As a centerpiece of the Patient Protection and Affordable Care Act (ACA) of 2010, the focus on preventive services is a profound shift from a reactive system that primarily responds to acute problems and urgent needs to one that helps foster optimal health and well-being. The ACA addresses preventive services for both men and women of all ages, and women in particular stand to benefit from additional preventive health services. The inclusion of evidence-based screenings, counseling and procedures that address women’s greater need for services over the course of a lifetime may have a profound impact for individuals and the nation as a whole.
Given the magnitude of change, the U.S. Department of Health and Human Services charged the IOM with reviewing what preventive services are important to women’s health and well-being and then recommending which of these should be considered in the development of comprehensive guidelines. The IOM defined preventive health services as measures—including medications, procedures, devices, tests, education and counseling—shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition.
The IOM recommends that women’s preventive services include:
- improved screening for cervical cancer, counseling for sexually transmitted infections, and counseling and screening for HIV;
- a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes;
- services for pregnant women including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully;
- at least one well-woman preventive care visit annually for women to receive comprehensive services; and
- screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner.
Why Physicians Are Reluctant to Share Patient Data: Fine Line Between Protecting Privacy and Public Health
Family doctors are reluctant to disclose identifiable patient information, even in the context of an influenza pandemic, mostly in an effort to protect patient privacy. A recently published study by Dr. Khaled El Emam the Canada Research Chair in Electronic Health Information at the University of Ottawa and the Children’s Hospital of Eastern Ontario Research Institute recently found that during the peak of the H1N1 pandemic in 2009, there was still reluctance to report detailed patient information for public health purposes.
These results are important today, so we can learn from that experience and prepare for the inevitable next pandemic.
“There is a perceived tradeoff between the public good and individual privacy. If we sway too much on the public good side, then all people’s health data would be made available without conditions,” explained Dr. El Emam. “If we sway too much on the individual privacy side then no health data would be shared without consent, but then this would potentially increase public health risks. Physicians are important gatekeepers of patient information, so we need to better understand the conditions under which they are willing to provide patient data so that everyone wins; we do not need to make these tradeoffs….
Twitter allows millions of social media fans to comment in 140 characters or less on just about anything: an actor’s outlandish behavior, an earthquake’s tragic toll or the great taste of a grilled cheese sandwich.
But by sifting through this busy flood of banter, is it possible to also track important public health trends? Two Johns Hopkins University computer scientists would respond with a one-word tweet: “Yes!”
Mark Dredze and Michael J. Paul fed 2 billion public tweets posted between May 2009 and October 2010 into computers, then used software to filter out the 1.5 million messages that referred to health matters. Identities of the tweeters were not collected by Dredze, a researcher at the university’s Human Language Technology Center of Excellence and an assistant research professor of computer science, and Paul, a doctoral student. ….
….”Our goal was to find out whether Twitter posts could be a useful source of public health information, ” Dredze said. “We determined that indeed, they could. In some cases, we probably learned some things that even the tweeters’ doctors were not aware of, like which over-the-counter medicines the posters were using to treat their symptoms at home.”
By sorting these health-related tweets into electronic “piles,” Dredze and Paul uncovered intriguing patterns about allergies, flu cases, insomnia, cancer, obesity, depression, pain and other ailments. ….
…Other tweets pointed to misuse of medicine. “We found that some people tweeted that they were taking antibiotics for the flu,” Paul said. “But antibiotics don’t work on the flu, which is a virus, and this practice could contribute to the growing antibiotic resistance problems. So these tweets showed us that some serious medical misperceptions exist out there.”
The health of a population is measured by the level of health and how this health is distributed within the population. The WHO publication from early 2010, entitled Equity, social determinants and public health programmes analysed from the perspective of thirteen priority public health conditions their social determinants and explored possible entry points for addressing the avoidable and unfair inequities at the levels of socioeconomic context, exposure, vulnerability, health-care outcome and social consequences. However, the analysis needs to go beyond concepts to explore how the social determinants of health and equity can be addressed in the real world.
This publication takes the discussion on social determinants of health and health equity to a practical level of how programmes have actually addressed the challenges faced during implementation. Social determinants approaches to public health: from concept to practice is a joint publication of the Department of Ethics, Equity, Trade and Human Rights (ETH), Special Programme for Research and Training in Tropical Diseases (TDR), Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and Alliance for Health Policy and Systems Research (AHPSR).
The case studies presented in this volume cover public health programme implementation in widely varied settings, ranging from menstrual regulation in Bangladesh and suicide prevention in Canada to malaria control in Tanzania and prevention of chronic noncommunicable diseases in Vanuatu.
- On Priority-Setting, Public Reason, and the Social Determinants of Health (medhumanities.org)
- Have I Got a Story for You: A Call for Public Health Storytelling (scienceblogs.com)
The Bringing Health Information to the Community blog (fondly referred to as the BHIC blog) was developed by the NN/LM MidContinental Region (NN/LM MCR) about four years ago as a way to provide information to staff at community based organizations and public health departments, clinics, and others outside of libraries that the MCR staff encountered in their outreach efforts. It was also created as a tool to be used by NN/LM MCR members to share information with people within their institutions and communities.
With the new NLM contract, the BHIC blog has moved over to become a national blog, and staff at four other RMLs (including the GMR!) will be contributing writers. The new URL is http://nnlm.gov/bhic/.
If you want to receive a daily digest of the BHIC blog postings, just email Siobhan Champ-Blackwell, at siobhan at creighton.edu, and you will be added to a distribution LISTSERV. The distribution list sends out only one email a day. You can subscribe directly to the blog and get an email each time a posting is made (4-5 emails a day). An RSS feed is also available.
According to Siobhan, “We are excited that the BHIC blog is recognized as a national resource, and we are looking forward to the growth that will occur through the participation of the other RMLs”. The GMR is proud to be a contributor to this great resource.
From a 11 May 2011 Medical News Today article
People who leave education with fewer academic qualifications may grow old faster, according to a DNA study that compared groups of people who spent different lengths of time in education and found the ones who spent the least time had shorter telomeres or “caps” on the ends of their DNA, a sign of premature aging in cells….
…BHF’s Associate Medical Director, Professor Jeremy Pearson, said the study reinforces the need to tackle social inequalities to combat ill health:
“It’s not acceptable that where you live or how much you earn — or lesser academic attainment — should put you at greater risk of ill health,” he said in a statement.
Andrew Steptoe, BHF Professor of Psychology at UCL, and colleagues, wrote about their findings in a paper published recently in the journal Brain, Behavior, and Immunity.
They were concerned that while there is evidence that low socioeconomic status is linked to faster biological aging, attempts to tie it telomere length have yielded inconsistent results.
Telomeres are short repetitive sequences of DNA that “cap” the ends of chromosomes and stop them degrading and fusing with their neighbours: imagine the tips on the ends of shoelaces that stop them fraying. Telomeres get consumed in cell division, and are replenished by an enzyme called telomerase, but there is a limit to how many times this can happen, and they gradually get shorter, limiting the number of times cells can divide, and in turn, lifespan….
…After adjusting for possible confounding factors, such as age, gender, various health indicators such as smoking and cholesterol, and lifestyle indicators such as exercise, they found that lower educational attainment was linked to shorter telomere length, while household income was not, and neither was employment grade.
In fact, the link between “telomere length and education remained significant after adjusting for current socioeconomic circumstances,” they wrote.
They also found that in men, the highest telomerase activity (the enzyme that repairs the telomeres) was in the lowest education group.
The researchers concluded that low socioeconomic status defined in terms of education but not current socioeconomic circumstances is linked to shorter telomeres.
This supports the idea that faster aging is not just a result of current economic circumstances or social status in a person’s life, but of long-term effects that start early in life, such as education.
The researchers also suggest that people with higher levels of education are probably better equipped with life skills like problem-solving that help them deal with the stresses of life, and this reduces the biological stress on their bodies, the so-called “allostatic load.
“Educational attainment but not measures of current socioeconomic circumstances are associated with leukocyte telomere length in healthy older men and women.”
Andrew Steptoe, Mark Hamer, Lee Butcher, Jue Lin, Lena Brydon, Mika Kivimäki, Michael Marmot, Elizabeth Blackburn, Jorge D. Erusalimsky.
Brain, Behavior, and Immunity, In Press, Uncorrected Proof, Available online 23 April 2011.
- Telomere Nobelist: Selling a ‘biological age’ test (newscientist.com)
- Risk of accelerated aging seen in PTSD patients with childhood trauma (eurekalert.org)
- Study finds link between chronic depression and accelerated immune cell aging (eurekalert.org)
Today (Tuesday 10 May), the (UK) National Institute for Health and Clinical Excellence (NICE) has launched NICE Pathways at its annual conference in Birmingham. An online tool for health and social care professionals, NICE Pathways brings together all connected NICE guidance on a topic in a user-friendly electronic flowchart.
Previously there has been no easy way to see at a glance everything NICE has said on a specific condition, for example diabetes, across all its separate published guidance. For the first time ever, this digital resource will allow users to quickly view and navigate NICE guidance and other tools on any given topic across an entire care pathway. For example, the postnatal care pathway considers everything from the baby’s first 24 hours up until the first 2 – 8 weeks.
The 18 pathways launched today cover alcohol-use disorders, anaemia management in chronic kidney disease, breast cancer, chronic heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dementia,depression, diabetes, diabetes in pregnancy, diet, glaucoma, neonatal jaundice, physical activity, postnatal care, smoking, stroke, and venous thromboembolism (VTE) prevention.
Covering the whole range of different types of NICE advice, including health technology appraisals, clinical guidelines, public health and social care advice, quality standards and implementation tools, this is part of a wider move to provide a more personalised, audience-focused way of looking at NICE guidance. …..
From the 1 May 2011 Science News Daily article
ScienceDaily (May 1, 2011) — Giving poor families land on which to grow crops has been shown to improve child nutrition. New research also shows that giving families non-agricultural land and better housing also is beneficial for children’s growth and nutrition…
…”Malnutrition is a major problem for the health of children under 5 years of age in rural Mayan Guatemalan villages,” said Dr. Agulnik, lead author of the study and a resident at Children’s Hospital Boston. “This study demonstrates that in areas where land scarcity is a major problem, land distributions supporting improved housing and community organization can improve child nutrition without changing a family’s income. It also suggests that in our population, living conditions, sanitation, crowding and community organization play a major role in causing child malnutrition.”
The study underscores the fact that childhood malnutrition is not only about food, said study co-author Paul Wise, MD, MPH, FAAP, who created a program at Stanford University in California called Children in Crisis to improve health care to children living in politically unstable regions. “While this study documents the terrible toll of poverty on child health, it also emphasizes the interaction between the child, infections, community life and the exercise of political power.”
- Persistent child malnutrition in Tanzania: Risks associated with traditional complementary foods (A review (foodhygiene2010.wordpress.com)
- Making a Business of Fighting Child Malnutrition (blogs.forbes.com)
- India’s child malnutrition puzzle (palakmathur.wordpress.com)
- Risk factors for the development of persistent diarrhoea and malnutrition in Burmese children (foodhygiene2010.wordpress.com)
- DJIBOUTI: Challenges remain, despite nutrition gains (goubet2day.wordpress.com)
- Dying hungry (bbc.co.uk)
The US Centers for Disease Control and Prevention has addressed violence as a public health issue since at least 1979 (CDC Timeline of Violence as a Public Health Issue).
New Data: Cost of Violent Deaths
In the United States, violence accounts for approximately 51,000 deaths annually. Estimating the size of this economic burden is helpful in understanding the resources that could be saved if cost-effective violence prevention efforts were applied.
Violence is a significant problem in the United States (U.S.). From infants to the elderly, it affects people in all stages of life. In 2006, 18,573 people died as a result of homicide and 33,300 took their own life. The number of violent deaths tells only part of the story. Many more survive violence and are left with permanent physical and emotional scars. Violence also erodes communities by reducing productivity, decreasing property values, and disrupting social services.
While the CDC does have violence prevention resources for public health professionals, it also has resources for the rest of us.
The Violence Prevention page includes resources on these topics. Many have hotline phone numbers.
- Mental and Psychological Effects of Children’s Cartoons (vatopaidi.wordpress.com)
- Build Healthy Teen Relationships To Prevent Teen Dating Violence (connectwithyourteens.net)
- LGBT Domestic Violence Assistance Programs React To Murder Of Gay Man By Husband (pinkbananaworld.com)
- Leading Workplace Violence Prevention Consulting Firm Acquires The Leading Workplace Violence Prevention Magazine (prweb.com)
- Toronto police, social group team up for conference on South Asian family violence (theglobeandmail.com)
- The intersection of psychology and public health (Monitor on Psychology, April 2011)
” At the CDC, Rodney Hammond worked to improve health for entire populations. As he retires, he predicts that the United States will need even more behavioral expertise to address burgeoning public health problems.””
Looking back on your career, what accomplishment are you most proud of?
I am really pleased that the CDC has taken a lead role in promoting the notion that violence is preventable. When CDC started working on violence prevention, the work was primarily focused on collecting and reporting data on violence. Then we moved toward developing evidence-based prevention strategies. Now we are working on community capacity building. We are poised now to help communities implement evidence-based prevention programs to reduce violence.
One violence-prevention program I’d like to highlight is called STRYVE, (www.safeyouth.gov), which stands for Striving to Reduce Youth Violence Everywhere. It includes an online tool that is allowing local groups to network, assess conditions and share information about gaps in their communities that need to be filled by strong violence-prevention strategies. “
Going forward, what do you think are the greatest opportunities for violence prevention?
You’re going to see more collaboration among government agencies, community groups and law enforcement. There’s no one model yet, but these collaborations might involve police referring people to programs in the community. Or it might involve using violence data — for instance, information about who is coming into hospitals for treatment after an assault — and determining which parts of a community are most at risk and what circumstances surround these injures, and targeting community resources accordingly.”
What role do you think psychology has to play in the future of public health?
I’ve noticed that many psychologists are getting master’s degrees in public health or just taking courses in public health during their doctoral training. Their involvement in the public health system will be very beneficial because some of the top public health problems — obesity, violence and smoking — have a lot to do with behavior. Psychologists bring unique expertise in how behavior can be influenced and how healthy behavior can be encouraged.”
Proper health care planning requires the collection and use of good factual public health statistics. Sadly, according to this report, quality collection and application of health measurements are lacking partly because there is not enough coordination among governmental agencies and private sector entities.
For the Public’s Health: The Role of Measurement in Action and Accountability assesses the current situation.
From the press release:
“To inform the public health community and all other sectors that contribute to population health, the Robert Wood Johnson Foundation commissioned the IOM to examine three major topics that influence the health of the public-measurement, laws, and funding. In this, the first of three reports, the IOM reviews current approaches for measuring the health of individuals and communities and suggests changes in the processes, tools, and approaches used to gather information about health outcomes and their determinants.”
“The IOM recommends developing an integrated and coordinated system in which all parties—including governmental and private sector partners at all levels—have access to timely and meaningful data to help foster individual and community awareness and action. “
- Two Health Data Tools for Research and Surveillance : Health Indicators Warehouse and Catalogue of Surveillance Systems (jflahiff.wordpress.com)
World’s Leading Scientists Join Forces To Set Priority Interventions To Save 36 Million Lives From Non-Communicable Diseases
World’s Leading Scientists Join Forces To Set Priority Interventions To Save 36 Million Lives From Non-Communicable Diseases***
NCDs (non-communicable diseases), mainly heart disease, stroke, diabetes,cancers, and chronic respiratory disease, are responsible for two out of every three deaths worldwide and the toll is rising.***A landmark global alliance between leading scientists and four of the world’s largest NGOs brings together evidence from a 5-year collaboration with almost 100 of the world’s best NCD experts and proposes a short-list of five priority interventions to tackle this increasing global crisis. Reducing tobacco and salt use, improving diets and physical activity, reducing hazardous alcohol intake, and achieving universal access to essential drugs and technologies have been chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility….
….The top priority must be to reduce tobacco use followed by lowering salt intake, say the authors. Key to the success of this intervention will be the accelerated implementation of the Framework Convention on Tobacco Control (FCTC) to achieve the proposed goal, “a world essentially free from tobacco by 2040″, where less than 5% of the population uses tobacco; achieving this goal would prevent at least 5.5 million premature deaths over 10 years.
By 2025, they would like to see salt intake reduced to less than 5 g per person. They point out that reducing global salt consumption by just 15% through mass-media campaigns and reformulation of processed foods and salt substitution could prevent an estimated 8.5 million deaths in just 10 years.
Importantly, the costs of these interventions will be small, say the authors. The yearly cost to implement tobacco control and salt reduction will be less than US 50 cents per person per year in countries like India and China. The total package of priority interventions will require a new global commitment of about $9 billion per year.
*** The free full text of this Lancet article may be found here, however registration is required.
- Health Crisis in South Asia : World Bank (itsinfoworld.wordpress.com)
- GRAND CHALLENGES IN GLOBAL HEALTH – “Rising Stars” (openmedicine.ca)
- Report says economic development could change worldwide face of cancer (eurekalert.org)
- NCD Alliance Unveils Ground-Breaking Document For Successful UN Summit On Non-Communicable Diseases (NCDS) (medicalnewstoday.com)
- Non-Communicable Disease Deaths Increasing Globally, Especially In Developing Nations (medicalnewstoday.com)
- Global Events Take Aim At Health’s Biggest Enemy: Non-Communicable Diseases (donttradeourlivesaway.wordpress.com)
- Chronic diseases now leading global killer: WHO (ctv.ca)
- Heart disease and cancer – the global threat omitted from the MDGs (guardian.co.uk)
- Headway is being made fighting communicable diseases globally, research suggests (jflahiff.wordpress.com)
- Emerging Global Mandate To Save 36 Million Lives From Non-Communicable Diseases (NCDs) (medicalnewstoday.com)
- Eat Healthy To Reduce The Risk Of Non-communicable Diseases (NCDs)
- Patients must set the agenda on non-communicable diseases (International Alliance of Patient Organizations, 17 May 2011)
“Geneva, Switzerland, 17 May 2011 – Patient advocates have called for a stronger role in setting the agenda in the design and delivery of strategies to prevent and manage non-communicable diseases (NCDs), and chronic diseases more broadly. This call was made at a Side Meeting to the World Health Organization (WHO) World Health Assembly in Geneva, Switzerland. The meeting was hosted by the International Alliance of Patients’ Organizations (IAPO) and two of its member patient groups; Alzheimer’s Disease International (ADI) and the Multiple Sclerosis International Federation (MSIF) and attended by over 50 participants including member state representatives, health professionals and WHO representatives…
…Speakers from Africa, Latin America and Europe highlighted, with practical examples, how patient advocates are contributing knowledge, experience and resources to support efforts to tackle chronic disease. Across the world in high, middle and low income countries, patient groups routinely provide health information and training to patients and health professionals. These have been shown to support prevention strategies and effective disease management to ensure that patients’ needs are met. ….
APHA (American Public Health Association) is raising awareness of the importance of injury and violence
prevention through National Public Health Week: Safety is No Accident: Live Injury-free.
ScienceDaily (Mar. 29, 2011) — Members of California’s aging lesbian, gay and bisexual population are more likely to suffer from certain chronic conditions, even as they wrestle with the challenges of living alone in far higher numbers than the heterosexual population, according to new policy brief from the UCLA Center for Health Policy Research.
Half of all gay and bisexual adult men in California between the ages of 50 and 70 are living alone, compared with 13.4 percent of heterosexual men in the same age group. And although older California lesbians and bisexual women are more likely to live with a partner or a family member than their male counterparts, more than one in four live alone, compared with one in five heterosexual women.
A lack of immediate family support may impact aging LGB adults’ ability to confront statistically higher rates of diabetes, hypertension, poor mental health, physical disability and self-assessed fair or poor health, compared with demographically similar aging heterosexual adults.
The study, which draws upon three cycles of data from the biennial California Health Interview Survey (CHIS), underscores the importance of considering these unique needs and chronic health conditions in providing health care and social services to the estimated 170,000 self-identified aging LGB adults in California — a population that will double in size over the next 20 years.
“Many aging LGB Californians do not have biological children or strong family support,” said Steven P. Wallace, the lead researcher on the project. “Organizations that serve these communities need to take this into account and consider outreach and support mechanisms that enable these individuals to maintain their independence and ability to age safely and in good health.”
The policy brief, “The Health of Aging Lesbian, Gay and Bisexual Adults in California,” includes the first data published on aging LGB adults based on a large statewide population. And among a population whose health needs are too often associated only with HIV and AIDS, the study offers the first insights about broader health conditions and trends….
- Groundbreaking report released: ‘Bisexual Invisibility: Impacts and Recommendations’ (pinkbananaworld.com)
- Lesbians, gays, bisexuals at higher risk for severe mental health problems (news.bioscholar.com)
- San Francisco Human Rights Commission Approves Groundbreaking Report: Bisexual Invisibility: Impacts and Recommendations (pinkbananaworld.com)
- Day 27- Sexuality in the US (feministactivism.wordpress.com)
- Bullying, Harassment of Gay/Lesbian Teens: Expert Q&A (webmd.com)
- Strong link found between victimization, substance abuse (eurekalert.org)
- Physiological Impacts Of Homophobia (mccswu.wordpress.com)
- Americans Have Higher Rates of Most Chronic Diseases Than Same-Age Counterparts in England (jflahiff.wordpress.com)
- Doctors lack data on LGBT community: report
America’s Most Distressed Areas, Including The Gulf Coast States And Washington, D.C., Threatened By Emerging Infections Of Poverty
America’s Most Distressed Areas, Including The Gulf Coast States And Washington, D.C., Threatened By Emerging Infections Of Poverty
Neglected infections of poverty are the latest threat plaguing the poorest people living in the Gulf Coast states and in Washington, D.C., according to Dr. Peter Hotez, Distinguished Research Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at The George Washington University and President of the Sabin Vaccine Institute, in an editorial published in the open-access journal PLoS Neglected Tropical Diseases on March 29th.
Hotez explains that current post-hurricane conditions in the Gulf coast states coupled with the BP oil disaster and extreme levels of poverty make these areas extremely vulnerable to neglected infections of poverty. Conditions such as dengue hemorrhagic fever and other vector borne neglected infections, like Chagas disease and cutaneous leishmaniasis, as well as non-vector borne neglected infections like trichomoniasis and toxocariasis, are affecting the people living in the region. Additionally, Hotez notes that Washington, D.C. is also among the worst U.S. cities in terms of life expectancy and health index, meaning its residents suffer from the lowest incomes, lowest educational attainment, and shortest life expectancy. Despite the fact that these conditions are triggers for neglected infections of poverty, no surveillance data currently exists to reflect their prevalence. Even trichomonaisis, which is extremely common in Baltimore, MD., has not been tracked.
“Because these infections are serious problems that perpetuate poverty, I am extremely concerned about the welfare of the people in these regions. [Editor Flahiff's emphasis]
Click here for the full text of the journal article written by Dr. Hotez, America’s Most Distressed Areas and Their Neglected Infections: The United States Gulf Coast and the District of Columbia
PBS NewsHour’s Global Health Watch features news and on-the-ground reports exploring the diseases, conditions, medical advances and policies affecting the health of people around the world.
Earthquake victims gather at the evacuation center in Kamaish
BLOG MARCH 24, 2011 Slideshow: TB a Silent KillerJust 22 countries contribute 80 percent of the global burden of tuberculosis.
A sampling from the March 25 2011 contents.
Each section includes Browse, Subscription, and Related Information options.
- Global Health
- Recent Global Health Trips – Guatamala includes videos, a blog, and news updates
- Blogs and reports on emerging news from Tokyo, Bangladesh, and Haiti
- The World’s Most Destructive Diseases
- Information on the top 5 non-communicable diseases and also top 5 infectious diseases
- Each disease or condition has information in these areas: global impact, causes, symptoms, prevention, and treatment
- From the Field (Archive) has links to current and past postings. There is a drop down menu organized by country.
- The For Teachers link has the heading For Teachers and Students. It includes lesson plans.
- Japan Crisis: What’s next for nuclear energy in the U.S.? (boingboing.net)
- PBS Newshour: Wind Turbines and Health (windconcernsontario.wordpress.com)
From the March 18 2011 DISASTR-OUTREACH-LIB **posting
Disaster Medicine and Public Health Preparedness
The March 2011 issue of this journal includes an article titled,
“Supporting Evidence-based Health Care in Crises: What Information Do Humanitarian Organizations Need?” ***as well as a selection of open access articles relevant to the Japan earthquake. [Submitted by Anna Gieschen]
Supporting Evidence-based Health Care in Crises
What Information Do Humanitarian Organizations Need?
Tari Turner, PhD, Sally Green, PhD and Claire Harris, MBBSAuthor Affiliations: Dr Turner and Dr Green are with the Australasian Cochrane Centre, Monash University, Victoria, Australia; and Dr Harris is with the Centre for Clinical Effectiveness, Southern Health, Victoria, Australia.
In crisis situations, there is an enormous burden of disease and very limited resources. To achieve the best possible health outcomes in these situations and ensure that scarce resources are not wasted, knowledge from health research needs to be translated into practice. We investigated what information from health research was needed by humanitarian aid workers in crisis settings and how it could be best provided. Semistructured interviews were conducted by telephone with 19 humanitarian aid workers from a range of organizations around the world and the results analyzed thematically. Participants identified a clear and currently unmet need for access to high-quality health research to support evidence-based practice in crisis situations. They emphasized that research into delivery of health care was potentially morevaluable than research into the effectiveness of particular clinical interventions and highlighted the importance of includingcontextual information to enable the relevance of the research to be assessed. They suggested that providers of health research information and humanitarian aid organizations work together to develop these resources. [editor Flahiff's emphasis]
**DISASTR-OUTREACH-LIB is a discussion group for librarians, information specialists and othersinterested in disaster information outreach to their communities and responding to information needs for all-hazards preparedness, response and recovery.
The DISASTR-OUTREACH-LIB archives are available at
- U.S. Unprepared for Major Radiation Emergency: Survey (jflahiff.wordpress.com)
- Emergency mental health lessons learned from Continental Flight 3407 disaster (scienceblog.com)
- Disaster Preparedness: Is Your Family Ready? (abcnews.go.com)
- Japan earthquake – disaster relief information sources (openmedicine.ca)
- Japan’s Disaster and the Limits of Self-Sufficiency (scienceblogs.com)
- Health care needs public acceptance of evidence based medicine (kevinmd.com)
ScienceDaily (Mar. 14, 2011) — Those working for healthier humans around the globe are making headway in fighting communicable diseases such as AIDS, malaria and diarrheal illness, according to research from the Frederick S. Pardee Center for International Futures in the University of Denver‘s (DU) Josef Korbel School of International Studies.
The center recently released the third in a series of five volumes [full online text of all 3 volumes] that focus on human progress in which researchers explore topics such as education, poverty, infrastructure and governance. The latest book is Improving Global Health: Forecasting the Next 50 Years [full online text] (Paradigm Publishers and Oxford University Press India, 2011).
The latest volume sheds light on a transition the authors see occurring in global health — a transition of disease burdens from communicable diseases to chronic ones such as cancer, diabetes and heart disease….
- Non Communicable Diseases Hit The World’s Poorest People (medicalnewstoday.com)
- In Africa, cancer is a burden that can no longer be ignored | Emilie Filou (guardian.co.uk)
- Non Communicable Diseases: The World’s Number One Killer For Women (medicalnewstoday.com)
The National Environmental Public Health Tracking Network integrates and presents health exposure and data information data from a variety of national, state, and city sources. It is part of the Environmental Public Health Tracking Program, a US Centers for Disease Control and Prevention Agency (CDC) which tracks and studies many of the exposures and health effects that may be related to environmental hazards.
On the Tracking Network, you can view maps, tables, and charts with data about:
- chemicals and other substances found in the environment, through Web pages as Tracking air quality and Tracking Housing Conditions
- some chronic diseases and conditions through the Health Effects page
- the area where you live through Info by Location
The Resources links at the home page (right column) include
- Communications features as podcasts, inks to social media (Facebook, Twitter), and data sources
- Quick reports which summarize key information
Online Continuing Education (CE) credits are available through NEHA e-learning. All CE classes may be viewed for free. Most CE credits are fee based, however some are free through the CDC and EPA. ( Tracking 101 online training link at About Tracking Program)
February 17, 2011 20:30
Wider implementation of policies is needed to save lives and reduce the health impact of harmful alcohol drinking, says a new report by WHO. Harmful use of alcohol results in the death of 2.5 million people annually, causes illness and injury to many more, and increasingly affects younger generations and drinkers in developing countries.
Alcohol use is the third leading risk factor for poor health globally. A wide variety of alcohol-related problems can have devastating impacts on individuals and their families and can seriously affect community life. The harmful use of alcohol is one of the four most common modifi able and preventable risk factors for major noncommunicable diseases (NCDs). There is also emerging evidence that the harmful use of alcohol contributes to the health burden caused by communicable diseases such as, for example, tuberculosis and HIV/AIDS.
Related WHO Web pages
- Management of Substance Abuse (currently featuring Global status report on alcohol and health 2o11 (3 March 2011)
- Rethinking Drinking provides research-based information about how your drinking habits can affect your health. Learn to recognize the signs of alcohol problems and ways to cut back or quit drinking. Interactive tools can also help you calculate the calories and alcohol content of drinks. (US National Institutes of Health)
Two Health Data Tools for Research and Surveillance : Health Indicators Warehouse and Catalogue of Surveillance Systems
Two Health Data Tools for Research and Surveillance : Health Indicators Warehouse and Catalogue of Surveillance Systems
Resource to help researchers and practitioners more easily investigate childhood obesity in America. The catalogue describes and provides access to surveillance systems (national, state, local) that collect data related to childhood obesity.
This web tool provides a catalogue of existing surveillance systems that contain data relevant to childhood obesity research. It includes local, state, and national systems that provide data at multiple levels.
Surveillance systems for this Catalogue were identified by reviewing existing reports of available systems and soliciting expert review and suggestions. The systems were chosen because they provide access to publicly available raw data gathered in the United States.
Some systems have been in operation for many years; others are relatively new. All, however, contain data pertaining to the past 10 years.
The Search Page contains links to 77 systems, a search box, and limits (age groups, geographic divisions, racial/ethnic group, and more)
The Health Indicators Warehouse serves as the data hub for the HHS Community Health Data Initiative by providing a single source for national, state, and community health indicators. (Related February 11 HHS press release may be found here)
Access to high quality data improves understanding of a community’s health status and determinants, and facilitates the prioritization of interventions. The purpose of the HIW is to:
- Provide a single, user-friendly, source for national, state, and community health indicators
- Meet needs of multiple population health initiatives
- Facilitate harmonization of indicators across initiatives
- Link indicators with evidence-based interventions
- Serve as the data hub for the HHS Community Health Data Initiative, a flagship HHS open government initiative to release data; encourage innovative application development; and catalyze change to improve community health
The Indicators page allows one to search through and alphabetical list of filters including chronic diseases, health care, health behaviors, health risks, physical environment, and public health structure.
Community Health Status Indicators (HRSA, CDC, NLM, PHF)
This web-based tool provides local public health agencies access to county health status profiles for improving community health by identifying resources and setting priorities. Visit the CHSI home page to read about the data sources, definitions, and notes, and then explore the CHSI dataset file.
County Health Rankings (RWJF and University of WI)
This interactive website provides access to 50 state reports with rankings of each county within each state according to its health outcomes and health determinants. The County Health Rankings are a key component of the Mobilizing Action toward Community Health (MATCH) project. MATCH is collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
Healthy People (HHS)
Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to: 1) Identify nationwide health improvement priorities; 2) Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress; 3) Provide measurable objectives and goals that are applicable at the national, State, and local levels; 4) Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge; and 5) Identify critical research, evaluation, and data collection needs. Healthy People 2020 contains 1200 objectives in 42 topic areas (923 with baseline data, 237 for which baseline data will be developed during the decade) designed to serve as this decade’s framework for improving the health of all people in the United States.
CMS has assembled measures from Medicare claims data at the state level and for 306 Hospital Referral Regions. The measures encompass a range of data for 2008, including: Utilization measures (e.g., Emergency Department Visits and Hospital Readmissions), Quality measures (e.g., Hospital Compare, Agency for Health Research and Quality (AHRQ) Prevention Quality Indicator (PQI), and AHRQ Patient Safety Indicators (PSI)).
IOM and NAE launch collegiate challenge aimed at solving health problems
Through creative technology development
From the February 17, 2011 Eureka News Alert
(National Academy of Sciences) “Go Viral to Improve Health: IOM-NAE Health Data Collegiate Challenge” was launched today by the Institute of Medicine and National Academy of Engineering to promote interaction among future health professionals, engineers, and scientists and to spur interest in harnessing new technologies and data to solve vexing health issues.
WASHINGTON — “Go Viral to Improve Health: IOM-NAE Health Data Collegiate Challenge” was launched today by the Institute of Medicine and National Academy of Engineering to promote interaction among future health professionals, engineers, and scientists and to spur interest in harnessing new technologies and data to solve vexing health issues. The challenge calls on university and college students studying engineering, computer science, and health disciplines to work in interdisciplinary teams to transform health data into new mobile apps, online tools or games, or other innovative products that can improve health at the community level.
The first place team will receive a $3,000 prize and the opportunity to demonstrate their product during the plenary session of the annual Community Health Data Initiative Forum on June 9, 2011. The second and third place teams will receive awards of $2,000 and $1,000 respectively, and both will have the chance to display their winning technologies in the exhibit hall at this national gathering of software engineers, developers, and health leaders. All winning teams will be reimbursed for up to $1,000 of their travel costs to the forum.
Participating teams must develop a web-based or mobile product that tackles a health issue in a creative way and encourages people in a community to interact with one another. The launch of the challenge coincides with the debut of the Health Indicators Warehouse, a vast collection of health data and indicator sets made available by the U.S. Department of Health and Human Services. Teams must tap this online warehouse to create their interactive technologies. Entries will be judged on how well they integrate health data from the warehouse and other information sources as well as their creativity, design, usability, and potential for the product to make an impact on the health issue selected by the team.
Both undergraduate and graduate students may compete. Teams must consist of a minimum of two and up to five individuals and include at least one member pursuing a degree in engineering or computer science and at least one member pursuing a degree toward a career in any of the health professions. The submission deadline is April 27, 2011. A detailed description of “Go Viral to Improve Health: IOM-NAE Health Data Collegiate Challenge” can be found at IOM website and NAE website and on Facebook. Questions can be directed to email@example.com.
“The IOM-NAE Health Data Collegiate Challenge seeks to tap the creativity and skills of the nation’s brightest young minds because we believe they have the ability to harness health data in novel ways that will make a healthy difference to their communities and to the nation as a whole,” said IOM President Harvey V. Fineberg. “This challenge provides a unique chance to showcase the innovation that can result from interdisciplinary collaboration and also an opportunity for students to gain experience and skills that we hope they will carry into their careers.”
“The trove of health data made available by the U.S. Department of Health and Human Services provides a wonderful opportunity for creative young people to design the next ‘viral app’ — one that can improve personal health and extend lives,” said NAE President Charles M. Vest. “‘Advancing Health Informatics‘ was one of 14 Grand Challenges for Engineering identified by the NAE as game-changers in the 21st century, and the interdisciplinary collaboration being encouraged between the fields of engineering and health by this challenge is a key to meeting that goal.”
The Institute of Medicine and National Academy of Engineering along with the National Academy of Sciences and National Research Council make up the National Academies. They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. For more information, visit http://national-academies.org.
Welcome to the new Alcohol Studies user interface. New features include:
Improved subject selection
Ability to email citations
More flexible boolean operators
Better error checking
This site provides access to the Alcohol Studies Database. The database contains over 80,000 citations for journal articles, books, book chapters, dissertations, conference papers, and audio-visual materials.
With this release we are offering a more intuitive interface which also provides much faster response times. Feedback appreciated.
The site was developed by the Scholarly Communication Center, the Center of Alcohol Studies , and the Rutgers University Libraries Search the Database
New health care law provides new funding to reduce tobacco use, obesity and heart disease, and build healthier communities
epartment of Health and Human Services Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law. Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.
“Prevention is something that can’t just happen in a doctor’s office. If we are to address the big health issues of our time, from physical inactivity to poor nutrition to tobacco use, it needs to happen in local communities,” said Sebelius. “This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the federal government as well as with private groups and state and local governments to help Americans live longer, healthier lives.”
The Prevention and Public Health Fund, part of the Affordable Care Act, is designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living. In FY2010, $500 million of the Prevention Fund was distributed to states and communities to boost prevention and public health efforts, improve health, enhance health care quality, and foster the next generation of primary health professionals. Today, HHS posted new fact sheets detailing how that $500 million was allocated in every state. Those fact sheets are available at www.HealthCare.gov/news/factsheets/prevention02092011a.html.
This year, building on the initial investment, new funds are dedicated to expanding on four critical priorities:
- Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer.
- Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law. They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings.
- Public Health Infrastructure ($137 million): These funds will help state and local health departments meet 21stcentury challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats.
- Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges.
The Obama Administration recognizes the importance of a broad approach to addressing the health and well-being of our communities. Other initiatives put forth by the Obama Administration to promote prevention include:
- The President’s Childhood Obesity Task Force and the First Lady’s Let’s Move! initiative aimed at combating childhood obesity.
- The American Recovery and Reinvestment Act of 2009 that provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction programs, and efforts to reduce healthcare-acquired infections.
- The Affordable Care Act’s National Prevention, Health Promotion and Public Health Council, composed of senior government officials, charged with designing a National Prevention and Health Promotion Strategy.
For more information about the FY2011 Prevention and Public Health Fund investments, visithttp://www.HealthCare.gov/news/factsheets/prevention02092011b.html.
- Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs (Healthcare.gov, April 29, 2011)
- Community-Based Prevention Essential Part For Health Care Cost Reform (hcfama.org)
Despite medical care expenditures that are the highest of any industrialized nation, deficiencies in the way health information is collected and a lack of agreement on the best indicators by which to measure progress are hindering efforts to improve Americans’ health, according to a new national report.
Released in December by the Institute of Medicine, the report calls on the nation’s health leaders to develop a core, standardized set of indicators to integrate and align health data and health outcome measurement at the national, state and local levels. According to the report, numerous health indicator sets developed in recent years and deployed in different contexts make assessment and comparison difficult for policy-makers and other decision-makers by highlighting similar information in different ways….
The report committee’s vision of the factors that create health in populations — community-based factors and social and environmental determinants — is “very different” from the way the current U.S. health care delivery system is structured, said Gold, noting that the report calls on the U.S. Department of Health and Human Services to produce an annual report informing policy-makers, health leaders and the public about important trends and disparities in the social and environmental determinants that affect health.
“The public health community…shares a commonality of interests and insight as to what the true determinants of health are, and what this report tries to put into sharp relief is that we need to do a better job of measuring the variables that create and detract from health in this country, and that we need to move that measurement strategy away from traditional biomedical variables,” said Gold, who is a professor and chair of community health and social medicine at the Sophie Davis School of Biomedical Education at the City College of New York.
The report, “For the Public’s Health: The Role of Measurement in Action and Accountability,” also recommends that the United States adopt a single, summary measure of population health. Death rates have long been used as the standard measure of population health, the report said, but life expectancy by itself cannot capture information about the health-related quality of life associated with chronic illnesses and injuries. Summary measures of population health, such as health-adjusted life expectancy, capture an overall picture of the well-being of communities.
Moreover, the report recommends that HHS assign the National Center for Health Statistics a leadership role in a “renewed population-health information system” through better coordination and integration of the determinants of health. The report further recommends that the National Prevention, Health Promotion and Public Health Council — the federal body created as part of last year’s health reform law — update Congress annually on NCHS’ progress in assuming such a leadership role.
To ensure the public’s awareness of the quality, safety, efficiency and appropriateness of clinical care services delivered in their communities, the report calls on state and local public health agencies in each state to collaborate with clinical care delivery systems. Local performance reports about overuse, underuse and misuse should be made available for selected interventions, the report said, including preventive and diagnostic tests, procedures and treatment.
The report also recommends that HHS work with relevant federal, state and local public-sector and private-sector partners and stakeholders to develop a performance-measurement system that promotes accountability among governmental and private-sector organizations that have responsibilities for protecting and improving population health at local, state and national levels.
Authoring committee member Martin J. Sepulveda, MD, FACP, called the report a “wake-up call” to the health care delivery system, policy-makers, governmental public health leaders, employers and other payers.
“It tells policy-makers that you can control the ‘mix’ part of total cost by focusing on the medical care delivery system — namely the proportions of controlled versus complicated people with chronic diseases, but the avalanche of new people with chronic diseases will continue to flood the system and will keep total cost high,” Sepulveda, IBM fellow and vice president for integrated health services at IBM Corp. in Somers, N.Y., told The Nation’s Health.
The report also tells governmental public health that it needs to “think differently” about its role in the health crisis and forge new relationships with the health care delivery system to break down barriers and create and use shared pools of data to inform policy-makers and consumers about critical performance matters such as overuse, underuse and misuse of medical care, Sepulveda said.
“It needs to play a key role in helping people know where health care value lies and who is and isn’t delivering it in their communities,” Sepulveda said.
Sponsored by the Robert Wood Johnson Foundation, the report is the first of three on public health strategies to improve health. Reports examining public health and the law and public health and financing are due to be released within the next year.
For more information or to read the report, visit www.iom.edu/reports.
While policy makers in Australia, the United Kingdom, and New Zealand debate whether alcohol advertising and sponsorship should be banned from sport, new research provides evidence that alcohol industry sponsorship is associated with more hazardous drinking in sportspeople compared to non-alcohol sponsorship.
Health scientists from Monash University, the University of Manchester, Deakin University and University of Western Sydney, asked Australian sportspeople about their drinking behaviours, sport participation, and what sorts of sport sponsorship they currently receive.
After accounting for other influences receipt of alcohol industry sponsorship in various forms was associated with significantly higher levels of drinking. Receipt of similar forms of sponsorship from non-alcohol industries such as, building firms, food or clothing companies was not related to higher drinking levels.
Of the 30 per cent of sportspeople reporting receiving alcohol industry sponsorship, 68 per cent met World Health Organisation criteria for classification as hazardous drinkers.
Sport is being misused to promote alcohol to sportspeople and the general population. The public do not need more encouragement to drink, and there are ways of replacing alcohol advertising and sponsorship dollars in sport,” Dr O’Brien said.
“Much like was done with tobacco, a proportion of the excise duty currently gathered by governments from alcohol sales could be ring fenced (hypothecated) for funding sport and cultural events. This would replace alcohol industry funding many times over,” Dr O’Brien said.
Norway and France have had longstanding bans in place with little apparent effect on sport, and this year Turkey banned all alcohol advertising and sponsorship of sport. France successfully hosted the 1998 FIFA World Cup with their alcohol sponsorship and advertising ban in place, and currently host the multi-nation Heineken Cup Rugby competition, renamed the H-Cup in France….
…Deakin University scientist Dr Peter Miller said “This study provides new evidence of the harms associated with alcohol industry sponsorship of sport and we believe that any sporting association serious about the well-being of young people should support calls for governments to provide alternative funding. It’s simply not worth gambling with their future for the sake of some easy money.”
Homeless people without enough to eat are more likely to be hospitalized
Mass. General study is first to document association between food, use of health services
Homeless people who do not get enough to eat use hospitals and emergency rooms at very high rates, according to a new study. One in four respondents to a nationwide survey reported not getting enough to eat, a proportion six times higher than in the general population, and more than two thirds of those had recently gone without eating for a whole day. The report will appear in the Journal of General Internal Medicine and has been released online.***
“The study is the first to highlight the association between food insufficiency and health care use in a national sample of homeless adults,” says lead author Travis P. Baggett, MD, MPH, of the Massachusetts General Hospital (MGH) General Medicine Division. “Our results suggest a need to better understand and address the social determinants of health and health-care-seeking behavior,”
Baggett and a team of investigators at MGH and the Boston Health Care for the Homeless Program analyzed survey data from 966 adult respondents to the 2003 nationwide Health Care for the Homeless User Survey. They found that homeless people who did not have enough to eat had a higher risk of being hospitalized in a medical or psychiatric unit than did those with enough to eat and also were more likely to be frequent users of emergency rooms. Neither relationship could be explained by individual differences in illness. Nearly half of the hungry homeless had been hospitalized in the preceding year and close to one-third had used an emergency room four or more times in the same year.
Baggett explains the study was sparked by his clinical experience caring for homeless individuals. “Homeless patients with inadequate food may have difficulty managing their health conditions or taking their medications. They may postpone routine health care until the need is urgent and may even use emergency rooms as a source of food. Whether expanding food services for the very poor would ameliorate this problem is uncertain, but it begs further study.” Baggett is an instructor in Medicine at Harvard Medical School.
UC Riverside professor outlines risks of daily exposure to toxicants and advocates regulatory changes to protect public health
RIVERSIDE, Calif. – Americans are exposed to hundreds, if not thousands, of suspected toxic substances every day, substances that affect the development and function of the brain, immune system, reproductive organs or hormones. Children are the most vulnerable. But no public health law requires product testing of most chemical compounds before they enter the marketplace.
That must change, UC Riverside professor Carl Cranor argues in a new book, “Legally Poisoned: How the Law Puts Us at Risk from Toxicants” (Harvard University Press, 2011).
The current harm-based or risk-of-harm-based legal structure for regulating exposure to toxic substances is problematic, says Cranor, a professor of philosophy and longtime advocate of reforming U.S. regulatory policies. “Because most substances are subject to post-market regulation, the existing legal structure results in involuntary experiments on citizens. The bodies of the citizenry are invaded and trespassed on by commercial substances, arguably a moral wrong.”
Scientists are finding that every industrial chemical and pesticide produced today is capable of entering our bodies, says Cranor, who has served on science advisory panels for the state of California and on Institute of Medicine and National Academy of Sciences committees. For three decades he has studied U.S. regulatory policy and philosophic issues concerning risks, science and the law, as well as the regulation of carcinogens and developmental toxicants, and protection of susceptible populations from new and existing technologies and toxicants. His research has been supported by the National Science Foundation and University of California Toxic Substances Research and Teaching Program.
Cranor notes that the Centers for Disease Control has identified more than 200 toxicants in the bodies of average Americans, a number that he contends is low only because the CDC has not yet developed protocols to reliably identify other substances. [See National Report on Human Exposure to Environmental Chemicals]
“The list is only going to grow over time,” Cranor says.
With the exception of pharmaceuticals and pesticides, the U.S. legal system permits most substances to come in without testing for toxicity, without knowing whether they cause cancer, birth defects, developmental effects, or reproductive effects. Only about 2 percent of 62,000 substances in commerce before 1979 have been reviewed at all for their toxicity by the U.S. Environmental Protection Agency, he says. Of the approximately 50,000 substances introduced since 1979, about 85 percent were allowed to market with no data concerning health effects.
Industrial, often toxic, chemicals are everywhere – bisphenol A used in plastic bottles and that lines cans of food; non-stick cooking surfaces or Gore-Tex material that contains perfluorinated compounds; curtains, baby car seats and TV sets manufactured with brominated flame-retardants; and countless cosmetic ingredients, industrial chemicals, pesticides, and other compounds, all of which enter our bodies and remain briefly or for years.
Chemical contamination is so prevalent, Cranor says, “that it will make future human studies more difficult; there will be no clean controls against which to compare people who are contaminated. We are all contaminated. It’s a question of more or less contamination. So it’s going to be increasingly difficult for the science to detect some of these effects in humans, when they exist.”
The legal process for identifying adverse health effects and removing the responsible substances from the marketplace is extremely slow, he says.
“The only way to reduce toxic contamination is to require testing of products before they come in to commerce,” he says. “If they appear to pose adverse health effects, they should not be permitted, or they should be required to be reformulated so the problems disappear.”
**Toxnet - databases on toxicology, hazardous substances, and environmental health
**ToxTown – Interactive guide to toxic chemicals and environmental health risks. Also in Spanish (ToxTown en español).
The Agriculture and Public Health Gateway allows researchers, journalists, advocates, and educators to explore the links between agriculture and public health by searching several databases simultaneously, or by browsing a vetted collection of reports, journal articles and other resources.
This gateway is A project of the Johns Hopkins Center for a Livable Future.
From the About page:
he Agriculture & Public Health Gateway connects visitors to numerous information sources within topic areas that link these two fields. It can be a powerful tool for researchers, journalists, advocates and educators, providing access to recommended resources linked from the site, as well as to powerful database search capabilities.
The two primary means of accessing information through the Gateway are the Browse by Subject collections and our Database Search:
Browse by Subject
Find collections of recommended resources on specific public health and agriculture topics. Each collection is divided into four categories:
- Reports & Other Documents – white papers, reports from government agencies or non-governmental organizations, fact sheets, brochures, or other “gray” literature on a topic.
- Peer-reviewed Journal Articles – a sampling of some of the best research on each topic.
- Relevant Organizations – includes governmental and non-governmental agencies, academic centers, and private-sector sources that are considered key information resources within a topic area.
- Other Tools & Resources – databases, books, films, videos, slide presentations, newspaper articles, or consumer guides, as well as other organizations’ lists of resources or Web links.
Concurrently search these key electronic libraries (and the Gateway site itself):
- AGRICOLA – National Agricultural Library collection includes more than 3.3 million bibliographic records of journal articles, theses, patents, software, and technical reports related to agriculture from 1979 to the present.
- PubMed – A service of the National Library of Medicine that includes more than 18 million citations for biomedical articles dating to the 1950s. Includes links to full-text articles.
- NASD – the National Agricultural Safety Database, a project of the National Institute for Occupational Safety and Health.
- EarthTrends – environmental database by the World Resources Institute that tracks environmental, social, and economic trends.
Link to Other Resources
Other Gateway resources include links to glossaries, listservs and newsletters, online photos and images, and event listings related to agriculture and public health.
Register as a Gateway Member
The U.S. Department of Health and Human Services today issued its new Strategic Framework on Multiple Chronic Conditions― an innovative private-public sector collaboration to coordinate responses to a growing challenge.
More than a quarter of all Americans ― and two out of three older Americans ― have multiple chronic conditions, and treatment for these individuals accounts for 66 percent of the country’s health care budget. These numbers are expected to rise as the number of older Americans increases.
The health care system is largely designed to treat one disease or condition at a time, but many Americans have more than one ― and often several ― chronic conditions. For example, just 9.3 percent of adults with diabetes have only diabetes, according to the Medical Expenditure Panel Survey from the Agency for Healthcare Research and Quality (AHRQ). And as the number of chronic conditions one has increases, so, too, do the risks of complications, including adverse drug events, unnecessary hospitalizations and confusion caused by conflicting medical advice.
The new strategic framework ― coordinated by HHS and involving input from agencies within the department and multiple private sector stakeholders ― expects to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions by fostering change within the system; providing more information and better tools to help health professionals ― as well as patients ― learn how to better coordinate and manage care; and by facilitating research to improve oversight and care.
“Individuals with multiple chronic conditions deserve a system that works for them,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “This new framework provides an important roadmap to help us improve the health status of every American with chronic health conditions.”
The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program. And individuals with multiple chronic conditions also face increased out-of-pocket costs for their care, including higher costs for prescriptions and support services.
“Given the number of Medicare and Medicaid beneficiaries with multiple chronic conditions, focusing on the integration and coordination of care for this population is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD.
The Affordable Care Act, with its emphasis on prevention, provides HHS with exciting new opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them.
“We need to learn rapidly how to provide high quality, safe care to individuals with multiple chronic conditions. AHRQ’s investments assess alternative strategies for prevention and management of chronic illness, including behavioral conditions, in persons with varying combinations of chronic illnesses,” said AHRQ Director Carolyn M. Clancy, MD.
HHS has taken action in recent months to improve the health of individuals with multiple chronic conditions. Some examples include:
- Administration on Aging (AoA)/ Centers for Medicare and Medicaid Services Administrator (CMS)
AoA and CMS jointly announced $67 million in grants to support outreach activities that encourage prevention and wellness, options counseling and assistance programs, and care transition programs to improve health outcomes in older Americans.
- Agency for Healthcare Research and Quality (AHRQ)
AHRQ awarded more than $18 million dollars (American Recovery and Reinvestment Act) in two categories of grant awards to understand how to optimize care of patients with multiple chronic conditions.
- Assistant Secretary for Planning and Evaluation (ASPE)
As part of an existing $40 million ASPE contract, the National Quality Forum is undertaking a project to develop and endorse a performance measurement framework for patients with multiple chronic conditions.
CDC is supporting a new project ― Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life ― in which the Institute of Medicine will convene a committee of independent experts to examine the burden of multiple chronic conditions and the implications for population-based public health action.
CMS has provided recent guidance to State Medicaid directors on a new optional benefit available Jan. 1, 2011, through the Affordable Care Act, to provide health homes for enrollees with at least two chronic conditions, or for those with one chronic condition who are at risk for another.
- Food and Drug Administration/ Assistant Secretary for Planning and Evaluation (FDA/ASPE)
FDA and ASPE launched a study to examine the extent to which individuals with multiple chronic conditions are being included or excluded from clinical trials for new therapeutic products.
- Indian Health Service (IHS)
IHS has expanded its Improving Patient Care Program to nearly 100 sites across the tribal and urban Indian health system to assist in improving the quality of health care for patients with MCC.
NIH has committed $42.8 million for a study to determine whether efforts to attain a lower blood pressure range in an older adult population will reduce other chronic conditions.
SAMHSA awarded $34 million in new funding to support the Primary and Behavioral Health Care Integration Program, which seeks to promote the integration of care with people with co-occurring conditions.
For more information about the new HHS Strategy on Multiple Chronic Conditions, go to:http://www.hhs.gov/ash/initiatives/mcc/
Trust for America’s Health is a “non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority”.”By focusing on PREVENTION, PROTECTION, and COMMUNITIES, TFAH is leading the fight to make disease prevention a national priority, from Capitol Hill to Main Street. We know what works. Now we need to build the resolve to get it done.”
Trust for America’s Health includes the following
- How Healthy Is Your State? (home page link) where you can select a state from the drop-down menu. Statistics include adult health indicators (as cancer and asthma), child and adolescent health facts (as pre-term labor), obesity and diabetes rates, and program spending
- Current Report topics include the flu, liver diseases, preventative health care, how public dollars are spent on health care, and keeping America’s food supply safe
- Advice is given on Advocacy issues, including writing representatives and joining grassroot organizations
- The Resource Library provides links to organization and other Web sites in topics as Health Reform Legislation, Health Disparities, Environmental Health, and Food Safety
Includes simple and clearly labelled diagrams of the circulatory system, the brain, the torso, the female reproductive system, and others. Summaries of systems and related information. Each diagram and rendering contains a brief discussion of the system in question, along with a selection of related information on the left-hand side of the page. The section titled “Effects of Stroke” is quite effective, and this site will be a useful resource for the general public, medical professionals, and others working in related fields.
Other Online Human Body Atlases***
“Visually Learn About the Human Body Using Our Interactive Animations”
Meant to supplement McGraw Hill Higher Education physical textbooks. Includes interactive animations and additional resources as quizzes and fact sheets. IPad compatible versions
A virtual 3D body that brings to life “thousands of medically accurate anatomy objects and health conditions in an interactive web-based platform.” Hundreds of interactive features and customized views that look through all of the body systems .Annotated Screenshots area save and share these powerful tools for use in a range of settings. While the Basic version is completely free, there are other levels of functionality available for a fee
The classic illustrated text of human anatomy (20th edition, 1918) is now available online. It is fully searchable by keyword, table of contents, or subject index containing 13,000 entries. From Bartleby.com.
InnerBody: Your Guide to Human Anatomy Online ***
“The place for fun, interactive and educational views of the human body.” You can explore human anatomy through illustrations, animation, tutorials, and descriptions.
“Human Anatomy On-line, the place for fun, interactive and educational views of the human body. This program contains over one hundred illustrations of the human body with animations and thousands of descriptive links.”
“layered, interactive, high resolution experience allows users to zoom, pan, rotate, the human body, and to visualize its organs, systems, bones, and muscles.”[From Google launches Body Browser/joycevalenz]
Designed for first year medical students, useful for others taking biology related courses. Material arranged in six sections ranging from extremities to the head and neck. Each area contains a variety of detailed anatomical charts, glossaries, and images. Each section includes many radiology resources for different perspective of the human body through x-rays, CT scans, and MRIs. Other helpful resources include fact sheets, quizzes, teaching materials, and other freely available course materials offered from other medical schools. State University of New York-Upstate Medical University [KMG]
“Animated Anatomies explores the visually stunning and technically complex genre of printed texts and illustrations known as anatomical flap books. These publications invite the viewer to participate in virtual autopsies, through the process of unfolding their movable leaves, simulating the act of human dissection. This exhibit traces the flap book genre beginning with early examples from the sixteenth century, to the colorful “golden age” of complex flaps of the nineteenth century, and finally to the common children’s pop-up anatomy books of today.”
A collection of games, videos, and other multimedia excursions. Created by Australian science teacher Ben Crossett. Games here include jigsaw puzzles, crosswords, word searches, and the catch all Just For Fun.
Anatomy Resources (American Association of Anatomists) includes these and many more
From the Dartmouth Medical School, the Human Anatomy Learning Web Site is a work in progress, focusing on the needs of first-time students of human anatomy. Its aim is to help students learn clinically relevant anatomy with maximum efficiency.
From the University of Minnesota.A collection of study aids for entry-level anatomy and physiology students. Self Tests … Inquiry, Ideas, Thoughts, Learning, Curriculum.
Pocket Body iPhone app (Google Chrome Biodigital Human)
The BioDigital Human is a 3D platform for the understanding of anatomy, disease and treatments.Interactive tools for exploring, dissecting, and sharing custom views, combined with detailed medical descriptions.
*** There are only a limited number of free comprehensive online human body atlases online.
If these do not fit your needs, consider going to a nearby public, academic, or medical library.
Many academic and medical libraries are open to the public (all libraries receiving state funding are open to the public). Don’t forget to ask for a reference librarian if you would like professional assistance!
Many academic and medical libraries provide at least some reference assistance to the public. Call ahead and ask about library services to the public. You may be pleasantly surprised.
As always, feel free to contact me by leaving a comment ( it will not be posted). Or email me at jmflahiff, currently residing at her yahoo dot com account.
I would be happy to search for an image or information meeting your needs. Will reply within 48 hour.
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Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism
[Flahiff's note: Here in Northwest Ohio, one area of concern is Lake Erie water sampling for organisms as E. coli and toxic algae. For years a private college was doing the testing with their own funds. The funds have dried up and the state is still trying to come up with reliable funding.]
The findings of this report by the Trust for America’s Health and Robert Wood Johnson Foundation are that budget cuts have imperiled a decade of progress in how the nation prevents, identifies, and contains new disease outbreaks and bioterrorism threats and responds to the aftermath of natural disasters.
Section 1 of the report provides a state by state evaluation on 10 key preparedness indicators in areas as funding, communication, planning, and staffing.
Section 2 of the report examines current federal policy issues and gives recommendations for improving disaster preparedness.
Gaps in preparedness are outlined (as workforce gaps) and examples of major emergency public health threats are identified. Hallmarks of all-hazards preparedness are also identified and National Health Security Strategy is outlined.
The report also includes expert perspectives national strategies and over 70 scientific/medical references in the endnotes section.
Key Findings of this Report (from page 5 of the report)
- 33 states and D.C. cut funding for public health from FY 2008-09 to FY 2009-10.
- Only 7 states can not currently share data electronically with health care providers.
- 10 states do not have an electronic syndromic surveillance system that can report and exchange information.
- Only six states reported that pre-identified staff were not able to acknowledge notification of emergency exercises or incidents within the target time of 60 minutes at least twice during 2007-08.
- Six states did not activate their emergency operations center (EOC) a minimum of two times in 2007-08.
- Only two states did not develop at least two After-Action Report/Improvement Plans (AAR/IPs) after exercises or real incidents in 2007-08.
- 25 states do not mandate all licensed child care facilities to have a multi-hazard written evacuation and relocation plan.
- 21 states were not able to rapidly identify disease-causing E.coli O157:H7 and submit the lab results in 90 percent of cases within four days during 2007-08.
- Only three states and D.C. report not having enough staffing capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1.
- Only one state decreased their Laboratory Response Network for Chemical Threats (LRN-C) chemical capability from August 10, 2009 to August 9, 2010.
The Disaster Information Management Research Center (DIMRC) helpswith national emergency preparedness, response, and recovery efforts. As part of NLM’s Specialized Information Services (SIS) division, DIMRC collects, organizes, and disseminates health information resources and informatics research related to disasters of natural, accidental, or deliberate origin.
It focuses on maintaining access to health information during disasters and developing services and projects for emergency providers and managers . (From the DMIRC about page).
A sampling of DMIRC resources
- Emergency and Response Tools as Wireless Information System for Emergency Responders (WISER). WISER helps emergency responders identify hazardous materials and respond to chemical emergencies. It contains information on over 400 chemicals and radiologic agents.
- Disaster Medicine and Public Health Literature . For example, the Resource Guide for Public Health Preparedness includes expert guidelines, factsheets, websites, technical reports, articles, and more.TOXLINE contains over three million references from the toxicology literature, including MEDLINE/PubMed, research in progress, and meeting abstracts.
- Librarians and Disasters has links to resources and tools as a bibliography on the librarian’s role in disasters and links to related listservs. The Emergency Access Initiative provides temporary free access to full text articles from major biomedicine titles to healthcare professionals, librarians, and the public affected by disasters.
Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:
- Encourage collaborations across sectors.
- Guide individuals toward making informed health decisions.
- Measure the impact of prevention activities.
Healthy People 2020 strives to:
- Identify nationwide health improvement priorities.
- Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
- Provide measurable objectives and goals that are applicable at the national, State, and local levels.
- Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge.
- Identify critical research, evaluation, and data collection needs.
The 40+ 2020 topics and objectives include
From an NLM-TOX-ENVIRO-HEALTH-L NOTICE ( a US National Library of Medicine listserv)
The Resource Guide for Public Health Preparedness has a new look and new
web address, http://phpreparedness.nlm.nih.gov. It is now a featured
resource on the Disaster Information Management Research Center (DIMRC)
web site, http://disasterinfo.nlm.nih.gov.
The Resource Guide was first developed by the New York Academy of Medicine
Library in 2002 with funding from the National Library of Medicine (NLM)
National Information Center on Health Services Research and Health Care
Technology (NICHSR). The Guide is now jointly funded by NICHSR and DIMRC.
The Guide continues to provide access to no-cost web materials on public
health preparedness topics for the public health workforce.
Recently, this database and web site moved to NLM and the content
continues to be maintained by the New York Academy of Medicine Library.
Previous web addresses will automatically take the user to the new web
address. Comments and questions about the Resource Guide may be sent to
[Editor Flahiff’s note: There does not seem to be any browse feature, there is, however, a Site map and search feature.
The Learning Connection home page allows one to search/browse by topic, media (as podcasts), and title.
A sampling of current products
Help a Hurting Heart (A Minute of Health with CDC) [podcast]
Immunizations and Vaccines (textbooks, flyers, manuals, posters, stickers, buttons and many more publication types)41.663938 -83.555212
By: Blendon RJ, Benson JM, SteelFisher GK and Connolly JM
In: Health Affairs, 29(11), pp.2033-2040 [click here for the full text of the article]
Publisher: Project HOPE-The People-To-People Health Foundation, Inc.
Published: November 2010
This analysis of national opinion polls shows that a majority of Americans support increased spending on public health in general and that they see public health interventions as saving money in the long term. At the same time, many do not favor increased federal spending in a number of areas that public health officials deem important. In addition, polls show striking partisan differences, with Republicans much less supportive than Democrats of additional spending on public health. This split may have political implications for the public health component of the new health reform law if there is a change in party control of one or more houses of Congress after the November 2010 elections. As a result, in order to sustain public support for increased spending, it will be critically important to give examples of cost savings from public health programs and to highlight how they have reduced mortality from major chronic illnesses, such as cancer, heart disease, and HIV/AIDS.
The History of Medicine Division of the US National Library of Medicine (NLM) maintains both print and online historical collections.
The print resources are available through the NLM History of Medicine Reading Room in Washington, DC.
The NLM librarians have made portions of the History of Medicine collection freely available online.
Against the Odds: Making a Difference in Global Health
Includes downloads, games, lesson plans, and a virtual related exhibit
Visible Proofs: Forensic Views of the Body
Focuses on the history of forensic medicine
An exhibition about anatomy and the artistic imagination
Historical Anatomies on the Web
High-quality images from important anatomical atlases in the Library’s collection
Profiles in Science
Archival collections of twentieth-century leaders in biomedical research and public health are available to the public through modern digital technology
Emotions and Disease (2000)
Frankenstein: Penetrating the Secrets of Nature (1998) (2009)
Excerpts from a US Food and Drug Adminstration (FDA) Oct 6 press announcement
The U.S. Food and Drug Administration today unveiled a report outlining the agency’s plans to advance regulatory science through its Regulatory Science Initiative.
Regulatory science is the science of developing new tools, standards and approaches for assessing the safety, efficacy, quality and performance of FDA-regulated products.
The report provides examples of current FDA activities in regulatory science and also considers how advancements in the field can help deliver better, safer, more innovative products to Americans in seven different public health areas.
Copies of the report will be released at the National Press Club in Washington, D.C., when FDA Commissioner Margaret A. Hamburg M.D. speaks to a club luncheon.
Her address will begin at 1 p.m. and will be broadcast live by C-SPAN.
For more information:
From a blog item sponsored by Masters of Public Health
These fifty Web sites offer assistance, news and information at all levels and in all topics from the flu to how the environment and animals contribute to public health issues.
Categories include Government Public Health, Public Health Associations and Organizations, Public Health Policy and Law, Public Health Web Sites and Libraries, and Journals.
The US Centers for Disease Control(CDC) has recently launched the National Environmental Public Health Tracking Network. This network is part of an organizational shift by the CDC from infectious disease to environmental health.
It aims to correlate how the environment might affect a person’s health and how people might affect the health of the environment. It also allows users to find local environmental health data.
Currently information is arranged under three topics at the home page:
- Environments (Homes, Outdoor Air, and Water)
- (7)Health Effects including asthma, lead poisoning, heart attacks, cancer, and reproductive/birth outcomes
- Info by Location where data are displayed by state, county, and zip code.
Check out the About page for more information.
Steve Luce of the CDC spoke about this product at this year’s CAPHIS **business meeting.
His presentation included the following points:
- The public is certainly welcome to view the data at the Web site. However, the CDC does not recommend that the public take actions based on the data. The data is being made available primarily for local entities to build programs based on that data.
- Privacy laws prevented access to some data at “very” local levels. That data would be available only to professionals with a need to know. Small geographic levels with small populations increase the probability that individuals could be identified.
- There are presently overlaps with Toxtown. However efforts are being made to reduce duplication.
**Consumer and Patient Health Information Section of the Medical Library Association