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Student Affected By Gun Violence Cites Numbers To Get Attention For Policy Reform

According to the Institute of Medicine, the past 25 years have seen a major paradigm shift in the field of violence prevention, from the assumption that violence is inevitable to a recognition that violence is preventable. Stephen Barton is a student who was shot during the gun violence at the movie theater in Aurora Colorado. Twelve persons died and dozens more were injured in that incident. Now Barton is taking the IOM assertion seriously. He has created a video on YouTube which seeks to get the attention of policy makers to create a plan to reduce gun violence.

According to Barton, 48,000 persons will be murdered with guns during the four year term of the next US president, a number far exceeding the number killed in the movie theater incident. A number so large in fact, says Barton, that it could fill 200 movie theaters. Watch the short video at http://www.youtube.com/watch?v=9yT8CSgh43E

The video is part of a campaign to get the presidential candidates talking about the issue. Visit www.demandaplan.org for more details.
 


Cause Of Documented Decline in Life Expectancy Is A Mystery

A recent report in Health Affairs by the University of Illinois’ Jay Olshansky and colleagues has documented that contrary to the overall upward trend in life expectancy for whites, blacks, and Hispanics, the trend for whites without a high school degree has been dropping. Between 1990 and 2008, life expectancy for the least educated white women has fallen by five years and for white men by 3 years. British epidemiologist Michael Marmot told the New York Times “the five year decline for white women rivals the catastrophic seven-year drop for Russian men in the years after the collapse of the Soviet Union.” Harvard’s David Cutler told the same newspaper that “There’s this enormous issue of why…it’s very puzzling and we don’t have a great explanation.”

The report also documented that in 2008 white men with 16 or more years of schooling lived 14.2 years longer on average than black men, and white women with higher education lived 10.2 years longer than black women. The authors call for “educational enhancements” at all ages and for all races to reduce the gaps in health and longevity.
 


CDC Highlights Missed Opportunities To Prevent Heart Disease and Stroke Through More Widespread Blood Pressure Control

According to the World Health Organization, hypertension is the leading cause of mortality in the world linked to over 7 million or 15% of all deaths in developing and developed countries. According to CDC, 67 million American adults have high blood pressure and more than half of these (36 million) don’t have it under control. This failure is contributing to nearly 1,000 deaths per day, according to CDC’s Vital Signs publication. The problems are that persons with uncontrolled blood pressure may not know they have it, and among those who do know, medicines are not bringing blood pressure under control.

The solution? According to CDC, doctors, nurses, and their patients need to pay regular and frequent attention to achieving control. They can do this if patients take their own blood pressure, know their numbers, take medicines as prescribed, and make healthy lifestyle changes (see related article below). For health systems and health providers, CDC is urging them to set goals, use a team-based approach, and track their performance with individual patients.

This focus on blood pressure control is part of the Million Hearts Initiative intended to prevent a million heart attacks and strokes by 2017.
 


Conference Report Says Hypertension Risk Can Be Cut By Two Thirds By Altering Four Factors

A report by American and Finnish scientists at the European Society of Cardiology documented significantly lower hazard ratios for men and women followed in a population-based cohort study. In the study, 9,637 Finnish men and 11,430 women aged 25-74 years without hypertension at baseline measurement from 1982 to 2002 were followed for a mean of 16 years. In this group, 709 men and 890 women developed hypertension. However, men who adhered to one or more of four lifestyle changes associated with alcohol consumption, physical activity, obesity, and consumption of vegetables, had lower hazard ratios which ranged from 0.33-0.74 depending on how many lifestyle factors they adhered to. Having all four lifestyle factors reduced hypertension risk by two thirds. Women who adhered to the protocol also experienced lower hazard ratios ranging from 0.37-0.89.

According to the authors, “lifestyle modification has a huge public health potential to prevent hypertension…the results should apply to the treatment of patients with hypertension who can reduce their blood pressure by modifying the four lifestyle factors alone, or by making these modifications while taking blood pressure lowering medication.”
 


Epidemiology At Work At NATO

A news release from the North Atlantic Treaty Organization this month describes a new real-time surveillance and alert system being developed by NATO to monitor the health situation of deployed troops, detect outbreaks and/or biological attacks, and measure the effectiveness of preventive measures.

According to the news release, epidemiologist Benjamin Queyriaux, a lieutenant colonel with NATO, is the deputy head of a new four-person team set up to develop a surveillance capability for what is labeled “Deployment Health”. Their NATO unit is called Deployment Health Surveillance Capability and is based in Munich Germany. Among the concerns of the group are keeping tabs on the malaria incidence among deployed troops, detecting flu outbreaks, and detecting outbreaks caused by any infectious agents released intentionally.

According to the DHSC commander, the system is “…a good example of a smart defense applied to public health—rather than try to gather fragmentary data from a few allied nations, NATO is building a single system that will offer a complete overview of the health situation of deployed troops.”
 


Enormity Of The Global Tobacco Epidemic Comes Into Greater Focus With Data From First Survey Across Countries

A recent article in The Lancet reporting the results from the first wave of the Global Adult Tobacco Survey (GATS) in 14 low and middle-income countries reveals the enormity of the challenge still remaining in tobacco control and highlights that even a huge body of evidence that is as good as it gets about the causal role of tobacco in health has not been sufficient to prevent or control harms from tobacco.

And these are enormous. According to the report, WHO estimates that 6 million people die from tobacco-related causes annually. This is akin to the world experiencing another holocaust every year! An estimated 1 billion premature deaths will occur in this century if current patterns continue. In 2011, chronic disease epidemiologists identified tobacco control as the most urgent and immediate priority intervention among all possible chronic disease control measures. 

According to Jeff Koplan from the Emory Global Health Institute and Judith Mackay from the World Lung Foundation writing in The Lancet about the survey, “the main challenge is how to translate the findings from GATS and other surveys into health policy. Many governments do not instinctively reach for data when designing policy. Assumptions that research findings will lead to policy change, basing policy on evidence, are overly optimistic…” The authors went on to say “the need to bridge the existing gaps between research, policy, and practice is a global phenomenon.” They called for more collaboration between researchers, policy makers, and health care providers to bridge these gaps.
 


“Emergency Epidemiologist” Works To Document Death Toll In African Refugee Camps To Help Plan More Effective Interventions

An epidemiologist blogging on the website of Doctors Without Borders has documented her experiences in collecting prospective surveillance data on deaths and health status to help guide the interventions being carried out by her organization to help refugees in the Jaman refugee camp in Upper Nile State in Southern Sudan. In this situation, she was able to show that mortality rates were well above the emergency threshold. “Getting good data might not seem the first priority in an emergency but it is essential to understand and respond appropriately to the needs of the population affected,” according to Ruby Siddiqui. She entitles her blog Emergency Epidemiology—A Day In The Life Of An Emergency Epidemiologist. Readers who wish to read all of her blog posts over the 30 day stint in the South Sudan may do so at http://blogs.msf.org/rubys/
 




New Salmonella Cantaloupe Outbreak Follows On The Heels Of Listeriosis Cantaloupe Cases and Deaths Last Year

A new gastrointestinal illness outbreak tied to bacteria associated with cantaloupes is being investigated by CDC and state and local health departments. The 2012 outbreak has affected 141 persons according to CDC as of August 17. There have been cases in 20 states so far, most of them in Kentucky though the outbreak has been traced preliminarily to a farm in southwestern Indiana. There have been 31 hospitalizations and 2 deaths reported. Last year, cantaloupes were responsible for 146 cases with four strains of listeria monocytogenes from 28 states. In that outbreak 30 deaths and one miscarriage were reported. The largest number of cases was in Colorado where the production fields of Jensen Farms were located.

The peculiar netted skin of the cantaloupe may be implicated in harboring bacteria. The FDA recommends rinsing raw vegetables thoroughly under running tap water before use even if they will be peeled. Also, firm produce should be scrubbed and dried before use.


Ongoing West Nile Outbreak Being Called The Largest Ever In The US

As of August 22, CDC is reporting 1,118 cases of West Nile virus infections in 38 states with 41 deaths. It is the largest West Nile virus outbreak to occur in the US since first reported in 1999. Lyle Petersen, CDC’s vector-borne disease specialist, told the media that the peak usually occurs in mid-August and that he expects many more cases as it takes a couple of weeks for people to develop illness. The cause for the record number of cases this year is unknown but Petersen speculated that unusually warm weather conditions could have made it easier for transmission to humans to occur. Texas has been at the epicenter of the epidemic with approximately half of the cases (586) and half of the deaths (21).

To protect themselves, Americans are being urged to “fight the bite” by using mosquito repellent with DEET, dressing in long pants and sleeves, being extra careful at dusk and dawn, and draining any standing water around their premises.
 



Worldwide Maternal Deaths Are Down Significantly, But Different Estimates of the Decline Have Been Produced

If epidemiologists ever need another example of why it is important to get estimates right, the example provided by the dispute about the number of worldwide maternal deaths could serve very well.

According to a report from the UN last week, the number of maternal deaths dropped from 543,000 to 287,000 over the 20 year period 1990-2010, a decline of 47 percent.  That’s big progress. However, according to the NY Times, a report from the Institute for Health Metrics and Evaluation in 2010 disputed that the baseline estimate of maternal deaths was stable at over 500,000 per year. That would mean that progress has actually been less dramatic over the same time period than it would appear from UN figures.

The Institute found that actually deaths have been declining from about 500,000 as far back as 1980 to fewer than 350,00 as of 2008, and that the rate of decline in the maternal mortality ratio (maternal deaths per 100,000 live births) has been declining 1.3% per year since 1990. Using that estimate, the true decline would be about half of that claimed by the UN. 

Why does this make a difference if the overall message—that deaths are down significantly—does not change? The head of Every Mother Counts, an advocacy group, explained to the Times, “It didn’t do any good when different reports diverged by 100,000—or when the drop seemed so rapid. That sent a message that it’s easier to save lives than it is.” That’s an important conclusion for those on the front lines of the battle to reduce maternal deaths.


Major National Push Launched To Reduce Obesity in the US

A multi-pronged initiative “Weight of the Nation” involving what appears to be an unprecedented degree of collaboration and coordination between different segments of American society has been launched in May to fight obesity. According to CDC, obesity is common, serious, and costly. It estimates that 35.7% (more than a third) of adults are obese, and approximately half that percentage of children and adolescents is obese (17%). Among the prongs in the initiative is a 2012 Weight of the Nation conference held in Washington DC in May which covered key prevention activities and will be made available online, a report and 5 major recommendations from the IOM intended to constitute a system of large-scale transformative approaches, and a four-part documentary series by HBO entitled “Weight of the Nation” broadcast in mid-May and now available online [ http://theweightofthenation.hbo.com ].

According to IOM, five critical goals are 1) integrating physical activity into people’s daily lives, 2) making healthy food and beverage options available everywhere, 3) transforming marketing and messages about nutrition and activity, 4) making schools a gateway to healthy weights, and 5) galvanizing employers and health care professionals to support healthy lifestyles.


Epidemiologist Richard Wilkinson Explains Causal Pathway Between Inequality and Lower Social Well-Being

In an online interview with Theresa Riley on the Bill Moyers website, British epidemiologist Richard Wilkinson explained how he connects the dots between inequality and poor social outcomes such as more violence, worse life expectancy, more mental illness, more obesity, more people in prison, and more teenage births. According to Wilkinson, in more unequal societies, the prevalence of trust is significantly lower between people as status competition increases. These poorer relationships in turn lead to increases in chronic stress which affect the immune and cardiovascular systems. In a surprising statement, Wilkinson told Riley that one recent study found whether or not you have friends is marginally more important to your health than whether you smoke.

Wilkinson noted in his interview that “the pattern we’ve found in our research is quite extraordinarily clear.” Asked what is missing in the struggle against inequality, Wilkinson said, “what’s missing is action…not nearly enough is being done…”


Scathing Data Reported By One Epidemiologist Leads To Hiring Another To Get More Data

“It got to the point where I wanted to see the action that’s connected to these findings, and I decided it wasn’t happening at a pace I was comfortable with.” That’s how epidemiologist Timothy Ryan, hired by former governor of Wyoming Dave Frudenthal to study occupational health, characterized for the NY Times his reason for leaving the job last December. After finding that Wyoming had the highest workplace fatality rate in the country for all but one year from 2003-2008, Ryan wrote what was described by a media source as a “scathing” report and concluded that the state lacked a culture of workplace safety.

A new report by the Wyoming Star-Tribune quotes Gary Hartmann, a policy adviser to the new Governor Mead, that the state is now ready to hire a replacement for Ryan. According to Hartmann, “That person needs to be the safety champion for the state of Wyoming.” And in a remark that can lead to epidemiologists questioning the power of data to catalyze change, Hartmann added, “we need good data, we need careful data, we need to have that data so we can make good decisions.”



Child Injuries Still Number #1 Cause Of Death

A new issue of CDC’s Vital Signs highlights the fact that a child dies every hour in the United States from an injury amounting to over 9,143 deaths in 2009. Motor vehicle crashes, which dropped by 41% between 2000-2009, still account for approximately half of all child deaths. The next leading cause of death is suffocation which affects infants and accounts for just over a thousand deaths or 13% of all child deaths in 2009. Other causes in order of importance are drowning, poisonings, fire, and falls.

While progress has been considerable in lowering child deaths, the US rate is four times greater than that of countries with the lowest rates such as Sweden, the Netherlands, and the United Kingdom (2-2.9 per 100,000 vs 8.7 in the US). Likewise variation is considerable between states, ranging from a low of less than 5 in Massachusetts and New Jersey to more than 23 in South Dakota and Mississippi. In 2009 according to CDC, more that 5,700 children’s lives would have been saved if the lowest state death rate was achieved nationally.


New Blog on Philosophy and Epidemiology

A new blog has been started by Alex Broadbent on philosophy and epidemiology at wordpress.com According to the University of Johannesburg philosopher, “I'm hoping the site will develop into a forum for discussions on conceptual and methodological issues related to epidemiology and public health science and policy.”

To read entries and post replies, visit http://philosepi.wordpress.com

 

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Systematic Review Finds Positive Feelings Protect Against Heart Disease and More

A review of more than 200 studies by Harvard School of Public Health researchers has found that positive psychological well  being protects against cardiovascular disease independently of traditional risk factors and ill-being. In a press release from the School, lead author Julia Boehm noted that “The absence of the negative is not the same thing as the presence of the positive. We found that factors such as optimism, life satisfaction, and happiness are associated with reduced risk of CVD regardless of such factors as a person’s age, socioeconomic status, smoking status, or body weight…For example, the most optimistic individuals had an approximately 50% reduced risk of experiencing an initial cardiovascular event compared to their less optimistic peers.”

The behaviors and biological functions of the optimistic persons differed from the less optimistic and the authors note that if future research continues to indicate that optimism comes before cardiovascular health, “this has strong implications for the design of prevention and intervention strategies.” To read the paper, visit Psychological Bulletin April 17, 2012.
 


New Report Finds Breast Cancer Can Be Classified As At Least 10 Different Diseases

A new report in the April 18 online issue of Nature has performed detailed genetic analyses on breast tumor samples from nearly 2,000 women and categorized the patterns uncovered into ten separate categories with different molecular fingerprints each with a different outcome ranging from extremely poor to good. The analyses are more detailed than what has been done before and the information is being called crucial new information about breast cancer. This is because the information may lead to finding new drugs to target different characteristics of the tumors. According to one of the authors, breast cancer should be regarded as an umbrella term for a range of diseases. The head of Cancer Research UK told the press this study will completely change the way we look at breast cancer.
 



Researchers Call For Addressing Definitional Issues In New Field Of “Surgical Epidemiology”

“The eye cannot see what the mind does not know.” With words like these, Amardeep Thind, a head and neck surgeon and health services researcher in Canada and US colleagues have published a call to action in the World Health Organization Bulletin for more effort to be placed into defining the field of surgical epidemiology and its goals and objectives. The usual “distribution and determinants” definition of epidemiology does not work well for surgical interventions, particularly in developing countries which is the area Thind and colleagues are most focused on. They call for consensus-building among stakeholders to resolve the outstanding issues.

Definitional issues are important say the investigators because “the validity and reliability of our estimates depend on clear definitions of what we seek to measure. That’s because there is a chance that surgical interventions in these settings can be shown to be cost-effective public health tools.

 


Surgeon General Releases 31st Report Focused on Tobacco-Related Issues—This Time Among Young People

A new report from Dr Regina Benjamin, US Surgeon General, estimates that 1,200 people die each day in the US due to smoking and that each of these dying smokers is replaced by 2 young persons between the ages of 12-25 who start smoking each day. How do you explain this? According to the report, tobacco companies spend more than a million dollars an HOUR in the US alone to market their products. If an estimated 2,400 new smokers are created each day, and the tobacco companies spend more that 24 millon dollars per day, that equates to more than 10,000 spent on each young person induced to smoke.

Other highlights which can be gleaned from the report are that today more than 600,000 middle school students and 3 million high school students smoke cigarettes. Rates of decline for cigarette smoking have decreased in the last decade producing 3 million more young smokers today than we would have had if progress had not slowed. Successful tobacco control programs include mass media campaigns, higher tobacco prices, smoke-free laws and policies, evidence-based school programs, and sustained community wide efforts.
 




Epidemiologist Heads Effort To Digitize Private Physician Medical Records

“Data is power”. Setting aside grammatical concerns for a moment, the idea is clear. Data can be useful for a whole host of purposes. That’s the thinking of Farzad Mostashari, a physician epidemiologist, according to a profile about him in Kaiser health news. Mostashari is in charge of the federal office with billions of dollars to distribute to physicians who automate their medical records. Some doctors could earn bonuses of up to $64,000 over six years to install and use electronic record systems. As an epidemiologist, Mostashari can see the potential payoff in terms of data monitoring to detect outbreaks, evaluate the efficacy of medical procedures, uncover new approaches to care, and cut unnecessary costs.  The passage of the new health care reform act with the provision to show meaningful use of electronic health care records by 2015 may guarantee employment for epidemiologists and public health professionals for some time to come!
 


Experts Say Exposure At Japanese Nuclear Plant Too Small To Produce Detectable Health Impacts

“There’s no opportunity for conducting epidemiological studies that have any chance of success. The doses are just too low. If you were to do a proposal, it would not pass a scientific review.” These are the views of cancer epidemiologist John Boice speaking at a recent National Press Club panel discussion and reported in the NY Times. Other panelists concurred with Boice’s view. While the fear of radiation is widespread, in fact, the expected number of new cancer cases as a result of it is so low as to be undetectable from background cancer rates which normally affect 41 out of every 100 persons. And that small number of excess deaths contrasts with the estimated 20,000 persons who lost their lives as a result of the earthquake and tsunami.
 


New Journal of Epidemiology and Global Health Launched

A new journal with a special interest in publishing evaluations of policies which have been implemented based on epidemiological and public health research has been launched by Elsevier. The new journal will be edited by Ziad Memish, an assistant deputy minister of health for preventive medicine from the Ministry of Health in Saudi Arabia. Faculty from Emory University, where Memish also holds an adjunct appointment, are also involved with the journal. In an accompanying article in the first issue, Memish and co-author Anne Marie Pardon from Elsevier highlight how non-communicable diseases (NCD’s) are now in the spotlight as a result of the UN General Assembly’s Summit on NCD’s last September. This journal can be considered an offshoot of this heightened interest.

 


New York State Health Department Investigators Conclude Outbreak Of Tic Disorders Is Mass Psychogenic Illness

In a new report issued at the end of January, the New Your State Department of Health and its collaborating co-investigator organizations found no environmental or infectious etiologies for the mystery illness affecting 12 cases of tic-like behaviors at LeRoy High School in upstate New York near Buffalo.

The investigators now consider the outbreak to be conversion disorder, a disease category characterized by physical symptoms without an identified cause other than psychological stress. Three of the twelve students had illness associated with tic symptoms before they attended the high school (three new students with possible tic symptoms were reported during the investigation and are currently under review).

The details of the cases provided the investigators with clues. Cases ranged in age from 13-19 years and all were female. Onset of the symptoms was in the latter half of 2011 between May and December. The cases are in different grade levels and no common in-school or after school activities were identified, though four participated in soccer and two in cheerleading. No temporal relationship between vaccination with HPV vaccine and symptom onset was apparent. Significant life stressors were identified in 11 of the cases.

In interpreting the results, investigators determined that the occurrence of symptoms only in female students, the lack of faculty/staff involvement, and the range of time of symptom onset were not consistent with an environmental or infectious etiology.

Because of publicity surrounding a hypothesis put forth by the advocate Erin Broncovich about a chemical spill resulting from a train derailment, investigators checked out that area and found no cause for concern. Another diagnosis ruled out was Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (PANDAS) because none of the cases met the five PANDAS criteria.

Working with NIH, the state health department has offered all of the patients a no-cost specialized medical consultation to continue their care.







BioMed Central To Halt Publication of Online Journal Epidemiologic Perspectives and Innovations

The Epidemiology Monitor has learned from the University of Minnesota’s George Maldonado, editor of the online journal  Epidemiologic Perspectives and Innovations, that BioMed Central will cease publication of the journal as of March 30, 2012 because the journal does not publish enough articles to fit BioMed Central’s business model. According to Maldanado, “We are exploring alternative on-line publishers.”

The other online epidemiology journal which was launched at approximately the same time is Emerging Themes in Epidemiology. According to its editor, Peter Smith from the London School of Hygiene and Public Health, there are no similar actions being taken for that journal.


Emily The Epidemiologist Now Playing On “The Bachelor”

The Epidemiology Monitor always considers unusual situations involving epidemiologists to be newsworthy items for our readers including such situations as the one at PepsiCo where a senior epidemiologist is employed as described in our February print issue. However, one of the most unexpected situations to come to our attention this month is the one involving a University of North Carolina epidemiologist who is currently one of the contestants on the Bachelor, a popular US “reality” TV show in which young women compete to be selected by an eligible male bachelor. We investigated to learn more about the woman who is only known on the show as Emily the epidemiologist. Here is what we have learned so far from our online sleuthing.

Emily is Emily O’Brien a former psychology major at Duke University and currently a PhD student at the UNC School of Public Health who published a paper last year on whether hospital arrival day is a factor on the outcome of stroke patients. Other reports are that she named  East of Eden as her favorite book, she likes to dance, is the smartest contestant, and she is not afraid to speak out about people who exhibit what she considers unacceptable behavior. For example, she does not like skinflints on dates!





Graphic Novel Features “Metaphysical Epidemiologist”

It is certainly turning into a strange month when we can read about epidemiologists working in “strange” positions at PepsiCo, appearing on “strange” TV reality shows like the Bachelor, and now featured in a “strange” novel entitled Witch Doctor.

What is described as a charmingly demented graphic novel has made its appearance in book form. As described on boingboing.net, it is about a metaphysical epidemiologist bent on stamping out Cthulhuism. What is a metaphysical epidemiologist and what is Cthulhuism you ask? According to the blurb about the novel, a metaphysical epidemiologist is one who specializes in tracking down and eradicating transdimensional pestilences. As for Cthulhuism, we learned on Wikipedia that he or it is a fictional character who first appeared in a short story in the pulp magazine Weird Tales in 1928 as a malevolent entity trapped in an underwater city in the South Pacific and described as being "- an octopus, a dragon, and a human caricature -"

In the first volume in the Witch Doctor series entitled Under the Knife other characters include Penny Dreadful (a possessed former art students whose internal demon feeds on pandimensional horrors) and Eric Gast, a paramedic who's learning the metaphysics trade.

According to Cory Doctorow on Boing Boing, “the metaphysics they reveal through the gruesome adventures in this volume has a weird internal consistency, but it's so cockeyed and frankly revolting that I can honestly say it never occurred to me before they scarred me with it.  This is a fine debut, and I can't wait for future volumes.”

To look at a preview of the graphic novel, visit http://tinyurl.com/87bmg7  to purchase the novel at Amazon.com

We invite any readers of such novels to do a review and send us your comments. We are curious to learn what card-carrying, earthbound epidemiologists might think of this novel!


Harvard’s New Epidemiology Chair Speaks Out On Her New Job, Public Health, And Epidemiology

Michelle Williams, the new chair of the Harvard Department of Epidemiology last summer was recently interviewed for a Harvard news publication about her plans for the Department and her thoughts about the field. Here are some excerpts from the interview.

“I want to still be very much involved in the first-person moment of teaching and bringing people along. Students are freethinking, freewheeling. They’re fearless. And that helps my science. I think we all benefit from them more than we would admit.”

“The fact that in public health , our mission is to discover and to translate those discoveries into ways that change the world and alleviate or prevent suffering is a pretty amazing thing.”

“It is important for epidemiologists to continue to lead the change in documenting the adverse health outcomes of Westernized diets and sedentary lifestyles, even in low-income countries.”

“Health disparities is a huge issue here in the United States, but disparities in global health get your attention really quickly.”




  Archives

Social Epidemiologist Interviewed in Epidemiology Pinpoints His Most Influential---And His Least Appreciated---Publications.

“I really am only interested in work that will make the world a different place.” That also  means looking for pivotal issues to investigate and not doing “ordinary research”, according to Leonard Syme, University of California Berkeley epidemiologist speaking out in an interview in the latest issue of Epidemiology.

Syme, described as one of progenitors of the field of social epidemiology, was inspired early in his career by the findings of sociologist Emile Durkheim indicating the  undeniable influence of underlying social factors in causing suicide in different populations. Syme has devoted his career to elucidating these “causes of the causes”.

He told the interviewer, the University of British Columbia’s W Thomas Boyce, he considers “Rethinking Disease: Where Do We Go From Here”, published in the Annals of Epidemiology in 1996, as his most influential paper. In it he called for a greater focus on defining diseases by what social and environmental causes increase susceptibilities to them, much as infectious diseases are referred to as water-borne or food-borne since these broad, fundamental causes are responsible for multiple different diseases.

In his career, Syme has also sought to change the way epidemiologists seek to use data to intervene in population health by calling for less top down messaging about risk factors to a more participatory approach which involves more intensively the persons affected by the diseases being targeted. Syme called his paper "Social Determinants of Health: The Community As An Empowered Partner” his most underappreciated paper. It sought to point out the need for researchers to become experts in working with the people who are the intended recipients of  interventions. “ And that message I don’t think has gotten through,” according to Syme.


New HIV Infections Down 21% And Agencies Are Talking About Ending The AIDS Epidemic

An estimated 34 million people are now living with HIV, an increase of 17% over the last decade, according to UNAIDS. Why? The number of persons dying from AIDS in 2010 has fallen to 1.8 million from a peak of 2.2 million in the mid-2000’s, and an estimated 2.5 million deaths have been averted in middle to low income countries since 1995 due to the introduction of antiretroviral therapy.

There were 2.7 million new infections in 2010. This was 15% less than in 2001 and 21% below the number of new infections at the peak of the epidemic in 1997. About 1.2 million of the persons living with HIV are in the USA.

There appears to be added momentum to World AIDS Day on December 1 this year because the tools to halt AIDS are now in hand. According to UNAIDS, “We are on the verge of a significant breakthrough in the AIDS response. The vision of a world with zero new HIV infections, zero discrimination, and zero AIDS-related deaths has captured the imagination…Just a few years ago, talking about ending the AIDS epidemic in the near term seemed impossible, but science, political support, and community responses are starting to deliver clear and tangible results.




Epidemiologist Uses Animated Clay Cartoon To Help Translate Data Into Practice

An editorial in the November 19 issue of The Lancet has brought attention to an animated clay cartoon (claymation) produced by Ian Roberts, an epidemiologist at the Clinical Trials Unit of the London School of Hygiene and Tropical Medicine. What makes the animation interesting for epidemiologists is that the video was created to help translate into practice the positive results of a clinical trial of tranexamic acid for bleeding trauma patients.  Roberts was interested in using social media to deliver the message about the life-saving potential of the drug when survey data revealed that the drug is being underutilized despite the compelling RCT results about the drug’s benefits were compelling. In the animation, according to Lancet, a clay trauma victim bleeding profusely from the abdomen happily avoids bleeding to death by means of a timely injection of the drug. The goal is for the YouTube video to go viral and make an impact on treatment for trauma victims. According to one report, Robert estimates that full use of the drug could save 140,000 lives worldwide each year.

Watch the claymation at:

http://www.youtube.com/watch?v=pIoYJUf1uls&feature=youtu.be

http://www.youtube.com/watch?v=udJQNqCWOzo&feature=related


Canadians Recommend Against Routine Breast Cancer Screening for Women 40-49 Years of Age

The Canadian Task Force on Preventive Health Care now recommends against routinely screening for breast cancer for women aged 40-49, but does recommend screening every 2-3 years for women 50-69 and 70-74 (Canadian Medical Association Journal, November 22, 2011) The estimated number needed to screen (NNS) to prevent one death from breast cancer in the youngest age group is 2108 for screening conducted once every 2-3 years for about 11 years. According to the recommendations, preventing this one death would also result in about 690 women having a false positive mammogram, leading to additional testing and to an estimated 75 women having an unnecessary biopsy. Estimates of overdiagnosis of breast cancer were not available for this age group but in women 39 years and older, the group estimates 5 women will have an unnecessary lumpectomy or mastectomy for every 1000 women screened. The Task Force judgment is that “this ratio of potential benefit to harm does not justify routine screening in women 40-49 years of age". The Task Force acknowledged that women who place a higher value on a small reduction in mortality and are less concerned about undesirable consequences are likely to choose screening.


Large Danish Cohort Study Of Mobile Phone Use Finds No Association With Brain Cancer
Case Closed? Not Yet Say Researchers

It is impressive to read about the type of epidemiological studies which the Danes can carry out. The latest example is a nationwide cohort study of over 350,000 residents born after 1925 and divided into subscribers and non-subscribers of cell phones. The cohort accrued almost 4 million person years of followup in the period 1990-2007. The risk was close to 1.0 for both men and women and no there was no evidence of a dose response relationship by duration of exposure or by anatomical location of the tumor nearby where the handset is usually held.

The results were not as subject to the biases associated with previous studies,but nevertheless, the authors concluded conservatively that additional studies with longer followup and with large populations with minimal exposure and selection bias “are warranted.” It looks as if it will be years away before researchers are willing to give cell phones a clean bill of health, but for now the preponderance of evidence is negative. If the goal of the research is to establish “safety” as one epidemiologist has said, one can wonder what the definition of that will require and whether agreement can ever be reached that “safety” has been proven since it requires proving a negative.

One interesting comment came from a physician on Long Island who noted that the biggest cell phone risk is using it while driving to speak, text, or check emails. That’s worth acting on.  


Pregnant Women With 2009 H1N1 Infection Have Much Poorer Pregnancy Outcomes

A cohort of 256 hospitalized pregnant women with confirmed H1N1 infection in late 2009 and early 2010 and 1220 pregnant woman controls were followed-up by researchers at Oxford University to ascertain pregnancy outcomes. Results reported in BMJ showed that perinatal mortality among infected women was 39 per 1,000 live births versus 7 in controls, mostly due to an increase in stillbirths among the cases. These findings reinforce those which call for vaccination of pregnant women, not only for the sake of the mother, but also for the sake of the fetus.   

 






It’s Not Just Prostate Cancer Screening Coming Under Fire But Breast Cancer Screening As Well

The recent guidelines on prostate cancer screening from the US Preventive Services Task Force call for discouraging the use of PSA screening because reviewers could not adequately demonstrate a net benefit of screening, or that the benefits in terms of lives saved outweighed the harms caused by treatment. The prevalence of screening is high in the US and many men and doctors believe their lives have been saved by the test. Now mammography screening, which caused a controversy two years ago when the Task Force withdrew its recommendation for routine screening, has come under close scrutiny by a group of investigators from Dartmouth.

They report in the Archives of Internal Medicine that, as with men surviving prostate cancer, most women with screen detected breast cancer have not had their lives saved by screening. The researchers estimated that the probability of having a life saved for breast cancer was always less than 25% under the conditions of their study, and in all likelihood was probably well below 10%.  It is not clear how the authors expect women to use this information. They claim it should “put cancer survivor stories in their proper context”. That seems to translate into don’t believe most of what you hear!    


Public Broadcasting System Examines The Health Effects Of Income Inequality By Talking With Epidemiologists

Because of the Occupy Wall Street movement, everyone’s awareness of income inequality has been heightened recently. Also, a new report from the nonpartisan Congressional Budget Office shows just how bad the situation has become in the United States with the wealthiest segment experiencing triple digit increases (275%) in income compared to more meager increases ranging from 18-75% in other income classes. An interview with British epidemiologists Michael Marmot and Richard Wilkinson by the Public Broadcasting Service helps to understand the health consequences of these disparities. Below are excerpts from the interview in late September.

Wilkinson: Societies with bigger income differences between rich and poor do worse on a whole range of measures. They have worse health. They have more violence. They have more drug problems. Standards of child well-being are worse.

Wilkinson: Perhaps two or three times the mental illness as the more equal countries. Because, in a more unequal society, there is more status competition. We judge each other more by status, and we feel more judged.

Marmot: Health and disease are the good and bad effects of where you are in the hierarchy, mediated by the effects of chronic stress.

Wilkinson: Money becomes more important because it says what your’re worth. So people in more unequal societies work longer hours, much longer hours, are more likely to get into debt. They save less of their income.

Wilkinson: We sometimes say, if you want to live the American dream, you should move to Finland or Denmark, which have much higher social mobility.








New Movie “Contagion” Receives High Marks From Epidemiologists

“Contagion”, a new thriller described by one commentator as an ‘Oh God Oh God We’re All Going To Die’ movie, is receiving positive reactions from epidemiologists both for its realism and its entertainment value. The story involves the spread of a new emerging ME-1 virus from bats to humans which spreads quickly around the world and kills many of those infected.

The NIH’s Anthony Fauci, director of the Allergy and Infectious Diseases Institute told CIDRAP news “It’s one of the most accurate movies I have seen on infectious disease outbreaks of any type…It did depict what would be an extremely rare possibility of a worst-case scenario…Audiences will look at this and say, ’Could it happen?’ Certainly it could happen, but it’s extremely unlikely to happen.”

The film’s chief science advisor was Columbia University’s Ian Lipkin who is John Snow Professor of Epidemiology and Director of the Center for Infection and Immunity in the School of Public Health. In an interview in Wired Science, Lipkin said the fictional ME-1 virus is a paramyxovirus that infects the lungs and brain and was modeled on Nipah virus. “We considered casting other viruses, he said, “but this was the best.”

Experts from CDC were consulted about the story and some scenes were actually filmed at CDC in Atlanta. In addition to being dubbed accurate and entertaining, epidemiologists are seeing other benefits because the film educates the public about a possible threat and helps make the case for a strong, well-funded public health system. A New York Times reviewer called the movie “a giant in-your-face public service advertisement for the world’s beleaguered health agencies.”


Forbes Article Questions Scientific Soundness of IARC Conclusion On Cell Phones

A recent provocative article in Forbes online magazine entitled “Behind the World Health Organization’s ‘Cancerous’ Pronouncement on Cell Phones’ has called into question the scientific soundness of the recent IARC report which called radiation frequency from cell phones a “possible carcinogen”. The reason for the critique by Geoffrey Kabat, a cancer epidemiologist at Albert Einstein and author of “Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology”, is his conclusion and that of other epidemiologists that the bulk of the evidence shows no increased risk.

If so, how could the committee conclude that cell phones are a possible carcinogen? Kabat’s view is that non-science related factors such as the inclusion of a Swedish investigator on the committee--a vocal promoter of his finding that phone use is associated with an increased risk of glioma--gave excessive weight to this limited evidence considered potentially very flawed by some epidemiologists familiar with the study.

Another explanation is contained in the remarks of a committee member who told Kabat that the IARC “wanted to send a message” that we still have limited information about the possible effects of cell phones, particularly among children, and that a clean bill of health for cell phones is premature. That seems hard to argue with from a public health perspective.

Actually, Kabat’s objection appears not to be with the IARC’s conclusion, since indeed the data on cell phone risk are still limited and monitoring has not been carried out long enough to be fully convinced about the safety, but with the IARC’s terminology. He calls the term “possible carcinogen” as it applies to cell phones an “ambiguous label” and “unfortunate” because it means one thing to scientists working for IARC and something different to the general public. Thus, it seems the IARC report is problemmatic more from a communication than a scientific perspective.

Kabat warns that the label chosen—possible carcinogen-- is likely to be misused in the future to make it seem that we have more of a risk than the evidence justifies. He reminds readers that we need to rely on scientists to use clear language to tell us what things are worth worrying about.

To read the Forbes article, visit:
 
http://www.forbes.com/sites/realspin/2011/08/23/world-health-organization-cancerous-cell-phones/

 






9/11 Tenth Year Remembrance Provides Opportunity To Highlight Public Health’s Role

The ten year anniversary of the events of 9/11 this month have been the occasion for remembrance ceremonies, but also for preparation of a report reminding Americans of the importance of public health preparedness. Prepared by the Trust for America’s Health (TFAH) and entitled “Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense”, the report includes 30 first-hand, on the ground accounts of public health professionals who were directly involved in the response to 9/11 and the anthrax tragedies.

Additionally, the report inventories the significant improvements in preparedness since 9/11. According to TFAH’s Jeff Levi, “Public health had not traditionally been considered among the first responders, but ten years ago, that changed forever.”

The report also catalogues the list of ongoing gaps in preparedness and states that “the top lesson we learn and relearn in each tragedy and emergency is that being prepared means we must sustain enough resources and vigilance so we can prevent what we can and respond when we have to…the current economic climate and budget cuts at federal, state, and local level mean that the progress made over the past decade could be lost.”

Perhaps public reaction to the new movie “Contagion” will help reverse the complacency which is at the heart of failure to achieve full public health preparedness.

To access the full report, visit http://healthyamericans.org/assets/files/TFAH911Anthrax10YrAnnvFINAL.pdf


Times Reports Death of Bruce Dan Who Helped Link Tampons and Toxic Shock Syndrome

Bruce Dan, a medical television personality, who helped link tampons and toxic shock syndrome while working as an EIS Officer at the CDC, died in Baltimore on September 6 at age 64, according to a recent obituary in the NY Times. The obituary details the history of the investigations in 1980 which found that a large group of cases occurred in menstruating women using tampons. One brand of tampons, Rely, carried a higher risk because its lubricant increased the level of toxins in the bacterium. According to the Times, Rely was removed from the market and other brands were redesigned to help prevent bacterial growth. In 1981, Dan and others received the Langmuir Prize for epidemic investigation and a US Public Health Service Commendation Medal. To read the full obituary, visit the Times online at:

http://www.nytimes.com/2011/09/11/health/research/11dan.html

 




Facebook Used In An Outbreak Investigation

The recent statement in Science Times was attention-grabbing---“Social media…are changing the way epidemiologists discover and track the spread of disease.” Using an example from a Los Angeles outbreak of a flu-like illness with chest pains, chills, and fever, the Times reported that attendees at a Playboy Mansion fund raising party posted their illness information on Facebook and had arrived at their own diagnosis—legionellosis-- by the time a CDC epidemiologist arrived.

These results are all the more astonishing since the attendees at the party were all dispersed around the world by the time they got sick. While the Times says CDC will not comment yet on the outbreak, legionella bacteria were reportedly isolated from a hot tub. CDC’s deputy director for information science told the Times, “we can’t turn the clock back…it just makes perfect sense to adapt the speed and flexibility of social networking to disease surveillance.”

Another example of growing use of social media is the fact that the CDC epidemiologist used Facebook to document the symptoms, recommend diagnostic tests to followers on the Facebook page, and recruited study subjects to fill out CDC’s online questionnaire. Other uses of online information to assist epidemiologists include investigating search terms to identify early cases of flu and a new project to track dengue. However, none of the examples are quite as startling as the one related to the Playboy Mansion investigation. Stay tuned to learn if CDC eventually confirms legionnella or some other agent as the cause of the outbreak.


What Is A Computational Epidemiologist?

The recent article in Science Times described above referred to an assistant professor of pediatrics at Harvard as a leader among self-described “computational epidemiologists”. Since the term was unfamiliar to us and we are always on the lookout for new applications of epidemiology, we made an inquiry. Wikipedia has a short three sentence definition as “a multi-disciplinary field utilizing techniques from computer science, mathematics, geographic information science, and public health to develop tools and models to aid epidemiologists in their study of the spread of diseases. It differs from bioinformatics in that it is centered more around studying how diseases spread, and not the actual disease itself.”

Another unfamiliar term in the article was “crowdsourced epidemiology”. According to Wikipedia, crowdsourcing is “the act of outsourcing tasks, traditionally performed by an employee or contractor to an undefined, large group of people or community (a "crowd"), through an open call.” In epidemiology, one application of this is the mobile application Outbreaks Near Me which has been downloaded by thousands of persons and through which persons have reported outbreaks. Questions arise as to whether or not this type outbreak detection has any advantages over the more traditional approaches because the reporters may not be representative and can skew the information. This limitation applies to many other potential uses of  “public science”.






Epidemiologists Seek To Put Numbers Behind The Deaths Caused By Social Factors

“When you can measure what you are speaking about, and express it in numbers, you know something about it. But when you cannot, your knowledge is of a meager and unsatisfactory kind.” This quote attributed to Lord Kelvin seems to have been taken to heart by Columbia University epidemiologist Sandro Galea and colleagues. They surveyed the literature between 1980 and 2007 to identify studies with estimates about the link between social factors and adult all-cause mortality, calculated summary relative risk estimates, obtained population level estimates of the prevalence of each factor, and calculated the population attributable fraction for each factor. They found that approximately 245K deaths in 2000 attributable to low education, 176K to racial segregation, 162K to low social support, 133K to individual level poverty, 119K to income inequality, and 39K to area level poverty.

Galea was quoted in the NY Times saying “If you say that 193,000 deaths are due to heart attack, then heart attack matters. If you say 300,000 deaths are due to obesity, then obesity matters. Well, if 291,000 deaths are due to poverty and income inequality, then those things matter too.” In their paper, Galea and colleagues conclude that “these findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations.”  Co-authors in the AJPH June issue were Melissa Tracy, Katherine Hoggatt, Charles DiMaggio, and Adam Karpati.


European E Coli Outbreak Traced Back To Lot of Fenugreek Seeds Imported From Egypt

The outbreak of shiga-toxin producing E.coli (STEC) in May and June 2011 in Europe has now totaled 265 cases with Hemolytic Uremic Syndrome (HUS) and 3151 non-HUS cases and there have been 42 deaths, all but one in Germany. A report from the European Food Safety Authority in early July implicated a particular lot of fenugreek seeds imported from Egypt in December 2009 [http://www.efsa.europa.eu/en/supporting/doc/176e.pdf].

Several seed types (alfalfa, fenugreek, lentils, adzuki beans, and radish) were suspected in Germany, however, a separate cluster of cases occurring in France in June 2011 gave investigators an important clue. While three types of sprouting seeds were implicated in France (fenugreek, mustard, and rocket), only fenugreek seeds were common to both outbreaks. They became the focus of the investigation and were traced back to Egypt. Results from the microbiological tests carried out on seeds have been negative, possibly due to the limitations of the tests used or the sampling plan used to select the seeds for testing.

The hypothesis is that the fenugreek seeds became contaminated with STEC 0104:H4, the implicated agent, at some point prior to leaving the Egyptian importer. According to the report, this reflects a production or distribution process which allowed contamination of fecal material of human or animal origin, possibly at the farm level but still not established.
 


Sweet and Vicious—The Case Against Sugar

The science writer Gary Taubes was being his provocative self as he has been in the past about the field of epidemiology and about dietary components and chronic diseases. The occasion for his latest report came as the cover story about sugar for a health and wellness issue of the New York Times Sunday magazine in April.

Taubes has been persuaded that sugar is toxic by the evidence and arguments made principally by Robert Lustig of the University of California San Francisco School of Medicine. The mechanism envisaged is for high levels of sugar consumption to cause fat to accumulate in the liver, followed by insulin resistance and metabolic syndrome which in turn can lead to heart disease, diabetes, and obesity. According to Taubes, sugar and high fructose corn syrup “…could be toxic, but they take years to do their damage. It doesn’t happen overnight. Until long term studies are done, we won’t know for sure.” And some cancers such as breast cancer may also be one consequence of insulin resistance and metabolic syndrome.

Taubes confesses in the article that sugar scares him. “I’d like to eat it in moderation, I’d certainly like my two sons to be able to eat it in moderation, to not overconsume it, but I don’t actually know what that means, and I’ve been reporting on this subject and studying it for more than a decade…Officially I’m not supposed to worry because the evidence isn’t conclusive, but I do.”


Cell Phones and Cancer—A Journalist’s Highly Regarded Review of the Evidence

In a review article of cell phones and brain cancer which an epidemiology colleague has called a model of balanced investigation and presentation, Columbia University’s Siddhartha Mukherjee, has concluded that “…as of now, the evidence remains far from convincing.” He bases this conclusion on the fact that casting a wide-net to incriminate cell phones “has yet to find solid proof of risk for cellphone radiation. And while more definitive studies are needed, he raises the possibility that even these studies might not give us the degree of proof we want.

 In the article, he seeks to remind those who may be disappointed by the failure to incriminate cell phones that we need standards by which not only to rule in carcinogens, but also to rule them out. Otherwise, he says, the effect is like crying wolf too often. People get numb to your warnings. Thus, failing to rule potential carcinogens in or out leads to a degeneration of our scientific language about cancer.


This Time Harvard Study Says Coffee May Reduce The Risk of Cancer

Senior epidemiologists easily remember the study reported in the NEJM on March 12, 1981 by investigators at Harvard about a possible relationship between coffee and pancreatic cancer. The report is infamous in the annals of epidemiology because of the publicity it received and because the association is often referred to by epidemiologists as the example of a false positive association. At the time, the lead investigator and well known epidemiologist Brian MacMahon was quoted as saying that he had stopped drinking coffee.

Now it is ironic that another report should come from Harvard, this time pointing to the potential benefits of coffee in protecting against the most lethal or advanced forms of prostate cancer. Investigators studied 47,911 men in the Health Professionals Follow Up Study who reported their coffee consumption patterns every four years between 1986 and 2008. Over this period, 5,035 cases of prostate cancer were found, including 642 that were lethal. In the Harvard study, consuming six or more cups daily produced an 18% lower risk of any form of prostate cancer and a 60% lower risk of developing lethal prostate cancer. The risk reductions were found with either regular or decaffeinated coffee.

The authors did not go out on a limb to recommend coffee drinking as a cancer preventive measure at this point, stating “it is premature to recommend that men increase their coffee intake to reduce advance prostate cancer risk based on this single study. However, our findings are potentially important given the lack of identified modifiable risk factors for advanced prostate cancer.”


CDC Tongue In Cheek Blog Post Gets Wide Circulation

You just never know. CDC routinely posts information on its public health preparedness blog and gets a few thousand hits. Then it posts one about preparing for a “zombie apocalypse” and the servers crash because so many people want to read about the upcoming disaster. In the process, hopefully they learn what it takes to be prepared for a public disaster and CDC gets its message, or at least part of it, across to a wide range of Americans. Go figure. Perhaps epidemiologists and other scientists with a message to convey that is not getting through, say on climate change or autism and vaccines could use this approach. Maybe a tongue in cheek post about how Gravity Is Not A Law After All or How Evolution Has Not Really Happened.  To read the original “Preparedness 101: Zombie Apocalypse” visit

 http://blogs.cdc.gov/publichealthmatters/2011/05/preparedness-101-zombie-apocalypse/


 
 
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