[e-book] Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition “The Pink Book”
Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition “The Pink Book”.
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This illustration depicts the influenza virus. Graphic created by Dan J. Higgins, Division of Communication Services, CDC
The 13th Edition Epidemiology and Prevention of Vaccine-Preventable Diseases, a.k.a. the “Pink Book,” provides physicians, nurses, nurse practitioners, physician assistants, pharmacists, and others with the most comprehensive information on routinely used vaccines and the diseases they prevent.
Typical chapters include a description of the disease, pathogenesis, clinical features, laboratory diagnosis, medical management, epidemiology, vaccination schedule and use, contraindications and precautions, adverse reactions following vaccination, vaccine storage and handling, and references.
Six appendices contain a wealth of reference materials including: vaccine minimum ages and intervals, current and discontinued vaccines, vaccine contents, foreign vaccine terms, and more.
To view online or download to print specific sections, see links below.
Order a bound copy from the Public Health Foundation Learning Resource Center
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[Report] County-Level Variation in Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, 2012
From the US Centers for Disease Control and Prevention
The map illustrates the geographic variation across counties and shows that counties with the highest prevalence of Medicare beneficiaries with 6 or more chronic conditions are located predominantly in southern states (eg, Texas, Florida, Kentucky) and northeastern states (eg, New York, Pennsylvania). Counties with the lowest prevalence are found mostly in western states (eg, Oregon, Montana, Wyoming). [A text description of this figure is also available.]
Background
Preventing chronic conditions and controlling costs associated with the care for people with chronic conditions are public health and health care priorities. The number of chronic conditions increase with age: more than two-thirds of Medicare beneficiaries 65 years or older have 2 or more chronic conditions, and more than 15% have 6 or more (1,2). People with multiple chronic conditions use more health care services than people who do not have them, and they account for a disproportionate share of health care spending (2,3). The prevalence of multiple chronic conditions varies substantially by state (4); more granular geographic information on multiple chronic conditions can provide a better understanding of the burden of chronic conditions and the implications for local public health programs and resources. The objective of this geographic information system (GIS) analysis was to describe county-level prevalence patterns of Medicare beneficiaries with 6 or more chronic conditions.
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[Online tool] Community Health Status Indicators (CHSI) Website Launch
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.
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[Report] Women and Girls at Risk of Female Genital Mutilation/Cutting in the United States
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.
[Report] Mortality Among Blacks or African Americans with HIV Infection (is declining) — United States, 2008–2012
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…
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[Pew Report] Most View the CDC Favorably; VA’s Image Slips
From the 22 January 2015 Pew Center post
More Partisan Opinions of the EPA, CIA
The public continues to express positive views of many agencies of the federal government, even though overall trust in government is near historic lows. Large majorities express favorable views of such government agencies as the Centers for Disease Control and Prevention (CDC), NASA and the Defense Department.
In fact, favorable opinions surpass unfavorable views for seven of eight government agencies tested – the IRS is the lone exception. In a survey last February, however, just 24% said they could trust the government in Washington always or most of time. (See this interactive for more on trust in government.)
….
More at http://www.people-press.org/2015/01/22/most-view-the-cdc-favorably-vas-image-slips/2/, including tables on NSA, IRS, and VA; views based on party affiliation and Tea Party Republicans
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[Press release] Flexible work schedules improve health, sleep | EurekAlert! Science News
Flexible work schedules improve health, sleep | EurekAlert! Science News.
From the 22 January 2015 press release
Giving employees more control over their work schedules may help curb sleep deficiency, according to health researchers.
“In the absence of sufficient sleep, we are not as attentive or alert, we process information more slowly, miss or misinterpret social and emotional cues and decision making is impaired,” said Orfeu M. Buxton, associate professor of biobehavioral health, Penn State. “For example, we may misjudge risks by undervaluing negative consequences and overvaluing potential rewards.”
About 30 percent of U.S. adults reported not regularly getting a sufficient amount of sleep, a 2012 Centers for Disease Control survey found. Sleep deficiency has been linked to increased risk of automobile crashes, chronic disease and early mortality. Improving adequate sleep within the population is a goal of Healthy People 2020, a federal initiative that sets national objectives and monitors progress concerning the health of the nation.
Buxton and colleagues looked to see if a workplace intervention, designed to increase family-supportive supervision and give employees more control over their work time, improved sleep quantity and quality. They report their results in an article published online today (Jan. 21) in the journal Sleep Health.
The researchers followed 474 employees as part of a Work, Family and Health Network study conducted at an information technology company, with about half of the employees serving as the control while the other half experienced the study intervention. Both employees and their supervisors participated.
The intervention was designed to reduce conflicts between work and personal life, and focused on two main cultural shifts: allowing employees to decide on when and where they worked and training supervisors to support their employees’ personal lives. Those who were assigned to the intervention were encouraged to be completely flexible about when and where they would work — at the office, from home or elsewhere — while still working the same number of hours as the control group. All of the participants wore a sleep-monitoring watch, a device that tracks movement to monitor periods of sleep.
…
[News] Scientists say tweets predict heart disease and community health — Tech News and Analysis
Psychological Science / UPenn
Scientists say tweets predict heart disease and community health — Tech News and Analysis.
Excerpt from the 22 January 2015 article
University of Pennsylvania researchers have found that the words people use on Twitter can help predict the rate of heart disease deaths in the counties where they live. Places where people tweet happier language about happier topics show lower rates of heart disease death when compared with Centers for Disease Control statistics, while places with angry language about negative topics show higher rates.
The findings of this study, which was published in the journal Psychological Science, cut across fields such as medicine, psychology, public health and possibly even civil planning. It’s yet another affirmation that Twitter, despite any inherent demographic biases, is a good source of relatively unfiltered data about people’s thoughts and feelings,well beyond the scale and depth of traditional polls or surveys. In this case, the researchers used approximately 148 million geo-tagged tweets from 2009 and 2010 from more than 1,300 counties that contain 88 percent of the U.S. population.
(How to take full advantage of this glut of data, especially for business and governments, is something we’ll cover at our Structure Data conference with Twitter’s Seth McGuire and Dataminr’s Ted Bailey.)
What’s more, at the county level, the Penn study’s findings about language sentiment turn out to be more predictive of heart disease than any other individual factor — including income, smoking and hypertension. A predictive model combining language with those other factors was the most accurate of all.
That’s a result similar to recent research comparing Google Flu Trends with CDC data. Although it’s worth noting that Flu Trends is an ongoing project that has already been collecting data for years, and that the search queries it’s collecting are much more directly related to influenza than the Penn study’s tweets are to heart disease.
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[News article] Study reveals lack of data on opioid drugs for chronic pain — ScienceDaily
From the article
Date:January 15, 2015Source:University of ConnecticutSummary:Researchers have found little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.
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[Research summary] New Research Review Looks at Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain
From the AHRQ Web site
A new research review from AHRQ’s Effective Health Care Program found that while the evidence on the effectiveness and harms of opioid therapy for chronic pain treatment is limited, there is an increased risk of serious harms based on the opioid dose given. The research review assesses observational studies that suggest that use of long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures and heart attack, when compared with patients who are not being prescribed opioids. The review noted that more research is needed to understand the long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and strategies. The review is titled, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” AHRQ has also released a statistical brief from the Healthcare Cost and Utilization Project titled, “Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012.” According to the brief, hospitalization rates for opioid overuse more than doubled from 1993 to 2012 and increased at a faster rate for people age 45 and older. In addition, AHRQ Director Rick Kronick, Ph.D., has published a blog about opioids.
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How Twitter Can Revolutionize Public Health
by Catherine Bartlett, MPH student
credit: connection.sagepub.com
As much as people may try to deny it, traditionally healthcare organizations are rarely early adopters of new technologies. The lack of electronic health systems, computerized methods of communication, filing, and overall resistance to change has left many health care organizations years behind other high tech industries.
Public health officials have used many different strategies to engage the general public, from billboards, radio PSAs, to the CDC’s unique “prepare for the zombie apocalypse” web campaign. Although some may dismiss Twitter as frivolous or silly, it is an excellent platform to educate and communicate with a large group of people in a succinct way (140 characters to be exact). Indeed, over the past five years, Twitter has become one of the most popular social media and sharing platforms in the world. According to the Twitter blog, more than 500 million tweets are…
View original post 248 more words
[Article] Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2014
From the 4 February 2014 Annals of Internal Medicine article by Carolyn B. Bridges, MD; Tamera Coyne-Beasley, MD, MPH, on behalf of the Advisory Committee on Immunization Practices
View a larger version of the graphic and the accompanying article here
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[Press release] United Health Foundation’s America’s Health Rankings Finds Americans Are Making Considerable Progress in Key Health Measures
From the 11 December 2013 press release
- Hawaii is the healthiest state
- Nationwide, Americans improved in the majority of the measures captured by the Rankings
- Improvements span key behavioral measures including smoking and physical inactivity
- 2013 marks the first time since 1998 that America’s obesity crisis did not worsen
- Serious challenges remain; maintaining momentum is keyMINNETONKA, Minn. (Dec. 11, 2013) – Americans are making considerable progress in their overall health, according to United Health Foundation’s 2013 America’s Health Rankings®: A Call to Action for Individuals & Their Communities.
Nationwide, Americans improved in the majority of the measures captured by the Rankings. The most notable gains came in key behavioral measures, including smoking, which dropped from 21.2 percent of the adult population to 19.6 percent. Seventeen states had significant drops in smoking, with the largest seen in Nevada, Maryland, Oklahoma, Kansas and Vermont.
Physical inactivity dropped from 26.2 percent of the adult population to 22.9 percent, and America’s obesity rate remained approximately the same as reported in 2012 (27.6 percent of the adult population in 2013 compared with 27.8 percent in 2012). This marks the first time since 1998 that obesity rates have not worsened.
State rankings
Hawaii has taken the title of healthiest state. Vermont, last year’s reported No. 1 state, is ranked second this year and has ranked among the top five states for the last decade. Minnesota is third, followed by
Massachusetts and New Hampshire. Mississippi ranks 50th this year, and Arkansas (49), Louisiana (48), Alabama (47) and West Virginia (46) complete the list of the five least healthy states.
Top-seated Hawaii scored well along most measures particularly for having low rates of uninsured individuals, high rates of childhood immunization, and low rates of obesity, smoking and preventable hospitalizations. Like all states, Hawaii also has areas where it can improve: it has higher-than-average rates of binge drinking and occupational fatalities, and lower-than-average rates of high school graduation.
To see the Rankings in full, visit: http://www.americashealthrankings.org.
Despite progress, significant challenges remain
When it comes to improving the nation’s health, there is still much to be done. Obesity has leveled off; however, it must remain a top priority, as 27.6 percent of adults nationwide report being obese. With rates of physical inactivity, smoking and diabetes at 22.9 percent, 19.6 percent and 9.7 percent, respectively, there is still considerable room for improvement in key health measures.
“I am encouraged by the progress we’ve made this year and am hopeful that the leveling off we see in America’s obesity is a sign of further improvement to come,” said Reed Tuckson, M.D., external senior medical adviser to United Health Foundation. “We should certainly celebrate these gains. They encourage us to continue to identify and effectively implement best practices in these areas and in addressing diabetes, heart disease and other chronic health conditions that compromise Americans’ health and vitality.”
Georges Benjamin, M.D., executive director of the American Public Health Association, said: “Every year, the America’s Health Rankings report details the nation’s health successes and challenges on a state- by-state level, providing specific areas where citizens and states alike can focus to continue to improve the health of our nation. I am pleased to see the progress we’ve made and hope we can keep up the good work.”
United Health Foundation calls for sustained momentum
“United Health Foundation is committed to continuing to identify ways to improve state health in measurable, meaningful ways,” said Rhonda Randall, D.O., senior adviser to United Health Foundation and chief medical officer of UnitedHealthcare Retiree Solutions. “I hope we soon see the day when we are cheering year-over-year improvements in obesity, and I look forward to seeing our nation’s percentage of smokers continue to decline.”
“Those of us who dedicate our careers to public health know we can’t improve what we don’t measure,” said Eduardo Sanchez, M.D., chairman, Partnership for Prevention. “The America’s Health Rankings report and the online tools show us where we’ve made strides in promoting better health and, importantly, where we still have work to do.”
The America’s Health Rankings report and its tools – including analysis not only of state populations but also subpopulations within states – are designed to identify health opportunities in communities as well as
multi-stakeholder, multi-disciplinary approaches to address those opportunities. Through its programs and grants, United Health Foundation shines a spotlight on the health of America while promoting evidence- based solutions. As part of this commitment, United Health Foundation has partnered with the Association of State and Territorial Health Officials and the National Business Coalition on Health to create learning laboratories that identify and promote best practices and innovations in public health. To learn more about America’s Health Rankings – and to get information on how to help improve community health – visit http://www.americashealthrankings.org.
About America’s Health Rankings®
America’s Health Rankings is an annual comprehensive assessment of the nation’s health on a state-by state basis. It is published jointly by United Health Foundation, American Public Health Association and Partnership for Prevention.
The data in the report come from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau. The report is reviewed and overseen by a Scientific Advisory Committee, with members from leading academic institutions, government agencies and the private sector.
America’s Health Rankings is the longest-running report of its kind. For 24 years, the Rankings has provided an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socioeconomic data to determine national health benchmarks and state rankings. The Rankings employs a unique methodology, developed and annually reviewed by a Scientific Advisory Committee of leading public health scholars. For more information, visit http://www.americashealthrankings.org.
About United Health Foundation
Guided by a passion to help people live healthier lives, United Health Foundation provides helpful information to support decisions that lead to better health outcomes and healthier communities. The Foundation also supports activities that expand access to quality health care services for those in challenging circumstances and partners with others to improve the well-being of communities. After its establishment by UnitedHealth Group [NYSE: UNH] in 1999 as a not-for-profit, private foundation, the Foundation has committed more than $210 million to improve health and health care. For additional information, please visit http://www.unitedhealthfoundation.org.
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[Press release] Measles Still Threatens Health Security

English: Estimated immunization coverage with Measles-containing vaccine (WHO 2010) Deutsch: Geschätzte Immunisierungsrate mit Masernimpfstoff (WHO 2010) (Photo credit: Wikipedia)
From the 5 December 2013 CDC Press Release
Measles Still Threatens Health Security
On 50th Anniversary of Measles Vaccine, Spike in Imported Measles Cases
Fifty years after the approval of an extremely effective vaccine against measles, one of the world’s most contagious diseases, the virus still poses a threat to domestic and global health security.
On an average day, 430 children – 18 every hour – die of measles worldwide. In 2011, there were an estimated 158,000 measles deaths.
In an article published on December 5 by JAMA Pediatrics, CDC’s Mark J. Papania, M.D., M.P.H., and colleagues report that United States measles elimination, announced in 2000, has been sustained through 2011. Elimination is defined as absence of continuous disease transmission for greater than 12 months. Dr. Papania and colleagues warn, however, that international importation continues, and that American doctors should suspect measles in children with high fever and rash, “especially when associated with international travel or international visitors,” and should report suspected cases to the local health department. Before the U.S. vaccination program started in 1963, measles was a year-round threat in this country. Nearly every child became infected; each year 450 to 500 people died each year, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness.
People infected abroad continue to spark outbreaks among pockets of unvaccinated people, including infants and young children. It is still a serious illness: 1 in 5 children with measles is hospitalized. Usually there are about 60 cases per year, but 2013 saw a spike in American communities – some 175 cases and counting – virtually all linked to people who brought the infection home after foreign travel.
“A measles outbreak anywhere is a risk everywhere,” said CDC Director Tom Frieden, M.D., M.P.H. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day. Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security.
Eliminating measles worldwide has benefits beyond the lives saved each year. Actions taken to stop measles can also help us stop other diseases in their tracks. CDC and its partners are building a global health security infrastructure that can be scaled up to deal with multiple emerging health threats.
Currently, only 1 in 5 countries can rapidly detect, respond to, or prevent global health threats caused by emerging infections. Improvements overseas, such as strengthening surveillance and lab systems, training disease detectives, and building facilities to investigate disease outbreaks make the world — and the United States — more secure.
“There may be a misconception that infectious diseases are over in the industrialized world. But in fact, infectious diseases continue to be, and will always be, with us. Global health and protecting our country go hand in hand,” Dr. Frieden said.
Today’s health security threats come from at least five sources:
- The emergence and spread of new microbes
- The globalization of travel and food supply
- The rise of drug-resistant pathogens
- The acceleration of biological science capabilities and the risk that these capabilities may cause the inadvertent or intentional release of pathogens
- Continued concerns about terrorist acquisition, development, and use of biological agents.
“With patterns of global travel and trade, disease can spread nearly anywhere within 24 hours,” Dr. Frieden said. “That’s why the ability to detect, fight, and prevent these diseases must be developed and strengthened overseas, and not just here in the United States.”
The threat from measles would be far greater were it not for the vaccine and the man who played a major role in creating it, Samuel L. Katz, M.D., emeritus professor of medicine at Duke University. Today, CDC is honoring Dr. Katz 50 years after his historic achievement. During the ceremony, global leaders in public health are highlighting the domestic importance of global health security, how far we have come in reducing the burden of measles, and the prospects for eliminating the disease worldwide.
Measles, like smallpox, can be eliminated. However, measles is so contagious that the vast majority of a population must be vaccinated to prevent sustained outbreaks. Major strides already have been made. Since 2001, a global partnership that includes the CDC has vaccinated 1.1 billion children. Over the last decade, these vaccinations averted 10 million deaths – one fifth of all deaths prevented by modern medicine.
“The challenge is not whether we shall see a world without measles, but when,” Dr. Katz said.
“No vaccine is the work of a single person, but no single person had more to do with the creation of the measles vaccine than Dr. Katz,” said Alan Hinman, M.D., M.P.H., Director for Programs, Center for Vaccine Equity, Task Force for Global Health. “Although the measles virus had been isolated by others, it was Dr. Katz’s painstaking work passing the virus from one culture to another that finally resulted in a safe form of the virus that could be used as a vaccine.”
Related articles
- Measles still poses threat to U.S. despite being “eliminated” (cbsnews.com)
- CDC: Rise in Imported Measles Cases Threatens US (health.yahoo.net)
- CDC: Measles Still A Threat (radio.foxnews.com)
- US Measles Cases This Year Are Triple The Annual Average: CDC – Huffington Post (huffingtonpost.com)
- Measles still a risk, 50 years after the introduction of the vaccine (theglobaldispatch.com)
- RT @Fischblog: “Before the measles vaccine was achieved 50 years ago, the disease killed 2.6 mio people around the world every year” http:/… (wired.com)
[News article] CDC Report Card: Good, Bad Marks On Target Battles
From the 21 November 2013 CBS report
About three years ago, the nation’s top public health agency picked its battles. Now, it’s issuing its own report card on reaching those goals: Pretty good but needs improvement.
The seven “winnable battles” singled out by the Centers for Disease Control and Prevention set goals for 2015, such as cutting adult smoking to 17 percent and pushing childhood obesity down to about 15 percent.
The agency released its first progress report Thursday, and CDC officials said they’re mostly pleased.
From the CDC Winnable Battles Progress Report page
(specifically
http://www.cdc.gov/winnablebattles/targets/pdf/winnablebattlesprogressreport.pdf)
OVERVIEW
To keep pace with emerging public health challenges and to address the leading causes of illness, injury, disability, and death, the Centers for Disease Control and Prevention (CDC) initiated an effort to achieve measurable impact on selected Winnable Battles. These Winnable Battles were chosen based on the magnitude of the health problems and our ability to make significant progress to improve outcomes.
There are evidence-based strategies available now to address the critical health challenges presented by each of the Winnable Battles areas. We have established important indicators and targets for measuring progress. Together with our partners, we can have a meaningful impact on health through a dedicated focus on these Winnable Battles.
In 2010, CDC identified the following Winnable Battles:
- Tobacco – Tobacco use is the leading preventable cause of disease, disability, and death in the U.S.
- Nutrition, Physical Activity, and Obesity – More than 72 million adults and 12 million youth in the U.S. are obese
- Food Safety – Foodborne diseases sicken 1 out of 6 Americans each year
- Healthcare-Associated Infections (HAIs) – 1 out of 20 hospitalized patients contracts an HAI
- Motor Vehicle Safety – Motor vehicle crashes are a leading cause of death among Americans ages 1 to 54
- Teen Pregnancy – The U.S. has one of the highest rates of teen pregnancy of any developed nation in the world
- HIV – More than 1 million people in the U.S. are living with HIV
Related articles
- CDC report card on priorities: Pretty good, needs improvement (globalnews.ca)
- How The CDC Did On Its Most Recent Report Card (wonderfultips.wordpress.com)
- CDC report card: Good, bad marks on target battles (boston.com)
- CDC report card: Good, bad marks on target battles (star-telegram.com)
[Reblog] How to find good vaccine information online
Although a number of my posts voice my concerns about “Big Pharm”, I still get an annual flu shot and keep up with vaccines.
Why? Overall I believe they are good public health measures. Still believe in herd immunity and my responsibility to others.
From the 14 November 2013 post by at KevinMD.com
(Please read the comments also for good additional information.)
Dr. Google, you’ve let a whole lot of people down.
If you Google a vaccine question, and many parents have, you’re very likely to find a good, science-based answer — but it will be buried among dozens of sites with anti-science, pro-disease propaganda. The mountain of misinformation is staggering, with multiple anti-vaccine sites repeating each other in a seemingly endless loop of worry and dread. Let neither facts nor truth nor glimmer of honesty stay them from the swift completion of their self-appointed fear mongering rounds.
Fortunately, there are ways to make sure you’re getting reliable answers to your questions.
Start with the CDC’s vaccine home page, which leads to comprehensive information about just about any vaccine health topic.
Prefer an academic center over a government site? The Children’s Hospital of Philadelphia (perhaps the best children’s medical center in the world) has their own very comprehensive vaccine site, and even their own vaccine information app.
Looking for a more global view? Try the World Health Organization’s vaccine page.
Willing to put up with a little snark? Several good science bloggers frequently discuss vaccine topics, no holds barred, and end up with some robust back-and-forth in the comments. Try Respectful Insolence, The Skeptical Raptor, or Neurologica.
Finally, if what you’d like is a meta-search that looks at only the best vaccine information sources, and weeds out the crap, try this science based vaccine search engine.
Parents don’t have the time to wade through the idiocy — they want real, genuine information to help make decisions. Google won’t do that for you, but these links will.
Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.
Matthew Toohey MD This author is spot on in addressing a real problem: these mercola-type internet sites are very harmful. They have the right to free speech but we must combat what is clearly destructive and unsubstantiated ‘health’ information. These sites have found a niche and strike a nerve for a lot of people who have come to the realization that western medicine doesn’t always have a cure for what ails them.
These sites play off this reality and work to trump up a sense of conspiracy which we as humans seem to have a weakness for.
Some people are distrustful of major ‘government’ websites like CDC.
On my site, I am honest about each vaccine’s effectiveness and potential side effects. I also explain why I support their use, one at a time:
http://pediatriciannextdoor.co…
I hope it helps
May Wright Along the same lines: what would be handy for people who want to try to refute anti-vaccine memes on social media (FB, Twitter, blogs) is a resource page which features some of the most popular “arguments” against vaccines, all in one place, and then has links to science-based refutations on various sites. So, for instance, it would have the meme I saw doing the rounds of Facebook this morning, that “Gardasil has killed and injured more women than the disease it’s meant to protect!!11!!”, or the one about “I’m not injecting aborted fetuses into my baby, #ProLife SAY NO TO VACCINES!!” and then a few links to credible sources of information which provide the relevant facts?Maybe such a page or site already exists, if so I’d love a link to it.
MissMeg Here are two good, government-operated sites which vaccine investigators won’t want to miss.The first is a CDC site that lists vaccine ingredients:
http://www.cdc.gov/vaccines/pu…The second is the Vaccine Injury Compensation Program:
http://www.hrsa.gov/vaccinecom…
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- Vaccinations, “For the Greater Good” (vaccinesforchildren.wordpress.com)
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[Reblog] With CDC Seasonal Flu Data Unavailable, An Electronic Medical Record Offers a Glimpse of Early Activity Levels
From the 13 October 2013 post at The Health Care Blog By IYUE SUNG
As Washington remains deadlocked on the implementation of the Affordable Care Act, the US government’s shutdown has resulted in the furlough of nearly 70% of the Centers for Disease Control‘s (CDC’s) workforce. CDC Director Tom Frieden recently shared his thoughts in a tweet. We agree whole-heartedly. Although it’s all too easy to take the CDC staff for granted, they are the frontline sentinels (and the gold standard) for monitoring disease outbreaks. Their ramp-down could have serious public health consequences.
We are particularly concerned about the apparent temporary discontinuation of the CDC’s flu surveillance program, which normally provides weekly reports on flu activity. Although flu season typically begins in late fall, outbreaks have occurred earlier in previous years. In 2009, flu cases started accumulating in late summer/early fall. And given the potential for unique variants, such as the swine or avian flu, every season is unpredictable, making the need for regular CDC flu reports essential. We therefore hope to see the CDC restored to full capacity as soon as possible.
In the meantime, we would like to help by sharing data we have on communicable diseases, starting with the flu.
Because the athenahealth database is built on a single-instance, cloud-based architecture, we have the ability to report data in real time. As we have described in earlier posts, the physicians we serve are dispersed around the country with good statistical representation across practice types and sizes.To get a read on influenza vaccination rates so far this season, we looked at more than two million patients who visited a primary care provider between August 1 and September 28, 2013 (Figure 1). We did not include data on vaccinations provided at retail clinics, schools or workplaces.
This year’s rates are trending in parallel to rates over the last four years, and slightly below those of the 2012-2013 season. However, immunizations accelerate when the CDC, and consequently the media, announce disease outbreaks and mount public awareness campaigns.
As for the government shutdown, nearly everyone hopes for a quick end. Should the standoff drag on, detection of the flu (or other diseases) may be delayed, in theory endangering the public. Fortunately, we currently see no evidence of an early influenza outbreak. But recent history shows that the flu can begin spreading at any time, and once it does begin, it spreads very quickly, as shown in Figure 2.
We believe that our data provides a reliable view of seasonal flu trends. Last year, wewrote about the 2012-2013 flu season and found that patterns in our patient population (consisting of a large proportion of patients receiving immunizations in primary care settings) closely mirrored CDC trends. With that in mind, we believe that sharing our 2013-2014 data would be valuable to the health care community.
Whether our nation’s politicians can come to an agreement tomorrow or next month, we will continue to deliver reports that monitor population health and look ahead to contributing any information we can. If you have any suggestions or comments – on the flu or other diseases where up-to-date data would be valuable – please leave a comment here or e-mail me directly at isung@athenahealth.com.
Iyue Sung is the Director of Core Analytics at athenahealth. The post originally appeared on the athenahealth blog.
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- The flu season has started – but CDC isn’t tracking it (medicalstaffingnetwork.wordpress.com)
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Untreatable: Report by CDC details today’s drug-resistant health threats
From the US Centers for Disease Control 16 September press release
Landmark report ranks threats, outlines four core actions to halt resistance
Every year, more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result, according to a new report issued by the Centers for Disease Control and Prevention. The report, Antibiotic Resistance Threats in the United States, 2013, presents the first snapshot of the burden and threats posed by antibiotic-resistant germs having the most impact on human health. The threats are ranked in categories: urgent, serious, and concerning.
Threats were assessed according to seven factors associated with resistant infections: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics, and barriers to prevention. Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. C. difficile causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.
“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC Director Tom Frieden, M.D., M.P.H. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”
…….
Four Core Actions to Fight Antibiotic Resistance
- Preventing Infections, Preventing the Spread of Resistance
- Tracking Resistance Patterns
- Improving Use of Today’s Antibiotics (Antibiotic Stewardship)
- Developing New Antibiotics and Diagnostic Tests
…….
Read the entire press release here
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[Re-post] Opting-Out Of Vaccines; Dipping Below Herd Immunity
From the post at Boston Public Radio
With more and more families opting out of vaccinating their kids, one of the most sacred of public health goals, the concept of herd immunity, is being threatened.
A recent piece in Scientific American featured tantalizing graphics — on view above — illustrating this scary trend. According to this analysis, the vaccination rates in some states — Oregon, West Virginia and Colorado, for instance, are shockingly low. So low, in fact, that they’ve dropped below the “herd immunity” levels (or what is thought to be the safe threshold) for MMR (measles, mumps and rubella) and DTP (diphtheria, tetanus and pertussis).
So what’s the deal with herd immunity? According to the CDC, a population has reached herd immunity when a sufficient proportion is immune to a particular infectious disease. Immune population members get that protection either by being vaccinated or by having a prior infection.
Related articles
- What Is Herd Immunity? (scientificamerican.com)
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- Despite the Science, Marin Vaccination Opt-Outs Increase (blogs.kqed.org)
- Pneumonia vaccine for children also protects older adults (upi.com)
- Measles Goddess’ Wrath Hits Victoria (luckylosing.com)
- IH warns of whooping cough ‘surge’ in West Kootenay (revelstoketimesreview.com)
- Racing Towards Death- Do You Want To? (scitablescience.wordpress.com)
- Tony Abbott wrong on child immunisation rates (abc.net.au)
- I’ll admit it: Wakefield’s research has been replicated over and over again (thepoxesblog.wordpress.com)
August is National Immunization Awareness Month
The Centers for Disease Control and Prevention (CDC) has a whole Web site on Vaccines and Immunizations
Some highlights
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- Report: Teen HPV vaccination rate still lagging (mysanantonio.com)
Are you up-to-date on your immunizations? August is National Immunization Awareness month, a public health campaign sponsored by the CDC to recognized the importance of vaccination and to bring awareness to vaccinations that are not meeting national goals. Vaccines are the best prevention for some serious often life-threatening illnesses. This campaign is targeting a different group each week during the month of August: students starting college, students k-12, adults 26+, and pregnant women and newborns. The CDC is providing educational materials to healthcare providers so that they can encourage their patients to get immunized. Accessibility to vaccines has improved now that many pharmacists can deliver adult vaccinations. Howis your pharmacy taking advantage of this campaign toimprove vaccination rates in adults?
For more information click here CDC
Life Expectancy Shortest In Southern ‘Poverty Belt’ (INFOGRAPHIC)
From the 19 July post at HuffPost
Living in a high-poverty area often means a lifetime of struggle with underperforming public schools, limited job opportunities, higher crime rates, and poor nutrition, health care and housing — all of which can add up to a shorter, sicker retirement.
Americans who live in the South can expect to live fewer healthy years past 65 than those who live in other parts of the country, according to a new report from the CDC. Health disparities among seniors in their final years align closely with profound geographical differences in poverty. The region where more than 30 percent of people live in high-poverty areas — dubbed the “poverty belt” by The Atlantic’s Richard Florida, falls right over the states with the lowest healthy life expectancies. As inequality in the U.S. climbs steadily, this public health crisis may only expand.
From the US Centers for Disease Control and Prevention site
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- South lags in state-by-state study of life expectancy for seniors (cbsnews.com)
- Healthy Life Expectancies at Age 65 Highest in Hawaii, Lowest in Mississippi (cdc.gov)
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How to Handle Mold/Mycotoxin Exposure at Home or at Work – Where To Get Help
I usually don’t reblog articles that endorse commercial products or alternative/complementary medicine (without biomedical evidence).
Still, this post had a lot of good information on testing and one’s rights.A few years back at a library where I worked, some of the folks at circulation were having breathing difficulties. They believed it was the HVAC system, but did not report it. Now I wish I could have worked with them to report it….
The folks at the circ desk were union, I was not. So they were more protected than I…..Resources
- MedlinePlus: Molds, including
- Molds in the environment (US Centers for Disease Control)
- Brief Guide to Mold, Moisture, and Your Home(Environmental Protection Agency, Indoor Environments Division)
- Molds (US Occupational Safety and Health Administration – OSHA)
- Legal Aspects of Mold Contamination (Clean Water Partners – Environmental Law Experts)
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- Preventing mold from forming in your home (mysouthwestga.com)
- Understanding Mold (moldremoversnj.wordpress.com)
- The way crucial is actually Health in our life (meizitangstrongbuys.wordpress.com)
- Mycotoxins=diabetes? (larahentz.wordpress.com)
State Medicaid Coverage Limited in Treating Painkiller Addiction — Stateline
Source: A Public Health Approach to Drug Control in Canada, Health Officers Council of British Columbia, 2005 (Photo credit: Wikipedia)
State Medicaid Coverage Limited in Treating Painkiller Addiction — Stateline.
Excerpts from the 17 July 2013 article at Stateline Daily
To Mark Publicker, a doctor in Portland, Maine, who practices addiction medicine, it’s a clear case of discrimination. You wouldn’t deprive a diabetic of insulin. You wouldn’t stop giving hypertension drugs to a patient with high blood pressure after successful treatment. You wouldn’t hold back a statin from a patient with high cholesterol…
..
Many private insurance companies and state Medicaid agencies across the country impose sharp limitations on access to medications used in the treatment of the addiction to prescription painkillers known as opioids.
A report commissioned by the American Society of Addiction Medicine found that Medicaid agencies in just 28 states cover all three of medications that the Food and Drug Administration has approved for opioid addiction treatment: methadone, buprenorphine and naltrexone. The study also found that most state Medicaid agencies, even those that cover all three medications, place restrictions on getting them by requiring prior authorization and re-authorization, imposing lifetime limitations and tapering dosage strengths. The study was done by the substance abuse research firm Avisa Group.
“Now that we finally have medications that are shown to be effective and cost-effective it is shameful to throw up roadblocks to their use,” said Mady Chalk, director of the Center for Policy Research and Analysis at the Treatment Research Institute, which researches all aspects of substance abuse.
By any measure, there is an epidemic in the misuse of prescription drugs, most of it involving abuse of opioid painkillers such as OxyContin or Percocet. The Centers for Disease Control and Prevention reported that 12 million Americans acknowledged using prescription painkillers for nonmedical reasons in 2010.
…
Related articles
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- Doctors prescribe narcotics too often for pain, CDC chief says – Los Angeles Times (latimes.com)
- Newly born and withdrawing from drugs: As number of Maine babies exposed to opiates rises, experts explore new options (bangordailynews.com)
- How Long-Term Use of Painkillers Affects the Brain (painkillersaddiction.wordpress.com)
- CDC Chief: Doctors Prescribe Pain Killers Too Often (counselheal.com)
- Many Preventive Services Not Available To Medicaid Beneficiaries (medicalnewstoday.com)
- Accepting or Rejecting the Medicaid expansion provision contained in the ACA will be determined by outcome of the Virginia Governor’s race this November. (coherentramblingsforcoherentminds.wordpress.com)
Solve the outbreak!
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Public Health--Research & Library News
Do you want to be a disease detective? the Centers for Disease Control and Prevention (CDC) have released a new app, Solve the Outbreak.
New outbreaks happen every day and CDC’s disease detectives are on the front lines, working 24/7 to save lives and protect people. When a new outbreak happens, disease detectives are sent in to figure out how outbreaks are started, before they can spread. with this new, free app for the iPad, you can play the role of an Epidemic Intelligence Service agent. Find clues about outbreaks and make tough decisions about what to do next: Do you quarantine the village? Talk to people who are sick? Ask for more lab results?
With fictional outbreaks based on real-life cases, you’ll have to puzzle through the evidence to earn points for each clue. The better your answers, the higher your score – and the more quickly you’ll save lives…
View original post 33 more words
Children’s Environmental Health (Informative Web Page with Links from the US CDC)
The environment affects children differently than adults. Because their bodies are still growing, children are at greater risk if they are exposed to environmental contaminants. Contaminants are anything that can cause something to become unclean, polluted, or not pure. They can be found anywhere and some are unsafe. A toddler playing in dirt contaminated with high levels of lead can become sick from lead poisoning. A child with asthma playing outside when the air quality is bad may have an asthma attack. Environmental hazards are not just outside, but can also be found inside a child’s home or school. Children living in older homes with lead-based paint can get sick from breathing lead dust or swallowing chipping paint. Drinking water from a private well and even a community water system is also a concern if it’s contaminated. Bacteria and other harmful chemicals can be a threat to anyone’s health, but especially to young children.
Click here for the Daily Air Quality Forecast
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CDC Releases First FluView Report for 2012-2013 Influenza Season (Week ending October 13)
From the announcement
The Centers for Disease Control and Prevention today issued the first “FluView” influenza activity report for the U.S. 2012-2013 flu season. The 2012-2013 reporting season began on September 30. The first FluView report shows that influenza activity is low nationwide.This season, FluView has new interactive visualization tools.
Where
To access the FluView report please go to (www.cdc.gov/flu/weekly).
Additional Information
CDC routinely tracks influenza activity in the United States with a system that determines when and where influenza activity is occurring, what influenza viruses are circulating, and detects changes in influenza viruses.
The system also measures the burden of influenza disease in the United States, including tracking flu-related illness, hospitalizations and deaths. Data for the week ending October 6 indicate that influenza activity is low nationally at this time.This year, FluView includes enhanced web-based interactive applications which can provide dynamic visuals of the influenza data collected and analyzed by CDC. These FluView Interactive applications, allow people to create customized, visual interpretations of influenza data, as well as comparisons across flu seasons, regions, age groups, and a variety of other demographics.
CDC can’t predict how severe the upcoming flu season will be. However, the agency recommends that everyone 6 months of age and older get vaccinated against influenza each year. More than 112 million doses of seasonal influenza vaccine already have been distributed by vaccine manufacturers in the United States this season and more is expected.
For more information about influenza, please go to www.cdc.gov/flu/weekly/fluviewinteractive.htm
Here’s a few excerpts from the first weekly report (it is rather long and includes quite a few graphs and graphics)
U.S. Virologic Surveillance:
WHO and NREVSS collaborating laboratories located in all 50 states and Washington, D.C. report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. Region specific data can be found at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html.
Week 41 No. of specimens tested 3,285 No. of positive specimens (%) 129 (3.9%) Positive specimens by type/subtype Influenza A 61 (47%) 2009 H1N1 4 (6.6%) Subtyping not performed 31 (50.8%) H3 26 (42.6%) Influenza B 68 (53%) Centers for Disease Control and Prevention
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Weekly Report: Image Download
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“What Doctors Don’t Tell You” magazine – reviewed in BMJ and Quackometer
From the blog item by Gary Schwitzer at HealthNewsReview.org
Dr. Margaret McCartney, who helped launch the PrivateHealthScreening.org site we wrote about yesterday, has a piece in the BMJ this week, “What a new consumer health magazine doesn’t tell you.” (Subscription required for full access.) Excerpts:
“It looks just like any other magazine on the shelves of the newsagent aimed at middle aged women: glossy, 100 pages, with a smiling, confident looking woman on the cover. What Doctors Don’t Tell You, a monthly magazine that launched in September 2012, claims to explain how to “discover treatments that are safer and more effective.” …
In the October issue’s news section the article “Thyme is better for acne than creams” starts, “Thyme is more effective than prescription creams for treating acne . . .The herb outperformed pharmaceuticals in a series of laboratory tests, killing the actual bacteria that cause acne . . . Not only is thyme more effective, but it’s kinder on the skin too, say the researchers. Most pharmaceuticals cause a burning sensation and irritation to the skin, whereas thyme and other herbal preparations have none of these side effects.” The article references the Society for General Microbiology’s spring conference in Dublin this year. This research was reported through a press release; it was an in-vitro model; and the researchers did not compare side effects with current prescription creams.
Another article says, “Army personnel with noise deafness and tinnitus are commonly deficient in B12, but enjoy an improvement in symptoms after taking B12 vitamins.” The study referred to contained 12 patients receiving vitamin B12 and was not a randomised controlled trial.
The editorial on Gardasil, headed “Lock up your daughters,” warned that “your doctor and your daughter’s school nurse are not likely to tell you about the 100-plus American girls who suddenly died after receiving an HPV [human papillomavirus] vaccine.” Although there are valid concerns about the long term efficacy of HPV, to suggest that it has led to death is alarmist and does not reflect or explain the evidence collated by the Food and Drug Administration. Informed choice has to be about fair information, not scaremongering; we should hardly wish for a repeat of the measles, mumps, and rubella (MMR) vaccine debacle.
Although medical journals carry advertisements for drugs, the ones in this magazine are an extraordinary shrine to non-evidenced based medicine. …
It is right to criticise medicine, but the same standards must be applied to all interventions, “alternative” or not. We now realise how important it is to ensure that fair evidence, free of bias, is used in making medical decisions. There is no point in substituting bad medicine for bad science, and it is not clear from this magazine where the hierarchies of evidence stand, and the limitations and uncertainties that arise in research are not consistently explained. The magazine’s liability statement—“the publishers cannot accept any responsibility for any damage or harm caused by any treatment, advice or information contained in this publication”—should perhaps be better printed on the cover, in an unmissable font.”
She’s not the only one giving What Doctors Don’t Tell You a critical eye. The Quackometer blog refers to “Fifty Shades of Quackery.”
I’ll show you a screenshot from that blog that should be titillating enough to send you there to see more.
“It looks just like any other magazine on the shelves of the newsagent aimed at middle aged women: glossy, 100 pages, with a smiling, confident looking woman on the cover. What Doctors Don’t Tell You, a monthly magazine that launched in September 2012, claims to explain how to “discover treatments that are safer and more effective.” …
In the October issue’s news section the article “Thyme is better for acne than creams” starts, “Thyme is more effective than prescription creams for treating acne . . .The herb outperformed pharmaceuticals in a series of laboratory tests, killing the actual bacteria that cause acne . . . Not only is thyme more effective, but it’s kinder on the skin too, say the researchers. Most pharmaceuticals cause a burning sensation and irritation to the skin, whereas thyme and other herbal preparations have none of these side effects.” The article references the Society for General Microbiology’s spring conference in Dublin this year. This research was reported through a press release; it was an in-vitro model; and the researchers did not compare side effects with current prescription creams.
Another article says, “Army personnel with noise deafness and tinnitus are commonly deficient in B12, but enjoy an improvement in symptoms after taking B12 vitamins.” The study referred to contained 12 patients receiving vitamin B12 and was not a randomised controlled trial.
The editorial on Gardasil, headed “Lock up your daughters,” warned that “your doctor and your daughter’s school nurse are not likely to tell you about the 100-plus American girls who suddenly died after receiving an HPV [human papillomavirus] vaccine.” Although there are valid concerns about the long term efficacy of HPV, to suggest that it has led to death is alarmist and does not reflect or explain the evidence collated by the Food and Drug Administration. Informed choice has to be about fair information, not scaremongering; we should hardly wish for a repeat of the measles, mumps, and rubella (MMR) vaccine debacle.
Although medical journals carry advertisements for drugs, the ones in this magazine are an extraordinary shrine to non-evidenced based medicine. …
It is right to criticise medicine, but the same standards must be applied to all interventions, “alternative” or not. We now realise how important it is to ensure that fair evidence, free of bias, is used in making medical decisions. There is no point in substituting bad medicine for bad science, and it is not clear from this magazine where the hierarchies of evidence stand, and the limitations and uncertainties that arise in research are not consistently explained. The magazine’s liability statement—“the publishers cannot accept any responsibility for any damage or harm caused by any treatment, advice or information contained in this publication”—should perhaps be better printed on the cover, in an unmissable font.”
She’s not the only one giving What Doctors Don’t Tell You a critical eye. The Quackometer blog refers to “Fifty Shades of Quackery.”
Related Resource
- Patients want to understand the medical literature (with links to resources for patients)(jflahiff.wordpress.com)
- patientINFORM plain language summary Web sites are provided by participating publishers to help patients or their caregivers more fully understand the implications of research and to provide links to the full text of research articles they’ve selected from participating journals. The publishers allow readers following links from patientINFORM material on the health organizations’ sites to access the full text of these articles without a subscription, and they provide patients and caregivers with free or reduced-fee access to other articles in participating journals.
- “Summaries for Patients” are brief, non-technical summaries of studies and clinical guidelines published inAnnals of Internal Medicine. The Summaries aim to explain these published articles to people who are not health care providers.
- Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Analysis)
- How to Evaluate Health Information on the Internet (US National Cancer Institute)
- Quackwatch (a private corporation operated by Stephen Barrett, MD)
-
…And a Rumor Control site of Note (in addition to Quackwatch)National Council Against Health Fraud National Council Against Health Fraud is a nonprofit health agency fousing on health misinformation, fruad, and quackery as public health problems. Links to publications, position papers and more.
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U.S. Launches Interactive HIV/AIDS Database on Census.gov
From the July 23 2012 US Census press release
The U.S. Census Bureau today launched aninteractive global resource on the prevalence of HIV infection and AIDS cases and deaths. The database was developed in 1987 and now holds 149,000 statistics, an increase of approximately 10,800 new estimates in the last year, making it the most complete of its kind in the world. The launch comes as thousands of people worldwide meet in Washington, D.C., for the International AIDS Conference this week.
The resource is maintained by the Census Bureau with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).
U.S. Global AIDS Coordinator Ambassador Eric Goosby, head of PEPFAR, said on the launch, “This release of the HIV/AIDS database will expand global access to data that are critical to understanding the epidemic. This information is invaluable for the evidence-based response PEPFAR is championing.”
Census Bureau Director Robert Groves said “This database provides the people who need it with quality statistics — supporting the life-saving efforts of our partners at PEPFAR and USAID and the doctors, nurses and public health officials working to reach the end of AIDS.”
The tool is a library of statistics from more than 12,000 articles in international scientific and medical journals, individual countries’ annual HIV/AIDS surveillance reports, and papers and posters presented at international conferences.
The menu-driven access tool permits users to search for statistical information in countries and territories across the world, as well as by subpopulation, geographic subarea (such as urban and rural), age, sex and year (back to 1960).
Statistics for the United States are available separately from the Centers for Disease Control and Prevention.
Related articles
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Highest-Value Preventive Services Save Billions if Applied to 90 Percent of U.S. Population
From the 12 June 2012 article at the Robert Woods Foundation Web site
Identifying the highest-value clinical and community preventive services
Published: Jun 12, 2012
Dates of Project: 2006–2012
Field of Work: Identifying high-value evidence-based clinical and community preventive services.
Problem Synopsis: The health impact and cost-effectiveness of clinical preventive services such as smoking cessation or breast cancer screening needs to be examined and re-examined as more and better data becomes available, and as analytical tools improve. Disparities in the use of services also need to be examined and documented.
Similarly, preventive interventions to improve health at the community level such as seat belt laws, need to be examined for their health and economic impact.
Synopsis of the Work: A research team at the Partnership for Prevention:
- Updated rankings of clinical preventive services recommended by the U.S. Preventive Services Task Force
- Estimated the health and economic benefits for the U.S. population and selected subpopulations of increasing their use
- Quantified disparities in their provision
- Developed and tested methods for estimating the health and economic impact of interventions to improve health at the community level that were recommended by the Centers for Disease Control and Prevention
Key Results and Findings:
- The research team updated the rankings of clinical preventive services recommended by the CDC. When published in 2012, the analysis will show that highly rated services—including childhood immunizations, tobacco cessation counseling, and discussing daily aspirin use to prevent heart disease—continue to be a good value because of their health impact and cost-effectiveness.
- The team found that providing 90 percent of the U.S. population with three clinical preventive services—tobacco cessation screening and assistance; discussing daily aspirin use; and alcohol screening with brief counseling—would generate an estimated net savings of more than $1 billion each, per year. In addition, these three services plus colorectal cancer screening each would prevent the loss of more than 100,000 years of life, a year.
- The team found troubling disparities, and specific opportunities for improvement, in the use of clinical preventive services among racial and ethnic populations.
- The team created analytic tools to assess the health and economic benefits of interventions to improve health and prevent disease at the community level, and used them to assess interventions to reduce tobacco use and increase physical activity.
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-
Journals call for integration between public health and primary care (PublicHealthNewsWire)
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- Key Preventive Health Services – Only Half Of U.S Adults Benefitted Before 2010 (medicalnewstoday.com)
- Many Lacked Preventive Care Before Health Reform Law: U.S. Report (news.health.com)
- No Preventive Care For 1 In 2 U.S. Adults (personalliberty.com)
- A population health approach to wellness (kevinmd.com)
- 90-95% of Cancers are Preventable (anoil4everyailment.com)
CDC Study Finds Universal Motorcycle Helmet Laws Increase Helmet Use, Save Money
http://www.cdc.gov/media/releases/2012/p0614_motorcycle_laws.html
Annual cost savings in states with universal motorcycle helmet laws were nearly four times greater (per registered motorcycle) than in states without these comprehensive laws, according to a Morbidity and Mortality Weekly Report study released by the Centers for Disease Control and Prevention…
…
Helmets prevent 37 percent of crash deaths among riders and 41 percent among passengers. They also prevent 13 percent of serious injuries and 8 percent of minor injuries to riders and passengers.
Related articles
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- Study Finds Universal Motorcycle Helmet Laws Increase Helmet Use, Save Money (cdc.gov)
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- CDC: Motorcycle helmet laws reduce deaths (mercurynews.com)
- Motorcycle Helmet Laws Save Lives and Dollars: CDC (news.health.com)
- CDC: Motorcycle helmet laws reduce deaths (onlineathens.com)
- CDC: Motorcycle helmet laws reduce deaths [POLL] (azfamily.com)
- Motorcycle helmet laws reduce deaths, federal study says (thegazette.com)
Federal agencies should take advantage of opportunities to promote integration of primary care and public health
From the 28 March 2011 Eureka news alert
WASHINGTON — The traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of ensuring the health of populations, says a new report from the Institute of Medicine. Integration of these fields will require national leadership as well as substantial adaptation at the local level, said the committee that wrote the report.
[ The report is free and available at http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx
The above link also includes a briefing slides (an overview) and a report brief.]
The report recommends ways that the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) could foster integration between primary care and public health through funding, policy levers, and other means. Collaboration presents an opportunity for both primary care and public health to extend their reach and achieve the nation’s population health objectives, the committee noted.The committee’s recommendations are based on its review of published papers as well as case studies in specific cities — Durham, N.C.; New York City; and San Francisco — where integration efforts have taken place. The review showed that successful integration of primary care and public health requires community engagement to define and tackle local population health needs; leadership that bridges disciplines and jurisdictions and provides support and accountability; shared data and analyses; and sustained focus by partners.
The Patient Protection and Affordable Care Act (ACA) authorizes HRSA and CDC to launch several new programs. The agencies should coordinate these programs and funding streams with other partners at the national, state, and local levels to spur momentum. Promising opportunities include building incentives to promote interactions with local public health departments into HRSA’s funding for community health centers; encouraging hospitals to treat primary care and community health as priorities as they strive to earn federal tax exempt status through demonstrated community benefits; and fostering collaboration among health departments and community health centers to improve the provision of preventive clinical services to Medicaid recipients.
The medical home model and the new accountable care organizations (ACOs) established by ACA also offer opportunities for integration. As more primary care practices move toward the patient-centered medical home model, public health departments could work with these practices and spread the benefits of care coordination to the community, the committee said. As ACOs — groups of hospitals and clinicians that work together to provide primary care and other health care services to Medicare beneficiaries — begin operating, they should reach out to health departments to forge links to community programs and public health services.
Training primary care and public health professionals in aspects of each other’s fields will help promote a more integrated work force, the report adds. HRSA and CDC should work together to develop training grants and teaching tools that can prepare the next generation of health professionals for shared practice. For example, HRSA should use its Title VII and VIII primary care training programs to support curriculum development and training opportunities that involve aspects of public health, and CDC’s Epidemic Intelligence Service officers could assist HRSA-supported community health centers in using public health data to guide the care they provide.
“While integrating fields that have long operated separately may seem like a daunting endeavor, our nation has undertaken many major initiatives, such as building both a national hospital system and an extensive biomedical research infrastructure and significantly expanding high-tech clinical capacity through investments in specialty medicine,” said committee chair Paul J. Wallace, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group, Falls Church, Va. “It’s time we did the same for primary care and public health, which together form the foundation of our population’s overall well-being. Each of these foundational elements could be stronger if they were better coordinated and collaborated more closely.”
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The report was sponsored by the Centers for Disease Control and Prevention, Health Resources and Services Administration, and United Health Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The Institute of Medicine, National Academy of Sciences, National Academy of Engineering, and National Research Council together make up the independent, nonprofit National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.
New community health approach aims to combats chronic disease, empower patients, reduces costs
From the 8 February 2012 Eureka News Alert
New community health approach aims to combats chronic disease, empower patients, reduces costs
Value of Accountable Care Community approach to public health promotion and disease prevention outlined in new paper released today
AKRON, Ohio, February 8, 2012 – A new community-wide collaboration to reduce the impact of chronic disease and empower patients is generating impressive early results, leaders of the Accountable Care Community (ACC) initiative said today. The Akron-based Austen BioInnovation Institute in Akron (ABIA) is leading the initiative with its founding institutional members and more than 60 public and private community partners.
The groundbreaking effort supported by the Centers for Disease Control and Prevention unites medical, public health and social science professions, nonprofits and faith-based and community organizations for an “all-hands-on-deck” approach to public health. Eventually, communities across the country will be able to apply this new model toward public health, reducing the tremendous negative impact chronic disease has on their economies, said Dr. Janine Janosky, head of ABIA’s Center for Community Health Improvement, who is leading the effort described in a white paper released today.
The news comes just weeks after an Institute of Medicine report called for a new public health approach based on “enhanced collaboration among the public health, health care and community non-healthcare sectors” to address the challenges of chronic disease. The World Health Organization refers to the growing impact of chronic disease as “a global epidemic” reaching crisis levels. The Robert Wood Johnson Foundation estimates that by 2030, half the U.S. population will have at least one chronic condition.
The ABIA, along with national experts and more than 60 Akron organizations, have been collaborating for more than a year on a new, integrated, and measurable strategy to community health that could be replicated in other U.S. communities. The ACC approach detailed in the report “Healthier by Design: Accountable Care Community” utilizes a unique “impact equation” that measures the benefits of a seamless approach to community health, including metrics for a patient empowerment and market value of health, said Dr. Frank L. Douglas, ABIA president and chief executive officer.
“The amount spent on healthcare and health initiatives in the United States should translate into good health for the community and its residents. Unfortunately, America’s public health continues to lag behind other nations. Further, we are now in an era of debate about how to reverse the unsustainable cost trends and improve the health outcomes and quality of life for our fellow man,” Dr. Douglas said. “The development of this inventive Accountable Care Community model, which not only speaks of the need for collaboration but actually enables all parties to be on the same page with an integrated, measurable strategy, promises to improve the health of millions of patients.”
In Akron, the ACC approach uniquely aligns public, private and philanthropic resources in a coordinated fight to improve community health by identifying and closing gaps in health education, access and delivery. The group’s initial pilot project focused on diabetes self-management. Ultimately, participants changed their behaviors and took increased control over their disease. Significant results included decreases in blood sugar and bad cholesterol levels, weight loss, decreased body mass, and a decline in emergency room visits. An additional program demonstrated nearly a total of $225,000 of cost savings or cost avoidance for local healthcare institutions through the use of volunteers and community services to monitor and serve low-income, medically underserved patients with diabetes….
Related articles
- Collaborative Care for Living Well with Chronic Disease (recruitingforhealthcarejobs.wordpress.com)
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National Intimate Partner and Sexual Violence Survey (NISVS)
From the US Centers for Disease Control and Prevention Web site
On average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States, based on a survey conducted in 2010. Over the course of a year, that equals more than 12 million women and men. Those numbers only tell part of the story—more than 1 million women are raped in a year and over 6 million women and men are victims of stalking in a year. These findings emphasize that sexual violence, stalking, and intimate partner violence are important and widespread public health problems in the United States.
Sexual Violence Victimization
More than three-quarters of female victims of completed rape (79.6%) were first raped before their 25th birthday, with 42.2% experiencing their first completed rape before the age of 18 (29.9% between 11–17 years old and 12.3% at or before age 10) (Figure 2.2).
More than one-quarter of male victims of completed rape (27.8%) were first raped when they were 10 years old or younger (data not shown).
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- Sexual Violence, Stalking, and Intimate Partner Violence Widespread in the U.S. (prnewswire.com)
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- Sexual Violence, Stalking, and Intimate Partner Violence Widespread in the US (cdc.gov)
- CDC: Startling data about sexual, physical violence (seattletimes.nwsource.com)
- What Does CDC’s New Data About Sexual Assault Reveal? (thefrisky.com)
- Nearly 1 in 5 Women in U.S. Survey Report Sexual Assault (nytimes.com)
- CDC survey finds nearly 1 in 5 US women report sexual assault (abclocal.go.com)
- Survey: 1 in 3 women affected by partner’s violent behavior (cnn.com)
- Intimate Partner Violence in the US (feministphilosophers.wordpress.com)
- A call to action prompted by violence against women (seattletimes.nwsource.com)
- LGBTQ Intimate Partner Violence Up in 2010, Says Report (pinkbananaworld.com)
- Nearly 1 in 5 US women have been victims of sexual assault, CDC finds (guardian.co.uk)
States could see substantial savings with tobacco control programs
States could see substantial savings with tobacco control programs
From the Eureka News Alert, Mon Nov 28, 2011 00:00
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- Tobacco Use Prevention and Global Health Effectiveness (gph2110.wordpress.com)
- CDC: States with Strong Tobacco Control Programs More Likely to Reduce Smoking Rate (ibtimes.com)
- Smoking Down Over Five-Year Period (prweb.com)
- The economic benefits of tobacco control rapidly outweigh tobacco tax revenues (gizmag.com)
CDC Issues Initial 2011-2012 Seasonal FluView Report

CDC Issues Initial 2011-2012 Seasonal FluView Report
http://www.cdc.gov/media/releases/2011/p1014_fluview_report.html
The Centers for Disease Control and Prevention has released the initial FluView report for the U.S. 2011-2012 flu season with the message that flu activity is currently low, making this the perfect time to get vaccinated.
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- Annual Childhood Flu Vaccines May Interfere With Development of Crossresistance (jflahiff.wordpress.com)
- More Than 690,000 Americans Have Already Been Vaccinated Against The Flu This Season, SDI Reports – Cdc Supports Expanded Access To Flu Vaccination (prweb.com)
- Flu season is coming. Are you ready? (today.msnbc.msn.com)
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HPV vaccine myths put health, lives at risk, say health leaders: Airing the facts
HPV vaccine myths put health, lives at risk, say health leaders: Airing the facts.
Excerpts from this blog item from the American Public Health Association
HPV vaccine myths put health, lives at risk, say health leaders: Airing the facts
Vaccination rates for human papillomavirus are lagging for teens, and a complicated web of confusion and misinformation may be to blame, according to public health leaders.
Several strains of HPV can cause cervical cancer, and two vaccines, Gardasil and Cervarix, have been shown conclusively to defend against those strains. The Food and Drug Administration recommended in 2006 that girls receive the vaccine before they become sexually active so that they are protected at the outset. In 2009, FDA approved the use of the vaccine for boys as well.
According to the Centers for Disease Control and Prevention, about 6 million people in the U.S. become infected with HPV each year and each year about 12,000 women are diagnosed with cervical cancer, leading to about 4,000 deaths.
Studies have shown the vaccine to be overwhelmingly safe, CDC said. As of June 2011, about 35 million doses of Gardasil had been distributed in the United States. CDC’s adverse event tracking mechanisms reported about 18,000 adverse events, 92 percent of which were nonserious events, such as fainting, swelling at the injection site and headache. Sixty-eight deaths were reported, but there is “no unusual pattern or clustering to the deaths that would suggest that they were caused by the vaccine, and some reports indicated a cause of death unrelated to vaccination,” CDC said.
And yet, fed perhaps by misinformation or squeamishness about the idea of their children becoming sexually active, some parents are opting not to vaccinate, and the vaccination rates are lagging, according to CDC.
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- Michele Bachmann (R-Mars): HPV Vaccine ‘Ravages’ Girls (littlegreenfootballs.com)
- HPV vaccine (bupa.com.au)
- Massive HPV And Rubella Vaccine Campaign For Girls And Women Globally (medicalnewstoday.com)
- Vital Signs: Dozens of HPV Types Are Not Yet Competing (nytimes.com)
- Males 11-21 Should Get Gardasil HPV Vaccine (children.webmd.com)
- CDC could soon recommend boys receive HPV vaccine (cnn.com)
- HPV Vaccines not Monitored on Canadian Reservations (indiancountrytodaymedianetwork.com)
- Educating Teens, Parents May Reverse Lack of Vaccinations (livescience.com)
- Special Editorial: Should I vaccinate my child against HPV? (child-psych.org)
Syphilis Rises 36% In USA In Four Years
[On a personal note, I believe I knew 2 men in Liberia who had STD’s. One developed an eye condition that is usually caused by syphilis, another developed sporadic muscle spasms that are usually associated with syphilis..
Now I think that when I was in Liberia in 1980/81 as a Peace Corps in education, I should have taught a whole week on sexually transmitted diseases…1980 was the year HIV/AIDS was identified as a disease I think]
From the 17 November 2011 Medical News Today page
From 2006 to 2010, the number of reportedsyphilis cases in the USA rose 36%. Among young, African-American males the rate rose by 135%, according to a report issued by the Centers for Disease Control and Prevention (CDC).
The authors explained that sexually transmitted diseases (STDs) are hidden epidemics of huge health and economic consequences in the USA. STDs are called hidden epidemics because a considerable number of infected people are unwilling to come forward openly, and also because of the social and biologic characteristics of these types of diseases.
The authors wrote:
“All Americans have an interest in STD prevention because all communities are impacted by STDs and all individuals directly or indirectly pay for the costs of these diseases.”
The CDC believes that sexually active males with male partners should be screened for STDs once every three months, rather than yearly.
Gonorrhea – reported cases of gonorrhea fell 16% over the four-year period, down to their lowest levels ever. However, over the last year they have risen slightly. In 2010 there were over 300,000 reported cases. According to some CDC surveillance systems, gonorrhea is becoming resistant to the only medication available for this disease.
Chlamydia – the number of reported cases rose 24%, due to an increase in screenings. There were approximately 1.3 million cases reported in 2010. The majority of people in America with Chlamydia are undiagnosed – they don’t know they have it. The CDC recommends that all sexually active young women be screened annually; less than half of them do so.
Syphilis – after a long period of increased rates, the incidence of syphilis dropped 1.6 since 2009. The rate among young, African-American males rose 134% from 2006 to 2010. The rate among African-American MSM (men who have sex with men) rose considerably, the reported added.
Nineteen million new cases of STDs are diagnosed annually in the USA. STDs cost the health-care system $17 billion a year.
Of those in high risk groups, only half are being tested, the authors wrote. A significant number of infected individuals are unaware, because they have no symptoms……
Educational Resources
- 2010 Sexually Transmitted Diseases Surveillance (US Centers for Disease Control)
- Sexually Transmitted Diseases(US Centers for Disease Control) –publications, fact sheets, and more
From the MedlinePlus page for Sexually Transmitted Diseases
-
Overviews
- Sexually Transmitted Diseases (STDs)(Mayo Foundation for Medical Education and Research)
- Sexually Transmitted Diseases (STDs)
(National Institute of Allergy and Infectious Diseases)
- Sexually Transmitted Diseases (STDs)
(National Institute of Child Health and Human Development)
-
Diagnosis/Symptoms
- Genital Problems in Men(American Academy of Family Physicians)
- Genital Problems in Women(American Academy of Family Physicians)
- STD Symptoms: Common STDs and Their Symptoms(Mayo Foundation for Medical Education and Research)
-
Prevention/Screening
- Condoms(Mayo Foundation for Medical Education and Research)
- STD Testing: What to Know Before Your Appointment(Mayo Foundation for Medical Education and Research)
-
Specific Conditions
- Gonorrhea, Chlamydia, and Syphilis(American College of Obstetricians and Gynecologists)
- Granuloma Inguinale(Merck & Co., Inc.)
- Lymphogranuloma Venereum (LGV)(Centers for Disease Control and Prevention)- PDF
- Also available in Spanish
- Molluscum (Molluscum Contagiosum)(Centers for Disease Control and Prevention)
- Pubic “Crab” Lice (Pthiriasis)(Centers for Disease Control and Prevention)
- Return to top
-
Related Issues
- Cervicitis(Mayo Foundation for Medical Education and Research)
- Hepatitis B(American Academy of Family Physicians)
- Also available in Spanish
- Role of STD Detection and Treatment in HIV Prevention(Centers for Disease Control and Prevention)
- Also available in Spanish
- STDs and Related Conditions (and Oral Health)(Columbia University, College of Dental Medicine)
- Vaginitis
(National Institute of Allergy and Infectious Diseases)
- Return to top
-
Pictures & Photographs
- Lymphogranuloma Venereum (LGV)(Logical Images)
- Molluscum Contagiosum(Logical Images)
- Pubic Lice (Pediculosis Pubis)(Logical Images)
- Return to top
-
Health Check Tools
- Genital Pain in Men(DSHI Systems)
- Genital Sores(DSHI Systems)
- Vaginal Discharge(DSHI Systems)
- Return to top
-
Tutorials
- Sexually Transmitted Diseases(Patient Education Institute)
- Also available in Spanish
- Return to top
Related articles
- Syphilis rates drop, but STDs still big problem (msnbc.msn.com)
- Syphilis Increase in U.S. Leads to Call for More Screenings (businessweek.com)
- New STD Rates “Shockingly High” (dgsma.wordpress.com)
- Report: Blacks Hit by STDs More Than Whites (theroot.com)
- Chlamydia Tops STDs Reported to CDC (webmd.com)
- Two sex-spread diseases increase, syphilis down (seattletimes.nwsource.com)
- New Data Show Syphilis Threatens the Health of a New Generation of Gay and Bisexual Men (cdc.gov)
- CDC: Fewer teens are having sex (marksloanmd.wordpress.com)
US Centers for Disease Control and Prevention (CDC) Social Media Options
The US Centers for Disease Control and Prevention (CDC) has many social media options for one to keep informed on CDC campaigns, health and safety news and information, and educational resources.
Social Media campaigns all one to explore CDC’s current efforts in subjects as Peanut Butter Recalls.
CDC conveys information through a variety of social media tools as blogs, email updates, podcasts, and online video.
Social networking sites include Facebook, MySpace, and Daily Strength. Daily Strength is a collection of safe, anonymous, online support groups focused on specific health topics to help people overcome their personal challenge or support a loved one through theirs. CDC hosts a group page on DailyStrength that provides access to CDC’s featured health information to empower individuals to lead healthier, safer lives.
The content at the CDC’s social media Web site can be overwhelming.
Another approach would be to search CDC for a topic of interest at the CDC home page. Each topic will have links to related social media. Try these approaches from the CDC home page.
- click on Diseases and Conditions, then select a specific disease or condition.
- click on Emergency Preparedness and Response, then Social Media (within Radiation information box)