From the 16 October 2014 press release
American Journal of Preventive Medicine supplement addresses critical challenges to public health
Ann Arbor, MI, October 16, 2014 – Although disease outbreaks and epidemics drawing worldwide attention emphasize the importance and acute need for public health professionals, the world faces a longer-term challenge—a public health workforce that is truly effective in the 21st century. In a new supplement to the American Journal of Preventive Medicine, ***experts address critical challenges to public health, from workforce development, capacity building, partnership and collaborations, and changes and needs in workforce composition.
As the U.S. healthcare system evolves and communities gain more access to care, diverse forces are driving change, and the practice of public health is adapting. Given the challenges to the public health system and those faced as a nation—including urgent health threats (e.g., antibiotic resistance, prescription drug use and overdose, global health security) and decreased funding for addressing public health concerns—having trust in public health practitioners, their scientific knowledge, and particularly the public health system, has never been more important.
“The public health workforce is now not only required to take a lead in protecting citizens’ health, but it also must provide the evidence base needed for linking public health information with clinical services and activities; offer targeted, scalable public health interventions; and support clinical services in a way that affects populations at large,” notes Guest Editor Fátima Coronado, MD, MPH, Deputy Associate Director for Science, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. “This supplement is both timely and important because it reviews some of the critical challenges faced by the public health workforce, discusses selected changes under way, and highlights data-driven research to advance the field of public health services and systems research.”
This groundbreaking supplement, The Public Health Workforce, includes 22 articles from more than 30 institutions, agencies, foundations and public companies and covers two major areas: public health workforce capacity building and public health workforce size and composition.
Key topics in the Supplement include:
- How to clearly define the public health workforce challenges using cause-and-effect diagrams and a concise roadmap.
- Use of Massive Open Online Courses (MOOCs) by the School of Public Health at Harvard and concerns about retention of the knowledge gained using that method of instruction.
- How the CDC conducts workforce development within its own organization.
- Do students who receive adequate training in Public Health and Community Medicine tend to practice in areas with physician shortages?
- How do we count public health workers? In the first study since 2000, 50% of all public health workers are employed at the local level, with 30% and 20% at the state and federal levels, respectively.
- How can we define public health workers properly? A taxonomy has been developed which is a necessary step to continuously monitor the size and composition of the workforce to ensure sufficient capacity to deliver essential public health services.
- Data show that part-time public health workers are a low percentage of the total workforce and the percentage has decreased over the last 5 years.
- Despite relatively uncompetitive pay, local health departments experience lower rates of employee turnover than state health agencies and lower rates than state and local government in general.
- How can we align public health workforce competencies with population health improvement goals?
- How the Public Health Accreditation Board (PHAB) developed the standards and measures to encourage health departments to strengthen the current public health workforce and strategically develop the workforce of tomorrow.
- Do Internal Medicine Residency Programs develop public health competencies?
- How a training program for racial and ethnic minorities for careers in public health sciences has resulted in 60% of the students entering public health careers.
- Will epidemiology education change rapidly enough to keep up with trends in communications and computing?
- How the growth of cities, “Big Data,” and cognitive computing will change the public health workforce.
- Building a Culture of Health – How the public health workforce will not only provide medical care but will help to establish a Culture of Health.
- Nursing as a critical driver of the Culture of Health.
Guest Editors Dr. Coronado and Denise Koo, MD, MPH, Office of Public Health Scientific Services, CDC, Atlanta, GA, and Kristine Gebbie, DrPH, RN, Faculty of Health Sciences, Flinders University, Adelaide, South Australia, write that “we are buoyed by the increased efforts to meet workforce challenges and the valuable contribution of researchers and practitioners to strengthen the public health workforce. Efforts to strengthen the public health workforce should be a continuing priority involving well-planned, evidence based, and coordinated actions from decision makers undaunted by the mission of transforming public health and improving the population’s health while facing the complex landscape of the 21st century.”###***The article may be available for free or low cost at your local public, academic, or hospital/medical center library. Call ahead and ask for a reference librarian.
People who are homeless face many health threats and are among the heaviest users of hospital services. Safe and affordable housing, some experts assert, is a necessary first step to care effectively for people with chronic mental health and substance abuse problems who live on the streets. And there is some evidence that this approach may, in some circumstances, even save taxpayers money (but probably not as much as is often claimed).
In an influential 2009 study in Seattle, researchers analyzed medical and law enforcement costs for 91 people given supportive housing and found that costs dropped to about half the level seen among 35 comparable homeless people on a waiting list. But note that this savings estimate doesn’t include the capital costs of building and refurbishing apartments. Raising capital is likely to be a tall hurdle for many communities and this issue often gets ignored in news reports about the promise of supportive housing.
From the 20 January 2014 Kevin MD post
Meet Damien, my Facebook friend, photographer, and IT guy.
This morning, he messages me: “I would like to make an appointment.”
I reply: “For?”
“High blood pressure.”
I offer to see him, but he never comes in. Weeks later, he writes, “I got busy Pam. How are you? High blood pressure pills keep making me sick. I am doing the best I can. On bad days it is like 208/118.”
Friends don’t let Facebook friends die. And 208/118 is incompatible with life. I’m a family doc–a-sleuth. It’s my job to spy on people. On Damien’s page, I find a dozen photos of lynchings — his reaction to today’s Trayvon Martin verdict. A black boy murdered in a land where killers roam free. Trayvon died a senseless death, but Damien shouldn’t have to. I suspect today is a bad day for Damien’s arteries. So I call him up. “I’m worried about you, man. I’m coming over to check on you tonight.” An hour later, I’m in his living room.
…While infectious diseases remain a significant problem in the developing world, cancer, heart disease, obesity, diabetes, and other non-communicable diseases are now among the fastest growing causes of death and disability around the globe. In fact, nearly three-quarters of the 38 million people who died of chronic diseases in 2012 lived in low- or middle-income countries .
The good news is that many NCDs can be prevented by making lifestyle changes, such as reducing salt intake for hypertension, stopping smoking for cancer and heart disease, or venting cookstove fumes for lung disease. Other NCDs can be averted or controlled by taking medications, such as statins for high cholesterol or metformin for diabetes.
Excerpts from the 26 June 2014 article at Pew Chartitable Trust
Among the state apps focused exclusively on health or public safety:
- The Minnesota Air app provides real-time information about air quality conditions in 10 reporting areas across the state, as well as pollution forecasts for the Twin Cities and Rochester.
- The Every Woman Counts app in California lets women know when it’s time to make an appointment for mammograms and Pap tests. Users enter information about their screening history and select a schedule for their exams, and the app sends them reminders.
- The MyVaxIndiana app enables parents to keep track of their children’s vaccination records. The information comes from a state immunization system and is updated by health care workers, schools and doctors.
- The NMWatch app in New Mexico uses GPS mapping to allow residents, emergency managers and responders to monitor up-to-date wildfire activity. It not only helps people who need to know whether to evacuate, but it alerts those with respiratory problems who might be affected by thick smoke in their neighborhood.
More state agencies that oversee health or emergency management have recognized that they need to embrace mobile technology to stay connected with citizens.
“It’s a natural progression,” said Theresa Pardo, director of the Center for Technology in Government at the University at Albany, a research center that focuses on innovation in government technology. “I think these new apps are really powerful. What underlies them is a massive effort to identify and integrate in sophisticated ways data that is relevant to an individual, particularly in the event of a crisis.”
Communicating critical, life-saving information during emergencies and directing the public to services after disasters is an enormous challenge for states, said Karen Cobuluis, spokeswoman for the National Emergency Management Association, the professional association for state emergency management directors.
A Long Way to Go
While states are moving rapidly to make advances in digital technology, they still have a long way to go when it comes to overseeing their apps and mobile device projects.
In an October 2013 survey of state chief information officers, 58 percent called their state’s efforts to manage apps and mobile device projects “mostly” or “totally” fragmented and uncoordinated.
The association’s Robinson said that most states today don’t have an “enterprise-wide, well-coordinated roadmap” for investing in and deploying mobile technology. “It’s serious for the states because of the implications. There’s no shared strategic direction,” he said. “We need to address how we’re managing mobile devices.”
Robinson of NASCIO said that in many states, apps are being launched agency by agency, which creates more complexity. Plus, states often lack the in-house technical expertise to develop their own apps, so they’re forced to use outside contractors.
Sources of Pollution
From the Web site
The State of the Air 2014 shows that the nation’s air quality worsened in 2010-2012, but remains overall much cleaner than just a decade ago.
More than 147.6 million people—47 percent of the nation—live where pollution levels are too often dangerous to breathe, an increase from last year’s report.
Despite that risk, some seek to weaken the Clean Air Act, the public health law that has driven the cuts in pollution since 1970.
Web site includes the following
- Options to
- Search air quality by zip code (for “grades”)
and state (for “report cards”)
- Compare your air
- Health Effects of Ozone and Particle Pollution
- Key Findings
- Ozone Pollution — More than 4 in 10 people lived in areas with unhealthful levels of ozone in 2010-2012. See which cities with the worst ozone had even more unhealthy air days.
- Year-round Particle Pollution — More than 46.2 million people live in an area burdened year-round by unhealthful levels of deadly particle pollution. See which cities saw continued progress in cleaning up sources and which suffered even more pollution.
- Short-term Particle Pollution — Many cities endured more days where particle pollution spiked during this period. Fourteen percent (14%) of people in the United States live where they suffered too many days with unhealthful levels of particle pollution.
- Cleanest Cities — Only four cities made the cleanest list in all three categories, but several were among the cleanest in two.
- People at Risk — Nearly half of the people in the U.S. live in counties that have unhealthful levels of either ozone or particle pollution. Learn more about people who face the greatest risk—probably someone you know is one of them.
- What Needs to be Done to Get Healthy Air— What do we need to do as a nation? How can you help clean up the air?
National Prevention Week is a SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues. National Prevention Week 2014 is about Our Lives. Our Health. Our Future. We’ll be highlighting the important role each of us has in maintaining a healthy life and ensuring a productive future.
There are many ways to make a difference. Explore the National Prevention Week website to learn more about how you can get involved, from planning a community event to participating in the “I Choose” Project.
Men who have been incarcerated and released are more than twice as likely to die prematurely as those who have not been imprisoned, according to a new study published by Georgia State University criminologist William Alex Pridemore.
Former prisoners are more likely to die early from infectious and respiratory diseases, drug overdoses and homicides. Causes of this “mortality penalty” include increased exposure to diseases like TB and HIV, the prolonged stress of the prison environment, the disruption of important social bonds and, upon release, the struggle to reintegrate into society and employment.
“We know that stress can weaken immune systems,” Pridemore said. “And in a very unpleasant twist of events, at the precise moment when these men are most vulnerable to a compromised immune system due to stress – that is, when they are incarcerated – they are most exposed to a host of communicable diseases whose rates are much higher in the prison population.”
Pridemore’s empirical analysis of the Izhevsk (Russia) Family Study, was published online this month in the Journal of Health and Social Behavior. Titled “The Mortality Penalty of Incarceration: Evidence from a Population-based Case-control Study of Working Age Males,” it is among the first sociological studies to look at the short- and long-term impacts of incarceration on the mortality of prisoners after their release.
More than 2.5 million people are incarcerated in the United States – 95 percent of whom will eventually be released. Incarceration rates in the United States and Russia, at 730 and 519 per 100,000 residents, are among the highest in the world.
MEDIA CONTACTJennifer French Giarratano
“Earlier research looked at the collateral consequences of mass imprisonment that started in the 1970s, when the U.S. went on an incarceration binge. Most focused on incarceration’s limits on job prospects and earnings, marriages and its impact on communities,” he said. “Now research is turning to its impact on health.
“Ironically, prisons provide an opportunity to screen and treat a population that may be unlikely or unable to take advantage of community-based health care,” he continued. “Prisons should work with inmates, prior to their release, and provide health screenings and treatment and help them plan for their short-term and long-term health care needs. This investment will benefit not only the individual health of current and former prisoners, but also taxpayers and the broader community by way of improved population health.
Pridemore’s findings are timely given the recent release of the National Research Council’s report, The Growth of Incarceration in the United States, which has politicians and the public reconsidering mass incarceration.
“Careful research shows that many of the consequences of contact with the penal system – especially the mortality penalty of incarceration – go well beyond what we consider just punishment,” he said.
William Alex Pridemore is a Distinguished University Professor in the Andrew Young School of Policy Studies at Georgia State University. His research focuses on the social structure and violence and the sociology of health.
Interesting blog posting highlighting a few challenges epidemiologists face with kidney complications
From the 13 May 2014 post at robertbryan22
I’m catching up on my stack of periodicals. The 11 April issue of Science featured some fascinating articles related to public health [attn: Lexi].
The first, Mesoamerica’s Mystery Killer, focuses on chronic kidney disease of unknown etiology (CKDu) in Central America and it reads like a novel:
A young doctor in training at the hospital, Ramón García Trabanino, first brought CKDu to light. “The whole hospital was flooded by renal patients,” remembers García Trabanino, who began working at the hospital in the late 1990s. “I thought, ‘Why are all these people here with kidney disease? It’s not normal.’ ” An adviser suggested he do a study.
Over 5 months, García Trabanino interviewed 202 new patients with end-stage renal disease. Medical records and personal histories uncovered an obvious cause for CKD in only one-third of the patients, equally split between men and women. Of the rest, 87% were men and the majority worked in agriculture and lived in coastal areas, he and his co-authors reported in September 2002. Their report in the Pan American Journal of Public Health speculated that patients who had CKD with características peculiares might have developed the disease after exposure to herbicides and insecticides.
Health officials took little interest in this greenhorn’s findings. “I spoke with PAHO and I remember them laughing at me,” García Trabanino says. “They thought I was crazy.” The Ministry of Health in El Salvador took no action, but it did give him an award for his study. “The judges must have been drunk that night,” he says.
[Press release] New CDC study finds dramatic increase in e-cigarette-related calls to poison centers | Press Release | CDC Online Newsroom | CDC
Rapid rise highlights need to monitor nicotine exposure through e-cigarette liquid and prevent future poisonings
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.
[Podcast] Early Stress Gets Under the Skin: Promising Initiatives to Help Children Facing Chronic Adversity
Disadvantaged children who often experience deep poverty, violence, and neglect simultaneously are particularly vulnerable to the pernicious effects of chronic stress. New research reveals that chronic stress alters childrens’ rapidly developing biological systems in ways that undermine their ability to succeed in school and in life. But there is good evidence that specialized programs can help caretakers learn to be more supportive and responsive. High-quality childcare can offer a safe, warm, and predictable environment amid otherwise chaotic lives, and home visiting programs can help both parents and foster parents learn to provide an environment of greatly reduced stress for their children.
On May 7, Princeton University and the Brookings Institution released the Spring 2014 volume and accompanying policy brief of the Future of Children. The release event featured researchers and policy experts who explained how chronic stress “gets under the skin” to disrupt normal development and how programs can provide the support so urgently needed by children who face chronic stress.
[Press release] Regulating legal marijuana could be guided by lessons from alcohol and tobacco, study says
As U.S. policymakers consider ways to ease prohibitions on marijuana, the public health approaches used to regulate alcohol and tobacco over the past century may provide valuable lessons, according to new RAND Corporation research.
Recent ballot initiatives that legalized marijuana in Colorado and Washington for recreational uses are unprecedented. The move raises important questions about how to best allow the production, sales and the use of marijuana while also working to reduce any related social ills.
A new study published online by the American Journal of Public Health outlines how regulations on alcohol and tobacco may provide guidance to policymakers concerned about the public health consequences of legalizing marijuana.
Among the issues outlined in the study are how to reduce youth access to marijuana, how to minimize drugged driving, how to curb dependence and addiction, how to restrict contaminants in marijuana products, and how to discourage the dual use of marijuana and alcohol, particularly in public settings.
“The lessons from the many decades of regulating alcohol and tobacco should offer some guidance to policymakers who are contemplating alternatives to marijuana prohibition and are interested in taking a public health approach,” said Beau Kilmer, co-director of the RAND Drug Policy Research center and a co-author of the paper. “Our goal here is to help policymakers understand the decisions they face, rather than debate whether legalization is good or bad.”
The analysis details some of the questions policymakers must confront when consideringless-restrictive marijuana laws. Those questions include: Should vertical integration be allowed, or should there be separate licenses for growing, processing and selling marijuana? What rules are needed to make sure a marijuana product is safe? Should marijuana be sold in convenience stories or only in specialized venues? Should taxes be assessed per unit of weight, as a percent of the price or on some other basis, such as the amount of psychoactive ingredients in marijuana?
“Based on the national experience with alcohol and tobacco, it seems prudent from a public health perspective to open up the marijuana market slowly, with tight controls to test the waters and prevent commercialization too soon while still making it available to responsible adults,” said Rosalie Liccardo Pacula, co-director of the RAND Drug Policy Research Center and a co-author of the paper. “Of course, perspectives other than public health objectives might motivate policymakers to adopt different or fewer regulations. These are simply lessons learned from a public health perspective.”
The article discusses a variety of strategies used to control alcohol and tobacco that also may be appropriate for regulation of marijuana. Those include keeping prices artificially high to curb use, adopting a state-run monopoly on sales and distribution, limiting the types of products sold, restricting marketing efforts, and restricting consumption in public spaces.###
Support for the study was provided by the Robert Wood Johnson Foundation’s Public Health Law Research Program and RAND. Other authors of the report are Alexander C. Wagenaar of the University of Florida College of Medicine, Frank J. Chaloupka of the University of Illinois, Chicago, and Jonathan P. Caulkins of the Heinz School of Public Policy at Carnegie Mellon University.
Since 1989, the RAND Drug Policy Research Center has conducted research to help policymakers in the United States and throughout the world address issues involving alcohol and other drugs. In doing so, the center brings an objective and data-driven perspective to an often emotional and fractious policy arena.
The World Health Organization (WHO) has crafted this site that is dedicated to “public health, social and environmental determinants of health (PHE).” On the site, visitors can look over the WHO’s publications and news releases, along with multimedia features and event listings. Guests should start by browsing the Publications which contain timely reports on pharmaceuticals in drinking-water and children’s environmental health. The Health Topics area contains information about how WHO is working to reduce indoor air pollution, outdoor pollution, and chemical safety. The site also contains links to its overall global strategy via working papers and policy statements. [KMG]
[Report] Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?
Originally posted on Full Text Reports...:
Source: PLoS ONE
Doctors, lawyers and criminal justice agencies need methods to assess vulnerability to violent radicalization. In synergy, public health interventions aim to prevent the emergence of risk behaviours as well as prevent and treat new illness events. This paper describes a new method of assessing vulnerability to violent radicalization, and then investigates the role of previously reported causes, including poor self-reported health, anxiety and depression, adverse life events, poverty, and migration and socio-political factors. The aim is to identify foci for preventive intervention.
A cross-sectional survey of a representative population sample of men and women aged 18–45, of Muslim heritage and recruited by quota sampling by age, gender, working status, in two English cities. The main outcomes include self-reported health, symptoms of anxiety and depression (common mental disorders), and vulnerability to violent…
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Originally posted on Patrick Mackie:
Environmental health practitioners, particularly those who studied and qualified in the last twenty years, will be very familiar with Margaret Whitehead and Göran Dahlgren’s model of the social determinants of health, shown below in the well-known model from their 1991 publication.
Environmental health as a profession works at the interfaces between, generally, people’s living and working conditions and their health and wellbeing. But these are only one set of environmental factors that affect health in terms of morbidity and mortality, and there are other governmental and social actors that can work together to intervene and change the outcomes for real people in the real world. That’s why the new public health arrangements in England are game-changing for the profession and for the health of the public generally, and that’s why finding an evidence-base to target suitable and effective interventions that will really make a difference for people is so important.
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Rice University analysis of state efforts show dramatic gains in reducing airborne particulate matter
HOUSTON – (March 27, 2014) – National efforts in the last decade to clear the air of dangerous particulate matter have been so successful that most urban areas have already attained the next benchmark, according to new research by Rice University.
Atmospheric researchers at Rice studied the state implementation plans (SIPs) from 23 regions mandated by the Environmental Protection Agency to reduce particulate matter (PM) smaller than 2.5 microns (PM 2.5) to less than 15 micrograms per cubic meter by 2009.
The Rice analysis appears this week in the Journal of the Air and Waste Management Association.
All but one of the regions studied reported they had met the goal by deadline. States with regions that met the deadline included Connecticut, Georgia, Illinois, Indiana, Kentucky, Maryland, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee and West Virginia, as well as the District of Columbia. The final region, Alabama, reported attainment in 2010.
PM 2.5 concentrations in the nonattainment regions that filed SIPs to attain the standard by 2009 declined by an average 2.6 micrograms per cubic meter – significantly greater improvement than in regions that had attained the standard from its inception. The study showed PM reductions in the SIP regions were broadly spread, rather than pinpointed at the most polluted monitors.
“One of the things we were most interested in looking at was to see if states were cherry-picking their measures to meet the standard by reducing pollution at their worst monitors, compared with how much they were doing to bring down levels all across the region so that people were breathing cleaner air,” said Daniel Cohan, an associate professor of civil and environmental engineering at Rice.
“It was encouraging to find that across the country, we have seen overall particulate-matter levels come down. We found very slight extra improvement at monitors that were targeted the most, but regions that had to develop plans achieved pretty solid controls that didn’t just pinpoint the worst monitors. And the large populations of these regions benefited.”
Cohan and Rice alumna Ran Chen also documented that air pollution continued to decline even after the 2009 standards were met. The majority of the SIP regions had already attained the mandated 2014 goal of 12 micrograms per cubic meter by 2012.
“We’ve been on a good trajectory,” Cohan said. “This demonstrates that the combination of state and federal controls has been substantially improving air quality in the U.S.”
- See more at: http://news.rice.edu/2014/03/27/us-clean-air-efforts-stay-on-target/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Science360NewsServiceComplete+%28Science360+News+Service%3A+Complete%29&utm_content=Netvibes#sthash.eZJySuaf.dpuf
Around 1 in 5 of the population were infected in both recent outbreaks of seasonal flu and the 2009 H1N1 influenza pandemic, but just 23% of these infections caused symptoms, and only 17% of people were ill enough to consult their doctor.
These findings come from a major new community-based study comparing the burden and severity of seasonal and pandemic influenza in England over 5 years, published in The Lancet Respiratory Medicine journal.
“Reported cases of influenza represent the tip of a large clinical and subclinical iceberg that is mainly invisible to national surveillance systems that only record cases seeking medical attention”, explains lead author Dr Andrew Hayward from University College London, UK.
“Most people don’t go to the doctor when they have flu. Even when they do consult they are often not recognised as having influenza. Surveillance based on patients who consult greatly underestimates the number of community cases, which in turn can lead to overestimates of the proportion of cases who end up in hospital or die. Information on the community burden is therefore critical to inform future control and prevention programmes.”*
The Flu Watch study tracked five successive cohorts of households across England over six influenza seasons between 2006 and 2011. The researchers calculated nationally representative estimates of the incidence of influenza infection, the proportion of infections that were symptomatic, and the proportion of symptomatic infections that led to medical attention.
Participants provided blood samples before and after each season for influenza serology, and all participating households were contacted weekly to identify any cases of cough, cold, sore throat or ‘flu-like illness”. Any person reporting such symptoms was asked to submit a nasal swab on day 2 of illness to test for a variety of respiratory viruses using Real-Time, Polymerase Chain Reaction (RT-PCR) technology.
The results show that on average 18% of the unvaccinated community were infected with influenza each winter season—19% during prepandemic seasons and 18% during the 2009 pandemic. But most (77%) of these infections showed no symptoms, and only around 17% of people with PCR-confirmed influenza visited their doctor. Compared with some seasonal flu strains, the 2009 pandemic strain caused substantially milder symptoms.
The study indicates that primary-care surveillance greatly underestimates the extent of infection and illness in the community. The rate of influenza across all winter seasons was on average 22 times higher than rates of disease recorded by the Royal College of General Practitioners Sentinel Influenza-Like Illness Surveillance Scheme.
According to Dr Hayward, “Despite its mild nature, the 2009 pandemic caused enormous international concern, expense, and disruption. We need to prepare for how to respond to both mild and severe pandemics. To do this we need more refined assessments of severity, including community studies to guide control measures early in the course of a pandemic and inform a proportionate response.”
Writing in a linked Comment, Dr Peter William Horby from the Oxford University Clinical Research Unit in Vietnam says, “In view of the undoubtedly high rates of subclinical influenza infection, an important unanswered question is the extent to which mild and asymptomatic influenza infections contribute to transmission…A large number of well individuals mixing widely in the community might, even if only mildly infectious, make a substantial contribution to onward transmission.”
He concludes, “Surveillance of medically attended illnesses provides a partial and biased picture, and is vulnerable to changes in consulting, testing, or reporting practices. As such, it is clear that reliable estimates of the infection and clinical attack rates during the early stages of an influenza epidemic requires the collection of standardised data across the whole range of disease severity, from the community, primary care, and secondary care.”
Originally posted on NobodyisFlyingthePlane:
“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…
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It was terribly sad listening to the bother of a “legal high” victim on the radio this morning. The now banned N-Bomb LSD copycat drug had left his brother severely brain damaged and dependent on 24 hour care for the rest of his life.
Surely it is time to stop using the incredibly misleading term ‘legal high’ with its safe, non-addictive, not-bad-enough-to-be-banned connotations. It’s a lie. The internet is littered with websites selling untold numbers of chemical compounds, blithely labelled with seductive names and proclaimed as legal, ‘quality research chemicals and herbal incense’, getting away with it through a bold disclaimer of “STRICTLY NOT FOR HUMAN CONSUMPTION”.
To try and start classifying them is financially and logistically possible, even though the All-Party Parliamentary Group for Drug Policy Reform (clue is in the name) calls for the Utopian solution of the an introduction of a new category for psychoactive substances whereby their supply can be ‘regulated’ and a review of the government lead for drugs to ensure a health focus. Yeah right.
The first step from the government surely has to be to a serious focus on deterrence. Insist on accurate labeling such as ‘high risk unclassified highs’ in all commentary – because there is never, ever anyway of the public being sure what is in the psychoactive substance. Possession should automatically incur a significant fine – pills, powder, whatever – you are potentially endangering yours and others lives. It may be herbs and talc but life is too short to test everything – the European Monitoring Centre for Drugs and Drug Addiction identified 73 new substances in 2012 alone – and it sends a message of principle. It is ridiculous that they can have ‘not fit for human consumption’ on the packet as a legal requirement alongside names such as gogaine, spellweaver, charlie and e-scape.
The American example of “analogue” legislation which simply automatically bans any new substance that has a similar chemical structure to an already banned drug is worth considering but it can never keep pace with new products coming to market. There are hundreds if not thousands of labs in Asia where new synthetic drugs are synthesised to imitate the effects of existing legal drugs. We have to keep this simple, and act now, if we are to prevent more tragic episodes of injury and death.
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.
The Top Five Useless Chronic Pain Treatments (Psychology Today), What not to do to help the chronic pain patient.Published on January 31, 2014 by Dr. Mark Borigini, M.D. in Overcoming Pain
Total releases of toxic chemicals decreased 12 percent from 2011-2012, according to the U.S. Environmental Protection Agency’s (EPA) annual Toxics Release Inventory (TRI) report released today. The decrease includes an eight percent decline in total toxic air releases, primarily due to reductions in hazardous air pollutant (HAP) emissions.
“People deserve to know what toxic chemicals are being used and released in their backyards, and what companies are doing to prevent pollution,” said EPA Administrator Gina McCarthy. “By making that information easily accessible through online tools, maps, and reports, TRI is helping protect our health and the environment.”
The 2012 data show that 3.63 billion pounds of toxic chemicals were either disposed or otherwise released into the environment through air, water, and land. There was also a decline in releases of HAPs such as hydrochloric acid and mercury, which continues a long-term trend. Between 2011 and 2012, toxic releases into surface water decreased three percent and toxic releases to land decreased 16 percent.
This is the first year that TRI has collected data on hydrogen sulfide. While it was added to the TRI list of reportable toxic chemicals in a 1993 rulemaking, EPA issued an Administrative Stay in 1994 that deferred reporting while the agency completed further evaluation of the chemical. EPA lifted the stay in 2011. In 2012, 25.8 million pounds of hydrogen sulfide were reported to TRI, mainly in the form of releases to air from paper, petroleum, and chemical manufacturing facilities.
Another new addition to TRI reporting is a requirement for each facility located in Indian country to submit TRI reports to EPA and the appropriate tribe, and not the state where the facility is geographically located. EPA finalized this requirement in a 2012 rule aimed at increasing tribal participation in the TRI Program.
This year’s TRI national analysis report includes new analyses and interactive maps for each U.S. metropolitan and micropolitan area, new information about industry efforts to reduce pollution through green chemistry and other pollution prevention practices, and a new feature about chemical use in consumer products.
The annual TRI report provides citizens with critical information about their communities. The TRI Program collects data 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.
The 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. Many of the releases from facilities that are subject to TRI reporting are regulated under other EPA program requirements designed to limit harm to human health and the environment.
Also available is the expanded TRI Pollution Prevention (P2) Search Tool, which now allows users to graphically compare facilities within the same industry using a variety of environmental metrics.
Toxics Release Inventory National Analysis
Under the Emergency Planning and Community Right-to-Know Act (EPCRA), facilities must report their toxic chemical releases to EPA by July 1 of each year. The Pollution Prevention Act of 1990 also requires facilities to submit information on waste management activities related to TRI chemicals.
More information on the 2012 TRI analysis, including metropolitan and micropolitan areas is available atwww.epa.gov/tri/nationalanalysis.
What tools are available to help me conduct my own analysis?
A variety of online tools available from the Data and Tools webpage will help you access and analyze TRI data.
Where can I get downloadable files containing the data used in the 2012 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.
[Press release] CDC study shows that child passenger deaths have decreased 43 percent from 2002 – 2011
Research has shown that using age- and size-appropriate child restraints (car seats, booster seats, and seat belts) is the best way to save lives and reduce injuries in a crash. Yet the report found that almost half of all black (45 percent) and Hispanic (46 percent) children who died in crashes were not buckled up, compared to 26 percent of white children (2009-2010).
The Vital Signs report also found that:
- One in three children who died in crashes in 2011 was not buckled up.
- Only 2 out of every 100 children live in states that require car seat or booster seat use for children age 8 and under.
Child passenger restraint laws result in more children being buckled up. A recent study by Eichelberger et al, showed that among five states that increased the required car seat or booster seat age to 7 or 8 years, car seat and booster seat use tripled, and deaths and serious injuries decreased by 17 percent.
To help keep children safe on the road, parents and caregivers can:
- Use car seats, booster seats, and seat belts in the back seat—on every trip, no matter how short.
- Rear-facing car seat from birth up to age 2
Buckle children in a rear-facing seat until age 2 or when they reach the upper weight or height limit of that seat.
- Forward-facing car seat from age 2 up to at least age 5 When children outgrow their rear-facing seat, they should be buckled in a forward-facing car seat until at least age 5 or when they reach the upper weight or height limit of that seat.
- Booster seat from age 5 up until seat belt fits properlyOnce children outgrow their forward-facing seat, they should be buckled in a booster seat until seat belts fit properly. The recommended height for proper seat belt fit is 57 inches tall.
- Seat belt once it fits properly without a booster seatChildren no longer need to use a booster seat once seat belts fit them properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck).
- Install and use car seats according to the owner’s manual or get help installing them from a certified Child Passenger Safety Technician.
[Article] Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2014
From the 4 February 2014 Annals of Internal Medicine article by Carolyn B. Bridges, MD; Tamera Coyne-Beasley, MD, MPH, on behalf of the Advisory Committee on Immunization Practices
Vaccine Risk Perceptions and Ad Hoc Risk Communication: An Empirical Assessment | Full Text Reports…
From the Social Science Research Network
Vaccine Risk Perceptions and Ad Hoc Risk Communication: An Empirical Assessment by Dan M. Kahan
Yale University – Law School; Harvard University – Edmond J. Safra Center for Ethics
January 27, 2014
CCP Risk Perception Studies Report No. 17
Based on survey and experimental methods (N = 2,316), the Report presents two principal findings:
first, that vaccine risks are neither a matter of concern for the vast majority of the public nor an issue of contention among recognizable demographic, political, or cultural subgroups;
and second, that ad hoc forms of risk communication that assert there is mounting resistance to childhood immunizations themselves pose a risk of creating misimpressions and arousing sensibilities that could culturally polarize the public and diminish motivation to cooperate with universal vaccination programs.
Based on these findings the Report recommends that government agencies, public health professionals, and other constituents of the public health establishment
Number of Pages in PDF File: 82
The report may be downloaded for free at the above URL
Some excerpts from the report
1. There is deep and widespread public consensus, even among groups strongly divided on other issues such as climate change and evolution, that childhood vaccinations make an essential contribution to public health. …
2. In contrast to other disputed science issues, public opinion on the safety and efficacy of childhood vaccines is not meaningfully affected by differences in either science comprehension or religiosity. …
3. The public’s perception of the risks and benefits of vaccines bears the signature of a gen- eralized affective evaluation, which is positive in a very high proportion of the population. …
4. Among the manifestations of the public’s positive orientation toward childhood vaccines is the perception that vaccine benefits predominate over vaccine risks and a high degree of confi- dence in the judgment of public health officials and experts. …
B. Normative and prescriptive conclusions
1. Risk communicators—including journalists, advocates, and public health professionals— should refrain from conveying the false impression that a substantial proportion of parents or of the public generally doubts vaccine safety.
2. Risk communicators should avoid resort to the factually unsupportable, polemical trope that links vaccine risk concerns to climate-change skepticism and to disbelief in evolution as evi- dence of growing societal distrust in science.
Remember, correlation does not equal causation!
And the selection of variables (as gun ownership) may be questioned by some…
Still, an interesting graph
[Report] Adult illicit drug users are far more likely to seriously consider suicide | Full Text Reports…
From the 16 January SAMSHA news release ( US Substance Abuse & Mental Health Services Administration)
Adults using illicit drugs are far more likely to seriously consider suicide than the general adult population according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report finds that 3.9 percent of the nation’s adult population aged 18 or older had serious thoughts about suicide in the past year, but that the rate among adult illicit drug users was 9.4 percent.
According to SAMHSA’s report, the percentage of adults who had serious thoughts of suicide varied by the type of illicit substance used. For example, while 9.6 percent of adults who had used marijuana in the past year had serious thoughts of suicide during that period, the level was 20.9 percent for adults who had used sedatives non-medically in the past year.
“Suicide takes a devastating toll on individuals, families and communities across our nation,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “We must reach out to all segments of our community to provide them with the support and treatment they need so that we can help prevent more needless deaths and shattered lives.”
Those in crisis or who know someone they believe may be at immediate risk of attempting suicide are urged to call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or go to http://www.suicidepreventionlifeline.org. The Suicide Prevention Lifeline network, funded by SAMHSA, provides immediate free and confidential, round-the-clock crisis counseling to anyone in need throughout the country, every day of the year.
This report, “1 in 11 Past Year Illicit Drug Users Had Serious Thoughts of Suicide,” is based on the findings of SAMHSA’s 2012 National Survey on Drug Use and Health (NSDUH) report. The NSDUH report is based on a scientifically conducted annual survey of approximately 70,000 people throughout the country, aged 12 and older. Because of its statistical power, it is a primary source of statistical information on the scope and nature of many substance abuse and mental health issues affecting the nation.
The complete survey findings are available on the SAMHSA web site at: http://www.samhsa.gov/data/spotlight/spot129-suicide-thoughts-drug-use-2014.pdf
For more information about SAMHSA visit: http://www.samhsa.gov/.
From the 16 January 2014 Tel Aviv University press release
AU research shows that some warning labels can make products like cigarettes more appealing
Many products, like cigarettes and medications, are stamped with warning labels alerting consumers to their risks. Common sense suggests these warnings will encourage safer choices.
But now Dr. Yael Steinhart of Tel Aviv University‘s Recanati Business School, along with Prof. Ziv Carmon of INSEAD in Singapore and Prof. Yaacov Trope of New York University, has shown that warning labels can actually have the opposite effect. When there is a time lag between reading a warning and then buying, consuming, or evaluating the associated products, the warnings may encourage trust in the manufacturers of potentially dangerous products, making them less threatening. Published in Psychological Science, the study findings could help improve the efficacy of warning labels.
“We showed that warnings may immediately increase concern and decrease consumption,” said Dr. Steinhart. “But over time, they paradoxically promote trust in a product and consequently lead to more positive product evaluation and more actual purchases.” The findings have important implications for regulators and managers in fields including consumer products, healthcare, and finance.
The best laid plans
The study is based on an idea called “the construal-level theory” (CLT), developed by Prof. Trope and Prof. Nira Liberman of TAU’s School of Psychological Sciences. When thinking about objects over a period of time, people tend to construe them abstractly, emphasizing what they describe as “high-level features” and suppressing “low-level features.” The high-level feature of warning labels is that they build trust in consumers by creating the impression that all the relevant information about the products is being presented. The low-level feature of warning labels is that they make consumers more aware of the products’ negative side effects.
The CLT holds that over long periods of time, consumers deemphasize side effects and emphasize the feeling of trust communicated by warnings over time. Ironically, this may increase the purchase, consumption, and assessment of the associated products.
Absence makes the heart grow fonder
From the 8 January 2014 ScienceDaily article
As people get older, their bodies wear down and become less resilient. In old age, it’s common for people to become “clinically frail,” and this “frailty syndrome” is emerging in the field of public health as a powerful predictor of healthcare use and death.
Now researchers Vicki Myers and Prof. Yariv Gerber of the Department of Epidemiology and Preventive Medicine at the School of Public Health at Tel Aviv University’s Sackler Faculty of Medicine and colleagues have found that poor people are more than twice as likely as the wealthy to become frail after a heart attack. The findings, published in the International Journal of Cardiology, could help doctors and policymakers improve post-heart-attack care for the poor.
“By defining frailty, which combines many areas of medicine, we can predict which people are at the highest risk after a heart attack,” said Ms. Myers. “And we found a strong connection between frailty and socioeconomic status.”
- 2012 Web Version | PDF Version [ - .8.74 MB] | State Snapshots
For the tenth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and theNational Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care.
New this year are chapters on care coordination, and health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.
The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations.
The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities.
From the 14th January Science Daily article
School drug testing does not deter teenagers from smoking marijuana, but creating a “positive school climate” just might, according to research reported in the January issue of the Journal of Studies on Alcohol and Drugs.
An estimated 20 percent of U.S. high schools have drug testing; some target students suspected of abusing drugs, but often schools randomly test students who are going out for sports or clubs. The policies are controversial, partly because there is little evidence they work. And in the new study, researchers found no effects on high schoolers’ drug experimentation.
Of 361 students interviewed, one third said their school had a drug testing policy. Over the next year, those kids were no less likely than other students to try marijuana, cigarettes or alcohol.
“Even though drug testing sounds good, based on the science, it’s not working,” said Daniel Romer, Ph.D., of the University of Pennsylvania Annenberg Public Policy Center in Philadelphia.
At best, Romer said, the policies might convince kids to lay off the drug their school is testing for — which is most commonly marijuana. But even if that’s true, Romer added, students in school sports and clubs are actually not the ones at greatest risk of developing drug problems. “So as a prevention effort,” Romer said, “school drug testing is kind of wrong-headed.”
So what does work? In this study, there was evidence that a positive school climate might help.
MD-led study is first to link racism-related factors and cellular age
COLLEGE PARK, Md. – A new University of Maryland-led study reveals that racism may impact aging at the cellular level. Researchers found signs of accelerated aging in African American men who reported high levels of racial discrimination and who had internalized anti-Black attitudes. Findings from the study, which is the first to link racism-related factors and biological aging, are published in the American Journal of Preventive Medicine.
Racial disparities in health are well-documented, with African Americans having shorter life expectancy, and a greater likelihood of suffering from aging-related illnesses at younger ages compared to whites. Accelerated aging at the biological level may be one mechanism linking racism and disease risk.
“We examined a biomarker of systemic aging, known as leukocyte telomere length,” explained Dr. David H. Chae, assistant professor of epidemiology at UMD’s School of Public Health and the study’s lead investigator. Shorter telomere length is associated with increased risk of premature death and chronic disease such as diabetes, dementia, stroke and heart disease. “We found that the African American men who experienced greater racial discrimination and who displayed a stronger bias against their own racial group had the shortest telomeres of those studied,” Chae explained.
Even after adjusting for participants’ chronological age, socioeconomic factors, and health-related characteristics, investigators found that the combination of high racial discrimination and anti-black bias was associated with shorter telomeres. On the other hand, the data revealed that racial discrimination had little relationship with telomere length among those holding pro-black attitudes. “African American men who have more positive views of their racial group may be buffered from the negative impact of racial discrimination,” explained Chae. “In contrast, those who have internalized an anti-black bias may be less able to cope with racist experiences, which may result in greater stress and shorter telomeres.”
The findings from this study are timely in light of regular mediareports of racism facing African American men. “Stop-and-friskpolicies, and other forms of criminal profiling such as ‘driving orshopping while black’ are inherently stressful and have a real impact on the health of African Americans,” said Chae. Researchers found that racial discrimination by police was most commonly reported by participants in the study, followed by discrimination in employment. In addition, African American men are more routinely treated with less courtesy or respect, and experience other daily hassles related to racism.
Chae indicated the need for additional research to replicate findings, including larger studies that follow participants over time. “Despite the limitations of our study, we contribute to a growing body of research showing that social toxins disproportionately impacting African American men are harmful to health,” Chae explained. “Our findings suggest that racism literally makes people old.”
[Online Book] Subjective Well-Being: Measuring Happiness, Suffering, and Other Dimensions of Experience (2013)
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.
- Data on people’s self-reported ‘experienced’ well-being could help inform policies (sciencedaily.com)
- Political economy of happiness (knrajlibrary.wordpress.com)
- Subjective Well-being (venitism.blogspot.com)
- Self-reported ‘experienced’ well-being could help inform policies (medicalnewstoday.com)
- ‘Gut instinct’ makes for happy relationship, researchers say (irishtimes.com)
- Mindfulness: State or trait? (mentalworkout.com)
[Press release] United Health Foundation’s America’s Health Rankings Finds Americans Are Making Considerable Progress in Key Health Measures
- Hawaii is the healthiest state
- Nationwide, Americans improved in the majority of the measures captured by the Rankings
- Improvements span key behavioral measures including smoking and physical inactivity
- 2013 marks the first time since 1998 that America’s obesity crisis did not worsen
- Serious challenges remain; maintaining momentum is keyMINNETONKA, Minn. (Dec. 11, 2013) – Americans are making considerable progress in their overall health, according to United Health Foundation’s 2013 America’s Health Rankings®: A Call to Action for Individuals & Their Communities.
Nationwide, Americans improved in the majority of the measures captured by the Rankings. The most notable gains came in key behavioral measures, including smoking, which dropped from 21.2 percent of the adult population to 19.6 percent. Seventeen states had significant drops in smoking, with the largest seen in Nevada, Maryland, Oklahoma, Kansas and Vermont.
Physical inactivity dropped from 26.2 percent of the adult population to 22.9 percent, and America’s obesity rate remained approximately the same as reported in 2012 (27.6 percent of the adult population in 2013 compared with 27.8 percent in 2012). This marks the first time since 1998 that obesity rates have not worsened.
Hawaii has taken the title of healthiest state. Vermont, last year’s reported No. 1 state, is ranked second this year and has ranked among the top five states for the last decade. Minnesota is third, followed by
Massachusetts and New Hampshire. Mississippi ranks 50th this year, and Arkansas (49), Louisiana (48), Alabama (47) and West Virginia (46) complete the list of the five least healthy states.
Top-seated Hawaii scored well along most measures particularly for having low rates of uninsured individuals, high rates of childhood immunization, and low rates of obesity, smoking and preventable hospitalizations. Like all states, Hawaii also has areas where it can improve: it has higher-than-average rates of binge drinking and occupational fatalities, and lower-than-average rates of high school graduation.
To see the Rankings in full, visit: http://www.americashealthrankings.org.
Despite progress, significant challenges remain
When it comes to improving the nation’s health, there is still much to be done. Obesity has leveled off; however, it must remain a top priority, as 27.6 percent of adults nationwide report being obese. With rates of physical inactivity, smoking and diabetes at 22.9 percent, 19.6 percent and 9.7 percent, respectively, there is still considerable room for improvement in key health measures.
“I am encouraged by the progress we’ve made this year and am hopeful that the leveling off we see in America’s obesity is a sign of further improvement to come,” said Reed Tuckson, M.D., external senior medical adviser to United Health Foundation. “We should certainly celebrate these gains. They encourage us to continue to identify and effectively implement best practices in these areas and in addressing diabetes, heart disease and other chronic health conditions that compromise Americans’ health and vitality.”
Georges Benjamin, M.D., executive director of the American Public Health Association, said: “Every year, the America’s Health Rankings report details the nation’s health successes and challenges on a state- by-state level, providing specific areas where citizens and states alike can focus to continue to improve the health of our nation. I am pleased to see the progress we’ve made and hope we can keep up the good work.”
United Health Foundation calls for sustained momentum
“United Health Foundation is committed to continuing to identify ways to improve state health in measurable, meaningful ways,” said Rhonda Randall, D.O., senior adviser to United Health Foundation and chief medical officer of UnitedHealthcare Retiree Solutions. “I hope we soon see the day when we are cheering year-over-year improvements in obesity, and I look forward to seeing our nation’s percentage of smokers continue to decline.”
“Those of us who dedicate our careers to public health know we can’t improve what we don’t measure,” said Eduardo Sanchez, M.D., chairman, Partnership for Prevention. “The America’s Health Rankings report and the online tools show us where we’ve made strides in promoting better health and, importantly, where we still have work to do.”
The America’s Health Rankings report and its tools – including analysis not only of state populations but also subpopulations within states – are designed to identify health opportunities in communities as well as
multi-stakeholder, multi-disciplinary approaches to address those opportunities. Through its programs and grants, United Health Foundation shines a spotlight on the health of America while promoting evidence- based solutions. As part of this commitment, United Health Foundation has partnered with the Association of State and Territorial Health Officials and the National Business Coalition on Health to create learning laboratories that identify and promote best practices and innovations in public health. To learn more about America’s Health Rankings – and to get information on how to help improve community health – visit http://www.americashealthrankings.org.
About America’s Health Rankings®
America’s Health Rankings is an annual comprehensive assessment of the nation’s health on a state-by state basis. It is published jointly by United Health Foundation, American Public Health Association and Partnership for Prevention.
The data in the report come from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau. The report is reviewed and overseen by a Scientific Advisory Committee, with members from leading academic institutions, government agencies and the private sector.
America’s Health Rankings is the longest-running report of its kind. For 24 years, the Rankings has provided an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socioeconomic data to determine national health benchmarks and state rankings. The Rankings employs a unique methodology, developed and annually reviewed by a Scientific Advisory Committee of leading public health scholars. For more information, visit http://www.americashealthrankings.org.
About United Health Foundation
Guided by a passion to help people live healthier lives, United Health Foundation provides helpful information to support decisions that lead to better health outcomes and healthier communities. The Foundation also supports activities that expand access to quality health care services for those in challenging circumstances and partners with others to improve the well-being of communities. After its establishment by UnitedHealth Group [NYSE: UNH] in 1999 as a not-for-profit, private foundation, the Foundation has committed more than $210 million to improve health and health care. For additional information, please visit http://www.unitedhealthfoundation.org.
- Better blood pressure control, stop-smoking programs and faster treatment are a few of the reasons for a dramatic decline in U.S. stroke deaths in recent decades.
DALLAS, Dec. 5, 2013 — Stroke deaths in the United States have declined dramatically in recent decades due to improved treatment and prevention, according to a scientific statement published in the American Heart Association journal Stroke.
The American Stroke Association commissioned this paper to discuss the reasons that stroke dropped from the third to fourth leading cause of death.
“The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, Dr. P.H., chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. “The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death.”
Public health efforts including lowering blood pressure and hypertension control that started in the 1970s have contributed greatly to the change, Lackland said.
Four-year trend in survival probability by periods 1987–1991, 1992–1996, 1997–2001, and 2002– 2006 among men and women aged 18 to 54 y with a first ischemic stroke.
Smoking cessation programs, improved control of diabetes and abnormal cholesterol levels, and better, faster treatment have also prevented strokes. Improvement in acute stroke care and treatment is associated with lower death rates.
“We can’t attribute these positive changes to any one or two specific actions or factors as many different prevention and treatment strategies had a positive impact,” Lackland said. “Policymakers now have evidence that the money spent on stroke research and programs aimed at stroke prevention and treatment have been spent wisely and lives have been saved.
“For the public, the effort you put into lowering your blood pressure, stopping smoking, controlling your cholesterol and diabetes, exercising and eating less salt has paid off with a lower risk of stroke.”
Stroke deaths dropped in men and women of all racial/ethnic groups and ages, he said.
“Although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages,” Lackland said. “We need to keep doing what works and to better target these programs to groups at higher risk.”
Co-authors are Edward J. Roccella, Ph.D., M.P.JN., committee chair; Anne F. Deutsch, R.N., Ph.D.; Myriam Fornage, Ph.D.; Mary G. George, M.D., M.S.P.H.; George Howard, Dr. P.H.; Brett M. Kissela, M.D., M.S.; Steven J. Kittner, M.D., M.P.H.; Judith H. Lichtman, Ph.D., M.P.H.; Lynda D. Lisabeth, Ph.D, M.P.H.; Lee H. Schwamm, M.D.; Eric E. Smith, M.D., M.P.H.; and Amytis Towfighi, M.D., on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Quality of Care and Outcomes Research, and Council on Functional Genomics and Translational Biology.
For the latest heart and stroke news, follow us on Twitter: @HeartNews.
For updates and new science from Circulation, follow @CircAHA.
The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association’s science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at www.heart.org/corporatefunding.Darcy Spitz: (212) 878-5940; Darcy.Spitz@heart.orgJulie Del Barto (broadcast): (214) 706-1330; Julie.DelBarto@heart.orgFor Public Inquiries: (800) AHA-USA1 (242-8721)
- American Heart Association reports U.S. stroke deaths declining due to improved prevention, treatment (clarksvilleonline.com)
- U.S. Stroke Deaths Declining Due to Improved Prevention, Treatment (newsroom.heart.org)
- US stroke deaths declining due to improved prevention, treatment (eurekalert.org)
- Improved prevention, treatment leads to decline in U.S stroke deaths (medicalnewstoday.com)
- Decline in Stroke Death Among Americans: Study Confirms (scienceworldreport.com)
- Improved Prevention, Treatment Led to Significant Declines in US Stroke Death (counselheal.com)
- Blood pressure control tied to decline in stroke mortality over past 50 years (drsonnywong.wordpress.com)
- Blood pressure control tied to decline in stroke mortality over past 50 years (drkevincoy.wordpress.com)
In this one hour webinar which is part of the Hot Topics series, representatives from four health jurisdictions in Washington State discuss their experiences developing policies and enforcing laws to promote smoke-free air in public places.
Air date: December 17, 2013
[recording will be freely available after Dec 17]
- Describe how public health agencies are being challenged by the presence of hookah lounges, vapor-producing products, and possibly marijuana lounges.
- List effective public policy or enforcement strategies for combating hookah lounges, vapor-producing products, and potential marijuana lounges.
- List three considerations when deciding whether to take legal proceedings against an establishment for violating Smoking in Public Places laws.
Local, state, and tribal public health practitioners; board of health members; health department legal counsel
Slides and Resources
- Slides will be posted immediately before the session.
- An Introduction to E-Cigarettes for States and Locals, Tobacco Control Network
Use of prescription, over-the-counter medications also of concern in CAMH’s latest Ontario Student Drug Use and Health Survey (OSDUHS)
December 11, 2013 – Alcohol consumption and smoking among Ontario students in grades 7-12 is at an all-time low; however recreational use of over-the-counter drugs is on the rise. Prescription drug misuse and driving after using drugs also remain elevated according to the 2013 Ontario Student Drug Use and Health Survey (OSDUHS) released today by the Centre for Addiction and Mental Health (CAMH). The survey of 10,272 students from across Ontario is Canada’s longest-running systematic study of alcohol and other drug use among youth, and one of the longest-running surveys in the world
Over-the-counter and prescription drugs
The survey shows one in eight (representing 120,000 middle and high school students in Ontario) reported taking a prescription opioid pain medication recreationally in the last year, and the majority of these students said that they got the drugs from home. About one per cent (representing 13,500 students) reported using stimulant drugs (used to treat ADHD) without a prescription. There was an increase in the number of students who reported using over-the-counter cough medication to “get high,” with over 94,000 students (about 10%) engaging in this behaviour. This was the only drug to show an increase in recent years. One in six high school students reported symptoms of a drug use problem; this represents 132,700 students in grades 9-12.
Substance use and driving
Eighteen per cent of students reported being a passenger in a car driven by someone who had been drinking alcohol. Four per cent of students with a G-class driver’s license said they had driven a vehicle within one hour of consuming two or more drinks – this is an estimated 12,700 adolescent drivers in Ontario.
Cannabis smoking and driving levels were even higher. Despite the serious impact that smoking cannabis can have on psychomotor skills and the ability to drive safely, one in ten licensed students reported driving a car within one hour of smoking cannabis. This represents 31,500 adolescent drivers in Ontario. Fourteen per cent of students reported being a passenger in a car where the driver had been using drugs.
“The number of students who report using cannabis and driving has remained the same in recent years which tells us that students do not take the potential dangers of driving while under the influence seriously,” said Dr. Robert Mann, CAMH Senior Scientist and OSDUHS Principal Investigator. “The public health messages around the dangers of drinking and driving seem to have had an impact on our youth but the same can’t be said for cannabis use, which is worrisome.”
Alcohol use among Ontario students reached an all-time low with 50 per cent (representing 483,900 students) reporting drinking alcohol in the past year. “Though the overall decline shows promise, we see that the kids who are drinking are doing so in dangerous ways,” added Dr. Mann. “One in five (representing 193,400 students) reports binge drinking at least once in the past month and a similar percentage report blacking out on at least one occasion when drinking alcohol in the past year. Eight per cent report being injured or injuring someone else while they had been drinking.”
New this year
New in this year’s OSDUHS are questions on the use of waterpipes and electronic cigarettes. Almost 10 per cent (representing 88,400 students) reported smoking tobacco through a waterpipe in the past year. About 15 per cent of high school students (representing 99,800 students) reported smoking electronic cigarettes in their lifetime. For the first time the survey asked students whether they had used synthetic cannabis, commonly known by street names, “K2” or “spice.” Two per cent – representing over 17,000 students – had tried the drug.
“These new numbers give us some insight into the use of alternative and emerging drugs among young people,” said Dr. Hayley Hamilton, CAMH Scientist and Co-Investigator on the OSDUHS. “We see that while cannabis use among students is holding steady since our last survey at around one quarter of students, this new synthetic form has emerged and we will want to track its prevalence in future surveys. The same holds for smoking – while the rate of students smoking has leveled off over the past few years, we see that youth are still smoking cigarettes and tobacco, but in alternate ways.”
- Students in Toronto and Western Ontario reported the nonmedical use of opioid prescription pain medication at higher rates than the rest of the province (15 per cent and 13 per cent respectively)
- Students in the north were less likely to use prescription opioid pain medication (7 per cent) but reported higher rates of hazardous drinking than the provincial average (19 per cent and 16 per cent respectively)
- Students in the east reported higher rates of hazardous drinking than the provincial average (20 per cent and 16 per cent respectively)
For further information, please contact Michael Torres, Media Relations, CAMH at (416) 595-6015 or firstname.lastname@example.org
The Centre for Addiction and Mental Health (CAMH) is Canada’s largest mental health and addiction teaching hospital, and one of the world’s leading research centres in the field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
OSDUHS is Canada’s longest-running systematic study of alcohol and other drug use among youth, and one of the longest-running surveys in the world. During the 2012-13 school year, 10,272 students from across Ontario in grades 7 to 12 participated in the survey, administered on behalf of CAMH by the Institute for Social Research at York University.
- Is driving high the new drinking and driving for Ontario teens? (globalnews.ca)
- Is smoking cannabis and driving the new drinking and driving? (medicalxpress.com)
- Prescription drug abuse among youth on the rise: Report (sunnewsnetwork.ca)
- Cough syrup, marijuana use up in Ontario high schools (cbc.ca)
- More Ontario teens drive after using marijuana than after drinking: study (globalnews.ca)
- Is driving high the new drinking and driving for Ontario teens? | Globalnews.ca (kimmiecats.wordpress.com)
[News article] Britain’s poor ‘will die before they retire’ if pension reforms aren’t matched by health improvements
Thousands of Britain’s poorest people “will be dead before they can retire” if sweeping pension reforms are not matched by urgent action on health inequalities between rich and poor, experts have said.
Plans to raise the basic state pension age to 70 for people currently in their twenties were laid out in the George Osborne’s Autumn Statement this week. But with male life expectancy at birth as low as 66 in some of the most deprived parts of the country, public health experts have warned that a “one size fits all” pension age risks condemning many to a life without retirement.
Average UK life expectancy at birth was 78.2 in 2010. Nationally, the figure is increasing, but huge variations exist and progress has been slower in deprived communities where poverty leads to poor diets, smoking rates are higher and alcohol abuse more common.
In Glasgow City, where male life expectancy at birth is 71.6, boys born in 2010 are expected to die on average 13.5 years earlier than those born in the London borough Kensington and Chelsea, where life expectancy is 85.1. Girls in born in the London borough in 2010 can expect 12 more years of life than those in Glasgow. Even these figures veil vast inequalities that exist within regions, with life expectancies as low as 66 years in some of Glasgow’s most deprived areas.
Martin McKee, professor of European Public Health at the London School of Hygiene and Tropical Medicine, and fellow of the Faculty of Public Health, said that if the Government wanted to raise the pension age, they must first tackle health inequalities.
“George Osborne is thinking about the average life expectancy. The average life expectancy is fairly meaningless if you’re living in a former coal mining village in Nottinghamshire or in inner-city Glasgow,” he toldThe Independent. “There are many parts of the country where people have nowhere near the average life expectancy and, crucially, nowhere near the average healthy life expectancy. It’s not just the fact people will be dead before they reach pensionable age, it’s that they will be unfit to work.”
David Walsh, a public health expert at the Glasgow Population Health Centre said that a single pension age across all areas of the country was “at the very least problematic”.
- Britain’s Poor Will Die Before They Retire (sorendreier.com)
- Britain’s poor ‘will die before they retire’ if pension reforms aren’t matched by health improvements (engineeringevil.com)
- Living Longer…and Longer…. (worthwhile.typepad.com)
- Work until you’re 70: Chancellor George Osborne accused of ‘living in fantasy land’ over Autumn Statement pension reforms (independent.co.uk)
- Ever receding retirement? (centrallobby.politicshome.com)
- State pension: age-old problems | Editorial (theguardian.com)
Measles Still Threatens Health Security
On 50th Anniversary of Measles Vaccine, Spike in Imported Measles Cases
Fifty years after the approval of an extremely effective vaccine against measles, one of the world’s most contagious diseases, the virus still poses a threat to domestic and global health security.
On an average day, 430 children – 18 every hour – die of measles worldwide. In 2011, there were an estimated 158,000 measles deaths.
In an article published on December 5 by JAMA Pediatrics, CDC’s Mark J. Papania, M.D., M.P.H., and colleagues report that United States measles elimination, announced in 2000, has been sustained through 2011. Elimination is defined as absence of continuous disease transmission for greater than 12 months. Dr. Papania and colleagues warn, however, that international importation continues, and that American doctors should suspect measles in children with high fever and rash, “especially when associated with international travel or international visitors,” and should report suspected cases to the local health department. Before the U.S. vaccination program started in 1963, measles was a year-round threat in this country. Nearly every child became infected; each year 450 to 500 people died each year, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness.
People infected abroad continue to spark outbreaks among pockets of unvaccinated people, including infants and young children. It is still a serious illness: 1 in 5 children with measles is hospitalized. Usually there are about 60 cases per year, but 2013 saw a spike in American communities – some 175 cases and counting – virtually all linked to people who brought the infection home after foreign travel.
“A measles outbreak anywhere is a risk everywhere,” said CDC Director Tom Frieden, M.D., M.P.H. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day. Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security.
Eliminating measles worldwide has benefits beyond the lives saved each year. Actions taken to stop measles can also help us stop other diseases in their tracks. CDC and its partners are building a global health security infrastructure that can be scaled up to deal with multiple emerging health threats.
Currently, only 1 in 5 countries can rapidly detect, respond to, or prevent global health threats caused by emerging infections. Improvements overseas, such as strengthening surveillance and lab systems, training disease detectives, and building facilities to investigate disease outbreaks make the world — and the United States — more secure.
“There may be a misconception that infectious diseases are over in the industrialized world. But in fact, infectious diseases continue to be, and will always be, with us. Global health and protecting our country go hand in hand,” Dr. Frieden said.
Today’s health security threats come from at least five sources:
- The emergence and spread of new microbes
- The globalization of travel and food supply
- The rise of drug-resistant pathogens
- The acceleration of biological science capabilities and the risk that these capabilities may cause the inadvertent or intentional release of pathogens
- Continued concerns about terrorist acquisition, development, and use of biological agents.
“With patterns of global travel and trade, disease can spread nearly anywhere within 24 hours,” Dr. Frieden said. “That’s why the ability to detect, fight, and prevent these diseases must be developed and strengthened overseas, and not just here in the United States.”
The threat from measles would be far greater were it not for the vaccine and the man who played a major role in creating it, Samuel L. Katz, M.D., emeritus professor of medicine at Duke University. Today, CDC is honoring Dr. Katz 50 years after his historic achievement. During the ceremony, global leaders in public health are highlighting the domestic importance of global health security, how far we have come in reducing the burden of measles, and the prospects for eliminating the disease worldwide.
Measles, like smallpox, can be eliminated. However, measles is so contagious that the vast majority of a population must be vaccinated to prevent sustained outbreaks. Major strides already have been made. Since 2001, a global partnership that includes the CDC has vaccinated 1.1 billion children. Over the last decade, these vaccinations averted 10 million deaths – one fifth of all deaths prevented by modern medicine.
“The challenge is not whether we shall see a world without measles, but when,” Dr. Katz said.
“No vaccine is the work of a single person, but no single person had more to do with the creation of the measles vaccine than Dr. Katz,” said Alan Hinman, M.D., M.P.H., Director for Programs, Center for Vaccine Equity, Task Force for Global Health. “Although the measles virus had been isolated by others, it was Dr. Katz’s painstaking work passing the virus from one culture to another that finally resulted in a safe form of the virus that could be used as a vaccine.”
- Measles still poses threat to U.S. despite being “eliminated” (cbsnews.com)
- CDC: Rise in Imported Measles Cases Threatens US (health.yahoo.net)
- CDC: Measles Still A Threat (radio.foxnews.com)
- US Measles Cases This Year Are Triple The Annual Average: CDC – Huffington Post (huffingtonpost.com)
- Measles still a risk, 50 years after the introduction of the vaccine (theglobaldispatch.com)
- RT @Fischblog: “Before the measles vaccine was achieved 50 years ago, the disease killed 2.6 mio people around the world every year” http:/… (wired.com)
[Magazine article] Long-Term Disease Database Proves the Value of Vaccines | Observations, Scientific American Blog Network
To find out when whooping cough started making a comeback in Ohio, or how often measles kills in America, we turn to historical records. But those records aren’t very useful when they’re squirreled away in a distant office basement. The same goes for when they are embedded in a report—you can only look at them in the same way you might admire a painting, but you cannot drop the data into a spreadsheet and hunt for statistical significance. If you are only looking at a couple years’ worth of information that formatting dilemma is not such a big deal. You can scour the data and manually punch it into your analysis. It only becomes a huge problem when you are looking at hundreds or thousands of data points.
Such is the problem that public health experts at University of Pittsburgh encountered when they were exploring old medical data and developing models that predict future outbreaks. “We found ourselves going back and pulling out historical datasets repeatedly. We kept doing it over and over and finally got to the point where we thought it would be not only a service to ourselves but everybody if all the data was made digital and open access,” says Donald Burke, the dean of Pittsburgh’s graduate school of public health.
Four years ago, buoyed by funds from the National Institutes of Health and the Gates Foundation, they started the process of digitalizing 125 years worth of medical records. The endeavor was dubbed Project Tycho, named for the Danish nobleman Tycho Brahe who made the voluminous astronomical observations that Kepler later tapped to develop the laws of planetary motion. (But no pressure, right?)
The online, open-access resource now features accounts of 47 diseases between 1888 and today. It includes data from the weekly Nationally Notifiable Disease Surveillance reports for the United States, standardized in such a way that the data can be immediately analyzed.
In the research world, that’s a big accomplishment. Making this data usable takes more than casually monitoring a scanner while sipping coffee. The data has to be made uniform, a tedious process of manual input with unenviable tasks like removing periods, dashes and other inconsistencies while identifying data gaps.
Pittsburgh researchers also gave their new data trove a test drive to illustrate what could be done with the data. They mined Tycho for information on eight common diseases detailed in the records—polio, measles, rubella, mumps, hepatitis A, diphtheria and pertussis. Looking at available records before and after vaccines were discovered for those diseases, they estimated that 103 million cases of those contagious diseases have been prevented since 1924, (assuming the reductions were all attributable to vaccination programs). Their findings are published in this week’sNew England Journal of Medicine. The data also points to what can happen when communities become too lax about vaccinations (among other factors). They quantified the resurgence in recent years of pertussis throughout the country, particularly in the Midwest to Northwest and in the Northeast and also ongoing cases of mumps. “Reported rates of vaccine refusal or delay are increasing,” the authors write. “Failure to vaccinate is believed to have contributed to the reemergence of pertussis, including the large 2012 epidemic.”
When vaccines work well, sometimes “people no longer fear the disease and they undervalue the vaccine and in some ways that is what is going on right now,” says Burke, pointing to the discredited vaccine-autism link which prompted some parents to turn away from childhood vaccines. With this newly available data collection, more can be done than simply looking at where the disease is happening—or not happening. Researchers can begin looking for drivers of disease and identifying patterns about the burden of disease by say, climate or socioeconomic-status.
Flip through some of the data yourself here after it becomes searchable to the public on November 28.
[One has to register to view data, for institution I just entered private citizen and my registration was accepted. The database interface is very user friendly!]
- Vaccines work. Period. (sciencebasedmedicine.org)
- Researchers develop massive database to help fight deadly diseases… (medicalxpress.com)
- A rebuke to the antivaccine movement: A hundred million cases of disease prevented and millions of lives saved by vaccines [Respectful Insolence] (scienceblogs.com)
- Childhood vaccines prevent disease but risks remain (triblive.com)
- FDA scientist discusses recent pertussis vaccine study (theglobaldispatch.com)
- Trove of Public Health Data Unlocked by Pitt Researchers to Help Fight Deadly Contagious Diseases (medindia.net)
- Anti-Vaxxers Take Note: Vaccines Have Prevented 100 Million Serious Childhood Diseases In U.S. Since 1888 (reason.com)
- Katie Couric promotes dangerous fear mongering with show on the HPV vaccine (richarddawkins.net)
The release and publication of Project Tycho™ data has been featured in an article of the New York Times online and print version of Thursday November 28th entitled “The Vaccination Effect: 100 Million Cases of Contagious Disease Prevented”. It emphasizes that the large amount of data digitized by the project provides an invaluable resource for science and policy and the importance of vaccination programs in the United States.
Through a collaboration with the Open Government Initiative, Project Tycho™ data have been listed on HealthData.gov as new open access resource for governmental data. In addition on the listing, HealthData.gov has agreed to host Project Tycho™ level 1 and level 2 data that can each be downloaded from this site as a one CSV file with a single click. Comments on this release have been made in the HealthData.gov blog.
After four years of data digitization and processing, the Project Tycho™ Web site provites open access to newly digitized and integrated data from the entire 125 years history of United States weekly nationally notifiable disease surveillance data since 1888. These data can now be used by scientists, decision makers, investors, and the general public for any purpose. The Project Tycho™ aim is to advance the availability and use of public health data for science and decision making in public health, leading to better programs and more efficient control of diseases. Read full press release.
Three levels of data have been made available: Level 1 data include data that have been standardized for specific analyses, Level 2 datainclude standardized data that can be used immediately for analysis, and Level 3 data are raw data that cannot be used for analysis without extensive data management. See the video tutoral.
November 28, 2013 |A Project Tycho™ study estimates that 100 million cases of contagious diseases have been prevented by vaccination programs in the United States since 1924
In a paper published in the New England Journal of Medicine entitled “Contagious diseases in the United States from 1888 to the present,” aProject Tycho™ study estimates that over 100 million cases have been prevented in the U.S. since 1924 by vaccination programs against polio, measles, mumps, rubella, hepatitis A, diphtheria, and pertussis (whooping cough). Vaccination programs against these diseases have been in place for decades but epidemics continue to occur. Despite the availability of a pertussis vaccine since the 1920s, the largest pertussis epidemic in the U.S. since 1959 occurred last year. This study was funded by the Bill & Melinda Gates Foundation and the National Institutes of Health and all data used for this study have been released through the online Project Tycho™ data system as level 1 data.
“Historical records are a precious yet undervalued resource. As Danish philosopher Soren Kierkegaard said, we live forward but understand backward,” explained Dr. Burke, senior author on the paper. “By ‘rescuing’ these historical disease data and combining them into a single, open-access, computable system, we can now better understand the devastating impact of epidemic diseases, and the remarkable value of vaccines in preventing illness and death.” See an interview with the authors and an animation on the analysis.
Not sure if this is the right approach. I was brought unto be personally responsible for my actions and not rely on others to create ways to help me do the right things. Part of my thinks money spent on these grants could be better spent elsewhere. These ideas seem to be only shotgun approaches and do not really address underlying issues.
Still, I think their hearts are in the right place.
Through a series of small grants, we’re is exploring the utility of applying behavioral economic principles to perplexing health and health care problems—everything from getting seniors to walk more to forgoing low-value health care.
At a recent meeting in Philadelphia we challenged grantees to compete in an Innovation Tournament. The goal was to identify testable ideas that leverage behavioral economic principles to help make people healthier by working with commercial entities. Participants were assigned to groups and made their best pitches to their colleagues. And of course we used a behavioral economics principle (financial incentives) to increase participation: Each member of the first, second and third place teams received Amazon gift cards.
Eight teams made the finals:
1. Love Lock: This team addressed the issue of driving and texting by proposing an app that could be installed on your cell phone that would send reminders not to text while driving. This team would work with car insurance and mobile phone carrier companies and provide discounts to those who get it installed. The behavioral economics principles being tested are default choice and opt-out.
2. McQuick & Fit: Too many people eat unhealthy food. This team’s idea was to have a rewards card that can only be used to purchase healthy food. With each purchase, the customer would earn points toward free, healthy foods. Online orders would be placed through a website that would feature salient labeling and allow for defaults to order healthy meals. The behavioral economics principles at play include pre-commitment, default choice, labeling, and incentives.
3. Just Bring Me Water: The problem tackled by this team is “regrettable” calories—mindlessly consuming whatever is put in front of you, such as free bread at a restaurant, or soda on a plane. The innovation: when booking a table online or calling for a reservation, you could ask to “opt-out” of the complimentary bread or chips that are offered. This would reduce the consumption of regrettable calories.
4. Lunch Club: This group looked at addressing gluttony through a partnership with a chain restaurant. When going out for a meal, portions are typically bigger and diners consume more. But what if you had the option of doggy-bagging one third of the meal for another meal—framed as “buy dinner and get lunch free”? And, if you took this option, you would get a scratch off as an enhanced incentive and immediate reward. The behavioral economic principles being tested here include loss aversion, active choice, and incentives.
5. Snooze, But Don’t Lose: People don’t get enough good sleep, which leads to poor executive functioning and safety issues. To increase safety, productivity, and efficiency, this group proposed using a Fitbit to build in reminders to go to bed earlier and provide feedback on good sleep. The behavioral economic principles at play are pre-commitment and loss aversion.
6. Google Coach: This team’s idea was to create good habit formation, specifically commitment to a health plan, whether it was getting more sleep, adhering to a diet, or taking vitamins regularly. The group proposed partnering with Google and using its calendar and mobile phone platform to program smart defaults that are personalized to the individual. For example, people could actively schedule exercise or sleep based on their schedule on Google calendar. The group hypothesized that intelligent defaults are better than people planning themselves (without defaults).
7. The Basketeers: This team wanted to optimize consumers’ baskets at grocery stores and supermarkets, increasing the amount of healthy items purchased. The group suggested partnering with an online supermarket to create different packages of food for customers to purchase. For example, there could be the J-Lo package, which would bundle together food items that this aspirational star would most likely eat. In addition, when checking out, the website would assess the customer’s basket for healthier options, such as switching whole milk for skim milk. As a reward, consumers would get discounts and express delivery for choosing healthier options.
8. Team REV (Re-Engineering Vending): Soda and other sugar sweetened beverages lead to obesity. This team proposed partnering with beverage companies to make vending machines more fun, while optimizing them to help people make healthier beverage selections. For instance, the vending machine would have sensors and as you approach the unhealthy items, the healthier item buttons would light up. The behavioral economics principle applied here is choice architecture.
The participants voted for their top three choices. Lunch Club came in third while Love Lock and Google Coach tied for first place. And, you might wonder, how does a group of behavioral economists and psychologists break a tie? By playing rock, paper, scissors. Team Love Lock won.
This post originally appeared in the RWJF Pioneering Ideas Blog.
- How a behavioral economist eats Thanksgiving dinner (washingtonpost.com)
- What behavioral economics is and what it is not.. (mostlyeconomics.wordpress.com)
- Meet the ‘Genius’ Whose Ideas About Behavioral Economics Could (Someday) Change Lives (psmag.com)
- Decisions, Decisions…Behavioral Economics and Behavioral Change (rwjfblogs.typepad.com)
- Eight Innovative Ideas to Influence Health Behavior (rwjfblogs.typepad.com)
- Next challenges in behavioral economics (alessandroinnocenti.wordpress.com)
- Lose weight, Get Gold in Dubai (blogs.wsj.com)
Twelve ideas to help you stay healthy during flu season
The 2013 flu season has begun, and while it is still early in the season, cases have already been reported in the U.S. Winter gatherings can bring together people who are vulnerable to the cold & flu virus.
People who get together for the winter holidays can be exposed to viruses from other parts of the region and can pick up and spread the illness from wherever they’ve been. Here are some small, individual changes you can make lending to a healthy winter season.
- Drink black or green tea with lemon and honey. Drinking hot tea while breathing in the steam stimulates the cilia – the hair follicles in the nose – to move out germs more efficiently. Lemon thins mucus and honey is antibacterial.
- Consume enough protein. Diets that are too low in protein can deplete the immune system. The current recommendation for protein intake is at least 60 grams per day for adult women and at least 75 grams per day for adult men, depending on age, activity level and if they need to gain/lose weight.
- Slowly exhale. When walking past a person who is sneezing or coughing, slowly exhale until you’re past them. This avoids you inhaling contaminated air.
- Try Zinc lozenges. If you get a scratchy throat, zinc lozenges can relieve cold symptoms faster.
- Eat your fruits and vegetables. Eating 5 or more fruits and vegetables each day will provide many vitamins and minerals necessary for your immune system to function properly. Try to choose more vegetables than fruit.
- Sanitize your space. You can sanitize commonly touched items (cell phones, grocery carts, keyboards, gym equipment) to help the spread of germs. Remember, rhinoviruses causing cold & flu symptoms can live on surfaces for up to 48 hours!
- Pamper your nose. The job of your nose is to filter allergens, bacteria, and viruses floating in the air. By using saline nasal rinses, you can help flush germs and clear secretions in your upper airway.
- Consume enough water. The urge to drink water can decrease in colder months, but the need for water is still important. Consuming enough fluids will eliminate toxins from your lymph system which keeps your immune system functioning properly.
- Get a massage for your immune system! Massage increases circulation which boosts immunity by nourishing cells with more oxygen filled blood. Click here to learn about our massage services.
- Sanitize your brushes. Think about the items you may reuse every day and consider cleaning or replacing them (cosmetics and make up brushes, toothbrushes, hair brushes, hand towels). A quick swipe of an alcohol wipe on a tube of lipstick or washing make up brushes in an antibacterial soap can support a healthy immune system.
- Sleep. Research shows that adults need 7-8 hours of sleep to stimulate an immune response from our natural killer cells which are the cells that attack viruses.
- Humidity. Dry air in the winter can cause your lips, mouth, & nose to become dry and cracked. Cracked skin can be an entry point for bacteria and viruses. Consider a humidifier to help keep moisture in the air.
Homemade Sani Wipes:
Fold or cut paper towels or napkins and put them into a wipe container. Use 1 1/2 cup of warm water, add 1 Tbsp. of coconut oil, and 1 tsp. of alcohol. Add 3 drops of lavender oil if you like. Then mix well and pour the mixture into the container of napkins to saturate them. Makes 2 containers.
Your health and wellness crew in WELLAWARE wish you a healthy winter season.
- Patz, A. (2013, December). Live healthy. Health 27(10).
- CDC. (2013, November 22). Seasonal Influenza. Retrieved fromhttp://www.cdc.gov/flu/
- CDC. (2012, October). Nutrition for everyone: protein. Retrieved fromhttp://www.cdc.gov/nutrition/everyone/basics/protein.html
- Beyond an Apple a Day: 10 Germ-Busting Tips for Cold and Flu Season (redtri.com)
- Study Finds How Flu Evolves to Escape Immunity (medindia.net)
- Above the inFLUence > If you’re sick, don’t work. If your work requires you to come in sick, let us know. (newsreview.com)
- Tip of the Week: Cold and Flu Season (pacusher.wordpress.com)
- Personalized Flu Vaccines Approved By FDA: New, Unique Options For The Elderly, Children, And People With Allergies (medicaldaily.com)
- 5 Tips on How to Stay Flu Free (roserenea91.wordpress.com)
- Vaccines, Flu & Other Seasonal Ailments: What You Need To Know (whnt.com)
“This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.”
Researchers take a page from weather forecasting to predict seasonal influenza outbreaks in 108 cities across the country
Scientists were able to reliably predict the timing of the 2012-2013 influenza season up to nine weeks in advance of its peak. The first large-scale demonstration of the flu forecasting system by scientists at Columbia University’s Mailman School of Public Health was carried out in 108 cities across the United States.
Results are published online in the journal Nature Communications.
The flu forecasting system adapts techniques used in modern weather prediction to turn real-time, Web-based estimates of influenza infection into local forecasts of the seasonal peak by locality. Influenza activity peaked in cities in the southeast as early as December 2012, but crested in most of the country in the first weeks of 2013.
Year to year, the flu season is highly variable. It can happen anywhere from December to April. But when it arrives, cities can go from practically no cases to thousands in a very short time. “Having greater advance warning of the timing and intensity of influenza outbreaks could prevent a portion of these influenza infections by providing actionable information to officials and the general public,” says first author Jeffrey Shaman, PhD, assistant professor of Environmental Health Sciences at Columbia University’s Mailman School of Public Health.
For the public, the flu forecast could promote greater vaccination, the exercise of care around people sneezing and coughing, and a better awareness of personal health. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, are necessary.
The new study builds on the researchers’ 2012 study that used the system to retrospectively predict the peak of the flu in New York City for the years 2003-2008. That research was limited to one city and performed as a test of the system. The current study is the first to make predictions in actual real-time and for the whole country.
Beginning in late November of 2012, the researchers used the flu forecasting system to perform weekly estimates for 108 cities. They shared the results with the CDC and posted them online in an academic archive. Near the end of 2012, four weeks into the flu season, the system had predicted 63% of cities accurately. As the season progressed, the accuracy increased. By week four, it successfully predicted the seasonal peak in 70% of the country. It was able to give accurate lead-times up to nine weeks in advance of the peak; most lead-times were two to four weeks.
The flu forecasts were also much more reliable than those made using alternate, approaches that rely on historical data. “Our method greatly outperformed these alternate schemes,” says Dr. Shaman.
The researchers saw regional differences in the accuracy of the system, but they were likely within normal variation. “As an example, retrospectively, we’ve been able to predict the flu in Chicago very well; this year we did a terrible job in that city. For other cities, the opposite held. It averages out. On the whole the system performed very well,” Dr. Shaman says. However, there were hints of geographical differences. “We were able make better predictions in smaller cities. Population density may also be important. It suggests that in a city like New York, we may need to predict at a finer granularity, perhaps at the borough level. In a big sprawling city like Los Angeles, we may need to predict influenza at the level of individual neighborhoods.”
Google Flu Trends Goes “Off the Rails”
The researchers designed the flu forecasting system to use combined data from 1) Google Flu Trends, which makes estimates of outbreaks based on the number of flu-related search queries, and 2) region-specific reports from the Centers for Disease Control on verified cases of flu. The system approach is analogous to weather forecasting, which employs real-time observational data to reduce model forecasts error. In the last year, the researchers slightly modified the system to be more representative of flu rather than flu and other respiratory problems. Nevertheless, there was unusual level of “noise” in the data related to problems with Google Flu Trends.
How did this happen? One explanation is the high number of media stories about the flu, including some about the flu forecasting system itself. The result was a spike in people using Google to research the flu, which could have overloaded the Flu Trends algorithm. It’s an irony not lost on Dr. Shaman. “There was a tremendous amount of media attention accorded to the flu last year. I was part of the problem myself,” he says. Another factor may have been the particular strain of flu in circulation. “The flu was very virulent and was making people very sick, more so than previous seasons,” says Dr. Shaman. Again this could have led to spike in flu-related Google search queries. (In October, Google announced that it has revised the Flu Trends, which Dr. Shaman hopes will make flu forecasting more accurate.)
The system will be put back in action as soon as the flu season begins again. “Right now there are few cases of the flu, but as soon as the needle starts to move, we will start making predictions,” says Dr. Shaman. This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.
Worldwide, influenza kills an estimated 250,000 to 500,000 people each year, according to the World Health Organization. In the U.S. 3,000-49,000 die from the flu every year, and about 45% of Americans were vaccinated for the flu, according to the CDC.
Co-authors include Wan Yang and James Tamerius, post-doctoral students of Dr. Shaman (Dr. Tamerius is currently at the University of Iowa); Alicia Karspeck at the National Center for Atmospheric Research; and Marc Lipsitch at the Harvard School of Public Health.
Funding was provided by the National Institutes of Health (GM100467, ES009089) and the Department of Homeland Security. Dr. Lipsitch discloses consulting or honorarium income from the Avian/Pandemic Flu Registry (Outcomes Sciences; funded in part by Roche), AIR Worldwide, Pfizer and Novartis. All other authors declare no competing financial interests.
- Will You Get the Flu? This Real-Time Flu Forecaster Could Tell You (healthland.time.com)
- Flu predictions get more accurate (philedufutureboytech.wordpress.com)
- Flu predictions get more accurate (news.cnet.com)
- Flu predictions get more accurate (news.cnet.com)
- First real-time flu forecast successful (eurekalert.org)
- Scientists Use Weather Forecasting Methods to Predict Flu Season Peak (usnews.com)
- Real-Time Flu Forecast Predicts Outbreaks in Each US City (livescience.com)
- Flu Forecast: Scientists Develop Predict Influenza By Utilizing Weather Forecasting Ideas (wonderfultips.wordpress.com)
After years of state spending cuts, mental health budgets increased in 37 states this year, according to a new report by the National Alliance on Mental Illness.
“Arguably the most notable development was that Texas increased mental health spending by $259 million over two years, the largest increase in its history,” NAMI said in a statement accompanying the report. South Carolina, which had cut mental health programs the deepest in recent years, was also among those states to increase funding this year.
Overall, the increased investment in mental health, spurred in part by the deadly shootings last year in Aurora, Colo., and Newtown, Conn., represents a dramatic reversal from recent years. Between 2009 and 2012, state spending in mental health services dropped by $4.35 billion.
According to NAMI, only six states decreased mental health funding this year – Alaska, Wyoming, Nebraska, Louisiana, North Carolina and Maine.
Aside from money, the NAMI report said states enacted other measures related to mental health. Five states passed legislation to improve the early identification of mental illness in children and youth. Seventeen states adopted laws to tighten restrictions on gun ownership by those considered dangerously mentally ill. And 19 states tinkered with laws pertaining to court-ordered treatment of those with mental illness.
- Newtown shooting prompts increase in mental health funding, not gun control – CTV News (knlive.ctvnews.ca)
- Funding cuts puts Atlanta mental health program at risk (onlineathens.com)
- Gov. McDonnell launches investigation into mental health policies (wtvr.com)
- Newtown Prompts Flood of Mental-Health Spending by U.S. States (bloomberg.com)
- Study examines delivery of outpatient mental health treatment (medicalnewstoday.com)
- NAMI co-hosting mental health discussion (mercedsunstar.com)
- Increasing Access to Psychotropic Medications | Mental Health Summit (pharmaceuticalintelligence.com)
- Mental health conditions cause greater stigma in families than physical problems (psypost.org)
About three years ago, the nation’s top public health agency picked its battles. Now, it’s issuing its own report card on reaching those goals: Pretty good but needs improvement.
The seven “winnable battles” singled out by the Centers for Disease Control and Prevention set goals for 2015, such as cutting adult smoking to 17 percent and pushing childhood obesity down to about 15 percent.
The agency released its first progress report Thursday, and CDC officials said they’re mostly pleased.
To keep pace with emerging public health challenges and to address the leading causes of illness, injury, disability, and death, the Centers for Disease Control and Prevention (CDC) initiated an effort to achieve measurable impact on selected Winnable Battles. These Winnable Battles were chosen based on the magnitude of the health problems and our ability to make significant progress to improve outcomes.
There are evidence-based strategies available now to address the critical health challenges presented by each of the Winnable Battles areas. We have established important indicators and targets for measuring progress. Together with our partners, we can have a meaningful impact on health through a dedicated focus on these Winnable Battles.
In 2010, CDC identified the following Winnable Battles:
- Tobacco – Tobacco use is the leading preventable cause of disease, disability, and death in the U.S.
- Nutrition, Physical Activity, and Obesity – More than 72 million adults and 12 million youth in the U.S. are obese
- Food Safety – Foodborne diseases sicken 1 out of 6 Americans each year
- Healthcare-Associated Infections (HAIs) – 1 out of 20 hospitalized patients contracts an HAI
- Motor Vehicle Safety – Motor vehicle crashes are a leading cause of death among Americans ages 1 to 54
- Teen Pregnancy – The U.S. has one of the highest rates of teen pregnancy of any developed nation in the world
- HIV – More than 1 million people in the U.S. are living with HIV
- CDC report card on priorities: Pretty good, needs improvement (globalnews.ca)
- How The CDC Did On Its Most Recent Report Card (wonderfultips.wordpress.com)
- CDC report card: Good, bad marks on target battles (boston.com)
- CDC report card: Good, bad marks on target battles (star-telegram.com)
Antibiotics aren’t doing what they’re supposed to do anymore. You know, kill infections. Since Alexander Fleming invented penicillin 75 years ago, nearly all bacteria have mutated into strains impervious to antibiotics. Those souped up bacteria now kill hundreds of thousands of people, at a minimum, each year. And according to a new issue of medical journal The Lancet focused on antibiotic-resistant bacteria, things could soon get a whole lot scarier.+
“Rarely has modern medicine faced such a grave threat. Without antibiotics, treatments for minor surgery to major transplants could become impossible…,” argue a team of UK medical experts in one article in a series on antibiotic resistance (paywall) in The Lancet. ”Infection-related mortality rates in developed countries might return to those of the early 20th century,” they say.
The reason antibiotics are no longer doing what they’re supposed to is mainly that they’re being given to the wrong patient. Instead of people with severe infections or risk of infection, the majority of antibiotics are consumed by animals and people who aren’t sick enough to justify their use.
Pigs, chickens, cows, fish and other animals consume the majority of the 100,000-200,000 tonnes (110,000-220,000 tons) of antibiotics manufactured each year, as farmers try to keep growing large and healthy animals under unsanitary conditions. The bacterial strains created in these conditions can spread to humans.
At the same time, perverse incentives in poor countries encourage overuse. People often take antibiotics available over-the-counter, says The Lancet’s report on global resistance, and self-medication by consumers is common. The lack of sound medical care in some areas means that pharmaceutical companies are the chief source of information on when to take antibiotics and in what dose.
- Superbugs are spreading in Europe as antibiotics are overused (qz.com)
- IL Expert: Antibiotic-Resistant Superbugs a Growing Threat (publicnewsservice.org)
- Guess What Happens When The Antibiotics Stop Working (theawl.com)
- ‘Re-engineer healthcare to develop antibiotic resistance’ (thehindu.com)
- New warning says ‘superbugs’ could erase century of medical advances (foxnews.com)
- Worldwide Antibiotics Warning: Resistance ‘Growing’ (prayingforoneday.wordpress.com)
- Antibiotics Warning: Resistance ‘Growing’ (news.sky.com)