We Are What We Breathe: The Impacts of Air Pollution on Employment and Productivity – Up Front Blog – Brookings Institution

Excerpts from the report
We Are What We Breathe: The Impacts of Air Pollution on Employment and Productivity – Up Front Blog – Brookings Institution

The Impact of Air Pollution on Health and Productivity
Air pollutants are linked to higher rates of infant mortality, increased frequencies of low birth weight, greater risks of asthma attacks and other forms of respiratory sickness, and premature mortality among adults. The incidence of low birth weight has been associated with higher health care costs and reduced earnings later in life. More broadly, good health is also a requisite for being productive on the job, and thus air pollution also affects employment and productivity.

In an intriguing new paper, elevated ozone concentrations, even at levels well below current federal air quality standards, was found to reduce productivity of farm workers in California. Another study found that higher carbon monoxide concentrations result in increased school absences.

In short, air pollution has a direct impact on the health and productivity of today’s and tomorrow’s work force.

Related articles

• Shanghai air pollution reaches record levels – how to track air quality around the world (environmentaleducationuk.wordpress.com)
• Half of US population breathes polluted air: report (news.bioscholar.com)
• Asthma in the US: Growing Every Year (cdc.gov)
• The Link Between Air Pollution and Asthma (everydayhealth.com)

JAMIA reports on people, their information needs and social networks

From the 6 May 2011 Eureka news alert

The May issue of JAMIA, the top-ranked journal reporting on informatics in biomedical and health informatics, features new scientific research—in print and online—on healthcare’s hottest HIT-related topics, written by prominent experts working in health and biomedicine.

[The online May issue may be found here. Most articles are by paid subscription/fee only.
For suggestions on how to get articles for free, click here.]

Editor-in chief Lucila Ocho-Machado bullets some of the rich content in the newly released, current issue:

• “A secure protocol for protecting the identity of providers when disclosing data for disease surveillance” (Editor’s Choice, available free online) — Lead author Khaled El Emam of Children’s Hospital of Eastern Ontario Research Institute, Ottawa, proposes a protocol to protect the privacy of providers who disclose data for public health purposes. A related online appendix describes the technical details.
• “Rank-based spatial clustering: an algorithm for rapid outbreak detection” — Lead author Jialan Que of the RODS Laboratory at the Department of Biomedical Informatics at University of Pittsburgh describes a new algorithm for rapid outbreak detection that ranks regions according to risk, then uses these rankings to define clusters, in contrast with other techniques that search for predetermined cluster shapes around a high-risk area.
• “Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access” (Editor’s Choice, available free online) —Lead author Urmimala Sarkar of University of California’s Department of Medicine, Division of General Internal Medicine, describes disparities in patient usage of a diabetes online resource, and indicates that the gap cannot be solely justified on the basis of differences in access to technology.
• “Can poison control data be used for pharmaceutical poisoning surveillance?” — Lead author Christopher A. Naun of Intermountain Injury Control Research Center in Salt Lake City, reports on the pros and cons of using poison control data for decision support related to pharmaceutical surveillance.

Other JAMIA content includes examination of:

• electronic health records in small physician practices
• the quality and safety of diabetes-related online social networks
• information needs of case managers caring for people living with HIV
• the accuracy of a computerized clinical-decision support system for asthma assessment and management

“This issue provides a sample of the diversity of approaches and disciplines that make our field so fascinating,” says Dr. Ohno-Machado, introducing the current issue. She reminds readers that “informatics is as much concerned about people, their information needs, and their social networks, as it is about algorithms and systems.”

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JAMIA is jointly published by AMIA and the BMJ Group. Its content appears online at www.jamia.org

AMIA, as the voice of the biomedical and health informatics community, plays an important role in medicine, health care, and science, encouraging the use of data, information and knowledge to improve both human health and delivery of healthcare services. AMIA is an unbiased, authoritative source of information within the professional informatics community and the health care industry, committed to driving health improvements and improving healthcare delivery.

Related articles

• The Evolving World of Informatics: Biomedical Informatics, Bioinformatics, Clinical Informatics, Public Health Informatics, and more (medicineandtechnology.com)
• Health Informatics and Social Media (scienceroll.com)
• Fuller to give ‘Preventative Informatics’ lecture (bluecoastlive.wordpress.com)
• IU Personalized Medicine Institute to develop targeted and individualized treatments (jflahiff.wordpress.com)
• Report from AMIA – All Diseases will become Orphan (ehealth.johnwsharp.com)

Health Care Delivery Needs To Be A Science Too, Carolyn Clancy Tells University Of Maryland

From the 6 May 2011 Medical News Today article

Carolyn Clancy, MD, director of the federal Agency for Healthcare Research and Quality (AHRQ), says that although the U.S. “leads the way” in science to develop medical methods, the country still needs to treat health care delivery as a science.

Health care should emulate Starbucks in teamwork, Clancy told a standing-room audience at Pharmacy Hall at the University of Maryland School of Pharmacy. “They get it. You order a drink at the cashier, even one of those complicated ones. The cashier repeats it back to you and writes it on the cup. Then she repeats it to the person making it, who also repeats it. Most of medicine has not done that. They do a better job at Starbucks.” …

…Delivering the annual Andrew G. Dumez Memorial Lecture, “Research Meets Practice at the RX: Keeping Patients and Consumers at the Center of Care,” Clancy provided a high-level view of the current challenges to improve the quality of care, as well as the pharmacists’ roles in those challenges. As a producer of what Clancy called “benchmark” reports for health care industry and policymakers, AHRQ “supports research that helps people make more informed decisions and improves the quality of health care services,” according to its website.

Clancy praised the current collaborative trend in health care research, which is designed to inform health care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care. Such “patient-centered research,” she said, greases the skids of scientific advances into actual clinical practice and usable information for clinicians and patients.

During the creation of the American Recovery and Reinvestment Act of 2009, “All parties agreed,” she said, that “patient-centered care needs to involve more than clinical intervention. It also needs to include such things as drug-to-drug interaction, care management, avoiding hospital stays” and more.

Clancy said a recent AHRQ report found that progress has been made in data collection in the health care system as more providers are collecting and storing patient data. The team concept in health care transcends the “my data” mentality of the past, she said. “We are getting to a point when data are ubiquitous, allowing for more success in using comparative effectiveness as a tool, with improved methods that can support learning and improvement at the front lines of care delivery.”

Addressing the pharmacy students in attendance, Clancy said, “If there was ever a time when we need you, it is now. It is becoming increasingly important to safety and quality is to do medicine as a team sport. And the pharmacist is a vital member of the team.” …..

Related articles

• Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist (jflahiff.wordpress.com)
• Navigating the Health Care System (nlm.nih.gov)

Dietary Salt Restriction May Be Detrimental to One’s Health (and a rebuttal in the journal Lancet)

For years the conventional medical wisdom has been to reduce salt intake for improved cardiovascular health and reduced hypertension risks.

Now it seems that limiting dietary salt may not only not work as advocated, but also be detrimental to one’s health.

From the 3 May  News@JAMA site (Journal of the American Medical Association)

May 3, 2011
Author Insights: Questioning the Benefits of Salt Restriction
Filed under: Cardiovascular Disease/Myocardial Infarction,Diet,Hypertension,Stroke — Mike Mitka @ 4:09 pm

Research by Jan A. Staessen, MD, PhD, of the University of Leuven in Belgium and colleagues, raises questions regarding whether population-wide sodium restriction will actually lower cardiovascular risks. (Image: University of Leuven)

Research by Jan A. Staessen, MD, PhD, of the University of Leuven in Belgium and colleagues, raises questions regarding whether population-wide sodium restriction will actually lower cardiovascular risks. (Image: University of Leuven)
National policies that advise restricting sodium (salt) intake to reduce the risk of hypertension might not provide the anticipated cardiovascular benefits and may even be detrimental to health, report researchers in an article in today’s JAMA.
In the study, the researchers categorized the 3681 study participants according to sodium intake, using a procedure that measures sodium in the urine over a 24-hour period, considered the gold standard for such assessment. At a median of nearly 8 years later, participants in the group with the lowest sodium intake at the beginning of the trial were significantly more likely than the other 2 groups to die of cardiovascular disease.

The researchers also found that these 3 groups had the same risk of developing hypertension, regardless of initial sodium intake. They did find in a subgroup of 1499 study participants who had sodium intake measured at the beginning and at the end of the study that an increase in sodium intake was associated with an increase in systolic (but not diastolic) blood pressure. However, this relationship did not result in a higher risk of complications from hypertension or cardiovascular disease, such as heart attack or stroke.

Jan A. Staessen, MD, PhD, professor of medicine at the University of Leuven in Belgium and one of the study’s authors, discusses his team’s findings:

news@JAMA: Are you surprised by your results?

Dr Staessen: Not so much. We started this research more than 25 years ago, and in all our studies, it was almost impossible to find an association between blood pressure and 24-hour sodium excretion. We were a bit surprised to see an inverse relationship between sodium intake and cardiovascular death.

news@JAMA: Why would lowering sodium intake possibly increase cardiovascular risk?

Dr Staessen: Ours is an epidemiological study so we cannot be sure of the underlying mechanism. But if you decrease sodium intake a lot, you activate some of the systems that conserve sodium and they are known to have a negative influence on cardiovascular outcomes. This may be an underlying mechanism.

news@JAMA: Where does your study fit into the discussion of mandating sodium restriction in foods to improve health, as advocated by some public health officials and government agencies?

Dr Staessen: One should be very careful when one wants to implement [sodium restriction], as it is based on short-term studies mainly in hypertensive populations. Whether one can extrapolate these short-term results over the long term remains to be seen, especially as our study and 2 previous studies have shown an inverse association between sodium intake and mortality.

news@JAMA: What is needed to provide a clearer picture of the benefits and risks of controlling sodium consumption?

Dr Staessen: What one needs is a long-term interventional study to look at cardiovascular complications. Reducing blood pressure is not what one is in this for. You want to show that it actually changes cardiovascular outcomes.

Related articles

• The Science Is Settled (maxredline.typepad.com)

• Less Salt, Less Strokes, Says New Research (Science Daily, August 11, 2011)

• To Salt Or Not To Salt, That Is The Question (Medical News Today, June 2011)
• Eat Less Salt – and Die? (psychologytoday.com)
• Is the war on salt justified? (macleans.ca)
• Heart Benefits From Cutting Back on Salt? (webmd.com)

        “A new eight year long European study concludes that salt consumption is not dangerous and may in fact be beneficial. This is certainly contrary to advice from American Medical Association, American Heart Association and the Center for Disease Control and Prevention, which says higher sodium consumption can increase the risk of heart disease. It’s not unusual to see differing opinions, but what are we ordinary folks to make of the controversy? The study followed 3,681 middle-aged Europeans who did not have high blood pressure or heart disease at the start of the study…”

• High Potassium-To-Sodium Ratio May Reduce Risk Of Cardiovascular Disease (Medical News Today, 6 May 2011)
• False Assumption That Salt is “Bad” For Us Is Creating Iodine Deficiency (Health and Well-Being Blog)
• High salt diet ‘lowers heart disease risk’ (news.bioscholar.com)
• ‘Salt intake drop could increase chances of heart disease’ (dailymail.co.uk)
• Cochrane Salt/Blood-Pressure Message Blasted in the Lancet “July 28, 2011 (London, United Kingdom) — Two preventive-medicine experts in the UK are crying foul over a recent and controversial meta-analysis that concluded cutting salt consumption would have no clear health benefits [1]. In a Comment published in the July 30, 2011 issue of theLancet, Dr Feng J He (Queen Mary University, London, UK) and Dr Graham A MacGregor(Wolfson Institute of Preventive Medicine, Barts, London, UK) say that the meta-analysis published simultaneously by Taylor and colleagues in the Cochrane Review [2] and the American Journal ofHypertension [3] and press release that accompanied it “reflect poorly on the reputation of the Cochrane Library and the authors.””…….
• Eat Less Salt – and Die? (psychologytoday.com)
• Is the war on salt justified? (macleans.ca)
• Heart Benefits From Cutting Back on Salt? (webmd.com)