Dr. Buttery's Public Health BLOG

The Annie E. Casey Foundation has released its 2006 Kids Count Data-Book online.
The broad array of data presented each year in the KIDS COUNT Data Book is intended to illuminate the status of America’s children and to assess trends in their well-being. By updating the assessment every year, KIDS COUNT provides ongoing benchmarks that can be used to see how states have advanced or regressed over time. Readers can also use KIDS COUNT to compare the status of children in their state with those in other states across several dimensions of child well-being. Furthermore, the annual presentation of KIDS COUNT data allows incremental improvements to the Data Book as new data become available and methods are refined.

Although the 10 measures used in KIDS COUNT to rank states can hardly capture the full range of conditions shaping kids’ lives, we believe these indicators possess three important attributes: (1) They reflect a wide range of factors affecting the well-being of children, such as health, adequacy of income, and educational attainment. (2) They reflect experiences across a range of developmental stages—from birth through early adulthood. (3) They permit legitimate comparisons because they are consistent across states and over time. Research shows that the 10 KIDS COUNT key indicators capture most of the yearly variation in child well-being reflected in other indices that utilize a much larger number of indicators. For more information about the criteria used to select KIDS COUNT indicators, see page 178.

Posted by at 1:24 PM | Permalink | Comments (0)

This week's editorial in the BMJ is worth reading. Despite all the problems with the NHS, at the BMA annual conference a few people spoke against funding through general taxation, pointing to the European social insurance model, which delivers higher quality care, though at higher cost. And a few spoke against care being free at the point of access, suggesting that charges would moderate demand, enhance patient responsibility, and help bridge the funding gap. But when it came to a vote, support for the founding principles of the NHS was overwhelming.

Equally overwhelming was rejection of US-style health care. "The very last thing the UK should do is go for the American model," said the Chairman of Council, Jim Johnson. After voting in support of the NHS's values, the meeting agreed that these could not be delivered through private corporations.

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

From the Harvard School of Public Health today, this News Release:
In the first national study of the effects of intimate partner violence on the health of women during pregnancy and the health of newborn children, researchers from the Harvard School of Public Health (HSPH) demonstrated that violence from male partners, both in the year prior to and during a woman’s pregnancy, increases her risk of serious health complications during pregnancy. Such abuse also increases a woman’s risk of delivering prematurely and that her child will be born clinically underweight and in need of intensive care. The paper appears in the July 2006 issue of the American Journal of Obstetrics and Gynecology. How many of he underweight children we see in public health clinics result from such abuse?

Posted by at 1:29 PM | Permalink | Comments (0)

Immunization is among the most successful and cost-effective public health interventions. Immunization programs have led to eradication of smallpox, elimination of measles and poliomyelitis in regions of the world, and substantial reductions in the morbidity and mortality attributed to diphtheria, tetanus, and pertussis. The World Health Organization (WHO) estimates that 2 million child deaths were prevented by vaccinations in 2003. Nonetheless, more deaths can be prevented through optimal use of currently existing vaccines. This report summarizes estimates of deaths attributed to vaccine-preventable diseases (VPDs) and vaccination coverage by WHO region and outlines the Global Immunization Vision and Strategy developed by WHO and the United Nations Children's Fund (UNICEF) and partners for implementation during 2006-2015.
Ref: MMWR. 2006;55:511-515

Posted by at 11:47 AM | Permalink | Comments (0)

From the Royal Society of Medicine in the UK we find that new research indicates that efforts to reduce antibiotic resistance led to a decrease in the prescribing of antibiotics by doctors yet an increase in hospitalizations for respiratory infections like pneumonia.

In analyses of more than 15.5 million hospitalizations and 5.5 million outpatient visits per year over 8 years, this trend was particularly strong between 1998 and 2002.

The study, published in the Journal of the Royal Society of Medicine, examined the relationship between antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA.

Posted by at 12:10 PM | Permalink | Comments (0)

Would you believe that thousands of patients in hospitals each year are at risk of potentially fatal infections because health care workers do not wash their hands on enough occasions, according to researchers from UNSW.
“From a young age, we are taught that we wash our hands to protect ourselves from germs, but we really need to get the message into the community that we wash our hands to protect others too,� she said. “It’s the same principle with health care workers.
“They often elect not to wash their hands for minor touches, because subconsciously they think it is not placing themselves at risk,� said Professor McLaws. “But those minor touches from making a bed to taking a patient’s temperature, for instance, may cause a problem for the next patient who is immuno-compromised, is on antibiotics, has just been to surgery, has a tube in place or a breach in their skin.
MRSA and other staph can cause infection by getting into the body through broken skin or into the blood stream.

Posted by at 12:05 PM | Permalink | Comments (0)

A news release from the HSPH describes how three variations of a human gene appear to impact human tuberculosis susceptibility, providing insight into why some patients infected with the Mycobacterium tuberculosis pathogen develop the full-blown disease and others do not. A joint team between Harvard and Oxford Universities note that approximately one-third of the world's population is thought to be infected with the M. tuberculosis pathogen, yet only about 10 percent becomes ill with the active disease.

Posted by at 11:55 AM | Permalink | Comments (0)

A news release from the American Institute for Cancer Research today notes that The one thing on which all nutritionists seem to agree is that consumption of vegetables and fruit helps fight many chronic diseases. Researchers trying to discover just how these plant food bolster our immune systems have focused for sometime on phytochemicals.
Experts at AICR believe that when research methodology is fine-tuned and models for studying the effect of multiple chemicals simultaneously are perfected, the anticancer activity of phytochemicals will be demonstrated. Meanwhile, they recommend eating a mostly plant-based diet affording a great variety of phytochemicals in order to fight chronic disease and to manage weight.

Posted by at 11:36 AM | Permalink | Comments (0)

A study reported in the Lancet this week shows how knowledge about Kuru, may be used as a template for vCJD.
Between 1957 and 2004, the total number of cases of kuru exceeded 2700. The lower limit of incubation time may be as few as 5 years. Although the mean incubation time is 12 years, Collinge and colleagues also discovered incubation times above 50 years. They conclude that existing models and estimates of the vCJD epidemic could be “substantial underestimations�. This study provides a unique insight into the natural history of human prion disease. It combines cultural, clinical, genetic, and pathological evidence to draw a highly informative picture of great contemporary value.
RERF:The Lancet, Volume 367, Issue 9528, 24 June 2006-30 June 2006, Pages 2068-2074

Posted by at 4:11 PM | Permalink | Comments (0)

We have learned this year of the financial disasters of the NHS. Now we learn that the German Health System is in deep financial trouble although for some what different reasons. Too many hospitalizations, too many prescriptions, and too many people failing to pay their insurance. As we worry about our spiralling costs, which are much worse than in countries that provide universal coverage, we should learn, although that may not be possible, how to avoid the same traps, We continue to react rather than plan long term.

Posted by at 10:12 AM | Permalink | Comments (0)

Posted by at 12:38 PM | Permalink | Comments (0)

WHO has just released a statement about women's health which should be read by all of us in public health.
Globally, inadequate sexual and reproductive health services have resulted in maternal deaths and rising numbers of sexually transmitted infections (STIs), particularly in developing countries. WHO estimates that 340 million new cases of sexually transmitted bacterial infections, such as chlamydia and gonorrhoea occur annually in people aged 15 - 49. Many are untreated because of lack of access to services. In addition, millions of cases of viral infection, including HIV, occur every year. The sexually transmitted human papilloma virus (HPV) infection is closely associated with cervical cancer, which is diagnosed in more than 490 000 women and causes 240 000 deaths every year.
While this may be true globally, it is just as true in the US and other 'advanced' countries which give little support to prevention of STDs and prefer to focus on treatment.

Posted by at 11:42 AM | Permalink | Comments (0)

From today's Telegraph (UK) we find that British travellers are more at risk of contracting the most deadly form of malaria now than they were 20 years ago, leading medical authorities reported this week.

According to figures from the Health Protection Agency (HPA), about 1,300 British travellers last year contracted Plasmodium falciparum, a potentially fatal strain of malaria. This is more than twice the number of cases reported in 1985.

Travellers need to be more careful about proectection against infectious diseases.

Posted by at 11:30 AM | Permalink | Comments (0)

The American Medical Association (AMA) today announced new policy on direct-to-consumer (DTC) advertising of prescription drugs and implantable medical devices. The new policy includes imposing a temporary moratorium on the advertising of newly approved drugs and guidelines for pharmaceutical companies to follow when preparing DTC advertising.

"A temporary moratorium on DTC advertising of prescribed drugs and medical devices will benefit both the patient and physician," said AMA President-elect and AAPHP member Ronald M. Davis, MD. "Physicians will have the opportunity to become better educated on the pros and cons of prescription drug uses before prescribing them, and will be better able to determine when they are best suited for their patients' medical needs."

Posted by at 12:29 PM | Permalink | Comments (1)

As horses are to the Kentucky Derby, fireworks are to the Fourth of July. Bright lights, loud bursts and colorful flying displays signifying the national holiday add to an enjoyable July 4th celebration. Whether sparked by children or ignited by adults, firework precautions should be considered to ensure a safe holiday event. The Jewish Hospital Hand Care Center and the hand surgeons at Kleinert Kutz Hand Care Center warn of the possible dangers associated with fireworks.
The National Council on Fireworks Safety recommends
Have an adult present
· Keep a water source near
· Use common sense
· Read and follow directions on labels
· Buy from a reliable source
· Use eye protection

Posted by at 12:17 PM | Permalink | Comments (1)

The WHO has just published a new report "Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease" which again shows that progress in improving health comes not from medical care but from fairly simple pubic health environmental changes. Diarrhoeal disease and Malaria can be prevented in large part by environmental; modifications. The executive summary is well worth reading by all of us in public health.

Posted by at 10:31 AM | Permalink | Comments (0)

A commentary in this Week's Lancet is well worth raading. It reminds us that i it is 10 years since the first reports suggesting that combination highly active antiretroviral therapy (HAART) can potently and perhaps indefinitely suppress HIV replication. The focus now is what to do if side effects of treatment cause patients to discontinue treatment. See Volume 367, Issue 9527 , 17 June 2006-23 June 2006, Pages 1955-1956

Posted by at 12:06 PM | Permalink | Comments (0)

Posted by at 12:22 PM | Permalink | Comments (0)

Behavioral change for tobacco addiction remains an unfulfilled dream

Of the 44.5 million adult smokers in the United States, 70 percent want to quit and 40 percent make a serious quit attempt each year, but fewer than 5 percent succeed in any given year. Effective tobacco cessation interventions are available and could double or triple quit rates, but not enough smokers request or are being offered these interventions. Nicotine is highly addictive and a major public health concern. A national, coordinated strategy for tobacco control that casts a wide net is needed to address this critical gap.

This was a key finding of an NIH state-of-the-science panel convened this week to assess the available scientific evidence on tobacco use prevention, cessation, and control. Full text of the panel’s draft state-of-the-science statement is available at http://consensus.nih.gov, including the panel’s identification of promising directions for future research.

Posted by at 11:08 AM | Permalink | Comments (0)

It appears we may be on the threshold of primary prevenbtion for type II diabetes if the new research from the Beth Israel Deaconess Medical Center can be translated into action. See the article in the June 15th issues of the NEJM:

A study in the June 15 issue of The New England Journal of Medicine (NEJM) reveals that elevated levels of a molecule called RBP4 (retinol binding protein 4) can foretell early stages in the development of insulin resistance, a major cause of type 2 diabetes as well as cardiovascular disease.

The new findings, led by researchers at Beth Israel Deaconess Medical Center (BIDMC), offer a potential new target for the development of anti-diabetic therapies to lower serum RBP4 levels as well as an early means of identifying individuals who are at risk of developing diabetes – before the onset of overt disease.

Posted by at 11:02 AM | Permalink | Comments (0)

This news release from UCSF may be the harbinger of interventions to prevent/control other addictions to food, cocaine etc.

UCSF's Habit Abatement Clinic is testing a vaccine that enlists help from the immune system to keep nicotine away from the brain. The vaccine is designed to help smokers quit and to limit the urge to start smoking again.

Called NicVax, the investigational vaccine is being developed by Nabi Biopharmaceuticals to prevent and treat nicotine addiction and to help people quit smoking. Normally when a smoker inhales, nicotine is carried by the bloodstream to the brain, where it triggers neuro-receptors to generate positive sensations that can lead to addiction. The vaccine stimulates the immune system to produce antibodies that recognize the small nicotine molecule. Bound to these antibodies, nicotine molecules no longer can cross the blood-brain barrier and enter the brain.

Posted by at 11:00 AM | Permalink | Comments (0)

Posted by at 1:56 PM | Permalink | Comments (0)

Another diet myth:
The review, published in the March 2006 issue of the British Nutrition Foundation's Nutrition Bulletin, examines more than 30 studies conducted over the past 30 years (with more than half published in the past decade) and concludes that the dietary cholesterol in eggs "has no clinically significant impact" on coronary heart disease (CHD) risk.
More importantly, the authors, Dr. Bruce Griffin and Dr. A. Lee of the Centre for Nutrition & Food Safety, School of Biomedical & Molecular Sciences, University of Surrey, UK, stated, "to view eggs solely in terms of the effects of their dietary cholesterol… is to ignore the potential benefits of egg consumption on coronary risk factors, including obesity, diabetes and metabolic syndrome."
Eggs are naturally nutrient rich. One egg provides 13 essential nutrients -- including high quality protein, choline, folate, iron and zinc -- for only about 75 calories. Experts recommend choosing nutrient dense foods, such as eggs, to help get needed nutrients without excess calories.

Posted by at 3:59 PM | Permalink | Comments (0)

From the NIAID today:
HIV Disease Model Details Survival Benefits of HIV Therapies
Increasingly effective HIV therapy—including a decade of highly active antiretroviral therapy (HAART)—has provided 3 million years of extended life to Americans with AIDS since 1989, report researchers funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). Most interesting is the table appended to the report showing that since 1989 survival benefit in increased months of life have risen from 3.1 to 159.9

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

Just reported from the Institute of Cancer Research in the UK are the results of the largest ever genome-wide scan for lung cancer-susceptibility which found 64 specific sequence changes in the genome that can affect an individual’s risk of lung cancer.The researchers found 64 specific changes that affect lung cancer susceptibility. The changes are “low-penetrance alleles� meaning that individually they only contribute to the development of cancer in a minor way.
The researchers found 64 specific changes that affect lung cancer susceptibility. The changes are “low-penetrance alleles� meaning that individually they only contribute to the development of cancer in a minor way.
Professor Richard Houlston from The Institute said, “The exact nature of lung cancer susceptibility is extremely complex, it is important to remember that tobacco smoke is far and away the biggest risk factor for lung cancer. Whilst our research indicates that certain individuals could be at a higher risk of developing the disease it has been proven that the majority of cases of lung cancer are caused by tobacco smoke.�

Posted by at 12:23 PM | Permalink | Comments (0)

An article from the UM newsroom today reveals research on on the topic:
To vaccinate or not? To treat or not? Study explores how we make health decisions involving risks & benefits
Imagining things from another’s perspective may help in making tricky medical choices, U-M and VA authors say
The findings may help individuals who face tough health choices, and decision-makers who make choices for larger groups. It may also help illuminate situations where individuals make medical decisions that go against the advice from experts and authorities, and help guide doctors.
The results were striking. Only 48 percent of individuals who imagined being the patient said they would choose the flu vaccine for themselves, but 57 percent of those imagining being parents would decide to vaccinate a child, 63 percent of respondents taking on a physician role would advise a patient to get it, and 73 percent of those acting as medical directors would choose to vaccinate large numbers of patients.
The same pattern repeated for the chemotherapy scenario, with 60 percent choosing it for themselves, 72 percent choosing it for their children and 68 percent opting to advise individual patients and groups to get it.

Posted by at 11:18 AM | Permalink | Comments (0)