01.27.12

Chemicals Undermine Vaccines?

Posted in environment, Epidemiology, prevention, research at 12:40 pm by

Perfluorinated compounds, a class of manufacturing chemicals, may be harming the immune system in a way that reduces the effectiveness of standard childhood vaccines according to Environmental epidemiologist Philippe Grandjean of the Harvard School of Public Health and his colleagues who measured PFC levels in 587 children in Denmark, while still in utero and at age 5, when the children came in for their booster shots, and age 7. Comment: There were no control subjects without PFC levels present so further studies should be made using children without PFCs in the blood for controls. If this is confirmed then we must consider how to develop methods to test almost everything inhaled, eaten or applied to skin, which may be impossible. We also need better epidemiology to identify diseases that might be biologically plausible as environmentally dependent.

01.24.12

Black Tea Cuts Blood Pressure

Posted in Epidemiology, prevention, Surveillance, translational research at 3:56 pm by

Drinking three cups each day for six months lowered both diastolic and systolic blood pressure by 2 to 3 mm, according to Jonathan Hodgson, PhD, of the University of Western Australia in Perth, and colleagues. Following a randomized trial that included 95 men and women ages 35 to 75 (mean age 56 for men and 57 for women) who were regular tea drinkers. Comment: It is important to differentiate between statistically and clinically significant results. This was a poor study using a small population who were already tea drinkers and with very small numbers when the subgroup were divided by age and sex, and no history given of length and strength of previous tea drinking.

Many People Continue to Smoke after Being Diagnosed with Cancer

Posted in Behavioral Medicine, chronic disease, Epidemiology, prevention, Surveillance at 3:53 pm by

A new analysis has found that a substantial number of lung and colorectal cancer patients continue to smoke after being diagnosed.
The investigators determined smoking rates around the time of diagnosis and five months after diagnosis in 5,338 lung and colorectal cancer patients. At diagnosis, 39 percent of lung cancer patients and 14 percent of colorectal cancer patients were smoking; five months later, 14 percent of lung cancer patients and 9 percent of colorectal cancer patients were still smoking. A substantial minority of cancer patients continue to smoke after being diagnosed. Comment: Adverse behaviors are very difficult to prevent, even when it is clear that they may be an imminent cause of death.

01.21.12

A growing segment of neurologically impaired children is increasingly dependent on children’s hospitals

Posted in chronic disease, Epidemiology, Policy, prevention, Surveillance, translational research at 1:35 pm by

Boston, Mass; because of care advances, more infants and children with previously lethal health problems are surviving. Many, however, are left with lifelong neurologic impairment. The researchers analyzed KID data from 1997, 2000, 2003 and 2006, encompassing 25.7 million hospitalizations of children age 0 to 18. Of these, 1.3 million hospitalizations were for children with neurologic conditions, primarily cerebral palsy and epilepsy. Comment: not only does the cost of care go up as neurologically damaged children increase in age but the cost to the educational systems for these children in school is often in the hundreds of thousands of dollars a year. More effort needs to go into prevention to reduce cerebral palsy and prevent other neurological damage. Perhaps consideration should be given to the preconceptual counseling as children pass through puberty to understand how pregnancy can be dangerous to them and their offspring, without considering family history and potential genetic injury..

01.20.12

Statin Use in Postmenopausal Women Associated With Increased Diabetes Risk

Posted in chronic disease, Epidemiology, Policy, prevention, Surveillance at 12:20 pm by

ScienceDaily (Jan. 9, 2012) — The use of statins in postmenopausal women is associated with increased diabetes risk, according to a study published Online First by the Archives of Internal Medicine. In this study, researchers used WHI data through 2005 and included 153,840 women without diabetes and with a mean (average) age of 63.2 years. While this is a reminder that many useful medications have side effects and that men’s health and women’s health before this data is a retrospective analysis of cohort has all the limitations associated with such studies and needs confirmation with a prospective blinded study before policy recommendations can be considered.

Group says sex poses little risk for heart attack survivor.

Posted in Behavioral Medicine, chronic disease, Epidemiology, Policy, prevention, research at 12:18 pm by

This consensus statement is the result of significant studies published in the article quoted below, and the risk of one hour of sexual activity the week is said to be less than one per 10,000 person years of exposure. While additional guidelines are provided such as the risk from extra marital sex and likelihood that if you cannot climb two sets of stairs without getting angina you may have a problem, the data gives very little information that can be used for a specific individual unless an extensive cardiovascular workup is performed. Such costs may well be prohibitive while it is unlikely that a person who really wants to indulge in sexual activity is going to be deterred by this study, despite all the warnings in the Viagra and similar commercials. Circulation. 2012: published online before print Jan. 19 , 2012,

New Test Offers Greater Accuracy in Early Detection of Colorectal Cancer

Posted in chronic disease, Epidemiology, prevention, research, technology at 12:12 pm by

This study underscore the great potential of the stool DNA test as a colorectal cancer screening tool,” says lead author from the Mayo Clinic, “Along with its high accuracy, this test approach could improve participation rates due to its patient-friendly features. The test is noninvasive; requires no bowel preparation, medication restriction, or diet change; and can be performed on mailed-in samples without the need, expense, or inconvenience of a health care visit.” Sensitivity was 64 percent for polyps larger than 1 centimeter (cm), 77 percent for those larger than 2 cm and 92 percent for those larger than 4 cm.

20% of American adults may suffer from mental illness each year!

Posted in Behavioral Medicine, economics, Policy, prevention, Surveillance at 12:11 pm by

The Washington Post (1/19, Brown) reports, “About 20 percent of American adults suffer some sort of mental illness each year, and about five percent experience a serious disorder that disrupts work, family or social life, according to a government report released Thursday” by the Substance Abuse and Mental Health Services Administration (SAMHSA).” One has to consider how mental illness is diagnosed and that deviations from a totally sedate life without any deviation towards either anxiety or depression is rare. I found this just another of those statements that shows how adverse the American public is toward risk and how so many people want a specialist to provide a pill for any deviation from normal, whatever that is. Sure statements as the above only increase the cost of healthcare with no evidence that there is any benefit.

01.17.12

Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage

Posted in Policy, prevention, Surveillance at 12:50 pm by

A policy analysis from the National Institute for healthcare reform states “there is little debate about a growing primary care workforce shortage in the United States. A secondary problem contributing to addressing capacity shortfalls is that the distribution of primary care practitioners often is mismatched with patient needs. For example, patients in rural areas or low-income patients—particularly the uninsured—may have greater problems accessing primary care services than well-insured, suburban residents.” The AMA takes issue with one of the report recommendations for increased training and integration of primary care nurse practitioners into the workforce. I believe the AMA is absolutely wrong on this issue and does little more than reflect the influence of specialists. The accreditation agencies for medical schools continue to focus on specialty training which is supported by numerous federal grants. Support for training of primary care practitioners of any kind is minimal. Lack ofsupport for practitioners of primary care whether physician or nursing practitioners detracts from their remaining in medical shortage areas. The recommendations for improving the workforce have already been tried and found effective in many states but the resources provided to support these initiatives has been very small. The AMA. The AAMC and accrediting bodies need to focus on the need for health of the whole population to improve the quality of care today. Their academic policies over the last 10 to 20 years have done nothing to contribute to improvement of health care for the population as a whole.

Dangerous Combo: Headphones, Walking

Posted in Behavioral Medicine, Policy, prevention, Surveillance at 12:41 pm by

in a report in Medpage today we learn that 100 headphone-wearing American pedestrians have been struck by trains, cars, or other vehicles since 2004. The question should be at what level of injury and death in a population over 300 million should new protective (restrictive) laws they developed. This is no different to the current questions about the use of cell phones and texting technology in motor vehicles. When people injure themselves due to their own behaviors this is different from when they injure others, even then there needs to be consideration about when the government is responsible for individual behaviors. There is little data to show that many interventions have worked other than the use of seatbelts in cars and the intensive advertising about the danger of smoking..

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