Dr. Buttery's Public Health BLOG

From Baylor College of Medicine: Exercise can't stop the aging process, but experts at Baylor College of Medicine in Houston say that for the elderly, whether it's weight training, walking, swimming or biking, 30 minutes of exercise three to five times a week is a good prescription for aging.

"It's never too late to start exercising," said Dr. Robert Roush, an associate professor of medicine-geriatrics at BCM. "Being physically active and exercising regularly can help prevent or delay some diseases and disabilities as people age."

Loss of muscle mass typically begins in the 30s or 40s. As muscles shrink, fat cells take their place and that leads to a slowdown in metabolism and weight gain even if caloric intake and expenditure remains the same.

Posted by at 9:55 AM | Permalink | Comments (778)

Whooping Cough Vaccine Not Just for Kids Anymore
From St. Louis University In the first study of its kind, researchers at Saint Louis University have demonstrated that immunization with a new vaccine could potentially prevent more than a million cases of pertussis (whooping cough) each year in adolescents and adults.

Most children are protected from pertussis by a series of vaccines in early childhood. But the vaccine protection wanes after a decade or so, leaving adolescents and adults susceptible to the bacterial infection.

"It's a misconception that you're protected from pertussis for life if you've been vaccinated as a child," said Stephen J. Barenkamp, M.D., professor of pediatrics and one of the study's clinical investigators. He also is director of the Pediatric Research Institute at the Saint Louis University School of Medicine. "The study demonstrated that an estimated one in 300 adolescents and adults contracts the illness each year. The results also demonstrate that an effective vaccine is now available for this population and its use should be strongly encouraged."

Posted by at 1:21 PM | Permalink | Comments (0)

A new anesthetic technique for vasectomy that does not involve the use of needles has been shown to be safe and effective, according to a recent study presented by Dr. Marc Goldstein of NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Department of Urology. NewYork-Presbyterian/Weill Cornell is the first and only site in the Northeast to offer the new technique.
No-scalpel vasectomy — unlike conventional vasectomy, which involves two scrotal incisions — involves one tiny puncture, resulting in fewer complications and quicker recovery time.

Posted by at 1:16 PM | Permalink | Comments (0)

From the CDC: Diabetes now affects nearly 21 million Americans – or 7 percent of the U.S. population – and more than 6 million of those people do not know they have diabetes, according to the latest prevalence data released today by the Centers for Disease Control and Prevention (CDC). This number represents an additional 2.6 million people with diabetes since 2002. Another 41 million people are estimated to have pre-diabetes, a condition that increases the risk of developing type 2 diabetes – the most common form of the disease – as well as heart disease and stroke.

Posted by at 1:09 PM | Permalink | Comments (0)

Projected global deaths by cause, all ages, 2005

This graph from the lancet shows the burden of expected deaths from chronic disease world wide. I hope no one has a question about the need for better preventive medicine/public health interventions.

Posted by at 12:28 PM | Permalink | Comments (0)

The lack of sustained human-to-human transmission
suggests that this AH5N1 avian virus does not currently have the
capacity to cause a human pandemic. But, given the known
potential for antigenic shift—either from a gradual process of
adaptive genetic mutation within the virus or by a snap gene
reassortment with a human influenza A virus6—the virus could
acquire the mechanism for rapid human transmission and cause
explosive global spread, facilitated by current air travel. Pigs and
humans seem to be the “mixing vessels” for genetic exchange
when coinfected by both animal and human flu viruses. Close
domestic proximity of fowl, pigs, and people facilitates this, a
situation common in Asia.
The optimistic alternative to this apocalyptic viewpoint is that
the appearance of a modified avian virus capable of triggering a
human pandemic is unlikely: there have been more than 3300
flu outbreaks in birds with 150 million killed and only 118
human cases,3 5 and the disease in birds is proving containable
with good surveillance and prompt action.

Posted by at 10:29 PM | Permalink | Comments (1)

this press release from the Salk Institute reviews staff research that shows "We often make unwise choices although we should know better. Thunderstorm clouds ominously darken the horizon. We nonetheless go out without an umbrella because we are distracted and forget. But do we? Neurobiologists at the Salk Institute for Biological Studies carried out experiments that prove for the first time that the brain remembers, even if we don’t and the umbrella stays behind. They report their findings in the Oct. 20th issue of Neuron. "

Posted by at 10:20 AM | Permalink | Comments (0)

An interesting study from this week's BMJ suggests that early retirement may be something to avoid. However, this study was made for the petrochemical industry. I wonder if early retirement has the same effect in other industrial sectors?

Posted by at 10:15 AM | Permalink | Comments (1)

No connection shown between vaccine and autism: There is no credible link between the measles, mumps, and rubella vaccine and any long term disability, including Crohn's disease and autism, a Cochrane Library review of 31 high quality studies concludes. The review also says that lack of confidence in the vaccine has caused great damage to public health ( Cochrane Database Syst Rev 2005;(3):

Posted by at 3:19 PM | Permalink | Comments (1)

From the Economist today is a wonderful story of how immunization may improve the economic outlook of poor countries.
Dr Bloom and Dr Canning (from the HSPH) believed that previous attempts to quantify the non-medical benefits of vaccination had been too narrow. These had looked at such data as the cost of a programme per life saved, but had failed to take account of recent work on the effects of health on incomes. For their study, they and Mr Weston identified how vaccination, in particular, might increase wealth.

Posted by at 4:48 PM | Permalink | Comments (0)

Most clinicians already believed this intuitively from observation, but it is nice to have it confirmed by science. This news story from the Medical College of Georgia reports that "Heredity plays a major role in determining the blood lipid profile and heart rate variability of blacks and whites, two major risk factors for coronary artery disease, researchers say."
“There are some interesting ethnic differences in cardiovascular risk factors, including the fact that blacks tend to have higher HDL (high-density lipoprotein) and lower triglycerides, which is an advantage, and we suspect it is due to genetic influences,” says Dr. Catherine L. Davis, clinical health psychologist at the Medical College of Georgia.

Posted by at 12:14 PM | Permalink | Comments (0)

From the KFF:
Reduce high-cost hospitalizations, such as those for readmitted heart failure patients;
Reduce payment disparities for patients with similar conditions;
Reduce use of unnecessary medical tests and procedures;
Eliminate of payments to hospitals for complications related to medical errors;
Negotiate of reduced prescription drug prices;
Standardize of health insurance products to reduce administrative costs;
Increase use of evidence-based medical guidelines for tests and procedures;
Guarantee patient access to a regular health care provider to direct and supervise their care;
Eliminate of duplication of medical tests and procedures; and
Implement of health information technology.

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

From an editorial in the Lancet, October 13:
Last month, President Bush launched the International Partnership on Avian and Pandemic Influenza at the plenary meeting of the UN General Assembly. On Oct 6–7, a meeting with representatives from 80 countries and involved organisations was held in Washington, DC, to affirm commitment to work together. At the same time, Bush summoned vaccine manufacturers to discuss ways to increase their willingness to produce influenza vaccines. The Senate passed legislation authorising US$4 billion for additional purchases of the anti-influenza medication oseltamivir to increase coverage from a current 4·3 million to 20 million people. However, how effective these vaccines and drugs are is as yet unclear.

Amid this flurry of welcome activity, a draft of the US preparedness report leaked to The New York Times last week gives pause for thought. One of its most important shortcomings, according to an unnamed health offical who had provided the draft report, is that it does not say who is in charge of coordinating a response. Last month, the UN appointed David Nabarro, a senior public-health expert at WHO, to lead the coordination of the UN response to avian influenza. What is also urgently needed is strong national and regional leadership; unrestricted transparency in surveillance and preparedness plans from all countries, including China; and renewed research efforts to find the best methods of prevention and treatment. Without these measures, what is already looking like an inevitable influenza pandemic may be as deadly as that which struck in 1918.

Posted by at 1:27 PM | Permalink | Comments (0)

From the BMJ - Oct 14: European governments must prepare for a pandemic of avian influenza that could strike at any time, warned Markos Kyprianou. The European Union commissioner for health spoke at a press conference held last week during the European Health Forum Gastein, a health "think tank" that meets annually in Bad Gastein in Austria.

"Getting sufficient vaccine presents a major challenge," he said. "Industry needs financial incentives to increase its output. We have set up a public-private partnership to do this, and EU member states should make use of it now by entering into prepurchase agreements for a vaccine."

Discussions of fast track approval of a vaccine by the European Medicines Agency are underway, he said, and the EU is contributing to international efforts to help deal with the source of the infection in South East Asia.

Preparations for the arrival of avian flu became more urgent at the weekend when it was announced that infected birds had been discovered in Turkey and Romania. Results of tests to establish if the cases are of the H5N1 strain, which has killed more than 60 people worldwide, were due to be announced on Wednesday, after the BMJ had gone to press.

Posted by at 1:20 PM | Permalink | Comments (0)

From the BMJ News; research from the European Heart Journal shows that
"Too many people with heart disease continue to smoke even after they are aware of their condition. Less than half the patients who smoked before needing hospital treatment for a coronary event quit afterwards.

Wilma Scholte op Reimer, lead author of the study and epidemiologist at the Erasmus University Medical Centre in Rotterdam, described the finding as "unbelievable." "It makes me wonder if they are truly aware of the risk that they are taking," she said.

The finding shows that smoking rates in heart patients have not changed since 1996, when a similar study was done. In the latest study, 21% of coronary patients were persistent smokers after treatment compared with 19% in the earlier study. "

Posted by at 1:13 PM | Permalink | Comments (0)

How do we prevent the media from cuasing panic? In the UK people are panicking because the NHS has not ordered enough Tamiflu in case of an avian flu outbreak. However, there is evidence that Tamiflu will not work. By the time the flue migrates to Western Europe and the US the strain may have changed again so that premature development of a vaccine may be worse than nothing. But how can we educate the public and politicians to lower their expectations for miracles?

Posted by at 12:56 PM | Permalink | Comments (0)

Rush University Medical Center has made the news by reinventing the wheel. The staff are telling older patients to bring all their medicines (both prescribed and OTC) in a paper bag when they come to the clinics. I was taught this in residency training 50 years ago!!

Posted by at 12:49 PM | Permalink | Comments (0)

This week the BMJ reports that the U.S. is not the only country involved in the quagmire of evaluating complementary medical therapies (CAM). Citizens in both the US and the UK are voting for CAM with their feet, based on anecdotes and uncertain evidence. The BMJ author notes that the popularity of CAM should not be confused with its value. Payment by reimbursement agents should be based on effectiveness, not politics or popularity.

Posted by at 7:13 PM | Permalink | Comments (0)

This week the CDC reports an outbreak of poliovirus infection among 4 unvaccinated children in an Amish Ccommuity in Minnesota. The index case was 7 months old. This infant had severe combined immunodeficiency. The last wild poliovirous outbreak in the US was in 1979.

Posted by at 7:02 PM | Permalink | Comments (0)

No heath-service system has yet developed a useful strategy for managing the huge numbers of overweight and obese poeple in their community, states a seminar in this weeks issue of The Lancet. The number of deaths per year attributable to obesity is roughly 30,000 in the UK and ten times that in the USA, where obesity is set to take over smoking in 2005 as the main preventable case of illness and premature death.
Excess body weight is the sixth most important risk factor contributing to the overall burden of disease worldwide, and 1.1 blIllon adults and 10% of children are now classified as obese. Despite these figures, neither the medical management nor the societal preventive challenge are currently being met, state seminar authors David Haslem (National Obesity Forum, UK) and Philip James (International Obesity Task force),
The authors suggest that more collaboration between nursing, dietetic and physical-activity experience is needed to develop novel ways.to tackle obesity. Dr. Haslam states: The medical profession is only now waking up to the political and industrial challenges, as well as the medIcal challenge. Our new scientific understanding of obesity is helping to validate a new approach to tackling the problem but the response of the medical profession to both its management and prevention is still at an early stage ."

Posted by at 2:07 PM | Permalink | Comments (1)

From University College London. this report:
Ozone is being wrongly blamed for many of the deaths during hot weather spells, finds a new UCL (University College London) study. UCL scientists warn that amidst all the concerns over air pollution, the more basic health message of ‘staying cool when the weather is hot' may be being forgotten.

The study, published online in the journal Environmental Research, modelled the daily mortality rate of people over 65 (who suffer most of the heat-related deaths) in Greater London from 1991 to 2002. The model included daily temperatures, humidity, sunshine and wind and assessed any effects of atmospheric ozone, particulates and sulphur dioxide. UCL researchers then analysed general mortality trends for days when mean air temperatures exceeded 18C.

Posted by at 11:27 AM | Permalink | Comments (0)

A report from Cancer Reseach UK states "Almost two thirds of all women newly diagnosed with breast cancer are now likely to survive for at least 20 years – Cancer Research UK predicts today.

Women between 50 and 69, the age at which breast cancer is most commonly diagnosed, have an even better prognosis with 72 per cent likely to reach the 20 year mark.

And almost 80 per cent of breast cancer patients in that age range will survive at least 10 years according to a report* by Cancer Research UK epidemiologist Professor Michel Coleman."

Posted by at 10:45 AM | Permalink | Comments (0)

In a seperate reports from Emory University and The University of Queensland "The results of a major clinical trial involving 12,167 women shows Gardasil, a genetically-engineered vaccine by Merck & Co., was 100 percent effective in preventing persistent infection with the two major strains of the human papillomavirus (HPV) that account for 70 percent of cervical cancer cases. As far as a cancer vaccine goes, this is the best we have," says Dr. Ault, of Emory, who has spent much of his career researching the HPV vaccine. "In four or five generations we've gone from cervical cancer being the most common cause of cancer death in the United States for women to being a vaccine-preventable disease. That's a really remarkable story if you trace this research over the last 50 to 60 years."
Dr Ian Frazer of UQ's Centre for Immunology and Cancer Research said "It is very rare, almost unheard of, to achieve a 100% efficacy rate in any treatment, so these results are truly wonderful”

Posted by at 10:29 AM | Permalink | Comments (7)

It is not only the U.S. that does not provide fluoridated drinking water to all its citizens. This report from the UK illustrates to problems of ensuring universal access to fluoridated drinking water.

Posted by at 12:27 PM | Permalink | Comments (0)

Research from team lead by UCI shows that:
By increasing cigarette taxes, raising the smoking age and adopting new or enforcing current regulations that prevent or delay youth smoking, elected officials and other policy makers can improve lives and save billions of taxpayer dollars, according to a UC Irvine-led tobacco policy consortium.

“Our research shows that reducing smoking initiation in youth is likely to offer the largest public health impact during this new century,” said Daniel Stokols, UCI professor of planning, policy and design, who helped establish the consortium – a partnership of researchers, community leaders, health advocates, school administrators, teachers and elected officials.

Posted by at 10:23 AM | Permalink | Comments (0)

And we thought we had problems with the U.S. System
"Britain's National Health Service (NHS) as the public used to know it—a centrally managed, publicly owned, government-financed health system—is no more. The end of the NHS was confirmed last week by health secretary Patricia Hewitt, who pledged to continue with plans to introduce market-based contestability (the Government's byword for competition) into primary care, despite strong opposition from many health workers. Although Hewitt is promising limits to private-sector incursions into state care, the launch this week of new cooperatives of doctors to bring venture capital into the health service shows that something very important and dramatic is happening to British health care."

Posted by at 12:29 PM | Permalink | Comments (0)

Scientists at the Centers for Disease Control and Prevention have successfully reconstructed the influenza virus strain responsible for the 1918 pandemic, a project that greatly advances preparedness efforts for the next pandemic.

“This groundbreaking research helps unlock the mystery of the 1918 flu pandemic and is critically important in our efforts to prepare for pandemic influenza,” said CDC Director Dr. Julie Gerberding. “We need to know much more about pandemic influenza viruses. Research such as this helps us understand what makes some influenza viruses more harmful than others. It also provides us information that may help us identify, early on, influenza viruses that could cause a pandemic.”

Currently available antiviral drugs have been shown to be effective against influenza viruses similar to the 1918 influenza virus.

Joint statement from NIH & CDC

Posted by at 11:05 AM | Permalink | Comments (266)

This report , The "Annual Report to the Nation on the Status of Cancer, 1975-2002," published in the Oct. 5, 2005, issue of the Journal of the National Cancer Institute*, shows observed cancer death rates from all cancers combined dropped 1.1 percent per year from 1993 to 2002. According to the report's authors, declines in death rates reflect progress in prevention, early detection, and treatment; however, not all segments of the U.S. population
Death rates from all cancers combined declined 1.5 percent per year from 1993 to 2002 in men, compared to a 0.8 percent decline in women from 1992 to 2002**. Lung cancer is the leading cause of cancer deaths in both men and women. Death rates decreased for 12 of the top 15 cancers in men, and nine of the top 15 cancers in women.

Posted by at 2:23 PM | Permalink | Comments (0)

The OP-ED piece by Robert Goldberg in the Washington Times, Sept 23, should be required reading for all students of the Public's Health.
"The public and private health system in New Orleans and other communities in the Gulf coast region have been wiped out. Federal support will be required to reconstruct and enhance health-care facilities and patient care in the region, particularly for those previously underserved by what was washed away."
"Health insurance should be made portable. As people travel from place to place to find jobs and rebuild their lives, they should not have to apply and reapply for insurance. Each family or individual should be given debit cards to pay for health care and insurance premiums. They should be able to buy coverage from anywhere in the country at a group rate. To support this latter change, HHS should create a catastrophic fund in cooperation with the affected states to encourage health plans to participate in the face of potentially expensive claims."

Posted by at 1:48 PM | Permalink | Comments (0)

A fascinating study from Rush University Medical Center. Will refusal of pediatricians to continue care for families who refuse all immunizations promote or decrease the liklihood of immunization?
Pediatrician Dr. Erin A. Flanagan-Klygis, of Rush University Medical Center, writes that the rate of unvaccinated children has risen significantly since 1995. While most parents continue to believe that vaccination is important, a large number express concerns about vaccine safety. Although most parents depend on their pediatrician's advice and counsel in their decision to vaccinate their children, when a parent refuses one or all vaccines the relationship between parent and pediatrician may be weakened. "Some pediatricians may choose to end their participation in the care of children whose parents refuse vaccinations."

Posted by at 1:16 PM | Permalink | Comments (0)

A recent report from the WHO show that the US is not the only nation battling obesity.
According to WHO estimates, more than 75% of women over the age of 30 are now overweight in countries as diverse as Barbados, Egypt, Malta, Mexico, South Africa, Turkey, and the United States. Estimates are similar for men, with over 75% now overweight in, for example, Argentina, Germany, Greece, Kuwait, New Zealand, Samoa, and the United Kingdom. Notably, the Western Pacific islands of Nauru and Tonga have the highest global prevalence of overweight where nine out of every 10 adults are overweight.

“The sheer magnitude of the overweight and obesity problem is staggering,” said Dr Catherine Le-Galès Camus, WHO Assistant Director-General of Noncommunicable Diseases and Mental Health. “The rapid increase of overweight and obesity in many low and middle income countries foretells an overwhelming chronic disease burden in these countries in the next 10 to 20 years, if action is not taken now.”

This is one more indicator that public health agencies, while remaining alert for emerging infectious diseases need to pay mroe attention to the prevention of chronic diseases.

Posted by at 1:10 PM | Permalink | Comments (0)

This interview from the Johns Hopkins School of Public Health destroys one more environmental myth.
Rolf Halden, PhD, PE in this Q & E
Q:What do you make of this recent email warning that claims dioxins can be A:released by freezing water in plastic bottles?
No. This is an urban legend. There are no dioxins in plastics. In addition, freezing actually works against the release of chemicals. Chemicals do not diffuse as readily in cold temperatures, which would limit chemical release if there were dioxins in plastic, and we don’t think there are."

Posted by at 12:36 PM | Permalink | Comments (0)

This article from the telegraph today shows that concern over children's food is important in countries other than the U.S.
"Plans to revolutionise school meals for almost eight million children by doubling spending, enforcing healthy eating and ensuring that all pupils learn how to cook were announced yesterday.

The Government published the report of a committee set up by Ruth Kelly, the Education Secretary. It concluded: "The state of many school meals is an indictment of more than two decades of public policy which has in effect stripped nutrients off plates, removed skills from kitchen staff and seen the take-up of school meals drop precipitously."

Posted by at 12:24 PM | Permalink | Comments (0)

This study from the University of Wisconsin
"When they're done right, certain prevention and intervention programs reduce delinquent behavior," Small says. These programs are much less expensive than the costs associated with juvenile crime. The cost of housing a juvenile offender in Wisconsin correction facilities during 2004 was $68,255 - a figure projected to increase nearly 20 percent by 2007. This does not include costs to crime victims or to society for future adult crime and incarceration.

In contrast, the average cost per child for the most effective prevention programs was well under $10,000 per year, or 85 to 90 percent lower than in a corrections facility.

Posted by at 12:48 PM | Permalink | Comments (0)

(UM)ANN ARBOR, MI – The same philosophy used to make better cars and computer chips can also save the lives of heart attack patients, a new study finds.

In fact, 26 percent fewer patients died in the first year after their heart attack when hospitals used quality-improvement tactics to prevent crucial heart-care steps from “slipping through the cracks” — in much the same way a car company ensures that a car is made well before it leaves the factory.

The steps included a checklist that doctors, nurses and patients in 33 Michigan hospitals had to complete before each patient could leave the hospital. The checklist, based on national heart-care guidelines, helped make sure that patients got crucial drugs, tests and lifestyle advice that could help prevent another heart attack.

Posted by at 12:42 PM | Permalink | Comments (0)