Recently in Public Health Category

Your immune system is a tremendously sustainable system! But we can exercise it with a dose of... laughter.

John Cleese takes us on a tour of a laughter therapy practice in India.

Laughter promotes stress reduction, community bonding, stronger immune system... and joy. What a simple solution!

Nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and '70s.

These new medical schools are seeking to address an imbalance in American medicine that has been growing for a quarter century.

Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. 

In a weird aberration of "outsourcing", the medical field was outsourcing medical education to foreign countries, and then hiring foreign nationals to work in our American healthcare system, presumably at lower rates and longer hours.

During the 1980s and '90s only one new medical school was established.

"Huge numbers of qualified American kids were not getting into American medical schools or going abroad to study," Dr. Lawrence G. Smith, dean of the proposed Hofstra University School of Medicine, in Hempstead, N.Y., which is not yet recruiting students, said last week. "I think it was a kind of wake-up call."

The proliferation of new schools is also a market response to a rare convergence of forces:

• a growing population;
  
• the aging of the health-conscious baby-boom generation;
  
• the impending retirement of, by some counts, as many as a third of current doctors;
  
• the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.

Colleges serve a "Gatekeeping Function" as well as education of new practitioners.  By carefully limiting the number of trained professionals, those with established careers have less competition -- and that can be important to personal care services that must maintain a full staff even when they have a light load of patients.  Under-staffing also causes long delays in getting an appointment, and has healthcare consequences when care is delayed.

If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country.

Read more at the REFERENCE SOURCE:  New York Times

Despite a general belief among physicians that extreme obesity is too difficult to treat, except with bariatric surgery, researchers at the Pennington Biomedical Research Center have learned a substantial proportion of individuals with extreme obesity can lose 10-percent or more of their body weight through medical treatment that does not include surgery.

10% Loss Improves Risk Factors and Health

Furthermore, even though those individuals are still obese, they have improvements in risk factors and other health markers.

Weight Loss Surgery Not Often Affordable or Reimbursed by Insurance

"This is important, because surgery is not often affordable or reimbursed by insurance," said leading scientist Dr. Donna Ryan. "In fact, many medical treatments are frequently not reimbursed by insurance if they are for obesity. So this research is needed to show that primary care doctors are capable of helping obese patients lose weight to improve health, even those with extreme obesity. "

Ryan said losing only five-percent of body weight can reap healthy benefits for the extremely obese, and nearly 61-percent of those in her clinical trial achieved that. More than 40-percent lost 10-percent body weight or more.

Physicians Trained in Intensive Medical Intervention

Ryan and her team spread out across Louisiana to recruit and train practicing physicians and their office staffs in eight cities in what she called "intensive medical intervention," in which physicians used a combination of medication, low-calorie diets and behavior changes. All of the techniques were endorsed by national guidelines for obesity management. Training of physicians and their staffs took about a day and a half.

Funded by the Louisiana Office of Group Benefits, which provides health coverage for state employees, the research team contacted state employees, seeking participants to screen for and enroll in the trial. Nearly 400 participants enrolled in the two-year trial, called LOSS, using the nearest trained physicians.

About half of the participants received the intensive medical intervention, the other half received what Ryan called "usual care." 

Program Starts with Low-calorie Liquid Diet

Those in the intense intervention group were immediately placed on a low-calorie liquid diet. They gradually moved to a low calorie, highly controlled diet using meal replacements, and received weight loss medication and group behavioral therapy that included lessons in exercise, activity, self-monitoring and recommendations for walking, water exercise and weight training. The group sessions were supervised by office staff.

Recommended Activities

• exercise
• activity
• self-monitoring
  
• recommendations for walking
• water exercise
  
• weight training

Success in Daily Routine of Doctor's Practice

"We conducted this trial as close to the reality of a typical clinic setting as we could," Ryan said, "We didn't want to learn just if these strategies worked, but if they would work in the daily routine of a doctor's practice."

Challenge of Keeping Weight Off

Ryan noted that the continual challenge in weight loss is keeping weight off, and that means sticking with a routine.

More than 50% of the LOSS participants stuck with it for two years or more, keeping much of the weight off, but Ryan said that does leave room for improving weight loss maintenance.

The LOSS trial results were published in the current issue of the Archives of Internal Medicine.

The Pennington Biomedical Research Center is a campus of the Louisiana State University System and conducts basic, clinical and population research.

More information about recalled food products is available on the Food Safety and Inspection Service Web site at http://www.fsis.usda.gov/

Federal Food Safety and Inspection
The Food Safety and Inspection Service (FSIS) is the public health agency in the U.S. Department of Agriculture responsible for ensuring that the nation's commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged.

Product Recall Specifics:  Call the Manufacturing  Company
Consumers with questions regarding recalled items should contact companies that issue recalls.

Testing Products for Safety
The Hygienic Laboratory in Iowa is one example of food testing to prevent outbreaks spreading. With techniques such as DNA fingerprinting, lab testing can identify specific contaminants, such as Salmonella.

The Hygienic Laboratory is the state of Iowa's environmental and public health laboratory, with facilities located at the University of Iowa's Research Campus in Iowa City and at the Iowa Lab Facilities in Ankeny, a Des Moines suburb. For more information about the laboratory and its programs and services, visit http://www.uhl.uiowa.edu.

Research of hearing loss has been difficult over the years.  New research is tracking how premature infants lose hearing, and how it can be prevented.  This knowledge could have broader application to adults.

Both humans and mice are particularly vulnerable to noise- and drug-induced hearing loss at young ages.

Sound levels measured by Clark and Weathers showed that premature infants being airlifted tested were exposed to almost 100 decibels for a period of 12 minutes before takeoff, similar to a lawn mower or chain saw. These levels could be especially damaging to premature babies.

"The laboratory mouse is a well-established model for human hearing," says coauthor Kevin K. Ohlemiller, Ph.D., research associate professor of otolaryngology. "They possess similar inner ear anatomy and physiology and similar patterns of age-related, noise-induced and drug-related hearing loss."

Ohlemiller worked with Elizabeth A. Fernandez, then a doctoral student in the Program in Audiology and Communication Sciences, to see if loud noise and a low dose of kanamycin would exacerbate each other's effects. Because the first month of life is when mice are most vulnerable to noise and drugs that damage hearing, 20- to 30-day old mice were injected with either kanamycin or saline solution twice a day for 11 days. They were then exposed to 110 decibels of noise for 30 seconds.

Two surprising findings arose.

First, this particular strain of mice was very sensitive to noise-induced hearing loss. Significant loss of some sensory cells in the ear resulted in permanent hearing damage, even over the short time span.

Second, a regular, low dose of kanamycin completely protected the mice against this sensory cell damage and hearing loss. The protective effect of repeated doses persists for at least two days after the last injection, the scientists noted.

Researchers plan to use these hearing research findings in a number of ways.

They can map the genes in this strain of mice to determine what makes them so noise-sensitive and possibly figure out how kanamycin protects sensory cells in the ear.

In addition, the findings open up new possibilities for clinical research.

Learning how kanamycin protects the ear's sensory cells could help scientists develop drugs with similar effects. Medications that protect the ears from damaging noise levels could benefit a wide range of groups, from soldiers to airline workers to premature babies.

Basic Science Research PLUS Clinical Problem & Practice

"This very dramatically points out the benefits of having basic scientists who can take a clinical problem and find a result opposite of what we expected," Clark says. "These results not only energize laboratory scientists and begin new lines of research, but they also have implications for clinical practice. This has been an amazing sequence of events, to start a project in a helicopter and end up under a microscope."

Fernandez EA, Ohlemiller KK, Gagnon PM, Clark WW. Protection against noise-induced hearing loss in young CBA/J mice by low-dose kanamycin. Journal of the Association for Research in Otolaryngology. Jan. 22, 2010 (advance online publication).

Funding from National Institutes of Health and the Washington University School of Medicine in St. Louis Department of Otolaryngology supported this research.

Chronic kidney disease affects 26 million people in the United States.

Challenging prevailing wisdom that only children with end-stage kidney disease suffer physical, social, emotional and educational setbacks from their disease, research led by Johns Hopkins Children's Center shows that even mild to moderate kidney disease may seriously diminish a child's quality of life.

The findings, reported in the February issue of Pediatrics, suggest that earlier attention to quality-of-life issues in children with chronic kidney disease is needed.

"Even mild and moderate declines in kidney function may lead to serious physical, emotional, intellectual and social challenges," says lead investigator Arlene Gerson, Ph.D., a pediatric psychologist at Hopkins Children's.

Kidney Disease Screening is Needed

"What this means is we should be thinking about screening children for these challenges and intervening earlier than we once thought."

Recently diagnosed children who report learning problems may benefit from help before grades drop, researchers say, noting that children with chronic diseases currently do not qualify for special education until their scores decline dramatically.

Links Between Kidney Function and Quality of Life

In their study of 402 children, ages 2 to 16, with mild-to-moderate kidney disease, researchers analyzed the link between kidney function, disease severity, age of onset and disease duration, on the one hand, and physical, emotional, psychological and school functioning on the other.

The researchers also compared quality-of-life outcomes between healthy children and children with early-stage kidney disease. Children with mild-to-moderate kidney disease and their parents reported worse overall outcomes on standard quality-of-life questionnaires and worse outcomes on all quality-of-life factors.

Specifically, children with early-stage kidney disease scored on average 75 out of 100 on quality-of-life measures, compared to 83 out of 100 for healthy children. The difference was especially pronounced in school functioning, where children with early-stage kidney disease scored 64 out 100, compared to 80 out of 100 for healthy children.

How Children Cope with Kidney Disease

The study also found that the younger the child at the time of the diagnosis and the longer the child lived with kidney disease, the better the overall quality of life, a surprising finding, suggesting that as time passes children learn to cope better with their condition, the researchers say.

The researchers found that children with impaired growth and shorter stature, a common effect of their disease, had worse overall quality of life and poorer physical functioning, an indicator of the importance of early treatment.

Treatments for Children's Kidney Disease

"Timely and individually tailored treatment, be it with nutrition, salt supplements or growth hormones, if needed, can make a big difference. We cannot overemphasize the importance of early intervention in children with early stages of chronic kidney disease," says senior investigator Susan Furth, M.D. Ph.D., a pediatric nephrologist at Hopkins Children's.

The research is part of an ongoing 57-center study funded by the National Institutes of Health to study chronic kidney disease in children.

EnviroFacts is an online tool that maps your area of choice with specific details about water quality, hazardous waste, air and land toxics, compliance issues and more.

Pollution Map...Online

The free online tool is based on GIS (Geographic Information Systems) where data is input into a visual format like a map. You can customize the type of information to display on your map or even map by topic instead of location to learn more about that issue. Search by Zip Code, City or County.

Check on the UV Index for your area... or who produces air emissions!
Identify Brownfields, or Hazardous Waste Sties... or Water Discharges... or Public Water Systems Violations...

It pays to know where invisible or hidden dangers lurk...

Research a neighborhood before you move there!
Reserach what's IN YOUR current neighborhood!
Find a community service project to clean up for your family and neighbors...

Learn about the natural systems in your community...and how they affect your health:

• Air
• Land
• Facilities
• Water
• Toxics
• Waste
• Radiation
• Compliance
• ...Other

Visit http://www.epa.gov/enviro/ to explore this newly updated program.

The possibilities are endless as you explore your world on a different level. This resource can be used for school or for your own personal interests. Maybe it could lead to community service projects based on the pollution issues in your area or a great visual for a class project. You can also take a look at the Community Service Projects page on EPA's High School Website or just see the resources out there for you to use.

Learning WHAT is in your community is the first, vital step to doing something about the problem -- and avoiding what can be harmful to you and your family.  Knowledge is power!

Learn more

Reduce Heart Disease, Stroke and Heart Attacks

Scientists writing in The New England Journal of Medicine conclude that lowering the amount of salt people eat by even a small amount could reduce cases of heart disease, stroke and heart attacks as much as reductions in smoking, obesity and cholesterol levels.

If Americans consumed half a teaspoon less salt per day, there would be between 54,000 - 99,000 fewer heart attacks each year and between 44,000 - 92,000 fewer deaths, according to the study, which was conducted by scientists at University of California San Francisco, Stanford University Medical Center and Columbia University Medical Center.

Processed Foods are the Key Source of Salt

Health authorities at federal, state and municipal levels are considering policies to mandate that food companies reduce salt in processed foods, which are considered to be the source of much of the salt Americans eat.

For 40 years in this country we've been trying to get individuals to reduce the amount of sodium we consume and it hasn't worked.

New York City announced an initiative to urge food manufacturers and restaurant chains to reduce salt in their products nationwide by 25 percent over the next five years.

California, according to an author of the study, Kirsten Bibbins-Domingo, an associate professor of medicine and epidemiology at University of California, San Francisco, is considering setting salt limits on food the state purchase for schools, prisons and other public institutions.

The Institute of Medicine, the independent research arm of the National Academies of Science, will be issuing a report soon that will make recommendations about reducing salt intake, including actions government and manufacturers can take.

The Food and Drug Administration was considering whether to change the designation of salt from a food additive that is generally considered safe to a category that would require companies to give consumers more information alerting them to high levels of salt in food.

Greatest Benefit:  Blacks, Hypertension and Seniors

The researchers found that everyone would benefit from less salt, but people at higher risk for heart problems -- blacks, people with hypertension and people over 65 -- would benefit most.

While research isn't showing that individuals will be greatly affected by small changes in salt intake, "Small incremental changes in salt, such as lowering salt in tomato sauce or breads and cereals by a small amount, would achieve small changes in blood pressure that would have a measurable effect across the whole population," researchers said.

Huh?  Does YOUR salt intake affect MY health?   I understand public health concepts, but this seems a bit strained.  However, if what they mean is that people who eat way too much salt will take action and reduce their personal health... I can see that rationale. 

In the meantime, ask your medical adviser if you are overdoing the salt for your own good health!

Read More at NY Times

December 14, 2009

Non-surgical Method for Diagnosing Breast Cancer Safe, Nearly as Effective as Surgical Biopsy, New Report Finds

Some methods of minimally invasive biopsy for breast cancer are nearly as accurate as surgical biopsy but have much less risk of harms, according to a new report funded by theUS HHS' Agency for Healthcare Research and Quality (AHRQ).

The report found that certain core needle biopsies could distinguish between malignant and benign lesions approximately as accurately as open surgical biopsy, which is commonly considered the "gold standard" method of evaluating suspicious lesions.

Core needle biopsies have a much lower risk of severe complications than open surgical procedures, researchers found in a report published this month in Annals of Internal Medicine.

The report also found that women who are initially diagnosed with breast cancer by surgical biopsy are more likely to undergo multiple surgical procedures during treatment than women who are initially diagnosed with breast cancer by core needle biopsy.

"One challenge of providing appropriate care for patients is finding balance between the accuracy of a test or procedure and causing the least harm and burden to patients," said AHRQ Director Carolyn M. Clancy, M.D. "This report indicates that core needle biopsy may strike that balance in many instances. Patients should continue to speak to their doctor when making important decisions about testing, and use all available information to make the decision that is right for them."

Open surgical biopsies, which involve removing a sample of tissue from the suspicious area through a surgical incision, are highly accurate. The procedure may be performed under general anesthesia, sedation plus local anesthesia, or local anesthesia only. But, while generally considered safe, open surgical biopsies are surgical procedures that, like all surgeries, carry a small amount of risk. Given that only a fraction of women who undergo breast biopsy procedures are diagnosed with cancer, use of traditional biopsy leads to large numbers of women who do not have cancer undergoing an invasive surgical biopsy.

By contrast, a core needle biopsy is a procedure that removes breast tissue through a hollow core needle inserted through the skin. The procedure is usually performed under local anesthesia. Multiple core-needle samples may be taken from the suspicious area.

Because it is less invasive, core-needle biopsy costs less than open surgical biopsy, consumes fewer resources, and generally is preferred by patients, according to the report.

The report found that recent technological improvements to core needle biopsy, including stereotactic guidance, ultrasound guidance and vacuum assistance, have improved the method's accuracy.

AHRQ's new report, Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions, is the newest analysis from the Agency's Effective Health Care program. That program, authorized by the Medicare Prescription Drug, Improvement and Modernization Act, represents an important Federal effort to compare alternative treatments for health conditions and make the findings public. The program is intended provide information in order to help patients, doctors, nurses, and others choose the most effective treatments. Information, including the new report and summary guides for clinicians and patients, can be found at http://www.effectivehealthcare.ahrq.gov.

In combination with the new penalties for violations of the HIPAA Privacy Rule, a use or disclosure of genetic information in violation of the HIPAA Privacy Rule could result in a fine of $100 to $50,000 or more for each violation.

The interim final rule will help ensure that genetic information is not used adversely in determining health care coverage and will encourage more individuals to participate in genetic testing, which can help better identify and prevent certain illnesses.

"Echoing the late Senator Ted Kennedy, our efforts to protect Americans undergoing genetic testing from having the results of that testing used against them by their insurance companies is one of the 'first major new civil rights' of the new century," said HHS Secretary Kathleen Sebelius.

Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases. Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.

The interim final rule with request for comments and the notice of proposed rulemaking implement Title I of the Genetic Information Nondiscrimination Act of 2008 (GINA). Under GINA, and the interim final rule, group health plans and issuers in the group market cannot:

• increase premiums for the group based on the results of one enrollee's genetic information;
• deny enrollment; impose pre-existing condition exclusions;
  
• or do other forms of underwriting based on genetic information.
  
• In the individual health insurance market, GINA prohibits issuers from using genetic information to deny coverage, raise premiums, or impose pre-existing condition exclusions.
• Group health plans and health insurance issuers in both the group and individual markets cannot request, require or buy genetic information for underwriting purposes or prior to and in connection with enrollment.
  
• Plans and issuers are generally prohibited from asking individuals or family members to undergo a genetic test.

"Today's genetic technologies yield data that are vital to helping Americans make personal, medical decisions. It is essential that we protect such information and ensure it is not misused by health plans or insurers," said Labor Secretary Hilda L. Solis. "The rules issued today protect individuals against the unwarranted use of information related to their personal health because no one should have to fear that disclosure of their medical data will put their job or health coverage at risk."

Additionally, HHS, through its Office for Civil Rights (OCR), issued a notice of proposed rulemaking with a 60-day comment period, to propose changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to prohibit health plans from using or disclosing genetic information for underwriting purposes.

Please visit http://edocket.access.gpo.gov/2009/pdf/E9-22504.pdf to view the new regulations and www.dol.gov/ebsa for more information about them. For additional information on the OCR notice of proposed rulemaking, please visit: www.hhs.gov/ocr/privacy.