Dr. Buttery's Public Health BLOG

Despite all the Hoopla about a smallpox bioterror incident, this news from Imperial College, London today describes how a series of simple public health policies would be able to effectively contain the spread of smallpox if it were released into a population. Ccomputer models were used to test three main public health policies used to control epidemics, and found different but high levels of effectiveness in all.
The first policy the team looked at was rash-motivated case isolation, in which infected individuals with a rash sought medical care, were identified as smallpox cases and subsequently isolated.
The second policy the researchers looked at was combining contact tracing with vaccination to create a policy of 'ring' vaccination.
The third policy combined regional mass vaccination with isolation and contact tracing with vaccination.
All these modes were used during the successful fight against smallpox 20 years ago.

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

This new report from the WHO, Environmental Burden of Disease-series 13, , Global Burden of Disease of Solar Ultraviolet Radiation estimates that up to 60,000 deaths a year worldwide are caused by too much exposure to ultraviolet radiation (UVR). Of those 60,000 deaths, an estimated 48,000 are caused by malignant melanomas, and 12,000 by skin carcinomas.
The new WHO report is the first-ever systematic examination of the global health burden due to UVR. It investigates nine adverse health outcomes from excess UVR exposure. The main three, which cause the greatest burden of disease from UVR, are cutaneous malignant melanomas, and non-melanoma skin cancers developing in different cell layers of the skin (squamous cell carcinomas and basal cell carcinomas). In addition, UVR causes sunburn, skin photoageing, cortical cataracts (eye lens opacities), pterygium (a fleshy growth on the surface of the eye), reactivation of herpes of the lip (cold sores) and the rare squamous cell carcinomas of the eye.

Posted by at 11:04 AM | Permalink | Comments (1)

This press release from the Radiological Society of North America discusses the problem of radiographic diagnoses in obese people.
The increase of obesity in the United States doubled the number of inconclusive diagnostic imaging exams over a 15-year period, according to a study featured in the August issue of Radiology. Researchers assessed all radiology exams performed at Massachusetts General Hospital (MGH) between 1989 and 2003 to determine the effects of obesity on imaging quality and diagnosis.
Similarly, when trying to perform a physical exam on an obese person heart sounds, breath sounds and intra-abdominal organs are difficult to detect, reducing the physician's ability to diagnose problems. I remember one patient who was so obese I could not detect a 7 month pregnancy

Posted by at 10:53 AM | Permalink | Comments (1)

This article published in the new "Journal of OB & Neonatal Nursing" concludes that providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process.

Posted by at 10:32 AM | Permalink | Comments (0)

From Georgetown University today is this:Natural, also called fertility awareness-based, methods of family planning may be just what some women are looking for, but most physicians do not learn about them during medical school or residency training, according to Victoria Jennings, PhD, and Helain Landy, MD, of Georgetown University Medical Center. Their paper, appearing in the July issue of Contemporary Obstetrics & Gynecology, addresses this gap in training and its implications.

Physicians play an important role in helping a woman chose an appropriate contraceptive method. “Ideally a physician should be aware of the pros and cons of all available types of family planning so that she or he is able help a patient chose the method that is best for her needs,� said Jennings, who is the director of Georgetown University’s Institute for Reproductive Health. “An important component in helping a patient choose an appropriate contraceptive method is to consider her preferences as well as medical eligibility criteria,� she said.

Posted by at 10:25 AM | Permalink | Comments (0)

Research from Imperial College, London, shows how certain genetic strains of common STDs can be used to track community spread of an STD and apply public health interventions.
Rresearchers from Imperial College and the Health Protection Agency used molecular typing to analyse different strains of gonorrhoea. Out of a total of 2045 strains recovered in London during a six month period, they were able to identify 21 prevalent strains, each infecting between 20 and 124 individuals. Seven of these strains were almost exclusively from homosexual men, while the other 14 were from almost exclusively from heterosexuals, suggesting very little spread of gonorrhoea between different behavioural groups.

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

In “Protecting Young Women from HIV/AIDS: The Case Against Child and Adolescent Marriage,� (published by the Guttmacher Institute) Shelley Clark of McGill University et al. analyze data from national surveys from 29 countries and find that:
Marriage exposes young women to frequent, unprotected sex, especially when the couple wants to have children. In most countries, more than 80% of adolescents who had had unprotected sex in the last week were married.
Husbands of adolescent wives tend to be much older (by 5-14 years, on average) and more sexually experienced then their wives and are therefore more likely to be HIV-positive. Adolescent brides are also more likely to marry into polygamous unions.
Adolescent wives are often cut off from formal education as well as other public sources of information such as regular television and radio programs. In all 29 countries, women who married as adults stayed in school longer than young women who married before they turned 18.
Even when they are aware of HIV risk, most young married women rely on remaining faithful to their husbands—and their husbands remaining faithful to them—as their sole protection from the virus.
The reseach continues with recommendation to prevent this spread of HIV.

Posted by at 10:42 AM | Permalink | Comments (0)

This study from UC, to be published in September, calls for a ban on lead-based paints world wide. The researchers say that lead-based paint production poses a global health threat, and a worldwide ban is urgently needed to avoid future public health problems. About 50 percent of the paint sold in China, India and Malaysia—none of which appear to have regulations on lead—had lead levels 30 times higher than U.S. regulations. In contrast in Singapore, which has well-enforced regulations, only 10 percent of paint samples were above U.S. regulations, the highest being six times the U.S. limit. The researchers state that “Paint manufacturers are aggressively marketing lead-based paints in countries without lead content restrictions,� says a professor of environmental health at UC. “In some cases, companies are offering the same or similar products, minus the lead, in a regulated country.�

Posted by at 11:06 AM | Permalink | Comments (0)

All public health practitioners should read the policy forum in this week's journal, Science. The forum discusses New York City's public health plan to test all its residents for diabetes, using the hemoglobin A1C levels. If abnormal, the individual would be counseled about diabetes and referred to a source of care. If already under care both the individual and medical practitioner would be counseled. While this seems, hypothetically, a reasonable plan, the forum questions how much intrusion into our personal lives, in the name of disease prevention/modification, is acceptable. Further it questions how closely public health should be linked into the treatment system. We have good examples for infectious diseases, where public health programs limit the spread of communicable diseases. The question about a chronic disease with a large behavioral component (overeating, lack of exercise) such as diabetes may require more careful thought. Are we approaching Huxley's Brave New World too quickly? What will the health department do about those who have no access to medical care? What will they do about those who take no notice of their probably heavy handed education?

Posted by at 9:50 AM | Permalink | Comments (0)

If the UK’s National Health Service (NHS) is to be saved from failure and privatisation its future should be planned by those independent of any personal conflict of interest, states the author of a Comment in this week’s issue of The Lancet.
William Jeffcoate, a Contributing Editor at The Lancet, writes that this may well be an “impossible task� for the politicians currently charged with the job. “If the British public want to retain the principles of the NHS, and to see it flourish once more, then they should understand that this is the only option,� he argues.
The NHS was once a successful organisation, where dedicated health-care professionals provided first-rate care to rich and poor, under a minimalist system of management. It was also remarkably cheap. Today the NHS is a shadow of what is was - the mismanagement of those in power has meant that hospitals are failing, staff are demoralised, and vast sums of money are consumed while services become progressively shoddy, writes Jeffcoate.

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

Whooping cough “endemic� among UK school children, say experts. Whooping cough in school age children with persistent cough: prospective cohort study in primary care BMJ Online First

Nearly 40% of school age children in the United Kingdom who visit their family doctor with a persistent cough have evidence of whooping cough infection, even though they have been fully immunised, finds a study published on bmj.com today.

These startling results suggest that whooping cough is endemic among young children in the UK, with important implications for clinical practice and immunisation policy, say the authors.

Posted by at 12:20 PM | Permalink | Comments (0)

Today we had a major article in our newspaper about the elderly loosing health insurance. Today from the Mayo Clinic we get an article about spending on intensive care, which today comprises 30-40 percent of hospital costs, may go even higher as the population ages, according to a new Mayo Clinic study.

Published in the July issue of Mayo Clinic Proceedings, the study found that older people and those with chronic illnesses have the highest rates of end-of-life intensive care unit (ICU) use. Given that the country's aging population has an increasing prevalence of chronic diseases, the ICU may be treating more and more people at the end of life, the study's authors say.

But, what about prevention?

Posted by at 12:15 PM | Permalink | Comments (0)

An article in today's JAMA states that In 2006 in the United States, it is estimated that lung cancer will cause 73 020 deaths in women, proportionately only slightly fewer than the estimated 90 470 deaths in men. Lung cancer now accounts for more deaths in women than any other cancer, more even than the second and third cancer killers (breast and colon cancer) combined

Posted by at 10:27 AM | Permalink | Comments (0)

Should we lower cholesterol as much as possible? BMJ Volume 332, pp 1330-2

New US recommendations for lowering cholesterol levels would increase the risk of harmful side effects with no overall reduction in deaths, warn experts in this week’s BMJ.

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

One more 'last' study on the topic Measles Mumps Rubella and mercury-based immunizations cleared as causes of autism from McGill UNiversity in Montreal.
"There is no relationship between the level of exposure to MMR vaccines and thimerosal-containing vaccines and rates of autism," says Dr. Eric Fombonne, Director of Pediatric Psychiatry at the Montreal Children's Hospital of the MUHC and lead investigator of the new study. Thimerosal was used to prevent bacterial and fungal contamination in the manufacture of various vaccines until its elimination from vaccine formulas in 1996 in Quebec. "According to our data, the incidence of autism was higher in children who were vaccinated after thimerosal was eliminated from vaccines," says Dr. Fombonne.

Posted by at 12:02 PM | Permalink | Comments (0)

From the University of Michigan a note about soft drinks which may surprise many, The news release has a good video attached.
Believe it or not, more than 20 percent of our daily calories come from the things that we drink. says Susan Aaronson, M.S., R.D., wellness coordinator for the M-Fit Health Promotion Division at the University of Michigan Health System. “In fact, the World Health Organization recommends that people consume only about 10 percent of their calories from liquids. So those extra calories from liquid beverages are adding to American’s obesity epidemic, making it more difficult for people to lose weight.�

Posted by at 10:40 AM | Permalink | Comments (0)

From HSPH this Monday A prospective study of 42,847 middle-aged and older U.S. men participating in the Health Professionals Follow-up Study has found that a healthy lifestyle is associated with a lower risk of coronary heart disease (CHD), even among men taking antihypertensive or lipid-lowering medications. The research, which is the first to look at the role of a healthy lifestyle and CHD in men in this age group, is published in the July 3, 2006, online edition of Circulation.
One mroe study that puts reponsiblity for health on the individual's shoulders. Insurance companies need to place a dividend on healthy lifestyles, just like they do on use of seat belts.

Posted by at 10:40 AM | Permalink | Comments (1)

In this week's BMJ is a paper describing increased resistance to treatment by head lice. This suggests the need for better preparation to provide advice to schools and parents this coming fall. Around 80% of 316 lice tested were resistant to the treatment, equating to resistance to four out of five head lice affecting primary schoolchildren in Wales, say the authors. The experiment needs repeating in the US.

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

A June 29 news release from the University of Utah discusses a study showing that motorists who talk on handheld or hands-free cellular phones are as impaired as drunken drivers.

"We found that people are as impaired when they drive and talk on a cell phone as they are when they drive intoxicated at the legal blood-alcohol limit� of 0.08 percent, which is the minimum level that defines illegal drunken driving in most U.S. states, says study co-author Frank Drews, an assistant professor of psychology. “If legislators really want to address driver distraction, then they should consider outlawing cell phone use while driving.�

Psychology Professor David Strayer, the study's lead author, adds: “Just like you put yourself and other people at risk when you drive drunk, you put yourself and others at risk when you use a cell phone and drive. The level of impairment is very similar.�

Posted by at 10:41 AM | Permalink | Comments (1)