Flu - Shift vs. Drift
In Science last week (Science 22 December 2006:Vol. 314. no. 5807, pp. 1884 - 1886) a paper by Erik van Nimwegen explains how genetic drift is different from genetic shift and the annual changes in the Influenza A (H3N2) virus.
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In Science last week (Science 22 December 2006:Vol. 314. no. 5807, pp. 1884 - 1886) a paper by Erik van Nimwegen explains how genetic drift is different from genetic shift and the annual changes in the Influenza A (H3N2) virus.
We should all read the editorial in this week's NEJM (Volume 355 December 28, 2006 Number 26) by Drs. Wenzel and Edmond from VCU, about the potential for life saving preventive interventions when Central Venous Lines are used in ICUs. Health Directors could easily be involved in prevention aspects of hospital infection control adding their prestige to the hospital infection control specialists trying to intervene.
From the Johns Hopkins Cancer Center: Sildenafil and other “impotence drugs� that boost the production of a gassy chemical messenger to dilate blood vessels and produce an erection now also show promise in unmasking cancer cells so that the immune system can recognize and attack them, say scientists at the Johns Hopkins Kimmel Cancer Center. The new Hopkins study homes in on a tactic used by cancers to avoid detection by the immune system by turning elements of that system to its own advantage, says Ivan Borrello, M.D., assistant professor at the Johns Hopkins Kimmel Cancer Center. Borrello and his colleagues found that tumors exploit nitric oxide-producing immune cells to create a sort of “fog� that keeps them hidden from white blood cells (T-cells) that mount attacks on tumors.
Won't the drug companies love this news.
How often do we have to repeat the message that handwashing is one of the best forms of primary prevention, An article in yesterday's Wall Street Journal. Common-sense safety and hygiene practices, often overlooked by doctors, can almost wipe out a dangerous type of blood infection that kills thousands of patients each year in U.S. hospitals, according to a study. The steps include making sure doctors and nurses wash their hands and wear protective clothing. The study, published in today's New England Journal of Medicine, focused on central-line catheters, which deliver drugs and nutrition to patients through a vein in the neck, chest or groin. The topic is covered well in PBS presentation of October, 2006 "Remaking American Medicine".
A novel method pf preventing disease. Use the human body as a vector to immunize mosquitoes against malaria. The vaccine, so far tested only in mice, would prompt the immune system of a person who receives it to eliminate the parasite from the digestive tract of a malaria-carrying mosquito, after the mosquito has fed upon the blood of the vaccinated individual. The vaccine would not prevent or limit malarial disease in the person who received it.
One more "herbal" use bites the dust. From the BMJ this week [BMJ Volume 333 pp 1293-4]. The belief that mistletoe can help treat cancer is a myth which can cause harm, warn doctors in this week’s Christmas issue of the BMJ. The warning follows the case of a cancer patient who attended hospital with a tumour-like growth under the skin induced by mistletoe. Some patients with cancer inject themselves mistletoe extract in the hope of improving their condition, writes complementary medicine expert, Professor Edzard Ernst in an accompanying editorial. In continental Europe, at least 30 different mistletoe preparations are available and in Germany, the insurance system pays for this treatment. A Google search also showed that 145,000 websites promote or mention mistletoe as a treatment for cancer. Mistletoe has been tested extensively as a treatment for cancer, but the most reliable trials fail to show benefit, and some reports show considerable potential for harm. The costs of regular mistletoe injections are also high. Dr. Ernst recommends mistletoe as a Christmas decoration and for kissing under but not as an anticancer drug.
See today's BMJ for an article by Don Combs from EVMS (BMJ 2006;333:1308-1311 (23 December)) on how new technology may transform medical care. It is only a short step to think about how these technologies may also change the face of population health.
Reported by many media outlets today the Centers for Disease Control and Prevention said that "the biggest U.S. measles outbreak in a decade...was traced back to a 17-year-old girl who had traveled to Romania without first getting vaccinated." The other patients "became infected after they attended a church gathering with her the day after her return," and "only two of the 34 people had been vaccinated against measles." Again, we see how hard it is to get everyone vaccinated against a virus that spreads so easily. Herd immunity for measles requires near 100% immunization of he population.
HHS Secretary Mike Leavitt today announced the United States has formally accepted the revised International Health Regulations (IHR), and will begin the process of implementing these new international rules immediately instead of waiting for them to take effect in June 2007. Secretary Leavitt made the announcement during a week-long visit to the People’s Republic of China.
The International Health Regulations are an international legal instrument that governs the roles of the World Health Organization (WHO) and its member countries in identifying and responding to and sharing information about public health emergencies of international concern.
First adopted by WHO Member States in 1969, the current IHRs apply to only three diseases: cholera, yellow fever and plague. However, in recent decades, increases in international travel and trade, along with marked developments in communication technology, have led to new challenges in the control of emerging and re-emerging infectious diseases. More information about the International Health Regulations (2005) is available at http://www.who.int/csr/ihr/en/.
A study in JAMA today (JAMA. 2006;296:2832-2838) suggests that vitamin D levels and development of Multiple Sclerosis (MS) are related. Because this is an observational study cause and effect cannot be determined. The study was well designed but the senior author cautions that use of vitamin D supplements for MS prevention should not be undertaken until efficacy is proven. How long will it be before we see vitmain D pushed by the vitamin industry, and will this negate the abilty to study cause and effect?
A University of Manchester researcher has won a prestigious award for an innovation that could help deliver pollution-free water to people around the world.
Dr Nigel W Brown has been given the Award for Innovation by the Royal Society of Chemistry Process Technology Group, in recognition of five years of research into a system called Aquacart that removes toxic organic contaminants from waste water.
As an expanding body of work continues to confirm links between exercise and improved brain function in older adults, a new study by researchers at the University of Illinois at Urbana-Champaign and Vrije Universiteit in Amsterdam suggests similar improvements among younger populations as well. Physical activity may be beneficial to cognition during early and middle periods of the human lifespan and may continue to protect against age-related loss of cognitive function during older adulthood,� said Charles H. Hillman, a U. of I. professor of kinesiology and of community health and the lead author of the study, published in the current edition of the journal Health Psychology. "Physical activity may be beneficial to cognition during early and middle periods of the human lifespan and may continue to protect against age-related loss of cognitive function during older adulthood,� said Charles H. Hillman, a U. of I. professor of kinesiology and of community health and the lead author of the study, published in the current edition of the journal Health Psychology.
A food borne outbreak from norovirus, apparently due to infected food handlers, at an Olive Garden restaurant in Indiana has been reported. Several hundred patrons have become ill. This outbreak emphasises the need for careful scrutiny of worker's hygienic practices. Handwashing basins should be visible to the staff and management. Any staff leaving work areas must be required to wash hands thoroughly, in view of others, before starting food handling again. Workers harboring infectious agents may not show. or report, symptoms. Managers may need better training in worker observation.
How much money do we waste that could be spent to improve the public's health, that is diverted to useless nostrums, because of media attention to media stars without any science background. Now we find one more 'complementary medicine', Black Cohosh, supposedly used to treat postmenopausal symptoms has been found worthless. According to USAToday sales of black cohosh supplements soared after an NIH-sponsored study in 2002 reported that hormone therapy — the most effective treatment for menopause symptoms — raised users' risk of heart attacks, breast cancer, blood clots and stroke. U.S. black cohosh sales rose 26% from 2002 to 2003 to $15.7 million, according to the Natural Foods Merchandiser, a trade magazine.
The FDA is investigating a Norovirus outbreak which has been associated with raw, frozen oysters on the half shell from South Korea. Eight individuals have been confirmed as becoming ill as a result of consuming the raw oysters at a private event in Woodburn, Oregon. On December 8, FDA testing of oysters from the same production lot showed positive results for norovirus. While raw oysters on the half shell are considered a delicacy they filter huge amounts of water and are frequently associated with disease outbreaks.
Health poilicy Gurus have been pushing hospital mortality rate comparisons as a form of quality control. Now Researchers at the University of Pennsylvania School of Medicine have found that hospitals with high and low performance on Medicare quality measures had little difference in the rate of death for three common conditions at the hospitals, indicating that the performance measures may not accurately reflect patient outcomes. Findings are reported in the December 13th issue of JAMA. this compllex issue is worth reviewing.
A study from researchers at the University of Michigan Health System and the Veterans Affairs Ann Arbor Healthcare System suggests that a program focusing on increasing step length and speed is more effective at improving mobility and balance than tai chi. This is the first comparison of two balance training programs in which each type of program has been proven to reduce falls, notes lead author Joseph O. Nnodim, M.D., Ph.D., clinical instructor in the Division of Geriatric Medicine at the U-M Health System and a research scientist at the VA Ann Arbor GRECC.
From Cancer Research UK today, a ten year trial in which women between the ages of 40 and 50 were invited for annual breast screening did not show a significant reduction in breast cancer mortality. The trial was the first of its kind to invite only women of 40 or 41 at the start of the trial to ensure all results were based solely on screening before age 50. Currently, when women reach the age of 50 they are invited for screening every three years by the NHS Breast Screening Programme. Should we change our recommendations in the US and use these funds elsewhere in the prevention field?
In a commentary in the current Issue of JAMA (JAMA. 2006;296:2611-2613., David A. Kindig comments on steps to take since the IOM released its report on Pay for Perfomance and Medicare.. Among his remarks (the full commentary should be read by all of us) he says the health of the US population is far from optimal, both in terms of mean outcomes compared with other nations and in the unacceptable disparities within the country. The United States currently ranks 25th in women's life expectancy at birth among developed nations; while within the United States, the mortality rate for blacks (1098/100 000 persons) is 31% higher than the mortality rate for whites (836/100 000 persons). Adults with more than 13 years of education have a mortality rate of 211/100 000 persons while those with less than a high school education have a mortality rate of 575/100 000 persons. Minnesota has a mortality rate of 749/100 000 persons while Mississippi has a rate of 1035/100 000 persons. The percentage of persons reporting fair to poor health is 6% for persons above the poverty line and 20% for those in poverty
40 years ago when at Johns Hopkins SPH I heard this goal. Technology might make this goal more realistic than it was. The Malaria Vaccine Technology Roadmap, a new global strategy, was launched December 4, 2006, at the Global Vaccine Research Forum in Bangkok. The Roadmap calls for joint action among the world's leading international health organizations to accelerate the development and licensing of a highly effective malaria vaccine. It seeks to develop a malaria vaccine by 2025 that would have a protective efficacy of more than 80% against clinical disease and would provide protection for longer than four years. Look also at the Zambia Survey and the Malaria Vaccine Initiative at PATH
A Johns Hopkins study suggests that only one in five inner-city children with chronic asthma gets enough medicine to control dangerous flare-ups of the disease. “It’s clear that kids who need preventive drugs aren’t getting them,� says lead author Arlene Butz, Sc.D., R.N., asthma specialist at the Children’s Center. Previous research indicates that inner-city children are at special risk because their living conditions include other asthma triggers, such as exposure to secondhand smoke and mouse and cockroach allergens.
From Dartmouth Medical School today: investigators are learning more about how low doses of arsenic, such as the levels found in drinking water in many areas of the United States, affect human physiology. In a paper published online on Dec. 2 in the journal Chemical Research in Toxicology, the researchers report that three different steroid hormones all show similar responses to arsenic, suggesting a broader effect and a common mechanism of arsenic on how these hormones function. At very low doses (comparable to what is found in drinking water at the current and previous U.S. regulatory limits, in the range of 5-50 ppb) arsenic enhances hormone-stimulated gene expression, by two- to three-fold. At slightly higher doses (in the range of 50-200 ppb, commonly found in drinking water from contaminated wells in New Hampshire and elsewhere in the U.S.) arsenic has the exact opposite effect, strongly and almost completely inhibiting hormone-stimulated gene expression by these receptors.
Just released from ACOG: Recent recommendations for HIV screening, human papillomavirus (HPV) vaccination, and preconception care are among those highlighted in the revised primary and preventive care periodic assessments recommended for women by The American College of Obstetricians and Gynecologists (ACOG). The updated recommendations, published in the December issue of Obstetrics & Gynecology, provide ob-gyns with a comprehensive schedule of age-appropriate screening exams, laboratory tests, immunizations, and counseling for non-pregnant adolescents and adult women.
Consumer reports yesterday released findings of its study on the sanitary aspect of chickens as food. If you eat undercooked or mishandled chicken, our new tests indicate, you have a good chance of feeling miserable. CR’s analysis of fresh, whole broilers bought nationwide revealed that 83 percent harbored campylobacter or salmonella, the leading bacterial causes of foodborne disease. Even more interesting for those using "organic" chickens; chickens labeled as organic or raised without antibiotics and costing $3 to $5 per pound were more likely to harbor salmonella than were conventionally produced broilers that cost more like $1 per pound. Oh Boy! Is it easy to scam the public! Complementary foods are just as silly as complementary medicines.
IN an article in the LA Times today reporters Brink & Solovitch examine the evidence for taking vitamins and find it lacking. "Essentially, if you don't take multivitamins, there's no reason to start," says Dr. J. Michael McGinnis, senior scholar at the Institute of Medicine and chair of the NIH state-of-the-science panel on the role of multivitamins. "If you do, there's no evidence to stop." Also says Dr. Charles Halsted, editor of the American Journal of Clinical Nutrition: "You're deluding yourself if you think you're preventing a heart attack or cancer with a multivitamin. It's a waste of money if you're perfectly healthy and have a proper diet." Yet we waste millions of dollsrs on these worthless nostrums.