Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] How poverty shapes the brain

From the 30 March 2015 ScienceBlog post

Family income is associated with children’s brain structure, reports a new study in Nature Neuroscience coauthored by Teachers College faculty member Kimberly Noble. The association appears to be strongest among children from lower-income families.

“We can’t say if the brain and cognitive differences we observed are causally linked to income disparities,” said Noble, who currently is both a TC Visiting Professor and Director of the Neurocognition, Early Experience and Development Lab of Columbia University Medical Center, but will join TC’s faculty as Associate professor of Neuroscience and Education in July in the Department of Biobehavioral Sciences. “But if so, policies that target poorest families would have the largest impact on brain development.”

The results do not imply that a child’s future cognitive or brain development is predetermined by socioeconomic circumstances, the researchers said.
Read more at http://scienceblog.com/77532/how-poverty-shapes-the-brain/#FpSAIVrhPFfM4hGJ.99

March 31, 2015 Posted by | Public Health | , , , , , , | Leave a comment

[News release] Quarantine yes/no?

From the 24 March 2015 EurkAlert!

The authors discuss how the use of quarantine can unintentionally introduce secondary and tertiary effects. If individuals show symptoms but are not isolated immediately, they will contaminate the quarantine group, and if individuals without symptoms are cohorted with a group already symptomatic, the risk of transmission will increase. The other unintended consequence is to patients admitted to hospitals for other medical reasons, e.g., heart attacks, strokes, trauma, and cancer.

The issue of psychological stress during quarantine is also addressed. These include fear of the disease and possible confinement, and the effects on family, friends and colleagues.

Before civil liberties are suspended, decision-makers must use evidence-based data to support their decisions. Public health officials and political figures should avoid taking unnecessary harsh precautions in their effort to appear on top of the situation. Per Dr. Barbisch, Major General, US Army (ret): “Quarantine should only be used if the inherent restrictions will effectively reduce the spread of the disease.”

March 27, 2015 Posted by | Public Health | | Leave a comment

[News release] George Washington University to hold national conference on integrating health and legal care

From the 25 March 2015 EurkAlert!

he National Center for Medical-Legal Partnership, part of Milken Institute School of Public Health at the George Washington University, will host its tenth annual conference on April 9-10, 2015, in McLean, Virginia to discuss how to better address the social and legal problems negatively impacting the health of 50 million low-income Americans. Leaders from law, health care, public health and government in 38 states will present research and strategies aimed at effectively integrating health and legal care.

With featured remarks from Lauren Taylor, co-author of The American Health Care Paradox, Jeffrey Levi, executive director of Trust for America’s Health, and Phillip Alberti, senior director for health equity research & policy at the Association of American Medical Colleges, participants will explore topics including:

  • The intersection of health and legal problems for veterans, children and chronically ill individuals;
  • The ways that providing integrated legal care for patients can help meet community benefit requirements for public hospitals; and
  • The ability of legal care to strengthen population health interventions.

A full agenda is available at: http://www.medical-legalpartnership.org/join-movement/summit/

March 27, 2015 Posted by | Public Health | , , , , , , , , , , | Leave a comment

[News release] Emergency medicine physicians urge colleagues to help prevent gun violence

From the 25 March 2015 UC Davis news release

In an editorial posted online today in the Annals of Emergency Medicine, two practicing emergency medicine physicians from the University of California, Davis, and Brown University — both thought leaders at the forefront of finding solutions to the public health crisis of gun violence — urge their colleagues to take direct action to protect the health and safety of patients and communities.

Their editorial follows the Feb. 24 call to action by eight health professional organizations, including the American College of Emergency Physicians, and the American Bar Association, to reduce firearm injuries and deaths in the U.S. — unprecedented support that suggests mobilization to prevent firearm violence may be underway.

“Firearm violence causes nearly as many deaths as motor vehicle crashes,” said Garen J. Wintemute, an emergency medicine professor at UC Davis and a national authority on evidence-based strategies to prevent firearm violence. “Firearms are involved in most homicides and suicides, and the number of suicides by firearm is increasing — especially among older white men.

“Emergency medicine physicians have limited opportunities to prevent a death once a shooting has occurred, because most people who die from their wounds do so where they are shot. Gun ownership or having a gun in the household is a well-documented risk factor for a violent death. For that reason, we believe physicians should also work to help prevent shootings,” he said.

The authors describe how America successfully reduced motor-vehicle-related deaths by better vehicle and roadway design and public policies that make driving under the influence a crime. Yet no comparable public-health campaign focused on reducing gun violence has been launched.

The authors particularly emphasize the need for a national policy requiring background checks on all transfers of firearms to help prevent access to firearms by those who are prohibited from having them. They recommend adding two other high-risk groups to the list of individuals who are prohibited from purchasing firearms. These include persons with a history of violent misdemeanor convictions, such as assault and battery and domestic violence, as well as those with a documented history of addiction and alcohol abuse.

“Controlled studies of felons, those who have committed violent misdemeanors and persons prohibited for mental-health reasons have all shown reductions in risk for future violence of 25 percent or more when these individuals are denied firearm purchases,” said Megan Ranney, an emergency medicine physician and director of the Emergency Digital Health Innovation program at Rhode Island Hospital and the Warren Alpert Medical School of Brown University.

The authors also address mental illness and gun violence. While they agree with recommendations that focus on behavior and expanded access to treatment, they emphasize that serious mental illness directly accounts for only 4 percent of interpersonal violence. In contrast, mental illness is associated with between 47 and 74 percent of suicides. The risk of firearm injury increases when mental illness coexists with alcohol abuse, drug abuse and a history of prior violence.

“Physicians need to include questions about firearms when assessing risk of violence in their patients, and need to act on the information, especially when patients are expressing thoughts of dangerousness to themselves or others, are intoxicated or are in the emergency department for a violence-related injury,” Ranney said.

At a time when civilian fatalities from gunshot wounds for 2004 to 2013 have outnumbered combat fatalities from World War II, the authors welcome the unprecedented support from leading organizations of health and legal professionals for policy recommendations to reduce gun violence.

“Physicians can take direct action to protect the health and safety of patients and communities,” Wintemute said. “While we may not all agree on all the specifics, enough of us will agree on enough of them to make a difference for the better.”

The Violence Prevention Research Program is an organized research program of the University of California, Davis, that conducts leading-edge research to further America’s efforts to understand and prevent violence. Since its founding over 30 years ago, the program has produced a uniquely rich and informative body of research on the causes, nature and prevention of violence, especially firearm violence. Current areas of emphasis include the prediction of criminal behavior, the effectiveness of waiting period and background-check programs for prospective purchasers of firearms, and the determinants of firearm violence. For more information, visit www.ucdmc.ucdavis.edu/vprp

Founded in 1863, Rhode Island Hospital in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Last year, Rhode Island Hospital received more than $55 million in external research funding. It is also home to Hasbro Children’s Hospital, the state’s only facility dedicated to pediatric care. For more information on Rhode Island Hospital, visitwww.rhodeislandhospital.org, follow us on Twitter @RIHospital or like us on Facebook http://www.facebook.com/rhodeislandhospitalpage.

 

Related article

Texas bill would prohibit doctors from asking about guns

While legislation expanding how and where Texans can carry weapons is dominating the Legislature this week, one state lawmaker is targeting the doctor’s office as a place to keep the federal government from learning who owns guns.

Over the objections of the medical community, state Rep. Stuart Spitzer, R-Kaufman, has filed a bill that would prohibit doctors from asking patients whether they own a firearm and makes the Texas Medical Board, which licenses physicians, responsible for doling out punishment.

 

March 27, 2015 Posted by | Public Health | , , , | Leave a comment

[News release] Air pollution linked to increased risk of anxiety and stroke

Remember, correlation does not mean cause! See also the rebuttal below

From the 24 March 2015 MedicalExpress item

Air pollution is linked to a higher risk of stroke, particularly in developing countries, finds a study published in The BMJ today. In a second article, new research also shows that air pollution is associated with anxiety.

Stroke is a leading cause of death and kills around 5 million people each year worldwide. Common risk factors include obesity, smoking and . But the effect of the environment, such as, air pollution is uncertain because evidence is lacking.

In a  and meta analysis, a team of researchers from Edinburgh University looked at the association between short term air pollution exposure and stroke related hospital admissions and deaths. In total, they analysed 103  that covered 28 countries across the world.

Gaseous pollutants included in the analysis were , nitrogen dioxide and ozone. In addition, particulate matter was included: PM 2.5 ( less than 2.5 µm in size) and PM 10 (coarse particles less than 10 µm in size).

Results showed an association between carbon monoxide (1.5% increased risk per 1 ppm), sulphur dioxide (1.9% per 10 ppb) and  (1.4% per 10 ppb) and stroke related hospital admissions or death. The weakest association was found for ozone.

Both PM 2.5 and PM 10 were associated with hospital admissions or deaths due to stroke, by 1.1% and 0.3% per 10 µg/m3 increment respectively. The first day of air pollution exposure was found to have the strongest association.

Low- to middle-income countries experienced the strongest associations compared to high-income countries. Only 20% of analysed studies were from low- to middle-income countries – mostly mainland China – despite these countries having the highest burden of stroke.

Both studies were observational and no definitive conclusions can be drawn about cause and effect, and the teams of researchers call for more research.

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March 26, 2015 Posted by | Public Health | , , , , | Leave a comment

[News release] Common bacteria on verge of becoming antibiotic-resistant superbugs

From the 25 March 2015 MedicalExpress item

Common bacteria on verge of becoming antibiotic-resistant superbugs

Bacteria that cause many hospital-associated infections are ready to quickly share genes that allow them to resist powerful antibiotics. The illustration, based on electron micrographs and created by the Centers for Disease Control and Prevention, shows one of these antibiotic-resistant bacteria. Credit: CDC/James Archer

 

Antibiotic resistance is poised to spread globally among bacteria frequently implicated in respiratory and urinary infections in hospital settings, according to new research at Washington University School of Medicine in St. Louis.

The study shows that two genes that confer resistance against a particularly strong class of antibiotics can be shared easily among a family of  responsible for a significant portion of hospital-associated infections.

Drug-resistant germs in the same family of bacteria recently infected several patients at two Los Angeles hospitals. The infections have been linked to medical scopes believed to have been contaminated with bacteria that can resist carbapenems, potent antibiotics that are supposed to be used only in gravely ill patients or those infected by .

“Carbapenems are one of our last resorts for treating bacterial infections, what we use when nothing else works,” said senior author Gautam Dantas, PhD, associate professor of pathology and immunology. “Given what we know now, I don’t think it’s overstating the case to say that for certain types of infections, we may be looking at the start of the post-antibiotic era, a time when most of the antibiotics we rely on to treat bacterial infections are no longer effective.”

March 26, 2015 Posted by | health care, Public Health | , , , , | Leave a comment

[News release] Are our schools damaging children’s eyes?

From the 24 March 2015 EurkAlert!

Over the last 30 years, short sight, or myopia, has become a global health problem. The most dramatic rise has been in Singapore, Taiwan, China’s cities and elsewhere in East Asia. Rates can be as high as 80-90 per cent among children leaving secondary schools in the region. As many as a fifth of them have severe myopia and so are at high risk of eye problems in later life. In Western countries rates are increasing; although not as rapidly as in East Asia.

The Myopia Mystery

Compensating for myopia using a corrective lens.

Compensating for myopia using a corrective lens. (Photo credit: Wikipedia)

The cause of myopia, and the means to prevent it, are unclear despite more than 150 years of scientific research. Many theories have been put forward to explain why children’s eyesight gets worse as they go through school. Too much close work is one of the more popular ones, while heredity is another. Both have been hotly debated down the years.

Is Myopia Like Rickets?

The new study compares the history of school myopia with the bone disease rickets. During the 17th century, rickets was common among children in England and then reached epidemic levels through northern Europe and North America. In some cities, 80 per cent of children were affected. The remedy proved elusive until the 1920s, when scientists found that a lack of sunlight, resulting in vitamin D deficiency, was the cause of rickets. Myopia, like rickets, is a seasonal condition which seems to get worse in the winter. Recent research on myopia has revived an old theory from the 1890s, that school children who spend more time outdoors have lower levels of myopia. However, unlike rickets, low ambient light levels rather than low vitamin D levels seem to be the deciding factor in myopia.

March 25, 2015 Posted by | Public Health | , , | Leave a comment

[News release] Population Could Outpace Water by Mid-Century

From the 23 March 2015 Duke University news release

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Population growth could cause global demand for water to outpace supply by mid-century if current levels of consumption continue. But it wouldn’t be the first time this has happened, a Duke University study finds.

Using a delayed-feedback mathematical model that analyzes historic data to help project future trends, the researchers identified a regularly recurring pattern of global water use in recent centuries. Periods of increased demand for water — often coinciding with population growth or other major demographic and social changes — were followed by periods of rapid innovation of new water technologies that helped end or ease any shortages.

Based on this recurring pattern, the model predicts a similar period of innovation could occur in coming decades.

“Researchers in other fields have previously used this model to predict earthquakes and other complex processes, including events like the boom and bust of the stock market during financial crises, but this is the first time it’s been applied to water use,” said Anthony Parolari, postdoctoral research associate in civil and environmental engineering at Duke, who led the new study.

“What the model shows us is that there will likely be a new phase of change in the global water supply system by the mid-21st century,” Parolari said.

“This could take the form of a gradual move toward new policies that encourage a sustainable rate of water use, or it could be a technological advancement that provides a new source of water for us to tap into. There’s a range of possibilities,” he said.

Data on global water use shows we are currently in a period of relatively stagnant growth, he said. Per-capita water use has been declining since 1980, largely due to improved efficiency measures and heightened public awareness of the importance of conserving Earth’s limited supply of freshwater. This has helped offset the impacts of recent population growth.

“But if population growth trends continue, per-capita water use will have to decline even more sharply for there to be enough water to meet demand,” he said. The world’s population is projected to surge to 9.6 billion by 2050, up from an estimated 7 billion today.

“For every new person who is born, how much more water can we supply? The model suggests we may reach a tipping point where efficiency measures are no longer sufficient and water scarcity either impacts population growth or pushes us to find new water supplies,” Parolari said.

Water recycling, and finding new and better ways to remove salt from seawater, are among the more likely technological advances that could help alleviate or avoid future water shortages, he said.

March 25, 2015 Posted by | Public Health | , , , , , , , , | Leave a comment

[Scientific article] The dissemination of staph infections in hospitals

From the ScienceDaily summary

Date:March 19, 2015
Source:PLOS
Summary:Wireless sensors recording human interactions explain the transmission of germs, such as MRSA, in hospitals, according to new research.

The results indicate that the study of individuals contact may help identify increased risk of transmission situations and ultimately reduce the burden of nosocomial S. aureus transmission.

The researchers say: “Contact networks have been increasingly used in modeling the spread of infectious diseases. Yet, the contacts collected were often incomplete or used proxies that were thought to capture situation at risk. In this unique experiment, the joint analysis of contact and carriage validates the use of close-proximity interactions recorded by electronic devices, and opens a new field for prevention measures in hospitals.”

March 24, 2015 Posted by | Public Health | , , , , , | Leave a comment

From the 2 March 2015 Guttmacher Institute press release

Increasing Publicly Funded Family Planning Services Could Substantially Reduce These Costs

U.S. government expenditures on births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21 billion in 2010, according to “Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010,” by Adam Sonfield and Kathryn Kost. In 19 states, public expenditures related to unintended pregnancies exceeded $400 million in 2010. Texas spent the most ($2.9 billion), followed by California ($1.8 billion), New York ($1.5 billion) and Florida ($1.3 billion); those four states are also the nation’s most populous.

Unintended pregnancies U.S. map of public costs

Previous research has demonstrated that investing in publicly funded family planning services enables women to avoid unwanted pregnancies and space wanted ones, which is good not only for women and families, but also for society as a whole. In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 would have been 75% higher.

Sonfield and Kost report that the total gross savings from averting all unintended pregnancies in 2010 would have been $15.5 billion. This is less than the total public cost of all unintended pregnancies, because even if all women had been able to time their pregnancies as they wanted, some still would have had planned births that were publicly funded. These potential savings do not account for the cost of providing family planning services and other interventions that might be required to prevent the unintended pregnancies.

“Reducing public expenditures related to unintended pregnancies requires substantial new public investments in family planning services,” says Sonfield. “That would mean strengthening existing programs, such as the Title X family planning program, as well as working to ensure that the Affordable Care Act achieves its full potential to bolster Medicaid and other safety-net programs. We know we can prevent unintended pregnancies and the related costs. There are public programs in place that do it already, but as these data show, there is significantly more progress to be made.”

The new research also highlights the central role played by Medicaid and other public insurance programs in providing critical pregnancy-related care—including prenatal care, labor and delivery, postpartum care and infant care—that help keep women and babies healthy. Fifty-one percent of the four million births in the United States in 2010 were publicly funded, including 68% of unplanned births and 38% of planned births.

“These findings demonstrate the continuing importance of Medicaid and other public health insurance programs in preserving maternal and child health, and in supporting pregnancy-related care,” says Adam Sonfield, coauthor of the new report.

For more information:

Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since 2002

Fact Sheet: Unintended Pregnancy in the United States (national)

State Facts on Unintended Pregnancy

Fact Sheet: Publicly Funded Family Planning Services in the United States (national)

State Facts on Publicly Funded Family Planning Services

State Data Center

March 21, 2015 Posted by | Public Health | , , , , , | Leave a comment

[News release] New knowledge strengthens risk assessment of chemical cocktails in food

From the THURSDAY 19 MAR 15 Technical University news release By Miriam Meister 

Cocktaileffekt

Denmark’s largest research project on chemical cocktail effects infood, spearheaded by the National Food Institute, Technical University of Denmark, has just been completed. It has established that even small doses of chemicals can have significant negative effects if they are present together. A reliable method for calculating the effects of chemical cocktails has been developed in the project. The project has also shown a need for limiting the Danish population’s exposure to certain substances.

The fact that the traditional way of assessing potential harmful effects of chemicals only takes the individual chemicals into account has long been of concern. Especially since this approach does not take into account the effects that can occur in humans when the chemicals are present at the same time in a cocktail. A serious concern is that substances can amplify each other’s effects, so that their combined effect becomes greater than what can be predicted by looking at the individual chemicals.

“Our research shows that indeed, little strokes fell great oaks also when it comes to chemical exposure. Going forward this insight has a profound impact on the way we should assess the risk posed by chemicals weare exposed to through the foods we eat.”

A recently completed, four-year research project on cocktail effects in foods, led by the National Food Institute, has established that when two or more chemicals appear together, they often have an additive effect. This means that cocktail effects can be predicted based on information from single chemicals, but also that small amounts of chemicals when present together can have significant negative effects.

”Our research shows that indeed, little strokes fell great oaks also when it comes to chemical exposure. Going forward this insight has a profound impact on the way we should assess the risk posed by chemicals we are exposed to through the foods we eat,” Professor Anne Marie Vinggaard from the National Food Institute says.

Danes’ exposure to chemicals via foods

In order to assess the risk posed by various chemicals, it is essential to know what the typical human exposure to a particular chemical is. The cocktail project has created an overview of the amount of pesticides and other contaminants that humans are exposed to via foods.

This work has shown that Danes’ intake of pesticides through foods is relatively limited. However, there is a need for reducing exposure to substances such as lead, cadmium, PCBs and dioxins.

The endocrine disrupting effects of chemicals have generally not been adequately studied. However, in cases where knowledge about the effects is available, the results show a need to reduce the intake of endocrine disrupting chemicals from current levels, such as phthalates and fluorinated chemicals.

March 21, 2015 Posted by | Nutrition, Public Health | , , , , , , | Leave a comment

Loneliness and Social Isolation as Risk Factors for Mortality A Meta-Analytic Review

From the article, Perspectives on Psychological Science, March 2015  vol. 10 no. 2 227-237

Several lifestyle and environmental factors are risk factors for early mortality, including smoking, sedentary lifestyle, and air pollution. However, in the scientific literature, much less attention has been given to social factors demonstrated to have equivalent or greater influence on mortality risk (Holt-Lunstad, Smith, & Layton, 2010). Being socially connected is not only influential for psychological and emotional well-being but it also has a significant and positive influence on physical well-being (Uchino, 2006) and overall longevity (Holt-Lunstad et al., 2010House, Landis, & Umberson, 1988Shor, Roelfs, & Yogev, 2013). A lack of social connections has also been linked to detrimental health outcomes in previous research. Although the broader protective effect of social relationships is known, in this meta-analytic review, we aim to narrow researchers’ understanding of the evidence in support of increased risk associated with social deficits. Specifically, researchers have assumed that the overall effect of social connections reported previously inversely equates with risk associated with social deficits, but it is presently unclear whether the deleterious effects of social deficits outweigh the salubrious effects of social connections. Currently, no meta-analyses focused on social isolation and loneliness exist in which mortality is the outcome. With efforts underway to identify groups at risk and to intervene to reduce that risk, it is important to understand the relative influence of social isolation and loneliness.

Living alone, having few social network ties, and having infrequent social contact are all markers of social isolation. The common thread across these is an objective quantitative approach to establish a dearth of social contact and network size. Whereas social isolation can be an objectively quantifiable variable, loneliness is a subjective emotional state. Loneliness is the perception of social isolation, or the subjective experience of being lonely, and thus involves necessarily subjective measurement. Loneliness has also been described as the dissatisfaction with the discrepancy between desired and actual social relationships (Peplau & Perlman, 1982).

March 21, 2015 Posted by | Consumer Health, Public Health | , , , , , , , , | Leave a comment

[Report] Raising Minimum Wage Good for Public Health, Not Just Wallets: Advocates Call for Federal Increas

Raising Minimum Wage Good for Public Health, Not Just Wallets: Advocates Call for Federal Increase
http://thenationshealth.aphapublications.org/content/45/2/1.1.full
For a growing chorus of public health practitioners, raising the minimum wage is a fundamental step in addressing two key determinants of health: income and poverty.

March 16, 2015 Posted by | Public Health | , , , , | Leave a comment

[Online tool] Community Health Status Indicators (CHSI) Website Launch

 

Screen Shot 2015-03-16 at 5.17.22 AM

 

 

 

 

From the  12 March 2015 press release 

CDC has released the updated Community Health Status Indicators (CHSI) online tool that produces public health profiles for all 3,143 counties in the United States. Each profile includes key indicators of health outcomes, which describes the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors, and the physical environment.

Each profile includes key indicators of health outcomes, which describes the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors, and the physical environment.

The re-designed online application includes updated peer county groups, health status indicators, a summary comparison page, and U.S. Census tract data and indicators for sub-populations (age groups, sex, and race/ethnicity) to identify potential health disparities.  In this new version of CHSI, all indicators are benchmarked against those of peer counties, the median of all U.S. counties, and Healthy People 2020 targets.  Organizations conducting community health assessments can use CHSI data to:

  • Assess community health status and identify disparities;
  • Promote a shared understanding of the wide range of factors that can influence health; and
  • Mobilize multi-sector partnerships to work together to improve population health.

March 16, 2015 Posted by | Health Statistics, Public Health | , , , , | Leave a comment

[News release] Millions of women and children get improved health services

From the 10 March 2015 EurekAlert!

Massive health program: $34 billion spent on women and children since 2010; New goal: End preventable deaths of women and young children

An ambitious 2010 initiative to improve the health of women and children around the world has turned into the fastest growing global public health partnership in history, attracting $60 billion in resources. Some $34 billion, nearly 60 percent of the total, has already been disbursed.

The Every Woman Every Child movement has now gathered more than 400 commitments by more than 300 partners around the world, ranging from governments and foundations to business, civil society and low-income countries themselves.

The movement stems from the Global Strategy for Women’s and Children’s Health, launched by United Nations Secretary-General Ban Ki-moon in 2010 to accelerate progress towards the Millennium Development Goals (MDGs) for health.

Every Woman Every Child has set off a major wave in attention to improving essential health care for millions of poor women and children. Major gains in the past five years include greater professional maternity care, family planning, prenatal and postnatal care, childhood vaccinations, oral rehydration therapy and improving access to drugs to prevent mother-to-child transmission of HIV.

The result of such increased care is that maternal and child death rates have fallen in every one of the Global Strategy’s 49-targeted countries in the latest four years.

“The synergy between education and health is evident. Education and health are, quite simply, the drivers of change and development. Education empowers women and girls to live healthier lives and as a result, fewer children are dying. The evidence is clear, better education leads to better health outcomes.

“One of the most important lessons we have learned through the Millennium Development Goals is that to make progress we need an integrated and multifaceted approach,” says Kathy Calvin, president of the UN Foundation. “Effective partnerships are not just about financing; they also tap into partner expertise, innovation, and resources to deliver results. Every Woman Every Child has shown that when each sector contributes its unique strengths and capacities, we can save lives.”

Keys to progress

Significant improvements in key health indicators mainly in 49-targeted countries during its five-year history of Every Women Every Child include:

  • 870,000 new health care workers.
  • 193 percent increase in prevention of mother-to-child HIV treatment.
  • 49 percent increase in oral rehydration therapy for treating infant diarrhea.
  • 44 percent increase in exclusive breastfeeding.
  • 25 percent rise in post-natal care for women.
  • 25 percent rise in skilled birth attendance.

March 15, 2015 Posted by | Educational Resources (High School/Early College(, health care, Health News Items, Public Health | , , , , , | Leave a comment

Re-engaging Elaine Scarry’s The Body in Pain A Thirtieth Anniversary Retrospective, 10th-11th Dec 2015, University of Brighton

Originally posted on Progressive Geographies:

9352807Re-engaging Elaine Scarry’s The Body in Pain A Thirtieth Anniversary Retrospective 10th-11th December 2015 Grand Parade University of Brighton, UK

Understanding Conflict Research Cluster Critical Studies Research Group

Keynotes: Prof Elaine Scarry and Prof Joanna Bourke

The year 2015 marks the thirtieth anniversary of Elaine Scarry’s The Body in Pain. In this seminal text, Scarry offers a radical and original thesis on the relationship between embodiment, pain, wounding and imagining, arguing that pain is central to “the making and unmaking of the world”. Widely regarded as a classic, the text has influenced work on notions of the body, war, torture and pain in a variety of academic disciplines – from philosophy, to anthropology, to cultural geography, to political theory, to many others – as well as informing debates and discussions in medical science, NGOs, charities and other parts of society. In the years since its publication the text has only become…

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March 15, 2015 Posted by | Public Health | , , , , | Leave a comment

Poll finds US public sees ill health as resulting from a broad range of causes

Good study. However I would like to see how this compares with what researchers believe are causes/correlations of ill health and how best to address the causes/correlations.

From the 2 March 2015 Harvard School of Public Health press release

Many believe their health has been impacted by negative childhood experiences

A new NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll finds that more than six in ten people living in the U.S. (62%) are concerned about their future health. Nearly four in ten (39%) said that they had one or more negative childhood experiences that they believe had a harmful impact on their adult health.

Causes of ill health

“When the public thinks about the causes of ill health, it’s not just about germs. They also see access to medical care, personal behavior, stress, andpollution as affecting health,” said Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.

When given a list of 14 factors that might cause ill health, the top five causes cited by the public as extremely important are lack of access to high-quality medical care (42%), personal behavior (40%), viruses or bacteria (40%), high stress (37%), and exposure to air, water, or chemical pollution (35%).

Those rankings diverge, however, among ethnic groups.

Actions to improve health

Given the wide range of reasons given for why ill health occurs, it is not surprising that people in the U.S. have a very broad view of the actions that could be taken to improve people’s health. The top five things (from a list of 16) that the public believes would improve people’s health a great deal are: improving access to affordable healthy food (57%), reducing illegal drug use (54%), reducing air, water, or chemical pollution (52%), increasing access to high-quality health care (52%), and improving the economy and the availability of jobs (49%).

 

 

March 7, 2015 Posted by | Public Health | , , , , , , , | Leave a comment

[Press release]Zombie outbreak? Statistical mechanics reveal the ideal hideout | EurekAlert! Science News

Zombie outbreak? Statistical mechanics reveal the ideal hideout | EurekAlert! Science News.

To be presented at the 2015 APS March Meeting in San Antonio, Texas, March 5

From the press release

A team of Cornell University researchers focusing on a fictional zombie outbreak as an approach to disease modeling suggests heading for the hills, in the Rockies, to save your brains from the undead.

Reading World War Z, an oral history of the first zombie war, and a graduate statistical mechanics class inspired a group of Cornell University researchers to explore how an “actual” zombie outbreak might play out in the U.S.

During the 2015 American Physical Society March Meeting, on Thursday, March 5 in San Antonio, Texas, the group will describe their work modeling the statistical mechanics of zombies–those thankfully fictional “undead” creatures with an appetite for human flesh. (See the abstract: http://meeting.aps.org/Meeting/MAR15/Session/S48.8)

Why model the mechanics of zombies? “Modeling zombies takes you through a lot of the techniques used to model real diseases, albeit in a fun context,” says Alex Alemi, a graduate student at Cornell University.

March 7, 2015 Posted by | Public Health, Uncategorized | , , , , , | Leave a comment

[Report] Sex, contraception, or abortion? Class gaps in unintended childbearing | Brookings Institution

Sex, contraception, or abortion? Class gaps in unintended childbearing | Brookings Institution.

Screen Shot 2015-03-07 at 5.32.41 AM

From the report

A poor woman is about five times as likely as an affluent woman to have an unintended birth, which further deepens the divides in income, family stability, and child outcomes. But what is behind the gap? That is the question we address in our new paper, Sex, Contraception, or Abortion? Explaining Class Gaps in Unintended Childbearing, and in this data interactive.”

March 7, 2015 Posted by | Public Health | , , , , , , | Leave a comment

United Nations News Centre – Over 5 billion people worldwide lacking access to essential medicines, says UN report

United Nations News Centre – Over 5 billion people worldwide lacking access to essential medicines, says UN report.

From the 3 March 2015 report

A patient in a hospital in Cambodia is given some pain killers. Photo: World Bank/Masaru Goto

3 March 2015 – Three quarters of the world population has no access to proper pain relief treatment, according to a report by the United Nations body charged with overseeing Governments’ compliance with international drug control treaties, which was released in London today.

Around 5.5 billion people still have limited or no access to medicines containing narcotic drugs such as codeine or morphine the Vienna-based International Narcotics Control Board (INCB) says in its Annual Report for 2014, which went on to point out that around 92 per cent of all morphine used worldwide is consumed by only 17 per cent of the world population, primarily living in the United States, Canada, Western Europe, Australia and New Zealand.

The report, which calls on Governments to address the discrepancy in order to comply with International Drug Control Conventions, notes that natural disasters and armed conflicts around the world can further limit access to essential medicines and the Board stressed that in cases of emergency medical care, simplified control measures can be applied.

For example in the Philippines following the destruction by Typhoon Haiyan in 2013, the Board pointed out to all countries as well as to providers of humanitarian assistance the simplified procedures for the export, transportation and delivery of medicines containing substances under international control.

In its Report, the INCB notes that drug control measures do not exist in a vacuum and that, in their implementation of the drug control conventions, States must also comply with obligations under other treaties, including international humanitarian law and their international human rights obligations, such as allowing civilians to have access to medical care and essential medicines during armed conflicts.

Additionally, the INCB noted that States were charged with deciding specific sanctions for drug-related offences, but should avoid application of the death penalty for such cases.

To achieve a balanced and integrated approach to the drug problem, Governments also should ensure that demand reduction is one of the first priorities of their drug control policies, while they should put greater emphasis on and provide support and appropriate resources to prevention, treatment and rehabilitation, the Report says.

Among the rest of the Report’s findings were an increase in the number of new psychoactive substances (NPS) by 11 per cent and a 66 per cent increase in global consumption of methylphenidate, a stimulant primarily used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD).

The Report also pointed out that the legalization of production, distribution, sale and consumption of cannabis and its derivatives for recreational purposes in Uruguay, together with the moves by States in the United States to legalise sale and distribution of cannabis for non-medical purposes, ran counter to article 4 of the 1961 Single Convention on narcotic drugs, which requires States to limit the use of narcotic drugs to medical and scientific purposes.

March 7, 2015 Posted by | health care, Public Health | , , , , | Leave a comment

[Website] Social Impact Calculator

The Social Impact Calculator is “a new tool that allows you to put a dollar value on the benefits of things like an affordable home, a great school or access to transit.”

Screen Shot 2015-03-03 at 5.11.21 AM

From the 13 January 2015 blog post at Investing in Community Change

The Low Income Investment Fund (LIIF) has created the Social Impact Calculator – a tool that allows you to put a dollar value to the impact of capital investments.

LIIF is a community development financial institution (CDFI) that invests in capital projects in low income communities in an effort to provide families with access to healthy, green and economically strong places to live. Using the Social Impact Calculator, LIIF is able to monetize the impact of capital investments in communities — such as funding for housing, child care centers and charter schools — and assess how well its investments are creating opportunities and reducing inequities in communities.

How does it work? The Social Impact Calculator estimates social returns using research and translating data into monetary values. For example, investments in affordable housing can create discretionary income for families by reducing the burden of housing costs. Those savings can be used by families to cover additional needs, such as food and healthcare. Similarly, as suggested by research, investing in high-performing schools can increase a child’s lifetime earnings while also reducing costs associated with incarceration.

LIIF has made the Social Impact Calculator available to the public and invites communities to explore how they might use the calculator to assess their own efforts. In addition, LIIF invites you to provide feedback about the Social Impact Calculator.

 

 

March 3, 2015 Posted by | Public Health | , , , , | Leave a comment

[Repost] Investigating the health impacts of fracking

For anyone looking for in depth vetted resources.
From the 23 February 2015 post at Covering Health (Association of Health Care Journalists)

he fracking controversy has been high profile in recent years, and tempers are short on all sides of the subject. Some groups see natural gas and the process used to extract it – hydraulic fracturing, or “fracking” – as a boon to energy production in the U.S., while others see it as a pernicious threat to people and the environment.

As shown in this New York Times interactive infographic, fracking (sometimes called “unconventional gas drilling”) is a complicated process. It involves high-pressure injection of fluids into natural gas reserves that lie thousands of feet underground, trapped in layers of shale. In addition, there’s a landslide of conflicting information and anecdotal evidence.

So, as a reporter, how do you sift through the various interests and pull out a story that is relevant to your community?

…..

February 25, 2015 Posted by | Public Health | , , , | Leave a comment

[News article] Middle East Mystery Disease Triggers Early Resurgence

From the 20 February 2015 Scientific American article

English: Saudi Arabia

English: Saudi Arabia (Photo credit: Wikipedia)

International health experts head to Saudi Arabia to help determine why MERS cases are soaring again

Infectious disease watchers are again wondering what is going on in Saudi Arabia. Since the beginning of February the Saudis have reported 52 cases of Middle East respiratory syndrome—better known as MERS; 40 have come to light in the past week or so alone. Since the disease first hit the world’s radar in September 2012 only two months have racked up more cases than this one has. They were April and May 2014, when Saudi Arabia had rampantMERS outbreaks in several hospitals.*

An expert delegation from the United Nation’s human and animal health agencies began a three-day mission to the Arabian Peninsula’s geographically largest country Wednesday, trying to get to the bottom of why MERS cases are soaring.

This is the time of year in which the number of MERS cases has climbed in the past, although not enough time has elapsed to make clear whether that pattern will continue. In the past two springs large hospital outbreaks in Saudi Arabia have certainly created the appearance of a high season for MERS transmission, which some scientists believe exists and is linked to the birth and weaning of young camels. The animals are known to be susceptible to the virus and can transmit it to people.


According to the daily updates posted online by the Saudi health ministry, most of the recent cases—unlike during past surges—did not report contact with camels or with other people infected with MERS—either in the community or in a hospital setting. “It seems quite a few are not health care associated,” says Koopmans…

 

February 22, 2015 Posted by | Public Health | , | Leave a comment

[Reblog] Going Viral: The Re-Emergence of Preventable Diseases

From the 19 February 2015 post at Policy Interns

From an aging population to the growing threat of pandemic influenza and other emerging infectious diseases as well as the rapid growth of obesity and other chronic illnesses, the most persistent and costly challenges to American health and well-being fall increasingly on the public health system and on public health professionals at all levels. Unlike health care, which often intervenes when an individual is already sick with a costly disease, the focus of public health is prevention rather than treatment of diseases. Public health professionals, working with state and local health departments, laboratories, and other public health organizations, play a vital and increasingly central role in protecting a population’s health. Yet the Center for Disease Control (CDC) and other public health observers have repeatedly identified deficiencies in public health infrastructure and workforce.

Regional interstate planning, preparing for mass vaccination and the distribution of medical supplies, and development of adequate surge capacity are incomplete or insufficient. The Government Accountability Office concluded in 2004 that “no State is fully prepared to respond to a major public health threat,” an assessment that the CDC reiterated in 2008.

PH expenditures

One might look at Figure 1 and think, where are the lines for public health expenditures on federal, state, and local levels? They’re there, almost completely parallel to the x-axis. Federal public health spending underperformed a number of other U.S. health sector expenditure categories overall. As a percentage of all U.S. health expenditures, federal public health spending was lower in 2008 than it was in 1966. To make matters worse, the Fiscal Year 2015 request proposes a $51 million decrease for the immunization program due to an expectation of increased insurance coverage for immunization services in 2015. This is yet another cut to public health spending that will undoubtedly affect population health.

Program operations, which contribute to disease surveillance, public awareness and provider education, took a $14 million cut.

While proponents of the ACA said the majority of the proposed fiscal 2016 cuts again will go toward vaccine purchasing and won’t affect immunization infrastructure funds, this cannot be the whole picture. The families and children currently using these programs will be in jeopardy because insurance coverage alone is not enough to ensure high vaccination rates.

February 22, 2015 Posted by | Public Health | , , , , , | Leave a comment

[Report] Lifetime Job Demands, Work Capacity at Older Ages, and Social Security Benefit Claiming Decisions

From the Center for Retirement Research at Boston College  

We use Health and Retirement Study data linked to the Department of Labor’s O*Net classification system to examine the relationship between lifetime exposure to occupational demands and retirement behavior. We consistently found that both non-routine cognitive analytic and non-routine physical demands were associated with worse health, earlier labor force exit, and increased use of Social Security Disability Insurance. The growing share of workers in jobs with high levels of cognitive demand may contribute to growth in DI use.

February 19, 2015 Posted by | Public Health | , , , , , , , , , | Leave a comment

[Press release] Large numbers of teenage girls experience sexual coercion in relationships | EurekAlert! Science News

Large numbers of teenage girls experience sexual coercion in relationships 

Generic image of a teenage girl

From the 11 February 2015 from Bristol University

More than four in ten teenage schoolgirls in England* have experienced sexual coercion, new research by University of Bristol academics launched today [11 February] reveals. Most were pressured to have sex or other sexual activity, and in some cases, this included rape. And many of the 13-17-year-olds had also suffered physical attacks, intimidation or emotional abuse from their boyfriends.

The study also found that a high proportion of teenage boys regularly viewed pornography and one in five harboured extremely negative attitudes towards women.

The research in England was undertaken between 2013-2015 by a team of researchers from the Universities of Bristol and Central Lancashire. The study, was also carried out in Norway, Italy, Bulgaria and Cyprus as well as England.  It is one of the biggest of its kind ever undertaken in Europe, involving a school-based survey of 4,500 children and 100 interviews with young people

 

February 15, 2015 Posted by | Public Health | , , , , , | Leave a comment

[Report] Women and Girls at Risk of Female Genital Mutilation/Cutting in the United States

English: updated prevalence of FGM in Africa

English: updated prevalence of FGM in Africa (Photo credit: Wikipedia)

From the February 2015 Population Reference Bureau report

The Population Reference Bureau (PRB) data included in this data brief are preliminary. A new Centers for Disease Control and Prevention (CDC) report on female genital mutilation/cutting in the United States also will be released soon, providing additional information on women and girls at risk.

(February 2015) Female genital mutilation/cutting (FGM/C), involving partial or total removal of the external genitals of girls and women for religious, cultural, or other nonmedical reasons, has devastating immediate and long-term health and social effects, especially related to childbirth. This type of violence against women violates women’s human rights. There are more than 3 million girls, the majority in sub-Saharan Africa, who are at risk of cutting/mutilation each year. In Djibouti, Guinea, and Somalia, nine in 10 girls ages 15 to 19 have been subjected to FGM/C. Some countries in Africa have recently outlawed the practice, including Guinea-Bissau, but progress in eliminating the harmful traditional practice has been slow.1 Although FGM/C is most prevalent in sub-Saharan Africa, global migration patterns have increased the risk of FGM/C among women and girls living in developed countries, including the United States.

Increasingly, policymakers, NGOs, and community leaders are speaking out against this harmful traditional practice. As more information becomes available about the practice, it is clear that FGM/C needs to be unmasked and challenged around the world.

The U.S. Congress passed a law in 1996 making it illegal to perform FGM/C and 23 states have laws against the practice.2 Despite decades of work in the United States and globally to prevent FGM/C, it remains a significant harmful tradition for millions of girls and women. In the last few years, renewed efforts to protect girls from undergoing this procedure globally and in immigrant populations have resulted in policy successes. In Great Britain and in other European countries, a groundswell of attention has focused on eradicating the practice among the large immigrant populations of girls and women who have been cut or are at risk of being cut. Moreover, in 2012 the 67th session of the UN General Assembly passed a resolution urging states to condemn all harmful practices that affect women and girls, especially FGM/C. The UN resolution was a significant step toward ending the practice around the world.

In the United States, efforts to stop families from sending their daughters to their home countries to be cut led to a 2013 law making it illegal to knowingly transport a girl out of the United States for the purpose of cutting. FGM/C has gained attention in the United States in part because of the rising number of immigrants from countries where FGM/C is prevalent, especially sub-Saharan Africa. Between 2000 and 2013, the foreign-born population from Africa more than doubled, from 881,000 to 1.8 million.3

The Risk of FGM/C in the United States

In 2013, there were up to 507,000 U.S. women and girls who had undergone FGM/C or were at risk of the procedure, according to PRB’s preliminary data analysis. This figure is more than twice the number of women and girls estimated to be at risk in 2000 (228,000).4 The rapid increase in women and girls at risk reflects an increase in immigration to the United States, rather than an increase in the share of women and girls at risk of being cut. The estimated U.S. population at risk of FGM/C is calculated by applying country- and age-specific FGM/C prevalence rates to the number of U.S. women and girls with ties to those countries. A detailed description of PRB’s methods to estimate women and girls at risk of FGM/C is available.

February 10, 2015 Posted by | Consumer Health, Public Health | , , , , , | Leave a comment

[Report] Mortality Among Blacks or African Americans with HIV Infection (is declining) — United States, 2008–2012

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L0052223 A circle incorporating the words \’African American againstCredit: Wellcome Library, London. Wellcome Imagesimages@wellcome.ac.uki mages.wellcome.ac.uk A circle incorporating the words \’African American against AIDS\'; advertisement by the Sacramento County Department of Health and Human Services. Colour lithograph.

 

From the 6 February 2015 MMWR article

…The results of these analyses indicate that black persons living with HIV experienced higher numbers and rates of deaths during 2008–2012 than other races/ethnicities. However, the numbers and rates of death declined consistently during the same period. The death rate per 1,000 persons living with HIV among blacks decreased 28% during 2008–2012, more than the overall decline (22%) seen among all persons living with HIV. Other than among blacks, such a consistent decline was observed only among Hispanics or Latinos…

February 9, 2015 Posted by | Public Health | , , , , | Leave a comment

[Reblog] Climate Change – Public Health’s Next Challenge

 

Projected_impact_of_climate_change_on_agricultural_yields_by_the_2080s,_compared_to_2003_levels_(Cline,_2007)

EEA (14 December 2010): Projected impact of climate change on agricultural yields. European Environment Agency, Copenhagen, Denmark. Last modified September 5, 2011.

 

From the 7 February 2015 post at thefeverblog – what’s hot in public health

….The world is at a dire turning point in the fight against climate change. If the world doesn’t begin taking action to mitigate the impact of climate change the outcomes will be catastrophic (even though some research is saying that’s going to happen, regardless).

A growing discussion in the United States is how we are equipping future citizens, business leaders, health leaders, etc. to be part of the solution to reducing greenhouse gas emissions and mitigating those risks. But according to my preliminary research in climate change science being integrated into science curriculum, we aren’t doing that at all. From personal experience with a Bachelors of Science in Applied Sciences in Public Health, I have never had a professor talk about climate change nor talk about solutions and how we as public health professionals fit into different roles. If young adults and children aren’t aware of climate change, how is it ever going to be brought to the forefront of discussion? How is change going to happen? Sure, federal and state governments can use the power of public policy to control emissions, but what about the solutions to the inevitable problem looming? Solutions such as emergency preparedness planning (since we can safely assume this is going to be a needed expertise), green space, active transportation, infrastructure to prevent rising sea levels from flooding major cities, etc.

As progressive public health departments move towards allocating resources to chronic disease prevention (and obviously, rightfully so), it will be incredibly important to ensure emergency preparedness, epidemiology, and environmental health aren’t lost in the mix. Professionals in health communications and community engagement will be critical pieces, but ultimately don’t have the legal authority of an Environmental Health professional to enforce state and federal mandates, nor have the expertise in emergency preparedness. This is a call for sustained and increased funding for local health departments. The climate change discussion is happening internationally and on a federal level, but those discussions aren’t trickling down to the local level. I would attribute this to climate change being a backburner issue and one that doesn’t have an acute impact (like an Ebola outbreak). The impacts are longitudinal and over long periods of time.

February 9, 2015 Posted by | environmental health, Public Health | , , | Leave a comment

[Magazine article] Reducing Lifestyle Diseases Means Changing Our Environment

 

From the 5 February 2015 Scientific American article

How and why our bodies are poorly suited to modern environments—and the adverse health consequences that result—is a subject of increasing study. A new book The Story of the Human Body by Daniel Lieberman, chair of the Department of Human Evolutionary Biology at Harvard, chronicles major biological and cultural transitions that, over the course of millions of years, transformed apes living and mating in the African forests to modern humans browsing Facebook and eating Big Macs across the planet.

“The end product of all that evolution,” he writes, “is that we are big-brained, moderately fat bipeds who reproduce relatively rapidly but take a long time to mature.”

But over the last several hundred generations, it has been culture—a set of knowledge, values and behaviors—not natural selection, that has been the more powerful force determining how we live, eat and interact. For most of our evolutionary history, we were hunter-gatherers who lived at very low population densities, moved frequently and walked up to 10 miles a day in search of food and water. Our bodies evolved primarily for and in a hunter-gatherer lifestyle.

….

 

Read the entire article here

 

February 7, 2015 Posted by | Consumer Health, Public Health | , , , , | Leave a comment

How mobile is transforming healthcare: Report

Janice Flahiff:

Immediately thought of my Liberian FB friends, a nurse and dean at a community college, a healthcare screener upcountry in a small town (my Peace Corps site back in 1980/81), and a Methodist deacon (one of my former students). All went above and beyond the call of duty during the Ebola crisis.
Back in 2009 I participated in a service project group in Liberia. Was taken aback by noticing that at least half of those over 18 seemed to have cell phones. Believed this was quite good. The roads overall are pretty bad, unpaved, and nearly impassible during the 3 month rainy season. So the cell phones really keep people connected, and relay information well. I get rather irked when I read comments (FB, editorials, etc) that say poor people should not have cell phones. Well, I strongly disagree, overall I believe they save money (think transportation costs for many information needs at the least!). How arrogant for some of “the haves” to believe “the have nots” are not using their scarce resources wisely.
Not sure what I can do to advance mobile health in Liberia, but I will do what I can.
Thanks for posting this, I have forwarded this to my Liberian FB friends. Most likely stuff they already know. The deacon obtained his PhD in theology in DC, the nurse/deacon is very aware of technology, and the healthcare screener is from Nigeria and has a good education and is very much a world citizen.

Originally posted on ScienceRoll:

The Economist came up with a report about How mobile is transforming healthcare including infographics and analyses. You can download the report here.

According to a new survey, mobile technology has the potential to profoundly reshape the healthcare industry, altering how care is delivered and received.

Executives in both the public and private sector predict that new mobile devices and services will allow people to be more proactive in attending to their health and well-being.

These technologies promise to improve outcomes and cut costs, and make care more accessible to communities that are currently underserved. Mobile health could also facilitate medical innovation by enabling scientists to harness the power of big data on a large scale.

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February 7, 2015 Posted by | Public Health | , , , , , , | Leave a comment

[Medical Journal Editorial] Using Drugs to Discriminate — Adverse Selection in the Insurance Marketplace

From the Perspective article by Douglas B. Jacobs, Sc.B., and Benjamin D. Sommers, M.D., Ph.D.at the 5 Feburary edition of the New England Journal of Medicine

Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). Before the legislation was passed, insurers in the nongroup market regularly charged high premiums to people with chronic conditions or denied them coverage entirely. To address these problems, the ACA instituted age-adjusted community rating for premiums and mandated that plans insure all comers. In combination with premium subsidies and the Medicaid expansion, these policies have resulted in insurance coverage for an estimated 10 million previously uninsured people in 2014.1

There is evidence, however, that insurers are resorting to other tactics to dissuade high-cost patients from enrolling. A formal complaint submitted to the Department of Health and Human Services (HHS) in May 2014 contended that Florida insurers offering plans through the new federal marketplace (exchange) had structured their drug formularies to discourage people with human immunodeficiency virus (HIV) infection from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.2

Insurers have historically used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of this approach — which we call “adverse tiering” — is not to influence enrollees’ drug utilization but rather to deter certain people from enrolling in the first place.

We found evidence of adverse tiering in 12 of the 48 plans — 7 of the 24 plans in the states with insurers listed in the HHS complaint and 5 of the 24 plans in the other six states (see theSupplementary Appendix for sample formularies). The differences in out-of-pocket HIV drug costs between adverse-tiering plans (ATPs) and other plans were stark (seegraphAverage HIV-Related Costs for Adverse-Tiering Plans (ATPs) versus Other Plans.). ATP enrollees had an average annual cost per drug of more than triple that of enrollees in non-ATPs ($4,892 vs. $1,615), with a nearly $2,000 difference even for generic drugs. Fifty percent of ATPs had a drug-specific deductible, as compared with only 19% of other plans. Even after factoring in the lower premiums in ATPs and the ACA’s cap on out-of-pocket spending, we estimate that a person with HIV would pay more than $3,000 for treatment annually in an ATP than in another plan.

Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans. A recent analysis of insurance coverage for several other high-cost chronic conditions such as mental illness, cancer, diabetes, and rheumatoid arthritis showed similar evidence of adverse tiering, with 52% of marketplace plans requiring at least 30% coinsurance for all covered drugs in at least one class.3 Thus, this phenomenon is apparently not limited to just a few plans or conditions.

Adverse tiering is problematic for two reasons. First, it puts substantial and potentially unexpected financial strain on people with chronic conditions. These enrollees may select an ATP for its lower premium, only to end up paying extremely high out-of-pocket drug costs. These costs may be difficult to anticipate, since calculating them would require knowing an insurer’s negotiated drug prices — information that is not publicly available for most plans.

Second, these tiering practices will most likely lead to adverse selection over time, with sicker people clustering in plans that don’t use adverse tiering for their medical conditions.

Read the entire Perspective here

February 6, 2015 Posted by | Consumer Health, Public Health | , , , , , , | Leave a comment

[Report] Investing in the Health of Young Adults

From the 30 October 2014 Institute of Medicine Report

Young adulthood—ages approximately 18 to 26—is a critical period of development with long-lasting implications for a person’s economic security, health, and well-being.

Recognizing the need for a special focus on young adulthood, the Health Resources and Services Administration and the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, the Robert Wood Johnson Foundation, The Annie E. Casey Foundation, and the Department of Defense commissioned the Institute of Medicine (IOM) and National Research Council (NRC) to convene a committee of experts to review what is known about the health, safety, and well-being of young adults and to offer recommendations for policy and research.

The resulting report, Investing in the Health and Well-Being of Young Adults, offers federal, state, and local policy makers and program leaders, as well as employers, nonprofit organizations, and other community partners’ guidance in developing and enhancing policies and programs to improve young adults’ health, safety, and well-being. In addition, the report suggests priorities for research to inform policies and programs for young adults.

 

Related report –> 2014 Consumer Health Mindset (Aon Hewitt,)
Excerpt from Full Text Reports

From press release:

A new analysis from Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE:AON) finds that Millennials put a lower priority on medical care than other generations. However, they are the most likely to want employers to play an active role in supporting their overall health and wellbeing.

The analysis is based on data from the 2014 Consumer Health Mindset report, a joint survey of more than 2,700 U.S. employees and their dependents conducted by Aon Hewitt, the National Business Group on Health and The Futures Company. Aon Hewitt analyzed the perspectives, behaviors and attitudes of employees from different generations towards health and wellness.

According to the analysis, Millennials are the least likely to participate in activities focused on prevention and maintaining or improving physical health compared to other generations. About half (54 percent) have had a physical in the last 12 months, compared to 60 percent of Generation X and 73 percent of Baby Boomers. In addition, just 39 percent say preventive care is one of the most important things to do to stay healthy, compared to 49 percent of Generation X and 69 percent of Baby Boomers.

Millennials are also less likely to participate in a healthy eating/weight management programs (21 percent), compared to Generation X (23 percent) and Baby Boomers (28 percent). Interestingly, they are the most likely generation to engaging in regular exercise (63 percent), compared to 52 percent of Generation X and 49 percent of Baby Boomers.

February 6, 2015 Posted by | Consumer Health, Public Health | , , , , , , , , , , | Leave a comment

[Reblog] Health is Life

From the 2 February 2015 post at the Health Care Blog by By ALEXANDRA DRANE

The literature is clear – when life goes wrong, health goes wrong. Case in point – it’s now estimated that workplace stress alone is causing additional expenditures of between $125 to $190 billion a year – representing 5 to 8 percent of national spending on health care…and even more importantly – 120,000 deaths a year.

There are growing examples of individuals and organizations that get this stuff – and that are fielding solutions to help. Companies like Health Leads (meeting us on the lowest rung of Maslow’s Hierarchy and getting us access to heat, water, safety…), and Iora Health (meeting us squarely where we are and getting us support for our caregiver stress, our divorce, our substance issue…). I recently got to be part of the latest Robert Wood Johnson Foundation’s Pioneering Ideas Podcast (link below) and in the process learned how broadly this idea is spreading…Dr. Paul Tang of linkAges from Palo Alto Medical Foundation(a project RWJF supports) talks about stress, and its effects – especially on seniors – and what we can do about it. Harvard economist/MacArthur Genius Grant winner Sendhil Mullainathan shares ideas for transforming health and healthcare in a world where ‘attentional real estate’ – given the messy realities of life – is scarce.  We double dog dare you to listen here:

As an industry with a mantra to heal, this is ground zero. We need to expand our definition of health to include life – and take this on not just as our obligation, but as our opportunity to address the fundamental drivers of health. And let’s not stop there. Let’s practice radical empathy with each other, and with ourselves. Let’s do it in the privacy of our homes, and let’s bring that raw authenticity with us to our work. Whatever you do to start acknowledging that health is life – start it now… maybe just by closing your eyes and inhaling a big fat breath of fresh air while reminding yourself, ‘I am not alone in this crazy world, because we all feel alone and on some level we are all crazy – but only in the very best of well-intentioned ways.’

February 6, 2015 Posted by | Consumer Health, Public Health, Workplace Health | , , | Leave a comment

[Reblog] Women’s Health Issues: Special Collection on Women’s Heart Health | Full Text Reports…

Women’s Health Issues: Special Collection on Women’s Heart Health | Full Text Reports….

Women’s Health Issues: Special Collection on Women’s Heart Health

February 3, 2015

Special Collection on Women’s Heart Health
Source: Women’s Health Issues

For American Heart Month 2015, the editorial team at Women’s Health Issues has assembled a special collection of research on women’s cardiovascular health published in the journal since mid-2011, following the release of updated American Heart Association guidelines on the prevention of cardiovascular disease in women. The articles address healthcare services for women at risk for cardiovascular disease; social determinants of health; and physical activity in specific populations of women.

These articles will be accessible for free during the month of February 2015 so that they are available to a wider interested audience.

February 5, 2015 Posted by | Consumer Health, Public Health | , | Leave a comment

[press release] One in three people would risk shorter life rather than take daily pill to avoid heart disease

Study does not address why, which I would really like to know!
My cholesterol is high, but I do not take a statin, against the advice of the doctor. Still not convinced they work after reading several evidence based biomedical journal articles. But I admit I am not consistent. Am exercising and watching what I eat.

heart_disease_1

From the 3 February 2015 American Heart Association press release

Study Highlights

  • In a survey, one in three adults say they would risk living a shorter life rather than taking a daily pill to prevent cardiovascular disease.
  • About one in five say they were willing to pay $1,000 or more to avoid taking a daily pill for the rest of their lives.
  • Most respondents weren’t willing to trade any weeks of life to avoid daily medication.

Embargoed until 3 p.m. CT/4 p.m. ET Tuesday, Feb. 3, 2015

DALLAS, Feb. 3, 2015 — One in three people say they would risk living a shorter life instead of taking a daily pill to prevent cardiovascular disease, according to new research inCirculation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Researchers at the University of California San Francisco (UCSF) and the University of North Carolina at Chapel Hill surveyed 1,000 people (average age 50) via the Internet hypothetically asking how much time they were willing to forfeit at the end of their lives to avoid taking daily medication. They were also asked the amount of money they would pay and the hypothetical risk of death they were willing to accept to avoid taking medications to prevent cardiovascular disease.

The survey showed:

  • More than 8 percent of participants were willing to trade as much as two years of life to avoid taking daily medication for cardiovascular disease; while roughly 21 percent would trade between one week and a year of their lives.
  • About 70 percent said they wouldn’t trade any weeks of their lives to avoid taking a CVD pill daily
  • About 13 percent of participants said they would accept minimal risk of death to avoid taking a pill daily; 9 percent said they’d risk a 10 percent chance; and about 62 percent weren’t willing to gamble any risk of immediate death.
  • About 21 percent said they would pay $1,000 or more to avoid taking a pill each day for the rest of their lives, but 43 percent said they wouldn’t pay any amount.

 

February 4, 2015 Posted by | Public Health | , | Leave a comment

[Press release] SAMHSA’s new report tracks the behavioral health of America

From the press release, Monday, January 26, 2015

A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends — many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.

SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key aspects of behavioral healthcare issues affecting American communities including rates of serious mental illness, suicidal thoughts, substance use, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.

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The Barometer indicates that the behavioral health of our nation is improving in some areas, particularly among adolescents. For example, past month use of both illicit drugs and cigarettes has fallen for youth ages 12-17 from 2009 to 2013 (from 10.1 percent to 8.8 percent for illicit drugs and 9.0 percent to 5.6 percent for cigarettes). Past month binge drinking among children ages 12-17 has also fallen from 2009 to 2013 (from 8.9 percent to 6.2 percent).

The Barometer also shows more people are getting the help they need in some crucial areas. The number of people receiving treatment for a substance use problem has increased six percent from 2009 to 2013. It also shows that the level of adults experiencing serious mental illness who received treatment rose from 62.9 percent in 2012 to 68.5 percent in 2013.

 

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The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.

“The Barometer provides new insight into what is happening on the ground in states across the country,” said SAMHSA’s Administrator, Pamela S. Hyde. “It provides vital information on the progress being made in each state as well as the challenges before them.  States and local communities use this data to determine the most effective ways of addressing their behavioral healthcare needs.”

The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.

For the first time, the Barometer provides analyses broken down by poverty level (above or below) and health insurance status. This data can help provide researchers, policy makers, public health authorities and others a better understanding of how income and insurance coverage affect access and utilization of behavioral healthcare services.

To view and download copies of the national or any state Behavioral Health Barometer, please visit the SAMHSA web site at http://www.samhsa.gov/data/browse-report-document-type?tab=46.

For more information, contact the SAMHSA Press Office at 240-276-2130.


The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Last Updated: 01/26/2015

February 3, 2015 Posted by | Psychiatry, Psychology, Public Health | , , , , , , | Leave a comment

[Press release] Top 10 challenges facing global pharmaceutical supply chains

English: Value, supply and demand chains

English: Value, supply and demand chains (Photo credit: Wikipedia)

 

 

 

 

 

From the 2 February 2015 New York University press release

Ten years after the 2005 Paris Declaration on Aid Effectiveness reported on the need for better coordination in the global fight against disease, global pharmaceutical supply chains remain fragmented and lack coordination, facing at least 10 fundamental challenges, according to a newly published paper by professors at NYU Wagner and MIT-Zaragoza.

“Heroes may win battles, but it is capable supply chains that win wars [against disease],” write Natalie Privett, assistant professor of management and policy at the Robert F. Wagner Graduate School of Public Service at New York University, and David Gonsalvez, professor of supply chain management at the MIT-Zaragova International Logistics Program, and former global supply chain director with General Motors. Yet, they add, the global health pharmaceutical delivery (GHPD) supply chains are wanting.

The research article, entitled “The top ten global health supply chain issues: Perspectives form the field,” has been published in Operations Research for Health Care, an academic journal. It sheds light on the key areas of weakness and what specifically is needed to strengthen the pharmaceutical supply chains.

Privett and Gonsalvez interviewed and surveyed 22 individuals with various roles in supply chains and asked them to identify the “top ten” challenges as they see them. The areas of concern which were most often cited include: lack of coordination; inventory management; absent demand information; human resource dependency; order management; shortage avoidance; expiration; warehouse management; temperature control; and shipment visibility.

“Lack of coordination in the GHPD supply chain is a root cause issue whose existence aggravates nearly every other issue director or indirectly,” according to the article.

The paper draws attention to both the needs and opportunities in GHPD supply chains in an attempt to “drive future actions, policies, and research which can ultimately improve pharmaceutical delivery in developing regions and save lives.”

To read the article, please visit:http://www.sciencedirect.com/science/article/pii/S2211692314200002.

 

February 3, 2015 Posted by | Public Health | , , , , , , , | Leave a comment

[Research article] Cyberpsychology, Behavior, and Social Networking

Pornography is not a victimless crime, it affects all of us through dehumanization of women, children, and men.  Sex is distorted, people are viewed as objects. How can this not affect behaviors of the viewers in their everyday life, and thus victimize (or at the very least adversely effect us all? The brain cannot possibly just shut off and on when it comes to what it views.

English: Nations based on their laws involving...

English: Nations based on their laws involving pornography. Please see the legend for more details. Nederlands: Landen op basis van hun wetten over pornografie. Zie de legenda voor meer details. (Photo credit: Wikipedia) Legend at http://commons.wikimedia.org/wiki/File:Pornography_laws.svg#Legend

 

From the abstract at Cyberpsychology, Behavior, and Social Networking (14 January 2015)

The purpose of this review was to determine whether an association exists between sexual risk behaviors and pornography consumption. Consumption of pornography is common, yet research examining its link with sexual risk behaviors is in its infancy. Indicators of sexual risk behavior, including unsafe sex practices and a higher number of sexual partners, have been linked to poor health outcomes. A systematic literature search was performed using Medline, PsycINFO, Web of Knowledge, Pubmed, and CINAHL. Studies were included if they assessed the association between pornography use and indicators of sexual risk behaviors in an adult population. A total of 17 were included in the review, and all were assessed for research standards using the Quality Index Scale. For both Internet pornography and general pornography, links with greater unsafe sex practices and number of sexual partners were identified. Limitations of the literature, including low external validity and poor study design, restrict the generalizability of the findings. Accordingly, replication and more rigorous methods are recommended for future research.

February 3, 2015 Posted by | Public Health | , , , | Leave a comment

[News article] California declares electronic cigarettes a health threat

From the 28 January 2015 Met article

SACRAMENTO, Calif. – California health officials say electronic cigarettes are a health threat, especially to children, and should be strictly regulated like tobacco products.

A report released Wednesday by the California Department of Public Health says e-cigarettes emit cancer-causing chemicals and get users hooked on nicotine. California Health Officer Ron Chapman says new generations of young people will become nicotine addicts if the products remain largely unregulated.

E-cigarettes heat liquid nicotine from cartridges into inhalable vapour without tar and other chemicals found in traditional cigarettes. E-cigarette makers say their products are far safer than tobacco.

Other states including Oklahoma and Arkansas already have issued advisories cautioning the use of e-cigarettes. California’s advisory comes after a state lawmaker introduced legislation this week to ban e-cigarettes in public places.

January 29, 2015 Posted by | Public Health | , , , | Leave a comment

[Reblog] Calling all #Parents and #Carers – Do you have a child/care for a child aged 12 – 18 years

Hoping for the best for this community. A service worth looking into.
(If this is not an image of Warwickshire, please let me know!]

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THE RUPERT BROOKE WETHERSPOONS RUGBY WARWICKSHIRE AUG 2013

From the 27 January 2015 blog post at  safe in warwickshire

 

Sexual Exploitation is in the news a lot at the moment. The media often write about situations where a number of men, are exploiting girls in towns/cities. Children can be sexually exploited in different ways.

Warwickshire County Council is currently developing resources for parents and carers to help them keep their children and young people safe from abuse and exploitation.

To make the resources as useful as possible we would like to know what you, as parents and carers of young people would like to know and how you would like to receive this information. To do this we have created a short online survey, that should take no more than 5 minutes to complete.

…..

January 27, 2015 Posted by | Public Health | , | Leave a comment

[Press release]Health Canada Publishes Findings From Wind Turbine Noise and Health Study |

Icon of Wind Turbines

Icon of Wind Turbines (Photo credit: Wikipedia)

Health Canada Publishes Findings From Wind Turbine Noise and Health Study |

From the 2014-11-06  Health Canada press release

Today, Health Canada published findings from the Wind Turbine Noise and Health Study. Launched in 2012, in collaboration with Statistics Canada, this study explored the relationship between exposure to wind turbine noise and the health effects reported by, and measured in, people living near wind turbines.

In the effort of being more open and transparent, the findings are available on Health Canada’s website. The findings provide a more complete overall assessment of the potential impacts that exposure to wind turbines may have on health and well-being.

No evidence was found to support a link between exposure to wind turbine noise and any of the self-reported or measured health endpoints examined. However, the study did demonstrate a relationship between increasing levels of wind turbine noise and annoyance towards several features (including noise, vibration, shadow flicker, and the aircraft warning lights on top of the turbines) associated with wind turbines.

It is important to note that the findings from this study do not provide definitive answers on their own and must be considered in the context of a broader evidence base.

Health Canada has consulted the Wind Turbine Noise and Health Study Expert Committee on these findings. Detailed analysis and results will be shared with Canadians and the international (scientific) community over the next several months with updates provided on the Health Canada website.

Health Canada will hold a technical background briefing with interested media at 11:00 AM EST today (Dial-in information below).

Quick Facts

  • The study was conducted in Southwestern Ontario and Prince Edward Island and included 1238 households out of a possible 1,570 households living at various distances from 399 separate wind turbines in 18 wind turbine developments.
  • This study is the first study related to wind turbine noise to implement the use of both self-reported and physically measured health endpoints.
  • Measured health-related indicators included hair cortisol as a biomarker of stress, blood pressure, resting heart rate and sleep.

Related Products

Wind Turbine Noise and Health Study Results Pamphlet

Wind Turbine Noise

Frequently Asked Questions

Associated Links

Wind Turbine Noise and Health Study: Updated Research Design and Sound Exposure Assessment

January 27, 2015 Posted by | Public Health | , , , , , , | Leave a comment

[Press release] Model predicts public response to disease outbreaks

Model predicts public response to disease outbreaks

From the 14 January 2015  press release

David L. Chandler | MIT News Office
January 14, 2015

Sometimes the response to the outbreak of a disease can make things worse — such as when people panic and flee, potentially spreading the disease to new areas. The ability to anticipate when such overreactions might occur could help public health officials take steps to limit the dangers.

Now a new computer model could provide a way of making such forecasts, based on a combination of data collected from hospitals, social media, and other sources. The model was developed by researchers at MIT, Draper Laboratory, and Ascel Bio, and is described in a paper published in the journal Interface.

The research grew out of earlier studies of how behavior spreads through social networks, explains co-author Marta Gonzalez, an assistant professor of civil and environmental engineering at MIT. The spread of information — and misinformation — about disease outbreaks “had not been studied, and it’s hard to get detailed information on the panic reactions,” Gonzalez says. “How do you quantify panic?”

One way of analyzing those reactions is by studying news reporting on outbreaks, as well as messages posted on social media, and comparing those with data from hospital records about the actual incidence of the disease.

In many cases, the reaction to an outbreak can cause more harm than the disease itself: For example, the researchers say, curtailing travel and distribution of goods can create economic damage, or even lead to rioting and other behavior that can exacerbates a disease’s spread. Wide publicity of an outbreak can also cause health care facilities to be overrun by people concerned about minor symptoms, potentially making it difficult for those affected by the disease to obtain the care they need, the researchers add.

To study the phenomenon, the team looked at data from three disease outbreaks: the 2009 spread of H1N1 flu in both Mexico and in Hong Kong, and the 2003 spread of SARS in Hong Kong. The model they developed could accurately reproduce the population-level behavior that accompanied those outbreaks.

In these cases, public response was often disproportionate to actual risk; in general, the research showed, diseases that are rare or unusual frequently receive attention that far outpaces the true risk. For example, the SARS outbreak in Hong Kong produced a much stronger public response than H1N1, even though the rate of infection with H1N1 was hundreds of times greater than that of SARS.

This analysis did not specifically address the ongoing Ebola epidemic in West Africa — but once again, Gonzalez says, “The response [is] just not justified by the extent of the disease.”

 

January 27, 2015 Posted by | Public Health | , , , , , , , | Leave a comment

[Reblog] SurroundHealth – 2015 Top 10 Predictions in Public Health

SurroundHealth – 2015 Top 10 Predictions in Public Health.

Excerpt from the 6 January 2015 post

Ready or not, the Affordable Care Act (ACA) is once again heading to the Supreme Court. At stake is whether the law allows consumers purchasing insurance through the Federal portal to extend the same discounts that states provide. Eliminating the discount could gut the exchange’s value to federal consumers. In the meantime, it’s enrollment as usual for 2015. Share this this updated ACA enrollment guide from the IOM.

2. Defending Safety Net and Programs and Regulations

  • Medicare Private voucher program proposal. With a new GOP majority, I expect to revisit proposals to privatize Medicare. The American Public Health Association (APHA) is on record opposing such a policy move as undermining the foundation of Medicare’s guaranteed coverage. Brace yourselves for some ideological power-plays over health care access for seniors.
  • Access to Abortion Services. APHA supports Access to abortion and ensuring the availability of qualified practitioners. The access to safe and legal abortion services at the state level has narrowed rapidly across the majority of US states since 2013. Now, this sharply partisan issue is likely provoke both Congressional challenges and more states to seeking to restrict these services, especially for low-income women.
  • Environmental Protections. Expect attacks on environmental regulations and the Environmental Protection Agency (EPA). Republicans are candid that their goal is to end the EPA. Clean air standards and more may be threatened.

3. New Vaccines

  • Ebola Vaccine. Likely the most fast-tracked vaccine trials ever, I’m not the only one predicting that we’ll see an ebola vaccine in 2015. Together with infection control protocols established for the affected West African countries, this will hasten the end to what had seemed an intractable crisis—though we’re not likely to snuff out ebola completely within the year.
  • HPV Nonavalent Vaccine. Merck’s nine-valent HPV vaccine received FDA approval in 2014. It’s very likely that this will replace, or partially replace, their current quadrivalent (4-valent) version. The newer vaccine will increase the percentage of cancer-causing HPV types prevented from 70% to 90% and potentially prevent tens of thousands of cancers per year. It may only need 2 doses instead of the current 3. The Advisory Committee on Immunization Practices (ACIP) should make a recommendation in the first half of 2015 with rollout later in the year.

4. National Policy on Police Violence in Communities of Color

January 27, 2015 Posted by | Public Health | , , , , | Leave a comment

When free speech conflicts with public health objectives: Yale ISP Conference « Wikimedia blog

When free speech conflicts with public health objectives: Yale ISP Conference « Wikimedia blog.

The Public Health and First Amendment Conference took place at Yale University. Harkness Tower photo by Hilary Richardson, licensed under CC-BY-SA-4.0

 

 

 

 

 

 

 

 

 

 

 

First Amendment jurisprudence frequently pits societal ideals against free speech. A recent conference at Yale Law Schoolshowed that this is no less the case when commercial free speech protections conflict with public health regulatory objectives.

The conference, Public Health in the Shadow of the First Amendment, was co-sponsored by the Information Society Project, the Yale Global Health Justice Partnership, and the Yale Health Law and Policy Society on October 17 and 18, 2014. The event brought together public health advocates, medical professionals and First Amendment scholars to discuss the implications of recent controversial First Amendment case law. The panels highlighted several areas where courts have protected commercial speech in spite of unpopular consequences for public health policy. Hilary Richardson attended the conference on behalf of the Wikimedia Foundation legal team, given its interest in free speech law.

This conference was especially relevant to Wikipedia’s coverage of medical or health related topics. Since the content for pages on Wikipedia is entirely user-generated by thousands of volunteer editors, critics may argue that imperfection is inherent in the medical content pages. It is up to our community of editors to strike a balance between maximizing the total sum of freely available knowledge and removing information that could be misleading. If you think this sounds like an impossible task, here is some food for thought: in October alone, the New York Times wrote about how Wikipedia became one of the most trusted sources on the Internet for learning about Ebola, and four Wikipedians published a scholarly article on Dengue fever in a peer-reviewed journal based on a collaboratively edited Wikipedia article. In addition to meticulously curating the Ebola page on Wikipedia, Dr. James Heilman startedWikiProject Medicine in order to improve medical and health content on Wikipedia and “benefit the world by giving the general public and health care professionals a text they can all read, appreciate, and respect, free of charge.” Medical schools like UCSF have forged partnerships with WikiProject Medicine so that top medical students can identify gaps in information and update entries using their own knowledge and credible resources.

….

Professor Post provided insight into how we theorize the First Amendment and why we understand it to protect commercial speech at all. According to Post, the primary distinction between speech that is covered by the First Amendment and speech that is not comes down to our democratic value of self-governance: speech triggers First Amendment coverage when it participates in the formation of public opinion because we want the government to be responsive to public opinion. Generally, this creates a First Amendment right which is speaker-oriented. However, this changed when the Supreme Court invented the commercial speech doctrine. In Virginia Pharmacy,[3] the Court gave two rationales: we need efficient distribution of information in order to have efficient markets, and we protect commercial speech because it distributes information which is necessary for citizens to participate in public opinion formation. Post argued that in this sense, Virginia Pharmacy created a First Amendment right of the receiver to hear information rather than speak it. In the context of commercial speech, the Supreme Court conceives of the public as people capable of processing information. This suggests that it is up to the people to decide what information they need.

Professor Volokh echoed Post and Bambauer in his agreement that First Amendment protections are about protecting a free market, so that it is better for people to have more information when making decisions. Volokh stressed that the logic behind the commercial speech doctrine is that even though we may think that patients and doctors may make bad decisions, it is possible that government regulators might as well: “the First Amendment directs us to be especially skeptical of regulations that seek to keep people in the dark for what the government perceives to be their own good.”

January 26, 2015 Posted by | Health News Items, Public Health | , , , , , , | Leave a comment

[Journal article] What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health

What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health 

From the January/February 2015 journal article abstract

If there is one thing that health care experts seem to agree on, it is the importance of preventive care. Anything that can help the American public to do a better job of understanding, accessing, and affording effective preventive care and thereby helping them to avoid potential threats to their health should be indisputably a good thing for individuals, families, and society.

Recommendations for the public about what preventive care services an individual might need at different points in his or her life can be one important tool in this tool box, and that goes double for recommendations that speak with the imprimatur of the U.S. Department of Health and Human Services (DHHS). So, a series of fact sheets on “staying healthy” from the Agency for Healthcare Research and Quality (AHRQ)—a branch of DHHS devoted to evidence-based improvements to the provision of U.S. health care—should be a welcome and valued resource (Agency for Healthcare Research and Quality (AHRQ), 2014a, Agency for Healthcare Research and Quality (AHRQ), 2014b).

In this light, it is disappointing to find the AHRQ fact sheets falling short of the mark in some critical ways related to their recommendations on sexual and reproductive health care. The four fact sheets—for women of all ages, women at age 50 and older, men of all ages, and men at age 50 and older—contain a wealth of good advice about screenings and preventive medicine that a patient might need. However, they leave out many effective sexual and reproductive health-related preventive services—perhaps most notably any mention of contraceptive services and supplies—that have been endorsed by other agencies in the DHHS and by the medical establishment more broadly, and that have been promoted through the Affordable Care Act’s (ACA) requirements for private health plans to cover preventive services without patient out-of-pocket costs (HealthCare.gov, 2014, Sonfield, 2012). The AHRQ fact sheets compound those oversights by seeming to imply that they embody the sum total of DHHS’s preventive care recommendations, when in reality they seem to be based almost exclusively on the recommendations of a single body, the U.S. Preventive Services Task Force.

Full text of the article here

January 26, 2015 Posted by | Public Health | , , , , , , , | Leave a comment

[Press release] US needs harm-reduction approach to drug use, researcher says

US needs harm-reduction approach to drug use, researcher says 

From the 14 January 2015 Rice University press release

Neill: Approach minimizes harm associated with drug use for the individual and society    

HOUSTON – (Jan. 14, 2015) – The United States’ law-and-order approach to reducing the supply of drugs and punishing sellers and users has impeded the development of a public health model that views drug addiction as a disease that is preventable and treatable. A new policy paper from Rice University’s Baker Institute for Public Policy advocates that a harm-reduction approach would more effectively reduce the negative individual and societal consequences of drug use.

According to the paper’s author, Katharine Neill, the rate of federal inmates incarcerated for drug offenses hovered at just under 50 percent in 2011, and in 2013 the Obama administration’s budget asked for $25.6 billion to fight the drug war, $15 billion of which was directed toward law enforcement. In addition, by some estimates, state and local governments spend a combined total of $51 billion per year on drug-related law enforcement efforts, which suggests they have a lot to gain by investing in treatment options, Neill said.

“That law enforcement efforts continue to dominate drug policy highlights the need to reframe the discourse on drug use and addiction,” said Neill, the Baker Institute’s Alfred C. Glassell III Postdoctoral Fellow in Drug Policy. “While emphasizing the cost-saving benefits of treatment is important, this should be coupled with more public conversations focusing on drug addiction as a disease requiring medical treatment, not politically based solutions. Reframing the issue in this way should increase the likelihood that a public health approach to drug policy will be adopted for the long term.”

The paper, “Tough on Drugs: Law and Order Dominance and the Neglect of Public Health in U.S. Drug Policy,” is published in the journal World Medical and Health Policy.

Emphasizing harm reduction is a popular public health approach to drugs, Neill said. “A harm-reduction approach recognizes the permanence of drugs in society and, instead of trying to eradicate drug use, focuses on minimizing harm associated with drug use for the individual and society,” she said. “This encompasses a variety of objectives, including preventing individuals from using drugs, treating individuals who want to stop using drugs, preventing drug use where it increases the chances of negative outcomes such as driving while on drugs, and helping individuals who want to continue using drugs do so in a way that does not further compromise their health or the health of others.” This last objective is often achieved through needle-exchange programs intended to prevent the spread of HIV and hepatitis C and is more controversial than other policies, Neill said.

Harm reduction is multidimensional and can include contradictory objectives, she said. For example, some proponents wish to decriminalize drug use and focus on helping drug users get the resources they need for treatment or to continue to use drugs safely, while others accept the illegality of drug use so long as treatment is more available. Others argue that distinctions should be made between drugs according to the risks they pose to the user and society and that policy should be based on these distinctions. “Still, most advocates of harm reduction agree on some basic tenets, including the view that addiction is a disease requiring medical assistance, the desire to minimize risky behavior without requiring abstinence and the need to protect the public from the consequences of drug use, which includes punishing individuals who commit acts that harm others,” Neill said.

– See more at: http://news.rice.edu/2015/01/14/us-needs-harm-reduction-approach-to-drug-use-baker-institute-researcher-says/#sthash.2OCJoKRU.dpuf

January 23, 2015 Posted by | Public Health, Uncategorized | , , , , , , , , | Leave a comment

[Press release] Penn Medicine Bioethicists Call for Return to Asylums for Long-Term Psychiatric Care

Bioethicists call for return to asylums for long-term psychiatric care 

From the 20 January 2015 Penn Medicine press release

JAMA Viewpoint Characterizes Current Model for Treating Mentally Ill as “Ethically Unacceptable and Financially Costly”

PHILADELPHIA — As the United States population has doubled since 1955, the number of inpatient psychiatric beds in the United States has been cut by nearly 95 percent to just 45,000, a wholly inadequate equation when considering that there are currently 10 million U.S. residents with serious mental illness. A new viewpoint in JAMA,written by Dominic Sisti, PhDAndrea Segal, MS, and Ezekiel Emanuel, MD, PhD, of the department of Medical Ethics and Health Policy in the Perelman School of Medicine at theUniversity of Pennsylvania, looks at the evolution away from inpatient psychiatric beds, evaluates the current system for housing and treating the mentally ill, and then suggests a modern approach to institutionalized mental health care as a solution.

English: Pilgrim Psychiatric Center

English: Pilgrim Psychiatric Center (Photo credit: Wikipedia)

“For the past 60 years or more, social, political and economic forces coalesced to move severely mentally ill patients out of psychiatric hospitals,” write the authors. They say the civil rights movement propelled deinstitutionalization, reports of hospital abuse offended public consciousness, and new drugs gave patients independence. In addition, economics and federal policies accelerated the transformation because outpatient therapy and drug treatment were less expensive than inpatient care, and the federal legislation like the Community Mental Health Centers Act and Medicaid led to states closing or limiting the size of so-called institutions for mental diseases.

However, the authors write, “deinstitutionalization has really been transinstitutionalization.” Some patients with chronic psychiatric diseases were moved to nursing homes or hospitals. Others became homeless, utilizing hospital emergency departments for both care and housing. But “most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities. Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder.” According to the authors, “this results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness and incarceration.”

Instead, the authors suggest that a better option for the severely and chronically mentally ill, and the most “financially sensible and morally appropriate way forward includes a return to psychiatric asylums that are safe, modern and humane.”  They argue that the term ‘aslyum’ should be understood in its original sense — a place of safety, sanctuary and healing.

“Asylums are a necessary, but not sufficient component of a reformed spectrum of psychiatric services,” write the authors. Reforms need to expand the role of these institutions to address a full range of integrated psychiatric treatment services — from providing care to patients who cannot live alone or are a danger to themselves and others, to providing care to patients with milder forms of mental illness who can thrive with high-quality outpatient care. These fully-integrated, patient-centered facilities do exist in the U.S. today, but more are needed to provide 21st century care to patients with chronic, serious mental illness.

 

January 23, 2015 Posted by | Public Health | , , , , , , , , | Leave a comment

[Press release] Equation helps identify global disparities in cancer screening and treatment | EurekAlert! Science News

Equation helps identify global disparities in cancer screening and treatment | EurekAlert! Science News.

From the 20 January 2015 press release

Disparities in cancer screening, incidence, treatment, and survival are worsening globally. In a new study on colorectal cancer, researchers found that the

Age-standardised death rates from Colon and re...

Age-standardised death rates from Colon and rectum cancers by country (per 100,000 inhabitants). (Photo credit: Wikipedia)

mortality-to-incidence ratio (MIR) can help identify whether a country has a higher mortality than might be expected based on cancer incidence. Countries with lower-than-expected MIRs have strong national health systems characterized by formal colorectal cancer screening programs. Conversely, countries with higher-than-expected MIRs are more likely to lack such screening programs.

The findings suggest that the MIR has potential as an indicator of the long-term success of global cancer surveillance programs. “The MIR appears to be a promising method to help identify global populations at risk for screenable cancers. In this capacity, it is potentially a useful tool for monitoring an important cancer outcome that informs and improves health policy at a national and international level,” said Dr. Vasu Sunkara, lead author of the Cancerstudy. Senior author Dr. James Hébert, who had used the MIR previously at the state and national level within the US, added that the use of the MIR internationally opens new possibilities for testing the relationship between this important indicator of cancer outcome and characteristics of countries’ health care delivery systems.

 

January 23, 2015 Posted by | Public Health | , , , , , | Leave a comment

[Reblog] A ‘birth lottery’ still determines who gets to live longest, healthiest life

A ‘birth lottery’ still determines who gets to live longest, healthiest life | joe rojas-burke.

From the 16 June 2014 post at JOE ROJAS-BURKE- Science Writer

The latest data suggest that lack of social mobility remains as significant a problem as it was decades ago. In the generation entering the U.S. workforce today, those who started life in the bottom fifth of income distribution have about a 9 percent chance of reaching the top fifth. That compares with an 8.4 percent chance for kids born in 1971, according to research by economists Raj Chetty of Harvard, Emmanuel Saez of the University of California, Berkeley, and colleagues.

What’s astonishing are the huge differences in mobility depending on where you grow up, The odds of escaping poverty and gaining prosperity are less than 3 percent for kids in many places across the South and Rust Belt states. But in some parts of the Great Plains, more than 25 percent of kids born to the poorest parents move into the upper-income strata as adults, the economists found. The datasets are available here.

The probability that a child born in the bottom fifth of the income distribution will reach the top fifth of the income distribution, based on data for those born from 1980-85. (Source:   Raj Chetty, Nathaniel Hendren, Patrick Kline, and Emmanuel Saez)

I don’t think it’s a coincidence that the places on this map with the lowest social mobility also tend to have the worst health outcomes. Lack of mobility is strongly correlated with worse segregation, greater income inequality, poor local school quality, diminished social capital, and broken family structure – factors that are also linked to poor health.

Even when poor children manage to escape poverty, a “birth lottery” may still determine who gets to live longest and healthiest. Exposure to adverse conditions during fetal development and early infancy appears to be capable of causing irreversible consequences decades later, such as increased vulnerability to weight gain, diabetes, heart disease, and premature death.

January 22, 2015 Posted by | Public Health | , , , , , | Leave a comment

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