[NY Times Article] Risk Calculator for Cholesterol Appears Flawed

From the 17 November 2013 article at the NY Times

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with anonline calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

Dr. Nancy Cook and Dr. Paul M. Ridker of Harvard Medical School found that a new online calculator used to assess heart treatment options overestimated the risks that many people face.

The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.

“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

The controversy set off turmoil at the annual meeting of theAmerican Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.

Dr. Sidney Smith, the executive chairman of the guideline committee, said the associations would examine the flaws found in the calculator and determine if changes were needed. “We need to see if the concerns raised are substantive,” he said in a telephone interview on Sunday. “Do there need to be changes?”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal.

…..

Related articles

• Does calculator overstate heart attack risk? (cnn.com)
• NYT: Risk calculator for cholesterol appears flawed (nbcnews.com)
• Experts Warn New Cholesterol Calculator Doesn’t Add Up (healthland.time.com)
• Cholesterol Math Doesn’t Add Up (healthland.time.com)
• Some Doctors Challenge New Statin Guidelines (news.health.com)
• Calculator may overstate heart attack risk (wyff4.com)

 

[AHA article] (Aerobics /Preventive Medicine pioneer) Dr. Kenneth Cooper is keynote speaker at Scientific Sessions 2013

Back in college I took a “physical fitness” class.  One of Dr. Cooper’s books was required reading. Very inspiring. Good to see he is still a living example of his well tested theories of aerobic exercise and wellness  program benefits.

From the 18 November American Heart Association article

In the early 1960s, when the great Space Race was being fueled by the escalating Cold War, a former track and basketball star from Oklahoma envisioned himself soaring through the Milky Way.

This tall, lanky fellow was an Army doctor, but the lure of space flight led him to transfer to the Air Force. He became certified in aerospace medicine. Then he developed training programs for astronauts – some for before they took off, others to help them remain in shape while floating weightlessly in outer space. All along, his sights were set on becoming among a select group of “science astronauts.”

Imagine how different life on Earth would be today if Kenneth Cooper, MD, MPH, hadn’t shifted gears.

Cooper actually was still in the Air Force when he published “Aerobics,” a book that did as much for the health of Americans as the Apollo 11 lunar landing did for the aerospace industry. Cooper’s book, by the way, came out first – more than a year before Neil Armstrong planted the U.S. flag on the moon.

That book is now available in more than 40 languages. Cooper has spoken in more than 50 countries, and written 18 more books. He is the “Father of Aerobics” and a big reason why the number of runners in the United States spiked from 100,000 when his book came out to 34 million in 1984.

…

Having proven the benefits of preventive medicine and wellness in the military, he was ready to shift to the private sector.

The private sector, however, wasn’t ready for him.

When he opened his clinic in Dallas, naysayers told him, “You can’t limit your practice to taking care of healthy people. People only want to see their physicians when they’re sick.” And those were the kind ones. Others turned him in to the local medical society’s board of censors.

“They thought I was going to kill people by putting them on treadmills for stress testing,” Cooper said. “I’d been doing it in the Air Force for 10 years!”

The big picture turned out more clearly. Baby Boomers became exercisers, triggering a fitness craze that produced what he calls “the glory years of health in America.” As Boomers have aged, and future generations have made fitness a lower priority, health had spiraled in the wrong direction. It’s been 17 years since the Surgeon General recommended 30 minutes of physical activity most days of the week, and the statistics show that most Americans aren’t doing it.

“For many years, I’ve put people into five health categories, ranking them from very poor to excellent. Research constantly shows that major gains can be made by moving up just one category, even if it’s just from very poor to poor,” Cooper said. “If we can get the 50 million Americans who are totally inactive today to move up just one category, think of the dramatic effect that would have. Just by avoiding inactivity!”

…

Related articles

• A Prescription From the ‘Father of Aerobics’ – Exercise Is Medicine (debbiestrauch.wordpress.com)
• Aerobic Exercise Improves Memory, Brain function and Physical Fitness (parasyaseen.wordpress.com)

 

[Press Release] 1 minute of CPR video training could save lives

NSA BAHRAIN_130708-N-AZ907-005 (Photo credit: U.S. Naval Forces Central Command/U.S. Fifth Fleet)

From the 16 November 2013 American Heart Association press release via EurkAlert

RESS Abstract 19453/157 (Omni Dallas Hotel, Dallas Ballroom D-H)

Just one minute of CPR video training for bystanders in a shopping mall could save lives in emergencies, according to research presented at the American Heart Association’s Scientific Sessions 2013.

Researchers used a one-minute CPR video to improve responsiveness and teach compression only CPR to people with no CPR experience.

Participants were divided into two groups: 48 adults looked at the video, while 47 sat idle for one minute. In a private area with a mannequin simulating a sudden collapse, both groups were asked to do “what they thought best.” Researchers measured responsiveness as time to call 9-1-1 and start chest compression and CPR quality reflected by chest compression depth, rate and hands-off interval time.

Adults who saw the CPR video called 9-1-1 more frequently, initiated chest compression sooner, had an increased chest compression rate and a decreased hands-off interval, researchers said.

“Given the short length of training, these findings suggest that ultra-brief video training may have potential as a universal intervention for public venues to help bystander reaction and improve CPR skills,” said Ashish Panchal, M.D., Ph.D. lead researcher of the study.

Related articles

• Watching just one-minute CPR video increases reaction in an emergency: Study (sunnewsnetwork.ca)

 

From a previous post (which includes videos)

A link to information about the new CPR guidelines (Compression – Airway- Breathing) may be found here.
A presskit with media materials, statements from experts, and real life stories may be found here.

Excerpt from the American Heart Association Oct 18, 2010 news release

Statement Highlights:

• The 2010 AHA Guidelines for CPR and ECC update the 2005 guidelines.
• When administering CPR, immediate chest compressions should be done first.
• Untrained lay people are urged to administer Hands-Only CPR (chest compressions only).

DALLAS, Oct. 18, 2010 — The American Heart Association is re-arranging the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation andEmergency Cardiovascular Care, published in Circulation: Journal of the American Heart Association.

Recommending that chest compressions be the first step for lay and professional rescuers to revive victims ofsudden cardiac arrest, the association said the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-A-B (Compressions-Airway-Breathing).[Editor Flahiff’s emphasis]

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” said Michael Sayre, M.D., co-author of the guidelines and chairman of the American Heart Association’s Emergency Cardiovascular Care (ECC) Committee. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away.”

In previous guidelines, the association recommended looking, listening and feeling for normal breathing before starting CPR. Now, compressions should be started immediately on anyone who is unresponsive and not breathing normally.

All victims in cardiac arrest need chest compressions. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim’s brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.

The change in the CPR sequence applies to adults, children and infants, but excludes newborns.

Other recommendations, based mainly on research published since the last AHA resuscitation guidelines in 2005:

• During CPR, rescuers should give chest compressions a little faster, at a rate of at least 100 times a minute.
• Rescuers should push deeper on the chest, compressing at least two inches in adults and children and 1.5 inches in infants.
• Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.
• Rescuers should avoid stopping chest compressions and avoid excessive ventilation.
• All 9-1-1 centers should assertively provide instructions over the telephone to get chest compressions started when cardiac arrest is suspected.

[Press Release] More Than 3,200 Serving Life Without Parole for Nonviolent Offenses, Finds ACLU

American Civil Liberties Union (Photo credit: Wikipedia)

 

Seems I’m reading and re-posting criminal justice items today…
Selected this one because I am an ardent opponent of the death penalty.  And when the death penalty is abolished, there still are plenty of criminal justice issues that need addressing/resolving.
This statistic is new to me. Justice needs to be served, but life without parole for nonviolent offenders?  The punishment in these cases does not fit the crime.

 

Excessive Sentences for Drug and Property Crimes; Extreme Racial Disparities Shown

 

From the 13 November 2013 ACLU press release

 

NEW YORK – In the first-ever study of people serving life without parole for nonviolent offenses in the United States, the American Civil Liberties Union found that at least 3,278 prisoners fit this category in federal and state prisons combined.

“A Living Death: Life Without Parole for Nonviolent Offenses” features key statistics about these prisoners, an analysis of the laws that produced their sentences, and case studies of 110 men and women serving these sentences. Of the 3,278 prisoners, 79 percent were convicted of nonviolent, drug-related crimes such as possession or distribution, and 20 percent of nonviolent property crimes like theft.

“The punishments these people received are grotesquely out of proportion to the crimes they committed,” said Jennifer Turner, ACLU human rights researcher and author of the report. “In a humane society, we can hold people accountable for drug and property crimes without throwing away the key.”

The ACLU estimates that, of the 3,278 serving life without parole for nonviolent offenses, 65 percent are Black, 18 percent are white, and 16 percent are Latino, evidence of extreme racial disparities. Of the 3,278, most were sentenced under mandatory sentencing policies, including mandatory minimums and habitual offender laws that required them to be incarcerated until they die.

“The people profiled in our report are an extreme example of the millions of lives ruined by the persistent ratcheting up of our sentencing laws over the last forty years,” said Vanita Gupta, deputy legal director of the ACLU. “We must change our sentencing practices to make our justice system smart, fair, and humane. It’s time to undo the damage wrought by four decades of the War on Drugs and ‘tough-on-crime’ attitudes.”

Douglas Ray Dunkins Jr., who has served 22 years so far, told the ACLU, “It’s devastating, horrible, not being around to see [my children] graduate and go to school.” Dicky Joe Jackson, who has served 17 years, said, “I would rather have had a death sentence than a life sentence.”

The federal courts account for 63 percent of the 3,278 life-without-parole sentences for nonviolent offenses. The remaining prisoners are in Louisiana (429 prisoners), Florida (270), Alabama (244), Mississippi (93), South Carolina (88), Oklahoma (49), Georgia (20), Illinois (10), and Missouri (1). The ACLU estimates that federal and state taxpayers spend $1.8 billion keeping these people in prison for life instead of more appropriate terms.

In addition to interviews, correspondence, and a survey of hundreds of prisoners serving life without parole for nonviolent offenses, the ACLU based “A Living Death” on court records, a prisoner survey, and data from the United States Sentencing Commission, Federal Bureau of Prisons, and state Departments of Corrections obtained through Freedom of Information Act and open records requests.

“A Living Death” features comments from the prisoners’ family members, and in multiple instances, prisoners’ sentencing judges express frustration and outrage at the severity of the punishment the law required. Judge Milton I. Shadur told Rudy Martinez as he sentenced Martinez to life without parole: “[F]airness has departed from the system.”

The report includes recommendations to federal and state governments for changes in sentencing and clemency. The proposed policy reforms would help bring balance back to sentencing—crucial steps to reduce our nation’s dependence on incarceration.

“We must change the laws that have led to such unconscionable sentences,” said Turner. “For those now serving life without parole for nonviolent offenses, President Obama and state governors must step in and reduce their sentences. To do nothing is a failure of justice.”

The ACLU has placed ads online and in print to raise public awareness of the prisoners serving life-without-parole for nonviolent offenses and the larger problem of mass incarceration. Featuring photographs of six prisoners profiled in “A Living Death,” the ads will appear multiple times in print and online in such national outlets as Jet, The Nation, The New York Times, USA Today, and The Washington Post.

The report is available here:
aclu.org/fairandsmart

 

Related articles

• 8 Shocking Facts From the ACLU’s Report on Life Without Parole (nation.time.com)
• 23 Petty Crimes That Have Landed People in Prison for Life Without Parole – New ACLU report documents the disturbing growth of endless sentences. (newsforage.com)
• ACLU: Alabama 3rd in state prisoners serving life without parole for non-violent crimes (al.com)
• ACLU: more than 3,200 serving life without parole for nonviolent crimes (jurist.org)
• ACLU: Over 3,000 Prisoners Serving Life Without Parole for Nonviolent Crimes (abcnews.go.com)

 

[Reblog] Criminal Law and Public Health – Working at Cross-Purposes?

: Criminal Justice Center (Photo credit: Wikipedia)

 

From the 18th November 2013 post at HealUoS

 

According to recent news reports, the city of Edinburgh is getting tough on those who seek sensual pleasures outside of the confines of their own homes.  The police have asked that condoms be banned from saunas as a way of trying to prevent sexual activity on the premises, and city Councillors have been asked to stop issuing licenses for saunas and massage parlours.

Besides being a naïve and impractical way to prevent people from having sex, there has been, unsurprisingly, a strong condemnation of such a move on the grounds of its potential negative effect on public health.  The charity Scot-pep, for instance, has warned that implementing the police proposal on condoms could lead a HIV epidemic, as well as the proposal to limit establishments where sex workers can meet clients puts them at greater risk from some of the inherent hazards of plying their trade outdoors.

There has been a long history in the United Kingdom of a connection between the criminal justice system and public health.  In some cases, it has been a beneficial relationship in which everything from firearms restrictions, requirements for seat belts, motorcycle helmets and child safety seats and restrictions on intoxicating substances, provide examples where the criminal justice system has been used to mitigate or prevent behaviours that are harmful to individual and population health.  Nevertheless, not all intersections of criminal justice and public health are mutually beneficial.  What is most notable is the distinct progression that has been made from a so-called “policing model of public health”, that often focused on ideas of moral hygiene and legal moralism, which remained influential in Britain into the 19th century, towards more social models of public health that focus on health promotion, harm reduction and social justice.

…

Read the entire post here

 

[Reblog] Emergency Medical Information in a Wallet

From the 16 November 2013 post of Aurun Martin’s Blog

How many of us have our emergency medical information in our physical wallets? This might not be a relevant question today because patient healthcare records are stored online in this digital age.

What happens if something unfortunate occurs when one is traveling and do not have access to Internet or even a smartphone? One possible solution is to have a paper-based health card in your wallet.

But, then the health card can hold only limited information. So, what is the prioritized information that the card can hold? I can think of the following important information:

• Name, age, gender, blood group
• Family history, allergies
• Personal doctor’s contact number
• Unique healthcare Id linked to one of your unique identification cards (E.g. Election Card, Driving License, etc.)

http://www.health.ny.gov/publications/0972.pdf

This card works well in a scenario when the person is in an emergency situation, and someone else looks at the card and shares the information possibly to a national healthcare toll-free number (wishful thinking!) or healthcare provider referencing the unique healthcare Id.

Most wallets contain pictures of family members, identification cards, credit and debit cards, cash, and coins. In this crowded wallet, do we have room to add this important card that might save our lives?
Most important, how does the other person know the existence of this precious card in our wallet?

Few links are shared below to enter your healthcare information, download, and print the health card:

• Medicine Wallet Card – http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/safemeds/walletform.html
• Health Information Document – http://www.health.ny.gov/publications/0972.pdf
• Get My Health Card – http://www.getmyhealthcard.org/index.php/get-my-card

Related articles

• Free Emergency Medical ID Wallet Card Generator (myfrugalsavings.com)