Prison: The New Psychiatric Ward?

I recently read an article in the New York Times that talked about the status of mental health care in Texas. This article talked about the problems that have arisen over the last few years and how it seems to only be getting worse. Unfortunately, the mental health care funding is already extremely low in the state and is continuing to be drastically cut.

This article specifically talks about the transformation of prisons into a type of mental institution. This is because so many mentally ill patients are sent there as the only option. There is an insufficient amount of legitimate mental institutions in the state, and those that do exist do not have nearly enough space for all of the help-seeking people. One prison, the Harris County Jail, has seen the number of inmates explode and now has 108 beds for the mentally ill and more than 15 full-time psychiatrists. Some mentally ill inmates claim that this is now the best mental health care available to them in Houston.

The rest of the article goes on to explain why these prisons are having to be transformed into a primary source of mental health care and explains the implications that go along with doing so. Lawmakers who are desperately trying to deal with budget shortfalls accumulating to 15-27 billion dollars often turn to deeper cuts in community-based mental health treatment. With more cuts expected in the near future, totaling to 20% reduction in financing, the problem of mentally ill in prisons, on the streets, and in hospitals is bound to increase.

This article was interesting because it showed the importance of the economical barrier of public health. So often, lack of finances play a role in the problems with public health around the world. This can be easily seen in the lives of those living in low income countries, but this article also expresses the difficulty with distribution of finances. In part of the article, it mentions that in order to not raise taxes, there was little other option for cutting health care expenditures and closing the budget gap. This raises the question, how do we decide what is worth putting money toward and what is okay to take money from? Like in all public health issues, the money used for change must come from somewhere. But is drawing from mental health instead of raising taxes really the right way to obtain that money in this situation?

Finally, this article deals a lot with the idea of prevention versus treatment in terms of cost benefit. The article mentions that it is much more expensive to treat mental health problems by providing care in an emergency room, jail or crisis center, than it is to finance community-based health care in the first place. So who is right: those that want to cut costs and bridge that budget gap, or those that want to focus on prevention and save money in the long run?

Measles Mania

This article addresses the issue of serious diseases being spread in the confined situation of an airplane that was previously undiagnosed. This scare has occurred many many times through various situations, and each time it is a cause for much panic all across news sources and a large cascade of events occurs from our public health sector. In this specific case that occurred on February 22nd, this last Tuesday, a woman with the measles traveled through three different airports. She made several stops all the way from Europe and finally ending in New Mexico where she was diagnosed with measles. Measles is a viral disease that is highly contagious, and symptoms are characterized with a fever initially, and so patients that were five rows in front of or behind the infected woman were called by the CDC and asked to simply watch themselves for if they begin developing a fever. People that were also taken into special consideration on the flight are babies, small children, or individuals that have a medical history of conditions where their immune system might be compromised.

An interesting part of this article was the ways in which public health departments deal with this problem. In a separate case of the same nature, a woman who was 24 years old who was traveling from France to Boston developed measles and was diagnosed in Boston. An interesting fact that I did not know was that there is actually a small window of time in which people that had not been previously vaccinated can get vaccinated after exposure to the pathogen and have the vaccine still work effectively. Going on this principle, Boston actually held a free clinic for measles vaccinations on Friday. It was also identified by CDC spokesman Tom Skinner that most of the measles cases that present in the US are imported in from abroad, in situations such as this at the airports.

This is a beneficial article for all of us because these type of situations are the difficult parts of public health but some of the most crucial when it comes to emergency response, and this is a gap in society that public health can fill with expertise. I thought the most interesting bit of information is the window that you can still receive a vaccination in and have it be effective towards the pathogen that an individual is exposed to. It makes me really glad to see that Boston was able to host the clinic free as well, because I feel like if the participants had to pay for their care many would not have gotten it, only increasing the prevalence of the disease that was carried in. This is really good practice and I am glad that public health succeeding is highlighted here.

Kenya's Mentally Ill Locked Up and Forgotten

I hope everyone takes time to read this article because it has some very powerful stories of just how real this problem is for the people of Kenya and probably in many other countries as well. In this article, a few Kenyan families talk about the challenges they have faced because of mental health issues within their family. Milkah Moraa has been taking care of her son, Thomas, for 30 years because of a mental disorder that started when he was three. He is tied to his bed most days so that he does not run away from his family. The family has tried many doctors and hospitals without any help, but they have been unsuccessful in finding ways to help Thomas. The family has had to move multiple times because neighbors shunned Thomas and the entire family. Thomas and his family are not the only Kenyans that go through this every day of their lives.

The problem in Kenya is much worse than the social stigma that often is associated with mental health and examples of this stigma can be seen in many posts throughout this blog. Kenya does have a serious social stigma that they deal with, but more than anything, there is a neglect associated with mental health. Entire families are forced to hide and neglect their loved ones suffering from mental illness. The article talks about children chained in chicken coops and filthy shacks. These people are neglected by every level of their country, from the government to their neighbors.

The government may be most to blame for this epidemic of neglect and abuse sweeping their country. Inadequate resources and corruption are easily seen in the government. The article estimates that 3 million Kenyans have mental disabilities but the government spends less than 1% of its health budget on mental health. This translates to a quarter of patients that go to hospitals are complaining of mental health issues. This is unacceptable considering the health budget is probably already limited, and the government spends less than 1% of the money it has on a problem that 25% of patients complain about. How many more people with these mental health issues cannot even make it to the hospital. Also, corruption only worsens the problem as $3 billion of public money was stolen in 2009 alone, ten times what the government annually spends on global health.

The government needs to take steps to solve this problem in their country. There is only one psychiatric hospital in the entire country, and it is considered more of a prison than a place for people to heal. More hospitals need to be set up that will help the Kenyan people recover from their mental disabilities. Education programs need to be established to educate the population of mental disabilities and ways to treat them at home. Families need to be educated as to how to best care for their loved ones that are suffering instead of the feeling that there is nothing they can do but tie them to a bed. Finally the government needs to put more financial resources into the mental health department because a quarter of their patients at hospitals are complaining of mental problems. The government has to finally come to reality with respect to the health challenges facing their people today.

This is not an easy problem to fix because it is once again ingrained into the minds of the people, but I think an important start is families becoming educated in taking care of their loved ones because many of these families cannot afford extensive hospital stays and treatment. How can the government work to educate the population as a whole on ways to deal with mental health within their families?

Article: http://www.cnn.com/2011/WORLD/africa/02/25/kenya.forgotten.health/index.html

Every Bite You Take

"Every Bite You Take" Article

If you were asked to remember everything you ate yesterday, could you recall each item with pin-point accuracy? For 30 seconds, see how much you can remember, and also try to recollect how you obtained the food, or whether you cooked it or not.

From my own experience as a college student, academics is practically a full-time job. Having made studying and homework my top priority, all the minute details of what I ate, or how much I exercised this week seem trivial at the end of the day. However, ever since this Global Health class, I have learned one key point: that these sort of details, and my failure to recognize them as critical to my everyday habits, are what make up one of the most essential and fundamental underlying problems of public health. Our diets have an increasingly significant impact on our overall total health and the sorts of risk factors that we are exposed to.

In this article (which I HIGHLY encourage everyone to read), a study was performed years ago to test the dietary memory of individuals. What were deemed as results were personally shocking. A psychologist at Baylor College of Medicine, who had dedicated his life to studying children's diets, could not even successfully recall the dinner he had made the night before. This observation is a truth that exposes organic human nature and its toll on public health findings. For epidemiologists, studies that require a questionnaire or rely on people reporting their own activities will inevitably incur overwhelming errors in calculations. Human memory is imperfect; this flaw is what keeps our epidemiological studies from achieving true factuality.

"These mistakes are more than a reminder of the human memory's fallibility: they threaten to undermine the foundations of modern medical epidemiology. In this field, researchers make associations between past events and experiences, and later ones such as the emergence of cancer or other diseases. But if the initial records are inaccurate, these associations can be weak, misleading, or plain wrong," says author Brendan Borrell.

Dietary recollection is just one problem of many. Human inaccuracy also affects studies of smoking, stress, exercise, or pollution (anything that relies on people reporting their own exposures).

Recently, a contraption was developed by researchers Baranowski and Vineis. This walkman-sized environmental sensor fits int he pockets of people's clothing or backpacks and acts to measure the air quality of the places that people in San Diego, CA, are exposed to on a daily basis. "When participants in the study leave the vicinity of a 'home' beacon, the device switches between two filters, making it possible for Chillrud to distinguish between exposures at home and elsewhere" (Borrell). A GPS helps detect the global positioning of the individual at times when the device measure low air quality. After several days of use, the filters are chemically analyzed to identify harmful toxins in the air. From this information, researchers can deduce how the layout of a city, "with its parks, hills, and smog traps, influences physical activity and ultimately, public health" (Borrell). This device also cleverly monitors heart rate to determine where individuals are exercising the most. This forefront in medical technology could open up a new door for more accurate studies.

The US National Cancer Institute has also started an investigation called ASA24 (Automated Self-Administered 24-hour Dietary Recall). This experiment will test children on how well they can recall their portion sizes. Photo-prompts of various portion sizes are given to the children, who choose which size they believe accurately represents their diet from days before. The goal is to "build a web-based tool that other researchers can use in place of food diaries, for instance, link up dietary habits, genetic signatures, and risk of disease" (Borrell).

As far as the diet test at the beginning of this post, how did it go? In a short time limit, were you able to easily recall everything you ate? My guess is, no. I could not myself. This is a vital consideration of public health that I believe, if investigated more thoroughly, could change the behaviors of many people, thus (hopefully) prompting a more positive outlook on risk factors and how we can manipulate them for our own good. I hope that you read this article and find it as interesting as I did, because it really exposes a lot of ideas that we can all relate to, but may not realize it.

Challenge

Out of curiosity did anyone come up with a country to meet Professor Rozier's challenge? The requirements as I remember them were to come up with a country that was able to advance and industrialize without the repercussions of environmental degradation... more or less, correct me if I'm wrong.

The best I could do was Australia. Australia, while a civilized nation, is not a hugely industrial nation, but I do believe it meets the qualifications Professor Rozier was looking for. Australia cannot afford to tax its environment as it is in such a precarious position already. Australia's extreme climates are prone to drought, and its seasonal effects also wreak havoc with the nation. As an island, they must be particularly careful of rising sea levels and the natural disasters which can occur as a result of climate change.

Any thoughts? Other countries, why Australia doesn't work?

Rising Food Prices Create Future Challenge for Health Care

There is an interesting article online that I found that discusses the future problems the world will face with growing food prices globally. It discusses how the increasing population on the planet has created a sharper demand for food, causing prices to rise. This in has led to food prices becoming a contributing factor in pushing people into poverty.

It discusses how in the past year alone food prices have risen almost 30%. Although prices aren't the highest they have ever been, the high prices of 2008 led to riots and starvation in countries across the world. The article then throws out the staggering statistic that some 44 million people have been pushed into poverty from June 2010 to January 2011 due to the increase in food prices. This increase in food prices poses many threats to the global community, including everything from political instability to an increased spread of infectious disease.

One thing that struck me about the article is the reaction from the World Bank. Their view was that an increase in foreign aid will be a main factor in stabilizing prices around the world. Although I believe that this most certainly will help the situation, I think that more creative and long-lasting solutions should be found to keep the costs of food from affecting vulnerable populations. One important way that food prices could be stabilized, I believe, is through localizing food production. In the coming decades more and more people will have moved into urban centers around the world. One interesting idea that has been around for a few years is that of "skyfarming". By bringing food production into the city, citizens would have better access to fresh food while decreasing the environmental impact of feeding the planet's growing population. Another large benefit of this is that it is weather-proof. With poorer harvests on the rise due to climate change, the ability to control a steady source of food can mean the difference for thousands of people.

Another challenge that rising food prices bring to public health is the potential for instability between countries with limited resources. It is already predicted that world's supply of fresh water will put a strain on political relations in the future. The added strain of food resources could be a tipping point that could lead to an array of health problems including war, displacement, and poverty-related diseases.

After the past couple weeks it is quite easy to see how a revolution in one country can set off a chain of revolutions in others. It should be the goal not only of public health workers, but also governments, to make sure that something such as increasing food prices don't exacerbate the strain put on the most vulnerable in society. By increasing funding and research in ideas such as "skyfarming", we can prevent such disasters from ever occurring.

Crib Injuries Illustrate Behavior Challenges

A study from the Children's Hospital of Columbus, Ohio, published in the New York Times showed that an alarming number of children end up being injured from falling out of their cribs. This problem may appear to be unrelated to the issue of public health, but really, what's more related than an issue affecting dozens of children each day that could be fixed by simple government regulation changes on the manufacturing of cribs?
Though there have previously been statistics on the number of crib-related deaths, this was the first study to specifically focus on injuries that were non-fatal to children. The majority of these injuries, 9 out of 10, ended up giving the children either neck or head injuries, as this was the primary area of trauma when they fell.
Surprisingly, the number of injuries actually increased with the age of the child, reaching a peak when the child was around two years old. This trend occurred because as children aged, their parents failed to raise the safety bar in their cribs, instead leaving them at a level that left the kids free to climb out once they acquired walking abilities. Looking at data that was collected from 1990 through 2008, 181,654 children received this type of injury. Of this, 1.2 percent of the children died from their injuries.
The issue here is less an issue of having proper safety equipment in place, the safety bars are on cribs, but a matter of getting parents to actually follow the guidelines to keep their children safe. This underlines one of the main problems in public health, which is the disparity between people knowing what they should do and actually following through on it. It can be seen in the fact that I'm still not praying/meditating on a regular basis, it can be seen in the fact that people still smoke and die of lung cancer every year, and it is a problem that needs to be addressed somehow. Whether it be through parents keeping their children safe in cribs or any of the many other public health issues, behavior change is a major problem.

Creative Solutions to the HIV Prevention Problem

About a week ago, the New York Times covered a very unique strategy to combat the spread of HIV. A clinic in Vancouver, British Columbia, called Insite, acts as a "safe injection site." The program provides nurse supervision, clean needles, and a effective testing system for the drug addicts on the Vancouver streets. It is estimated that about 800 injections occur a day at Insite. The clinic is part of a huge effort in the area to cut down on what was once the fastest growing HIV rate on the continent. This project is a perfect example of public health in the community. It illustrates beautifully the way that a prevention program can cut down long term costs and protect the entire community from the spread of a deadly disease. Although the prevention program is very expensive, it is actually very cost effective. It is estimated that the Canadian government saves an average of $300 million on AIDS treatment.

It seems so puzzling to me that other countries do not see the importance of prevention programs like these. They are hugely beneficial for the health of the community, and they are amazingly cost effective. In an era when both the state and federal governments are far in debt, new and creative health care options must be explored. We need to find ways to lower the cost of health care while providing all with access to adequate health. While these goals seem impossible, programs like these may go a long way.

I understand that the moral implications of this program are extremely controversial. Even in Canada, where the right to health is in the Bill of Rights, the program is undergoing hearings in the Canadian Supreme Court to stay operational. Insite has a special exemption from the narcotics laws in Canada. While nurses cannot inject the patients with drugs, the patients are not at any legal risk for drug use.

What are the barriers that prevent countries like the United States from seeing the benefits of prevention plans and Public Health?

Viva la Revolucion!

For anyone looking for a quick, succinct summary of the ongoing revolutions throughout the Middle East, this short article is pretty decent:

http://news.yahoo.com/s/yblog_thelookout/20110214/ts_yblog_thelookout/egypts-impact-unrest-sweeps-the-middle-east

Careful with the Coal

A few days ago an article was published by the New York Times highlighting the issues that surround our coal industry in the United States. The fact that coal is a resource that is plentiful, and has been used for a long time, means that it is a cheap resource compared to others and has been used in a frenzy to power about half of our electrical needs. However, it is beginning to be understood the grave effects that this utilization will mean for ours as well as future generations.

In this study conducted by students at Harvard's Medical Research Center, the costs of coal are beginning to be calculated, and alarm is being raised in several different areas. As we have discussed in class, it is usually extremely difficult to measure the public health impact of many different issues because they occur on such large scales and from such a variety of mediums that it is very difficult to create a narrow and specific enough study to attain data that is needed. However, these students at Harvard succeeded in mapping the financial impacts that coal use is having on the health of mining communities, as well to our national funding.

It was seen that in mining communities like Appalachia, there is a severe amount of premature deaths that occur due to coal mining, and this literally costs the economies in the area about 74.6 billion dollars a year. And this figure only accounts for the losses associated with deaths. Costs in total, including injury, in the most conservative estimate presents as 175 billion dollars a year nationally. At this, 80 percent of these costs were related to well documented and understood issues in health, such as lung and heart disease.

Dr. Paul Epstein of Harvard Medical school is also greatly concerned with the impacts that coal mining is having on cancer rates in mining areas. “Part of the epidemic of cancer can be attributable to some of these carcinogens that we’re pouring into the groundwater from extracting fossil fuels,” he said.

The effects that the entire life cycle of coal, all the way from extraction to combustion, accosts for one third to over a half trillion dollars every single year. The argument that the Harvard Medical Students make is that the research dedicated to non-fossil fuel energy sources is actually economically competitive with our continuation of using resources like coal, besides the fact that it is more favorable for our outlook into the future.

The public health issues that this raises are, how can we as proponents of public health express the urgency of these type of things that cannot be necessarily directly seen and understood by officials in areas of government or simply people that reside in the areas affected by the coal mining? For example, all of the carcinogens and other hazardous materials that are added to the groundwater supply due to this trend has extremely serious impacts on both the environment and the health of individuals. The first step was conducting this study and making the numbers very visible for all to see. However, the next step is helping people to understand what these numbers mean and finding a way to put our urgency of concern into sincere action.

F.D.A. Approves Band Device for Less Obese

The Article

Recently, the FDA has approved the revamping of the standards deemed necessary in order to qualify for Lap-Band surgery. Lap-Band is a stomach-restricting device, created by Allergan, that works by surgically placing a silicone band around the upper part of the stomach. This band is inflatable and restricts how much a person can eat. The purpose of this surgery is to treat obesity in those patients who qualify. Adjustable gastric band surgery was designed for obese people with a body mass index (BMI) of 40 or greater, assuming they have no other obesity-related health problems. Patients who applied for the surgery with a BMI of at least 35 and who had obesity-related problems such as hypertension (high blood pressure), sleep apnea, osteoarthritis, GERD, or diabetes were also considered appropriate for the surgery

With the new policy approved by the FDA, patients with BMI's of 30 and with obesity-related health problems can now qualify for the surgery. It is estimated that this will open up the door for 26 million Americans to be newly eligible for the surgery. In a society where our culture is surrounded by fast-food and stationary entertainment, obesity has become one of the most prominent conditions affecting Americans. Scores of patients being diagnosed with diabetes has increase exponentially within the past decade or so. The Lap-Band surgery option that is now available to 26 million new Americans will hopefully push more obese people to consider this as a life-changing option. Studies have shown that patients who underwent Lap-Band surgery "lost an average of 18 percent of their weight after a year." This 18 percent can be a huge jump for some people who are deemed moderately to morbidly obese.

From 2007-2008, the Center for Disease Control and Prevention (CDC), performed a study that examined US Adults and obesity trends. The prevalence of obesity was 32.2% among adult men and 35.5% among adult women. This is almost 1/3 of our population that is considered obese. Nevertheless, some people do not see the cost-benefit analysis of obesity in an unbiased way. Those who are obese not due to disease, but lack of physical activity and healthy habits, are making conscious decisions to carry out their lifestyle that way. So what can we do to help change these people's mindset? Make them change their behavior!

However, as we discussed in class before, behavior change is a difficult process. There are so many underlying factors that border behavior change that cause an individual's ability to successfully carry out the change to occur. Some factors include transportation, lack of knowledge, limited resources of healthy food options, prices, employment status, time management, etc. Hopefully, because the Lap-Band surgery is a quick procedure, more people will look to reverse their obesity in this way. It might not be the best way for them to do so, however at least they are thinking about changing their lifestyle, which is a necessary action that comes with the surgery.

Some benefits of Lap-Band:

• Mostly reversible: stomach returns to normal if the band is removed but does have many adhesions making a revision surgery more dangerous
• No cutting or stapling of the stomach
• Short hospital stay
• Quick recovery
• Adjustable without additional surgery

Here is another interesting link regarding obesity trends in the U.S.:

http://www.cdc.gov/obesity/causes/index.html

So, what do you think about Lap-Band? Are we targeting weight loss in the wrong way? Should we be promoting healthy habits, exercising, eating & sleeping right, etc., or should we focus our time and money on surgical techniques?

High on Anxiety

With the stress most of us undergo day to day, I am sure we all understand the anxiety we might get before a test, the end of lab, crossing Grand, etc. But if given the choice between feeling anxious or feeling relaxed before and during those activities, which would most of us choose? According to this article, the anxiety.

Some people apparently perform better while anxious or prefer feeling anxious. While this seems to have been a relatively small study, I personally feel like its results may have been spot on. I personally would much rather be nervous before a test, than totally at peace. I think it's a common misconception that people suffering from anxiety or neurosis are desperate for prescription medication; on the contrary, I would think that many people shun medication for a number of reasons. Today, mental health issues remain highly stigmatized both socially and personally. No one wants to admit to depression/anxiety issues, and broadcasting them in public is not exactly appealing either. Many people are still skeptical as well of drugs that affect behavior or the brain--seeing them as dangerous, not allowing them to be themselves, unhelpful, pointless, or just plain not understanding their effects and their mechanics.

In this case, further study is most definitely needed to see if these two studies have any real significance. Each study only looked at a very specific population: undergraduates. The sample group was also relatively small in each case. I wonder what kind of success the study might find over a broader population and larger sample.

It is also interesting to see the distinction Kent Berridge makes about the emotions of want and like. The article says, "Wanting to feel an emotion is not the same thing as enjoying that emotion, points out neuroscientist Kent Berridge of the University of Michigan, who discovered that wanting and liking are mediated by two distinct sets of neurotransmitters."

In the last paragraph they talk about how the anxious often get used to their condition and when they lose it, they experience boredom or prefer to return to their anxious state than not feel. How then do we go about treating anxiety if this is true? Is some anxiety healthy? In my mind, I think so. But I also think that this is more of a personal issue. Some people are worriers, others are more care-free.

Nonetheless, this is a nice, short piece that peaked my interest, but leaves a lot to be explored and clarified.

Article: http://www.newsweek.com/2011/02/06/high-on-anxiety.html

Drug Addiction in Newborns

An article that I recently read discussed the issue of drug addiction in newborns. More specifically, this article talked about babies that were born addicted to pain killers. Babies that undergo withdrawal are prone to feeding problems, vomiting, diarrhea, tremors and even seizures. This issue is becoming more and more prevalent in the health world today. According to the article, form 2003 to 2008, the number of babies diagnosed with withdrawal more than doubled. Florida even recorded lower birth rates over the last five years, yet the number of babies treated for withdrawal tripled. Doctors used to be baffled at the proper treatment because this used to be such an uncommon occurrence. Now however, there are guidelines and protocols specifically for infant withdrawal because they see cases practically every day.

Unfortunately, there are few treatment clinics and programs offered to pregnant women who are addicted to pain killers. Therefore, there is little hope that the babies will avoid addiction as well. This shows that although there is increased protocol for treatment, little has been done to address this issue as a public health problem, or study its causes. Something needs to be done at the preventative level in order to help these drug addicted mothers stop the passing of addiction onto their newborns. But what exactly does that prevention entail? This issue is so new, or rather becoming more prevalent just recently, that possible preventions are yet to be discovered or attempted.

I think that this article is a fantastic example of the research opportunities that are made available by public health. This requires the work of all the sub-fields. For example, bio statisticians can focus on gaining more concrete data. Environmental health specialists and behavioral scientists can attempt to identify the major causes and make drug addiction programs more available. Since new issues such as infant addiction are arising daily, it is necessary for public health specialists to be constantly aware. This just proves that there are new health issues presented every day around the world—issues that we know very little, or nothing about. The possibility for discovery is seemingly endless as situations change and time moves on. As of now, doctors are very uncertain of the future for these newborns. I think as people interested in public health, we take this as an invitation, a challenge to discover something truly beneficial.

CDC's Annual Report Released Today

The U.S. Centers for Disease Control and prevention [CDC] published their 34th annual report today. An article in Modern Medicine summarized the findings. The report showed that 25% of all deaths in 2007 were due to Heart Disease.
One of the highlighted findings of the report was that there has been a greater than 12-fold increase in adult use of statins to lower cholesterol between the period from 1988-1994 and 2005-2008. Between 2005 and 2007, one half of all men between the ages of 65 and 74 had taken a statin.

What are statins and how do they work? Statins act to inhibit cholesterol synthesis in liver cells by binding HMG CoA reductase, an enzyme that acts early in the pathway that would convert Acetyl Co enzyme A into cholesterol. Physicians prescribe statins for patients with elevated cholesterol levels, since excess cholesterol can lead to an inflammatory response, plaque build up in blood vessels, heart attacks and/or ischemic events.

To see the full CDC health report, follow this link.

Ecuadorean Villagers May Hold Secret to Longevity

The New York Times today ran an article on a village in Ecuador in which villagers with Laron dwarfism were found to be free of diabetes and cancer.

I find the genetics behind disease onset very interesting and this article certainly presents many of the great benefits that can be uncovered with a greater understanding of genes. The general premise is that there is an aging gene, IGF-1, that allows people to age. People with Laron syndrome don't have this gene, which accounts for their lack of growth when they reach puberty. That certain aging processes (loss of telomeres, etc.) are linked with cancerous growths hints at the potential of this study.

Research into these microbiological processes has the potential to prolong a great deal of lives as cancer and diabetes contributes to a large amount of deaths each year. Further research should be encouraged. However, the article hints that while there may be a cure for cancer and diabetes on the way, the overall death rates for these Ecuadorian villagers still remained high due to alcoholism and various accidents. This goes to show the importance of encouraging other healthy habits even if the main afflictions to the population are cured. So while the focus should be fixed on cancer and diabetes, which are extremely inhibitive diseases and a threat to human health, other causes of early death should not be forgotten. That alcoholism and obesity were cited in the article as being prevalent in the village, suggests that while this gene may be influential in preventing the onset of diabetes and cancer healthy habits are lacking.

Finally, the article also cites a lack of transparency among pharmaceutical companies in their development of drugs. While the village was used as a major data source in the development of IGF-1 drugs by the drug companies, the villagers own needs for the drug was ignored. I feel this goes to show the greed displayed by many drug companies in placing a certain profit margin ahead of various needs. The irony of the situation only serves to compound the dismay. But hopefully further studies into aging processes can help lessen the severe impact of cancer and other age-related diseases.

Heart Guidelines Revised to Better Reflect Real Life

Article: http://pagingdrgupta.blogs.cnn.com/2011/02/15/heart-guidelines-revised-to-better-reflect-real-life/

Heart disease is the leading cause of death in the United States, especially among women. The disease has been steadily rising among the most prevalent diseases for many years and the numbers continue to grow. The American Heart Association is now beginning to take new approaches to the prevention of heart disease by looking at the type of patients doctors regularly treat instead of the participants in clinical trials. Many of the participants of clinical trials are usually healthier than actual patients doctors see on a regular basis, so the American Heart Association is adjusting its recommendations for prevention and tailoring them more specifically for each individual. Not one list of things to do will work for every patient, so doctors are starting to individualize the treatment and prevention of heart disease. I believe this can also be applied to the community and calculating risk factors and preventative measures that could be taken by people within a community.

Public education of the risks that lead to heart disease are very important so that people that may be more susceptible can take necessary precautions. Everyone knows that being overweight and not exercising can lead to heart disease, but it is just as important to know that women that have had preeclampsia or rheumatoid arthritis also have an increased risk for heart disease. It is necessary to educate certain ethnicities of their risks to certain diseases. For example, African American women have high risk of hypertension and Hispanic women are particularly at risk for diabetes.

Women have to be extremely conscious of taking preventative measures because research shows they are much more at risk than men. 55,000 more women than men die from stroke each year. These preventative measures often have to be looked at by public health officials in the same way we were looking at our behavioral changes in class today. The same barriers exist for those trying to overcome their risk for heart disease as for those of us trying to exercise or eat fresh fruit. Women from lower income communities may not have the available resources to eat healthy all the time or exercise regularly at a gym. Not that the lack of a gym membership prevents exercise, but it is just another thing that can make a behavior change less convenient. Also, many women that are just trying to support their family and barely can get by are not going to be as willing to give a lot of thought to a disease that they do not even have and may never have. They are going to prefer to focus on the real pressing problems that have to be dealt with every single day. How do we find and educate them about things that can be done for their health without taking time out of their lives or costing any money?

There are many barriers to overcome in fighting this problem of making women aware of the risk they are at for disease like heart disease. Many people do not have health insurance and will not have the luxury of going to the doctor until they are actually sick. Educational programs need to be set up in the communities where high percentages of people do not have health insurance. What are some ways to make the general public aware of risk factors and preventative measures without a physical doctor visit? Heart disease is a killer disease, but it is also one that has many preventative measures. It should not take a doctor visit to make everyone aware of some of the simple steps that can be taken to prevent this disease, because honestly every single person is at risk. Overcoming the barriers to behavioral change is difficult for many people, but preventative measures that are more tailored to certain people is a good way to make these changes seem more attainable, and ultimately achieve a healthier population.

HIV rates decline sharply in Zimbabwe

link: http://www.nytimes.com/2011/02/15/health/15global.html?_r=1&ref=health


In a region of the world that is devastated by sexually transmitted diseases, one country is actually in the black when it comes to its success in combatting these dieseases. Zimbabwe, a country in the heart of Southern Africa, has seen its number of individuals infected with HIV decrease sharply in the past decade. In 1997, public health officials estimated that over one fourth of the country's population was HIV-positive. As was seen in last class, and which I so clearly chose to point out, those numbers were most likely a lot higher. However, in a decade, the number of infected individuals fell by 13%, an astounding number even in parts of the world where HIV is not so prevalent. So what exactly played into this amazing decrease? Simple: the citizens of Zimbabwe were, and are currently, having less sex.

Before Zimbabwe's economic collapse in the early part of the last decade, having multiple and frequent sexual partners was a social norm. Now however, men can no longer afford to pay for sex or support multiple girlfriends under the present economic regime. Women are no longer going to bars or beer halls to meet men, and having an STD is now subject to shame rather than pride, as men used to use HIV as a proof of masculinity.

Of course, public health programs are in the mix as well, as AIDS awareness and education has also contributed to the falling numbers. Once again, education has proved itself worthy in the line of duty in the prevention of disease. Zimbabweans who are educated in the consequences of HIV/AIDS are much less likely to have multiple sex partners, and many Zimbabweans now use condoms.

I think this article is perfect for what we are talking about in class. The whole article was based on interviews of 200 Zimbabweans, a job that seems fitting for an epidemiologist. As for the numbers, only a biostatistician could have turned the epidemiologists' data into the decreasing percentage that we see today. I feel like so often, we are exposed to the disparities and ailments that plague our world today. However, in this article I found some bright light. I think it is extremely important to build on the successes of Zimbabwe, and educational tactics that have proved affective should become more widespread.

Creative Vaccinations

Here is a very interesting article I found from the Scientific American website. In this article, researchers were discussing a very exciting and creative possible solution for sepsis problems in malnourished children in low and middle income countries. The idea is to take something that is normally seen as a problem--traces of cow vaccinations making their way into milk--and attempting to make it a solution. The researchers' plan is to vaccinate dairy cows against sepsis-causing bacteria. Theoretically, antibodies against the bacteria will also be present in the cow's colostrum (first milk) along with a variety of other antibodies usually present in the colostrum. This milk, which they claim is produced in quite large quantities by the cows, would then be relatively cost-effective to distribute to malnourished children. Hopefully the antibodies would be able to keep harmful bacteria from entering the bloodstream and leading to sepsis. Although researchers seem to be quite unsure about whether their idea will work, I think it is a fantastic example of the kind of creative thinking that leads to global health breakthroughs. After all, where would we be without the then-radical ideas of public health pioneers like Florence Nightingale and John Snow?

Empathy and Health Equity

I wrote this article for the University News after attending AED's panel on promoting health equity in St. Louis. Were any of you able to attend the discussion? If so, what did you think/learn?