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Published on Nov 13, 2015
In the fall of 2015, the Missouri Chapter of American Planning Association, the HEAL Partnership, and Trailnet received a Plan4Health grant from the CDC in partnership with American Planning Association and American Public Health Association to work together to implement pop up traffic calming demonstrations. The demonstrations were used as a tool to educate one another on how to create safer streets in the City of St. Louis.
Watch how these demonstrations helped community members, elected officials, and city staff better understand how traffic calming could help their communities.
Missouri Chapter of the American Planning Association: http://www.mo-apa.org
HEAL Partnership: https://www.facebook.com/HEALPartners…
From the 22 March 2016 Kansas State Univ news release
Tuesday, March 22, 2016
Lester Loschky, associate professor of psychological sciences at Kansas State University, used six shots, a 12-second clip, from the 1979 James Bond film, “Moonraker,” to measure eye movements and understanding.
MANHATTAN — Hollywood-style films may control viewers’ attention more than originally thought, according to a Kansas State University researcher.
Lester Loschky, associate professor of psychological sciences, recently published “What Would Jaws Do? The Tyranny of Film” in PLOS ONE. The study suggests viewers may have limited cognitive control of their eye movements while trying to understand films.
“Hollywood-style filmmakers have developed stimuli — such as shorter shot length, more motion in the frame and higher contrast — that is amazing at directing the viewers’ attention from moment to moment in exactly the way that the filmmaker wants,” Loschky said. “It is not that film producers have complete mind control because we willingly participate in it — we enjoy movies — but they do have a lot of control over our attention.”
Loschky compared eye movements of people who watched a three-minute clip of “Moonraker,” a 1979 James Bond film, with people who watched the last 12 seconds of the clip. His hypothesis, called the “Tyranny of Film,” was that film viewers’ eye movements are separate from a person’s understanding.
“We are investigating film perception and film comprehension together,” Loschky said. “In a static picture, people look at different things at different times, but during a movie suddenly everybody is looking at the same things at the same time.”
Loschky said that in the last 100 years, filmmakers slowly have gotten better at getting every viewer to look at the same place at the same time, a measurement called attentional synchrony. He attributes that to what he calls MTV-style editing, which is a greater frequency of cuts and shorter shot lengths. The researchers hypothesize that filmmakers are so good at influencing viewers’ eye movements in Hollywood-style movies that viewers’ understanding does not necessarily affect where they look.
From the 21 March 2016 EurkAlert
More older adults used multiple medications and dietary supplements, and taking them together put more people at increased risk for a major drug interaction, according to a new study published online by JAMA Internal Medicine.
Most older adults in the United States use prescription and over-the-counter medications and dietary supplements. There is increased risk among older adults for adverse drug events and polypharmacy.
Dima M. Qato, Pharm. D., M.P.H., Ph.D., of the University of Illinois at Chicago, and coauthors analyzed nationally representative data to examine changes in medication use, which included concurrent use of prescription and over-the counter medications and dietary supplements, to gauge potential for major drug interactions.
The study group included 2,351 participants in 2005-2006 and 2,206 in 2010-2011 who were between the ages of 62 and 85. In-home interviews and direct medication inspection were performed.
The authors report:
- Concurrent use of at least five prescription medications increased from 30.6 percent to 35.8 percent over the study period.
- Concurrent use of five or more medications or supplements of any type increased from 53.4 percent to 67.1 percent.
- Use of over-the-counter medications declined from 44.4 percent to 37.9 percent.
- Dietary supplement use increased from 51.8 percent to 63.7 percent. Multivitamin or mineral supplements and calcium were the most commonly used supplements during the study period.
- About 15.1 percent of older adults in 2010-2011 were at risk for a major drug interaction compared with an estimated 8.4 percent in 2005-2006. For example, preventive cardiovascular medications and supplements were increasingly used together in interacting drug regimens.
From the 18 March 2016 Univ of Toronto news release
Stage magicians are not the only ones who can distract the eye: a new cognitive psychology experiment demonstrates how all human beings have a built-in ability to stop paying attention to objects that are right in front of them.
We see much less of the world than we think we do
Perception experts have long known that we see much less of the world than we think we do. A person creates a mental model of their surroundings by stitching together scraps of visual information gleaned while shifting attention from place to place. Counterintuitively, the very process that creates the illusion of a complete picture relies on filtering out most of what’s out there.
In a paper published today in the journal Attention, Perception, & Psychophysics a team of U of T researchers reveal how people have more “top-down” control of what they don’t notice than many scientists previously believed.
“The visual system really cares about objects,” says postdoctoral fellow J. Eric T. Taylor, who is the lead author on the paper. “If I move around a room, the locations of all the objects — chairs, tables, doors, walls, etc. — change on my retina, but my mental representation of the room stays the same.”
Objects play fundamental role in how we focus our attention
Objects play such a fundamental role in how we focus our attention that many perception researchers believe we are “addicted” to them; we couldn’t stop paying attention to objects if we tried. The visual brain guides attention largely by selecting objects — and this process is widely believed to be automatic.
From the 11 March 2016 Harvard Medical School news release
…..The New England Journal of Medicine recently published a review of the “brain science” related to addiction and its management by Dr. Nora Volkow and her colleagues. It is a great review with terrific graphics. I’ve sent it to several of my colleagues.
It would take many blog posts to summarize in detail what goes on in the article (let alone the brain), so I’ll hit the points that are most meaningful to me as a practitioner and citizen — and forgive me if I get a little personal.
A look into the science of addiction
The most depressing course I took in college was an introduction to behaviorism. The low point was when I came to believe that free will did not exist, though I later came to believe that this was a narrow and false conclusion. Humans, with our over-developed frontal cortices, have the power to choose not to respond the way, for example, a pigeon would in an experiment of rewards and punishments. When I became a doctor, I perceived that people suffering with addiction were stripped of their fundamental liberty to choose to live life as they would want (within social and economic constraints). I can honestly say that helping to restore some of that freedom is among the most rewarding things I do as a doctor. That’s the personal stuff.
An addicted person’s impaired ability to stop using drugs or alcohol has to do with deficits in the function of the prefrontal cortex — the part of the brain involved in executive function. The prefrontal cortex has several important jobs: self-monitoring, delaying reward, and integrating whatever the intellect tells you is important with what the libido is telling you. The difficulty also has to do with how the brain, when deprived of the drugs to which it is accustomed, reacts to stress.
What this all means for overcoming an addiction
It is not enough simply to “just say no.”
The person needs to develop alternative sources of joy and reward, and people who have been isolating themselves in order to drink or use drugs without inhibition may need to work in a purposeful way to re-acquire habitual “joy” — social interactions, physical pleasures like a swim or a bike ride, and other healthy, enjoyable rewards.
At the same time, to say that substance use disorders are “all biology” is an over-simplification. Clearly, there are people on the mild end of the spectrum who have the ability to choose to stop or cut back. For these people, when the rewards of not using outweigh those of using, they stop. Some people with a pattern of unhealthy drug or alcohol use that meets criteria for a diagnosis of substance use disorder may also “mature” out of it without formal treatment. However, the more severe the diagnosis (in other words, the more diagnostic criteria that are met), the less likely this is to happen.
From the 11 March WHO news release
There is no specific repellent that works better against the Aedes mosquito
There are many repellents that are effective against all mosquitoes including Aedes mosquitos. Effective repellents contain DEET (diethyltoluamide) or IR 3535 or Icaridin which are the most common biologically active ingredients in insect repellents. Active ingredients are listed on the product label. The following active ingredients repel or kill the mosquito when it rests or approaches the body: DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3- [N-butyl-N-acetyl], aminopropionic acid ethyl-ester) or Icaridin (piperidinecarboxílico acid-1, 2- (2-hydroxyethyl) – 1-metilpropilester).
There is no minimum or maximum percentage of active ingredient required. Insect repellents may be applied to exposed skin to protect against the bites of mosquitoes or on the clothes. WHO recommends covering the skin with clothing as much as possible and using insect repellents as effective measures to protect against bites from mosquitoes that transmit viruses such as chikungunya, dengue, yellow fever and Zika.
Repellents must be used in strict accordance with the label instructions. There is no evidence of any restriction of the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label.
No evidence that vaccines cause microcephaly in babies
There is no evidence linking any vaccine to the increases in microcephaly cases that were observed first in French Polynesia during the 2013-2014 outbreak and more recently in northeastern Brazil.
An extensive review of the literature published in 2014 found no evidence that any vaccine administered during pregnancy resulted in birth defects.
No evidence that pyriproxyfen insecticide causes microcephaly
A team of WHO scientists recently reviewed data on the toxicology of pyriproxyfen, one of 12 larvicides that WHO recommends to reduce mosquito populations. It found no evidence that the larvicide affects the course of pregnancy or the development of a fetus. The US Environmental Protection Agency and EU investigators reached a similar conclusion when they carried out a separate review of the product.
No evidence that the Zika outbreak and unusual increase in microcephaly cases in Brazil is linked to recent releases of genetically modified mosquitoes in Brazil
No evidence that sterilized male mosquitoes contribute to the spread of Zika
Bacteria used to control the male mosquito population are not spreading Zika further
Fish can help stop Zika.
Some countries affected by Zika and dengue are using biological methods as part of an integrated approach to mosquito control. El Salvador, for example, with strong support from fishing communities, is introducing larvae-devouring fish into water storage containers.
From the 26 February 2016 HealthNewsReview item
Do borders really exist in medicine, where the mere act of crossing political boundaries changes what screening programs are recommended? It seems that they do exist, and they’re well guarded.
Generating numerous headlines in major Canadian papers such as the National Post, The Toronto Star, Globe and Mail and Reuters, the Canadian Task Force on Preventive Health Care came out this week with new recommendations on colon cancer screening, essentially saying that routine colonoscopies were not justified. By contrast, in the United States, the U.S. Preventive Services Task Force (USPSTF) 2015 guidelines say that adults aged 50–75, should have a colonoscopy every 10 years; FIT (fecal immunochemical testing) or gFOBT (guaiac fecal occult blood testing ) annually or flexible sigmoidoscopy every 10 years plus FIT annually.
For this age group the Canadian Task Force says there is insufficient evidence to justify using colonoscopy for routine screening for colorectal cancer. They recommend patients should undergo the fecal occult blood testing every two years or flexible sigmoidoscopy – a procedure which examines the lower part of the colon and rectum every 10 years. These colon cancer screening guidelines, published in the Canadian Medical Association Journal, are for low-risk people: asymptomatic adults, aged 50 to 74 who have no prior history of the disease, no family history or symptoms such as blood in the stool, or a genetic disposition to the disease.
From the 28 February 2016 post at HealthNewsReview
We’re pleased to publish the following guest post by Dr. Michael Joyner, a medical researcher at the Mayo Clinic who recently joined our team as a contributor. These views are his own. You can follow him on twitter @DrMJoyner.
Last week there was a big shindig at the White House reviewing progress from the first year of the million-person Precision Medicine Initiative (PMI).
As you might imagine, an event of this magnitude drew considerable (mostly glowing) coverage from major US health news media:
This is an exciting scientific undertaking — one that merits the attention these outlets have devoted to it. But the coverage sounded mostly like cheerleading, and none of these stories included a skeptical word about the many challenges ahead and how they could thwart the initiative’s lofty objectives. I watched the webcast of the event with a critical eye and took notes as I was watching. Here are a six of the things that I thought journalists should have been thinking about and writing about as they covered the event:
1) A number of new partnerships and pilot programs related to enrollment of participants, data sharing, analytics, biobanks and privacy were announced. There are no real results yet, so it is simply too soon to tell what elements of what was announced will succeed, partially succeed, or stall.
2) Francis Collins, the director of the National Institutes of Health and a prime mover in Precision Medicine, clearly stated that it should take three to four years to meet the one million person enrollment goal of the program. This is an ambitious timeline. The last time that something like this was tried in the National Children’s Study, enrollment goals were never met and the program was ultimately cancelled. As STAT has previously reported, experts in population health have observed similarities between the PMI and the National Children’s Study and the comments by Dr. Collins are a clear marker for evaluating the success of PMI going forward.
3) There were a number of interesting presentations of patient and family vignettes at the meeting. While PMI is supposed to transform health and healthcare for all Americans, three of the four stories were about extremely rare diseases that have nothing to do with the big killers like diabetes, cancer, and heart disease. There is no argument by PMI skeptics about the role of gene sequencing in rare diseases, but dealing more effectively with those diseases has nothing to do with the prediction, prevention, and improved treatment of the major causes of death. The fourth presentation was about breast cancer and it was unclear to me exactly what elements of precision medicine were involved in the care of this patient (who happened to be a surgeon). In the absence of big transformative population findings for common diseases, some might argue that the rare disease community is being leveraged to generate support for a much larger and perhaps misdirected program.
4) There was no mention of some of the potholes that are out there or that have emerged in the last year. For example, the National Cancer Institute’s MATCH trial, designed to match the genetic signatures of tumors with targeted therapy, is having trouble “matching” (subscription required). And a study from Europe has cast at least some doubt on just how effective broad-based used of “targeted therapy” will be. There is also plenty of room to question the idea that data mining electronic health records is going to be transformative. The barriers to actually getting this done are significant and range from the quality of the data in electronic health records, issues related to who owns the data, protocols for data sharing, and a host of technical and statistical issues. Big data can certainly be helpful but it can also mislead.
Consumer Reports magazine and affiliated publications use evidence reports from AHRQ’s Evidence-based Practice Centers Program to inform consumers and clinicians about prescription drugs’ effectiveness and safety. Read the case study.
(From the US Agency for Healthcare Research and Quality)
Among the U.S. noninstitutionalized population in 2013, the 1 percent of Americans with the highest health care expenses accounted for nearly 22 percent of the nation’s total health care expenditures. Members of that group had annual average expenses of $95,200. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #480: Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2013.)
From the 10 March 2016 National Academies Science Engineering Health news release
Latest Biennial Review of Health Problems That May Be Linked to Agent Orange Exposure During Vietnam War Upgrades Bladder Cancer and Hypothyroidism, Downgrades Spina Bifida
WASHINGTON – The latest and final in a series of congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War changed the categorization of health outcomes for bladder cancer, hypothyroidism, and spina bifida and clarified the breadth of the previous finding for Parkinson’s disease. The committee that carried out the study and wrote this report, Veterans and Agent Orange: Update 2014, reviewed scientific literature published between Oct. 1, 2012, and Sept. 30, 2014.
Bladder cancer and hypothyroidism were moved to the category of “limited or suggestive” evidence of an association from their previous positions in the default “inadequate or insufficient” category. A finding of limited or suggestive evidence of an association means that the epidemiologic evidence indicates there could be a link between exposure to a chemical and increased risk for a particular health effect. A finding of inadequate or insufficient evidence indicates that the available studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of such a link. For both bladder cancer and hypothyroidism, new results from a large study of Korean veterans who served in the Vietnam War were compellingly suggestive of an association. In combination with pre-existing supportive epidemiologic findings and substantial biologic plausibility, the new information provided evidence to merit a change in category of association for these two outcomes.
In addition to reviewing the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides, the committee was asked to address the specific question of whether various conditions with Parkinson’s-like symptoms should qualify the assignment of Parkinson’s disease to the limited or suggestive category of association with herbicide exposure. The committee noted that Parkinson’s disease is a diagnosis of exclusion, and therefore, the diagnostic standards for this condition should not be assumed to have been uniform in the epidemiologic studies that constitute the basis for this association or in the claims submitted by veterans. Consequently, there is no rational basis for exclusion of individuals with Parkinson’s-like symptoms from the service-related category denoted as Parkinson’s disease. To exclude a claim for a condition with Parkinson’s-like symptoms, the onus should be on the U.S. Department of Veterans Affairs (VA) on a case-by-case basis to definitively establish the role of a recognized factor other than the herbicides sprayed in Vietnam.
Given that this is the final report mandated by the Agent Orange Act, the committee developed recommendations for future actions to advance the well-being of Vietnam veterans, including that the VA should continue epidemiologic studies of the veterans; develop protocols that could investigate paternal transmission of adverse effects to offspring; and design a study to focus on specific manifestations in humans of dioxin exposure and compromised immunity, which have been clearly demonstrated in animal models. The committee also called for a careful review of evidence concerning whether paternal exposure to any toxicant has definitively resulted in abnormalities in the first generation of offspring. In addition, the committee formulated recommendations for improved assembly and evaluation of information necessary for monitoring possible service-related health effects in all military personnel, including creating and maintaining rosters of individuals deployed on every mission and linking U.S. Department of Defense and VA databases to systematically identify, record, and monitor trends in veterans’ diseases.
From the 10 March 2016 Penn Medicine news release
Research has implications for better understanding the relationship between “good” cholesterol function – in addition to level — and heart disease risk
PHILADELPHIA – The generally accepted medical maxim that elevated HDL cholesterol (HDL-C) is “good” has been overturned by a multi-center, international study, led by researchers from the Perelman School of Medicine at the University of Pennsylvania. They show that a certain genetic cause of increased HDL-C may actually be “bad,” noting that a specific mutation in a gene which encodes a cell receptor protein that binds to HDL prevents the receptor from functioning. The mutation causes an increased risk of coronary heart disease even in the presence of elevated levels of HDL-C or “good” cholesterol. Their findings are published this week in Science.
Previous research raised the possibility that HDL might not be quite as protective against heart disease as generally believed by cardiologists, especially after several clinical trials of HDL-raising drugs showed little or no effect. “The thinking about HDL has evolved recently to the concept that it may not directly protect against all heart disease,” said senior author Daniel J. Rader, MD, chair of the department of Genetics. “Our results indicate that some causes of raised HDL actually increase risk for heart disease. This is the first demonstration of a genetic mutation that raises HDL but increases risk of heart disease.”
Rader and his colleagues sequenced the lipid-modifying regions of the genomes of 328 people with markedly elevated HDL (along with a control group with lower HDL) to identify genetic causes of high HDL. One of the genes they focused on was SCARB1, which encodes for Scavenger Receptor B1 (SR-B1), the major receptor for HDL on cell surfaces.
In the course of this sequencing, they identified, for the first time, a person without any SCARB1 function, typified by an extremely high HDL-C level of about 150 mg/dL, whereas the normal level is about 50 mg/dL. The subject had two copies of a SCARB1 mutation called P376L, which the team showed caused a breakdown in HDL receptor function.
Burning more calories linked with greater gray matter volume, reduced Alzheimer’s risk (11 March 2016EurkAlert)
Excerpt – “Whether they jog, swim, garden or dance, physically active older persons have larger gray matter volume in key brain areas responsible for memory and cognition, according to a new study by researchers at the University of Pittsburgh School of Medicine and UCLA.
The findings, published today in the Journal of Alzheimer’s Disease, showed also that people who had Alzheimer’s disease or mild cognitive impairment experienced less gray matter volume reduction over time if their exercise-associated calorie burn was high.
A growing number of studies indicate physical activity can help protect the brain from cognitive decline, said investigator James T. Becker, Ph.D., professor of psychiatry, Pitt School of Medicine. But typically people are more sedentary as they get older, which also is when the risk for developing Alzheimer’s disease and other dementias increases.
Different kinds of physical activity shown to improve brain volume & cut Alzheimer’s risk in half (another 11 March 2016 EurkAlert)
Excerpt- “LOS ANGELES, CA/PITTSBURGH, PA, March 11, 2016: A new study shows that a variety of physical activities from walking to gardening and dancing can improve brain volume and cut the risk of Alzheimer’s disease by 50%.
This research, conducted by investigators at UCLA Medical Center and the University of Pittsburgh, is the first to show that virtually any type of aerobic physical activity can improve brain structure and reduce Alzheimer’s risk. The study, funded by the National Institute of Aging, was published on March 11 in the Journal of Alzheimer’s Disease.”
Reminds me of my sister who is a pharmacist. She goes on yearly medical missions to Haiti. The folks working in the pharmacy at the clinic there have only a high school education. My sister is a stickler when it comes to pharmacy practice/licensing in the US. But very much in awe with her Haitian colleagues and what they know and are able to do.
From the 10 March 2016 item at Covering Health:Monitoring the Pulse of Health Care Journalism
A recent news package in The Seattle Times by reporter Will Drabold took a look at how the controversy over dental therapists is unfolding in the state of Washington.
Drabold examined the challenges faced by poor Medicaid patients in seeking dental care. He spoke with health care advocates who believe that technically-trained mid-level providers could bring much-needed care to poor and isolated communities. He also interviewed tribal leader Brian Cladoosby, whose Swinomish tribe had just defied state restrictions to hire a dental therapist. And he spoke with state dental association officials, who made it clear that they – like the American Dental Association – believe dental therapists lack the training to perform these expanded duties.
Dental therapists, who often are compared to nurse practitioners, are trained to deliver a range of services including screenings, cleanings, preventive care, fillings and extractions. While the therapists do work under the supervision of dentists, dental groups often contend that dentists alone have the training to perform what they consider irreversible surgical procedures, such as drilling and extracting teeth.
In spite of resistance from organized dentistry, variations of the therapist model already are being used in Alaska’s tribal lands and in the state of Minnesota. Dental therapists have been approved in Maine and are being considered in a number of other states.
A recent article in the National Review used the term “advocacy research” to describe unscientific articles published in predatory journals to promote a social or political agenda.
I have been observing and blogging about this for some time and wish I had come up with the term “advocacy research,” for it fits the concept perfectly.
The National Review article says,
Another trend, related and equally worrisome, is the increasing frequency of publication of the results of flawed “advocacy research” that is designed to give a false result that supports a certain cause or position and can be cited by activists long after the findings have been discredited. The articles are often found in the predatory open-access journals.
Because journals with an honest peer review process won’t publish unscientific advocacy research, predatory journals have become the venue of choice for people promoting unscientific agendas.
Here’s an example — illustrated in the screenshot above — with both a political and commercial motive. The article, “Asbestos-Related Research: First Objectivity then Conclusions,” (HTML, PDF) tries to make the case that government regulations prohibiting the manufacture and sale of asbestos products are “excessive.”
Read the entire blog post here
From the 8 March 2015 Rice University news release
HOUSTON – (March 8, 2016) – Approximately 25 percent of Texans say they lack confidence in understanding some of the most basic terminology about health insurance plans, according to a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation (EHF). The report found uninsured, low-income and Hispanic Texans were least likely to understand health-plan terms like “premium,” “copayment” and “provider network.”
Credit: thinkstockphotos.com/Rice University
The survey asked Texans about their confidence level in understanding seven terms that describe various features of health insurance plans. While one-quarter of all the respondents lacked confidence in their understanding of the terminology, there are significant differences among various subgroups.
Researchers found at least half of those who are uninsured said they didn’t fully understand five of the seven terms. In fact, the rates of lack of confidence for uninsured Texans were nearly double that of those with health insurance.
“This research shows that understanding the key parts of a health insurance plan can be tough, especially for the uninsured,” said Elena Marks, EHF’s president and CEO and a nonresident health policy fellow at the Baker Institute. “These numbers illustrate the continuing need to offer education and outreach targeting the uninsured so they can better understand their health insurance options.”
– See more at: http://news.rice.edu/2016/03/08/new-report-25-percent-of-texans-say-they-dont-understand-basic-health-insurance-terms/#sthash.vadJ9t9y.dpuf
From the 9th March 2016 Concordia University news release
A Concordia study shows that education and physical activity can significantly slow down grey-matter aging
Montreal, March 9, 2016 — Taking the stairs is normally associated with keeping your body strong and healthy. But new research shows that it improves your brain’s health too — and that education also has a positive effect.
In a study recently published in the journal Neurobiology of Aging, researchers led by Jason Steffener, a scientist at Concordia’s PERFORM Centre, show that the more flights of stairs a person climbs, and the more years of school a person completes, the “younger” their brain physically appears.
The researchers found that brain age decreases by 0.95 years for each year of education, and by 0.58 years for every daily flight of stairs climbed — i.e., the stairs between two consecutive floors in a building.
“There already exist many ‘Take the stairs’ campaigns in office environments and public transportation centres,” says Steffener. “This study shows that these campaigns should also be expanded for older adults, so that they can work to keep their brains young.”
From the 8 March 2016 Texas A & M news release
Imagine that the next time your doctor orders a round of tests, in addition to cholesterol and vitamin D, she also orders a genome sequence. It sounds like science fiction, but the day might come sooner than you think.
Precision medicine—in which each patient’s prevention and treatment decisions are tailored for them—has been a buzzword in the health care industry recently. President Barack Obama launched his Precision Medicine Initiative, and other countries have similar projects underway.
With concerns about the cost of health care, though, can we afford precision medicine?
In certain instances, precision medicine can actually save money. For example, if patients can be screened for drug hypersensitivity before being prescribed certain drugs, they won’t have to be treated later, which is better for patients and cuts down on costs. A similar approach works for choosing treatments.
“When you use a therapy to target only the individuals who will benefit, you avoid wasting drugs or other resources on people who you know won’t get any benefit, and who might actually be harmed,” said David Threadgill, Ph.D., professor and holder of the Tom and Jean McMullin Chair of Genetics at the Texas A&M Health Science Center College of Medicine and director of the Texas A&M Institute for Genome Sciences and Society.
Of course, it’s not quite that simple. “Whether the economics works out in favor of precision medicine depends on two things: the difficulty and the cost of finding the best candidates who will benefit from specific, tailored treatments,” said Robert L. Ohsfeldt, Ph.D., health economist and professor in the Department of Health Policy & Management at the Texas A&M School of Public Health. “You have to know a lot about the disease process and how individual characteristics—genetics and environmental factors like diet or exposure to toxins—mediate the treatment response.”
Continue reading on Vital Record.
From the 8 March 2016 Columbia University news release
“Astudy by researchers at Columbia University’s Mailman School of Public Health looked at the associations between firearm-related laws and firearm homicides, suicides, and unintentional injuries and deaths. The paper is the first to explore the evidence from around the world on gun laws and gun violence to determine whether gun restrictions help reduce gun deaths. While the research did not conclusively prove that restrictions, or relaxation of laws, reduce gun deaths, the results indicate that gun violence tended to decline after countries passed new restrictions on gun purchasing and ownership. Findings are published online in the February issue of Epidemiologic Reviews.
The researchers reviewed the findings from 130 studies conducted from 1950 to 2014 in 10 countries that had overhauled their gun law, mostly in the developed world, including the U.S., Australia, and Austria. A few studies looked at gun laws in middle-income countries, including Brazil, Colombia and South Africa.
“In most countries, we saw evidence of reduction in the firearm death rates after the enactment of firearm legislation” said Julian Santaella-Tenorio, a doctoral student in Epidemiology at Columbia University’s Mailman School and the study’s lead author.
Santaella-Tenorio and his Columbia co-authors, Professors Magdalena Cerdá and Sandro Galea, also found evidence that specific laws, such as background checks and rules on storage, reduced specific kinds of gun deaths including intimate partner homicides and firearm unintentional deaths in children, respectively.
By comparison, laws in place about carrying concealed weapons or standing your ground either had no effect on gun deaths or increased gun violence. “While our review is not proof that gun laws reduce violence, and also taking into account that for some countries there are very few papers examining firearm laws effects, we did see evidence showing an association between firearm laws and a decline in firearm homicide and suicide rates,” noted Santaella-Tenorio.
“Since we limited our review to changes in firearm policy and not ownership in general or other types of policy, the debate should not end here.”
– See more at: https://www.mailman.columbia.edu/public-health-now/news/do-gun-restrictions-help-reduce-gun-deaths#sthash.EpAJImmS.dpuf
From the 7 March 2016 news release
When a solution to a problem seems to have come to you out of thin air, it turns out you’ve more than likely been struck with the right idea, according to a new study.
A series of experiments conducted by a team of researchers determined that a person’s sudden insights are often more accurate at solving problems than thinking them through analytically.
“Conscious, analytic thinking can sometimes be rushed or sloppy, leading to mistakes while solving a problem,” said team member John Kounios, PhD, professor in Drexel University’s College of Arts and Sciences and the co-author of the book “The Eureka Factor: Aha Moments, Creative Insight and the Brain.” “However, insight is unconscious and automatic — it can’t be rushed. When the process runs to completion in its own time and all the dots are connected unconsciously, the solution pops into awareness as an Aha! moment. This means that when a really creative, breakthrough idea is needed, it’s often best to wait for the insight rather than settling for an idea that resulted from analytical thinking.”
Experiments with four different types of timed puzzles showed that those answers that occurred as sudden insights (also described as Aha! moments) were more likely to be correct. Moreover, people who tended to have more of these insights were also more likely to miss the deadline rather than provide an incorrect, but in-time, answer. Those who responded based on analytic thought (described as being an idea that is worked out consciously and deliberately) were more likely to provide an answer by the deadline, though these last-minute answers were often wrong.
– See more at: http://drexel.edu/now/archive/2016/March/Insight_Correctness/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Science360NewsServiceComplete+%28Science360+News+Service%3A+Complete%29&utm_content=Netvibes#sthash.5dhxWU92.dpuf
From the 8 March 2016 blog item at Selam Selam by Laura Kihlström
Once in a month my husband and I pack Amos in his stroller and walk a few blocks to our closest health care center. We take the elevator to the fourth floor and enter Neuvola, the maternity and child care clinic, or ‘Place for Advice’ as translated freely from the Finnish word.
Neuvola is a Finnish public health care service available for all expectant mothers and children for free.
Maternal and child health is crucial, a cornerstone of development for all countries. Currently in the world approximately 830 women die every day from preventable causes related to pregnancy and childbirth and an estimated 5.9 million children die annually before they reach the age of 5.
The numbers for maternal and child mortality used to be staggering in Finland as well. Just 80 years ago, out of 1000 children a total of 95 died before reaching the age of 5. Now that number is less than 3, one of the lowest in the whole world. Similarly, the rate of maternal deaths used to be high, with 400 mothers dying per 100,000 births. Today, such deaths do basically not occur.
Who are we to thank for this?
The story of Neuvola dates back to the 1920s.
Mr. Arvo Ylppö, a Finnish pediatrician, was determined to decrease infant mortality in Finland. He got his motivation from Germany where he studied and observed, for instance, that the cause of death for prematurely born infants can be traced to treatable conditions instead of simple underdevelopment.
The ideas he then implemented in Finland are, in essence, preventive health care measures.
He supported efforts to educate health care professionals, along with midwives, to municipalities. The services provided by Neuvola were to be free of charge and voluntary. At its core were to be the provision of guidance for mothers and families, a complete vaccination programme as well as the detection of abnormalities in a child’s development as early as possible.
These remain the activities of Neuvola even today.
Neuvola started small, but today it reaches practically all expectant mothers and children in Finland from their birth to the beginning of primary education which is usually at the age of 7. It has been a tremendous success story. My mother used Neuvola services, now I do too. It is a privilege shared by many generations.
It is not an exaggeration to say that Finland is one of the best countries in the world for parents.
From the 7 March 2016 Children’s Hospital of Philadelphia news release
Analyzing the immediate neighborhood surroundings of teenaged homicide victims, Philadelphia researchers found that neglected conditions — vacant lots, poor street lighting, fewer parks and less-traveled thoroughfares — were in much greater abundance compared to neighborhoods where adolescents were safer. Without attributing cause and effect, the new study adds to previous research suggesting that modifying specific outdoor features with low-cost improvements may foster community interaction and potentially reduce youth violence in cities.
A couple walk past a young homeless man in London’s Clink Street.
“Homicide is a leading cause of death in U.S. adolescents and young adults, especially among African Americans, but the factors influencing violence are complex,” said corresponding author Alison J. Culyba, MD, MPH, an adolescent medicine specialist and epidemiologist at The Children’s Hospital of Philadelphia (CHOP). “Large-scale violence-prevention programs addressing poverty and educational disparities are absolutely necessary, but may require long-term investment to yield results. We focused on a different level — modifiable features of the built environment that might be factors in violence risk.”
Culyba and her CHOP co-authors collaborated with researchers from the Perelman School of Medicine at the University of Pennsylvania, led by epidemiologist Charles C. Branas, PhD, the senior author and director of the Penn Injury Science Center.
The study appeared today in JAMA Pediatrics.
“One theory that resonated with a lot of the things we found points to the importance of busy streets in promoting outdoor activity, interaction and cohesion in communities, which could potentially deter street violence,” said Branas, who has led several previous studies suggesting that urban parks and greening vacant lots encourage people to become invested in maintaining their neighborhoods and may reduce violent crime.
Both Culyba and Branas stress that this study does not show that street features and other elements cause or reduce homicide. Rather, they say, street lighting, pedestrian infrastructure, public transit, parks and vacant lot greening may be promising targets for future research to discover whether such interventions may provide social and health benefits.
From the 7 March 2016 University of Toronto news release
Professor Milica Radisic and her team have created a new platform for growing realistic human heart and liver tissue outside the body. The technique could help drug companies discover and prevent negative side effects. (Photo: Caz Zyvatkauskas)
Researchers at U of T Engineering have developed a new way of growing realistic human tissues outside the body. Their “person-on-a-chip” technology, called AngioChip, is a powerful platform for discovering and testing new drugs, and could eventually be used to repair or replace damaged organs.
Professor Milica Radisic (IBBME, ChemE), graduate student Boyang Zhang and their collaborators are among those research groups around the world racing to find ways to grow human tissues in the lab, under conditions that mimic a real person’s body. They have developed unique methods for manufacturing small, intricate scaffolds for individual cells to grow on. These artificial environments produce cells and tissues that resemble the real thing more closely than those grown lying flat in a petri dish.
Left to right: Team members Miles Montgomery, Professor Milica Radisic, Boyang Zhang and Yimu Zhao (Photo: Geoff George)
The team’s recent creations have included BiowireTM — an innovative method of growing heart cells around a silk suture — as well as a scaffold for heart cells that snaps together like sheets of Velcro™. But AngioChip takes tissue engineering to a whole new level. “It’s a fully three-dimensional structure complete with internal blood vessels,” says Radisic. “It behaves just like vasculature, and around it there is a lattice for other cells to attach and grow.” The work — which is published todayin the journal Nature Materials — was produced collaboratively with researchers from across U of T, including Professor Michael Sefton (ChemE, IBBME), Professor Aaron Wheeler (Chemistry, IBBME) and their research teams, as well as researchers from Toronto General Hospital and University Health Network.
Zhang built the scaffold out of POMaC, a polymer that is both biodegradable and biocompatible. The scaffold is built out of a series of thin layers, stamped with a pattern of channels that are each about 50 to 100 micrometres wide. The layers, which resemble the computer microchips, are then stacked into a 3D structure of synthetic blood vessels. As each layer is added, UV light is used to cross-link the polymer and bond it to the layer below.
These tiny polymer scaffolds contain channels that are about 100 micrometres wide, about the same diameter as a human hair. When seeded with cells, the channels act as artificial blood vessels. By mimicking tissues in the human heart and other organs, these scaffolds provide a new way to test drugs for potentially dangerous side effects. (Image: Tyler Irving/Boyang Zhang/Kevin Soobrian)
When the structure is finished, it is bathed in a liquid containing living cells. The cells quickly attach to the inside and outside of the channels and begin growing just as they would in the human body.
From the 7 March 2016 Brookings report
This Tuesday, March 8, marks the first International Women’s Day since world leaders agreed last September to launch the Sustainable Development Goals (SDGs) for 2030. A more rounded conception of gender equality marks one of the SDGs’ most important improvements compared to their predecessor Millennium Development Goals (MDGs). Two SDG targets help to illustrate the broadening geopolitical recognition of the challenges. They also help to underscore how much progress is still required.
A renewed target: Protecting mothers’ lives
The SDGs are also carrying forward the previous MDG priority of maternal health. Target 3.1 aims as follows: “By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.” Formally this falls under Goal 3 for health and wellbeing, but it certainly represents a gender equality objective too. Part of that is by definition; mothers are female. Part of it is driven by the need to overcome gender bias; male decision-makers at all levels might overlook key health issues with which they have no direct personal experience.
A new target: Eliminating child marriage
The inclusion of SDG target 5.3 adds one of the most important new priorities to the global policy agenda: to “eliminate all harmful practices, such as child, early and forced marriage, and female genital mutilation.”
From the 7 March 2016 EurkAlert
“Key findings from the study, which are representative of the nation, showed that regardless of income, age, race, occupation, full-time or part-time work status, health status or health insurance coverage, workers without paid sick leave were three times more likely to delay medical care than were workers with paid sick leave. They also were three times more likely to forgo needed medical care altogether. Furthermore, families of workers without paid sick leave were two times more likely to delay medical care and 1.6 times more likely to forgo needed medical care. The lowest-income group of workers without paid sick leave were at the highest risk of delaying and forgoing medical care for themselves and their family members — making the most financially vulnerable workers the least likely to be able to address health care concerns in a timely manner.
The researchers also found that working adults with paid sick leave benefits missed one-and-a-half days more of work because of an illness or injury compared to workers without paid sick leave, indicating that they were more likely to take time off work to care for themselves or family when needed.”
From the 8 March 2016 Imperial College London press release
Avoidable harm to patients is still too high in healthcare in the UK and across the globe.
Safety therefore must be a top healthcare priority for providers and policy makers alike.
These are the findings of two reports launched today by researchers from Imperial College London. Both reports, produced by NIHR Imperial Patient Safety Translational Research Centre (PSTRC), provide evidence on the current state of patient safety and how it could be improved the future. They urge healthcare providers to embrace a more open and transparent culture to encourage continuous learning and harm reduction.
The first report focuses on the current system used by NHS staff to report patient safety incidents, called the National Reporting and Learning System (NRLS). The report authors explain this system requires refinement and renovation, so as to take advantage of new technologies and recent behavioural insights. For example app-based technologies offer a simplified platform that engages staff in the incident reporting process. This will not only improve the ease of reporting, but also the accuracy of data reported.
In particular, the report reiterates problems around under-reporting of safety incidents, and reveals structural concerns within the NRLS, that have inhibited its usefulness as a tool to drive safety improvement.
The second report, Patient Safety 2030, suggests a ‘toolbox’ for patient safety. This would include: using digital technology to improve safety; providing robust training and education, and strengthening leadership at the political, organisational, clinical and community levels. Other points in the ‘toolbox’ include effective and high-quality education and training; strengthening measurement methods, including incident reporting, and exploring new digital solutions.
However, the authors warn that interventions implemented to reduce avoidable patient harm must be engineered with the whole system in mind, and empower patients and staff to become more involved in preventing harm and improving care.
Ultimately, both reports issue a global call-to-action on patient safety: both for individual health systems to convert the evidence on how to improve patient safety into everyday practice, and for the global community of health systems to share learnings from each other’s successes and failures.
The publications: “NRLS Research and Development Final Report”, funded by NHS England, will be presented on March 8th at the Royal Society in London. The “Patient Safety 2030”, funded by a grant from the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK, will be presented on March 9th at the Patient Safety Global Action Summit 2016.
From the 4 March 2014 EurkAlert
AURORA, Colo. (March 4, 2016) – – Researchers at the University of Colorado School of Medicine, along with experts from across the country, have developed a set of policy recommendations that would improve the quality of behavioral health care patients receive in clinical settings.
The Eugene S. Farley, Jr. Health Policy Center, with support from the Robert Wood Johnson Foundation, released recommendations in a report, “Creating a Culture of Whole Health,” that offers practical improvements that would eliminate the artificial separation of “mental health” from “physical health.” The report provides recommendations that call for creating a new approach to health care.
“The health care system differentiates physical and behavioral health care, patients don’t,” said Benjamin Miller, PsyD, director of the Eugene S. Farley, Jr. Health Policy Center and assistant professor of family medicine at the CU School of Medicine. “They seek care in a single setting with providers they trust in clinics that are convenient for them to visit. There should be no ‘wrong door’ preventing patients from accessing appropriate care.”
To improve the quality of care, Miller and the project team make several recommendations. Among them:
- policymakers and payers should establish payment methodologies that support team, not individual, providers;
- policymakers and payers should invest in a national technical assistance center focused on how to improve care by revising federal, state and local policy and regulatory barriers;
- providers should engage communities in service to advancing needs for behavioral health and assure consistency across care delivery;
- providers should share information on how to operationalize successful strategies, such as telehealth; and
- businesses and philanthropies could create resources and technical assistance strategies that improve access to data for patients and other providers.
From the 4 March 2016 EurkAlert
“MINNEAPOLIS – Young adults with hostile attitudes or those who don’t cope well with stress may be at increased risk for experiencing memory and thinking problems decades later, according to a study published in the March 2, 2016, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“We may not think of our personality traits as having any bearing on how well we think or remember things, but we found that the effect of having a hostile attitude and poor coping skills on thinking ability was similar to the effect of more than a decade of aging,” said study author Lenore J. Launer, PhD, with the National Institutes of Health in Bethesda, Md., and a member of the American Academy of Neurology.”
An excerpt from Quality vs. Quantity by By MICHEL ACCAD, MD at The Health Care Blog (4 March 2016)
“If we bear in mind that medical care consists of decisions and choices made in the face of uncertainty, then the quality of a decision can only be determined in real time, in a specific context, in light of all its alternatives. A third-party payer—public or private, single or multiple—cannot possibly obtain the needed knowledge to make that determination. For an outsider, the quality chasm is metaphysically impossible to cross. Measuring quality is grasping at straws.”
The future of public health in the United States is difficult to predict, but the challenges public health has yet to overcome are much more certain. As Keck, Scutchfield, and Holsinger point out i…
Source: The US is far behind peer nations in aligning policies with her public’s health.
How many times have people said “You must take care of yourself?” when caring for an elderly loved on who’s hospitalized. There’s stress. …too many things to take care…
Source: 13 Tips for Surviving Hospitalization of an Aging Parent or Spouse
Time to Talk Tips on Complementary Health Practices Information Resources By Evelyn Cunico, M.A., M.S. Posted June 02, 2015 Background “Time to Talk Tips” is one of the resources in the…
Source: Time to Talk Tips on Complementary Health Practices
Guest post by Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD For doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable…
For doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable or a game changer. It is not cynicism but a healthy skepticism towards marketing over substance. Doctors want to see the evidence that a drug actually works rather than just a good story about why it should work.
Often, however, this skepticism does not last. After a few months, still without any evidence, the doctor finds herself buying in, just a little, to the hype. OK, let me just see what everyone is talking about, she thinks. She begins recommending the drug herself. She still thinks of herself as cautious and conservative—while her colleagues use the treatment widely, she thinks it has a more narrow and defined role. Probably the pill does not work for everyone, but in a select group of people.
A few more years go by, and she gets comfortable with the once-hyped treatment. She now knows how to manage its complications; she thinks she has a good sense of who it benefits; and she considers it a part of her practice.”
Source: Ending medical reversal
What does it take to write an award-winning article? For Richard Mark Kirkner, the process involved finding the right idea, pursuing the reporting doggedly, and then putting it together in one comp…
“In a new How I Did It, Kirkner explains his thinking: “Whenever new medical technology is put to use, hospitals and specialty clinics like to put the best spin on it. But it can take years for such new medical equipment to prove its mettle compared with existing methods.””
Source: Here’s how one journalist discovered the rush to robotic surgery was ahead of the evidence
For those who missed it and are interested. Also see supplementary materials (bad pun).
Erectile Dysfunction/Sexual Enhancement
As many as 30 million American men have erectile dysfunction (ED). If you’re one of them and considering a so-called “herbal Viagra,” you should discuss the situation with your health care provider. Conventional treatments are available that may help you. Another important reason to see your health care provider is that ED may be a sign of an underlying health problem that needs to be treated, such as clogged blood vessels or nerve damage from diabetes. Furthermore, the U.S. Food and Drug Administration (FDA) has warned that some products marketed as dietary supplements for male sexual enhancement or ED contain prescription drug ingredients or related substances. These products may interact in dangerous ways with medicines.
Bottom Line: No complementary health approaches have been shown to be safe and effective for sexual enhancement or treating ED. Safety is a serious concern with regard to dietary supplements promoted for ED or sexual enhancement.
Safety: Many supplements promoted for ED and sexual enhancement have been found to be tainted with drug ingredients or related substances. These contaminants may interact with prescription drugs in harmful ways. For example, some of the contaminants in these supplements may interact with drugs that contain nitrates, leading to a dangerous decrease in blood pressure. People with diabetes, high blood pressure, high cholesterol, or heart disease often take drugs containing nitrates, and men with these conditions frequently have ED.
Warning signs that a dietary supplement for ED may be tainted with potentially harmful substances include:
- Claims that the product is a natural alternative to prescription drugs or has effects similar to those of drugs
- Promises that the product will work very rapidly or that its effects will last for a day or more
- Personal testimonials about incredible benefits from the product.
For more information on ED, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Web site.
From a page from the US EPA
EPA is combining different types of data to characterize impacts of chemicals to human health and the environment. The research provides accessible information to support scientific discovery and sustainable decisions. EPA researchers are using scientific advances to identify chemical characteristics and features that are associated with potential for environmental and human health impacts.
The research is generating chemical, biological and toxicological information to advance the understanding of relationships between chemical characteristics and potential impacts of use. This research will help EPA and others evaluate these chemicals prior to use to ensure they are the most effective and safest chemicals to use.
Our research analyzing the life cycle of chemicals focuses on four areas:
Nanoparticles and Emerging Materials
Environmental and human health impacts of chemical use across the chemical/product life cycle
EPA is developing ways to efficiently evaluate environmental and human health impacts of chemical use across the chemical/product life cycle to support sustainability analysis, assessment of chemical alternatives and to help inform risk-based decisions.
EPA evaluates the risk of pesticide use to threatened and endangered species. This research is using population effects and spatial distribution to develop ecological risk models to predict potential risk to ecological systems and the environment.
- Markov Chain Nest Productivity Model: estimates the impact of pesticide exposures on the reproduction success of bird populations.
- Web Ice: estimates acute toxicity to aquatic and terrestrial organisms for use in risk assessment.
- EcoTox: Provides information on adverse effects of single chemical stressors to ecologically relevant aquatic and terrestrial species. It includes more than 780,000 test records covering 12,000 aquatic and terrestrial species and 11,000 chemicals.
Source: Time to Talk Tips on Complementary Health Practices
From the Source
By Evelyn Cunico, M.A., M.S.
Posted June 02, 2015
“Time to Talk Tips” is one of the resources in the “Time to Talk Campaign,” managed by the National Center for Complementary and Integrative Health (NCCIH), at the National Institutes of Health (NIH).
Like any health-related decision, your decision about whether to use complementary health practices is central to your health and safety. Yet, information you find on the Web is not always specific to your illness or based on scientific evidence.
The NIH monthly consumer-friendly series, “Time to Talk Tips,” discusses specific health topics, together with the scientific evidence related to those topics. The series is designed to encourage you and your medical doctors or other healthcare providers to talk about any complementary practice that you are considering.
Examples of “Time to Talk Tips”
The series includes simple tips, such as, taking vitamin C regularly does not reduce the likelihood of getting a cold, but may improve some cold symptoms, and some dietary supplements may interact with prescription or over-the-counter medications or other dietary supplements.
The consumer tips accompany topics found in the NCCIH Clinical Digest for Health Professionals, which is a monthly e-newsletter for medical doctors and other healthcare providers. The Clinical Digest addresses the state of science on complementary health practices for a variety of health conditions.
How to Make “Time to Talk Tips” Work for You
The same topics that are found in the NCCIH Clinical Digest and the “Time to Talk Tips” are discussed in monthly Twitter chats, allowing you, as a member of the public, to interact with NCCIH Information Specialists, to ask questions, and to receive answers in real time.
The NCCIH “Time to Talk Tips” monthly series on complementary health practices was started in 2012. If you access the NCCIH website, “Time to Talk Tips on Complementary Health Practices,” on a regular basis, you can see the list of tips grow, from month to month.
Stay informed in the following ways:
Resources for Patients from the National Institutes of Health
Disclaimer: The information presented in this blog should not replace the medical advice of your doctor. You should not use this information to diagnose or treat any disease, illness, or other health condition without first consulting with your medical doctor or other healthcare provider.