Dr. Buttery's Public Health BLOG

From the Karolinska Institute today: A Swedish HIV vaccine study conducted by researchers at Karolinska Institutet (KI), Karolinska University Hospital and the Swedish Institute for Infectious Disease Control (SMI) has produced surprisingly good results. Over 90 per cent of the subjects in the phase 1 trials developed an immune response to HIV.

"Never has such a good result been seen with a vaccine of this type," says Professor Eric Sandström, Chief Physician at Karolinska University Hospital.

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How do we get useful messages to the public about what helps improve health and what is harmful? Look at this report from the UK's Telegraph. How much information do we get from activists? In the long run how much distraction do they cause? This article is a good summary for why it is difficult to get public health messages across that are believable, and which result in behavioral change.

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FDA conducted an exhaustive and highly resource-intensive evaluation of the relevant scientific data evidence on ephedrine alkaloids before issuing its final rule, which became effective in 2004. The court found that the 133,000-page administrative record compiled by FDA supports the agency's findings that dietary supplements containing ephedrine alkaloids pose an unreasonable risk of illness or injury to users, especially those suffering from heart disease and high blood pressure.

No dosage of dietary supplements containing ephedrine alkaloids is safe and the sale of these products in the United States is illegal and subject to FDA enforcement action.

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The U.S. Food and Drug Administration (FDA) today announced approval of Plan B, a contraceptive drug, as an over-the-counter (OTC) option for women aged 18 and older. Plan B is often referred to as emergency contraception or the "morning after pill." It contains an ingredient used in prescription birth control pills--only in the case of Plan B, each pill contains a higher dose and the product has a different dosing regimen. Like other birth control pills, Plan B has been available to all women as a prescription drug. When used as directed, Plan B effectively and safely prevents pregnancy. Plan B will remain available as a prescription-only product for women age 17 and under.

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Many in Publlc Heal;th have been concerned about the socioeconmic differentials in prevelance of disease and disability. Now from the NEJM this week, Meredith Minkler et al. report on whether a gradient in disability exists in the United States among persons with middle-class and upper-class incomes, not just lowest incomes.
A social-class gradient was observed for both men and women between the ages of 55 and 84, a gradient that held true even at the upper rungs of the socioeconomic ladder. For example, in comparison to persons between the ages of 55 and 64 who lived at 700 percent of the poverty line or above, persons of the same age but below the poverty line had six times the odds of reporting a functional limitation. With increasing income, the odds ratio declined. A significant gradient was present up to, but not beyond, the age of 85 years.
Ref:Volume 355:695-703 August 17, 2006 Number 7 Meredith Minkler, Dr.P.H., et Al - Gradient of Disability across the Socioeconomic Spectrum in the United States

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In this week's NEJM is an artIcle by Dr David Sack about the current resurgence of Cholera. Public health staff who advise travellers about foreign travel should read the article which discusses current prevention and intervention if cholera strikes. Ref: Volume 355:649-651 August 17, 2006 Number 7, Sack DA et Al: Getting Serious abut Cholera

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An article in a recent edition of the Canadian Medical Association Journal shows that when exposure to tobacco use takes, place addiction may occur as early as the first puff. The authors' interpetation of the study was that symptoms of nicotine dependence develop soon after first puff, and can precede monthly, weekly and daily smoking. Cessation interventions that manage dependence symptoms may be needed soon after first puff
See: CMAJ • August 1, 2006; 175 (3). Gervais,a. et al.

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A study from Washington University published in today's NEJM found that the magnetic resonance imaging (MRI) scans were able to determine abnormalities in the white matter and gray matter of the brains of very pre-term infants, those born at 30 weeks or less. Following the infants from birth to age 2, the researchers were able to grade those abnormalities to predict the risk of severe cognitive delays, psychomotor delays, cerebral palsy, or hearing or visual impairments that may be visible by age 2.
More than 2 percent of all live births are infants born before 32 weeks of gestation. Nationwide, the rate of premature births jumped 13 percent between 1992 and 2002, according to the March of Dimes. Recent data show that 50 percent of children born prematurely suffer some neurodevelopmental challenges, such as crawling, walking upright, running, swinging arms, and other activities that require coordination and balance. Among pre-term infants who survive, 5 percent to 15 percent have cerebral palsy, severe vision or hearing impairment or both, and 25 percent to 50 percent have cognitive, behavioral and social difficulties that require special educational resources.

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In an expanded use of epidemiology a report from UNC today shows that billing data routinely collected by primary care providers can help public health authorities detect outbreaks of emerging infections.
The researchers compared the primary care practice data to similar data collected during the same period at UNC Hospitals' Emergency Department. The team found spikes of activity during the year, with increases occurred first in the primary care practice. This suggests that the practice may have seen patients with influenza earlier than the emergency department. The researchers conclude that it is feasible to implement surveillance in primary care practices at low cost and with minimal staff effort.

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A report from UCLA published in today's NEJM shows that MRSA is the most common cause of skin and soft-tissue infections among patients presenting in emergency rooms across the country. MRSA is resistant to the antibiotics used for years to treat these skin conditions, such as cephalexin and dicloxacillin.

"The study points to the rising prevalence of this type of MRSA and the need for clinicians to culture infections and make sure the proper antibiotic is administered to treat MRSA," said Dr. Gregory J. Moran, the study's principal investigator and a clinical professor of medicine in the department of emergency medicine and the division of infectious diseases at Olive View–UCLA Medical Center.

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A new report from Johns Hopkins shows that pairing a common tuberculosis drug, isoniazid, with highly active antiretroviral therapy (HAART) is more effective than either therapy on its own at preventing full-blown TB disease in people with HIV.
In the Hopkins survey, sicker patients - those with immune cell CD4 counts of less than 350 per cubic milliliter of blood - were found to benefit more, with a 66 percent reduced risk of TB, compared to those with higher CD4 counts, whose risk went down by 56 percent.

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Clarification of a recent report of swans with H5 and N1 subtype viruses. This release from the USDA may help you to calm fears of citizens who ask the health department about the report. Evidence of LPAI H5N1 has been found on two occasions in wild birds in the United States. In 1975 and 1986, it was detected in wild ducks. These detections occurred as part of routine sampling. LPAI H5N1 has also been detected in Canada, most recently in 2005.
Fact Sheet: AVIAN INFLUENZA Low Pathogenic H5N1 vs. Highly Pathogenic H5N1 Latest UPDATE August 14, 2006

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From the Guttmacher Institute today: 15–24-year-olds account for nearly half of the five million new cases of HIV infection worldwide each year is sure to be frequently cited.
Less widely known is that 15–24-year-olds account for half of the 40,000 new infections in the United States. Young Americans also account for nearly half of new diagnoses of STIs other than HIV. Like adolescents everywhere, American teens need honest, complete information about sexual health to better protect themselves.

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One more vaccine added to the complex system. Today, the MMWR (Vol 55/No RR-12) published the recommendations of the Advisory Committee on Immunization Practices for use of rotavirus vaccine to prevent disease in infants and children less than 5 years of age.

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The weeks NEJM contains an article on direct marketing of Genetic Testing. It is worth reading by all. One problem is consumers whose science background is insufficient to know what the test might mean. There is the problem of false postives when scared consumers demand testing en-masse. There is the problem of false negative tests for those who need intervention but the test tells them there is no problem. There is no counseling available with online testing. This will further divide those with insurance/money to buy the test from those without It perpetuates trhe problems of advertising by the pharmaceutical and medical technology industry. It relies on the paranoia perpetuated by the 'media'..

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NHLBI today released a guide to physical activity to prevent heart disease.
“Your Guide to Physical Activity and Your Heart� presents comprehensive and easy-to-understand information on the impact of physical activity on your heart, as well as the power of physical activity to keep you healthy overall. Since physical inactivity is one of several major heart disease risk factors that you can do something about, the 44-page guide is full of practical tips, including sample walking and jogging programs, instructions for finding your target heart rate zone, ideas for making fitness a family affair, and an overview of the best physical activities for a healthy heart.
“When it comes to getting in shape, what’s good for you is good for your whole family,� said NHLBI’s Karen A. Donato, S.M., R.D., program coordinator of both We Can! (Ways to Enhance Children’s Activity and Nutrition), NIH's national education program to prevent childhood obesity, and the NHLBI Obesity Education Initiative. “To maintain health, all adults should be moderately active for at least 30 minutes per day on most days of the week. To help manage body weight and prevent unhealthy weight gain, at least 60 minutes per day is recommended. Children and adolescents also need to be active for at least 60 minutes per day. So pry the kids off the couch and help yourself stay fit as well by doing enjoyable activities together.�

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State and local health directors, and public health policy makers, should take careful note of today's Guttmacher Institute report. “The new data confirm that the decline in the U.S. abortion rate has stopped almost completely,� says Dr. Sharon L. Camp, Guttmacher president and CEO. “This troubling development is no surprise, given that unintended pregnancy rates have come to a near-standstill as well, and have actually worsened dramatically for low-income women.�
“These trends are alarming, and should be a wake-up call to policymakers at the federal and state levels to do more to help women, especially those at greatest risk, avoid unwanted pregnancies,� argues Dr. Camp. “There is an urgent need to strengthen evidence-based policies that have been proven to reduce unintended pregnancy and the need for abortion.

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If you love to eat raw oysters,Beware! Find out their origin before eating.
The Food and Drug Administration is advising consumers to avoid eating raw oysters harvested in the Pacific Northwest as a result of reports that some of the oysters recently harvested from that region were contaminated with Vibrio parahaemolyticus (Vp), a bacteria that can cause gastrointestinal illness.
In recent months, there has been an unusual increase in bacterial illness associated with eating raw oysters from the Pacific Northwest. The illnesses are associated with the naturally occurring bacterium Vp, which is most prevalent during summer months when water temperatures in the Pacific Northwest are most favorable for its growth. While Vp can cause mild gastrointestinal disorders in healthy individuals, older persons and those with weak immune systems are at greater risk for serious more illness, such as septicemia (infection of the blood system).

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This week's (August 4) Lancet is a must read edition for anyone interested in HIV, whether you are interested in the funding of investigation, the transferrence of knowledge about AIDS/HIV, the development of preventive interventions or modification of HAART that may offer fewer side effects.

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