Dr. Buttery's Public Health BLOG

One more reason to stay in school. A new study from Northwestern University's Feinberg School of Medicine shows that older people with inadequate health literacy had a 50 percent higher mortality rate over five years than people with adequate reading skills. Inadequate or low health literacy is defined as the inability to read and comprehend basic health-related materials such as prescription bottles, doctor appointment slips and hospital forms. "It's a matter of life or death," said David Baker, M.D., lead author of the study and chief of general internal medicine at the Feinberg School and at Northwestern Memorial Hospital. "The excess number of deaths among people with low literacy was huge. The magnitude of this shocked us." "When patients can't read, they are not able to do the things necessary to stay healthy," Baker noted. "They don't know how to take their medications correctly, they don't understand when to seek medical care, and they don't know how to care for their diseases.” Baker thinks this is why they are much more likely to die.

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Most newspapers today carried a story about the failure of patients to follow prescription directions, or to continue medications until told to stop. This results in thousands of people who fail to respond to efforts to prevent progress or develpment of chronic diseases. Those who want more information should go to the web page of the National Council on Patient Information and Education.

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Gallup's annual update on Americans' smoking habits finds the rate of cigarette smoking among the adult population near the low point in the more than 60-year history of this question. Additionally, the poll shows a continuing decline in the amount of cigarettes U.S. smokers smoke each day. Only one in four smokers say they began smoking prior to age 16, the lowest percentage Gallup has measured. The vast majority of smokers continue to express a desire to quit, but also consider themselves addicted to cigarettes.

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It may sound like science fiction, but University of Florida researchers are developing devices that can interpret signals in the brain and stimulate neurons to perform correctly, advances that might someday make it possible for a tiny computer to fix diseases or even allow a paralyzed person to control a prosthetic device with his thoughts.

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Rearchers from Oregon State University said in a recent report in Pharmacological Research, that due to lifestyle, diet, loss of appetite and other factors associated with aging, millions of American citizens over age 65 are facing malnutrition at a time of their life when adequate, appropriate food and micronutrient intake is critical, leading to increased vulnerability to a range of degenerative diseases – a situation that is both unnecessary and easily preventable.

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The World Health Organization (WHO) is today releasing the first ever report highlighting children's special susceptibility to harmful chemical exposures at different periods of their growth. Air and water contaminants, pesticides in food, lead in soil, as well many other environmental threats which alter the delicate organism of a growing child may cause or worsen disease and induce developmental problems. Over 30% of the global burden of disease in children can be attributed to environmental factors. The vulnerability of children is increased in degraded and poor environments. Neglected and malnourished children suffer the most. These children often live in unhealthy housing, lack clean water and sanitation services, and have limited access to health care and education. For example, lead is known to be more toxic to children whose diets are deficient in calories, iron and calcium. One in five children in the poorest parts of the world will not live longer than their fifth birthday, mainly because of environment-related diseases.

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While today's BMJ carries an analysis of problems within the NHS, Dr. Heath's recommendations apply equally well to the US Health System, whatever permutations are developed over the next two years. The current enthusiasm for market forces seems to be making changes politically unacceptable and so nothing is being done about the expansionist health technology industry, which is driving demand for health care through the deliberate inflation of fear. The definitions of disease are being extended to include more people as patients and preventive medicine pursues an ever greater number of risk factors, each of which triggers a search for more technological interventions.

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

A fascinating report in today's BMJ on deveopment of oral vaccines from plants is well worth reading. Professor Arntzen and his team at Arizona State University are getting closer with an oral vaccine against Norwalk virus grown in a type of wild tobacco. "Exhaustive laboratory experiments show that this vaccine induces a powerful immune response in mice," he says. "Preliminary trials in humans should be underway within a year." A team of scientists from Japan reported preliminary success with rice engineered to carry a vaccine against subunit B of the cholera toxin.4 Mice fed the rice produced neutralising antibodies in their gut mucosa that seemed to protect them from an oral challenge with the cholera toxin
[BMJ 2007;335:180-182 (28 July)].

Posted by at 10:07 AM | Permalink | Comments (0)

From the American Cancer Society is a study of false beliefs about cancer which should be available on all health department web sites. The findings, published in the ACS journal Cancer, are based on a survey conducted in 2002 of nearly 1,000 US adults who had never had cancer. Participants were asked to respond to 12 statements about cancer with true, not true, or don't know. Discovery Health Channel and Prevention magazine helped design the survey.

Posted by at 10:02 AM | Permalink | Comments (0)

From the Wall Street Journal "The dearth of primary-care providers threatens to undermine the Massachusetts health-care initiative, which passed amid much fanfare last year. Newly insured patients are expected to avail themselves of primary care because the insurance covers it. And with the primary-care system already straining, some providers say they have no idea how they will accommodate an additional half-million patients seeking checkups and other routine care."

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From Consumer Reports the latest survey shows many parents have trouble telling if their children are overweight, according to a Consumer Reports June phone survey that polled 609 parents of children ages 5 to 17. Only 4 percent of survey respondents described their children as being 20 percent or more above their ideal weight or obese. But Consumer Reports found that 19 percent of those children fell in that category, using the reported weight, height, and sex of each child to calculate the body mass index (BMI)--ratios that help determine body fat. And while 21 percent of respondents described their children as being at least slightly overweight, Consumer Reports estimates that number at 36 percent of those surveyed.

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Another cutting edge study from Framingham suggests that that "obesity appears to spread from one person to another like a virus or a fad, researchers reported...in a first-of-its-kind study that helps explain -- and could help fight -- one of the nation's biggest public health problems." that "social networks play a surprisingly powerful role in determining an individual's chances of gaining weight." For example, when one spouse in the study "became obese, the other was 37-percent more likely to do so in the next two to four years, compared with other couples."
[Volume 357:370-379 July 26, 2007 Number 4]

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This study from University of Massachusetts Medical School shows that 10 percent of youth who become hooked on cigarettes are addicted within two days of first inhaling from a cigarette, and 25 percent are addicted within a month. Recent research has revealed that the nicotine from one cigarette is enough to saturate the nicotine receptors in the human brain. “Laboratory experiments confirm that nicotine alters the structure and function of the brain within a day of the very first dose. In humans, nicotine-induced alterations in the brain can trigger addiction with the first cigarette,”

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While it seems obvious this small study from UCSB confirms that advertisers have long understood the benefits of tailoring their messages to match the personality characteristics of their target audiences. A social psychologist at the University of California, Santa Barbara has now determined that the same concept applies to health communications delivered by medical professionals. The researchers also discovered that the effectiveness of these tailored messages depended on how much attention the participants paid to them.

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

From the Salk Institute Instead of immutable proprietary software, any species' genetic information resembles open source code that is constantly tweaked and optimized to meet the users' specific needs. But which parts of the code have withstood the test of time and which parts have undergone rapid evolutionary change has been difficult to assess. The study "reveals the regions that are currently targeted by natural selection or have been so during the evolutionary past." "As highlighted [in the] studies, many genes that harbor major-effect changes in wild populations are likely to mediate interactions with the environment," says Weigel. "Ultimately, experiments under more natural conditions will be required to fully appreciate the functional relevance of such sequence variation."

Posted by at 10:25 AM | Permalink | Comments (0)

Research from the McGill University Health Centre in Montreal shows babies under one month old, in the group of unexplained deaths, were more than seven times as likely to die while seated. The authors point out that their research indicates that the rate of deaths among seated babies is relatively small at just over 3%, and that there are no questions about the necessity or safety of car seats. Instead, extra care should be taken for very young babies in any type of infant seat.

Posted by at 10:18 AM | Permalink | Comments (0)

A sharp drop in breast cancer rates from 2003 to 2004 is linked to an even larger drop in women's use of hormone therapy that began around 2000, according to a Kaiser Permanente study. The study, conducted at Kaiser Permanente's Center for Health Research, reviewed the histories of 7,386 women diagnosed with invasive breast cancer and treated at Kaiser Permanente Northwest from 1980 through 2006. "The advantage of this news for women is that while you can't do anything about your genetic risk or family history, you can control what goes in your body. This gives women the chance to do something that decreases breast cancer risk."

Posted by at 9:15 AM | Permalink | Comments (0)

Cause or Association? Today's release from the NIH on use of calorie free sodas in Framingham raises many questions but gives no answers. The resaerchers do not provide any biological plausibility for a possible link between diet sodas and metabolic syndrome.

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At the 2007 International AIDS Society in Sydney according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "Three years ago, fewer than 300,000 people in the developing world were receiving the anti-retroviral drugs that help treat the virus. Last year, 2.2-million people in developing countries received the drugs. However, for every one person that you put in therapy, six new people get infected."

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Defying a veto threat from President Bush, the Senate Finance Committee approved a major expansion of the Children’s Health Insurance Program on Thursday, with a majority of Republicans joining all Democrats on the panel in supporting the legislation.
The vote, 17 to 4, sends the measure to the full Senate, which is expected to take it up within two weeks.

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Four pilot sites were selected to participate in this new community-based environmental health initiative, based on work with NACCHO's PACE-EH project.:
Cerro Gordo, Iowa;
the Cherokee Nation, Oklahoma;
Savannah, Georgia; and
Boston, Massachusetts.
The pilot collaboration sites, which range from urban centers to rural areas, were selected for the project because they had strong local leadership in addressing community issues, experience in working with a wide range of private and public sector partners, and a track record of successfully addressing local health or environmental issues.
Lessons learned from the pilot sites will form the basis for a federal model of collaboration to improve service delivery for community-based environmental health activities at the national level. Information gathered and tools developed will also expand our community-based tool kits and be used to develop targeted training and education for leadership development.

Posted by at 12:27 PM | Permalink | Comments (0)

The media have reported several aspects of trying to regulate Tobacco use. As usual in politics, it appears that the perception of "doing something" is more important than regulation based on science. There is no gold standard for evaluation of tobacco and its myriad components that compares to evaluation of therapuetic drugs. Congress is setting the FDA up for a fall. Click here for analysis and links from the Amercian Association of Public Health Physicians.

Posted by at 11:02 AM | Permalink | Comments (0)

At Yale University more emphasis is being placed on interrupting the life cycle of disease transmission than look for a new vaccine. Blocking a tick protein that protects the Lyme disease bacteria as it moves from mice back to the tick that infected them might reduce incidences of the illness among humans, reports Erol Fikrig, professor of internal medicine, in Cell Host & Microbe. Fikrig said the control and prevention of many insect-borne diseases has been primarily focused on trying to produce antibodies to fight the infection. The emphasis is now shifting to disrupting the insects’ life cycle.

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Health claims are statements about the beneficial effect on the body of a food, or its ingredients. When you see statements on food labels such as, 'helps maintain a healthy heart', or 'helps aid digestion', these are examples of health claims. General claims about benefits to overall good health, such as 'healthy' or 'good for you', will in future only be allowed to be used if accompanied by an appropriate and approved claim. This means that more general claims will be backed up by an explanation as to why the food is 'healthy' or what makes it a 'superfood'.
Finally labels are not allowed to claim that food can treat, prevent or cure any disease or medical condition. l

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Travellers overseas should take full advantage of the new CDC Yellow Book and its advice about preventing diseases when travelling abroad.

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Dr. Frank Filipetto, an assistant professor of Family Medicine at the UMDNJ-School of Osteopathic Medicine says “The best approach is prevention, followed by a well-stocked first aid kit and the knowledge to recognize the warning signs of potentially dangerous conditions.” Following his advice before heading to parks, beaches and campgrounds for summer holidays, families should be prepared by packing some prevention and pain medicine to cope with the bugs, burns, bumps and bruises that often occur during vacations.

Posted by at 1:31 PM | Permalink | Comments (0)

From Seattle Children's Hospital and Regional Medical Center comes a reminder about water safety in the summer: Fatal drowning remains the second-leading cause of injury-related death for children. In 2004 the Center for Disease Control and Prevention (CDCP) reported approximately 4,000 deaths resulting from water accidents, averaging nine per day. Non-fatal drownings are nearly five times higher in number, and can cause severe difficulties including brain damage, memory problems, learning disabilities or permanent loss of basic functioning. Drownings increase greatly in summer when children play at beaches, swimming pools, lakes, rivers and even small backyard wading pools. Areas of the country with rivers, beaches or lakes are especially vulnerable, but children can drown in just a few inches of water <

Posted by at 1:21 PM | Permalink | Comments (0)

Do you throw money away on bottled water? There are no standards and no testing by state or federal agencies. See today's comments from the New York Times on this ridiculous situation where the PT Barnum's have conned you.

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From the NIH findings are described in detail in America’s Children: Key National Indicators of Well-Being, 2007. Compared to national statistics for the previous year, there has been an increase in the percentage of children living with at least one working parent and the percentage of children living in households classified as food insecure has declined. High school students were more likely to have taken advanced academic courses and the percentage of young adults who completed high school has increased. The adolescent birth rate has dropped to a record low. Increasing were: the percentage of children served by community water systems that did not meet all applicable standards for healthy drinking water, and the percentage of children living in physically inadequate or crowded housing or housing that cost more than 30 percent of household income. The percentage of low birthweight infants also increased, as did the percentage of births to unmarried women. The rate at which youth were perpetrators of serious violent crime increased slightly.

Posted by at 10:35 AM | Permalink | Comments (0)

The report, "Health Coverage Proposals in California: Impact on Businesses," which was authored by researchers at UC Berkeley's Center for Labor Research and Education, analyzes Gov. Schwarzenegger's health care reform proposal and Assembly Bill 8 (AB 8). The researchers also say that the state could see an infusion of between $1.2 billion to $3.7 billion in new federal Medicaid matching funds to expand coverage to children and low-income parents, as well as a reduction of between $1.4 billion and $3.4 billion in employee and employer federal tax payments. Their report says both health reform packages would boost productivity as workers take off fewer sick days.

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

In just the first year of a special effort organized by the federal agency that runs the Medicare system, the University of Michigan Health System was able to significantly improve both the quality and efficiency of care that Medicare beneficiaries received at its hospitals and health centers, while also saving the Medicare system millions of dollars.
All 10 physician groups improved quality of care for Medicare beneficiaries who have diabetes, by achieving nationally recognized benchmarks for diabetes care quality. The U-M Faculty Group Practice, which includes all the physicians on the U-M Medical School faculty who treat patients at U-M facilities, achieved 95 percent of its targets for providing specific, proven treatments and preventive measures to people with diabetes.

Posted by at 11:34 AM | Permalink | Comments (0)

Surprise, surprise. Swimming is good, clean summer fun for small children—but University of Florida experts caution that swim diapers won’t necessarily keep the water clean, and that could spell trouble if sick kids go in the pool. A common illness called Norovirus infection can cause vomiting, abdominal cramps and diarrhea. And for children suffering from such an infection that last symptom can render swim diapers ineffective, said Fred Southwick, a professor and chief of the infectious disease division at UF’s College of Medicine. U.S. Centers for Disease Control and Prevention officials say no swim diapers are leakproof and that no manufacturer claims its products prevent diarrhea leakage. CDC devoted a page to the topic: . Children with diarrhea shouldn’t be allowed in pools, regardless of their swimwear, Southwick said.

Posted by at 11:25 AM | Permalink | Comments (2)

In a fascinating new study reported from King's College. London, lead researcher Dr Veronique Bataille says: ‘The results of this study are very exciting as they show, for the first time, that moley people who have a slightly increased risk of melanoma may, on the other hand, have the benefit of a reduced rate of ageing. This could imply susceptibility to fewer age-related diseases such as heart disease or osteoporosis, for example. Further studies are needed to confirm these findings.'

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

From today's Washington Post. an article by Beth Baker states that the happy-worker-equals-healthy-company model seems to be paying off. A 15-year review of literature from the fields of psychology, business, medicine, public health, sociology and economics suggests a link between job satisfaction and lower absenteeism, lower turnover and higher performance. Companies with health-promotion programs showed an average of $3.50 savings for every dollar spent, as measured by reduced absenteeism and health-care costs.

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Notably, the AMA "said that for each 10-percent increase in the price of cigarettes, youth smoking is reduced by 7 percent, and overall consumption by 4 percent. 'The higher the tax, the more substantial the future public health benefit," said Dr. Ronald M. Davis, president of the AMA. 'Fewer smokers means fewer people with strokes, heart attacks, cancer and other smoking-related health conditions.'" According to the CDC, "about 440,000 people in the U.S. die prematurely each year as a result of illnesses attributable to smoking."

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A new study appearing in the Journal of the American Geriatrics Society compares the efficacy of three programs designed for reducing falls and improving quality-of-life among the elderly; education, home safety assessment and modification (HSAM) and exercise training. The study also examines the secondary effects of these programs on functional balance, daily activity, fear of falling and depression level, finding that exercise training yields the most significant improvements.

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The technique used by the University of Nottingham to predict heart disease may be more accurate than that in the U.S. While the base data comes from the Framingham studies, as in the U.S., the modified database comes from research using data from a general practice research database called QRESEARCH, which is a joint partnership between the University of Nottingham and EMIS, a leading provider of IT systems to GPs. A person's chance of developing heart disease is estimated using standard risk factors such as age, sex, smoking, blood pressure and cholesterol. The researchers tracked the progress of 1.28 million healthy men and women, registered at 318 general practices over a period of 12 years up to April 2007.

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

One does not tend to think of elephants as part of the TB transmisison chain but It appears that they catch TB from humans in Asia (and elsewhere). Elephants are tested by washing out their trunks, Chest X-rays are not feasible. See the Elephant Care Internatinal Organization

Posted by at 10:27 AM | Permalink | Comments (0)

From the CDC: [mmwr July 6,2007]
• Pet store owners, health-care practitioners, and veterinarians should provide information to owners and potential purchasers of reptiles and amphibians about the risk for acquiring salmonellosis from their pets.
• Persons should always wash their hands with soap and water after handling reptiles and amphibians or theircages.
• Persons at increased risk for infection with serious complications from salmonellosis (e.g., children aged <5 years and immunocompromised persons) should avoid contact with reptiles and amphibians.
• Reptiles and amphibians should be kept out of households with children aged <5 years or immunocompromised persons. Families expecting a new child should give away
their pet reptiles and amphibians away before the infant arrives.
• Reptiles and amphibians should not be kept in child-care centers.
• Reptiles and amphibians should not be allowed to roam freely throughout the house.
• Reptiles and amphibians should be kept out of kitchens and other food-preparation areas to prevent contamination. Kitchen sinks should not be used to bathe pets or to wash their dishes, cages, or aquariums. If bathtubs are used for these purposes, they should be thoroughly
cleaned afterward.

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The ACIP has just released its 2007 advisory on flu and strongly recommended vaccination of all health-care workers

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Tuberculosis remains a persistent health threat in California, with over 2,800 cases reported in the state in 2006. California has more cases of tuberculosis in young children than any other state. Yet, the health care system in California could save nearly $1.3 million a year with few adverse public health effects if it discontinued universal tuberculosis skin testing of children entering kindergarten, according to a new study by researchers at the University of California, San Francisco. To be cost-effective, about 7 percent of the children who are being screened need to test positive, yet the positive rate in California is only 1%, and less in other states..

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A WHO study [WHO Research Into Global Hazards of Travel (WRIGHT) project] found that the risk of developing venous thromboembolism (VTE) approximately doubles after travel lasting four hours or more. However, the study points out that even with this increased risk, the absolute risk of developing VTE, if seated and immobile for more than four hours, remains relatively low at about 1 in 6000. Experts recognize that blood circulation can be promoted by exercising the calf muscles with up-and-down movements of the feet at the ankle joints. Moving feet in this manner encourages blood flow in the calf muscle veins, thus reducing blood stagnation.

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