Some links - I know, again

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!

Some recent links

1. 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.
2. 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.
3. 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.
4. 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.”

5. 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."

6. 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."

   
   

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

Once again - some links for you

1. 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.
2. 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."
3. 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.
4. 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.
   

Weekend links

1. 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.
   
   
2. 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."
   
   
3. 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.
   
   
4. 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."

5. 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.
   

Mental Health on Campus

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.

News links

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.
  

Can foreclosures cause public health problems?

What a cool article!
The gist of it: foreclosures = abandoned homes = neglected swimming pools = standing water = mosquitoes = increased incidence of West Nile Virus. What a connection to make.

Other possible public health problems that might result from foreclosures:
- Environmental toxin exposures as homes sit and are neglected.
- Mental health concerns stemming from homeowner stress. (A fact sheet about mental health & public health, another fact sheet, and an article.)
- Injuries from neighborhood kids playing around the foreclosed house.

Any other ideas?

Suicide prevention

Given the recent House episode about suicide, I thought it fitting to do a quick post about suicide and suicide prevention, as mental health as a public health issue is quickly gaining notice in the field. The House episode directed viewers to a mental health organization. The episode sparked a LOT of conversation in person and on blogs, for example this one. Or Google "house suicide episode" or some such phrase and you'll get over 3 million results!

Suicide is a serious matter. There are people and organizations out there. All I ask is that you reach out to 1 person. Know that whoever you are, whatever your situation is, there will always be 1 person who cares about you. It may not "all be ok" - no one can guarantee that. But please reach out, there will be a better day. 1-800-273-TALK

A couple links:
http://www.nmha.org/
http://www.save.org/
http://mentalhealth.samhsa.gov/SuicidePrevention/
http://www.mrsmicah.com/2009/04/09/why-im-glad-i-didnt-kill-myself/