Dr. Buttery's Public Health BLOG

From the Lancet on Feb 25th: With US health expenditure rising past 16% of the country’s total economic
output—a level almost 50% higher than in any other country—politicians and business executives are scrambling to
avoid the bills for America’s ragged patchwork of public and private health systems.
Opinion polls indicate that healthcare bills are now of greater concern to the US public than terrorism, illegal
immigration, or the rapidly rising cost of petrol. At present, the polls suggest, only the war in Iraq and job creation are
more worrying to the Americans.
However this seems to be one set of opinion polls our legislators ignore!

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From Promed today - Several years ago, there was a case of human tularemia in Wisconsin in the summer. The state epidemiologist's office determined that a cat had brought a tularemia-infected cottontail rabbit (_Sylvilagus
floridanus_) into the patient's home. With the widespread tularemia epizootic going on in Texas, it would seem that the risk of a similar situation, with pets bringing in dead or moribund rodents, is real, giving new meaning to the phrase "look what the cat dragged in!"

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According to the newsmedia the ACIP is about to recommend another vaccine, Rotateq, (against Rotavirus) for all children, as though the current schedule was not enough of a challenge. However no-one says who will pay for the vaccine, made by Merck, which is tagged at $187.50 wholesale, for the three dose series. The CDC has nothing on its website, which was last updated for rotavirus in 2001!

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From UCLA this first study of its kind focusing on newly homeless youth, UCLA researchers have found that high-risk sexual behavior did not predict whether these youths were tested for sexually transmitted diseases. Instead, they were tested only when someone became pregnant or got someone pregnant.

The findings, to be published in the May issue of the peer-reviewed journal AIDS and Behavior and available online at http://dx.doi.org/10.1007/s10461-005-9044-8, indicate that there is an urgent need for outreach programs targeting sexually active homeless youths - who are at particularly elevated risk for becoming infected with the human immunodeficiency virus (HIV) - for early STD screening.

Clincians don't always think about the public health significance of what they do!

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One of the TV vacuum cleaner salesmen pushes the value of his HEPA Filter. This new study from the University of Manchester shows that "High efficiency" vacuum cleaners no better at protecting against dust mites.
Researchers at the North West Lung Centre, run by The University of Manchester and based at Wythenshawe Hospital, have discovered that vacuum cleaners with "high-efficiency particulate air" or HEPA filters are no more effective than standard models at reducing exposure to dust-mites.
The team compared nasal air samples taken before and during vacuum cleaning using both HEPA and non-HEPA vacuum cleaners. They found a small increase in exposure to dust-mite during vacuuming with either type of machine, which was increased when emptying the dust compartments of either.
Lead investigator Dr Robin Gore said: "These vacuum cleaners are marketed to allergy-sufferers on the basis that they reduce a person's exposure to air-borne particles raised from carpeted floors. For allergy sufferers, such particles can trigger asthma attacks. However, we have already found that both HEPA- and non-HEPA vacuum cleaners can actually increase an individual's exposure to particles containing cat allergens.

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Kissing may not only lead to an STD, but also to meningitis. I doubt this news will stop teens from kissing.
Making the news today are the results of a research project funded by Meningitis Research Foundation which looked at why teenagers and young adults are the second most at risk group of contracting meningitis and septicaemia - the blood poisoning form of the disease.

One of the conclusions of the study, lead by Professor Robert Booy, co-director of the National Centre for Immunisation Research at the Sydney Children's Hospital, was that intimate kissing might be partly responsible for increased risk.

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From the American Physiological Society: There is a lot of good advice to help us avoid becoming obese, such as “Eat less,� and “Exercise.� But here’s a new and surprising piece of advice based on a promising area of obesity research: “Wash your hands.�

There is accumulating evidence that certain viruses may cause obesity, in essence making obesity contagious, according to Leah D. Whigham, the lead researcher in a new study, “Adipogenic potential of multiple human adenoviruses in vivo and in vitro in animals,� in the January issue of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology published by the American Physiological Society.

The study, by Whigham, Barbara A. Israel and Richard L. Atkinson, of the University of Wisconsin, Madison, found that the human adenovirus Ad-37 causes obesity in chickens. This finding builds on studies that two related viruses, Ad-36 and Ad-5, also cause obesity in animals.

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02/02/2006 - A handheld sensor could help food companies quickly detect within 10 minutes whether their
products are laden with Escherichia coli or listeria -- before they are shipped out of the plant. Industry news shows that there is an Increasing regulatory emphasis on food safety in plants and the cost of recalls has spurred food companies to seek faster ways of detecting pathogens.

Raj Mutharasan, an engineer at Drexel University in Philadelphia, Pennsylvania, has developed what he says is a cheap, quick and simple detector that just about anyone can use.

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One more reason to urge women to breast feed their children. Researchers at the University of Rochester Medical Center have found another reason to keep those fancy baby spoons in the drawer until infants reach 6 months old. Babies who are breastfed – exclusively – for the first six months have fewer cases of pneumonia and ear infections than babies who were introduced to other foods between 4 and 6 months.

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This research from the University of Liverpool, in the UK, discusses a method to predict Malaria, which is one of the world’s deadliest diseases, killing more than one million people every year, as well as infecting a further 500 million worldwide. The mosquito-borne illness is endemic in several regions globally, but is most acute in Africa, home to an estimated 90 per cent of all cases.

Dr Andy Morse from the Department of Geography and colleagues from the European Centre for Medium Range Weather Forecasting; Columbia University, New York and the Ministry of Health in Botswana, based their early-warning model on population vulnerability, rainfall and health surveillance data and then used forthcoming season forecasts for rainfall to predict unusual changes in the seasonal pattern of disease in Botswana. The team based their study on Botswana as its climate makes it susceptible to malaria epidemics.

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Poor emotional health, such as symptoms of depression and anxiety, may significantly reduce the likelihood that elderly patients will receive preventive health services, according to a study led by a Duke University Medical Center School of Nursing researcher. The researchers said their findings lead them to recommend that physicians actively screen older patients to determine if they might be experiencing symptoms of psychological distress.

The study showed people age 65 and older are up to 30 percent less likely to receive preventive services that are generally recommended for older adults, including influenza vaccinations, dental check-ups or clinical breast exams, said Joshua Thorpe, Ph.D., MPH, assistant research professor in the School of Nursing and senior fellow in the Duke University Center for Aging. Receiving these services may help control the costs of health care by preventing the need for more expensive health care services, Thorpe said.

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In an initial report from Duke University smokers trying to quit the habit may double their success rate by wearing a nicotine patch two weeks before their actual quit date, according to a Duke University Medical Center study. Currently, the patch's label warns against smoking while wearing the patch.

In a study of 96 smokers attempting to quit, 50 percent of those who wore the patch two weeks prior to quitting had stopped at four weeks. Only 23 percent of smokers who wore a placebo patch two weeks prior to quitting had stopped after four weeks. The same pattern appeared to continue for six months, although many of the study participants were no longer reachable to verify this trend, said the researchers

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In this week's issue of Science is a must read article for public health professionals. In a report from a Stockholm meeting a group of parasitologists suggest that despite the international interest in the big three diseases, HIV/AIDS, TB and Malaria a bigger bang for the buck would occur if diseases such as Hookworm, Schistosomiasis and Leishmaniasis were treated concurrently.

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An important editorial from the Lancet today discusses the interaction of children, their environment and some common diseases. Much of the data comes from the work of "Children's Health and the Environment in North America: a First Report on Available Indicators and Measures" The report is hyperlinked to the editorial. The report discusses criteria for issue inclusion and focuses, in the first iteration, on asthma, lead poisoning and water borne diseases with a hope that governments will use the data to set policy. In the U.S. we are at least 40 years behind the curve in preventing childhod lead poisoning.

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From a Feb 2 JAMA editorial on Adamantine resistance of Influneza A, by Wienstock and Zuccotti we find that the development of resistance to one of the two classes of drugs used to "prevent" or "treat" the flu. Although whether the cost of these drugs is worth shortening the length of illness by 24 hours is problematic, it is worth noting that the resistance may well have begun by widespread administration of the drugs to chickens! This editorial is worth reading in relation to setting Public Health Policy. The comments on the adverse newsmedia publicity are also valuable..

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Percentage of Births Attended by MIdwives - United States 2003

Approximately 8.0% of births were attended by midwives, more than double the 1990 rate of 3.9%. In six states (Alaska, Georgia, New Hampshire, New Mexico, Oregon, and Vermont), rates were at least twice as high as the national rate.

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When it started, I must admit that I never believed the Rotary Foundation had a prayer of succeeding, but the results are outstanding and show what private philanthropy can do. The Gates Foundation carries the activities of private foundations further on the world stage.

The WHO announces that the number of countries with indigenous polio has dropped to an all-time low of four, as polio eradication efforts enter a new phase involving the use of next-generation vaccines targeted at the two surviving strains of virus.

In 2006, monovalent vaccines, aimed at individual virus strains, will be the primary platform for eradication in all remaining polio-affected areas, announced the core partners in polio eradication – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control (CDC) and Prevention and UNICEF – enabling the eradication drive to hone in on poliovirus types 1 and 3.

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Landmark Hypertension Treatment Study Launches Extensive Physician and Patient Education Program to Improve Public Health
News from the NIH - Researchers in the largest high blood pressure clinical trial ever conducted are launching a comprehensive outreach program to improve high blood pressure control nationwide. About 150 physicians in 34 states and Washington, DC, have completed training to educate other physicians in their communities. Their goal: to help doctors and patients prevent and better treat high blood pressure.

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