Dr. Buttery's Public Health BLOG

From this week's Lancet several studies have shown that lung function in children is affected by urban, regional air pollution and exposure to traffic can result in adverse respiratory effects, including increased rates of asthma and other respiratory diseases. Some studies have shown that lung-function deficiency is related to residential exposure to traffic. However, whether traffic exposure adversely affects lung-function growth during the period of rapid lung development that occurs between the age of 10 and 18 years is unknown. This question is important in view of the established relation between diminished lung function in adulthood and morbidity and mortality rates.

Posted by at 10:31 AM | Permalink | Comments (1)

Dr. Guy Cardineau, research professor, Arizona State University now has a patent for growing genetically modified plants containing vaccines that fight human disease. The genetically modified crops of fruits and vegetables are freeze dried and converted into a powdered form to control the dosage of the vaccine. In this way, vaccines can be stored and administered more easily and safely than the current practice of using needles. Maybe more than one antigen per fruit, or a fruit cocktail that would avoid the many jabs and multiple schedules now required.

Posted by at 10:23 AM | Permalink | Comments (2)

From the Robert Wood Johnson Foundation today is the latest State of the States 2007, Building Hope, Raising Expectations.
The loss of coverage among the middle class is perhaps the most dramatic illustration of the growing problem of uninsurance. According to U.S. Census data, from 2002 to 2005, the number of uninsured Americans rose 7 percent to more than 46 million; among those with incomes of $50,000-$75,000, it rose 24 percent. Nearly four in five Americans who lost coverage during this time had annual incomes in excess of $50,000.

Posted by at 4:20 PM | Permalink | Comments (0)

SUNY at Buffalo's dental school is testing "No-Needle" anesthesia and "No-Drilling" cavity care. If the research proves that the initial hypotheses are correct it may reduce anxiety about going to the dentist and enhance secondary prevention. The study builds on side effets of nasal surgery that can benefit work on teeth in the upper jaw. A nasal spray may provide needleless anesthesia for work on the upper teeth and ozone may eliminate early decay.

Posted by at 10:36 AM | Permalink | Comments (1)

Genetic research may well lead to the control of chronic diseases, the major single cost to our health care systems. However businesses are patenting genes that may exist in our bodies. Will these same businesses charge us to modify our genes to prevent chronic disease? Isn't this legal blackmail? Should the patent office be allowed to issue patents for genes? Read Michael Chricton's new book, "NEXT" as he describes fiction that could become reaiity. Also read today's business section ot the New York Times and read the article "Someone (Other Than You) May Own Your Genes"

Posted by at 10:37 AM | Permalink | Comments (1)

HEALTHmap is an internet site that shows location of significant disease incidents around the world,

Posted by at 11:25 AM | Permalink | Comments (0)

An editorial in the Lancet today reviews the WHO recommendation for indoor spraying of DDT to prevent malarial transmisison [Volume 369, Issue 9558 , 27 January 2007-2 February 2007, Page 248 ]. The concern in countries affected by malaria is for evironmental fears of countries to which they exoprt. Hazard communication is important to analyse benefits that are real in malarial prone countries versus fears that are unlikly to develop in others.

Posted by at 11:04 AM | Permalink | Comments (0)

The lead editorial in tomorrow's Lancet focuses on the value of prevention for stroke. It notes that one third of all strokes occur to people younger than 70 years of age. Tthe editorial states that implementation of interventions that reduce hypertension, poor diet, and tobacco use will save more lives than all the thrombolytics, antiplatelets, and neuroprotectants combined. There is little doubt that for stroke, prevention really is better than cure. [The Lancet 2007; 369:247]

Posted by at 10:56 AM | Permalink | Comments (0)

This opinion piece by Arthur Allen in today's NY Times is worth reading as he describes the pitfalls of trying to vaccinate populations when the media sensationalize rare events. Tha fear of one or less deaths (among 20,000 or more recipients, depending oin the vaccine) may doom many thousands to death and disability from prevetable disease. As Spock would dsay, "the value of one must be weighed against the worth of many".

Posted by at 11:39 AM | Permalink | Comments (0)

A research team from Brown University has indentified a single protein that plays a major role in deadly prion diseases by smashing up clusters of these infectious proteins, creating the “seeds� that allow fatal brain illnesses to quickly spread. The findings are exciting, researchers say, because they might reveal a way to control the spread of prions through drug intervention. If a drug could be made that inhibits this fragmentation process, it could substantially slow the spread of prions, which cause mad cow disease and scrapie in animals and, in rare cases, Creutzfeldt-Jacob disease and kuru in humans.
Because similar protein replication occurs in Alzheimer’s and Parkinson’s diseases, such a drug could also slow progression of these diseases as well.

Posted by at 10:48 AM | Permalink | Comments (0)

A fascinating story in today's NY Times about a cardiologist whose practice focuses on prevention. The problem is that the practice does not pay for itself! Despite last night's State of the Union speech the President's plan will not move us one step closer to a "Health" plan. just make it less costly for some people to stick to the current medical interventions, after the fact.

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

In a large, randomized, placebo-controlled study of 22,071 healthy male physicians, taking a low-dose of aspirin every other day lowered the risk of receiving an initial asthma diagnosis by 22 percent. These findings, based on data from the double-blind Physicians’ Health Study, appear in the second issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Posted by at 10:39 AM | Permalink | Comments (0)

From Stanford School of Medicine researchers say there’s no evidence to suggest that this purported fountain of youth has any more effect than a trickle of tap water when it comes to fending off Father Time. “There is certainly no data out there to suggest that giving growth hormone to an otherwise healthy person will make him or her live longer,� said Hau Liu, MD, a research fellow in the division of endocrinology and in the Center for Primary Care and Outcomes Research, and first author of a review study published in the Jan. 16 issue of Annals of Internal Medicine. “We did find, however, that there was substantial potential for adverse side effects.�

Posted by at 10:28 AM | Permalink | Comments (0)

We should have learned from infectious disease legislation that legal interventions are hard to modify. This is why in most states Boards of Health are empowered to set disease reporting standards and immunization interventions. Just as New York is setting standards for Transfats we find new information from Brandeis University that this may not be the solution. But once legislated how does one change an intervention. Look at how long it took to modify the Delaney amendment to food and drug codes in Congress.

Posted by at 10:24 AM | Permalink | Comments (0)

From the NY Times: Bangor is believed to be the first city to outlaw smoking in cars with children. But Arkansas, Louisiana and Puerto Rico recently enacted similar bans, and at least three other states are considering them: California, Connecticut and Maine, where proponents hope the Bangor ban will be a catalyst for a state law. How far do you think public health agencies should proceed in becoming a health police, rather than health educators?

Posted by at 11:32 AM | Permalink | Comments (0)

From UNICEF, NEW YORK, USA, 18 January 2007- There has been an unprecedented decline in the number of child deaths from measles, thanks to a worldwide initiative to combat the disease, the Measles Initiative partnership announced today. “Reducing measles deaths by 60 per cent in just five years is an incredible achievement,� said UNICEF Executive Director Ann M. Veneman. “Immunizing children is clearly saving lives and contributing to the achievement of the Millennium Development Goals. "

Posted by at 12:31 PM | Permalink | Comments (0)

From the The Marois Lab at Vanderbilt University: two researchers are presenting a study aimed at identifying the "bottleneck" in the brain that makes it hard for people to multitask as a reason to avoid talking on a cellphone while driving. "Our new research offers neurological evidence that the brain cannot effectively do two things at once. People think if they are using a headset with their cellphone while driving, they are safe, but they're not, because they are still doing two cognitively demanding tasks at once," said René Marois, an associate professor of psychology at Vanderbilt University in Nashville, Tenn.

Posted by at 12:26 PM | Permalink | Comments (0)

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, in partnership with leading professional societies, health, and advocacy organizations today launches COPD Learn More Breathe Better, a national campaign designed to improve awareness among those at greatest risk for the disease. COPD treatments control symptoms, improve exercise capacity, and can prolong life. Advances in the treatment of nicotine addiction have led to greater success in smoking cessation — a critical intervention in COPD. Other treatments include inhaled bronchodilators, inhaled corticosteroids, and pulmonary rehabilitation, all of which have been shown to improve the quality of life of patients with COPD. Oxygen therapy for those with severe COPD prolongs life.

Posted by at 12:17 PM | Permalink | Comments (0)

From Washington University in St. Louis
COPD is the 4th leading cause of death in the US and the 2nd leading cause of disability
COPD kills more than 120,000 Americans each year. That's one death every 4 minutes
More than 12 million people are diagnosed with COPD
An additional 12 million likely have COPD and don't even know it

Posted by at 12:10 PM | Permalink | Comments (1)

From Loyola University today we read about first human case of insect-transmitted Chagas parasite in Louisiana and sixth ever in the United States. The discovery was made in July 2006 in a rural area of New Orleans. There is an endemic cycle in wild animals in Louisiana (approximately 30 – 40 percent of armadillos and opossums are infected with the Chagas parasite), this is the first report of infection in a human with the Chagas parasite by an insect in Louisiana.

Posted by at 10:23 AM | Permalink | Comments (0)

A new study from the Harvard School of Public Health reported today using a systematic review and meta-analysis of epidemiologic data to quantitatively assess the association between smoking, passive smoking and indoor air pollution and TB. They found consistent evidence that smoking is associated with an increased risk of TB; they also found that passive smoking (secondhand smoke) and the burning of biomass fuels was associated with an increased TB risk.
Ref: “Tobacco Smoke, Indoor Air Pollution and Tuberculosis: A Systematic Review and Meta-Analysis,� Hsienho Lin, Majid Ezzati, Megan Murray, PLoS Med 4(1): e20.

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

From the Fred Hutchinson Cancer Research Center today we find that two antiviral drugs, oseltamivir and zanamivir, are highly effective when given as a preventive measure to reduce the spread of the influenza virus. "Preventing the spread of influenza within families is an essential part of influenza management, regardless of the strain. This study shows that there is a clear benefit to be gained by giving antivirals to people who have been exposed to the virus to prevent the onset of symptomatic illness," said lead author M. Elizabeth (Betz) Halloran, M.D., D.Sc., a Hutchinson Center-based biostatistician.

Posted by at 10:13 AM | Permalink | Comments (0)

From Cornell University: Each year, tuberculosis kills nearly two million people while an estimated nine million develop the disease, including 450,000 new cases of multidrug-resistant TB, including people recently diagnosed with particularly lethal new resistant strains. today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test — developed more than a century ago — manages to detect TB in only about half of the cases.

Posted by at 11:15 AM | Permalink | Comments (1)

An interesting epidemiologic study from Holland, just published in the International Journal of Cancer, suggests that that more than 50% of cancers are avoidable. This simplistic study assumes that all cancers in Europe can be reduced to the level found in the country with the lowest rate for a specific cancer. The premise is that in each inatance a behavioral change is all that is necessary.

Posted by at 10:29 AM | Permalink | Comments (0)

In a press release from AHRQ today Dr. Clancy says "Too Few Americans Being Screened, Counseled To Prevent Colorectal Cancer, Obesity, Other Conditions.
Only about 52 percent of adults reported receiving recommended colorectal cancer screenings. About 56,000 Americans die from colorectal cancer, and 150,000 new cases are diagnosed each year. In 2002, the AHRQ-supported U.S Preventive Services Task Force urged initial screenings at age 50 and earlier for people at high risk.
Fewer than half of obese adults reported being counseled about diet by a health care professional. About one-third of American adults are obese, increasing the risks of high blood pressure, type 2 diabetes, stroke, heart disease and osteoarthritis. The Task Force recommends "intensive counseling and behavioral interventions" for obese adults.
Only 49 percent of people with asthma said they were told how to change their environment, and 28 percent reported receiving an asthma management plan. Asthma causes about 500,000 hospitalizations annually.
Only 48 percent of adults with diabetes received all three recommended screenings—blood sugar tests, foot exams and eye exams—to prevent disease complications. AHRQ estimates about $2.5 billion could be saved each year by eliminating hospitalizations related to diabetes complications.

Posted by at 10:05 AM | Permalink | Comments (0)

From today's MMWR this table has data on recent infant deaths from use of 'cold' medications. The MMWR details adverse reactions to use of 'cold' medications among more than 1500 children. Are we medicating children uneccesarily?

Posted by at 12:33 PM | Permalink | Comments (0)

From the University oF Queensland, Australia a report released today by the Australian Longitudinal Study on Women's Health based at the University of Newcastle and The University of Queensland and funded by the Australian Government's Department of Health and Ageing. “The report found that being overweight or obese was more consistently associated with chronic illness than smoking, alcohol use, or education,� said Professor Byles.
Professor Annette Dobson from UQ's School of Population Health said the findings showed that across all age groups, being overweight or obese was consistently linked to heart disease, hypertension, osteoporosis, diabetes, asthma and arthritis. While this is important for women in Australia, it should also be important for women elsewhere.

Posted by at 10:58 AM | Permalink | Comments (0)

From UMHC today: Scientists explain myths about cervical cancer and why use of HPV vaccine is essential to the health of women. An article that should be available on all health department web sites.

Posted by at 10:51 AM | Permalink | Comments (0)

Today the WHO said that Although more than 12 million people each year are bitten by dogs or snakes, or stung by scorpions, the world's capacity to treat them is inadequate. Effective treatment for these conditions is critically dependent on therapeutic sera, but this essential drug is often unavailable or unaffordable in the countries where it is most needed. The World Health Organization (WHO) is creating a five-year plan to boost production in developing countries, help authorities forecast market needs and strengthen regulatory capacity. On 10 January, the health agency will bring together the top experts in the area as well as recipient and donor countries, international organizations and manufacturers to agree to a global action plan. While Rabies is rare among people in the USA it can be a problem for many Americans travelling abroad.

Posted by at 1:13 PM | Permalink | Comments (0)

The Robert Wood Johnson Foundation (RWJF) has launched Common Ground: Transforming Public Health Information Systems. It hopes to:
Persuade public health agencies to integrate informatics principles and sound development methodologies to improve the delivery of public health services.
Examine existing public health service business processes—and define requirements for the information systems used to support these processes.
Help agencies develop new information system requirements that are more effective and that streamline the delivery of essential public health services.
Minimize duplicative efforts by identifying common business processes and information system requirements that are applicable across the pubic health field.
Encourage stakeholders at the local, state, and federal levels to endorse, adopt, and implement redesigned business processes and information system requirements that support public health preparedness and chronic disease prevention and control.

Posted by at 12:17 PM | Permalink | Comments (0)

The movement toward public health department accreditation took another step forward today with the announcement from the RWJF of a national collaborative venture between the National Network of Public Health Institutes (NNPHI) and the Public Health Leadership Society (PHLS). The Multistate Learning Collaborative-2 is working with 10 states. The objectives are to:
Bolster the public health performance assessment or accreditation programs in the 10 states;
Convene the states to share and explore quality improvement efforts;
Produce resources and tools to be used by others;
And inform the public health practice community about the findings and products of the project.

Posted by at 12:03 PM | Permalink | Comments (0)

CDC published the Recommended Immunization Schedules for Persons Aged 0-18 Years -- United States, 2007 on January 5th. The Rotavirus vaccine is added, while modifications are made to Flu, Varicella and HPV vaccines. The schedule has been divided into two parta; one for those less than 7 years of age, and one for those over 6 years of age. The second part highlights needs for the 11-12 year olds. It keeps getting more complex. It is time for computer based reminder schedules which can be integrated into developing Medical Records Systems.

Posted by at 10:34 AM | Permalink | Comments (0)

Few non-rescription vitamin preparations have been shown to make a difference to health, but Calcium & Vitamin D together are an exception. So much so that The Food and Drug Administration (FDA) is proposing to allow new claims on foods and dietary supplements containing calcium and Vitamin D to show their potential to reduce the risk of osteoporosis. The proposed rule would allow manufacturers to include new information on their food and supplement labeling and to eliminate certain other information,
The health claim will allow: a claim for calcium and vitamin D together and a reduced risk of osteoporosis
and will be shortened by:
Dropping the reference to sex, race, and age since the benefits apply to both sexes at all ages and race categories.
Dropping the need to identify the mechanism by which calcium reduces the risk of osteoporosis.
Dropping the requirement that the claim state that there are limits to benefit of calcium intakes above 200% of the Daily Value.

Posted by at 10:28 AM | Permalink | Comments (0)

The American Thoracic Society has updated its guidelines stating that "to eliminate tuberculosis (TB) in the United States, current guidelines should be changed to reclassify all foreign-born residents from high-incidence countries as “high-risk,� regardless of the amount of time they have lived in the U.S." This new guideline will be published in the January 2007 American Journal of Respiratory and Critical Care Medicine

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

A study from the University of Woisconsin, published in AJPM, analyzes a survey, conducted by the North American Quitline Consortium, of the 38 quitlines in operation in 2004, to obtain baseline information about their organization, financing, promotion and cost. The survey found that quitlines had a median per capita cost of 14 cents and a median cost per adult smoker of 85 cents. In comparison with other medical treatments, the cost is extremely modest, Keller says. "When compared with the total economic cost of smoking of $3,931 per year, per smoker, estimated by the Centers for Disease Control, quitlines are really a bargain," Keller says. Quitlines also have previously been shown to improve rates of quitting by 20 to 35 percent.

Posted by at 10:11 AM | Permalink | Comments (0)

For many years there has been a debate about whether routine circumcision should be carried out in newborns, as well as concerns about the methods. Now news about the value of circumcision in preventing transmission of AIDS may bring further discussion.

Posted by at 11:31 AM | Permalink | Comments (0)

After reading daily stories of chlidren driving drunk and killing strangers, and today's exposee of teen binge drinking we should agree that the 'War on Drugs' is lost; mainly due to the heavy handed approach. Too many people are in prison for one kind of substance abuse or another The behavior associated with substance abuse, whether the substance is legal or illegal, whether deemed a drug a nutritional substance, or a vice, is similar. Our whole "War" has failed just as the history of alcohol use during the thirties (prohibition) should have told us. We have wasted resources using a criminal justice (an oxymoron) approach rather than a public mental health approach. It is time to rethink the whole substance abuse dilemna, and at least stop putting people in prison for substance abuse. There are better ways.

Posted by at 10:52 AM | Permalink | Comments (1)

30 Years ago Ivan Illich discussed the Medicalization of Health, or "ovediagnosis" which is rewarded by the insurance companies and hospital administrators. Today an excellent article in the New York Times states that "What’s Making Us Sick Is an Epidemic of Diagnoses. The authors of the article, like Illich, say this epidemic is a threat to your health. It has two distinct sources. One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don’t like, and in the past, this was considered a part of life. Increasingly, however, such sensations are considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction.

Posted by at 10:28 AM | Permalink | Comments (0)

From ACOG today: All pregnant women, regardless of their age, should be offered screening for Down syndrome, according to a new Practice Bulletin issued today by The American College of Obstetricians and Gynecologists (ACOG). Previously, women were automatically offered genetic counseling and diagnostic testing for Down syndrome by amniocentesis or chorionic villus sampling (CVS) if they were 35 years and older. According to the new guidelines, the goal is to offer screening tests with high detection rates and low false positive rates that also provide patients with diagnostic testing options if the screening test indicates that the patient is at an increased risk for having a child with Down syndrome.

Posted by at 10:24 AM | Permalink | Comments (1)

From the Medical College of Georgia: by age 10, some black children already have high nighttime blood pressure, an early signal of impending cardiovascular disease, a new study shows. As they grow up, black children also show greater increases in nighttime blood pressure, according to a study that followed children’s blood pressures over 15 years. At night, blood pressure should drop because the body is resting, says Dr. Gregory Harshfield, director of MCG’s Georgia Prevention Institute and a co-author on the study published in the Dec. 19 edition of Circulation, the journal of the American Heart Association.

Posted by at 10:51 AM | Permalink | Comments (0)

What information should be found in a Personal Health record(PHR)? The issue is being debated on many fronts but I see little interest from public health groups. For those interested in population health and prevention why is this not a major topic today? The Robert Wood Johnson Foundation is taking a lead in defining the elements to be found in such a record, see today's business section of the AMA-NEWS This includes a summary of 15 pieces of data that insurance companies, rather than doctors, are expected to update . Who will monitor these pieces of data? Will it be as difficult to find and question as one's credit history? What is wrong with the current plan listed in Amednews? What about the uninsured? Do you really trust insurance comanies to be concerned for the population's health? How much of this current move is driven by profit rather than good health care? Much to think about. Make a New Year's resolution to become more knowledgeable about the topic.

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