Dr. Buttery's Public Health BLOG

A Hazard Study from Monash University in Australia reports that six people died and more than 150 went to hospital with scooter injuries in Victoria between 2000 and 2005. People older than 80 were over represented in both fatalities and hospital-treated injury cases. Further the study director says a national approach is needed urgently to deal with an impending epidemic of mobility scooter deaths and injuries. Scooters are becoming more popular as older and disabled people strive to maintain active, independent lives. People often see scooters as an alternative to cars, and not only as an aid for those who have trouble walking because of a major disability or health condition.

The hazard report said all the deaths and half the injuries resulted from major falls. Other major causes of injuries were collisions with cars, prams, bushes, trees and fences, and tip-overs on uneven surfaces or gutters. Head wounds, and face and leg and hip fractures were the most common injuries.

See the full report

Posted by at 12:01 PM | Permalink | Comments (1)

Scientists at UAB today discussed a crucial missing link in the search for the origin of HIV-1, the virus responsible for human AIDS. That missing link is the natural reservoir of the virus, which the team has found in wild-living chimpanzees in southern Cameroon.
Although researchers have long suspected that HIV-1’s origins lie in some way with chimpanzee infection through a closely related virus SIVcpz (simian immunodeficiency virus from chimpanzees), only a few captive apes had been found to harbor SIVcpz.

In the study, UAB Professor of Medicine Beatrice H. Hahn, M.D., and her team conducted the first-ever molecular epidemiological survey of SIVcpz infection in wild-living chimpanzees in west-central Africa. By analyzing ape fecal samples collected by trackers from the forest floor in remote jungle regions of Cameroon, Hahn and her colleagues were able to detect SIVcpz-specific antibodies and nucleic acids (viral genetic information) in as many as 35 percent of chimpanzees in some ape communities.

But how did it get from Cameroon to San Fransicsco, where humans with the disease were first decribed, and why the 25 year gap?

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Tobacco use is responsible for approximately one in 10 premature deaths among adults worldwide. Sponsored
by the World Health Organization (WHO), World No Tobacco Day is observed every year on May 31.
This year’s theme is Tobacco: Deadly in Any Form or Disguise.
The goal is to raise awareness about the harmful health effects of all forms of tobacco (e.g., cigarettes
[including light, low-tar, and mild], smokeless tobacco, bidis, kreteks, clove cigarettes, cigars, shisha [flavored
tobacco smoked in a hookah pipe], and others). For example, smokeless tobacco causes oral cancer and might
be a risk factor for cardiovascular disease; bidis increase the risk for oral, lung, and esophageal cancers;
and waterpipe smoking increases the risk for oral and lip cancer and obstructive lung disease.
The global burden of deaths attributable to tobacco use each year is estimated to double from 5 million in 2005
to 10 million in 2020 (5). Additional information on WHO’s tobacco control initiative and World No Tobacco Day activities is available at http://www.who.int/tobacco/en.

Posted by at 4:03 PM | Permalink | Comments (1)

Today's JAMA has a valuable article on chronic homelessness. Much damage may be done by the revolving doors of helping agencies who have not focused on the serial homeless. The study noted that the average cost in San Diego for the chronic homeless was $70,000 a year. It was much more cost effective to provide housing and concentrated case management to keep these individuals off the street.

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In this week's Lancet are two book reviews on the life of John Snow. One on the science of his life focussing on his skills in anaesthesiology "Operations without Pain" by a descendent, Stephanie Snow. Another one that focuses on his fight against Cholera "The Medical Detective": by Sandra Hempel.

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Once again, we learn that unnecessary medical tests are costing the U.S. health care system millions—and potentially billions— of dollars per year, and add unnecessary patient stress, say researchers from Georgetown University Medical Center and Johns Hopkins University in the June issue of the American Journal of Preventive Medicine.
The uathors say that among the many reasons that diagnostic interventions which lack evidence of benefit in asymptomatic patients are used are:

Studies have shown that many patients have expectations of receiving particular tests when visiting physicians.
It is possible that physicians are ordering these tests defensively, to guard against potential lawsuits.
Physicians may not be aware of USPSTF recommendations.
There may be a financial incentive to ordering these tests, especially if a physician’s office includes a laboratory.

Abput onxce a decade we see research that repats the information that a good hostry adn physical exam are far more use than batteris of tests. I wonder how much is the result ofthe seond observation. Our legislators, mostly lawyers, seem uninterEsted in changing the current state of affiARS..

Posted by at 10:17 AM | Permalink | Comments (0)

From the Kaiser Family Foundation May 18 daily reports:
The Wall Street Journal and the Washington Post on Tuesday examined CDC's new "preconception care" recommendations -- published in the April 21 edition of CDC's Morbidity and Mortality Weekly Report -- that encourage women to maintain physical and emotional health before they become pregnant. According to the Post, preconception care includes the recommendation that all women "between first menstrual period and menopause" take "folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions, such as asthma and diabetes, under control" (Payne, Washington Post, 5/16). The goal of CDC's recommendations is to make preconception care "as common as prenatal care" for all women, including those not planning to become pregnant, according to the Journal (Chernova, Wall Street Journal, 5/16). Read the rest of the story

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A concensus report from the NIH on the evidence for use of vitamins in prevention of chronic disease is worth reading. This is particularly true in view of the huge vitamin industry developed supposedly to keep people well! It is clear P.T. Barnum was right.

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A report from Duke University and the Wellcome Trust today noted that a team of British and American scientists has completed the detailed genetic mapping of human chromosome 1, the largest single unit of genetic material in the human genome and the final chromosome to be completely sequenced.
"This achievement effectively closes the book on an important volume of the Human Genome Project, which was started in 1990 to identify the genes and DNA sequences that provide a 'blueprint' for human beings," said Simon G. Gregory, Ph.D., assistant professor at the Duke Center for Human Genetics and lead investigator on the study.

"Armed with this new information, researchers now have new tools for probing fundamental biological questions and examining the genetic factors involved in a range of diseases and medical conditions, including Alzheimer's disease, Parkinson's disease, cancer, autism and mental retardation," Gregory said.

We can hope that this research will allow epidemiologists to study antecedents of disease more closely and enhance prevention efforts.

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Many of us have prescribed a codeine based medicine fo anyone with a cough, as secondary prevention while the patient heals him/her self. When I started medical school in the late 1940s we were taught that the best cough suppressant was Heroin, but is was not in our pharmocopeia because of its addictive properties. With this latest research from the U. of Manchester in the UK we find that we may have one more useless nostrum in our armementarium because it had not been critically evaluated. It appears it may not be as good as Mum's Chicken Soup!.
Scientists at the University of Manchester's North West Lung Centre have found that codeine - a standard ingredient in cough remedies - could be no more effective than an inactive placebo compound at treating cough.
"The effective treatment of chronic dry cough is an important unmet need in patients with chronic respiratory diseases, post-viral coughing and persistent coughing of unknown cause. Studies of cough in other clinical situations are urgently needed if codeine is to be continued to be used as a remedy."

Posted by at 10:49 AM | Permalink | Comments (2)

From UC Irvine today a study suggests body mass index standards for younger adults may not be appropriate for people in their 80s and 90s
The analysis found that study participants in their 80s and 90s who were overweight by BMI standards (25 to 29.9 range) had lower mortality rates than those who were in the normal range (18.5 to 24.9). The findings suggest that the BMI scale, which applies to all adults, may not be appropriate for the elderly and should be age-adjusted. This supports other research offering the same conclusion. The study appears in the May 15 issue of the American Journal of Epidemiology.

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A very useful article in Science Magazine, today, suggests a different set of priorities for vaccination against the Flu Virus should a pandemic occur. The table in the body of the article suggests that rather than the traditional medical/public health model using a "Life Cycle Principal" where the value of surviving years is more important than years lived. Those involved in public policy making should read this article.

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Public health officials need to read the article in week's Science Magazine on Public Health Progress in development, testing and introduction of rotaviros vaccines. They are valuable worldwide, not just in th US where it is estimated that rotavirus infections lead to 55-75,000 hospitalizations a year.

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Witth the increasing number and cost of vaccines, public health experts need to think carefully about the planned introduction of an HPV vaccine. This week's editorial in the BMJ is a "must read" piece.
With limited resources should this be a required vaccine. should it be an option at famiily planning and STD clinics?
Who should be required to authorize such a vaccine? Many questions need to be answered. If protection is used during sexual activity would a vaccine be necessary?

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New York University School of Medicine researchers today stated that approximately 15% of Asians living in New York City are chronically infected with hepatitis B virus. The conclusion is the result of screening in community health centers and local health departments. It is not repesentative of all New York Asians. I wonder if this is not an outcome for many low income, disadvantaged groups, rather than just Asains?

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Today the ACOG released a recommendation for visits of teens for preventive consultations.
ACOG reaffirms its recommendation that teenage girls first visit an ob-gyn between the ages of 13 and 15 in a new committee opinion published in the May 2006 issue of Obstetrics & Gynecology
Further, the statement went on to say "During these years, young teens face new issues regarding sexual and reproductive health and development on a daily basis. It's important that they develop a relationship with their ob-gyn"
I am not sure that this focus by ACOG is other than self serving. The concept is a good one but should be extended to family physicians. pediatricians, community health centers and local health departments.

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Despite research efforts to find modern factors that would explain the different life expectancies of men and women, the gap is actually ancient and universal, according to University of Michigan researchers.
Women live longer in almost every country, and the sex difference in lifespan has been recognized since at least the mid-18th century, said Daniel J. Kruger, a research scientist in the U-M School of Public Health and the Institute for Social Research. "It isn't a recent trend; it originates from our deep evolutionary history."
This skewed mortality isn't even unique to our species; the men come up short in common chimps and many other species, Kruger added.
"This whole pattern is a result of sexual selection and the roles that males and females play in reproduction," Kruger said, "Females generally invest more in offspring than males and are more limited in offspring quantity, thus males typically compete with each other to attract and retain female partners."

Posted by at 11:53 AM | Permalink | Comments (0)

Just because the president of a company appears in a company advertisement does not mean one should trust it. Think about the Sharper Image ads. for Ionic Air Purifiers. Now from UC Irvine comes a story that scientists verify that ionic and other air purifiers add to pollutants already in a room at levels that can exceed health standards
These results mean that people operating air purifiers indoors are more prone to being exposed to ozone levels in excess of public health standards,� said Sergey A. Nizkorodov, assistant professor of chemistry in the School of Physical Sciences at UCI.

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ACOG's Committee on Health Care for Underserved Women, spoke of the critical need for all women of reproductive age to have unimpeded access to emergency contraception, an essential treatment method for protecting and safeguarding their reproductive health. It's been estimated that greater access to EC could cut unintended pregnancy and abortion rates in half.
"With the Ask me. campaign, ACOG is stepping up our efforts to address this country's high rate of unintended pregnancy. Nearly half (49%) of the more than 6 million pregnancies that occur each year are unplanned,"
ACOG's supports making EC available directly to women over the counter. "The FDA's failure to act amounts to a quintessential shell game, in which women are the losers. Not granting national OTC status to Plan B® goes against their mission of promoting public health and welfare. EC's safety and efficacy are backed by decades of research and are not debatable," she added. "As champions of women's health, ACOG endorses non-prescription sales of emergency contraception."

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From the KFF weekly newsletter on Women's Health Policy:
Nearly 31% of girls ages 15 to 19 who have had sexual intercourse at least once become pregnant, and more than 13% of sexually active teenage boys say they have been involved in a pregnancy, according to a report released Wednesday by the Washington, D.C.-based not-for-profit group National Campaign To Prevent Teen Pregnancy. The report presents statistics from the 2002 National Survey of Family Growth for teenage boys and girls on age of "first sex,"

Posted by at 12:19 PM | Permalink | Comments (0)

The Kaiser Family Foundation, in its weekly policy report, discusses the new Jersey Public Interest Group's publication "Turning Medicine into Snake Oil".

The NJPIRG analyzed 170 enforcement letters that FDA sent to pharmaceutical companies during the five-year period through 2005 over false or misleading ads for the COX-2 inhibitor Vioxx and 149 other medications. According to the report:
About 62% of the false or misleading ads targeted physicians, who received information that understated or misrepresented the risks of medications in one-third of those cases;
Pharmaceutical companies in a number of cases concealed negative clinical trial results or misreported results; and
One-third of pharmaceutical companies that received letters from FDA received more than one letter for the same problem.

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