New links!

Lots going on this week, let's start right in:

First, H1N1 influenza. This situation has stretched local and state health departments even thinner than they already were. This is a major problem, as resources across the country are tight but expectations are high to handle the epidemic smoothly and without causing fear or panic. Speaking of panic, this article reveals some psychology about the fear and panic we humans tend towards. And this article examines the risk of new infectious diseases and people's reactions to that risk. Is there any way to reign this epidemic in? Find out here. And, finally, now that public concern is dying down (in conjunction with media attention waning, not coincidentally) will our focus on hand-washing die away too? Let's hope not.

On to other topics. As you may be aware, calorie counts on menus are popping up at fast food joints across the country, notably in New York City and in Chicago. This article examines the phenomenon and its impact, especially as federal legislation is pending.

The FDA is developing a new system to track and report adverse events of its products. We'll see how this story develops, but here is a summary article.

Finally, an article about parental refusal of the pertussis vaccine is in the latest issue of Pediatrics. The study found that children whose parents refuse the vaccine are at an increased risk of developing pertussis. The authors conclude that "these findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively."

Links for the last week or so

Obesity may raise risk for flu severity - A California survey has determined that obesity is a risk factor in increasing the severity of H1N1, alongside diabetes, heart disease, and pregnancy. The same is true across the country.

Sick time - This blog post mentions giving employees sick time. Amen! It's crucial to give employees sick time so they don't come to work with an infectious disease, and all the more so given the spread of H1N1. Plus it decreases the likelihood that kids who are out of school (due to a school closure for health purposes or just their own sick day) will be left unattended. Believe me, it does happen.

This funny L.A. Times article examines certain products to see what works and what doesn't. The bottom line of the article is that most gimmicky products aren't worth it. They review benzalkonium chloride-based hand sanitizers, disposable sleeves, and more. It's worth taking a look at to see the bizarre products out there!

Michigan has begun collecting height and weight information in order to track body mass indexes in their immunization registries. "Adding the data to the registry can help physicians and public health professionals identify children who are obese or at risk of being overweight and to evaluate programs to prevent or reduce it," the article states. This innovation will help public health surveillance. Go Michigan!

Frieden named new CDC director

Dr. Thomas Frieden has been named the next CDC director. Click here for an article announcing it with more information. He will replace Dr. Richard Besser who has been the acting CDC director since January.

Thoughts?

Food safety; Twitter for epis?

Is it safe to eat? This article outlines foodborne disease outbreaks and their prevalence in modern times. The author notes that food today is much safer with milk pasteurization, refrigeration, and other technologies. "Part of the explanation, public health experts say, is that the technology for identifying multistate outbreaks has improved greatly. Decades ago, the burden of illness was probably higher, but foods were not recalled as often, simply because investigators could not implicate them in a given outbreak. Now, modern genetic techniques can often link cases of food-borne illness, even in different parts of the country, allowing investigators to pinpoint the tainted food." Take a look at the rest of the article, it's interesting.

Twitter helping to identify epidemics? This visualization uses Twitter to track people's comings & goings around the globe. If not completely accurate or helpful to epidemiology, it's interesting. Take a look here.

A few links

Pistachio proposal could reduce food safety risks

Public health emergency funding takes hit

UN: Treaty expanded by 9 more dangerous chemicals

And last but certainly not least, "Do Everybody a Favor: Take a Sick Day." Seriously! If you're sick, don't come to work!

Statistical Beauty

The picture above depicts aluminum cans used in the US every 30 seconds -- 106,000 cans

Chris Jordan is a photographer/artist in Seattle who uses art to display public health statistics in a really neat way.

From his website, http://www.chrisjordan.com/, he says, "Running the Numbers looks at contemporary American culture through the austere lens of statistics. Each image portrays a specific quantity of something: fifteen million sheets of office paper (five minutes of paper use); 106,000 aluminum cans (thirty seconds of can consumption) and so on. My hope is that images representing these quantities might have a different effect than the raw numbers alone, such as we find daily in articles and books. Statistics can feel abstract and anesthetizing, making it difficult to connect with and make meaning of 3.6 million SUV sales in one year, for example, or 2.3 million Americans in prison, or 32,000 breast augmentation surgeries in the U.S. every month. This project visually examines these vast and bizarre measures of our society, in large intricately detailed prints assembled from thousands of smaller photographs. Employing themes such as the near versus the far, and the one versus the many, I hope to raise some questions about the roles and responsibilities we each play as individuals in a society that is increasingly enormous, incomprehensible, and overwhelming. ~chris jordan, Seattle, 2008"

These pictures are powerful reminders of our consumption as a nation, people and world. I'm most impressed by the fact that he counts the items he uses in each photograph to accurately display the stats. Jordan has amazing patience, imagination and a powerful effect with his images.

"When public health is successful, nothing happens."

This is a great article about the "invisible hand" of public health.

"When public health is successful, nothing happens, and therefore there is no news to report. You will never see a headline citing how many people dined in a clean restaurant, avoided an injury or did not contract a sexually transmitted disease. However, when an outbreak such as listeriosis or the H1N1 flu virus occurs, there is panic."

So true! Public health officials deal all the time with the question of how to communicate this message. And it matters for funding, too. How does one communicate that ample funds are needed to prevent something from happening... to make sure that there is no news? In the example of H1N1, this article underscores that the country is prepared. Now, they're talking about Canada, but the same goes for the U.S. Pandemic plans are in place.

The author notes, "in fact, they will continue to promote the best science on how to enhance the health of Canadians, whether with respect to infectious diseases, chronic diseases, injury prevention or environmental health (topics that are not as sexy as pandemics)." Excellent point, Vivek Goel! There are many aspects of public health that are not nearly as exciting as infectious disease and pandemics, but they are hugely important public health issues.

Links for the week

Given the H1N1 flu outbreak, should global surveillance of animal disease be activated? That will likely be a hot topic of conversation among epidemiologists and state public health veterinarians in coming months. Some diseases, like rabies, mad cow disease, and avian flu, are already under surveillance among animals. H1N1, however, is not - at least for now. However, the UN Food and Agriculture Organization asked for countries to report flu-like symptoms in pigs to combat H1N1. This article touches on this issue.

Using Google to help track an epidemic. Check out Google Flu if you haven't already. It uses Google search data and CDC flu surveillance data to track influenza trends for seasonal influenza. It's pretty interesting. Officials are working with Mexico to track similar trends in Mexico for H1N1. Apparently WHO also uses a "similar on-the-ground surveillance strategy" called the Global Public Health Intelligence Network, according to this article. This network is so cool! What if epidemiology were called "health intelligence" instead and we had CIA-like badges?? Now, the effectiveness of tools like this is still being evaluated. But still... very interesting potential.

Chicken pox.. I mean swine flu parties.. Wait, what? Apparently the "latest thing" in some circles is throwing an H1N1 party to infect your friends. This has been around for years for chicken pox, so that once all the kids have chicken pox, they are then immune. I won't speak to why some people think this is a good idea. I don't. Given how many kids die of seasonal influenza each year, this isn't funny. It's a bad idea. Viruses affect people differently, and it's just a bad idea. Don't do it. Buy a mask, wash your hands, cover your cough, etc.

Stop Swine Flu [the Game]

Stop Swine Flu Help to prevent the spread of the swine flu by catching your sneezes with a tissue.

Play this free game now!!

Chemical bath -- toxic chemicals in our products?

My last few posts have been about pregnancy and children...probably because I have a young niece in the family and another niece/nephew on the way. Babies on the brain! Regardless, there are a lot of moms out there who have been hearing information regarding possible carcinogens in their baby bath products. After a little bit of searching, sure enough I found a few articles and a nonprofit organization doing some real environmental research on cosmetics and bath products.

The Campaign for Safe Cosmetics did some laboratory testing on 48 baby bath products and found:

17 out of 28 products tested – 61 percent – contained both formaldehyde and 1,4-dioxane.
23 out of 28 products – 82 percent – contained formaldehyde at levels ranging from 54 to 610 parts per million (ppm).
32 out of 48 products – 67 percent – contained 1,4-dioxane at levels ranging from 0.27 to 35 ppm.

According to the site, 1,4-dioxane is a contaminant produced during manufacturing, the FDA does not require 1,4-dioxane to be listed as an ingredient on product labels. Without labeling, there is no way to know for certain how many products contain 1,4-dioxane—and no guaranteed way for consumers to avoid it. Most commonly, 1,4-dioxane is found in products that create suds, like shampoo, liquid soap and bubble bath.

For more information, visit their site.

In an effort for fair reporting and allowing the reader to hear both sides of the story, read about an article completely debunking the Campaign for Safe Cosmetics Report here: http://stats.org/stories/2009/baby_bath_cancer_mar13_09.html

I think it's important to have consumers and readers make their own decisions regarding their health. What is evident in both reports is that we are exposed to numerous chemicals in our bath and beauty products that we use every day. The chemicals may have health effects that are still currently unknown and it is up to epidemiologists and public health scientists to take into account all factors when making any conclusions. Whether the bath products of today will result in the cancer of tomorrow is yet to be determined. Overall, our environment has numerous possible carcinogens and we must attempt to limit our exposure to as many known carcinogens as possible. The epidemiology on this issue is still to be determined...

HIgh School Smoking

Has the vigilance in fighting cigarette use waned in the media for the past decade or is it just me? Perhaps other things to be vigilant about have been crowding the public health spotlight or perhaps the evidence behind the effects of tobacco has been too overwhelmingly clear that controversy and conversations around the addictiveness, poison of tobacco have dissipated. Regardless, a recent study by the National Center for Chronic Disease Prevention and Health Promotion reported in the Morbidity and Mortality Weekly Report on “High School Students Who Tried to Quit Smoking Cigarettes (United States, 2007).”

My first qualm with this report is the lack of denominator data. The authors reported that of students who have smoked cigarettes daily, 60.9% of them have tried to quit. They also reported the percentage of these students who were successful in quitting (12.2%). Now, I am sure the data can probably be found somewhere else, but my question is how many students smoke daily?! You don’t need to tell me the breakdown of who the people are that smoke but at least give the reader something to work with.

Anybody reading these reports wants to know… is whatever I am about to read important? And one of the ways the reader figures this out is by asking how many people this issue effects. If it affects .01% of the population then OK, the issue might be interesting but I really don’t need to think about it outside of this context. However, if the percentage is 5% with an issue such as daily smoking in high school students, that would be quite alarming.

I just don’t understand why the only two behaviors that were examined were:
1) Ever smoked cigarettes daily and tried to quit smoking, and
2) Ever smoked cigarettes daily, tried to quit smoking cigarettes, and were successful

Doesn’t it just seem logical to have a preceding question:

0) Ever smoked cigarettes daily

The Youth Risk Behavior Survey (YRBS) probably does ask this question in the survey, but why is it not reported as background to this study?

This report leaves the reader asking more questions like what about socioeconomic status? What about private school students versus public school students? Are there other differences that might explain why some students are more successful at stopping than others? The survey must have more to offer than just grade level, sex, and race/ethnicity…

The title looked fascinating to me but that was about it.

Interesting article about epidemics

Check out this interesting article about the history of epidemics. The graphic shows epidemics from the 1892 cholera outbreak to the 2003 SARS outbreak and details symptoms, modes of transmission, public health strategies, etc - including scapegoats.

Scapegoats have been common in epidemics, notably Eastern European Jewish immigrants in 1892, Chinese immigrants in 1900, and gay men in the HIV/AIDS epidemic. The author also notes that scapegoats are frequently caused by widespread misinformation... although he equates this to the current epidemic by saying the pork farmers are upset by the rumor eating pork causes H1N1 transmission. Hardly a scapegoat situation.

"Confusion and blame games aside, we can take heart that our public health professionals are working around the clock to prevent this crisis from getting out of control. One thing the history of epidemics teaches us is that given our remarkable arsenal of treatments, public health measures and rapid surveillance and communications ability, there’s never been a better time to have a pandemic than today — except, that is, tomorrow."