New Report Provides High-Impact Recommendations to Improve Prevention Policies in America

From the 29 January 2013 Trust for America’s Health news release 

Trust for America’s Health (TFAH) has released A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years – which provides high-impact recommendations to prioritize prevention and improve the health of Americans.

The Healthier America report outlines top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

“America’s health faces two possible futures,” said Gail Christopher, DN, President of the Board of TFAH and Vice President – Program Strategy of the W.K. Kellogg Foundation.  “We can continue on the current path, resigning millions of Americans to health problems that could have been avoided or we invest in giving all Americans the opportunity to be healthier while saving billions in health care costs.  We owe it to our children to take the smarter way.”

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.  Some recommendations include:

• Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
• Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
• Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities;
• Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
• Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit;
• Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
• Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs…..

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• Today’s children to live shorter lives (upi.com)

[Reblog] Bad Pharma (the book) comes to the US

 

[Reblog] From the 2 February 2013 post at HealthNewsReview.org

British physician and writer Ben Goldacre is on a North American tour.  His book, “Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients,” is released in the US on February 5. The book has been discussed in The Economist, The Public Library of Science blogs, The Guardian, and elsewhere. (Addendum one day later:  Carl Elliott also reviewed the book in the BMJ.)

He also has an op-ed in the New York Times, “Health Care’s Trick Coin.”  Excerpt:

“…the entire evidence base for medicine has been undermined by a casual lack of transparency. Sometimes this is through a failure to report concerns raised by doctors and internal analyses…. More commonly, it involves the suppression of clinical trial results, especially when they show a drug is no good. These problems would be bad enough on their own, but they are compounded by a generation of “fake fixes” that have delivered false reassurance, and so prevent realistic public discussion.

The best evidence shows that half of all the clinical trials ever conducted and completed on the treatments in use today have never been published in academic journals. Trials with positive or flattering results, unsurprisingly, are about twice as likely to be published — and this is true for both academic research and industry studies.

If I toss a coin, but hide the result every time it comes up tails, it looks as if I always throw heads. You wouldn’t tolerate that if we were choosing who should go first in a game of pocket billiards, but in medicine, it’s accepted as the norm. In the worst case, we can be misled into believing that ineffective treatments are worth using; more commonly we are misled about the relative merits of competing treatments, exposing patients to inferior ones.”

 

 

Patients Can Emit Small, Influenza-Containing Particles Into the Air During Routine Care

From the 31 January 2013 article at KevinMD.com

[The]majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head..

Vaccination of health providers remains a fundamental and key part of protecting them from influenza

 

A new study suggests that patients with influenza can emit small virus-containing particles into the surrounding air during routine patient care, potentially exposing health care providers to influenza. Published in The Journal of Infectious Diseases, the findings raise the possibility that current influenza infection control recommendations may not always be adequate to protect providers from influenza during routine patient care in hospitals…

…

The current belief is that influenza virus is spread primarily by large particles traveling up to a maximum of 3 to 6 feet from an infected person. Recommended precautions for health providers focus on preventing transmission by large droplets and following special instructions during aerosol-generating procedures. In this study, Dr. Bischoff and his team discovered that the majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head, and that concentrations of virus decreased with distance. The study addressed only the presence of influenza-containing particles near patients during routine care, not the actual transmission of influenza infection to others.

Fitted respirators are currently required for health care providers during aerosol-generating procedures with patients. During routine, non-aerosol-generating patient care, the current precautions recommend that providers wear a non-fitted face mask. Based on their findings, Dr. Bischoff and investigators are concerned that providers may still be exposed to infectious dosages of influenza virus up to 6 feet from patients with small wide-spreading particles potentially exceeding the current suggested exposure zones.

These findings suggest that current infection control recommendations may need to be reevaluated, the study authors concluded. The detection of “super-emitters” raises concerns about how individuals with high viral load may impact the spread of influenza, they noted. “Our study offers new evidence of the natural emission of influenza and may provide a better understanding of how to best protect health care providers during routine care activities,” the study authors wrote. However, studies of influenza virus transmission will be necessary before the role of super-emitters can be firmly established, they noted…

Whatever protective equipment or infection control practices are used for preventing influenza transmission, vaccination of health providers remains a fundamental and key part of protecting them from influenza, noted Dr. William Schaffner, professor medicine and chair of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved with the study. “Influenza vaccination, although not perfect, is the best tool we have to protect health care workers — and their patients — from influenza illness.

 

Related articles

• Health care providers may be at greater risk of flu exposure (eurekalert.org)
• Stand Back: Flu Virus Travels 6 Feet (livescience.com)
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• 2012-13 Influenza vaccine effectiveness: a preliminary estimate (bio230fall2010.wordpress.com)

 

7 reasons to boycott the Super Bowl from a medical standpoint

As an aside, I stopped participating in alumni band during football homecoming.
Just don’t want to be part of this sport which in increasingly unhealthy in the short and long run.

From the 30 January 2013 KevinMD post

You’ve probably watched the Super Bowl as I have many times, faithfully, elevating the occasion to some kind of macabre family tradition. It is a spectacle of athletic agility, drama, and struggle; the pinnacle of American sporting contests. Despite the heavy onslaught of commercialism, faux halftime culture, and evident violence on the field, we suspend our awareness that this event may not be a magical moment worth our time and validation, even as its winners call out to some magical Disney kingdom.

Here are 7 points to consider:

7. Obesity and cardiovascular disease. Up to 45% of youth participating in football are overweight or obese. The nature of the sport favors, and increasingly demands, a large body size. The physique acquired in adolescence often persists into adulthood.
According to a 2007 study of 653 boys ages 8-14 playing football in Michigan, 20% were overweight and another 25% were obese, as defined by body mass index.Studies have shown that linemen have high early mortality rates, and for all professional players who have played 5 years or more, life expectancy is less than 60.

6) MRSA infections and abscesses. Quarterbacks Tom Brady and Peyton Manning have suffered from it.

Read the entire post here

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Frontiers publishes systematic review on the effects of yoga on major psychiatric disorders

From the 25 January 2013 EurkAlert

Yoga on our minds: The 5,000-year-old Indian practice may have positive effects on major psychiatric disorders, including depression, schizophrenia, ADHD and sleep complaints

Yoga has positive effects on mild depression and sleep complaints, even in the absence of drug treatments, and improves symptoms associated with schizophrenia and ADHD in patients on medication, according to a systematic review of the exercise on major clinical psychiatric disorders.

Published in the open-access journal, Frontiers in Psychiatry, on January 25th, 2013, the review of more than one hundred studies focusing on 16 high-quality controlled studies looked at the effects of yoga on depression, schizophrenia, ADHD, sleep complaints, eating disorders and cognition problems.

Yoga in popular culture

Yoga is a popular exercise and is practiced by 15.8 million adults in the United States alone, according to a survey by the Harris Interactive Service Bureau, and its holistic goal of promoting psychical and mental health is widely held in popular belief.

“However, yoga has become such a cultural phenomenon that it has become difficult for physicians and patients to differentiate legitimate claims from hype,” wrote the authors in their study. “Our goal was to examine whether the evidence matched the promise.”

Read the entire article here

Health and Environment: A Closer Look at Plastics

#6620 recycled plastic (PET) bottles (Photo credit: Nemo’s great uncle)

From the 23 January 2013 article at Science News Daily

 Plastics have transformed modern society, providing attractive benefits but also befouling waterways and aquifers, depleting petroleum supplies and disrupting human health…

..

In a new overview appearing in the journal Reviews on Environmental Health, Halden and his co-author, ASU student Emily North, detail the risks and societal rewards of plastics and describe strategies to mitigate their negative impacts, through reconsideration of plastic composition, use and disposal.

“We are in need of a second plastic revolution. The first one brought us the age of plastics, changing human society and enabling the birth and explosive growth of many industries. But the materials used to make plastics weren’t chosen judiciously and we see the adverse consequences in widespread environmental pollution and unnecessary human exposure to harmful substances. Smart plastics of the future will be equally versatile but also non-toxic, biodegradable and made from renewable energy sources,” says Halden….

..plastics may be manufactured at low cost using little energy and their adaptable composition allows them to be synthesized in soft, transparent or flexible forms suitable for a broad range of medical applications. Because they can be readily disposed of, items like latex gloves, dialysis tubes, intravenous bags and plastic syringes eliminate the need for repeated sterilization, which is often costly and inefficient. Such single-use items have had a marked effect on reducing blood-borne infections, including hepatitis B and HIV…

..

he benefits of global plastics use can come at a steep price in terms of both human and environmental health. Continuous contact with plastic products, from the beginning to the end of life has caused chemical ingredients — some with potentially harmful effects — to form steady-state concentrations in the human body.

In recent years, two plastic-associated compounds have been singled out for particular scrutiny, due to their endocrine-disrupting properties: Bisphenol A (BPA) and di-(2-ethylhexyl)phthalate (DEHP). Studies of bioaccumulation have shown that detectable levels of BPA in urine have been identified in 95 percent of the adult population in the U.S. and both BPA and DEHP have been associated, through epidemiological and animal studies, with adverse effects on health and reproduction. These include early sexual maturation, decreased male fertility, aggressive behavior and other effects…

…

Biodegradeable plastics may break down in the environment into smaller polymer constituents, which may still pose a risk to the environment. Incineration liberates greenhouse gases associated with climate change. Landfilling of plastics, particularly in the enormous volumes now produced, may be an impractical use of land resources and a danger exists of plastics constituents entering the ground water. Finally, recycling of plastics requires careful sorting of plastic material, which is difficult. Recycled plastics tend to be of lower quality and may not be practical for health care and other application…

Read the entire article here

From the 23 January 2013 article at The American Medical Network

Many consumer products, such as water bottles and product containers, are made from various types of plastic. The Society of the Plastics Industry (SPI) established a classification system in 1988 to allow consumers and recyclers to properly recycle and dispose of different types of plastic. Manufacturers follow a coding system and place an SPI code, or number, on each plastic product, which is usually molded into the bottom. Although you should always verify the plastic classification number of each product you use, this guide provides a basic outline of the different plastic types associated with each code number.

Plastic marked with anSPI code of 1is made withPolyethylene Terephthalate, which is also known as PETE or PET. Containers made from this plastic sometimes absorb odors and flavors from foods and drinks that are stored in them. Items made from this plastic are commonly recycled. PETE plastic is used to make many common household items like beverage bottles, medicine jars, peanut butter jars, combs, bean bags, and rope. Recycled PETE is used to make tote bags, carpet, fiberfill material in winter clothing, and more.

Plastic marked with anSPI code of 2is made withHigh-Density Polyethylene, or HDPE. HDPEproducts are very safe and they are not known to transmit any chemicals into foods or drinks. HDPE products are commonly recycled. Items made from this plastic include containers for milk, motor oil, shampoos and conditioners, soap bottles, detergents, and bleaches. Many personalized toys are made from this plastic as well. (Please note: it is NEVER safe to reuse an HDPE bottle as a food or drink container if it didn’t originally contain food or drink!) Recycled HDPE is used to make plastic crates, plastic lumber, fencing, and more.

Plastic labeled with anSPI code of 3is made withPolyvinyl Chloride, or PVC. PVC is not often recycled and it can be harmful if ingested. PVC is used for all kinds of pipes and tiles, but it’s most commonly found in plumbing pipes. This kind of plastic should not come in contact with food items. Recycled PVC is used to make flooring, mobile home skirting, and more.

Plastic marked with anSPI code of 4is made withLow-Density Polyethylene, or LDPE. LDPE is not commonly recycled, but it is recyclable in certain areas. It is a very healthy plastic that tends to be both durable and flexible. Plastic cling wrap, sandwich bags, squeezable bottles, and plastic grocery bags are all made from LDPE. Recycled LDPE is used to make garbage cans, lumber, furniture, and more.

Plastic marked with anSPI code of 5is made withPolypropylene, or PP. PP is not commonly recycled, but it is accepted in many areas. This type of plastic is strong and can usually withstand higher temperatures. Among many other products, it is used to make plastic diapers, Tupperware, margarine containers, yogurt boxes, syrup bottles, prescription bottles, and some stadium cups. Plastic bottle caps are often made from PP as well. Recycled PP is used to make ice scrapers, rakes, battery cables, and more.

Plastic marked with anSPI code of 6is made withPolystyrene, also known as PSand most commonly known as Styrofoam. It is commonly recycled, but it is difficult to do so and often ends up in landfills anyway. Disposable coffee cups, plastic food boxes, plastic cutlery, packing foam, and packing peanuts are made from PS. Recycled PS is used to make insulation, license plate frames, rulers, and more.

The SPI code of 7is used to designate miscellaneous types of plastic that are not defined by the other six codes. Polycarbonate and Polylactide are included in this category. These types of plastics are difficult to recycle. Polycarbonate, or PC, is used in baby bottles, large water bottles (multiple-gallon capacity), compact discs, and medical storage containers. Recycled plastics in this category are used to make plastic lumber, among other products.

Consumers can make better plastic-purchasing decisions if they understand SPI codes and potential health hazards of each plastic, and recyclers can more effectively separate plastics into categories. Always check a product’s classification code prior to recycling it or re-using it. It’s important to stay educated about plastic classification numbers and plastic types; remember, informed consumers can demand that plastics manufacturers provide better products.

Read more:Health and environment: a closer look at plastics – Food & Nutrition -Public Health -http://www.health.am/ab/more/health-and-environment/#ixzz2ItM9aR2g

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Longer CPR extends survival in both children and adults

English: CPR training (Photo credit: Wikipedia)

From the 23 January 2013 EurkAlert article

CHOP experts are co-authors of 2 large studies of outcomes after in-hospital cardiac arrest

Experts from The Children’s Hospital of Philadelphia were among the leaders of two large national studies showing that extending CPR longer than previously thought useful saves lives in both children and adults. The research teams analyzed impact of duration of cardiopulmonary resuscitation in patients who suffered cardiac arrest while hospitalized.

“These findings about the duration of CPR are game-changing, and we hope these results will rapidly affect hospital practice,” said Robert A. Berg, M.D., chief of Critical Care Medicine at The Children’s Hospital of Philadelphia. Berg is the chair of the Scientific Advisory Board of the American Heart Association’s Get With Guidelines-Resuscitation program (GWTG-R). That quality improvement program is the only national registry that tracks and analyzes resuscitation of patients after in-hospital cardiac arrests.

The investigators reported data from the GWTG-Resuscitation registry of CPR outcomes in thousands of North American hospital patients in two landmark studies—one in children, published today, the other in adults, published in October 2012.

Berg was a co-author of the pediatric study, appearing online today in Circulation, which analyzed hospital records of 3,419 children in the U.S. and Canada from 2000 through 2009. This study, whose first author was Renee I. Matos, M.D., M.P.H., a mentored young investigator, found that among children who suffered in-hospital cardiac arrest, more children than expected survived after prolonged CPR—defined as CPR lasting longer than 35 minutes. Of those children who survived prolonged CPR, over 60 percent had good neurologic outcomes…..

Read the entire article here

Related blog items

• Hands-Only CPR video with Vinnie Jones: The European Way [ ScienceRoll]

• A New Order for CPR, named CAB (Compression-Airway- Breathing)

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Rumor Control – Flu Epidemic: Fact or Fiction

A 19th January post at MedPage Today addresses rumors and “conspiracy theories” about flu epidemic reports.

Responses in a recent survey ranged from blaming Hurricane Sandy (with a government coverup) to profit motivations by BigPharma to vaccine inffectiveness.

The entire article may be read here.

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Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2013

Vaccination; 041028-N-9864S-021 Yokosuka, Japan (Oct. 28, 2004) – Hospital Corpsman 3rd Class Tiffany Long of San Diego, Calif., administers the influenza vaccination to a crew member aboard USS Kitty Hawk (CV 63). Currently in port, Kitty Hawk demonstrates power projection and sea control as the U.S. Navy’s only forward-deployed aircraft carrier, operating from Yokosuka, Japan. U.S. Navy photo by Photographer’s Mate Airman Joseph R Schmitt (RELEASED) (Photo credit: Wikipedi

On January 11, 2013, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr)

In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months (1). Each season since 2004–05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent influenza-associated, medically attended acute respiratory infection (ARI).

This season, early data from 1,155 children and adults with ARI enrolled during December 3, 2012–January 2, 2013 were used to estimate the overall effectiveness of seasonal influenza vaccine for preventing laboratory-confirmed influenza virus infection associated with medically attended ARI.

After adjustment for study site, but not for other factors, the estimated vaccine effectiveness (VE) was 62% (95% confidence intervals [CIs] = 51%–71%). This interim estimate indicates moderate effectiveness, and is similar to a summary VE estimate from a meta-analysis of randomized controlled clinical trial data (2); final estimates likely will differ slightly.

As of January 11, 2013, 24 states and New York City were reporting high levels of influenza-like illness, 16 states were reporting moderate levels, five states were reporting low levels, and one state was reporting minimal levels (3). CDC and the Advisory Committee on Immunization Practices routinely recommend that annual influenza vaccination efforts continue as long as influenza viruses are circulating (1). Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated.

However, these early VE estimates underscore that some vaccinated persons will become infected with influenza; therefore, antiviral medications should be used as recommended for treatment in patients, regardless of vaccination status. In addition, these results highlight the importance of continued efforts to develop more effective vaccines……

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2011 EPA Toxic Release Inventory is releaed

From the EPA Web page

The TRI National Analysis is an annual report that provides EPA’s analysis and interpretation of the most recent TRI data. It includes information about toxic chemical releases to the environment from facilities that report to the TRI Program. It also includes information about how toxic chemicals are managed through recycling, treatment and energy recovery, and how facilities are working to reduce the amount of toxic chemicals generated and released.

WASHINGTON – Total toxic air releases in 2011 declined 8 percent from 2010, mostly because of decreases in hazardous air pollutant (HAP) emissions, even while total releases of toxic chemicals increased for the second year in a row, according to the U.S. Environmental Protection Agency (EPA) annual Toxics Release Inventory (TRI) report published today.

The annual TRI provides citizens with vital information about their communities. The TRI program collects information on certain toxic chemical releases to the air, water and land, as well as information on waste management and pollution prevention activities by facilities across the country. TRI data are submitted annually to EPA, states and tribes by facilities in industry sectors such as manufacturing, metal mining, electric utilities, and commercial hazardous waste facilities.

What’s new in the National Analysis this year?

• An investigation into declining air releases;
• More information about pollution prevention activities conducted at TRI facilities;
• Updated risk information;
• Enhanced Indian Country and Alaska Native Villages (ANVs) analysis.

What tools are available to help me conduct my own analysis?

A variety of online tools are available to help you access and analyze TRI data. When using TRI data, you may also want to explore the other data sources and information listed on the TRI Data and Tools webpage.

Where can I get downloadable files containing the data used in the 2011 National Analysis?

• Basic Data Files : Each file contains the most commonly requested data fields submitted by facilities on the TRI Reporting Form R or the Form A Certification Statement.
• Basic Plus Data Files : These files collectively contain all the data fields submitted by facilities on the TRI Reporting Form R or the Form A Certification Statement.
• Dioxin, Dioxin-Like Compounds and TEQ Data Files : These files include the individually reported mass quantity data for dioxin and dioxin-like compounds reported on the TRI Reporting Form R Schedule 1, along with the associated TEQ data.

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