Dr. Buttery's Public Health BLOG

"Far and away, the most serious hospital risk is a medication error," says Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Md. "All it takes is for someone to miss a decimal point and you could have a life-threatening mistake." A 2006 report from the Institute of Medicine estimated that every year, there are 450,000 injuries resulting from medication errors in hospitals, and perhaps many more that are unreported.

Posted by at 10:59 AM | Permalink | Comments (0)

On 26 September 2007 Norwegian Prime Minister Jens Stoltenberg unveilled "Deliver Now" during the Clinton Global Initiative annual meeting - part of a series of events to launch the campaign in New York. This is the second initiative of the Global Campaign for the Health MDGs. Prime Minister Stoltenberg will launch a "Network of Global Leaders" to provide political momentum and promote investment in mother and child health services. The global launch will be followed by regional launches and country action to begin in 2008. The campaign is being coordinated by The Partnership for Maternal, Newborn & Child Health.

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

Researchers from the Johns Hopkins Bloomberg School of Public Health, Cienfuegos, Cuba, and Loyola University had a unique opportunity to observe the impact of population-wide weight loss due to sustained reductions in caloric intake and an increase in energy output. This situation occurred during the economic crisis of Cuba in 1989-2000.“This is the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake,”

Posted by at 10:44 AM | Permalink | Comments (10)

An article in this week's New England Medical Journal, one more trying to determine how much danger, thimerosal in vaccines poses to children apparently finds no causal link. The problem is the weasel-words, circumlocutions and bad prose used to state the conclusion as well as the poor judgement of the study designers by including so epidemiologists with ties to Merck and other pharmaceutical companies in the study. While the study may have been free of bias it gives the perception of having been designed to favor the vaccine makers, and will not help when the issue go to court. This study has not done good service to the case for prevention.
[N Engl J Med 2007;357:1281-92.]

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

To be considered for the ADA’s Seal of Acceptance, products must withstand demanding review in a variety of areas. Among other things, manufacturers must:
Supply objective data from laboratory and clinical studies that support the product's safety, effectiveness and promotional claims
Submit ingredient lists for review and approval
Provide evidence that manufacturing and laboratory facilities meet ADA standards
After a rigorous review process, the American Dental Association (ADA) Council on Scientific Affairs has awarded the ADA Seal of Acceptance to Wrigley sugarfree chewing gums Orbit, Extra, and Eclipse, because they are clinically shown to help prevent cavities, reduce plaque acid and strengthen teeth

Posted by at 11:29 AM | Permalink | Comments (0)

In a commentary from this week's JAMA Stephen Havas, MD, MPH, MS; and associates state that approximately 16.7 million individuals worldwide, including 850 000 in the United States, annually die of cardiovascular diseases. Further, across populations, the progressive increase in blood pressure levels and the prevalence of hypertension with age are directly related to sodium intake. In the Dietary Approaches to Stop Hypertension-Sodium Trial, the largest decrease in SBP occurred when sodium intake was reduced from 2300 to 1500 mg/d.25 Attaining this level would necessitate reducing sodium in processed and restaurant foods by approximately 80% based on current dietary habits. From a public health perspective, lowering sodium by that amount should be the long-term goal. [JAMA. 2007;298:1439-1441]

Posted by at 10:12 AM | Permalink | Comments (0)

The American Cancer Society is doing something unprecedented in its latest publicity campaign to get Americans to sit up and take notice. Society CEO John R. Seffrin stated unequivocally earlier this month that transforming America's broken health care system is the only way to defeat cancer. In his announcement urging a national debate on health care access, Sefrin said that people who do not have access to timely and adequate health care miss cancer prevention, early detection and treatments that could ward off the disease or save lives.

Posted by at 1:30 PM | Permalink | Comments (0)

A comprehensive new national study of middle-aged and older adults, published in the Sept. 24 issue of the Archives of Internal Medicine, was performed by a team from the University of Michigan and the VA Ann Arbor Healthcare System. Despite decades of advances in diabetes care, African Americans and Latinos are still far less likely than whites to have their blood sugar under control, even with the help of medications, a new nationally representative study finds. That puts them at a much higher risk of blindness, heart attack, kidney failure, foot amputation and other long-term diabetes complications.

Posted by at 1:26 PM | Permalink | Comments (1)

A new workable secondary prevention technique to prevent esophageal reflux. Surgeons in the Oregon Health & Science University Digestive Health Center are the first and only in the United States to use a newly FDA-approved procedure known as EsophyX transoral fundoplication to stop the debilitating symptoms and complications of gastroesophageal reflux disease, or GERD, which affects some 14 million Americans every day.

Posted by at 1:23 PM | Permalink | Comments (7)

A study reported in todays Archives of Internal Medicine, states that "No consensus exists on the appropriate content of preventive visits and that most counseling services occurred outside the annual physicals" The surveillance shows that while physicians talk about the value of prevention, few practice it, despite effectiveness when used. [Ateev Mehrotra; Alan M. Zaslavsky; John Z. Ayanian, Arch Intern Med. 2007;167:1876-1883.]

Posted by at 10:16 AM | Permalink | Comments (0)

Nearly 230 Idaho residents have been sickened by a waterborne parasite this year, along with hundreds of others across the Rocky Mountain West, health officials said. An AP report states the cryptosporidium outbreak has reached record numbers, Idaho Department of Health and Welfare spokesman Tom Shanahan said, and has federal officials looking at the role water parks and public pools play in spreading the diarrhea-causing parasite. Health officials believe splash parks and other recreational water parks can offer the hardy parasite the opportunity to rapidly spread from person to person.

Posted by at 11:51 AM | Permalink | Comments (0)

Women sometimes feel there’s nothing they can do to improve their chances of survival after a breast cancer diagnosis. But there is, according to scientists at the University of North Carolina at Chapel Hill and other institutions. Don’t gain weight after age 40. A new study shows premenopausal women who gain more than 35 pounds after age 20 — prior to breast cancer diagnosis — are two times less likely to survive the disease. And postmenopausal women who gain more than 29 pounds after age 50 are nearly three times less likely to survive. Maintaining weight was not associated with the increased risk.

Posted by at 11:44 AM | Permalink | Comments (0)

A much-heralded H.I.V. vaccine has failed to work in a large clinical trial, dealing another serious setback to efforts to stop the AIDS epidemic. The vaccine’s developer, Merck, said yesterday that it had halted test vaccinations after the vaccine failed to prevent infection or reduce the severity of infection among volunteers who became infected during the trial. Hope for this elusive vaccine remains as about 30 other H.I.V. vaccines are being tested in people and all work somewhat differently, said Wayne C. Koff, a senior vice president of the International AIDS Vaccine Initiative in New York.

Posted by at 12:01 PM | Permalink | Comments (0)

In the NEJM this week is a review of one of the older AHRQ recommendations for quality care. The early use of beta-blockers for secondary prevention of repeat coronary events, after the first. It has taken 25 years for this measure to be practiced in all hospitals, but it has now reached universal adherence. [Thomas H. Lee, M.D. Volume 357:1175-1177]

Posted by at 11:14 AM | Permalink | Comments (0)

A "Perspective" essay in today's NEJM is well worth reading. Particularly interesting is the comment that a new compact needs to be formed where individuals take more responsibility for their own health. [M. Gregg Bloche, M.D., J.D. Volume 357:1173-1175]

Posted by at 11:05 AM | Permalink | Comments (1)

Forty-one U.S. hospitals [thirty-three hospitals and eight children's hospitals were named top facilities by] have been named 2007 Leapfrog Top Hospitals, based on results from the Leapfrog Hospital Quality and Safety Survey, a rating system that provides an up-to-the-minute assessment of a hospital’s quality and safety. The 2007 Top Hospitals list is based on 1,285 hospitals and evaluated them in four areas such as "having intensive care units staffed by specially trained doctors and having computerized order-entry systems for medications and other orders with error-prevention measures.

Posted by at 12:10 PM | Permalink | Comments (0)

The U.S. Food and Drug Administration (FDA) today sent a warning letter to Procter & Gamble for making unlawful claims about its Vicks Early Defense Foaming Hand Sanitizer (Early Defense) product. The agency says the product’s claims and directions for use cause it to be an unapproved new drug under the Federal Food, Drug, and Cosmetic Act. It cited specifically Procter & Gamble promotion of Early Defense for use by schoolchildren to prevent colds and to provide antimicrobial activity for up to three hours. Although FDA is not aware of significant health risks associated with Early Defense, the agency is concerned because this product has not been proven safe and effective for these claims.

Posted by at 12:07 PM | Permalink | Comments (0)

In an excellent example of secondary prevention a study of 2,127 patients who received the drug zoledronic acid (trade name Reclast) within 90 days of surgery for a hip fracture had a 28 percent reduction in death and were 35 percent less likely to suffer another fracture. "These data show that we can go beyond cutting the risks of future fractures to reducing the death rate after these disabling fractures," said Kenneth W. Lyles, M.D., geriatrician and endocrinologist who works at Duke University Medical Center

Posted by at 9:41 AM | Permalink | Comments (0)

from the AP today is news about the Parkland Hospital, Dallas, self check in sytem (similar to airline kiosks.) The story notes that the self check in system avoids standing in long lines when you think you are sick. Instead you sit down and wait hours for a nurse to reveiw the data and come to check your vital signs!

Posted by at 10:04 AM | Permalink | Comments (3)

In an editorial from the BMJ this week the writer noted that dire predictions from the tobacco industries that forecast the end of civilisation after banishing smoking from bars, & that the bar economy and tourism would collapse proved without merit. Smoke-free bars remain full from Dublin to New York, Auckland, Vancouver, Oslo, Sydney, Rome, and Glasgow. Legislation limiting smoking has led to significant reduction in exposure to tobacco smoke as measured by serum cotinine levels.

Posted by at 11:07 AM | Permalink | Comments (2)

A potential vaccine against malaria in children in Mali, Africa (where malaria is the major cause of death among chlidren under 10 years of age) is being tested by researchers from the University of Maryland School of Medicine and the University of Bamako ..

Posted by at 10:51 AM | Permalink | Comments (3)

The United States continues to spend the most on health care when compared to other Organization for Economic Cooperation and Development (OECD) countries. Health care prices and higher per capita incomes are major factors for higher U.S. spending, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health and Princeton University.
U.S. health care spending per capita was 2.5 times greater than the median OECD country.
The United States spent 15.3% of our gross domestic product on health care, which is substantially higher than any other OECD country.
Despite the fact that:
The United States had fewer physicians, nurses and hospital beds per capita than the OECD median.
The United States also had lower utilization rates than the OECD median for physician visits per capita, acute care bed days and average length of inpatient stay.

Posted by at 10:45 AM | Permalink | Comments (0)

In the Archives of Internal Medicine this week discussing the problem of labels on medication prescription bottles there was substantial variation in the font size of different items. The largest item on 71 (84%) of the labels was the pharmacy logo. The mean font size was 13.6 point for the pharmacy logo, 9.3 point for medication instructions, and 8.9 point for drug name. Auxiliary instructions and warning stickers were a mean 6.5-point font. As one ages, and are more likely to need a prescription, your eysight deteriorates making reading prescription labels more difficult!

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

New survey figures reported by UNICEF today show solid progress, with worldwide child deaths at a record low of 9.7 million per year – down from almost 13 million in 1990. Much of the progress reflected in the new child mortality figures is the result of widespread adoption of basic health interventions such as early and exclusive breastfeeding, measles immunization, vitamin A supplementation to boost children’s immune systems, and the use of insecticide-treated bednets to prevent malaria. Proper treatment of pneumonia, diarrhoeal diseases and severe malnutrition, and treatment of paediatric HIV/AIDS, are also important for child survival – as are hygiene promotion and access to safe drinking water and sanitation.

Posted by at 11:17 AM | Permalink | Comments (0)

From the NCHS today, a child born in the United States in 2005 can expect to live nearly 78 years (77.9) – a new high – according to a report released today by the Centers for Disease Control and Prevention (CDC), “Deaths: Preliminary Data for 2005.” Althogh this is a record for the US, it is still well behind many other countries, and does not describe the quailty of life for the aged.

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

Has Medical Care been too successful. Are we holding back death to have people vegetate with chronic diseases? Around the world the various health care systems are asking the same question about the mpact of chronic disease. Australia’s health care system needs new reform on the same scale as the introduction of Medicare in the 1970s if it is to cope with the 21st Century epidemics of chronic disease, says the head of a new health policy research centre to be launched at the University of Melbourne. Associate Professor Dunt says this is unsuitable for the treatment of chronic diseases which requires teams of health professionals as the fee-for-service system has developed a largely uncoordinated health care system based on mixed public/private health care sectors and the overlapping roles of Commonwealth and State governments in both funding and delivering services.”

Posted by at 11:01 AM | Permalink | Comments (1)

The renewed worldwide commitment to the reduction of maternal and child mortality, if translated into effective action, could help to provide the systemic changes needed for longterm elimination of maternal and neonatal tetanus. These are the conclusions of authors of a Seminar published early Online and in an upcoming edition of The Lancet. Dr Jos Vandelaer, World Health Organisation, Geneva, Switzerland, and colleagues, say: "Although easily prevented by maternal immunisation with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries, mainly in Asia and Africa."

Posted by at 11:17 AM | Permalink | Comments (0)

From the Massachussetts General Hosoital - Children under the age of 5 who receive an annual flu shot have a greatly reduced risk of needing to see their doctor or be admitted to the hospital because of flu-related illness. A new study in the September issue of Pediatrics that analyzes how many outpatient visits or hospitalizations might be prevented by childhood influenza immunization finds that vaccinating only half U.S. children could eliminate as many as 650,000 doctor's office visits and 2,250 hospitalizations in a year

Posted by at 11:12 AM | Permalink | Comments (0)

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. As of Jan. 15, 2009, health care providers can no longer submit any claims on paper, and eligibility checks also must be done online.

Posted by at 10:41 AM | Permalink | Comments (0)

Breasts move far more than ordinary bras are designed to cope with, according to a study by University of Portsmouth scientist Dr Joanna Scurr. And they also bounce more during exercise – up to 21cm rather than the maximum 16cm bounce measured in past studies. It is estimated that more than 50 percent of women experience breast pain when exercising. Significantly, Dr Scurr’s latest study also found that breasts move as much during slow jogging as they do at maximum sprint speed. Dr Scurr is working with major bra manufacturers in Britain and globally who are vying to design a bra which can lessen movement in all three dimensions and reduce much of the pain many women suffer when exercising.

Posted by at 10:34 AM | Permalink | Comments (1)

While staying germ-free can prevent the spread of disease and infections, leading a cleanlier lifestyle may be responsible for an increase in allergies among children. “It’s called the hygiene hypothesis,” says Marc McMorris, M.D., a pediatric allergist at the University of Michigan Health System. “We’ve developed a cleanlier lifestyle, and our bodies no longer need to fight germs as much as they did in the past. As a result, the immune system has shifted away from fighting infection to developing more allergic tendencies.”

Posted by at 11:16 AM | Permalink | Comments (0)

Physicians who score poorly on patient-physician communication skills exams are far more likely to generate patient complaints to regulatory authorities, says a new study led by McGill University’s Robyn Tamblyn and published in the September 5 issue of JAMA. Tamblyn’s team followed 3,424 physicians licensed to practice in Ontario and Quebec who took the Medical Council of Canada clinical skills examination between 1993 and 1996. They discovered a very strong relationship between those who scored poorly and later complaints by patients. There is no reason to suppose the same situation does not prevail in the U.S.

Posted by at 11:13 AM | Permalink | Comments (0)

Translational research if often difficult. This is particularly so when faced with expectations from parents, advanced by the media, due to misconceptions based on beliefs unsubstantiated by evidence, which has spawned a vast industry in the U.S. This industry promotes a belief that all brain dysfunction in children can be cured by appropriate education. If only this were the case. An editorial on the topic of translating brain research into deliverable practices, in this week's journal "Science" should be required reading for anyone who works with children suffering from developmental disabilities, particularly legislators and educators confronted by parent activists.

Posted by at 1:29 PM | Permalink | Comments (0)

The Dutch system, which took effect on Jan. 1, 2006, requires that all adults purchase health insurance and that all insurers offer a policy to anyone who applies, regardless of age or health. The system "hinges on competition among insurers," who are "expected to cut premiums, persuade consumers to live healthier lives and push hospitals to provide better and lower-cost care," the Wall Street Journal reports.

Posted by at 12:04 PM | Permalink | Comments (0)

World Rabies day is on Spetember 28th. Rabies in humans is 100% preventable through prompt appropriate medical care. Yet, more than 55,000 people, mostly in Africa and Asia, die from rabies every year - a rate of one person every ten minutes.

Posted by at 11:52 AM | Permalink | Comments (0)

In 2004, suicide was the third leading cause of death among youths and young adults aged 10–24 years in the United States, accounting for 4,599 deaths. Ileana Arias, director of the National Center for Injury Prevention and Control at the CDC, is quoted as saying, "Our news today is sobering and raises a great concern for us. ... Suicide is the third leading cause of death among people ages 10 to 24, surpassed only by car crashes and homicides.

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

Rock and pop stars are more than twice as likely as the rest of the population to die an early death, and within a few years of becoming famous, reveals research published ahead of print in the Journal of Epidemiology and Community Health.[Online First J Epidemiol Community Health 2007; doi]

Posted by at 12:34 PM | Permalink | Comments (0)

One more reason for recently pregnant women not to smoke. A study from Monell Chemical Senses Center in Philadelphia and published in Pediatrics finds that nicotine in the breast milk of lactating mothers who smoke cigarettes disrupts their infants' sleep patterns. “Infants spent less time sleeping overall and woke up from naps sooner when their mothers smoked prior to breastfeeding,” says lead author Julie A. Mennella, PhD, a psychobiologist at Monell.

Posted by at 12:29 PM | Permalink | Comments (0)