Kim’s public health blog

WHO-GENEVA — Malaria deaths reported from health facilities in Zambia have declined by 66%. This result along with other supporting data indicates that Zambia has reached the 2010 Roll Back Malaria target of a more than 50% reduction in malaria mortality compared to 2000. Rwanda, United Republic of Tanzania, and Sao Tome and Principe are the other African countries who have achieved major reductions in malaria mortality through accelerated malaria control activities. The decline in Zambia was especially steep after 3.6 million long-lasting insecticidal nets were distributed between 2006 and 2008. During this period malaria deaths declined 47% and nationwide surveys showed parasite prevalence declined 53% from 21.8% to 10.2% and the percentage of children with severe anemia declined 68% from 13.3% to 4.3%. Most moderate and severe anemia in children is caused by malaria. Also see today’s editorial in the Lancet [Volume 373, Issue 9673, 25 April 2009-1 May 2009, Pages 1409-1411]

The New York Times reports, “Data from the National Center for Health Statistics show that death rates over the past 60 years…plummeted for heart disease, stroke, and influenza and pneumonia,” while “for cancer, they barely budged.” In fact, “the cancer death rate, now about 200 deaths a year per 100,000 people of all ages and 1,000 deaths per 100,000 people over age 65 — is nearly the same now as it was in 1950, dropping only five percent.” According to researchers, cancer death rates “are considered the purest measure” to “assess progress in fighting the disease.” Michael S. Lauer, MD, FACC, director of the division of prevention and population sciences at the National Heart, Lung, and Blood Institute, notes that “with heart disease…there were transforming discoveries in prevention and treatment,” which “led to effective drugs to lower cholesterol and blood pressure, to the use of aspirin, and to smoking cessation programs, all of which reduced the number of heart attacks.” With cancer, however, “equivalent transforming advances have not emerged.” Comment: What role has screening played in this 5% decrease? Is this NYT story bad reporting or uncovering of the truth not told by the ACA and its allies? The best results seem to be intervention for breast cancer. Should death rates be the only measure of progress, should we not look at survival and quality of life among cancer victims?

The Washington Post reports, “Public health authorities are investigating two highly unusual cases of a previously unknown strain of swine flu that was found in the San Diego area late last month. “ How short our memory is. About 30 years ago (1976) there was an outbreak of ”Swine flu” at Fort Dix, New Jersey. The public health community went ballistic, as usual.. Millions of people were immunized against this flu and hundreds of people developed Guillian Barre syndrome. The outbreak never extended outside Fort Dix, I was at EVMA at the time. A group of use sampled swine at the large pig farms in southeast Virginia, as well as staff at the abattoirs. Nearly everyone we tested had antibodies against swine flu. There was no evidence of deleterious outcome among the abattoir workers. The primary physicians in the area had not noticed any pandemics,. Here we go again, with antibodies found in two people. Perhaps before we scream pandemic (for which we have no vaccine) we will find out what the antibody level is among swine in the area and what the antibody level is in those exposed the swine.

CDC received reports of 1,505 cases of malaria among persons in the United States, including one transfusion-related case and one fatal case, with onset of symptoms in 2007. The highest estimated relative case rates of malaria among travelers occurred among those returning from West Africa. Of 701 U.S. civilians who acquired malaria abroad, 441 (62.9%) reported that they had not followed an appropriate chemoprophylactic drug regimen. Persons at risk for malaria infection should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel and use personal protection measures to prevent mosquito bites.

The new report, Stronger Partnerships for Safer Food: An Agenda for Strengthening State and Local Roles in the Nation’s Food Safety System, was produced by the Department of Health Policy at The George Washington University School of Public Health and Health Services in partnership with the organizations that represent food safety officials and practitioners at the state and local levels: the Association of Food and Drug Officials (AFDO), the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO). For the first time, this diverse group of officials has come together to recommend a series of improvements in the roles of state and local agencies as partners in a national food safety system working to prevent foodborne illness. The report was funded by the Robert Wood Johnson Foundation.

As reported in the media today CDC has released data showing that reports of food borne Illness are level. This is an under reported phenomenon, just as are reports of STDs. The reported data shows that millions of people are affected annually, thousands hospitalized and several thousand die. Yet, despite these numbers there is little likelihood any improvement will occur. Food poisoning is common. Politicians get more credit for fighting the very rare such as ‘mad cow’ diseases which have affected a few hundred people worldwide, and only one or two in the USA. Just as Congress is considering loading tobacco control onto the FDA, the FDA and department of agriculture, as well as state public health and agriculture agencies lack staff for effective control of current programs such as food poisoning prevention. Congress will lambast beleaguered federal agencies which can only provide data (or spin if you prefer) but not criticize Congress or the Executive branch while they endure criticism. You have to have a very thick skin to be a federal agency manager.

From the American College of Sports Medicine heart health may be better protected and maintained with more recognition to the benefits of preventive measures – especially exercise. John Quindry, Ph.D., FACSM says people should be more aware of their heart attack risk factors, and fully realize the potential that preventive activity has for longevity and cardiovascular health, rather than relying solely on drug intervention. Risk factors can be divided into two segments: modifiable and non-modifiable.
Non-modifiable risk factors
Age (45+ for males, 55+ for females)
Family history of heart disease
Modifiable risk factors
High blood pressure
Diabetes
Cigarette smoking
High cholesterol
Poor diet
Sedentary lifestyle
Comment: There is nothing new in this advice, only the plea from one more source to realize that our behaviors lead to poor health, and that prescription drugs are not an adequate substitute. Unfortunately there is little that is easy about modifying behaviors. Healthy behaviors have to start with family role modeling and reinforcement in school.

Behavior treatment works as well as drugs for children with ADHD and bypasses the risk of medication’s side effects, a meta-analysis of 174 studies on ADHD treatment conducted at the University at Buffalo, has shown. This analysis found that teaching parents and teachers how to respond when children do things the right way — as well as when they display harmful or aggressive behavior — is effective, and in some cases more effective, than medication for ADHD. Comment: Illich would have liked this review. It enhances the point made in the article from the college of sports medicine that behavioral modification should be started early in life

Readers of this blog are familiar with BRFSS but may not have noted how this survey of teen behaviors shows that “bad habits clearly start at a young age,” as 85 percent of bicycle riders and 24 percent of motorcycle riders said they never or rarely wore helmets, and 11 percent of car passengers said they never or rarely used seat belts. Comment; One more item in today’s rant about modifying behaviors at a very young age, and do it within the family.

The U.S. Food and Drug Administration today cleared for marketing a new, more rapid test for the detection of influenza A/H5N1, a disease-causing subtype of the avian influenza A virus that can infect humans. The test, (AVantage A/H5N1 Flu Test) detects influenza A/H5N1 in throat or nose swabs collected from patients who have flu-like symptoms. The test identifies in less than 40 minutes a specific protein (NS1) that indicates the presence of the influenza A/H5N1 virus subtype. Previous tests cleared by the FDA to detect this influenza A virus subtype can take three or four hours to produce results.