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This month the American Academy of Family Physicians, College of Physicians, Academy of Pediatrics and the Osteopathic Association delivered a joint statement on the value of a Patient Centered Medical Home in an effort to raise the consciousness of the public in having a single point of care rather than choosing the yellow pages for every twinge.
In this week's BMJ, a report on a preventive intervention in parents of preschool children at risk of developing conduct disorder. The study shows that effective community level prevention is possible using regular service staff if they are properly trained in an evidence based program. Conduct disorder is a major health and social problem. It is the most common psychiatric disorder in childhood, with a prevalence of around 5% across the world. While in the early stages the success of this intervention is worth following.
In this week’s BMJ [BMJ 2007;334:662-663 (31 March)] A fascinating review of development of a British Genetic Database and discussion of the pros and cons of such data bases from both epidemiologic and privacy view points. Well worth reading
In this week's BMJ is a report [BMJ 2007;334:646 (31 March)] on a preventive intervention in parents of preschool children at risk of developing conduct disorder. While an early report it shows promise and is worth following. The study shows that effective community level prevention is possible using regular service staff if they are properly trained in an evidence based programme. Conduct disorder is a major health and social problem. It is the most common psychiatric disorder in childhood, with a prevalence of around 5% across the world.
From Sheffield University in the UK and Baylor University in the USA; scientists have discovered that a component of green tea called epigallocatechin gallate, or EGCG, prevents HIV from binding to our immune system cells by getting there first. Once EGCG has bound to our immune system cells there is no room for HIV to take hold.
Professor Mike Williamson, from the Department of Molecular Biology and Biotechnology at the University of Sheffield and who worked on the study, said: "Our research shows that drinking green tea could reduce the risk of becoming infected by HIV, and could also slow down the spread of HIV."
Those interested in the history of health & disease should take a look at "In Sickness and in Health": from the Unversity of Nottingham in the UK. An Historical Perspective on Medical Matters — illustrates both scientific progress, such as Jenner's development of inoculation as a preventative for smallpox, and the private experience of individuals and families as they sought remedies for illness. It draws on the historic records of the Nottingham General Hospital to show how nursing and health care was delivered locally.
How many more times will it be necessary to reinforce the benefits of breast feeding? Now in the Lancet, March 31st issue, we find that breast feeding, without supplements, is protective against the development of HIV infection in newborns of HIV positive mothers.
Travellers continue to import rare diseases. The MMWR reports 12 imported cases of Chikungunya fever in the March 30 edition. Chikungunya virus (CHIKV) is a mosquitoborne alphavirus indigenous to tropical Africa and Asia, where it causes endemic and epidemic chikungunya (CHIK) fever, an acute illness characterized by fever, arthralgias, and sometimes arthritis, commonly accompanied by conjunctivitis and rash. Although symptoms of CHIKV infection usually last days toweeks, joint symptoms and signs usually last for months and occasionally for 1 year or longer; deaths from CHIKV infection are rare.
Easter will be here shortly and some families will buy chicks and baby rabbits for their children. In today's [March 30] MMWR the lead feature concerns Salmonella outbreaks among people in contact with baby birds. Ths is preventable and purchases of small animals for Easter should be forgone
From this week's NEJM [Volume 356:1338-1343 March 29, 2007 Number 13] is a recommendation for that a single dose of the Zoster vaccine be universally administered to persons over 60, provided there is no contraindication.
In response to the urgent need to reduce the number of new HIV infections globally, WHO and the UNAIDS Secretariat convened an international expert consultation to determine whether male circumcision should be recommended for the prevention of HIV infection. Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men.
The U.S. Food & Drug Administration (FDA) is launching a special Web page to warn consumers about the dangers of buying isotretinoin (Accutane) online. Isotretinoin is a drug approved for the treatment of severe acne that does not respond to antibiotics. Improperly used, isotretinoin can cause severe side effects, including birth defects. Serious mental health problems have also been reported with isotretinoin use.
From the Kaiser Family Foundation a new study shows that as the fight against childhood obesity escalates, the issue of food advertising to children has come under increasing scrutiny. Policymakers in Congress, the Federal Trade Commission (FTC), and agencies such as the Institute of Medicine (IOM) have called for changes in the advertising landscape, and U.S. food and media industries are developing their own voluntary initiatives related to advertising food to children.
From Johns Hopkins today researchers find that Diabetes and high blood pressure, two conditions rooted in genetics and environmental surroundings, play a much greater role than race alone in determining who is mostly likely to develop heart failure, according to the latest study from cardiologists at Johns Hopkins. Each year, nearly 300,000 Americans die from heart failure.
From Brown University we find that up to 10 percent of women newly diagnosed with cancer in one breast develop cancer in the opposite breast. Results of a major clinical trial show that magnetic resonance imaging (MRI) scans are highly effective tools for quickly identifying these opposite breast cancers, detecting diseased tissue that other screening methods missed.
A review in Science, this week, of "The Great Lead Water Pipe Disaster" by Werner Troesken, MIT Press, provides a review of the dissemination of lead poisoning in children by use of lead water pipes, prior to the problems of leaded paint and leaded gasoline is worth reading by those with an interest in disease prevention..We still fail to learn from history.
In the Journal, Lancet - Infectious Disease, Volume 7, Issue 4 , April 2007, Page 249, Emma Wilkinson notes that health education in schools in Scotland , while improving knowledge, failed to change teen behaviors in relation to use of condoms or reduction of sexual activity.
Just as we have the naysayers on the use of immunizations for children in the U.S.A, the same problem occurs elsehwere as noted in the April issue of The Lancet-Infectious Diseases: V.7, Issue 4, April07, Page 235. Officials in northern Pakistan have admitted this month their failure to immunise more than 160 000 children against polio. Prominent Muslim clerics have condemned the ongoing vaccination programme as a conspiracy of the Christian west against Muslims, and say parents fear for the safety of their children amid rumours that the vaccine causes sexual impotence. In some areas vaccination teams have been attacked by locals. There is genuine concern that anti-vaccination propaganda, increasingly linked to anti-Americanism, will jeopardise targets to make the world polio-free.
An Ediorial in the Lancet This week [V.369, Issue 9566, 24 March, Page 965] states that comorbidity with tuberculosis and HIV/AIDS affects around 11 million people and killed nearly 200 000 in 2005. Yet, less than 0·5% of HIV-positive people were screened for tuberculosis that year.
In an article in the NEJM this week [Volume 356:1204-1205 March 22, 2007 Number 12] JF Modlin discusses the epidemioogy of Enterovirus 71 which can mimic poliomyelitis and believes it would be prudent to add enterovirus 71 to the list of emerging infections that threaten us, develop a plan to respond to an outbreak, and take the first steps toward developing a vaccine.
From the University of Queensland, Australia research by the Asia Pacific Studies Collaboration (APCSC) confirms that cigarette smoking substantially increases the risk of dying from lung cancer in both Australia/New Zealand (ANZ) and Asia, and importantly highlights the continuing popularity of cigarette smoking across large parts of Asia, including China, where the harmful effects of smoking are still not widely appreciated, further; giving up smoking can reduce the risk of dying from lung cancer by up to 70%
In a new, large-scale study, researchers from the Harvard School of Public Health (HSPH) examined the link between CHD deaths and firefighting and looked at specific job duties to see which might increase the risk of dying from a coronary event. The landmark study provides the strongest link to date between CHD and emergency firefighting duties. It found that putting out fires was associated with a risk about 10 to 100 times greater than the risk of dying from non-emergency duties. Published in the March 22 issue of the NEJM
From JAMA today [JAMA. 2007;297:1224-1232]; after widening during the late 1980s, the black-white life expectancy gap has declined because of relative mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart disease. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap from cardiovascular diseases, homicide, HIV, and infant mortality.
The current JAMA should be required reading for all of us in Public Health. The focus on changing the health care system and the issues of access and problems of the underserved are well documented. The issue of how to get the system to change is still unresolved.
Editorial: Access to Care as a Component of Health System Reform. Phil B. Fontanarosa; Drummond Rennie; Catherine D. DeAngelis. JAMA. 2007;297:1128-1130.
Commentaries
State-Federal Partnerships for Access to Care: An End and a Means: Arthur Garson Jr; David Blumenthal. JAMA. 2007;297:1112-1115.
Universal Health Care Coverage: A Potential Hybrid Solution. Harold S. Luft. JAMA. 2007;297:1115-1118.
Health Disparities and Access to Health Nicole Lurie; Tamara Dubowitz JAMA. 2007;297:1118-1121.
Structural Impairments That Limit Access to Health Care for Patients With Disabilities
Kristi L. Kirschner; Mary Lou Breslin; Lisa I. Iezzoni. JAMA. 2007;297:1121-1125.
There are many areas in the US where this technique developed at UNC Chapel Hill might work. A simple, affordable household filtration device can reduce the incidence of diarrhea, one of the leading causes of disease and death in developing countries, by up to 40 percent, researchers at the University of North Carolina at Chapel Hill have shown. “This technology has the potential to bring safe drinking water to many people in developing countries around the world who don’t have access to it now,” said Mark Sobsey, Ph.D., professor of environmental sciences and engineering at UNC’s School of Public Health. “These kinds of filters have been used in the developing world since the 1990s, but there was only anecdotal evidence that they actually improved health,” said Christine Stauber, a UNC doctoral candidate who helped direct the project in the Dominican Republic. “It was really exciting to collect scientific evidence in an objective study that showed the filters actually worked, at least in these communities.”
The three most common forms of acute viral hepatitis in the United States – hepatitis A, B and C – declined dramatically between 1995 and 2005, with hepatitis A and B at the lowest levels ever recorded since the government began collecting surveillance data more than 40 years ago, according to the Centers for Disease Control and Prevention (CDC). Despite the declines, more than 100,000 new cases of viral hepatitis were reported in 2005. “Although the declines in acute viral hepatitis are promising, the number of new infections remains high particularly among unvaccinated adults,” said Dr. John Ward, director of CDC’s division of viral hepatitis. “By vaccinating infants against hepatitis B, we have made great progress in reducing infections in children.
Knowing whether the meningitis is viral or bacterial is imperative to early effective treatment. But distinguishing between the two types of infection is difficult because of similar symptoms. Patients with viral meningitis usually recover within two weeks without any medical intervention. Bacterial meningitis, however, can lead to brain damage, hearing loss and even death if not treated properly The U.S. Food and Drug Administration (FDA) cleared for marketing a test that uses molecular biology to quickly detect the presence of viral meningitis.
From Diabetes-UK today, we find that younger people with Type 2 diabetes have a bigger risk than older people with the condition of developing cardiovascular disease (CVD), says research presented today. The research also showed that, although under-40s with Type 2 have a greater risk of getting heart disease than their counterparts over 40, they are less likely to receive treatment for it – particularly women.
From Diabetes-UK we learn that one in three people with Type 1 diabetes aged between 18 and 30 already has retinopathy, a complication of diabetes that can lead to blindness in later life, says a survey presented today. This problem will increas in the US with our excess of obesity (even type II) and its links to diabetes. Further the lack of access to health care by many of these individuals will only worsen the outcome
In "Science" today is an article on potential population overgrowth in Niger [Science 315, 1501 (2007); Martha Campbell, et al.] which should cause all of us in public health to think about the unintended consequences of interfering in disease without looking at the population effects of such interference. If we wipe out a disease so that the resulting population overgrowth results in deaths from famine, did we do well?
From the WHO today we learn that Tuberculosis has become one of the world's leading infectious killers - second only to HIV/AIDS.
From the CDC today--The three most common forms of acute viral hepatitis in the United States – hepatitis A, B and C – declined dramatically between 1995 and 2005, with hepatitis A and B at the lowest levels ever recorded since the government began collecting surveillance data more than 40 years ago, according to the Centers for Disease Control and Prevention (CDC).
From Bristol University in the UK today researchers are calling for more work into the reasons behind a big increase of young children with Type 1 diabetes. A new study, led by Bristol University, has discovered that the number of children under five-years-old with Type 1 diabetes has increased five-fold over 20 years. Whilst the largest rise of the condition was seen in children under five, Type 1 diabetes in under 15s almost doubled during the study. There was a 2.3 per cent increase in the number of children diagnosed with Type 1 diabetes each year.
A new study fom the Lancet[V.369, Iss.9565.17/3/07 pp882-884]: Forget mouth-to-mouth resuscitation. When somebody collapses in cardiac arrest, experts now say, bystanders should not bother breathing into his or her mouth, once considered a key component of cardiopulmonary resuscitation. "Rescue breathing is an oxymoron," says Gordon Ewy of the University of Arizona College of Medicine. "We've been doing it wrong for 40 years."
The landmark study, by Ken Nagao and colleagues at Surugadai Nihon University Hospital in Tokyo, found that twice as many of 4,241 cardiac-arrest victims who collapsed in front of others survived with good brain function if they got compressions only without mouth-to-mouth breathing. The study, the largest of its kind, appears in British medical journal The Lancet
UCL (University College London) researchers have found the first physiological evidence that invisible subliminal images do attract the brain’s attention on a subconscious level. The wider implication for the study, published in Current Biology, is that techniques such as subliminal advertising, now banned in the UK but still legal in the USA, certainly do leave their mark on the brain.
The health risks posed by mercury-contaminated fish is sufficient to warrant issuing a worldwide general warning to the public-especially children and women of childbearing age-to be careful about how much and which fish they eat.
Developed at the Eighth International Conference on Mercury as a Global Pollutant last August in Madison, Wis., the declaration is a synopsis of the latest scientific knowledge about the danger posed by mercury pollution. "The policy implications of these findings are clear," said James Wiener, a Wisconsin Distinguished Professor at the University of Wisconsin-La Crosse who served as technical chair for last summer's conference. "The declaration and detailed analyses presented in the five supporting papers clearly show that effective national and international policies are needed to combat this global problem."
From the British Journal of Sports Medicine researchers have found that sweat has the potential to transmit Hepatitis -B between wrestlers. Br J Sports Med. Published Online First: 1 March 2007. doi:10.1136/bjsm.2006.032847
Scientists at the Wellcome Trust Sanger Institute, where one-third of the human genome was sequenced, have now pioneered decoding the sequence of cancer genomes. They have carried out the broadest survey yet of the human genome in cancer by sequencing more than 250 million letters of DNA code, covering more than 500 genes and 200 cancers.
The survey, published in Nature today, shows that the number of mutated genes that drive development of cancer is greater than previously thought. Significantly, as well as driver mutations for cancer, each cell type carries many more passenger mutations that have hitchhiked along for the ride. The study shows that a challenge for cancer biologists will be to distinguish the drivers from the larger number of passengers.
One more blow for the 'Natural Foods" cult. From Queen's Unviersity, Ontario, Canada new findings by a Queen’s research team dispel the popular notion that eating so-called “natural? foods will protect against cancer. In fact, certain types of common foods and alcoholic beverages such as wine, cheese, yogurt and bread contain trace amounts of carcinogens. Maintaining a balanced diet from a variety of sources – including garlic – is a better choice, the researchers suggest.
From the LA Times yesterday: In response to a series of hepatitis A outbreaks at restaurants and catered events across L.A., county officials said Tuesday they might require food-service workers in all 25,000 eateries to be vaccinated for the virus. Dr. Jonathan E. Fielding, the county's director of public health, said workers who prepare uncooked food such as salads are most likely to pass on the disease, especially if they do not wear gloves. Nevertheless, he cautioned that the risk of infection even then was very low. At $200 a per person and more than 100,000 food handlers, a workforce moblity of 100% a year, it might cost half a billion dollars to protect against 200 people a year reportedly infected. This is assuming that all foodhandlers become immunized. Maybe handwashing enforcement is simpler.
See the Wall St. Journal video on the latest diet resaerch. The take away message is that although the Atkins diet seemed superior intially, the long term results were dissappointing. Very few of the participants, in any of the four diet tests groups, stuck to their their diets and weight loss in the long term. The message seems to be that it is not so much the diet as the will to change behavior and maintain the change.
Information in this week's JAMA is all that CT screening for lung cancer does is to raise the cost of diagnosis, raise anxiety and do nothing to prevent deaths. One of the tenets of public health programs is that one should not screen if you cannot make a difference. The authors conclude that screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks. . JAMA. 2007;297:953-961.
Working with high-risk maternal-fetal medicine specialists at Beth Israel Deaconess Medical Center, Joslin’s medical staff has established a Diabetes and Pregnancy Program to help women with diabetes and women at risk for developing the disease to get the care they need to minimize these risks and give birth to healthy babies. More information about this program can be found by clicking on the following link: http://www.joslin.org/754_880.asp
Many States still do not forbid the sale of raw milk. The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are reminding consumers of the dangers of drinking milk that has not been pasteurized, known as raw milk. Raw milk potentially contains a wide variety of harmful bacteria – including Salmonella, E. coli O157:H7, Listeria, Campylobacter and Brucella – that may cause illness and possibly death. From 1998 to May 2005 CDC identified 45 outbreaks of foodborne illness that implicated unpasteurized milk, or cheese made from unpasteurized milk. These outbreaks accounted for 1,007 illnesses, 104 hospitalizations, and two deaths. This is based on information in CDC's Morbidity and Mortality Weekly Report for the week of March 2, 2007. The actual number of illnesses was almost certainly higher because not all cases of illness are recognized and reported.
Data from a national study suggests that about one in four U.S. females between the ages of 14 and 59 years may have the sexually transmitted infection human papillomarivus (HPV), according to a study in the February 28 issue of JAMA. Human papillomavirus is estimated to be the most common sexually transmitted infection in the United States . Eileen F. Dunne, M.D., M.P.H., of the Centers for Disease Control and Prevention (CDC), Atlanta , and colleagues estimated the prevaccine prevalence of HPV in the U.S. by performing HPV DNA testing on 2,026 self-collected vaginal swabs among females age 14 to 59 years participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. (JAMA. 2007;297:876-878)
Smoking appears to increase the risk of becoming infected with tuberculosis and the risk for the development of active disease upon infection, according to an analysis of previously published research in the February 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. (Arch Intern Med. 2007;167:335-342)
About one-third of the world's population is infected with the bacteria that cause tuberculosis (TB), but the organism is usually rendered inactive by the immune system, according to background information in the article. Active tuberculosis developed in approximately 8.8 million individuals in 2003 and is responsible for about 1.7 million deaths worldwide each year. "It has long been suggested that tobacco smoking may affect rates of TB morbidity and mortality," the authors write. "This could be a result of increasing the risk of infection with TB mycobacteria, increasing the rate of active TB disease, or increasing the TB mortality rate; plausible mechanisms exist."
While medical advances prevented approximately 175,000 deaths in the United States between 1996 and 2002, eight times as many lives could have been saved by eliminating the higher death rates experienced by Americans with inadequate education, a Virginia Commonwealth University researcher says in a study published today.
According to Steven H. Woolf, M.D., M.P.H., professor in VCU's Department of Family Medicine and a member of the National Academy of Sciences' Institute of Medicine, if the death rate for college-educated adults applied to everyone, 1.4 million lives would have been saved during those years.
Dr. Joseph Chorley, assistant professor of pediatrics at Baylor College of Medicine in Houston, suggests parents wait for indicators of physical maturity before allowing their children to engage in intense, physically demanding activities and year-round sports. Indicators for boys include needing to shave and for girls, the beginning of menstruation, said Chorley, who is also a sports medicine specialist at Texas Children's Hospital. "Sports are a great way to enhance childhood, but they shouldn't take away from it," said Chorley. "Often parents lose perspective; only one in 10,000 high school varsity players will ever make money in pro sports. We shouldn't have an all-or-nothing attitude of either belonging to the physically elite or being a couch potato."
Issued – Thursday 1st March 2007, London, UK & Rixensart, Belgium - A new candidate vaccine against hepatitis E, developed collaboratively by GlaxoSmithKline (GSK) and the Walter Reed Army Institute of Research (WRAIR), was found to be 95.5% effective in a Phase Two trial, according to a study to be published in the New England Journal of Medicine. [Volume 356:895-903]
Hepatitis E, a waterborne strain of hepatitis that occurs almost exclusively in the developing world, is currently without cure or medical prophylaxis. Three doses were administered over six months. After the third dose and over a follow-up period of approximately 20 months, there was a 7% attack rate in those in the placebo group and a 0.3% rate in those who had received the vaccine. The trial’s results also show that the vaccine was well-tolerated, with a safety profile similar to placebo, except for increased pain at the injection site; the most common adverse reaction besides injection site pain was mild to moderate headache after vaccination.
Contradicting claims of disease prevention, an analysis of previous studies indicates that the antioxidant supplements beta carotene, vitamin A, and vitamin E may increase the risk of death, according to a meta-analysis and review article in the February 28 issue of JAMA. [JAMA. 2007;297:842-857]
Many people take antioxidant supplements, believing they improve their health and prevent diseases. Whether these supplements are beneficial or harmful is uncertain, according to background information in the article. Goran Bjelakovic, M.D., Dr.Med.Sci., of the Center for Clinical Intervention Research, Copenhagen University Hospital , Copenhagen , Denmark , and colleagues conducted an analysis of previous studies to examine the effects of antioxidant supplements (beta carotene, vitamins A and E, vitamin C [ascorbic acid], and selenium) on all-cause death of adults included in primary and secondary prevention trials. Using electronic databases and bibliographies, the researchers identified and included 68 randomized trials with 232,606 participants in the review and meta-analysis.
Erectile dysfunction drugs may be better than nitroglycerin in protecting the heart from damage before and after a severe heart attack, Virginia Commonwealth University researchers report today. During a heart attack, the heart is deprived of oxygen, which can result in significant damage to heart muscle and tissue. After the attack, most patients require treatment to reduce and repair the damage and improve their chances of survival. With the exception of early reperfusion, there are no available therapies that are truly effective in protecting or repairing such damage clinically.