Kim’s public health blog

The A,m healthgency for Healthcare Research and Quality and the AARP today released two new checklists designed to help men and women over the age of 50 learn how to stay healthy and prevent disease.
AHRQ and AARP also released an accompanying wall chart,the Staying Healthy at 50+ timeline, that provides information about recommended preventive services and can be posted in both clinical and community settings. These three publications Men: Stay Healthy at 50+, Checklists for Your Health; Women: Stay Healthy at 50+, Checklists for Your Health;and the Staying Healthy at 50+ timeline show at a glance the evidence-based recommendations from the U.S. Preventive Services Task Force regarding screening tests, preventive medicines and healthy lifestyle behaviors for people 50 and older.

The problems of antibiotic resistant bacteria including Methycillin resistant Staph, C.Difficile and Multiple drug resistant TB are discussed in this week’s journal “Science”. The medical profession has been telling patients and peers that too many antibiotics are used. In many countries they are used without much, if any, oversight.  Because of the poor return on investment few pharmaceutical companies are willing to invest in necessary research. Law suits do not help.  Goverments, as usual, are a day late and a penny short.  This issue (July 18) with its main topic is so important that any who have in interest in public health and infectious dseases should reed the articles. The problems of an unlikely flu pandemic pale into comparison beside the damage already being done by antibiotic resistance. This is a much more importanmt topic, both in the US and worldwide, than a possible flu pandemic.

Even though America spends more than $2 trillion annually on health care—more than any other nation in the world—tens of millions of Americans suffer every day from preventable diseases like type 2 diabetes, heart disease, and some forms of cancer that rob them of their health and quality of life.
Keeping people healthier is one of the most effective ways to reduce health care costs. This study, which was developed through a partnership of the Trust for America’s Health (TFAH), The Urban Institute, The New York Academy of Medicine (NYAM), the Robert Wood Johnson Foundation (RWJF), The California Endowment (TCE), and Prevention Institute, examines how much the country could save in health care costs if we invested more in disease prevention, specifically by funding proven community-based programs that result in increased levels of physical activity, improved nutrition (both quality and quantity of food), and a reduction in smoking and other tobacco use rates. After five years the return on investment will be $5.6 for each dollar invested.

The main focus of the law was to prevent cuts to Dr’s payments to prevent them from ditching Medicare patients.  We are also told that it will pay for checkups. Unfortunately there is little data to show routine check-up make a difference to patients’ health (although it improves Dr’s  income) once they have had an initial screening.  It would have been better  to pay for counselling about adverse behaviors such as failing to take prescribed medicines correctly.

Headlines in the media are all agog at a small experiment in Israel. A study of weight loss using three types of diet, among three groups of less than 100 people, resulted in weight loss of 5 lb a year for two years. There was constant health education and dietary advice given by the researchers, a condition that will not occur among the public at large. This might have been a useful practical study for a master’s course, but not something worth reporting in the New England Journal of Medicine, and the subsequent media ‘feeding’ frenzy. Do not be taken in by the stories about this poorly designed experiment. Fewer calories and more exercise are the key to loosing weight. There is no substitute.

There is a knowledge gap about healthcare issues for people over 90. Yet, “nonagenarians are the fastest-growing age group around the world.” Currently, “[t]here are fewer than two million nonagenarians in the United States, but federal officials predict that number could reach 12 million in just a couple of decades.” According to Claudia Kawas, associate director of the Institute for Brain Aging at the University of California-Irvine, “It’s really, really, really important that we understand the physiology of 90-year-olds.” In fact, some healthcare experts say that this “yawning knowledge gap…could have profound effects on the economy over the next few decades. Comment: It is high time for those in preventive medicine and public health, as well as those in charge of medical school curricula to focus on this bombshell, soon to explode.

The AP (7/16) reports, “Healthcare costs could be cut substantially if Americans stopped smoking, stopped overeating, and got in shape, a national expert told lawmakers from 11 Midwestern states on Tuesday.” The Centers for Disease Control and Prevention (CDC) “estimates that if Americans adopted such a healthy lifestyle, 80 percent of heart disease and stroke could be prevented,” according to Kenneth E. Thorpe, chairman of the Department of Health Policy and Management at Emory University. “Diabetes and cancer also would be reduced dramatically,” Comment: Why can’t we learn? This outcome was first validated by research from Anne Somers and Lester Breslow in the late 70’s in their Alameda County Survey. [Breslow L, Somers AR. The lifetime health-monitoring program. A practical approach to preventive medicine. [N Engl J Med. 1977 Mar 17;296(11):601-8.]

From the Wall Street Journal: Killings by home-care providers remain rare, but they are only the most extreme examples of what prosecutors and advocates for the elderly say is a growing number of cases of abuse, neglect or fraud in which home caregivers take advantage of the frail and the ill. And that’s prompting calls for better oversight of an industry that’s expanding fast as more Americans age and try to avoid nursing homes. Health aides are often certified nursing assistants, who are generally licensed and regulated. But the bulk of the abuse cases involves caregivers hired to provide nonmedical assistance. These caregivers, who aren’t required to receive specialized training, are only loosely overseen. Comment: With the increasing size of the elderly population, many of whom need assistance, but are not willing to go into nursing homes, there needs to be stringent oversight for any person willing to provide home assistance services.

University of British Columbia researchershave invented a sports helmet that reduces direct impact to the neck by up to 56 per cent, according to preliminary tests. “Existing helmets are not designed to protect the neck and the cervical region of the spine, which happens to be the weakest,” says co-inventor Peter Cripton, a Mechanical Engineering assistant professor in the Faculty of Applied Science. Comment: There are many head and neck injuries in sports leading to paralysis, particularly from two wheeled vehicles, horse riding, off road racing for example, all of which would benefit from an improved helmet

Many lIberals get choleric when anyone suggests that certain families seem to breed delinquents.  While the current research won’t change their attitudes it does add to depth to the debate.  In one of the first studies to link molecular genetic variants to adolescent delinquency, sociological research published in the August issue of the American Sociological Review identifies three genetic predictors–of serious and violent delinquency–that gain predictive precision when considered together with social influences, such as family, friends and school processes. Sociologists from the University of North Carolina-Chapel Hill explored the interaction of genetics and social influences and identified three genetic polymorphisms that–when examined in the context of modulating social controls–are significant predictors of delinquency.