Dr. Buttery's Public Health BLOG

An aid to assessing individual risks of 5 common chronic conditions is now available on the internet from Washington University in St. Louis. A few clicks of the mouse tell visitors to the "Your Disease Risk" Web site their risk for cancer, heart disease, diabetes, stroke and osteoporosis. The Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis recently launched this easy-to-use tool, which offers a wealth of information about risk factors and prevention strategies for five prominent diseases affecting millions of Americans. This tool should probably be available on all public health web sites, until a better one is found.

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Two addictions are worse than the sum of their parts. After six to nine months of abstinence from alcohol, recovering alcoholics who were also chronic smokers showed a significantly lower rate of improvement in tests of memory, reasoning, judgment, and visual/spatial coordination than non-smoking recovering alcoholics in a study conducted by researchers at the San Francisco VA Medical Center (SFVAMC). Not only did the smokers improve less, but their overall scores were lower than the non-smokers on most neurocognitive measures tested by the researchers.

Posted by at 10:38 AM | Permalink | Comments (0)

In the lead editorial today, in the BMJ, we find that influenza H5N1 is proving particularly resistant to undergoing the killer mutation that would allow efficient human to human transmission of the virus. Ten years after the strain first appeared in humans, it has killed just 191 people. For AIDS, however, it really is apocalypse now. Sceptics used to point out that there were more papers on AIDS than people with the condition, but that was a very long time ago. Sixty million people have now been infected with HIV and another 14 000 are acquiring the infection every day. Which is the important epidemic?

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The June Kaiser security update found the following worries among those surveyed.

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• Yesterday, the AMA at its annual meeting resolved to encourage additional funding for public health training for more physicians. The AMA, in conjunction with other appropriate organizations, will support the work of relevant groups to initiate the development of specific physician competencies for physicians engaged in public health practice. The AMA will also inform medical students and physicians of existing opportunities for physician training in preparation for public health practice. This action supports the April 2007 report of the IOM on the need for more physicians trained in public health

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

A study reported yesterday from,the Commmonwealth Fund repeats again, what primary care physicians have know for more than 50 years. Disparities in terms of access to and quality of care largely disappear when adults have a medical home, insurance coverage, and access to high-quality services and systems of care. A medical home is defined as a health care setting that provides patients with timely, well-organized care and enhanced access to providers. They experience no difficulty contacting their provider by phone; they experience no difficulty getting care or advice on weekends or evenings; and they report that their office visits are always well organized and on schedule.
However, this will not happen until the medical schools in the U.S. learn from every other medical school in the world that the focus of training should be on providing primary care, and that the reimburesment system (private or govermental) must fund a medical home with an emphasis on prevention and health maintaitence,.

Posted by at 10:21 AM | Permalink | Comments (0)

Most Massachusetts residents support a new state law to provide health coverage to almost all residents, including the individual mandate that requires residents to obtain coverage or pay a penalty, according to a new June poll of 1,003 Massachusetts residents. The public sees the law as benefiting many key groups in the state, with large majorities saying it will help people who are uninsured (72%), poor people (66%) and young people (60%). Small businesses stand out as the one group that the public perceives will be hurt by the law (52%, compared with 25% who say small businesses will benefit).

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From the 2006 NHIS. Insurance coverage differs sharply by age group.

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From the NHIS, 2006 showing the changes in insurance coverage

Posted by at 11:29 AM | Permalink | Comments (7)

On its front page, the New York Times (6/27) reports that according to a New York Times/CBS News/MTV poll, "Young Americans are more likely than the general public to favor a government-run universal health care insurance system." The problem is that young people rarely carry medical insurance unless they are still on their parents' policies, and they do not vote in enough numbers to make a difference.

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

Exenatide, a drug that is a synthetic form of a substance found in Gila monster saliva, led to healthy sustained glucose levels and progressive weight loss among people with type 2 diabetes who took part in a three-year study. John Buse, M.D., Ph.D., is lead researcher in the study “While this weight loss is encouraging, it’s important for people to understand that exenatide is not intended as a weight-loss drug and it is not approved for that purpose,” Buse said. “Only people with type 2 diabetes should take exenatide.”

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

The FDA is combing software and strategic evaluation to provide better surveillance of the food industry with early identification of new hazards and attacks on the food supply. The new system checks for:
Criticality - measure of public health and economic impacts of an attack
Accessibility - ability to physically access and egress from target
Recuperability - ability of system to recover from an attack
Vulnerability - ease of accomplishing attack
Effect - amount of direct loss from an attack as measured by loss in production
Recognizability - ease of identifying target
Use this link to access the FDA site for more information.

Posted by at 11:36 AM | Permalink | Comments (0)

Lots of headlines about "new" cures make it to the newspaper headlines, but frequently you need to read the small print, if you can find it, to see that the story is about animal research that has not yet been applied to humans, and may never be, or that numbers are small; such as one report available today on a new treatment for a common disease, that affects millions, but was tried on only 7 patients. Such studies should remain in the research journals, but reporters need to make deadlines just as researchers need to publish or perish!

Posted by at 11:27 AM | Permalink | Comments (0)

Boy! It is hard to get some messages out. Fox and CBS recently rejected a television commercial for Trojan condoms, the New York Times reports. According to the Times, the commercial, which premiered Monday night, features women at a bar surrounded by pigs. When one pig goes to the restroom and returns with a condom purchased at a vending machine, he is transformed into an attractive man. The end of the commercial carries the message: "Evolve: Use a condom every time." The ad will run on ABC, NBC and nine cable stations, including MTV, Comedy Central and Cartoon Network's Adult Swim. In addition, print ads will appear in 11 magazines, including Cosmopolitan and Glamour, and on seven Web sites. All of the ads highlight a Web site trojanevolve.com, the Times reports.

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Reported by a team of researchers at Fred Hutchinson Cancer Research Center in the June 22 issue of Science, provide a better understanding of this modern pandemic infection through the study of an ancient virus called Pan troglodytes endogenous retrovirus, or PtERV1. Evidence of human immunity to this ancient retrovirus first emerged with the sequencing of the chimpanzee genome. "Ultimately," said co-author Malik, "if we want to understand why our defenses are the way they are, the answers inevitably lie in these ancient viruses more so than the ones that have affected us only recently, such as HIV."

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Wiht a combination of smoing bans, TV ads, and increased taxes smoking has dropped dramatically in NYC over the last 5 years cmpared to the rest of the US.

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Another genetic breakthrough is detailed in the journal Science, this week, The complete geneome of of Ae. aegypti. With this information a step forward in prevention of malaria, a medical goal for well over 50 years, may take a step forward. [Science 22 June 2007: Vol. 316. no. 5832, pp. 1703 - 1704]

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In an excellent article in this week's BMJ, Iona Heath, A GP in London, says "the UK government has a clearly stated commitment to tackling health inequalities, while perversely allowing disparities in wealth to widen. The problem is that health inequality is directly related to socioeconomic inequality and cannot be separated from its underlying cause or solved independently. It is convenient for governments to believe that this can be done but the medical profession should not collude with them." This is no less true in the USA.[BMJ, 23 JUNE 2007; Volume 334, p 1301]

Posted by at 12:21 PM | Permalink | Comments (0)

A UCLA team collected data on 17,000 American women and men involved in the National Health and Nutrition Examination Survey. Among these adults, 606 reported having had a stroke. The researchers found that women 45 to 54 years old were more than twice as likely as men in the same age group to have had a stroke. There were no differences in stroke rates found in the 35-to-44 and the 55-to-64 age groups, they noted. The researchers found that the independent predictors of stroke in women of that age group were coronary artery disease and waist circumference, (both associated with obesity & type II diabetes.)

Posted by at 10:26 AM | Permalink | Comments (0)

From the University of Leicester researchers have found that Infants from smoking households accumulate cotinine, a metabolite of nicotine, which may have a detrimental effect on the cardiorespiratory system. Specifically, antenatal smoking may affect up to 25% of regnancies,11 causing morphological placental changes that lead to chronic fetal hypoxic stress and abnormal lung and brain development. The study found that
* If parents smoke, the baby smokes.
* Mother smoking is the most important contributing factor.
* Co-sleeping and the temperature of the room the baby sleeps in are also contributory factors.

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Women who get most of their daily calcium from food have healthier bones than women whose calcium comes mainly from supplemental tablets, say researchers at Washington University School of Medicine in St. Louis. Surprisingly, this is true even though the supplement takers have higher average calcium intake.

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From the University of Florida researchers have debated the cause-and-effect relationship for years. People with diabetes may suffer hormonal imbalances that predispose them to depression. On the other hand, depression is associated with physical and behavioral factors such as obesity and poor diet that some say could be enough to trigger diabetes in the elderly.
"This is the first study to evaluate diabetes as a risk factor for the onset of depression in older persons,” said study author Dr. Matteo Cesari, a geriatrician in UF’s Institute on Aging. “It’s likely we are looking at a vicious, self-feeding cycle: Diabetes causes depression, which may reduce adherence to diabetic treatment, therefore worsening the diabetic condition, and so on.”

Posted by at 1:02 PM | Permalink | Comments (0)

Reported today in Science: later this this month at the AMA meeting will be a vote on a resolution in support of strengthened ties between schools of medicine and veterinary science, increased collaboration in surveillance and the development of diagnostics, drugs, and vaccines across species barriers. For example the benefits of collaboration could go beyond zoonoses, says Jakob Zinsstag of the Swiss Tropical Institute in Basel. For instance, in Chad, Zinsstag has helped introduce joint vaccination campaigns for livestock and humans, which has helped raise vaccination rates of hard-to-reach nomadic populations. In the United Kingdom

Posted by at 10:25 AM | Permalink | Comments (2)

From today's BMJ an editorial[BMJ 2007;334 (16 June),] tells us that the US has the lowest percentage of primary care physicians, the highest percentage of population uninsured for primary care, and the lowest mean number of primary care visits per person per year. This will not be solved by training more doctors who will gravitate to the best paid specialties, but by changing the training to focus on primary care, along with medical school debt relief and practice support.

Posted by at 10:20 AM | Permalink | Comments (0)

Lyme disease is clearly a North Eastern U.S. Issue

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From the WHO today new data show that 13 million deaths worldwide could be prevented every year by making environments healthier. In some countries, more than one third of the disease burden could be prevented through environmental improvements. In 23 countries worldwide, more than 10% of deaths are due to just two environmental risk factors: unsafe water, including poor sanitation and hygiene; and indoor air pollution due to solid fuel use for cooking. Around the world, children under five are the main victims and make up 74% of deaths due to diarrhoeal disease and lower respiratory infections.

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

While policy makers talk about lack of primary care in the U.S. an international comparison showed patient-physician time in the US is about half the average of New Zealand and one-third of Australia. Such a severe shortfall impacts preventive care and management of chronic conditions in the US and could explain why the US does not achieve health outcomes that correspond to its higher level of investment in health care,” said study lead author Andrew Bindman, MD, of the University of California, San Francisco. Published on-line in the BMJ this week.

Posted by at 11:15 AM | Permalink | Comments (0)

The news media made a lot of one of the recommendations of the AMA's advisory committee on Childhood Obesity - "Tell kids they are fat" don't weasel word the issue.The AMA has published a set of recommendations and hopefully will provide a childhood version of their "Roadmaps for Clinical Practice series: Assessment and Management of Adult Obesity"

Posted by at 11:28 AM | Permalink | Comments (0)

From Brown University the first study in the developing world of directly observed antiretroviral therapy for HIV-infected children shows this form of treatment is an inexpensive, effective way to ensure that children take life-saving medications. Researchers at The Warren Alpert Medical School of Brown University, together with Maryknoll, the international Catholic charity, conducted the study. Results are published in the June issue of the American Journal of Public Health. A good example of transferring lessons learned in the U.S. to the international arena

Posted by at 11:19 AM | Permalink | Comments (0)

Yesterday the Kaiser Family Foundation had an excellent webcast on the issues of the cost of maternity care. The webcast is worth listening to. Look carefully at the newest buzz phrase "Consumer Driven Health Plans" which is an insurance company 'weasel' phrase to suck people into an expensive insurance program. Note that today JAMA has a commentary on 'value based' insurance which is another weasel phrase used by insurance sponsors to suck people into expensive insurance. Caveat Emptor is still well and thriving. It needs replacement by a universal access system not support from the AMA!

Posted by at 11:08 AM | Permalink | Comments (0)

From AHRQ today we find:
Increasing disparities were especially prevalent in chronic disease management.
Compared to their reference groups—
• Blacks had 90% more lower extremity amputations for diabetes.
• Asians were restrained in nursing homes 46% more often.
• American Indians and Alaska Natives were hospitalized from home health
care 15% more often.
• Hispanics had 63% more pediatric asthma hospitalizations.
• Poor people were 37% less likely to receive recommended diabetes care.

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

I wish I had faith that the legal system could understand the epidemiology behind the research that resulted in the IOM statement that there is no evidence to link autism and vaccines, including their components. Unfortunately courts rarely understand scientific enquiry. If this case succeeds, contrary to the epidemiologic evidence, the protection of vaccines may disappear if pharmaceutical companies see themselves at even more risk..

Posted by at 11:22 AM | Permalink | Comments (0)

The latest worldwide estimate of Alzheimer’s disease prevalence shows that 26.6 million people were living with the disease in 2006, according to research reported today at the 2nd Alzheimer’s Association International Conference on Prevention of Dementia in Washington, D.C. Researchers predict that global prevalence of Alzheimer’s will quadruple by 2050 to more than 100 million, at which time 1 in 85 persons worldwide will be living with the disease. The cost of this disease will break the bank of health systems around the world. It is one of the by products of our successs in defeating major killers such as heart disease, stroke and cancer.

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

MVP, a partnership between the World Health Organization (WHO) and the Seattle-based nonprofit, PATH, is collaborating with a vaccine producer, Serum Institute of India Limited (SIIL), to produce the new vaccine against serogroup A Neisseria meningitidis (meningococcus). The preliminary results of their study, a Phase 2 vaccine trial, reveal that the vaccine could eventually slash the incidence of epidemics in the “meningitis belt,” as 21 affected nations of sub-Saharan Africa are collectively known. The vaccine is expected to block infection by the serogroup A meningococcus, and therefore extend protection to the entire population, including the unvaccinated, a phenomenon know as “herd immunity.”

Posted by at 11:33 AM | Permalink | Comments (2)

Researchers from the University of Southampton. U.K., publish "Fat nation: Deciphering the distinctive geographies of obesity in England" which is a fascinating use of GIS to analyse where the problems occur, what parameters are associated with the distinct distributions and where one might focus intervention. Journal of Social Science and Medicine:Volume 65, Issue 1, July 2007, Pages 20-31

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

It is not only for Tb that quarantine may be necessary, but in this report from Oregon we find reckless behavior by another young adult male who has been spreading Measles. If quarantining an individual were not so difficult the local health department could have done more than issue a Warning. Lane County Public Health officials announced Monday they have confirmed a second case of measles in Eugene, Oregon. Quarantining individuals who are a danger to the community has become far too difficult. Lawyers really do not understand epidemiology

Posted by at 11:46 AM | Permalink | Comments (0)

Another major initiative of the Gates Foundation The Health Metrics and Evaluation Institute will be sited at the University of Washington in Seattle with a US$105 million core grant from the Gates Foundation over 10 years. The new institute fills a critical gap. The enormous political and financial attention now being paid to global health has not been matched by improved sources of information on the performance of health systems and new health programmes. This shortfall in knowledge is hampering efforts to create a favourable environment for investments in health. Worst of all, the evidence gap is harming work to improve the health of the most vulnerable populations in the world.

Posted by at 11:33 AM | Permalink | Comments (0)

In view of the media publicity on today's article in the American Journal of Clinical Nutrition [Am J Clin Nutr 2007;85:1586 –91] I recommend a careful reading. I believe the stated outcomes were wishful thinking because the small numbers of women in the study, divided into three groups, and the length of the study, were insufficient to account for the many confounding variables at work in the population from which the subjects were drawn.

Posted by at 11:15 AM | Permalink | Comments (8)

From the National Safety Council today we learn that accidental deaths in the United States are rising at an alarming rate, more than 20 percent over a 10-year period, reaching 113,000 deaths in 2005, according to the latest data available. The National Safety Council (NSC) warns that at the current rate, the nation’s all-time high of 116,385 accidental deaths, set in 1969, could be surpassed in the next few years. For people between 1 and 41 years of age, accidents are the leading cause of death in the nation. While accidents continue to be the 5th leading cause of death overall, exceeded only by heart disease, cancer, stroke and chronic lower respiratory diseases, accidental deaths are increasing at a greater rate than that of any of the top four causes of death.

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This article in the NEJM today, from NCCDPHP at the CDCP is well worth reading. The researchers focused on mortality from coronary heart disease in the United States, which has decreased substantially in recent decades. The study was to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed
to changes in cardiovascular risk factors. [NEJM 356;23 june 7, 2007] The burden of coronary heart disease in the United States remains enormous, even though associated mortality rates fell by more than 40% between 1980 and 2000. The largest contributions from medical therapies consistently came from secondary prevention.

Posted by at 10:26 AM | Permalink | Comments (0)

News from the University of Queensland Australia: Scientists have isolated at least 25 genes that cause seven of the most common hereditary diseases including diabetes and arthritis in the world's largest genetic study. The genes are responsible for heart disease, hypertension, type 1 and type 2 diabetes, Crohn's disease, bipolar disorder and rheumatoid arthritis, according to results published today in the international science journal Nature. Another 58 genes with possible links to the same family diseases have also been uncovered by British and Australian scientists working on the $16.6 million (£7 million) study funded by the Wellcome Trust Case Control Consortium (WTCC). Now to translate this information into chronic disease prevention

Posted by at 10:15 AM | Permalink | Comments (0)

New Research from Oxford University suggests that the dire straits promised by some global warming activists may not occur. As key players in the spread of disease ticks aren’t exactly man’s best friend but, according to Oxford University scientists, they may offer a vital clue that climate change is not to blame for an upsurge in many human diseases. While mosquitoes may be infamous for spreading malaria in Africa it is less well known that ticks spread Lyme disease throughout Europe and Tick-Borne Encephalitis from Eastern France, through Austria, Switzerland, Germany, Sweden and Eastern Europe including the Baltic States. The common assumption is that upsurges in such diseases in these regions are mainly due to climate change but new research published in PloS ONE contradicts this view.

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

From the Dana Farber Cancer Center: blacks in the United States are less certain than whites about recommendations to prevent lung cancer and are more fearful of having symptoms evaluated — beliefs that may keep them from seeking timely treatment for the disease, researchers from Dana-Farber Cancer Institute reported at the American Society of Clinical Oncology's annual meeting in Chicago. Blacks were also more likely to expect lung cancer to cause more symptoms prior to a diagnosis than were whites, said Christopher Lathan, MD, MPH, of Dana-Farber's Center for Outcomes and Policy Research and the study's lead author.

Posted by at 10:26 AM | Permalink | Comments (3)

The PHS has published interim guidelines for use of facemasks and/or respirators during a flu pandemic, or a significant outbreak.
• Whenever possible, rather than relying on the use of facemasks or respirators, close contact3 and crowded conditions should be avoided during an influenza pandemic.
• Facemasks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others. The time spent in crowded settings should be as short as possible.
• Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must take care of a sick person (e.g., family member with a respiratory infection) at home.
As a footnote, & possibly most important, is the recommendation for enhancing personal hygiene with frequent handwashing.

Posted by at 9:56 AM | Permalink | Comments (0)

From the AMA_News today; when Ron Davis becomes President of the AMA this month he will be the first board certified preventive medicine physician to serve as this important body's president. Dr. Davis was the first resident physician member of the AMA Board of Trustees from 1984 to 1987

Posted by at 4:15 PM | Permalink | Comments (0)

Research from the University of Arkansas by Ron Warren, associate professor of communication, shows ""Our primary conclusion is that little changed across the collection of food and beverage advertising analyzed in the two years of our sample. It appears that many advertisers selling unhealthy foods, at the very least, left their advertising practices unchanged despite a potential backlash from critics or the government," the researchers wrote. This despite promises from major vendors to change their ads in view of the epidemic of obesity. Isn't this the same kind of behavior exibited by the Tobacco Manufacturers?

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When meeting 2 years ago in Gleneagles, Scotland, the G8 leaders predicted that if their plan for Africa were implemented it would make it possible to deliver free basic health care and primary education for all and to provide near-universal access to treatment to people with HIV/AIDS by 2010 and to double the size of Africa's economy and trade by 2015. An editorial in the Lancet this week [Volume 369, Issue 9576, 2 June 2007-8 June 2007, Page 1833] states that Oxfam has calculated that over the past 2 years, 21 million children have died as a result of poverty, the equivalent of every child under 5 years in Canada, France, Germany, Italy, Japan, and the UK combined.

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