WASHINGTON, April 22, 2014 — Marijuana is in the headlines as more and more states legalize it for medicinal use or decriminalize it entirely. In the American Chemical Society’s (ACS’) newest Reactions video, we explain the chemistry behind marijuana’s high, and investigate what scientists are doing to ensure that legalized weed won’t send users on a bad trip. The video is available at http://youtu.be/4ukdUDCE56c
[Press release] The Lancet: Reducing just 6 risk factors could prevent 37 million deaths from chronic diseases over 15 years
Reducing or curbing just six modifiable risk factors—tobacco use, harmful alcohol use, salt intake, high blood pressure and blood sugar, and obesity—to globally-agreed target levels could prevent more than 37 million premature deaths over 15 years, from the four main non-communicable diseases (NCDs; cardiovascular diseases, chronic respiratory disease, cancers, and diabetes) according to new research published in The Lancet.
Worryingly, the findings indicate that not reaching these targets would result in 38.8 million deaths in 2025 from the four main NCDs, 10.5 million deaths more than the 28.3 million who died in 2010.
This is the first study to analyse the impact that reducing globally targeted risk factors will have on the UN’s 25×25 target to reduce premature deaths from NCDs by 25% relative to 2010 levels by 2025.
Using country-level data on deaths and risk factors and epidemiological models, Professor Majid Ezzati from Imperial College London, UK, and colleagues estimate the number of deaths that could be prevented between 2010 and 2025 by reducing the burden of each of the six risk factors to globally-agreed target levels—tobacco use (30% reduction and a more ambitious 50% reduction), alcohol use (10% reduction), salt intake (30% reduction), high blood pressure (25% reduction), and halting the rise in the prevalence of obesity and diabetes.
Overall, the findings suggest that meeting the targets for all six risk factors would reduce the risk of dying prematurely from the four main NCDs by 22% in men and 19% for women in 2025 compared to what they were in 2010. Worldwide, this improvement is equivalent to delaying or preventing at least 16 million deaths in people aged 30 years and 21 million in those aged 70 years or older over 15 years.
The authors predict that the largest benefits will come from reducing high blood pressure and tobacco use. They calculate that a more ambitious 50% reduction in prevalence of smoking by 2025, rather than the current target of 30%, would reduce the risk of dying prematurely by more than 24% in men and by 20% in women.
Originally posted on Metro News:
Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced after a recent Torstar News Service investigation.
The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.
“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”
Last week, Torstar revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.
At close to 300 homes, Torstar found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients…
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Originally posted on THL News Blog:
I was at the Ann Arbor YMCA the other day and overheard two women questioning the safety of chemicals used in makeup and other over the counter personal products. This conversation was prompted by someone’s sunscreen running into their eyes, making them partially blind for a few minutes, causing her to wonder if there are any chemicals in there she should be really worried about. I thought I would do a search for information about the safety of chemicals in makeup and share my results since it seems to be something people are interested in:
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Tel Aviv University research shows fat mass in cells expands with disuse
Over 35 percent of American adults and 17 percent of American children are considered obese, according to the latest survey conducted by the Centers for Disease Control and Prevention. Associated with diabetes, heart disease, stroke, and even certain types of cancer, obesity places a major burden on the health care system and economy. It’s usually treated through a combination of diet, nutrition, exercise, and other techniques.
To understand how obesity develops, Prof. Amit Gefen, Dr. Natan Shaked and Ms. Naama Shoham of Tel Aviv University’s Department of Biomedical Engineering, together with Prof. Dafna Benayahu of TAU’s Department of Cell and Developmental Biology, used state-of-the-art technology to analyze the accumulation of fat in the body at the cellular level. According to their findings, nutrition is not the only factor driving obesity. The mechanics of “cellular expansion” plays a primary role in fat production, they discovered.
By exposing the mechanics of fat production at a cellular level, the researchers offer insight into the development of obesity. And with a better understanding of the process, the team is now creating a platform to develop new therapies and technologies to prevent or even reverse fat gain. The research was published this week in the Biophysical Journal.
Getting to the bottom of obesity
“Two years ago, Dafna and I were awarded a grant from the Israel Science Foundation to investigate how mechanical forces increase the fat content within fat cells. We wanted to find out why a sedentary lifestyle results in obesity, other than making time to eat more hamburgers,” said Prof. Gefen. “We found that fat cells exposed to sustained, chronic pressure — such as what happens to the buttocks when you’re sitting down — experienced accelerated growth of lipid droplets, which are molecules that carry fats.
“Contrary to muscle and bone tissue, which get mechanically weaker with disuse, fat depots in fat cells expanded when they experienced sustained loading by as much as 50%. This was a substantial discovery.”
The researchers discovered that, once it accumulated lipid droplets, the structure of a cell and its mechanics changed dramatically. Using a cutting-edge atomic force microscope and other microscopy technologies, they were able to observe the material composition of the transforming fat cell, which became stiffer as it expanded. This stiffness alters the environment of surrounding cells by physically deforming them, pushing them to change their own shape and composition.
“When they gain mass and change their composition, expanding cells deform neighboring cells, forcing them to differentiate and expand,” said Prof. Gefen. “This proves that you’re not just what you eat. You’re also what you feel — and what you’re feeling is the pressure of increased weight and the sustained loading in the tissues of the buttocks of the couch potato.”
The more you know …
“If we understand the etiology of getting fatter, of how cells in fat tissues synthesize nutritional components under a given mechanical loading environment, then we can think about different practical solutions to obesity,” Prof. Gefen says. “If you can learn to control the mechanical environment of cells, you can then determine how to modulate the fat cells to produce less fat.”
The team hopes that its observations can serve as a point of departure for further research into the changing cellular environment and different stimulations that lead to increased fat production.
HUNTSVILLE, TX (3/20/14) — Parents who use alcohol, marijuana, and drugs have higher frequencies of children who pick up their habits, according to a study from Sam Houston State University.
The study, “Intergenerational Continuity of Substance Use,” found that when compared to parents who did not use substances, parents who used alcohol, marijuana, and other illicit drugs were significantly more likely to have children who used those same drugs. Specifically, the odds of children’s alcohol use were five times higher if their parents used alcohol; the odds of children’s marijuana use were two times higher if their parents used marijuana; and the odds of children’s other drug use were two times higher if their parent used other drugs. Age and other demographic factors also were important predictors of substance use.
“The study is rare in that it assesses the extent to which parent’s substance use predicts use by their children within age-equivalent and developmentally-specific stages of the life course,” said Dr. Kelly Knight of the College Criminal Justice’s Department of Criminal Justice and Criminology. “If a parent uses drugs, will their children grow up and use drugs? When did the parent use and when did their children use? There appears to be an intergenerational relationship. The effect is not as strong as one might believe from popular discourse, but when you measure it by developmental stage, it can provide important information on its impact in adolescence and early adulthood, specifically.”
The study examined the patterns of substance use by families over a 27-year period. It documents substance use over time, giving a more complete understanding of when substance use occurs, when it declines, and the influence of parents in the process.
According to the National Survey on Drug Use and Health in 2011, about 22.6 million Americans age 12 years and older said they used illicit drugs in the last month. Other studies show that drug use is associated with reduced academic achievement, lower employment rates, poorer health, dependency on public assistance, neighborhood disorganization, and an increase in the likelihood of involvement in crime, criminal victimization and incarceration. The cost of drug use in this country from lost productivity, healthcare, and criminal justice is nearly $600 billion.
By plotting the life course of substance use within families, the study may be a valuable tool for the development of intervention programs. The study suggests that if substance use can be curtailed in adolescence, it may help to curb its prevalence in future generations.
The study also helps pinpoint the use of different illicit substances over the span of a lifetime, including its emergence in adolescence and when that use may decline. For example, marijuana and other drug use is most prevalent in adolescence and generally declines before or at age 24. Alcohol use continues to increase throughout adolescence and young adulthood, and then remains relatively steady over the lifetime.
These findings come from the National Youth Survey Family Study, which has collected data from three generations over a 27-year period. The analysis is based on 655 parents and 1,227 offspring from 1977 to 2004.
Major ‘third-hand smoke’ compound causes DNA damage — and potentially cancer
DALLAS, March 16, 2014 — Leftover cigarette smoke that clings to walls and furniture is a smelly nuisance, but now research suggests that it could pose a far more serious threat, especially to young children who put toys and other smoke-affected items into their mouths. Scientists reported today that one compound from this “third-hand smoke,” which forms when second-hand smoke reacts with indoor air, damages DNA and sticks to it in a way that could potentially cause cancer.
Their talk was one of more than 10,000 presentations at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the world’s largest scientific society, taking place here through Thursday.
Bo Hang, Ph.D., who presented the research, said that although the idea of third-hand smoke made its debut in research circles just a few years ago in 2009, evidence already strongly suggests it could threaten human health.
“The best argument for instituting a ban on smoking indoors is actually third-hand smoke,” said Hang, a scientist at Lawrence Berkeley National Laboratory (LBNL).
Researchers have found that many of the more than 4,000 compounds in second-hand smoke, which wafts through the air as a cigarette is smoked, can linger indoors long after a cigarette is stubbed out. Based on studies led by Hugo Destaillats, Ph.D., also at LBNL, these substances can go on to react with indoor pollutants such as ozone and nitrous acid, creating brand-new compounds, some of which may be carcinogenic.
One of those compounds goes by the acronym NNA. Hang’s research has shown that NNA, a tobacco-specific nitrosamine, locks onto DNA to form a bulky adduct (a piece of DNA bound to a cancer-causing chemical), as well as other adducts, in lab test tubes. Other large compounds that attach to DNA tend to cause genetic mutations. NNA also breaks the DNA about as often as a related compound called NNK, which is a well-studied byproduct of nicotine and a known potent carcinogen. This kind of DNA damage can lead to uncontrolled cell growth and the formation of cancerous tumors.
Just as it took years to establish the cancer-causing effects of first-hand smoke that is inhaled as a person breathes in directly from the cigarette, making the connection between third-hand smoke or NNA and cancer could take a long time, Hang said. But early research into its nature, exposure and health effects is compelling enough that a research consortium dedicated to investigating third-hand smoke was formed in California in 2010. That consortium helped fund Hang’s work on NNA-induced DNA damage, which he said could eventually be used as biomarkers to identify people who have been exposed to third-hand smoke.
The biggest potential health risk is for babies and toddlers, he noted. As they crawl and put their hands or toys in their mouths, they could touch, swallow or inhale compounds from third-hand smoke. Their small size and early developmental stage make them more vulnerable than adults to the effects of environmental hazards.
“Phthalates belong to a group of industrial compounds known as endocrine disruptors because they interfere with the endocrine system, which governs the production and distribution of hormones in the body. The chemicals have been implicated in a range of health problems, including birth defects, cancers and diabetes.
But it is their effect on the human reproductive system that hasmost worried researchers. A growing body of work over the last two decades suggests that phthalates can rewire the male reproductive system, interfering with the operation of androgenic hormones, such as testosterone, that play key roles in male development. That mechanism, some experts believe, explains findings that link phthalate exposure to changes in everything from testicular development to sperm quality.”
“There are different kinds of phthalates complicating the picture; some seem to have a much larger effect than others. And these are far from the only factors, chemical and otherwise, that influence human fertility. Dr. Buck Louis’s group is looking at a broad range of industrial compounds, including heavy metals like lead and cadmium, that tend to accumulate in the body.
Phthalates, by contrast, tend to be metabolized within a few hours. Their impact would not be so profound if it were not that people are constantly exposed from multiple sources.
These include not only cosmetics and plastics, but also packaging, textiles, detergents and other household products. Phthalates are found in the tubing used in hospitals to deliver medications; in water flowing through PVC pipes; enteric coatings on pills, including some aspirin; materials used to create time-release capsules; and countless other products. In 2008, the government banned them in children’s toys, and the European Union is also moving forward on restrictions.
“The W.H.O. called them ‘pseudopersistent’ in one report,” Dr. Woodruff said, because continued exposure keeps phthalates in the body. But here’s the silver lining: the transient nature of these compounds also means that consumers can take fairly simple measures to reduce their phthalate levels.
One is to read the labels on cosmetics and other personal care products and to choose those without phthalates. Another is to be cautious with plastic food containers, and to avoid using them to heat food and drink, as the phthalates in them may get transferred to what you consume.
“These compounds leach from plastics,” Dr. Buck Louis said. “You can switch to glass for drinking. You can cook your frozen dinners on paper plates.”
Studies have shown that these kinds of actions do make a difference; experiments have found measurably lower levels within several days in people who make these changes.
“Lifestyle has an important place here,” said Dr. Buck Louis.”
California took steps to reduce the toxins found in children’s sleeping products and home and building supplies on Thursday, when regulators announced they would begin asking manufacturers to eliminate chemicals known to cause cancer and other illnesses.
In making the announcement, regulators with the California Department of Toxic Substances Control rolled out a program six years in the making — the first of its kind in the nation — that aims to minimize consumers’ exposure to toxic chemicals.
“I can’t even tell you what a big deal this is,” said Kathleen Curtis, the national coordinator for the Alliance for Toxic-Free Fire Safety, a nationwide coalition. “It’s huge, and it’s a super smart strategic move by the state of California.
On Thursday, state leaders announced the first round of top priority chemicals that they want reduced or eliminated from products many Californians use: children’s bedding items, spray foam used to insulate and weatherize buildings, and paint strippers, removers and surface cleaners. All of these products, state officials say, contain toxins that can cause cancer, hormone imbalances and environmental degradation.
Meredith Williams, deputy director of the Department of Toxic Substances Control, said the state’s message to manufacturers is this: If you want to sell products in California, you must make products that are safe — or risk being banned from the country’s largest economy.
The announcement signals a larger victory for environmental advocates who have been working for years to rid furniture of toxins that were added as flame retardants. Studies have shown that some of these flame retardants do very little to reduce fires and have been linked to startling health risks. One of the most widely used flame retardants is TDCPP, which, under the Safer Consumer Products regulations, the state will pressure manufacturers to remove from toddlers’ nap mats, cots, cribs, playpens and bassinets.
TDCPP is one of three chemicals the state announced it is targeting: the others are diisocyanates, a chemical found in spray polyurethane foam that is used to weatherize buildings, and has been linked to lung damage, asthma, cancer and respiratory ailments; and methylene chloride, a carcinogen found in paint or varnish removers, paint strippers and surface cleaners. Thursday’s announcement marked the start of what is expected to be a yearlong process that will include a public comment period, discussions with manufacturers and studies to identify safe substitutions. In October, the state will release a second, and much lengthier, list of priority chemicals and products, Williams said. Manufacturers who don’t meet the new standards could be compelled to label their ingredients or have their products banned from California as early as 2016,
Topics include”store/restaurant proximity, food prices, food and nutrition assistance programs, and how community characteristics—interact to influence food choices and diet quality.”
Options for printouts and exports (JPG and NPG).
A little tricky to use. Found by trial and error (I have a MacBook Pro) that the arrows on the lower right of my keyboard re-center the map.
Originally posted on NobodyisFlyingthePlane:
“What we need,” Freudenberg said to me, “is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”
Bittman contributes to the ongoing discussion here at NobodyisFlyingthePlane about how certain industries deflect public discourse from what is best for our citizens to what makes the most profit, no matter the consequences.
The author he quotes poses a series of questions which get at the heart of the matter.
“Shouldn’t science and technology be used to improve human well-being, not to advance business goals that harm health?”
Similarly, we need to be asking not “Do junk food companies have the right to market to children?” but “Do children have the right to a healthy diet?”
Essentially its a PR game. Do we let whole industries spin how the conversation is framed or do we let the…
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Chronic pain syndrome is an extremely complicated diagnosis and the treatment of its symptoms requires an interdisciplinary approach ranging from primary care physicians, physical therapists, anesthesiologists, and psychologists. Likewise, understanding the barriers to the treatment of chronic pain requires teasing out a similarly convoluted picture. Therefore, I’ve decided to write about the extremely complex and understudied relationship between poverty and pain. Not surprisingly, there are many components to this relationship because the American health care system is one that involves many players from the government, private sector, non-profits, and Medicare, Medicaid, TRICARE, Children’s Health Insurance Program, Social Security Administration, and the Veteran’s Administration, just to name a few. However my focus will be narrowed to concentrate on the relationship between living in poverty and efficacious treatment of chronic pain, the flip side of that relationship where individuals fall into poverty as a result of a life-altering, limiting, and costly diagnosis of chronic pain, and the stigma of poverty that consciously or unconsciously affects access to treatment for patients in pain.
Living in poverty increases an individual’s risk for pain on almost every level including musculoskeletal, sciatica, ulcer, and neuropathic. Poleshuck and Green suggest that an individual’s socioeconomic status permeates almost every level of why an individual may suffer with chronic pain including the ability to implement positive coping strategies, job type and satisfaction, access to quality health insurance, and even social support and interpersonal relationships.
too often research on chronic pain is conducted in areas that have significant financial resources instead of places such as churches, homeless shelters, and community centers. There are other things to consider here. People that live in poverty and suffer from pain may not have access to primary care givers, analgesics or pharmacies that carry analgesics, and pain specialists. As the U.S. population ages and increasingly more people are diagnosed with pain disorders, those on the fringe will suffer most. Of course, there is a moral argument to be made here but there is an economic one too. According to an article that came out in Science Daily in 2012, health economists at Johns Hopkins estimated that chronic pain cost as much as $635 billion a year which they found was higher than heart disease, diabetes, and cancer. This was a conservative estimate. Therefore, one could argue that it is a public health interest to employ strategies of risk management, access, and multidisciplinary approaches to pain to vulnerable groups who suffer disabling pain at a higher number and magnitude.
The Top Five Useless Chronic Pain Treatments (Psychology Today), What not to do to help the chronic pain patient.Published on January 31, 2014 by Dr. Mark Borigini, M.D. in Overcoming Pain
From the 30 January article
- Clean hands: a review of 67 randomized controlled trials (RCTs) indicated that handwashing, a traditional public health approach, as well as alcohol disinfectants and gloves, is likely effective.
- Zinc may work for children (and possibly adults) — at least 2 RCTs indicated that children who took 10 or 15 mg of zinc sulfate daily had lower rates of colds and fewer absences from school due to colds. The authors suggest that zinc may also work for adults.
- Probiotics: there is some evidence that probiotics may help prevent colds, although the types and combinations of organisms varied in the studies as did the formulations (pills, liquids, etc.), making comparison difficult.
- Antihistamines combined with decongestants and/or pain medications appear to be somewhat or moderately effective in treating colds in older children — but not in children under age 5 — and adults.
- Pain relievers: ibuprofen and acetaminophen help with pain and fever. Ibuprofen appears better for fever in children.
- Nasal sprays: ipratropium, a drug used to treat allergies and chronic obstructive pulmonary disorder, may alleviate runny nose when used in a nasal spray but has no effect on congestion.
Other approaches and treatments
According to the evidence, the benefits of frequently used remedies such as ginseng, (found in ColdFX), gargling, vapour rubs and homeopathy are unclear. Cough medicines show no benefit in children but may offer slight benefit in adults. Honey has a slight effect in relieving cough symptoms in children over age 1. Vitamin C and antibiotics show no benefit, and misused antibiotics can have associated harms.
The authors note that the evidence for preventing and treating colds is often of poor quality and has inconsistent results.
“Much more evidence now exists in this area, but many uncertainties remain regarding interventions to prevent and treat the common cold,” write the authors. “We focused on RCTs and systematic reviews and meta-analyses of RCTs for therapy, but few of the studies had a low risk of bias. However, many of the results were inconsistent and had small effects (e.g., vitamin C), which arouses suspicion that any noted benefit may represent bias rather than a true effect.”
From the 10 January 2014 Contra Costa Times article
State public health officials announced on Friday a new online database that shows which cosmetics sold in California contain certain harmful chemicals, offering the first state-run public resource to inform consumers about potentially hazardous products they use everyday on their skin and hair.
The long-awaited California State Cosmetics Program Product Database is part of a state law passed in 2005 that aims to expose products with potentially hazardous ingredients, and pressure manufacturers to reformulate makeup, soap, lotion and similar products with safer alternatives. The public can search the website by type of product, brand or ingredient, and will be shown a list of products made with chemicals that are known to cause cancer, reproductive harm or birth defects.
“It does not mean that the cosmetic product itself has been shown to cause cancer, but since most products are not extensively tested for safety, providing information on chemical components will allow consumers to make more informed choices,” said Dr. Ron Chapman, director of the state Department of Public Health.
As of November, the state had collected information from about 475 companies, which have disclosed the ingredients in roughly 30,000 products. The state is requiring only companies that sell in California and have more than $1 million per year in cosmetic sales to report the potentially harmful ingredients they use. The state is looking for about 900 chemicals that have been identified as harmful by Proposition 65 legislation and organizations such as the National Toxicology Program.
The database is part of the California Safe Cosmetics Act of 2005, legislation signed by then-Gov. Arnold Schwarzenegger. The law required the site to be up by Dec. 31, 2013, but a health department spokesman said it did not go live until Friday.
The law also gives the state some enforcement authority, such as requiring products are labeled with warnings.
“We are the one agency in the U.S. collecting this information on cosmetics,” Nerissa Wu, a state public health official who helped establish the program, told this newspaper in an interview last fall. “Our hope is that the market pressure that comes out of that … encourages manufacturers to reformulate.”
Advocates welcomed the database, but some worried that the state lacked the resources to enforce safer standards for cosmetics.
“This doesn’t ban anything. This doesn’t restrict anything,” said Gretchen Salter, senior program and policy manager at the San Francisco-based Breast Cancer Fund, an advocacy group that championed the 2005 legislation. “Ultimately our feeling is these products don’t belong in cosmetics in the first place.”
The database is at http://www.cdph.ca.gov/programs/cosmetics/Pages/default.aspx
Contact Heather Somerville at 510-208-6413. Follow her at Twitter.com/heathersomervil.
From the 14 January 2014 article
Patients with a single illness who take many drugs have an increased risk of being admitted to hospital, but for patients with multiple conditions, taking many medicines is now associated with a near-normal risk of admission. This is the key finding of work published in the British Journal of Clinical Pharmacology. Doctors call the situation where people take many drugs ‘polypharmacy’, a state of affairs that is becoming increasingly common in part because we have more elderly people and also a rising number of people are being diagnosed with multiple health conditions.
Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.
Dr Payne says that previous studies have missed the different effect that polypharmacy has in different people because they used overly simplistic approaches when looking at the effect of taking many drugs at once. He points out that their new work demonstrates the need for more sophisticated and nuanced approaches when measuring the impact of polypharmacy in future clinical research.
We were standing at Target in an aisle we’d never walked down before, looking at things we didn’t understand. Pill splitters, multivitamins, supplements, and the thing we were here to buy: a long blue pill box—the kind with seven little doors labeled “S M T W T F S “ for each day of the week, the kind that old people cram their pills into when they have too many to remember what they’ve already taken.
My husband, Joe Preston, shook his head. “Do I really need this?”
I grabbed it off the shelf and threw it in our basket. And when we got home, Joe—then a fit and fairly spry 30-year-old man with a boss-level beard—stood at the kitchen counter, dropping each of his prescriptions with a plink into the container.
I guess it’s true that life is full of surprises, but for the three years since Joe’s crippling pain was diagnosed as the result of an autoimmune disease called Ankylosing Spondylitis, our life has been full of surprises like this one. Pill boxes, trips to the emergency room, early returns from vacation. Terms like “flare-up” have dropped into our vocabulary. We’ve sat in waiting rooms where Joe was the only person without a walker or a cane. Most of our tears have been over the fact that these aren’t the kind of surprises either of us thought we’d be encountering at such a young age.
But here’s the thing: We recently realized we weren’t alone. Almost all of our friends are sick, too. When we met our friend Missy Narrance, Joe found solace in talking to her about his health. She’s 29 and has been battling lupus and fibromyalgia for the past 10 years. She’s been through chemotherapy twice, and her daily symptoms are so extreme that she was granted federal disability status when she was just 23 years old. In our close group of friends—who range from 25 to 35 years old—we know people with everything from tumors to chronic pain. Sometimes our conversations over beers on a Friday night turn to discussions of long-term care and miscommunication between doctors.
Despite the fact that America shells out more money on healthcare than any other country in the world, according to a report by the Centers for Disease Control and Prevention—and a hefty 75 percent of those dollars are going toward aiding people with chronic conditions—almost half of American adults had at least one chronic condition in 2005.
The rest of the article includes analysis on how personal choices must be backed up by facts. It points out that research has been done on how infrastructural changes (which need tax dollars) can improve public health. But there has to be political will.
Research on these aspects of public health have not been widely disseminated by the press.
From the 18th January 2014 at Scope (published by Stanford Medicine)
The mobile health market is rapidly growing, and it’s estimated that within five years 50 percent of mobile device users will have downloaded mobile health apps. While past surveys haveshown that patients are eager for doctors to recommend such apps, it remains unclear if physicians feel comfortable prescribing them.
Over on MedPage Today, writer Kristina Fiore explores the potential of physicians prescribing health apps, such as BlueStar, which is approved by the U.S. Food and Drug Administration and helps patients monitor diabetes. Several of the clinicians contacted for the story said they are open to the idea, assuming that patients are comfortable using the app and that data shows the app to be effective. From the article:
Sue Kirkman, MD, of the University of North Carolina at Chapel Hill, said a prescription app could be helpful, but its usefulness may be limited in that the patients “who want the app and are willing to enter data and respond to prompts may already be the more proactive ones.”
Kirkman added that she hopes potential insurer reimbursement for apps opens the door wider to support of reimbursement for self-management tools such as contact with diabetes educators.
“Right now, pretty much only face-to-face visits are covered, not the ongoing contacts by phone, fax, email, etc., that are really needed to help someone sustain behavior changes and self-manage their diabetes optimally,” she said.
Previously: Text message reminders shown effective in boosting flu shot rates among pregnant women, Texts may help people with diabetes manage care, Why physicians should consider patients’ privacy before recommending health, fitness apps and Designing a mobile app to help patients and doctors identify personalized food triggers
Photo by Intel Free Press
Will Docs Write Rx for Apps?[Medpage Today]
Doctors can now write scripts for the first prescription-only app — but the question remains whether they’ll pick up a prescription pad to write for mobile technology.
The app, BlueStar, is a tracker for patients with diabetes. It analyzes logged blood glucose data and offers advice based on trends it detects — such as telling patients to adjust their diets based on sugar levels after meals. Clinicians also receive a report on their patients’ progress.
Parent company WellDoc just won $20 million in venture financing for the app, and the company has a track record of success with online disease management tools and applications. WellDoc’s argument is that better blood sugar control will lead to better patients outcomes, and, thus, less spending on healthcare in the long run.
Read entire article here
Many people are confused about what the term public health means. As I have been working on the development of an academic course I have found myself having to explain to others what public health is. Public health is a field that encompasses many disciplines in an effort to promote and protect health and prevent disease and disability in defined populations and communities. We’re not talking about individuals and their health behaviors. Public health deals with large groups of people and health issues which can be defined very differently depending on what health issue we are talking about. Groups of people can be defined by things like location or where they physically live, for example, by city. Or, populations can be defined/grouped by a demographic like age, gender, and so on.
Why am I blogging about public health? I feel it’s necessary for all allied health professionals to have a…
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January 11, 2014 marked the 50th anniversary of the first Surgeon General’s Report on Smoking and Health. The 1964 landmark report, released by Surgeon General Dr. Luther Terry, was the first federal government report linking smoking and ill health, including lung cancer and heart disease. This scientifically rigorous report laid the foundation for tobacco control efforts in the United States. In the last 50 years, 31 Surgeon General’s Reports have been released, increasing our understanding of the devastating health and financial burdens caused by tobacco use. We now know that smoking causes a host of cancers and other illnesses and is still the leading preventable cause of death in the United States, killing 443,000 people each year. In 2014, we highlight half a century of progress in tobacco control and prevention, present new data on the health consequences of tobacco use, and introduce initiatives that can potentially end the tobacco use epidemic in the United States in the 32rd Surgeon General’s Report on smoking and health, The Health Consequences of Smoking—50 Years of Progress.
Additional Resources and Articles
- Treating Tobacco Use and Dependence: 2008 Update Includes new, effective clinical treatments for tobacco dependence that have become available since the 2000 Guideline was published.
- Anti-smoking efforts have saved 8 million American lives
- Study: U.S. tobacco control laws have saved 8 million lives over 50 years
- New E-Cig TV Spot Comes Very Close to Making Health Claims
- World Health Organization: Tobacco Free Initiative
- Tobacco Cessation: Robert Wood Johnson Foundation
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“Lasting changes will come from deep work by individuals to create systemic change.”
Reducing violence in neighborhoods enhances the community environ- ment and allows people to thrive. The prevention of violence facilitates community cohesion and participation, fosters neighborhood improve- ments, expands employment and educational opportunities, and improves overall health and well-being.
Violence influences where people live, work, and shop; whether parents let kids play outside and walk to school; and whether there is a grocery store or places for employment in the community. Violence jeopardizes health and safety directly— causing injuries, death, and emotional trauma. Witnessing or directly experiencing violence, as well as the fear of violence, are damaging, with consequences that also contribute to unhealthy behavior and a diminished community environment. Vio- lence and fear undermine attempts to improve healthy eating and active living, there- by exacerbating existing illnesses and increasing the risk for onset of disease, includ- ing chronic disease. They affect young people, low-income communities, and com- munities of color disproportionately. Violence and food- and activity-related chron- ic diseases are most pervasive in disenfranchised communities, where they occur more frequently and with greater severity, making them fundamental equity issues.
Chronic disease is a major health challenge—it contributes to premature death, lowers quality of life, and accounts for the dramatic rise in recent healthcare spend- ing. One striking example is the increasing prevalence of diabetes in the United States. Researchers predict that by 2034, the number of people suffering from dia- betes will likely double to 44.1 million, and related health care costs will triple to $336 billion.1 Improving healthy eating and active living environments and behaviors is the crucial link to preventing many forms of chronic disease. Health leaders have been making great strides in mounting a strong, effective response to chronic disease and in improving community environments to support healthy eating and activity. However, chronic disease prevention strategies—designing neighborhoods that encourage walking and bicycling to public transit, parks, and healthy food retail, or attracting grocery stores in communities that lack access to affordable fresh fruits and vegetables—are less effective when fear and violence pervade the environment. As more communities grapple with chronic disease, health practitioners and advocates are becoming increasingly aware of the need to address violence as a critical part of their efforts, and they are seeking further guidance on effective strategies.
The purpose of this paper is to provide guidance and deepen the understanding of the inter-relationship between violence and healthy eating and activity. It presents first-hand evidence based on a set of interviews Prevention Institute facilitated with community representatives—advocates and practitioners working in healthy eating and active living. Direct quotes from these interviewees appear in italics throughout this paper. In addition to the interviews, the Institute conducted a scan of peer- reviewed literature and professional reports that confirm the intersection between vio- lence and healthy eating and active living.3-12 …
**Prevention Institute was founded in 1997 to serve as a focal point for primary prevention practice—promoting policies, organizational practices, and collaborative efforts that improve health and quality of life. As a national non-profit organization, the Institute is committed to preventing illness and injury, to fostering health and social equity, and to building momentum for community prevention as an integral component of a quality health system.
Publications are online and free.
From the 17 December 2013 ScienceDaily article
The fact that smoking means a considerable health risk is nowadays commonly accepted. New research findings from Uppsala University and Uppsala Clinical Research Center show that smoking alters several genes that can be associated with health problems for smokers, such as increased risk for cancer and diabetes.
We inherit our genes from our parents at birth. Later in life the genetic material can be changed by epigenetic modifications, i.e. chemical alterations of the DNA the affect the activity of the genes. Such alterations are normally caused by aging but can also result from environmental factors and lifestyle.
In a study recently published in the journal Human Molecular Genetics the researchers have examined how the genes are changed in smokers and users of non-smoke tobacco. They could identify a large number of genes that were altered in smokers but found no such effect of non-smoke tobacco.
t has been previously known that smokers have an increased risk of developing diabetes and many types of cancer, and have a reduced immune defence and lower sperm quality. The results from the study also showed that genes that increase the risk for cancer and diabetes, or are important for the immune response or sperm quality, are affected by smoking.
Believe there is some truth to this. Once I started exercising regularly (at least 30 minutes four times a week), my LDL was raised considerably. My doctor was a bit taken aback.
“…drugs and exercise produced almost exactly the same [risk of dying] results”
Exercise can be as effective as many frequently prescribed drugs in treating some of the leading causes of death, according to a new report. The study raises important questions about whether our health care system focuses too much on medications and too little on activity to combat physical ailments.
For the study, which was published in October in BMJ, researchers compared how well various drugs and exercise succeed in reducing deaths among people who have been diagnosed with several common and serious conditions, including heart disease and diabetes.
The results consistently showed that drugs and exercise produced almost exactly the same results. People with heart disease, for instance, who exercised but did not use commonly prescribed medications, including statins, angiotensin-converting-enzyme inhibitors or antiplatelet drugs, had the same risk of dying from — or surviving — heart disease as patients taking those drugs. Similarly, people with diabetes who exercised had the same relative risk of dying from the condition as those taking the most commonly prescribed drugs. Or as the researchers wrote in statistics-speak, “When compared head to head in network meta-analyses, all interventions were not different beyond chance.”
On the other hand, people who once had suffered a stroke had significantly less risk of dying from that condition if they exercised than if they used medications — although the study authors note that stroke patients who can exercise may have been unusually healthy to start with.
Only in chronic heart failure were drugs noticeably more effective than exercise. Diuretics staved off mortality better than did exercise.
“We are not suggesting that anyone stop taking their medications,” he said. “But maybe people could think long and hard about their lifestyles and talk to their doctors” about whether exercise could and should be incorporated into their care.
- Exercise IS medical therapy! (getsane.org)
- STUDY: Exercise just as effective as drugs in fighting major disease… (telegraph.co.uk)
- This Doc’s Miracle Drug? Exercise (npr.org)
- Exercise As a Potent Exercise (jenny6566.wordpress.com)
[Online Book] Subjective Well-Being: Measuring Happiness, Suffering, and Other Dimensions of Experience (2013)
Subjective well-being refers to how people experience and evaluate their lives and specific domains and activities in their lives. This information has already proven valuable to researchers, who have produced insights about the emotional states and experiences of people belonging to different groups, engaged in different activities, at different points in the life course, and involved in different family and community structures. Research has also revealed relationships between people’s self-reported, subjectively assessed states and their behavior and decisions. Research on subjective well-being has been ongoing for decades, providing new information about the human condition. During the past decade, interest in the topic among policy makers, national statistical offices, academic researchers, the media, and the public has increased markedly because of its potential for shedding light on the economic, social, and health conditions of populations and for informing policy decisions across these domains.
Subjective Well-Being: Measuring Happiness, Suffering, and Other Dimensions of Experienceexplores the use of this measure in population surveys. This report reviews the current state of research and evaluates methods for the measurement. In this report, a range of potential experienced well-being data applications are cited, from cost-benefit studies of health care delivery to commuting and transportation planning, environmental valuation, and outdoor recreation resource monitoring, and even to assessment of end-of-life treatment options.
Subjective Well-Being finds that, whether used to assess the consequence of people’s situations and policies that might affect them or to explore determinants of outcomes, contextual and covariate data are needed alongside the subjective well-being measures. This report offers guidance about adopting subjective well-being measures in official government surveys to inform social and economic policies and considers whether research has advanced to a point which warrants the federal government collecting data that allow aspects of the population’s subjective well-being to be tracked and associated with changing conditions.
- Data on people’s self-reported ‘experienced’ well-being could help inform policies (sciencedaily.com)
- Political economy of happiness (knrajlibrary.wordpress.com)
- Subjective Well-being (venitism.blogspot.com)
- Self-reported ‘experienced’ well-being could help inform policies (medicalnewstoday.com)
- ‘Gut instinct’ makes for happy relationship, researchers say (irishtimes.com)
- Mindfulness: State or trait? (mentalworkout.com)
Negative studies are just as important to consumers as positive studies. They are essential blocks in the evidence base. They help everyone—consumers and health care providers—avoid interventions that don’t help.
A recent study in the New England Journal of Medicine, authored by six researchers at the National Heart, Lung, and Blood Institute (NHLBI), prompts some thoughts about studies with negative outcomes—and their importance in the entire research process.
In this report Dr. David Gordon, Dr. Michael Lauer, and their colleagues analyzed the 244 extramural, randomized clinical trials supported by NHLBI and completed between the years 2000 and 2011. The primary outcome was the time between completion of trials and publication of the main results in a peer-reviewed journal; the secondary outcome was the annual citation rates for these articles—i.e., how many times each article was cited in a given time period. The team also examined a number of trial characteristics that related to these questions, such as budget, number of participants, and whether the result was positive or negative.
Among the many interesting findings are that more than half of the studies analyzed (58 percent) yielded negative results. And intriguingly, of the 31 trials having the highest citation rates, only 8 (26 percent) had positive results. Studies supported by NHLBI, and indeed, studies supported by NCCAM, generally start with enthusiasm of the investigators, peer reviewers, and NIH. They generally start with the expectation (and indeed preliminary data) that the intervention being studied has the potential to improve patient outcomes. By and large, when no benefit is demonstrated, research teams are understandably disappointed. And Gordon and co-authors found that investigators completing negative studies are indeed significantly slower to publish.
Nevertheless, we do the research because we don’t know the answer! Negative studies are just as important to consumers as positive studies. They are essential blocks in the evidence base. They help everyone—consumers and health care providers—avoid interventions that don’t help.
There is an additional “silver lining.” Negative studies are extremely important in the research process. And the high-quality data produced during our well-performed, carefully monitored studies are of enormous value in deciding on follow-on questions and in the design of subsequent studies.
We learn from surprises—from discovering that we don’t always know what we think we know.
- The National Center for Complementary and Alternative Medicine incorporates negative study findings in
many of its products, including Herbs At A Glance
Last week in Cambridge, I spoke again (5th time?) at this event. Always an honor. Always a smart audience.
Thanks to Phil Hilts for the invitation and the opportunity to share our work with a new group of journalists.
Here are my slides.
- The Mammogram Myth, Alive and Well on “Good Morning America” (psychologytoday.com)
- Health Studies: Fact or False Hope? (kstp.com)
From 2010 to 2013, The Pew Charitable Trusts conducted a comprehensive assessment of the federal food additives regulatory program. Relying on a transparent process that engaged stakeholders, Pew examined food additive issues in partnership with the food industry, the public interest community, and the federal government, including the U.S. Food and Drug Administration, or FDA. We held five expert workshops and published six reports in peer-reviewed journals. This report summarizes our findings and provides recommendations to address the problems that we identified.
With more than 10,000 additives allowed in food, Pew’s research found that the FDA regulatory system is plagued with systemic problems, which prevent the agency from ensuring that their use is safe. The cause of this breakdown in our food safety regulatory process is an outdated law with two significant problems:
First, the law contains an exemption intended for common food ingredients; manufacturers have used this exception to go to market without agency review on the grounds that the additive used is “generally recognized as safe,” or GRAS, in regulatory parlance. FDA has interpreted the law as imposing no obligation on firms to tell the agency of any GRAS decisions. As a result, companies have determined that an estimated 1,000 chemicals are generally recognized as safe and have used them without notifying the agency. The firms usually use their own employees, consultants, or experts whom they select and pay to make the safety decision with no disclosure or apparent efforts to minimize the inherent conflicts of interest.
Second, the law does not give FDA the authority it needs to efficiently obtain the information necessary to identify chemicals of concern that are already on the market; set priorities to reassess these chemicals; and then complete a review of their safety. Moreover, the agency has not been given the resources it needs to effectively implement the original 1958 law. As a result, FDA has not reevaluated the safety of many chemicals originally approved decades ago, generally rechecking safety only when requested by a company to do so, or when presented with allegations of serious adverse health effects.
What FDA says today about the safety of additives
“It’s perhaps a time to look at what the legal framework looks like and what opportunities there are now to ask and answer questions in new ways because of advances in science and technology.”
— FDA Commissioner Margaret Hamburg, (Reuters, May 2013)
“We’re not driven by a sense that there is a pressing public health emergency. But there are decisions being made based on data that we don’t have access to, and that creates a question about the basis on which those decisions are made.”
— FDA Deputy Commissioner for Foods Michael Taylor, (Associated Press, March 2013)
“FDA plans to issue guidance to industry on meeting the GRAS criteria established under the Act.”
— FDA spokeswoman Theresa Eisenman, (USA Today, August 2013)
To remedy these problems, Pew’s report recommends that Congress update the Food Additives Amendment of 1958 to ensure that FDA:
- Approves the first use of all new chemicals added to food.
- Reviews new uses or changes to existing uses of previously approved additives.
- Streamlines its decision-making process so it is timely and efficient.
- Upgrades its science to determine safety.
- Uses the scientific tools and data it needs to set priorities to reassess the safety of chemicals already allowed in food and to take action where necessary.
- FDA’s trans fat decision: An opening for regulating salt, sugar? – Los Angeles Times (latimes.com)
- Not all chemicals in your food are labeled – or tested (examiner.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!”
- 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)
Data from the National Hospital Ambulatory Medical Care Survey, 2009–2010
- In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. The visit rate for this age group was 511 per 1,000 persons and increased with age.
- The percentage of ED visits made by nursing home residents, patients arriving by ambulance, and patients admitted to the hospital increased with age.
- Twenty-nine percent of ED visits by persons aged 65 and over were related to injury, and the percentage was higher among those aged 85 and over than among those aged 65–74 or 75–84.
- The percentage of ED visits caused by falls increased with age.
From 2000–2010, the number of persons in the United States aged 65 and over rose 15%, from 35.0 million to 40.3 million, and in 2010 this age group represented 13% of the population (1). It is estimated that by 2030, nearly one in five persons will be aged 65 and over (2). Given their growing proportion of the population, older individuals will comprise an increasing share of emergency department (ED) patients in the coming years. This is important because of the ED’s role in treating acute illness and injury in older adults and providing a pathway to these patients for hospital admission (3,4). This report describes ED visits made by individuals aged 65 and over and compares age groups 65–74, 75–84, and 85 and over.
[Brookings Conference] Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access
Check back after the conference, audio and/or video of the conference should then “be up”
On November 4, the Engelberg Center for Health Care Reform convened an expert workshop “Exploring Implications of the Nonprescription Drug Safe Use Regulatory Expansion (NSURE) Initiative on Reimbursement and Access.”
In an effort to address the undertreatment of common diseases and conditions, the U.S. Food and Drug Administration is exploring how a regulatory expansion of the nonprescription drug class might increase access to medications. This initiative, known as the Nonprescription Safe Use Regulatory Expansion (NSURE), is exploring how health care professionals and innovative technologies can serve as a condition to the safe use of drugs in a nonprescription setting.
Understanding the impact of NSURE on reimbursement and patient access to medication will be critical to the initiative’s success in addressing medical undertreatment. At this expert workshop, a wide range of experts and stakeholders explored previous effects from prescription-to-nonprescription medication switches, identified potential incentives for coverage of nonprescription drugs with Conditions of Safe Use, and investigated potential mechanisms for reimbursement.
This expert workshop was the third in a series of meetings that explored the NSURE initiative. To explore previous discussions regarding the potential role of health care professionals as a Condition of Safe Use within the NSURE initiative, please visit our expert workshop, “Nonprescription Medications with Conditions of Safe Use as a Novel Solution for Undertreated Diseases or Conditions”. To explore previous discussion regarding the role of technology in supporting the safe and effective use of nonprescription products, please visit our expert workshop, “Innovative Technologies and Nonprescription Medications: Addressing Undertreated Diseases and Conditions through Technology Enabled Self-Care”.
- 50 Years Old and Still Bounding Over the Counter: Kline’s Healthcare Practice Continues to Deliver Unmatched OTC Market Intelligence (prweb.com)
- Big pharma is finding new ways to expand drug life cycle by transitioning drugs from Rx to OTC (medcitynews.com)
- No age limit on morning-after pill (wjla.com)
- Common Non-Opioid Pain Medications (mnphysicalmedicine.com)
Here in Toledo, Ohio my (Catholic) parish boundary includes a nearby state prison.
The bishop’s office redrew parish boundaries a few years back and decided our parish, three miles from the prison, includes the Catholics at Toledo Correctional Institution. Quite a challenge for us, we have about 100 “churchgoers” on the average Sunday, about 2/3 are over age 60. About 20 baptized Catholics (of an inmate population of 1,220) are registered within our parish.
We were encouraged to write the inmates. So I did. After about 3 letter exchanges, one asked me to visit him. So, after 3 weeks of pondering, I did. It really isn’t any big deal. Robb is very articulate and we do have some lively discussions in areas of politics, Catholic Church “hot topics”, and philosophy.
In the past year, four inmates have been murdered. at Toledo Correctional. Allegedly by other inmates. In Michigan, only one inmate was murdered in the whole state in the last year. The rise in violence is in tandem with increasing overcrowding, especially double bunking in cells designed for single occupancy.
I am including this item because overcrowding is a safety and (mental) health issue. The murders here at Toledo Correctional were in the higher security levels, Robb is in the lowest security level. Still, I cannot imagine how this is impacting Robb’s mental health.
Excerpts from the handbook
(I realize American prisons are probably better than the worst of the worst internationally, still, there is room for improvement)
In very diverse environments and over many years, the ICRC has witnessed first- hand the consequences of overcrowding on detainees and on the authorities. Indeed, overcrowding is an increasingly widespread problem in a number of countries and places of detention. In itself, it is a very serious humanitarian concern, as it auto- matically generates substandard and often inhumane conditions of detention. Tens of thousands of people are forced to live for extended periods in congested accom- modation, with insufficient space to move, sit or sleep. This seriously compromises the ability of the administration to fulfil detainees’ basic needs in terms of living conditions, medical care, legal aid and family visits. Being squeezed into cramped living quarters, often in appalling hygiene conditions and with no privacy, makes the experience of being deprived of freedom—already stressful in normal circumstances— exponentially worse. It erodes human dignity and undermines detainees’ physical and mental health, as well as their reintegration prospects. In addition to putting excessive strain on infrastructures, it heightens the potential for tensions and conflicts among detainees and with staff. It quickly leads to difficulties in maintaining good order within the prison, resulting in potentially severe consequences in terms of safety for the detainees, as well as in terms of supervision and security.
While the consequences are particularly grave for the men, women and children deprived of their liberty, they also affect the frontline staff whose job it is to protect and meet the needs of the detainees. Overwhelmed by excessive numbers and directly exposed to the frustration of the detainees without the resources needed to guarantee security or access to the most basic services, detention staff work in difficult condi- tions and are exposed to constant pressure and risk.
ICRC knows from experience that situations of overcrowding, once established, trig- ger a downward spiral which has a negative impact on the entire criminal justice system as a result of increasing congestion, staff demotivation and the development of parallel coping mechanisms or corruption.
3. Broader consequences of excessive imprisonment
The impact of overcrowding does not remain within the prison walls. It can have a detrimental impact on public health. The cost of the excessive use of imprisonment, which is a fundamental reason for prison overcrowding in countries worldwide (see chapter B), can be significant, increasing the poverty levels and socio-economic mar- ginalization of certain groups of people and reducing funds available for other spheres of government expenditure.
3.1 The cost of imprisonment
Numerous studies have shown that imprisonment disproportionately affects people living in poverty. When an income generating member of the family is imprisoned, the sudden loss of income can have a severe impact on the economic status of the rest of the family—especially so in low resource countries where the state does not usually provide financial assistance to the poor and where it is not unusual for one person to financially support an extended family network. When released, often with no prospects for employment due to their criminal record, former prisoners are generally subjected to socio-economic exclusion and are vulnerable to an endless cycle of poverty, marginalization, criminality and imprisonment. Thus, imprisonment contributes directly to the impoverishment of the prisoner and his or her family. Studies have also shown that children of parents who have been imprisoned are more likely to come into conflict with the law and that once detained, they are likely to be further criminalized. Thus the cycle is expanded, creating future victims and reducing future potential economic performance
- State report rips Toledo prison (toledoblade.com, 09/13/2013)
“A state committee on Thursday issued a harsh, lengthy inspection report of the Toledo Correctional Institution, citing significant increases in assaults, high employee-turnover rates, rampant drug trading, and three homicides reported there in the past year.The 164-page report from the Correctional Institution Inspection Committee shows that inmate-on-inmate assaults increased by nearly 113 percent and inmate-on-staff assaults increased nearly 74 percent from 2010 to 2012. The legislatively established committee monitors prison facilities, conducts unannounced inspections of prisons, and writes reports of their activities.”
“The prison has the highest staff turnover rate — 16.5 percent — of all prisons in the state, according to the report. Most staff resignations come while employees are being investigated, according to the report.
Toledo Correctional “has historically had challenges recruiting quality staff, particularly in health care,” the report states.
Read more at http://www.toledoblade.com/State/2013/09/13/State-report-rips-Toledo-prison.html#RzJGpLqojeJcCKFA.99
Prison’s acts failed to halt homicides (toledoblade.com)
- U.S. Supreme Court refuses to hear California prison overcrowding case (mercurynews.com)
- Madagascar prison and ICRC work to battle plague by eliminating rats (theglobaldispatch.com)
- Supreme Court rejects California prison overcrowding appeal (sacbee.com)
- New Urban Institute report recommends policies to reduce federal prison growth (sentencing.typepad.com)
- Tim Robbins: Can Theater Help Solve California’s Prison Overcrowding Crisis? (huffingtonpost.com)
- For-Profit Prisons Are Big Winners Of California’s Overcrowding Crises (sunsetdaily.wordpress.com)
- Union warns of prison overcrowding (toledoblade.com)
- Looking for answers on overcrowded prisons (miamiherald.com)
Believe I’ve reblogged on this concept within the past two years…
Yes, this model is a bit pricy, but can we afford not to move in this direction?
At the vanguard of innovation in the nursing home industry, the three-year-old Leonard Florence Center for Living exemplifies a new model of long-term care known as the Green House, and nothing about it seems institutional. Each of the five upper floors constitutes two separate “households” with private rooms for 10 residents. The normally dominant nurse’s station has been eliminated and instead there are common areas in each household—a living room furnished with comfortable sofas and chairs around a fireplace, an open kitchen and a communal dining table where residents often eat together. Cooking, housekeeping and even laundry are handled by two certified nursing aides known as shahbazim—derived from Persian, it means “nurturing of elders”—who also care for residents. Traditional nursing homes, in contrast, have clear demarcations separating housekeepers, kitchen workers, nurses and aides, who follow rigid schedules for serving meals or dispensing medications.
At Leonard Florence, Mehlhop can sleep, bathe, eat and roam around whenever she wants. The environment is calm and cheery, with none of the physical restraints found in most nursing homes or the alarms that sound if residents get up from a wheelchair, for example. (Instead, patients wear ankle bracelets that help the staff keep tabs on them and will disable the elevator if a patient tries to leave.)
Leonard Florence is far from the only nursing facility striving to create a homelike atmosphere and improve residents’ quality of life. Building a new Green House or undertaking a major physical renovation can be part of the strategy, but other nursing homes are primarily working to transform how they’re run, embracing a movement known simply as “culture change” that entails shifting away from the emphasis on efficiency and economies of scale that characterizes most nursing homes. Culture change typically requires an operational reorganization to give staff members more autonomy and to let residents have a say in even the smallest details of their lives. “It’s about not looking at residents as a task, but rather as who they are as individuals,”
Yet building a new, small nursing home that can handle only a relative handful of residents is an expensive proposition. “If it weren’t for the price tag, everyone would be doing it,” says Barry Berman, chief executive officer of the Chelsea Jewish Foundation, which owns the Leonard Florence Center. The home cost $36 million to build, with some two-thirds of the money coming from private donations and government programs. Most traditional nursing homes cost less than half that much, but the Leonard Florence Center is over twice the size of a traditional nursing home and was the first Green House to be built in an urban area. Its multistory construction is also a departure from the usual single-level, ranch-style homes that are typical of Green House centers. The payoff, however, has been the residents’ lower hospitalization and readmission rates. The center has also received high scores for resident and family satisfaction, which Berman describes as “off the charts.” The foundation is now undertaking a $13 million renovation of a 30-year-old, 120-bed skilled nursing facility across town from Leonard Florence. “We’re bringing in as many elements of the Green House as we can and doing our best to retrofit a traditional nursing home,” says Adam Berman, chief operating officer of the nonprofit.
The Green House model is receiving increased academic scrutiny, and early studies have shown positive trends in quality of life for residents, greater family satisfaction, and a lower incidence of rehospitalization, bedsores, depression and other health problems. According to the Green House Project, 83% of Green Houses received a rating of four out of five stars or better on the Centers for Medicare & Medicaid Services’ five-star quality rating system, compared to 42% of nursing homes nationally. But the data are early. “The jury’s still out on whether Green Houses or other small homes achieve equal or better clinical outcomes than traditional models, and whether they’re financially sustainable—factors that may ultimately matter a lot more than the humanistic components in terms of their future growth…
Studies of the model’s effectiveness have found a higher quality of care, reduced staff turnover and lower rates of infections for residents….
As encouraging as such stories may be, however, there are questions about how far relatively small-scale efforts can go to reform a giant industry. In a 2010 study by Susan Miller, a professor of health services, practice and policy at Brown University School of Public Health, leadership issues, higher costs and regulatory problems were cited by long-term-care leaders as the most common barriers to implementing culture change. Yet many experts believe those obstacles can be overcome. For example, a campaign called Advancing Excellence in America’s Nursing Homes provides an array of do-it-yourself resources and networks of advisors to help improve clinical outcomes. More than 9,000 nursing homes have participated since the campaign’s launch in 2006. Meanwhile, federal regulators have adjusted some rules to encourage and reward culture change—for example, rather than checking that a nursing home has regular meal schedules, making sure that residents are well fed. And proponents point to studies showing that nursing homes committed to culture change may benefit financially. A study by Pioneer Network, for example, found that from 2004 to 2008, facilities undergoing culture change achieved higher occupancy rates and increased revenue.
- Great Green House Homes Article in Mass General Hospital Publication (asourparentsage.net)
- BUCKET LIST: Nursing Home Fulfilling Dreams (whotv.com)
- 7 Things to Ask When Considering a Nursing Home (oklahomalawyer.com)
- Report: Nursing Home Shift Needs More Oversight (wnyc.org)
- Long Term Care Facilities Should Anticipate Increased Scrutiny on Nursing Home Trust Fund Oversight (beneschhealthlaw.com)
- Beware of Nursing Home Trust Fund Theft (lawprofessors.typepad.com)
Pregnant women who abuse drugs, alcohol need compassion, not stigma from doctors and society: experts
My sentiments exactly, real humans do not shame!
Seeing a pregnant women smoking a cigarette, imbibing a glass of wine or using drugs is sure to raise a societal eyebrow.
But a new report says women with substance abuse problems should be treated with compassion by health providers and society at large, especially during pregnancy, because addiction is a brain disorder and not a personal failing.
“It’s harmful for us to look upon pregnant women with addiction issues and assume it’s as simple as saying: ’For the sake of the baby, stop using,”’ said Colleen Dell, research chair in substance abuse at the University of Saskatchewan.
The report says pregnancy offers an opportunity for doctors to help women seek treatment for addiction, while providing comprehensive care aimed at maximizing the health of both mother and baby.
That treatment should involve a wide range of care providers and programs, including addiction counselling, medication-assisted therapy and community resources for parents, the report says.
“When this continuum of care is provided, we see healthier babies and fewer premature births, and overall maternal and infant mortality rates go down,” said Finnegan.
But many women are hesitant to seek treatment because of the stigma around using a substance that’s known to be harmful to their developing fetus, she said.
It’s important to look at the antecedents to drug addiction, said Finnegan, noting that about 98% of the women in her clinic had been sexually or physically abused as children or as adults.
Often women also won’t seek medical help because they’re afraid of losing their children
“This is very much like PTSD (post-traumatic stress disorder). They have had trauma and taking a drug permits them to forget these terrible feelings that they have had. When they take the psychoactive drugs … they become addicted.
“So the first step is that we get them into treatment and help them feel welcome.”
Often women also won’t seek medical help because they’re afraid of losing their children to protective services if they admit to an addiction, she said, suggesting the judicial system has to change.
Dealing with stigma is the greatest challenge in trying to help pregnant women with an addiction, said Franco Vaccarino, a professor of psychiatry and psychology at the University of Toronto and chairman of the CCSA’s scientific advisory council.
“Addiction is a disorder of the brain,” he stressed.
‘Simply put, your brain is different after prolonged substance abuse than it was before’
“Simply put, your brain is different after prolonged substance abuse than it was before. Addiction fundamentally changes neurological functioning and it makes it next to impossible to just quit for the sake of the baby without significant supports.
“The challenge is anchoring the narrative of this discussion in health terms,” Vaccarino said. “If you anchor it in health terms and move it away from justice and moral and will-related issues, you focus the narrative around addiction, which is where it should be.”
- Pregnant women abusing drugs need compassion (cbc.ca)
- Drug use during pregnancy affects baby: report (metronews.ca)
- Case Explores Rights of Fetus Versus Mother (nytimes.com)
- Legal moves to further protect foetuses threaten rights of US mothers (irishtimes.com)
- Fetus ‘Personhood’ Law Results In Arrest And Shackling Of Pregnant Wisconsin Mom (addictinginfo.org)
- Fetus Sues Mother — Case Explores Rights of Fetus (articles.mercola.com)
- Task force targets pregnant drug abusers (kokomotribune.com)
- As Fetuses Gain Personhood, Women Lose It (abortion.ws)
- Sticks & Stones: Removing the Stigma of Addiction (aspireindianablog.wordpress.com)
- Substance abuse linked to troubled children (fijitimes.com)
For Rick Wallace, health science librarian and professor at Quillen College of Medicine, East Tennessee State University (ETSU), community outreach encompasses the entire state. He travels thousands of miles across Tennessee each year bringing vital health information to those in need, especially in rural communities.
“I love getting out from behind a desk and traveling to rural communities where people need health information,” he says.
In recognition of his singular dedication to the rural underserved, the Friends of the National Library of Medicine named Wallace the recipient of the 2013 Michael E. DeBakey Library Sciences Outreach Award. The national honor is bestowed annually on a health sciences librarian for outstanding service to rural or underserved populations and is presented at the 2013 FNLM awards gala.
“Being a health science librarian is a very personal thing,” says Wallace. “There’s a lot of technology out there now and it’s real easy to just sit in your office and tell people about the latest app. But for me it means getting out there and being involved in the community.
“I want every rural hospital and health center to have access to quality health information, to know how to search PubMed databases, use document delivery tools like Loansome Doc, and feel comfortable browsing MedlinePlus for consumer health information. They’re the best in the world, all part of the greatest biomedical library in the world, the National Library of Medicine.”
Wallace began his calling in health sciences at the University of Tennessee, Memphis Health Sciences Library, working in circulation, in 1987, before finally finding his way to ETSU in 1995.
Over the years, he has seen the medical librarianship position become more tenuous as large corporate hospitals acquire smaller local hospitals, consolidating them and eliminating library positions. “One of my biggest challenges now is selling the vision of the health science librarian as essential in the information age. There is such a push to cut everything that is not mandated. It can be tough to get some of these big medical institutions to recognize the value of a health science librarian.”
Wallace has spearheaded projects that have taken him back and forth across Tennessee. One such is “A Simple Plan,” which offers instruction in consumer health information for public librarians. For more than six years, Wallace and his assistants traveled thousands of miles annually training public librarians, distributing over 1500 articles over the last 17 years, and building relationships with some 40 rural hospitals and clinics, helping them obtain grants and pointing the way for rural public health departments to provide remote access to health information.
Wallace and his group also have shaped consumer health information programs for Hispanic farm workers, high school students, elderly patients and staff in nursing homes, and cancer patients. They have trained caregivers, religious leaders, and others to use health information tools. They’ve distributed smartphones, tablet computers—complete with clinical software—and other mobile devices to some 300 Tennessee clinicians.
For example, working with the Migrant Health Program for Rural Medical Services, Inc. (RMS), in Parrottsville, TN, which operates one of five primary care clinics in the state and provides primary healthcare to migrant farm workers in East Tennessee, Wallace initiated and helped write a series of grant proposals that brought NN/LM funding for innovative health education programs.
One grant brought community theater actors to the migrant camps to demonstrate good health practices for diabetes, perinatal care, and other topics. The grants also facilitated production of Spanish-language videos on prenatal care, and funded purchase of laptop computers and printers for Migrant Health Program educators, enabling them to access health information during home visits to the underserved.
Wallace also led a team on several Remote Area Medical (RAM) expeditions to provide free medical, dental, and vision care and information to more than 2,500 of the working poor.
Lucretia W. McClure, MA, of the Board of Directors of the Friends of the National Library of Medicine, lauds Wallace as “an active and integral contributor in serving rural and underserved members of Tennessee for almost 20 years.” She notes, “He has reached thousands of people and raised almost a half a million dollars in grants that have contributed to the betterment of overall health in rural Tennessee.”
Says Wallace, “A lot of the things we do are simple, but they make a difference. We try to make an impact; to help people make good medical decisions. I’d like to be remembered as only one of the mighty army of health professionals who helped people live better lives.”
By Thomas Conuel, NLM in Focus writer
- Should your doctor consult the librarian? (futurity.org)
- National Medical Librarians Month (phlibraryres.wordpress.com)
Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I’m Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Emergency room use and hospitalization rates for diabetes patients declined after a large California medical provider introduced an electronic health records system, finds a five year study recently published in the Journal of the American Medical Association.
The study of 170,000 Kaiser Permanente Northern California diabetes patients (from 2004-2009) found an average of 501 emergency department visits per 1000 patients declined to 490 after Kaiser’s clinics began to use an electronic health records system (EHR) for outpatient treatment.
The study found an average of 252 hospitalizations per 1000 diabetes patients declined to 238 per 1000 after Kaiser Permanente’s clinics used the health care provider’s EHR. The specific hospitalizations for ambulatory care-sensitive conditions also fell from a mean of 67 per 1000 to about 60 per 1000 diabetes patients after the use of an EHR for diabetes outpatient treatment.
The comparative, overall declines in emergency department visits and aforementioned hospitalizations among Kaiser Permanente’s diabetes patients were statistically significant, or did not occur by chance. There was no overall difference in the frequency of patient visits to a physician’s office after Kaiser’s clinics began to use the health system’s EHR.
The study’s nine authors estimate Kaiser’s cost savings from reduced emergency department and hospitalizations were about $158,478 per 1000 patients each year. Overall, they write (and we quote): ‘the estimated reductions in emergency department (ED) visits and hospitalizations that we identified for patients with diabetes may have potential to affect ED and hospitalization costs’ (end of quote).
The authors acknowledge future research needs to provide a more comprehensive assessment of the cost savings after the implementation of an EHR. They add the findings are limited to diabetes patients within one large health care provider (within one U.S. state) and may not be generalizable to other states and different medical systems. For example, the authors explain the reductions in emergency department use and reduced hospitalizations were not uniform among all of the 17 Kaiser Permanente clinics where the five year study was conducted.
On the other hand, the authors note the study is the most comprehensive to date about the impact of outpatient EHR use on adverse health outcomes. The authors explain they assessed diabetes patients in order to observe the impact of EHR use on an outpatient basis among adults with a chronic (or ongoing) medical condition over time.
The authors conclude (and we quote): ‘We extend the evidence of EHR-related improvements in care delivery by further describing statistically significant modest reductions in downstream adverse health outcomes measured by ED visits and hospitalizations’ (end of quote).
Meanwhile, MedlinePlus.gov’s personal health records health topic page provides information about the physician adoption of EHRs in the ‘statistics’ section. Information about the adoption of EHRs within residential care communities and office-based physicians also is provided within the same section.
A overview that explains how and why EHRs are implemented in medical centers is available in the ‘MedlinePlus Magazine’ section of MedlinePlus.gov’s personal health records health topic page.
A helpful explanation (from the National Institutes of Health) about how to protect the privacy and security of your health information is available in the ‘related issues’ section of MedlinePlus.gov’s personal health records health topic page.
MedlinePlus.gov’s personal health records health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about personal health records (and EHRs) as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s personal health records health health topic page, type ‘personal health records’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘personal health records (National Library of Medicine).’
Before I go, this reminder… MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.
To find MedlinePlus.gov, just type in ‘MedlinePlus.gov’ in any web browser, such as Firefox, Safari, Netscape, Chrome or Explorer. To find Mobile MedlinePlus.gov, just type ‘Mobile MedlinePlus’ in the same web browsers.
We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish. Some medical information is available in 43 other languages.
Your comments about this or any of our podcasts are always welcome. We welcome suggestions about future topics too!
Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov
That’s NLMDirector (one word) @nlm.nih.gov
A written transcript of recent podcasts is available by typing ‘Director’s comments’ in the search box on MedlinePlus.gov’s home page.
The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.
A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.
It was nice to be with you. I look forward to meeting you here next week.
PITTSBURGH, Nov. 1, 2013 – The red, swollen and painful gums and bone destruction of periodontal disease could be effectively treated by beckoning the right kind of immune system cells to the inflamed tissues, according to a new animal study conducted by researchers at the University of Pittsburgh. Their findings, published this week in the early online version of the Proceedings of the National Academy of Sciences, offer a new therapeutic paradigm for a condition that afflicts 78 million people in the U.S. alone.Periodontal disease currently is treated by keeping oral bacteria in check with daily brushing and flossing as well as regular professional deep cleaning with scaling and root planing, which remove tartar above and below the gum line. In some hard-to-treat cases, antibiotics are given. These strategies of mechanical tartar removal and antimicrobial delivery aim to reduce the amount of oral bacteria on the tooth surface, explained co-author and co-investigator Charles Sfeir, D.D.S., Ph.D., director, Center for Craniofacial Regeneration and associate professor, Departments of Periodontics and Oral Biology, Pitt’s School of Dental Medicine.“Currently, we try to control the build-up of bacteria so it doesn’t trigger severe inflammation, which could eventually damage the bone and tissue that hold the teeth in place,” Dr. Sfeir said. “But that strategy doesn’t address the real cause of the problem, which is an overreaction of the immune system that causes a needlessly aggressive response to the presence of oral bacteria. There is a real need to design new approaches to treat periodontal disease.”In the healthy mouth, a balance exists between bacteria and the immune system response to forestall infection without generating inflammation, said senior author Steven Little, Ph.D., associate professor and chair of the Department of Chemical and Petroleum Engineering, Pitt’s Swanson School of Engineering. But in many people, a chronic overload of bacteria sets up the immune system to stay on red alert, causing harm to the oral tissues while it attempts to eradicate germs.“There is a lot of evidence now that shows these diseased tissues are deficient in a subset of immune cells called regulatory T-cells, which tells attacking immune cells to stand down, stopping the inflammatory response,” Dr. Little said. “We wanted to see what would happen if we brought these regulatory T-cells back to the gums.”To do so, the researchers developed a system of polymer microspheres to slowly release a chemokine, or signaling protein, called CCL22 that attracts regulatory T-cells, and placed tiny amounts of the paste-like agent between the gums and teeth of animals with periodontal disease. The team found that even though the amount of bacteria was unchanged, the treatment led to improvements of standard measures of periodontal disease, including decreased pocket depth and gum bleeding, reflecting a reduction in inflammation as a result of increased numbers of regulatory T-cells. MicroCT-scanning showed lower rates of bone loss.“Mummified remains from ancient Egypt show evidence of teeth scraping to remove plaque,” Dr. Little noted. “The tools are better and people are better trained now, but we’ve been doing much the same thing for hundreds of years. Now, this homing beacon for Treg cells, combined with professional cleaning, could give us a new way of preventing the serious consequences of periodontal disease by correcting the immune imbalance that underlies the condition.”Next steps include developing the immune modulation strategy for human trials. In addition to Drs. Sfeir and Little, the research team included Ph.D. candidate Andrew J. Glowacki,, Sayuri Yoshizawa, D.D.S., Ph.D., Siddharth Jhunjhunwala, Ph.D., all of the University of Pittsburgh; and Andreia E Vieira, Ph.D., and Gustavo P. Garlet, D.D.S., Ph.D., of Sao Paulo University, Brazil.The project was funded by National Institutes of Health Grants 1R01DE021058-01 A1, 1R56DE021058-01, the Wallace H. Coulter Foundation, the Camille and Henry Dreyfus Foundation, the Arnold and Mabel Beckman Foundation and the Commonwealth of Pennsylvania.
- Treating gum disease by bringing needed immune cells to inflamed tissue (sciencedaily.com)
- Immune Therapy May Offer New Treatment for Periodontal Disease (news.softpedia.com)
- Gum disease treated by bringing needed immune cells to inflamed tissue (medicalxpress.com)
- Healthy Gums May Prevent Heart Disease (counselheal.com)
- Here’s How Caring for Your Teeth and Gums Can Prevent Heart Disease (medindia.net)
- How Oral Hygiene Affects the Rest of You (livescience.com)
- Gingivitis (flawlessdentistrynewton.wordpress.com)
- Some Facts about Periodontal Disease (dentalessence.wordpress.com)
- Brooklyn Orthodontist Links Oral Health to Overall Health (sunsetparkdental.wordpress.com)
[Brookings Institute report] Isabel V. Sawhill and Quentin Karpilow – Three Facts about Birth Control and Social Mobility
The ability to control our fertility, to have children when—and with whom—we want, is a precious gift of modern science. For women in particular, birth control has also been a boost for social mobility. But there is still progress to be made.
1. The Pill Transformed Women’s Life Chances
The Pill gave American women something genuinely new: a convenient and highly effective means of controlling their own fertility. Although the Pill was licensed by the by the FDA (as Enovid) in 1960, state and federal laws limited the access of young single women to oral contraception. But as those laws changed in the late 60s and early 70s, oral contraceptive use jumped among young single women. And look what happened to the gender mix of professional college courses:
Of course this could be coincidence. But the best researchers in the field don’t think so. Using sophisticated research designs, that isolate the causal effects of the Pill, scholars have shown that the diffusion of the Pill raised women’s college attendance and graduation rates (Hock, 2007), increased the representation of women in professional occupations (Goldin and Katz, 2002), and boosted female earnings (Bailey et al., 2012).
2. Unintended Pregnancies Still Too Common
But unintended pregnancy rates – 3 million or more a year – remain stubbornly high in the U.S. The benefits of birth control are being only partially realized. Half of all pregnancies are mistimed or unwanted – and 95 percent of all unintended pregnancies occur among women who either aren’t using contraception at all or aren’t using their contraceptive method consistently:
It is time for a new revolution in family planning, with even better contraception than the pill. Long-acting reversible contraceptives (LARCs) such as intra-uterine devices (IUDs) have a big role to play in solving America’s contraception deficit. Because these highly effective methods don’t require the daily maintenance that the Pill does, LARCs could potentially eliminate the problems of inconsistent use, as a study conducted in St Louis suggests.
3. Most Disadvantaged Need More To Lose
Early, unwed pregnancy rates are highest in the most disadvantaged communities. Recent research suggests that for those with starkly limited opportunities, better family planning may do little to improve their life trajectories. The impact of better contraception for this cohort is small for the depressing reason that they have so little to lose in the first place. These women need better family planning, but they also need better educational and work opportunities. In short, they need more to lose.
Earlier this week, I talked about these issues at an event sponsored by AEI and the Institute of Family Studies. In tomorrow’s blog post, I’ll set out the gains we could realize from getting better at birth control.
Senior Fellow, Economic Studies
A nationally known budget expert, Isabel Sawhill focuses on domestic poverty and federal fiscal policy. She is also co-director of the Center on Children and Families and the Budgeting for National Priorities Project at Brookings.
Senior Research Assistant, Center on Children and Families
- Family structure’s impact on children’s education and social mobility (aei-ideas.org)
- An Anti-Birth Control Employer Just Beat Obamacare in Federal Court (theatlanticwire.com)
- Obamacare Birth Control Mandate Struck Down By Appeals Court Over Religious Freedom Concerns (huffingtonpost.com)
- Birth Control Options: Think Outside the Pill (spreadthehealthbu.com)
Early life pain alters neural circuits in the brain that regulate stress, suggesting pain experienced by infants who often do not receive analgesics while undergoing tests and treatment in neonatal intensive care may permanently alter future responses to anxiety, stress and pain in adulthood, a research team led by Dr. Anne Murphy, associate director of the Neuroscience Institute at Georgia State University, has discovered.
n estimated 12 percent of live births in the U.S. are considered premature, researchers said. These infants often spend an average of 25 days in neonatal intensive care, where they endure 10-to-18 painful and inflammatory procedures each day, including insertion of feeding tubes and intravenous lines, intubation and repeated heel lance. Despite evidence that pain and stress circuitry in the brain are established and functional in preterm infants, about 65 percent of these procedures are performed without benefit of analgesia. Some clinical studies suggest early life pain has an immediate and long-term impact on responses to stress- and anxiety-provoking events.
The Georgia State study examined whether a single painful inflammatory procedure performed on male and female rat pups on the day of birth alters specific brain receptors that affect behavioral sensitivity to stress, anxiety and pain in adulthood. The findings demonstrated that such an experience is associated with site-specific changes in the brain that regulate how the pups responded to stressful situations. Alterations in how these receptors function have also been associated with mood disorders.
The study findings mirror what is now being reported clinically. Children who experienced unresolved pain following birth show reduced responsiveness to pain and stress.
- Research finds pain in infancy alters response to stress, anxiety later in life (eurekalert.org)
- Research finds pain in infancy alters response to stress, anxiety later in life (medicalxpress.com)
For Immediate Release
Dr. Jennifer Kuzma | 919.515.2592
Release Date: 10.28.13
Filed under Releases
New research from North Carolina State University and the University of Minnesota finds that people in the United States want labels on food products that use nanotechnology – whether the nanotechnology is in the food or is used in food packaging. The research also shows that many people are willing to pay more for the labeling.
Study participants supported labeling products in which nanotechnology had been added to food, as well as products in which nanotechnology had been incorporated into the packaging.
“We wanted to know whether people want nanotechnology in food to be labeled, and the vast majority of the participants in our study do,” says Dr. Jennifer Kuzma, senior author of a paper on the research and Goodnight-Glaxo Wellcome Distinguished Professor of Public Administration at NC State. “Our study is the first research in the U.S. to take an in-depth, focus group approach to understanding the public perception of nanotechnology in foods.”
The researchers convened six focus groups – three in Minnesota and three in North Carolina – and gave study participants some basic information about nanotechnology and its use in food products. Participants were then asked a series of questions addressing whether food nanotechnology should be labeled. Participants were also sent a follow-up survey within a week of their focus group meeting.
Study participants were particularly supportive of labeling for products in which nanotechnology had been added to the food itself, though they were also in favor of labeling products in which nanotechnology had only been incorporated into the food packaging.
However, the call for labeling does not indicate that people are necessarily opposed to the use of nanotechnology in food products. For example, many study participants indicated support for the use of nanotechnology to make food more nutritious or to give it a longer shelf life – but they still wanted those products to be labeled.
“People do have nuanced perspectives on this,” Kuzma says. “They want labeling, but they also want access to reliable, research-based information about the risks associated with labeled products – such as a Food and Drug Administration website offering additional information about labeled products.”
The researchers also found that about 60 percent of the study participants who responded to the follow-up survey were willing to pay an additional 5 to 25 percent of the product price for either nanotechnology-free products or for nanotechnology labeling.
The paper, “Hungry for Information: Public Attitudes Toward Food Nanotechnology and Labeling,” was published online Oct. 7 inReview of Policy Research. Lead author of the study is Jonathan Brown, a former graduate student at the University of Minnesota. The work was supported by National Science Foundation grant SES-0709056.
- Most Americans Want To See Labels On Their Nanofoods (redorbit.com)
- Public wants labels for food nanotechnology – and they’re willing to pay for it (nanowerk.com)
- Nanotech labels for food wanted and the public are prepared to pay for it (medicalnewstoday.com)
- Public wants labels for food nanotech — and they’re willing to pay for it (sciencedaily.com)
From the 23 July 2013 NPR item
A pediatrician who spent years defending childhood vaccines against the likes of actress/activist Jenny McCarthy has launched an assault on megavitamins and dietary supplements.
“If you take large quantities of vitamin A, vtamin E, beta carotene [or] selenium you increase your risk of cancer, risk of heart disease, and you could shorten your life,” says Dr. Paul Offit, a researcher at The Children’s Hospital of Philadelphia.
Many large studies in recent years have shown that vitamins and dietary supplements rarely help and often hurt, Offit says. Yet a huge number of people still believe that these products will improve their health. So, Offit says, he decided to challenge the false beliefs of “the church of vitamins and supplements.”
Offit made the remarks during an appearance in Washington, D.C., Monday to promote his latest book: Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine.
Offit, an infectious disease specialist and the co-inventor of a rotavirus vaccine, is best known for publicly challenging groups that claim there is a link between childhood vaccines and autism. That effort often pitted him against actress Jenny McCarthy, who became a spokeswoman for anti-vaccine groups.
One big problem with dietary supplements is a 1994 law that exempts them from the tighter scrutiny the FDA applies to its regulation of medicines, Offit says. So the makers of a garlic supplement can say that it “supports cardiovascular health” even though a government study found that garlic supplements didn’t lower cholesterol. Meanwhile, Offit says, patients clearly benefit from a range of FDA-approved statin drugs that actually do what garlic supplements claim to do.
Science And Supplements
Dietary supplements are often advertised as “natural,” Offit says, even though that term can be misleading. For example, almonds are a natural source of vitamin E. But you would have to eat 17 pounds of almonds to get the amount of vitamin E in a single capsule sold by one supplement maker, Offit says. “So how is this a natural thing to do?”
Offit says doctors are partly to blame for the growing popularity of high-dose vitamins and other dietary supplements. Rather than pushing back against patients who want to take them, he says, doctors have acted like waiters at a restaurant, simply asking, “What would you like?”
Many hospitals also include unproved dietary supplements in their list of medicines available to patients, Offit says. But he says his own institution, The Children’s Hospital of Philadelphia, plans to remove nearly all supplements from its list later this month.
Offit says his attack on dietary supplements has generated a steady stream of hate mail. But he says it’s not as harsh as the hate mail he used to get from people who believe vaccines cause autism. “This is more, I’m ‘a liar and a shill for the pharmaceutical industry,’ ” he says, “not, ‘You’re going to hell.’ ”
Offit has some strong defenders, though, including former President Jimmy Carter and Carter’s wife, Rosalynn. They sat in the front row at Offit’s appearance in D.C. And during a question and answer session, the former president rose to tell Offit: “You’ve been a hero around our house for a long time.”
- Children’s Hospital of Philadelphia becomes first in nation to disallow use of dietary supplements (jflahiff.wordpress.com)
- Philadelphia Children’s Hospital Bans Dietary Supplements (livescience.com)
- Supplements: Why They Will Destroy Your Health (ucsc.uloop.com)
- Children’s Hospital Of Philadelphia Bans Dietary Supplements From Its Pharmacy (forbes.com)
- Inside the quackish cult of alternative medicine (newstatesman.com)
- Are Vitamin Supplements Harmful To Your Health? (matthewkillorin.com)
- Vitamin Pills versus Food (realvitamins.wordpress.com)
- 5 Health Myths, Debunked! (asianscientist.com)
- Health experts warn against taking too many vitamin supplements (kdvr.com)
- Vitamin D supplements won’t help bones in healthy adults, review concludes (cbsnews.com)
On a personal note, my husband is very sensitive to e-cigarette vapors.
He finds he has to leave any room where they are being “smoked”.
E-cigarettes are becoming increasingly popular and widely available as the use of regular cigarettes drops. Recently, the Centers for Disease Control and Prevention (CDC) reported that e-cigarette use by children doubled from 2011 and 2012. The health effects of e-cigarettes have not been effectively studied and the ingredients have little or no regulation. Mayo Clinic’s Nicotine Dependence Center experts are available to discuss what people should know before trying e-cigarettes
Electronic cigarettes, often called e-cigarettes, are battery-operated devices that provide inhaled doses of a vaporized solution of either propylene glycol or vegetable glycerin along with liquid nicotine. An atomizer heats the solution into a vapor that can be inhaled. The process, referred to as “vaping,” creates a vapor cloud that resembles cigarette smoke. Some liquids contain flavoring, making them more appealing to users.
“As of right now, there is no long-term safety data showing the impact of repeated inhalation of propylene glycol or vegetable glycerin on lung tissue,” cautions Jon Ebbert, M.D., associate director at Mayo Clinic’s Nicotine Dependence Center. “There is some short-term data suggesting that e-cigarettes may cause airway irritation, but until we have long-term safety data, we are not recommending e-cigarettes for use among cigarette smokers to help people stop smoking.”
So, what is known about electronic cigarettes?
*Manufacturers claim that electronic cigarettes are a safe alternative to conventional cigarettes.
*The Food and Drug Administration (FDA) has questioned the safety of these products.
*FDA analysis of two popular brands found variable amounts of nicotine and traces of toxic chemicals, including known cancer-causing substances (carcinogens).
*The FDA has issued a warning about potential health risks associated with electronic cigarettes, but is not yet regulating their use or standards of manufacture.
“It’s an amazing thing to watch a new product like that just kind of appear. There’s no quality control,” says Richard Hurt, M.D., director of Mayo Clinic’s Nicotine Dependence Center. “Many of them are manufactured in China under no control conditions, so the story is yet to be completely told.”
- E-cigarette regulation debate heats up (wavy.com)
- Should e-cigs be treated like regular cigarettes? (utsandiego.com)
- Conn. Lawmaker To Propose Ban On E-Cigarettes In Public Places (newyork.cbslocal.com)
- Report Finds Too Many American Children Are Smoking Flavored Cigars (counselheal.com)
- Safer Cigarrettes (powerecigs.wordpress.com)
- Don’t smoke your e-cigarettes indoors, say London’s top restaurateurs (standard.co.uk)
- Cigarette alternatives may not be ‘safe’ tobacco (universityofcalifornia.edu)
- E-Cigarettes Now Being Used To Smoke Marijuana, Worrying Some Health Officials (medicaldaily.com)
- Council bureaucrats to ban “E-Cigarettes” in order to have a “clear policy” towards smoking. (visitscunthorpe.com)
In general, we know that most illnesses and diseases are caused by an interplay of genetics and environmental factors. While there is little we can do to alter genetic susceptibility, understanding what and how environmental factors exacerbate if not trigger illnesses and diseases can help you keep your child safe and healthy.
First, note that there are disease agents – chemical and biological – that your child is exposed to through ingestion, inhalation and dermal contact with soil, food, water and the air. That’s called direct exposure. The opposite, indirect exposure, involves contact with disease agents through interactions with parents and caretakers. For instance, if the father who works in the construction industry comes home and holds his baby, the baby may inhale industrial fumes from his work clothes or chemical residue from the father’s worksite may be transferred from the father’s skin to the baby. Through both modes, children absorb disease agents that alter hormones and disrupt metabolic processes thereby triggering a number of childhood illnesses. It’s also important to recognize that exploratory behavior for children includes putting objects in the mouth, hand-to-mouth contact, which increases the risk for exposure to environmental disease agents.
The chart below lists a number of common childhood illnesses, an associated environmental agent and potential direct and indirect sources of exposures. Use this list to determine if there are any sources of disease agents that you should keep away from your child.
Environmental Agent Potential Exposures Abdominal Pain Lead Batteries, smelting, painting, ceramics, enameling, welding, plumbing Acute Psychoses Lead
Carbon disulfide mercury
Fungicide, maternal infection, wood preserving, removing paint from old houses, viscose rayon Angina Methylene chloride
Improperly vented indoor combustion sources, traffic exhaust, car repair, furnaces, water heaters, gas grill, foundry, wood finishing Asthma Formaldehyde
Plastics, textiles, lacquer, playing with pets, polyurethane kits Cardiac Arrhythmia Fluorocarbons
Refrigerator repair, automobile emissions, cigarette smoke, paint thinners, propane gas Dermatosis Solvents
Plastics, metal cleaning, electroplating, machining, housekeeping, leather tanning Headache Carbon monoxide
Unvented kerosene, tobacco smoke, firefighting, dry cleaning, wood finishing, gas grill, water heaters, furnaces, automobile exhaust, improperly vented indoor combustion mechanisms Hepatitis Halogenated hydrocarbons Healthcare workers, lacquer Pulmonary
Farming, welding, smelting, chemical operations
- Air pollution a leading cause of cancer – UN agency (eco-business.com)
- Could Environmental Factors Be Playing A Role In Rise Of Kidney Disease? (greenerideal.com)
- Early-life exposure of frogs to herbicide increases mortality from fungal disease (sciencedaily.com)
- Smoking affects molecular mechanisms and thus children’s immune systems (eurekalert.org)
- Environmental factors ‘turn on and off’ cancer related genes (medicalxpress.com)
Realize this is a long post.
Guess I opted to include the full press release largely because I served in Africa as a Peace Corps volunteer.
Kudos to the Canadian government and all who work to alleviate pain and foster development everywhere.
So good to see an ever growing list of health applications for cell phones. Below is an example of an application for community health workers. Also good to see one project involving fathers!
10 projects nominated for grants up to $2 million; 10 projects awarded $270,000, including one to reduce harm to brains of pre-term babies caused by pain of multiple daily hospital needles, other procedures
Grand Challenges Canada, funded by the Government of Canada, today extended a total of $10.1 million to 14 bold, creative projects aimed at improving the early brain development of kids in low-resource countries.
Projects in Jamaica, Colombia, Bangladesh and Indonesia are scale-up award nominees (board-approved grants up to CDN $2 million, pending successful contract negotiations).
Seed grants of CDN $270,000 each are given to seven organizations overseas — in Vietnam (2 grants), Bangladesh, India, Kenya, Zambia and Peru. And three seed grants are given to Canadian organizations: the Hospital for Sick Kids, Toronto (two grants), and the University Health Network, Toronto.
All 14 projects will be implemented in developing countries: five in Africa, six in Asia and three in Latin America and the Caribbean.
“Impoverished brains result in impoverished countries,” says Dr. Peter A. Singer, CEO of Grand Challenges Canada. “For a wide range of sad, all-too-familiar and preventable reasons, an estimated 200 million children under 5 years old in the world’s 112 low- and middle-income countries will fail to reach their brain’s full development potential.”
“These projects illustrate well the success of our search for ‘bold ideas with big impact,’ pioneering new approaches worldwide to maximize the number of kids in low-resource countries who achieve and contribute to their fullest capabilities,” Dr. Singer added.
Says Mrs. Laureen Harper, honourary chairperson of the program: “The Grand Challenges Canada Saving Brains program is designed to help millions of children in developing countries who fail to reach their full development potential due to such factors as malnutrition, infection, birth complications, or a lack of nurturing and stimulation at an early age.”
Says the Honourable Christian Paradis, Canadian Minister of International Development and Minister for La Francophonie: “Our Government, under the leadership of Prime Minister Harper, is committed to advancing the health of the world’s most vulnerable mothers, newborns and children. We are proud to partner with Grand Challenges Canada to find innovative solutions to the most pressing global health challenges. The Saving Brains program is just one example of how innovation can help improve the lives of children in their earliest days. ”
Seed grant awards
Hospital procedures: mitigating harm of pain to brain development of a tiny preterm baby
The Centre for Global Child Health, Hospital for Sick Children (Toronto, Canada)
Working in Ghana, this project will introduce ways of alleviating pain for infants born prematurely and treated in special neonatal intensive care units (NICU)s — the tiniest of kids who experience moderate to severe pain several times daily due to diagnostic and therapeutic procedures such as blood sample collections and medicine injections.
Project leader Dr. Bonnie Stevens of Toronto’s Hospital for Sick Children says the severity of brain defects found later among children born preterm can be linked to the number of painful procedures experienced in the NICU.
“Higher volumes of painful procedures with inadequately managed pain have also been associated with cognitive, language and motor problems, and low academic achievement,” says Dr. Stevens. “Although the consequences of pain are known, procedural pain is frequently under-managed and under-prioritized.”
Worldwide, about 13 million infants are born preterm each year — a number growing steadily thanks to modern technologies. And even in North America, Europe and Australia, surveys show “neonates” are exposed to an average of 4 to 14 painful procedures daily, with only about 1 in 3 receiving pain relief.
Less is known about neonatal pain management in low- and middle-income countries, where the incidence of neonatal sickness and death is highest. However, a survey in Kenya showed that infants in seven special care newborn nurseries experienced, on average, four painful procedures daily, half of them injections and blood sample withdrawals. No form of analgesia was documented.
The project will introduce Ghanaian caregivers and parents to an integrated “Toolkit for Minimizing the Impact of Pain in Infants,” adapted from successful practices in Canada. Videos and other educational materials will detail simple, universally affordable, proven ways to mitigate procedural pain for an infant, such as:
- Sweet solutions (e.g., sucrose or glucose) administered orally prior to a painful procedure;
- Kangaroo care, where infants are held in skin-to-skin contact with a parent;
- Facilitated tucking, where infants are held in a fetal-like position to provide support and boundaries;
Combined, these interventions have a demonstrated cumulative pain-relieving effect.
“Inadequate resources are cited as the major impediment to pain management in infants as well as a lack of knowledge, severe staff shortages and formal training about pain. The proposed Toolkit intervention will address these issues,” says Dr. Stevens.
The project draws on existing partnerships between the University of Ghana School of Nursing, Korle Bu Teaching Hospital in Accra and Toronto’s Hospital for Sick Children, together training 1,000 pediatric nurses in Ghana over the next 10-15 years, supported by a Canadian government grant. Plans calls for the toolkit’s integration into the curriculum at the School of Nursing (where there is limited pain content) and its use scaled up to reach additional countries.
Says Dr. Stevens: “Decreasing the intensity of painful procedures in hospitalized infants using simple, inexpensive, evidence-based strategies has the potential to minimize both immediate stress and suffering, and the known longer-term impact of pain on the developing neonatal brain and cognitive deficits.”
Malaria in the womb: New malaria policies to protect early brain development in Malawi
University Health Network (Canada)
Each year, about 125 million pregnant women are at risk of placental malaria (PM) and about 25% of all pregnancies in sub-Saharan Africa are complicated by PM at delivery.
PM has profound maternal and fetal health consequences, including increased risk of anemia, preterm birth, fetal growth restriction and delivery of low birth weight infants. The impact of in-utero malaria exposure on fetal neurodevelopment is unknown, however researchers with the project team recently linked malaria-exposure in animals with persistent and long-term deficits in memory and behaviour.
Dr. Kevin Kain of the Toronto-based University Health Network, leader of this project in Malawi, says malaria exposure in the womb “may derail the developmental trajectory of generations of children.” And a shift in understanding — that malaria exposure may result not just in infant mortality and low birth weight but affects also long-term neurodevelopment “represents a change in paradigm that will initiate a re-evaluation of public health policies designed to protect women and children from the deleterious consequences of PM.”
Today’s approach to this problem — intermittent preventive treatment of pregnant women with sulfadoxine-pyrimethamine — is losing effectiveness due to rising drug resistance, resulting in persistent infections.
The new project involves a novel antenatal care policy that focuses resources on accurate point-of-care malaria diagnosis and effective case- management of infection to reduce the burden of malaria in pregnancy and protect early brain development.
The work is expected to provide “compelling evidence that will directly impact national and international policies on the prevention of malaria in pregnancy. If our findings support an intervention that leads to improved neurocognitive outcome for exposed infants, it will refocus public health policies towards protecting fetal brain development.”
Project collaborators include the University of Malawi, and the University of Liverpool, UK.
An Integrated Toolkit to Save Newborns’ Brains in Kenya
The Centre for Global Child Health, Hospital for Sick Children (Toronto, Canada)
The first month of life is a critical period in brain growth and development that can be affected in many ways, including from hypothermia and infection.
Reducing the number of these impediments to young brain growth is the aim of a toolkit created by Toronto’s Hospital for Sick Kids for use initially by mothers in Kenya.
Contents of the tool kit (which costs less than $5) include:
- A clean delivery kit to minimize infection at time of delivery
- A sterilizing gel that, applied to the umbilical stump, reduces certain severe infections by 75% and mortality from all causes by 25 to 40%;
- An emollient to promote skin integrity, helping to reduce infection and prevent hypothermia (and shown to reduce mortality in hospitalized preterm infants)
- A handheld scale to spot early warnings signaled by an infant’s weight, and a ThermoSpot to identify hypothermia and fever
- A mylar infant sleeve and reusable heating device to treat hypothermia
Information on infant stimulation, involving play and communication strategies proven beneficial to neurodevelopment in low birth weight newborns.
If any danger signals are found, community health workers will refer cases to appropriate health care.
“We believe that improved neurodevelopment outcomes at age 1 will translate into sustainable longer term gains in academic performance, employment, productivity, and ultimately more human capital,” says project leader Dr. Shaun Morris of the Hospital for Sick Kids.
Project collaborators include the Aga Khan University, Kenya.
Iron-fortified biscuits to reduce maternal and child anemia
St John’s Research Institute, Unit ofCBCI Society for Medical Education, Bangalore, (India)
Anemia — a low level of red blood cells causing a body’s reduced capacity to carry oxygen — results from micronutrient deficiencies, most often iron.
India has one of the highest rates of anemia globally: over 79% of children aged 6 to 8 months and 58% of the 26 million pregnant women each year. Some 17 million of these women have access to iron pills yet 11 million do not take them for the recommend time (adherence rate: 35%). Why? The pill is big and tastes metallic.
Yet iron deficiency anemia dramatically affects the health of a pregnant woman and her unborn baby, increasing risks of death and sickness during childbirth, including hemorrhage and low-birth weight. Long-term, iron deficiency anemia delays psychomotor development and impairs cognitive development in infants, preschool and school-aged children around the world.
Moreover, researchers say, the effects of anemia are, “not likely to be corrected by subsequent iron therapy… anemic children will have impaired performance in tests of language skills, motor skills, and coordination, reportedly equivalent to a 5 to 10 point deficit in IQ.”
Part of the answer may be an iron-fortified biscuit for use by pregnant women, indistinguishable in taste from popular Indian biscuits.
Coupled with marketing, project leaders say their new biscuit is more likely to be used by previously non-adherent pregnant women, and increase iron stores in newborns, “which translates to more sustainable and protected early brain development.”
“After extensive consumer research, the nutrition team led by Dr A.V. Kurpad and the project collaborators, Violet Health Inc have developed several prototypes specifically designed with the tastes and preferences of pregnant women in India,” says project leader Dr. Pratibha Dwarkanath of St John’s Research Institute, unit of CBCI Society for Medical Education.
“We estimate our solution to be more cost-effective than the iron pill, while reaching more anemic women and their children”
“After proof of concept, we anticipate a scaled trial in Karnataka within three years and reducing anemia in women and infants.”
Project collaborators include Violet Health, Inc., NY, and the Indian Institute of Management, India Bangalore.
Early childhood development in low-resource settings: There’s an app for that.
“CommCare” project empowers community health workers with new mobile software for health workers, parents and caregivers
Ugunja Community Resource Center (Kenya)
In an unprecedented effort, Kenya’s Ugunja Community Resource Center will empower community health workers in Western Kenya with field-tested, mobile phone software to individualize early child development care in the family home and monitor progress via the Internet.
Calling it “the world’s first mobile phone-based early childhood development software platform for low-resource settings,” project leader Aggey Omondi says the software suite will include “apps” for community health workers, for parents and for caregivers, offering practical advice, tools, educational aids and forms for assessing, fostering early childhood development, including cognitive development, nutritional support, management of common illnesses, and counselling on cognitive stimulation for parents and caregivers.
Equipped with mobile phones carrying the software, 30 community health workers will serve 1500households with at least one child under age 3, and 10 parents will receive mobile phones containing the relevant application.
The online monitoring program features a “dashboard” to help users visualize key process and performance indicators, as well as outcome metrics and an analytics suite to enable program managers to analyze trends.
Project collaborators include the Harvard Business School and Dimagi Inc. of Cambridge MA, the University of Pennsylvania and the Kenya Methodist University School of Medicine and Health.
Managing maternal depression and stimulating kids to promote neurodevelopment
International Centre for Diarrheal Disease Research (Dhaka, Bangladesh)
Almost 60% of kids in Bangladesh are at risk of poor development due to low body weight (22%) and undernutrition (41%), poverty, and sub-optimal stimulation due to low parenting knowledge.
The mother is usually the key childcare provider and her physical and mental health is a major predictor of child development, particularly in low and middle-income countries.
Using the service of home-based workers of community health clinics in rural Bangladesh, the International Centre for Diarrheal Disease Research will offer a combined intervention that includes both a “Thinking Healthy” program for mothers of children 6 to 12 months old with depressive symptoms and psycho-social stimulation for their children.
Says project leader Dr. Fahmida Tofail: “Previous projects have used only one or the other of the interventions — depression treatment or child’s psychosocial stimulation. In this approach, we address the mother and child together to produce an optimal child-friendly environment to maximize the investment.”
Project collaborators include the International Centre for Diarrheal Disease Research, Bangladesh, the University of the West Indies, and the Institute for Child Health at University College, London UK.
Community-based family coaching for children with developmental risks
Partners in Health / Socios En Salud Surcursal (Peru)
In Lima, Peru, researchers will demonstrate a standardized community-based screening and treatment program delivered by community health workers to 60 children (6 to 24 months old) at risk of neurodevelopmental delay (NDD).
The community health workers will identify and treat at-risk children and assist their caregivers, addressing multi-level problems. The intervention includes 1) coaching parents on how to stimulate their child’s to promote development, and 2) providing parents with social support and encouragement.
The kids and their primary caregivers will be randomly assigned to one of three interventions:
- monthly nutritional support alone;
- nutritional support plus 3 months of the intervention in the home; or
- nutritional support plus 3 months of the intervention in group settings.
Among the impacts to be measured and evaluated:
- Changes in child development and parenting
- The child, caregiver, and household characteristics that predict who benefits most
- How intervention should be delivered for maximum effect (one-on-one or group settings)
Says project leader Leonid Lecca: “The vicious cycle of developmental delay and limited socioeconomic opportunity (manifested in poor academic performance and child labor) have major impact at the societal level, in terms of economic productivity and social inequality.”
Project collaborators include the Harvard Medical School and Children’s Hospital, the Brigham and Women’s Hospital, and the University of California San Francisco Medical School, as well as stakeholders in Rwanda and Haiti who will help explore how to adapt this model for global dissemination.
Learning Clubs for women’s health and infant development
Research and Training Centre for Community Development (Vietnam)
Vietnamese researchers point to eight major risks to optimal early childhood brain development around the time of birth in resource-constrained settings:
- Intrauterine growth restriction
- Iron deficiency anaemia
- Iodine deficiency
- Unresponsive caregiving
- Insufficient cognitive stimulation
- Maternal mental health problems, and
- Exposure to family violence
And these risks interact: the poorest women who have experienced intimate partner violence are at the highest risk of common mental disorders. And, even when all other factors are controlled, those who experience common mental disorders during pregnancy are less likely to participate in essential preventive health care, including the use of iodized salt to prevent iodine deficiency and taking iron supplements to counter anaemia
Risks continue in early infancy, both for mom and baby: a third of mothers have common mental disorders, 22% of infants are moderately or severely anemic and 7.4% are stunted. Six-month-old infants of mothers with antenatal common mental disorders have infant cognitive development scores on average significantly lower than infants of mothers without common mental disorders in pregnancy.
To date, interventions in these settings have focused on one or at most two of these risks, and outcomes for child development have been, at best, only partially effective.
Capitalizing on 15+ years of experience in rural Vietnam, this project led by Vietnam’s Research and Training Centre for Community Development in Hanoi aims to pioneer a low-cost program addressing all eight risks through a structured, universal program combining information, learning activities and social support with groups of women at the same life stage: Learning Clubs for Women and Infants.
Content will include interventions to address all eight risks early childhood brain development, recognizing and integrating consideration of each woman’s health and social circumstances during pregnancy and in the years in which they are providing primary child care.
The benefit envisioned: enhanced fetal, newborn and early infant development through improved maternal nutrition, mental health, birth outcomes, sensitivity and responsiveness in care-giving and feeding and reduced exposure to family violence.
We estimate that this comprehensive approach will reduce preterm birth, anaemia, stunting, rates of cognitive and social emotional development at age six months, with the effects maintained at least to age three among young children in rural Vietnam.
Project collaborators include the Jean Hailes Research Unit, Australia’s Monash University and the Department of Medicine, University of Melbourne.
What about Dad?
Fathers Involvement: Saving Brains in Vietnam
Hanoi School of Public Health (Vietnam)
Recent research has shown that children of a highly-involved male parent show increased cognitive competence, greater empathy, and less sex-stereotyped beliefs. They have higher IQs, stronger verbal skills, are more academically motivated and successful, have fewer emotional and behavioural problems, show better emotional regulation, better social and problem-solving skills and greater overall life satisfaction.
This project by Hanoi’s School of Public Health aims to mobilize more fathers in parenting and involve them directly in the cognitive and emotional development of their infants, and to indirectly enhance infants’ nutritional status by having fathers encourage mother’s breastfeeding exclusivity and duration.
Fathers will be exposed to:
- Multimedia messages about the importance of breastfeeding and father involvement
- Small group antenatal and postpartum education via community health centers
- Individual at-home counselling
- Light- hearted public fathering contests, organized with the assistance of the local Farmers Association, to praise and reward teams of fathers demonstrating good fathering knowledge and behaviours, and
- Fathers Clubs, developed in collaboration with the Labour trade union and Farmers Association to provide peer support.The project involves 400 couples (with 400 children) in Vietnam’s Hai Duong province.
“Father-infant involvement is an important emerging innovation in developing countries,” says project leader Dr. Tran Bich. “Evolving cultural norms have resulted in fathering roles that range from traditional expectations of father as primarily economic provider and head of the household to more contemporary involvement with mothers and children.”
Project collaborators include Canada’s Brock University, St. Catherines, and St. Jerome’s University, Waterloo.
A new category of community workers in Zambia dedicated to early childhood development
Zambia Centre for Applied Health Research and Development (Lusaka, Zambia)
Recent research on brain development suggests that no single risk or developmental stress causes most harm; the main problem is the accumulated impacts of multiple early childhood adversities. Single risk factor interventions are, therefore, unlikely to achieve the highest possible impact on child development.
This project of the Zambia Centre for Applied Health and Development is designed as a comprehensive, integrated, community-based child development program, rolled out in Zambia’s Choma District.
The key innovation, and a critical improvement over previous efforts: establishment of a new cadre of health workers with the sole, explicit mission to monitor and support all aspects of child development under the age of 2.
The newly-trained, community-based “child development agents” (CDA) will form a natural link between mothers and the larger health system, including community health workers.
The CDA will have three principal responsibilities:
- Monitor children’s nutritional status on a monthly basis through home visits, and ensure immediate treatment of moderate to severe malnutrition and acute infections (malaria, diarrhea, and pneumonia) through local CHWs or public health facilities as needed.
- Ensure all children receive the full health benefits as defined in national guidelines, including exclusive breastfeeding to 6 months of age, a complete set of vaccinations, vitamin A supplementation, growth monitoring, and deworming every 6 months starting at 12 months of age.
- Coordinate local selected volunteer mothers in running a home -based stimulation component similar in nature to the ones successfully implemented in Cambodia
CDAs will be supported with mobile health technology to ensure continuous and efficient communication, monitoring and close implementation of service protocols.
The mobile device will serve three principal functions:
- Provide weekly visit reminders and a list of health services for mothers and children who missed services or appointments
- Allow CDAs to communicate with local CHWs and health facility staff to ensure immediate treatment of acute health conditions
- Support CDAs with visual materials (videos) to compliment their weekly training with volunteer mothers
Each CDA will be responsible for 250 households, which corresponds to approximately 50 to 60 children under the age of 2 in their communities. CDAs will enroll eligible mothers and their child in the study, and then will be responsible for the health and development of the respective child up to 24 months of age. Each week, the CDA will be sent a list mothers and children who missed a scheduled services or appointments through an automated electronic system; list of children that should be visited in the respective week for the monthly nutrition and health follow-up well; and reminder of content of early childhood learning sessions to support child nurturing. They will be monitored by CDA supervisors on a regular basis, and will be given verbal feedback on their performance. In each month, the best 10% of CDAs will receive a symbolic “CDA of the month” award.
The project will directly benefit 225 children in the short term, and, the hope, all Zambian children in the long run. Its main targets: reduced stunting and improved child development at age 2.
Says project leader Dr. Davidson Hamer: “The program has the potential to transform how mothers think about child development and early education, and to increase maternal understanding of age-appropriate development and cognitive stimulation.”
Project collaborators include America’s Harvard School of Public Health, and the Center for Global Health and Development at Boston University, and Zambia’s Centre for Infectious Diseases Research and Ministry of Health, Child Health Unit.
Large-scale award nominees
Putting online a proven, early cognitive stimulation program to help those helping kids in developing countries
University of the West Indies (Kingston, Jamaica)
A package of low-cost materials proven to help early cognitive stimulation will be made available online to support in-home interventions by community workers in developing countries, thanks to this project led by Christine Powell, PhD, Senior Lecturer at the Tropical Medicine Research Institute, University of West Indies. The materials can be used despite limited training by any qualified person (NGO, international agency, local government department) and include a curriculum, training manuals, books, play materials, and training videos, all tailored to the children’s culture.
The curriculum being placed online is the product of years of work pioneering the foundation for early childhood development in low resource settings. The web-based package is expected to provide skills and materials for 10 countries to adapt and implement the home cognitive stimulation package.
Stimulation and nutrition for pre-schoolers in rural Colombia
Universidad de los Andes (Bogotá, Colombia)
While there are government-run programs in urban centers, to now rural kids in Columbia have had available only a home-based daycare system run by women with little if any formal training.
Providing an integrated, two-stage intervention for children from 6 months to 5 years old is the idea behind of a project led by Raquel Bernal of Colombia’s Universidad de los Andes.
In the first stage, facilitators of existing family (home-visiting) services for pregnant women and children up to 30 months old will be trained to promote effective mothering, including nutrition, child development, and interaction with the child.
In the second stage, local mothers running community nurseries will receive 160 hours of training in topics such as fostering child development and developmental milestones in children 24-60 months old, and activities to encourage executive functioning of the child brain. Crucially, both curricular improvements will be implemented along with regular coaching and monitoring visits by trained supervisors.
An estimated 4,800 children will have access to more supportive developmental experiences as a result of this project.
Nutrition and psychosocial stimulation to improve development of malnourished children in Bangladesh
International Centre for Diarrheal Disease Research (Dhaka, Bangladesh)
Early cognitive development will be promoted through this program to treat malnourished children in rural Bangladeshi health clinics, improving the knowledge and skills of both mothers and field staff in early cognitive development. The anticipated outcome: improved language skills among children, as well as better mental and psychomotor development.
The project takes advantage of a time when kids and their parents are interacting with health clinics to provide more than just calories. challenge is how to do it in a way that is feasible to deliver by health workers with lots big workloads. The anticipated outcome: improvements in language, mental, and psychomotor development for approximately 3,000 children.
Golden Generation Program for community-based early childhood development
University of Mataram (Mataram, Indonesia)
The Golden Generation Program will integrate early development, health and nutrition programs to promote thriving children, and includes strategies to:
- enhance staff capabilities in early childhood development centers in villages;
- deploy of specially-trained community workers to coach and certify couples in early childhood development; and
- engage a mobile real-time data platform to link providers and clients to track infant growth and development, and flag needed interventions.
Program impact will be assessed through a randomized trial involving 80 communities, covering approximately 30,000 couples and their infants over a 2-year period.
To foster long-term sustainability and ongoing program development, the Program will also establish community worker cooperatives and a Center for Early Childhood Development at the University of Mataram.
The program is a collaboration between the University of Mataram, the Provincial and District Governments of Nusa Tenggara Barat Province, the Summit Institute of Development and the Harvard School of Public Health.
The Grand Challenges Canada Saving Brains Program promotes fulfillment of human capital potential by focusing on interventions that nurture brain development in the first 1,000 days of life. The goal of the Saving Brains program is to unlock the potential of children by developing and scaling up products, services and policies that protect and nurture early brain development in an equitable and sustainable manner. Almost CDN $30 million has been committed to date. In addition to projects, the Saving Brains program is investing in an authoritative quantification of the economic impact and true costs of poverty-related risk factors for cognitive and human capital development.
Grand Challenges Canada invites global, regional and corporate partners committed to enabling innovation for early brain development to join us in Saving Brains.
Please visit grandchallenges.ca and look for us on Facebook, Twitter, YouTube and LinkedIn.
About Grand Challenges Canada
Grand Challenges Canada is dedicated to supporting bold ideas with big impact in global health. We are funded by the Government of Canada through the Development Innovation Fund announced in the 2008 Federal Budget. We fund innovators in low and middle income countries and Canada. Grand Challenges Canada works with the International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and other global health foundations and organizations to find sustainable long-term solutions through integrated innovation – bold ideas which integrate science, technology, social and business innovation. Grand Challenges Canada is hosted at the Sandra Rotman Centre.
About Canada’s International Development Research Centre
The International Development Research Centre (IDRC) supports research in developing countries to promote growth and development. IDRC also encourages sharing this knowledge with policymakers, other researchers and communities around the world. The result is innovative, lasting local solutions that aim to bring choice and change to those who need it most.
As the Government of Canada’s lead on the Development Innovation Fund, IDRC draws on decades of experience managing publicly funded research projects to administer the Development Innovation Fund. IDRC also ensures that developing country researchers and concerns are front and centre in this exciting new initiative.
About Canadian Institutes of Health Research
The Canadian Institutes of Health Research (CIHR) is the Government of Canada’s health research investment agency. CIHR’s mission is to create new scientific knowledge and to enable its translation into improved health, more effective health services and products, and a strengthened Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 14,100 health researchers and trainees across Canada. CIHR will be responsible for the administration of international peer review, according to international standards of excellence. The results of CIHR-led peer reviews will guide the awarding of grants by Grand Challenges Canada from the Development Innovation Fund.
About the Department of Foreign Affairs, Trade and Development Canada
The mandate of Foreign Affairs, Trade and Development Canada is to manage Canada’s diplomatic and consular relations, to encourage the country’s international trade, and to lead Canada’s international development and humanitarian assistance.
About Sandra Rotman Centre
The Sandra Rotman Centre is based at University Health Network and University of Toronto. We develop innovative global health solutions and help bring them to scale where they are most urgently needed. The Sandra Rotman Centre hosts Grand Challenges Canada.
- Simple Method May Help Predict Tiny Preemies’ Outlook (nlm.nih.gov)
- Indiana University study shines new light on consequences of preterm births (eurekalert.org)
- Study Identifies New Consequences of Preterm Births (counselheal.com)
- Testing for Neonatal Sepsis: The Next Generation of Biomarkers (promega.wordpress.com)
- Neonatal Pain-Related Stress and NFKBIA Genotype Are Associated with Altered Cortisol Levels in Preterm Boys at School Age (plosone.org)
Researchers from Cornell University have identified some agricultural management practices in the field that can either boost or reduce the risk of contamination in produce from two major foodborne pathogens: salmonella, the biggest single killer among the foodborne microbes, and Listeria monocytogenes. Their findings are published ahead of print in the journal Applied and Environmental Microbiology.
“This is going to help make produce safer,” says Laura Strawn, a researcher on the study. “We could significantly reduce risk of contamination through changes that occur a few days before the harvest.”
Many of the risk factors were influenced by when they were applied to fields which suggests that adjustments to current practices may reduce the potential for contamination with minimal cost to growers, says Strawn.
Foodborne illness sickens an estimated 9.4 million, and kills around 1,300 annually in the US, according to the Centers for Disease Control and Prevention. Produce accounts for nearly half the illnesses, and 23 percent of the deaths.
“The research is the first to use field collected data to show the association between certain management practices and an increased or decreased likelihood of salmonella and L. monocytogenes,” says Strawn.
For salmonella, manure application within the year prior to the researchers’ sampling boosted the odds of a contaminated field, while the presence of a buffer zone between the fields and potential pathogen reservoirs such as livestock operations or waterways was protective.
Irrigation within three days before sample collection raised the risk of listeria contamination six-fold. Soil cultivation within the week before sampling also increased the chances of contamination.
“These findings will assist growers in evaluating their current on-farm food safety plans (e.g. “Good Agricultural Practices”), implementing preventive controls that reduce the risk of pre-harvest contamination, and making more informed decisions related to field practices prior to harvest,” says Strawn. “Small changes in how produce is grown and managed could result in a large reduction of food safety risks.”
- Small changes in agricultural practices could reduce produce-borne illness (phys.org)
- Small changes in ag practices could reduce produce-borne illness (esciencenews.com)
- Small changes in ag practices could reduce produce-borne illness (eurekalert.org)
- Major Foodborne Illness Outbreak Occurs During Government Shutdown (disinfo.com)
- Costco expands recall of Salmonella-tainted Foster Farms chicken (oregonlive.com)
- Device speeds concentration step in food-pathogen detection (sciencedaily.com)
- Device speeds concentration step in food-pathogen detection (esciencenews.com)
From the 7 October 2013 press release at Trust for America’s Health – Preventing Epidemics. Protecting People.
Prescription Drug Abuse: More than Half of States Score 6 or Less out of 10 on New Policy Report Card, While Drug Overdose Deaths Doubled in 29 States in the Last Decade
Washington, D.C. October 7, 2013 – A new report, Prescription Drug Abuse: Strategies to Stop the Epidemic, finds that 28 states and Washington, D.C. scored six or less out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Two states, New Mexico and Vermont, received the highest score receiving all 10 possible indicators, while South Dakota scored the lowest with two out of 10.
According to the report by the Trust for America’s Health (TFAH), prescription drug abuse has quickly become a top public health concern, as the number of drug overdose deaths – a majority of which are from prescription drugs – doubled in 29 states since 1999. The rates quadrupled in four of these states and tripled in 10 more of these states.
Prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C. Misuse and abuse of prescription painkillers alone costs the country an estimated $53.4 billion each year in lost productivity, medical costs and criminal justice costs. Currently only one in 10 Americans with a substance abuse disorder receives treatment.
“Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action.”
In the Prescription Drug Abuse report, TFAH – in consultation with a number of public health, clinical, injury prevention, law enforcement and community organization experts – reviewed a range of national recommendations and examined a set of 10 indicators of strategies being used in states to help curb the epidemic. There are indications that some of these efforts and strategies may be having a positive impact — the number of Americans abusing prescription drugs decreased from 7 million in 2010 to 6.1 in 2011, according to the National Survey on Drug Use and Health.
Some key findings from the report include:
- Appalachia and Southwest Have the Highest Overdose Death Rates: West Virginia had the highest number of drug overdose deaths, at 28.9 per every 100,000 people – a 605 percent increase from 1999, when the rate was only 4.1 per every 100,000. North Dakota had the lowest rate at 3.4 per every 100,000 people. Rates are lowest in the Midwestern states.
- Rescue Drug Laws: Just over one-third of states (17 and Washington, D.C.) have a law in place to expand access to, and use of naloxone – a prescription drug that can be effective in counteracting an overdose – by lay administrators.
- Good Samaritan Laws: Just over one-third of states (17 and Washington, D.C.) have laws in place to provide a degree of immunity from criminal charges or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose.
- Medical Provider Education Laws: Fewer than half of states (22) have laws that require or recommend education for doctors and other healthcare providers who prescribe prescription pain medication.
- Support for Substance Abuse Treatment: Nearly half of states (24 and Washington, D.C.) are participating in Medicaid Expansion – which helps expand coverage of substance abuse services and treatment.
- ID Requirement: 32 states have a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance.
- Prescription Drug Monitoring Programs: While nearly every state (49) has a Prescription Drug Monitoring Program (PDMP) to help identify “doctor shoppers,” problem prescribers and individuals in need of treatment, these programs vary dramatically in funding, use and capabilities. For instance, only 16 states require medical providers to use PMDPs.
“Fifty Americans die a day from prescription drug overdoses, and more than 6 million suffer from prescription drug abuse disorders. This is a very real epidemic – and warrants a strong public health response,” said Andrea Gielen, ScD, Director of the Johns Hopkins Center for Injury Research and Policy. “We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis.”
Key recommendations from the report include:
- Educate the public to understand the risks of prescription drug use to avoid misuse in the first place;
- Ensure responsible prescribing practices, including increasing education of healthcare providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment;
- Increase understanding about safe storage of medication and proper disposal of unused medications, such as through “take back” programs;
- Make sure patients do receive the pain and other medications they need, and that patients have access to safe and effective drugs;
- Improve, modernize and fully-fund Prescription Drug Monitoring Programs, so they are real-time, interstate and incorporated into Electronic Health Records, to quickly identify patients in need of treatment and connect them with appropriate care and identify doctor shoppers and problem prescribers;
- Make rescue medications more widely available by increasing access for at-risk individuals to naloxone and provide immunity for individuals and others seeking help; and
- Expand access to and availability of effective treatment options as a key component of any strategy to combat prescription drug abuse.
According to the National Center for Injury Prevention and Control (NCIPC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.
“The release of the prescription drug abuse report by the Trust for America’s Health represents a significant step forward in elevating public awareness of the state of prescription drug abuse in the US”, according to Ginny Ehrlich, CEO of Clinton Health Matters Initiative (CHMI). “We are proud that the Trust has completed this important research as part of its CHMI Commitment to Action and congratulate the Trust on continuing to advocate for innovation and action towards addressing this public epidemic.”
The report was supported by a grant from the Robert Wood Johnson Foundation.
Score Summary: A full list of all of the indicators and scores, listed below, is available along with the full report on TFAH’s web site at www.healthyamericans.org and RWJF’s web site athttp://www.rwjf.org/RxReport. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. Data for the indicators were drawn from a number of sources, including the National Alliance for Model State Drug Laws, NCIPC, Centers for Disease Control and Prevention, the Alliance of States with Prescription Drug Monitoring Programs, the National Conference of State Legislators, the Network for Public Health Law, the Kaiser Family Foundation and a review of current state legislation and regulations by TFAH. In August 2013, state health departments were provided with opportunity to review and revise their information.
10 out of 10: New Mexico and Vermont
9 out of 10: Kentucky, Massachusetts, New York and Washington
8 out of 10: California, Colorado, Connecticut, Delaware, Illinois, Minnesota, North Carolina, Oklahoma, Oregon, Rhode Island and West Virginia
7 out of 10: Florida, Nevada, New Jersey, Tennessee and Virginia
6 out of 10: Arkansas, District of Columbia, Georgia, Hawaii, Iowa, Louisiana, Maryland, Michigan, North Dakota, Ohio, Texas and Utah
5 out of 10: Alaska, Idaho, Indiana, Maine, Mississippi, Montana, New Hampshire and South Carolina
4 out of 10: Alabama, Arizona, Kansas, Pennsylvania, Wisconsin and Wyoming
3 out of 10: Missouri and Nebraska
2 out of 10: South Dakota
STATE-BY-STATE DRUG OVERDOSE MORTALITY RANKINGS
Note: Rates include total drug overdose mortality rates, the majority of which are from prescription drugs. 1 = Highest rate of drug overdose fatalities, 51 = lowest rate of drug overdose fatalities. Rankings are based on data from CDC’s National Center for Health Statistics, WONDER Online Database, 2010. The numbers are based on the number of people per 100,000.
1. West Virginia**** (28.9); 2. New Mexico (23.8); 3. Kentucky**** (23.6); 4. Nevada (20.7); 5. Oklahoma*** (19.4); 6. Arizona (17.5); 7. Missouri*** (17); 8. (tie) Tennessee** and Utah (16.9); 10. Delaware** (16.6); 11. Florida** (16.4); 12. Ohio*** (16.1); 13. Rhode Island** (15.5); 14. Pennsylvania (15.3); 15. Wyoming*** (15); 16. South Carolina*** (14.6); 17. Indiana**** (14.4); 18. Michigan*** (13.9); 19. Louisiana*** (13.2); 20. Washington (13.1); 21. (tie) District of Columbia and Montana** and Oregon** (12.9); 24. Colorado (12.7); 25. Arkansas** (12.5); 26. (tie) Alabama*** and Idaho** and New Hampshire** (11.8); 29. Alaska (11.6); 30. (tie) Mississippi***and North Carolina** (11.4); 32. (tie) Maryland and Massachusetts (11); 34. (tie) Hawaii and Wisconsin** (10.9); 36. Georgia*** (10.7); 37. California (10.6); 38. Maine (10.4); 39. Connecticut (10.1); 40. Illinois (10); 41. New Jersey (9.8); 42. Vermont** (9.7); 43. (tie) Kansas** and Texas (9.6); 45. Iowa**** (8.6); 46. New York (7.8); 47. Minnesota** (7.3); 48. Virginia (6.8); 49. Nebraska** (6.7); 50. South Dakota (6.3); 51. North Dakota (3.4).
** Drug Overdose Mortality Rates doubled from 1999 to 2010
*** Drug Overdose Mortality Rates tripled from 1999 to 2010
**** Drug Overdose Mortality Rates quadrupled from 1999 to 2010
Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make diseaseprevention a national priority. For more information, visit www.healthyamericans.org.
- Five more laws to help stop Maine’s prescription drug epidemic (bangordailynews.com)
- Report says states are failing to curb prescription drug abuse (wqad.com)
- Oklahoma ranks 5th in drug overdose, expert explains how to lower that rank (kfor.com)
- Prescription drug abuse in Pennsylvania (fox43.com)
- NSC report: only three states adequately addressing prescription drug abuse (sacbee.com)
Revealing influenza’s truly insidious nature, Whitehead Institute scientists have discovered that the virus is able to infect its host by first killing off the cells of the immune system that are actually best equipped to neutralize the virus.
Confronted with a harmful virus, the immune system works to generate cells capable of producing antibodies perfectly suited to bind and disarm the hostile invader. These virus-specific B cells proliferate, secreting the antibodies that slow and eventually eradicate the virus. A population of these cells retains the information needed to neutralize the virus and takes up residence in the lung to ward off secondary infection from re-exposure to the virus via inhalation.
- Researchers Discover How Flu Gains Foothold in the Body (news.health.com)
- Researchers Discover How Flu Gains Foothold in the Body (oddonion.com)
- Super Flu Vaccine Eliminates All Strains of the Virus (americanlivewire.com)
- Universal flu vaccine ‘blueprint’ (bbc.co.uk)
- How vaccines work (missvenecia.wordpress.com)
- Top Ten Myths About The Flu (charlotte.cbslocal.com)
According to The Illinois Environmental Protection Agency: Mercury poses a health risk to everybody but especially to young children and fetuses because they’re still developing. Prolonged low level exposure may cause learning disabilities by hurting the ability of children to think and read. Adults who have been exposed to high levels of mercury may experience trembling hands and numbness or tingling in their lips, tongues, fingers, and toes. Acute mercury poisoning especially through ingestion, can damage the brain, liver, kidneys, and even cause death.
Research published in Environmental Health and conducted in part by a scientist at the Institute for Agriculture and Trade Policy has revealed that high-fructose corn syrup (HFCS) is contaminated with the toxic heavy metal mercuryHigh-fructose corn syrup is used in almost everything, it seems. A second study conducted by David Wallinga, M.D., entitled “Not So Sweet: Missing Mercury andHigh Fructose Corn Syrup” reveals that nearly one-third of all grocery items sweetened with HFCS were contaminated with mercury
WHERE DOES ALL THE MERCURY COME FROM?
Most people don’t know how high-fructose corn syrup is really made. One of those processes is a bizarre chemical brew involving the creation of caustic soda by exposing raw materials to pools of electrified mercury in a large vat. Through this process, the caustic soda gets contaminated with mercury, and when corn kernels are exposed to this caustic soda to break them down, that contamination is passed through to the HFCS.
Another toxic chemical, glutaraldehyde, is also used in the production of HFCS. It’s so toxic that consuming even a small amount of it can burn a hole in your stomach.
- 6 Ways To Avoid High Fructose Corn Syrup This Halloween (organicauthority.com)
- Breaking news: High fructose corn syrup may kill brain cells – study (foodconsumer.org)
- High-Fructose Corn Syrup May Cause Cardiovascular Disease (atlantablackstar.com)
- High Fructose Corn Syrup (mycrampedkitchen.com)
- Top 10 Controversial Ingredients Found In Coca-Cola (toptenz.net)
- Soda – The Killer in Your Fridge (In Progress) (atlasdrugandnutrition.com)
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.
Links jobs and hazardous tasks with occupational diseases and their symptoms.
Information on the health effects of common household products under your sink, in the garage, in the bathroom and on the laundry room shelf.
Maps of hazardous chemicals with links to related health resources.
Interactive game for 7-11 years olds with lessons about household chemical hazards.
An interactive guide about how the environment, chemicals and toxic substances affect human health.
Tox Town en español
- Health Hazards in Household Products? Checking Everyday Items for Chemicals (scienceworldreport.com)
- EPA Quietly Withdraws Two Proposed Chemical Safety Rules (huffingtonpost.com)
- EPA Web Tool Expands Access to Scientific, Regulatory Information on Chemicals (workers-compensation.blogspot.com)
- Web tool expands access to scientific, regulatory chemical information (rdmag.com)
- EPA Web Tool Helps Manufacturers Choose Safer Chemicals (environmentalleader.com)
- It’s Not Easy Being Green (cen.acs.org)
A new paper suggests that lifestyle advice for people with diabetes should be no different from that for the general public – but diabetes may benefit more from that same advice.
In the study, the researchers investigated whether the associations between lifestyle factors and mortality risk differ between individuals with and without diabetes.
Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was formed of 6,384 persons with diabetes and 258,911 EPIC participants without known diabetes. Computer modelling was used to explore the relationship (in both those with and without diabetes) of mortality with the following risk factors: body-mass index, waist/height ratio, 26 food groups, alcohol consumption, leisure-time physical activity, smoking.
The researchers found that overall mortality was 62% higher in people with diabetes compared with those without. Intake of fruit, vegetables, nuts, seeds, pasta, poultry and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk.
While the strength of the association was different in those with diabetes versus those without, the associations were in the same direction in each case (see table 2 full paper). No differences between people with and without diabetes were detected for the other lifestyle factors including adiposity, alcohol consumption, physical activity, and smoking.
The authors say: “It appears that the intake of some food groups is more beneficial (fruits, legumes, nuts, seeds, pasta, poultry, vegetable oil) or more detrimental (soft drinks, butter, margarine, cake, cookies) with respect to mortality risk in people with diabetes. This may indicate that individuals with diabetes may benefit more from a healthy diet than people without diabetes. However, since the directions of association were generally the same, recommendations for a healthy diet should be similar for people with or without diabetes.”
- Healthy Diet and Lifestyle Advice Should be Similar for People With Diabetes and General Public (medindia.net)
- We Should All Live As If We Were Diabetics, Researchers Say (news.softpedia.com)
- Study shows that diet and lifestyle advice for those with diabetes should be ‘no different’ from that for general public (eurekalert.org)
- Is Alzheimer’s Type 3 diabetes? (newsinfo.inquirer.net)
- Study shows that diet and lifestyle advice for those with diabetes should be ‘no different’ from that for general public (fngnutrition.ca)
- Study shows that diet and lifestyle advice for those with diabetes should be ‘no different’ from that for general public (medicalnewstoday.com)
I just read a brief perspective article in the journal Evidence Based Medicine, “Medical apps for smartphones: lack evidence undermines quality and safety.” It is a quick little read and it brings up some very real and interesting points which I will try to summarize.
- There is no official vetting system for medical apps – Some apps are blatantly wrong and dangerous, some are out of date therefore also dangerous.
- Lack of information and clinical involvement in the creation of the apps – There is a paucity of information regarding the creator of the app. Some apps have no physician involvement.
- Companies (authors specifically mention Pharma) creating apps could create conflicts of interest and ethical issues – Pharma apps could produce drug guides or clinical decision tools that subtlety push their own products.
The FDA will regulate some apps but not all. The FDA will regulate apps that control a medical device or displays, stores, analyzes patient data (example: electrocardiogram). They will also regulate apps that use formulas or algorithms to give patient specific results such as diagnosis, treatment, recommendation or differential diagnosis. Finally they will regulate apps that transform a mobile device into a medical device (example: apps that use attachments or sensors to allow the smartphone to measure blood glucose).
That still leaves a ton of medical apps hanging out there in the app stores which are largely unregulated. The article states, “Until now, there has been no reported harm to a patient caused by a recalled app. However, without app safety standards, it is only a matter of time before medical errors will be made and unintended harm to patient will occur.” Basically it is the Wild West in the medical app arena.
There are two groups that are trying to evaluate medical apps. iMedicalApps.com and the Medical App Journal review various apps directed toward medical professionals. I take issue with the article authors who state these sites are a “good starting point for peer-reviewing apps, the current assessment criteria do not address the scientific evidence for their content, but rather matters of usability, design, and content control.” While I don’t use the Medical App Journal as often, I use iMedicalApps.com quite often and they do more than just assess the usability and design. I have read reviews where they question the medical correctness of apps, intended audience, and have even pushed for more information regarding authorship/responsibility. Several of their reviews questioned an app’s update schedule and updated content. They have also investigated, questioned, and reported instances of fraud and plagiarism with medical apps. I think iMedicalApps does a very good job in a very flooded market, but there are areas for improvement. As with any website that relies on a large number of reporters/reviewers, there is some variance in the quality based on the reviewer. I haven’t found any reviews that are bad, just some are better and more thorough than others. Perhaps a little more explanation or transparency regarding how they determine the accuracy or validity of medical app might be helpful, or a standardized checklist about the things they look at. I realize evaluating the latest UpToDate app is different compared to an app on EKGs. UpToDate already has an established proven product where as there is more to investigate and validate with an app that isn’t a version of an already established product.
The authors believe the medical community needs to be more involved with regulating medical apps. They suggest:
- Official certification marks guaranteeing quality
- Peer review system implemented by physicians’ associations or patient organizations
- Making high quality apps more findable by adding them to hospital or library collections
1. I like the idea of having an official certification indicating quality, but there are two things that must be addressed prior to that.
First you have to get the organizations to actually take responsibility for looking at apps that are in their area of expertise. The field is already cumbersome, I am not sure many organizations are able to handle that. Although I have found that several journals have now included app reviews. While they can’t come close to scratching the surface of medical apps, these journals often have MDs, RNs, MPTs writing reviews and evaluating the content. Specifically I have found some good reviews in the physical therapy and nursing journals.
Second, there is growing problem with fake certifications. If an app is created by a company or people who already don’t care about its accuracy or is a plagiarizing a product, they probably have no qualms about lifting the image of the certification and posting it on their website. They could create their own certifications to fake (but legit sounding) orgs and post those on their app’s site too. Official certification is a good idea and I like it but there needs to be more to it to make sure it truly represents quality.
2. I personally believe the writers at iMedicalApps.com are on their way to something of a peer review system. Right now they only have one person review an app. While that completely makes sense from a writing perspective, perhaps they can implement some sort of peer review process where more than just one person is reviewing the app, yet still retain the one voice post for ease of reading. Perhaps they could reach out to a few medical professionals who are leaders in their field to review specific apps. Thus giving the reviewed app a little bit more weight. This along with astandardized check list or illustrating how they review the medical accuracy of an app would make the information on their site even more important and provide an excellent way of separating the wheat from the chaff.
3. An online repository of approved apps would be great. Some hospital IT departments that have mobile device policies have this, but they seem to be only hospital type apps like Citrix or database subscription apps like LexiComp, PubMed, UpToDate, etc. While these apps are important, there is little worry about apps like LexiComp, UpToDate, or PubMed because they were well established medical information products before their app. Their app is just an extension of their verified product. I don’t see a lot of IT departments that have investigated having a pool of apps that aren’t hospital specific or from database subscriptions. Additionally, IT would either need to rely on an outside sources like iMedicalApps or content experts within the field in that hospital to build the app pool. IT would have no way of verifying the authenticity and validity of an app on pediatric emergency medicine.
Finally, getting hospitals to buy bulk licenses to apps is tricky at best. With exception of a few places like Epocrates, Unbound Medicine, Inkling, and Skyscape (many of those companies dealt with institutional subscriptions before app stores….remember PDAs?) there are very few places that sell or license apps to a group of people. The purchasing of apps was created as an individual service. Now academic medical centers may have a foot in the door with iTunes U, but I have heard that discussions with Apple and their app store and hospitals is an “interesting” process. The same principle applies to library repositories. Instead of IT aggregating the apps, the library would do that. There are a lot of library’s that already have great lists suggesting various medical apps. But the vast majority of medical libraries have app resources guides, suggesting apps that the individual must buy. Also just like with an IT repository of apps, the librarian must rely on sites like iMedicalApps.com or their own physician suggestions to ensure they are listing quality apps.
Like I said it is the Wild West when it comes to medical apps. That is because the whole app industry is a new frontier. There are quality and accuracy problems with other apps in the app stores. A pedometer app with errors is not going to kill somebody, but an inaccurate medical app can. Yes, the medical community needs to get involved in evaluating apps, but so does Apple and Google. Right now Apple’s iTunes store feedback and ranking system while good for games, is not adequate for medical apps and can easily be subject to fraud. Additionally, Apple is extremely tight lipped about its app store rules and regulations. Some apps have extreme difficulty getting approved, while others fly through approval process only to be mysteriously removed later. There is no transparency to the Apple App Store. For example, there is no information about the app Critical APPraisal which was determined to be a plagiarized version of Doctor’s Guide to Critical Appraisal. The app was available in the App Store July 2011. However, if you searched today for the app, you wouldn’t be able to find it in the App Store, it simply disappeared. Unless you happen to read the article in BMJ, iMedicalApps.com, or a few other British publications, you would have no clue as to why the app was removed. When it comes to dangerous apps, disappearing them from the App Store is not good enough. You must have transparency when it comes to medicine.
According to an updated BMJ article, the doctors accused of plagiarizing The Doctor’s Guide to Critical Appraisal to use in their app Critical APPraisal, have been cleared of plagiarism by the Medical Practitioners Tribunal Service.
“A regulatory panel rejected charges by the General Medical Council (GMC) that Afroze Khan, Shahnawaz Khan, and Zishan Sheikh acted dishonestly in knowingly copying structure, contents, and material from a book, The Doctor’s Guide to Critical Appraisal, when developing their Critical APPraisal app, representing it as their own work, and seeking to make a gain from the material.”
Shahnawaz Khan and Afroze Khan were also accused of dishonestly posting positive reviews of the app on the Apple iTunes Store without disclosing that they were co-developers and had a financial interest in the app. The GMC found that Shahnawaz Khan no evidence that he knew that the app, which was initiallly free, would later sold for a fee. His case was concluded without any findings. However, the GMC panel found that “Afroze Khan’s conduct in posting the review was misleading and dishonest.” Yet they considered this type of dishonesty to be “below the level that would constitute impairment of this fitness to practise.” The GMC panel said it was an isolated incident and did not believe it would be repeated in which they “considered his good character and testimonials attesting to his general probity and honesty and decided not to issue a formal warning.”
Health Apps (Free and Low Cost)
Free and low cost Health Apps in this section include:
And these may be helpful when selecting health apps
- FDA plans to approve some medical apps (wwlp.com)
- Evaluating mobile weight loss apps on use of evidence-based behavioral strategies (eurekalert.org)