Kim’s public health blog

ScienceDaily (Aug. 20, 2008) — Chronic lead poisoning, caused in part by the ingestion of contaminated dirt, affects hundreds of thousands more children in the United States than the acute lead poisoning associated with imported toys or jewelry. Could treating contaminated soil with water prevent this public health scourge? In a study appearing in the August issue of the journal Applied Geochemistry, Gabriel M. Filippelli, Ph.D., professor of earth sciences conducted a literature review of studies of urban soils as a persistent source of lead poisoning and also investigated the lead burden in the soils from a number of cities, including Indianapolis. His findings reveal that older cities like Indianapolis have a very high lead burden resulting in a lead poisoning epidemic among their youngest citizens.  Comment: The home environment causing lead poisoning is nothing new. #) years ago studies near the I 95 beltway in the region of the Pentagon showed contaminated soil from tetraethyl;l lead, and associated poisoning among children. This study was one of many that lead to the banning of lead in gasoline. There is also the problem of lead paint flaking from houses into the soil, that is well known in urban housing. While the idea of protecting children from soil is useful, it is more important to ensure that lead paint in housing is either removed or protected using rental codes. This has been well demonstrated for more than 40 years, but the realty industry has fought protection of children, usually low income renters, who have little power to protect themselves.

A study reported in this week’s JAMA suggested that “stemming the pandemic of type 2 diabetes is a public health priority and will require a multi-faceted approach,” wrote Molly Kile and David Christiani, Comment:The evidence is not terribly good. The data is from a crossectional study which can demonstrate association but NOT causality. No background data on exposures is provided, only data on blood levels that provide no evidence of length of exposures and whether arsenic exposure preceded onset of diabetes.

25 percent of Hispanics in the United States don’t have a regular healthcare provider to treat their medical needs,” according to a survey conducted by the Pew Hispanic Center and the Robert Wood Johnson Foundation. over “one in four Hispanic adults in the U.S….report obtaining no healthcare information from medical professionals in the previous year.” Meanwhile, almost “80 percent said they act on the information they receive from media sources.” Comment: The most telling point in the study was that 36 percent of males and 37 percent of individuals ages 18 to 29 lack[ing] a usual source of care. Hispanics have similar problems to other minority groups with lack of financial access to both insurance and primary care However, just providing financial access as recommended by both political parties will make little difference without a significant increase in access to a regular source of primary care, which neither party is addressing. Also, many of those without a usual source of care are young and without disease.

The United States faces a serious shortage of family physicians, especially in rural and poorer communities,” according to a report released on Monday by the National Association of Community Health Centers.The group noted that “[t]here are too few primary-care doctors and nurses to meet growing healthcare needs,” and “availability depends on location.” The data showed that “56 million Americans do not have a regular source of healthcare due to shortages of physicians in their communities,” although many of these people have health insurance. In fact, some healthcare experts say that “even if universal healthcare comes into play tomorrow, not everyone would have access to a healthcare provider.” The report’s authors “estimate that in order to provide services to these medically disenfranchised Americans, as well as current patients, health centers will need up to 60,000 more primary-care professionals, and up to 44,500 additional nurses.”

From Sciencedaily new researchin the latest issue of the Society of Chemical Industry’s (SCI) Journal of the Science of Food and Agriculture shows there is no evidence to support the argument that organic food is better than food grown with the use of pesticides and chemicals. Many people pay more than a third more for organic food in the belief that it has more nutritional content than food grown with pesticides and chemicals. But the research by Dr Susanne Bügel and colleagues from the Department of Human Nutrition, University of Copenhagen, shows there is no clear evidence to back this up.  Comment: No surprise here as there is little biological plausibility for the belief among food extremists that “Organic’ food is better than that grown with standard agricultural practices. You just pay more. As PT Barnum said about suckers. “there is one born every minute.”

60 years ago when in medical school I and my fellow students, along with the audience laughed ourselves sick at Roger Livsey (in the movie Dr. in The House) act as a swearing ,scalpel throwing surgeon at the ‘Radcliffe’ Infirmary in Oxford, particularly those of  us from London. Now, at last, according to the Boston Globe, the Joint Commission (JC), the national group that accredits healthcare organizations, “is requiring all hospitals, nursing homes, and other healthcare facilities to adopt ‘zero-tolerance’ policies by Jan. 1, including codes of conduct, ways to encourage staff to report bad behavior, and a process for helping and, if necessary, disciplining offenders.” An increasing amount of “research suggest[s] that swearing, yelling, and throwing objects are not just rude and offensive to co-workers, but hurt patients by increasing the likelihood of medical errors.”

New research links family relationships to childhood bullying. Elizabeth Sweeney, a University of Cincinnati master’s degree student in sociology, presented her findings Aug. 3 at the 103rd annual meeting of the American Sociological Association. Sweeney says her review of the literature found that children raised by authoritarian parents – parents who are demanding, directive and unresponsive – are the most prone to act out bullying behavior. On the other hand, there were parallels showing that children raised by nurturing, warm, responsive parents were less likely to bully.

A wonderful example of how to confuse people. .Food and Drug Administration (FDA) has approved six influenza vaccines intended to target strains that “are likely to cause flu in the United States” during the 2008-09 season. Agency officials explained that every year, the “vaccines are modified to reflect the virus strains most likely to be circulating,” and the “closer the match between the circulating strains and the strains in the vaccines, the better the protection.” Last year’s flu vaccine didn’t match two of three main types of flu that sickened people. Still, the “vaccination remains the cornerstone of preventing influenza. Comment: The problem is that the flu virus mutates so rapidly, and dispersion is so simple (with air travel) that it is very difficult to predict what strain will be dominant in the US each fall. It still takes so long to identify and prepare a new targeted vaccine that we will have to wait for improved technology before a real annual match tor currently circulating strains can be developed..

A new study from researchers at Ohio State University and the University of Kentucky found that high school students students may be more inclined to learn life-changing behaviors from someone they know and trust. “The actual person teaching makes a difference in how students learn. When there is a good relationship, that really facilitates learning and motivation. And we found that in almost every area, the regular classroom teachers were more effective, they were better,” said Eric Anderman, co-author of the study and professor of educational psychology at Ohio State. Better training of teachers may be more productive than bringing in outside experts.
[Ohio State University (2008, August 5). Teacher-student Relationships Key To Learning Health And Sex Education. ScienceDaily.]

A study in this week’s Annals of Internal Medicine reported on data from the 1999-2004 NHANES survey of US Households. The study identified at least 11 million uninsured people with chronic diseases. the most common being heart disease, high blood pressure, and diabetes. Lack of insurance meant that such individuals were far less likely to attempt to obtain medical care, and unlikely to be able to afford medicines to control their diseases. As a result they were more likely to be unproductive workers, and to be disabled or die early from their conditions.  All this increasing the cost of the nation’s medical care system.
[Ann Intern Med. 2008;149:170-176.]