Kim’s public health blog

Researchers at the Nordic Cochrane Centre in Copenhagen analysed evidence from thirteen acupuncture pain trials involving over 3,000 patients. The trials compared three arms of treatment (real acupuncture, placebo or ‘pretend’ acupuncture or no acupuncture) for a broad range of common conditions such as knee osteoarthritis, migraine, low back pain and post-operative pain.  They found a small analgesic effect of real acupuncture compared to placebo acupuncture. This corresponded to a reduction in pain levels of about 4mm on a 100mm pain scoring scale. A 10mm reduction on this scale is classed as ‘minimal’ or ‘little change’ so the apparent analgesic effect of acupuncture seems to be below a clinically relevant pain improvement, say the authors. Comment: I wonder how often we have to repeat research on complementary medicines before we stop wasting research dollars?

USA Today reports, “More patients are having surgery without staying in the hospital overnight, and these ‘outpatient’ operations now make up two-thirds of all surgeries,” according to a report from the National Center for Health Statistics at the Centers for Disease Control and Prevention. The report shows that “the rate of visits to free-standing surgical centers tripled from 1996 to 2006, to 15 million surgeries and other procedures a year.” Comment, increasingly there is less need for beds in hospitals and less need to build new hospitals, except to replace technologically incapable institutions. More planning effort has to be placed on ambulatory services, But hospital activists keeping pushing legislators to fund bedded services.

From today’s AMA news we read about prevention efforts within the new stimulus package. However there is no discussion of who will deliver these interventions as much prevention takes place in local health departments, being cut back from current efforts by the slow economy, and in offices of primary care practitioners, whose numbers are dwindling rapidly and who can no longer keep up with the large number of chronically ill people knocking on their office doors.

As the nation gets fatter, a report in Sciencedaily today states in the United States, nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed, according to epidemiologists from the national institutes of health and the centers for disease control and prevention, whose study includes newly available data from an oral glucose tolerance test. Failure to control weight is leading to hugely increasing costs for medical care and shows the failure to develop early effective prevention for obesity.

Substance abuse is the most commonly reported behavioral risk factor among patients with TB in the United States. Patients who abuse substances are more contagious (eg, smear positive) and remain contagious longer because treatment failure presumably extends periods of infectiousness. Increased transmission is consistent with our finding that patients who abuse substances were more likely to be involved in a localized genotype cluster, which can represent recent transmission.[ Arch Intern Med. 2009;169(2):189-197.]

The “HealthGrades” Seventh Annual Hospital Quality and Clinical Excellence study identifies hospitals in the top five percent nationally in terms of mortality and complication rates across 26 procedures and diagnoses, from heart attacks to total knee replacement. Hospitals achieving this level of care are designated as ‘Distinguished Hospitals for Clinical Excellence’ by HealthGrades and are identified on the organization’s consumer Web site, HealthGrades.com. Many hospitals excel in a given service line, but what differentiates these top hospitals is their quality achievement across a broad range of procedures and treatments. “This study echoes others that have found distinct quality gaps between top-performing hospitals and others,” said Rick May, MD, HealthGrades senior physician consultant and an author of the study.

On its front page, the Washington Post , “A new study concludes that hundreds of young children in the District experienced potentially damaging amounts of lead in their blood when lead levels were dramatically rising in the city’s tap water.” The peer-reviewed study, which will appear in the journal Environmental Science and Technology, found that in some “high risk neighborhoods, the number of toddlers and infants with blood-lead concentrations that can cause irreversible IQ loss and developmental delays more than doubled after harmful levels of lead began leaching into the city’s drinking water in 2001.” The report said the estimated 42,000 children, now aged four to nine, “might be at risk of future health and behavioral problems linked to lead.” Comment: One would think that after more than 40 years of trying to reduce the impact of lead on children’s’ health we could avoid it. Failure to enact strict rental codes are part of the problem. Landlords should be required to ensure that the homes they rent are safe for children.

Queensland University of Technology researcher Dr Vinesh Oommen, from the Institute of Health and Biomedical Innovation, has done a large-scale literature review of everything written and researched about open-plan offices and how they affect employees, and the news, he said, is not good. Queensland University of Technology researcher Dr Vinesh Oommen, from the Institute of Health and Biomedical Innovation, has done a large-scale literature review of everything written and researched about open-plan offices and how they affect employees, and the news, he said, is not good.

It is true that they will not get pregnant, but they are still exposing themselves to sexually transmitted infections, said Dr. Mariam Chacko, professor of pediatrics – adolescent and sports medicine at BCM. Oral sex can expose both men and women to gonorrhea, syphilis, herpes, human papillomavirus, or HPV, and HIV (the human immunodeficiency virus associated with AIDS), said Chacko.
“Adolescents and teenagers need to be aware that there is no such thing as zero risk,” said Chacko, who is also medical director of the Baylor Teen Health Clinic. “While many of these infections may be less common in the mouth and throat than in the genitalia, oral sex cannot be considered safe.” It is true that they will not get pregnant, but they are still exposing themselves to sexually transmitted infections, said Dr. Mariam Chacko, professor of pediatrics – adolescent and sports medicine at BCM. Such infections are transmitted orally when the membrane of the lips, mouth and throat comes in contact with the genitalia, she said. Except for HIV, these infections can be transmitted even when there is no cut or sore on the mouth, Chacko said.

• The severity of first heart attacks dropped significantly over 15 years among 10,285 hospitalized Americans which may help to explain the decline in death from coronary heart disease.
• Prevention efforts as well as improvements in hospital care appear to have contributed to the decline in severity.
“This landmark study suggests that better prevention and better management in the hospital have contributed to the reduction in deaths,” said Merle Myerson, M.D., Ed.D., lead author of the study. “The reduction in severity of first-time heart attacks, along with other factors, has impacted on the declining number of deaths from coronary heart disease” Myerson said. “This tells us that better primary prevention as well as better care for those with acute heart attacks is working. Attributing the reduction in severity to specific causes will be an important next step so effective strategies can be reinforced and public health policies can be better directed.”