Dr. Buttery's Public Health BLOG

"In almost every state, children in the poorest and least-educated households suffer the worst health outcomes," according to a report compiled by the Robert Wood Johnson Foundation. The data indicate that "16 percent of children ages 17 and younger are in less than optimal health based on their parents' reports -- this rate varies widely across states from a high of 22.8 percent in Texas, to a low of 6.9 percent in Vermont." Comment: There is nothing new about a link between poverty and reduced health status. This has been well documented for over 50 years. What is new is the difference among children living in poverty by state.” Further the report starts out “lf parents want their children to grow up to live long, healthy lives” which gets to the crux of the issue that too many children grow up with two parents to care from them. This burden is much worse for low income children.

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According to the WHO, the total number of people aged 15–49 years who were living with HSV-2 infection worldwide in 2003 is estimated to be 536 million, while the total number of people who were newly infected with HSV-2 in 2003 is estimated to be 23.6 million. While the estimates are limited by poor availability of data, general trends are evident. For example, more women than men were infected, and the number infected increased with age. Although prevalence varied substantially by region, predicted prevalence was mostly higher in developing regions than developed regions.

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New research published in the Sept. 24 issue of JAMA reinforces importance of Black Americans getting screened. Black Americans have a higher occurrence of colon polyps, according to a new study. This is a significant finding considering the incidence of colon cancer among black men has increased and remained unchanged among black women during the last 20 years.
“These data show that Blacks who receive screening are more likely to have serious polyps, compared to Whites, and are therefore likely to benefit from more intensive screening. Black men and women age 50 years and older should be strongly encouraged to receive colon cancer screening,” said Lieberman, who also is co-director of the OHSU Digestive Health Center at the Center for Health & Healing and a member of the OHSU Cancer Institute. According to the researchers, colorectal cancer prevalence and death are higher among black patients. Death rates for black men and women are 38 percent to 43 percent higher than for white men and women, and incidence rates are 15.5 percent to 23 percent higher in black individuals.

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CT colonography (CTC), known as virtual colonoscopy, is as accurate at screening for colorectal cancers and pre-cancerous polyps as conventional colonoscopy, the current screening standard, according to the National CT Colonography Trial, a nationwide multicenter study that included the San Francisco VA Medical Center (SFVAMC). "This is a landmark study," says study co-author Dr. Judy Yee, chief of radiology at SFVAMC and professor and vice-chair of radiology at the University of California, San Francisco. "It demonstrates that CTC is a practical alternative to other, more invasive methods of colon cancer screening. The hope is that these results will encourage more health care payers to cover screening CT colonography." The study appears in the September 18, 2008 issue of the New England Journal of Medicine.

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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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Tobacco use is the leading preventable cause of disease and premature death in the United States. The 2004 Surgeon General report found convincing evidence for a direct causal relationship between tobacco use and the following cancers: lung and bronchial, laryngeal, oral cavity and pharyngeal, esophageal, stomach, pancreatic, kidney and renal pelvis, urinary bladder, and cervical cancers and acute myelogenous leukemia AML). This report provides state-level cancer incidence data and recent trends for cancers associated with tobacco use.
Results: Approximately 2.4 million cases of tobacco-related cancer were diagnosed during 1999–2004. Age adjusted incidence rates ranged from 4.0 per 100,000 persons (for AML) to 69.4 (for lung and bronchial cancer). High rates occurred among men, black and non-Hispanic populations, and older adults. Higher incidence rates of lung and laryngeal cancer occurred in the South compared with other regions, particularly the West, consistent with high smoking patterns in the South.

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A new study by University of Pennsylvania sociology professor Jason Schnittker shows that, while more Americans believe that mental illness has genetic causes, the nation is no more tolerant of the mentally ill than it was 10 years ago. According to Schnittker’s research, genetic arguments have, in fact, increased public support for medical treatment but at the same time aren’t clearly associated with improvements in overall tolerance levels. The study explores tolerance in terms of social distancing: unwillingness to live next door to a mentally ill person, have a group home for the mentally ill in the neighborhood, spend an evening socializing with a mentally ill person, work closely with such a person on the job, make friends with someone with a mental illness or have a mentally ill person marry into the family. Comment: I wonder how much of the problem cited above has to do with lawyers who use ‘mental ill health’ as a technique to get people out of punishment (99% of the time it fails) and the efforts of mental health activists to take over the entire budget of the US.

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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.

Posted by at 10:52 AM | Permalink | Comments (1)

25 percent of Hispanics in the United States don't have a regular healthcare provider to treat their medical needs," according to a survey conducted by the Pew Hispanic Center and the Robert Wood Johnson Foundation. over "one in four Hispanic adults in the U.S....report obtaining no healthcare information from medical professionals in the previous year." Meanwhile, almost "80 percent said they act on the information they receive from media sources." Comment: The most telling point in the study was that 36 percent of males and 37 percent of individuals ages 18 to 29 lack[ing] a usual source of care. Hispanics have similar problems to other minority groups with lack of financial access to both insurance and primary care However, just providing financial access as recommended by both political parties will make little difference without a significant increase in access to a regular source of primary care, which neither party is addressing. Also, many of those without a usual source of care are young and without disease.

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Do not believe most of the reports in the media that tell us there are important changes in health behaviors. A number of media such as ABC News and Health Day tell us that the latest CDC report "America\'s Children, in Brief" highlight increases in teen births and low birth weight. The data do not show this. A 'change of 1 birth/1000 teens is probably nothing more than a statistical fluctuation. What you should look for is changes in five year trends, not single year numbers. However politicians and activists continually take such data out of context while the news media fail to validate the data, usually because the reporters have no training in use and abuse of data.

Posted by at 11:18 AM | Permalink | Comments (0)

June 24, 2008 -- Diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released today by the Centers for Disease Control and Prevention (CDC), which provide estimates for every county in the US..Comment: How much of this is related to more overweight? How much is due to earlier diagnosis? How much is due to increased sensitivity of tests? How much is due to increased push for doctors to diagnose diabetes earlier? How much is due to improved access of Medicaid? Probably some or all. This is a disease which can be treated and for many people prevented, if we take rsponsiblity for our own behaviors.

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The Washington Post (6/12, A4, Brown) reports that "Americans' life expectancy reached a record high of 78.1 years in 2006, with disparities among ethnic groups and between the sexes generally narrowing," according to findings published in the June 11 issue of the Centers for Disease Control and Prevention's (CDC) National Vital Statistics Reports. Notably, the "death rates from most diseases went down, with influenza mortality falling steeply, and AIDS mortality marking its 10th straight year of decline." Furthermore, "infant mortality in 2006 also fell from the previous year, continuing a trend stretching back nearly 50 years." Melonie P. Heron, Ph.D., a demographer at the National Center for Health Statistics, said, "This report has a lot of good news." The increase to 78.1 years "is due mainly to falling mortality rates in almost all the leading causes of death,"

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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)

"For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women," according to a study published in PLoS Medicine. Lead author Christopher J.L. Murray, M.D., a physician and epidemiologist at the University of Washington, and colleagues at the Harvard School of Public Health. Women seem to learn slowly from the adverse behavior of men. While the survey cannot pin direct cause and effect to these results, the public health community has seen the excess of obesity, smoking, minimal exercise, poor diet and the adverse effects of increasing urbanization upon the population. To change these outcomes it will be necessary to change the infrastructure of the social support system, instead of maintaining the current barriers between health, social service, mental health, primary care and nutrition programs.

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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."

Posted by at 11:42 AM | Permalink | Comments (1)

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.

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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.

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

In a new report from the NCHS; approximately half of 1 percent (0.47 percent) of the U.S. household population between the ages of 18 and 49 are living with HIV, according to estimates from CDC’s National Center for Health Statistics (NCHS) based on surveys conducted between 1999-2006. This is still too many, since the behaviors resulting in the infections are for the most part preventable.
Sub groups within the overall population shows:
Men ages 18-49 are more likely to be infected (0.7 percent) than women (0.2 percent).
Two percent of non-Hispanic black adults ages 18-49 were infected with HIV compared to 0.23 percent of white adults and 0.3 percent of Mexican-American adults.
Adults aged 18-49 who are infected with the herpes simplex type 2 virus (HSV-2) are more than 15 times likely to also be infected with HIV. An estimated 2 percent of HSV-2 positive adults ages 18-49 also have HIV.

Posted by at 9:23 AM | Permalink | Comments (0)

Schlundt and his colleagues at Meharry Medical College in Nashville, Tenn.
examined 2002 data from the U.S. Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey. Seatbelt use declined as BMI increased, with approximately 55 percent of extremely obese individuals reporting they did not use a seatbelt. The connection between increased body mass index and decreased seatbelt use held even when controlling for other factors, such as gender, race and seatbelt laws in the respondent’s state. Maybe accident report forms used by EMS and police need to include obesity as a factor to be coded when investigating accidents.

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The latest version of "Health- United States" for 2007 has just been published. In its highlights the authors state "The United States spends more on health per capita than any other country, and U.S. health spending continues to increase, though the rate of increase has slowed for the third consecutive year. Spending increases are due to increased intensity and cost of services and a higher volume of services needed to treat an aging population." Repeatedly throughout its over 500 pages are data on the increasing problems of chronic idsease due to poor health behaviors.

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In a 7 country survey of health system performance, as seen by recipients of care, the USA finished dead last. When will we some some sensible move toward change instead of the little steps recommended by most presidential contenders?

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A new review just published in the American Journal of Respiratory Diseases shows that COPD from chronic bronchitis and emphysema is rising in women. They are catching up with and exceeding men as they continue to smoke while men are slowing down their smoking. Sometimes we need to learn from each other, not just repeat the same errors. Thank you Virginia Slims!

Posted by at 9:23 AM | Permalink | Comments (0)

There has been much international attention focused on MDG-4—to reduce under-5 mortality by two-thirds between 1990 and 2015. There is still a huge disparity between the industrialized countries and the rest of the world.

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Cancer stands as the leading disease-related cause of death for U.S. children, the Centers for Disease Control and Prevention said in a report. Better treatments are improving survival rates, the CDC said. The cancer death rate for U.S. children was 34.2 per million for children up to age 19 in 1990, but fell to 27.3 per million in 2004, the CDC said. This death rate has declined 1.7 percent per year during this period, according to the CDC. "It's not that we're having less cancer diagnosed. The incidence rates, the new-case rates are the same. It's just that we're getting better survival," the CDC's Dr. Lori Pollack said in a telephone interview.

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From NIDA Large numbers of American adolescents are putting themselves and others at great risk by driving while under the influence of illicit drugs or alcohol, according to a study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH). In 2006, 30 percent of high school seniors reported driving after drinking heavily or using drugs, or riding in a car whose driver had been drinking heavily or using drugs, at least once in the prior two weeks. These findings are based on data obtained from the Monitoring the Future study, in which nationally representative samples of high school seniors have been surveyed annually since 1975. The data analysis is published in the November issue of the Journal of Studies on Alcohol and Drugs. We have seen such results of driving drunk in our own commnities, but there seems to be little effort reported to change drinking behavior.

Posted by at 9:47 AM | Permalink | Comments (0)

Reviewing the following news from Children's Hospital, Pittsburgh. should lead us to wonder whether ATV advertising for children has become worse than the subliminal Tobacco Advertising for children. In 2007, admissions for ATV-related injuries at Children’s Hospital of Pittsburgh of UPMC already have reached an all-time high with two months remaining in the year. “Despite many warnings about the dangers of kids riding on and driving ATVs, every year we continue to see this tragic increase in the number of young children injured, often with injuries that lead to permanent disabilities or can even be fatal,” said Barbara Gaines, MD, director of the Benedum Pediatric Trauma Program at Children’s. “This year we’ve treated kids as young as 2 who were passengers on ATVs and, in some instances, kids as young as 5 and 6 were driving these powerful machines designed for adults.”

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America’s Health Rankings ™ – 2007 Edition shows Vermont at the top of the list of healthiest states. This is the first year Vermont has been ranked number one. The state has had a steady climb in the rankings for the last seven years from an initial position of eighth in 2001. Minnesota is ranked second this year; it was first in the 2006 Edition. Minnesota has been first for the last four years and for 11 of the 18 Editions of this report. Hawaii is number three, followed by New Hampshire, Connecticut and Utah. Mississippi is 50th and the least healthy state, while Louisiana is 49th. Arkansas, Oklahoma and Tennessee complete the bottom five states.

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After this week's JAMA article on MRSA it is worth reading the CDC fact sheets, rather than relying on news media reports. The facts sheet cover both health facilty acquired MRSA and community acquired MRSA.

Posted by at 10:26 AM | Permalink | Comments (0)

From the American College of Gastroenterology we find that obesity is the strongest risk factor for Colorectal Cancer among women; greater than smoking. Although smoking posed a significant increased risk for colorectal neoplasia, researchers found that for women, obesity was the highest attributable risk factor for developing the disease.

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

"The evidence is unmistakable: We are truly turning the tide in the cancer battle," said John R. Seffrin, PhD, chief executive officer of the American Cancer Society. "The gains could be even greater if everyone in the US had access to essential health care, including primary care and prevention services." Looking at the population as a whole, the report shows that cancer death rates have decreased for the majority of the 15 most commonly diagnosed cancers in men and women.

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

A study from the RAND corporation published in this week's NEJM finds that children in the United States fail to get recommended health care more than half of the time, according to a new study that is the largest and most comprehensive examination of health care quality for America’s children. They are not receiving recommended preventive care and screening services, such as regular weight and measurement checks to ensure that they are growing properly and not at risk for obesity; nor are they receiving standard care for conditions such as asthma and diarrhea. While the study lays the fault at pediatrician's doors there is liuttle said about the failure of families toi seek care, or follow the advice given.

Posted by at 9:41 AM | Permalink | Comments (1)

While many newsmedia are publiciziing this report from yesterday's MMWR about the work limitations associated with 'arthritis' this survey is based on individual response, but is not validated by evidence from examination, or reports from place sof employment. This survey needs more extensive evaluation before drawing too many conclusions, particularly before developing public policies.

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Many telephone surveillance systems -- including the world's largest, the Behavioral Risk Factor Surveillance System, which was established in 1984 by the Centers for Disease Control and Prevention and state health departments -- traditionally have collected data by landline phones. Now, sizeable chunks of the population have chosen to become entirely wireless, making it much more difficult -- and expensive -- to reach them. The National Health Interview Survey found that half of cell-phone-only users are younger than 30 and 22% are low-income adults, or those earning less than 200% of the poverty level. In addition, the cell-phone-only users were: The major issue is how representative cell phone users are of the entire population, and how to maintain accurate surveys.

Posted by at 11:09 AM | Permalink | Comments (0)

It is not surprising that a study from the University of Michigan showed patterns of educational success or failure are well established for most adolescents by the time they reach the end of eighth grade, while drug use has only begun to emerge. The researchers found that the strongest and most long-lasting effects of early educational success or failure are not on drinking or illicit drug use, but on cigarette use. Unfortunately the research focuses on behavior in school and not on the chidren's families. I would be willing to bet that the children with the best outcomes have the strongest family structures. There is really nothing new or surprising about this 'research.'

Posted by at 9:35 AM | Permalink | Comments (0)

A week ago there was an article in a major medical journal questioning the value of giving flu vaccine to the elderly, a group to whom I belong. Now, in the NEJM today, we have an article extolling the value of giving flu vaccine to the elderly [N Engl J Med 2007;357:1373-81.] The conclusions of the latest study are that during 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved..

Posted by at 10:42 AM | Permalink | Comments (0)

An article [Arch Pediatr Adolesc Med. 2007;161:978-985. ] in the Pediatric Archives today analyses current NHANES data and concludes that dietary supplement use has increased among adults in recent years, yet it appears to have remained relatively constant or to have declined in children. The prevalence of supplement use increases from low levels in infants and young children to about 49% for 5-year-old children, followed by a steady decline to 20% among 15-year-old adolescents, with an increase among older teenagers (28%) and into young adulthood. Most interestingly children in higher-income families, children with less recreational screen time, and children in smoke-free households are most likely to use supplements. In contrast, children in families with lower income, non-Hispanic black children, children in families without heath insurance, children in households where people smoke, and children who spend more time engaged in recreational screen time are the least likely to take supplements.

Posted by at 10:03 AM | Permalink | Comments (0)

At a recent meeting of ACOG "The issue has been whether thyroid screening should be a routine test during prenatal care," ACOG says there is no evidence that identifying and treating pregnant women with subclinical hypothyroidism improves either maternal or infant outcomes. The US Preventive Services Task Force says there must be demonstrated improvement in important health outcomes of those individuals identified through screening before recommending routine screening of asymptomatic people. "There just isn't any data that supports the routine screening of millions of pregnant women for subclinical hypothyroidism every year because the long-term effects are not certain and there is no evidence that any treatment would make a difference in the long run,"

Posted by at 10:52 AM | Permalink | Comments (1)

"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)

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)

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)

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)

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)

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