Kim’s public health blog

In the Wall Street Journal (1/22) Doctor’s Office column, Benjamin Brewer, MD, writes, “It’s high time to build a modern primary care system that meets the needs of all Americans. It won’t be easy and will require an uncomfortable discussion about medical costs and benefits. But judging from Mr. Obama’s inaugural address, he may be the man to get change started.” Brewer calls for adequate funding of primary care, and an “overhaul of Medicare, so our medical system gets the results we deserve for the money we’re spending.” Moreover, he writes, “Decades of research have shown that good primary care reduces costs and improves outcomes, yet we have ignored these fundamental facts to our detriment. I see this blind spot as the biggest flaw in our current system.”

Secondary prevention of adverse effects of diabetes can be minimized with use of the new standards for self monitoring from the Center for Clinical Excellence on the UK (NICE). Self monitoring supported by education is therefore one of the key tools available to people with diabetes to enable them to self manage effectively. Essential to this is the person being able to discuss the purpose of self monitoring, how to interpret and act upon results. It is important that the blood glucose levels being aimed for are as near normal as possible (that is in the range of those of a person who does not have diabetes).

Good news for those of us over 65, a new UCLA study, available in the American Journal of Epidemiology found that light to moderate drinking among seniors reduced their odds of developing physical problems that would prevent them from performing common tasks such as walking, dressing and grooming. “If you start out in good health, alcohol consumption at light to moderate levels can be beneficial,” said lead study author Dr. Arun Karlamangla, an associate professor of medicine in the division of geriatrics at the David Geffen School of Medicine at UCLA. “But if you don’t start out healthy, alcohol will not give you a benefit.”

The more alcohol costs, the less people drink it. That’s the conclusion of a new analysis of data from more than 100 studies gauging the impact of higher booze pricing — typically in the form of higher taxes — on American drinking habits. “The price level at which alcohol is sold affects what people drink,” observed Alexander C. Wagenaar, a professor of epidemiology and health policy research at the University of Florida’s College of Medicine. Comment: Whenever the price of a commodity reduces its availability on the open market criminal intervention takes place. We have seen this with prohibition and with illegal drugs. As cigarette taxes increase we see more bootlegging and under the counter sales of cigarettes. Alcohol addicts will choose other substances to substitute for store bought alcohol.

From the MMWR today we learn that Nucleic Acid amplification tests (NAA) have been available for 10 years and can identify TB infection/Disease much earlier than the gold standard of TB Culture. The CDC recommends routine use of NAA in the battery of testing to identify Tuberculosis. Such tests would be particularly useful in immigrant and homeless populations who may move during the extrend3ed time for culturing, and be lost to follow up.

Since the pneumococcal vaccine for children was introduced. Pneumococcal infections for all age groups, not just children have fallen. Rates of pneumococcal meningitis dropped 64 percent in children under age two from 1998-1999 to 2004-2005. With fewer contagious babies to spread germs, fewer older kids and adults are getting sick, according to study co-author Nancy Bennett, M.D., of the University of Rochester School of Medicine and Dentistry in the Jan. 15 issue of the New England Journal of Medicine.

Washington, D.C., January 14, 2008 – As the 111th Congress begins its first term and the Obama administration prepares to assume power, the American Public Health Association (APHA) urges our elected leaders to recognize the importance of public health as the foundation for a strong national health system able to address the many health challenges facing our nation.

From the Mailman School of Public Health Dr. Santelli and his team analyzed data from the Youth Risk Behavior Survey, a nationally representative survey of U.S. high school students, collected from 1991 to 2007. Students were categorized into groups according to risky behaviors — such as smoking or alcohol use — and each group was examined for trends in four sexual behaviors: ever having sexual intercourse, having four or more lifetime partners, current sexual activity, and the use of contraception during the last sexual experience. However, the data confirm no matter where they fell on the risk spectrum, teens seemed positively influenced by social forces and intervention messages in the 1990s and early 2000s, when there was a decline in sexual experience and number of sexual partners across the board.  “The three biggest changes in adolescent behaviors in the last 16 years have been delaying sex, increasing the use of condoms, and reducing the number of partners,” notes Dr. Santelli. “All three are areas that HIV education has clearly identified as goals.”

On the same day in ScienceDaily has two reports; one from a Duke University professor who want all diets to be “Low Glycemic” carbohydrates which were tested in a small sample of diabetics with close control, and a report from a University of Virginia professor who says it is not carbohydrates but total calories and exercise in balance. My belief is that the U. Va professor makes a better argument.

Politics and public health should not mix. There have been reports of resistance to Tamiflu by avian strains of flu for at least two years. With most flu seeming to start its annual rounds in the far east it is not surprising that such resistance should appear as new annual strains of flue make their way to the U.S. This has been the Achilles heel of pandemic planning with HHS recommending, and states paying to store Tamiflu. The politics of homeland security trump epidemiology every time. Joseph Bresee, M.D., chief of influenza epidemiology and prevention at the CDC, said that the “emergence of Tamiflu-resistant strains that can spread easily from one person to another makes it more difficult for doctors to use drugs to treat people who are at high risk of severe flu complications, such as pneumonia.” There were reports last year from Europe and other countries that a certain type of flu — H1N1 — was resistant to oseltamivir, according to Dr. Joseph Bresee.