Epidemiology Café

Some links - I know, again

2010-06-04T11:27:00.002-04:00

We're all about to leave for the CSTE Annual Conference in Portland, OR. So there's not too much time for a full blog post.

However, here are some links for some plane reading:

A May MMWR article discusses attitudes toward mental illness. It's an interesting read. Hopefully the public will give more well-needed sympathy to those suffering from mental illness after more attention is given to the subject.
Jerome Groopman discusses toxic chemicals in a recent New Yorker article.
You may have already seen this NY Times article about salt.
Ah, how to allocate the huge pot of cash from the health care reform law to the public health community? Is there such thing as too much money? Robert Gould discusses in Kaiser Health News.
This is a long report, but the executive summary of this GAO report about food safety weaknesses should prove to be interesting.

Happy reading!

Interesting links

2010-05-27T13:29:00.002-04:00

Things are crazy here while we prepare for the CSTE Annual Conference, but here are a couple of links to satisfy your public health craving:

Big Decline in Heart Attacks If All States Had Smoking Bans - an interesting article from Bloomberg saying that heart attacks would drop by 18,000 per year. Isn't that an incentive to implement smoking bans. 39 states currently have some sort of smoking ban.
No Benefit in Delayed Immunization - That's right, folks, another immunization article asserting that vaccinating your kids against deadly and debilitating infectious diseases is a good thing! This one is from the Wall Street Journal.
British Medical Council Bars Doctor Who Linked Vaccine With Autism - Dr. Andrew Wakefield has been banned from practicing medicine after his widely known Lancet journal article was retracted recently. This New York Times article discusses the recent news.
In E. Coli Fight, Some Strains Are Largely Ignored - I will admit that I haven't finished reading this article, but it basically discusses how some strains of e. coli are tested for in labs and some are not, and the implications of this situation. Should be a good read.

Happy reading, readers!

Links and Lyme

2010-05-18T09:14:00.005-04:00

First, some web links:

The Produce Safety Project is calling for food safety reform, says this article in Cattle Network (yes, Cattle Network). The report recommends improved data collection, creating a cabinet-level agency for food safety, and use best practices from Europe.
A little food safety reminder, speaking of reform: We can all reduce our risk of foodborne illness with a little supermarket safety, and this article from CBS News can tell you how.
This article raises the red flag that only 58% of Idaho's 2-year-olds are vaccinated to current recommendations. This situation is not exclusive to Idaho; other pockets of the U.S. have extremely low vaccination rates.
It's that time of year when the risk of contracting Lyme disease increases with our outdoor activities. Read some articles about Lyme disease and how to prevent contracting it: 1 from The Signal, 1 about a rally to promote Lyme disease awareness, a page from CDC, and the American Lyme Disease Foundation, an advocacy organization. The bottom line is cover up and use a bug spray with DEET to prevent tick bites.
And while we're at it, here's some info about West Nile Virus and CDC's "Fight the Bite!" campaign. Bug spray, guys! It's worth it!

Health care reform: Public health gets into the mix

2010-05-13T08:09:00.002-04:00

Now that the health care reform bill is law, the money is out there and waiting to be spent. The Patient Protection and Affordable Care law, previously H.R. 3590, provided for a $15 billion prevention fund. Nonprofit organizations and public health officials are now looking to allocate those funds, and there is quite a bit of competition for the money.

This article from MSNBC and this one from Kaiser Health News discusses some of the pulls from different organizations. Paul Jarris, Exec Director of ASTHO (Association for State & Territorial Health Officials), is pushing for a big chunk of the fund to go directly to state and local health departments, who are hurting from the economy, having to cut back services and experiencing severe capacity problems. This table from ASTHO shows the various public health funding opportunities in the law.

Take a look - it's a lot of money, and a lot of organizations and agencies deserve some of it. But... a lot don't. It will be interesting to see how it plays out.

H1N1 - vaccine, lessons learned

2010-05-04T14:29:00.002-04:00

Reuters has posted an article saying there are 71 million doses of H1N1 vaccine left in the U.S. That's right, readers, million. Holy cow! (Or should I say chicken... get it?)

And here is a USA Today editorial on 5 lessons to be learned from the pandemic. Some points are well-taken; for example, the feds can't do it all. State and local health departments and other responders are vital to the fabric of our public health infrastructure and are critical to maintain in order to bolster preparedness.

Here are lessons learned from Jeffrey Levi, of Trust for America's Health, as posted on The Huffington Post. He, again, mentions public health department resources and the need to increase resources to be able to adequately respond to a situation such as the H1N1 pandemic.

Overall, the county is significantly more prepared to respond to a pandemic now than we were a few short years ago, but there are still major gaps in our core public health capabilities that must be addressed if we're going to be able to protect the American public from future threats.

Here are lessons learned from CIDRAP, the University of Minnesota's Center for Infectious Disease Research and Policy. This article also highlights infrastructure and capacity but touches on risk factors for pregnant women and obese populations as well.

And here is a previously-posted Op-Ed by Richard Wenzel in the NY Times about what has been learned from the H1N1 pandemic.

Happy reading, and feel free to post your own lessons learned!

Qatar's growing health problems

2010-05-03T09:36:00.001-04:00

The NY Times reports on chronic disease and other health problems suffered by Qataris in the Middle East. Very interesting how the American lifestyle has spread to other countries that are gaining in wealth.

amednews: Child vaccine rates hinge on educating parents :: March 15, 2010 ... American Medical News

2010-04-21T16:25:00.000-04:00

amednews: Child vaccine rates hinge on educating parents :: March 15, 2010 ... American Medical News

Maternal Deaths Decline Sharply Across the Globe

2010-04-15T14:58:00.002-04:00

Great, some good news in public health! The NYTimes reports that maternal deaths are declining worldwide. The interesting point brought up in the article is that some advocates want to keep the news relatively quiet for fear of funding drying up because the problem is perceived as solved. The author of the study insisted that the new data are really positive and need to be shared with the world!

The data dispelled the belief that the statistics had been stuck in one dismal place for decades, he said. So money allocated to women’s health is actually accomplishing something, he said, and governments are not throwing good money after bad.

What We Learned From H1N1's First Year

2010-04-13T08:51:00.003-04:00

This article by Richard Wenzel of the Virginia Commonwealth University discusses what we learned in the past year about H1N1. It brings up some interesting points, like the discrepancy in recommendations about masks, reducing risk of transmission, and community mitigation strategies.

It is not an easy task, but our public health authorities need to become clearer about the lexicon of uncertainty.

And Wenzel ends the article with a reality and a call to action:

But the struggle between people and pathogens is a part of life itself. We cannot continue to be surprised every time a new virus emerges. Instead, we must use the lessons we’ve learned during the year since H1N1 arrived to develop more effective public health responses.

FDA Conducting Fewer Inspections of Food Makers

2010-04-09T14:32:00.001-04:00

FDA Conducting Fewer Inspections of Food Makers

National Public Health Week!

2010-04-06T15:51:00.007-04:00

It's been awhile since I did a posting of interesting links. Enjoy!

National Public Health Week is this week! Go public health!
Norovirus: Tara Parker-Pope has an article in the NYT about noro and how difficult it is to get rid of it. Take a look, and see CDC's page about noro for more information.
Superbugs: This has been awhile, but it's an interesting Nick Kristof piece about antibiotics and the rise of superbugs and the implications of those superbugs.
HIV prevalence in DC: Some promising news about the HIV epidemic in Washington, D.C. is explained in this article.
Travel's impact on pandemics: An interesting Canadian study will analyze the impact of travel and travel restrictions on the H1N1 pandemic.

Summer's here!

2010-04-05T14:41:00.005-04:00

Wow has it been a long time since I've posted. Sorry about that! It's been busy here at CSTE, and we've been working quite hard on everything from international influenza consultations to CDC/CSTE Applied Epidemiology Fellowship interviews to Annual Conference planning.

Now it's April 5, and in Atlanta that means summer is here! Some summer public health tips:

Food safety
Summer means picnics, baseball games, hikes, and lots of outdoor eating. Keep yourself salmonellosis free this summer, and follow tips from organizations like this one. The basics are clean, separate, cook, and chill. And if you do have a foodborne illness, notify your local health department!
Tick/bug bites
Summer means bug bites, that's a fact, and there are a few things to do to keep yourself healthy and hopefully bite-free. This article gives some tips: stay on well-traveled paths, wear long-sleeved shirts and long pants in the woods, wear DEET-containing bug repellants, and check yourself, children, and pets carefully after walking in the woods. Here is some info from CDC about vectorborne and rickettsial diseases. Finally, some "Fight the Bite!" info about West Nile Virus.
Fun in the sun
Use sunscreen - cover that delicate skin! Use safe sun practices to avoid the dreaded sunburn.
Be safe
And, last but not least, be safe. Injury accounts for a huge number of deaths during the summertime, so keep an eye out for yourself and your loved ones. Fireworks, boating and swimming, and general injury prevention - all important.

Doctors' Advice to Obama: Kick the Cigarette Habit - Stop Smoking - FOXNews.com

2010-03-01T15:44:00.001-05:00

Doctors' Advice to Obama: Kick the Cigarette Habit - Stop Smoking - FOXNews.com

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The damage of the anti-vaccination movement - latimes.com

2010-02-26T11:34:00.001-05:00

The damage of the anti-vaccination movement - latimes.com

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Salt reduction - does it make sense as a public health policy?

2010-02-26T10:46:00.002-05:00

Here is an interesting NY Times piece about salt intake. It starts with a quiz: If companies are forced to use less salt, what would be the effect?

A) More than 44,000 deaths would be prevented annually (as estimated recently in The New England Journal of Medicine).
B) About 150,000 deaths per year would be prevented annually (as estimated by the New York City Department of Health and Mental Hygiene).
C) Hundreds of millions of people would be subjected to an experiment with unpredictable and possibly adverse effects (as argued recently in The Journal of the American Medical Association).
D) Not much one way or the other.
E) Americans would get even fatter than they are today.

According to this article, there is no right answer, because the evidence is so conflicting.

So what should we do about salt intake? See this post from a couple weeks ago for the answer.

And PS: Here is a "Room for Debate" article from the NY Times seeking answers from several prominent food folks. Interesting.

Health Insurance isn't really like other insurance

2010-02-24T14:08:00.007-05:00

The idea that health insurance is different from all other types of insurance came up in a casual conversation and it got me thinking -- health insurance is something that you know you will use at some point. Prescription drugs, eye glasses, dental check ups, etc - everyone will access the health care system at some point for some thing. Health insurance also differs from other types of insurance because other types are generally focused on a negative occurrence. Fire, flood, car, homeowners, life insurance -- all associated with slightly unlikely, negative events. All of these insurance types are priced according to the risk the insurance company takes in relation to your probability of having that event. Life insurance at age 25 is much cheaper than at age 55 due to this reason.

Health insurance is a little different however, as it is insuring you for events that are highly likely to occur numerous times throughout the year. The scale and cost of being insured for these events follows the same model as the other insurance types but is used for routine access to the benefits of insurance rather than exceptional access.

So this really gets into a larger discussion of health care reform. There is an article on Bloomberg.com that gets into assessment of risk, ignoring pre-existing conditions, employer based health insurance and more. "Ignoring pre-existing conditions might sound compassionate, but it is the equivalent to declaring that a fire-insurance company must charge the same amount for a modern house with smoke detectors and interior fireproofing as a century-old, wooden-frame former stable, complete with some hay left over, and a basement full of painting supplies. Taking the analogy further, the same premium must be charged for a well-protected, unscathed house as for one that is already on fire. The business of insurance is about determining risk and charging accordingly. It's why insurance companies exist. If we eliminate that, medical insurers are just form-processing companies for the government. Worse, we lose a valuable economic input: that of accurate risk assessment and pricing, without which sensible management of medical expenses is impossible."

For the full article on bloomberg.com please visist: http://www.bloomberg.com/apps/news?pid=20601039&sid=a2ArEkqK7AZ4

And keep in mind the original purpose of health insurance when you ponder health care/insurance reform. What is the purpose and what is the best way for accomplishing that purpose?

Did the WHO manipulate the H1N1 pandemic??

2010-02-19T15:38:00.003-05:00

I've come across several articles lately that indicate (ok, downright say) that the World Health Organization (WHO) misled the public regarding facts about the H1N1 influenza pandemic. (Is this like the "link" between vaccines and autism?)

Apparently there are charges that "the agency deliberately fomented swine flu hysteria." An epidemiologist at the WHO himself said that there was a giant mis-allocation of funds that favored the pharmaceutical companies who made the H1N1 influenza vaccines. The author of the Forbes.com article says that the WHO was covering itself for the millions (billions) of dollars spent on preparing for a pandemic of H1N1 or H5N1 that never materialized (until now). The Parliamentary Assembly of the Council of Europe (PACE) delcared that this "false pandemic" is "one of the greatest medicine scandals of the century." Whoa!!! Really? Preparing for something we didn't know the severity of was a scandal? A hoax? Really?

Luckily, ("unquestionably") H1N1 has been much milder than seasonal influenza and than previously expected. But there was no way to know whether it would increase in intensity or not (clearly, it did not). Look, there will be varying opinions as to whether this could have been predicted or not. But, in the end, isn't it better that we were overprepared than underprepared? Imagine how scathing the media would have been if public health were to have not been ready for widespread morbidity and mortality? What then? Exactly. That's what I'm saying.

Yes, there were resources lost on preparations for this pandemic. But that's what public health does - it prepares for things that may or may not happen, and then when those things don't happen, the public never knows about it. That is preparedness at its best. You don't know how good your water system is until your neighboring city's system falls to pieces, and then you realize how well you're protected against everyday things.

This. Is. Public. Health.

Forbes.com article
Atlantic Free Press article
Council of Europe article

Is the US swine flu epidemic over? | ajc.com

2010-02-08T11:08:00.001-05:00

Is the US swine flu epidemic over? | ajc.com

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How the CDC counts H1N1 cases

2010-02-05T11:54:00.003-05:00

Thought you (you one person reading this, you) might be interested in this Wall Street Journal blog post about how CDC counts H1N1 cases.

The accompanying print article discusses how H1N1 information is based on flawed data. Carl Bialik writes that CDC relies on "the nation's patchy surveillance system" for its data - Well, Carl, if the U.S. were to fully fund states to perform adequate surveillance, maybe we'd be able to provide better data for you! (Are you listening, Congress?)

Salt intake: the new public health hot topic shaking onto the scene

2010-02-03T12:07:00.004-05:00

A recent New England Journal of Medicine article discusses reducing salt intake and its benefit to society. A national effort to reduce salt intake by 3 g (1200 mg of sodium) per day could reduce the incidence of coronary heart disease by 60,000-120,000, stroke by 32,000-66,000, and heart attacks by 54,000-99,000. Wow! The number of deaths annually due to these diseases could decrease by up to 90,000. Wow! And... for those number-crunchers, this could save the country $10-24 billion annually. Yes, annually.

And: "Even if the interventionreduced salt intake by just 1 g per day, the benefits wouldstill be substantial and would warrant implementation." Now that's saying something.

The authors say there are 2 approaches to reducing salt intake:

The individual approach involves individual consumers to reduce their daily intake through voluntary dietary decisions. However, the authors say, this method has been attempted and does not work.
The public health approach involves getting manufacturers to reduce the amount of salt in processed foods.

New York City has started an initiative to get restaurants to reduce the amount of salt in food served to New Yorkers - a 25% reduction over 5 years has been proposed. The Institute of Medicine (IOM) is about to release a report about salt intake. And the FDA is considering
changing the designation of salt to a category that would give consumers more information. [All from this New York Times article.]

One editorial article from the New York Times mentions that most salt in people's diets comes from processed foods, not from adding salt individually. So the processed foods are what we should be targeting - restaurants and food manufacturers. Let the battle begin!

This post comes in honor of World Salt Awareness Week, according to CDC. (There's a week/month for everything, eh?) Check out this fact sheet about salt and salt intake.

And check out this previous post by Lisa for more about reducing sodium levels.

Important news about vaccines

2010-02-02T14:37:00.002-05:00

Everyone has heard the rumor that vaccines lead to autism. Well, here is breaking news: The Lancet, the journal that published Dr. Andrew Wakefield's 1998 groundbreaking study linking autism to vaccines, has formally retracted the article. This is hugely important news in the public health and vaccine world. According to this breaking CNN article, the author was found to be acting unethically in conducting his research.

Smoking Cessation Part 2: Public Health's Response

2010-01-19T11:52:00.011-05:00

Now that I've discussed smoking cessation options and the cost-effectiveness of smoking cessation, it's time to bring public health into the story (of course). This post will focus on what public health does to encourage smoking cessation on a population-wide level.

Naturally, public health encourages individuals to stop smoking. CDC's website offers how to quit, the benefits of quitting, etc. But there are several big-picture strategies that public health has employed to encourage the population to stop smoking.

Smoking cessation education campaigns - This method includes public service announcements, ad campaigns, etc. Smoke-Free Illinois has this ad campaign. Tobacco Free California has some great materials and website, including clever e-cards that you can send smoker friends. And check out this video from Iowa's Just Eliminate Lies video that works to eliminate tobacco companies' effects on youth.

Smoking bans - Many states have enacted smoking bans to restrict smoking in public places. According to the American Lung Association, 26 states and D.C. have enacted laws banning smoking to some degree. And these bans seem to work; air pollution in restaurants and bars have decreased, and some areas have reported decreased heart attacks and other health effects, although these findings are somewhat debatable. A recent IOM report states that "smoking bans can have a substantial impact on public health."
Scare tactics - Ah, the scare tactic. Yes, this fits in with #1, but it is a particular type of ad campaign. This type is sometimes employed by public health departments and other times by private non-profit organizations. The Truth campaign is probably the most well-known of these campaigns. However, this tactic may not work. A recent article stated that this public shaming technique may not be effective: "People are made to feel really, really bad about their smoking and are treated quite badly, but feel quite helpless in quitting," said Kirsten Bell, a medical anthropologist.
Cigarette taxes - Taxes, the American way, right? Well, it's true in the case of cigarette taxes. Taxes on cigarettes range from $0.07 (South Carolina) to $3.46 (Rhode Island). And according to the Campaign for Tobacco Free Kids, these taxes work: For every 10 percent increase in the price of cigarettes, youth smoking decreases by 7 percent and overall smoking decreases by 4 percent. Click here for related scientific studies. And the federal tax increased in 2009 from $0.39 per pack to $1.01 per pack.

So there are a few ways public health tries to curb smoking. These along with individual smoking cessation tactics are aimed at improving the public's health overall, a noble cause.

Infectious diseases threaten the Haitian population

2010-01-19T11:48:00.001-05:00

Now that the initial relief effort has started in Haiti, the threat of infectious disease looms. Read more here:

http://www.nationalpost.com/news/story.html?id=2442706

Plastics & chemicals: Part 2

2010-01-19T09:53:00.003-05:00

This article states that the FDA is rethinking its stance on BPAs. Take a look and reference this posting about plastics & chemicals that I posted about a month ago.

Smoking Cessation: Effectiveness and Cost Effectiveness

2010-01-14T10:41:00.005-05:00

Smoking is a gigantic problem in the U.S. According to CDC, smoking is the single most preventable cause of disease, disability, and death in the U.S. Over 40 million adults smoke in this country, and 126 million adults and children are exposed to secondhand smoke. Although trends have indicated that tobacco use is on the decline, it is still a huge issue.

And it's pervasive in our society. I mean, even movies like Avatar feature characters who smoke! The WHO encourages media to limit or eliminate smokers highlighted in TV shows and movies.

If you smoke, stop! It's hard, no doubt. It takes the average smoker several times for quitting to actually stick. And here are some options to do so:

Quitting cold turkey - Quitting all of a sudden and sustaining it undoubtedly requires a great deal of will and determination. Enlist your friends, family, and coworkers to help you quit.
Nicotine fading - This method involves reducing your tobacco intake slowly until you eventually quit. This option is inexpensive, easy, and reduces the potential for withdrawal.
Nicotine replacement therapies (NRTs) - These therapies include nicotine gum and nicotine skin patches, and they are recommended with reservations as part of a "comprehensive smoking cessation program."
Finally, there are prescription medications such as Zyban that help people stop smoking.
Support groups and counseling can also help greatly when combined with other methods.

Insurance companies are covering smoking cessation aids more and more, recognizing the cost effectiveness of helping their patients quit. The benefits and cost effectiveness are overwhelming. One article states, "The results of existing economic evaluations consistently indicate that smoking cessation interventions are relatively cost-effective in terms of cost per life-year saved." An article in JAMA also suggests smoking cessation is cost-effective. Based on a study of various interventions, the study found that smoking cessation is a particularly cost-effective intervention, compared with other preventive health interventions. "The more intensive theintervention, the lower the cost per QALY [quality-adjusted life year] saved, which suggeststhat greater spending on interventions yields more net benefit."

And that smoking cessation is cost-effective just makes common sense! "If you’re paying about 10 bucks a day for a pack of cigarettes in New York City, that adds up to about $6,000 over two years," said Thomas Glynn, of the American Cancer Society. "You could check yourself into the in-patient program at Mayo Clinic for that," he says in this recent New York Times article.

Of course, the tobacco industry is ridiculously powerful. This webpage (albeit a little extreme) showcases tobacco companies and their truths. Another site also highlights the pervasiveness of tobacco companies. Tobacco companies claim to aid in smoking cessation, but from their business's perspective, why should they? If smokers across the country quit, they buy fewer cigarettes, and their profits decrease, equaling no more company. It's in their financial interest to keep smokers smoking!

The bottom line: Tobacco use is a problem in the U.S. Quitting benefits your health and it is cost effective to do so. Resolve to quit today!

Here are more resources:
http://www.naquitline.org/
http://www.smokefree.gov/
http://whyquit.com/
http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm

Update to Google Flu

2010-01-14T10:35:00.004-05:00

Google Flu updated recently to now include 121 cities across the country. Interesting.

Food Safety iPhone Apps

2010-01-14T10:12:00.004-05:00

This article in Food Safety News talks about iPhone apps for food safety. Hm, I guess every market can find an iPhone niche!

Food Watch New York City: This app uses data from the NYC Department of Health & Mental Hygiene to give inspection ratings for restaurants nearby, as determined by the phone's GPS.
Locavore: This one keeps you apprised of local food available near you. It also locates farmers' markets, tells you when fruits & vegetables are coming into season, and links to Wikipedia and Epicurious sites.
Still Tasty: This app tells you the shelf life of your produce, products, and groceries. It tells you the expiration date of your foods, including an alert function. Finally, it tells you how long you can keep various types of foods in the fridge or freezer.
Good Guide: Good Guide helps you find safe, healthy, sustainable products by scanning the barcode. You can find product ratings, and the health/environmental/social performance of various brands.

Happy shopping and eating!

Vaccines and herd immunity

2010-01-07T13:33:00.003-05:00

Vaccines - ah, that long-controversial topic. Well, vaccines have resurfaced in the news this week. Some news about vaccines that might be of interest to you:

A recent study from CDC shows that more U.S. kids are immunized and that disparities among socioeconomic groups are decreasing. "While these disparities persisted through the study period, they did get smaller, and racial and urban/suburban/rural disparities were no longer statistically significant by 2008." Of course, "additional work is needed to make sure that the underserved groups of children are vaccinated and protected against vaccine preventable diseases," says the author of the study.
The American Academy of Pediatrics has released its 2010 immunization schedule for children. Changes include the addition of a recommendation to get the influenza A (H1N1) vaccine and revaccination for meningococcal disease.
This article in USA Today explains the concept of herd immunity and its importance. It includes the standard USA Today human interest components (too much for my tastes), but it is a good snapshot of immunizations and their importance among the community. Nationally, 1.48% of children have exemptions from school immunization requirements, but this number is much higher in certain parts of the U.S. A recent study found that children who are unvaccinated are 9 times more likely to contract chicken pox and 23 times more likely to contract whooping cough.
The article states, "before vaccines became available, hundreds of thousands of Americans — including thousands of children — routinely came down with dreaded infectious diseases each year. Although vaccines have nearly eliminated many of these diseases, doctors say outbreaks in unvaccinated communities put everyone at risk."

Lonely office links

2009-12-23T09:49:00.003-05:00

It's 2 days before Christmas. All the CSTE-ers are off celebrating, leaving the lonely Jewish girl here. To work? Nah, to blog! So here are some links for you to peruse while you're getting away from your visiting families:

A New York dog is confirmed to have H1N1. The American Veterinary Medicine Association (and surely the National Association for State Public Health Veterinarians as well) wants to ensure the public that while the virus can be passed from human to animal, there is no evidence the virus can be passed from animal to human. No need to stop petting Fido.
Associated Content's health news section has come out with the Top 10 health stories of the decade. H1N1 is #1, while health care reform comes in at #9. Hm. Other stories that made the cut include food safety, screening tests, and the HPV vaccine (all stories I've blogged about here!).
The Washington Post reports that fewer people are getting tested for H1N1, which "proves" that the second peak has subsided. Has it? Could this just mean that fewer people are being tested because physicians are assuming flu-like symptoms to be H1N1? Fewer tested could just mean that.... fewer are tested, not that the incidence of H1N1 is declining.
This op-ed piece discusses One Health, the initiative/idea that animal and human health intersect in increasingly important ways. It is, indeed, a concept that is gaining ground, and so I encourage you to take a look.
This editorial in the NY Times discusses the end to abstinence-only funding for sex education programs. It includes an important quote:
Ideology, censorship and bad science have no place in public health policy.

Sugary cokes = Fat

2009-12-16T15:04:00.002-05:00

A new video out from the NYC's health department shows, in pretty gross terms, how drinking sugary cokes makes you fat. (In the South, "coke" is a ubiquitous term for "soda.") This article details some of the implications of drinking sugary beverages and some of the action being taken around the country. Watch for yourself:

Shamelessly proud

2009-12-16T11:03:00.003-05:00

This has less to do with public health and more to do with how proud I am of my dad! He recently went on a media blitz, doing 19 TV and radio spots in one morning to promote kids' health during the flu season. Here I've posted 1 of the TV spots. Enjoy!

Here is the website that includes more information about fighting and preventing flu:
http://www.5minutesformom.com/TylenolFlu/.

A couple links for the day

2009-12-15T15:08:00.003-05:00

This article discusses a newly-developed pandemic planning tool that will help health officials "quickly analyze pandemics and craft better response strategies." The author also says, "these results could be valuable in developing an aggressive preventive strategy and deciding how best to use limited resources."
Second, the health world today is discussing a new study that shows the overuse of CT scans can lead to cancer deaths, says this article. "Widespread overuse of CT scans and variations in radiation doses caused by different machines... are subjecting patients to high radiation doses that will ultimately lead to tens of thousands of new cancer cases and deaths," says the study. The article emphasizes that the risk for any one individual is relatively small, but the overall risk for the population is much larger.
Finally, in breaking news from the NYT, a million doses of infant H1N1 vaccine have been recalled, apparently because they are slightly less potent than recommended. Unfortunately, this slip-up will probably mean even more negative publicity for the vaccine and for public health. Oh, boy.

Some recent links

2009-12-14T09:43:00.005-05:00

This interesting article discuses evidence-based medicine and the recent mammogram recommendations (I know, they're still talking about it.) Take a look and see what you think.
As I've discussed before, climate change is expected to have a major impact on health and public health. This article is about its impact on mental health specifically. The point that makes the most sense is that climate change is expected to bring more natural disasters, bringing more life upheaval and therefore more stress and mental health issues.
Cancer death rates are declining, according to this article. Researchers who found this statistic examined colorectal cancer as an example, and found that the decline was mostly due to better screening. Here is the study from which the article draws, which is worth a read - interesting.
The CDC has reported that the death toll from H1N1 is at 10,000, but also suggests that the number of new cases could be trickling off. It says one in five Americans have had H1N1. Mike Osterholm says, in my opinion accurately, that this pandemic is not over:
“So the C.D.C. says 50 million have been infected so far,” he said. “Another 50 million have been vaccinated. And maybe 20 million have got innate immunity because of their age. You do the math — that’s 120 million who are immune out of 320 million, so two-thirds of the population is still not immune. It’s amazing how many people are acting as if this is all wrapped up. The numbers could still go up dramatically.”
This article describes the dismal state of public health and its critical understaffed numbers. It's a great article.
"If swine flu is a test of public health, we've already flunked. And we have only ourselves -- and the political leaders who have been disinvesting in public health since 1980 -- to blame."
Finally, a new report from the Institute of Medicine about the National Vaccine Plan seeks to elevate vaccines to a higher public health priority, increase funding, and other recommendations. This article explains the highlights of the report. The updated plan is expected to take effect in 2010. However, the development of this plan does not ensure its implementation:
"Siegel has doubts that the proposed policy can be implemented and enforced. 'There are extremely difficult obstacles -- fear, noncompliance, media hype and poor government choices,' he said."

Plastics & chemicals

2009-12-08T10:05:00.002-05:00

There has been a lot of attention given to the safety of plastics lately, specifically centering around BPAs, or bisphenol A. Bisphenol A is a compound used to make certain plastics, mostly #7 and #3 plastics. Recently, disputes have come up regarding the safety of BPAs; previously determined safe levels of BPAs are being challenged due to new scientific studies.

Although the evidence remains uncertain, some journalists like Nicholas Kristof have been vocal in their opinion to ban chemicals like BPAs from their households. Consumer Reports reviewed the levels of BPAs in food containers and found higher-than-desired levels in things like canned foods.

The Environmental Protection Agency (EPA) is reviewing its policy on BPAs, developing its chemical management program and producing action plans. The Food & Drug Administration (FDA) is also reviewing the safety of BPAs - a ruling is expected any day (the announcement was supposed to come recently but has been delayed.)

This article from Science News details some of the effects of BPAs in plastics. Effects include heart arrhythmias, gene modification, estrogen changes, and more. Another interesting article can be found here in Scientific American. CDC has a good fact sheet with all the basics of BPAs. According to this fact sheet, Americans have widespread exposure to BPAs, and females have higher levels of BPAs in their urine than males - children have higher levels as well. The National Toxicology Program has expressed concern for adverse effects of BPAs due to "developmental toxicity for fetuses, infants, and children" primarily because of "effects on the brain, behavior, and prostate gland."

What are we doing about this besides reviewing policies? Well, some states have begun to ban BPA chemicals from their plastics and some manufacturers have begun voluntarily taking BPAs out of their products. Canada widely bans BPAs in baby bottles.

What should we as consumers do, bottom line? Try to decrease your exposure to BPAs by avoiding #7 plastics. Mothers should limit their and their infants' exposure to BPAs by using BPA-free or glass baby bottles (or breastfeed but that's a whole 'nother blog post.)

Recent cancer screening guidelines reveal delicate balance between public health, private practice

2009-12-02T09:10:00.002-05:00

Recent cancer screening guidelines reveal delicate balance between public health, private practice

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End of life care

2009-11-30T09:30:00.004-05:00

End of life, or palliative, care is a touchy subject. And I seem to be on a roll with touchy subjects lately like suicide and "unsexy" health threats, so let's keep rolling with this one!

An organization called Engage with Grace is encouraging families to discuss end of life care during this holiday season. Engage with Grace has a one-slide quiz to help get the conversation started to discuss family members' wishes at the end of their lives. This NPR blog discusses this initiative a bit more. The American Academy of Hospice and Palliative Medicine has more information as well.

It can be incredibly difficult to think about these issues inside one's own head, much less with one's family. Death is a hard subject, and no one enjoys thinking about it. But a little conversation ahead of time can prepare your loved ones for when the time comes. This article in the NYTimes discusses palliative care physicians and their role in the conversation. This video shows more of what is in this article.

".. As an aging population wrangles with how to gracefully face the certainty of death, the moral and economic questions presented by palliative care are unavoidable: How much do we want, and need, to know about the inevitable? Is the withholding of heroic treatment a blessing, a rationing of medical care or a step toward euthanasia?"

The article discusses, amongst other things, the growing subspecialty of palliative care and its importance with an aging population. It notes that an enormous amount of a person's healthcare spending is spent during the last 6 months to 2 years of one's life, and much of the time this is Medicare and/or Medicaid spending.

But, most importantly, it's vital to be comfortable with the concept of end of life care. It is a subject that this country is scared to talk about, but one that is incredibly crucial. It's not about "death panels" but rather about caring for your loved ones at the end of their inevitably finite lives. There is honor in dying with dignity and grace and in discussing one's wishes to do so.

2009-11-30T09:23:00.002-05:00

An interesting story on NPR this morning about how the media cover teen suicide. Worth a listen!

Once again - some links for you

2009-11-24T08:23:00.006-05:00

I wrote a few weeks ago about unsexy health threats, and chronic disease could probably fit under that category. Certainly the Global Alliance for Chronic Disease thinks so. This organization, founded in June, is trying to increase awareness of the prevalence of chronic disease around the world, even in developing countries. This article details more about this organization and this issue.
Food safety legislation has been given the next push forward in the Senate. This article says that the full Senate won't take up the legislation until 2010, but Congress is certainly looking to move on food safety legislation of some sort this session. "The Senate bill would expand U.S. Food and Drug Administration (FDA) oversight of the food supply and shift its focus toward preventing, rather than reacting, to foodborne outbreaks. FDA would have the power to order recalls, increase inspection rates and require all facilities to have a food safety plan."
I have briefly mentioned the economy's effect on public health, and this article repeats that message - the economy has affected the public's health and well-being. Respondents to a recent survey indicated that they were more likely to overeat and less likely to exercise due to stress about the economy. Respondents were also less likely to take care of health problems in a timely manner. And, last but certainly not least, emotional health was adversely affected by the economy.
And finally, our favorite topic du jour - the recent change in the U.S. Preventive Services Task Force's recommendations on breast cancer screenings.

This article provides a good, solid perspective on the recommendation change, explaining a bit about why the public has a hard time accepting the fact that screenings are not always in our best interests: "Statisticians and epidemiologists know this for a fact. The problem is, there's no way to tell which of the tumors are dangerous and need to be treated and which are harmless and would be best left alone. So all of them get treated, often aggressively. The medical establishment calls this overdiagnosis."

This article's title, "New mammogram guidelines are confusing, but here's why they make sense," says it all. The article notes that the new guidelines are in line with international recommendations and goes through the recommendation in a detailed manner, explaining each point. The potential harms from widespread mammogram screening include radiation exposure, false-positives, and the incorrect notion that early detection is always a good thing. It's a good article.

This NY Times op-ed piece by Robert Aronowitz has an interesting premise: "Why do we keep coming around to the same advice — but never comfortably follow it?" The column details some of the history of cancer screening and treatment and how increased diagnoses of cancer led to increased pressure to screen earlier and diagnose earlier and more often. He makes a very good point:
"You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail. This doesn’t make sense. We could do more research and hold more consensus conferences. I suspect it would confirm the data we already have. But history suggests it would never be enough to convince many people that we are screening too much."

And, finally, "What watching ESPN could teach us about mammograms" - this title immediately caught my eye. Basically, this article says that statistical data are presented in the sports world every day and understood - why can't the same thing be done in public health? Why is the message clouded? Great question! The answer is that we have messaging problems, we public health professionals. It's true. It also gives a link to the National Cancer Institute's breast cancer assessment tool - interesting.

Gobble gobble

2009-11-23T15:58:00.003-05:00

Before you down your share of turkey this Thanksgiving, keep part of your brain on food safety. First of all, thaw your bird properly. Second, cook your bird to the proper temperature. Third, don't let food sit out too long after it's cooked - the bugs will love breeding to their hearts' content while you chat around the dining room table.

Here is an article that has a bunch of helpful links.

Enjoy and happy Turkey Day!

Some links for you

2009-11-18T09:12:00.006-05:00

Massachusetts public health officials explain the dissemination of their H1N1 vaccine allotment. Patience, all you patients out there!
The WHO has discovered new data that show that 1.2 million people over the age of 5 die of foodborne illness each year in Southeast Asia and Africa. That number is significantly higher than previously estimated, providing new reason to address this issue in the developing world.
In case you're one who needs everything, check out these iPhone apps about H1N1.
There is a new tool to show where AIDS treatment and care in San Francisco is lacking. Click here for the map itself.
Obesity is an alarming public health issue, and this latest article has alarming numbers. If trends stay as they are now, 43% of adults will be obese in 2018. Wow.
This article highlights that many public health professionals around the country are being reassigned from their normal job duties to work on H1N1 assignments. This is disrupting usual public health activities that address ongoing problems that are not going away simply because this pesky flu virus has shown up. It's a problem, but it doesn't appear it will be solved.
Representative David Camp says in this articl e about the breast cancer screening recommendations: "I mean, let the rationing begin. This is what happens when bureaucrats make your health care decisions." Right, the U.S. Preventive Services Task Force is bureaucrats. They're not experienced physicians and trained professionals. Sure.
Lots of money is being poured into fighting healthcare-associated infections. This article details the stimulus funding being given to the issue.

Cancer screenings, Part 2

2009-11-17T10:26:00.002-05:00

Since my last posting about cancer screenings (conveniently linked for a little refresher), new information has come out about breast cancer screening.

The U.S. Preventive Services Task Force, the panel in charge of determining preventive services standards, has deemed that mammograms should begin at age 50 instead of the previous recommendation of 40. It also recommends that screenings be conducted every 2 years instead of every year; the harms are greatly reduced while the benefits remain the same.

Here is a link to the USPSTF recommendations.
NPR had a big story this morning about this topic.
The Annals of Internal Medicine outlines the data that went into this decision.

The basis for this updated recommendation is that screening too often and too early can lead to unnecessary testing of any abnormal result, which can cause physical and psychological harm. The risk of false positives also pose psychological harm. The New York Times writes, "while many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment."

The interesting thing is the reaction to this new recommendation. The National Cancer Institute will investigate revising its guidelines in light of this report, but the American Cancer Society and the American College of Radiology are both sticking with their previous guidelines of starting screening at age 40.

While some will bristle at the idea of pushing back a cancer screening, looking at the population's overall health and benefits of these screenings is important. Overall, it is more beneficial to delay screening until age 50 unless a woman has an increased risk of breast cancer. It may be hard to stomach for some individuals, but the cost-effectiveness is overwhelming.

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

2009-11-09T11:32:00.003-05:00

An interesting article about Paul Offit and vaccines.

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

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Unsexy health threats

2009-11-04T09:26:00.004-05:00

There are lots of sexy-sounding health problems. Some of the topics du jour include HIV, malaria, and, currently, influenza. But what are the actual leading causes of death, in the U.S. and internationally?

In the U.S., the leading causes of death are heart disease, cancer, and stroke - all chronic conditions. While pandemic influenza may be causing a lot of morbidity these days, it is chronic disease - caused by obesity, mostly - that cause the greatest number of deaths in the U.S.

Abroad, it's a different story. According to the Global Health Council, the leading causes of death among children are pneumonia and diarrhea, both preventable diseases. Maternal health is also a huge issue; it is the second leading cause of death among women worldwide. These tables from the WHO outline leading causes of death by the country's income level, revealing interesting disparities between low-income countries and high-income countries.

Nicholas Kristof has done a great job reporting about deaths due to pregnancy or childbirth; he quotes the U.N. in a July column, saying " in Pakistan, a woman dies every 35 minutes because of problems from pregnancy or childbirth." He also spoke out about pneumonia: "pneumonia gets very little attention from donors or the public health community, yet it kills more than two million children a year, according to Unicef and the World Health Organization."

This article in the NY Times on October 29 compelled me to blog about this. After all, this blog is devoted to domestic public health issues. But this article was too important to ignore. "Diarrhea kills 1.5 million young children a year in developing countries — more than AIDS, malaria and meaasles combined — but only 4 in 10 of those who need the oral rehydration solution that can prevent death for pennies get it." Diarrhea is, most certainly, not a sexy topic, but it is one that is vital to discuss.

While AIDS continues to be a huge problem that needs attention, especially in certain parts of the world like Africa, these smaller diseases also need equal attention, especially because they are treatable.

Weekend links

2009-11-02T09:56:00.004-05:00

There have been several teen suicides in California, prompting public outcry against suicide, which is the 3rd leading cause of death among teens, according to CDC. Actions are being taken to curb suicide in California, including counseling, suicide hotlines, and other measures. "These poor kids died from an untreated psychiatric illness, or undertreated. It's not as if it's a mysterious thing and it's not as if it's not preventable," says Madeline Gould, a psychiatrist. Once again, and I reference another suicide posting I've done, suicide is preventable, and it's important to treat mental illness and reach out to people.
Not surprisingly, H1N1 is hindering health departments' ability to conduct other activities. Dr. David Fleming, health officer in Seattle, says, "we're being held hostage by a national shortage of the vaccine."
The Infectious Diseases Society of America conference brought a lot of discussion of various infectious diseases this weekend. Antibiotic resistance is still a concern, according to this article in the Atlanta Journal-Constitution. There is also a virulent strain of MRSA going around, posing another infection-related problem in hospitals.
At the IDSA conference, Dr. Paul Offit, a frequent vaccine spokesperson, spoke out for the H1N1 vaccine. Another article about the speech can be found here.
"... Now the seasonal flu vaccine and H1N1 flu vaccine are being skipped by millions of people who somehow distrust the science that went into making them, even though the illnesses they cause can be fatal.
But hey, it’s a free country. Paul Offit just throws up his hands: “Is it your right to catch and transmit a potentially fatal infection? The answer is ‘yes,’” he says."
The article continues:
"So despite vaccines’ overwhelming safety profile when compared to the risks run by exposure to the diseases they prevent, and despite the exhortations of the CDC and World Health Organization, some people just gravitate toward other sources of information they deem more reliable."
In food safety news, the Produce Safety Project put out results of a survey showing that there are significant gaps in foodborne illness response. The survey asked about types of questionnaires administered, the time frame in which they were completed, types of questions asked, and how the data collected were used. They found that state health departments don't ask about fresh produce initially, use a mixed questionnaire with open- and closed-ended questions, and are more likely to interview an individual linked with an outbreak. This survey did not assess staffing or funding levels, which will be discussed in a forthcoming assessment by CSTE about foodborne illness epidemiology capacity. They did report, however, that "the decisions of the responding states appear to be driven by available resources." Very true.

Can Saudi Arabia prevent an H1N1 outbreak at the hajj?

2009-10-30T10:02:00.005-04:00

A very interesting story in yesterday's New York Times. (I know, another NYT article, but that's my newspaper of choice and I'm sticking to it.)

"Saudis Try to Head Off Swine Flu Fears Before Hajj"

So: will they be able to? They are recommending that those who are young, pregnant or elderly, and even those with certain chronic conditions, stay home this year. The hajj is a central ritual of Islam, and I am very skeptical that Saudi Arabia will be able to convince countries to not let or strongly discourage people from participating in this important tenet. In 2008, 3 million participated in this annual pilgrimage, this year taking place November 25-29.

Saudi Arabia, the host country of the hajj, has contacted public health experts from America medical schools and the U.S. Navy's medical laboratory in Cairo for help with any assistance they may need. (And they will need assistance!) In 2008, a flu outbreak occurred at the Catholic World Youth Day in Sydney, at which a Tamiflu-resistant strain emerged.

Officials recognize that it will be impossible to keep H1N1 away from the event and even to slow its spread. So they are encouraging those most vulnerable to stay home. Will this work, though? It is such an important part of Islam - the fifth of the five pillars of Islam. Will those who are coming be able to access the H1N1 vaccine? That is doubtful too, although China says it will vaccinate all of its pilgrims attending the hajj.

It will be very interesting to monitor this story in the next few weeks and see what happens - we'll keep you updated at the Epi Cafe!

Mr. T - and more!

2009-10-27T16:10:00.004-04:00

Who can resist all of the H1N1 public service announcements going around? First was the video featuring Elmo, then the Atlanta Falcons, and now... you guessed it... Mr. T. He was quoted as saying “I’m the baddest in the world, and the flu gonna be all washed up when I’m through with it,” Mr. T said. “No, I don’t hate the virus. I pity the flu.” Perhaps not hard-hitting news, but still newsworthy, I'd argue!
(And by the way, this is from The Rebel Yell. Not a real news story!)

CDC has published new guidelines about infection control for H1N1 in hospitals. Because of the shortage of recommended N95 respirators, other measures must be taken to reduce risk of infection. Click here to view the guidance and here to read the RWJF Public Health Digest article about this issue.

This article also discusses infection control, in a larger sense. It mentions 10 ways hospitals can reduce infections, from hand washing to reporting laws to computer surveillance.

By now, of course, you've heard about Obama declaring H1N1 a national emergency. If not, read it here! This doesn't have anything to do with prevalence or severity. Rather, it opens up resources and allows hospitals and health departments to do more to cope with the pandemic.

This article has nothing to do with anything, but I didn't know the field of psychiatric epidemiology existed. So that was interesting to learn.

According to a recently published study, Holocaust survivors are more likely to get cancer later in life, perhaps due to the extraordinary physical and mental stress they underwent in the 1930s and 40s. This AJC article explains more.

Finally, CBS News reported that H1N1 is not as prevalent as thought, according to a 'study' they conducted. Effect Measure, a great epidemiology/public health blog (besides this one of course), examined this article and took issue with it.

2 H1N1 Links

2009-10-27T15:21:00.002-04:00

First, the Obama girls have gotten their H1N1 vaccinations. Good for you, girls, and good for you, parents, for setting the example that the vaccine is acceptable. And, in case you were wondering, the vaccine is readily available in the DC area, and the White House doctor applied to receive 2 doses of vaccine just like every other site would apply.

Second, an article sure to spark controversy. This article asks the question, "Who should get a chance to survive when the number of severely ill people far exceeds the resources needed to treat them all?" It is an interesting issue, one that will surely bring debate to your dinner table.

The coolest video

2009-10-26T15:46:00.002-04:00

This video is so neat! It explains how a virus, specifically influenza, invades one's body. This is from NPR. Click here for the web link.

Mental Health on Campus

2009-10-26T08:54:00.003-04:00

Mental health is a growing issue in the U.S. I've blogged about mental health issues before (suicide prevention, financial stressors, and mental health in the armed services.)

This time, I'm writing about mental health on college campuses. Due to the growing number of children and teens taking medication for mental health issues, mental health has become a major concern among college administrators. They are seeing more and more freshman students arrive with not only extra-long twin sheets but also anti-depressants, anti-anxiety, and anti-psychotic medications.

Crises such as the Virginia Tech tragedy emphasizes the need that exists for mental health services on college campuses and for more outreach and education to students.

NPR had an interesting story this morning about mental health on campuses. Financial constraints have made it difficult for colleges to pay for counselors, even though the International Association of Counseling Services recommends having one counselor for every 1,000 students.

The bottom line, for any friends or family, is to keep an eye out for unusual or uncharacteristic behaviors, as these may be warning signs of mental illness. Communicate with them, find out what's going on, and help them to get the professional assistance they need.

Infection control, influenza, and more!

2009-10-23T09:35:00.007-04:00

Infection control:
TheraDoc has come out with a new patient surveillance tool to monitor multi-drug resistant organisms such as MRSA. These patient surveillance systems are interesting - they don't play into public health surveillance systems, however, so it will be interesting to see how things like this affect the healthcare-associated infections surveillance that public health departments do. The American Recovery and Reinvestment Act (ARRA) included a lot of funding for the surveillance and prevention of healthcare-associated infections.

Influenza:

First, Minnesota has confirmed one case of the H1N1 virus in a pig. This may be the first indication that it is present in some swine in the U.S., according to this CNN article. The USDA assured the public that pork is still safe to eat.
This tool created by the Georgia Division of Public Health shows Georgia residents where they can find the H1N1 vaccine. The division has a lot of information on their H1N1 home page. They also have a PSA featuring Ovie Mughelli of the Atlanta Falcons.
This story on NPR conveys how skeptical people are of the H1N1 vaccine. My anecdotal experience is mixed - I've heard skeptics as well as those eager to get themselves or their children vaccinated. Some "public figures" like Glenn Beck are opposing vaccination. "Beck told his viewers on Fox News that he would do 'the exact opposite' of whatever the government recommends." Now, I would do the exact opposite of anything that Glenn Beck says, but that's my own personal opinion.

An interesting point is that "public opinion surveys show that doctors and nurses are seen as the most credible sources of information on these kinds of medical decisions, but there has also been a flurry of media reports about some health professionals resisting mandatory vaccination campaigns at certain hospitals." So patients are getting a mixed message from doctors and nurses, even, which doesn't help the situation.

This article released on Tuesday reemphasizes the safety of vaccines and how vaccines are a huge public health success story.

Another article in the New York Times discusses how the H1N1 vaccine has "revitalized" the debate over vaccines. "Anti-vaccinators, as they are often referred to by scientists and doctors, have toiled for years on the margins of medicine. But an assemblage of factors around the swine flue vaccine — including confusion over how it was made, widespread speculation about whether it might be more dangerous than the virus itself, and complaints among some health care workers in New York about a requirement that they be vaccinated — is giving the anti-vaccine movement a fresh airing, according to health experts."
This article discusses preparing one's business in case an outbreak of H1N1 hits the office. It's a valid concern; absenteeism can be a huge source of lost productivity, especially during a pandemic.

Chronic disease:
I know what you're thinking: Finally, some focus on something else besides influenza.

A recent article in Health Affairs suggests that convenience stores and fast food chains are largely responsible for the obesity epidemic in South Los Angeles. Based on this study, lawmakers are considering limiting the density of such stores unless they sell fruits and vegetables, according to the LA Times. Last year, the district banned the establishment of new convenience stores for one year. The Health Affairs article suggests this one-year ban was not the best approach, because the density of convenience stores isn't high enough to be of concern compared to the rest of L.A. The article suggests that menu labeling and restricting excess calorie consumption would be much more effective.

The article states: "Although the actual policy was based on questionable premises, this represents an important conceptual step forward. Research has made it clear that frequency and saliency of food cues in the environment, the types of food available, and the portion sizes served are key issues that effective policies need to address."
Although Health Affairs suggested menu labeling as a possible intervention in Los Angeles, a study of the New York City labeling law has produced results that suggest otherwise. New York City found several obstacles that need to be overcome: a.) voluntary posting of nutritional information is unlikely to succeed due to the overwhelming resistance of the restaurant industry, b.) many public health disciplines (environmental health, chronic disease, public health law, communications, and more) need to collaborate effectively, and c. ) additional steps beyond the posting of nutritional information are needed to reduce overeating.

Another study in Health Affairs indicated that menu labeling was noticed by consumers, and it may have influenced their choices, but overall calorie consumption was not affected.

Serious H1N1 Clip

2009-10-22T09:02:00.002-04:00

... And here's a more serious clip, this one from 60 Minutes about H1N1 and CDC's response.\

Watch CBS News Videos Online

Click here for more information and an article relating to this clip.

Funny H1N1 Clip

2009-10-22T08:25:00.003-04:00

This clip is funny - I had to share it. Take a look (and if you're not feeling funny today, chill out, it's just a comedy sketch.)

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Doubt Break '09

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Health Care Crisis

Cancer screenings - new research

2009-10-21T14:20:00.004-04:00

Check out this article in today's New York Times. It questions the benefit of prostate and breast cancer screening. Anything else I might say would just be reiterating the article, so I'll refer you directly to it.

Cost effectiveness of Gardasil for boys

2009-10-19T14:53:00.004-04:00

This article discusses the (non) cost-effectiveness of the Gardasil vaccine among boys. It's an interesting read. A previous post discusses cost-effectiveness, that post specifically about cancer screening. What do you think?

H1N1 self-assessment tool

2009-10-12T11:38:00.003-04:00

There is a new self-assessment tools for H1N1 that seem quite interesting.

Emory University and Microsoft have come out with one self-evaluation tool. This tool assesses whether the user has H1N1 or another virus. The user is asked, at the end of the assessment, if he or she would like to submit the data to Emory for research purposes. It will be interesting to follow-up and see how the data are used. Here is the privacy statement that talks about how the data are used if submitted. Once symptom and basic demographic info is entered, the assessment is given.

When I entered my fake data, the tool told me "you probably don't have the flu, but you may be sick from something else" and told me to go to my physician if I am worried about my health. It then gave me resources to find more information.

Flu.gov also houses this self-evaluation tool.

Today's links

2009-10-07T11:50:00.002-04:00

First, the EPA set out new standards that airlines have to test and disinfect water on planes. Ew, you mean they weren't doing this before? Read here for the article, and read here for more from the EPA.

Second, and a biggie. The first doses of H1N1 vaccine are just now becoming available, and there is much excitement over it. According to this article, several states were offering the nasal spray to children, with shots beginning next week. Public health officials are battling myths and opposition to the vaccine, posing public relations troubles for CDC and state health departments.

Here is an article about immunizations and opposition to them.

Finally, a tongue-in-cheek article from the Huffington Post about Big Pharma and H1N1.

Enjoy!

H1N1 vaccine: "Don't blame flu shots for all ills"

2009-10-02T11:37:00.004-04:00

The NYTimes published a great article about the forthcoming H1N1 vaccine. The article states that when the public starts receiving the H1N1 vaccine, there will be deaths and other health issues such as heart attacks, strokes, and miscarriages. However, these illnesses are not necessarily caused by the vaccine. Basically, federal officials are in a public relations nightmare. How can they explain to the public (and in a tiny sound clip, no less) this non-causal relationship?

There are thousands of people who have, say, seizures every day. If the proportion of those who have recently received the vaccine and have a seizure is statistically significantly higher than those who have not received the vaccine, there may be a causal relationship. If, however, the rate of seizures among vaccinated and unvaccinated people is similar, a relationship is unlikely.

The article says:

"To defend itself, Dr. Butler [chief of the swine flu vaccine task force at CDC] said, the C.D.C, has compiled data on how many problems like heart attacks, strokes, miscarriages, seizures and sudden infant deaths normally occur. And it has broken those figures down for various high-priority vaccine groups, like pregnant women or children with asthma. When vaccinations begin, it plans to gather reports from vaccine providers, hospitals and doctors, looking for signs of adverse events, so it can detect problems before rumors grow."

The emphasis on this point stems from several sources. First, the 1976 vaccination program against swine flu had horrendous problems with Guillain-Barré syndrome as well as deaths that were attributed to the vaccine. Second, anti-vaccine groups are much more prominent and vocal now than they have ever been, and these groups may pose threats to the credible information being put out from sources such as CDC. Third, it's just plain confusing. It's hard to understand, especially for a public getting information from multiple and possibly conflicting sources.

So all those who are reading this (which isn't many), spread the word! There will be illnesses and health events that happen after people get the H1N1 vaccine. But most of these events are likely to have occurred anyway. CDC will be closely monitoring health events to determine whether they are caused by the vaccine or not, rest assured.

Here's another article in the Washington Post about the same issue.

Sneezing 101

2009-10-02T10:03:00.003-04:00

This video is just too adorably cute not to post. We all know to Cover our Cough, but this presents it in the cutest of ways! It is a PSA from the Virginia Department of Health.

Social determinants of health

2009-09-22T10:13:00.010-04:00

It may be intuitive to those who are public health-minded, but one's environment influences one's health. Social determinants of health has a large body of literature, and this post will attempt to summarize it.

According to the WHO, the social determinants of health are "the conditions in w hich people are born, grow, live, work and age, including the health system." A person's circumstances heavily influences his or her health status as well as overall health inequities.

Recently, the NYTimes and the Robert Wood Johnson Foundation reported that "research suggests social circles influence public health behaviors." For example, one study cited in the article found that a person's risk of obesity increased by 10% when a friend gained weight. According to this pie chart, lifestyle can determine up to 51% of one's health. If that lifestyle is centered around unhealthy environments and behaviors, influenced by one's surroundings, we can improve health drastically by changing one's surroundings.

This image, from the Commission on Social Determinants of Health's final report, illustrates the relationship between determinants of health and health inequities. The report says, "the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries." This Commission called for three areas of action: to tackle the daily living conditions in which people are born, grow, live, work and age; to tackle the structural drivers of those conditions at global, national and local levels; and to carry out more research to measure the problem, evaluate action and increase awareness.

There are several reasons and theories of why socioeconomic status (SES) influences health so heavily. I won't detail them in this posting as there are many articles that do so quite well (try here and here). Included in the theories are reasons of income disparities, social capital, racial discrimination, access to medical care, social support, and more. Lifestyle and physical environment causes may explain many of these issues; these two factors point to broader cultural and social trends that construct a framework in which health may be 'doomed' to be poor.

There are numerous articles citing the lack of healthy eating options, sidewalks, and safe neighborhoods for poor communities. Driving in Atlanta, this situation is abuabundantly clear. The nice neighborhoods have great grocery stores, walkable sidewalks, and overall lovely atmospheres; in contrast, the poorer neighborhoods have small and dingy grocery stores, unwalkable streets, and rundown atmospheres. These poor environments are not conducive to healthy eating or physical activity, but perhaps more importantly they may make it difficult to have a happy and meaning life with high social capital and support, crucial to overall well-being.

In sum, there are a number of factors beyond genetic makeup and personal behaviors that determine health status. These factors are crucial for public health to address in order to improve the population's health.

Sculptures

2009-09-17T15:31:00.004-04:00

"Sculptures" is probably the last thing you thought you'd see as a blog post title here. Luke Jerram has produced these beautiful sculptures - of diseases... specifically, E. coli, HIV, and H1N1 influenza. Aren't they cool?

E. coli

HIV

H1N1

Sesame Street encourages you to be healthy!

2009-09-02T09:00:00.002-04:00

Even Sesame Street is urging you to be healthy! This is a cute little video featuring Elmo.

Competing priorities

2009-09-01T14:26:00.003-04:00

Public health has always faced the challenge of competing priorities. Is a vaccination campaign more important than a healthy lifestyle campaign? Should the focus be reducing cancer rates or improving infant mortality? There are thousands of possibilities.

This year, the obvious challenge is that H1N1 is taking over the world. According to some estimates, 90,000 may die of H1N1 this season. While CDC doesn't like that estimate, the media has caught hold of it and hyped it up. Another estimate says that 12-24% of the population could get H1N1, up from 6-8% this spring. Whatever the situation ends up being, it's definitely getting people's attention.

This perhaps over-hyped attention is taking the focus away from just about every other public health issue going on right now. For example, CDC just announced that life expectancy hit an all-time high of 77.9 in 2007. $26 million will be spent on opening new health centers across the country. And sales of tobacco to underage youth fell to a new low. This article discusses how preparations for influenza have delayed an obesity initiative at a Boston area school.

While H1N1 may indeed turn out to be quite dangerous, and we need to adequately prepare for the next wave of the pandemic, we also need to keep in mind other public health issues affecting people every day. Obesity initiatives, safety measures, food safety, and other issues need to be at the front of our minds too. Because after the H1N1 scare dies down, our children will still be overweight, our environments not safe enough, and our food not secure.

Yes, more links - including CDC e-cards (hilarious)

2009-08-26T10:05:00.003-04:00

Some links (along with some commentary):

CDC urges caution on estimates of H1N1 - A White House panel recently provided modeled estimates that up to 90,000 people could die of H1N1 this season. CDC cautioned against that number, saying that the scenario was unlikely and that it's still working on its own projections. This article also reports that some vaccine may be released early to some high-risk populations.
HHS will collect hospital bed data electronically during the H1N1 flu season. This will be done through the HAvBED system that is currently in place due to emergency preparedness measures. It should be interesting to monitor this and see what data this system produces.
Schools preparing for H1N1 - Colleges are already being hit by waves of H1N1 now that students are back to campuses. Lower-level schools are preparing to be vaccination clinic sites; according to a National School Boards Association survey, 75% of superintendents surveyed would be willing to host a clinic. And, don't forget, CDC is recommending that schools not close during an outbreak but rather remain open and mitigate the spread of the virus.
Some H1N1 vaccine will be available as early as mid-September, says CDC's National Center for Immunizations and Respiratory Disease. (I can hear my colleague on a conference call discussing the implications of this as I write!) This was one of the recommendations put out by the White House Council of Advisors on Science and Technology earlier this summer. See all the recommendations here - they're quite interesting.
H1N1 on social media - Public health, meet the 21st century! CDC is keen on keeping the public aware of public health goings on through various social media outlets.
1. CDC has a Facebook page that includes periodic updates on recent findings & news.
2. CDC also has several different Twitter accounts: CDC_eHealth (general social media), CDCemergency (emergency updates), and CDCflu (seasonal and H1N1 influenza updates).
3. Other social media outlets include YouTube, Flickr, MySpace, and others.
4. Check out these CDC e-cards - they're hilarious. Everything from creating a healthy home, thanking someone for their support as they become seizure-free (seriously), and Valentine's Day injury prevention tips (yeah, seriously).

Links

2009-08-21T14:36:00.002-04:00

I know, you're saying "More links? Write a real article!" Well, there are just so many interesting links, I can't help myself.

The Wall Street Journal reports that H1N1 (we are not calling it swine flu anymore, people!) may affect businesses and the workplace with people out sick. CSTE is heavily involved in putting together a Continuity of Operations plan so that we can carry on our work tasks while at home if needed. Talk to your employer about it!
The 2009 Flu Vaccination Challenge - the beginning of flu season means the beginning of the flu challenge, a campaign to raise vaccination rates among health care workers. The podcast linked to on this page features Dr. William Schaffner, a great speaker!
There is a new vaccine being developed for norovirus, very interesting. This vaccine stems from the tobacco plant; plant-based vaccines can be developed more quickly and therefore get to the public more quickly.
A new study in Science (as reported here in the Atlanta Journal-Constitution) indicates that students and parents should get the H1N1 vaccine first, so that those most likely to get the virus are protected. The current guidance is for those who are most likely to be hit hard by the virus to be vaccinated first. An interesting debate.
This article reports on a new finding that individuals enrolled in the food stamp program are more likely to gain weight. One of the recommendations of the study is that there be economic incentives for food stamp recipients to buy healthier foods.

Links for the day

2009-08-19T16:08:00.002-04:00

A few interesting articles for your reading interest. (Is anyone reading this blog? If so, please comment below!)

I don't usually post international news here, but this was too good to pass up. This article discusses chronic disease prevalence in Africa. You think it's a country filled to the brim with HIV and infectious disease problems, but chronic disease is creeping up too.
This article discusses the rate of H1N1 among blacks and Hispanics, saying that the rate is much higher in Boston. I wonder if this is the case in other areas as well.
Just found this blog about pandemic influenza. It links to a WHO report about transparency during public health emergencies.
Surprise, surprise. The housing market woes affect people's mental health. The full article is available from the American Journal of Public Health, but here is an article summarizing it.
The title of this article says it all: Swine Flu, The Next Wave: What you need to know as the virus threatens to spread with the start of the school year. (Note: the article is in Q&A form but is not as dramatic as the title suggests.)
And last, but not least, a subject I'm sure you're all awake at night wondering about: How did Mozart die? New research suggests strep throat, says an epidemiologist.

Links of the day

2009-08-10T12:30:00.003-04:00

Some links to peruse:

CNN's thoughts on H1N1 as school begins across the country
Recommendations to not close schools but sequester students at home in case of H1N1 this fall
New food safety legislation was passed by the House
An unexpected beneficiary of the new food safety bill - technology companies
The new OSHA head (officially named the assistant secretary of labor for the U.S. Occupational Safety and Health Administration) is an epidemiologist!
Another outbreak - this time of ground beef primarily in California

And, finally, an article combating Dr. Sears and his "alternative vaccine schedule." The article states:

"Dr. Sears claims to listen to parental concerns and to be impartial when it comes to whether or not, or how, to vaccinate. He says that, rather than tell them what to do, he prefers to give parents all the information they need to make their own, informed decisions. But instead of accurately discussing the science for concerned parents, correcting the pervasive vaccine myths and misinformation so prevalent in the media, on-line, and in our communities, he distorts, misinterprets, and misleads."

Immunizations: Not just for kids!

2009-08-07T09:35:00.004-04:00

Today's subject is adult immunizations. That's right, they're not just for kids! Adultvaccination.org says that "each year, about 50,000 adults die from diseases that can be prevented by vaccines."

Here is the adult immunization schedule from CDC. It includes Tdap, HPV, varicella, influenza, shingles, and more.

A recent National Foundation for Infectious Diseases survey found that people are most likely to listen to their doctor about getting immunized. The Foundation reports that "The vast majority of respondents (87 percent) said they are very or somewhat likely to get a vaccine if
their doctor recommends it." And as adult vaccination rates are low, physicians are being urged to talk to their patients about immunizations.

There is also a racial disparity in adult vaccination rates. For example, 67% of older adults received a flu vaccine, but only 50% of blacks and Hispanics. The disparity is even wider for pneumococcal vaccination.

Some of the issue is the lack of knowledge about the important role vaccines play. According to the AMA News, "only 30% of young adults know that flu kills more Americans than any other vaccine-preventable disease."

So get on it. Get vaccinated. It's pretty likely you've been meaning to get that tetanus shot that's out of date. Go ahead and update your other vaccines as long as you're at the doctor's office. It may just save your life.

Preventive care

2009-08-04T13:40:00.003-04:00

Preventive care. Good, right? Prevent diseases from occurring in the first place instead of treating those conditions once they occur. Sure, sounds great! And it probably saves money too, right? Wrong.

While prevention makes good sense, and should happen (in most cases, anyway), prevention does not save money. (See this Kaiser article.) There are some exceptions. Childhood immunizations by and large save money, as do smoking cessation programs. But Pap smears, screening for prostate cancer, and other preventive care programs do not save money.

Many involved with health care reform mistakenly tout that these new prevention measures will save us money in the long run. That simply isn't true. Adding prostate cancer screening, for example, will cost Medicare $2.8 billion over 10 years.

Please don't misunderstand me. I am a big proponent of cost-effective preventive care. Stressing the cost-effective part. Cost-effective doesn't necessarily mean cost saving. If the intervention costs less than, say, $50,000 per life year saved, it may be deemed cost-effective. (This is an arbitrary figure that just illustrates how cost effectiveness is measured. An intervention may cost $1 per life year saved - pretty good! - or $1 million per life year saved - pretty bad! - and the cutoff point is VERY subjective.

Let's take the example of cervical cancer screening. Screening women (who have had a normal Pap smear) for cervical cancer every 3 years costs $262,800 per life year saved vesus the $1.1 million screening every year. (Russell's "Educated Guesses") Indeed, the Agency for Healthcare Research and Quality (AHRQ) does not recommend annual screening, because there is no evidence "that annual screening achieves better outcomes than screening every 3 years."

So, in sum, preventive care is not always cost-effective. Sometimes it is. Sometime it's not. But the determination of when something is cost-effective is extraordinarily subjective. Screening your mother for breast cancer may be worth $1 million to you but only $1 to someone else. It's a very tricky business.

More articles about prevention:
Health prevention often costs more than it saves
Do prevention or treatment services save money? The wrong debate
Preventive care and cost savings
Preventive care not always cost effective
Does preventive care save money?

News links

2009-08-03T10:58:00.003-04:00

Several interesting articles from the weekend that may be of interest:

Keeping healthy while flying - Spreading germs on a plane can be mitigated by keeping your hands clean (duh) and using common-sense public health practices.
Possible vaccine controversy with the coming H1N1 vaccine - The author discusses the importance of a public education campaign around vaccine safety.
Our very own Lisa had an article published in a recent MMWR! This article discusses the paper about the National Electronic Disease Surveillance System (NEDSS).
The House passed a food safety bill - This bill will require more frequent FDA inspections.
Mental health is an important issue in the military - This article discusses suicide rates among soldiers.
And, just for fun, Michael Pollan had a recent article discussing the changes in American cooking habits in light of the new Julia Child movie, "Julie & Julia." I thought it was an interesting article.

H1N1 Vaccine News

2009-07-30T08:37:00.002-04:00

CDC has released the latest H1N1 vaccine news and the priority populations for receiving the vaccine. The Advisory Committee on Immunization Practices (ACIP) met yesterday and determined recommendations. Priority populations include:

pregnant women,
infant caregivers,
health care and emergency workers,
those 6 months - 4 years old, and
those 5 - 18 years old who have a complicating health condition such as a compromised immune system or chronic health disorder.

Before the vaccine is widely released, it will go through a series of clinical trials to test for safety. Officials are hoping the vaccine, made by 5 companies, will be available in October. It is important to note that there will be two influenza vaccines this fall: one for the H1N1 virus and one for the 'normal' seasonal virus. Each protects against a separate strain, and you will need to be vaccinated against both for full influenza protection.

Atlanta Journal-Constitution article
MMWR article about seasonal influenza vaccine

Obesity & Upstream Issues

2009-07-28T14:56:00.004-04:00

Essentially, obesity boils down to one issue: People take in more calories than they expend. But of course we know there are many other issues that contribute to this: cost of food, access to healthy foods and environments, media and advertising, school lunch programs, agricultural subsidies, and more.

According to CDC, obesity costs the U.S. $47.5 million, and that's a 1998 figure! This USA Today article puts that figure much higher, around $147 billion. And check out this website to see a chronological view of how obesity has spread throughout the U.S. from 1985 to 2008 - it's disgusting how widespread it is!

The new movie Food, Inc. hits on some upstream issues associated with obesity, some of which are mentioned above in this posting. Cost of and access to healthy foods and environments are a huge issue; healthy foods cost more than unhealthy foods.

Agricultural subsidies are a huge part of this. The U.S. government pays farmers to grow tons upon tons of corn and soybean crops which lead to tons upon tons of high fructose corn syrup, hydrogenated soybean oil, and feed for beef and pork. I did some fascinating research on this subject in grad school and found that many, many issues are intertwined to make this issue very complex.

Some links to get you started:
A report from UC-Davis
A NY Times article
A British Medical Journal article
"The Fat of the Land"
Food and Water Watch - a watch-dog type group
A Michael Pollan article

Happy reading! Now you'll see why I try to eat organic or grass-fed beef and chicken now. And why the Farm Bill should be called the Food Bill.

It's all connected. A very interesting topic.

Public health in Africa Part 1: HIV

2009-07-20T09:08:00.003-04:00

My trip to Africa was amazing! Beyond the huge number of animals we saw, interacting with the people was an especially wonderful component of the trip. We went to Botswana, Namibia, and Zimbabwe, with a stop in South Africa.

Africa is a complex continent, especially when it comes to HIV. The HIV rates are staggering. In Botswana, 23.9% of adults are infected with HIV, an unbelievable figure. Namibia, Zimbabwe, and South Africa are slightly lower, but not much. This article published in today's NY Times details South Africa's lag in circumcision and fighting their high HIV rate.

While in South Africa for the day, my family and I visited a public hospital in Johannesburg. It was a sobering visit. We saw overcrowded wards, almost 100 children in a pediatric ward that is supposed to house many fewer patients. The neonatal intensive care unit was also overburdened, a unit whose patients need critical personalized care. The hospital was in need of supplies and staff. One nurse told us that they have a big problem with orphans whose parents have died of AIDS. It was very eye-opening.

We saw several ads for HIV prevention, in the form of posters and billboards. We also saw a free condom dispenser. One of our tour guides wore a T-shirt that said "We are getting tested in Caprivi", a walking advertisement for prevention.

So there is some progress being made. But it is slow. It was quite a trip.

Cancer screening

2009-07-17T13:57:00.003-04:00

One of the most interesting classes I took in grad school examined the cost effectiveness of various public health interventions. We discussed prostrate cancer screening, cholesterol screening, and cervical cancer screening. It was fascinating to learn that many public health prevention interventions make sense but are not always cost effective. That's another story.

Today, the issue is cancer screening. According to this article in the NY Times, screening the entire population for certain types of cancer is not cost effective and can even be harmful. Certainly cancer screening generally is positive - and screening for some types of cancer is very useful. Don't get me wrong, I'm not down on screening generally. But blanket screening is not helpful and "do come with medical risks" as well as economic costs.

This article states that there are several possible bad outcomes, including "needless anxiety," "unnecessary procedures that can lead to complications," and false positives, to name a few. "Screening is useful only if, on balance, the deaths prevented by treating cancers outweigh the harm done by treatments that are not medically necessary."

For example, the federal recommendations for cancer tests include cervical cancer screening - but the catch is that the recommendation is to screen every 3 years. Many women are told to come in annually. Part of this is to get women in the door to make sure they are healthy overall, but part of this is needless screening. Women who have had 3 normal Pap smears in a row can receive cervical cancer screening every 3 years, not every year.

The bottom line: Talk to your physician about which screenings are appropriate for your age, lifestyle, risk factors, and family history. You may need some, but you may not need all.

WHO to stop tracking H1N1 cases

2009-07-17T13:42:00.003-04:00

Wow, it's been awhile! I've been out of the country (Africa!) and we've been busy here at the office. I will post a public-health-related posting about Africa, which was fascinating, but for now, here is a little H1N1 update.

Apparently, WHO says it will stop tracking H1N1 cases. Very interesting. It said in a "briefing note" posted on the website late Thursday that tracking would cease. One of the reasons indicated is that poorer countries are having a hard time keeping up with the load on their epidemiologists and laboratories. The website says that "there is still an ongoing need in all countries to closely monitor unusual events, such as clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection, clusters of respiratory illness requiring hospitalization, or unexplained or unusual clinical patterns associated with serious or fatal cases." New countries with H1N1, however, will still be reported on the WHO website.

It is unclear what the agency will track exactly now. Dr. Michael Osterholm, quoted in the NY Times article, says that "bad measures can be worse than no measure at all" and that he hopes this "will force the public health community to come up with better [measures]."

Very interesting. We'll have to keep an eye on this.

Are you too salty?

2009-06-15T14:22:00.005-04:00

After attending the CSTE annual conference and hearing a plenary on reducing sodium levels in our foods, it got me thinking... how much sodium is actually in my diet? I think I eat relatively normal foods with the occasional processed foods. I always choose the low-sodium or sodium-free soups from the grocery store but is that enough of an effort?

According to an article in the Wall Street Journal in April, nearly 70% of the US population is hypertensive and should follow a stricter guideline of 1,500 mgs a day. You can cut your risk of hypertension by lowering your salt intake early on in life. So, why is it so difficult for Americans to regulate their sodium levels? Because Americans eat enormous amounts of processed foods and restaurant meals. We don't cook at home anymore as a nation (and in fact, neither do I) and this is resulting in higher blood pressures and expanding waist lines.

What suprised me about the article is that even raw chicken is enhanced with salt water to make it plumper and heavier ($$ cha ching!) AND that bakery goods and breakfast bars have higher sodium levels than you would expect.

"Even low-sodium labels have different meanings: "Sodium free" means less than 5 mg per serving; "very low" has less than 35 mg; "low" is less than 140. "Reduced sodium" just means that it's down 25% from what an earlier formulation was -- but could still be high in sodium, just like "No added salt" doesn't mean salt free."

What to do? You can ask restaurants to use less salt when you order, experiment with natural herbs and spices, use half the salt the recipe calls for and just get used to consuming less salt. Actually, those are all REALLY EASY things to do.

"It may take a while to get accustomed to less salt, but once your tastes adjust, you may not want to go back. Commissioner Frieden likens reducing salt to switching from whole milk to skim milk. "If you go back, whole milk tastes like heavy cream," he says."

I'm in favor for people taking ownership of their diet. Not enough people are 'active eaters' and really consider what they are eating before they buy or eat it. People with diabetes have had to monitor their diets for years. But I argue (and the article does too) that we ALL need to monitor our intake of sodium, sugar and other minerals and vitamins. If our nation is going to collectively reduce our belt size, we need to be mindful of what we put in our mouths. Perhaps reducing salt is the first step to putting the consumer back in control of their diets.

Vaccine safety

2009-06-10T13:04:00.002-04:00

This post has been on my mind since the inception of this blog: vaccine safety. Vaccines have been around for over 200 years, starting with the smallpox vaccine in the late 18th century, continuing through influenza, polio, measles, and now the full schedule of recommended vaccinations. There has been speculation since the beginning about the safety of vaccines, and I'm here to tell you and give you information about how vaccines are safe and should absolutely, positively, 100% be given to children.

The links below have information that says it all. However, in a nutshell, those unvaccinated through exemptions are overwhelmingly more likely to contract a vaccine preventable disease. Disease incidence corresponds to exemption increases, according to Kris Ehresmann of the Minnesota Department of Health as explained during the CSTE Annual Conference. "Saying 'no' to vaccines is saying 'yes' to disease," said Tina Tan, state epidemiologist of New Jersey.

Vaccine safety is monitored in several ways by the government through passive and active surveillance (VAERS, VSD, NVAC, etc.) Large issues with vaccines are overhyped by the media; however, most adverse events are minor and vaccination is far more safe than not.

Look for information about the safety of the forthcoming H1N1 vaccine. Stay tuned to this issue but know that there are several groups working together to ensure the safety of the vaccine. They are already working on the challenges associated with this vaccination campaign.

Don't forget that pediatricians are always willing to answer questions and provide information. They will give you trustworthy information about vaccines. Be wary of anti-vaccine websites that look legit. Your physician is the best source of medical information.

Links:
CDC - always a good source of public health information
Vaccine Safety Datalink (VSD) publications
Sound Advice audio interviews from the American Academy of Pediatrics (AAP)
Vaccinate Your Baby
Pictures of vaccine preventable diseases - Many parents these days are too young to remember the days of measles, polio, and other vaccine preventable diseases. The likelihood of an adverse event is very, very low. The likelihood of your child contracting a vaccine preventable disease if she or he is unvaccinated is much, much higher.
WhyIChoose.org - a California campaign

New links

2009-06-08T12:11:00.003-04:00

Here are 2 new links for the day. The first is about a new electronic reporting system by Orion Health Inc. The second discusses lessons from the H1N1 outbreak. It is by my favorite writer! (Ok, it's my dad. But he is qualified to write such an article as a practicing pediatrician who is involved with the American Academy of Pediatrics and the public health community.)

Some headlines ... briefly

2009-06-07T16:23:00.005-04:00

See below for more details, but this blog will be light this week due to our Annual Conference. But here are a few headlines to peruse:

Tom Frieden to take over CDC Monday
State public health laboratories in the spotlight
This article highlights how much states and counties are hurting.
A general public health opinion/human interest piece.
Is FDA regulation of tobacco a good idea or a bad idea? Hard to say, there are lots of arguments (which I cannot get into now with my current time contraints) but this article has quite an opinion!
I told you - H1N1 has not gone away. Click here.

CSTE Annual Conference

2009-06-07T16:04:00.002-04:00

Why is the Epi Cafe so quiet? Why do you not hear the sound of espresso machines whirring and scholarly epidemiology discussion?

We're at the CSTE Annual Conference, of course! Follow us on Twitter during the conference, taking place in Buffalo, NY, at http://twitter.com/CSTEConference or by using the hashtag #cste2009.

Our agenda includes plenaries from Richard Besser, Jeffrey Levi and Joseph Perz, dozens of breakout sessions, and hundreds of poster presentations. The topics range from healthcare associated infections to health disparities to food safety to chronic disease to influenza and much much more!

H1N1 - out of media spotlight but not gone

2009-06-05T11:21:00.002-04:00

For those of you who think that because media coverage of H1N1 has dropped off, the scare is over, think again!

This article summarizes the U.S. preparations for a second wave of H1N1 that is expected to hit the U.S. (and the Northern Hemisphere in general) in the fall. The article mentions a Trust for America's Health report that finds that "while the investment in pandemic planning and stockpiling of antiviral medications have paid off, recent cuts in public health departments have meant many did not have adequate resources to carry out flu plans."

So, the bottom line is stay vigilant and encourage your lawmakers to invest in public health! Click here and enter your zip code to find your lawmakers' contact information.

Food safety tips for the summer

2009-06-04T15:10:00.003-04:00

Summer is here (at least in Atlanta), and with summer brings picnics, BBQs, and lots of other fun outdoor socializing. A peril that comes with such socializing, however, is foodborne illness. In order to avoid getting sick, try these tips from fightbac.org. And if you have some spare time, check out this food safety crossword puzzle! And here's some information courtesy of Food Safety Education Month (which is in September).

Clean: Wash hands & surfaces often.
Separate: Don't cross-contaminate.
Cook: Cook to proper temperature.
Chill: Refrigerate promptly.

New links!

2009-05-27T14:22:00.003-04:00

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 stressthe need to further understand why parents refuse immunizationsand to develop strategies for conveying the risks and benefitsof immunizations to parents more effectively."

Links for the last week or so

2009-05-22T09:36:00.003-04:00

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

2009-05-15T09:23:00.002-04:00

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?

2009-05-13T10:43:00.003-04:00

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

2009-05-12T13:24:00.003-04:00

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

2009-05-11T09:29:00.005-04:00

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."

2009-05-08T07:56:00.003-04:00

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

2009-05-07T16:20:00.004-04:00

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]

2009-05-05T14:30:00.002-04:00

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?

2009-05-04T16:00:00.008-04:00

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

2009-05-04T10:18:00.007-04:00

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

2009-05-04T09:30:00.006-04:00

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."

Dirty mouth? You could be breathing dirty air...

2009-04-30T11:11:00.007-04:00

An article today mentions that 186.1 million people live in communities with dangerously high levels of air pollution. That's greater than 50% of the US population, so odds are, it's probably you.

Cleanest city overall? Fargo, ND -- the only city to pass in all three categories: ozone pollution, year round particle pollution and short-term particle pollution. But who lives in Fargo anyway?

Dirtiest city? Los Angeles! It has held it's number one spot for the past 10 years. Gross.

Other dirty cities for ozone: Bakersfield, Calif.; Visalia-Porterville, Calif.; Pittsburgh-New Castle, Pa.; and Fresno-Madera, Calif.

Air pollution can have serious affects -- one study showed that live expectancy increased in 51 cities by 5 months (!!) between 1980-2000 due to air pollition reductions.

The article suggests aiding the cause by using less electricity, drive less, avoid burning wood or trash and push for clean-up of old diesel bus fleets in their communities. You can also plant some trees and increase the green space around your home.

Check out the State of the Air at: American Lung Association

FYI - Fulton County, GA get's a big ole F. Not surprising given the traffic in Atlanta but still disappointing.

WHO General-Director increases influenza pandemic alert to Phase 5

2009-04-30T08:15:00.004-04:00

So what does that mean exactly? The phases are mapped out by the World Health Organization and sketch out the face of a possible influenza pandemic. Currently, we're still at pandemic-alert.

Interpandemic period

Phase 1 : No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.
Pandemic alert period

Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

Pandemic period

Phase 6: Pandemic: increased and sustained transmission in general population.
Notes: The distinction between phases 1 and 2 is based on the risk of human infection or disease resulting from circulating strains in animals. The distinction is based on various factors and their relative importance according to current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically localized or widespread, and other scientific parameters.

If you have a lot of time on your hands, or are interested -- check out the WHO global Influenza preparedness plan here. It might be interesting to see how well the US and the world as a whole is following the plans set prior to the reality of an actual pandemic. There are so many different variables that could never be accounted for when a group of people are writing a plan. And as we all know -- rarely do things happen according to a plan. Unfortunately when this whole pandemic is over, the US and the world's actions will be scrutinized and judged. It's important to keep in mind that the folks at the ground level are working as hard as ever to keep the public safe.

Yet again... more swine flu news

2009-04-29T11:29:00.004-04:00

Here are a bunch of articles about swine flu. Most of these aren't news news - nothing hot-off-the-presses. Just some background stuff and some interesting links to take a look at.

Swine flu - a primer. From CNN.com.

What is an epidemic? From Smithsonian.com.

Just to underscore what swine flu is about - it's not a foodborne disease. You won't get it from eating pork. Not eating pork won't prevent you from getting it. (Says me, but also say the pork farmers in the U.S. as well.)

So as this outbreak has hit, we have several holes in our political leadership. The secretary of Health and Human Services has just been confirmed (Kathleen Sebelius) but the posts of CDC director and Surgeon General are still open. This article provides insight on this.

Some commentary from a New York Times blog.

And last but NOT least, how to prevent contracting swine flu? WASH YOUR HANDS. This fact sheet (with pictures, just in case you need help) is going up on my office bathroom mirror in a few minutes. For good hygiene and also for swine flu. Come on, people, wash your hands after you use the bathroom!

Links for the week

2009-04-29T10:59:00.003-04:00

The Kaiser Family Foundation reports results from a survey that show Americans find the HIV epidemic less urgent, even after the latest incidence estimate showed that more people than previously thought are contracting the virus each year. Interesting results - one would think public pressure to do something about the HIV epidemic would be even higher, but it's not.

Generally, public health is important! If you're reading this, the concept is nothing new - I'm preaching to the proverbial choir. This article brings home the point once again. Epidemiology and surveillance, clean water, disease treatment and prevention, food safety, and more. The author, Valerie Bassett, puts this very eloquently: "Who needs public health? We all do. Every resident of the Commonwealth - whether aware of it or not - relies on a strong, functioning public health system - a system that is greatly endangered. Without public health, there is no way for the Commonwealth to succeed in education, economic growth, environmental innovation, or civic engagement."

Take a look at this article about doctor shortages. While not directly public health, it certainly has an impact on public health.

In case you haven't heard, red meat isn't good for you.

See my next post for updates on swine flu!

Swine flu video from 1976

2009-04-29T10:49:00.002-04:00

Swine flu

2009-04-27T10:10:00.004-04:00

The swine flu outbreak is here and it's real. See my last post for more information, but here are a couple good places to visit:

Obviously any news site would be good - cnn.com, New York Times, whatever you news source of choice is. And of course CDC is always a good standby for all public health related news. http://www.cdc.gov/swineflu/ is the place to start.

This New York Times article has a good "Understanding Swine Flu" graphic that is interesting and helpful. Click here to go to the graphic.

This map shows where the outbreaks are, it's a good visual way to picture the spread of the outbreak.

It is important to note that the U.S. declaring a public health emergency does not mean that all hell should break loose. It just frees up resources, allows antivirals to be positioned in case they're needed, etc. The precautions you should take are to wash your hands with warm, soapy water and stay away from being in close contact with those who are sick. That's just general common sense!