Health and Medical News and Resources

General interest items edited by Janice Flahiff

[News article] Strategies that reduce early hospital readmissions

From the 13 May 2014 ScienceDaily article

30-day readmissions can be reduced by almost 20 percent when specific efforts are taken to prevent them, a review has found. Key among these are interventions to help patients deal with the work passed on to them at discharge. “Effective approaches often are multifaceted and proactively seek to understand the complete patient context, often including in-person visits to the patient’s home after discharge,” says the lead author.

To put this problem into context, studies estimate that 1 in 5 Medicare beneficiaries is readmitted within 30 days of a hospitalization, at a cost of more than $26 billion a year. “Patients are sent home from hospitals because we have addressed their acute issues,” says Dr. Leppin. “They go home with a list of tasks that include what they were doing prior to the hospitalization and new self-care tasks prescribed on discharge. Some patients cannot handle all these requests, and it is not uncommon for them to be readmitted soon after they get home. Sometimes these readmissions can be prevented.”

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May 14, 2014 Posted by | health care | , | Leave a comment

[Reblog] Mesoamerica’s Mystery Killer

Structures of the kidney: 1.Renal pyramid 2.In...

Structures of the kidney: 1.Renal pyramid 2.Interlobar artery 3.Renal artery 4.Renal vein 5.Renal hilum 6.Renal pelvis 7.Ureter 8.Minor calyx 9.Renal capsule 10.Inferior renal capsule 11.Superior renal capsule 12.Interlobar vein 13.Nephron 14.Minor calyx 15.Major calyx 16.Renal papilla 17.Renal column (no distinction for red/blue (oxygenated or not) blood, arteriole is between capilaries and larger vessels (Photo credit: Wikipedia)

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.

,,,

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May 14, 2014 Posted by | Public Health | , | Leave a comment

[Press release] New CDC study finds dramatic increase in e-cigarette-related calls to poison centers | Press Release | CDC Online Newsroom | CDC

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

Infographics: Poison center calls involving e-cigarettes have risen. 

Poison center calls involving e-cigarettes have risen.
Entire infographic Adobe PDF file

The number of calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014, according to a CDC study published in today’s Morbidity and Mortality Weekly Report. The number of calls per month involving conventional cigarettes did not show a similar increase during the same time period.

More than half (51.1 percent) of the calls to poison centers due to e-cigarettes involved young children under age 5, and about 42 percent of the poison calls involved people age 20 and older.

The analysis compared total monthly poison center calls involving e-cigarettes and conventional cigarettes, and found the proportion of e-cigarette calls jumped from 0.3 percent in September 2010 to 41.7 percent in February 2014.  Poisoning from conventional cigarettes is generally due to young children eating them. Poisoning related to e-cigarettes involves the liquid containing nicotine used in the devices and can occur in three ways: by ingestion, inhalation or absorption through the skin or eyes.

“This report raises another red flag about e-cigarettes – the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, M.D., M.P.H.  “Use of these products is skyrocketing and these poisonings will continue.  E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”

E-cigarette calls were more likely than cigarette calls to include a report of an adverse health effect following exposure. The most common adverse health effects mentioned in e-cigarette calls were vomiting, nausea and eye irritation.

Data for this study came from the poison centers that serve the 50 states, the District of Columbia, and U.S. Territories. The study examined all calls reporting exposure to conventional cigarettes, e-cigarettes, or nicotine liquid used in e-cigarettes.  Poison centers reported 2,405 e-cigarette and 16,248 cigarette exposure calls from September 2010 to February 2014. The total number of poisoning cases is likely higher than reflected in this study, because not all exposures might have been reported to poison centers.

“The most recent National Youth Tobacco Survey showed e-cigarette use is growing fast, and now this report shows e-cigarette related poisonings are also increasing rapidly,” said Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health.  “Health care providers, e-cigarette companies and distributors, and the general public need to be aware of this potential health risk from e-cigarettes.”

Developing strategies to monitor and prevent future poisonings is critical given the rapid increase in e-cigarette related poisonings. The report shows that e-cigarette liquids containing nicotine have the potential to cause immediate adverse health effects and represent an emerging public health concern.

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May 13, 2014 Posted by | Consumer Health, Public Health | Leave a comment

[News article] Health Insurance, Death Rates and the Affordable Care Act

Health Insurance, Death Rates and the Affordable Care Act.

From the 12 May 2014 article at Pew State and Consumer Initiatives

The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act. 

In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that “health reform in Massachusetts was associated with a significant decrease in all-cause mortality.” 

 

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                                        A portion of the chart

The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person’s life expectancy.

…..

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May 13, 2014 Posted by | Health Statistics | , , , | Leave a comment

[Reblog] The illegal ways patients buy drugs

The illegal ways patients buy drugs.

From the 27 March 2014 KevinMD article by Pamela Wible, MD

Tom is diabetic, asthmatic, and broke. He’s back for a checkup.

“I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.”

“How did you get extended release? They’re super expensive.”

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“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”

Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.

“Are you good on your inhalers?” I ask.

“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”

…….

And from one of the comments

Considering the high prices that pharmaceutical companies are allowed to legally charge in the US, this kind of thriving illegal underground market does not surprise me at all. It may be wrong and potentially dangerous, but it’s also wrong for Big Pharma to price millions of Americans out of being able to buy the drugs they need legally. Think of that huge segment of the population as “what the market can’t bear.”

Read the entire article here

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May 13, 2014 Posted by | health care | , | Leave a comment

Antibiotic resistance: 6 diseases that may come back to haunt us

Originally posted on :

Re-blogged from www.theguardian.com

Still think of TB, typhoid and gonorrhoea as infections from the past? WHO’s terrifying report will make you think again.

Diseases we thought were long gone, nothing to worry about, or easy to treat could come back with a vengeance, according to the recent World Health Organisation report on global antibiotic resistance. Concern at this serious threat to public health has been growing; complacency could result in a crisis with the potential to affect everyone, not just those in poor countries or without access to advanced healthcare. Already diseases that were treatable in the past, such as tuberculosis, are often fatal now, and others are moving in the same direction. And the really terrifying thing is that the problem is already with us: this is not science fiction, but contemporary reality. So what are some of the infections that could come back to haunt us?

Read the…

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May 12, 2014 Posted by | Uncategorized | Leave a comment

[Reblog] Seven Nation Army (update on the link between heart disease and food)

Excerpts from the 11 May 2014 item at The Paleo Pocket

Investigative author Nina Teicholz, author of The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, has been investigating dietary fat and disease for nearly a decade. She has traced the history of the academic dietary establishment’s idea that you should reduce fat in your food – the idea that has lead to a replacement of fat with carbohydrates, turning us from fat burners to sugar burners. Her story has been published in many places, among them theWall Street Journal, where it quickly went to the top of the Popular Now list:

The Questionable Link Between Saturated Fat and Heart Disease

1961 was the year of the first recommendation from the nutrition committee on the American Heart Association that people should eat less fat, in particular saturated fat, in order to reduce heart disease. This came from a Dr. Ancel Keyes, who built his career on this theory. He was a highly persuasive man who obtained a seat on the committee. America was struggling with rising heart disease at the time and people wanted answers.

Where was his proof? He had done a “Seven Countries” study that was considered the most thorough study on the link between heart disease and food. For this study he picked countries that were likely to support his theory, such as Yugoslavia, Finland and Italy. He ignored France, Switzerland, West Germany and Sweden, countries with high-fat diets and low rates of heart disease.

And so today people suffer from the effects of replacing fat with carbohydrates turning to blood sugar. Nina Teicholz:

One consequence is that in cutting back on fats, we are now eating a lot more carbohydrates—at least 25% more since the early 1970s. Consumption of saturated fat, meanwhile, has dropped by 11%, according to the best available government data. Translation: Instead of meat, eggs and cheese, we’re eating more pasta, grains, fruit and starchy vegetables such as potatoes. Even seemingly healthy low-fat foods, such as yogurt, are stealth carb-delivery systems, since removing the fat often requires the addition of fillers to make up for lost texture—and these are usually carbohydrate-based.

The problem is that carbohydrates break down into glucose, which causes the body to release insulin—a hormone that is fantastically efficient at storing fat. Meanwhile, fructose, the main sugar in fruit, causes the liver to generate triglycerides and other lipids in the blood that are altogether bad news. Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.

The real surprise is that, according to the best science to date, people put themselves at higher risk for these conditions no matter what kind of carbohydrates they eat. Yes, even unrefined carbs. Too much whole-grain oatmeal for breakfast and whole-grain pasta for dinner, with fruit snacks in between, add up to a less healthy diet than one of eggs and bacon, followed by fish. The reality is that fat doesn’t make you fat or diabetic. Scientific investigations going back to the 1950s suggest that actually, carbs do.

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May 12, 2014 Posted by | Nutrition | , , , , , , | Leave a comment

[Press release] Emerging trends in worker health and safety

From the 8 May 2014 EurkAlert

Abstracts at AIHce 2014 to cover several major areas including healthcare, ergonomics and public health and safety

FALLS CHURCH, Va. (May 8, 2014) – Eleven abstracts to be presented at the 2014 American Industrial Hygiene Conference and Exposition (AIHce) will reveal some exciting new strategies to protect worker health. These approaches range from advancing the safety culture in academic laboratories to minimizing the risks to workers in healthcare settings.

“These scientific abstracts and case studies show us exciting new opportunities and methods for providing workers and communities with a healthier and safer environment,” said AIHA President Barbara J. Dawson, CIH, CSP. “We’re certain that these presenters will inspire their colleagues with the solutions and best practices they will need to excel in their daily workplace challenges.”

Nearly 350 abstracts will be presented May 31 through June 5, 2014, at the Henry B. Gonzalez Convention Center in San Antonio. The meeting, based on the theme, “Evolution and Journey to a Safer Tomorrow,” is expected to draw more than 5,000 occupational and environmental health and safety professionals from around the world.

Below are short summaries of the 11 conference presentations highlighting new trends in the IH industry in the fields of ergonomics, air quality, noise exposure, healthcare, and public health and safety. For additional information on these presentations, please contact Nicole Racadag at (703) 846-0700 or nracadag@aiha.org.

Ergonomics

Musculoskeletal Disorders in Texas and the United States 
Michelle Cook, PhD(c), MPH
University of Texas Health Science Center School of Public Health, Austin, TX

From 2003 to 2009, trends in nonfatal occupational musculoskeletal disorders (MSDs) declined from 26,810 to 14,690 in Texas and from 435,180 to 283,800 in the United States. In 2009, occupational MSDs accounted for 24.4 percent and 29.4 percent of all nonfatal occupational injuries and illnesses (NOII) in Texas and the U.S., respectively. This presentation will look at how occupational MSDs, which cost U.S. businesses $15.2 billion in 2008, still account for a large number of NOII and continue to be a public health concern.

Safe Patient Handling Technologies
Elise Condie, MS
RMIT University, Melbourne, VIC, Australia

This research discusses ways to help nursing staff use modern patient mobilization technology in hospital settings. Use of this equipment is better for nurses and prevents injuries to staff while reducing falls and pressure ulcers among patients who need help to move, thus helping patients get discharged from the hospital sooner.

Laboratory Health and Safety

Advancing Safety in Academic Research Laboratories
Lawrence M. Gibbs, MEd, MPH, CIH
Stanford University, Stanford, CA

Stanford University convened a faculty-led task force to review and evaluate safety in campus research laboratories and to recommend ways to promote and advance a robust and positive safety culture among researchers.

Infection Control Issues

Occupationally-Acquired Influenza among Healthcare Workers
Rachael M. Jones, PhD, MPH
University of Illinois at Chicago School of Public Health, Chicago, IL

Healthcare workers provide care to patients with influenza and may develop influenza as a result of occupational exposures, but they may not recognize the infection as being related to their work environment. Influenza has not been widely recognized as an occupationally-acquired infection. This is the first effort to tabulate its burden on healthcare workers.

Specialty Building IAQ

Secondhand Tobacco Smoke Exposure in New Orleans Bars and Casinos
Daniel J. Harrington, ScD, CIH
Louisiana State University School of Public Health, New Orleans, LA

Secondhand tobacco smoke is a significant health hazard that causes a wide range of cardiovascular and respiratory health effects, including cancer. The researchers measured levels of secondhand smoke in smoking bars, casinos, and smoke-free bars in New Orleans in 2011.

Airborne Hazardous Chemicals in Hairdressing Salons in Taiwan
Che-Jung Chang
National Taiwan University, Taipei, Taiwan

This study found that the levels of formaldehyde in hair salon products and other hazardous chemicals found in hair salons in Taiwan might exceed the World Health Organization’s indoor air guideline for the public.

Occupational Injuries of Healthcare Workers

Nonwage Losses Associated with Occupational Injury Among Healthcare Workers
Hasanat Alamgir, PhD, MBA
University of Texas School of Public Health, San Antonio, TX

This study was designed to quantify the economic and quality of life consequences experienced by healthcare workers in Canada for the most common types of occupational injuries. Findings showed that many of these occupational injuries in healthcare workers are not usually captured or recorded in official workers’ compensation statistics.

Biosafety and Environmental Microbiology

Public Health Risk from Legionella Pneumophila in Whirlpool Spas
Thomas Armstrong, PhD
TWA8HR Occupational Hygiene Consulting, LLC, Branchburg, NJ

Legionella bacteria thrive in warm water, such as in that of whirlpool spas and whirlpool spas’ water mist. An estimated 10 to 20 percent of the community-acquired pneumonia cases (more than 60,000 deaths in the U.S. per year and 4.2 million treatments for pneumonia) may be caused by Legionnaires’ disease.

Protecting the Public and Workers

Employee Exposure to Air Contaminants After Hurricane Sandy
Kerry-Ann Jaggassar, MSc
ENVIRON, Boston, MA

This presentation will discuss how an industrial hygiene-based assessment was used to evaluate the risk of potential worker exposure to air contaminants of concern during the aftermath of Hurricane Sandy.

Lessons in CSR from Hurricanes Katrina and Sandy
William Sothern, MA, MS
Microecologies Inc., New York, NY

This presentation will look at the “reciprocal generosity paradigm” which, if embraced by businesses on a large scale, could promote substantial corporate investment in public health initiatives, while at the same time serving the interests of corporate stakeholders.

Community Noise

Noise Controls for Indoor and Outdoor Shooting Ranges
Stephen Katz, Academy Award® winner
Stephen Katz & Associates, Los Angeles, CA

This case study examined the measurement of noise at shooting ranges using multiple high-level instrumentation microphones and a high-speed, multi-channel recorder.

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AIHce 2014 is co-sponsored by the American Industrial Hygiene Association® (AIHA) and the American Conference of Governmental Industrial Hygienists® (ACGIH). AIHA will mark the 75th anniversary of the industrial hygiene profession at this premier event, and celebrate its long history of protecting worker health and serving the IH community.

Information for Media: http://aihce2014.org/general-information/press/

 

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May 10, 2014 Posted by | Workplace Health | , , , | Leave a comment

[Research article]Morality Rebooted: Exploring Simple Fixes to Our Moral Bugs

From the abstract

Morality Rebooted: Exploring Simple Fixes to Our Moral Bugs

Ting Zhang ,Harvard Business School

Francesca Gino ,Harvard University – Harvard Business School

Max H. Bazerman ,Harvard Business School – Negotiations, Organizations and Markets Unit
April 21, 2014

Harvard Business School NOM Unit Working Paper No. 14-105

Abstract:      

Ethics research developed partly in response to calls from organizations to understand and solve unethical behavior. Departing from prior work that has mainly focused on examining the antecedents and consequences of dishonesty, we examine two approaches to mitigating unethical behavior: (1) values-oriented approaches that broadly appeal to individuals’ preferences to be more moral, and (2) structure-oriented approaches that redesign specific incentives, tasks, and decisions to reduce temptations to cheat in the environment. This paper explores how these approaches can change behavior. We argue that integrating both approaches while avoiding incompatible strategies can reduce the risk of adverse effects that arise from taking a single approach.

May 10, 2014 Posted by | Psychology | , , , , , | Leave a comment

[Press release] Alcohol’s role in traffic deaths vastly underreported: Study

Alcohol’s role in traffic deaths vastly underreported: Study.

PISCATAWAY, NJ – It’s no secret that drinking and driving can be a deadly mix. But the role of alcohol in U.S. traffic deaths may be substantially underreported on death certificates, according to a study in the March issue of the Journal of Studies on Alcohol and Drugs.

Between 1999 and 2009, more than 450,000 Americans were killed in a traffic crashes. But in cases where alcohol was involved, death certificates frequently failed to list alcohol as a cause of death.

Why does that matter? One big reason is that injuries are the leading cause of death for Americans younger than 45, according to the Centers for Disease Control and Prevention. And it’s important to have a clear idea of alcohol’s role in those deaths, explained Ralph Hingson, Sc.D., of the U.S. National Institute on Alcohol Abuse and Alcoholism.

“We need to have a handle on what’s contributing to the leading cause of death among young people,” Hingson said. What’s more, he noted, researchers need reliable data to study the effects of policies aimed at reducing alcohol-related deaths.

“You want to know how big the problem is, and if we can track it,” Hingson said. “Is it going up, or going down? And what policy measures are working?”

For the new study, I-Jen Castle, Ph.D., and a team led by Hingson focused on traffic deaths because, of all types of accidental fatalities, that’s where researchers have the best data. This is partly because many U.S. states—about half right now—require that fatally injured drivers be tested for blood alcohol levels, and nationwide about 70% of those drivers are tested.

Hingson’s team used a database maintained by the National Highway Traffic Safety Administration, called the Fatality Analysis Reporting System (FARS)—which contains the blood alcohol levels of Americans killed in traffic crashes. They compared that information with deaths certificate data from all U.S. states.

Overall, they found, death certificates greatly underreported the role of alcohol in traffic deaths between 1999 and 2009: Just over 3 percent listed alcohol as a contributing cause. But based on the FARS figures, 21 percent of those deaths were legally drunk.

The picture varied widely from state to state. In some states—such as Maryland, Nevada, New Hampshire, and New Jersey—alcohol was rarely listed on death certificates. Certain other states did much better, including Delaware, Iowa, Kansas, and Minnesota. It’s not fully clear why alcohol is so often left off of death certificates. One reason could be the time it takes to get blood-alcohol test results back. Coroners or medical examiners usually have to file a death certificate within three to five days, Hingson’s team notes, but toxicology results might take longer than that.

The reasons for the wide variation among states aren’t known either. But Hingson said that’s an important question. “Some states have been pretty successful,” he noted. “What are they doing right?”

It doesn’t seem to be only a matter of passing laws: States that mandate alcohol testing for deceased drivers did not always do better when it came to reporting alcohol as a contributor on death certificates.

Whatever the reasons, Hingson said, the role of alcohol in injury deaths may be seriously underestimated on death certificates. And the situation is likely worse with other types of accidental deaths, such as falls, drug poisoning/overdoses, and drowning, for which there is no mandatory blood alcohol testing or other reporting systems.

Hingson said he thinks testing should be done in those cases as well.

 

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May 10, 2014 Posted by | Consumer Safety | , , , , | Leave a comment

[Slideshare on health reporting] Lessons from 1,889 story reviews

Lessons from 1,889 story reviews.

Forty-five slides on how to evaluate medical/health news articles.

By  Publisher, HealthNewsReview.org at HealthNewsReview.org on Apr 01, 2014

 

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May 10, 2014 Posted by | Health News Items | , , , , | Leave a comment

[Reblog] Marijuana’s Clinical Risks, Benefits, and Uncertainties

Marijuana’s Clinical Risks, Benefits, and Uncertainties.

From the Director’s comments

Jerome Groopman, M.D., Harvard University Medical School, notes there is recent clinical evidence regarding marijuana’s health risks, benefits, tradeoffs, as well as uncertainties. Dr. Groopman, who often writes about biology, health, and medicine for lay audiences, adds the supporting evidence on all sides is important in view of current efforts to make marijuana legal for medicinal and/or recreational use across the U.S.

Currently, marijuana is available for medicinal use in 20 U.S. states and the District of Columbia. Colorado now permits the sale of marijuana for recreational use (in small quantities). The state of Washington also will permit the sale of marijuana (or cannabis) for recreational use (also in small quantities) for the first time this spring.

Dr. Groopman, an internist, reports two systematic reviews (involving about 6,100 patients with a variety of medical conditions) suggest marijuana is useful to treat a number of diseases and conditions including: anorexia, nausea and vomiting, glaucoma, and irritable bowel disease. Marijuana also is clinically useful to treat: muscle spasticity, multiple sclerosis, epilepsy, Tourette’s syndrome, and symptoms of ALS (Lou Gehrig’s disease).

However, Dr. Groopman emphasizes there is a tradeoff of health risks versus benefits from marijuana use — similar to other medical drugs and procedures. For example, he notes current evidence suggests marijuana’s clinical risks include: decreased reaction time, reduced attention and concentration, a decline in short term memory, and an ability to assess external risks.

Dr. Groopman, who is a member of the Institute of Medicine, adds one study found marijuana impaired the performance of pilots on a flight simulator for as much as 24 hours. Similarly, Dr. Groopman notes studies on drivers suggest a strong association between cannabis and collisions. He adds research suggests drivers who use marijuana are two to seven times more likely to be responsible for accidents compared to motorists who do not use drugs or alcohol.

In addition, Dr. Groopman reports some evidence suggests a statistical association between marijuana use and the development of schizophrenia and other psychosis later in life. Dr. Groopman reports these findings are based on meta-analyses (from studies of the health records of young persons in Sweden, New Zealand, and Holland, who did and did not smoke marijuana).

Dr. Groopman explains the latter research does not suggest there is a causal link between marijuana use and psychosis’ development. Dr. Groopman, who has published five books about health and medicine, argues the state of current evidence suggests a need for more definitive research (via double blind, randomized, placebo-controlled approaches) to better assess the possible relationship between marijuana and psychosis’ development.

Moreover, Dr. Groopman notes there is some evidence that marijuana is associated with possible addiction and compulsive cravings that foster user dependence. Nevertheless, he reports other street drugs, such as cocaine or heroin, seem to retain comparatively higher risks of user addiction and dependence than marijuana.

Dr. Groopman continues the current evidence is somewhat equivocal about marijuana’s impact on pain reduction. He writes (and we quote): “While chronic pain seems amenable to amelioration by marijuana, its impact on reducing acute pain, such as after surgery, is minimal’ (end of quote).

Overall, Dr. Groopman explains if the arguments of marijuana’s critics and supporters are assessed through a clinical research perspective, some positions may not be supported by a robust evidence-base, some positions may be one-dimensional, and others might or might not be sustained. He concludes (and we quote): ‘.. as more studies are conducted on marijuana for medical or recreational uses, opponents and enthusiasts may both discover that they were neither entirely right nor entirely wrong’ (end of quote).

The essay, which includes a review of recent books about marijuana’s health risks and benefits, can be found at: nybooks.com.

Meanwhile, a website (from the National Institute on Drug Abuse) devoted to the topic whether marijuana is or is not medicine is available in the ‘related issues’ section of MedlinePlus.gov’s marijuana health topic page. Some tips for parents about teen and adult marijuana use (also from the National Institute on Drug Abuse) are found in the ‘overviews’ section of MedlinePlus.gov’s marijuana health topic page.

MedlinePlus.gov’s marijuana health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to relevant clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about marijuana and health as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s marijuana topic page type ‘marijuana’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘marijuana (National Library of Medicine).’ MedlinePlus.gov also has health topic pages on drug abuse and substance abuse problems.

Marijuana Small Amount

Marijuana Small Amount (Photo credit: Wikipedia)

 

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May 10, 2014 Posted by | Consumer Health, Medical and Health Research News | , , , | Leave a comment

Is the ‘Hidden Brain’ Behind Some Health Disparities? – The NIH Record – May 9, 2014

Is the ‘Hidden Brain’ Behind Some Health Disparities? – The NIH Record – May 9, 2014.

Excerpts

Turns out, it wasn’t the devil that made you do it. It was your “hidden brain.” That’s what Shankar Vedantam suggested at a recent lecture on unconscious bias at work, part of the 2013-2014 Deputy Director for Management Seminar Series. Vedantam said he “coined the term ‘hidden brain’ to describe mental activities that happen outside our conscious awareness.

“Is it possible,” he wondered, “that some of the [health] disparities we’re seeing are not the result of bad people behaving badly, but of well-intentioned people who are unintentionally doing the wrong thing? Is it possible that unconscious biases of well-intentioned people are responsible for these disparities that we observe?”

 

A science correspondent with National Public Radio whose reporting focuses on human behavior and the sciences, Vedantam suggested that sometimes the snap judgments or preconceived notions we exhibit turn out to be wrong not because we’re evil people but because we’re not concentrating on what we’re doing. Our brains are, in a sense, functioning on autopilot.

To illustrate false moves we make automatically, Vedantam showed several optical illusions that indicated how unconscious bias doesn’t just distort perception, but often alters the way things really are.

“Our minds change reality to reflect the biases that we have inside our own heads,” he explained.

Reading, Vedantam said, is a perfect example of the hidden brain at work. Once you learn to read and are accustomed to reading, he said, your mind takes shortcuts. You naturally skip or fill in, without consciously thinking about it. Unlike a new reader, then, you don’t register every single word on a page. Otherwise, you’d spend all day reading just one page.

In the same way, Vedantam argues, your mind in many cases anticipates—pre-judges—situations throughout daily life.

So, how do we overcome the effects that unconscious biases have on us? Vedantam says we can pay closer attention to our decision-making in certain situations, recognize the way we’re leaning and simply tug our minds in the opposite direction. In addition, since our environment shapes our mind, we can surround ourselves with experiences and friendships outside our comfort zone. If you broaden what goes into your thinking, then you broaden what comes out of it.

 

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May 10, 2014 Posted by | Psychology | , , , , , , | Leave a comment

[Podcast] Early Stress Gets Under the Skin: Promising Initiatives to Help Children Facing Chronic Adversity

From the 7 May 2014 item at the Brookings Institute

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.

 

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May 8, 2014 Posted by | Health Education (General Public), Public Health, Educational Resources (Health Professionals) | , , , , , | Leave a comment

[Press Release] Mother’s Day science: Reactions highlights amazing facts about pregnancy — video

From the 6 May 2014 EurkAlert

WASHINGTON, May 6, 2014 — Pregnant women go through a lot to bring a baby into this world: 2 a.m. food cravings, hypersensitivity to certain smells and morning sickness, not to mention labor and delivery. In honor of Mother’s Day, the American Chemical Society’s (ACS’) newest Reactions video highlights the chemistry behind a pregnant woman’s altered sense of taste and smell, how mom’s diet influences baby’s favorite foods and other pregnancy phenomena. The video is available at http://youtu.be/Gnqjh-L4e9g


And because moms always deserve more, we’ve created a bonus video on what scientists believe causes dreaded morning sickness in pregnant women. The bonus video can be seen here: http://youtu.be/09bCTERVrms

Subscribe to the series at Reactions YouTube, and follow us on Twitter @ACSreactions to be the first to see our latest videos.

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May 8, 2014 Posted by | Health Education (General Public) | | Leave a comment

[News article] Early depression, anger may taint love life even 20 years later, study shows

 

Emotions show

Emotions show (Photo credit: Wikipedia)

From the 7 May 2014 article at ScienceDaily

Negative emotions people may have suffered as young adults can have a lasting grip on their couple relationships, well into middle age, research demonstrates. The study followed 341 people for 25 years, and found that negative emotions they may have suffered as young adults can have a lasting grip on their couple relationships, well into middle age. The fact that depression and anger experienced during the teen years clung to people, even through major life events such as child-rearing, marriages and careers was surprising, researchers note.

Read the entire article here

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May 8, 2014 Posted by | Psychology | , , , , | Leave a comment

[News article] mHealth still untapped resource for docs

From the 18 April article at Healthcare IT news

mHealth still untapped resource for docs
People cite privacy concerns for lack of adoption

For the most part, providers are still wary over the mHealth movement. And this caution just might be preventing them from big care improvement opportunities, say the findings of a new study.

The study, commissioned by mobile professional services firm Mobiquity, finds some 70 percent of consumers use mobile apps every day to track physical activity and calorie intake, but only 40 percent share that information with their doctor.

[See also: mHealth market scales to new heights.]

Privacy concerns and the need for a doctor’s recommendation are the two factors hindering the use of mobile and fitness apps for mHealth reasons, say officials with the Boston-based Mobiquity, which produced “Get Mobile, Get Healthy: The Appification of Health and Fitness.”

That, officials said, means the healthcare community has to take a more active role in promoting these types of apps and uses.

“Our study shows there’s a huge opportunity for medical professionals, pharmaceutical companies and health organizations to use mobile to drive positive behavior change and, as a result, better patient outcomes,” said Scott Snyder, Mobiquity’s president and chief strategy officer, in a press release. “The gap will be closed by those who design mobile health solutions that are indispensable and laser-focused on users’ goals, and that carefully balance data collection with user control and privacy.”

[See also: FCC creates mHealth task force.]

The study, conducted between March 5 and 11, focused on 1,000 consumers who use or plan to use health and fitness mobile apps.

According to the study:

  • 34 percent of mobile health and fitness app users say they would use their apps more often if their doctor recommended it
  • 61 percent say privacy concerns are hindering their adoption of mobile apps. Other concerns include time investment (24 percent), uncertainty on how to start (9 percent) and not wanting to know about health issues (6 percent).
  • 73 percent said they are more healthy because they use a smartphone and apps to track health and fitness
  • 53 percent discovered, through an app, that they were eating more calories than they realized
  • 63 percent intend to continue or increase their mobile health tracking over the next five years
  • 55 percent plan to try wearable devices like pedometers, wristbands or smartwatches
  • Using a smartphone to track health and fitness is more important than using the phone for social networking (69 percent), shopping (68 percent), listening to music (60 percent) or even making/receiving phone calls (30 percent).

“We believe 2014 is the year that mobile health will make the leap from early adopters to mainstream,” Mobiquity officials said in their introduction to the survey. “The writing is on the wall: from early rumors about a native health-tracking app in the next version of Apple’s iPhone operating system to speculation that Apple will finally launch the much-anticipated iWatch, joining Google, Samsung and Pebble in the race to own the emerging wearables market.”

[See also: Realizing the mHealth promise.]

 

……..

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May 6, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Engage with McGovern Lecturer Prior to MLA 14

From the Krafty Librarian blog (May 2014)
Engage with McGovern Lecturer Prior to MLA 14

It is crunch time and I know everybody going to MLA 14 in Chicago is scrambling to tie up lose ends at work or for Chicago.   But as you go over your schedule for MLA you might want to check out the McGovern Lecturer, Dr. Aaron Carroll’s blog or his Facebook page. Dr. Carroll has invited MLA members and attendees to begin a conversation with him in advance of the annual meeting on topics of interest by posting on his blog, friending him on Facebook, following him on Twitter, or emailing him.

For his lecture, Dr Carrol will be addressing issues on the Affordable Care Act and health care policy.  His blog, “The Incidental Economist: Contemplating health care with a focus on research, an eye on reform,” is “mostly about the U.S. health care system and its organization, how it works, how it fails us, and what to do about it.”  Dr Carroll is one of the Editors in Chief of the blog which also has several contributors who have “professional expertise in an area relevant to the health care system” as researchers and professors in health economics, law and other health service areas.

The Affordable Care Act and its impact on libraries and how librarians can help hospitals deal with certain aspects of it is a bit of a interest for me.  I have taught several classes to library groups in the past year about librarians can better align their goals to that of the hospital.  Since many hospitals goals are now focused around parts of the Affordable Care Act it makes sense that medical libraries develop strategies to support their institution’s Affordable Care Act goals.

For example…How can the medical library help the hospital

  • Prevent readmissions
  • Increase focus on preventive care
  • Improve patient satisfaction
  • Deal with Meaningful Use (not exactly ACA but very entwined)

Depending on the focus of the library or librarian, we might be able to help more than we or our administration realize.  Here is what some libraries are doing already…

  • Partnering with IT or CIO to provide evidence based medicine resources within the EMR
  • Partnering with IT or CIO to make sure that order sets are based on best available evidence
  • Embedded librarians rounding with patient care teams to help provide necessary information for patient care
  • Help provide patient education documents and information and make them accessbile to patients through the patient portal
  • Work with doctors to provide a prescription for health information to the patient through the EMR

Not only is it important the librarians do these things to help their institutions (BTW no one librarian can do it all but they should be doing something) achieve their goals, but it is equally important that we need to be MEASURING our impact.  If we don’t measure it, it didn’t happen.  Measuring can be tricky but it is necessary, especially if you want to keep your library and your job.  Gone are the days where you can say I did 103 MEDLINE searches for doctors and that helped them treat patients.  Really? How do you know those MEDLINE searches helped them? Did you ask what became of the search? Did you track how your information was being used?  All you know is that you did 103 searches. You don’t know whether that was a benefit to the institution or not.  We assume it was, but administration doesn’t assume anything.

I am looking forward to hearing Dr. Carroll speak.  But before I see him at MLA, I am going to try and start to engage with him to find out what we librarians can do to help our institutions deal with the ACA and make our ourselves more valuable to the institution.  I encourage everyone else to do the same with their own thoughts and questions prior to MLA.

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May 6, 2014 Posted by | Librarian Resources | , , , , , , | Leave a comment

[Reblog] The Problem of Pain: When Best Medical Advice Doesn’t Equal Patient Satisfaction

From the 4 April 2014 post by Karen Sibert, MD at The Health Care Blog


The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.

The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.

If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.

….

 

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May 3, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Reblog] Fatal Error (in Health Care)

 

The VA Palo Alto Health Care System in Palo Al...

The VA Palo Alto Health Care System in Palo Alto, California. (Photo credit: Wikipedia)

From the 4 April 2014 post by Rob Lamberts, MD at The Health Care Blog

The janitor approached my office manager with a very worried expression.  ”Uh, Brenda…” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh…well…I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer….”  He cleared his throat nervously, “Uh…his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on the screen?” she asked, growing more curious.

“On the screen.  It said something about an ‘illegal operation.’  I was worried that he had done something illegal and thought you should know,” he finished rapidly, seeming grateful that this huge weight lifted.

Relieved, Brenda laughed out loud, reassuring him that this “illegal operation” was not the kind of thing that would warrant police intervention.

Unfortunately for me, these “illegal operation” errors weren’t without consequence.  It turned out that our system had something wrong at its core, eventually causing our entire computer network to crash, giving us no access to patient records for several days.

The reality of computer errors is that the deeper the error is — the closer it is to the core of the operating system — the wider the consequences when it causes trouble.  That’s when the “blue screen of death” or (on a mac) the “beach ball of death” show up on our screens.  That’s when the “illegal operation” progresses to a “fatal error.”

The Fatal Error in Health Care 

Yeah, this makes me nervous too.

We have such an error in our health care system.  It’s absolutely central to nearly all care that is given, at the very heart of the operating system.  It’s a problem that increased access to care won’t fix, that repealing the SGR, or forestalling ICD-10 won’t help.

It’s a problem with something that is starts at the very beginning of health care itself.

The health care system is not about health.

……

For any solution to have a real effect, this core problem must be addressed.  The basic incentive has to change from sickness to health.  Doctors need to be rewarded for preventing disease and treating it early. Rewards for unnecessary tests, procedures, and medications need to be minimized or eliminated.  This can only happen if it is financially beneficial to doctors for their patients to be healthy.

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May 3, 2014 Posted by | health care | , , | Leave a comment

[Press release] Regulating legal marijuana could be guided by lessons from alcohol and tobacco, study says

From the 24 April 2014 EurkAlert

 

 

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.”

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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.

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May 3, 2014 Posted by | Public Health | , , | Leave a comment

[Press release] Cannabis chemistry: How scientists test pot for potency and safety (video)

From the 22 April 2014 EurkAlert

WASHINGTON, April 22, 2014 — Marijuana is in the headlines as more and more states legalize it for medicinal use or decriminalize it entirely. In the American Chemical Society’s (ACS’) newest Reactions video, we explain the chemistry behind marijuana’s high, and investigate what scientists are doing to ensure that legalized weed won’t send users on a bad trip. The video is available at http://youtu.be/4ukdUDCE56c

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May 3, 2014 Posted by | Consumer Health, Medical and Health Research News | , , , | Leave a comment

[Web site review] WHO: Public Health and Environment

     WHO: Public Health and Environment
Screen Shot 2014-05-03 at 5.23.15 AM

http://www.who.int/phe/en/

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]

 

 

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May 3, 2014 Posted by | Public Health | , , , , , | Leave a comment

[Press release] The Lancet: Reducing just 6 risk factors could prevent 37 million deaths from chronic diseases over 15 years

From the 2 May 2014 press release

Reducing or curbing just six modifiable risk factors—tobacco use, harmful alcohol use, salt intake, high blood pressure and blood sugar, and obesity—to globally-agreed target levels could prevent more than 37 million premature deaths over 15 years, from the four main non-communicable diseases (NCDs; cardiovascular diseases, chronic respiratory disease, cancers, and diabetes) according to new research published in The Lancet.

Worryingly, the findings indicate that not reaching these targets would result in 38.8 million deaths in 2025 from the four main NCDs, 10.5 million deaths more than the 28.3 million who died in 2010.

This is the first study to analyse the impact that reducing globally targeted risk factors will have on the UN’s 25×25 target to reduce premature deaths from NCDs by 25% relative to 2010 levels by 2025.

Using country-level data on deaths and risk factors and epidemiological models, Professor Majid Ezzati from Imperial College London, UK, and colleagues estimate the number of deaths that could be prevented between 2010 and 2025 by reducing the burden of each of the six risk factors to globally-agreed target levels—tobacco use (30% reduction and a more ambitious 50% reduction), alcohol use (10% reduction), salt intake (30% reduction), high blood pressure (25% reduction), and halting the rise in the prevalence of obesity and diabetes.

Overall, the findings suggest that meeting the targets for all six risk factors would reduce the risk of dying prematurely from the four main NCDs by 22% in men and 19% for women in 2025 compared to what they were in 2010. Worldwide, this improvement is equivalent to delaying or preventing at least 16 million deaths in people aged 30󈞲 years and 21 million in those aged 70 years or older over 15 years.

The authors predict that the largest benefits will come from reducing high blood pressure and tobacco use. They calculate that a more ambitious 50% reduction in prevalence of smoking by 2025, rather than the current target of 30%, would reduce the risk of dying prematurely by more than 24% in men and by 20% in women.

…….

 

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May 3, 2014 Posted by | Consumer Health, Medical and Health Research News | , , , , | Leave a comment

[News article] Edible flowers may inhibit chronic diseases — ScienceDaily

 

Salad with candied walnuts, persimmon slice, c...

Salad with candied walnuts, persimmon slice, cheese (feta?), dried cranberries and pansies. (Photo credit: Wikipedia)

Edible flowers may inhibit chronic diseases — ScienceDaily.

From the April news article

Common edible flowers in China are rich in phenolics and have excellent antioxidant capacity, research has shown. Edible flowers, which have been used in the culinary arts in China for centuries, are receiving renewed interest. Flowers can be used as an essential ingredient in a recipe, provide seasoning to a dish, or simply be used as a garnish. Some of these flowers contain phenolics that have been correlated with anti-inflammatory activity and a reduced risk of cardiovascular disease and certain cancers.

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May 2, 2014 Posted by | Medical and Health Research News, Nutrition | , , , | Leave a comment

[News article] Marijuana use may increase heart complications in young, middle-aged adults — ScienceDaily

 

English: Close up shot of some high quality ma...

English: Close up shot of some high quality marijuana. (Photo credit: Wikipedia)

Marijuana use may increase heart complications in young, middle-aged adults — ScienceDaily.ews

From the April report

Marijuana use may result in heart-related complications in young and middle-aged adults. Nearly 2 percent of the health complications from marijuana use reported were cardiovascular related. A quarter of these complications resulted in death, according to a study. Surveillance of marijuana-related reports of cardiovascular disorders should continue and more research needs to look at how marijuana use might trigger cardiovascular events, researchers say.

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May 2, 2014 Posted by | Medical and Health Research News | , , , | Leave a comment

[Report] 40% of Children Miss Out on the Parenting Needed to Succeed in Life

Janice Flahiff:

Father and child, Dhaka.

Father and child, Dhaka. (Photo credit: Wikipedia)

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Originally posted on Full Text Reports...:

40% of Children Miss Out on the Parenting Needed to Succeed in Life
Source> Sutton Trust

Four in ten babies don’t develop the strong emotional bonds – what psychologists call “secure attachment” – with their parents that are crucial to success later in life. Disadvantaged children are more likely to face educational and behavioural problems when they grow older as a result, new Sutton Trust research finds today.

The review of international studies of attachment, Baby Bonds, by Sophie Moullin (Princeton University), Professor Jane Waldfogel (Colombia University and the London School of Economics) and Dr Liz Washbrook (University of Bristol), finds infants aged under three who do not form strong bonds with their mother or father are more likely to suffer from aggression, defiance and hyperactivity when they get older.

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May 2, 2014 Posted by | Medical and Health Research News, Psychiatry, Psychology | , , , | Leave a comment

[Report] Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?

Originally posted on Full Text Reports...:

Is Violent Radicalisation Associated with Poverty, Migration, Poor Self-Reported Health and Common Mental Disorders?
Source: PLoS ONE

Background
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.

Methods
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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May 2, 2014 Posted by | Psychiatry, Psychology, Public Health | , , , , , , | Leave a comment

[Report] Chocolate Milk Consequences: A Pilot Study Evaluating the Consequences of Banning Chocolate Milk in School Cafeterias

Janice Flahiff:

Another reason to seriously look at all angles of a potential policy change before considering implementing!

 

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Originally posted on Full Text Reports...:

Chocolate Milk Consequences: A Pilot Study Evaluating the Consequences of Banning Chocolate Milk in School Cafeterias
Source: PLoS ONE

Objectives
Currently, 68.3% of the milk available in schools is flavored, with chocolate being the most popular (61.6% of all milk). If chocolate milk is removed from a school cafeteria, what will happen to overall milk selection and consumption?

Methods
In a before-after study in 11 Oregon elementary schools, flavored milk–which will be referred to as chocolate milk–was banned from the cafeteria. Milk sales, school enrollment, and data for daily participation in the National School Lunch Program (NSLP) were compared year to date.

Results
Total daily milk sales declined by 9.9% (p<0.01). Although white milk increased by 161.2 cartons per day (p<0.001), 29.4% of this milk was thrown away. Eliminating chocolate milk was also associated with 6.8% fewer students eating school lunches, and although other factors were also involved, this is…

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May 2, 2014 Posted by | Nutrition | , , , , | Leave a comment

[Journal Article] My Manager Took My Lunch Money: A Look at Workplace Bullying

From the March 2014 article by  Pamela Kravitz at International Journal of Business, Humanities and Technology

Workplace bullying is when a person is singled out by others for embarrassing or intimidating treatment. Studies find that 37-50 percent of workers have been exposed to bullying. This paper defines behaviors, recognizes methods, and discusses the policies managers and employees can use in an attempt to eliminate bullying in the workplace.

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May 2, 2014 Posted by | Workplace Health | , , , | Leave a comment

[Reblog] In the cloud: How coughs and sneezes float farther than you think

From the 8 April 2014 MIT news article

Novel study uncovers the way coughs and sneezes stay airborne for long distances.

The next time you feel a sneeze coming on, raise your elbow to cover up that multiphase turbulent buoyant cloud you’re about to expel.

That’s right: A novel study by MIT researchers shows that coughs and sneezes have associated gas clouds that keep their potentially infectious droplets aloft over much greater distances than previously realized.

“When you cough or sneeze, you see the droplets, or feel them if someone sneezes on you,” says John Bush, a professor of applied mathematics at MIT, and co-author of a new paper on the subject. “But you don’t see the cloud, the invisible gas phase. The influence of this gas cloud is to extend the range of the individual droplets, particularly the small ones.”

Indeed, the study finds, the smaller droplets that emerge in a cough or sneeze may travel five to 200 times further than they would if those droplets simply moved as groups of unconnected particles — which is what previous estimates had assumed. The tendency of these droplets to stay airborne, resuspended by gas clouds, means that ventilation systems may be more prone to transmitting potentially infectious particles than had been suspected.

With this in mind, architects and engineers may want to re-examine the design of workplaces and hospitals, or air circulation on airplanes, to reduce the chances of airborne pathogens being transmitted among people….

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May 2, 2014 Posted by | Medical and Health Research News | , , , , | Leave a comment

2m elderly will have no adult child to provide care by 2030

Originally posted on Empathic Urbanite:

66259-425x283-Woman_and_son Wow. 2 million of us without carers! When I started this enterprise I knew that we were an ageing population and there’d be a lot of need for care in the future. But I hadn’t considered that there’d be so many childless people, which basically DOUBLES the number of people who will need paid care workers.

“By 2030, 230,000 people who need more than 20 hours of care a week will not have a relative to provide it, the think tank said.”

This is an IPPR report, so it’s solid evidence that our society, culture and especially government needs to start supporting care agencies and offering much better individual training and organisational opportunities if we are to meet this massive challenge. And don’t forget, when we talk about older people in the future, it’s not a report about some vague ‘other’, this time, we are talking about ourselves!

Three Sisters…

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May 2, 2014 Posted by | health care | , , , , , | Leave a comment

[News Article] The Steep cost of Life Saving Drugs

Originally posted on Medication Health News:

ID-10057221 With many new drugs being brought to market, there has been increased talk about the pricing of many agents. Today, drugs in question include Evzio, a new naloxone auto-injector and  Sovaldi, a new antiviral for hepatitis C. These agents could save many lives, but their potential high costs could be a barrier to many of the patients of need. How should we solve this dilemma?  Should the subsidies be provided to those in need of these therapies?  What are your thoughts?

For additional information, please see the news analysis in the New York Times.

Image courtesy of [ddpavumba]/FreeDigitalPhotos.Net

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May 2, 2014 Posted by | health care | , , , | Leave a comment

[Reblog of an Alzheimer item] The 36-Hour Day Podcast: Getting Help

Originally posted on Johns Hopkins University Press Blog:

Today is the fifth and final in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

Podcast #5: Excerpt from Chapter 10: Getting Help

In this excerpt from Chapter 10, Dr. Rabins focuses on the need for caregivers to have outside help and have time away from the responsibilities of caregiving. He describes how to find good information on available services, how to seek and accept help from friends and neighbors,  and how to address problems you may encounter.

You can find this podcast and the rest of the series of podcasts here.

mace

These podcasts are excerpted from a Johns Hopkins University Press audio…

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May 2, 2014 Posted by | health care, Health Education (General Public) | , , , , | Leave a comment

[Reblog] ‘Inherently dangerous’ drugs routinely prescribed to seniors: Report

Originally posted on Metro News:

Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced after a recent Torstar News Service investigation.

The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.

“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”

Last week, Torstar revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.

At close to 300 homes, Torstar found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients…

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April 29, 2014 Posted by | Consumer Health, Consumer Safety, health care | , , , , | Leave a comment

[Report] One Year after West, Texas: One in Ten Students Attends School in the Shadow of a Risky Chemical Facility

Janice Flahiff:

Of course, just because a facility is associated with hazardous chemicals doesn’t mean an accident will happen.

Still, I was surprised at just how many students go to schools so close to these facilities.

 

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Originally posted on Full Text Reports...:

One Year after West, Texas: One in Ten Students Attends School in the Shadow of a Risky Chemical Facility
Source: Center for Effective Government

One year after the fertilizer facility explosion in West, Texas, which destroyed and severely damaged nearby schools, an analysis by the Center for Effective Government finds that nearly one in ten American schoolchildren live and study within one mile of a potentially dangerous chemical facility.

The analysis, displayed through an online interactive map, shows that 4.6 million children at nearly 10,000 schools across the country are within a mile of a facility that reports to the U.S. Environmental Protection Agency’s (EPA) Risk Management Program. Factories, refineries, and other facilities that report to the program produce, use, and/or store significant quantities of certain hazardous chemicals identified by EPA as particularly risky to human health or the environment if they are spilled, released into the air, or are…

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April 29, 2014 Posted by | environmental health, Uncategorized | , , , , | Leave a comment

[Reblog] Harsh socio-economic conditions affect the genetic health of children

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.

Social determinants of health - Dahlgren and Whitehead 1991

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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April 29, 2014 Posted by | environmental health, Nutrition, Public Health | , , | Leave a comment

[Reblog] Chemical Concerns : What is in My Makeup?

Janice Flahiff:

Great links to reputable resources!

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Originally posted on THL News Blog:

I was at the Ann Arbor YMCA the other day and overheard two women questioning the safety of chemicals used in makeup and other over the counter personal products. This conversation was prompted by someone’s sunscreen running into their eyes, making them partially blind for a few minutes, causing her to wonder if there are any chemicals in there she should be really worried about. I thought I would do a search for information about the safety of chemicals in makeup and share my results since it seems to be something people are interested in:

  1. A good place to start is this FDA Fact Sheet article. It’s a quick two page PDF that has excellent tips on makeup use and regulation.
  2. Womenshealth.gov put out this great guide to cosmetics. It answers questions like “what’s in cosmetics” and “how can…

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April 29, 2014 Posted by | Consumer Health | | Leave a comment

[News Article] New AARP report looks at onus on spousal caregivers

From the 24 April 2014 article at Covering Health

A new report from the The United Hospital Fund and AARP Public Policy Institute finds that spouses who act as the primary family caregiver routinely perform complex medical and nursing tasks without adequate in-home support from health care professionals, especially when compared with non-spousal family caregivers.

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“Wedding vows include the promise to be there “in sickness and in health”, but we should not expect spouses to do things that can make nursing students tremble without offering them instructions and support. They should not have to do this important work at home alone. They need and deserve support from professionals, other family members, and the community,” Reinhard said.

It’s unclear why spouses receive less help, but Reinhard and co-authors Carol Levine and Sarah Samis of the United Hospital Fund theorize that choice, lack of awareness about resources, financial limitations, or fear of losing independence play a role. The report calls for additional research to help tailor interventions that support but do not supplant the primary bond between spouses.

 

Read the entire article here

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April 29, 2014 Posted by | health care | , , | Leave a comment

[Tedx Talk] Truth That Lasts: David Newman at TEDxColumbiaEngineering

Good points about the limits of observational studies and how NNT (number needed to treat) is a good indicator of the efficacy of an intervention. Also good point of how a good preventive diet can often trump medications/surgery. 
Well worth the 18 minutes of viewing.

From the Web site

Published on Sep 29, 2012

Dr. Newman is the Director of Clinical Research in the Emergency Department at the Mt. Sinai School of Medicine, and an Iraq war veteran. In addition to being widely published in medical journals he has written health care articles for the New York Times and is the author of Hippocrates’ Shadow: Secrets From the House of Medicine. For the past ten years he has concentrated his work in medical evidence translation and appraisal. He is also the editor-in-chief for two online publications, TheNNT.com, a resource for health care evidence summaries, and SMART-EM, a monthly audio review. He lives in New York City with his wife and teaches at both Mount Sinai School of Medicine and at Columbia University.

 

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April 29, 2014 Posted by | Educational Resources (High School/Early College(, Health Statistics | , , , | Leave a comment

Nearly 4 Million Mentally Ill Left Uninsured

Nearly 4 Million Mentally Ill Left Uninsured.

April 9, 2014 Posted by | Uncategorized | Leave a comment

10 persistent cancer myths debunked

Originally posted on Access Science:

Ever been told that eating superfoods prevents cancer? Or the one about sharks not being able to get cancer? If you’ve wondered how much truth is behind these ‘facts’ you should follow this link. Cancer Research have put out a fantastic blogpost debunking these cancer myths amongst others. Well worth a quick read!

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April 2, 2014 Posted by | Uncategorized | Leave a comment

Anthropology and Public Health

Originally posted on HIV/AIDS in Global Context (PH770 - CUNY SPH):

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One major statement that stuck out to me from Ida Susser’s discussion of her book AIDS, Sex and Culture was that “anthropology starts where public health ends.” In her lecture she discussed how easy it is to switch hats from public health to anthropologist. Susser was able to emphasize the fact that public health professionals must understand how data frames ideas. For example, an HIV mortality rate men to women of 10:1 is looked at differently from a public health eye then from an anthropologist eye. Public health would put more funding and research into men and would discount women since they are dying at a lesser rate than men. Anthropology would look deeper at similarities and differences, both within and among societies, and would pay attention to race, sexuality, class, gender, and nationality.

Public health addresses infectious disease epidemiology. However, anthropology can help inform public health about other components…

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April 2, 2014 Posted by | Uncategorized | Leave a comment

[Press release] US clean-air efforts stay on target

From the 27 March 2014 Rice University Press Release

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

…..

 

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March 31, 2014 Posted by | Public Health | , , , , , | Leave a comment

[Reblog] Pitfalls of retrospective database studies

Originally posted on Health Services Authors:

As you know a part of my work consists to participate in studies based on the extraction from retrospective databases and the analysis of the informations thus retrieved. The eligibility of the beneficiaries to the provision that represents the study’s outcome is always a major concern. There is two explanations for a beneficiary not having access to a care according to the data retrieved from the reimbursement base: either a real lack of access or a non eligibility of the care for a record in the reimbursement data base (for example if the insured is covered by another insurance or has lost his coverage and has exited from the health plan)*. I have always to keep in mind that I work on secondary data which are only a reflection of the primary data the reality of which I try to apprehend.
The dilemma is pretty well addressed in this article:

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March 31, 2014 Posted by | Medical and Health Research News | , | Leave a comment

[News item] Religion, spirituality influence health in different but complementary ways — ScienceDaily

Religion, spirituality influence health in different but complementary ways — ScienceDaily.

Date:
March 28, 2014
Source:
Oregon State University
Summary:
Religion and spirituality have distinct but complementary influences on health, new research indicates. A new theoretical model defines the two distinct pathways. “Religion helps regulate behavior and health habits, while spirituality regulates your emotions, how you feel,” explains one of the authors.

 

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March 31, 2014 Posted by | Medical and Health Research News, Psychology | , , , , , | Leave a comment

[News Article] Gulf war illness not in veterans’ heads but in their mitochondria — ScienceDaily

Disclaimer: My husband’s cousin developed diabetes after serving in Afghanistan. Diabetes did not run in the family nor did he have a lifestyle that predisposed him to this disease (in our opinion, of course).  The VA did pay for his treatment, no questions asked.
Am thankful that research is being done to show just how war related chemicals, and even preventive agents are very harmful and deadly.

 

Gulf war illness not in veterans’ heads but in their mitochondria — ScienceDaily.


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Date:
March 27, 2014
Source:
University of California, San Diego Health Sciences
Summary:
Veterans of the 1990-91 Persian Gulf War who suffer from “Gulf War illness” have impaired function of mitochondria – the energy powerhouses of cells, researchers have demonstrated for the first time. The findings could help lead to new treatments benefitting affected individuals — and to new ways of protecting servicepersons (and civilians) from similar problems in the future.

Golomb noted that impaired mitochondrial function accounts for numerous features of Gulf War illness, including symptoms that have been viewed as perplexing or paradoxical.
“The classic presentation for mitochondrial illness involves multiple symptoms spanning many domains, similar to what we see in Gulf War illness. These classically include fatigue, cognitive and other brain-related challenges, muscle problems and exercise intolerance, with neurological and gastrointestinal problems also common.”
There are other similarities between patients with mitochondrial dysfunction and those suffering from Gulf War illness: Additional symptoms appear in smaller subsets of patients; varying patterns of symptoms and severity among individuals; different latency periods across symptoms, or times when symptoms first appear; routine blood tests that appear normal.
“Some have sought to ascribe Gulf War illness to stress,” said Golomb, “but stress has proven not to be an independent predictor of the condition. On the other hand, Gulf veterans are known to have been widely exposed to acetylcholinesterase inhibitors, a chemical class found in organophosphate and carbamate pesticides, nerve gas and nerve gas pre-treatment pills given to troops.
“These inhibitors have known mitochondrial toxicity and generally show the strongest and most consistent relationship to predicting Gulf War illness. Mitochondrial problems account for which exposures relate to Gulf War illness, which symptoms predominate, how Gulf War illness symptoms manifest themselves, what objective tests have been altered, and why routine blood tests have not been useful.”

Civilians Also Trace Illness to Work in Gulf War

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March 31, 2014 Posted by | Medical and Health Research News | , , , | Leave a comment

[Press release] Stigmas, once evolutionarily sound, are now bad health strategies

Cannot but think of the New Testament headings, especially of lepers.

Stigmas, once evolutionarily sound, are now bad health strategies.

Stigmatization may have once served to protect early humans from infectious diseases, but that strategy may do more harm than good for modern humans, according to Penn State researchers.

“The things that made stigmas a more functional strategy thousands of years ago rarely exist,” said Rachel Smith, associate professor of communication arts and sciences and human development and family studies. “Now, it won’t promote positive health behavior and, in many cases, it could actually make the situation worse.”

Stigmatizing and ostracizing members stricken with infectious diseases may have helped groups of early humans survive, said Smith, who worked with David Hughes, assistant professor of entomology and biology. Infectious agents thrive by spreading through populations, according to Smith and Hughes, who published an essay in the current issue of Communication Studies.

For early humans, a person who was stigmatized by the group typically suffered a quick death, often from a lack of food or from falling prey to a predator. Groups did not mix on a regular basis, so another group was unlikely to adopt an ostracized person. Infectious disease stigmas may have evolved as a social defense for group-living species, and had adaptive functions when early humans had these interaction patterns.

However, modern society is much larger, more mobile and safer from predators, eliminating the effectiveness of this strategy, according to Smith.

“In modern times, we mix more regularly, travel more widely, and also there are so many people now,” Smith said. “These modern interaction patterns make stigmatization unproductive and often create more problems.”

Hughes studies disease in another successful society, the ants, which have strong stigma and ostracism strategies that serve group interests at the cost to individuals.

“Ants are often held up as paragons of society and efficiency but we certainly do not want to emulate how they treat their sick members, which can be brutal,” said Hughes.

Stigmatization could actually make infectious disease management worse. The threat of ostracization may make people less likely to seek out medical treatment. If people refuse to seek treatment and go about their daily routines, they may cause the disease to spread farther and faster, according to the researchers, who are both investigators in the Center of Infectious Disease Dynamics in Penn State Huck Institutes of the Life Sciences.

Stigmatization may harm a person’s ability to survive a disease. Ostracization may increase stress, lessening the body’s ability to fight off diseases and infections.

“People are very sensitive to rejection and humans worry about being ostracized,” said Smith. “These worries and experiences with rejection can cause problematic levels of stress and, unfortunately, stress can compromise the immune system’s ability to fight off an infection, accelerating disease progression.”

Once applied, a stigma is difficult to remove, even when there are obvious signs that the person was never infected or is cured. Health communicators should make sure they intentionally monitor if their public communication or intervention materials create or bolster stigmas before using them, Smith said.

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March 31, 2014 Posted by | health care, Medical and Health Research News | , , , , , | Leave a comment

Cigarette smoking prevalence in US counties: 1996-2012

Originally posted on Full Text Reports...:

Cigarette smoking prevalence in US counties: 1996-2012
Source: Population Health Metrics

Background
Cigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action.

Methods
We used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011.

Results
Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging…

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March 29, 2014 Posted by | Uncategorized | Leave a comment

Solitary Confinement and Risk of Self-Harm Among Jail Inmates

Originally posted on Full Text Reports...:

Solitary Confinement and Risk of Self-Harm Among Jail Inmates (PDF)
Source: American Journal of Public Health

Objectives.
We sought to better understand acts of self-harm among inmates in correctional institutions.

Methods.
We analyzed data from medical records on 244 699 incarcerations in the New York City jail system from January 1, 2010, through January 31, 2013.

Results.
In 1303 (0.05%) of these incarcerations, 2182 acts of self-harm were committed, (103 potentially fatal and 7 fatal). Although only 7.3% of admissions included any solitary confinement, 53.3% of acts of self-harm and 45.0% of acts of potentially fatal self-harm occurred within this group. After we controlled for gender, age, race/ethnicity, serious mental illness, and length of stay, we found self-harm to be associated significantly with being in solitary confinement at least once, serious mental illness, being aged 18 years or younger, and being Latino or White, regardless of gender.

Conclusions.
These self-harm…

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March 29, 2014 Posted by | Uncategorized | Leave a comment

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