Dr. Buttery's Public Health BLOG

Every Tuesday and Thursday afternoon you can hear the pitiful cries. Mothers enter the doctor's surgery ashen-faced to queue up for the next round of injections. They leave half an hour later, cramming chocolate into their babies' mouths to stop their sobbing. When my husband took our five-year-old for his 20th injection since he was born, the doctor missed and jabbed my husband's leg instead. Parents watched in horror as he limped out of the surgery. (The Telegraph - Jan 30.2005)

There has to be a better way!!

Posted by at 5:39 PM | Permalink | Comments (0)

In today's Lancet, Peter Blair and colleagues1 report on successful prevention of sudden infant death syndrome (SIDS). Their results are based on a 20-year population-based study of all unexpected infant deaths in Avon, UK.
In the developed world, SIDS was responsible for more infant deaths beyond the neonatal period than any other cause.2 In retrospect, we should conclude that a SIDS pandemic prevailed. The dramatic decline in SIDS incidence shown by Blair and colleagues is a major public-health success. Similar successes have been noticed elsewhere.

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We rarely think about this scourge in the U.S.A. The latest review by the WHO shows remarkable progress.
Europe was so badly affected during the 13th century that by 1225 there were around 19 000 leprosaria—hospitals to house lepers. By 1350, the disease started to wane in Europe, possibly because the black death killed so many of Mycobacterium leprae's hosts. But today M leprae's effects are still seen worldwide, especially in India where 260 000 of the 408 000 people diagnosed in 2004 reside.

In 1991, the World Health Assembly adopted a resolution to eliminate leprosy by 2000, defining elimination as reducing the prevalence to below one case per 10 000 population. By 2005, the goal had not been met, despite the provision of free multidrug therapy by Novartis from 2000 onwards. Despite these failures, there will be a great deal to cheer about on World Leprosy Day on Jan 29. In 1985, 122 countries had prevalence rates above one case per 10 000. Now, only nine do: Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and Tanzania.

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A vaccine can be made in short time and induces robust immune response in mice and chickens against the deadly H5N1 virus

University of Pittsburgh researchers announced they have genetically engineered an avian flu vaccine (using adenovirus) from the critical components of the deadly H5N1 virus that completely protected mice and chickens from infection. Avian flu has devastated bird populations in Southeast Asia and Europe and so far has killed more than 80 people.

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Using a popular internet game that traces the travels of dollar bills, scientists have unveiled statistical laws of human travel in the United States, and developed a mathematical description that can be used to model the spread of infectious disease in this country. This model is considered a breakthrough in the field.

"We were confident that we could learn a lot from the data collected at the http://www.wheresgeorge.com bill-tracking website, but the results turned out far beyond our expectations," said Lars Hufnagel, a post-doctoral fellow at the Kavli Institute for Theoretical Physics at the University of California, Santa Barbara and co-author of an article describing the research in the January 26 issue of the journal Nature.

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Waist circumference can predict a woman’s risk of developing diabetes and of experiencing a cardiovascular event such as a heart attack or stroke, and could serve as a simple screening test to identify women at risk, according to an enlightening report in the January/February 2006 issue (Vol. 15, No. 1) of Journal of Women’s Health. The paper is available free online .

Posted by at 10:21 AM | Permalink | Comments (5)

The U.S. Food and Drug Administration (FDA) considers the sale of unlicensed or unapproved influenza -related products as a potentially significant threat to the public health and is taking measures to protect consumers from fraudulent products that claim to prevent or treat seasonal or avian (bird) influenza in people.

Consumers should be aware that currently there are no approved vaccines for preventing avian influenza in people nor are there any drugs approved for treating the specific symptoms of avian influenza. (Although several vaccines and drugs have been approved for the prevention and treatment of seasonal influenza, it is often impossible for unsuspecting consumers to differentiate between these products and those that are not genuine.)

There is always another health scam! How much of this is the result of aggressive reporting by the news media?

Posted by at 10:19 AM | Permalink | Comments (0)

Research from the University of Leeds (U.K.) shows that "mobile phones are not associated with an increased risk of the most common type of brain tumour, finds the first UK study of the relationship between mobile phone use and risk of glioma. The results are published online by the BMJ today.

The four year study by the Universities of Leeds, Nottingham and Manchester and the Institute of Cancer Research, London found those who had regularly used a mobile phone were not at a greater overall risk of developing this type of tumour."

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From this week's JAMA is a study showing that if an ingunal hernia does not bother you, don't fix it. Why don't we learn from other countries? I have relatives in the UK who have had mild inguinal hernias for years without having them fixed. The NHS has a policy of not fixing it if it is not causing symptoms.

Posted by at 11:04 AM | Permalink | Comments (0)

From the CDC : While the primary strategy for preventing complications of influenza infections is annual vaccination, antiviral medications with activity against influenza viruses can be effective for the prophylaxis and treatment of influenza. Two classes of antivirals are currently available—the M2 ion channel inhibitors (i.e., the two adamantanes amantadine and rimantadine) and the neuraminidase inhibitors (i.e., oseltamivir and zanamivir). The neuraminidase inhibitors are effective for the treatment and prophylaxis of influenza A and B, while the adamantanes are only active against influenza A viruses. This alert provides new information about the resistance of influenza viruses currently circulating in the United States to the adamantanes, and it makes an interim recommendation that these drugs not be used during the 2005–06 influenza season.

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

This article from UAB published in last week's NEJM suggests that it is not the journey but the destination that determines likely travellers' illnesses.

The worldwide collaborative study — based on clinical data collected from more than 17,000 travelers ill enough to see a physician after returning home — formalizes anecdotal theories on trends related to travel disease and also underscores the value of global tracking as bird flu, SARS and other emerging infections loom.

The information, used by study authors to outline trends associating diseases with particular geographic regions, was collected through GeoSentinel, an established network of International Society of Travel Medicine-member clinics.

Posted by at 11:07 AM | Permalink | Comments (0)

From the NHI last week come the following "Most Behaviors Preceding Major Causes of Preventable Death Have Begun By Young Adulthood"
By the time they reach early adulthood, a large proportion of American youth have begun the poor practices contributing to three leading causes of preventable death in the United States: smoking, overweight and obesity, and alcohol abuse. This finding is according to an NIH-funded analysis of the most comprehensive survey of adolescent health behavior undertaken to date.

The analysis also found that significant health disparities exist between racial groups, and that Americans are less likely to have access to health care when they reach adulthood than they did during the teenage years.

The original study comes from the Jan 2006, Archives of Pediatrics & Adolescent Medicine.

We need to start young to teach appropriate behaviors. At some time schooling will have to include behavioral modification. When I went to school 60 years ago "proper behavior" was part of intsruction!

Posted by at 11:20 AM | Permalink | Comments (1)

This news from the University of Rochester Medical Center "The flu hasn’t even hit hard yet this year, but it seems like everyone’s getting sick. What’s the deal?"
Metapneumovirus. Rhinoviruses. Coronaviruses. Parainfluenza. Respiratory syncytial virus (RSV). Pronouncing the names of the microbes can be almost as difficult as bearing the illnesses themselves. They’re on doorknobs, faucets, and appliance handles all around you, and maybe in your nose and lungs too. Some of the viruses are also wafting through the air you breathe, looking to land in your eyes or nose and set up house inside your body. And those are just the respiratory germs – never mind Strep in the throat and ears, or Norwalk viral agents that attack the GI system, and so on.
While RSV may sound new, the best way to prevent it – washing your hands – is not.

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The term "Privacy" has been hijacked by the Luddites in the US to prevent progress, particularly in the health care field. This story from the BMJ this week on Germany's "introduction of electronic health cards" may have hit some technical snags, but the project is moving forward
The electronic card will replace the existing health insurance card, which shows the name and date of birth of the holder and the name of their health insurance company. As well as a digital photo of the holder, the new electronic version will contain information such as electronic drug prescriptions on a microprocessor. Optional medical information such as a record of drugs prescribed, data for emergencies (such as blood group and any chronic diseases), history of surgery, radiography findings, or doctors’ letters can also be stored if the individual asks for it. Patients can also include their own health documentation, such as a disease diary.

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We would expect that as chlidren survive adolescence their health would improve, until they reach their mid forties and start to develop chronic diseases. This study from the SPH-UNC Chapel Hill shows that "Becoming an adult can be hazardous to your health" with leading health indicators showing serious declines as adolescents become adults. The declines in health indicators spanned both sexes and all racial and ethnic groups. The study compared the health of whites, blacks, Asians, Hispanics and American Indians. All groups showed significant declines in health from adolescence into young adulthood.

Posted by at 1:57 PM | Permalink | Comments (4)

In this news release from St. Jude Children's Hospital is the commen that "The cure rate for the once almost universally fatal childhood cancer acute lymphoblastic leukemia (ALL) could reach 90 percent in the near future, thanks to improvements in diagnosis and treatment over the past four decades, according to investigators at St. Jude Children’s Research Hospital. Almost 4,000 cases of ALL are diagnosed in the United States each year, about two-thirds of which are in children and adolescents, making this disease the most common cancer in this age group." Now all we need is to know how to prevent it to start with.

Posted by at 1:46 PM | Permalink | Comments (0)

From the January 13, 2006, MMWR an abstract from the NEISS-AIP identified that in 2002 35 children less than 4 years old died from unintentional medication poisoning. Pharmaceuticals accounted for 1.336,209 unintentional exposures. of which 42.6% were in children < 65 years of age. Why can't we prevent these exposures? Isn't this a role for local health departments? It seems we should be able to prevent 99+% of these exposures. Is too hard for put child proof locks on cupboards and store medicines in them?

Posted by at 12:33 PM | Permalink | Comments (0)

A fascinating study from CU-Boulder, published today in JAMA , shows that "Following six nights of monitored sleep lasting eight hours per night, the study participants were given a performance test that involved adding randomly generated, two-digit numbers, said Wright. Based on the results, the researchers concluded the subjects exhibited the most severe impairments from sleep inertia within the first three minutes after awakening, he said.

The most severe effects of sleep inertia generally dissipated within the first 10 minutes, although its effects are often detectable for up to two hours, according to the study authors."

When someone wakes you up with a phone call and asks for a decision, put them off for a while.

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This is the time of year that many of us have URIs. The ACCP has just produced an "Evidence-Based Clinical Practice Guidelines for Cough". Although extensive and complex the guidelienes are are worth reading as they , again with others, do recommend against the use of antibiotics for the common cold/URI. This information should probably be posted on public health web sites After consultation with local physicians. The pdf. download is not restricted.

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From the RWJF comes a report of a series of research initiatives. One of the more important to Primary Care and Public Health focuses on the need for behavioral change in primary care

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