Herbal medicines such as licorice, Indian rennet and opium poppy, are at risk of contamination with toxic mold, according to a new study. The authors of the study say it’s time for regulators to control mold contamination. An estimated 64% of people use medicinal plants to treat illnesses and relieve pain. The herbal medicine market is worth $60 billion globally, and growing fast. Despite the increasing popularity of herbal medicine, the sale of medicinal plants is mostly unregulated.
On July 20 a man who was ill flew on commercial planes from the heart of the Ebola epidemic in Liberia to Lagos, Nigeria’s largest city. That man became Nigeria’s first Ebola case—the index patient. In a matter of weeks some 19 people across two states were diagnosed with the disease (with one additional person presumed to have contracted it before dying).
But rather than descending into epidemic, there has not been a new case of the virus since September 5. And since September 24 the country’s Ebola isolation and treatment wards have sat empty. If by Monday, October 20 there are still no new cases, Nigeria, unlike the U.S., will be declared Ebola free by the World Health Organization (WHO).
What can we learn from this African country’s success quashing an Ebola outbreak?
“30 years ago, the elderly were not expected to be active at all – they were actually advised not to exercise as it was considered dangerous. Playing cards were seen as a more fitting activity. Today, we are all expected to live active, healthy lives until the day we die – in good health – at the age of 90. Old age has, in a sense, been cancelled, says PhD Aske Juul Lassen from University of Copenhagen’s Center for Healthy Aging.
Aske Juul Lassen has just defended his PhD thesis entitled Active Ageing and the Unmaking of Old Age for which he has conducted field work in two activity centres for the elderly in Greater Copenhagen and analysed WHO’s and EU’s official policy papers on active ageing.
“I compare the EU and WHO perceptions of ageing with the everyday activities I have observed among the elderly. The elderly do a lot of things, which I consider active ageing and which give them an enhanced quality of life, but they are also activities that would never be characterized as “healthy” by health authorities. The question is how we define “good ageing” and how we organise society for our ageing generations.”
Billiards and beer can also be active ageing
One of the everyday activities Aske Juul Lassen observed was billiards: In one of the activity centres for the elderly, in which he conducted field work, 10-15 men between the ages of 70 and 95 meet to play billiards four times a week.
“Playing billiards often comes with a certain life style – drinking beer and drams for instance – and I am quite sure this was not what WHO and EU meant when they formulated their active ageing policies. But billiards does constitute active ageing. Billiards is, first of all, an activity that these men thoroughly enjoy and that enhances their quality of life while immersing them in their local community and keeping them socially active. And billiards is, secondly, very suitable exercise for old people because the game varies naturally between periods of activity and passivity and this means that the men can keep playing for hours. Not very many old people can endure physical activity that lasts five hours, but billiards enables these men to spread their physical activity out through the day,” says Aske Juul Lassen.
“We therefore need a broader, more inclusive concept of healthy and active ageing that allows for the communities the elderly already take part in and that positively impact their everyday lives, quality of life, and general health. It must also allow for the fact that the elderly do not constitute a homogenous group of people: activities that for some seem insurmountable will be completely natural for others.”
According to Aske Juul Lassen, one of the positive side effects of the activities at the activity centres for the elderly is that the activities take their minds off illness; they do not focus as much on their ailments when they are engaged in billiards or some of the other activities that the centres have on offer.
I don’t usually reblog items with ads (esp with products as alcohol!).
However, the content seemed very informative.
On a personal note, think it is a crying shame so much money and time is spent on beauty treatments. Says a lot about our culture and how we perceive others, constant comparing ourselves with others, etc….
Beauty is pain, or so the saying goes. (In the case of bikini waxing, we wholeheartedly agree.) And, while all of the tweezing, dyeing, and primping can be challenging at times, here’s what it should never be: hazardous to our health.
Unfortunately, increasing evidence suggests that some beauty treatments may be associated with a host of ills, from antibiotic-resistant infections to respiratory problems. Whether you’re a woman who gets her hair chemically straightened or you’re a salon worker who handles those chemicals, it’s important to understand potential risks — and how to protect yourself.
Of course, the majority of beauty treatments are safe when performed by a licensed professional, and our goal isn’t to stoke fear or turn you off from some much deserved Me Time. But, wouldn’t you rather be informed? After all, nothing’s quite as attractive as a woman in the know.
Here, nine beauty treatments that have the potential to cause some harmful side effects — plus, expert advice on making sure you stay as healthy as you are pretty.
Current information regarding consumer health, clinical trials, AIDS–related drug information, MeSH® pharmacological actions, PubMed® biomedical literature, and physical properties and structure is easily retrieved by searching a drug name. A varied selection of focused topics in medicine and drug–related information is also available from displayed subject headings.
Hundreds of thousands of American youth are following marijuana-related Twitter accounts and getting pro-pot messages several times each day, researchers at Washington University School of Medicine in St. Louis have found.
The tweets are cause for concern, they said, because young people are thought to be especially responsive to social media influences. In addition, patterns of drug use tend to be established in a person’s late teens and early 20s.
In a study published online June 27 in the Journal of Medical Internet Research, the Washington University team analyzed messages tweeted from May 1 through Dec. 31, 2013, by a Twitter account called Weed Tweets@stillblazintho. Among pro-marijuana accounts, this one was selected because it has the most Twitter followers — about 1 million. During the eight-month study period, the account posted an average of 11 tweets per day.
“As people are becoming more accepting of marijuana use and two states have legalized the drug for recreational use, it is important to remember that it remains a dangerous drug of abuse,” said principal investigator Patricia A. Cavazos-Rehg, PhD. “I’ve been studying what is influencing attitudes to change dramatically and where people may be getting messages about marijuana that are leading them to believe the drug is not hazardous.”
Although 19 states now allow marijuana use for medical purposes, much of the evidence for its effectiveness remains anecdotal. Even as Americans are relaxing their attitudes about marijuana, in 2011 marijuana contributed to more than 455,000 emergency room visits in the United States, federal research shows. Some 13 percent of those patients were ages 12 to 17.
A majority of Americans favor legalizing recreational use of the drug, and 60 percent of high school seniors report they don’t believe regular marijuana use is harmful. A recent report from the U.N. Office on Drugs and Crime said that more Americans are using cannabis as their perception of the health risk declines. The report stated that for youth and young adults, “more permissive cannabis regulations correlate with decreases in the perceived risk of use.”
IMAGE:This is another recent marijuana-related message from the Weed Tweets Twitter account.
Cavazos-Rehg said Twitter also is influencing young people’s attitudes about the drug. Studying Weed Tweets, the team counted 2,285 tweets during the eight-month study. Of those, 82 percent were positive about the drug, 18 percent were either neutral or did not focus on marijuana, and 0.3 percent expressed negative attitudes about it.
Many of the tweets were meant to be humorous. Others implied that marijuana helps a person feel good or relax, and some mentioned different ways to get high.
With the help of a data analysis firm, the investigators found that of those receiving the tweets, 73 percent were under 19. Fifty-four percent were 17 to 19 years old, and almost 20 percent were 16 or younger. About 22 percent were 20 to 24 years of age. Only 5 percent of the followers were 25 or older.
“These are risky ages when young people often begin experimentation with drugs,” explained Cavazos-Rehg, an assistant professor of psychiatry. “It’s an age when people are impressionable and when substance-use behaviors can transition into addiction. In other words, it’s a very risky time of life for people to be receiving messages like these.”
Cavazos-Rehg said it isn’t possible from this study to “connect the dots” between positive marijuana tweets and actual drug use, but she cites previous research linking substance use to messages from television and billboards. She suggested this also may apply to social media.
“Studies looking at media messages on traditional outlets like television, radio, billboards and magazines have shown that media messages can influence substance use and attitudes about substance use,” she said. “It’s likely a young person’s attitudes and behaviors may be influenced when he or she is receiving daily, ongoing messages of this sort.”
The researchers also learned that the Twitter account they tracked reached a high number of African-Americans and Hispanics compared with Caucasians. Almost 43 percent were African-American, and nearly 12 percent were Hispanic. In fact, among Hispanics, Weed Tweets ranked in the top 30 percent of all Twitter accounts followed.
“It was surprising to see that members of these minority groups were so much more likely than Caucasians to be receiving these messages,” Cavazos-Rehg said, adding that there is particular concern about African-Americans because their rates of marijuana abuse and dependence are about twice as high as the rate in Caucasians and Hispanics.
The findings point to the need for a discussion about the pro-drug messages young people receive, Cavazos-Rehg said.
AUDIO:Twitter has become one of the most popular social media sites among young people, and researchers at Washington University School of Medicine in St. Louis have been looking at Twitter….
“There are celebrities who tweet to hundreds of thousands of followers, and it turns out a Twitter handle that promotes substance use can be equally popular,” she said. “Because there’s not much regulation of social media platforms, that could lead to potentially harmful messages being distributed. Regulating this sort of thing is going to be challenging, but the more we can provide evidence that harmful messages are being received by vulnerable kids, the more likely it is we can have a discussion about the types of regulation that might be appropriate.”
Whether it’s to cut down on the number of calories they consume or any of a variety of other reasons, some people use sugar substitutes – also called high-intensity sweeteners – to sweeten and add flavor to their foods. They can be used alone to sweeten foods and beverages such as iced tea or coffee, or as an ingredient in other products. There are a number of sugar substitutes on the market from which to choose.
“Sugar substitutes are called ‘high-intensity’ because small amounts pack a large punch when it comes to sweetness,” says Captain Andrew Zajac, U.S. Public Health Service (USPHS), director of the Division of Petition Review at the Food and Drug Administration (FDA).
According to Zajac, unlike sweeteners such as sugar, honey, or molasses, high-intensity sweeteners add few or no calories to the foods they flavor. Also, high-intensity sweeteners generally do not raise blood sugar levels.
The FDA has approved a new high-intensity sweetener called advantame.
Advantame—which does not yet have a brand name (such as Sweet’N Low, a brand name for saccharin, or Equal, a brand name for aspartame)—has been approved as a new food additive for use as a sweetener and flavor enhancer in foods, except meat and poultry.
Examples of uses for which advantame has been approved include baked goods, non-alcoholic beverages (including soft drinks), chewing gum, confections and frostings, frozen desserts, gelatins and puddings, jams and jellies, processed fruits and fruit juices, toppings, and syrups.
How Do You Know It’s Safe?
FDA is required by law to review all new food additives for safety before they can go on the market. The process begins when a company submits a food additive petition to FDA seeking approval. One exception is for substances “generally recognized as safe,” or GRAS, because those substances are generally recognized by qualified experts as safe under the conditions of intended use and are exempt from the food additive approval process.
Zajac explains that the agency’s scientists thoroughly review all the scientific evidence submitted by a company to ensure the product is safe for the intended use.
“In determining the safety of advantame, FDA reviewed data from 37 animal and human studies designed to identify possible toxic (harmful) effects, including effects on the immune, reproductive and developmental, and nervous systems,” Zajac says.
Advantame is chemically related to aspartame, and certain individuals should avoid or restrict the use of aspartame. To that end, FDA evaluated whether the same individuals should avoid or restrict advantame, as well.
People who have phenylketonuria (PKU), a rare genetic disorder, have a difficult time metabolizing phenylalanine, a component of both aspartame and advantame. Newborns are tested for PKU using a common “heel-prick” test before they leave the hospital.
Foods containing aspartame must bear an information statement for people with PKU alerting them about the presence of phenylalanine. But advantame is much sweeter than aspartame, so only a very small amount needs to be used to reach the same level of sweetness. As a result, foods containing advantame do not need to bear that statement.
Five Already on the Market
The last high-intensity sweetener approved by FDA was Neotame (brand name Newtame) in 2002. The other four on the market, and are:
Saccharin, was first discovered and used in 1879, before the current food additive approval process came into effect in 1958. Brand names include Sweet‘N Low
Aspartame, first approved for use in 1981. Brand names include Equal
Acesulfame potassium (Ace-K), first approved for use in 1988. Brand names include Sweet One
Sucralose, first approved for use in 1998. Brand name is Splenda
In addition to the six high-intensity sweeteners that are FDA-approved as food additives, the agency has received and has not questioned GRAS notices for two types of plant/fruit based high-intensity sweeteners: certain steviol glycosides obtained from the leaves of the stevia plant (Stevia rebaudiana (Bertoni) Bertoni) and extracts obtained from Siraitia grosvenorii Swingle fruit, also known as Luo Han Guo or monk fruit.
While these high-intensity sweeteners are considered safe for their intended uses, certain individuals may have a particular sensitivity or adverse reaction to any food substance. Consumers should share with their health care provider any concerns they have about a negative food reaction.
In addition, FDA encourages consumers to report any adverse events through MedWatch: FDA’s safety information and adverse event reporting program.
OpenFDA offers easy access to FDA public data and highlight projects using these data in both the public and private sector to further regulatory or scientific missions, educate the public, and save lives.
In the future, openFDA will provide a platform for public challenges issued by the FDA and a place for the community to interact with each other and FDA domain experts with the goal of spurring innovation around FDA data.
We’re currently focused on working on datasets in the following areas:
Adverse Events: FDA’s publically available drug adverse event reports, a database that contains millions of adverse event and medication error reports submitted to FDA covering all regulated drugs.
Recalls(coming soon): Enforcement Report and Product Recalls Data, containing information gathered from public notices about certain recalls of FDA-regulated products
Documentation(coming soon): Structured Product Labeling Data, containing detailed product label information on many FDA-regulated product
We’ll be releasing a number of updates and additional datasets throughout the upcoming months.
Injuries from pool chemicals led to nearly 5,000 emergency room visits in 2012, according to a study released Thursday by the Centers for Disease Control and Prevention.
Nearly half of these preventable injuries were in children and teenagers and more than a third occurred at a home. Pool chemical injuries were most common during the summer swim season, from Memorial Day to Labor Day, and almost half occurred on weekends.
“Chemicals are added to the water in pools to stop germs from spreading. But they need to be handled and stored safely to avoid serious injuries,” said Michele Hlavsa, chief of CDC’s Healthy Swimming Program.
Residential pool owners and public pool operators can follow these simple and effective steps to prevent pool chemical injuries:
Read and follow directions on product labels.
Wear appropriate safety equipment, such as goggles and masks, as directed, when handling pool chemicals.
Secure pool chemicals to protect people and animals.
Keep young children away when handling chemicals.
NEVER mix different pool chemicals with each other, especially chlorine products with acid.
Pre-dissolve pool chemicals ONLY when directed by product label.
Add pool chemical to water, NEVER water to pool chemicals.
The study analyzed data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). NEISS captures data on injuries related to consumer products from about 100 hospital emergency departments nationwide. The NEISS data can then be used to calculate national estimates.
May 19–25, 2014 is Recreational Water Illness and Injury (RWII) Prevention Week. The theme for RWII Prevention Week 2014 is Healthy and Safe Swimming: We’re in it Together. It focuses on the role of swimmers, aquatics and beach staff, residential pool owners, and public health officials in preventing drowning, pool chemical injuries, and outbreaks of illnesses.
Chlorine and bromine do not kill germs instantly; most are killed within minutes. So it is important that everyone help keep germs out of the water in the first place by not swimming when ill with diarrhea and taking kids on bathroom breaks. Protect yourself by not swallowing pool water.
The number of calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014, according to a CDC study published in today’s Morbidity and Mortality Weekly Report. The number of calls per month involving conventional cigarettes did not show a similar increase during the same time period.
More than half (51.1 percent) of the calls to poison centers due to e-cigarettes involved young children under age 5, and about 42 percent of the poison calls involved people age 20 and older.
The analysis compared total monthly poison center calls involving e-cigarettes and conventional cigarettes, and found the proportion of e-cigarette calls jumped from 0.3 percent in September 2010 to 41.7 percent in February 2014. Poisoning from conventional cigarettes is generally due to young children eating them. Poisoning related to e-cigarettes involves the liquid containing nicotine used in the devices and can occur in three ways: by ingestion, inhalation or absorption through the skin or eyes.
“This report raises another red flag about e-cigarettes – the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, M.D., M.P.H. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”
E-cigarette calls were more likely than cigarette calls to include a report of an adverse health effect following exposure. The most common adverse health effects mentioned in e-cigarette calls were vomiting, nausea and eye irritation.
Data for this study came from the poison centers that serve the 50 states, the District of Columbia, and U.S. Territories. The study examined all calls reporting exposure to conventional cigarettes, e-cigarettes, or nicotine liquid used in e-cigarettes. Poison centers reported 2,405 e-cigarette and 16,248 cigarette exposure calls from September 2010 to February 2014. The total number of poisoning cases is likely higher than reflected in this study, because not all exposures might have been reported to poison centers.
“The most recent National Youth Tobacco Survey showed e-cigarette use is growing fast, and now this report shows e-cigarette related poisonings are also increasing rapidly,” said Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health. “Health care providers, e-cigarette companies and distributors, and the general public need to be aware of this potential health risk from e-cigarettes.”
Developing strategies to monitor and prevent future poisonings is critical given the rapid increase in e-cigarette related poisonings. The report shows that e-cigarette liquids containing nicotine have the potential to cause immediate adverse health effects and represent an emerging public health concern.
Jerome Groopman, M.D., Harvard University Medical School, notes there is recent clinical evidence regarding marijuana’s health risks, benefits, tradeoffs, as well as uncertainties. Dr. Groopman, who often writes about biology, health, and medicine for lay audiences, adds the supporting evidence on all sides is important in view of current efforts to make marijuana legal for medicinal and/or recreational use across the U.S.
Currently, marijuana is available for medicinal use in 20 U.S. states and the District of Columbia. Colorado now permits the sale of marijuana for recreational use (in small quantities). The state of Washington also will permit the sale of marijuana (or cannabis) for recreational use (also in small quantities) for the first time this spring.
Dr. Groopman, an internist, reports two systematic reviews (involving about 6,100 patients with a variety of medical conditions) suggest marijuana is useful to treat a number of diseases and conditions including: anorexia, nausea and vomiting, glaucoma, and irritable bowel disease. Marijuana also is clinically useful to treat: muscle spasticity, multiple sclerosis, epilepsy, Tourette’s syndrome, and symptoms of ALS (Lou Gehrig’s disease).
However, Dr. Groopman emphasizes there is a tradeoff of health risks versus benefits from marijuana use — similar to other medical drugs and procedures. For example, he notes current evidence suggests marijuana’s clinical risks include: decreased reaction time, reduced attention and concentration, a decline in short term memory, and an ability to assess external risks.
Dr. Groopman, who is a member of the Institute of Medicine, adds one study found marijuana impaired the performance of pilots on a flight simulator for as much as 24 hours. Similarly, Dr. Groopman notes studies on drivers suggest a strong association between cannabis and collisions. He adds research suggests drivers who use marijuana are two to seven times more likely to be responsible for accidents compared to motorists who do not use drugs or alcohol.
In addition, Dr. Groopman reports some evidence suggests a statistical association between marijuana use and the development of schizophrenia and other psychosis later in life. Dr. Groopman reports these findings are based on meta-analyses (from studies of the health records of young persons in Sweden, New Zealand, and Holland, who did and did not smoke marijuana).
Dr. Groopman explains the latter research does not suggest there is a causal link between marijuana use and psychosis’ development. Dr. Groopman, who has published five books about health and medicine, argues the state of current evidence suggests a need for more definitive research (via double blind, randomized, placebo-controlled approaches) to better assess the possible relationship between marijuana and psychosis’ development.
Moreover, Dr. Groopman notes there is some evidence that marijuana is associated with possible addiction and compulsive cravings that foster user dependence. Nevertheless, he reports other street drugs, such as cocaine or heroin, seem to retain comparatively higher risks of user addiction and dependence than marijuana.
Dr. Groopman continues the current evidence is somewhat equivocal about marijuana’s impact on pain reduction. He writes (and we quote): “While chronic pain seems amenable to amelioration by marijuana, its impact on reducing acute pain, such as after surgery, is minimal’ (end of quote).
Overall, Dr. Groopman explains if the arguments of marijuana’s critics and supporters are assessed through a clinical research perspective, some positions may not be supported by a robust evidence-base, some positions may be one-dimensional, and others might or might not be sustained. He concludes (and we quote): ‘.. as more studies are conducted on marijuana for medical or recreational uses, opponents and enthusiasts may both discover that they were neither entirely right nor entirely wrong’ (end of quote).
The essay, which includes a review of recent books about marijuana’s health risks and benefits, can be found at: nybooks.com.
Meanwhile, a website (from the National Institute on Drug Abuse) devoted to the topic whether marijuana is or is not medicine is available in the ‘related issues’ section of MedlinePlus.gov’s marijuana health topic page. Some tips for parents about teen and adult marijuana use (also from the National Institute on Drug Abuse) are found in the ‘overviews’ section of MedlinePlus.gov’s marijuana health topic page.
MedlinePlus.gov’s marijuana health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to relevant clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about marijuana and health as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s marijuana topic page type ‘marijuana’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘marijuana (National Library of Medicine).’ MedlinePlus.gov also has health topic pages on drug abuse and substance abuse problems.
WASHINGTON, April 22, 2014 — Marijuana is in the headlines as more and more states legalize it for medicinal use or decriminalize it entirely. In the American Chemical Society’s (ACS’) newest Reactions video, we explain the chemistry behind marijuana’s high, and investigate what scientists are doing to ensure that legalized weed won’t send users on a bad trip. The video is available at http://youtu.be/4ukdUDCE56c
Reducing or curbing just six modifiable risk factors—tobacco use, harmful alcohol use, salt intake, high blood pressure and blood sugar, and obesity—to globally-agreed target levels could prevent more than 37 million premature deaths over 15 years, from the four main non-communicable diseases (NCDs; cardiovascular diseases, chronic respiratory disease, cancers, and diabetes)according to new research published in The Lancet.
Worryingly, the findings indicate that not reaching these targets would result in 38.8 million deaths in 2025 from the four main NCDs, 10.5 million deaths more than the 28.3 million who died in 2010.
This is the first study to analyse the impact that reducing globally targeted risk factors will have on the UN’s 25×25 target to reduce premature deaths from NCDs by 25% relative to 2010 levels by 2025.
Using country-level data on deaths and risk factors and epidemiological models, Professor Majid Ezzati from Imperial College London, UK, and colleagues estimate the number of deaths that could be prevented between 2010 and 2025 by reducing the burden of each of the six risk factors to globally-agreed target levels—tobacco use (30% reduction and a more ambitious 50% reduction), alcohol use (10% reduction), salt intake (30% reduction), high blood pressure (25% reduction), and halting the rise in the prevalence of obesity and diabetes.
Overall, the findings suggest that meeting the targets for all six risk factors would reduce the risk of dying prematurely from the four main NCDs by 22% in men and 19% for women in 2025 compared to what they were in 2010. Worldwide, this improvement is equivalent to delaying or preventing at least 16 million deaths in people aged 30 years and 21 million in those aged 70 years or older over 15 years.
The authors predict that the largest benefits will come from reducing high blood pressure and tobacco use. They calculate that a more ambitious 50% reduction in prevalence of smoking by 2025, rather than the current target of 30%, would reduce the risk of dying prematurely by more than 24% in men and by 20% in women.
Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced after a recent Torstar News Service investigation.
The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.
“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”
Last week, Torstar revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.
At close to 300 homes, Torstar found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients…
I was at the Ann Arbor YMCA the other day and overheard two women questioning the safety of chemicals used in makeup and other over the counter personal products. This conversation was prompted by someone’s sunscreen running into their eyes, making them partially blind for a few minutes, causing her to wonder if there are any chemicals in there she should be really worried about. I thought I would do a search for information about the safety of chemicals in makeup and share my results since it seems to be something people are interested in:
A good place to start is this FDA Fact Sheet article. It’s a quick two page PDF that has excellent tips on makeup use and regulation.
Womenshealth.gov put out this great guide to cosmetics. It answers questions like “what’s in cosmetics” and “how can…
Tel Aviv University research shows fat mass in cells expands with disuse
Over 35 percent of American adults and 17 percent of American children are considered obese, according to the latest survey conducted by the Centers for Disease Control and Prevention. Associated with diabetes, heart disease, stroke, and even certain types of cancer, obesity places a major burden on the health care system and economy. It’s usually treated through a combination of diet, nutrition, exercise, and other techniques.
To understand how obesity develops, Prof. Amit Gefen, Dr. Natan Shaked and Ms. Naama Shoham of Tel Aviv University’s Department of Biomedical Engineering, together with Prof. Dafna Benayahu of TAU’s Department of Cell and Developmental Biology, used state-of-the-art technology to analyze the accumulation of fat in the body at the cellular level. According to their findings, nutrition is not the only factor driving obesity. The mechanics of “cellular expansion” plays a primary role in fat production, they discovered.
By exposing the mechanics of fat production at a cellular level, the researchers offer insight into the development of obesity. And with a better understanding of the process, the team is now creating a platform to develop new therapies and technologies to prevent or even reverse fat gain. The research was published this week in the Biophysical Journal.
Getting to the bottom of obesity
“Two years ago, Dafna and I were awarded a grant from the Israel Science Foundation to investigate how mechanical forces increase the fat content within fat cells. We wanted to find out why a sedentary lifestyle results in obesity, other than making time to eat more hamburgers,” said Prof. Gefen. “We found that fat cells exposed to sustained, chronic pressure — such as what happens to the buttocks when you’re sitting down — experienced accelerated growth of lipid droplets, which are molecules that carry fats.
“Contrary to muscle and bone tissue, which get mechanically weaker with disuse, fat depots in fat cells expanded when they experienced sustained loading by as much as 50%. This was a substantial discovery.”
The researchers discovered that, once it accumulated lipid droplets, the structure of a cell and its mechanics changed dramatically. Using a cutting-edge atomic force microscope and other microscopy technologies, they were able to observe the material composition of the transforming fat cell, which became stiffer as it expanded. This stiffness alters the environment of surrounding cells by physically deforming them, pushing them to change their own shape and composition.
“When they gain mass and change their composition, expanding cells deform neighboring cells, forcing them to differentiate and expand,” said Prof. Gefen. “This proves that you’re not just what you eat. You’re also what you feel — and what you’re feeling is the pressure of increased weight and the sustained loading in the tissues of the buttocks of the couch potato.”
The more you know …
“If we understand the etiology of getting fatter, of how cells in fat tissues synthesize nutritional components under a given mechanical loading environment, then we can think about different practical solutions to obesity,” Prof. Gefen says. “If you can learn to control the mechanical environment of cells, you can then determine how to modulate the fat cells to produce less fat.”
The team hopes that its observations can serve as a point of departure for further research into the changing cellular environment and different stimulations that lead to increased fat production.
HUNTSVILLE, TX (3/20/14) — Parents who use alcohol, marijuana, and drugs have higher frequencies of children who pick up their habits, according to a study from Sam Houston State University.
The study, “Intergenerational Continuity of Substance Use,” found that when compared to parents who did not use substances, parents who used alcohol, marijuana, and other illicit drugs were significantly more likely to have children who used those same drugs. Specifically, the odds of children’s alcohol use were five times higher if their parents used alcohol; the odds of children’s marijuana use were two times higher if their parents used marijuana; and the odds of children’s other drug use were two times higher if their parent used other drugs. Age and other demographic factors also were important predictors of substance use.
HarmCausedByDrugsTable (Photo credit: Wikipedia) Source “Scoring drugs”, The Economist, data from “Drug harms in the UK: a multi-criteria decision analysis”, by David Nutt, Leslie King and Lawrence Phillips, on behalf of the Independent Scientific Committee on Drugs. The Lancet. 2010 Nov 6;376(9752):1558-65. d
“The study is rare in that it assesses the extent to which parent’s substance use predicts use by their children within age-equivalent and developmentally-specific stages of the life course,” said Dr. Kelly Knight of the College Criminal Justice’s Department of Criminal Justice and Criminology. “If a parent uses drugs, will their children grow up and use drugs? When did the parent use and when did their children use? There appears to be an intergenerational relationship. The effect is not as strong as one might believe from popular discourse, but when you measure it by developmental stage, it can provide important information on its impact in adolescence and early adulthood, specifically.”
The study examined the patterns of substance use by families over a 27-year period. It documents substance use over time, giving a more complete understanding of when substance use occurs, when it declines, and the influence of parents in the process.
According to the National Survey on Drug Use and Health in 2011, about 22.6 million Americans age 12 years and older said they used illicit drugs in the last month. Other studies show that drug use is associated with reduced academic achievement, lower employment rates, poorer health, dependency on public assistance, neighborhood disorganization, and an increase in the likelihood of involvement in crime, criminal victimization and incarceration. The cost of drug use in this country from lost productivity, healthcare, and criminal justice is nearly $600 billion.
By plotting the life course of substance use within families, the study may be a valuable tool for the development of intervention programs. The study suggests that if substance use can be curtailed in adolescence, it may help to curb its prevalence in future generations.
The study also helps pinpoint the use of different illicit substances over the span of a lifetime, including its emergence in adolescence and when that use may decline. For example, marijuana and other drug use is most prevalent in adolescence and generally declines before or at age 24. Alcohol use continues to increase throughout adolescence and young adulthood, and then remains relatively steady over the lifetime.
These findings come from the National Youth Survey Family Study, which has collected data from three generations over a 27-year period. The analysis is based on 655 parents and 1,227 offspring from 1977 to 2004.
Major ‘third-hand smoke’ compound causes DNA damage — and potentially cancer
DALLAS, March 16, 2014 — Leftover cigarette smoke that clings to walls and furniture is a smelly nuisance, but now research suggests that it could pose a far more serious threat, especially to young children who put toys and other smoke-affected items into their mouths. Scientists reported today that one compound from this “third-hand smoke,” which forms when second-hand smoke reacts with indoor air, damages DNA and sticks to it in a way that could potentially cause cancer.
Their talk was one of more than 10,000 presentations at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the world’s largest scientific society, taking place here through Thursday.
Bo Hang, Ph.D., who presented the research, said that although the idea of third-hand smoke made its debut in research circles just a few years ago in 2009, evidence already strongly suggests it could threaten human health.
“The best argument for instituting a ban on smoking indoors is actually third-hand smoke,” said Hang, a scientist at Lawrence Berkeley National Laboratory (LBNL).
Researchers have found that many of the more than 4,000 compounds in second-hand smoke, which wafts through the air as a cigarette is smoked, can linger indoors long after a cigarette is stubbed out. Based on studies led by Hugo Destaillats, Ph.D., also at LBNL, these substances can go on to react with indoor pollutants such as ozone and nitrous acid, creating brand-new compounds, some of which may be carcinogenic.
One of those compounds goes by the acronym NNA. Hang’s research has shown that NNA, a tobacco-specific nitrosamine, locks onto DNA to form a bulky adduct (a piece of DNA bound to a cancer-causing chemical), as well as other adducts, in lab test tubes. Other large compounds that attach to DNA tend to cause genetic mutations. NNA also breaks the DNA about as often as a related compound called NNK, which is a well-studied byproduct of nicotine and a known potent carcinogen. This kind of DNA damage can lead to uncontrolled cell growth and the formation of cancerous tumors.
Just as it took years to establish the cancer-causing effects of first-hand smoke that is inhaled as a person breathes in directly from the cigarette, making the connection between third-hand smoke or NNA and cancer could take a long time, Hang said. But early research into its nature, exposure and health effects is compelling enough that a research consortium dedicated to investigating third-hand smoke was formed in California in 2010. That consortium helped fund Hang’s work on NNA-induced DNA damage, which he said could eventually be used as biomarkers to identify people who have been exposed to third-hand smoke.
The biggest potential health risk is for babies and toddlers, he noted. As they crawl and put their hands or toys in their mouths, they could touch, swallow or inhale compounds from third-hand smoke. Their small size and early developmental stage make them more vulnerable than adults to the effects of environmental hazards.
“Phthalates belong to a group of industrial compounds known as endocrine disruptors because they interfere with the endocrine system, which governs the production and distribution of hormones in the body. The chemicals have been implicated in a range of health problems, includingbirth defects, cancers and diabetes.
But it is their effect on the human reproductive system that hasmost worried researchers. A growing body of work over the last two decades suggests that phthalates can rewire the male reproductive system, interfering with the operation of androgenic hormones, such as testosterone, that play key roles in male development. That mechanism, some experts believe, explains findings that link phthalate exposure to changes in everything from testicular development to sperm quality.”
“There are different kinds of phthalates complicating the picture; some seem to have a much larger effect than others. And these are far from the only factors, chemical and otherwise, that influence human fertility. Dr. Buck Louis’s group is looking at a broad range of industrial compounds, including heavy metals like lead and cadmium, that tend to accumulate in the body.
Phthalates, by contrast, tend to be metabolized within a few hours. Their impact would not be so profound if it were not that people are constantly exposed from multiple sources.
These include not only cosmetics and plastics, but also packaging, textiles, detergents and other household products. Phthalates are found in the tubing used in hospitals to deliver medications; in water flowing through PVC pipes; enteric coatings on pills, including some aspirin; materials used to create time-release capsules; and countless other products. In 2008, the government banned them in children’s toys, and the European Union is also moving forward on restrictions.
“The W.H.O. called them ‘pseudopersistent’ in one report,” Dr. Woodruff said, because continued exposure keeps phthalates in the body. But here’s the silver lining: the transient nature of these compounds also means that consumers can take fairly simple measures to reduce their phthalate levels.
One is to read the labels on cosmetics and other personal care products and to choose those without phthalates. Another is to be cautious with plastic food containers, and to avoid using them to heat food and drink, as the phthalates in them may get transferred to what you consume.
“These compounds leach from plastics,” Dr. Buck Louis said. “You can switch to glass for drinking. You can cook your frozen dinners on paper plates.”
Studies have shown that these kinds of actions do make a difference; experiments have found measurably lower levels within several days in people who make these changes.
“Lifestyle has an important place here,” said Dr. Buck Louis.”
Mind the Store for Safer Chemicals: Phthalates (Photo credit: DES Daughter)
California took steps to reduce the toxins found in children’s sleeping products and home and building supplies on Thursday, when regulators announced they would begin asking manufacturers to eliminate chemicals known to cause cancer and other illnesses.
In making the announcement, regulators with the California Department of Toxic Substances Control rolled out a program six years in the making — the first of its kind in the nation — that aims to minimize consumers’ exposure to toxic chemicals.
“I can’t even tell you what a big deal this is,” said Kathleen Curtis, the national coordinator for the Alliance for Toxic-Free Fire Safety, a nationwide coalition. “It’s huge, and it’s a super smart strategic move by the state of California.
On Thursday, state leaders announced the first round of top priority chemicals that they want reduced or eliminated from products many Californians use: children’s bedding items, spray foam used to insulate and weatherize buildings, and paint strippers, removers and surface cleaners. All of these products, state officials say, contain toxins that can cause cancer, hormone imbalances and environmental degradation.
Meredith Williams, deputy director of the Department of Toxic Substances Control, said the state’s message to manufacturers is this: If you want to sell products in California, you must make products that are safe — or risk being banned from the country’s largest economy.
The announcement signals a larger victory for environmental advocates who have been working for years to rid furniture of toxins that were added as flame retardants. Studies have shown that some of these flame retardants do very little to reduce fires and have been linked to startling health risks. One of the most widely used flame retardants is TDCPP, which, under the Safer Consumer Products regulations, the state will pressure manufacturers to remove from toddlers’ nap mats, cots, cribs, playpens and bassinets.
TDCPP is one of three chemicals the state announced it is targeting: the others are diisocyanates, a chemical found in spray polyurethane foam that is used to weatherize buildings, and has been linked to lung damage, asthma, cancer and respiratory ailments; and methylene chloride, a carcinogen found in paint or varnish removers, paint strippers and surface cleaners. Thursday’s announcement marked the start of what is expected to be a yearlong process that will include a public comment period, discussions with manufacturers and studies to identify safe substitutions. In October, the state will release a second, and much lengthier, list of priority chemicals and products, Williams said. Manufacturers who don’t meet the new standards could be compelled to label their ingredients or have their products banned from California as early as 2016,
“What we need,” Freudenberg said to me, “is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”
Bittman contributes to the ongoing discussion here at NobodyisFlyingthePlane about how certain industries deflect public discourse from what is best for our citizens to what makes the most profit, no matter the consequences.
The author he quotes poses a series of questions which get at the heart of the matter.
“Shouldn’t science and technology be used to improve human well-being, not to advance business goals that harm health?”
Similarly, we need to be asking not “Do junk food companies have the right to market to children?” but “Do children have the right to a healthy diet?”
Essentially its a PR game. Do we let whole industries spin how the conversation is framed or do we let the…
Chronic pain syndrome is an extremely complicated diagnosis and the treatment of its symptoms requires an interdisciplinary approach ranging from primary care physicians, physical therapists, anesthesiologists, and psychologists. Likewise, understanding the barriers to the treatment of chronic pain requires teasing out a similarly convoluted picture. Therefore, I’ve decided to write about the extremely complex and understudied relationship between poverty and pain. Not surprisingly, there are many components to this relationship because the American health care system is one that involves many players from the government, private sector, non-profits, and Medicare, Medicaid, TRICARE, Children’s Health Insurance Program, Social Security Administration, and the Veteran’s Administration, just to name a few. However my focus will be narrowed to concentrate on the relationship between living in poverty and efficacious treatment of chronic pain, the flip side of that relationship where individuals fall into poverty as a result of a life-altering, limiting, and costly diagnosis of chronic pain, and the stigma of poverty that consciously or unconsciously affects access to treatment for patients in pain.
Living in poverty increases an individual’s risk for pain on almost every level including musculoskeletal, sciatica, ulcer, and neuropathic. Poleshuck and Green suggest that an individual’s socioeconomic status permeates almost every level of why an individual may suffer with chronic pain including the ability to implement positive coping strategies, job type and satisfaction, access to quality health insurance, and even social support and interpersonal relationships.
too often research on chronic pain is conducted in areas that have significant financial resources instead of places such as churches, homeless shelters, and community centers. There are other things to consider here. People that live in poverty and suffer from pain may not have access to primary care givers, analgesics or pharmacies that carry analgesics, and pain specialists. As the U.S. population ages and increasingly more people are diagnosed with pain disorders, those on the fringe will suffer most. Of course, there is a moral argument to be made here but there is an economic one too. According to an article that came out in Science Daily in 2012, health economists at Johns Hopkins estimated that chronic pain cost as much as $635 billion a year which they found was higher than heart disease, diabetes, and cancer. This was a conservative estimate. Therefore, one could argue that it is a public health interest to employ strategies of risk management, access, and multidisciplinary approaches to pain to vulnerable groups who suffer disabling pain at a higher number and magnitude.
Clean hands: a review of 67 randomized controlled trials (RCTs) indicated that handwashing, a traditional public health approach, as well as alcohol disinfectants and gloves, is likely effective.
Zinc may work for children (and possibly adults) — at least 2 RCTs indicated that children who took 10 or 15 mg of zinc sulfate daily had lower rates of colds and fewer absences from school due to colds. The authors suggest that zinc may also work for adults.
Probiotics: there is some evidence that probiotics may help prevent colds, although the types and combinations of organisms varied in the studies as did the formulations (pills, liquids, etc.), making comparison difficult.
Antihistamines combined with decongestants and/or pain medications appear to be somewhat or moderately effective in treating colds in older children — but not in children under age 5 — and adults.
Pain relievers: ibuprofen and acetaminophen help with pain and fever. Ibuprofen appears better for fever in children.
Nasal sprays: ipratropium, a drug used to treat allergies and chronic obstructive pulmonary disorder, may alleviate runny nose when used in a nasal spray but has no effect on congestion.
Other approaches and treatments
According to the evidence, the benefits of frequently used remedies such as ginseng, (found in ColdFX), gargling, vapour rubs and homeopathy are unclear. Cough medicines show no benefit in children but may offer slight benefit in adults. Honey has a slight effect in relieving cough symptoms in children over age 1. Vitamin C and antibiotics show no benefit, and misused antibiotics can have associated harms.
The authors note that the evidence for preventing and treating colds is often of poor quality and has inconsistent results.
“Much more evidence now exists in this area, but many uncertainties remain regarding interventions to prevent and treat the common cold,” write the authors. “We focused on RCTs and systematic reviews and meta-analyses of RCTs for therapy, but few of the studies had a low risk of bias. However, many of the results were inconsistent and had small effects (e.g., vitamin C), which arouses suspicion that any noted benefit may represent bias rather than a true effect.”
English: Original description: “This full color 17″x22″ poster is planned for use in doctor’s offices, clinics, other healthcare facilities, and media outlets. It is intended to raise awareness about appropriate antibiotic use for upper respiratory infections in adults. It explains that antibiotics are not the best answer for a cold or flu.” (Photo credit: Wikipedia)
From the 10 January 2014 Contra Costa Times article
Assorted cosmetics and tools (Photo credit: Wikipedia)
State public health officials announced on Friday a new online database that shows which cosmetics sold in California contain certain harmful chemicals, offering the first state-run public resource to inform consumers about potentially hazardous products they use everyday on their skin and hair.
The long-awaited California State Cosmetics Program Product Database is part of a state law passed in 2005 that aims to expose products with potentially hazardous ingredients, and pressure manufacturers to reformulate makeup, soap, lotion and similar products with safer alternatives. The public can search the website by type of product, brand or ingredient, and will be shown a list of products made with chemicals that are known to cause cancer, reproductive harm or birth defects.
“It does not mean that the cosmetic product itself has been shown to cause cancer, but since most products are not extensively tested for safety, providing information on chemical components will allow consumers to make more informed choices,” said Dr. Ron Chapman, director of the state Department of Public Health.
As of November, the state had collected information from about 475 companies, which have disclosed the ingredients in roughly 30,000 products. The state is requiring only companies that sell in California and have more than $1 million per year in cosmetic sales to report the potentially harmful ingredients they use. The state is looking for about 900 chemicals that have been identified as harmful by Proposition 65 legislation and organizations such as the National Toxicology Program.
The database is part of the California Safe Cosmetics Act of 2005, legislation signed by then-Gov. Arnold Schwarzenegger. The law required the site to be up by Dec. 31, 2013, but a health department spokesman said it did not go live until Friday.
The law also gives the state some enforcement authority, such as requiring products are labeled with warnings.
“We are the one agency in the U.S. collecting this information on cosmetics,” Nerissa Wu, a state public health official who helped establish the program, told this newspaper in an interview last fall. “Our hope is that the market pressure that comes out of that … encourages manufacturers to reformulate.”
Advocates welcomed the database, but some worried that the state lacked the resources to enforce safer standards for cosmetics.
“This doesn’t ban anything. This doesn’t restrict anything,” said Gretchen Salter, senior program and policy manager at the San Francisco-based Breast Cancer Fund, an advocacy group that championed the 2005 legislation. “Ultimately our feeling is these products don’t belong in cosmetics in the first place.”
Patients with a single illness who take many drugs have an increased risk of being admitted to hospital, but for patients with multiple conditions, taking many medicines is now associated with a near-normal risk of admission. This is the key finding of work published in the British Journal of Clinical Pharmacology. Doctors call the situation where people take many drugs ‘polypharmacy’, a state of affairs that is becoming increasingly common in part because we have more elderly people and also a rising number of people are being diagnosed with multiple health conditions.
Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.
Medicine drugs (Photo credit: Wikipedia)
Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.
We were standing at Target in an aisle we’d never walked down before, looking at things we didn’t understand. Pill splitters, multivitamins, supplements, and the thing we were here to buy: a long blue pill box—the kind with seven little doors labeled “S M T W T F S “ for each day of the week, the kind that old people cram their pills into when they have too many to remember what they’ve already taken.
My husband, Joe Preston, shook his head. “Do I really need this?”
I grabbed it off the shelf and threw it in our basket. And when we got home, Joe—then a fit and fairly spry 30-year-old man with a boss-level beard—stood at the kitchen counter, dropping each of his prescriptions with a plink into the container.
I guess it’s true that life is full of surprises, but for the three years since Joe’s crippling pain was diagnosed as the result of an autoimmune disease called Ankylosing Spondylitis, our life has been full of surprises like this one. Pill boxes, trips to the emergency room, early returns from vacation. Terms like “flare-up” have dropped into our vocabulary. We’ve sat in waiting rooms where Joe was the only person without a walker or a cane. Most of our tears have been over the fact that these aren’t the kind of surprises either of us thought we’d be encountering at such a young age.
But here’s the thing: We recently realized we weren’t alone. Almost all of our friends are sick, too. When we met our friend Missy Narrance, Joe found solace in talking to her about his health. She’s 29 and has been battling lupus and fibromyalgia for the past 10 years. She’s been through chemotherapy twice, and her daily symptoms are so extreme that she was granted federal disability status when she was just 23 years old. In our close group of friends—who range from 25 to 35 years old—we know people with everything from tumors to chronic pain. Sometimes our conversations over beers on a Friday night turn to discussions of long-term care and miscommunication between doctors.
The rest of the article includes analysis on how personal choices must be backed up by facts. It points out that research has been done on how infrastructural changes (which need tax dollars) can improve public health. But there has to be political will.
Research on these aspects of public health have not been widely disseminated by the press.
The mobile health market is rapidly growing, and it’s estimated that within five years 50 percent of mobile device users will have downloaded mobile health apps. While past surveys haveshown that patients are eager for doctors to recommend such apps, it remains unclear if physicians feel comfortable prescribing them.
Over on MedPage Today, writer Kristina Fiore explores the potential of physicians prescribing health apps, such as BlueStar, which is approved by the U.S. Food and Drug Administration and helps patients monitor diabetes. Several of the clinicians contacted for the story said they are open to the idea, assuming that patients are comfortable using the app and that data shows the app to be effective. From the article:
Sue Kirkman, MD, of the University of North Carolina at Chapel Hill, said a prescription app could be helpful, but its usefulness may be limited in that the patients “who want the app and are willing to enter data and respond to prompts may already be the more proactive ones.”
Kirkman added that she hopes potential insurer reimbursement for apps opens the door wider to support of reimbursement for self-management tools such as contact with diabetes educators.
“Right now, pretty much only face-to-face visits are covered, not the ongoing contacts by phone, fax, email, etc., that are really needed to help someone sustain behavior changes and self-manage their diabetes optimally,” she said.
The app, BlueStar, is a tracker for patients with diabetes. It analyzes logged blood glucose data and offers advice based on trends it detects — such as telling patients to adjust their diets based on sugar levels after meals. Clinicians also receive a report on their patients’ progress.
Many people are confused about what the term public health means. As I have been working on the development of an academic course I have found myself having to explain to others what public health is. Public health is a field that encompasses many disciplines in an effort to promote and protect health and prevent disease and disability in defined populations and communities. We’re not talking about individuals and their health behaviors. Public health deals with large groups of people and health issues which can be defined very differently depending on what health issue we are talking about. Groups of people can be defined by things like location or where they physically live, for example, by city. Or, populations can be defined/grouped by a demographic like age, gender, and so on.
Why am I blogging about public health? I feel it’s necessary for all allied health professionals to have a…
January 11, 2014 marked the 50th anniversary of the first Surgeon General’s Report on Smoking and Health. The 1964 landmark report, released by Surgeon General Dr. Luther Terry, was the first federal government report linking smoking and ill health, including lung cancer and heart disease. This scientifically rigorous report laid the foundation for tobacco control efforts in the United States. In the last 50 years, 31 Surgeon General’s Reports have been released, increasing our understanding of the devastating health and financial burdens caused by tobacco use. We now know that smoking causes a host of cancers and other illnesses and is still the leading preventable cause of death in the United States, killing 443,000 people each year. In 2014, we highlight half a century of progress in tobacco control and prevention, present new data on the health consequences of tobacco use, and introduce initiatives that can potentially end the tobacco use epidemic in the United States in the 32rd Surgeon General’s Report on smoking and health, The Health Consequences of Smoking—50 Years of Progress.
“Lasting changes will come from deep work by individuals to create systemic change.”
Reducing violence in neighborhoods enhances the community environ- ment and allows people to thrive. The prevention of violence facilitates community cohesion and participation, fosters neighborhood improve- ments, expands employment and educational opportunities, and improves overall health and well-being.
Violence influences where people live, work, and shop; whether parents let kids play outside and walk to school; and whether there is a grocery store or places for employment in the community. Violence jeopardizes health and safety directly— causing injuries, death, and emotional trauma. Witnessing or directly experiencing violence, as well as the fear of violence, are damaging, with consequences that also contribute to unhealthy behavior and a diminished community environment. Vio- lence and fear undermine attempts to improve healthy eating and active living, there- by exacerbating existing illnesses and increasing the risk for onset of disease, includ- ing chronic disease. They affect young people, low-income communities, and com- munities of color disproportionately. Violence and food- and activity-related chron- ic diseases are most pervasive in disenfranchised communities, where they occur more frequently and with greater severity, making them fundamental equity issues.
Chronic disease is a major health challenge—it contributes to premature death, lowers quality of life, and accounts for the dramatic rise in recent healthcare spend- ing. One striking example is the increasing prevalence of diabetes in the United States. Researchers predict that by 2034, the number of people suffering from dia- betes will likely double to 44.1 million, and related health care costs will triple to $336 billion.1 Improving healthy eating and active living environments and behaviors is the crucial link to preventing many forms of chronic disease. Health leaders have been making great strides in mounting a strong, effective response to chronic disease and in improving community environments to support healthy eating and activity. However, chronic disease prevention strategies—designing neighborhoods that encourage walking and bicycling to public transit, parks, and healthy food retail, or attracting grocery stores in communities that lack access to affordable fresh fruits and vegetables—are less effective when fear and violence pervade the environment. As more communities grapple with chronic disease, health practitioners and advocates are becoming increasingly aware of the need to address violence as a critical part of their efforts, and they are seeking further guidance on effective strategies.
The purpose of this paper is to provide guidance and deepen the understanding of the inter-relationship between violence and healthy eating and activity. It presents first-hand evidence based on a set of interviews Prevention Institute facilitated with community representatives—advocates and practitioners working in healthy eating and active living. Direct quotes from these interviewees appear in italics throughout this paper. In addition to the interviews, the Institute conducted a scan of peer- reviewed literature and professional reports that confirm the intersection between vio- lence and healthy eating and active living.3-12 …
**Prevention Institute was founded in 1997 to serve as a focal point for primary prevention practice—promoting policies, organizational practices, and collaborative efforts that improve health and quality of life. As a national non-profit organization, the Institute is committed to preventing illness and injury, to fostering health and social equity, and to building momentum for community prevention as an integral component of a quality health system. Publications are online and free.
The fact that smoking means a considerable health risk is nowadays commonly accepted. New research findings from Uppsala University and Uppsala Clinical Research Center show that smoking alters several genes that can be associated with health problems for smokers, such as increased risk for cancer and diabetes.
We inherit our genes from our parents at birth. Later in life the genetic material can be changed by epigenetic modifications, i.e. chemical alterations of the DNA the affect the activity of the genes. Such alterations are normally caused by aging but can also result from environmental factors and lifestyle.
In a study recently published in the journal Human Molecular Genetics the researchers have examined how the genes are changed in smokers and users of non-smoke tobacco. They could identify a large number of genes that were altered in smokers but found no such effect of non-smoke tobacco.
t has been previously known that smokers have an increased risk of developing diabetes and many types of cancer, and have a reduced immune defence and lower sperm quality. The results from the study also showed that genes that increase the risk for cancer and diabetes, or are important for the immune response or sperm quality, are affected by smoking.
Exercise can be as effective as many frequently prescribed drugs in treating some of the leading causes of death, according to a new report. The study raises important questions about whether our health care system focuses too much on medications and too little on activity to combat physical ailments.
For the study, which was published in October in BMJ, researchers compared how well various drugs and exercise succeed in reducing deaths among people who have been diagnosed with several common and serious conditions, including heart disease and diabetes.
The results consistently showed that drugs and exercise produced almost exactly the same results. People with heart disease, for instance, who exercised but did not use commonly prescribed medications, including statins, angiotensin-converting-enzyme inhibitors or antiplatelet drugs, had the same risk of dying from — or surviving — heart disease as patients taking those drugs. Similarly, people with diabetes who exercised had the same relative risk of dying from the condition as those taking the most commonly prescribed drugs. Or as the researchers wrote in statistics-speak, “When compared head to head in network meta-analyses, all interventions were not different beyond chance.”
On the other hand, people who once had suffered a stroke had significantly less risk of dying from that condition if they exercised than if they used medications — although the study authors note that stroke patients who can exercise may have been unusually healthy to start with.
Only in chronic heart failure were drugs noticeably more effective than exercise. Diuretics staved off mortality better than did exercise.
“We are not suggesting that anyone stop taking their medications,” he said. “But maybe people could think long and hard about their lifestyles and talk to their doctors” about whether exercise could and should be incorporated into their care.
Subjective well-being refers to how people experience and evaluate their lives and specific domains and activities in their lives. This information has already proven valuable to researchers, who have produced insights about the emotional states and experiences of people belonging to different groups, engaged in different activities, at different points in the life course, and involved in different family and community structures. Research has also revealed relationships between people’s self-reported, subjectively assessed states and their behavior and decisions. Research on subjective well-being has been ongoing for decades, providing new information about the human condition. During the past decade, interest in the topic among policy makers, national statistical offices, academic researchers, the media, and the public has increased markedly because of its potential for shedding light on the economic, social, and health conditions of populations and for informing policy decisions across these domains.
Subjective Well-Being: Measuring Happiness, Suffering, and Other Dimensions of Experienceexplores the use of this measure in population surveys. This report reviews the current state of research and evaluates methods for the measurement. In this report, a range of potential experienced well-being data applications are cited, from cost-benefit studies of health care delivery to commuting and transportation planning, environmental valuation, and outdoor recreation resource monitoring, and even to assessment of end-of-life treatment options.
Subjective Well-Being finds that, whether used to assess the consequence of people’s situations and policies that might affect them or to explore determinants of outcomes, contextual and covariate data are needed alongside the subjective well-being measures. This report offers guidance about adopting subjective well-being measures in official government surveys to inform social and economic policies and considers whether research has advanced to a point which warrants the federal government collecting data that allow aspects of the population’s subjective well-being to be tracked and associated with changing conditions.
Negative studies are just as important to consumers as positive studies. They are essential blocks in the evidence base. They help everyone—consumers and health care providers—avoid interventions that don’t help.
A recent study in the New England Journal of Medicine, authored by six researchers at the National Heart, Lung, and Blood Institute (NHLBI), prompts some thoughts about studies with negative outcomes—and their importance in the entire research process.
In this report Dr. David Gordon, Dr. Michael Lauer, and their colleagues analyzed the 244 extramural, randomized clinical trials supported by NHLBI and completed between the years 2000 and 2011. The primary outcome was the time between completion of trials and publication of the main results in a peer-reviewed journal; the secondary outcome was the annual citation rates for these articles—i.e., how many times each article was cited in a given time period. The team also examined a number of trial characteristics that related to these questions, such as budget, number of participants, and whether the result was positive or negative.
Among the many interesting findings are that more than half of the studies analyzed (58 percent) yielded negative results. And intriguingly, of the 31 trials having the highest citation rates, only 8 (26 percent) had positive results. Studies supported by NHLBI, and indeed, studies supported by NCCAM, generally start with enthusiasm of the investigators, peer reviewers, and NIH. They generally start with the expectation (and indeed preliminary data) that the intervention being studied has the potential to improve patient outcomes. By and large, when no benefit is demonstrated, research teams are understandably disappointed. And Gordon and co-authors found that investigators completing negative studies are indeed significantly slower to publish.
Nevertheless, we do the research because we don’t know the answer! Negative studies are just as important to consumers as positive studies. They are essential blocks in the evidence base. They help everyone—consumers and health care providers—avoid interventions that don’t help.
There is an additional “silver lining.” Negative studies are extremely important in the research process. And the high-quality data produced during our well-performed, carefully monitored studies are of enormous value in deciding on follow-on questions and in the design of subsequent studies.
We learn from surprises—from discovering that we don’t always know what we think we know.
From 2010 to 2013, The Pew Charitable Trusts conducted a comprehensive assessment of the federal food additives regulatory program. Relying on a transparent process that engaged stakeholders, Pew examined food additive issues in partnership with the food industry, the public interest community, and the federal government, including the U.S. Food and Drug Administration, or FDA. We held five expert workshops and published six reports in peer-reviewed journals. This report summarizes our findings and provides recommendations to address the problems that we identified.
With more than 10,000 additives allowed in food, Pew’s research found that the FDA regulatory system is plagued with systemic problems, which prevent the agency from ensuring that their use is safe. The cause of this breakdown in our food safety regulatory process is an outdated law with two significant problems:
First, the law contains an exemption intended for common food ingredients; manufacturers have used this exception to go to market without agency review on the grounds that the additive used is “generally recognized as safe,” or GRAS, in regulatory parlance. FDA has interpreted the law as imposing no obligation on firms to tell the agency of any GRAS decisions. As a result, companies have determined that an estimated 1,000 chemicals are generally recognized as safe and have used them without notifying the agency. The firms usually use their own employees, consultants, or experts whom they select and pay to make the safety decision with no disclosure or apparent efforts to minimize the inherent conflicts of interest.
Second, the law does not give FDA the authority it needs to efficiently obtain the information necessary to identify chemicals of concern that are already on the market; set priorities to reassess these chemicals; and then complete a review of their safety. Moreover, the agency has not been given the resources it needs to effectively implement the original 1958 law. As a result, FDA has not reevaluated the safety of many chemicals originally approved decades ago, generally rechecking safety only when requested by a company to do so, or when presented with allegations of serious adverse health effects.
What FDA says today about the safety of additives
“It’s perhaps a time to look at what the legal framework looks like and what opportunities there are now to ask and answer questions in new ways because of advances in science and technology.”
— FDA Commissioner Margaret Hamburg, (Reuters, May 2013)
“We’re not driven by a sense that there is a pressing public health emergency. But there are decisions being made based on data that we don’t have access to, and that creates a question about the basis on which those decisions are made.”
— FDA Deputy Commissioner for Foods Michael Taylor, (Associated Press, March 2013)
“FDA plans to issue guidance to industry on meeting the GRAS criteria established under the Act.”
— FDA spokeswoman Theresa Eisenman, (USA Today, August 2013)
To remedy these problems, Pew’s report recommends that Congress update the Food Additives Amendment of 1958 to ensure that FDA:
Approves the first use of all new chemicals added to food.
Reviews new uses or changes to existing uses of previously approved additives.
Streamlines its decision-making process so it is timely and efficient.
Upgrades its science to determine safety.
Uses the scientific tools and data it needs to set priorities to reassess the safety of chemicals already allowed in food and to take action where necessary.
Back in college I took a “physical fitness” class. One of Dr. Cooper’s books was required reading. Very inspiring. Good to see he is still a living example of his well tested theories of aerobic exercise and wellness program benefits.
From the 18 November American Heart Association article
In the early 1960s, when the great Space Race was being fueled by the escalating Cold War, a former track and basketball star from Oklahoma envisioned himself soaring through the Milky Way.
This tall, lanky fellow was an Army doctor, but the lure of space flight led him to transfer to the Air Force. He became certified in aerospace medicine. Then he developed training programs for astronauts – some for before they took off, others to help them remain in shape while floating weightlessly in outer space. All along, his sights were set on becoming among a select group of “science astronauts.”
Imagine how different life on Earth would be today if Kenneth Cooper, MD, MPH, hadn’t shifted gears.
Cooper actually was still in the Air Force when he published “Aerobics,” a book that did as much for the health of Americans as the Apollo 11 lunar landing did for the aerospace industry. Cooper’s book, by the way, came out first – more than a year before Neil Armstrong planted the U.S. flag on the moon.
That book is now available in more than 40 languages. Cooper has spoken in more than 50 countries, and written 18 more books. He is the “Father of Aerobics” and a big reason why the number of runners in the United States spiked from 100,000 when his book came out to 34 million in 1984.
Having proven the benefits of preventive medicine and wellness in the military, he was ready to shift to the private sector.
The private sector, however, wasn’t ready for him.
When he opened his clinic in Dallas, naysayers told him, “You can’t limit your practice to taking care of healthy people. People only want to see their physicians when they’re sick.” And those were the kind ones. Others turned him in to the local medical society’s board of censors.
“They thought I was going to kill people by putting them on treadmills for stress testing,” Cooper said. “I’d been doing it in the Air Force for 10 years!”
The big picture turned out more clearly. Baby Boomers became exercisers, triggering a fitness craze that produced what he calls “the glory years of health in America.” As Boomers have aged, and future generations have made fitness a lower priority, health had spiraled in the wrong direction. It’s been 17 years since the Surgeon General recommended 30 minutes of physical activity most days of the week, and the statistics show that most Americans aren’t doing it.
“For many years, I’ve put people into five health categories, ranking them from very poor to excellent. Research constantly shows that major gains can be made by moving up just one category, even if it’s just from very poor to poor,” Cooper said. “If we can get the 50 million Americans who are totally inactive today to move up just one category, think of the dramatic effect that would have. Just by avoiding inactivity!”
Gun use in PG-13 movies has more than tripled since 1985
Researchers worry about effects on teen viewers
COLUMBUS, Ohio – The amount of gun violence shown in PG-13 films has more than tripled since 1985, the year the rating was introduced.
In fact, the most popular PG-13 movies of 2011 and 2012 showed significantly more gun violence than R-rated movies of the same time period, a new study reveals.
“It’s shocking how gun use has skyrocketed in movies that are often marketed directly at the teen audience,” said Brad Bushman, co-author of the study and professor of communication and psychology at The Ohio State University.
“You have to wonder why we are seeing this surge in gun violence in PG-13 movies, when it isn’t appearing in G, PG and R-rated films.”
Bushman conducted the research with Patrick Jamieson, Ilana Weitz and Daniel Romer of the Annenberg Public Policy Center at the University of Pennsylvania. The study was published online Nov. 11, 2013, in the journal Pediatrics.
Bushman said the results are concerning because other research has revealed the presence of a “weapons effect”: People who simply see a gun, or even a picture of a gun, are more aggressive toward others.
“Based on what researchers have found, it is not good for teens to be viewing this much gun violence in films,” he said.
PG movies suggest that “some material may not be suitable for children,” according to the Motion Picture Association of America, which creates the ratings. PG-13 movies carry a sterner warning: “Parents strongly cautioned. Some material may be inappropriate for children under 13.” The MPAA says a PG-13 movie “may go beyond the PG rating” in violence “but does not reach the restricted R cateogry.”
PG-13 movies are also the most popular among viewers – 13 of the top 25 films in release during 2012 carried that rating, including seven of the top 10, according to the MPAA.
“By the standards of the MPAA, PG-13 movies shouldn’t have as much violence as R-rated movies, but they clearly do. It appears sex scenes are more likely to result in an R rating than scenes of violence,” Bushman said.
The researchers studied a database of 915 films that were drawn from the 30 top-grossing films for each year from 1950 to 2012. Researchers identified violent sequences performed by each character for each five-minute segment of the films.
They also noted whether each violent sequence since 1985 (the first full year after the PG-13 rating was introduced) included the use of a gun.
Overall, findings showed that the rate of violent sequences nearly quadrupled from 1950 to 2010. Since 1985, 94 percent of the movies studied (367 in total) had one or more five-minute segments that included violence. Overall, the films contained 700 segments with gun violence.
Findings showed that R-rated films averaged about 1.54 segments per hour featuring gun violence, and that number didn’t fluctuate much from 1985 to 2010. Movies rated G and PG averaged 0.41 segments of gun violence per hour, which also hasn’t changed since 1985.
The story is much different for films rated PG-13, Bushman said. In 1985, PG-13 movies essentially didn’t have any scenes of gun violence, but the number rose steadily until about 2005, when it began escalating even faster.
By 2010, PG-13 films averaged as many sequences featuring gun violence per hour as R-rated films. In 2011 and 2012, PG-13 movies actually had more gun violence than R-rated movies.
“The trend of increasing gun violence in PG-13 movies is disturbing because of what we know about the weapons effect and because those are the films kids are most attracted to,” Bushman said.
The weapons effect was first shown in 1967, in a study by psychologists that showed participants who were provoked until angry acted more aggressively toward others when there was a gun on a table in front of them.
Since then, more than 50 other studies have replicated the weapons effect, even among people who weren’t angry.
“Seeing these violent gun scenes in movies may be strengthening the weapons effect among young people,” Bushman said.
“In addition, these movies essentially provide young people scripts for how to use guns in real life, as we have seen in copycat killings. It is a bad situation.”
Data from the study were collected as part of The Coding of Media and Health Project at the Annenberg Public Policy Center. Funding for this study came from the APPC and the Robert Wood Johnson Foundation.
Data from the National Hospital Ambulatory Medical Care Survey, 2009–2010
In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. The visit rate for this age group was 511 per 1,000 persons and increased with age.
The percentage of ED visits made by nursing home residents, patients arriving by ambulance, and patients admitted to the hospital increased with age.
Twenty-nine percent of ED visits by persons aged 65 and over were related to injury, and the percentage was higher among those aged 85 and over than among those aged 65–74 or 75–84.
The percentage of ED visits caused by falls increased with age.
From 2000–2010, the number of persons in the United States aged 65 and over rose 15%, from 35.0 million to 40.3 million, and in 2010 this age group represented 13% of the population (1). It is estimated that by 2030, nearly one in five persons will be aged 65 and over (2). Given their growing proportion of the population, older individuals will comprise an increasing share of emergency department (ED) patients in the coming years. This is important because of the ED’s role in treating acute illness and injury in older adults and providing a pathway to these patients for hospital admission (3,4). This report describes ED visits made by individuals aged 65 and over and compares age groups 65–74, 75–84, and 85 and over.
On November 4, the Engelberg Center for Health Care Reform convened an expert workshop “Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access.”
In an effort to address the undertreatment of common diseases and conditions, the U.S. Food and Drug Administration is exploring how a regulatory expansion of the nonprescription drug class might increase access to medications. This initiative, known as the Nonprescription Safe Use Regulatory Expansion (NSURE), is exploring how health care professionals and innovative technologies can serve as a condition to the safe use of drugs in a nonprescription setting.
Understanding the impact of NSURE on reimbursement and patient access to medication will be critical to the initiative’s success in addressing medical undertreatment. At this expert workshop, a wide range of experts and stakeholders explored previous effects from prescription-to-nonprescription medication switches, identified potential incentives for coverage of nonprescription drugs with Conditions of Safe Use, and investigated potential mechanisms for reimbursement.
Here in Toledo, Ohio my (Catholic) parish boundary includes a nearby state prison.
The bishop’s office redrew parish boundaries a few years back and decided our parish, three miles from the prison, includes the Catholics at Toledo Correctional Institution. Quite a challenge for us, we have about 100 “churchgoers” on the average Sunday, about 2/3 are over age 60. About 20 baptized Catholics (of an inmate population of 1,220) are registered within our parish.
We were encouraged to write the inmates. So I did. After about 3 letter exchanges, one asked me to visit him. So, after 3 weeks of pondering, I did. It really isn’t any big deal. Robb is very articulate and we do have some lively discussions in areas of politics, Catholic Church “hot topics”, and philosophy.
In the past year, four inmates have been murdered. at Toledo Correctional. Allegedly by other inmates. In Michigan, only one inmate was murdered in the whole state in the last year. The rise in violence is in tandem with increasing overcrowding, especially double bunking in cells designed for single occupancy.
I am including this item because overcrowding is a safety and (mental) health issue. The murders here at Toledo Correctional were in the higher security levels, Robb is in the lowest security level. Still, I cannot imagine how this is impacting Robb’s mental health.
Excerpts from the handbook
(I realize American prisons are probably better than the worst of the worst internationally, still, there is room for improvement)
In very diverse environments and over many years, the ICRC has witnessed first- hand the consequences of overcrowding on detainees and on the authorities. Indeed, overcrowding is an increasingly widespread problem in a number of countries and places of detention. In itself, it is a very serious humanitarian concern, as it auto- matically generates substandard and often inhumane conditions of detention. Tens of thousands of people are forced to live for extended periods in congested accom- modation, with insufficient space to move, sit or sleep. This seriously compromises the ability of the administration to fulfil detainees’ basic needs in terms of living conditions, medical care, legal aid and family visits. Being squeezed into cramped living quarters, often in appalling hygiene conditions and with no privacy, makes the experience of being deprived of freedom—already stressful in normal circumstances— exponentially worse. It erodes human dignity and undermines detainees’ physical and mental health, as well as their reintegration prospects. In addition to putting excessive strain on infrastructures, it heightens the potential for tensions and conflicts among detainees and with staff. It quickly leads to difficulties in maintaining good order within the prison, resulting in potentially severe consequences in terms of safety for the detainees, as well as in terms of supervision and security.
While the consequences are particularly grave for the men, women and children deprived of their liberty, they also affect the frontline staff whose job it is to protect and meet the needs of the detainees. Overwhelmed by excessive numbers and directly exposed to the frustration of the detainees without the resources needed to guarantee security or access to the most basic services, detention staff work in difficult condi- tions and are exposed to constant pressure and risk.
ICRC knows from experience that situations of overcrowding, once established, trig- ger a downward spiral which has a negative impact on the entire criminal justice system as a result of increasing congestion, staff demotivation and the development of parallel coping mechanisms or corruption.
3. Broader consequences of excessive imprisonment
The impact of overcrowding does not remain within the prison walls. It can have a detrimental impact on public health. The cost of the excessive use of imprisonment, which is a fundamental reason for prison overcrowding in countries worldwide (see chapter B), can be significant, increasing the poverty levels and socio-economic mar- ginalization of certain groups of people and reducing funds available for other spheres of government expenditure.
3.1 The cost of imprisonment
Numerous studies have shown that imprisonment disproportionately affects people living in poverty. When an income generating member of the family is imprisoned, the sudden loss of income can have a severe impact on the economic status of the rest of the family—especially so in low resource countries where the state does not usually provide financial assistance to the poor and where it is not unusual for one person to financially support an extended family network. When released, often with no prospects for employment due to their criminal record, former prisoners are generally subjected to socio-economic exclusion and are vulnerable to an endless cycle of poverty, marginalization, criminality and imprisonment. Thus, imprisonment contributes directly to the impoverishment of the prisoner and his or her family. Studies have also shown that children of parents who have been imprisoned are more likely to come into conflict with the law and that once detained, they are likely to be further criminalized. Thus the cycle is expanded, creating future victims and reducing future potential economic performance
State report rips Toledo prison (toledoblade.com, 09/13/2013)
“A state committee on Thursday issued a harsh, lengthy inspection report of the Toledo Correctional Institution, citing significant increases in assaults, high employee-turnover rates, rampant drug trading, and three homicides reported there in the past year.The 164-page report from the Correctional Institution Inspection Committee shows that inmate-on-inmate assaults increased by nearly 113 percent and inmate-on-staff assaults increased nearly 74 percent from 2010 to 2012. The legislatively established committee monitors prison facilities, conducts unannounced inspections of prisons, and writes reports of their activities.”
“The prison has the highest staff turnover rate — 16.5 percent — of all prisons in the state, according to the report. Most staff resignations come while employees are being investigated, according to the report.
At the vanguard of innovation in the nursing home industry, the three-year-old Leonard Florence Center for Living exemplifies a new model of long-term care known as the Green House, and nothing about it seems institutional. Each of the five upper floors constitutes two separate “households” with private rooms for 10 residents. The normally dominant nurse’s station has been eliminated and instead there are common areas in each household—a living room furnished with comfortable sofas and chairs around a fireplace, an open kitchen and a communal dining table where residents often eat together. Cooking, housekeeping and even laundry are handled by two certified nursing aides known as shahbazim—derived from Persian, it means “nurturing of elders”—who also care for residents. Traditional nursing homes, in contrast, have clear demarcations separating housekeepers, kitchen workers, nurses and aides, who follow rigid schedules for serving meals or dispensing medications.
At Leonard Florence, Mehlhop can sleep, bathe, eat and roam around whenever she wants. The environment is calm and cheery, with none of the physical restraints found in most nursing homes or the alarms that sound if residents get up from a wheelchair, for example. (Instead, patients wear ankle bracelets that help the staff keep tabs on them and will disable the elevator if a patient tries to leave.)
Leonard Florence is far from the only nursing facility striving to create a homelike atmosphere and improve residents’ quality of life. Building a new Green House or undertaking a major physical renovation can be part of the strategy, but other nursing homes are primarily working to transform how they’re run, embracing a movement known simply as “culture change” that entails shifting away from the emphasis on efficiency and economies of scale that characterizes most nursing homes. Culture change typically requires an operational reorganization to give staff members more autonomy and to let residents have a say in even the smallest details of their lives. “It’s about not looking at residents as a task, but rather as who they are as individuals,”
Yet building a new, small nursing home that can handle only a relative handful of residents is an expensive proposition. “If it weren’t for the price tag, everyone would be doing it,” says Barry Berman, chief executive officer of the Chelsea Jewish Foundation, which owns the Leonard Florence Center. The home cost $36 million to build, with some two-thirds of the money coming from private donations and government programs. Most traditional nursing homes cost less than half that much, but the Leonard Florence Center is over twice the size of a traditional nursing home and was the first Green House to be built in an urban area. Its multistory construction is also a departure from the usual single-level, ranch-style homes that are typical of Green House centers. The payoff, however, has been the residents’ lower hospitalization and readmission rates. The center has also received high scores for resident and family satisfaction, which Berman describes as “off the charts.” The foundation is now undertaking a $13 million renovation of a 30-year-old, 120-bed skilled nursing facility across town from Leonard Florence. “We’re bringing in as many elements of the Green House as we can and doing our best to retrofit a traditional nursing home,” says Adam Berman, chief operating officer of the nonprofit.
The Green House model is receiving increased academic scrutiny, and early studies have shown positive trends in quality of life for residents, greater family satisfaction, and a lower incidence of rehospitalization, bedsores, depression and other health problems. According to the Green House Project, 83% of Green Houses received a rating of four out of five stars or better on the Centers for Medicare & Medicaid Services’ five-star quality rating system, compared to 42% of nursing homes nationally. But the data are early. “The jury’s still out on whether Green Houses or other small homes achieve equal or better clinical outcomes than traditional models, and whether they’re financially sustainable—factors that may ultimately matter a lot more than the humanistic components in terms of their future growth…
Studies of the model’s effectiveness have found a higher quality of care, reduced staff turnover and lower rates of infections for residents….
As encouraging as such stories may be, however, there are questions about how far relatively small-scale efforts can go to reform a giant industry. In a 2010 study by Susan Miller, a professor of health services, practice and policy at Brown University School of Public Health, leadership issues, higher costs and regulatory problems were cited by long-term-care leaders as the most common barriers to implementing culture change. Yet many experts believe those obstacles can be overcome. For example, a campaign called Advancing Excellence in America’s Nursing Homes provides an array of do-it-yourself resources and networks of advisors to help improve clinical outcomes. More than 9,000 nursing homes have participated since the campaign’s launch in 2006. Meanwhile, federal regulators have adjusted some rules to encourage and reward culture change—for example, rather than checking that a nursing home has regular meal schedules, making sure that residents are well fed. And proponents point to studies showing that nursing homes committed to culture change may benefit financially. A study by Pioneer Network, for example, found that from 2004 to 2008, facilities undergoing culture change achieved higher occupancy rates and increased revenue.
Seeing a pregnant women smoking a cigarette, imbibing a glass of wine or using drugs is sure to raise a societal eyebrow.
But a new report says women with substance abuse problems should be treated with compassion by health providers and society at large, especially during pregnancy, because addiction is a brain disorder and not a personal failing.
“It’s harmful for us to look upon pregnant women with addiction issues and assume it’s as simple as saying: ’For the sake of the baby, stop using,”’ said Colleen Dell, research chair in substance abuse at the University of Saskatchewan.
The report says pregnancy offers an opportunity for doctors to help women seek treatment for addiction, while providing comprehensive care aimed at maximizing the health of both mother and baby.
That treatment should involve a wide range of care providers and programs, including addiction counselling, medication-assisted therapy and community resources for parents, the report says.
“When this continuum of care is provided, we see healthier babies and fewer premature births, and overall maternal and infant mortality rates go down,” said Finnegan.
But many women are hesitant to seek treatment because of the stigma around using a substance that’s known to be harmful to their developing fetus, she said.
It’s important to look at the antecedents to drug addiction, said Finnegan, noting that about 98% of the women in her clinic had been sexually or physically abused as children or as adults.
Often women also won’t seek medical help because they’re afraid of losing their children
“This is very much like PTSD (post-traumatic stress disorder). They have had trauma and taking a drug permits them to forget these terrible feelings that they have had. When they take the psychoactive drugs … they become addicted.
“So the first step is that we get them into treatment and help them feel welcome.”
Often women also won’t seek medical help because they’re afraid of losing their children to protective services if they admit to an addiction, she said, suggesting the judicial system has to change.
Dealing with stigma is the greatest challenge in trying to help pregnant women with an addiction, said Franco Vaccarino, a professor of psychiatry and psychology at the University of Toronto and chairman of the CCSA’s scientific advisory council.
“Addiction is a disorder of the brain,” he stressed.
‘Simply put, your brain is different after prolonged substance abuse than it was before’
“Simply put, your brain is different after prolonged substance abuse than it was before. Addiction fundamentally changes neurological functioning and it makes it next to impossible to just quit for the sake of the baby without significant supports.
“The challenge is anchoring the narrative of this discussion in health terms,” Vaccarino said. “If you anchor it in health terms and move it away from justice and moral and will-related issues, you focus the narrative around addiction, which is where it should be.”
“I love getting out from behind a desk and traveling to rural communities where people need health information,” he says.
In recognition of his singular dedication to the rural underserved, the Friends of the National Library of Medicine named Wallace the recipient of the 2013 Michael E. DeBakey Library Sciences Outreach Award. The national honor is bestowed annually on a health sciences librarian for outstanding service to rural or underserved populations and is presented at the 2013 FNLM awards gala.
“Being a health science librarian is a very personal thing,” says Wallace. “There’s a lot of technology out there now and it’s real easy to just sit in your office and tell people about the latest app. But for me it means getting out there and being involved in the community.
“I want every rural hospital and health center to have access to quality health information, to know how to search PubMed databases, use document delivery tools like Loansome Doc, and feel comfortable browsing MedlinePlus for consumer health information. They’re the best in the world, all part of the greatest biomedical library in the world, the National Library of Medicine.”
Wallace began his calling in health sciences at the University of Tennessee, Memphis Health Sciences Library, working in circulation, in 1987, before finally finding his way to ETSU in 1995.
Over the years, he has seen the medical librarianship position become more tenuous as large corporate hospitals acquire smaller local hospitals, consolidating them and eliminating library positions. “One of my biggest challenges now is selling the vision of the health science librarian as essential in the information age. There is such a push to cut everything that is not mandated. It can be tough to get some of these big medical institutions to recognize the value of a health science librarian.”
Wallace has spearheaded projects that have taken him back and forth across Tennessee. One such is “A Simple Plan,” which offers instruction in consumer health information for public librarians. For more than six years, Wallace and his assistants traveled thousands of miles annually training public librarians, distributing over 1500 articles over the last 17 years, and building relationships with some 40 rural hospitals and clinics, helping them obtain grants and pointing the way for rural public health departments to provide remote access to health information.
Wallace and his group also have shaped consumer health information programs for Hispanic farm workers, high school students, elderly patients and staff in nursing homes, and cancer patients. They have trained caregivers, religious leaders, and others to use health information tools. They’ve distributed smartphones, tablet computers—complete with clinical software—and other mobile devices to some 300 Tennessee clinicians.
For example, working with the Migrant Health Program for Rural Medical Services, Inc. (RMS), in Parrottsville, TN, which operates one of five primary care clinics in the state and provides primary healthcare to migrant farm workers in East Tennessee, Wallace initiated and helped write a series of grant proposals that brought NN/LM funding for innovative health education programs.
One grant brought community theater actors to the migrant camps to demonstrate good health practices for diabetes, perinatal care, and other topics. The grants also facilitated production of Spanish-language videos on prenatal care, and funded purchase of laptop computers and printers for Migrant Health Program educators, enabling them to access health information during home visits to the underserved.
Wallace also led a team on several Remote Area Medical (RAM) expeditions to provide free medical, dental, and vision care and information to more than 2,500 of the working poor.
Lucretia W. McClure, MA, of the Board of Directors of the Friends of the National Library of Medicine, lauds Wallace as “an active and integral contributor in serving rural and underserved members of Tennessee for almost 20 years.” She notes, “He has reached thousands of people and raised almost a half a million dollars in grants that have contributed to the betterment of overall health in rural Tennessee.”
Says Wallace, “A lot of the things we do are simple, but they make a difference. We try to make an impact; to help people make good medical decisions. I’d like to be remembered as only one of the mighty army of health professionals who helped people live better lives.”
Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I’m Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what’s new this week in MedlinePlus.
Emergency room use and hospitalization rates for diabetes patients declined after a large California medical provider introduced an electronic health records system, finds a five year study recently published in the Journal of the American Medical Association.
The study of 170,000 Kaiser Permanente Northern California diabetes patients (from 2004-2009) found an average of 501 emergency department visits per 1000 patients declined to 490 after Kaiser’s clinics began to use an electronic health records system (EHR) for outpatient treatment.
The study found an average of 252 hospitalizations per 1000 diabetes patients declined to 238 per 1000 after Kaiser Permanente’s clinics used the health care provider’s EHR. The specific hospitalizations for ambulatory care-sensitive conditions also fell from a mean of 67 per 1000 to about 60 per 1000 diabetes patients after the use of an EHR for diabetes outpatient treatment.
The comparative, overall declines in emergency department visits and aforementioned hospitalizations among Kaiser Permanente’s diabetes patients were statistically significant, or did not occur by chance. There was no overall difference in the frequency of patient visits to a physician’s office after Kaiser’s clinics began to use the health system’s EHR.
The study’s nine authors estimate Kaiser’s cost savings from reduced emergency department and hospitalizations were about $158,478 per 1000 patients each year. Overall, they write (and we quote): ‘the estimated reductions in emergency department (ED) visits and hospitalizations that we identified for patients with diabetes may have potential to affect ED and hospitalization costs’ (end of quote).
The authors acknowledge future research needs to provide a more comprehensive assessment of the cost savings after the implementation of an EHR. They add the findings are limited to diabetes patients within one large health care provider (within one U.S. state) and may not be generalizable to other states and different medical systems. For example, the authors explain the reductions in emergency department use and reduced hospitalizations were not uniform among all of the 17 Kaiser Permanente clinics where the five year study was conducted.
On the other hand, the authors note the study is the most comprehensive to date about the impact of outpatient EHR use on adverse health outcomes. The authors explain they assessed diabetes patients in order to observe the impact of EHR use on an outpatient basis among adults with a chronic (or ongoing) medical condition over time.
The authors conclude (and we quote): ‘We extend the evidence of EHR-related improvements in care delivery by further describing statistically significant modest reductions in downstream adverse health outcomes measured by ED visits and hospitalizations’ (end of quote).
Meanwhile, MedlinePlus.gov’s personal health records health topic page provides information about the physician adoption of EHRs in the ‘statistics’ section. Information about the adoption of EHRs within residential care communities and office-based physicians also is provided within the same section.
A overview that explains how and why EHRs are implemented in medical centers is available in the ‘MedlinePlus Magazine’ section of MedlinePlus.gov’s personal health records health topic page.
A helpful explanation (from the National Institutes of Health) about how to protect the privacy and security of your health information is available in the ‘related issues’ section of MedlinePlus.gov’s personal health records health topic page.
MedlinePlus.gov’s personal health records health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about personal health records (and EHRs) as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s personal health records health health topic page, type ‘personal health records’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘personal health records (National Library of Medicine).’
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A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.
It was nice to be with you. I look forward to meeting you here next week.
PITTSBURGH, Nov. 1, 2013 – The red, swollen and painful gums and bone destruction of periodontal disease could be effectively treated by beckoning the right kind of immune system cells to the inflamed tissues, according to a new animal study conducted by researchers at the University of Pittsburgh. Their findings, published this week in the early online version of the Proceedings of the National Academy of Sciences, offer a new therapeutic paradigm for a condition that afflicts 78 million people in the U.S. alone.
Periodontal disease currently is treated by keeping oral bacteria in check with daily brushing and flossing as well as regular professional deep cleaning with scaling and root planing, which remove tartar above and below the gum line. In some hard-to-treat cases, antibiotics are given. These strategies of mechanical tartar removal and antimicrobial delivery aim to reduce the amount of oral bacteria on the tooth surface, explained co-author and co-investigator Charles Sfeir, D.D.S., Ph.D., director, Center for Craniofacial Regeneration and associate professor, Departments of Periodontics and Oral Biology, Pitt’s School of Dental Medicine.
“Currently, we try to control the build-up of bacteria so it doesn’t trigger severe inflammation, which could eventually damage the bone and tissue that hold the teeth in place,” Dr. Sfeir said. “But that strategy doesn’t address the real cause of the problem, which is an overreaction of the immune system that causes a needlessly aggressive response to the presence of oral bacteria. There is a real need to design new approaches to treat periodontal disease.”
In the healthy mouth, a balance exists between bacteria and the immune system response to forestall infection without generating inflammation, said senior author Steven Little, Ph.D., associate professor and chair of the Department of Chemical and Petroleum Engineering, Pitt’s Swanson School of Engineering. But in many people, a chronic overload of bacteria sets up the immune system to stay on red alert, causing harm to the oral tissues while it attempts to eradicate germs.
“There is a lot of evidence now that shows these diseased tissues are deficient in a subset of immune cells called regulatory T-cells, which tells attacking immune cells to stand down, stopping the inflammatory response,” Dr. Little said. “We wanted to see what would happen if we brought these regulatory T-cells back to the gums.”
To do so, the researchers developed a system of polymer microspheres to slowly release a chemokine, or signaling protein, called CCL22 that attracts regulatory T-cells, and placed tiny amounts of the paste-like agent between the gums and teeth of animals with periodontal disease. The team found that even though the amount of bacteria was unchanged, the treatment led to improvements of standard measures of periodontal disease, including decreased pocket depth and gum bleeding, reflecting a reduction in inflammation as a result of increased numbers of regulatory T-cells. MicroCT-scanning showed lower rates of bone loss.
“Mummified remains from ancient Egypt show evidence of teeth scraping to remove plaque,” Dr. Little noted. “The tools are better and people are better trained now, but we’ve been doing much the same thing for hundreds of years. Now, this homing beacon for Treg cells, combined with professional cleaning, could give us a new way of preventing the serious consequences of periodontal disease by correcting the immune imbalance that underlies the condition.”
Next steps include developing the immune modulation strategy for human trials. In addition to Drs. Sfeir and Little, the research team included Ph.D. candidate Andrew J. Glowacki,, Sayuri Yoshizawa, D.D.S., Ph.D., Siddharth Jhunjhunwala, Ph.D., all of the University of Pittsburgh; and Andreia E Vieira, Ph.D., and Gustavo P. Garlet, D.D.S., Ph.D., of Sao Paulo University, Brazil.
The project was funded by National Institutes of Health Grants 1R01DE021058-01 A1, 1R56DE021058-01, the Wallace H. Coulter Foundation, the Camille and Henry Dreyfus Foundation, the Arnold and Mabel Beckman Foundation and the Commonwealth of Pennsylvania.
The ability to control our fertility, to have children when—and with whom—we want, is a precious gift of modern science. For women in particular, birth control has also been a boost for social mobility. But there is still progress to be made.
1. The Pill Transformed Women’s Life Chances
The Pill gave American women something genuinely new: a convenient and highly effective means of controlling their own fertility. Although the Pill was licensed by the by the FDA (as Enovid) in 1960, state and federal laws limited the access of young single women to oral contraception. But as those laws changed in the late 60s and early 70s, oral contraceptive use jumped among young single women. And look what happened to the gender mix of professional college courses:
But unintended pregnancy rates – 3 million or more a year – remain stubbornly high in the U.S. The benefits of birth control are being only partially realized. Half of all pregnancies are mistimed or unwanted – and 95 percent of all unintended pregnancies occur among women who either aren’t using contraception at all or aren’t using their contraceptive method consistently:
Earlier this week, I talked about these issues at an event sponsored by AEI and the Institute of Family Studies. In tomorrow’s blog post, I’ll set out the gains we could realize from getting better at birth control.
A nationally known budget expert, Isabel Sawhill focuses on domestic poverty and federal fiscal policy. She is also co-director of the Center on Children and Families and the Budgeting for National Priorities Project at Brookings.
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner. (For those wishing to see pictures of a 2009 Friends of Liberia service trip to this West African country, please visit www.fol.org. My photo album is included).
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My professional work experience and education includes over 10 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news,
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Krafty (Medical)Librarian,” a collection of writings from Michelle Kraft on items of interest to medical librarians. She tends to write on technology and medical libraries but she also writes about things in general on librarianship, medicine and health”
Research Buzz, “news about search engines, digital archives, online museums, databases, and other Internet information collections since 1998″
Free Government Information, a “place for initiating dialogue and building consensus among the various players (libraries, government agencies, non-profit organizations, researchers, journalists, etc.) who have a stake in the preservation of and perpetual free access to government information”
Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”