New from Health Affairs: Community development and health

Public Health--Research & Library News

It has been known for some time that many factors beyond health care influence health. More recently, networks of real estate developers, banks, city planners, and non-profit groups have been collaborating with public health and related health-focused institutions to improve health. A key goal is to invest in low-income communities by affording them access to nutritious food, green spaces, and other healthful attributes.

This latest health policy brief from Health Affairs and the Robert Wood Johnson Foundation describes activities under way as well as the potential for these two groups to work together, as follows:

• Efforts underway: A look at successful projects, such as the redevelopment of San Francisco’s largest public housing community, Sunnydale. Through a partnership between the developers and the University of California, data are being collected to establish a baseline measurement of residents’ social and physical well-being.

• Federal Initiatives: From the new White House Office of Urban…

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ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients

 

From the 14 December press release via Eureka Alerts

As part of its ongoing efforts to ensure safe, effective and appropriate medical imaging, the American College of Radiology has joined the ABIM Foundation and eight other medical specialty societies in Choosing Wisely. The new campaign promotes wise choices by physicians and patients to improve health outcomes, avoid unnecessary interventions and make efficient use of healthcare dollars.

The ACR will develop a list of five things to reduce unnecessary imaging exams ordered by physicians and improve quality of care. The list names imaging exams whose necessity should be discussed before being ordered. The list also equips providers with steps to help ensure safe, appropriate use of scans.

“Medical imaging exams are a perfect fit for Choosing Wisely. Scans lower healthcare costs by replacing more invasive surgeries and allowing for shorter hospital stays. Although imaging use is down significantly since 2008 and Medicare spending on imaging is the same as in 2004, opportunities remain to ensure appropriate ordering of scans. As greater access to imaging is directly tied to increased life expectancy, ACR will identify areas where care can be improved without restricting patient access,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors……

…….

The ACR list, and those of other Choosing Wisely partners, will be released in April 2012. To learn more, visit ChoosingWisely.org.

The ChoosingWisely Web page includes the following under Resources

• Five Things Physicians and Patients Should Question
• Choosing Wisely Video Mini-Series
  

This series of six video vignettes featuring physicians and patients emerged from research the ABIM Foundation conducted to better understand public and professional attitudes about stewardship of finite resources. Watch the videos.

 

Related articles

• ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients (medicalxpress.com)

Study takes aim at education-based death rate disparities

From the 15 December 2011 news release via Eureka alerts

WASHINGTON, DC — A study in the December issue of the American Sociological Review has brought new understanding as to why death rates for less educated middle aged adults are much higher than for their more educated peers despite increased awareness and treatments aimed at reducing health disparities.

[Full text of the article  The Enduring Association between Education and Mortality: The Role of Widening and Narrowing Disparities is free at http://asr.sagepub.com/content/76/6/913.full.pdf+html

Click here for the accompanying 7 minute interview podcast.  The author talks about the findings in his work, implications, and touches on the processes of doing the research and writing the paper. The author comes across as knowledgeable, reflective, willing to learn from others,  grateful for financial support, and driven to share his knowledge for the benefit of all]

For decades, data has shown that middle aged adults with low education levels—that is high school or less—are twice as likely to die as those with higher education levels. Professor Richard Miech, of the Department of Health and Behavioral Sciences at the University of Colorado Denver’s College of Liberal Arts and Sciences, and his colleagues wanted to better understand why this persists. They found that as new causes of death emerge, people with lower education levels are slower to respond with behavioral changes, creating a moving target that often remains a step ahead of prevention. Almost all causes of death that are on the increase are fueled by high rates of mortality among people with lower education, a trend that counters any progress made in the reduction of today’s health disparities….

Read the entire Eureka News alert

Related articles

• Study takes aim at education-based death rate disparities (eurekalert.org)
• Health gap has grown among young US adults, study finds (eurekalert.org)
• Substantial Health Disparities Among Young US Adults (jflahiff.wordpress.com)
• Call to fight deaths from diabetes (mirror.co.uk)
• New city data to help improve health in neighborhoods (Baltimore Sun)

Brain’s Failure to Appreciate Others May Permit Human Atrocities

From the 15 December 2011 Medical News Today article

A father in Louisiana bludgeoned and beheaded his disabled 7-year-old son last August because he no longer wanted to care for the boy. For most people, such a heinous act is unconscionable.

But it may be that a person can become callous enough to commit human atrocities because of a failure in the part of the brain that’s critical for social interaction. A new study by researchers at Duke University and Princeton University suggests this function may disengage when people encounter others they consider disgusting, thus “dehumanizing” their victims by failing to acknowledge they have thoughts and feelings.

This shortcoming also may help explain how propaganda depicting Tutsi in Rwanda as cockroaches and Hitler’s classification of Jews in Nazi Germany as vermin contributed to torture and genocide, the study said.

“When we encounter a person, we usually infer something about their minds. Sometimes, we fail to do this, opening up the possibility that we do not perceive the person as fully human,” said lead author Lasana Harris, an assistant professor in Duke University’s Department of Psychology & Neuroscience and Center for Cognitive Neuroscience. Harris co-authored the study with Susan Fiske, a professor of psychology at Princeton University.

Social neuroscience has shown through MRI studies that people normally activate a network in the brain related to social cognition — thoughts, feelings, empathy, for example — when viewing pictures of others or thinking about their thoughts. But when participants in this study were asked to consider images of people they considered drug addicts, homeless people, and others they deemed low on the social ladder, parts of this network failed to engage.

What’s especially striking, the researchers said, is that people will easily ascribe social cognition — a belief in an internal life such as emotions — to animals and cars, but will avoid making eye contact with the homeless panhandler in the subway.

“We need to think about other people’s experience,” Fiske said. “It’s what makes them fully human to us.”…

Read the entire article

 

 

 

Related articles

• A brain’s failure to appreciate others may permit human atrocities (esciencenews.com)
• A brain’s failure to appreciate others may permit human atrocities (eurekalert.org)
• Why Leaders Should Care About Cognitive Neuroscience (forbes.com)
• Scientists’ Idea Helps Explain ‘What and Where’ People See (prnewswire.com)
• Wisdom through Mindfulness: Cognitive Neuroscience of Mindfulness Meditation (adultadhdhelp.net)

Further Study Necessary To Better Utilize Nature’s Medicine Cabinet

From the 15 December 2011 Medical News Today article

There are probably at least 500 medically useful chemicals awaiting discovery in plant species whose chemical constituents have not yet been evaluated for their potential to cure or treat disease, according to a new analysis by a New York Botanical Garden scientist who has more than 15 years of experience in collecting plants for natural-products discovery programs.

Currently, 135 drugs on the market are derived directly from plants; the analysis indicates that at least three times as many disease-fighting substances have yet to be found that could be developed into drugs or used as the basis for further drug research.

“Clearly, plant diversity has not been exhausted, and there is still great potential in the plant world,” said James S. Miller, Ph.D., Dean and Vice President for Science at the Botanical Garden.

Dr. Miller’s analysis, “The Discovery of Medicines from Plants: A Current Biological Perspective,” is published in the December issue of the peer-reviewed journal Economic Botany. …

[Web site of journal is here, for options on how to get the article for free or at low cost, click here]

…

Dr. Miller argues that one possible explanation for the low yield is the relatively crude way in which plant extracts were tested for their pharmaceutical potential. Plants may contain as many as 500 to 800 different chemical compounds, but the screening programs of the late 20th century used extracts made from a whole plant or at best extracts that contained many hundreds of compounds.

Under those circumstances, one compound may interfere with the action of another, or the amount of one compound may be too small to register in a mix of hundreds of chemicals.

To correct this problem, new technologies now allow researchers to separate complex mixtures of natural products into a “library” of relatively pure compounds that can be tested individually. A 2002 study demonstrated that testing such libraries dramatically improves discovery rates. …..

Read the entire news article

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• Nature’s medicine cabinet could yield hundreds of new drugs (scienceblog.com)
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• Work sheds new light on medicinal benefits of plants (eurekalert.org)
• Scientists examine toxicity of medicinal plants in Peru (physorg.com)
• Missouri Botanical Garden scientists examine toxicity of medicinal plants in Peru (eurekalert.org)
• World’s largest medicinal botanic garden in China (news.bioscholar.com)
• Botanical Dietary Supplements Background Information (everydayhealth.com)
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Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children

Proportion of MRSA human blood isolates from participating countries in 2008***

From the 14 December edition of Full Text Reports

Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children

Source:  Archives of Pediatrics & Adolescent Medicine

Objective
To investigate in children the association between antibacterial drugs and subsequent diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) in the community.

Design
Population-based case-control study in children 1 to 19 years of age.

Setting
Primary care, General Practice Research Database, United Kingdom, 1994-2007.

Participants
Cases were children who had MRSA diagnosed as outpatients, and controls were individually matched on age and practice, with the matched case’s diagnosis date as the index date for both.

Main Exposures
Antibacterial agents prescribed 180 to 30 days prior to the index date, excluding prescriptions 30 days before the index date to prevent protopathic bias.

Outcome Measures
Rate ratios (RRs) estimated from the odds ratios of exposure in cases compared with controls using conditional logistic regression, adjusted for comorbid conditions, other prescription drug use, and hospitalization.

Results
The rate of MRSA was 4.5 per 100 000 per year. Of 297 cases and 9357 controls, 52.5% and 13.6%, respectively, received antibacterial drug prescriptions during the 150-day exposure window. The adjusted RR with any antibacterial drug was 3.5 (95% confidence interval [CI], 2.6-4.8). The RRs increased with the number of prescriptions (2.2 [95% CI, 1.5-3.2], 3.3 [95% CI, 1.9-5.6], 11.0 [95% CI, 5.6-21.6], and 18.2 [95% CI, 9.4-35.4] for 1, 2, 3, and 4 prescriptions, respectively). The RR was particularly elevated for quinolones at 14.8 (95% CI, 3.9-55.8), with wide variation among antibacterial classes.

Conclusion
While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs, such agents are associated with a dose-dependent increased risk, concordant with findings in adults.

***Image from http://commons.wikimedia.org/wiki/File:EARSS_MRSA_2008.sv, Institute for Public Health and the Environment (RIVM), Epidemiology and Surveillance, 3720 BA Bilthoven,The Netherlands

 

Related Resources

• MRSA (MedlinePlus) A general guide with links to overviews, diagnosis/symptoms, specific conditions, news items, and more
• MRSA Infection (eMedicine Health)  A patient/consumer guide with links to diagnosis/symptoms, risk factors, images, and slideshows
• Methicillin-resistant Staphylococcus Aureus (MRSA) Infections (CDC) Comprehensive guide with links to definition, symptoms, prevention, people at risk, environmental cleaning, statistics, and educational resources

   

Related articles

Disclaimer: Links below are for informational/awareness only

                            The inclusion of any article here does not necessarily mean agreement with this author’s beliefs 

• MRSA In Children: Do You Know The Signs? (vintagevicki.com)
• Pimples (and Rosacea) Link to MRSA (tfollowers.com)
• MRSA found in Iowa meat (scienceblogs.com)
• Forget MRSA, Fear VRSA (alternativendhealth.wordpress.com)
• MRSA: From A Nosocomial Pathogen To An Omnipresent Source Of Infection (medicalnewstoday.com)
• More MRSA Found In U.S. Retail Meat (Turkey, Too) (wired.com)

AMA: New policies that will impact the future of medicine

 

From the 14 December article at KevinMD.com by PETER W. CARMEL, MD

The AMA adopted new policy that, among other things, supports legislation that would require manufacturers of all drugs and biologics to notify the FDA of any discontinuance, interruption or adjustment in the manufacture of a drug that may result in a shortage. The AMA will also advocate for the FDA and/or Congress to require drug manufacturers to establish a plan for continuity of the supply of vital and life-sustaining medications and vaccines to avoid production shortages whenever possible.

With the implementation of the Affordable Care Act underway, health insurance exchanges have received significant attention as a new way for millions of Americans to obtain health insurance coverage from private insurers. New AMA policy supports using the open marketplace model for exchanges to increase competition and maximize patient choice. The policy also asks the AMA to advocate for the inclusion of actively practicing physicians and patients in health insurance exchange governing structures and for developing systems that allow for real-time patient eligibility information.

In addition to promoting the open marketplace model for health insurance exchanges, the AMA continued to endorse giving Medicare patients greater choice in seeing the physicians they want and need to see. The AMA reaffirmed support for the Medicare Patient Empowerment Act, which would eliminate current restrictions on private contracting with Medicare patients. New policy calls on the AMA to initiate and sustain a well-funded grassroots campaign to secure passage of the bill in Congress. This legislation ensures that if patients choose to see a physician that is not in the Medicare system they can still receive the benefits they have earned.

AMA delegates also recognized that onerous administrative burdens can divert a physician’s attention away from patient care. New policy calls on the AMA to work vigorously to stop implementation of ICD-10, a new code set for medical diagnoses. Currently, physicians use 14,000 diagnosis codes under ICD-9, but under ICD-10 the number of codes would grow by about 55,000.

Physicians are already working to integrate electronic health records into their offices, and the implementation of ICD-10 will place significant and costly burdens on the practice of medicine with no direct benefit to patients. At a time when we are working to get the best possible value for our health care dollars, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions….

 

 

Related articles

• AMA Adopts New Policies During Final Day of Semi-Annual Meeting (AMA news release)

Items included

• Guidelines for Health Insurance Exchanges
• Virtual Medical IDs
• Stop the Implementation of ICD-10
• Stop Legal Prohibition of Male Circumcision
• AMA Votes To Work ‘Vigorously’ To Stop ICD-10 Implementation (listahit.wordpress.com)

• AMA hoping to stop ICD-10 use in billing (listahit.wordpress.com)
• The AMA Finally Takes A Stand Against ObamaCare Thinking In Washington (forbes.com)
• AMA Wants To Put Brakes On ICD-10 Implementation (informationweek.com)
• ICD-10: Why Bother? (3mhealthinformation.wordpress.com)
• Doctors vs. the AMA (reason.com)