, and one national partner group.

Table: Fetal Alcohol Syndrome Grant Table

(dollars in millions) FY 2013

Final

FY 2014 Enacted

FY 2015 Request

2015 +/-2014

Number of Awards 25¹ 15² 12² -3

- New Awards 2 10 0 -10

- Continuing Awards 23 5 12 +7

Average Award $0.152 $0.226 $0.264 +$0.038

Range of Awards $0.013–$0.500 $0.075–$0.275 $0.250–$0.275 N/A

Total Awards $3.809 $3.400 $3.175 -$0.225

1 This number includes 14 BRFSS grantees funded in FY2013 via a National Center for Chronic Disease Prevention and Control FOA with funding ranging from $13K to $30. They are also included within the 23 continuing awards for FY13.

2 The number of awards decreases from 2014 to 2015 because three of the five continuation awards projected in FY14 are extensions that will not exceed 12-months of funding.

132 http://www.cdc.gov/ncbddd/fasd/index.html

133 http://www.cdc.gov/ncbddd/fasd/research-preventing.html

134 http://www.cdc.gov/ncbddd/fasd/training.html#RTCs

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Folic Acid

CDC will continue efforts to eliminate folic acid-preventable neural tube defects (NTDs)¹³⁵ like spina bifida and anencephaly, which are severe birth defects of the brain and spine. Almost all babies born with anencephaly will die shortly after birth and children with spina bifida often face life-long disabilities. CDC’s accomplishments and expertise in NTDs have been instrumental in demonstrating that a daily intake of four-hundred micrograms of folic acid, before and during pregnancy, can greatly reduce the risk of NTDs. In addition, over the past ten years, efforts to fortify cereal grain products labeled as enriched in the United States has achieved cost-savings of approximately $4.5 billion ($100 saved for each $1 invested). By working with internal and external partners in surveillance, training, awareness, and prevention, CDC will continue to provide information on the benefits of folic acid fortification, determine optimal blood folate levels, and monitor health disparities.

In FY 2015, CDC will fund one to two competitively-selected grantees to increase folic acid intake among women of reproductive age; support NTD prevention efforts; and enhance training, surveillance, and monitoring of NTDs and blood folate levels. In 2013, this grant award was not impacted by sequestration; reductions were taken to other activities. Grantees will consist of multilateral organizations and non-governmental organizations.

Table: Folic Acid Grant Table

(dollars in millions) FY 2013

Final

Range of Awards $0.040–$0.609 $0.050–$0.427 $0.050–$0.427 N/A

Total Awards $0.649 $0.477 $0.477 $0.000

2012 Actual 2013 Actual 2014 Target 2015 Target

CDC Will Improve Alcohol Screening and Intervention Rates

Percentage of primary care providers who screen women of reproductive age for risky alcohol use and

 provide appropriate, evidence-based interventions to reduce alcohol-exposed pregnancy for those at risk

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Spina Bifida Surveillance and Research

Despite the successes of folic acid fortification, there are still many people living with spina bifida¹³⁶ in the United States today, and each year, about 1,500 more babies are born with this debilitating condition. While most cases of spina bifida are preventable with folic acid, some are not; there are still questions to be answered about risk factors for those neural tube defects that are not preventable with folic acid.

In FY 2015, CDC will fund 17-18 competitive spina bifida awards to improve surveillance capacity, better

understand the epidemiology, and identify other modifiable causes of spina bifida. These grants will identify and implement strategies to prevent spina bifida—the annual medical care and surgical costs for which exceed $200 million. Grantees will consist of state health departments as well as academic, multilateral, and non-profit organizations.

Table: Spina Bifida Surveillance and Research Grant Table

(dollars in millions) FY 2013

Final

Range of Awards $0.005–$0.196 $0.005-$0.227 $0.005–$0.227 N/A

Total Awards $0.682 $0.629 $0.629 $0.000

Infant Health

Early life experiences can significantly affect a person’s health and wellbeing for decades to come. To promote healthy starts to life, CDC will support infant health¹³⁷ activities, on several fronts: strengthening global birth defects surveillance; supporting global efforts to increase folic acid intake among women of reproductive age;

improving early identification of autism and other developmental disabilities; supporting birth defects surveillance, research, intervention, and prevention activities; and developing, implementing, and evaluating prevention strategies around cytomegalovirus (a virus that can cause serious disease in babies who are infected before birth).

In FY 2015, CDC will fund three to six competitive infant health awards to conduct the aforementioned infant health activities. Grantees will consist of governmental and non-government organizations.

Table: Infant Health Grant Table

(dollars in millions) FY 2013

Final

Range of Awards $0.025–$0.250 $0.050–$0.250 $0.050–$0.250 N/A

Total Awards $0.900 $0.875 $0.875 $0.000

136 http://www.cdc.gov/ncbddd/spinabifida/index.html

137 http://www.cdc.gov/ncbddd/jump/child.html

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Hearing loss is another infant health issue with significant life-long impact early identification of infants with hearing loss and receipt of intervention improves outcomes and prevents an estimated $200 million in

additional education costs each year. In FY 2015, CDC will provide support through a cooperative agreement to develop guidelines for medical home providers to help ensure children identified with hearing loss receive the interventions they need and avoid extended delay in follow-up.

In addition, CDC supports activities to simplify reporting and standardization of hearing screening, diagnostic, and intervention data by expanding the capacity of public health programs to electronically receive and

exchange this data. By making it easier for healthcare providers to report and receive data about infants needing services, CDC helps ensure all infants with hearing loss are identified early and reach their full potential. Also, CDC supports research to identify ways to ensure infants receive recommended services and assess the outcomes of children identified with hearing loss. CDC previously funded research to develop and evaluate a clinic-based screening and brief intervention related to cytomegalovirus infection, since about 1 in 5 children born with congenital cytomegalovirus infection will develop permanent issues, such as hearing loss.

Table: Infant Health (Hearing Loss) Grant Table

(dollars in millions) FY 2013

Final

Range of Awards $0.136–$0.225 $0.100–$0.250 $0.100–$0.250 N/A

Total Awards $0.654 $0.300 $0.300 $0.000

Autism

CDC’s FY 2015 request includes $23,031,000 for autism activities in budget authority. CDC will support work in autism and developmental disabilities through the multi-site Autism and Developmental Disabilities Monitoring (ADDM) Network¹³⁸, which uses the gold standard method for estimating prevalence and describing the

characteristics of children with autism and other developmental disabilities. Data from the ADDM Network show about 1 in 88 children have been identified as having autism in the United States. CDC will also continue

investigating the risk factors for autism through the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE)¹³⁹. The CADDRE Network conducts the Study to Explore Early Development

(SEED)¹⁴⁰, which is the largest study in the United States working to identify factors that may put children at risk for autism and other developmental disabilities.

CDC will continue to support efforts to improve early identification by working closely with partners and other federal agencies¹⁴¹. CDC works through its existing systems and networks to disseminate materials on early identification and developmental monitoring to healthcare professionals, early childhood educators, and parents of young children. Addressing autism costs an estimated $3.2 million in lifetime costs per child. Early identification and intervention can improve functioning and outcomes for children, and saves an estimated

$650,000 per child over their lifetime. Despite this, most children are not diagnosed until after age 4, even though developmental concerns before age 3 are noted for almost 90% of children with autism.

In FY 2015, CDC anticipates funding 20 competitive autism awards to enhance surveillance and research for autism and other developmental disabilities, monitor prevalence and contributing risk factors, and better inform

138 http://www.cdc.gov/ncbddd/autism/addm.html

139 http://www.cdc.gov/ncbddd/autism/caddre.html

140 http://www.cdc.gov/ncbddd/autism/seed.html

141 http://iacc.hhs.gov/index.shtml

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policies and programs for prevention and services. These grants will also help evaluate strategies to reduce racial and ethnic disparities in the identification of autism and other developmental disabilities.

Table: Autism Grant Table

(dollars in millions) FY 2013

Final

FY 2014 Enacted

FY 2015 Request

2015 +/-2014

Number of Awards 20 20 20 0

- New Awards 2 12 0 -12

- Continuing Awards 18 8 20 +12

Average Award $0.591 $0.605 $0.605 $0.000

Range of Awards $0.025–$1.050 $0.025–$1.050 $0.025–$1.050 N/A

Total Awards $11.821 $12.544 $12.544 $0.000

Congenital Heart Defects

CDC continues to expand work on congenital heart defects¹⁴² through cooperative agreements designed to better understand the survival, healthcare utilization, and longer term outcomes of adolescents and adults affected by congenital heart defects.

In FY 2015, CDC will competitively fund at least three new awards to state health departments, academic sites, or other institutions to improve the epidemiology of congenital heart defects across the life span, with emphasis on adolescents and adults, preventing congenital heart defect occurrence, and improving the lives of those born with a congenital heart defect. Funding will primarily support activities to collect, link, and analyze data related to congenital heart defects.

Table: Congenital Heart Defects (CHD) Grant Table

(dollars in millions) FY 2013

Final

FY 2014 Enacted

FY 2015 Request

2015 +/-2014

Number of Awards 4 4 4 0

- New Awards 0 1 3 +2

- Continuing Awards 4 3 1 -2

Average Award $0.296 $0.350 $0.500 +$0.150

Range of Awards $0.035–$0.396 $0.050–$0.450 $0.050 - $0.650 N/A

Total Grant Awards $1.184 $1.400 $2.000 +$0.600

142 http://www.cdc.gov/ncbddd/heartdefects/index.html

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