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n 2005, a total of 4.0% of respondents reported a history of MI, and 4.4% reported a history of angina/CHD. A total of 6.5% of respondents reported a history of one or more of these conditions (MI, angina/CHD, or both).
"Most young U.S. children are getting their recommended vaccinations, but rates for teens are lagging, especially for some newer vaccines," according to statistics published in the Aug. 31 issue of the CDC's Morbidity and Mortality Weekly Report. Healthy People 2010 vaccination goals for children 13 to 17 have yet to be met. This is especially true for the vaccines for diphtheria, tetanus, pertussis and chicken pox
AN editorial in this week's JAMA, that focuses on physician response to childhood obesity also explains why this is a Public Health issue, not just a physician-patient issue.
[JAMA. 2007;298:920-922.]
From the Census Bureau today in the publication "Income, Poverty, and Health Insurance Coverage in the United States: 2006 report [PDF].' we learn that the nation’s official poverty rate declined for the first time this decade, from 12.6 percent in 2005 to 12.3 percent in 2006. There were 36.5 million people in poverty in 2006, not statistically different from 2005. The number of people without health insurance coverage rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.
Dr. Henry Simmons, president of the National Coalition on Health Care, a nonpartisan group in Washington, said, "About two-thirds of the increase in the number of uninsured last year came in households with pretax income of $75,000 or more." He added, "Rising health-care costs and the general economic slowdown probably has increased the number of uninsured since the end of 2006. ... This has now created a massive and growing national economic crisis"
Graphic images illustrating the devastating effects that tobacco can have on health will be printed on all tobacco packets from next year, the U.K. Health Secretary Alan Johnson announced today.
The 15 images to be used were chosen following a consultation in 2006, market research and a public vote. The move makes the UK the first country in the EU to introduce such visual warnings on all tobacco products aimed at raising awareness, helping smokers who want to quit and further reducing smoking related illnesses.
From Kaiser Permanente, the largest study of its kind, this research shows that the risk of childhood obesity rises in tandem with a pregnant woman's blood sugar level and that untreated gestational diabetes nearly doubles a child's risk of becoming obese by age 5 to 7. The study also shows for the first time that by treating women with gestational diabetes, the child's risk of becoming obese is significantly reduced. In fact, children whose moms were treated for gestational diabetes had the same risk for becoming obese as children whose mothers had normal blood sugar levels.
From the U-M School of Public Health in the first known comprehensive analysis of whether antibacterial soaps work better than plain soaps, Allison Aiello and her team found that washing hands with an antibacterial soap was no more effective in preventing infectious illness than plain soap. Moreover, antibacterial soaps at formulations sold to the public do not remove any more bacteria from the hands during washing than plain soaps. Soaps useed in hospitals may be more effective, but were not part of the study.
Despite all the messages to control obesity a report from the "Trust for America’s Health (TFAH)" reveals adult obesity rates rose in 31 states last year, according to the fourth annual F as in Fat: How Obesity Policies are Failing in America. Twenty-two states experienced an increase for the second year in a row; no states decreased. A new public opinion survey featured in the report finds 85 percent of Americans believe that obesity is an epidemic. Economics and Social Science have been labeled "Dismal Sciences" in the past because they promised much and accomplished little. We need to add "Behaviorual Science" to this list.
In the UK, Nice, the equivalent of AHRQ, the cost effectiveness threshold is emerging as a key factor in the House of Commons Health Select Committee inquiry into NICE, which has received evidence that the threshold may be too generous. An advantage of the way in which the United Kingdom funds the NHS is that its patients do not have to judge whether or not the health benefits of their treatment are worth its costs. But someone, somehow, still has to grapple with the decision over the value that is placed on health. This valuation lies at the heart of the work performed by NICE—which, since its inception in 1999, has adopted a cost effectiveness threshold range of £20 000 (29 500; $40 000) to £30 000 per quality adjusted life year (QALY) gained. NICE does not accept or reject healthcare technologies on cost effectiveness grounds alone,3 4 5 although it is undoubtedly a major deciding factor. But the uncomfortable truth is that NICE's threshold has no basis in either theory or evidence. [BMJ 2007;335:358-359] Do we have the same problem in the US?
A fascinating discovery about how folate levels could be affected biologically, as a serendipitous finding in a basic bench research study. At Johns Hopkins. Amzel and colleague Maurice Bessman and their labs were in the middle of systematically characterizing how members of a family of related enzymes in bacteria can recognize specific molecules. With each family member, they isolated purified enzyme, grew crystals of pure enzyme, and figured out the enzyme’s 3-D structure by using techniques that use X-rays. We had to ask, "Can the bacteria make folate if we remove the orf17 gene?” says Amzel. Bessman and colleagues then “knocked-out” the gene and, predictably, the bacteria made 10 times less folate than usual. Such research can lead to new ways to enhance drugs, even though not the intent of the study.
Worth reviewing. The WHO 2007 Annual Report is now available on line. It marks a turning point in the history of public health, and signals what could be one of the biggest advances in health security in half a century. It shows how the world is at increasing risk of disease outbreaks, epidemics, industrial accidents, natural disasters and other health emergencies which can rapidly become threats to global public health security. The report explains how the revised International Health Regulations (2005), which came into force this year, helps countries to work together to identify risks and act to contain and control them. The regulations are needed because no single country, regardless of capability or wealth, can protect itself from outbreaks and other hazards without the cooperation of others. The report says the prospect of a safer future is within reach - and that this is both a collective aspiration and a mutual responsibility.
This editorial from the NEJM today is a "Must Read" for everyone concerned with improving health status in the US.[Volume 357:733-735 August 23, 2007 Number 8]
This annual report states that 2007 brought the announcement of the steepest decline in ancer deaths ever recorded in the United States. This milestone reflects the wisdom of our national investments in cancer research and care and is one of the most encouraging signs of progress since the war on cancer was declared in 1971. Yet this year alone, over a half million more Americans will lose their battle with cancer. Tragically, nearly two-thirds of these deaths could have been prevented through changes in lifestyle.
In this week's JAMA Matthew Hansen, M.D., an OHSU resident in emergency medicine, conducted the study with colleagues while he was a medical student at Case Western Reserve University in Cleveland. They reviewed the electronic medical records of more than 14,000 children ages 3 to 18 who were seen by a pediatrician at least three times for well-child visits between June 1999 and September 2006. They found that found that only about one in four children with hypertension is diagnosed with the condition.
Advancing the Nation’s Health: A Guide for Public Health Research Needs, 2006-2015 is a critical resource for research areas that should be addressed during the next decade by CDC and its partners in response to current and future needs and events. The Research Guide will serve as an essential resource for defining a more focused CDC health protection research agenda of research priorities aligned with the Health Protection Goals developed by CDC
Eighty percent of high school students and 44 percent of middle school students attend “drug-infested” schools where they have personally witnessed illegal drug use, illegal drug dealing, illegal drug possession, and students drunk or high at school, according to the 12th annual back-to-school survey conducted by The National Center on Addiction and Substance Abuse (CASA) published this month. For more information on adolescents and substance abuse, please visit ACPM’s adolescent health website: http://www.acpm.org/ah/SubstanceUse.htm. For more information on this study, please go to: http://www.casacolumbia.org.
For years activists have warned about the danger of Acrylamide in food. Now reported in Health Day. "data are accumulating, and it appears that acrylamide in the diet does not appear to be an important breast cancer risk factor," said study author Lorelei Mucci, an assistant professor of medicine at Harvard Medical School and an assistant professor of epidemiology at Harvard School of Public Health in Boston. "We probably couldn't rule out that eating very high levels of acrylamide is associated with a very, very small increase in risk, but in terms of it being an important public health risk factor for breast cancer I don't think acrylamide is a major risk factor," she said. Acrylamide is classified as a "probable" human carcinogen but only based on earlier animal studies in which the animals were exposed to levels of acrylamide up to 100,000 times higher than that normally consumed through foods.
The New York Times today has an excellent summary of the problems of unintended lead poisoning through the ages.
A study from Stanford University School of Medicine shows that a case-management approach helped a diverse group of patients reduce their overall risk of heart disease by roughly 10 percent, and did so in a cost-effective way. The surprise is that the university headlines this study as groundbreaking. Case management has been recommended by many groups involved in chronic disease management for many years. What is surprising is that Stanford medical school is just finding this out.
Electronic drug prescriptions can be delivered to pharmacists in all 50 states for the first time this week as Alaska became the final state to join the technological bandwagon.
Minnesota is near the front of the pack of states pursuing health information technology, as it begins to implement new laws requiring e-prescribing, paperless health plan claims and eventually an interoperable e-medical record for every Minnesotan. Starting January 15, 2009, health care providers can no longer submit any claims on paper, and eligibility checks also must be done online." In addition, proposed new legislation would require that "all Minnesota doctors, hospitals and other health care providers implement interoperable e-medical records (EMR) for their patients by the beginning of 2015. The legislature has appropriated $14 million to help small, rural health care providers and safety net clinics acquire EMR systems.
A new report from AHRQ indicates that increasing health system costs are associated with lack of effective secondary prevention of identified disease. This care could be provided in primary care settings. In 2004, hospital costs for potentially preventable conditions totaled nearly $29 billion—one out of every 10 dollars of total hospital expenditures. As many as 4.4 million hospital stays could possibly be prevented with better ambulatory care, improved access to effective treatment, or patient adoption of healthy behaviors.
In Science this week is a wonderful editorial by Donald Kennedy labelled "Pork & Punishment." I wonder if any members of Congress, or their staff members, will read it and see themselves. The current approval of Congress has almost dropped to single digits, yet we keep electing untrained individuals whose whole life is based on perception rather than reality. I guess we deserve what we get!
Found in a new publication the WHO on intellectual property rights, under the discussion of the value of new innovations if not made available to to those in poverty, the chart below shows the drastic reduction in lie expectancy in certain African countries as the result of HIV infection coupled with resurgence of TB and Malaria.
From today's NEJM an article on pharmaceutical advertsiing. Since 2000, direct-to-consumer advertising of prescription drugs has continued to grow both in absolute dollars and relative to other forms of promotion. Although the evidence base is growing, there are few data to support an assessment of the balance of the costs and benefits of such advertising. The debate over whether and how direct-to-consumer advertising should be more tightly regulated takes place against a backdrop of growing concern about the growth of health care spending, particularly in the Medicare program. Gaining a better understanding of the effects of direct-to-consumer advertising for prescription drugs has important public health implications not only for the United States and New Zealand, where such advertising is also permitted, but also for Canada and the European Union, where such advertising is banned but has been subject to recent challenge. [Volume 357:673-681 August 16, 2007]
The World Health Organization (WHO) today issued new global guidance for the use of insecticide-treated mosquito nets to protect people from malaria. For the first time, WHO recommends that insecticidal nets be long-lasting, and distributed either free or highly subsidized and used by all community members. The long-lasting insecticidal nets (LLINs) are designed to be effective without re-treatment for the life of the net. At around US$ 5 per net, LLINs are a simple and cost-effective intervention against malaria. “This data from Kenya ends the debate about how to deliver long-lasting insecticidal (or just mosquito nets) nets,” said Arata Kochi, head of the WHO’s Global Malaria Programme. Malaria, which is preventable and treatable, still kills more than one million people each year, mainly African children under five years of age.
In the UK, a test of use of 'decision support' computer software "GRAIDS" in general practices can significantly improve the management of patients concerned about their family history of breast and bowel cancer. There is growing interest in the broader application of the family history of common disease in preventive health (Yoon et al, 2003). The Center for Disease Control has recently developed a similar electronic family history tool for use in primary care that is undergoing evaluation. This trial demonstrates the potential of the software to improve the management of familial cancer in primary care, assuming the accuracy of current risk assessment guidelines.
From JAMA this week a study of the value of HPV vaccine for those already infected shows that administration of the vaccine does not minimize the disease. The study's conclusion was that In women positive for HPV DNA, HPV-16/18 vaccination does not accelerate clearance of the virus and should not be used to treat prevalent infections. [JAMA. 2007;298:743-753]
I wonder how often we have to be told about the dangers of buying products from developing countries with a poor track record of safety surveillance. Again, in today's media, we are told about the dangers of more products from China, this time toys for chldren, that contain lead.
In the NYT today is an article about Alzheiner's disease which among other items, notes that most "researchers say no breakthrough is around the corner, and it could easily be a decade or more before anything comes along that makes a real difference for patients." The numbers associated with the condition "are staggering." About 4.5 million Americans have Alzheimer's, one-in-10 over 65 and nearly half of those over 85. "Taking care of them costs $100 billion a year, and the number of patients is expected to reach 11 million to 16 million by 2050.
In the latest Journal of the American College of Cardiology, a study from University of Texas Southwestern Medical Center at Dallas, shows that people who develop fat around the middle have more atherosclerotic plaque than those who have smaller waist-to-hip ratios,” said Dr. James de Lemos, associate professor of internal medicine and senior author of the study. “The risk was the same for both men and women who develop abdominal fat.” Calcium was more likely to be found in the arteries of patients with the greatest waist-to-hip ratio, the researchers discovered. People with the largest waist-to-hip ratio had a twofold increase in the incidence of calcium deposits — a strong indicator of future cardiovascular ailments including heart attacks.
Once again, an article that demonstrates lack of effectiveness of vitamin pills,. This time for heart disease. In an article in this week's Archives of Internal Medicine Dr. JoAnn E. Manson, the study's principal investigator and chief of preventive medicine at Brigham and Women's Hospital, says: "The randomized, double-blind, placebo-controlled study was 'the first large-scale trial of vitamin C in cardiovascular disease prevention.'" This study "looked at the effectiveness of vitamin C, vitamin E and beta-carotene supplements individually, as well as all three supplements at doses above the recommended daily allowance in two- and three-way combinations." Dr. Manson added, "The findings also mean 'we have to redouble the efforts on conventional prevention' such as healthy diet, exercise, weight control and avoiding tobacco. Taking pills containing antioxidants doesn't reduce the risk of heart disease in women most at risk"
[Arch Intern Med. 2007;167:1610-1618.]
Some well meaning individuals have been touting smokless tobacco as a relatively danger free alternative to cigarettes. Now from the American Cancer Society we find that It may not be inhaled into the lungs, but smokeless tobacco exposes users to some of the same potent carcinogens as cigarettes. In the August issue of Cancer Epidemiology, researchers at the University of Minnesota Cancer Center Biomarkers & Prevention, a journal of the American Association for Cancer Research, report that users of smokeless tobacco are exposed to higher amounts of tobacco-specific nitrosamines -- molecules that are known to be carcinogenic -- than smokers.
From VCU, using data from the Mid-Atlantic Twin Registry, Kenneth S. Kendler, M.D., a professor of psychiatry and human genetics in VCU’s School of Medicine and lead author said “As we grow and move out of our own home environment, our genetically influenced temperament becomes more and more important in influencing the kinds of friends we like to hang out with. “The study shows how genetic and family environmental factors influence the ways in which we create our own social environment as we grow.”
• Genes likely influence the friends we choose
• Study shows that genetics and family environment influence how we create our own social environment
• Research offers insight into which individuals may be at risk for future substance abuse or antisocial behavior
From the University of Birmingham in the UK a new study has uncovered changes to our immune systems which may explain why we become more vulnerable to common infections as we get older. Dr Laxman Nayak from the University’s Centre for Applied Gerontology, which works to promote awareness of the needs of older people adds: “We know that elderly people are more vulnerable to a range of infectious diseases, without knowing exactly why. It is very good to see that in recent years there has been more research to explain the biological processes at work, as this opens up the possibility of treatments to boost immunity. These kinds of findings also send out the message that we shouldn’t accept that ill health is an inevitable part of getting older.”
Researchers at Columbia University Medical Center have now identified a surprising and critically important novel function of the skeleton. In this published research, authors show that an increase in osteocalcin activity prevents the development of type 2 diabetes and obesity in mice. This discovery potentially opens the door for novel therapeutic avenues for the prevention and treatment of type 2 diabetes. “The discovery that our bones are responsible for regulating blood sugar in ways that were not known before completely changes our understanding of the function of the skeleton and uncovers a crucial aspect of energy metabolism, These results uncover an important aspect of endocrinology that was unappreciated until now.”
The current medical fad, "Patient-Centered Care" according to a study from the University of Iowa suggests that it doesn't work for everybody. In fact, some patients are significantly less likely to follow doctors' orders and feel satisfied with their care when physicians take the patient-centered approach. Some patients, especially older patients, prefer a doctor with a more traditional "doctor-centered" or "paternalistic" style, someone who spends less time explaining a condition and seeks little patient input when it comes to treatment decisions. The study showed that when those patients are matched with patient-centered doctors who want them to take a highly active role, they're less likely to follow treatment recommendations or feel satisfied with their care.
A Report on Recommendations of the Task Force on Community Preventive Services published in the MMWR this week shows strong evidence that universal school-based programs decrease rates of violence and aggressive behavior among school-aged children. Program effects were demonstrated at all grade levels. An independent meta-analysis of school-based programs confirmed and supplemented these findings. On the basis of strong evidence of effectiveness, the Task Force recommends the use of universal school-based programs to prevent or reduce violent
behavior.
More than one in three men are over the danger limit for drink on late-night city streets, a Cardiff University study has found. The study, funded by the Alcohol and Education Research Council, and led by Dr Simon Moore and Professor Jonathan Shepherd of the University’s Violence & Society Research Group, surveyed 893 drinkers on Friday and Saturday evenings on the streets of Cardiff across twelve months. From breath analysis, they found that more than a third of men and one-sixth of women had a blood alcohol concentration above the “at risk” level of 0.15 per cent. This is twice the drink-drive limit and is the internationally-recognised level at which risk of injury and ill health rises steeply.
There is no reason to believe that similar results would not be found in the U.S.
A new University of Georgia study finds that pectin, a type of fiber found in fruits and vegetables and used in making jams and other foods, kills prostate cancer cells. The study, published in the August issue of the journal Glycobiology, found that exposing prostate cancer cells to pectin under laboratory conditions reduced the number of cells by up to 40 percent. UGA Cancer Center researcher Debra Mohnen and her colleagues at UGA, along with Vijay Kumar, chief of research and development at the VA Medical Center in Augusta, found that the cells literally self-destructed in a process known as apoptosis. Pectin even killed cells that aren’t sensitive to hormone therapy and therefore are difficult to treat with current medications.
Blogger Comment; Before the news media stampede us into a new fruit fad we must differentiate between lab testing and real life. It is unlikely that pectins can move through the gut into the body unchanged. Much more work needs to be completed before we can determine what part of the pectin molecule may serve to prevent cancers.
Researchers at the University of Michigan Health System analyzed the responses of more than 11,000 participants in the national Health and Retirement Study. They found that 50 percent of older adults had a moderate to severe form of at least one of the following conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment or hearing impairment.
From the Robert Wood Johnson Foundation we find that increasing the use of just five preventive services would save more than 100,000 lives every year in the U.S., according to a new study released today by Partnership for Prevention. That includes 45,000 lives that would be saved each year if more adults took a daily low-dose aspirin to prevent heart disease. The new study, funded by the federal Centers for Disease Control and Prevention, Robert Wood Johnson Foundation and WellPoint Foundation, found that a few measures—such as more adults getting flu shots and being screened for cancer—could save tens of thousands of lives each year in the United States. The study found serious deficiencies in the use of preventive care for the nation as a whole—and particularly troubling shortfalls among racial and ethnic populations.
Lives saved annually:
* 45,000 if we increased to 90 percent the portion of adults who take aspirin daily to prevent heart disease.
* 42,000 If we increased to 90 percent the portion of smokers who are advised by a health professional to quit.
* 14,000 if we increased to 90 percent the portion of adults age 50 and older who are up to date with any recommended screening for colorectal cancer.
* 12,000 if we increased to 90 percent the portion of adults age 50 and older immunized against influenza.
AND
* 30,000 cases of pelvic inflammatory disease if we increased to 90 percent the portion of sexually active young women screened per year for chlamydia infection
From Children's Hospital in Seattle we learn that despite marketing claims, parents who want to give their infants a boost in learning language probably should limit the amount of time they expose their children to DVDs and videos such as “Baby Einstein” and “Brainy Baby.” Rather than helping babies, the over-use of such productions actually may slow down infants eight to 16 months of age when it comes to acquiring vocabulary, according to a new study by researchers at the University of Washington and Seattle Children’s Hospital Research Institute.
In today's JAMA is a review of such non-pharmaceutical interventions as quarantine during the 1918 flu pandemic. The review demonstrates a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment. Of course we did not have the ACLU telling us about rights instead of responsibilities.!
[JAMA. 2007;298:644-654.]
In today's JAMA is an article on the value of testing older men for Osteoporosis. For men =>65 with previous fractures, and for men over 80 bone density testing may be worthwhile, although the cost per individual found to be osteoporotic may be high. in the absence of a prior fracture or other substantial additional fracture risk factors, The densitometry and follow-up treatment strategy may be cost-effective only for men aged 80 years or older. [JAMA. 2007;298:629-637. ]
In Today's JAMA there are articles and editorials about access to immunization. Among the snippets is the following: "New vaccines recommended for children have doubled in the past five years and the cost to fully vaccinate a child -- about $1,170 -- is 7.5-times higher in 2007 than it was in 1995." The research was based a survey of "state immunization program managers in 48 states from January to June 2006."
For those interested in the topic, and ashamed of the performance of the United Nations, the current issue of the Lancet [Volume 370, Issue 9585 pp. 361-456 (4 August 2007-10 August 2007)] contains some valuable philosophic discussions on health & human rights, that apply not only to the UN, but to the developed nations..
Despite media hype, the research published in this week's Archives of Pediatrics & Adolescent Medicine on a possible relationship between obesity and birth defects. although statistically significant, shows only a moderate risk. However, obesity is a risk for so many problems that this is one more reason to pay attention to exercise and diet.
[Arch Pediatr Adolesc Med. 2007;161:729]
"We once thought that IUDs could only be used in married, monogamous women because of a perceived increase in the risk of pelvic infections," said lead investigator, Catherine A. Matthews, M.D., assistant professor in the Department of Obstetrics and Gynecology at VCU.
"From our study, we now know that IUDs are safe to use in all women who don't have an acute infection of the cervix. Therefore, young, unmarried, sexually active women can now be considered good candidates for this contraceptive option, which doesn't require taking a pill, patch, or injection," she said.