Dr. Buttery's Public Health BLOG

Simon Wessely in his review of the Textbook of Disaster Psychiatry in the British Medical Journal this week explains that before 1980 everyone assumed that people who were mentally robust before a disaster would recover smoothly afterwards. After 1980 some argued that long term disorders could arise even in the most robust individuals. The "result was an explosion of interest and research" in post traumatic stress disorder and the belief (now recognised to have been mistaken) that everyone who experienced a disaster needed help in the form of immediate psychological interventions such as debriefing. Yet, Wessely says, lessons learnt in the second world war remain true today: people in cities bombed into submission don’t necessarily cave in. Are we so different from the British? Or is it the tort lawyers and mental health activists who push this fad in the US?

Posted by at 6:15 PM | Permalink | Comments (2)

A follow-up to a recent blog on childhood lead poisoning, new data from the U. Cincinatti published in PLoS Medicine today shows that Childhood lead exposure is associated with region-specific reductions in adult gray matter volume. Affected regions include the portions of the prefrontal cortex and ACC responsible for executive functions, mood regulation, and decision-making. These neuroanatomical findings were more pronounced for males, suggesting that lead-related atrophic changes have a disparate impact across sexes. This analysis suggests that adverse cognitive and behavioral outcomes may be related to lead's effect on brain development producing persistent alterations in structure. This research provides biological plausability to the long standing belief that lead poisoning of children causes both learning deficits and antisocial behavior. It also provides evidence for an evironmental cause of behavioral deficits in children from slum areas where lead is most likely to be found.

Posted by at 10:39 AM | Permalink | Comments (0)

Don' t trust what you read in the news media. In PLoS Medicine Gary Schwitzer reviews 500 stories published by major media. Among his conclusions were that:
The daily delivery of news stories about new treatments, tests, products, and procedures may have a profound—and perhaps harmful—impact on health care consumers.
That journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.
As a result even careful reading of news stories, without examining the source of the data may be harmful to readers, and those they care for. The internet will usually provide links to the original research where the reader can look for the quality of the data.

Posted by at 9:52 AM | Permalink | Comments (0)

Many people do not realize that TB (Tuberculosis) is still a relatively common illness. It is brought into the U.S. by travellers and immgrants. At present, two billion people worldwide are believed to have latent or dormant TB. Of those infected, but with no signs or symptoms of disease, eight to nine million will develop TB each year, of whom 1.6 million will die. While Isoniazid therapy is 90 percent effective for those who complete it, in reality, fewer than 50 percent do. . The high attrition rate can have serious public heath effects, not only for the patients who fail to complete therapy, but also for the individuals they may later infect. Four months of Rifampin instead of the current nine months of Isoniazid costs significantly less for the healthcare system and is more likely to be completed by the infected person.

Posted by at 9:44 AM | Permalink | Comments (0)

According to research from the University of Texas Health Science Center at Houston a new study provides added justification that a thiazide-type diuretic is the best first-choice drug for hypertensive patients. Why do we have to keep reinventing the wheel? A study on Veteran's completed 50 years ago showed similar findings. The public always wants New Technology or New Drugs in the mistaken belief that new is always better. Had we applied the information from the original VA study and the Framingham study as carefully as the 'Joint National Committee on High Blood Pressure' wants to do today we would have saved millions of lives, reduced disability and saved billions of dollars. As I have noted in other blogs population data often take years to collect. In the arena of chronic diseases, in particular, we should require that before new drugs are put on the market that the outcome of their use is evaluated in 10's of thousands of people, as tends to be the case in studies in Europe before approval. We have to keep recalling new drugs not because they were ineffective, but once let out into the general population of 300 million people the deficits became evident. No new drugs should be approved without population based studies which could assure us that only useful drugs, with minimal side effects (all drugs have side effects), that perform better than current medicines be approved. Part of the problem can be laid at the doors of 'research" universities and the publish or perish demand on their scholars, while drug companies are allowed to advertise prescription medicine to the public. We are one of only 2 countries that sllow such a travesty..

Posted by at 9:28 AM | Permalink | Comments (5)

Some fascinating research published in the New England Journal of Medicine this week has identified social links may either enhance your likelihood of smoking or lead to quitting smoking. It all depends on your peer group. Both are important. The editorial [n engl j med 358;21 may 22, 2008] states that increasingly smoking behavior is marginalized to smaller peer groups, while larger peer groups have influenced their members to stop smoking, and that smoking is not accepted among their peers. The journal states that adult smoking is now down to 19%, a significant decrease over the last 30 years. Behavioral changes occurs slowly, As we move to change behaviors that lead to chronic diseases, such as heart disease and diabetes from overeating we must realize that these are strategic policies that may take decades. We must not panic if change is not seen next year or the year after. This message needs to be translated for politicians who only want to fund programs that have results during their current incumbency.

Posted by at 10:24 AM | Permalink | Comments (0)

A new study published in Nature Nanotechnology Online today suggests that it was not the chemical composition of asbestos but the physical characteristics, and that other chemicals may be just as bad. Carbon nanotubules are similar physically to asbestos and are now being reported a likely to cause lung cancer and mesothelioma, just as asbestos does. There have been similar suggestions about the physical effects for the last 20 years. This is one of the reasons that fibreglass insulation installers are required to wear masks as they work. The data from the past also show that asbestos was much more dangerous when used by smokers. We should expect similar results with physically similar compounds.

Posted by at 9:39 AM | Permalink | Comments (0)

For those of us who had corneal tranplants years ago and have to use contact lenses , the new artificial corneas that will be available this year may be a solution, but it may be best to wait 2-3 years until there is more experience with their use. For those of us whose eye doctors have difficulty with obtaining the best fit for prescriptions a new automated system appears to be a significant option as it is introduced into the doctor's offices.

Posted by at 10:33 AM | Permalink | Comments (0)

According to a Cincinnati Children’s Hospital Medical Center study children are more vulnerable to the harmful effects of lead exposure at the age of 6 than they are in early childhood. For parents this means it is just as important to know about lead in your home and yard when your children reach school age as it was when they were toddlers. It also should raise the concern of parents everywhere to ensure their children are protected by community codes that require that all housing units are made lead safe, particularly rental units.
Approximately 310,000 U.S. children age 1 to 5 years have blood lead levels greater than 10 micrograms per deciliter, the level at which the Centers for Disease Control and Prevention recommends public health actions be initiated. But research has consistently shown that blood lead levels considerably lower than 10 micrograms per deciliter are associated with adverse effects.

Posted by at 2:55 PM | Permalink | Comments (0)

A fascinating "Perspective" on autism,. the MMR vaccine, the National Advisory Committee on Immunization and the Vaccine Injury Compensation Program is presented in today's New England Journal of Medicine (N. engl j med 358;20 may 15, 2008), which discusses the origin of the compensation program, and the failure of the program to follow a science base in its awards, opening the door to great injury to the vaccine program and setting the stage for another rush of pharmaceutical companies to flee from tthe vaccine field. If the current case in court is decided on feelings, rather than science, millions of people may die in the near future from lack of vaccines.

Posted by at 6:37 PM | Permalink | Comments (0)

Looking at the mutliple research studies on health it becomes clear, despite the poor quality of many studies, there are two consistent messages that should be taken to heart, To grow older and have less likelihood of cancer and improved mental abilities as one ages it is necessary to indulge in regular exercise and learning. The studies show that likelihood of cancer, heart disease, and diabetes, among other chronic diseases, are lower among those who exercise. The likelihood of mental deterioration, Alzheimer's diseases and limited cognitive ability are decreased with lifelong learning. Use your muscles and your brain daily and your health will be enhanced.

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

From the Guttmacher Institute today research, which surveyed women and family planning providers nationwide, uncovered a number of factors that impede women’s ability to use contraceptives consistently and correctly over the long term. “Helping women who do not want to become pregnant to use contraceptives more effectively is sound public policy that will reduce unintended pregnancy,” says study author Jennifer Frost, asenior research associate. Half of teh women seeking to avoid pregnancy remain at risk—some use no contraceptive at all (8%), some have periods of nonuse (15%) and some use their method inconsistently or incorrectly (27%). “Finding the ‘right’ contraceptive method is not a one-time decision—rather it’s a series of choices as women’s life circumstances and contraceptive needs change,” says Dr. Frost.

Posted by at 9:57 AM | Permalink | Comments (1)

An interesting 'Perspective' has been published in the BMJ this week by Roger England asking the public health field to consider whether it took the wrong approach to AIDS. The 'Think' piece notes that AIDS is not more important than malaria, pneumonia, diabetes or heart disease in developing countries. It also notes that if it were not for the diatribes of the Gay Communities AIDS would have been treated like other sexually transmitted diseases such as syphilis or gonorrhea and that faster progress might have been made. Further the public health community should not have shelved action against other major killing diseases in favor of AIDS. Maybe now is the time to place AIDS into perspective and treat it both as a chronic disease, like TB, and as an acute infectious disease like syphilis.

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

Acccording to an article in the May AJPM (Volume 34, Issue 6, Pages 463-470) "Only 28% of children beetween 18 & 30 months of age were correctly immunized." These children either had no immunization, only part of the required set or missed necessary doses to be properly protected. The U.S. falls way behind developing countries that can ill afford expensive medical interventions and understand the value of preventing infectious diseases. The activists in this country get too much press whlie they spout invalidated theories about the dangers of immunizations. Being old enough to have seen children in iron lungs, to have seen children mentally damaged from measles and mumps. to have seen children with multiple organ damage from measles, sterility from mumps and heart abnormalities from maternal rubella I find it incredible that so many people cannot see the value of protecting theit own children as well as all others, even if very rare side effects do occur. Nothing is 100% safe. We have been misled by tort lawyers whose first answer to any damage is to sue, and whose second act to to push uninformed politicians to make special exceptions. Remember that no-one can prove that nothing occurs, yet this is the mantra of activists.

Posted by at 9:45 AM | Permalink | Comments (0)

New research suggests that more pregnant women are prediabetic, and that infant health can be improved by evaluating diabetic predisposition. The American Diabetes Association states "The number of pregnant women with pre-existing diabetes is rapidly increasing, leading to increased health risks for both the mothers and their unborn children. The seriousness of this problem was brought home by a new ADA-funded study, which showed a doubling of the number of pregnant women with diabetes over a seven-year period."
Women are at higher risk for diabetes if they:
Are overweight
Are physically inactive
Are over the age of 45
Have a family history of diabetes (parent, brother, or sister)
Are a member of high-risk ethnic population (e.g., African American, Hispanic/Latino, Native American, Asian American, Pacific Islander)
Had gestational diabetes (diabetes during pregnancy) or had a baby weighing more than nine pounds at birth
Have high blood pressure
Have abnormal blood fat levels (cholesterol or triglycerides)
Have been diagnosed with Polycystic Ovarian Syndrome (a condition of irregular periods and infertility)
Have ever been told you have pre-diabetes
Have a history of heart disease or stroke

Posted by at 10:50 AM | Permalink | Comments (0)

One more article that indicates the value of breast feeding. In an article titled, Breastfeeding and Child Cognitive Development Dr. Michael S. Kramer, Scientific Director of the Canadian Institutes of Health Research (CIHR), Institute of Human Development, reports the results from following the same group of 14,000 children for 6.5 years.
The study provides the strongest evidence to date that prolonged and exclusive breastfeeding makes kids smarter," said Kramer, a Professor of Pediatrics and of Epidemiology & Biostatistics in the McGill University Faculty of Medicine and lead investigator in the study.
"The effect of breastfeeding on brain development and intelligence has long been a popular and hotly debated topic,” says Dr. Kramer. "While most studies have been based on association, however, we can now make a causal inference between breastfeeding and intelligence – because of the randomized design of our study.”

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

The NHANES survey conducted by the CDC during 2005 & 2006. Hispanics had the highest breast feeding rates. There is nothing better for human children than human milk. The contents of the milk contain antibodies and other components not found in any of the alternatives. As for other beneficial health habits the rate was lowest among the poorest, the rural and the unmarried women whose only source of advice is often local health departments who are frequently underfunded. The problem continues despite Maternal and Child Health programs starting with the 'milk kitchens ' in New York in the late 1800s and early 1900s having shown the value of breast feeding for more than 100 years. We learn slowly, caring for poor women and their children has little political appeal compared to sexy topics such as autism with its vocal advocates and media interest.

Posted by at 9:25 AM | Permalink | Comments (0)