A challenging provocative post from a physician
Excerpts from the 25 August 2014 blog item at JeffreySterlingMD.com
Somewhere in the midst of reconciling the parts of me that are physician, public health professional and African-American male, I realized that I don’t have the luxury to simply review the medical aspects of gunshot wounds. As an African-American, I have lived my entire life learning and having it reinforced that I and others of my kind are a misunderstanding or inappropriate interaction away from becoming a statistic. As a physician I get to treat, and as a public health professional I get to report and fashion broad solutions to various challenges, but as an African-American, I get to live a certain reality that for me began when my father died from a gunshot wound when I was a small child.
We live in a country that is without debate the most violent country on earth, both outside of and within all parts of our borders. From the individual’s rights to bear militia levels of arms to the police’s increasing position as military units, from the contradictions of allowing both “Open Carry” and “Stand Your Ground,” we are spiraling toward an inevitable conclusion.
You want to participate in a challenge? Stop being so deficient of attention about what’s happening before our eyes, and think and ask what the inevitable conclusion of all of this is going to be. Regardless of your political persuasion, there are issues to be addressed.
Consider the following facts from the Children’s Defense fund,
- approximately 2900 children and teens died from guns in the US in both 2008 and 2009. (Does anyone think the numbers have declined since then?) That’s one child or teen every 3 hours. That’s eight children or teens every day. That’s 55 children or teens every week for two years. What is our country’s response to this? What are you specifically doing to contribute to a solution to this?
- Young Blacks are being exterminated by gunshot wounds in this country.
Read the entire post here
Great ideas on a variety of exercises. Not for seniors only!
From the article at the US National Institutes of Health, last reviewed on October 27, 2011
Chapter 3: Drugs From Nature, Then and Now – Medicines By Design – Science Education – National Institute of General Medical Sciences
Long before the first towns were built, before written language was invented, and even before plants were cultivated for food, the basic human desires to relieve pain and prolong life fueled the search for medicines. No one knows for sure what the earliest humans did to treat their ailments, but they probably sought cures in the plants, animals, and minerals around them.
[The table of contents]
He found that the ingredient, called parthenolide, appears to disable a key process that gets inflammation going. In the case of feverfew, a handful of controlled scientific studies in people have hinted that the herb, also known by its plant name “bachelor’s button,” is effective in combating migraine headaches, but further studies are needed to confirm these preliminary findings….
DocuBase Article: World Health Statistics 2014.
From the 19 May 2014 summary at DocuTicker
From Health-related Millennium Development Goals – Summary of Status and Trends:
With one year to go until the 2015 target date for achieving the MDGs, substantial progress can be reported on many health-related goals. The global target of halving the proportion of people without access to improved sources of drinking water was met in 2010, with remarkable progress also having been made in reducing child mortality, improving nutrition, and combating HIV, tuberculosis and malaria.
Between 1990 and 2012, mortality in children under 5 years of age declined by 47%, from an estimated rate of 90 deaths per 1000 live births to 48 deaths per 1000 live births. This translates into 17 000 fewer children dying every day in 2012 than in 1990. The risk of a child dying before their fifth birthday is still highest in the WHO African Region (95 per 1000 live births) – eight times higher than that in the WHO European Region (12 per 1000 live births). There are, however, signs of progress in the region as the pace of decline in the under-five mortality rate has accelerated over time; increasing from 0.6% per year between 1990 and 1995 to 4.2% per year between 2005 and 2012. The global rate of decline during the same two periods was 1.2% per year and 3.8% per year, respectively.
Nevertheless, nearly 18 000 children worldwide died every day in 2012, and the global speed of decline in mortality rate remains insufficient to reach the target of a two-thirds reduction in the 1990 levels of mortality by the year 2015.
+ Direct link to document (PDF; 2.4 MB)
Two tables from the report
Obesity: Not just what you eat.
Tel Aviv University research shows fat mass in cells expands with disuse
Over 35 percent of American adults and 17 percent of American children are considered obese, according to the latest survey conducted by the Centers for Disease Control and Prevention. Associated with diabetes, heart disease, stroke, and even certain types of cancer, obesity places a major burden on the health care system and economy. It’s usually treated through a combination of diet, nutrition, exercise, and other techniques.
To understand how obesity develops, Prof. Amit Gefen, Dr. Natan Shaked and Ms. Naama Shoham of Tel Aviv University’s Department of Biomedical Engineering, together with Prof. Dafna Benayahu of TAU’s Department of Cell and Developmental Biology, used state-of-the-art technology to analyze the accumulation of fat in the body at the cellular level. According to their findings, nutrition is not the only factor driving obesity. The mechanics of “cellular expansion” plays a primary role in fat production, they discovered.
By exposing the mechanics of fat production at a cellular level, the researchers offer insight into the development of obesity. And with a better understanding of the process, the team is now creating a platform to develop new therapies and technologies to prevent or even reverse fat gain. The research was published this week in the Biophysical Journal.
Getting to the bottom of obesity
“Two years ago, Dafna and I were awarded a grant from the Israel Science Foundation to investigate how mechanical forces increase the fat content within fat cells. We wanted to find out why a sedentary lifestyle results in obesity, other than making time to eat more hamburgers,” said Prof. Gefen. “We found that fat cells exposed to sustained, chronic pressure — such as what happens to the buttocks when you’re sitting down — experienced accelerated growth of lipid droplets, which are molecules that carry fats.
“Contrary to muscle and bone tissue, which get mechanically weaker with disuse, fat depots in fat cells expanded when they experienced sustained loading by as much as 50%. This was a substantial discovery.”
The researchers discovered that, once it accumulated lipid droplets, the structure of a cell and its mechanics changed dramatically. Using a cutting-edge atomic force microscope and other microscopy technologies, they were able to observe the material composition of the transforming fat cell, which became stiffer as it expanded. This stiffness alters the environment of surrounding cells by physically deforming them, pushing them to change their own shape and composition.
“When they gain mass and change their composition, expanding cells deform neighboring cells, forcing them to differentiate and expand,” said Prof. Gefen. “This proves that you’re not just what you eat. You’re also what you feel — and what you’re feeling is the pressure of increased weight and the sustained loading in the tissues of the buttocks of the couch potato.”
The more you know …
“If we understand the etiology of getting fatter, of how cells in fat tissues synthesize nutritional components under a given mechanical loading environment, then we can think about different practical solutions to obesity,” Prof. Gefen says. “If you can learn to control the mechanical environment of cells, you can then determine how to modulate the fat cells to produce less fat.”
The team hopes that its observations can serve as a point of departure for further research into the changing cellular environment and different stimulations that lead to increased fat production.
Just completed an online continuing ed medical librarian class on emerging technologies.
Week 4 focused on gamification. Went into the course a bit wary on gamification. However,
if developed and implemented properly, it could prevent medical errors.
A local hospital was in the news two years ago for a failed kidney transplant procedure. The donor kidney was placed in the medical waste container. By the time the error was noticed, the kidney was no longer usable.
From the 14 March 2014 EurkAlert
A collaborative project in North Texas could help physicians and nurses improve communication.
Television shows have been using tension between hospital personnel as compelling drama for years. But, in the real world, misunderstandings and miscommunication in the healthcare environment can cause errors with long-lasting, even fatal consequences.
With that in mind, researchers at the University of Texas at Arlington College of Nursing, Baylor Scott & White Health and UT Dallas developed a video-game simulation that they say can teach doctors and nurses to work more collaboratively by playing out tense situations in a virtual world.
The federally funded project recently received two national awards at the 4th Annual Serious Games and Virtual Environments Arcade & Showcase during the 2014 International Meeting on Simulation in Healthcare in San Francisco. The honors included a Best-in-Show award for the Academic Faculty Category and a 4th place award in the Technology Innovations division.
“Our hope is that this project will enhance patient safety and, ultimately, improve patient outcomes,” said Beth Mancini, a UT Arlington nursing professor and Associate Dean of the College of Nursing. “Being honored by the judges at this year’s International Meeting on Simulation in Healthcare tells us that the virtual learning environment we’ve built is among the very best in terms of content and design.”
Read the entire press release here
Links to a few items from the course I took
- Gamification pioneer Yu-kai Chou, provides an overview of Gamification.
(His Web site including description of Octoanlysis is here)
From the class….Choose read a minimum of two (2) of these articles to get a better sense of how gamification is being used in various industries.
- In Gaming, A Shift from Enemies to Emotions. NPR. All Tech Considered. January 7, 2014.
- Silverman, Rachel (Nov 2, 2011). “Latest Game Theory: Mixing Work and Play — Companies Adopt gaming Techniques to Motivate Employees”. Wallstreet Journal.
- Takahashi, Dean (August 25, 2010). “Website builder DevHub gets users hooked by “gamifying” its service”. VentureBeat.
- Sinanian, Michael (April 12, 2010). “The ultimate healthcare reform could be fun and games”. Venture Beat.
- A Game wit Heart, Gone Home is a Bold Step in Storytelling. NPR. All Tech Considered. Dec. 26, 2013.
Order or Download Your Free Patient Packet | NCCAM
From the Web page
Order or Download Your Free Patient Packet
As part of the Time To Talk campaign, NCCAM has developed a packet of helpful materials to help you begin a dialogue with your health care providers. Order your packet online or call 1-888-644-6226 and use reference code D393.
Each packet contains:
- Backgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF
- TELL tip sheet: This sheet provides tips for talking with health care providers.Download PDF
- Patient wallet card: This card will help to keep track of all medications, including dietary supplements and other complementary health products, and will be a handy reference during visits to your health care provider.Download PDF
- Get the Facts: Are You Considering Complementary and Alternative Medicine? This fact sheet will assist you in your decision making about using CAM.Download PDF
Order your packet online or call 1-888-644-6226 and use reference code D393.
Back in 1980/81 I was a Peace Corps volunteer in Liberia, West Africa.
Cancer was basically unheard of. Children were dying at high rates of preventable diseases/conditions as malaria and diarrhea. Most diseases were infectious and/or related to environmental conditions as malaria, dengue fever, and cholera.
Always thought that cancer was not prevalent because the diet was healthy. Everything I ate was what we call “organic”.
Now the tide not only is turning, it has turned.
Just one note, the term “developing country” is a misnomer. All countries are developing!
From the 3 February 2014 BBC article
The globe is facing a “tidal wave” of cancer, and restrictions on alcohol and sugar need to be considered, say World Health Organization scientists.
It predicts the number of cancer cases will reach 24 million a year by 2035, but half could be prevented.
The WHO said there was now a “real need” to focus on cancer prevention by tackling smoking, obesity and drinking.
The World Cancer Research Fund said there was an “alarming” level of naivety about diet’s role in cancer.
Fourteen million people a year are diagnosed with cancer, but that is predicted to increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.
The developing world will bear the brunt of the extra cases.
Dr Chris Wild, the director of the WHO’s International Agency for Research on Cancer, told the BBC: “The global cancer burden is increasing and quite markedly, due predominately to the ageing of the populations and population growth.
“If we look at the cost of treatment of cancers, it is spiralling out of control, even for the high-income countries. Prevention is absolutely critical and it’s been somewhat neglected.”
A third of people said cancer was mainly due to family history, but the charity said no more than 10% of cancers were down to inherited genes.
The WHO’s World Cancer Report 2014 said the major sources of preventable cancer included:
- Obesity and inactivity
- Radiation, both from the sun and medical scans
- Air pollution and other environmental factors
- Delayed parenthood, having fewer children and not breastfeeding
Continue reading the main story
Adult illicit drug users are far more likely to seriously consider suicide
National Suicide Prevention Lifeline (Photo credit: Wikipedia)
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/.
Seniors moving to homecare based services face more hospital risk.
From the 8 January 2014 ScienceDaily article
… Aging-in-Place House Plans by Nicolleli Architects. [not an endorsement]
Seniors want greater access to home- and community-based long-term care services. Medicaid policymakers have been happy to oblige with new programs to help people move out of expensive nursing homes and into cheaper community or home care. It seems like a “win-win” to fulfill seniors’ wishes while also saving Medicaid programs money, but a new study of such transitions in seven states finds that the practice resulted in a 40 percent greater risk of “potentially preventable” hospitalizations among seniors dually eligible for Medicaid and Medicare.
“We are trying to move people into the community and I think that is a really great goal, but we aren’t necessarily providing the medical support services that are needed in the community,” said Andrea Wysocki, a postdoctoral scholar in the Brown University School of Public Health and lead author of the study published online in the Journal of the American Geriatrics Society. “One of the policy issues is how do we care for not only the long-term care needs when we move someone into home- and community-based settings but also how do we support their medical needs as well?”
Wysocki said her finding of a higher potentially preventable hospitalization risk for seniors who transitioned to community- or home-based care suggests that some medical needs are not as well addressed in community settings as they are in nursing homes. More vigilant and effective treatment for chronic, already-diagnosed ailments such as chronic obstructive pulmonary disease could prevent some of the hospitalizations that occur.
There are two likely reasons why care in home and community settings is not as effective in preventing hospitalizations, Wysocki said.
[One]Nursing homes provide round-the-clock care by trained nurses and doctors, but workers with much less medical training provide community- and home-care services.
[Two] In addition, while Medicaid pays for long-term care, Medicare pays for medical care, meaning that Medicaid programs do not have a built-in financial incentive to prevent hospitalizations. Home- and community-based care is less expensive for Medicaid regardless of the medical outcome.
Read the entire article here
From the 2013 Guttmacher Institute Web site
• Most American families want two children. To achieve this, the average woman spends about five years pregnant, postpartum or trying to become pregnant, and three decades—more than three-quarters of her reproductive life—trying to avoid an unintended pregnancy.
• Most individuals and couples want to plan the timing and spacing of their childbearing and to avoid unintended pregnancies, for a range of social and economic reasons. In addition, unintended pregnancy has a public health impact: Births resulting from unintended or closely spaced pregnancies are associated with adverse maternal and child health outcomes, such as delayed prenatal care, premature birth and negative physical and mental health effects for children. [2,3,4]
• For these reasons, reducing the unintended pregnancy rate is a national public health goal. The U.S. Department of Health and Human Services’ Healthy People 2020 campaign aims to reduce unintended pregnancy by 10%, from 49% of pregnancies to 44% of pregnancies, over the next 10 years.
• Currently, about half (51%) of the 6.6 million pregnancies in the United States each year (3.4 million) are unintended (see box).
• In 2008, there were 54 unintended pregnancies for every 1,000 women aged 15–44. In other words, about 5% of reproductive-age women have an unintended pregnancy each year.
• By age 45, more than half of all American women will have experienced an unintended pregnancy, and three in 10 will have had an abortion..
• The U.S. unintended pregnancy rate is significantly higher than the rate in many other developed countries.
Incidence of Unintended Pregnancy (State)
• At least 37% of pregnancies in every U.S. state are unintended. In 31 states and the District of Columbia, more than half of pregnancies are unintended (see map).
• Rates of unintended pregnancy are generally highest in the South and Southwest, and in states with large urban populations.
• States with the highest unintended pregnancy rates in 2008 were Delaware (70 per 1,000 women aged 15–44), California (66), Mississippi (66), Louisiana (63), Florida (62), New York (62), Hawaii (61), Georgia (60) and New Jersey (60).
• The lowest unintended pregnancy rates in 2008 were found in New Hampshire (31 per 1,000 women aged 15–44), Wisconsin (35), Maine (36), and Vermont (37). 
Read the entire article here
From the 22 November post at HealthNewsReview.blog
You probably saw, read, or heard about news of an observational study in the New England Journal of Medicine pointing to a statistical association between nut consumption and lower death rate. Larry Husten did a good job explaining the study on Forbes.com.
The NEJM itself posted a YouTube video that had journal editor Jeffrey Drazen’s voice over an animated explanation. I hadn’t seen such NEJM videos before. Take a look. Drazen ends: “I would be nuts to think that eating nuts alone would add years to my life.”
I wish I had that kind of budget. Frankly, I wish I had any budget.
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