Dr. Buttery's Public Health BLOG

A number of studies have shown associations between individual lifestyle factors, such as smoking and diet, and risk of chronic diseases, including cardiovascular diseases, type 2 diabetes and various cancers. Few studies, however, have looked at the bottom line -- how a combination of lifestyle factors might influence mortality. A new, large-scale study from researchers at the Harvard School of Public Health (HSPH) shows that women who followed a combination of healthy lifestyle factors -- not smoking, maintaining a healthy weight, regular physical activity and a healthy diet -- had a dramatically lower risk of dying from all causes during the two-and-a-half decades of the study. Furthermore, their risk reduction surpassed that from following any single healthy factor alone. It is the largest and longest-running study to directly estimate the impact of a combination of lifestyle factors on mortality. The study appears in advance online on Wednesday, September 17, 2008 in The British Medical Journal.

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ScienceDaily (Aug. 20, 2008) — Chronic lead poisoning, caused in part by the ingestion of contaminated dirt, affects hundreds of thousands more children in the United States than the acute lead poisoning associated with imported toys or jewelry. Could treating contaminated soil with water prevent this public health scourge? In a study appearing in the August issue of the journal Applied Geochemistry, Gabriel M. Filippelli, Ph.D., professor of earth sciences conducted a literature review of studies of urban soils as a persistent source of lead poisoning and also investigated the lead burden in the soils from a number of cities, including Indianapolis. His findings reveal that older cities like Indianapolis have a very high lead burden resulting in a lead poisoning epidemic among their youngest citizens. Comment: The home environment causing lead poisoning is nothing new. #) years ago studies near the I 95 beltway in the region of the Pentagon showed contaminated soil from tetraethyl;l lead, and associated poisoning among children. This study was one of many that lead to the banning of lead in gasoline. There is also the problem of lead paint flaking from houses into the soil, that is well known in urban housing. While the idea of protecting children from soil is useful, it is more important to ensure that lead paint in housing is either removed or protected using rental codes. This has been well demonstrated for more than 40 years, but the realty industry has fought protection of children, usually low income renters, who have little power to protect themselves.

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A study reported in this week's JAMA suggested that ``stemming the pandemic of type 2 diabetes is a public health priority and will require a multi-faceted approach,'' wrote Molly Kile and David Christiani, Comment: The evidence is not terribly good. The data is from a crossectional study which can demonstrate association but NOT causality. No background data on exposures is provided, only data on blood levels that provide no evidence of length of exposures and whether arsenic exposure preceded onset of diabetes.

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A study in this week's Annals of Internal Medicine reported on data from the 1999-2004 NHANES survey of US Households. The study identified at least 11 million uninsured people with chronic diseases. the most common being heart disease, high blood pressure, and diabetes. Lack of insurance meant that such individuals were far less likely to attempt to obtain medical care, and unlikely to be able to afford medicines to control their diseases. As a result they were more likely to be unproductive workers, and to be disabled or die early from their conditions. All this increasing the cost of the nation's medical care system.
[Ann Intern Med. 2008;149:170-176.]

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In recognition that chronic disease is not only a concern for "developed countries" the NIH's "Fogarty International Center's" new strategic plan intensifies focus on chronic non-communicable diseases while continuing to address the unfinished infectious diseases agenda. Five goals give Fogarty renewed momentum in our mission to support global health research, build partnerships between U.S. and foreign research institutions and train the next generation of scientists to address the world's compelling research needs. The Goals are:
Address the growing epidemic of chronic, non-communicable diseases
Bridge the implementation research training gap
Develop human capital in developing world
Foster a sustainable research environment in low- and middle-income countries
Build strategic alliances and funding partnerships

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According to an article in the American Journal of Clinical Oncology so many women survive for many years after treatment for breast cancer, due to improved treatment protocols, that like a number of other previously fatal diseases breast cancer is now a chronic diseaes and should be treated with longevity and quality of life in mind rather than just delaying death.

Posted by at 8:34 AM | Permalink | Comments (1)

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.

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This article in the NEJM today, from NCCDPHP at the CDCP is well worth reading. The researchers focused on mortality from coronary heart disease in the United States, which has decreased substantially in recent decades. The study was to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed
to changes in cardiovascular risk factors. [NEJM 356;23 june 7, 2007] The burden of coronary heart disease in the United States remains enormous, even though associated mortality rates fell by more than 40% between 1980 and 2000. The largest contributions from medical therapies consistently came from secondary prevention.

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News from the University of Queensland Australia: Scientists have isolated at least 25 genes that cause seven of the most common hereditary diseases including diabetes and arthritis in the world's largest genetic study. The genes are responsible for heart disease, hypertension, type 1 and type 2 diabetes, Crohn's disease, bipolar disorder and rheumatoid arthritis, according to results published today in the international science journal Nature. Another 58 genes with possible links to the same family diseases have also been uncovered by British and Australian scientists working on the $16.6 million (£7 million) study funded by the Wellcome Trust Case Control Consortium (WTCC). Now to translate this information into chronic disease prevention

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A diet rich in fruits, grains and low-fat dairy products has been shown to significantly lower blood pressure, but few Americans with high blood pressure are following it, according to research from Wake Forest University School of Medicine reported at the 22nd Annual Scientific Meeting of the American Society of Hypertension. Only 22 percent of hypertensives were following the Dietary Approaches to Stop Hypertension (DASH) diet.

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A review in Science, this week, of "The Great Lead Water Pipe Disaster" by Werner Troesken, MIT Press, provides a review of the dissemination of lead poisoning in children by use of lead water pipes, prior to the problems of leaded paint and leaded gasoline is worth reading by those with an interest in disease prevention..We still fail to learn from history.

Posted by at 11:27 AM | Permalink | Comments (0)

From Diabetes-UK today, we find that younger people with Type 2 diabetes have a bigger risk than older people with the condition of developing cardiovascular disease (CVD), says research presented today. The research also showed that, although under-40s with Type 2 have a greater risk of getting heart disease than their counterparts over 40, they are less likely to receive treatment for it – particularly women.

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From Diabetes-UK we learn that one in three people with Type 1 diabetes aged between 18 and 30 already has retinopathy, a complication of diabetes that can lead to blindness in later life, says a survey presented today. This problem will increas in the US with our excess of obesity (even type II) and its links to diabetes. Further the lack of access to health care by many of these individuals will only worsen the outcome

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Smoking appears to increase the risk of becoming infected with tuberculosis and the risk for the development of active disease upon infection, according to an analysis of previously published research in the February 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. (Arch Intern Med. 2007;167:335-342)
About one-third of the world's population is infected with the bacteria that cause tuberculosis (TB), but the organism is usually rendered inactive by the immune system, according to background information in the article. Active tuberculosis developed in approximately 8.8 million individuals in 2003 and is responsible for about 1.7 million deaths worldwide each year. "It has long been suggested that tobacco smoking may affect rates of TB morbidity and mortality," the authors write. "This could be a result of increasing the risk of infection with TB mycobacteria, increasing the rate of active TB disease, or increasing the TB mortality rate; plausible mechanisms exist."

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