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And sone want to emulate the NHS!
From today's Telegraph
An NHS trust is stopping all non-urgent surgery at a hospital and closing the waiting list at another in an attempt to reduce its forecast deficit of £68 million.
The 92 planned operating sessions across the trust are being cut to 50 and overall treatment at the hospitals will fall by 25 per cent.
The World Health Organization (WHO) Regional Committee for Africa comprising health ministers from 46 Member States has declared tuberculosis an emergency in the African region - a response to an epidemic that has more than quadrupled the annual number of new TB cases in most African countries since 1990 and is continuing to rise across the continent, killing more than half a million people every year.
Globally, TB is second only to HIV/AIDS as a cause of illness and death of adults, accounting for nearly nine million cases of active disease and two million deaths every year. Although it has only 11% of the world's population, Africa accounts today for more than a quarter of this global burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.
It all seems so simple, but from the KFF Health Policy Reports
While parents can access their teenagers' nonconfidential paper records, EHR systems thus far do not have a way to prevent parents from accessing confidential material. As a result, many EHR providers are "revoking parental access to children's records as soon as they turn 13," according to the Journal. In addition, teenagers generally cannot access their own records because their status as a minor does not permit them to enter into the necessary security agreements for EHRs.
Reports provides links to groups who are examining this conundrum.
From the Kasier Familiy Foundation Reproductive Health Report.
The U.S. is the only nation that is a "major economic power" with a total fertility rate high enough to maintain its work force and economic prosperity as the population ages, according to a Population Reference Bureau report released on Tuesday, the Wall Street Journal reports. Most other wealthy nations' total fertility rates are declining as the population of older, nonworking citizens expands.
In an August 22 report from the WHO the goals (or Millenium Report. similar to Healthy People) states that "Despite gains in reducing poverty worldwide, the data presented in the new WHO report indicate that if trends established in the 1990s continue, the majority of developing countries will not achieve the health MDGs. This in turn will affect progress towards other goals. With less than ten years to the target date of 2015, none of the poorest regions of the developing world are on track to meet the child mortality target. For maternal mortality, declines have been limited to countries which already have lower mortality levels. The goal of reversing the spread of HIV/AIDS and reversing the incidence of malaria and other communicable diseases remains a huge challenge in sub-Saharan Africa. The safe water target may be achieved globally, but not in sub-Saharan Africa.
"Providing universal access to broad-based health services could save several million children's lives each year,” said Dr LEE. “That would reverse the downward trends and bring us two-thirds of the way to meeting the child mortality goal, and 70% to 80% towards meeting the maternal mortality goal.” “We have the treatments; the technology is known and affordable,” Dr LEE said. “The problem in many countries is getting the staff, medicines, vaccines and information to those who need them on time and in sufficient quantities. In too many countries, the health systems to do that either do not exist or are on the point of collapse.”
Health and the Millennium Development Goals also identifies future health challenges in the developing world. If health is to have its full impact on reducing poverty, there is a need to address:
the growing burden of noncommunicable disease in the developing world, which is leading to a “double burden” of ill-health;
the “nutrition transition” in which people in developing countries begin to adopt unhealthy eating habits common in richer countries and suffer the health consequence;
the need for universal access to reproductive and sexual health services as agreed at the Cairo International Conference on Population and Development; and
the impact of globalization on the spread of disease and migration of health staff.
According to today's London Telegraph
The virus has turned up at the threshold of Europe. Last week Russian scientists revealed that thousands of domestic birds around the Chelyabinsk region of the Ural mountains had perished after contracting H5N1, which had apparently been transported there by migrating birds.
Prof Neil Ferguson, an expert on virus epidemics at Imperial College, London. says "such an epidemic is most likely to start once the H5N1 virus infects someone already harbouring standard human flu. "hen the two viruses can recombine to produce a type capable of human-to-human transmission,"
To think that when I was in the Army 50 odd years ago I thought that Penicillin would allow us to eradicate syphilis. Now, from the University of New South Wales in Australia a report, which has just been published in the Medical Journal of Australia, Infectious syphilis notifications in inner Sydney rose more than 10-fold (from 6 in 1999 to 162 in 2003), and the increase was confined to men. Combined NSW Health data on infectious syphilis notifications from 1998-2003, a case series of 57 homosexually active men diagnosed with early syphilis in inner Sydney from December 2002 to January 2004 and a prospective cohort study of syphilis among 1333 HIV-negative homosexually active men in Sydney recruited from June 2001 to December 2003.
WASHINGTON—Virginia and the District of Columbia have joined a growing list of states that require health plans participating in Medicaid to adopt NCQA standards and measures as an integral part of their quality oversight efforts. Under a new agreement between the Commonwealth and participating plans, all Virginia Medicaid managed care plans must hold NCQA Accreditation or come forward for review by the end of 2005. Additionally, the District of Columbia Department of Health will require its Medicaid plans to report 41 HEDIS measures, including those that assess cancer, diabetes, and asthma care. These announcements reflect the growing emphasis among state Medicaid programs on measuring and improving clinical quality.
From the BMJ Friday, August 19
A pandemic is likely, but Europe is getting prepared. Is the US approach as good as the UKs?
In the 20th century, the world experienced three influenza A pandemics: "Spanish flu" claiming 20-40 million lives in 1918-9 and the "Asian flu" of 1957 and "Hong Kong flu" of 1968, each of which claimed 1-4 million lives. It might be about to face another.
Birds are the natural hosts of influenza A, but most avian viruses are not transmitted to humans. However, the current influenza A/H5N1 virus is more virulent in birds than in the past and is associated with human infections. Since its appearance in Hong Kong in 1997, the H5N1 epizootic, affecting both wild birds and domestic poultry, has spread to most countries in South East Asia and recently to Russia and Kazakhstan, directly threatening Europe. An epidemic of another less virulent virus, A/H7N7, in the Netherlands in 2003 emphasised the potential for emergence of infection in Europe.
From the August 12 Edn of Science, Jon Cohen:
If AIDS researchers reported that a vaccine protected 65% of the participants in an efficacy trial, the news would be trumpeted across the globe. Two weeks ago at an AIDS meeting in Brazil, a study revealed that male circumcision produced that level of protection in South Africa. Many major media did not even mention this advance!
From the Daily Telegraph August 15,2005
With 2,000 newly qualified medics in Britain unable to find a position, life on the dole beckons even after six years of training - which is why a growing number are moving to Australia. We should be so lucky. If we were to move to a planned health and medical system we might have 100,000 redundant physicians and have affordable accessible health services! Now, if we could do the same for lawyers.
The August 11 issue of the MMWR has a fascinating summary of how US residents acquired rabies during the last 15 years.
Four (4) were acquired due to transplants from a single donor. Nine (9) From animal bites which occurrred while travelling abroad. Twenty of 29 persons tested for rabies type caught rabies from bats - the single major cause of rabies transmission in the U.S.
A fascinating interview with Dr Al. Sommers, Dean of the School of Public Health at Hopkins, as he gets ready to retire to continue teaching and research. Where has public health been, where is it going, why should we pay more attention to public health.?
From Johns Hopkins Medicine news release.
In an article to be published in The New England Journal of Medicine, the Hopkins pathologist and microbiologist J. Stephen Dumler, M.D., a professor at The Johns Hopkins University School of Medicine, highlights the importance of the recent outbreak in Arizona as the first confirmed cases that could be traced back to ticks carried into to the state on feral dogs, an animal group whose population has markedly increased. And, as the number of dogs has increased, so have the number of ticks. A detailed study of this latest outbreak by the United States Centers for Disease Control and Prevention (CDC) is featured in the same edition of the NEJM online Aug. 11.
From JAMA this week, One more study showing that childhood vaccination does not lead to illnesses needing hospitalization.
From the University of New Castle Upon Tyne
Mothers-to-be with lower levels of the vitamin folate in their body during early pregnancy are more likely to have babies with lower, or less healthy, birth weights, a study has revealed.
Conversely, researchers from the University of Newcastle upon Tyne, UK, who examined nearly 1,000 women and their newborn babies, found that higher levels of folate (found in some vegetables, fruits and cereals, and also known as vitamin B9, or folic acid) were linked with increased birth weights.
Expectant mothers who smoked were more likely to have lower levels of folate in their blood, which might explain why women who smoke often have lighter babies.
The health benefits of folic acid for babies are already known but this is the first time that folate levels commonly seen in UK mothers in early pregnancy have been linked with birth weight. The study is published in the British Journal of Nutrition.
From the August 6 Lancet "ViewPoint."
Endowed with $26 billion and a larger annual global health budget than WHO. In January, 2003, the Foundation launched a Grand Challenges in Global Health initiative to stimulate scientific researchers to develop solutions to critical scientific and technological problems that, if solved, could lead to important advances against diseases of the developing world. Administered by the Foundation of the National Institutes of Health, the Grand Challenges initiative issued an open call to investigators from anywhere in the world to propose ideas to an international scientific board. In October, 2003, the first 14 Grand Challenges were announced; selected from more than 1000 submissions, and readied for research proposals, which are currently competing for $200 million in research grants. grouped into seven goals, ranging from improving the measurement of health status to bettering nutrition, vaccines, and treatments for infections, and control of vector-borne diseases, the Grand Challenges appear poised to improve the health of the underdeveloped world.
Goal: To improve childhood vaccines
GC#1: Create effective single-dose vaccines that can be used soon after birth
GC#2: Prepare vaccines that do not require refrigeration
GC#3: Develop needle-free delivery systems for vaccines
Goal: To create new vaccines
GC#4: Devise reliable tests in model systems to evaluate live attenuated vaccines
GC#5: Solve how to design antigens for effective, protective immunity
GC#6: Learn which immunological responses provide protective immunity
Goal: To control insects that transmit agents of disease
GC#7: Develop a genetic strategy to deplete or incapacitate a disease-transmitting insect population
GC#8: Develop a chemical strategy to deplete or incapacitate a disease-transmitting insect population
Goal: To improve nutrition to promote health
GC#9: Create a full range of optimal, bioavailable nutrients in a single staple plant species
Goal: To improve drug treatment of infectious diseases
GC#10: Discover drugs and delivery systems that minimise the likelihood of drug resistant microorganisms
Goal: To cure latent and chronic infections
GC#11: Create therapies that can cure latent infections
GC#12: Create immunological methods that can cure chronic infections
Goal: To measure disease and health status accurately and economically in developing countries
GC#13: Develop technologies that permit quantitative assessment of population health status
GC#14: Develop technologies that allow assessment of individuals for multiple conditions or pathogens at point-of-care
From the Londond School of Hygiene & Tropical Medicine
Old-fashioned head lice treatment beats chemicals
Friday 5 August 2005
Old-fashioned methods of getting rid of head lice in children are far more effective than current chemical treatments, researchers revealed yesterday (FRI).
Using a fine-tooth comb and conditioner on wet hair was four times more effective than popular chemical-based treatments like lotions and shampoo.
London School of Hygiene & Tropical Medicine (LSHTM) researcher Dr Nigel Hill said: "Millions of pounds are spent each year by desperate parents or through NHS prescriptions on lice treatments and many seem to be virtually useless.
"It's clear insecticide treatments are not working very well at all and if you speak to parents and school nurses they will confirm that."
Dr Hill explained that lice had become resistant to the insecticides most commonly used to kill them.
We are told about the value of complementary therapy, but this is usually activist cant. Now research shows that Echinacea does not work. From the BMJ news - an abstract of an article in the Lancet last week.
Echinacea is a popular herbal remedy for colds. As with many other popular herbal remedies, evaluation has been patchy and inconclusive. A carefully controlled and double blinded experiment now provides the strongest evidence so far that Echinacea does not work, thanks to 399 volunteers who agreed to be inoculated with rhinovirus type 39.
For seven days before the inoculation and five days afterwards, the young adult volunteers took one of three well defined formulations of Echinacea or a placebo. Treatment was randomly allocated. Altogether 349 of the volunteers caught a cold. Compared with placebo, none of the formulations prevented infection, relieved symptoms, or speeded up recovery. The volunteers were isolated in hotel rooms throughout the experiment, where they completed questionnaires of symptoms twice a day and had a nasal lavage every morning. Their nasal secretions were weighed and analysed for viruses, leucocytes, and inflammatory markers. The volunteers came back three weeks after the experiment to have blood taken to measure their serum concentrations of neutralising antibody to the rhinovirus.
The Echinacea preparations, which were isolated from the species Echinacea angustifolia, had no impact on any measure of infection including viral titres or inflammatory markers in nasal secretions. They contained different proportions of the alkamides, polysaccharides, and caffeic acid derivatives thought to be active in Echinacea products available on the high street. These products are likely to be equally ineffective.
New England Journal of Medicine 2005;353: 341-8
Vaccine preservative is not the cause of autism, say US officials
Thiomersal, a mercury containing preservative used in children’s vaccines known in the US as Thimerosal, is not the cause of autism, said top officials from key US government agencies at a joint news conference on 19 July.
The announcement, held one day before a rally sponsored by 11 autism groups in Washington, DC, caused a fierce reaction among parents’ groups and several politicians, who criticised the government’s claims as politically motivated and aimed, in part, at deterring product liability suits against makers of the vaccines.
(what would you expect activists to say when they are publicly told they are wrong??)
Dr Gerberding was joined by other officials who repeatedly emphasised that on the basis of many studies involving "thousands of children . . . the preponderance of evidence consistently does not reveal an association between thimerosal and autism."
From the BMJ today. The epidemiology of error
It's becoming clear that providing safe and effective care requires not only expert clinicians, but also well designed care processes and organisational supports. Industrial processes have long since developed the concept of zero tolerance for error, building quality into production. To better understand why errors occur, health care is now taking advantage of tools such as root cause analysis and failure mode effects analysis, tools already in use in fields such as aviation. Perhaps even more important, many countries are investing significant resources in electronic health record systems that provide clinicians, and hopefully patients, with improved access to relevant data and decision support. When used effectively by care teams these systems will be a powerful tool for preventing many types of errors. Equally important are efforts to promote a culture of safety: a recognition that errors are most often the result of poorly designed systems, while at the same time encouraging everyone to identify and learn from errors.
As we entered a new millennium, we saw that medicine had arrived at a tipping point. The patient safety story coincided with the long awaited arrival of credible patient centred health care. Patients had, as never before, access to credible online information. Clinicians became interested in the concepts of sharing decisions and communicating risk, and it became obvious that medical paternalism was on borrowed time.
From the Kaiser Family Foundation "Daily Reports"
Rep. Henry Waxman (D-Calif.) on Tuesday sent a letter to FDA Commissioner Lester Crawford asking the agency to consider the findings of a new, not-yet-published study before requiring manufacturers to include a package warning stating that condoms do not protect against the transmission of the sexually transmitted disease human papillomavirus, CQ HealthBeat reports (CQ HealthBeat, 8/3). According to Waxman, a study presented last month at the 16th biennial meeting of the International Society for Sexually Transmitted Diseases Research in Amsterdam, the Netherlands, found that condoms significantly reduced the risk of HPV transmission among women. Researchers studied 200 female university students for 22 months -- with medical exams conducted every four months -- and found that women who used condoms 100% of the time were 70% less likely to acquire HPV than women who used condoms less than 5% of the time, according to Waxman (Waxman letter text, 8/2). "The new study, combined with previous evidence, seriously undermines the call by some conservative organizations and lawmakers for labeling that warns consumers that condoms do not protect against HPV," Waxman wrote.
Reaction
"This is a debate Congressman Waxman lost five years ago when President Clinton signed a bill into law requiring the FDA to come up with a medically accurate condom label," John Hart, spokesperson for Sen. Tom Coburn (R-Okla.), who has led efforts to change condom labeling, said (CQ HealthBeat, 8/3). Coburn last month lifted a hold he had placed on Crawford's nomination to become commissioner because of concerns about FDA failing to implement congressionally mandated labeling for condoms that clarifies the limits of their effectiveness. According to Hart, FDA assured Coburn that it will implement the law requiring more accurate condom labeling (Kaiser Daily Reproductive Health Report, 7/18). An HHS spokesperson said FDA had received the letter and had no immediate comment on its contents or possible condom label changes (CQ HealthBeat, 8/3). More than half of sexually active people in the U.S. at some time contract HPV, which can cause genital warts and is associated
During my entire public health career a constant has been concern about outcome of extremely low birthweight infants of approximately 2 lbs or less.
This study from Case Western Reserve University confirms what many of us believe. The issue is how much more can we do to ensure pregnancies last long enough to allow the fetus to reach a weight likely to result in better outcome.
"In the United States in 2002, there were 22,845 live births with a birth weight of 500 to 999 g [1.1 to 2.2 lbs.], of whom approximately 70 percent survived. Our findings underscore the extraordinary costs of care that will be needed to manage the medical, educational, and other service needs of the large proportion of these ELBW children who develop chronic conditions. Proactive planning for the long-term health and educational care needs of all ELBW survivors is essential to optimally treat and possibly improve outcomes through preventative and early intervention services. The American Academy of Pediatrics has emphasized the importance of providing a medical home for children with special health care needs, coordinating their care, involving family, and assisting in navigation of the complex federal, state, and local systems that provide services required by these children. All of these services are highly relevant for the continuing long-term care of ELBW children who survive as a result of neonatal intensive care," the authors conclude."
A fascinating study from the National Academy of Sciences
"We suggested to 228 subjects in two experiments that, as children, they had had negative experiences with a fattening food. An additional 107 subjects received no such suggestion and served as controls. In Experiment 1, a minority of subjects came to believe that they had felt ill after eating strawberry ice cream as children, and these subjects were more likely to indicate not wanting to eat strawberry ice cream now. In contrast, we were unable to obtain these effects when the critical item was a more commonly eaten treat (chocolate chip cookie). In Experiment 2, we replicated and extended the strawberry ice cream results. Two different ways of processing the false suggestion succeeded in planting the false belief and producing avoidance of the food. These findings show that it is possible to convince people that, as children, they experienced a negative event involving a fattening food and that this false belief results in avoidance of that food in adulthood. More broadly, these results indicate that we can, through suggestion, manipulate nutritional selection and possibly even improve health."
The problem is small numbers and short term follow-up. I used hypnosis for the same effect 50 years ago. It worked for a while for some subjects. Many studies have shown the value of advice from Physicians.
University College London Hospital NHS Foundation Trust (UCLH) today announced the UK's first successful implementation of IDX ® Carecast™ – a landmark step in implementing electronic patient records (EPR), opening up the prospect of a virtually paperless hospital and a revolution in patient care,
Over coming months Carecast will gradually replace traditional paper records with information being stored online and immediately accessible throughout the Trust's 8 hospitals. UCLH is the first European hospital to use the IDX Carecast system, one of the most sophisticated anywhere in the world. It is earmarked for use throughout the NHS in London as part of the NHS's radical modernisation of its IT system. Carecast will provide immediate benefits for patients across the UCLH hospitals, but particularly in the Accident & Emergency and Maternity departments.
Lost notes and delayed test results will be a thing of the past. Patients will no longer have to repeat their case histories every time they have an appointment and the electronic patient record will help in the fight against hospital acquired infection by allowing much better tracking of where patients have been.
From the UK "Lung" organization; it appears the TB vaccines that work in the UK and Europe may fail completely, if not make the disease worse, in equatorial regions such as Africa, India and other Asian countries, due to genetic differences in target cells.
A May 2005 report from the CDC states that as of September 2004, federally appropriated terrorism preparedness funds paid the salaries of 460 epidemiologists working in several program areas: 53% (243) worked in terrorism and emergency preparedness, 33% (153) in infectious diseases, 5% (24) in environmental health, and 9% (39) in chronic disease, injury, maternal and child health, occupational health, and other relevant program areas. Among the 390 epidemiologists working in terrorism and emergency preparedness, 62% were paid with federal terrorism preparedness funds (Table), whereas 38% were paid with state or other funds. Although an overall increase in the number of infectious disease epidemiologists did not occur from 2001 to 2004, nearly 20% were paid with federal terrorism preparedness funds.