Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Repost] Getting Real About Chemical Risks

 

From the 14 October Cover Story at Chemical and Engineering News

Many people assume that the chemicals in their detergents, floor cleaners, and other household products have undergone rigorous safety testing. But little is known about the potential risks associated with most of the estimated 80,000 chemicals in commerce today.

While industry tries to dispel links to illnesses that go beyond what science can prove, the public is skeptical because companies have a financial stake in showing their products are safe. This leads both sides to look to the federal government for help.

The agency charged with overseeing the safety of chemicals in the marketplace is the Environmental Protection Agency. EPA has the authority to require industry to provide extensive toxicity data for pesticides. But for most other chemicals, EPA must show that a substance is likely to be a risk to human health or the environment in order to require industry to provide safety data. Manufacturers don’t often give toxicity data to EPA voluntarily, nor does the agency have the resources to assess tens of thousands of chemicals using traditional in vivo rodent-based studies.

Instead, EPA has turned to computational modeling. One ambitious effort, called ToxCast, aims to screen thousands of chemicals for biological activity using about 600 high-throughput biochemical and cell-based assays. The data are then integrated with existing in vivo animal toxicity data and structure-activity information to predict toxicity.

But ToxCast has had problems. Most of the assays were developed for drug discovery, not to assess the hazards of chemicals in the environment. For example, thyroid-disrupting compounds in the environment can work through multiple pathways, but commercial tests focus on just one—a chemical binding to the thyroid receptor. If a chemical acts on a different pathway it will test negative, even though it does disrupt the thyroid.

 

Related Resources (via a US National Library of Medicine Web page)

 

  • Haz-Map

    Links jobs and hazardous tasks with occupational diseases and their symptoms.

  • Household Products Database

    Information on the health effects of common household products under your sink, in the garage, in the bathroom and on the laundry room shelf.

  • TOXMAP

    Maps of hazardous chemicals with links to related health resources.

  • ToxMystery

    Interactive game for 7-11 years olds with lessons about household chemical hazards.

  • Tox Town

    An interactive guide about how the environment, chemicals and toxic substances affect human health.
    Tox Town en español

 

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October 18, 2013 Posted by | Consumer Health, environmental health | , , , , , , | 2 Comments

[Repost] Prescription Drug Use Among Medicare Patients Highly Inconsistent

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From the 17 October 2013 Science Daily article

 A new report from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive.

In their first look at prescription drug use, Dartmouth researchers also find that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.

“There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States,” said Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.

“This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it,” said Katherine Hempstead, Ph.D., M.A., senior program officer at the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. “Instead of varying widely, patterns of care should be nearly uniform across the country for non- controversial drug therapies with a strong evidence for their use.”

The new report offers an in-depth look at how prescription drugs are used by Medicare beneficiaries in the program’s Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional health care markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs. To examine the quality of care, the report looks at prescription use in three categories:

  •  Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
  •  Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
  •  Potentially harmful medications, for which risks generally outweigh benefits. 1

Read the entire article here

The full Dartmouth report may be found here

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October 18, 2013 Posted by | health care | , , , | Leave a comment

Population Health Implications of the Affordable Care Act: Workshop Summary (2013)

 

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From the 16 October 2013 summary at Full Text Reports

Source: Institute of Medicine

Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement.

Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest proportion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health.

Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their concept of community benefit, the ACA has expanded the arena for interventions to improve health beyond the “doctor’s” office. Improving the health of the population – whether in a community or in the nation as a whole – requires acting to transform the places where people live, work, study, and play. This report examines the population health-oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action.

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October 18, 2013 Posted by | health care | , , , , , , | Leave a comment

Over One Million Community Health Center Patients in 25 States Will Remain Uninsured and Left Out of Health Reform, New Report Says

From the 16 October 2013 summary at Full Text Reports

Source: George Washington University School of Public Health

A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services (SPHHS) examines the impact of health reform on community health centers (CHCs) and their patients. “Assessing the Potential Impact of the Affordable Care Act on Uninsured Community Health Center Patients: A Nationwide and State-by-State Analysis,” estimates that more than 5 million health center patients would have gained coverage had all states participated in a sweeping Medicaid expansion. However, nearly half of all CHCs are located in states that have opted out of the expansion. As a result, more than a million uninsured CHC patients who would have been covered under a nationwide Medicaid expansion will be left without the protection of health insurance, the report says.

Additional quotes from the report (George Washington University School of Public Health press release)

Shin and his colleagues analyzed data from both the 2009 Health Center User Survey and the 2011 Uniform Data System to gauge the impact of the ACA on health center patients nationally and in all 50 states and the District of Columbia.  Based on conservative assumptions, the analysis showed that over one million health center patients in the opt-out states who would have gained Medicaid coverage under an expansion will likely remain without insurance. These patients are very poor but do not qualify for the traditional Medicaid program and often cannot pay for health care – even at reduced fees, the study concludes. Ironically, these patients are also too poor to qualify for subsidies that would allow them to purchase health insurance at reduced rates on the new Health Insurance Exchanges.

The bottom line for the 518 health centers located in the opt-out states: the report says they’ll forgo approximately $555 million they would have received had their states expanded Medicaid, yet by law, they will still be treating all community residents, including those who lack health insurance or the means to pay for care.

“Health centers in the opt-out states will face an ongoing struggle to meet the need for care in medically underserved communities as a result of the potential loss of hundreds of millions of dollars in revenues in 2014 alone,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at SPHHS and a co-author of the report.

The report paints a very different picture for the 582 health centers in states that participate in the Medicaid expansion. Approximately 2.8 million patients at these health centers will gain coverage as a result of that decision. This added coverage will translate into a potential revenue increase of over $2 billion, which will support expanded staff and services.

States that have rejected the Medicaid expansion might reconsider and decide to expand coverage. Ohio’s just-announced Medicaid expansion is estimated to translate to over 63,000 residents gaining coverage and an additional $29 million in revenue gains in 2014 across 33 health centers. But in the near term, the report warns that many poor people living in the 25 opt-out states will continue to lack coverage and might find long wait times at clinics, long distances to find care, and other barriers that could translate to delays in treatment or no care at all. CHCs in those states will be unable to add much-needed services such as mental health or dental care, or to expand into remote or other seriously underserved areas—places where people have to travel for hours just to find a doctor.

“Community health centers represent the backbone of the nation’s safety net, providing high quality care to more than 20 million Americans who live in underserved neighborhoods,” says Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. “Without the Medicaid expansion, CHCs in opt-out states will fall behind and will have trouble providing the kind of care that keeps people and communities healthy.”

– See more at: https://sphhs.gwu.edu/content/over-one-million-community-health-center-patients-25-states-will-remain-uninsured-and-left#sthash.lgwN3pNL.dpuf

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October 18, 2013 Posted by | health care | , , , , | Leave a comment

Divided We Stand: Three Psychological Regions of the United States and Their Political, Economic, Social, and Health Correlates

hmm… could you envision these maps in a tourist guide book??

Psychological Regions

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From the 17 October 2013 summary at Full Text Reports 

There is overwhelming evidence for regional variation across the United States on a range of key political, economic, social, and health indicators. However, a substantial body of research suggests that activities in each of these domains are typically influenced by psychological variables, raising the possibility that psychological forces might be the mediating or causal factors responsible for regional variation in the key indicators. Thus, the present article examined whether configurations of psychological variables, in this case personality traits, can usefully be used to segment the country. Do regions emerge that can be defined in terms of their characteristic personality profiles? How are those regions distributed geographically? And are they associated with particular patterns of key political, economic, social, and health indicators? Results from cluster analyses of 5 independent samples totaling over 1.5 million individuals identified 3 robust psychological profiles: Friendly & Conventional, Relaxed & Creative, and Temperamental & Uninhibited. The psychological profiles were found to cluster geographically and displayed unique patterns of associations with key geographical indicators. The findings demonstrate the value of a geographical perspective in unpacking the connections between microlevel processes and consequential macrolevel outcomes.

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October 18, 2013 Posted by | Uncategorized | , , | Leave a comment

What makes a data visualization memorable?

Many postings here make use of visuals.  And of course, some visuals are better than others.
At times, I thought about just what made a good visual, but much like art, thought it was in the eye of the beholder.

So, when I came across this article, just had to post!

No conclusions yet, but some interesting hypotheses that go against the grain.

From the press release at Harvard School of Engineering and Applied Science

(Via Science 360 News Service  – a Web site of the National Science Foundation – a US Govt Agency
                          which was on hiatus during the government shutdown)

 

COMPUTER SCIENTISTS AT HARVARD AND COGNITIVE SCIENTISTS AT MIT TEAM UP TO SETTLE A DEBATE OVER “CHART JUNK”

A range of visualization types. (Image courtesy of Michelle Borkin, Harvard SEAS.)

Which of these visualizations will you remember later? (Images courtesy of Michelle Borkin, Harvard SEAS.)

Cambridge, Mass. – October 16, 2013 – It’s easy to spot a “bad” data visualization—one packed with too much text, excessive ornamentation, gaudy colors, and clip art. Design guru Edward Tufte derided such decorations as redundant at best, useless at worst, labeling them “chart junk.” Yet a debate still rages among visualization experts: Can these reviled extra elements serve a purpose?

Taking a scientific approach to design, researchers from Harvard University and Massachusetts Institute of Technology are offering a new take on that debate. The same design elements that attract so much criticism, they report, can also make a visualization more memorable.

Detailed results were presented this week at the IEEE Information Visualization (InfoVis) conference in Atlanta, hosted by the Institute of Electrical and Electronics Engineers.

For lead author Michelle Borkin, a doctoral student at the Harvard School of Engineering and Applied Sciences (SEAS), memorability has a particular importance:

“I spend a lot of my time reading these scientific papers, so I have to wonder, when I walk away from my desk, what am I going to remember? Which of the figures and visualizations in these publications are going to stick with me?”

But it’s more than grad-school anxiety. Working at the interface of computer science and psychology, Borkin specializes in the visual representation of data, looking for the best ways to communicate and interpret complex information. The applications of her work have ranged from astronomy to medical diagnostics and may already help save lives.

Her adviser, Hanspeter Pfister, An Wang Professor of Computer Science at Harvard SEAS, was intrigued by the chart junk debate, which has flared up on design blogs and at visualization conferences year after year.

Together, they turned to Aude Oliva, a principal research scientist at MIT’s Computer Science and Artificial Intelligence Lab, and a cognitive psychologist by training. Oliva’s lab has been studying visual memory for about six years now. Her team has found that in photographs, faces and human-centric scenes are typically easy to remember;landscapes are not.

“All of us are sensitive to the same kinds of images, and we forget the same kind as well,” Oliva says. “We like to believe our memories are unique, that they’re like the soul of a person, but in certain situations it’s as if we have the same algorithm in our heads that is going to be sensitive to a particular type of image. So when you find a result like this in photographs, you want to know: is it generalizable to many types of materials—words, sound, images, graphs?”

“Speaking with [Pfister] and his group, it became very exciting, the idea that we could study what makes a visualization memorable or not,” Oliva recalls. “If it turned out to be the same for everyone, we thought this would be a win-win result.”

For Oliva’s group, it would provide more evidence of cognitive similarities in the brain’s visual processing, from person to person. For Pfister’s group, it could suggest that certain design principles make visualizations inherently more memorable than others.

With Harvard students Azalea A. Vo ’13 and Shashank Sunkavalli SM ’13, as well as MIT graduate students Zoya Bylinskii and Phillip Isola, the team designed a large-scale study—in the form of an online game—to rigorously measure the memorability of a wide variety of visualizations. They collected more than 5,000 charts and graphics from scientific papers, design blogs, newspapers, and government reports and manually categorized them by a wide range of attributes. Serving them up in brief glimpses—just one second each—to participants via Amazon Mechanical Turk, the researchers tested the influence of features like color, density, and content themes on users’ ability to recognize which ones they had seen before.

The results meshed well with Oliva’s previous results, but added several new insights.

“A visualization will be instantly and overwhelmingly more memorable if it incorporates an image of a human-recognizable object—if it includes a photograph, people, cartoons, logos—any component that is not just an abstract data visualization,” says Pfister. “We learned that any time you have a graphic with one of those components, that’s the most dominant thing that affects the memorability.”

Visualizations that were visually dense proved memorable, as did those that used many colors. Other results were more surprising.

“You’d think the types of charts you’d remember best are the ones you learned in school—the bar charts, pie charts, scatter plots, and so on,” Borkin says. “But it was the opposite.”

Unusual types of charts, like tree diagrams, network diagrams, and grid matrices, were actually more memorable.

“If you think about those types of diagrams—for example, tree diagrams that show relationships between species, or diagrams that explain a molecular chemical process—every one of them is going to be a little different, but the branching structures feel very natural to us,” explains Borkin. “That combination of the familiar and the unique seems to influence the memorability.”

The best type of chart to use will always depend on the data, but for designers who are required to work within a certain style—for example, to achieve a recognizable consistency within a magazine—the results may be reassuring.

“A graph can be simple or complex, and they both can be memorable,” explains Oliva. “You can make something familiar either by keeping it simple or by having a little story around it. It’s not really that you should choose to use one color or many, or to include additional ornaments or not. If you need to keep it simple because it’s the style your boss likes or the style of your publication, you can still find a way to make it memorable.”

At this stage, however, the team hesitates to issue any sweeping design guidelines for an obvious reason: memorability isn’t the only thing that matters. Visualizations must also be accurate, easy to comprehend, aesthetically pleasing, and appropriate to the context.

“A memorable visualization is not necessarily a good visualization,” Borkin cautions. “As a community we need to keep asking these types of questions: What makes a visualization engaging? What makes it comprehensible?”

As for the chart junk, she says diplomatically, “I think it’s going to be an ongoing debate.”

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This research was supported by the National Science Foundation (NSF, grant 1016862), Google, and Xerox, as well as graduate research fellowships from the Department of Defense and the NSF.

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October 18, 2013 Posted by | Uncategorized | , , , , | Leave a comment

The first medical paper about Google Glass.

From the abstract at Springer Link

Graduate medical education (GME) is a balance between providing optimal patient care while ensuring that trainees (residents and fellows) develop independent medical decision making skills as well asand the ability to manage serious medical conditions. We used one form of wearable technology (“Google Glass”) to explore different scenarios in cardiovascular practice where fellows can better their education. We specified different scenarios encountered during routine clinical care in the month of July 2013. These scenarios were chosen based on their clinical significance, the difficulty posed to early stage trainees and the possibly deleterious effects of misdiagnosis or treatment. A mock trainee wearing Google glass enacted each scenario. Live video stream from the glass was transmitted via Wi-Fi or Bluetooth which could have been received by a smartphone, tablet or personal computer. In conclusion, wearable technology has the potential to enhance medical education and patient safety once widely available. Medical institutions should work on policies regarding the use of such technologies to enhance medical care without compromising patient privacy.

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October 18, 2013 Posted by | Educational Resources (Health Professionals) | , , | Leave a comment

   

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