The aging population.
As we age many of us may need nursing support (up to one in three of those turning 65 in 2010.) The proportion of the "aged" population is increasing dramatically due to our ability to extend lives and modify chronic diseases.
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February 29, 2008
By Sixth Grade Nearly One In Six Children Are Alcohol Users
University of Minnesota School of Pubic Health finds nearly one in six children are already alcohol users. Sixth-grade users of alcohol were significantly different from the non-users on almost all risk factors examined. For example, users were more likely to be male, engage in violent or delinquent behavior, and have friends who used alcohol. Researchers suggest a prevention program prior to sixth grade in which parent involvement is central. Students should receive developmentally-appropriate messages that correct inaccurate perceptions that 'drinking is normal' and that provide tweens with the skills to refuse alcohol. In addition, interventions should include parental involvement in order to help create opportunities for increased parent-child communication and provide parents with the skills to increase monitoring. But how many of these children have a stable family life with two parents in the home? We are not given that information.
From Research to Practice
Researchers at Purdue University have developed a new technology that can simultaneously screen thousands of samples of food or water for several dangerous food-borne pathogens in one to two hours. With the repeated recalls of tainted produce and the inablity of local communities to provide sufficient funds to inspect food service places adequately, and usually only after an outbreak shows the deficiency, this is a technology that needs rapid translation from the laboratory to the field.
February 28, 2008
Mpping Malaria Incidence
With support from the Welcome Institute in the UK researchers have been mapping Malaria in an effort to understand how to limit its spread and focus limited resources more carefully. About 35 percent of the world's population is at risk of contracting deadly malaria. This new map (the first in several decades) is important in part because it offers hope that malaria could be eliminated in certain areas using currently available tools, such as bed nets treated with insecticide that kills mosquitoes, the researchers said. It will also help donors and international agencies target investments in control measures where they are most likely to achieve the biggest gains.
More than 500 million cases of malaria are reported annually. Of those afflicted, about one million die; 80 percent of them are children in sub-Saharan Africa.
February 27, 2008
Antidepressants are ineffective for most patients
In a study published in PLoS Medicine today, psychologists at the University of Hull in the UK, found that antidepressants have no clinically significant effects in all cases apart from a small group of the most severely depressed patients. Their analysis showed that in comparison to placebo effects, antidepressants do not have clinically significant effects in mildly depressed patients or in most patients who suffer from very severe depression. Furthermore, the apparent clinical effectiveness of antidepressants in the small group of extremely depressed patients is somewhat distorted. The seemingly good result came from fact that these patients’ response to the placebo decreased, rather than any notable increase in their response to antidepressants.
Is this just one more case of overmedication due to irrespossible advertising and the need of doctors to "do something"?
February 26, 2008
Updated Clinician’s Guide to Prevention and Treatment of Osteoporosis
The National Osteoporosis Foundation (NOF) is releasing its new Clinician’s Guide to Prevention and Treatment of Osteoporosis representing a major breakthrough in the way healthcare providers evaluate and treat people with low bone mass or osteoporosis and the risk of fractures.
The NOF summarizes universal recommendations in its 5 Steps to Bone Health. These 5 Steps advise people to:
1. Get the daily recommended amounts of calcium and vitamin D.
2. Engage in regular weight-bearing and muscle-strengthening exercise.
3. Avoid smoking and excessive alcohol.
4. Talk to your healthcare provider about bone health.
5. Have a bone density test and take medication when appropriate.
Improved Cognitive Health among Older Americans
From the NIH today we find that getting older is less likely to be associated with declining memory. Rates of cognitive impairment among older Americans are on the decline, according to a new study supported by the National Institutes of Health (NIH) comparing the cognitive health of older people in 1993 and 2002. Higher levels of education were associated with better cognitive health.
The report appears in Feb. 20, 2008, issue of Alzheimer's & Dementia (now online). The National Institute on Aging (NIA), part of the National Institutes of Health (NIH), and Harvard University, funded the study conducted by Kenneth M. Langa, M.D., Ph.D., and colleagues at the University of Michigan, University of Pennsylvania, and Group Health Cooperative of Puget Sound in Seattle. The National Institute of Mental Health (NIMH), also part of NIH, provided additional support.
Primary Care consultations can cut breast cancer risk
The time has come for breast cancer risk assessment, counseling and genetic testing to move from cancer specialists to the realm of primary care, according to a presentation at the AAAS annual meeting, held this year in Boston.
"A growing body of evidence has documented the benefits of preventive measures for high-risk women including those with mutations in the BRCA1 and BRCA2 genes," said Funmi Olopade, MD. "Referral for cancer-risk assessment and BRCA testing in the primary care setting is a necessary next step towards personalized medicine for women at risk for breast cancer."
Most high-risk women present in the primary care setting. Primary care physicians should learn about the genetics of cancer risk, take a comprehensive personal and family history and advise patients who appear to be at increased risk about the plusses, minuses and limitations of genetic testing and risk-reduction strategies.
Why can't We Learn from Others?
STD infections continue to increase in prevalence inteh U.S. but in Australia a new study indicates that the safe sex message is getting through to Australian women, with nearly 70 per cent of those surveyed currently using contraception and 15 per cent using not one but two contraceptive methods to prevent pregnancy and protect themselves from sexually transmitted diseases.It uses survey data from more than 3000 women aged between 18 and 44 about their contraceptive use. The variation in the seven most prevalent contraceptive practices between different age groups, marital status, parity, education level, place of residence, birthplace, and Aboriginal or Torres Strait Islander descent was examined.
Two-thirds of respondents were using contraception, including more than 15 per cent who used more than one method. The contraceptive pill was the most widely used method (39 per cent), followed by the condom (28 per cent). Interestingly, more than one-quarter of pill users (28 per cent) were using condoms as well.
Limit Visits during Flu Season
Duke Hospital is limiting access by visitors with Upper Respiratory Infections (URI). Many of these will be Influenza and can harm those in the hospital already. Similarly businesses should tell employees with URIs to stay home. counsel all employees to wash hands frequently, and stop shaking hands when greeting visitors.
The cost of getting old.
Data from projections on the cost of medical care show that within the next 40-50 years, if unrestrained, medical care will use up 50% of the GNP! Within the next 10 years, according to reports in major news papers today, the Centers for Medicaid & Medicare Services (CMS). While we are living longer, and many living without significant disease or deterioration, those who do not observe good health habits early will break the the US fiscal system. We cannot keep puttering along tinkering with the fringes of medical care organisation. Neither can we continue to focus on institutional care, but need to commit to a system that ensure access for all to good quality primary care, with a focus on health instead of disease. There are many who think that whatever the cvost we must treat all disease with a high tech approach. Every additional dollar we spend on treating disease, instead of preventing it is a dollar less for food, housing, education, transportation and productivity.
February 25, 2008
Presenting data
A wonderful presentation on how to make data useful and translate it into understandable form.
February 23, 2008
The War on Obesity
A fascinating article in the current American Journal of Public Health examines the value of dietary guidelines and the evidence supporting them. In particular the critique is concerned about the potential ill effects of dietary changes when the public may believe they are fully informed. We should be particularly careful about emulating the public health intervention on eliminating trans fats that has been enacted in New York City. While data may be fair on the value of reducing fats to prevent cardiovascular disease, there is almost no data on ill effects from the elimination of trans fats. Many of the dietary guidelines are based in flimsy evidence with politics playing a major role. We need to be very careful about trying to change behavior by legislation, without much better data than that currently available. The accompanying article about the critique, by Woolf & Nestle should also be read, as well as the author's response to Woolf & Marantz.
February 22, 2008
Adults fail to recognize heart attack warning signs
A new CDC study reveals that an alarming number of adults fail to recognize heart attack warning signs and symptoms that could, if heeded, save their lives, according to a new Centers for Disease Control and Prevention (CDC) study conducted in 14 states. Men (22.5 percent), blacks (16.2 percent), Hispanics (14.3 percent), and those with less than a high school education (15.7 percent) are less likely to know the major signs of a heart attack. They were also least likely to call for emergency assistance; compared to women (30.8 percent), whites (30.2 percent) and those with higher educations (33.4 percent).
Underinsured getticg care too late
According to a new American Cancer Society study of 3.5 million cancer patients with 12 of the most common cancer types. Uninsured or Medicaid-insured patients are far more likely to be diagnosed with an advanced stage cancer than those with private insurance, What's more, many of those advanced cancers were types that could have been detected early through proper screening. The review suggests people without private health insurance aren't getting the best possible care when it comes to cancer prevention and early detection.
Cancer Facts and Figures 2008
From the Annual Report of the American Cancer Society we learn that cancer death rates have decreased by 18.4% among men and 10.5% among women since the early 1990s. But while reports from the last two years have seen declines in the overall number of cancer deaths (in 2003 and 2004), this year's report examining 2005 data shows an increase (559,312 cancer deaths in 2005 compared to 553,888 in 2004). Cancer mortality rates continue to drop and they're doing so at a rate fast enough that over half a million deaths from cancer were averted between 1990/1991 and 2004."
February 16, 2008
Is Public Health Losing Credibility?
On today's Richmond Times Dispatch editorial pages are discussions about the efforts of public health activists to mandate "health" policies that are becoming policing actions.. While educational efforts to reduce smoking have had some success, particularly among men, constant new legislative efforts are turning public health agencies into police departments. Now with foci on how we can cook what we are allowed to eat, when we are allowed to eat (laws to ban restaurants from serving food to over weight people), in addition to suggested laws on how much we must exercise and suggestions to tax our weight, Aldous Huxley must be spinning in his grave. The Brave New World is here. Walter WIllaims is correct about the camel's nose under the tent. We are moving from education, the strength of past public health efforts, to policing behavior. We are part of the way there with behavioral agencies that have expanded from improving mental health into social tinkering. All these efforts, while well intentioned are dangerous to the public's well being..
February 15, 2008
WHO & Tobacco
Based on a report sponsored by a foundation established by New York City mayor Michael R Bloomberg the WHO recommends a public policy that would increase one particular form of taxation even further—a move that would effectively tax citizens everywhere to life instead. Increasing taxes on tobacco products is a proven method of reducing their consumption and is one of the six core interventions in the WHO Report on the Global Tobacco Epidemic 2008. The six-point plan is a clear roadmap, supported by country-specific data and includes:
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
February 12, 2008
Living to 100 may be easier
In an editorial in the current Archives of Internal Medicine William J Hall discussed papers by Dellara F. Terry, Yates and himnself, and others. about more people living to 100 through a combination of genes and personal habits such as moderate diet and alcohol use, not smoking, moderate exercise, sufficient rest, an active brain and early secondary prevention of common chronic diseases. There were no magic potions, no magic pills, no complementary medicine. Just a careful approach to living. At the same time we must consider the impact of large numbers of nonagenarians and cetenarians who may not have good retirement plans and will need social support systems which are inneffective at best, currently. This is a two edged blessing.
February 11, 2008
Women Prefer Contraceptive Ring Over Patch
In a study researchers report in the current issue of Obstetrics and Gynecology that more women are happier with the ring than the patch. “Although oral contraceptives are the most commonly used reversible form of contraception in the United States, continuation rates are only 40 percent at six months of use,” the authors write. In addition, prior studies have shown that in the third month of use, about half of women miss three or more pills each cycle, likely decreasing contraceptive effectiveness.
February 9, 2008
Race for the “$1,000 Genome”
The potential for analysis of the individual human genome is advancing rapidly, according to a report in the NY Times today. If the cost of sequencing a human genome can drop to $1,000 or below, experts say it would start to become feasible to document people’s DNA makeup to tell what diseases they might be at risk for, or what medicines would work best for them. A DNA genome sequence might become part of each newborn’s medical work-up, while sequencing of cancer patients’ tumors might help doctors look for ways to attack them. This would be a great translation of research into prevention practice.
February 7, 2008
One more study to frost the activists.
A Japanese study, published in the British Journal "Cancer" today, again refutes the claims by health activists that using cell phones will cause cancer. Researchers found that regular mobile phone users were not at an increased risk of three types of brain cancer. Although a few studies have shown an association between mobile phones and cancer, the majority found no link. The largest study to date, involving 420,000 people, showed no link with any type of cancer, even after 10 years of use.
Epidemiology & Policy
An analysis by AHRQ has identified the most expensive medical conditions that keep driving up the cost of medical care. Public health programs need to focus their skills on reducing these conditions, in addition to their traditional programs. The ten conditions are:
Heart conditions—$76 billion.
Trauma disorders—$72 billion.
Cancer—$70 billion.
Mental disorders, including depression—$56.0 billion.
Asthma and chronic obstructive pulmonary disease—$54 billion.
High blood pressure—$42 billion.
Type 2 diabetes—$34 billion.
Osteoarthritis and other joint diseases—$34 billion.
Back problems—$32 billion.
Normal childbirth—$32 billion.
Prevention of heart disease among diabetics
We are told today about the early stoppage of NIH sponsored research (the ACCORD study) to reduce heart disease deaths among diabetics by strict and aggressive control of blood sugar levels. Early results have shown that aggressive treatment is more harmful than moderate approaches. Now we need to learn why, and how to provide better care of diabetics. Clearly primary prevention by encouraging better weight control, more exercise, and better diets are preferable to fixing the problem after it occurs. It is too bad that behavioral science has so little to offer.
Screening is not always the answer
Evaluations released today by AHRQ recommend NOT screening for drug abuse and vaginosis.Despite politicians' desires to look as though they are doing something useful, passing laws to require screening for many conditions does not meet the standards of scientific scrutiny, The major problem is a false positive; labelling people as having a condition when screened for while they do not have it. A false accusation of drug use has many disastrous effects. The evidence shows the treatment programs are minimally effective, despite the claims of proponents. A false negative is much less harmful.
February 6, 2008
One more reason not to smoke.
New research shows that cigarette smokers are four times as likely as nonsmokers to report feeling unrested after a night’s sleep. The study, appearing in the February issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians
February 5, 2008
Heart Disease Deaths Continue to Decline in American Women
Heart disease deaths in American women continued to decline in 2005, and for the first time, have declined six years consecutively, covering the years 2000-2005, according to newly analyzed data announced today by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Preliminary data for 2005, the most recent year for which data are available. The analysis shows that women are living longer and healthier lives, and dying of heart disease at much later ages than in the past years. Women need to be aware of the major risk factors:
age (55 or older for women);
a family history of early heart disease;
high blood pressure;
high blood cholesterol;
diabetes;
smoking;
being overweight or obese; and
being physically inactive.
Perverted Science.
The Washington Post today reports on a medical economist's research in Holland that purports to show that healthy people are a drain on the state's economy! The reason being that smokers and obese people die early and thair overall cost to the state is less!. So, what are we supposed to do? All smoke and overeat so we die sooner? SIlly research and bad policy, but Aldous Huxley would love it.
February 1, 2008
Anti-Malaria Efforts Yield New Success
The findings from Rwanda and Ethiopia are the first to show a greater than 50 percent reduction in malaria mortality nationwide in "high burden" countries.
Malaria is responsible for 2 percent of all deaths worldwide and 9 percent of deaths in Africa. Each year, about 1.1 million deaths -- almost all in children -- are directly attributable to the disease, and at least a million more occur from complications such as severe anemia. In Africa, where most cases occur, malaria costs $12 billion a year in medical expenses and lost productivity.
Two key items in the current "tool kit" are bed nets treated with insecticide that lasts as much as five years, and treatment with at least two drugs, one of them artemisinin, a compound derived from a Chinese herbal medicine.
Improving health at birth
Two news researach projects have found significant ways toi improve pregnancy outcome.
Researchers at the University of North Carolina-Chapel Hill found that administering magnesium sulfate intravenously could not only "halt [early] contractions" and preeclampsia, but it is also believed to reduce blood vessel constriction in the infants' brains. Treatment was associated with a 50% reduction in cerebral palsy.
A University of Texas Medical Branch team has found that folic acid "might cut the chances of delivering a premature baby by half or more.