Dr. Buttery's Public Health BLOG

This latest IARC Monograph states that oral contraceptives make some women more suscepitble to certain cancers, whilst protecting against others. Dr Peter Boyle, Director of IARC. the Major Public Health Importance as:
These new IARC Monographs [volume 91] address exposures that are experienced daily by many millions of women world-wide." It is of enormous public health importance that we identify and understand the full range of effects of these products." Worldwide, more than 100 million women – about 10% of all women of reproductive age – currently use combined hormonal contraceptives. In addition, there has been widespread use of hormonal menopausal therapy: approximately 20 million worsen in developed countries at its peak, around the year 2000.

Posted by at 1:52 PM | Permalink | Comments (0)

When Commissioner of Health for Virginia I really objected to the studies we had to perform every time an activist convinced a legislator that something was dangerous. The funds used for these studies had to be taken from programs that we knew worked, such as vaccinations and prenatal care. I cannot tell how many time I have told people that disinfection of water to promote safety from disease causing organisms was a safe procedure. Now:
From UNC News Service, Chapel Hill NC
When one cuts through the "bureauspeak" it appears that more refined studies whch should have shown stonger evidence for effects on pregnancy did not do so. It is high time legislators stopped knee jerk reactions to activist rumors and funded known public health interventions such as immunization, hypertension control, prenatal care and food safety.

Posted by at 1:30 PM | Permalink | Comments (0)

The Commission on Health Care for the UK puts out annual reports on health status. There is no comparable body in the US. The closest reports are those from the Kaiser Family Foundation and the Institute of Medicine.
This year, the report reviews the state of healthcare from the point of view of the people who use healthcare services. This mainly refers to patients, but also includes carers and others who use services.
Are people able to gain access to the healthcare services that they need? Are the services safe, effective and sensitive to their needs?
How well do providers inform and involve people in the development and improvement of their services?
Are people getting a fair deal from healthcare services and the lessons that we can all learn from their experiences?

Posted by at 11:28 AM | Permalink | Comments (0)

One of the national health objectives for 2010 is to increase to at least 95% the proportion of children aged <6 years who participate* in fully operational, population-based immunization registries (objective 14-26)
This report summarizes data from CDC's 2003 Immunization Registry Annual Report (IRAR). The findings of the 2003 IRAR indicate that approximately 44% of U.S. children aged <6 years participated in an IIS. Increasing health-care provider participation by linking EMRs to IISs is vital to meeting the national health objective.

Posted by at 2:15 PM | Permalink | Comments (0)

CDC's annual opdate on Influenza Recommendations was published today. It includes 5 principles:
1) Any peson with potential compromise of respiratory function should be vaccinated
2) All health care workers should be vaccinated
3) Use of both types of vaccine are recommended, using LAIV when inactivated vaccine is in short supply.
4) Vaccine antigen activity content recommendeed.
5) CDC will assess vaccine availability and make timely reocmmendations.

Posted by at 2:08 PM | Permalink | Comments (0)

A fascinating report in today's Telegraph.
Homeopathy has been proved more successful and cost-effective than conventional medicine in the first comparison of the two approaches.
Researchers in Germany recruited more than 400 adults and children with long-term health problems ranging from sinusitis to insomnia and depression. Half were treated using conventional therapy; the other half were treated homeopathically. After six months, the condition of the patients treated homeopathically had improved significantly more, and more quickly,
Too bad the refernce was not provided!

Posted by at 11:32 AM | Permalink | Comments (2)

For years public health interventions to control infectious disease epidemics has been accepted as a proper role for public health agencies. Now in New York this approach has bene taken a step further with the announcement of monitoring of diabetes control, by sending reports of diabetes lab. tests to the NY DoH. We are not told yet what will be done with these tests and how the results will be used to manage individual control of diabetes. Is this an exccess of public health activism? Is this a false alarm set off by an eager reporter? Has this been approved by the state legislature? Is this a step toward control of individual behavior in the name of disease supression? Is this further expansion of the 'behavioiral police'? There are many unansweered questions, Stay tuned.

Posted by at 11:11 AM | Permalink | Comments (1)

From Imperial College, London.
A hormone found in the small intestine has provided a crucial breakthrough in developing new drugs to tackle the growing obesity epidemic, claim scientists. Obesity now affects more than half of all UK adults, costing the UK up to £3.7 billion a year in sickness absence and treatments.

In an article published today in Diabetes, the world's top diabetes research journal, a team from Imperial College London and Hammersmith Hospitals NHS Trust has used injections of oxyntomodulin, a naturally occurring digestive hormone found in the small intestine, to reduce body weight and calorific intake in overweight volunteers.
Ref: Subcutaneous oxyntomodulin reduces body-weight in overweight and obese subjects: a double blind randomised controlled trial. Diabetes, Vol 54, August 2005. Diabetes 54:2390-2395, 2005

Posted by at 10:59 AM | Permalink | Comments (0)

A fascinating study reported in the August AJPM on the role information about vaccines may play in our immunization rates in the U.S.
The study shows:
Satisfaction with the amount and quality of information provided by healthcare providers may be an important factor in whether immunization schedules are optimized for children.
In this study of a nationally representative sample of parents with children under the age of 6 years, only two thirds felt that they had enough information on immunizations for their children.

Posted by at 8:29 PM | Permalink | Comments (0)

This reminds us of the long incubation period of rabies. Travellers need reminding of the dangers of stray animals when overseas.
A British woman just died of rabies, after being bitten by a stray dog while on holiday in Goa.
Alison Dwerryhouse, 39, a shop assistant from Bury, near Manchester, became ill on her return to England and died at the Walton Centre, a specialist neurology and neurosurgery hospital in Liverpool, on Saturday (July 16).
She was bitten on April 9 and is the 23rd Briton to die of rabies, in all cases contracted overseas, since 1946. No one has contracted rabies in Britain since 1902.

Posted by at 11:43 AM | Permalink | Comments (0)

This Third Report presents first-time exposure information for the U.S. population for 38 of the 148 chemicals included in the Report. The Report also includes the data from the Second Report; that is, data for 1999-2000.
The summary of the report suggests uses by public health agencies and cautions readers that the presence of a chemical does not mean the chemical causes diseases. The report reiterates that diseases is a dose related phenomenon. This report should be of special interest to students who want to study an environmental chemical for their terminal project

Posted by at 2:21 PM | Permalink | Comments (0)

Fromthe BMJ Round Up of news - July 22, 2005:
US health system doesn't give value for money, report says
New York Janice Hopkins Tanne

More is spent per person on health care in the United States than in any of the other 29 industrialised countries in the Organization for Economic Cooperation and Development (OECD). The reason is higher prices in the United States, not malpractice litigation and defensive medicine, says an annual study published in Health Affairs (2005;24:903-14).
That study covered 12 000 patients treated in US and Canadian hospitals (Archives of Internal Medicine 2005;165:1506-13).

The study also refutes the argument that high spending in the US means that healthcare capacity is high. It says that many other OECD countries have a higher number of doctors, nurses and hospital beds per population and their spending is much lower than that in the US.

Posted by at 11:51 AM | Permalink | Comments (1)

The weeks BMJ has an wonderful editorial about health status after the break-up of the Soviet Union. It is worth reading. I don't want to give away the punch line. I hope someone will comment on this piece

Posted by at 11:42 AM | Permalink | Comments (0)

My previous Blog was about the increaing cost of medical care. I wonder how many of these hospitalizations could have been prevented with better access to and integration of primary xare?

Posted by at 4:22 PM | Permalink | Comments (0)

For those who want easy access to details on medical care spending the 3rd edition of the KFF Medicare Chartbook is now available in .pdf format. It is worth knowing that 'Health Care" spending in 2002 was 14.9% of the GDP according to the center for Medicare & Medicaid Services (CMS), According to an article from the February 2004 Issue of Health Affairs - "Health Spending Projections through 2013" Health spending is projected to account for 18.4 percent of GDP by 2013, up from its current high point of 14.9 percent in 2002.

Posted by at 10:32 AM | Permalink | Comments (0)

Despite the flood of ads on TV promising to make you live longer and better there is little data to support any of the claims. See today's JAMA:
Essential Nutrients: Food or Supplements?
Where Should the Emphasis Be?
Alice H. Lichtenstein, DSc; Robert M. Russell, MD
JAMA. 2005;294:351-358.
"The most promising data in the area of nutrition and positive health outcomes relate to dietary patterns, not nutrient supplements. "
"There are insufficient data to justify an alteration in public health policy from one that emphasizes a food-based diet to fulfill nutrient requirements and promote optimal health outcomes to one that emphasizes dietary supplementation."

Posted by at 10:11 AM | Permalink | Comments (0)

The RWJF has taken on another important public health topic by providing
24-month innovation grants are each for $300,000 (see list below)

Examples of innovations include:

PDA-based assessment of health risks for adolescents with tailored in-office counseling, and follow up through community referrals and web-based resources;
Creation of new types of staff positions, such as a community health educator and referral liaison who will serve as a bridge between the practice, patient, and community in the form of a one-stop-shopping health behavior referral service;
Interactive voice response system used to conduct risk assessment and deliver tailored counseling over the phone;
Electronic health record prompts for providers with different options for counseling and follow up including web-based, telephone-based, and group visits;
Reframing the 2-year old well-child visit to focus on family lifestyle risk assessment and behavior change for the entire family through referrals to lifestyle counselors.

Posted by at 7:30 PM | Permalink | Comments (0)

How often do we have be told? This week's Lancet carries a commentary about the 27,000 children a year, under 5 years of age, who die from preventable infections in countries with limited resources. Providing soap and instructions in its use reduced many of the infections and consequent deaths. Didn't we learn something about the prevention of "death bed" fever more than a 100 years ago, from handwashing? We don't need to throw money at these countries as the G8 activists suggested. We need to provide minimal limited resources.

Posted by at 2:59 PM | Permalink | Comments (1)

From Cox News Service
Reports examination of cord blood by an activist group, on 10 bloods. No data on measurement levels, just a statement about toxic compounds in blood of newborns. Remember that everything is Toxic, it just depends on the dose. Expect story to be repeated and get wilder as days go by.

Posted by at 12:22 PM | Permalink | Comments (0)

From the CDC
2005 recommendations include new or updated information regarding 1) vaccination of persons with conditions leading to compromise of the respiratory system; 2) vaccination of health-care workers; 3) clarification of the role of live, attenuated influenza vaccine (LAIV) in vaccine shortage situations; 4) the 2005--06 trivalent vaccine virus strains: A/California/7/2004 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens (for the A/California/7/2004 [H3N2]-like antigen, manufacturers may use the antigenically equivalent A/New York/55/2004 virus, and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus); and 5) the assessment of vaccine supply, timing of influenza vaccination, and prioritization of inactivated vaccine in shortage situations

Posted by at 11:59 AM | Permalink | Comments (213)

The Food and Drug Administration (FDA) is issuing a nationwide warning to consumers against drinking unpasteurized orange juice products distributed under a variety of brand names by Orchid Island Juice Company of Fort Pierce, Florida, because they have the potential to be contaminated with Salmonella Typhimurium and have been associated with an outbreak of human disease caused by this organism.

Posted by at 2:16 PM | Permalink | Comments (0)

A new analysis of birth records from the Center for Immigration Studies shows that immigrants (legal & illegal) accounted for a larger share of births in 2002 than in 1910, during the peak of the last great wave of immigration. The children born to immigrants are arguably the most important long-term legacy of immigration and are a key measure of its magnitude. The new report provides detailed information on births to immigrants for every state and many counties, including estimates for births to illegal aliens.
In 2002, 23 percent of all births in the United States were to immigrant mothers (legal or illegal), compared to 15 percent in 1990, 9 percent in 1980 and 6 percent in 1970.
Even at the peak of the last great wave of immigration in 1910, the share of births to immigrant mothers did not reach the level of today. And after 1910 immigration was reduced, whereas current immigration continues at record levels, thus births to immigrants will continue to increase.
Our best estimate is that 383,000, or 42 percent, of births to immigrants are to illegal alien mothers. Thus births to illegals now account for nearly 1 out of every 10 births in the United States.

Posted by at 4:55 PM | Permalink | Comments (3)

While many of us are familiar with the Cancer Atlas started in Dartmouth some time ago. The UK Statistics system has developed its own cancer atlas. The UK statistics program says.
"This atlas describes the geographical patterns in cancer incidence and mortality across the the UK and Ireland and relates them to risk factors and to levels of socio-economic deprivation. The inclusion of charts, tables and maps with data at the health authority level provides a detailed picture of the geographical variation, by sex where appropriate, in 21 common cancers (which account for around 90 per cent of all cancers). Maps display the geographical patterns for each type of cancer compared with the overall average for the UK and Ireland. The geographical patterns for the 21 cancers are compared and contrasted."
The atlas is downloadable as a PDF file with many interesting maps. A good application of GIS to health & disease analysis

Posted by at 10:13 AM | Permalink | Comments (0)